BACKGROUNDTriple-phase enhancement of multi-slice computed tomography (MSCT) has markedly improved the diagnostic accuracy of hepatocellular carcinoma (HCC), and MSCT angiography (MSCTA) has been proved useful in detecting vascular anatomy noninvasively. This study aimed to explore the value of MSCTA by triple-phase enhancement in preoperative evaluation of HCC.

METHODSFifty-six consecutive cases of primary HCC scheduled for resection were studied with MSCTA by triple-phase enhancement. The raw data images were processed on a workstation for multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction. The findings after processing of the data were compared with those after surgery or intraoperative sonography.

RESULTSThe false positive rate of MSCTA by triple-phase enhancement was 10.1% and its false negative rate was 4.3% in detecting HCC. No significant difference was observed in MSCTA and surgery or intraoperative sonography in detecting vascular anatomy anomalies and pathologic variations, whereas significant difference was found in detecting bile duct invasion with MSCT compared to intraoperative sonography.

CONCLUSIONSMSCTA by triple-phase enhancement not only improves the detection of HCC, but also provides valuable preoperative information about hepatic vascular architecture and parenchyma. MSCTA by triple-phase enhancement is worthy of application as a non-invasive method in preoperative evaluation of HCC.

Adult ; Angiography ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Female ; Hepatic Artery ; diagnostic imaging ; Hepatic Veins ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Radiographic Image Enhancement ; Tomography, X-Ray Computed

Angiography ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo study the principle and surgical managements for the patients with anatomic variants of hepatic artery in the procedure of pancreaticoduodenectomy (PD).

METHODSOne hundred and seventy-six patients who underwent PD between January 2000 and July 2007 were investigated retrospectively. Hepatic arterial variants were analyzed according to the intraoperative finding and CT imaging were reviewed postoperatively.

RESULTSHepatic arterial variants were found intraoperatively in 20 cases of all 176 patients. Accessory right heptic artery, replaced right heptic artery and common heptic artery arising from the superior mesenteric artery (SMA) were present in 9 (5.1%), 5 (2.8%), 4 (2.3%) cases respectively,and replaced right heptic artery coming from the gastroduodenal artery was present in 2 cases (2.9%). All the variants of hepatic arteries arising from the superior mesenteric artery could be observed in spiral CT imaging. Most of the variant arteries were dissected intact intraoperatively except 2 cases with accessory right heptic artery arising from SMA.

CONCLUSIONSPerforming CT scan preoperatively, especially CTA,is effective to diagnose these disorders. Skillful surgical techniques can manage the anatomic variants safely.

Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Radiography ; Retrospective Studies

An accurate segmentation of vascular systems is fundamental for many medical applications. In this paper, we propose a 3D vessel enhancement and extraction method. It is based on the analysis of Hessian matrix and Gaussian mixture model-expectation-maximization (GMM-EM) algorithm. Firstly, tube-like vessels were detected and enhanced based on the Hessian matrix eigenvalues. And then, the vascular system was segmented, and then a rough system was obtained with GMM-EM. Hessian-based filters were found to be sensitive to noise and sometimes gave discontinued vessels. Hence, we utilized the closing operation to avoid discontinuity and a 3D-filter on the segmented vessels to reduce noise brought by the contrast agent. Finally, a searching method based on spatial connected area is presented to connect the vascular system in 3D. The experimental results illustrated the efficiency of the method for 3D liver vessel segmentation proposed in this paper.
Algorithms ; Hepatic Artery ; diagnostic imaging ; Hepatic Veins ; diagnostic imaging ; pathology ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Liver ; blood supply ; diagnostic imaging ; Portal Vein ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

OBJECTIVETo improve the diagnostic accuracy of focal nodular hyperplasia (FNH) of the liver by analyzing its findings by helical CT multiphase scanning.

METHODSA retrospective analysis of the plain scanning and dynamic enhanced scanning helical CT findings was conducted in 20 pathologically verified FNH cases.

RESULTSOn plain CT scans, the FNH lesions appeared as heterogeneous or homogeneous hypodense areas. In the arterial phase, all lesions were vigorously and homogeneously enhanced except for the central scar and lesions in 1 case. In 6 cases, tortuous and dilated arteries were seen in the center or peripheral of the lesion in 16-slice spiral CT. In the portal venous phase and delayed phase, the lesions were slightly hyperdense, isodense or slightly hypodense. Central scar was found in 13 cases, which showed late enhancement. Atypical findings included multinodular FNH in 2 cases, pseudocapsular enhancement in 2 cases, calcification in 1 case, and necrosis in 1 case.

CONCLUSIONMultiphase helical CT scanning can fully display the pathological and blood supply characteristics of FNH and improve the differentiation of FNH from other malignant hypervascular tumors.

Adolescent ; Adult ; Aged ; Female ; Focal Nodular Hyperplasia ; diagnostic imaging ; Hepatic Artery ; diagnostic imaging ; Humans ; Liver ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Reproducibility of Results ; Tomography, Spiral Computed ; methods

OBJECTIVETo scrutinize the enhancement pattern at hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) by helical CT examination in order to differentiate small hepatocellular carcinoma (SHCC) from small hepatic cavernous hemangioma (SHCH).

METHODSIn 38 patients (41 lesions) with SHCC and 35 patients (45 lesions) with SHCH, the images at HAP, PVP and DP were recorded as to the characteristic of enhancements with the average CT value at the HAP monitored and compared.

RESULTSThe enhancement patterns of SHCC at the HAP, PVP, and DP were assessed as hyper-hypo-hypodense in 20 lesions, hyper-iso-hypodense in 6 lesions, hyper-hyper-hypodense in 3 lesions, hyper-iso-isodense in 5 lesions, iso-hypo-hypodense in 3 lesions, and hypo-hypo-hypodense in 4 lesions. The enhancement patterns of the SHCH were assessed as a peripheral hyperdense nodular at HAP, then progressively enlarged at PVP and turned into a isodense or homogeneous hyperdense nodular at DP in 27 lesions, hyper-hyper-iso or hyperdense in 9 lesions, hyper-iso-isodense in 3 lesions, hypo-hypo-hypodense in 6 lesions. The enhancement CT values at the HAP of homogeneous hyperdense SHCC and SHCH were (40.4 +/- 15.5) Hounsfield Unit (HU) and (102.8 +/- 18.9) HU respectively (P < 0.01).

CONCLUSIONMost of the small hepatocellular carcinoma and small hepatic cavernous hemangioma have typical appearance by triple-phase helical CT examination, and can easily and properly be diagnosed. But it is difficult to distinguish SHCC from SHCH with atypical appearance in isolated cases. Hence differentiation may be difficult. Therefore, further examinations such as MRI, ultra-sonography or isotope scintigraphy are helpful in the differential diagnosis.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; Diagnosis, Differential ; Female ; Hemangioma, Cavernous ; diagnostic imaging ; Hepatic Artery ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Tomography, Spiral Computed ; methods

The diagnostic value of 16-slices spiral computed tomography (CT) for portal vein disorders was evaluated. Forty-one patients were scanned by the 16-slices spiral-CT. The celiac trunk, portal vein and their branches were reconstructed by volume rendering (VR), multiplanar volume reconstruction (MPVR) and maximum intensity projection (MIP) technique, and the results were compared with digital subtraction angiography (DSA). VR, MPVR and MIP could display celiac trunk, portal vein, inferior vena cava and their branches and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery-portal vein. The results from 16-slices CT were better than DSA and identical with pathologic ones. The vessel three-dimension reconstruction technique of 16-slices spiral CT is valuable for evaluating the portal systemic disorders.
Adult ; Aged ; Angiography ; methods ; Angiography, Digital Subtraction ; Arteriovenous Fistula ; diagnostic imaging ; Embolism ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; Humans ; Hypertension, Portal ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; abnormalities ; diagnostic imaging ; Tomography, Spiral Computed ; Vena Cava, Inferior ; diagnostic imaging

OBJECTIVETo evaluate the capability of multidetector CT (MDCT) for the diagnosis of arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC).

METHODSTwo hundred and eighty-two patients with HCC were examined by both enhanced thin slice MDCT scanning in early hepatic arterial phase, late hepatic arterial phase, portal venous phase and digital subtraction angiography (DSA). The criteria for diagnosis of APS: (1) Earlier enhancement or stronger opacification of main portal trunk and/or the first order branches compared with that of superior mesenteric vein or splenic vein; (2) Earlier enhancement or stronger opacification of the second order and smaller portal venous branches compared with that of main portal trunk. The presence and degree of APS demonstrated with MDCT and DSA were analysed by double blind method.

RESULTSIn 282 HCC patients, 56 were complicated with APS. MDCT demonstrated central APS in 48 patients with 41 severe and 7 moderate shunt, one revealing no APS by DSA due to the giant HCC focus. Among 7 patients with light peripheral APS, two lesions were not revealed by DSA due to faint shunt and the last lesion in the patient with mixed APS was revealed both by APS and DSA.

CONCLUSIONMultidetector CT was a simple, effective and noninvasive new technique for the diagnosis of arterioportal shunt associated with hepatocellular carcinoma.

Adult ; Aged ; Angiography, Digital Subtraction ; Arteriovenous Fistula ; diagnostic imaging ; etiology ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; abnormalities ; diagnostic imaging ; Tomography, Spiral Computed ; methods

OBJECTIVETo evaluate the value of angiography and cholangiography on the diagnosis and interventional treatment of vascular and biliary complications after liver transplantation.

METHODSSixteen of 46 patients (15 men and 1 woman, 17 - 60 years old) after orthotopic liver transplantation received angiography due to abnormal ultrasonography or edema of lower limbs, or cholangiography due to progressing jaundice. Percutaneous transluminal angioplasty or drainage was performed in some patients.

RESULTSFifteen patients experienced vascular complications and 4 patients had biliary complications. Three of them appeared to have both vascular and biliary complications. Hepatic artery complications were the most common complications (9/16), including hepatic artery thrombosis or stenosis (6/9), bleeding (2/9) and hepatic artery-dissecting aneurysm (1/9). One patient with hepatic artery thrombosis received transcatheter thrombolysis and two patients with bleeding received coil embolization. Inferior vena cava and portal vein stenosis were observed in 6 and 2 patients, respectively. After balloon angioplasty or stent placement, clinical symptoms were alleviated. Biliary complications, including biliary stricture and anastomotic bile leak, occurred in 4 patients. Jaundice decreased after percutaneous transhepatic cholangiography and drainage.

CONCLUSIONSBesides diagnosis, interventional methods include mini-invasive treatment for patients with vascular and biliary complications after liver transplantation. Balloon angiography and stent placement for venous stenosis are useful procedure for the treatment of these problems.

Adolescent ; Adult ; Biliary Tract Diseases ; diagnostic imaging ; therapy ; Cholangiography ; Female ; Hepatic Artery ; diagnostic imaging ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Vascular Diseases ; diagnostic imaging ; therapy ; Vena Cava, Inferior ; diagnostic imaging

Adult ; Aged ; Arteriovenous Fistula ; complications ; diagnostic imaging ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; Hepatic Veins ; abnormalities ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods