OBJECTIVE: The reliability of size measurements of liver metastases from neuroendocrine tumors (NETs) on contrast-enhanced computed tomography (CT) phases made by different readers may be hampered due to transient, variable rim enhancement in arterial phase (AP) or portal venous phase (PVP) images. We aimed to assess the reliability of tumor size measurements in pre- and post-contrast scans. MATERIALS AND METHODS: The study coordinator selected target lesions according to Response Evaluation Criteria in Solid Tumors 1.1 guidelines in 44 consecutive patients with pathologically confirmed NET liver metastases. Two blinded readers measured the longest diameters of target lesions on pre-contrast, AP, and PVP images twice with a 4-week interval. Inter- and intra-observer agreements were evaluated using Bland-Altman plots and 95% limit of agreement (LOA) calculations. RESULTS: Of the 79 target lesions (approximate mean size of 3 cm), 45 showed rim enhancement. Inter-observer agreement assessed based on LOA was highest in pre-contrast CT images (−6.1–5.7 mm), followed by PVP (−7.9–7.1 mm) and AP (−8.5–7.4 mm) images. Intra-observer agreement showed the same trend: −2.8–2.9 mm and −2.9–2.9 mm for readers 1 and 2, respectively, on pre-contrast CT, −2.8–2.9 mm and −3.0–3.2 mm, respectively, on PVP, and −3.2–4.2 mm and −3.4–3.2 mm, respectively, on AP images. Mean tumor diameters differed significantly among the phases in the following increasing order: pre-contrast CT, PVP, and AP images. CONCLUSION: There was better inter- and intra-observer agreement in size measurements of NET liver metastases on precontrast scans than on AP and PVP scans. Pre-contrast CT may be the optimal for measuring NET liver metastases if its accuracy is proven.
Humans ; Liver* ; Loa ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Response Evaluation Criteria in Solid Tumors

BACKGROUND/AIMS: The prevalence of occult HBV infection (OBI) in patients with chronic hepatitis C (CHC) in Korea has not been reported. Additionally, it is unclear whether OBI influences treatment outcome in CHC patients. We investigated the prevalence of OBI and its impact on treatment outcome in patients with CHC. METHODS: Seventy-six patients with CHC were enrolled and treated with pegylated or conventional interferon and ribavirin. Hepatitis B virus (HBV) DNA was detected by nested polymerase chain reaction. RESULTS: Among the 68 patients who completed treatment and follow-up, HBV DNA was detected in serum from nine (13.2%) patients, liver tissue from 10 (14.7%), and serum or liver tissue from 15 (22.1%). OBI was diagnosed in nine (12.7%) control subjects. No difference in the prevalence of OBI between patients with CHC and controls was observed (13.2 vs. 12.0%; p = 0.92). No significant differences in age, sex, genotype 1 frequency, amount of hepatitis C virus RNA, anti-hepatitis B surface antigen/anti-hepatitis B core-IgG seropositivity, staging, or histology grading were observed in patients with or without HBV DNA. Sustained virological response was achieved in 73.3% of patients with OBI and 83.0% without OBI (p = 0.46). CONCLUSIONS: These results demonstrate that a significant proportion of patients with CHC have occult HBV infection and that OBI does not affect treatment outcome in patients with CHC.
DNA ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B virus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Liver ; Prevalence ; Ribavirin ; RNA ; Treatment Outcome

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

Extrahepatic metastasis of hepatocellular carcinoma (HCC) can be found in various organs, but metastasis to the female genital tract is extremely rare. A 48-year-old woman who had undergone curative left lobectomy for small HCC 4 years earlier was admitted because of sequential alpha-fetoprotein elevation. Upon abdominal MRI and hepatic angiography, no evidence of HCC recurrence was found in the remnant liver. However, a positron emission tomography CT scan showed a hypermetabolic lesion in the uterine fundus, which was revealed as metastatic HCC after total hysterectomy. This is, to our knowledge, the first documented case of metastatic uterine tumor that originated from HCC without intrahepatic recurrence.
alpha-Fetoproteins ; Angiography ; Carcinoma, Hepatocellular ; Female ; Humans ; Hysterectomy ; Liver ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Uterine Neoplasms

as useful as the conventional suction technique for the cytopathological evaluation of thyroid nodules.
Suction ; Thyroid Gland* ; Thyroid Nodule*

PURPOSE: To describe the US findings of corpus luteum cyst rupture in order to elucidate the associated clinical features. MATERIALS AND METHODS: Twenty patients with proven corpus luteum cyst rupture were included in this study. The US findings of these patients were retrospectively analyzed in terms of the presence of designable cyst, size of the cyst, thickness and blood flow of the cyst wall, extension and echogenicity of peritoneal fluid, and involved site (right or left ovary). We also surveyed the clinical features such as the onset period according to the menstrual cycle, and the presence of suspectable cause. RESULTS: Fourteen of the 20 patients revealed designable cysts (mean diameter of 2.6 cm) with thick walled cysts (mean thickness, 4.6 mm, 2.4 -6.8 mm) and increased blood flow. Six patients didn 't reveal any cyst but only hematoma in adnexa. All patients had hemoperitoneum in the pelvic cavity, and the hemoperitoneum was extended to Morrison's pouch in 8 patients and to the subphrenic space in 6. The cysts occurred in the right adnexa in 15 patients and in the left in 5. Mean interval from the last menstrual period (LMP) was 26 days (13-44 days) and 6 of the 8 patients for whom it had been possible to obtain detailed history taking had had coitus just before the occurrence of symptom. CONCLUSION: When women who are hospitalized for acute abdomen and who are in luteal phase reveal US findings of hematoma or thick-walled cyst in adnexa and hemoperitoneum, a corpus luteum cyst rupture is highly suspected. In our case study the corpus luteum cyst rupture predominantly occurred in the right side, and the most suspectable cause was trauma such as coitus in the luteal phase.
Abdomen, Acute ; Ascitic Fluid ; Coitus ; Corpus Luteum* ; Female ; Hematoma ; Hemoperitoneum ; Humans ; Luteal Phase ; Menstrual Cycle ; Ovarian Cysts* ; Retrospective Studies ; Rupture

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. Not only does XGC occasionally present as a mass formation with adjacent organ invasion like a malignant neoplasm, it can also infrequently be associated with gallbladder cancer. In the situation, it is difficult to make a differential diagnosis between the diseases. Here, we describe a case of a simultaneous XGC and a carcinoma of the gallbladder in a 61-year-old woman. To the best of our knowledge, there are only a small number of reports on this combination of diseases.
Adenocarcinoma/complications/diagnosis/*pathology/surgery ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis/complications/diagnosis/*pathology/surgery ; Endosonography ; Female ; Gallbladder Neoplasms/complications/diagnosis/*pathology/surgery ; Granuloma/complications/diagnosis/*pathology ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Staging ; Prognosis ; Risk Assessment ; Tomography, X-Ray Computed ; Xanthomatosis/complications/diagnosis/*pathology

Liver infarction and acrodermatitis enteropathica are rare complications of chronic pancreatitis. This report shows the case of a 56-year-old man who developed liver infarction due to portal vein thrombosis from chronic pancreatitis and acrodermatitis enteropathica during the course of his treatment. The rare combination of these complications in a patient with chronic pancreatitis has never previously been reported in the literature.
Acrodermatitis/*etiology/pathology/therapy ; Chronic Disease ; Human ; Infarction/*etiology ; Liver/*blood supply ; Male ; Middle Aged ; Pancreatitis/*complications ; Portal Vein ; Venous Thrombosis/complications/etiology ; Zinc/administration & dosage/deficiency

PURPOSE: Purpose: To compare the diagnostic accuracy of ferumoxides-enhanced MR with that of combined CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA) in the preoperative detection of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: For preoperative evaluation, 20 patients with HCC underwent ferumoxides-enhanced MR and combined CTAP and CTHA. The MR protocol included fat-suppressed respiratory-triggered fast spin echo, T2*-weighted fast multiplanar gradient-recalled acquisition in the steady state, proton density-weighted fast multiplanar spoiled gradient-recalled echo, and breath-hold in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo. In all patients, laparotomy was performed. The presence or absence of HCC was confirmed by pathologic examination in the resected liver and by intraoperative ultrasonography of remaining liver, or by follow up. Images were reviewed by three radiologists working independently; regarding the presence or absence of HCC in each segment, each observer assigned one of five confidence levels. A receiver operating characteristic (ROC) curve was fitted to these confidence ratings, and the diagnostic accuracy of each modality was evaluated by calculating the Az value (area under the ROC curve) and compared with that of other modalities. The sensitivity and specificity of each modality in the detection of HCC were also calculated and compared, and using a κstatistic, inter-observer agreement for each modality was assessed. RESULTS: In 28 of 160 liver segments, 30 HCCs were present. For ferumoxide-enhanced MR the mean Az value was 0.958, and for combined CTAP and CTHA this value was 0.948. The difference was not statistically significant. The mean sensitivities of ferumoxide-enhanced MR and combined CTAP and CTHA were 92.9% and 90.9%, respectively, the difference being statistically insignificant. The mean specificities of these modalities were, respectively, 98.9% and 93.6%. The difference was statistically significant. For both ferumoxide-enhanced MR and combined CTAP and CTHA, interobserver agreement was excellent. CONCLUSION: In the preoperative detection of HCC, ferumoxide-enhanced MR imaging of the liver showed a diagnostic accuracy similar to that of combined CTAP and CTHA. Its specificity, however, was higher.
Angiography* ; Carcinoma, Hepatocellular* ; Follow-Up Studies ; Humans ; Iron ; Laparotomy ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Portography* ; Protons ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: To evaluate the efficacy of two-phase dynamic helical CT, including the gastric mucosal phase, for the detection of atypical non-hyperattenuating early gastric carcinoma (EGC). MATERIALS AND METHODS: In 32 patients, we evaluated the two-phase helical CT findings of endoscopically suspected EGC for changes of the inner hyperattenuating mucosal layer, the hypoattenuating outer layer and the serosal surface. Two gastrointestinal radiologists working together reached their conclusions before pathologic diagnosis had been made. The first, so-called gastric mucosal, phase was obtained 38 -45 sec after the start of IV injection of 150 ml/sec contrast material at a rate of 4 ml/sec to obtain maximum enhancement of the mucosal layer. RESULTS: Among 32 patients, EGC was confirmed in 30 and AGC (T2) in two. Using two-phase helical CT, the detection rate for typical hyperattenuating EGC was 27 % (8/30). Lesions showing focal interruption of the mucosal layer without abnormal enhancement of the outer layer (EGC atypical enhancement pattern type 1) were detected in five patients during the mucosal phase, and were pathologically confirmed as 3 EGC IIc+III, 1IIc+IIa, and I IIb+IIc. Lesions showing a locally protuding lesion of the inner and preserved outer layers, with a smooth serosal surface (EGC atypical enhancement pattern type 2) and which could be distinguished from normal folds, were detected in six patients during the mucosal phase, and were pathologically confirmed as 2 EGC IIb+IIc, 1 IIc+IIa, and 3 IIc+IIb. Lesions were less distinct during the equilibrium phase, and there was no change in the enhancement pattern. The overall detection rate for EGC in which an atypical enhancement pattern was added to the typical one showed improvement (19/30, 63 % ). CONCLUSION: Helical CT using a two-phasic scan technique including the mucosal phase was efficient for various combinations of EGC II and/or III, including IIc. The findings were atypical and non-hyperattenvating, but reliable, and improved the overall detection rate.
Diagnosis ; Humans ; Stomach Neoplasms* ; Tomography, Spiral Computed*