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*

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 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

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 make the guideline for diagnosis and treatment policy of various hepatocytic nodular lesions detected during the imaging diagnosis of cirrhotic liver and to get our own data about hepatocellular carcinoma based on Korean patients. MATERIALS AND METHODS: We retrospectively reviewed 40 confirmed hepatocellular carcinomas foilwed up with CT more than once without any treatment. Total numbers of follow-up were 50. First, we input the data of initial and follow-up diameter visible on CT images and follow-up interval of each mass to the computer, and got the mean growth rate curve and growth curve of hepatocelluiar carcinoma using a program of Quattro-pro, one of the spreadsheet. And then the doubling time was also calculated using Schwarz's formula. RESULTS: According to the growth rate curve, the tumor under 3 cm in diameter showed relatively show growing pattern but the one above 3 cm in diameter showed rapid growing pattern. Mean growth curve also showed rapid turning point around 3 cm. Overall mean doubling time was 82 days(mean +/- SD = 82.3 +/- 56.2): 119 days in the tumors smaller than 30 mm in diameter, 69 days larger than 30 mm in diameter. CONCLUSION: Hepatocellular carcinoma'is relatively slowly growing tumor and shows rapid increase of its growth rate when it is larger than 30 mm in diameter as a turning point. We think that this fact could make an important role to determine the treatment policy of various hepatocytic nodular lesions suspecting hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Diagnosis ; Follow-Up Studies* ; Humans ; Liver ; Retrospective Studies

To evaluate the correlation between the internal echo patterns and henodynamics in hepatic cavernous hemangioma, we compared the interanal echo pattern with the hemodynamic pattern examined by intravenous bolus CT(multi-phase incremental bolus dynamic CT) in 34 diagnosed hemangiomas (25 patients). We classified cavernous hemangiomas as two different hemodynamic patterns according to the findings of the early phase of intravenous bolus CT scans. Early enhancing type means that most portion of a mass is enhanced during the early hpase and late enhancing type means that only minimal peripheral portion of a mass is enhanced during the early phase. We classified ultrasonogrphic patterns as hypoechoic and hyperechoic according to main echogenicity of the mass. The late enhancing type tends toward the high echo type (20/21) and the early enhancing type tends to ward the low echo type (11/13) (p<0.01) Therefore, we believe that the early enhancing type which represents rapid contrast inflow toward mass, contains large portions of cavernous space and showes hypoechoic, but late enhancing type which represents late contrast inflow toward a mass, contains large portions of fibrous space and showes hyperechoic. In conclusion, there was significant correlation between internal hemodynamics and echo patterns in hepatic cavernous hemangioma.
Hemangioma ; Hemangioma, Cavernous* ; Hemodynamics* ; Tomography, X-Ray Computed

To evaluate the correlation between the internal echo patterns and henodynamics in hepatic cavernous hemangioma, we compared the interanal echo pattern with the hemodynamic pattern examined by intravenous bolus CT(multi-phase incremental bolus dynamic CT) in 34 diagnosed hemangiomas (25 patients). We classified cavernous hemangiomas as two different hemodynamic patterns according to the findings of the early phase of intravenous bolus CT scans. Early enhancing type means that most portion of a mass is enhanced during the early hpase and late enhancing type means that only minimal peripheral portion of a mass is enhanced during the early phase. We classified ultrasonogrphic patterns as hypoechoic and hyperechoic according to main echogenicity of the mass. The late enhancing type tends toward the high echo type (20/21) and the early enhancing type tends to ward the low echo type (11/13) (p<0.01) Therefore, we believe that the early enhancing type which represents rapid contrast inflow toward mass, contains large portions of cavernous space and showes hypoechoic, but late enhancing type which represents late contrast inflow toward a mass, contains large portions of fibrous space and showes hyperechoic. In conclusion, there was significant correlation between internal hemodynamics and echo patterns in hepatic cavernous hemangioma.
Hemangioma ; Hemangioma, Cavernous* ; Hemodynamics* ; Tomography, X-Ray Computed

Gall bladder wall varices are unusual manifestations of protal hypertention. Authors report 4 cases of gall bladder wall varices which were easily detected in IV bolus CT. All of our cases showed main portal vein obstruction but preserved intrahepatic portal flows with development of cavernous transformation. We could easily identify tortous and tubular structures with strong contrast enhancement in the gall bladder wall, compatible with gall bladder wall varices, at the early phase of IV bolus CT. Comparing with Doppler sonography, IV bolus CT is an easy and useful method for detection of gall bladder wall varices even in case of no prior information for portal vein abnormality.
Diagnosis* ; Methods ; Portal Vein ; Urinary Bladder* ; Varicose Veins