No abstract available.

PURPOSE: To elucidate the dynamic features of CT scans in peripheral cholangiocarcinoma for the differentiation of this tumor from various primary hepatic neoplasms. MATERIALS AND METHODS: Materials were 24 cases of pathologically confirmed peripheral cholangiocarcinoma. Contrast enhancement patterns of central and peripheral portion of the masses were analyzed at three phases including arterial dominant(22), tissue equilibrial(24), and postequilibrial(9). Other associated CT findings and laboratory data were analyzed. RESULTS: Serum total billrubin was mostly below 2mg/dl(22/24), hepatitis B surface antigen was positive in 0nly 9%, serum alphafetoprotein was elevated in 18%, carcinoembryonic antigen in 47%, cancer antigen 19-9 in 60%. In the arterial dominant image(22), 50% of the cases showed peripheral hyperdensity and 50% total hypodensity. In the tissue equilibrial images(24), 63% showed total hypodensity, 25% peripheral hyperdensity, and 13% total isodensity. In the postequilibrial images(9), 45% showed peripheral hypodensity, 33% total hyperdensity, and 22% total hypodensity. The relative CT density of central portion of mass was higher in later phase than earlier phase. Associated findings were IHD dilatation(18) or stone(2), lymphadenopathy(11), ipsilateral lebar shrinkage(7), surrounding cystic mass(2), calcification within the mass(2) and choledochal cyst (2). CONCLUSION: Dynamic features of CT scans were useful for the systematic differentiation of the peripheral cholangiocarcinoma from various primary hepatic neoplasm.
Carcinoembryonic Antigen ; Cholangiocarcinoma* ; Choledochal Cyst ; Hepatitis B Surface Antigens ; Liver Neoplasms ; Tomography, X-Ray Computed*

Sixty seven cases of segmental arterial hyperperfusion and thirty one cases of segemental portal hypoprfusion detected among 803 cases of arterial and portal dominant CT were studied for he evaluation of etiology and mechanism causing intrahepatic segmental abnormal perfusion in normal portion of the liver around hepatic mass. Hepatic masses causing segmental abnormal perfusion were hepatocellular carcinoma, peripheral cholangiocarcinoma, metastasis, abscess, and cavernous hemangioma. Segmental portal hypoperfusion was seen on the area of segmental arterial hyperperfusion in all the cases and segmental arterial hyperperfusion was seen on the area of segmental portal hypoperfusion in 77% of cases. In conclusion, there are intrahepatic segmental portal and arterial abnormal perfusions in normal portion around hepatic mass, and these phenomena may be developed with close reciprocal alteration between both portal and hepatic arterial flows.
Abscess ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Hemangioma, Cavernous ; Liver* ; Neoplasm Metastasis ; Perfusion* ; Portal Vein*

Sixty seven cases of segmental arterial hyperperfusion and thirty one cases of segemental portal hypoprfusion detected among 803 cases of arterial and portal dominant CT were studied for he evaluation of etiology and mechanism causing intrahepatic segmental abnormal perfusion in normal portion of the liver around hepatic mass. Hepatic masses causing segmental abnormal perfusion were hepatocellular carcinoma, peripheral cholangiocarcinoma, metastasis, abscess, and cavernous hemangioma. Segmental portal hypoperfusion was seen on the area of segmental arterial hyperperfusion in all the cases and segmental arterial hyperperfusion was seen on the area of segmental portal hypoperfusion in 77% of cases. In conclusion, there are intrahepatic segmental portal and arterial abnormal perfusions in normal portion around hepatic mass, and these phenomena may be developed with close reciprocal alteration between both portal and hepatic arterial flows.
Abscess ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Hemangioma, Cavernous ; Liver* ; Neoplasm Metastasis ; Perfusion* ; Portal Vein*

No Abstract Available.

PURPOSE: The purpose of our study was to characterize the enhancing patterns of hepatic metastasis from gastric adenocarinoma using multi-phase incremental bolus dynamic CT with obtained both in early and late phase contrast scan and to evaluate the its advantages. METHODS AND MATERIALS: Of 33 cases of multi-phase incremental bolus dynamic CT with proved hepatic~metastasis from gastric adenocarinoma, we classified dynamic enhancement patterns as three types according to early phase contrast enhancement, and then analized the late phase contrast enhancement, more metastasis detection, segmental abnormal arterial perfusions and correlation between pathologic type. RESULTS: Type I (totally hypodense lesion) was in 18 patients(55%), type II (peripheral high density area) was seen in 13 patients (39%), and type III (near totally hyperdense lesion) was seen in two patients(6%). But in late phase, masses showed totally hypodense area in 26 patients(79%), central high with peripheral low density area(PLDA) in six patients(18%) and totally isodense in one patient(3%). More metastatic masses were detected with early phase in 11 patients(33%) as compared with late phase contrast. Segmental arterial hyperperfusion around the lesions, which could represent intrahepatic portal branch invasion, was seen in 10 patients(30%). There was no correlation between pathologic type and enhancement pattern of lesions. CONCLUSION: Multi-phase incremental bolus dynamic CT could represent variable hemodynamic changes of hepatic metastatic masses and was useful to evaluate the qualitative and quantitative analysis of hepatic metastases.
Hemodynamics ; Humans ; Neoplasm Metastasis* ; Perfusion ; Stomach Neoplasms* ; Stomach*

PURPOSE: To identify the longterm hemodynamics of various hepatic masses and to determine any differential findings by using postangiographic CT performed with increased amount of contrast media and time than conventional contrast CT. MATERIALS AND METHODS: 50 confirmed masses consisted of 22 hepatocellular carcinoma, 10 cholangiocarcinoma, 9 metastasis, and 9 cavernous hemangioma were included. The changes of the density of internal viable tumor portion relative to surrounding normal liver parenchyma in postangiographic CT from that in conventional CT were classified as 3 patterns; no specific changes, increase, or decrease. RESULTS: in 22 cases of hepatoceilular carcinoma, six cases showed no relative density change, four cases increase, and twelve cases decrease. In ten cases of cholangiocarcinoma, one case showed no change, nine cases increase. In nine cases of metastasis, four cases showed no change, five cases increase. In nine cases of hemangioma, all cases showed increase. CONCLUSION: In postangiographic CT which emphasize the significance of postequilibrium and delayed phase, other hemodynamic changes undetected in angiography could more easily be comprehended. Considering the differing amount of consumed contrast media and time duration, and with reference of other imaging modalities, differential diagnosis of hepatic masses based on longterm hemodynamics could easily be made.
Angiography ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Contrast Media ; Diagnosis, Differential ; Hemangioma ; Hemangioma, Cavernous ; Hemodynamics ; Liver ; Neoplasm Metastasis ; Specific Gravity

PURPOSE: To prove whether the arterioportal shunt, especially transvasal shunt is one of the cause of the hypovascular hepatocellular carcinoma. MATERIALS AND METHODS: We evaluated the early phase images of table incremental dynamic CT and hepatic angiography in 20 cases of hepatoceltular carcinomas with transvasal arterioportal shunt. RESULTS: In hepatic arteriography, 18 cases were hypovascular and the remained 2 cases showed hypervascular tumor staining than surrounding normal hepatic parenchyme. In the early phase dynamic CT, 18 cases were hypodense(including 4 cases of focal hyperdensity in hypodense background), one was isodense and remaining one was hyperdense. CONCLUSION: Arterioportal shunt, especially transvasal shunt may make originally hypervasular hepato-cellular carcinoma to hypovascular lesion in the early phase dynamic CT or hepatic arteriography. In attempt to differentiate hepatic masses by tumor vascularity in recently widely used table incremental dynamic CT, the vascular patterns of the mass should be considered by close evaluation of vascular pattern of the liver, such as morphology of perfusion abnormality and arterioportal shunt, etc.
Angiography ; Carcinoma, Hepatocellular* ; Liver ; Perfusion

We compared 87 portographic filling defects detected by portal CT in 64 patients were compared with those obtained by indirect portography. The indirect portography could visualize portogram only in anterior-posterior view. But the portal portal CT could visualize both portogram and hepatogram. We examined the portal CT and indirect portography and compared the accuracy of the both methods to evaluate the limitation and significance of the indirect protography. The mass shape lesions were seen on the portal CT which means portal flow defects of the mass lesions only could not depict totally in indirect portography (0%, 0/41). And the larger defects than real mass lesion were seen in portal CT means mass with associated portal flow defect and find portal vein invasion around the mass in 52% (24/46) of the indirect portography. Among them, only 66% of mass were detected correctly in the indirect portography comparing with mass lesion in portal CT. In summary, indirect portogram could not detect small filling defects which detected in portal CT and could not depict the extent of large filling defects. It also could not visualize correctly the protal flow in non-lesion side of the liver parenchyma.
Humans ; Liver ; Portal Vein ; Portography*

Among previously proposed etiological factors of chondromalacia patellae, abnormality in the extensor mechanism of the knee joint has been attributed as a cause of chondromalacia patellae by many authors Malalignment in the extensor mechanism of the knee joint is supposed to cause the positional change of patella. This positional change of patella can be measured by Q angle and P/PT ratio. Hereby we intened to classify the relationahip between the above measurement lenoting the positional change of patella and chondromalacia patellae. These values were obtained from 60 patients found to have chondromalacia patellae in Han Gang Sacred Heart Hospital, from Jan. 1977 to Sep. 1978. Values were also obtained from 60 normal persons as a control group. Thus a statistical analysis was made for the possible relationship between extensor mechanism of the knee joint and chondromalacia patellae. The following conclusion were made, 1. The sex ratio was 1:1.3 with female preponderance. There was 26 male and 34 female patients, common age group of chondromalacia patellae was age 20-40 years. 2. The average value of Q angle was 11 in control group, while 18 in chondromalacia patellae, having the difference of 7. 3. The average values of Q angle among different sexes were reviewed. The male control group had 9 of average value of Q angle, while male chondromalacia patellae had 16. The female control group had 12 of average value of Q angle, while female chondromalacia patellae had 20. 4. The average value of P/PT ratio was 1.03 in control group, while 0.9 in chondromalacia patellae, having the difference 0.13. For P/PT ratio in different sexes, the average value was 1.01 in male control group. while 0.9 in male chondromalacia patellae. The average value of P/PT ratio was 1.04 in female control group, while 0.89 in female chondromalacia patellae, 5. For statistical survey for these differences, P value was examined by t-test methods. The statistical diffrences of Q angle in male control group and chondromalacia patellae was 3.4 and it was 2.06 in he female. The difference between control group and the chondromalacia patellae in the overall seves was 2.61, thus having statistical significance.
Cartilage Diseases ; Chondromalacia Patellae ; Female ; Heart ; Humans ; Knee Joint ; Knee ; Male ; Patella ; Sex Ratio