A patient with multiple-organ echinococcosis suffered from liver echinococcosis,lung echinococcosis,and pelvic echinococcosis successively in the past three decades.From the first operation at 19 years-old,she underwent operations several times due to the recurrence of multiple organ involvement.Echinococcosis is a zoonotic disease.Although the liver usually is the primary site,the disease can also invade many other organs.Diagnosis is typically based on disease history and imaging findings.Thorough removal of the lesions during the first operation is particularly important.Comprehensive evaluations and multi-disciplinary team are helpful in the treatment of patients with multiple organ invasion.
Adult ; Diagnostic Imaging ; Echinococcosis/surgery* ; Female ; Humans ; Liver/parasitology* ; Lung/parasitology* ; Pelvis/physiopathology* ; Young Adult

Objective To explore the ability of texture analysis of gadoxetic acid-enhanced magnetic resonance imaging (MRI) T1 mapping images, as well as T1-weighted (T1W), T2-weighted (T2W) and apparent diffusion coefficient (ADC) maps for distinguishing between varying degrees of hepatic fibrosis in an experimental rat model.Methods Liver fibrosis in rats was induced by carbon tetrachloride intraperitoneal injection for 4-12 weeks (n=30). In the control group (n=10) normal saline was applied. The MRI protocol contained T2W, diffusion weighted imaging, pre-and post-contrast image series of T1W and T1 mapping images. METAVIR score was used to grade liver fibrosis as normal (F0), mild fibrosis (F1-2), and advanced fibrosis (F3-4). Texture parameters including mean gray-level intensity (Mean), standard deviation (SD), Entropy, mean of positive pixels (MPP), Skewness, and Kurtosis were obtained. Nonparametric Mann-Whitney U test was used to compare the average value of each texture parameter in each sequence for assessing the difference between F0 and F≥1 as well as F0-2 and F3-4. Receiver operating characteristic (ROC) curves were obtained to assess the diagnosing accuracy of the parameters for differentiating no liver fibrosis from liver fibrosis and rats with liver fibrosis grading F0-2 from those with grading F3-4. The area under ROC curve (AUC) was calculated to evaluate the diagnostic efficiency of texture parameters.Results Finally, 20 rats completed MR T1 mapping image scan. The pathologic staging of these 20 rats was no fibrosis (F0, n=6), mild fibrosis (F1-2, n=5) and advanced fibrosis (F3-4, n=9). On pre-contrast T1 mapping image, Entropy was seen to be statistically significant higher in the F≥1 group than that in the F0 group at each spatial scaling factor (SSF) setting (P=0.015, 0.015, 0.015, 0.013, 0.015 and 0.018 respectively to SSF=0, 2, 3, 4, 5, 6), and Mean of the F≥1 rats was statistically significant higher than that of the F0 rats at SSF 4, 5, 6 (P=0.004, 0.006, and 0.013, respectively). Entropy and Mean showed a moderate diagnostic performance in most SSF settings of T1 mapping pre-contrast images for differentiation of normal liver from liver fibrosis.Conclusions Certain texture features of gadoxetic acid-enhanced MR images, especially the Entropy of non-contrast T1 mapping image, was found to be a useful biomarker for the diagnosis of liver fibrosis.
Animals ; Contrast Media ; pharmacology ; Diffusion Magnetic Resonance Imaging ; Disease Models, Animal ; Gadolinium DTPA ; pharmacology ; Liver Cirrhosis ; diagnostic imaging ; physiopathology ; Male ; Rats ; Rats, Sprague-Dawley

According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.
Disease Progression ; Elasticity Imaging Techniques/instrumentation/*methods ; Fatty Liver/complications/diagnostic imaging ; Humans ; Hypertension, Portal/complications ; Liver/*diagnostic imaging/physiopathology ; Liver Cirrhosis/diagnostic imaging/pathology

This study was aimed to investigate the imaging features of collateral circulation in Budd-Chiari syndrome (BCS) and hepatitis B related liver cirrhosis (LC) with multi-detector computed tomography (MDCT), and to discuss the value of MDCT in differential diagnosis of Budd-Chiari syndrome and hepatitis B related LC. Sixty cases of LC confirmed by medical history and laboratory examination and 15 cases of BCS proven by histopathology or ultrasonography were recruited in the present study. Morphological changes and anatomic characteristics were assessed with three dimensional (3D) vascular reconstruction of MDCT in all 75 cases. There were significantly more subjects with caudate lobe enlargement in BCS (11 cases, 73%) than in LC (5 cases, 8%). In BCS group, extrahepatic collateral circulation of ascending lumbar and azygous collateral pathways were found in 9 cases and epigastric varicose veins in 8 cases. Intrahepatic venous collaterals were documented in 12 cases combined with ascending lumbar and azygous vein collaterals in 9 cases and retroperitoneal varicose vein plexus in 6 cases. These intra- and extra-hepatic venous collaterals were not dectected in patients with LC. Morphological changes of the caudate lobe and the enhanced pattern of liver parenchyma were significantly different between patients with BCS and LC. Thus, it could be well concluded that contrast-enhanced CT scan and 3D CT angiography are very useful in differential diagnosis of BCS and LC.
Adult ; Angiography ; methods ; Budd-Chiari Syndrome ; diagnostic imaging ; physiopathology ; Collateral Circulation ; physiology ; Diagnosis, Differential ; Female ; Hepatic Veins ; diagnostic imaging ; Hepatitis B ; complications ; Humans ; Liver Cirrhosis ; diagnostic imaging ; physiopathology ; virology ; Male ; Middle Aged ; Multidetector Computed Tomography ; methods ; Young Adult

OBJECTIVETo investigate the value of liver stiffness measured by acoustic radiation force impulse imaging(ARFI) in assessing hepatic functional reserve in patients with space-occupying lesions in the liver.

METHODSSixty-three patients with space-occupying lesions in the liver were enrolled. Liver stiffness (LS) measurements with ARFI and indocyanine green(ICG) retention test were performed in the same day, and plasma clearance rate of indocyanine green(ICG-K), ICG retention at 15 minutes(ICGR15) as well as 10 effective values of LS were recorded. The correlation between Child-Pugh score, ICGR15, ICG-K, and LS were evaluated.

RESULTSThe LS measurements with ARFI failed in one patient. A strong correlation between LS and ICGR15(r=0.789, P<0.01) and an inverse correlation between LS and ICG-K(r=-0.738, P<0.01) were observed. Besides, there was a significant correlation between LS measurements and Child-Pugh score(r=0.929, P<0.01) . The LS significantly differed among patients with Child-Pugh class A, B, and C(P<0.01) .

CONCLUSIONARFI is a simple, feasible and non-invasive method for assessing hepatic functional reserve in patients with space-occupying lesions in the liver.

Adult ; Aged ; Elasticity Imaging Techniques ; Female ; Humans ; Liver ; diagnostic imaging ; pathology ; physiopathology ; Liver Function Tests ; Liver Neoplasms ; diagnostic imaging ; physiopathology ; Male ; Middle Aged

A 58-year-old Chinese woman presented with deranged liver function tests, which was discovered incidentally during surveillance for statins therapy. Ultrasonography and computed tomography revealed a large lipoma originating from the greater omentum, which was treated with surgical resection. This case is reported due to the rare occurrence of omental lipomas.
Abdomen ; diagnostic imaging ; pathology ; Female ; Humans ; Lipoma ; diagnosis ; surgery ; Liver ; physiopathology ; Liver Function Tests ; Middle Aged ; Omentum ; pathology ; surgery ; Peritoneal Neoplasms ; diagnosis ; surgery ; Radiography, Abdominal ; methods ; Treatment Outcome ; Ultrasonography

BACKGROUNDBoth non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) are closely associated with many metabolic disorders. Invasive coronary angiography (CAG) is a common approach as an intervention for CAD. However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.

METHODSTotally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled. Abdominal computed tomography (CT) was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score (Gensini score). Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P < 0.05 was considered statistically significant.

RESULTSOf 542 patients studied, 248 (45.8%) were found to have NAFLD by abdominal CT, and 382 patients (88%) were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG (odds ratio (OR), 95% confidence interval (CI): 7.585 (4.617-12.461); P < 0.001). NAFLD was significantly more common in patients as CAD severity increased (P < 0.001).

CONCLUSIONSThe presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

Aged ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Fatty Liver ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease

INTRODUCTIONThe 2005 American Association for Study of Liver Diseases (AASLD) diagnostic criteria allow non-invasive diagnosis of hepatocellular carcinoma (HCC) based on their enhancement pattern but we have observed a high incidence of atypical enhancement characteristics in HCC associated with portal vein thrombosis. This study seeks to examine the radiological features of this particular subgroup.

MATERIALS AND METHODSPatients with HCC and portal vein thrombosis who underwent pre-treatment multiphasic CT imaging were drawn from a surgical database. The arterial, portal venous and delayed phase images were assessed qualitatively and quantitatively (with region of interest [ROI] analysis) for lesion hypervascularity and washout. The background enhancement of the left and right lobes of the liver was also quantifi ed by ROI analysis.

RESULTSTwenty-fi ve lesions in 25 patients were selected for analysis. Qualitative analysis showed that 10/25 (40%) lesions demonstrated arterial hypervascularity while 16/25 (64%) lesions showed washout. Ten out of 25 (40%) lesions demonstrated both arterial hypervascularity and washout. Quantitative analysis showed that the average absolute lesion enhancement from precontrast to arterial phases was 49.1 (± 17.1) HU for hypervascular lesions compared to 23.8 (± 16.6) HU for non-hypervascular lesions (P <0.01). The mean absolute enhancement of the background liver parenchyma in the arterial phase was 13.79 (± 7.9) HU for hypervascular lesions compared to 36.6 (± 30.6) HU for non-hypervascular lesions (P = 0.03).

CONCLUSIONA large proportion of HCC with portal vein thrombosis lack characteristic arterial hypervascularity, which may be secondary to compensatory increased arterial supply to the background liver. This is a potential pitfall when applying imaging criteria for diagnosis of HCC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Pattern Recognition, Automated ; Portal Vein ; diagnostic imaging ; physiopathology ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Venous Thrombosis ; diagnostic imaging ; etiology

This study sought to determine the value of portal venography with 64-slice MDCT in the evaluation of compensatory circulation resulting from decompensated posthepatitic cirrhosis (PHC), and in the clarification of its anatomic distribution. Thirty-six patients with clinically confirmed compensatory circulations resulting from PHC were enrolled in this study. They underwent thoracicoabdominal triphasic enhancement CT scans with 64-slice MDCT. The data of the portal venous phase acquired were used for obtaining CT-MIP (maximum intensity projection) images of portosystematic collaterals such as gastric fundic and esophageal varices, paraumbilical veins, spleno-renal shunts, and their inflowing and outflowing vessels. On CT-MIP portography, gastric fundic varices were shown in 35 cases (97%) and esophageal varices in 30 cases (83%). The left gastric vein was the common inflowing vessel of the varices in 34 cases (94%); it was mainly originated from splenic vein in 24 cases (67%). With regard to the outflowing vessels, they were commonly azygos vein in 30 cases (83%). As for paraumbilical veins in 7 cases (19%), the inflowing vessel was the left branch of portal vein, and the outflowing vesse was the superficial epigastric vein. Cavernous transformation of the portal vein was seen in 5 cases (14%) and cavernous transformation of splenic vein was seen in 16 cases (44%). CT-MIP venography with 64-row MDCT could be considered as an effective and noninvasive method for detecting the compensatory circulation resulting from decompensated PHC.
Adult ; Aged ; Aged, 80 and over ; Collateral Circulation ; Esophageal and Gastric Varices ; diagnostic imaging ; epidemiology ; Female ; Hepatitis B ; complications ; Humans ; Liver Cirrhosis ; diagnostic imaging ; etiology ; physiopathology ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; pathology ; Portography ; methods ; Tomography, Spiral Computed ; methods

Diagnosis, Differential ; Diagnostic Errors ; Diaphragm ; diagnostic imaging ; physiopathology ; Echinococcosis, Hepatic ; diagnosis ; pathology ; surgery ; Female ; Hernia, Diaphragmatic ; diagnosis ; diagnostic imaging ; Humans ; Liver ; parasitology ; pathology ; surgery ; Tomography, X-Ray Computed