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Liver magnetic resonance imaging: State of the art

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World Journal of Gastroenterology 2010年第13期16卷 1558-1559页

作者： Paul E Sijens department of radiology University Medical Center Groningen and University of Groningen

Magnetic resonance imaging (MRI) has now been used for about three decades to characterize the human liver in a non-invasive way, that is without the need of using ionizing radiation or removing tissue samples. During the past few years, technical progress has been considerable and novel applications of MRI have been implemented in the clinic. The beginning of a new decade offers an excellent opportunity for having fi ve experts to present their view on the current status of MRI (and magnetic resonance spectroscopy) in the study of perfusion, fat and iron contents, diffusion and the metabolism of diffuse liver diseases. This topic highlight series thus provides an update of current knowledge in the fi eld of liver MRI.

关键词： Liver Magnetic resonance imaging

Vascular invasion in pancreatic cancer:Imaging modalities,preoperative diagnosis and surgical management

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World Journal of Gastroenterology 2010年第7期16卷 818-831页

作者： Nicolas C Buchs Michael Chilcott Pierre-Alexandre Poletti Leo H Buhler Philippe Morel clinic for Visceral and Transplantation Surgery Department of SurgeryUniversity Hospitals of GenevaGeneva1211Switzerland department of radiology University Hospitals of GenevaGeneva1211Switzerland

Pancreatic cancer is associated with a poor prognosis,and surgical resection remains the only chance for curative *** the absence of metastatic disease,which would preclude resection,assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer.A frequent error is to misdiagnose an involved major ***,surgical exploration with pathological examination remains the"gold standard"in terms of evaluation of resectability,especially from the point of view of vascular ***,current imaging modalities have improved and allow detection of vascular invasion with more accuracy.A venous resection in pancreatic cancer is a feasible technique and relatively ***,a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular *** the discovery of an arterial invasion during the operation might require an aggressive management,discovery before the operation should be considered as a *** of vascular invasion remains one of the most important challenges in pancreatic *** aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.

关键词： Vascular invasion Cancer Pancreas Management

Giant pseudoaneurysm of the splenic artery within walled of pancreatic necrosis on the grounds of chronic pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 87-89页

作者： Milica Mitrovic Jovanovic Dusan Saponjski Aleksandra Djuric Stefanovic Aleksandra Jankovic Stefan Milosevic Katarina Stosic Djordje Knezevic Jelena Kovac department of Abdominal radiology Center for Radiology and MRIClinical Center of SerbiaBelgradeSerbia Faculty of Medicine University of BelgradeBelgradeSerbia clinic for Digestive Surgery–First Surgical clinic Clinical Center of SerbiaBelgradeSerbia

Chronic pancreatitis is a long-standing inflammation of the pancreas,characterized by progressive inflammatory and fibrotic changes,resulting in permanent structural damage of pancreatic parenchyma[1].Pancreatitis(chronic or acute)is the primary risk factor for pseudo-splenic artery aneurysms,along with pancreatic pseudocysts and *** the disease progresses,patients with chronic pancreatitis may develop complications due to exocrine and endocrine pancreatic functional loss,such as fat malabsorption with steatorrhea,glucose intolerance,and ultimately diabetes mellitus[1,2].Furthermore,severe pancreatic inflammation can cause weakening of vessel walls,with subsequent formation of arterial *** artery is the most commonly affected visceral artery[2,3].Liver cirrhosis,portal hypertension,liver transplantation,atherosclerosis,hypertension,pregnancy and multiparity are main risk factors for true splenic artery aneurysms[2].Rupture and intraperitoneal bleeding is the cause of death in 30%−50%of ***,prompt diagnosis and appropriate treatment are of great clinical importance[4,5].Herein,we present a case of a giant splenic artery pseudoaneurysm within a walled of necrosis involving pancreatic parenchyma,as a complication of long standing chronic pancreatitis.

关键词： pancreatitis aneurysm inflammation

Peripancreatic collections in acute pancreatitis: Correlation between computerized tomography and operative fi ndings

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World Journal of Gastroenterology 2010年第34期16卷 4291-4296页

作者： Santhi Swaroop Vege Joel G Fletcher Rupjyoti Talukdar Michael G Sarr Miles and Shirley Fiterman Center for Digestive Diseases Rochester MN 55905 United States department of radiology Mayo Clinic Rochester MN 55905 United States department of Surgery Mayo Clinic Rochester MN 55905 United States

AIM: To evaluate the ability of contrast-enhanced computerized tomography (CECT) to characterize the nature of peripancreatic ***: Twenty five patients with peripancreatic collections on CECT and who underwent operative intervention for severe acute pancreatitis were retrospectively studied. The collections were classified into (1) necrosis without frank pus; (2) necrosis with pus; and (3) fluid without necrosis. A blinded radiologist assessed the preoperative CTs of each patient for necrosis and peripancreatic fluid collections. Peripancreatic collections were described in terms of volume, location, number, heterogeneity, fluid attenuation, wall perceptibility, wall enhancement, presence of extraluminal gas, and vascular ***: Fifty-four collections were identif ied at operation, of which 45 (83%) were identif ied on CECT. Of these, 25/26 (96%) had necrosis without pus, 16/19 (84%) had necrosis with pus, and 4/9 (44%) had fluid without necrosis. Among the study characteristics, fluid heterogeneity was seen in a greater proportion of collections in the group with necrosis and pus, compared to the other two groups (94% vs 48% and 25%, P = 0.002 and 0.003, respectively). Among the wall characteristics, irregularity was seen in a greater proportion of collections in the groups with necrosis with and without pus, when compared to the group with fluid without necrosis (88% and 71% vs 25%, P = 0.06 and P < 0.01, respectively). The combination of heterogeneity and presence of extraluminal gas had a specif icity and positive likelihood ratio of 92% and 5.9, respectively, in detecting pus. CONCLUSION: Most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue. CECT has a somewhat limited role in differentiating the different types of collections.

关键词： Contrastenhanced computerized tomogra-phy Correlation Pancreatic necrosis Pancreatitis Peripancreatic fluid collection Surgery

Comparative study of endoscopy *** intrahepatic portosystemic shunt in the management of gastric variceal bleeding

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Gastroenterology Report 2015年第1期3卷 75-82页

作者： Gursimran Singh Kochhar Udayakumar Navaneethan Jason Hartman Jose Mari Parungao Rocio Lopez Ranjan Gupta Baljendra Kapoor Paresh Mehta Madhu Sanaka department of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOHUSA Case Western School of Medicine ClevelandOHUSA department of Vascular and Interventional radiology Cleveland Clinic FoundationClevelandOHUSA

Background and Aim:Gastric varices are associated with high *** have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt(TIPS)is more effective in the treatment of gastric *** compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal ***:The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to *** compared to studied between the two treatment modalities were the short-term treatment outcomes,including re-bleeding within 30 days,length of hospital stay and in-hospital ***-Meier survival analysis was performed to assess factors associated with in-hospital ***:A total of 169 patients were included in the *** TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 *** was no evidence to suggest any significant differences in demographics or disease *** were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days(17.4%vs.17.2%;P=0.98),median length of stay in the hospital(4.5 days vs.6.0 days;P紏0.35)or in-hospital mortality(9.0%vs.11.1%;P=0.74).In-hospital mortality was evaluated for 149 patients and lower albumin(P=0.015),higher MELD score(P<0.001),higher CTP score(P=0.005)and bleeding(P=0.008)were all significantly associated with in-hospital ***:These findings suggest that both treatments are equally *** offers a safe,effective alternative to TIPS for gastric varices,and physician may choose the best therapy for each patient,factoring in the availability of TIPS or cyanoacrylate,the individual patient’s presentation,and cost.

关键词： transjugular intrahepatic portosystemic shunt(TIPS) cyanoacrylate injection gastric varices gastrointestinal bleeding

Impact of transjugular intrahepatic portosystemic shunt on post-colectomy complications in patients with ulcerative colitis and primary sclerosing cholangitis

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Gastroenterology Report 2015年第3期3卷 228-233页

作者： Gursimran Kochhar Udayakumar Navaneethan Jose Mari Parungao Jason Hartman Ranjan Gupta Rocio Lopez Arthur J McCullough Baljiendra Kapoor Bo Shen department of Gastroenterology and Hepatology The Cleveland ClinicClevelandOHUSA Case Western Reserve University School of Medicine ClevelandOHUSA department of Vascular and Interventional radiology The Cleveland ClinicClevelandOHUSA

Objective:Primary sclerosing cholangitis(PSC)occurs in approximately 5%of patients with ulcerative colitis(UC).The risk of colon cancer is higher in patients undergoing colectomy,who have simultaneous PSC&*** aim was to study the impact,in terms of post-colectomy survival and complications,of transjugular intrahepatic portosystemic shunt(TIPS)before colectomy in these ***:In this retrospective,case-control study,information was obtained on demographics,disease characteristics,TIPS characteristics,and post-colectomy *** patients with PSC and UC who underwent TIPS prior to colectomy(the Study group)and 37 patients with PSC and UC who underwent only colectomy without TIPS(the Control group)were *** an analysis of variance or the non-parametric Kruskal-Wallis test were used for continuous variables and Fisher’s Exact test or Pearson’s chi-squared test was used for categorical ***:There was no difference in themean age between the two groups;however patients in the Study group had lower platelet count(P=0.005)as well as higher Model for End-Stage Liver disease(MELD)scores(P<0.001).Also,patients in the Study group had increased PSC severity as determined by Mayo PSC Risk Scores(1.50 vs.0.20)(P=0.001).Total bilirubin levels were higher in the Study group(2.3 vs.0.8mg/dL)(P=0.011).Comparing the post-operative complication rates without adjusting for disease severity,the Study group hadmore wound infections(P=0.034),more wound dehiscence(P=0.022),and a higher re-admission rate within 30 days(P=0.032);however,the post-operativemortality was not significantly ***:Patients with PSC and UC who underwent TIPS prior to colectomy had higher rates of complications;however,this was probably due to the greater severity of cirrhosis and PSC in this population.

关键词： primary sclerosing cholangitis ulcerative colitis transjugular intrahepatic portosystemic shunt(TIPS) colectomy

Unmasking lower gastrointestinal bleeding under administration of norepinephrine

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World Journal of radiology 2022年第12期14卷 375-383页

作者： David John Werner Nicolai Wenzel Nael Abusalim Ralf Kiesslich Till Baar Achim Tresch Johannes Wilhelm Rey department of radiology Helios Dr.Horst-Schmidt-ClinicWiesbaden 65199HessenGermany Radiologie Rhein-Nahe Krankenhaus St.MarienwörthBad Kreuznach 55543Rheinland-PfalzGermany department of Diagnostic and Interventional radiology Medical Center HanauHanau 63450HessenGermany department of Internal Medicine II Helios Dr.Horst-Schmidt-ClinicWiesbaden 65199HessenGermany Institute for medical Statistics and Computational Biology Faculty of MedicineUniversity of CologneCologne 50923Nordrhein-WestfalenGermany department of Gastroenterology and Endoscopy Medical Center OsnabrueckOsnabrueck 49076NiedersachsenGermany

BACKGROUND Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal *** extravasation is a prerequisite for successful *** angiography is helpful in the detection of elusive *** We performed a retrospective analysis of angiographic treatment in patients with lower gastrointestinal hemorrhage and initially negative angiographies,as well as the role of norepinephrine(NE)in unmasking *** We analyzed 41 patients with lower gastrointestinal bleeding after angiography who had undergone treatment over a period of 10 *** patients had a positive shock index and needed intensive *** In three of four patients,angiography disclosed the site of bleeding when NE was used during the procedure for hemodynamic *** We suggest that angiography performed after the administration of NE in unstable patients with gastrointestinal bleeding and an initially negative angiography has the potential to unmask bleeding sites for successful ***,this statement must be confirmed in prospective studies.

关键词： Lower gastrointestinal bleeding Endoscopy Provocative angiography Norepinephrine radiology Gastrointestinal bleeding

Radiation segmentectomy for hepatic malignancies: Indications, devices,dosimetry, procedure, clinical outcomes, and toxicity of yttrium-90 microspheres

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Journal of Interventional Medicine 2019年第1期2卷 1-4页

作者： Zhongzhi Jia Caoye Wang Ricardo Paz-Fumagalli Weiping Wang department of Interventional radiology Second People’s Hospital of ChangzhouChangzhou213003China The Center of medical Physics with Nanjing medical University Changzhou213003China department of Interventional radiology First People's Hospital of ChangzhouChangzhou213000China department of radiology Mayo ClinicJacksonvilleFL32224USA

Radiation segmentectomy(RS) is a new approach to90 Y radioembolization that has been designed to increase the safety and efficacy of radioembolization in patients with unresectable hepatic malignancies. With this technique,high doses(>190 Gy) of radiation are delivered to the tumor through radioembolization performed in a segmental fashion, potentially increasing the radiation dose to the tumor while minimizing injury to the liver parenchyma. The aim of this review is to provide a summary of the indications, device choice, dosimetry, procedure, clinical outcomes, and toxicity of RS based on the clinical series currently available.

关键词： Hepatic malignancy Yttrium-90 Radioembolization Radiation segmentectomy

Quantification of liver fat deposition in obese and diabetic patients:A pilot study on the correlation with myocardium and periapical fat content

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Liver Research 2022年第2期6卷 103-110页

作者： Xi Chen Hui-Quan Wen Qing-Ling Li Li-Shan Shen Xiao-Wen Luo Bin Zhou Ruo-Mi Guo department of radiology The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina department of VIP medical Center The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina department of Cardiology The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina

Backgroud and aim:Non-alcoholic fatty liver disease(NAFLD)is a worldwide health problem,which associated with systemic health problems and causes a higher risk of all-cause *** leading causes of death in NAFLD patients are cardiac complications followed by NAFLD-related liver *** study aimed to quantitatively measure the contents of liver and cardiac fat with varying degrees of NAFLD in an obese group and a type 2 diabetes mellitus(T2DM)group to explore differences and *** and methods:This study included 170 patients who underwent echo asymmetry and least square estimation-iron quantification sequencing at 3.0 T magnetic resonance *** fraction values were quantitatively measured in regions of interest of the liver,myocardium,and periapical adipose ***:In both the obese and T2DM groups,cardiac fat content was correlated with liver fat content using linear regression(Pclinic.

关键词： Cardiac fat content Diabetes mellitus Obesity Non-alcoholic fatty liver disease(NAFLD) Type 2 diabetes mellitus(T2DM) Magnetic resonance imaging(MRI)