Ciliated hepatic foregut cyst (CHFC) is a rare benign lesion consisting of ciliated pseudostratified columnar epithelium, loose subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. We encountered a patient with retroperitoneal and posterior mediastinal neurilemmoma and additional CHFC mimicking metastasis. Abdominal CT examination demonstrated that the posterior mediastinal and retroperitoneal lesions were lobulated, well-defined tumors with a neural foraminal extension that were pathologically confirmed as neurilemmomas. Unenhanced CT indicated that the additional lesion was a slightly hypodense mass relative to surrounding parenchyma at the medial segment of the left lobe of the liver, and after the IV ad-ministration of contrast material, the lesion did not show enhancement.
Connective Tissue ; Epithelium ; Humans ; Liver ; Muscle, Smooth ; Neoplasm Metastasis* ; Neurilemmoma ; Tomography, X-Ray Computed

No abstract available.
Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Toes*

OBJECTIVE: To compare the performance of superparamagnetic iron oxide (SPIO) -enhanced magnetic resonance (MR) imaging at 1.5T and dual-phase spiral computed tomography (CT) for the depiction of small hypervascular hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Forty-three patients with 70 small nodular HCCs (5-20 mm; mean, 13.7 mm) were examined. Diagnosis was based on the results of surgical biopsy in 22 patients and by the combined assessment of MR imaging, lipiodol CT, alpha feto-protein levels, and angiographic findings in 21. MR imaging consisted of respiratory-triggered turbo spin-echo T2-weighted imaging, T1-weighted fast low-angle shot, and T2* -weighted fast imaging with steady-state precession imaging before and after SPIO enhancement. CT imaging was performed with 5-mm collimation and 1: 1.4 pitch, and began 30 and 65 secs after the injection of 150 mL of contrast medium at a rate of 3 mL/sec. Two blinded observers reviewed all images independently on a segment-by-segment basis. Diagnostic accuracy was evaluated using receiver operating characteristics (ROC) analysis. RESULT: The mean areas (Az) under the ROC curves were 0.85 for SPIOenhanced MR imaging and 0.79 for dual-phase spiral CT (p < .05). The mean sensitivity of SPIO-enhanced MR imaging was significantly higher than that of CT (p < .05), i.e. 70.6% for MR imaging and 58.1% for CT. MR imaging had higher false-positive rates than dual-phase spiral CT, but the difference was not statistically significant (3.7% vs 3.3%) (p > .05). CONCLUSION: SPIO-enhanced MR imaging is more sensitive than dual-phase spiral CT for the depiction of small hypervascular hepatocellular carcinomas.

No abstract available.
Lasers, Solid-State* ; Papilloma*

PURPOSE: To compare liver hemangioma with hepatocellular carcinoma (HCC), as seen on superparamagneticiron oxide (SPIO)-enhanced MR images. MATERIALS AND METHODS: The study involved 30 patients with 51 focal hepatic mass lesions (31 hemangiomas, 20 HCCs). Breath-hold T1-weighted fast low angle shot (FLASH) and respiratory-triggered T2-weighted turbo-spin echo (TSE) images were obtained at 1.5 T before and after intravenous administration of SPIO particles. For quantitative analysis, percentage signal intensity change (PSIC) and contrast-to-noise ratio (CNR) of the lesions were calculated for T1-weighted FLASH and T2-weighted TSE before and after intravenous administration of SPIO particles. In addition, lesion conspicuity and imaging artifacts were analyzed qualitatively. RESULTS: After SPIO administration, percentage signal intensity increase on T1-weighted FLASH images was 73.0 +/-22.1% for hemangiomas and 21.8 +/-12.6% for HCCs, the difference being significant (p < 0.05). Taking a signal increase of 40% on postcontrast T1-weighted FLASH as the cut-off value, sensitivity and specificity for hemangiomas were 96.8% and 100%, respectively. In addition, the percentages of signal intensity loss on T2-weighted TSE images for hemangiomas and HCCs were 35.5 +/-17.2% and 0.2 +/-10.5%, respectively (p < 0.05). A comparison of lesion to liver CNR before and after SPIO infusion showed readings-for hemangiomas and HCCs, respectively - of 15.4 +/-6.0 and 4.7 +/-4.4 on T1-weighted FLASH images, and -2.6 +/-0.7 and 2.7 +/-4.4 on T2-weighted TSE images (p < 0.05). Qualitative analysis indicated that the conspicuity of HCCs was noticeably greater on postcontrast T2-weighted TSE images than on precontrast images (p < 0.05). CONCLUSION: The positive enhancement seen on T1-weighted FLASH images and the negative enhancement on T2 weighted TSE observed in liver hemangiomas after the administration of SPIO particles are valuable diagnostic features that can help characterize hemangiomas and differentiate them from HCCs.
Administration, Intravenous ; Artifacts ; Carcinoma, Hepatocellular* ; Hemangioma* ; Humans ; Iron* ; Liver ; Magnetic Resonance Imaging* ; Sensitivity and Specificity

OBJECTIVE: To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients. MATERIALS AND METHODS: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method. RESULTS: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01). CONCLUSION: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis ; Contrast Media/*administration & dosage ; Female ; Gadolinium DTPA/*diagnostic use ; Humans ; Iron/*diagnostic use ; Liver Neoplasms/*diagnosis/secondary ; *Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Observer Variation ; Oxides/*diagnostic use ; Predictive Value of Tests ; Sensitivity and Specificity

PURPOSE: To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures. MATERIALS AND METHODS: In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases. CONCLUSION: Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Classification ; Depression ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Soft Tissue Injuries

PURPOSE: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. MATERIALS AND METHODS: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. RESULTS: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. CONCLUSIONS: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.
Acupuncture* ; Defecation ; Diet ; Drinking ; Flatulence ; Gastrectomy* ; Gastrointestinal Diseases ; Humans ; Ileus* ; Intestinal Pseudo-Obstruction ; Intestine, Small ; Length of Stay ; Outcome Assessment (Health Care) ; Prospective Studies ; Stomach Neoplasms*

BACKGROUND: The information on nasal transport and the metabolism of peptides have been obtained from pharmacokinetic investigations in experimental animals. However, there are no transport and metabolic studies of human nasal epithelial cells. In this study, the permeability characteristics and the metabolic properties of in vitro human nasal cell monolayers were investigated. Material and METHODS: Normal human inferior nasal conchal tissue samples were obtained from patients undergoing endoscopic nasal cavitary surgery. The specimens were cultured in a transwell using an air-liquid interface (ALI) culture, and the transepithelial electrical resistance (TEER) value of the blank filter and confluent cell monolayers were measured. To determine the % leakage of mannitol, 4µmol 14C-labelled mannitol was added and the % leakage was measured every 10 minute for 1 hour. RESULT: Human nasal epithelial cells in the primary culture grew to a confluent monolayer within 7 days and expressed microvilli. The tight junction between the cells was confirmed by transmission electron microscopy. The TEER value of the blank filter, fifth day and seventh day reached 108.5 ohm.cm2, 141 ohm.cm2 and 177.5 ohm.cm2, respectively. Transcellular % leakage of the 14C-mannitol at 10, 20, 30, 40, 50 and 60 minutes was 35.67±5.43, 34.42±5.60, 32.75±5.71, 31.76±4.22, 30.96±3.49 and 29.60±3.68 %, respectively. CONCLUSION: The human nasal epithelial monolayer using ALI using techniques is suitable for a transcellular permeability study. The data suggests that human nasal epithelial cells in as ALI culture technique shows some promise for a nasal transport and metabolism study.
Animals ; Culture Techniques* ; Electric Impedance ; Epithelial Cells* ; Humans* ; Mannitol ; Metabolism ; Microscopy, Electron, Transmission ; Microvilli ; Peptides ; Permeability ; Tight Junctions

PURPOSE: To compare the efficacy of breathhold and non-breathhold sequences in the detection of hepatocellular carcinoma (HCC) in cirrhotic patients using superparamagnetic iron oxide (SPIO)-enhanced MR imaging, and to determine the optimal sequence combination. MATERIALS AND METHODS: By means of unenhanced and iron-oxide-enhanced MRI, 29 patients with 49 nodular HCCs were evaluated for the presence of HCC nodules. Twenty-one were male and eight were female, and their ages ranged from 38 to 71 (mean, 56) years. Eight different MR sequences were used, including four non-breath-hold sequences and four breath-hold, and images were obtained before and after the administration of S-PIO particles. Non-breath-hold sequences included T2-, proton density-weighted SE, and TSE imaging, while breath-hold sequences comprised T1-weighted fast low-angle shot (T1wFLASH), half-Fourier acquisition single shot turbo spine echo (HASTE), T2-weighted fast imaging with steady-state free precession (T2*wFISP) and T2-weighted breath-hold TSE (T2wBHTSE). Image analysis involved both quantitative and qualitative analysis. The quantitative parameters calculated were signal-to-noise (S/N) ratios for livers and tumors, contrast to noise (C/N) ratios for tumors seen on precontrast and postcontrast images, and percentage of signal intensity loss (P-SIL) after SPIO injection. Images were analysed qualitatively in terms of image artifacts and lesion conspicuity, and prior to calculating sensitivity, the numbers of lesions detected using various pulse sequences were counted. RESULTS: SPIO had a marked effect on liver S/N ratio but a minimal effect on tumor S/N ratio. PSIL was best in T2*wFISP images, while T2wSE images showed the second-best results (p< 0.05). Tumor-to-liver C/N values were also highest with T2*wFISP, while T2wTSE and HASTE images were next. Qualitative study showed that non-breath hold images and FISP were better than breath hold images in terms of lesion conspicuity. The latter, however, were much better than non-breath-hold images with regard to image artifacts (p <0 . 0 5 ) . Sensitivity after the injection of contrast material increased in every image sequence except T1wFLASH, and,in particular, postcontrast FISP and T2wTSE showed the best results (p> 0.05). CONCLUSION: SPIO-enhanced MR imaging effectively detected hepatocellular carcinoma in cirrhotic livers. In terms of lesion detection and improvement of the lesion to liver C/N ratio, the FISP sequence was at least as good as non-breath-hold sequences, but if the T2 suppression effect of SPIO is to be obtained, other breath-hold sequences are not appropriate. To help lesion characterization, we suggest that T1w-FLASH and non-breath- hold T2w-TSE imaging are added to the optimal SPIO-enhanced MR imaging sequence.
Artifacts ; Carcinoma, Hepatocellular ; Female ; Humans ; Iron ; Liver ; Magnetic Resonance Imaging* ; Male ; Noise ; Protons ; Spine