Purpose To analyze the sources of errors and discuss the techniques to eliminate pitfalls in detecting deep vein thrombosis (DVT) of the proximal lower extremities with color duplex ultrasonography (CDUS). Methods Sixty-eight cases with initial and repeat venous CDUS of the proximal lower extremities were retrospectively reviewed. The repeat was done within 24 hours after initial CDUS scanning. Comparing repeated images to initial ones, the pitfalls and sources of error in CDUS of the proximal lower extremities were discussed. Results In total 68 repeat studies, there were 62 results as same as initials and 4 cases of false negative DVT and 2 cases of false positive DVT. Conclusion Venous CDUS in detecting DVT is observer dependent. Some pitfalls and errors can be eliminated and corrected with proper scan techniques. CDUS is the most valuable imaging modality for assessing suspected DVT in the proximal lower extremities.

Cavernous hemangioma is the most common benign hepatic tumor. Typically, the most common features revealed by ultrasound(US) include its small size(4cm or less in diameter), uniform hyperechogenicity, welldefined margins, position in the subcapsular region of the right lobe of the liver, and some posterior echo enhancement. In addition, follow-up scanning may reveal changes in size, though this is rare. The US findings of hepatic hemangiomas may vary, however, especially when lesions are large and/or multiple. For that reason, differential diagnosis between this condition and hepatocellular carcinomas, metastatic lesions, lymphomas and other tumors is difficult. An understanding of the various sonographic findings of hepatic hemangioma can facilitate the early detection of the condition.
Carcinoma, Hepatocellular ; Classification* ; Diagnosis, Differential ; Follow-Up Studies ; Hemangioma* ; Hemangioma, Cavernous ; Liver ; Lymphoma ; Ultrasonography

Vascular complications after liver transplantation may involve the hepatic artery, and hepatic and portal veins. Arterial complications are common and significant vascular complications include thrombosis or stenosis, as well as pseudoaneurysms. Venous complications include thrombisis or stenosis of the inferior vena cana, or hepatic or portal vein. Since recent evidence has shown that emergent revascularization leads to improved graft salvage and patient survival with a relatively low rate of late biliary complications, accurate and pronpt di-agnosis of hepatic arterial complications is important. Doppler US is a relatively inexpensive, accurate, and non-invasive method of diagnosing the vascular complications which may arise from liver transplantation.
Aneurysm, False ; Constriction, Pathologic ; Hepatic Artery ; Humans ; Liver Transplantation* ; Liver* ; Portal Vein ; Thrombosis ; Transplants

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction. is a high-speed, heavily T2-weighted sequence with a great sensitivity for fluid (11). This advance may make it possible to use breath-hold turbo spin-echo MR.
Comparative Study ; Female ; Human ; Inflammatory Bowel Diseases/*diagnosis ; Intestinal Neoplasms/*diagnosis ; Intestinal Obstruction/*diagnosis ; Intestine, Small/*pathology ; *Magnetic Resonance Imaging ; Male ; Middle Age ; *Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to evaluate the CT findings of parasitic ectopic infestation in theperitoneal cavity, a transitional route for parasites invading the gastrointestinal tract, to migrate to varioustarget organs. MATERIALS AND METHODS: CT scans of nine patients with pathologically(n=8) or serologically(n=1)proven intraperitoneal involvement of parasitic infestation were retrospectively reviewed. The primary causes ofparasitic infestation in nine patients were Paragonimus westermani(n=5), Sparganosis(n=2), and hepaticfascioliasis(n=2). We analyzed the CT findings with regard to the sites and patterns of lesions in the peritonealcavity and gastrointestinal track, as well as in other solid organs. The clinical features of these patients werealso evaluated. RESULTS: The clinical symptoms and signs were chronic abdominal pain and general weakness inseven patients, while peripheral blood eosinophilia was observed in four. The CT features of these nine patientsincluded multiseptated cystic masses of 2 -6cm, diameter (mean 4.1 +/-1.7cm) in the omentum or mesentery insix(67%), omental or mesenteric infiltration in seven(78%), focal peritoneal thickening in seven(78%),lymphadenopathy in five(56%), and ascites in four(44%). In six of the nine patients, the gastrointestinaltract(stomach in four, colon in one, both stomach and colon in one) was concomitantly involved with focal wallthickening. Branching patterns of hypoattenuating lesions were noted in the liver of three patients ; two of thesehad hepatic fascioliasis and one had paragonimiasis. CONCLUSION: Ectopic parasitic infestation in the peritonealcavity manifests as mass formation, adjacent gastrointestinal wall thickening, and focal peritonitis. Anunderstanding of these image features is important for both early diagnosis and adequate treatment.
Abdominal Pain ; Ascites ; Colon ; Early Diagnosis ; Eosinophilia ; Fascioliasis ; Gastrointestinal Tract* ; Humans ; Liver ; Mesentery ; Omentum ; Paragonimiasis ; Paragonimus ; Parasites ; Peritonitis ; Retrospective Studies ; Stomach ; Tomography, X-Ray Computed

Zollinger-Ellison syndrome (ZES) involves hypergastinemia produced by a gastrin-secreting tumor. Not only can it cause an ulcer but may also behave as a malignant lesion, metastasizing to the liver or other organs. The development of potent antisecretory agents for controlling acid secretion as well as techniques for localizing these islet cell tumors, has led to greatly improved survival rates. We describe a case of Zollinger-Ellison syndrome, emphasising the radiologic findings, and including a review of the literature.
Adenoma, Islet Cell ; Liver ; Survival Rate ; Ulcer ; Zollinger-Ellison Syndrome*

PURPOSE: To assess the malignant potential of small(< or =15mm) portal defects seen on CT arterial portography,the findings of CT hepatic arteriography and lipiodol CT CT were reviewed. MATERIALS AND METHODS: In 91 patientswho underwent both CTAP and CTHA, small portal defects were re-viewed for frequency, multiplicity and location. Weprospectively evauluated changes in the size and enhance-ment pattern of malignant lesions on follow up CTaccording to density on CTHA, location, lipiodol deposits on lipiodol CT, and multiplicity. RESULTS: Among the 91patients, 102 small defects were defected in 42 patients(46%). Small portal defects were benign, malignant, and ofundetermined malignant potential in 77%, 20% and 3% of cases, respectively. Small portal defects that werehyperattenuated on CTHA, and lipiodol deposits on lipiodol CT, were malignant in 42% and 70% of cases,respectively. Location and multiplicity did not show statistically significant variation between benign andmalignant defects. CONCLUSION: Small portal defects are common and there is a high probability that portaldefects smaller than 15mm are benign, even in patients with a known hepatic mass and defect that washyperattenuated on CTHA. If a small defect showed lipiodol deposit on lipiodol CT, malignancy must be suspected.
Angiography* ; Ethiodized Oil* ; Follow-Up Studies ; Humans ; Liver* ; Portography*

PURPOSE: To assess the clinical and pathologic features of each type of intrahepatic cholangiocarcinoma,which is divided into three types according to gross appearance, and to determine the efficacy of CT in detectingthis tumor. MATERIALS AND METHODS: The pathologic and CT features of 53 surgically proven cases of intrahepaticcholangio-carcinoma were reviewed. On the basis of their gross appearance, the tumors were divided into threetypes, as follows: mass forming (n=33), periductal infiltrating (n=6), and intraductal growth type (n=14). CTscans were analyzed for sensitivity of detection and correlation between a tumors appearance and itshistopathology. RESULTS: The most common histopathologic feature of mass forming and periductal infiltrating typewas tubu-lar adenocarcinoma, while in the intraductal growth type, papillary adenocarcinoma (100%) was common.With regard to pattern of tumor spread, intrahepatic and lymph node metastasis were more common in the massforming and periductal infiltrating type than in the intraductal growth type. CT findings including intra-hepaticmass, ductal wall thickening or intraductal mass associated with segmental dilatation of intrahepataic bile ducts,corresponded with these morphologic types. CONCLUSION: This classification according to gross appearance is ofconsiderable value when interpreting the pathologic features of intrahepatic cholangiocarcinoma. CT seems to be auseful modality for the detection of tumors and may be consistent with their gross morphologic findings.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Bile ; Cholangiocarcinoma* ; Classification ; Dilatation ; Lymph Nodes ; Neoplasm Metastasis

Hepatolithiasis is rare in western countries, but is fairly common in East Asia, including Japan, China, and Taiwan. Calcium bilirubinate stones account for the majority of intrahepatic calculi, while intrahepatic cholesterol stones are very rare, the incidence being 0.37% of all gallstones. However, several investigators have recently reported an increased incidences of cholesterol gallstones in hepatolithiasis cases and have discussed the differing mechanisms for their formation in the intrahepatic biliary tree of patients with calcium bilirubinate stones and cholesterol stones. We report two cases of intrahepatic cholesterol stone, with emphasis on the radiologic findings, and review the literature.
Biliary Tract ; Bilirubin ; Calculi ; China ; Cholesterol* ; Far East ; Gallstones ; Humans ; Incidence ; Japan ; Research Personnel ; Taiwan

PURPOSE: To describe the CT and ERCP findings of mass-forming chronic pancreatitis. MATERIALS AND METHODS: CT and ERCP features were assessed in 13 patients suffering from mass-forming chronic pancreatitis. Diagnosis was on the basis of surgery (n=5), percutaneous needle biopsy (n=3), and clinical follow-up (n=5). Contrast-enhanced CT was available for all patients: five underwent dynamic study and ERCP was performed in 12. On CT and ERCP, both groups were evaluated with regard to the presence and degree of pancreatic ductal dilatation (greater or less than 50 % of total gland width), double duct sign, enhancement pattern, pancreatic parenchymal calcification (site and distribution pattern), mass identification, the direction of infiltration, pancreatic parenchymal atrophy, configuration at the site of obstruction in the pancreatic and common bile duct, lymphadenopathy, vascular encasement, and vascular engorgement or increased collateral vessels in the peripancreatic space. RESULTS: Seven of 13 patients had suffered chronic alcoholism. Serum CA19-9 levels were normal in all patients except one. Common CT and ERCP findings of mass-forming chronic pancreatitis included pancreatic duct dilatation (92.3%), double duct sign(69.2%), inhomogeneous enhancement of the mass (69.2%), and the presence of calcification (61.5%). Patterns of pancreatic duct dilation were irregular in five patients (38.4%) and smooth in three (23.1 %).In all patients, duct dilatation was less than 50 % of total gland width. Enhancement patterns of the pancreatic mass were inhomogeneous (69.2%), a nonenhancing low attenuation mass (15.3%), and homogeneous enhancement (15.3 %). Configuration at the site of obstruction in the pancreatic duct was abrupt termination in two patients (15.4 %) and smooth termination in two (15.4 %). The common bile duct teminated abruptly in three patients (23.1%), and in four (30.8 %) smooth narrowing was abserved. CONCLUSION: Common findings of mass-forming chronic pancreatitis were duct dilatation of less than 50 % of total gland width, double duct sign, inhomogeneous enhancement of the mass, and the presence of calcification. These were combined with observation of clinical findings such as chronic alcoholism and CA19-9 levels, which are useful indicators for differentiating mass-forming chronic pancreatitis from pancreatic cancer.
Alcoholism ; Atrophy ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Diagnosis ; Dilatation ; Follow-Up Studies ; Humans ; Lymphatic Diseases ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis, Chronic* ; Tomography, X-Ray Computed