Perihepatic capsulitis is associated with various diseases, such as Fitz-Hugh-Curtis syndrome, systemic lupus erythematosus, perforated cholecystitis, perforated hepatic abscess, and tuberculous peritonitis. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and is characterized by the widespread millet-like hematogenous dissemination of Mycobacterium tuberculosis. We describe a 24-year-old virgin patient presenting with right upper quadrant and costovertebral angle pain. Diffuse perihepatic capsular enhancement was observed in abdominal computed tomography scans. Chest radiography showed miliary tuberculosis, and a polymerase chain reaction hybridization assay of sputum revealed the presence of M. tuberculosis. Symptoms improved after administering anti-tuberculosis medications. This report describes a rare case of miliary tuberculosis accompanying perihepatitis.
Cholecystitis ; Humans ; Liver Abscess ; Lupus Erythematosus, Systemic ; Mycobacterium tuberculosis ; Peritonitis, Tuberculous ; Polymerase Chain Reaction ; Radiography ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Miliary ; Young Adult

Hepatocellular carcinoma is one of the most prevalent malignancies and frequent causes of death worldwide. Treatment options of hepatocellular carcinoma consist of locoregional therapy, surgical resection, liver transplantation, and systemic therapy. Assessment of tumor response is required in patients receiving locoregional and systemic therapy. The Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 is widely used tumor response evaluation criteria. However, the RECIST does not reflect the extent of tumor necrosis after some locoregional therapies and molecular targeted agents. The Modified RECIST (mRECIST), which has the concept of viable tumor, was introduced in order to overcome this problem. The mRECIST were developed on the basis of RECIST version 1.1 and only tumoral tissue showing contrast uptake in arterial phase of dynamic radiologic imaging techniques was measured to assess tumor response. Recently, immune checkpoint inhibitors have emerged as a promising therapeutic modality for the treatment of hepatocellular carcinoma. To identify tumor response after immunotherapy, immune RECIST (iRECIST) has been proposed as consensusbased criteria. After achieving complete response after curative treatment, optimal surveillance was needed to detect recurrence. Individualized surveillance schedule should be considered, taking into consideration the risk factors of the patient and the risk associated with the treatment modalities.
Appointments and Schedules ; Carcinoma, Hepatocellular ; Cause of Death ; Humans ; Immunotherapy ; Liver Transplantation ; Necrosis ; Prognosis ; Radiography ; Recurrence ; Response Evaluation Criteria in Solid Tumors ; Risk Factors

OBJECTIVE: To compare the apparent diffusion coefficient (ADC) values of upper abdominal organs with 2 different 3.0 tesla MR systems and to investigate the usefulness of normalization using the spleen. MATERIALS AND METHODS: Forty-one patients were enrolled in this prospective study, of which, 35 patients (M:F, 27:8; mean age ± standard deviation, 62.3 ± 12.3 years) were finally analyzed. In addition to the routine liver MR protocol, single-shot spin-echo echo-planar diffusion-weighted imaging using b values of 0, 50, 400, and 800 s/mm2 in 2 different MR systems was performed. ADC values of the liver, spleen, pancreas, kidney and liver lesion (if present) were measured and analyzed. ADC values of the spleen were used for normalization. The Pearson correlation, Spearman correlation, paired sample t test, Wilcoxon signed rank test and Bland-Altman method were used for statistical analysis. RESULTS: For all anatomical regions and liver lesions, both non-normalized and normalized ADC values from 2 different MR systems showed significant correlations (r = 0.5196-0.8488). Non-normalized ADC values of both MR systems differed significantly in all anatomical regions and liver lesions (p < 0.001). However, the normalized ADC of all anatomical regions and liver lesions did not differ significantly (p = 0.065-0.661), with significantly lower coefficient of variance than that of non-normalized ADC (p < 0.009). CONCLUSION: Normalization of the abdominal ADC values using the spleen as a reference organ reduces differences between different MR systems, and could facilitate consistent use of ADC as an imaging biomarker for multi-center or longitudinal studies.
Aged ; *Diffusion Magnetic Resonance Imaging ; Echo-Planar Imaging ; Female ; Humans ; Image Processing, Computer-Assisted ; Kidney/*radiography ; Liver/*radiography ; Male ; Middle Aged ; Pancreas/*radiography ; Prospective Studies ; Spleen/*radiography

Chilaiditi sign refers to the presence of bowel gas under the right diaphragm which is similar in appearance to a pneumoperitoneum on radiography, and is caused by abnormal anatomic positioning of the colon or small bowel between the liver and the diaphragm. When symptoms are present, this condition is known as Chilaiditi syndrome. The most common symptoms are gastrointestinal. It has been less commonly associated with chronic, recurrent respiratory distress. We report acute respiratory distress without gastrointestinal symptoms exacerbated by Chilaiditi syndrome in a pneumonia patient with no history of chronic respiratory disease.
Chilaiditi Syndrome* ; Colon ; Diaphragm ; Hernia, Diaphragmatic ; Humans ; Liver ; Pneumonia* ; Pneumoperitoneum ; Radiography

No abstract available.
Adult ; Diagnosis, Differential ; Female ; Humans ; Liver/pathology/radiography/ultrasonography ; Peliosis Hepatis/pathology/*radiography ; Tomography, X-Ray Computed

We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7x3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient.
Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging/pathology ; Hepatitis B/complications/diagnosis ; Humans ; Liver/diagnostic imaging/pathology ; Liver Cirrhosis/etiology ; Liver Neoplasms/*diagnosis/diagnostic imaging/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Necrosis ; Radiography ; Remission, Spontaneous ; Ultrasonography ; alpha-Fetoproteins/analysis

No abstract available.
Aged, 80 and over ; Amiodarone/*adverse effects ; Anti-Arrhythmia Agents/*adverse effects ; Atrial Fibrillation/diagnosis/*drug therapy ; Drug-Induced Liver Injury/*etiology/radiography ; Female ; Humans ; Liver/*drug effects/radiography ; Predictive Value of Tests ; *Tomography, X-Ray Computed

OBJECTIVE: To assess the lesion conspicuity and image quality in CT evaluation of small (< or = 3 cm) hepatocellular carcinomas (HCCs) using automatic tube voltage selection (ATVS) and automatic tube current modulation (ATCM) with or without iterative reconstruction. MATERIALS AND METHODS: One hundred and five patients with 123 HCC lesions were included. Fifty-seven patients were scanned using both ATVS and ATCM and images were reconstructed using either filtered back-projection (FBP) (group A1) or sinogram-affirmed iterative reconstruction (SAFIRE) (group A2). Forty-eight patients were imaged using only ATCM, with a fixed tube potential of 120 kVp and FBP reconstruction (group B). Quantitative parameters (image noise in Hounsfield unit and contrast-to-noise ratio of the aorta, the liver, and the hepatic tumors) and qualitative visual parameters (image noise, overall image quality, and lesion conspicuity as graded on a 5-point scale) were compared among the groups. RESULTS: Group A2 scanned with the automatically chosen 80 kVp and 100 kVp tube voltages ranked the best in lesion conspicuity and subjective and objective image quality (p values ranging from < 0.001 to 0.004) among the three groups, except for overall image quality between group A2 and group B (p = 0.022). Group A1 showed higher image noise (p = 0.005) but similar lesion conspicuity and overall image quality as compared with group B. The radiation dose in group A was 19% lower than that in group B (p = 0.022). CONCLUSION: CT scanning with combined use of ATVS and ATCM and image reconstruction with SAFIRE algorithm provides higher lesion conspicuity and better image quality for evaluating small hepatic HCCs with radiation dose reduction.
Adult ; Aged ; Aged, 80 and over ; Algorithms ; Carcinoma, Hepatocellular/*radiography ; Contrast Media ; Female ; Fluoroscopy ; Humans ; Image Enhancement/*methods ; Liver Neoplasms/*radiography ; Male ; Middle Aged ; Prospective Studies ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Tomography, X-Ray Computed/*methods ; Young Adult

Gadoxetate disodium is a widely used magnetic resonance (MR) contrast agent for liver MR imaging, and it provides both dynamic and hepatobiliary phase images. However, acquiring optimal arterial phase images at liver MR using gadoxetate disodium is more challenging than using conventional extracellular MR contrast agent because of the small volume administered, the gadolinium content of the agent, and the common occurrence of transient severe motion. In this article, we identify the challenges in obtaining high-quality arterial-phase images of gadoxetate disodium-enhanced liver MR imaging and present strategies for optimizing arterial-phase imaging based on the thorough review of recent research in this field.
Angiography ; Arteries/anatomy & histology ; Contrast Media/*chemistry ; Gadolinium DTPA/*chemistry ; Humans ; Liver/*radiography ; *Magnetic Resonance Imaging

OBJECTIVE: To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM). MATERIALS AND METHODS: Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups. RESULTS: Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a > or = 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001). CONCLUSION: Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.
Adult ; Aged ; Colorectal Neoplasms/mortality/*pathology ; Contrast Media/administration & dosage ; Ethiodized Oil/*administration & dosage ; Female ; Hepatic Artery/radiography ; Humans ; Liver Neoplasms/*drug therapy/mortality/*radiography/secondary ; Male ; Middle Aged ; Perfusion Imaging/*methods ; Prospective Studies ; Survival Rate ; Tomography, X-Ray Computed/methods