Clear cell hepatocellular carcinoma (CHCC) is defined as a tumor which contains more than 50% of clear cells. However, CHCC with more than 90% of clear cells are extremely rare. We report a case of a 65-year-old woman who was found to have a solitary mass, which was histologically diagnosed as clear cell hepatocellular carcinoma composed of 90% or more clear cells. The tumor presented rim arterial phase hyperenhancement in computed tomography, magnetic resonance imaging, and computed tomography during hepatic arteriography, and was classified as LR-M category according to The Liver Imaging Reporting and Data System version 2018(LI-RADS v2018). This tumor may mimic other tumors with similar radiographic features, such as intrahepatic cholangiocellular carcinoma and metastatic tumor.
Background: Dual-energy computed tomography (DECT) enables the direct measurement of iodine accumulation in the extracellular space. Objective: To compare measures of liver fibrosis and function with extracellular volume (ECV) from iodine/water images using DECT. Methods: Data was obtained from 119 consecutive patients who underwent abdominal DECT. A region of interest was set in the right lobe of the liver, pancreas, spleen, and aorta on iodine density images. ECV was calculated using the following formula: ECV = (1 hematocrit) × [iodine concentration in the liver (or pancreas, spleen) / iodine concentration in the aorta]. The severity of liver fibrosis was estimated using the aminotransferase/platelet ratio index (APRI) and the Fibrosis-4 (FIB-4) index. Liver function was assessed by the Child-Pugh classification and albumin-bilirubin (ALBI) grade. Data were analyzed by Spearman rank correlation coefficient, one-way analysis of variance, and post hoc analysis. Results: The correlation between ECV and fibrosis indices (APRI and FIB-4) was only significant and with a weak magnitude for the liver ECV quantification at the equilibrium phase (r=0.25 and r=0.20, respectively). The correlations between liver function index and ECV quantification were more robust than with fibrosis index. The highest correlations (r=0.50) were found between ALBI grade and liver ECV at the equilibrium phase. Liver ECV value at the equilibrium phase were significant difference between ALBI grade 1 vs. 2 and grade 1 vs. 3. Conclusion: Liver ECV quantification by DECT is more suitable for evaluating liver function than liver fibrosis severity.
Objectives:: To evaluate the differences in contrast enhancement of abdominal organ on abdominal dynamic MRI using 0.1 mmol/kg 1.0M gadobutrol (GAD) versus 0.5M meglumine gadoterate (MG) in patients having liver hemangioma. Materials and methods:: Phantom study was performed with different concentration (0.05, 0.1, 0.3, 0.5, 0.7, 0.9, 1.0, 5.0 and 10 mmol/L) of GAD and MG. Sixty-two patients with liver hemangioma were enrolled. Contrast media were injected a rate of 2mL/s and the 40mL of saline followed. Monitoring scan was used for acquiring arterial phase. Two arterial phases, portal and equilibrium phase were obtained. One certified radiologist set region of interests on abdominal aorta, liver, pancreas, spleen, liver hemangioma. The relative enhancement ratio (RER) was calculated. Results:: In phantom study, the signal intensity of both contrast media was similar in lower concentration, however, signal intensity of MG was higher in more than 5.0 mmol/L. In clinical study, the RER of abdominal viscera on portal and equilibrium phase were higher in GAD. Hemangioma showed higher on equilibrium phase in GAD. The aortic RER did not show significant difference in all phases and liver RER on 2nd arterial phase showed much higher in GAD. Arterial phase in GAD might have been late for optimal timing. Conclusions:: When same injection protocol used for abdominal dynamic MRI, arterial phase became late in case of using GAD. The higher T1 relaxivity value showed significant higher enhancement in abdominal viscera on portal phase and equilibrium phase and hemangioma showed also significant higher enhancement on equilibrium phase.
BACKGROUND Pancreatitis is a severe inflammatory pancreatic disease commonly due to bile duct stones or excessive alcohol usage, with clinical manifestations of abdominal pain, nausea, fever, and fluid collections. Healthy persons with less symptomatic pancreatitis are quite rare. Herein, we report a case of a patient with an undetermined onset of pancreatitis mimicking left arm cellulitis due to thrombotic vasculitis of the brachiocephalic vein. CASE SUMMARY A 50-year-old woman visited our hospital for tenderness in the left arm over several recent days. She was diagnosed with cellulitis on the left arm due to left elbow tenderness. Intravenous antibiotics administration did not improve symptoms and laboratory data worsened; thus, chest and abdominal computed tomography (CT) was performed. CT demonstrated pancreatitis with pseudocyst around the pancreas extending to the mediastinum. Thrombotic vasculitis of the brachiocephalic to left brachial vein was observed, which could be the cause of left elbow pain. A pancreatic fistula was found in the head of the pancreas by endoscopic retrograde cholangiopancreatography, so a pancreatic cyst drainage tube via the duodenum was placed in the pseudocyst. Cyst content culture was positive for Escherichia coli infection. Clinical symptoms, imaging findings, and inflammatory reactions resolved gradually after starting therapeutic intervention. The mediastinal pancreatic pseudocysts shrunk, and the venous thrombi remained but shrunk. CONCLUSION The case of a patient with pancreatitis with an undetermined onset that mimics left arm cellulitis is reported. Deep vein thrombosis should be kept in mind when treating patients with severe inflammatory disease.
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