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ABSTRACT: To evaluate the application of contrast-enhanced ultrasonography (CEUS) in diagnosis of inflammatory pseudotumor of liver (IPL).
The contrast-enhanced untrasonography was performed in 32 cases of IPL and the results were retrospectively analyzed.
Among total 32 cases, 21 had absent contrast enhancement (type I); 6 had rimlike or stringlike enhancement during arterial phase and presented hypoechoic lesions during the late phase (type II); 2 had diffuse and homogeneous enhancement during early arterial phase,persisting hyperechoic during the late phase (type III); 3 had enhancement during arterial phases and washed out more quickly than liver parenchymal (type IV).
The perfusion pattern of IPL with CEUS varies, the predominant type is no contrast enhancement; type IV may be confused with atypical hepatic carcinoma, in that case the needle biopsy is necessary.
Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences 11/2010; 39(6):634-7.
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ABSTRACT: We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis (PVT) in patients who had liver tumors.
Seventeen consecutive patients who had cirrhosis, liver tumors, and PVT were prospectively studied with CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of thrombus enhancement on CEUS were considered diagnostic for malignant or benign PVT. Five patients also underwent percutaneous portal vein fine-needle biopsy under US guidance. All patients were followed-up. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas the enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy.
Follow-up showed signs of malignant thrombosis in 14 of 17 patients. CEUS showed early arterial enhancement of the PVT in 14 patients of 14 malignant PVT, 1 patient of 3 benign PVT and the absence of thrombus enhancement in 2 patients of 3 benign PVT. FNB confirmed the results for malignant PVT in four of five patients, for benign granulomatous inflammation PVT in one of five patients in which CEUS showed early arterial enhancement of the PVT. The sensitivity, specificity and accuracy is 100%, 66.7% and 93.3% at diagnosis of malignant PVT using CEUS. In one patient with intrahepatic bile duct stone, CEUS were positive for malignant PVT, whereas FNB was negative (benign granulomatous inflammation PVT); follow-up examination confirmed benign PVT.
CEUS seems to be the pretty sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis and tumors.
European journal of radiology 06/2009; 75(2):185-8. · 2.65 Impact Factor
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ABSTRACT: Arterioportal fistula (APF) is a rare cause of portal hypertension and may lead to death. APF can be congenital, post-traumatic, iatrogenic (transhepatic intervention or biopsy) or related to ruptured hepatic artery aneurysms. Congenital APF is a rare condition even in children. In this case report, we describe a 73-year-old woman diagnosed as APF by ultrasonography, computed tomography, and hepatic artery selective arteriography. The fistula was embolized twice but failed, and she still suffered from alimentary tract hemorrhage. Then, selective arteriography of the hepatic artery was performed again and venae coronaria ventriculi and short gastric vein were embolized. During the 2-year follow-up, the patient remained asymptomatic. We therefore argue that embolization of venae coronaria ventriculi and short gastric vein may be an effective treatment modality for intrahepatic APF with severe upper gastrointestinal bleeding.
World Journal of Gastroenterology 05/2009; 15(13):1656-9. · 2.47 Impact Factor
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ABSTRACT: Hepatic angiomyolipoma (HAML) is a rare tumor containing a variable amount of fat, vessels and smooth muscle. We report the image findings on ultrasonography and computed tomography (CT) of huge HAML.
The clinical, imaging and pathological data of a case of HAML were retrospectively collected and analyzed.
A huge heterogeneous hyperecho mass with anecho and hypoecho areas inside was found in the left hepatic lobe on ultrasonography. Color Doppler showed blood flow and arterial spectrum in it. CT scan showed a huge heterogeneous solid mass in the left lobe of the liver, with a low density and hypervascular area in arterial phase. The serum tumor marks were all negative. Ultrasound-guided biopsy was taken twice before resection and both showed necrosis tissue and reaction of inflammatory cells. Postoperative pathological results showed that the tumor was composed of epithelioid smooth muscle cells, thick-walled blood vessels and a few adipose cells with necrosis. The immunohistochemistry results showed appearance of typical HAML, with HMB-45 positive and alpha fetoprotein (AFP) negative.
Preoperative diagnosis of HAML relies on combination of CT, MRI and ultrasonography. Our case of HAML showed heterogeneous hyperecho image on ultrasonography. Ultrasound-guided biopsy combined with morphological manifestation and specimen examination for HMB-45 may be helpful in the diagnosis of HAML.
Hepatobiliary & pancreatic diseases international: HBPD INT 03/2005; 4(1):152-5. · 1.08 Impact Factor
