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Background: Diagnostic accuracy of double-contrast barium enema (DCBE) depends upon the barium sulfate coating efficiency in the colon. Objective: To evaluate effects of three laxatives on barium sulfate coating efficiency in the large intestine, sigmoid colon, and hepatic flexure in DCBE. Methods: This retrospective study included patients receiving DCBE after pre-procedure cleansing with Dulcolax® with castor oil (DC), Klean-Prep® (KP), or Fleet®. Patients’ DCBE images were reviewed. Results: Among 373 cases of DCBE, 151 received DC, 147 received KP, and 75 received Fleet. For DCBE, the optimal extent of barium sulfate residue coated on the wall of the large intestine is less than one-fourth of bowel wall width; the DC group had a higher percentage of less than one-fourth of bowel wall than that of the KP or Fleet group (both p < 0.0167). DC, KP and Fleet have comparable barium sulfate coating efficiency in the sigmoid colon. However, in the hepatic flexure, the DC group had a higher percentage of barium sulfate coating without interruption than that of the KP or Fleet groups (both p < 0.0167). Conclusion: DC has a better barium sulfate coating efficiency in the hepatic flexure compared with KP and Fleet.

Programmed cell death protein-1 (PD-1) inhibitors have shown promising results for treating advanced hepatocellular carcinoma (HCC). However, the clinical utility of such inhibitors in HCC patients with vascular tumor thrombosis remains unclear. This study investigated PD-1 inhibitor efficacy in advanced HCC with macrovascular invasion in a clinical setting. Among the 110 patients with unresectable HCC treated with PD-1 inhibitors, 34 patients with vascular metastases in the portal vein and inferior vena cava were retrospectively compared with 34 patients without tumor thrombi. The vascular response and its effect on survival were assessed. Predictors of survival were identified using multivariate analysis. Among patients achieving objective response, those with and without thrombi exhibited similar response to immunotherapy and comparable survival. Among the 34 patients with tumor thrombi, including 13 receiving PD-1 inhibitors alone and 21 receiving it in combination with tyrosine kinase inhibitors, the median overall survival was 8.9 months (95% confidence interval 3.2–12.6). The objective response rate of vascular metastasis was 52.9%, and vascular responders had a significantly longer survival than did non-responders (11.1 vs 3.9 months). Failure to obtain a vascular response correlated significantly with increased post-treatment Child–Pugh score or class. Multivariate analysis showed that vascular response was a significant positive factor for longer overall survival. Treatment-related grade 3/4 adverse events occurred in 3 (8.8%) of the patients with tumor thrombi. Immunotherapy with PD-1 inhibitors may be a feasible treatment option for HCC with tumor thrombi owing to the high response rate of tumor thrombi and favorable survival outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-020-02845-9.

Introduction: The tumor microenvironments of different organs often differ and thus may affect the immunotherapy response. Objective: This study elucidated that the efficacy of programmed cell death protein-1 (PD-1) inhibitors varies across different metastatic sites among individuals with advanced hepatocellular carcinoma (HCC). Methods: We retrospectively analyzed treatment outcomes in advanced HCC patients receiving PD-1 inhibitors with or without a combination of tyrosine kinase inhibitors (TKIs). Both the overall response rate (ORR) and organ-specific response rate (OSRR) were assessed using Response Evaluation Criteria in Solid Tumors 1.1 criteria. A survival analysis and its predictors were determined using a multivariate analysis. Results: We analyzed 42 advanced HCC patients (median age: 58.0 years; 78.6% males). Thirty (71.4%) patients were sorafenib-experienced and 27 (64.3%) were administered a combination of TKIs. The ORR was 14.3% and the disease control rate was 33.3%. The median overall survival (OS) and progression-free survival (PFS) were 12.0 and 2.9 months, respectively. The OSRRs were 14.7, 23.8, 28.6, and 50.0% for the liver, lungs, lymph nodes, and vascular response, respectively. The multivariate analysis indicated that the vascular response was significantly associated with PFS. ECOG performance status was a significant independent predictor of OS. Conclusions: PD-1 inhibitors improved OS and PFS in advanced HCC patients. Their efficacies varied among the metastatic locations regardless of the combination of TKIs; in particular, a higher response in vascular metastases was correlated with a longer PFS. PD-1 inhibitors may deliver a synergistic benefit in patients undergoing traditional therapy and progression in other organs in vascular responders.

The aim of the study was to use a previously proposed mask region–based convolutional neural network (Mask R-CNN) for automatic abnormal liver density detection and segmentation based on hepatocellular carcinoma (HCC) computed tomography (CT) datasets from a radiological perspective. Training and testing datasets were acquired retrospectively from two hospitals of Taiwan. The training dataset contained 10,130 images of liver tumor densities of 11,258 regions of interest (ROIs). The positive testing dataset contained 1,833 images of liver tumor densities with 1,874 ROIs, and negative testing data comprised 20,283 images without abnormal densities in liver parenchyma. The Mask R-CNN was used to generate a medical model, and areas under the curve, true positive rates, false positive rates, and Dice coefficients were evaluated. For abnormal liver CT density detection, in each image, we identified the mean area under the curve, true positive rate, and false positive rate, which were 0.9490, 91.99%, and 13.68%, respectively. For segmentation ability, the highest mean Dice coefficient obtained was 0.8041. This study trained a Mask R-CNN on various HCC images to construct a medical model that serves as an auxiliary tool for alerting radiologists to abnormal CT density in liver scans; this model can simultaneously detect liver lesions and perform automatic instance segmentation.

Background: Limited evidence is available on the regeneration of and functional changes to remnant pancreas after pancreatectomy. Therefore, we investigated the correlation between changes in volume and endocrine function in the remnant pancreas. Methods: Ninety patients undergoing pancreaticoduodenectomy (PD) and 45 undergoing distal pancreatectomy (DP) from January 2009 to December 2017 were included in this prospective study. Computed tomography was used to determine the volume of remnant pancreas 3 months, 1 year, and 2 years after pancreatectomy. Findings: The remnant pancreas volume compared to the initial residual pancreas was 80·79%, 68·67%, and 65·34% in the PD patients (p

Endoscopic retrograde cholangiopancreatography (ERCP)‐related perforation leads to high morbidity and mortality. The Stapfer classification divides patients with different perforation locations and suggests management accordingly. The classification may be unknown if perforation is not detected during endoscopy. We classified patients with ERCP‐related perforation (ERP) through computed tomography (CT) and observed the clinical outcomes with varyingly invasive management. Fifty‐two cases of ERP between July 2009 and December 2017 were retrospectively reviewed. Of them, 41 who underwent CT for ERCP were included. According to their CT findings, we divided patients into air‐alone (n = 16), air‐fluid (n = 18), and fluid‐alone (n = 7) groups. Perforation severity was graded using the Clavien‐Dindo classification for surgical complications. Demographic data and clinical outcomes among different groups were analyzed. Fifteen patients (37%) had an unknown Stapfer classification. More than half of the patients in the air‐fluid group had a Clavien‐Dindo complication grade of >3. Four patients underwent surgical repair; all of them were from the air‐fluid group. All patients in the air‐ and fluid‐alone groups underwent medical treatment without need for subsequent salvage surgery. The air‐fluid group had the longest mean hospital stay (25.1 ± 21.9 days) and the exclusive two mortality cases in this study. Patients with ERCP can be divided into groups with different outcomes according to the presence of air or fluid on CT images. Because patients with both air and fluid have the worst clinical outcome, they may require more aggressive treatment than patients with either air or fluid alone.

Background/Aims: The purpose of this study is to report our results using a computed tomography (CT)-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels. We retrospectively reviewed the records of patients referred to our department for pancreatic mass biopsy. Patients and Methods: The records of patients (from June 2008 to August 2014) in whom biopsy was performed under CT guidance with a coaxial needle using a fat transversing technique were reviewed. Patient demographic data and biopsy outcomes were collected. We aimed to compare differences between lesion size and biopsy outcome, the independent two-samples t-test was used. Results: A total of 122 patients who underwent 17-G coaxial needle biopsy were included. The mean pancreatic lesion size was 3.2 cm, and in 30 patients it was more than 4 cm. The majority of lesions were located in the head of the pancreas (44.3%). No transorgan biopsies were performed. In most patients, the biopsy was performed via a fat traversing detour route (93.4%), and a successful diagnosis was made based on the biopsy outcome in 96.7% patients. Complications occurred in five patients (4.1%); three of the patients developed a fever, and two developed pancreatitis. All patients recovered with symptomatic treatment. Conclusion: CT-guided coaxial core biopsy of pancreatic lesions using a fat detour route appears to be a safe and effective method for obtaining pancreatic lesion biopsies with a high success rate and low complication rate.

Mannitol carrier and drug-carrier composite particles were produced via low-temperature supercritical assisted atomization (LTSAA). The enhanced aerosolization of the mannitol carrier particles with added L-leucine could be attributed to the formation of fine corrugated particles, which reduced the interparticle cohesion and led to better flowability of the mannitol carrier particles. A poorly water-soluble drug, beclomethasone dipropionate (BDP), and mannitol co-precipitated during LTSAA with the optimal addition of 9.1 mass % L-leucine. The in vitro aerosolization and dissolution experiments indicated that the fine particles fraction (FPF) of the drug-carrier composite particles was 3.4 times (FPF = 49.9 %) higher than that of the as-received BDP (FPF = 14.7 %) and the 63.2 % drug release time of the drug-carrier composite particles was 15.6 times faster than that of as-received BDP. This study suggests that the drug-carrier composites produced using LTSAA can be employed in the instant formulation of inhalable dry powder.

Background Glioma stem cells (GSCs) contribute to tumor recurrence and drug resistance. This study characterizes the tumorigenesis of CD133+ cells and their sensitivity to pharmacological inhibition. Methods GSCs from human U87 and rat C6 glioblastoma cell lines were isolated via magnetic cell sorting using CD133 as a cancer stem cell marker. Cell proliferation was determined using the WST-1 assay. An intracranial mouse model and bioluminescence imaging were used to assess the effects of drugs on tumor growth in vivo. Results CD133+ cells expressed stem cell markers and exhibited self-renewal and enhanced tumor formation. Minocycline (Mino) was more effective in reducing the survival rate of CD133+ cells, whereas CD133− cells were more sensitive to inhibition by the signal transducer and activator of transcription 3 (STAT3) inhibitor. Inhibition of STAT3 decreased the expression of CD133+ stem cell markers. The combination of Mino and STAT3 inhibitor synergistically reduced the cell viability of glioma cells. Furthermore, this combination synergistically suppressed tumor growth in nude mice. Conclusion The results suggest that concurrent targeting of different subpopulations of glioblastoma cells may be an effective therapeutic strategy for patients with malignant glioma.

Patients with developmental dysplasia of the hip (DDH) generally undergo multiple x-ray examinations of both hip joints. During these examinations, the gonads are completely exposed to radiation, unless shielded. Although many types and sizes of gonad shields exist, they often do not provide adequate protection because of size and placement issues; additionally, these shields are frequently omitted for female patients. Our aim was to assess gonad protection during x-ray examination that is provided by gonad shields designed for individual female patients with DDH.We retrospectively retrieved data from the Picture Archiving and Communication System database; pelvic plain x-ray films from 766 females, 18 years old or younger, were included in our analysis. Based on x-ray measurements of the anterior superior iliac spine, we developed a system of gonad shield design that depended on the distance between anterior superior iliac spine markers. We custom-made shields and then examined shielding rates and shielding accuracy before and after these new shields became available. Standard (general-purpose) shields were used before our custom design project was implemented. The shielding rate and shielding accuracy were, respectively, 14.5% and 8.4% before the project was implemented and 72.7% and 32.2% after it was implemented. A shield that is more anatomically correct and available in several different sizes may increase the likelihood of gonad protection during pelvic x-ray examinations.

Endoscopic, ultrasound-guided tissue acquisition (EUS-TA) with rapid on-site evaluation is recommended as a first choice in the diagnosis of pancreatic lesions. Since EUS facilities and rapid on-site evaluation are not widely available, even in medical centers, an alternative for precise diagnoses of pancreatic tumor is warranted. The percutaneous computed tomography-guided, core needle biopsy (CT-CNB) is a commonly applicable method for biopsies. Our institute has developed a fat-transversing approach for pancreatic biopsies which is able to approach most tumors in the pancreas without penetrating organs or vessels. Herein, we report a 15-year experiment of pancreatic tumor coaxial CT-CNB in 420 patients. The success rate of tissue yielding by the technique was 99.3%. The overall sensitivity, specificity, and accuracy were 93.2%, 100%, and 93.4%, respectively. The diagnostic accuracy could be increased to 96.4% in 2016&ndash, 2018 (after the learning curve period). The overall complication rate was 8.6%. Neither life-threatening major complications, nor seeding through the biopsy tract, were observed. Our study supported the hypothesis that CT-CNB could be a complementary option for diagnostic tissue acquisition in patients with unresectable or metastatic pancreatic tumors when EUS-TA is either unsuitable or unavailable.

To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches.A total of 43 liver cirrhosis patients (mean age, 62.19±9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE.PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81±1.69×10(3)/mm(3) before PSE to 8.56±3.14×10(3)/mm(3) at 1 week after PSE (P0.001). Mean platelet count significantly increased from 62.00±22.62×10(3)/mm(3) before PSE to 95.40±46.29×10(3)/mm(3) 1 week after PSE (P0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ]=0.687, P0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16±8.96%.The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ=0.687.

This study investigated whether a thin renal cortex or any morphological kidney measurements can be predictors of post percutaneous nephrostomy (PCN) renal function, thereby lessening the need for the procedure.All patients underwent unilateral PCN that were performed under sonographic and fluoroscopic guidance. Kidney morphological measurements were subsequently taken to measure residual renal function; a thin renal cortex was defined from a computed tomography (CT) showing a cortical thickness10 mm. Urine output was recorded daily, with patients divided into anuric and nonanuric groups.Morphological measurements of residual renal function, such as renal length (p=0.004), renal width (p=0.004), renal thickness (p=0.008), and renal size (p=0.004) were significantly higher in nonanuric than anuric patients. Urine output increased by 85.47 ml/day for every millimetre increase in renal width (p=0.026) and 65.31 ml/day for every millimetre increase in renal thickness (p=0.024). Simple linear regression analyses showed that cancer patients had a significantly lower urine output (358.73 ml/day; p=0.046) than those without cancer.This study showed that urine output and other clinical data can provide an index to evaluate residual renal function before deciding to perform PCN procedures.

To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/TACE) can increase the delivery and effectiveness of TAE/TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT.HCC patients (BCLC stage A or B) were randomized to (n = 51) or not to (n = 50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3 months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours.Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11 % vs. 12.5 %, respectively), and was statistically significant in the group receiving nitroglycerine (P = 0.023). There was no difference between the two groups in disease response (P = 0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05 mg/mL vs. 4.40 mg/mL, respectively, P 0.001; median percentage 82.01 % vs. 36.75 %, respectively, P 0.001).Nitroglycerine increased delivery of the Lipiodol emulsion via TAE/TACE to HCC tumours with significant tumour reduction. Dual-energy CT can accurately quantify the amount of Lipiodol deposited in tumours.• Nitroglycerine improves delivery of tumour-targeted therapy via enhanced permeability and retention. • In hepatocellular carcinoma, nitroglycerine added to TAE/TACE showed greater tumour reduction. • Dual-energy CT can reliably quantify the amount of Lipiodol in TAE/TACE.

BACKGROUND Although it is generally felt that a catheter with a locking string can achieve better fixation and thus prevent catheter displacement, no formal study has ever substantiated this. METHODS We retrospectively reviewed the charts from 80 patients (mean age of 64.6 ± 14.76 y) who underwent percutaneous nephrostomy (PCN) over a 1-year period. RESULTS Most patients had catheters without locking strings and only 17 patients (21.3%) had catheters with locking strings. The median duration of catheter placement was 29 days (interquartile range 14 - 57 d). There were no significant differences in patients' characteristics or catheter outcomes between catheters with and catheters without locking strings (p > 0.05). In addition, no significant difference in the catheter 90-day survival between catheter types was found (log rank test, p = 0.638). On univariate analysis, tumor as an indication for PCN (p = 0.018), obstruction (p = 0.021) and displacement (p = 0.007) were associated with reduced catheter survival. The multivariate analysis indicated that tumor as an indication for PCN (HR: 0.28, 95% CI: 0.13 - 0.63, p = 0.002), obstruction (HR: 0.25, 95% CI: 0.08 - 0.77, p = 0.015) and catheter displacement (HR: 0.09, 95% CI: 0.03 - 0.31, p < 0.001) were independent hazard factors for reduced catheter 90-day survival. CONCLUSION No significant difference in either complication rate or 90-day survival was found between catheters with or without locking strings. These findings may prove helpful to the clinician in deciding the type of catheter to use during PCN.

In vivo 1 H MRS is a noninvasive imaging technique for the identification of malignancy. Musculoskeletal lesions vary in their composition, causing field inhomogeneity and magnetic susceptibility effects which may be technical and diagnostic challenges for MRS. This study investigated the factors that affect diagnostic accuracy in the use of MRS for the characterization of musculoskeletal neoplasms. During a 7-year period, 210 consecutive patients with musculoskeletal lesions larger than 1.5cm in diameter were examined. MRS of a single-voxel point-resolved spectroscopy sequence with TE=135ms was undertaken using a 1.5-T scanner. Lesions with a choline signal-to-noise ratio larger than 3.0 were considered to be malignant tumors. The diagnostic accuracy was calculated for all lesions and for subgroups on the basis of lesion type (bone and soft tissue), lesion composition (mixed and solid nonsclerotic), lesion size (≤4, >4–10 and >10cm), MR scanner (MR scanner 1 and 2) and selected voxel size (≤3, >3– 8a nd>8cm 3 ). Multivariate logistic regressions were performed to estimate the associations between each factor and diagnostic accuracy. The diagnostic accuracy was 73.3% for all lesions. The accuracy was 54.4% for mixed lesions and 80.4% for solid nonsclerotic lesions (p 4–10cm (p=0.04) and 63.6% for lesions of >10cm (p=0.007)]. There was no difference in diagnostic accuracy for bone versus soft-tissue lesions or as a function of MR scanner or voxel size. By the use of multivariate logistic regression, a solid nonsclerotic lesion was 3.15 times (95% confidence interval, 1.59–6.27) more likely than a mixed lesion to have a diagnosis (p=0.001). MRS can be used to characterize musculoskeletal lesions, particularly solid nonsclerotic lesions. Copyright # 2011 John Wiley & Sons, Ltd.

Since large-scale reports of pulmonary infarction in systemic lupus erythematosus (SLE) are limited, a retrospective study was performed for this manifestation in 773 hospitalized patients in southern Taiwan from 1999 to 2009. Pulmonary infarction was defined as the presence of pulmonary embolism, persistent pulmonary infiltrates, and characteristic clinical symptoms. Demographic, clinical, laboratory, and radiological images data were analyzed. There were 12 patients with pulmonary embolism and 9 of them had antiphospholipid syndrome (APS). Six patients (19 to 53 years, average 38.2 ± 12.6) with 9 episodes of lung infarction were identified. All cases were APS and four episodes had coincidental venous thromboembolism. There were four episodes of bilateral infarction and seven episodes of larger central pulmonary artery embolism. Heparin therapy was routinely prescribed and thrombolytic agents were added in two episodes. Successful recovery was noted in all patients. In conclusion, there was a 0.8% incidence of pulmonary infarction in patients with SLE, all with the risk factor of APS. Differentiation between pulmonary infarction and pneumonia in lupus patients should be made; they have similar chest radiography with lung consolidation but require a different clinical approach in management. Although this report is a retrospective study with relatively small numbers of lupus patients with lung infarcts, our observation might provide beneficial information on the clinical features and radiological presentations during the disease evolution of pulmonary infarction in SLE with APS.

To investigate the progression rate of small pancreatic cystic lesions and identify characteristics associated with their progression.Patients with pancreatic cystic lesions with at least 1-year of follow-up were evaluated retrospectively. We excluded patients with cysts larger than 3 cm or with features that were a concern for malignancy. In total, 135 patients were evaluated. The interval progression of the cysts was examined. Characteristics were compared between patients with and without progression.The pancreatic cysts ranged from 3 to 29 mm. The mean follow-up period was 4.5 ± 2.3 years and the mean progression rate was 1.0 ± 1.3 mm/year. Ninety patients showed interval progression and were divided into two groups; the minimal-change group (n = 41), who had cyst progression at less than 1 mm/year, and the progression group (n = 49), who had a progression rate of more than 1 mm/year. Compared with the cysts without progression, the lesions of the progression group were more frequently associated with tubular cyst, septation or a prominent pancreatic duct (P0.05). The odds ratio for progression was 5.318 for septation and 4.582 for tubular cysts.Small pancreatic cysts progress slowly. Lesions with tubular shape, septa, or prominent pancreatic duct were more likely to progress, and required further diagnostic intervention or shorter surveillance interval.

Objective. In this study, quantitative characterization of sonographic image texture and its correlation with histopathologic findings was developed for facilitating clinical diagnosis. A statistical feature matrix was applied to quantify the texture difference (ie, the dissimilarity) of the sonographic images for malignant and benign breast tumors. Methods. Thirty-three patients were recruited for this study. Imaging was performed on a commercially available sonographic imaging system in clinical use. The parameters used for image acquisition were kept the same during clinical examination. Results. On the basis of dissimilarity values, 3 phenomena were noted in the relatively large malignancies studied. First, stellate carcinoma showed the least dissimilarity on sonographic images; second, circumscribed carcinoma showed the most dissimilarity; and third, malignant tissue mixed with fibrous and cellular parts (dense lymphocyte infiltration and prominent intraductal tumors) had dissimilarity values in between. Image textures with smaller dissimilarity values (especially for those values

Objective: We conducted this study to correlate computed tomography (CT) images with the complications induced by CT-guided percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC). Methods: Twenty-two patients with ultrasonographically unreachable HCC were treated with CT-guided transthoracic PEI. The procedures and the CT findings were recorded to correlate with the various complications of PEI. Results: After the ethanol injection, 3 patterns of CT images were identified according to the distribution of ethanol (ie. intratumoral, extrahepatic, and intrahepatic patterns). The intrahepatic pattern was further classified as the branch, tubular, and infiltrative types. During the follow-up period. 3 patients developed biliary stricture, portal vein thrombosis, or tumor seeding. The tubular type was associated with the development of biliary stricture, whereas the branch type was related to the occurrence of portal vein thrombosis. These complications were considered to be caused by a greater amount of ethanol leakage into bile ducts or portal veins than in cases without complications (median = 17 mL vs. 0 mL, P = 0.002). Conclusions: Ethanol leakage is not uncommon when performing PEI; however, it seems to be safe when the leakage is less than 15 mL. Injection of a small amount of ethanol or monitoring by CT may be helpful in preventing the development of these complications.

The aim of the present study was to determine the correlation between dual-energy computed tomography (DECT) Hounsfield units (HU) and iron concentration, as well as the correlation between HU and magnetic resonance imaging (MRI)-derived R2 * values, in phantoms of the heart and liver tissue. Phantoms were constructed containing pig heart or liver tissue and varying concentrations of iron (0.1, 5, 10, 15, 20 and 25 mg/ml). The phantoms were then examined by DECT and MRI. Linear regression analysis was used to determine the correlations between HU and iron concentration and HU and R2 * values. The HU value of DECT increased with increasing iron concentrations in the liver and heart phantoms in a linear manner. The slope of the HU value change against iron concentration revealed that ΔH80-140 provided a better discernment of iron concentration as compared with ΔH100-140. The derived R 2 values were all >0.9 for the associations of DECT and MRI measurements with iron concentrations. Therefore, DECT may be used for the determination of iron concentration in the liver and heart tissue, with the results correlating with those obtained with MRI.

The suprahepatic region is a rare ectopic location of the gallbladder. It usually combines with right lobe anomaly of the liver. Here we report two unusual cases of suprahepatic gallbladder with agenesis or hypogenesis of the right lobe of the liver and biliary cancer. A patient with a gallbladder tumor was admitted to our emergency room with acute cholecystitis and liver abscess. Imagining examinations and operation confirmed the suprahepatic position of gallbladder, agenesis of the right lobe, and dissemination of gallbladder cancer. In the patient with cholangiocarcinoma, CT scans and percutaneous transhepatic cholangiography documented the presence of a hilar tumor and hypogenesis of the right lobe. Both of these patients died from biliary tract cancer soon after operation.

To investigate the 10-year results of treating low rectal cancer by a single surgeon in one institution.From Oct 1998 to Feb 2009, we prospectively followed a total of 62 patients with cT2-4 low rectal cancer with lower tumor margins measuring at 3 to 6 cm above the anal verge. All patients received neoadjuvant chemoradiation (CRT) for 6 wk. Among them, 85% of the patients received 225 mg/m(2)/d 5-fluorouracil using a portable infusion pump. The whole pelvis received a total dose of 45 Gy of irradiation in 25 fractions over 5 wk. The interval from CRT completion to surgical intervention was planned to be approximately 6-8 wk. Total mesorectal excision (TME) and routine defunctioning stoma construction were performed by one surgeon. The distal resection margin, circumferential resection margin, tumor regression grade (TRG) and other parameters were recorded. We used TRG to evaluate the tumor response after neoadjuvant CRT. We evaluated anal function outcomes using the Memorial Sloan-Kettering Cancer Center anal function scores after closure of the defunctioning stoma.The median distance from the lower margin of rectal cancer to the anal verge was 5 cm: 6 cm in 9 patients, 5 cm in 32 patients, 4 cm in 10 patients, and 3 cm in 11 patients. Before receiving neoadjuvant CRT, 45 patients (72.6%) had a cT3-4 tumor, and 21 (33.9%) patients had a cN1-2 lymph node status. After CRT, 30 patients (48.4%) had a greater than 50% clinical reduction in tumor size. The final pathology reports revealed that 33 patients (53.2%) had a ypT3-4 tumor and 12 (19.4%) patients had ypN1-2 lymph node involvement. All patients completed the entire course of neoadjuvant CRT. Most patients developed only Grade 1-2 toxicities during CRT. Thirteen patients (21%) achieved a pathologic complete response. Few post-operative complications occurred. Nearly 90% of the defunctioning stomas were closed within 6 mo. The local recurrence rate was 3.2%. Pathologic lymph node involvement was the only prognostic factor predicting disease recurrence (36.5% vs 76.5%, P = 0.006). Nearly 90% of patients recovered sphincter function within 2 year after closure of the defunctioning stoma.Neoadjuvant CRT followed by TME, combined with routine defunctioning stoma construction and high-volume surgeon experience, can provide excellent surgical quality and good local disease control.

BACKGROUND/AIMS Preoperative chemoradiation therapy (CRT) is standard procedure for locally advanced rectal cancer. The correlation of tumor response evaluated using CT according to response evaluation criteria in solid tumors (RECIST) with the histo-logical tumor regression grade (TRG) is not well-documented. METHODOLOGY Ninety-one patients with rectal cancer underwent CT examinations before and after preoperative CRT and following surgery. Clinical tumor staging and tumor response assessed according to RECIST were done on paired CT scans. Pathological tumor staging and TRGs were reviewed in resected specimens.Post-CRT CT findings and histological findings were compared. Survival analysis for 73 patients was done. RESULTS TRG was positively correlated with the CT-assessed tumor response (r=0.276, p=0.009). Thickened fibrotic areas and muscle disarray caused by fibrosis were more frequently seen in cases of patients over-diagnosed as having residual tumors. The ycT status was positively correlated with ypT status (r=0.44, p

A symptomatic Meckel's diverticulum (MD) may manifest as an intestinal obstruction secondary to a volvulus. We describe a case of a meconium-impacted MD associated with inflammatory adhesions to adjacent viscera that presented as an intestinal obstruction in a 4-h-old infant secondary to an ileal volvulus with resultant infarction of the diverticulum and ileal segment.

The main goal of this study was to investigate the applicability of parameters derived from diffusion tension imaging (DTI) in diagnosing carpal tunnel syndrome (CTS). Forty subjects were recruited, of which 19 were normal controls and 21 belonged to the CTS group. DTI of median nerves evaluated at 4 levels of the wrist (distal radius, pisiform bone, middle portion of the carpal tunnel, and hamate bone) and conventional MRI of the wrist was performed in normal and CTS subjects in two finger postures (extension and flexion). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were derived from DTI, and parameters related to abnormal hyperintensity of the median nerve were derived from conventional MRI. Electrophysiological tests, including nerve conduction velocity and F wave were also performed for comparison. The results of FA and ADC measurements did not depend on the measuring location and finger posture. Mean FA was decreased while mean ADC was increased by CTS. FA and ADC at the middle portion of the carpal tunnel was 0.47±0.05 and 1.37±0.12 (×10(-3) mm2/s) for the control group and 0.42±0.04 and 1.50±0.15 (×10(-3) mm2/s) for the CTS group, respectively. The linear correlations of FA and ADC versus electrophysiological indicators of CTS were significant (R2 ranged from 0.09 to 0.36), indicating FA and ADC from DTI had significant correlation with the existence and severity of CTS.

In vivo (1)H MRS is a noninvasive imaging technique for the identification of malignancy. Musculoskeletal lesions vary in their composition, causing field inhomogeneity and magnetic susceptibility effects which may be technical and diagnostic challenges for MRS. This study investigated the factors that affect diagnostic accuracy in the use of MRS for the characterization of musculoskeletal neoplasms. During a 7-year period, 210 consecutive patients with musculoskeletal lesions larger than 1.5 cm in diameter were examined. MRS of a single-voxel point-resolved spectroscopy sequence with TE = 135 ms was undertaken using a 1.5-T scanner. Lesions with a choline signal-to-noise ratio larger than 3.0 were considered to be malignant tumors. The diagnostic accuracy was calculated for all lesions and for subgroups on the basis of lesion type (bone and soft tissue), lesion composition (mixed and solid nonsclerotic), lesion size (≤4,4-10 and10 cm), MR scanner (MR scanner 1 and 2) and selected voxel size (≤3,3-8 and8 cm(3)). Multivariate logistic regressions were performed to estimate the associations between each factor and diagnostic accuracy. The diagnostic accuracy was 73.3% for all lesions. The accuracy was 54.4% for mixed lesions and 80.4% for solid nonsclerotic lesions (p 0.001). The diagnostic accuracy was lower for larger lesions [86.8% for lesions of ≤4 cm, 71.6% for lesions of4-10 cm (p = 0.04) and 63.6% for lesions of10 cm (p = 0.007)]. There was no difference in diagnostic accuracy for bone versus soft-tissue lesions or as a function of MR scanner or voxel size. By the use of multivariate logistic regression, a solid nonsclerotic lesion was 3.15 times (95% confidence interval, 1.59-6.27) more likely than a mixed lesion to have a diagnosis (p = 0.001). MRS can be used to characterize musculoskeletal lesions, particularly solid nonsclerotic lesions.

To identify factors that were related to the short term effectiveness of percutaneous transhepatic biliary drainage in cholangiocarcinoma patients and to evaluate the impact of palliative drainage on their survival.Seventy-four patients with hilar cholangiocarcinoma who underwent percutaneous biliary drainage were enrolled in the study. The demographic and laboratory data as well as the imaging characteristics were retrospectively analyzed to correlate with the bile output and reduction rate of serum bilirubin 1 wk after drainage.Patients with more bile duct visualized on percutaneous transhepatic cholangiography or absence of multiple liver metastases on imaging studies had more bile output after biliary drainage [odds ratio (OR): 8.471, P = 0.010 and OR: 1.959, P = 0.022, respectively]. Patients with prolonged prothrombin time had a slow decrease in serum bilirubin (OR: 0.437, P = 0.005). The median survival time was not significantly different in patients with low or high bile output (75 d vs 125 d, P = 0.573) or in patients with slow or rapid reduction of serum bilirubin (88 d vs 94 d, P = 0.576).The short term effectiveness of percutaneous biliary drainage was related to patient's prothrombin time or the extent of tumor involvement. It, however, had no impact on survival.

The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effective method to achieve biliary cannulation if an endoscopic approach fails. The two procedures in this technique can be carried out simultaneously or in stages. A simultaneous approach is reported to be associated with fewer complications, and patients undergoing this approach can recover and be discharged more rapidly. Here, we report a complication of pneumoperitoneum in a patient who underwent percutaneous and endoscopic procedures simultaneously for the removal of a common bile duct stone. It was supposed that prolonged air insufflation during endoscopy forced intestinal air to track into the peritoneal cavity through the bile ducts and the puncture tract. Accordingly, a short wait before removing the percutaneous catheter to deflate the intestinal air will be helpful to avoid such a complication.

To study the characteristics of clinical findings and CT imaging of perforated appendicitis for predicting the outcome of patients who received immediate appendectomy for perforated appendicitis.Thirty-eight patients with perforated appendicitis who received immediate appendectomy were retrospectively reviewed. During a median follow-up period of 1091 days, 13 patients had to be re-hospitalized owing to occurrence of complications relating to the immediate appendectomy. Accordingly, the patients were divided into two groups as either complication or non-complication group. The clinical characteristics and CT imaging of these two groups were compared.Those patients who delayed seeking medical advice were more prone to develop surgical complications after immediate appendectomy. CT imaging showing either fat stranding with remarkable fluid content or abscess indicates the presence of severe inflammation and is related to adverse surgical outcomes. Moreover, extraluminal appendicolith was more frequently found in the CT imaging of complication group.Patients with perforated appendicitis differ in their severity. Patients who seek medical advice late or have signs of severe inflammation or extraluminal appendicolith on their CT imaging are associated with more severe diseases and are prone to develop complications of surgery at this time and should be better treated conservatively.

Background Small pancreatic cystic lesions without concerning findings such as mural nodule are advised to undergo surveillance. However, they can trigger significant anxiety for patients and their physicians. We aimed to investigate the progression of pancreatic cystic lesion and find if any clinical and imaging features that might be associated with the progression. Patients and Methods Patients with pancreatic cystic lesions other than pseudocyst detected incidentally by sonography, computed tomography, or magnetic resonance imaging with at least one year follow-up were retrospectively enrolled. Cystic lesions larger than 3 cm in size or had solid component or accompanied with dilated pancreatic duct more than 5mm were excluded. The interval progression of cystic lesions was checked and the rate of change was determined. The clinical features of patients and imaging characteristics were compared between the patients with and without progression of pancreatic cystic lesion. Results In total, 166 patients were enrolled. The mean follow-up period was 4.3 ± 2.3 years (range 1.0 to 10.1 years) and the mean progression was 0.8 ± 1.3 mm/ year (range 0 to 6.1 mm). One hundred and seven patients had interval progression of pancreatic cystic lesion. These patients were further divided into two nearly equal groups, the minimal change group (n = 53) and the progression group (n = 54), by using a progression rate less or more than 1 mm/year. Regarding to the imaging features, tubular component, septation, or dilated pancreatic duct were more frequently associated with progressive pancreatic cystic lesions than minimal changed or unchanged lesions (p < 0.05). Compared to the unchanged lesions, the pancreatic cystic lesions were likely to be progressive if they had septation (OR 4.534, 95% CI: 1.384 14.852, p = 0.013) or tubular components (OR 4.247, 95% CI: 1.312 13.748, p = 0.016). Besides, patients with progressive cystic lesion were older than the other patients (p < 0.05). Conclusions Small pancreatic cystic lesion progressed slowly. However, lesions with tubular component, septation or pancreatic duct dilation may be related to mucinous neoplasm and therefore, were more apt to be progressive. Presence of these imaging features and together with an older age of patients may require a shorter surveillance interval. Clinical and Imaging Characteristic of Patients

Perforation of Meckel's diverticulum (MD) during the neonatal period may occur in the presence of distal colon obstruction. Herein, we describe a unique case of a 2-day-old infant that presented with pneumoperitoneum, in which a perforated MD was induced by distal intestinal obstruction secondary to total colonic aganglionosis. In the setting of neonatal perforated MD found intraoperatively, the determination of the possible precipitating etiology is necessary. The clinical history of delayed passage of meconium is emphasized, and either a rectal or colon biopsy is recommended intraoperatively to avoid overlooking the associated presence of Hirschsprung's disease.

In this paper, a liver disease diagnosis based on Gabor filters is proposed. Three kinds of liver diseases are identified: cyst, hepatoma and cavernous hemangioma. The diagnosis scheme includes two steps: features extraction and classification. The features derived from Gabor filters are obtained from the ROIs among the normal and abnormal CT images. In the classification step the SVM classifier is used to discriminate the different liver disease types. Finally the receiver operating characteristic curve is employed to evaluate the performance of the diagnosis system. The effectiveness of the proposed method is demonstrated through experimental results on CT images including 76 liver cysts, 30 hepatomas, and 40 cavernous hemangiomas. From the results, we can observe that the discrimination rate of cyst is higher than the other diseases, and the classification accuracy decreases slightly between cavernous hemangiomas and hepatomas. However, a normal region can be discriminated from all of these diseases entirely.