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Sample records for single nodule hepatocellular

  1. Hypervascular hyperplastic nodules appearing in chronic alcoholic liver disease: benign intrahepatic nodules mimicking hepatocellular carcinoma

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    Park, Won Kyu; Chang, Jay Chun; Kim, Jae Woon

    2006-01-01

    Hypervascular hyperplastic nodules in those patients with chronic alcoholic liver disease and who are hepatitis B and C negative have recently been reported on. The purpose of this study was to correlate the radiologic and pathologic findings with the clinical significance of these hypervascular hyperplastic nodules in chronic alcoholic liver disease. The study included eight hypervascular nodules of seven patients with chronic alcoholic liver disease, and these patients abused alcohol for more than 20 years. Eight hypervascular nodules were seen on the arterial phase of dynamic CT scans, but the possibility of HCC was excluded pathologically (n=4) or clinically. The radiologic and pathologic findings, and the changes of these nodules on follow up CT scans were retrospectively analyzed. All nodules showed good enhancement on the arterial phase. The tissue equilibrium phase of the dynamic CT scans showed isodensity in seven patients and low density in one patient. Ultrasound scans revealed hypoechoic findings for three nodules, isoechoic findings for two nodules, hyperechoic findings for one nodules, and two nodules were not detected. Angiograms (n=6) showed late incremental tumor staining, and all the nodules were well seen on the sinusoidal phase. CT during hepatic angiography (n=4) showed well stained tumor. CT during arterial portography (n=4) showed no defect in three nodules and nodular defect in on nodule. The MR images (n=3) showed low signal intensity in two nodules and iso-signal intensity in one nodule on T2WI. Five of six cases for which follow up CT scans were performed showed decrease in size and one was disappeared. Radiologically, it is often difficult to differentiate the hypervascular hyperplastic nodules seen in the chronic alcoholic liver disease from hepatocellular carcinoma, and histological confirmation is needed for excluded hepatocellular carcinoma. However, late tumor staining during the sinusoidal phase without any blood supply by feeding

  2. Hypervascular hyperplastic nodules appearing in chronic alcoholic liver disease: benign intrahepatic nodules mimicking hepatocellular carcinoma

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    Park, Won Kyu; Chang, Jay Chun; Kim, Jae Woon [College of Medicine, Yeungnam University, Daegu (Korea, Republic of)] (and others)

    2006-02-15

    Hypervascular hyperplastic nodules in those patients with chronic alcoholic liver disease and who are hepatitis B and C negative have recently been reported on. The purpose of this study was to correlate the radiologic and pathologic findings with the clinical significance of these hypervascular hyperplastic nodules in chronic alcoholic liver disease. The study included eight hypervascular nodules of seven patients with chronic alcoholic liver disease, and these patients abused alcohol for more than 20 years. Eight hypervascular nodules were seen on the arterial phase of dynamic CT scans, but the possibility of HCC was excluded pathologically (n=4) or clinically. The radiologic and pathologic findings, and the changes of these nodules on follow up CT scans were retrospectively analyzed. All nodules showed good enhancement on the arterial phase. The tissue equilibrium phase of the dynamic CT scans showed isodensity in seven patients and low density in one patient. Ultrasound scans revealed hypoechoic findings for three nodules, isoechoic findings for two nodules, hyperechoic findings for one nodules, and two nodules were not detected. Angiograms (n=6) showed late incremental tumor staining, and all the nodules were well seen on the sinusoidal phase. CT during hepatic angiography (n=4) showed well stained tumor. CT during arterial portography (n=4) showed no defect in three nodules and nodular defect in on nodule. The MR images (n=3) showed low signal intensity in two nodules and iso-signal intensity in one nodule on T2WI. Five of six cases for which follow up CT scans were performed showed decrease in size and one was disappeared. Radiologically, it is often difficult to differentiate the hypervascular hyperplastic nodules seen in the chronic alcoholic liver disease from hepatocellular carcinoma, and histological confirmation is needed for excluded hepatocellular carcinoma. However, late tumor staining during the sinusoidal phase without any blood supply by feeding

  3. CT detection of daughter nodules in hepatocellular carcinoma after lipiodol infusion via the hepatic artery

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    Ohishi, Hajime; Ohgami, Syoichi; Katsuragi, Masami

    1985-02-01

    The detectability of daughter nodules in 80 hepatocellular carcinomas was compared between CT assisted by Lipiodol Ultra Fluid (Lipiodol) infused via the hepatic artery and IHA (Infusion hepatic angiography). Lipiodol infused via the hepatic artery was selectively accumulated in the tumor vessels and the tumors and small daughter nodules appeared as markedly high density areas by CT. 18 cases in which the daughter nodules were detected were identified only by CT. Furthermore, in 38 cases CT demonstrated superior detectability of the daughthr nodules than IHA. In 15 cases the daughter nodules were newly detected in areas other than the invaded area where the primary tumor existed. This method is very effective in the diagnosis of daughter nodules of hepatocellular carcinoma. (author).

  4. Hemodynamics of hepatocellular carcinoma with single-level dynamic computed tomography during hepatic arteriography

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    Tanihata, Hirohiko

    2002-01-01

    The purpose of this study is to verify the hemodynamics of hepatocellular carcinoma (HCC) and to explore the draining pathway using single-level dynamic computed tomography during hepatic arteriography (single-level dynamic CTHA). One hundred one patients with 131 nodules of HCC underwent single level dynamic CTHA. Forty seven nodules were diagnosed by histological specimen and the other eighty four nodules by clinical findings of elevation in AFP and/or PIVKA II and hypervascular tumor in angiography. Single-level dynamic CTHA was performed under insertion of a catheter into proper hepatic artery or the more peripheral hepatic artery with a slice thickness of 3 mm at the same level. Each image of single level dynamic CTHA was continuously taken in a second for 40 seconds during injection of contrast medium at of 2 ml/sec for 10 seconds. The images of single-level dynamic CTHA were differentiated into three phases, as early phase 1 to 10 seconds, middle phase 11 to 20 seconds and late phase 21 to 40 seconds. After the analysis of the vascular pattern in each phase, the hemodynamics of HCC was classified into three patterns; hypovascular pattern in the 24 nodules whose average size was 13.4±4.2 mm, intermediate pattern in the 21 nodules whose average size was 20.8±7.8 mm and hypervascular pattern in 86 nodules whose average size was 31.6±16.3 mm. There were significant correlations between the tumor size and the vascular pattern. In the groups of hypovascular and intermediate pattern, the draining pathways were sinusoids. Of the 86 nodules of the group with hypervascular pattern, blood flow drained into portal vein including bright branch structure in 20 nodules, into portal vein and hepatic vein in 2 nodules, into portal vein and extrahepatic vein in 1 nodule, into hepatic vein in 11 nodules, into extrahepatic vein in 4 nodules and into sinusoids in 48 nodules. In conclusion, from a viewpoint of hemodynamics using single-level dynamic CTHA, I proposed the new

  5. Treatment of hepatocellular carcinoma: A single-center experience

    International Nuclear Information System (INIS)

    Florio, Francesco; Nardella, Michele; Balzano, Silverio; Caturelli, Eugenio; Siena, Domenico; Cammisa, Mario

    1997-01-01

    Purpose. The comparative efficacy of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) was investigated. Methods. Two hundred and sixty consecutive patients were retrospectively analyzed: 156 had received between one and six chemoembolization sessions at 3-month intervals, 33 had had PEI, and the remaining 71 patients refused any treatment. The follow-up ranged from 3 to 36 months. Survival rates were statistically analyzed by life-table analysis. Results. Patients' survival was affected by the number of nodules and by the Child's and Okuda's classes; no relationship was found between survival rates and the histologic grade or vascular supply of the tumor. In the case of a single lesion of Okuda's class I, TACE was more effective than PEI. In multifocal HCC, TACE was better than no treatment in Okuda's class I and Child's class A. Conclusion. We suggest TACE as the treatment of choice in Child A or Okuda I patients with multifocal HCCs; it seems of little help in Child B-C or Okuda II-III patients

  6. CEUS: An essential component in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma

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    Jang, Hyun-Jung, E-mail: Hyun-Jung.jang@uhn.ca [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada); Kim, Tae Kyoung, E-mail: Taekyoung.Kim@uhn.ca [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada); Burns, Peter N, E-mail: burns@sri.utoronto.ca [Department of Imaging Research, University of Toronto, Sunnybrook Health Sciences centre, 2075 Bayview Avenue, Toronto ON M4 N 3M5 (Canada); Wilson, Stephanie R, E-mail: Stephanie.wilson@albertahealthservices.ca [Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2R 1M5 (Canada)

    2015-09-15

    Highlights: • CEUS resolves hypervascular pseudolesions, frequent on CT and MR, from vascular shunts. • US has the advantage of showing a baseline nodule for characterization. • CEUS shows excellent sensitivity to contrast agents, providing superior arterial phase sensitivity. • Real-time CEUS performance shows optimally perfusion patterns of benign tumor nodules. • CEUS performed at surveillance detection of nodules is efficient and effective. - Abstract: Contrast-enhanced ultrasound (CEUS) plays an essential role in the evaluation of small nodules in livers at high-risk for hepatocellular carcinoma (HCC) and offers unique advantages over CT/MRI. These include the sensitive depiction of arterial hypervascularity of HCC, better demonstration of rapid washout for non-HCC malignancy as well as of very late washout of HCC. Visualization of early vascular filling patterns for benign hypervascular lesions is of indisputable value. A frequently uncounted benefit of CEUS includes the value of its performance following nodule detection at ultrasound surveillance, including one-stop exclusion of typical benignancy, preclusion of arterial pseudolesions shown on CT/MR, and the avoidance of miscorrelation of a nodule on surveillance and subsequent diagnostic imaging. Therefore, CEUS can effectively be used in the diagnostic algorithm for new liver nodules detected during HCC surveillance. Despite the fact that CEUS is actively used as a major diagnostic test for HCC in Asia, Europe, and Canada with increasing demands in clinical practice, CEUS is not included in the diagnostic tests for HCC in some major practice guidelines. In this manuscript, we focus on small nodules in patients at high-risk for HCC, and review some of the unique advantages of CEUS that contribute to lesion characterization and subsequent patient management, showing why CEUS should be an essential component of the diagnostic algorithm for HCC.

  7. Fate of pulmonary nodules detected by computer-aided diagnosis and physician review on the computed tomography simulation images for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Park, Hyo Jung; Kim, Jin Sung; Park, Hee Chul; Oh, Dong Ryul

    2014-01-01

    To investigate the frequency and clinical significance of detected incidental lung nodules found on computed tomography (CT) simulation images for hepatocellular carcinoma (HCC) using computer-aided diagnosis (CAD) and a physician review. Sixty-seven treatment-naive HCC patients treated with transcatheter arterial chemoembolization and radiotherapy (RT) were included for the study. Portal phase of simulation CT images was used for CAD analysis and a physician review for lung nodule detection. For automated nodule detection, a commercially available CAD system was used. To assess the performance of lung nodule detection for lung metastasis, the sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Forty-six patients had incidental nodules detected by CAD with a total of 109 nodules. Only 20 (18.3%) nodules were considered to be significant nodules by a physician review. The number of significant nodules detected by both of CAD or a physician review was 24 in 9 patients. Lung metastases developed in 11 of 46 patients who had any type of nodule. The sensitivities were 58.3% and 100% based on patient number and on the number of nodules, respectively. The NPVs were 91.4% and 100%, respectively. And the PPVs were 77.8% and 91.7%, respectively. Incidental detection of metastatic nodules was not an uncommon event. From our study, CAD could be applied to CT simulation images allowing for an increase in detection of metastatic nodules.

  8. Variation of stemness markers expression in tumor nodules from synchronous multi-focal hepatocellular carcinoma - an immunohistochemical study.

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    Lo, Regina Cheuk-Lam; Leung, Carmen Oi-Ning; Chok, Kenneth Siu-Ho; Ng, Irene Oi-Lin

    2017-08-01

    Advancing knowledge in molecular pathogenesis of hepatocellular carcinoma (HCC) opens up new horizons in the diagnostic, prognostic and therapeutic perspectives. Assessing the expression of molecular targets prior to definitive treatment is gaining importance in clinical practice. In this study, we investigated the variation in expression pattern of stemness markers in synchronous multi-focal HCC. In the first cohort, 21 liver explants with multi-focal HCC were examined for expression of stemness markers EpCAM, Sox9 and CK19 by immunohistochemistry (IHC). Expression data of 50 tumor nodules were analyzed to determine the concordance of expression among nodules in the same livers. In the second cohort, 14 tumor nodules from 6 multi-focal HCC cases proven as intra-hepatic metastasis were examined for Soc9 immunoexpression. In the first cohort, thirty nodules from 16 cases expressed one or more markers, with Sox9 being most frequently expressed. Complete concordance of expression pattern for all 3 markers was observed in 6 cases. Discrepancy of staining degree was noted in 4 cases for EpCAM, 14 cases for Sox9, and 6 cases for CK19. A two-tier or three-tier difference in staining scores was noted in 5 cases for Sox9 and one case for CK19. With Sox9, identical tumor morphology in terms of Edmondson grading and growth pattern did not infer the same degree of immunoexpression; and the largest tumor nodule was not representative of highest IHC score. In the second cohort of intra-hepatic metastasis, complete concordance of Sox9 expression level was observed in 5 out of 6 cases; while the remaining case showed a 1-tier difference of positive staining. Our findings suggested that clonality of tumor nodules is apparently an important factor to infer immunoexpression pattern. When there is limited information to discern multiple primaries versus intra-hepatic metastasis in multi-focal HCC, discordant degree of stemness markers expression among tumor nodules was commonly

  9. New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm.

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    Renzulli, Matteo; Biselli, Maurizio; Brocchi, Stefano; Granito, Alessandro; Vasuri, Francesco; Tovoli, Francesco; Sessagesimi, Elisa; Piscaglia, Fabio; D'Errico, Antonietta; Bolondi, Luigi; Golfieri, Rita

    2018-02-03

    Many improvements have been made in diagnosing hepatocellular carcinoma (HCC), but the radiological hallmarks of HCC have remained the same for many years. We prospectively evaluated the imaging criteria of HCC, early HCC and high-grade dysplastic nodules (HGDNs) in patients under surveillance for chronic liver disease, using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MRI and diffusion-weighted imaging. Our study population included 420 nodules >1 cm in 228 patients. The MRI findings of each nodule were collected in all sequences/phases. The diagnosis of HCC was made according to the American Association for the Study of Liver Diseases (AASLD) criteria; all atypical nodules were diagnosed using histology. A classification and regression tree was developed using three MRI findings which were independently significant correlated variables for early HCC/HCC, and the best sequence of their application in a new diagnostic algorithm (hepatobiliary hypointensity, arterial hyperintensity and diffusion restriction) was suggested. This algorithm demonstrated, both in the entire study population and for nodules ≤2 cm, higher sensitivity (96% [95% CI 93.5% to 97.6%] and 96.6% [95% CI 93.9% to 98.5%], P<0.001, respectively) and slightly lower specificity (91.8% [95% CI 88.6% to 94.1%], P=0.063, and 92.7% [95% CI 88.9% to 95.4%], P=0.125, respectively) than those of the AASLD criteria. Our new diagnostic algorithm also showed a very high sensitivity (94.7%; 95% CI 92% to 96.6%) and specificity (99.3%; 95% CI 97.7% to 99.8%) in classifying HGDN. Our new diagnostic algorithm demonstrated significantly higher sensitivity and comparable specificity than those of the AASLD imaging criteria for HCC in patients with cirrhosis evaluated using Gd-EOB-DTPA MRI, even for lesions ≤2 cm. Moreover, this diagnostic algorithm allowed evaluating other lesions which could arise in a cirrhotic liver, such as early HCC and HGDN. © Article author

  10. IS RESECTION OF HEPATOCELLULAR CARCINOMA IN THE ERA OF LIVER TRANSPLANTATION WORTHWILE? A single center experience

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    Paulo HERMAN

    Full Text Available ABSTRACT Background - Liver resection for hepatocellular carcinoma is a potentially curative therapeutic procedure that can be performed readily after its indication, without the need of a long waiting time and lower costs when compared to liver transplantation, being a good alternative in patients with preserved/good liver function. Objective - Evaluate long-term results of liver resection from a high volume single center for selected patients with hepatocellular carcinoma in a context of a long waiting list for liver transplant. Methods - One hundred and one patients with hepatocellular carcinoma, with a mean age of 63.1 years, and preserved liver function were submitted to liver resection. Clinical and pathological data were evaluated as prognostic factors. Mean follow-up was 39.3 months. Results - All patients had a single nodule and 57 (58.2% patients were within the Milan criteria. The size of the nodule ranged from 1 to 24 cm in diameter. In 74 patients, liver resection was performed with the open approach and in 27 (26.7% was done laparoscopically. Postoperative morbidity was 55.3% being 75.5% of the complications classified as Dindo-Clavien I and II and operative mortality was 6.9%. Five-year overall and disease free survival rates were 49.9% and 40.7%, respectively.After a log-rank univariate analysis, the levels of preoperative alpha-fetoprotein (P=0.043, CA19-9 (P=0.028, capsule invasion (P=0.03, positive margin (R1-R2 (P=0.004 and Dindo-Claviens' morbidity classification IV (P=0.001 were the only parameters that had a significant negative impact on overall survival. On the odds-ratio evaluation, the only significant factors for survival were high levels of alpha-fetoprotein (P=0.037, and absence of free margins (P=0.008. Conclusion - Resection, for selected cases, is a potentially curative treatment with acceptable morbidity and mortality and, in a context of a long waiting list for transplant, plays an important role for the

  11. Evolution of nodule stiffness might predict response to local ablative therapy: A series of patients with hepatocellular carcinoma.

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    Michael Praktiknjo

    Full Text Available Early information on treatment response of HCC to local ablative therapy is crucial. Elastography as a non-invasive method has recently been shown to play a potential role in distinguishing between benign and malignant liver lesions. Elastography of hepatocellular carcinoma (HCC in early response to local ablative therapy has not been studied to date.We prospectively included a cohort of 14 patients with diagnosis of HCC who were treated with local ablative therapy (transarterial chemoembolization, TACE and/or radiofrequency ablation, RFA. We used 2D shear-wave elastography (RT 2D-SWE to examine stiffness of HCC lesion before and 3, 30 and 90 days after local ablative therapy. Contrast-enhanced imaging after 90 days was performed to evaluate treatment response. Primary endpoint was stiffness of HCC in response to local ablative therapy. Secondary end point was tumor recurrence.Stiffness of HCC nodules and liver showed no significant difference prior to local ablative therapy. As early as three days after treatment, stiffness of responding HCC was significantly higher compared to non-responding. Higher stiffness before treatment was significantly associated with tumor recurrence.Nodule stiffness in general and RT 2D-SWE in particular could provide a useful tool for early prediction of HCC response to local ablative therapy.

  12. Dynamic contrast enhanced MR imaging for evaluation of angiogenesis of hepatocellular nodules in liver cirrhosis in N-nitrosodiethylamine induced rat model

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    Zhang, Wei; Chen, Hui Juan; Huang, Wei; Zhang, Long Jiang [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Wang, Zhen J. [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

    2017-05-15

    To investigate whether dynamic contrast -enhanced MRI (DCE-MRI) can distinguish the type of liver nodules in a rat model with N-nitrosodiethylamine- induced cirrhosis. Liver nodules in cirrhosis were induced in 60 male Wistar rats via 0.01 % N-nitrosodiethylamine in the drinking water for 35-100 days. The nodules were divided into three groups: regenerative nodule (RN), dysplastic nodule (DN), and hepatocellular carcinoma (HCC). DCE-MRI was performed, and parameters including transfer constant (K{sup trans}), rate constant (K{sub ep}), extravascular extracellular space volume fraction (V{sub e}), and initial area under the contrast concentration versus time curve (iAUC) were measured and compared. The highest K{sup trans} and iAUC values were seen in HCC, followed by DN and RN (all P < 0.05). The area under the receiver operating characteristic curve (AUROC) for DN and HCC were 0.738 and 0.728 for K{sup trans} and iAUC, respectively. The AUROC for HCC were 0.850 and 0.840 for K{sup trans} and iAUC, respectively. Ordinal logistic regression analysis showed that K{sup trans} had a high goodness of fit (0.970, 95 % confidence interval, 13.751-24.958). DCE-MRI is a promising method to differentiate of liver nodules. Elevated K{sup trans} suggested that the nodules may be transformed into HCC. (orig.)

  13. Follow-up for hepatic nodules detected only by angio-CT in noncancerous regions of the liver with hepatocellular carcinoma

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    Shuto, Taichi; Mikami, Shinichi; Hirohashi, Kazuhiro; Kubo, Shoji; Tanaka, Hiromu; Yamamoto, Takatsugu; Nakamura, Kenji; Kinoshita, Hiroaki

    1998-01-01

    As of March 1997, we routinely performed angio-CT or computed tomography during arterial portography (CTAP) and computed tomography during arteriography (CTA) before hepatic resection in 103 cases of hepatocellular carcinoma. Nine cases (9%) had ten nodules those were detected only by angio-CT before surgery, but were not found by palpation and intraoperative ultrasonography during surgery. The mean diameter of these nodules was 1 cm in angio-CT. These were not detected by other imaging tests, such as conventional CT, ultrasonography, or angiography. None of these nodules were the main tumor. All were hyperattenuated nodules according to CTA findings. After hepatic resection for the main tumors, these patients were followed in our outpatient clinic. Five patients suffered recurrence as of March 1998. Two of these nodules (20%) were preexisting nodules that were not detected during surgery. Moreover, these were located near the center of the liver in these patients. We found that at least 20% of the nodules detected only by angio-CT are true-positives, especially when they are located at the center of the liver. (author)

  14. Prognosis of small hepatocellular nodules detected only at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging as hypointensity in cirrhosis or chronic hepatitis

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    Higaki, Atsushi; Ito, Katsuyoshi; Tamada, Tsutomu; Sone, Teruki; Kanki, Akihiko; Noda, Yasufumi; Yasokawa, Kazuya; Yamamoto, Akira [Kawasaki Medical School, Department of Radiology, Kurashiki City, Okayama (Japan)

    2014-10-15

    To evaluate the prognosis of ''strict'' high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis. The study included thirty-three patients with 60 ''strict'' high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization). Ten (16.7 %) of 60 ''strict'' high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 ± 4.5 mm/year) were significantly higher than those in group B (3.4 ± 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 ± 189.5 day) was significantly shorter than in group B (419 ± 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization. Subsets of ''strict'' high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization. (orig.)

  15. Subcentimeter hypervascular nodules with typical imaging findings of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: Outcomes of early treatment and watchful waiting

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    Woo, Jung Han; Song, Kyoung Doo; Kim, Seong Hyun [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, 81 Irwon-Ro, Gangnam-Gu, Seoul (Korea, Republic of)

    2017-10-15

    To compare treatment outcomes of subcentimeter hypervascular nodules at high risk for developing into hepatocellular carcinomas (SHNHR) between early treatment and watchful waiting until progression to overt hepatocellular carcinoma (HCC) groups. SHNHRs were defined as subcentimeter hypervascular nodules with the usual imaging features of HCC on gadoxetic acid-enhanced magnetic resonance imaging (MRI). Among 63 patients with 74 SHNHRs, 27 (37 SHNHRs) received early treatment (treatment of < 1 cm nodules), and 36 (37 SHNHRs) underwent watchful waiting until progression to overt HCC. Risk factor analysis was performed for recurrence-free and local recurrence-free survival. Among the 36 patients who adopted watchful waiting, 33 eventually underwent treatment because their SHNHRs progressed to overt HCC. For recurrence-free survival, significant risk factors included number of previous treatments (HR, 1.181; p < 0.001), tumour number (HR, 1.943; p = 0.009), and α-feto protein level (HR, 1.005; p = 0.037) in the multivariate analyses. Treatment strategy was not a significant risk factor for recurrence-free survival. For local recurrence-free survival from the date of treatment, only treatment modality (transarterial chemoembolization) (HR, 6.879; p = 0.002) was a significant risk factor. Recurrence-free survival was not significantly different between early treatment and watchful waiting for SHNHRs. (orig.)

  16. Subcentimeter hypervascular nodule with typical imaging findings of hepatocellular carcinoma in patients with history of hepatocellular carcinoma: natural course on serial gadoxetic acid-enhanced MRI and diffusion-weighted imaging

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    Song, Kyoung Doo; Kim, Seong Hyun; Lim, Hyo Keun [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Jung, Sin-Ho [Sungkyunkwan University School of Medicine, Center for Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Samsung Advanced Institute for Health Sciences and Technology, Seoul (Korea, Republic of); Sohn, Insuk [Sungkyunkwan University School of Medicine, Center for Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul (Korea, Republic of); Kim, Hyung Sik [Gachon Medical School, Department of Radiology, Gil Medical Center, Incheon (Korea, Republic of)

    2015-09-15

    To evaluate the natural course of subcentimeter hypervascular nodules at high risk for developing into hepatocellular carcinomas (SHNHR) using serial magnetic resonance imaging (MRI) in patients with a history of hepatocellular carcinoma (HCC). An SHNHR was defined as a subcentimeter hypervascular nodule having typical imaging findings of HCC on gadoxetic acid-enhanced MRI and diffusion-weighted imaging. We included 39 patients with 46 SHNHRs (mean size ± standard deviation, 6.1 ± 1.6 mm; range, 3.2 - 9.0 mm). Overt HCC was defined as pathology proven HCC or a nodule larger than 1 cm with typical imaging findings of HCC. The cumulative rate and the independent predictive factors for progression to overt HCC were evaluated. The median follow-up period was 139 days (range, 64 - 392 days). The cumulative progression rate to overt HCC at 3, 6, 9, and 12 months was 13.9 %, 61.7 %, 83.2 %, and 89.9 %. The initial size of SHNHR was a significant predictor of progression to overt HCC, with an optimal cut-off value of 5.5 mm. The progression rate of SHNHR to overt HCC within 12 months was high (89.9 %) in patients with history of HCC. The initial size of SHNHR was an important predictor for progression to overt HCC. (orig.)

  17. Presence of non-hypervascular hypointense nodules on Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in patients with hepatocellular carcinoma.

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    Inoue, Masanori; Ogasawara, Sadahisa; Chiba, Tetsuhiro; Ooka, Yoshihiko; Wakamatsu, Toru; Kobayashi, Kazufumi; Suzuki, Eiichiro; Tawada, Akinobu; Yokosuka, Osamu

    2017-04-01

    Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) performed before curative therapy for hepatocellular carcinoma (HCC) can distinguish between intrahepatic distant recurrence and hypervascularization. This study aimed to retrospectively evaluate the presence of non-hypervascular hypointense nodules on hepatobiliary phase images from Gd-EOB-DTPA-enhanced MRI as a risk factor of the intrahepatic distant recurrence of early stage HCC following radiofrequency ablation (RFA). A total of 132 patients who underwent preprocedural Gd-EOB-DTPA-enhanced MRI followed by initial RFA were retrospectively analyzed. Post-RFA intrahepatic distant recurrence, which excluded the hypervascularization of non-hypervascular hypointense nodules detected by preprocedural Gd-EOB-DTPA-enhanced MRI, was evaluated according to the presence of non-hypervascular hypointense nodules on preprocedural Gd-EOB-DTPA-enhanced MRI. Intrahepatic distant recurrence rates following RFA were higher in patients with non-hypervascular hypointense nodules (1-year: 22.5%, 2-year: 52.1%, 5-year: 89.1%) compared with in patients without non-hypervascular hypointense nodules (1-year: 7.0%, 2-year: 28.8%, 5-year: 48.7%). The presence of non-hypervascular hypointense nodules was associated with markedly increased cumulative recurrence rates of both identical and different subsegment intrahepatic distant recurrence, being an independent risk factor for post-RFA identical and different subsegment intrahepatic distant recurrence (identical: HR = 2.365, P = 0.027; different: HR = 3.276, P DTPA-enhanced MRI obtained prior to RFA is an important predictive factor of intrahepatic distant recurrence following RFA of HCC. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  18. Radiofrequency Ablation of Hepatocellular Carcinoma with a “Nodule-in-Nodule” Appearance: Long-Term Follow-up and Clinical Implications

    International Nuclear Information System (INIS)

    Kang, Tae Wook; Rhim, Hyunchul; Song, Kyoung Doo; Lee, Min Woo; Cha, Dong Ik; Ha, Sang Yun; Ahn, Joong Hyun

    2017-01-01

    PurposeHepatocellular carcinoma (HCC) with a “nodule-in-nodule” (NIN) appearance has unique histological characteristics as an early HCC. We assessed long-term therapeutic outcomes of radiofrequency ablation (RFA) in HCC patients considering this appearance.Materials and MethodsOur Institutional Review Board approved this retrospective study, and the requirement for written informed consent was waived. Between May 2006 and April 2012, a total of 572 patients underwent RFA for single HCC as a first-line treatment. Patients were divided into a NIN HCC group (n = 22) and a non-NIN HCC group (n = 550), according to the NIN feature on pretreatment imaging studies. Local tumor progression (LTP) and disease-free survival (DFS) were compared. Prognostic factors for LTP and DFS were assessed using a Cox proportional hazards model.ResultsThe cumulative LTP rates were 4.6 and 4.6% at 3 and 5 years, respectively, in the NIN HCC group, and 15.9 and 20.5% in the non-NIN HCC group, with borderline statistical significance (p = 0.085). The corresponding DFS rates were 53.8 and 37.7% in the NIN HCC group and 44.0 and 31.7% in the non-NIN HCC group, with no significant difference (p = 0.318). Although on multivariate analysis only tumor size was a significant prognostic factor for LTP, there was a trend bordering on the significance for the NIN feature [hazard ratio (HR) = 0.19; p = 0.099]. However, it was not a significant factor for DFS (HR = 0.18; p = 0.682).ConclusionsThe NIN appearance, a rare (4%, 22/550) but unique feature of early HCC, may be a favorable prognostic factor for RFA in terms of local tumor control.

  19. Radiofrequency Ablation of Hepatocellular Carcinoma with a “Nodule-in-Nodule” Appearance: Long-Term Follow-up and Clinical Implications

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Tae Wook; Rhim, Hyunchul, E-mail: rhimhc@skku.edu; Song, Kyoung Doo; Lee, Min Woo; Cha, Dong Ik [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center (Korea, Republic of); Ha, Sang Yun [Sungkyunkwan University School of Medicine, Department of Pathology, Samsung Medical Center (Korea, Republic of); Ahn, Joong Hyun [Samsung Biomedical Research Institute, Biostatics Team, Samsung Medical Center (Korea, Republic of)

    2017-03-15

    PurposeHepatocellular carcinoma (HCC) with a “nodule-in-nodule” (NIN) appearance has unique histological characteristics as an early HCC. We assessed long-term therapeutic outcomes of radiofrequency ablation (RFA) in HCC patients considering this appearance.Materials and MethodsOur Institutional Review Board approved this retrospective study, and the requirement for written informed consent was waived. Between May 2006 and April 2012, a total of 572 patients underwent RFA for single HCC as a first-line treatment. Patients were divided into a NIN HCC group (n = 22) and a non-NIN HCC group (n = 550), according to the NIN feature on pretreatment imaging studies. Local tumor progression (LTP) and disease-free survival (DFS) were compared. Prognostic factors for LTP and DFS were assessed using a Cox proportional hazards model.ResultsThe cumulative LTP rates were 4.6 and 4.6% at 3 and 5 years, respectively, in the NIN HCC group, and 15.9 and 20.5% in the non-NIN HCC group, with borderline statistical significance (p = 0.085). The corresponding DFS rates were 53.8 and 37.7% in the NIN HCC group and 44.0 and 31.7% in the non-NIN HCC group, with no significant difference (p = 0.318). Although on multivariate analysis only tumor size was a significant prognostic factor for LTP, there was a trend bordering on the significance for the NIN feature [hazard ratio (HR) = 0.19; p = 0.099]. However, it was not a significant factor for DFS (HR = 0.18; p = 0.682).ConclusionsThe NIN appearance, a rare (4%, 22/550) but unique feature of early HCC, may be a favorable prognostic factor for RFA in terms of local tumor control.

  20. 12-month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules.

    Science.gov (United States)

    Bernardi, Stella; Stacul, Fulvio; Michelli, Andrea; Giudici, Fabiola; Zuolo, Giulia; de Manzini, Nicolò; Dobrinja, Chiara; Zanconati, Fabrizio; Fabris, Bruno

    2017-09-01

    Radiofrequency ablation has been advocated as an alternative to radioiodine and/or surgery for the treatment of autonomously functioning benign thyroid nodules. However, only a few studies have measured radiofrequency ablation efficacy on autonomously functioning benign thyroid nodules. The aim of this work was to evaluate the 12-month efficacy of a single session of radiofrequency ablation (performed with the moving shot technique) on solitary autonomously functioning benign thyroid nodules. Thirty patients with a single, benign autonomously functioning benign thyroid nodules, who were either unwilling or ineligible to undergo surgery and radioiodine, were treated with radiofrequency ablation between April 2012 and May 2015. All the patients underwent a single radiofrequency ablation, performed with the 18-gauge needle and the moving shot technique. Clinical, laboratory, and ultrasound evaluations were scheduled at baseline, and after 1, 3, 6, and 12 months from the procedure. A single radiofrequency ablation reduced thyroid nodule volume by 51, 63, 69, and 75 % after 1, 3, 6, and 12 months, respectively. This was associated with a significant improvement of local cervical discomfort and cosmetic score. As for thyroid function, 33 % of the patients went into remission after 3 months, 43 % after 6 months, and 50 % after 12 months from the procedure. This study demonstrates that a single radiofrequency ablation allowed us to withdraw anti-thyroid medication in 50 % of the patients, who remained euthyroid afterwards. This study shows that a single radiofrequency ablation was effective in 50 % of patients with autonomously functioning benign thyroid nodules. Patients responded gradually to the treatment. It is possible that longer follow-up studies might show greater response rates.

  1. [A single metastasis in the carpal bones as the first clinical manifestation of a hepatocellular carcinoma].

    Science.gov (United States)

    Corrales Pinzón, R; Alonso Sánchez, J M; de la Mano González, S; El Karzazi Tarazona, K

    2014-01-01

    Hepatocellular carcinoma is the most common primary tumor of the liver. Spreading outside the liver usually takes place in advanced stages of the disease, and bone is the third most common site of metastases. We present a case of hepatocellular carcinoma in which the first clinical manifestation was a single metastasis to the carpal bones. The interest of this case lies in the way this hepatocellular carcinoma manifested as well as in the unusual site of the metastasis. Copyright © 2012 SERAM. Published by Elsevier Espana. All rights reserved.

  2. Monopolar Radiofrequency Ablation of Thyroid Nodules: A Prospective Austrian Single-Center Study.

    Science.gov (United States)

    Dobnig, Harald; Amrein, Karin

    2018-04-01

    Monopolar radiofrequency ablation is currently deemed an exotic treatment option for benign thyroid nodules in many central European countries. The aim of this study was to evaluate prospectively the safety and efficacy of this method in a large patient cohort following its introduction in Austria. Peri- and post-interventional complications were analyzed for 277 patients. Efficacy was determined for 300 and 154 nodules at 3 and 12 months post treatment, respectively. All treatments were performed with an internally cooled 18G radiofrequency electrode using a free-hand, "moving-shot" technique following subcutaneous and local perithyroidal anesthesia. Mean patient age (SD) was 52 ± 12.9 years (75% female), and overall mean baseline nodule volume (SD) was 13.8 ± 15.9 mL. Nodules were visible in 62.8% of patients, 40% had a symptom score ≥4 on a 10-point visual analogue scale, and 14.4% had hyperthyroidism. Mean overall nodule volume reduction rates (VRR) at 3 and 12 months were 68 ± 16% and 82 ± 13%, respectively (p 30 mL) or baseline nodule composition (solid, mixed, cystic) revealed significantly higher VRRs for smaller and cystic nodules. Moreover, nodule shrinkage was accompanied by significantly improved symptom and cosmetic scores after 3 and 12 months (p hyperthyroid patients, 27 (84%) were euthyroid, four had subclinical hyperthyroidism, and one had subclinical hypothyroidism at last follow-up. Post-procedural complications were absent in 83% of patients, minimal in 12.9%, moderate and reversible in 3.2% (1.8% voice change, 0.7% hyperthyroidism, 0.3% wound infection treated with antibiotics, 0.3% epifascial hematoma), and irreversible in 0.7% (one case with hypothyroidism and one with a wound infection treated by surgery). It is concluded that a single treatment course with monopolar radiofrequency ablation is both safe and highly effective in terms of nodule volume reduction, relief of local symptoms, and (in patients with

  3. Vascular endothelial growth factor monitoring in advanced hepatocellular carcinoma patients treated with radiofrequency ablation plus octreotide: a single center experience.

    Science.gov (United States)

    Montella, L; Addeo, R; Caraglia, M; Faiola, V; Guarrasi, R; Vincenzi, B; Palmeri, A; Capasso, E; Nocera, V; Tarantino, L; Ariete, M; Martorelli, A; Del Prete, S

    2008-08-01

    Local therapies such as radiofrequency ablation (RFA) represent a valuable choice in limited hepatocellular carcinoma (HCC) and are increasingly used also in advanced tumors. Medical treatments generally gave frustrating results in advanced HCC especially if comorbidities exist. Several biologic non-chemotherapeutic drugs are currently tested in HCC and, among them, octreotide was evaluated in single series of HCC patients reporting conflicting results. We have treated a series of 35 patients affected by advanced HCC (26 M and 9 F; age range: 55-85 years, median: 73 years) with RFA followed by octreotide to primarily evaluate the safety of combined treatment and to give preliminary evaluation on its activity. We have also evaluated serum VEGF changes during the study. Child A and Child B represented 60% and about 34% of the cases, respectively. Only two patients with Child C compensated cirrhosis were included in this study. All patients have multiple liver HCC nodules and one had bone metastases. Two complete responses, 3 partial responses and 23 disease stabilization for at least three months were obtained (overall response rate, 14,2%; clinical benefit, 80%). Mean overall survival was 31.4 months. The combined treatment was well tolerated. Statistically significant correlation was found between serum VEGF and tumor progression. In conclusion, the combination of RFA and octreotide was active in advanced HCC, however, confirmation in a larger series is required.

  4. Carcinogen-induced mdr overexpression is associated with xenobiotic resistance in rat preneoplastic liver nodules and hepatocellular carcinomas.

    Science.gov (United States)

    Fairchild, C R; Ivy, S P; Rushmore, T; Lee, G; Koo, P; Goldsmith, M E; Myers, C E; Farber, E; Cowan, K H

    1987-11-01

    We have previously reported the isolation of a human breast cancer cell line resistant to doxorubicin (adriamycin; AdrR MCF-7 cells) that has also developed the phenotype of multidrug resistance (MDR). MDR in this cell line is associated with increased expression of mdr (P glycoprotein) gene sequences. The development of MDR in AdrR MCF-7 cells is also associated with changes in the expression of several phase I and phase II drug-detoxifying enzymes. These changes are remarkably similar to those associated with development of xenobiotic resistance in rat hyperplastic liver nodules, a well-studied model system of chemical carcinogenesis. Using an mdr-encoded cDNA sequence isolated from AdrR MCF-7 cells, we have examined the expression of mdr sequences in rat livers under a variety of experimental conditions. The expression of mdr increased 3-fold in regenerating liver. It was also elevated (3- to 12-fold) in several different samples of rat hyperplastic nodules and in four of five hepatomas that developed in this system. This suggests that overexpression of mdr, a gene previously associated with resistance to antineoplastic agents, may also be involved in the development of resistance to xenobiotics in rat hyperplastic nodules. In addition, although the acute administration of 2-acetylaminofluorene induced an 8-fold increase in hepatic mdr-encoded RNA, performance of a partial hepatectomy either before or after administration of 2-acetylaminofluorene resulted in a greater than 80-fold increase in mdr gene expression over that in normal untreated livers. This represents an important in vivo model system in which to study the acute regulation of this drug resistance gene.

  5. Adrenalectomy for metastases from hepatocellular carcinoma - a single center experience.

    Science.gov (United States)

    Popescu, Irinel; Alexandrescu, Sorin; Ciurea, Silviu; Brasoveanu, Vlad; Hrehoret, Doina; Gangone, Eliza; Boros, Mirela; Herlea, Vlad; Croitoru, Adina

    2007-05-01

    Adrenal metastases (AM) from hepatocellular carcinoma (HCC) are rarely seen in clinical practice. The treatment is not standardized, the indications and efficacy of different therapeutic approaches being still controversial. Between January 1995 and December 2005, 174 patients underwent liver resection for HCC in our center. AM were detected in four patients (2.3%): three of them had HCC and synchronous AM, and the remaining one developed AM 10 months after liver resection. All the patients with AM were treated by adrenalectomy (simultaneously with liver resection in synchronous metastases), followed by systemic chemotherapy. Non-resectable multifocal liver recurrences occurred in two patients, one of them having also a contralateral adrenal metastasis; these two patients are presently alive 26 and 43 months after adrenalectomy, respectively. Another patient died by liver recurrence 27 months postoperatively. The fourth patient is disease-free at 17 months after the initial operation. Adrenalectomy for AM from HCC should be performed whenever the primary tumor is well therapeutically controlled and the patient has a good performance status. Adrenalectomy offers the chance of more than 2 years survival in many patients. However, once AM are detected, the prognosis remains poor.

  6. Outcome of liver transplantation for hepatocellular carcinoma -- a single center experience.

    Science.gov (United States)

    Iacob, R; Iacob, S; Gheorghe, L; Gheorghe, C; Hrehoreţ, D; Brașoveanu, V; Croitoru, A; Herlea, V; Popescu, I

    2013-01-01

    Liver transplantation (LT) is a promising treatment for patients with liver cirrhosis associated with hepatocellular carcinoma (HCC). The aim of our study was to evaluate our experience regarding the clinical and pathological staging of HCC in patients who underwent LT, as well as recurrence free and overall survival. From January 2006 to December 2011, 38 patients with diagnosis of HCC, underwent LT in our Center. Demographic, clinical, imaging and pathologic information were recorded. A Cox proportional hazards survival analysis was performed in order to identify significant predictors of tumor recurrence and patient's death after LT. Eighteen patients (47.4%) in our study group were within Milan criteria. The mean follow-up was 22 months and the recurrence rate of HCC after LT was 13.2%. The 1, 3- year recurrence free survival rates were 85%, 74.3% respectively. The 1 and 3-year overall survival rates were 83.5% and 63.6% respectively. No significant predictor for HCC recurrence was identified in our study group by survival analysis, taking into account 13 different variables. As independent predictors of patient'ss death after LT for HCC however, the presence of diabetes mellitus (p=0.001), presence of more than 3 HCC nodules (p=0.03) and tumor recurrence after LT (p=0.03) were identified by multivariate Cox proportional hazards survival analysis. In our cohort HCC recurrence rate after LT was 13.2%. Diabetes mellitus, presence of more than 3 HCC nodules and HCC recurrence were significant predictors of poor overall survival after LT. Celsius.

  7. Comparison of four different protocols of I-131 therapy for toxic single thyroid nodule

    International Nuclear Information System (INIS)

    Zakavi, S.R.; Mousavi, Z.

    2007-01-01

    Full text: Aim: Radio-iodine therapy is the preferred method of treatment of toxic thyroid nodule, however there is no consensus on the dose of I-131 administered. The aim of this study was to compare 4 different dose protocols for treatment of these patients. Methods and patients: All patients with hyperthyroidism and single hot thyroid nodule were referred for I-131 therapy after thyroid physical examination, ultrasonography and measurements of 24 hours thyroid iodine uptake. They were randomly entered in one of 4 groups: fixed low dose (FLD), fixed high dose (FHD), calculated low dose (CLD) and calculated high dose (CHD). In fixed dose protocol, 13mCi of I-131 was administered for patients in FLD group and 22.5mCi was administered for patients in FHD group. Quimby formula was used for calculation of radio-iodine dose in calculated groups with 90-100uCi and 180-200uCi per gram of thyroid weight in CLD and CHD groups respectively. Patients were followed up for a mean of 2, 5, 10 , 22 and 50 months later and physical exam and measurements of thyroid values were done in each follow up. Results: One hundred and sixteen patients were studied. One 72 year old patient was decreased 2 months after treatment due to coronary artery disease and 18 other patients did not complete follow up. From 97 patients who completed follow- up 8 patients were male and 89 patients were female. Mean age of patients were 43.3 years (SD=13.4) and mean thyroid nodule weight was 51 grams (SD=19.2).Mean 24 hours thyroid uptake was 48.07% (SD=14.07). Follow up was done up to 85 months with a median follow up of 14 months. Twenty two patients were in CHD group, 23 patients in CLD, 25 patients in FLD and 27 patients in FHD group. No significant difference was noted in 4 groups regarding age, sex, thyroid uptake and thyroid weight. The mean administered dose was 10.5mCi (SD=3.2) and 18.7mCi (SD=5.3) in CLD and CHD groups respectively (P<0.001). In CHD group, hyperthyroidism was decreased from 33

  8. Hyper-attenuating nodules on CT during arterial portography (CTAP). Analysis using single-level dynamic CTAP

    International Nuclear Information System (INIS)

    Nasu, Akihiro; Kita, Ryuichi; Sakamoto, Yasuaki

    2007-01-01

    Recently several cases of hyper-attenuating nodules on CT during arterial portography (CTAP) have been reported as the chance of meticulous examination has been increasing. For the study reported here, seven cases of hyper-attenuating nodules on CTAP were analyzed by means of single-level dynamic CTAP (sCTAP). Peak values of the time-density curve from the 7 cases were 110, 106, 71, 75, 65, 45, 246 Hounsfield unit (HU) for the ROIs (regions of interest) placed on the nodule, and 63, 73, 41, 35, 20, 28, 22 HU for those placed on the surrounding liver parenchyma, respectively. Average peak value in another set of 46 cases as a control, including chronic hepatitis, liver cirrhosis and normal liver, was 55.3±17.6 HU. These results seem to indicate that portal flow shows an absolute increase in some cases of hyper-attenuating nodules on CTAP and that a decreased portal flow in the surrounding parencyma may cause the visual effect of hyper-attenuation on CTAP in some cases. (author)

  9. Detection of the Single-Session Complete Ablation Rate by Contrast-Enhanced Ultrasound during Ultrasound-Guided Laser Ablation for Benign Thyroid Nodules: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Shuhua Ma

    2016-01-01

    Full Text Available This study aimed to investigate the single-session complete ablation rate of ultrasound-guided percutaneous laser ablation (LA for benign thyroid nodules. LA was performed in 90 patients with 118 benign thyroid nodules. Contrast-enhanced ultrasound (CEUS was used to evaluate complete nodule ablation one day after ablation. Thyroid nodule volumes, thyroid functions, clinical symptoms and complications were evaluated 1, 3, 6, 12, and 18 months after ablation. Results showed that all benign thyroid nodules successfully underwent LA. The single-session complete ablation rates for nodules with maximum diameters ≤2 cm, 2-3 cm and ≥3 cm were 93.4%, 70.3% and 61.1%, respectively. All nodule volumes significantly decreased than that one day after ablation (P0.05. Three patients had obvious pain during ablation; one (1.1% had recurrent laryngeal nerve injury, but the voice returned to normal within 6 months after treatment. Thus, ultrasound-guided LA can effectively inactivate benign thyroid nodules. LA is a potentially viable minimally invasive treatment that offers good cosmetic effects.

  10. Identification of benign and malignant thyroid nodules by in vivo iodine concentration measurement using single-source dual energy CT

    Science.gov (United States)

    Gao, Shun-Yu; Zhang, Xiao-Yan; Wei, Wei; Li, Xiao-Ting; Li, Yan-Ling; Xu, Min; Sun, Ying-Shi; Zhang, Xiao-Peng

    2016-01-01

    Abstract This study proposed to determine whether in vivo iodine concentration measurement by single-source dual energy (SSDE) CT can improve differentiation between benign and malignant thyroid nodules. In total, 53 patients presenting with thyroid nodules underwent SSDE CT scanning. Iodine concentrations were measured for each nodule and normal thyroid tissue using the GSI-viewer image analysis software. A total of 26 thyroid nodules were malignant in 26 patients and confirmed by surgery; 33 nodules from 27 patients were benign, with 10 confirmed by surgery and others after follow-up. Iodine concentrations with plain CT were significantly lower in malignant than benign nodules (0.47 ± 0.20 vs 1.17 ± 0.38 mg/mL, P = 0.00). Receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.93; with a cutoff of 0.67, iodine concentration showed 92.3% sensitivity and 88.5% specificity in diagnosing malignancy. Iodine concentration obtained by enhanced and plain CT were significantly higher in malignant than benign nodules (9.05 ± 3.35 vs 3.46 ± 2.24 mg/mL, P = 0.00). ROC curve analysis showed an AUC of 0.93; with a cutoff value of 3.37, iodine concentration displayed 78% sensitivity, 95% specificity in diagnosing malignancy. Combining unenhanced with enhanced iodine concentrations, the diagnostic equation was: Y = –8.641 × unenhanced iodine concentration + 0.663 × iodine concentration. ROC curve showed an AUC of 0.98 (95% CI, 0.94, 1.00). With Y ≥ –2 considered malignancy, diagnostic sensitivity and specificity were 96%, 96.3%, respectively. This study concluded that SSDE CT can detect the differences in iodine uptake and blood supply between benign and malignant thyroid lesions. PMID:27684811

  11. Management of hyperfunctioning single thyroid nodules in the era of minimally invasive thyroid surgery.

    Science.gov (United States)

    Tan, Charles; Sidhu, Stan; Sywak, Mark; Delbridge, Leigh

    2009-05-01

    Both surgical excision and radioiodine ablation are effective modalities in the management of hyperfunctioning thyroid nodules. Minimally invasive thyroid surgery (MITS) using the lateral mini-incision approach has previously been demonstrated to be a safe and effective technique for thyroid lobectomy. As such MITS may offer advantages as a surgical approach to hyperfunctioning thyroid nodules without the need for a long cervical incision or extensive dissection associated with formal open hemithyroidectomy. The aim of the present study was to assess the safety and efficacy of MITS for the treatment of hyperfunctioning thyroid nodules. This is a retrospective case study. Data were obtained from the University of Sydney Endocrine Surgical Unit Database from 2002 to 2007. There were 86 cases of hyperfunctioning thyroid nodules surgically removed during the study period, of which 10 (12%) were managed using the MITS approach. The ipsilateral recurrent laryngeal nerve was identified and preserved in all cases with no incidence of temporary or permanent nerve palsy. The external branch of the superior laryngeal nerve was visualized and preserved in eight cases (80%). There were no cases of postoperative bleeding. There was one clinically significant follicular thyroid carcinoma in the series (10%). In nine of 10 cases (90%) normalization of thyroid function followed surgery. MITS is a safe and effective procedure, achieving the benefits of a minimally invasive procedure with minimal morbidity. As such it now presents an attractive alternative to radioiodine ablation for the management of small hyperfunctioning thyroid nodules.

  12. Diagnosis of Hepatocellular Carcinoma Complicating Liver Cirrhosis: Utility of Repeat Ultrasound-Guided Biopsy after Unsuccessful First Sampling

    International Nuclear Information System (INIS)

    Caturelli, Eugenio; Biasini, Elisabetta; Bartolucci, Francesca; Facciorusso, Domenico; Decembrino, Francesco; Attino, Vito; Bisceglia, Michele

    2002-01-01

    Purpose: To evaluate the utility of a second ultrasound-guided fine-needle biopsy of liver nodules thought to be hepatocellular carcinoma when the original biopsy has failed to provide a reliable diagnosis. Methods: Thirty-seven cirrhotic patients underwent ultrasound-guided fine-needle biopsy of liver nodules that were subsequently diagnosed as hepatocellular carcinoma. Each biopsy involved a single puncture with a 20 G cutting needle, which yielded pathologic material used both for cytologic and histologic studies. In 23 cases (mean diameter of nodules 48 mm) the biopsy furnished exclusively necrotic material (non-diagnostic subgroup); in the other 14 cases (mean diameter 26 mm) the biopsy yielded no neoplastic elements (false-negative subgroup). All 37 nodules were subjected to repeat biopsies performed in the same manner. Results: The repeat biopsies provided a diagnosis of hepatocellular carcinoma in six of the 23 patients from the non-diagnostic subgroup and in seven of the 14 in the false-negative subgroup. Overall, repeat biopsy produced a diagnostic gain of 35.1%. Conclusion: The chance of success with repeat biopsy of hepatocellular carcinoma is limited and may depend to some extent on the characteristics of the lesions (i.e., areas of necrosis in large nodules, well-differentiated cellular populations in small ones)

  13. Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Acunas, Buelent; Rozanes, Izzet

    1999-01-01

    This article presents a review of the literature regarding the use of transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). There have been two different approaches to the treatment: (a) percutaneous tumor ablation methods which can be divided into injectable and thermal methods; percutaneous ethanol injection (PEI) is the most widely used method, and (b) TACE. PEI is the treatment of choice for single HCCs smaller or equal to 3 cm in size. For patients with large HCCs combined TACE and PEI is probably the most effective nonsurgical treatment. In the presence of multiple HCC nodules, TACE remains the treatment of choice

  14. Computed Tomography Features of Benign and Malignant Calcified Thyroid Nodules: A Single-Center Study.

    Science.gov (United States)

    Kim, Donghyun; Kim, Dong Wook; Heo, Young Jin; Baek, Jin Wook; Lee, Yoo Jin; Park, Young Mi; Baek, Hye Jin; Jung, Soo Jin

    No previous studies have investigated thyroid calcification on computed tomography (CT) quantitatively by using Hounsfield unit (HU) values. This study aimed to analyze quantitative HU values of thyroid calcification on preoperative neck CT and to assess the characteristics of benign and malignant calcified thyroid nodules (CTNs). Two hundred twenty patients who underwent neck CT before thyroid surgery from January 2015 to June 2016 were included. On soft-tissue window CT images, CTNs with calcified components of 3 mm or larger in minimum diameter were included in this study. The HU values and types of CTNs were determined and analyzed. Of 61 CTNs in 49 patients, there were 42 malignant nodules and 19 benign nodules. The mean largest diameter of the calcified component was 5.3 (2.5) mm (range, 3.1-17.1 mm). A statistically significant difference was observed in the HU values of calcified portions between benign and malignant CTNs, whereas there was no significant difference in patient age or sex or in the size, location, or type of each CTN. Of the 8 CTNs with pure calcification, 3 exhibited a honeycomb pattern on bone window CT images, and these 3 CTNs were all diagnosed as papillary thyroid carcinoma on histopathological examination. Hounsfield unit values of CTNs may be helpful for differentiating malignancy from benignity.

  15. The single-nucleotide polymorphisms in CHD5 affect the prognosis of patients with hepatocellular carcinoma

    Science.gov (United States)

    Zhu, Xiao; Kong, Qingming; Xie, Liwei; Chen, Zhihong; Li, Hongmei; Zhu, Zhu; Huang, Yongmei; Lan, Feifei; Luo, Haiqing; Zhan, Jingting; Ding, Hongrong; Lei, Jinli; Xiao, Qin; Fu, Weiming; Fan, Wenguo; Zhang, Jinfang; Luo, Hui

    2018-01-01

    Previous studies showed that the low expressions of chromodomain-helicase-DNA-binding protein 5 (CHD5) were intensively associated with deteriorative biologic and clinical characteristics as well as outcomes in many tumors. The aim of this study is to determine whether CHD5 single nucleotide polymorphisms (SNPs) contribute to the prognosis of hepatocellular carcima (HCC). The SNPs were selected according to their linkage disequilibrium (LD) in the targeted next-generation sequencing (NGS) and then genotyped with TaqMan probers. We revealed a rare haplotype AG in CHD5 (SNPs: rs12564469-rs9434711) was markedly associated with HCC prognosis. The univariate and multivariate regression analyses revealed the patients with worse overall survival time were those with tumor metastasis and haplotype AG, as well as cirrhosis, poor differentiation and IV-TNM stage. Based on the available public databases, we discovered the significant association between haplotype AG and CHD5 mRNA expressions only existed in Chinese. These data proposed that the potentially genetic haplotype might functionally contribute to HCC prognosis and CHD5 mRNA expressions. PMID:29568352

  16. Single-domain monoclonal antibodies for the treatment of hepatocellular carcinoma | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The National Cancer Institute seeks parties to license human monoclonal antibodies and immunoconjugates and co-develop, evaluate, and/or commercialize large-scale antibody production and hepatocellular carcinoma (HCC) xenograft mouse models.

  17. Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbaek, Finn Noe; Bonnema, Steen Joop

    2007-01-01

    at inclusion and at 1, 3 and 6 months after treatment. RESULTS: Normalization of serum TSH was achieved in 7 out of 14 patients in the ILP group and in all 15 patients in the (131)I group (P=0.0025). In the ILP group, mean thyroid nodule volume reduction was 44+/-5% (s.e.m.; P... 47+/-8% (Phypothyroidism but no major side...... hypothyroidism. Using the present design, ILP seems inferior to (131)I therapy in normalization of serum TSH. The potential value of ILP as a non-surgical alternative to (131)I needs further investigation...

  18. Features and Outcome of Autonomous Thyroid Nodules in Children: 31 Consecutive Patients Seen at a Single Center.

    Science.gov (United States)

    Ly, Samantha; Frates, Mary C; Benson, Carol B; Peters, Hope E; Grant, Frederick D; Drubach, Laura A; Voss, Stephan D; Feldman, Henry A; Smith, Jessica R; Barletta, Justine; Hollowell, Monica; Cibas, Edmund S; Moore, Francis D; Modi, Biren; Shamberger, Robert C; Huang, Stephen A

    2016-10-01

    Most thyroid nodules are benign and their accurate identification can avoid unnecessary procedures. In adult patients, documentation of nodule autonomy is accepted as reassurance of benign histology and as justification to forgo biopsy or thyroidectomy. In contrast, the negative predictive value of nodule autonomy in children is uncertain. Some recent publications recommend surgical resection as initial management, but few address the degree of TSH suppression or the specific scintigraphic criteria used to diagnose autonomy. The objective of the study was to study the presenting features and cancer risk of children with autonomous nodules. Medical records of all 31 children diagnosed with autonomous nodules at our center from 2003 to 2014 were retrospectively reviewed. All children met full diagnostic criteria for autonomous nodules, defined by both autonomous 123 I uptake into the nodule and the suppression of uptake in the normal thyroid parenchyma on scintigraphy performed during hypothyrotropinemia. The median age of presentation was 15 years (range 3-18 y) with a female to male ratio of 15:1. Fifty-eight percent of patients had solitary nodules and 42% had multiple nodules. The median size of each patient's largest autonomous nodule was 39 mm (range 18-67 mm). Most of the children in this series (68%) had diagnostic biopsies and/or operative pathology of their largest autonomous nodule, which showed benign cytology or histology in all cases. In this pediatric series, the cancer rate observed in biopsied or resected autonomous nodules was 0%. Whereas larger studies are needed to confirm our findings, these results agree with earlier reports suggesting that thyroid cancer is rare in rigorously defined autonomous nodules and support that conservative management may be offered to selected children who meet strict diagnostic criteria for autonomous nodules, deferring definitive therapies until adulthood when the risks of thyroidectomy and 131 I ablation are lower.

  19. Relation of Serum Alkaline Phosphatase to liver scintigram in patients with hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, H; Harada, T; Nawata, J; Hayakawa, M; Nishioka, M; Takemoto, T; Yokoyama, T; Takahashi, M

    1982-12-01

    Serum Alkaline Phosphatase (ALP) was studied in relation to liver scintigrams of 54 patients with hepatocellular carcinoma. The ALP activity was higher with larger tumors and in multiple tumors. Within the single tumor group, the activity was higher when the tumor was located in the hilum than in the periphery. The incidence of ALP-1 isoenzyme (bile ALP) roughly paralleled the total ALP activity. These results suggest that the variation of serum ALP seen in each individual patients with hepatocellular carcinoma reflects the volume of cholestatic liver tissue, which is changed by the number, size and localization of the tumor nodules in the liver.

  20. Single-level dynamic spiral CT of hepatocellular carcinoma: correlation between imaging features and tumor angiogenesis

    International Nuclear Information System (INIS)

    Chen Weixia; Min Pengqiu; Song Bin; Xiao Bangliang; Liu Yan; Wang Wendong; Chen Xian; Xu Jianying

    2001-01-01

    Objective: To investigate the correlation of the enhancement imaging features of hepatocellular carcinoma (HCC) and relevant parameters revealed by single-level dynamic spiral CT scanning with tumor microvessel counting (MVC). Methods: The study included 26 histopathologically proven HCC patients. Target-slice dynamic scanning and portal venous phase scanning were performed for all patients. The time-density curves were generated with measurement of relevant parameters including: peak value (PV) and contrast enhancement ratio (CER), and the gross enhancement morphology analyzed. Histopathological slides were carefully prepared for the standard F8RA and VEGF immunohistochemical staining and tumor microvessel counting and calculation of VEGF expression percentage of tumor cells. The enhancement imaging features of HCC lesions were correlatively studied with tumor MVC and VEGF expression. Results: Peak value of HCC lesions were 7.9 to 75.2 HU, CER were 3.8% to 36.0%. MVC were 6 to 91, and the VEGF expression percentage were 32.1% to 78.3%. The PV and CER were significantly correlated with tumor tissue MVC (r = 0.508 and 0.423, P < 0.01 and 0.05 respectively). There were no correlations between PV and CER and VEGF expression percentage. Both the patterns of time-density curve and the gross enhancement morphology of HCC lesions were also correlated with tumor MVC, and reflected the distribution characteristics of tumor microvessels within HCC lesions. A close association was found between the likelihood of intrahepatic metastasis of HCC lesions with densely enhanced pseudo capsules and the presence of rich tumor microvessels within these pseudo capsules. Conclusion: The parameters and the enhancement imaging features of HCC lesions on target-slice dynamic scanning are correlated with tumor MVC, and can reflect the distribution characteristics of tumor microvessels within HCC lesions. Dynamic spiral CT scanning is a valuable means to assess the angiogenic activity and

  1. Transarterial chemo embolization for the treatment of hepatocellular carcinoma: A single center experience including 221 patients

    International Nuclear Information System (INIS)

    Zeeneldin, A.A.; Salem, S.E.; Ibrahim, A.A.; Tabashy, R.H.; Alieldin, N.H.

    2013-01-01

    Background: Hepatocellular carcinoma (HCC) is a major health problem in Egypt as well as in many countries. Trans arterial chemo embolization (TACE) is a treatment modality applicable to locally advanced HCC beyond surgery or ablative therapies and is associated with survival improvements. The aim of this study was to assess the outcomes of TACE in our center over the past four years. Methods: This is a retrospective cohort study that included 221 patients with locally advanced HCC treated with TACE in a single center between the years 2007 and 2010. The median age was 57 years with male predominance. Liver cirrhosis, viral hepatitis and Bilharziasis were encountered in 64%, 31% and 8% of patients, respectively. Abdominal pain was the most common presenting symptom (67%). Most cases were diagnosed based on radiology (57%) with a TNM stage I or II (73%) and a median AFP value of 150 ng/m L. Results: 221 patients received 440 cycles of TACE with a median of 2 cycles per patient. Cisplatin and doxorubicin (50 mg per cycle, each) were the most commonly used drugs. Impaired liver function was the most common toxicity. Liver cell failure occurred in 17% of patients. An objective tumor response was achieved in 44% of cases. The median overall survival (OS) was 16 months (95% Cl, 13-19 months) and the median progression free survival (PFS) was 6 months (95% Cl, 4.3-7.8 months). Responding patients, Child-Pugh class A and patients receiving standard doses of chemotherapy had a significantly better OS than their counterparts. Only Child-Pugh class A was associated with significantly longer PFS (p < 0.001). Conclusion: TACE produces reasonable responses and fair survival rates in locally advanced HCC but with noticeable toxicities. Proper patients selection and prompt liver support are mandates for improving TACE outcomes.

  2. Thyroid nodule

    International Nuclear Information System (INIS)

    McKenney, J.F.

    1975-01-01

    A palpable mass or nodule may represent any one of a large and diverse group of conditions that involve the thyroid. Whether the patient is euthyroid, hypothyroid, or hyperthyroid can be assessed, and the cause of hypofunction or hyperfunction can usually be determined. Scintiscanning provides important information on the anatomic structure of thyroid nodules. A hot nodule should be ablated by either radioiodine or surgery. A warm nodule usually responds to suppression therapy; if regression does not occur, the problem should be reevaluated. A cold nodule should be surgically excised, as microscopic study of such a lesion is mandatory

  3. [Thyroid nodule].

    Science.gov (United States)

    Clerc, Jérôme

    2005-01-31

    The thyroid nodule is a frequent, most often benign, chronic, multifocal and slowly progressive disease. The first line strategy is to diagnose cancerous nodules (thyroid nodules is controversial since the prognosis of thyroid cancer is excellent for lesions measuring less than 20 mm. Though imaging accuracy is quite limited in assessing the diagnosis of thyroid cancer, both ultrasounds (US) and thyroid scan are helpful to enhance nodular identification (>30%), to sort the nodules relevant for cytological sampling and to optimize the follow-up, the major source of health costs. Suspicious and non contributive FNAs must have a control FNA within 6 months. Nodules with a non suspicious FNA (>85%) require long term follow-up. This follow-up is mainly morphological. New or evolutive nodules, as assessed by palpation or US, will require iterative FNAs or should be considered for surgery. In patients with hyperfunctioning nodules on the scan (10 to 20%), a yearly evaluation of the TSH level is sufficient. These nodules account either for autonomously functioning ones, which slowly develop towards thyrotoxicosis, or for hyperplastic nodules frequently disclosing a lymphocytic thyroiditis. Morbidity due to thyroid autonomy is still underestimated especially in aging patients with TSH levels thyroid nodule is suggested.

  4. Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology.

    Science.gov (United States)

    Santambrogio, Roberto; Cigala, Claudia; Barabino, Matteo; Maggioni, Marco; Scifo, Giovanna; Bruno, Savino; Bertolini, Emanuela; Opocher, Enrico; Bulfamante, Gaetano

    2018-02-01

    Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double-blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2 cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2 cm) at histological evaluation. Statistical analysis showed that diameters ≤2 cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2 cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Incidence of malignant neoplasm in single nodules of the thyroid gland

    Energy Technology Data Exchange (ETDEWEB)

    Kligerman, J.; Braz, J.M.; Cabas Neto, J. (Instituto Nacional do Cancer, Rio de Janeiro (Brazil))

    1982-12-01

    Two hundred and seventy-two cases are presented of single nodular goiter of the thyroid gland, confirmed by histopathology, diagnosed and teated in the Head and Neck Department of Instituto Nacional do Cancer, Rio de Janeiro, Brazil. This experience demonstrated that the carcinoma occurrence, in these nodes, is low; as a routine, they are ressected-and it is shown that there's need for better selection of patients for surgery. It is believed that there's no doubt about the efficiency of the association of clinical data, scintillography, ultrasound results, suppression therapy and citology of aspiration biopsy in the surgical selection of patients.

  6. Multiphasic helical Computed Tomography of hepatocellular carcinoma. Evaluation after various percutaneous ablation procedures

    International Nuclear Information System (INIS)

    Catalano, O.; Esposito, M.; Lobianco, R.; Cusati, B.; Altei, F.; Siani, A.

    1999-01-01

    The purpose of this paper is to report the personal experience with helical CT evaluation of hepatocellular carcinoma treated with various percutaneous interventional procedures. From December 1996 to September 1998 it were examined with helical CT 41 patients (73 nodules in all) with hepatocellular carcinoma treated with percutaneous ablation therapies: conventional ethanol injection in 18 subjects (31 nodules), one-shot ethanol injection 3 (8 nodules), radiofrequency thermal ablation in 16 (25 nodules), and combined chemo embolization and ethanol injection in 4 (9 nodules). CT performed was 4-27 days after the last session, acquiring biphasic volumetric images in 14 patients and triphasic volumetric images in 27. A second treatment with subsequent CT study was performed for 28 lesions; 15 underwent 3 serial studies and 6 underwent 4 studies. Compared with pretreatment findings, the diameter was unchanged in 62% of the nodules and increased in 38%. Morphology was unchanged in 63% of the lesions while in 37% a mild deformation toward the needle path or a more regular and round shape was evident. Borders were unchanged in 37% of the cases and modified in 63%, appearing well-defined in 73% and ill-defined in 27%. The necrotic portion had a low attenuation with a nodule-to-parenchyma gradient more evident on delayed than on venous and finally arterial acquisitions; 8% of the lesions were not recognizable on unenhanced scans. During the arterial phase the residual tumor appeared hyperdense in 97% of the nodules and isodense in 3%, while during the portal phase it was hyperdense in 22%, isodense in 28% and hypodense in 50%, and during the delayed phase hypodense in 100%. Residual viable tissue was identified in 44% of the nodules and quantified as 100% in 1% of all lesions, > 75% in 3%, > 50% in 4%, > 25% in 23%. In conclusion, multiple-phase helical CT allows optimal depiction of primitive liver nodules treated with percutaneous interventional procedures and has a

  7. Detection of simulated pulmonary nodules by single-exposure dual-energy computed radiography of the chest: effect of a computer-aided diagnosis system (Part 2)

    International Nuclear Information System (INIS)

    Kido, Shoji; Kuriyama, Keiko; Kuroda, Chikazumi; Nakamura, Hironobu; Ito, Wataru; Shimura, Kazuo; Kato, Hisatoyo

    2002-01-01

    Objective: To evaluate the performance of the computer-aided diagnosis (CAD) scheme on the detection of pulmonary nodules (PNs) in single-exposure dual-energy subtraction computed radiography (CR) images of the chest, and to evaluate the effect of this CAD scheme on radiologists' detectabilities. Methods and material: We compared the detectability by the CAD scheme with the detectability by 12 observers by using conventional CR (C-CR) and bone-subtracted CR (BS-CR) images of 25 chest phantoms with a low-contrast nylon nodule. Results: Both in the CAD scheme and for the observers, the detectability of BS-CR images was superior to that of C-CR images (P<0.005). The detection performance of the CAD scheme was equal to that of the observers. The nodules detected by the CAD did not necessarily coincide with those by the observers. Thus, if observers can use the results of the CAD system as a 'second opinion', their detectabilities increase. Conclusion: The CAD system for detection of PNs in the single-exposure dual-energy subtraction method is promising for improving radiologists' detectabilities of PNs

  8. Imaging features of microvascular invasion in hepatocellular carcinoma developed after direct-acting antiviral therapy in HCV-related cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Renzulli, Matteo; Brocchi, Stefano; Golfieri, Rita [Sant' Orsola-Malpighi Hospital, Department of Diagnostic Medicine and Prevention, Bologna (Italy); Buonfiglioli, Federica; Conti, Fabio; Verucchi, Gabriella; Andreone, Pietro [University of Bologna, Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, Bologna (Italy); Serio, Ilaria [Sant' Orsola-Malpighi Hospital, Department of Digestive Diseases, Bologna (Italy); Foschi, Francesco Giuseppe [Ospedale di Faenza, Division of Internal Medicine, Faenza (Italy); Caraceni, Paolo; Mazzella, Giuseppe [University of Bologna, Department of Medical and Surgical Sciences (DIMEC), Bologna (Italy); Brillanti, Stefano [University of Bologna, Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences DIMEC, Bologna (Italy); U.O. di Gastroenterologia, Bologna (Italy)

    2018-02-15

    To evaluate imaging features of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) developed after direct-acting antiviral (DAA) therapy in HCV-related cirrhosis. Retrospective cohort study on 344 consecutive patients with HCV-related cirrhosis treated with DAA and followed for 48-74 weeks. Using established imaging criteria for MVI, HCC features were analysed and compared with those in nodules not occurring after DAA. After DAA, HCC developed in 29 patients (single nodule, 18 and multinodular, 11). Median interval between therapy end and HCC diagnosis was 82 days (0-318). Forty-one HCC nodules were detected (14 de novo, 27 recurrent): maximum diameter was 10-20 mm in 27, 20-50 mm in 13, and > 50 mm in 1. Imaging features of MVI were present in 29/41 nodules (70.7%, CI: 54-84), even in 17/29 nodules with 10-20 mm diameter (58.6%, CI: 39-76). MVI was present in only 17/51 HCC nodules that occurred before DAA treatment (33.3%, CI: 22-47) (p= 0.0007). MVI did not correlate with history of previous HCC. HCC occurs rapidly after DAA therapy, and aggressive features of MVI characterise most neoplastic nodules. Close imaging evaluations are needed after DAA in cirrhotic patients. (orig.)

  9. The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer

    International Nuclear Information System (INIS)

    Kagna, Olga; Solomonov, Anna; Fruchter, Oren; Keidar, Zohar; Bar-Shalom, Rachel; Israel, Ora; Yigla, Mordechai; Guralnik, Luda

    2009-01-01

    To evaluate whether PET/low-dose CT (ldCT) using 18 F-fluorodeoxyglucose (FDG) improves characterization of indeterminate single pulmonary nodules (SPNs) in patients at high risk of lung cancer. Retrospective analysis of 307 patients who underwent FDG-PET/CT for indeterminate SPNs identified 93 (70 men, age range 46-90 years) at high risk of lung cancer (age >40 years, minimum 10 pack-year smokers). SPNs were evaluated for the presence and intensity of FDG avidity and ldCT patterns. The performance of visual and semiquantitative FDG-PET/ldCT algorithms for characterization of SPNs was compared to that of ldCT. Incongruent FDG-PET and ldCT patterns were analyzed for significance in further patient management. Malignancy was diagnosed in 38% patients. FDG avidity defined 33 SPNs as true-positive (TP) and 2 as false-negative (FN) (malignant), and 41 as true-negative (TN) and 17 as false-positive (FP) (benign). For SUVmax of 2.2 (by ROC analysis) there were 27 TP, 8 FN, 48 TN and 10 FP SPNs. LdCT defined 34 TP, 1 FN, 28 TN and 30 FP lesions. Of the FP lesions on ldCT, 60% were FDG-negative. Visual PET/ldCT analysis had a sensitivity of 94%, a specificity of 70%, an accuracy of 80%, a positive predictive value (PPV) of 66%, and a negative predictive value (NPV) of 95% as compared to 77%, 83%, 81%, 73%, 86% for semiquantitative PET/ldCT and 97%, 48%, 66%, 53%, 96% for ldCT, respectively. Both PET/ldCT algorithms had statistically significantly higher specificity and accuracy than ldCT. Semiquantitative analysis showed significantly higher PPV and lower sensitivity and NPV than found with ldCT. A single screening procedure encompassing FDG-PET and ldCT may improve screening for lung cancer in high-risk patients. The significantly improved specificity may potentially reduce FP ldCT results and further unnecessary invasive procedures. (orig.)

  10. Correlation of single image Tc-99m MIBI scan and ultrasonography with fine needle aspiration cytology (FNAC) to assess neoplasia in solitary 'cold' thyroid nodules

    International Nuclear Information System (INIS)

    Sohaib, M.; Saeed, S.; Naseeb, H.K.; Hyder, S.W.

    2007-01-01

    Category-1 and 2 as true positive results sensitivity, specificity, positive predictive and negative predictive values of Tc-99m MIBI scanning were found to be 100, 90, 71 and 100% respectively. Ultrasonography also had a sensitivity of 100% considering solid and cystic lesions as test positive. But specificity of US was found to be only 13%. The sensitivity and specificity of the combined results of Tc-99m MIBI scintigraphy and ultrasonography were also not found to be significantly different from those of Tc-99m MIBI scan alone (100% and 91% respectively). Hence in patients with solitary cold thyroid nodules on Tc-99m Pertechnetate study, a single Tc-99m MIBI scan can be used reliably to assess neoplastic nature of the nodule with high degree of sensitivity and specificity. (author)

  11. Laparoscopic RFA with splenectomy for hepatocellular carcinoma.

    Science.gov (United States)

    Hu, Kunpeng; Lei, Purun; Yao, Zhicheng; Wang, Chenhu; Wang, Qingliang; Xu, Shilei; Xiong, Zhiyong; Huang, He; Xu, Ruiyun; Deng, Meihai; Liu, Bo

    2016-07-27

    The treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices. This was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of splenectomy. Laparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.

  12. Single nucleotide polymorphisms in MLH1 predict poor prognosis of hepatocellular carcinoma in a Chinese population.

    Science.gov (United States)

    Zhu, Xiaonian; Liu, Wei; Qiu, Xiaoqiang; Wang, Zhigang; Tan, Chao; Bei, Chunhua; Qin, Linyuan; Ren, Yuan; Tan, Shengkui

    2017-10-03

    Hepatocellular carcinoma (HCC) is a malignant cancer causing deleterious health effect worldwide, especially in China. So far clinical cure rate and long-term survival rate of HCC remains low. Most HCC patients after cancer resection have recurrence or metastasis within 5 years. This study aims to explore the genetic association of mutL homolog 1 ( MLH1 ) polymorphisms with HCC risk and prognosis. Four candidate MLH1 polymorphisms, rs1800734, rs10849, rs3774343 and rs1540354 were studied from a hospital-based case-control study including 1,036 cases (HCC patients) and 1,036 controls (non-HCC patients) in Guangxi, China. All these SNPs interacted with environmental risk factors, such as HBV infection, alcohol intake and smoking in the pathogenesis of HCC. However, only rs1800734 had significant difference between cases and controls. Compared to the AA genotype, patients with AG, GG and AG/GG genotype of rs1800734 had an increased risk of HCC [ORs (95% CI) = 1.217 (1.074∼1.536), 1.745 (1.301∼2.591) and 1.291 (1.126∼1.687)] and a decreased survival time [co-dominant, HR (95% CI) = 1.553 (1.257∼1.920); dominant, HR (95% CI) = 2.207 (1.572∼3.100)]. Furthermore, we found that tumor number, tumor staging, metastasis and rs1800734 were associated with the overall survival of HCC patients by multivariate COX regression analysis. No significant difference was found between the other three MLH1 polymorphisms with HCC risk and prognosis. Our study suggests MLH1 SNP, rs1800734 as a new predictor for poor prognosis of HCC patients.

  13. Sorafenib-Regorafenib Sequential Therapy in Advanced Hepatocellular Carcinoma: A Single-Institute Experience.

    Science.gov (United States)

    Ueshima, Kazuomi; Nishida, Naoshi; Kudo, Masatoshi

    2017-01-01

    Previously, no therapeutic agent has been known to improve the overall survival compared with placebo in patients with hepatocellular carcinoma (HCC), who have progressed after sorafenib. In this patient population, regorafenib was first demonstrated to confer a survival benefit in the RESORCE trial, and subsequently it was approved as a second-line treatment for patients with advanced HCC. An open-label expanded access program (EAP) of regorafenib was implemented for compassionate use. We investigated the efficacy and safety of regorafenib based on our experience of the RESORCE trial and the EAP. Data from 5 patients from the RESORCE trial and 6 from the EAP were analyzed retrospectively. All patients had tolerated prior sorafenib and were progressing during sorafenib treatment. The median progression-free survival was 9.2 months (95% CI 2.3-16.1). One patient achieved a partial response and 7 achieved stable disease. The objective response rate was 9.1%, and the disease control rate was 72.7%. No treatment-associated mortalities were observed. Grade 3 hypophosphatemia was observed in 2 patients, grade 2 anorexia was observed in 5 patients, and grade 3 neutropenia was observed in 2 patients. Grade 2 and grade 3 thrombocytopenia were observed in 2 and 3 patients, respectively. All treatment-related adverse events were improved by reduction or interruption of regorafenib. Five patients showed decreased serum albumin levels. Sorafenib and regorafenib sequential therapy presents a safe and effective treatment option for patients with advanced HCC. © 2017 S. Karger AG, Basel.

  14. Efficacy, safety, and biomarkers of single-agent bevacizumab therapy in patients with advanced hepatocellular carcinoma.

    Science.gov (United States)

    Boige, Valérie; Malka, David; Bourredjem, Abderrahmane; Dromain, Clarisse; Baey, Charlotte; Jacques, Nathalie; Pignon, Jean-Pierre; Vimond, Nadege; Bouvet-Forteau, Nathalie; De Baere, Thierry; Ducreux, Michel; Farace, Françoise

    2012-01-01

    Hepatocellular carcinoma (HCC) is a highly vascularized tumor in which neoangiogenesis contributes to growth and metastasis. We assessed the safety, efficacy, and potential biomarkers of activity of bevacizumab in patients with advanced HCC. In this phase II trial, eligible patients received bevacizumab, 5 mg/kg or 10 mg/kg every 2 weeks. The disease-control rate at 16 weeks (16W-DCR) was the primary endpoint. Circulating endothelial cells (CECs) and plasma cytokines and angiogenic factors (CAFs) were measured at baseline and throughout treatment. The 16W-DCR was 42% (95% confidence interval, 27%-57%). Six of the 43 patients who received bevacizumab achieved a partial response (objective response rate [ORR], 14%). Grade 3-4 asthenia, hemorrhage, and aminotransferase elevation occurred in five (12%), three (7%), and three (7%) patients, respectively. During treatment, placental growth factor markedly increased, whereas vascular endothelial growth factor (VEGF)-A dramatically decreased (p < .0001); soluble VEGF receptor-2 (p < .0001) and CECs (p = .03) transiently increased on day 3. High and increased CEC counts at day 15 were associated with the ORR (p = .04) and the 16W-DCR (p = .02), respectively. Lower interleukin (IL)-8 levels at baseline (p = .01) and throughout treatment (p ≤ .04) were associated with the 16W-DCR. High baseline IL-8 and IL-6 levels predicted shorter progression-free and overall survival times (p ≤ .04). Bevacizumab is active and well tolerated in patients with advanced HCC. The clinical value of CECs, IL-6, and IL-8 warrants further investigation.

  15. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carrafiello, Gianpaolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: gcarraf@tin.it; Lagana, Domenico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: donlaga@gmail.com; Ianniello, Andrea [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: ianand@libero.it; Nicotera, Paolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: paolonicotera@virgilio.it; Fontana, Federico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: fede.fontana@libero.it; Dizonno, Massimiliano [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: massimilianodizonno@libero.it; Cuffari, Salvatore [Service of Anaesthesiology and Palliative Care, University of Insubria, 21100 Varese (Italy)], E-mail: salvatore.cuffari@libero.it; Fugazzola, Carlo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: carlo.fugazzola@ospedale.varese.it

    2009-08-15

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  16. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Carrafiello, Gianpaolo; Lagana, Domenico; Ianniello, Andrea; Nicotera, Paolo; Fontana, Federico; Dizonno, Massimiliano; Cuffari, Salvatore; Fugazzola, Carlo

    2009-01-01

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  17. Clinical significance and predictive factors of early massive recurrence after radiofrequency ablation in patients with a single small hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Ju-Yeon Cho

    2016-12-01

    Full Text Available Background/Aims Radiofrequency ablation (RFA is one of the most frequently applied curative treatments in patients with a single small hepatocellular carcinoma (HCC. However, the clinical significance of and risk factors for early massive recurrence after RFA—a dreadful event limiting further curative treatment—have not been fully evaluated. Methods In total, 438 patients with a single HCC of size ≤3 cm who underwent percutaneous RFA as an initial treatment between 2006 and 2009 were included. Baseline patient characteristics, overall survival, predictive factors, and recurrence after RFA were evaluated. In addition, the incidence, impact on survival, and predictive factors of early massive recurrence, and initial recurrence beyond the Milan criteria within 2 years were also investigated. Results During the median follow-up of 68.4 months, recurrent HCC was confirmed in 302 (68.9% patients, with early massive recurrence in 27 patients (6.2%. The 1-, 3-, and 5-year overall survival rates were 95.4%, 84.7%, and 81.8%, respectively, in patients with no recurrence, 99.6%, 86.4%, and 70.1% in patients with recurrence within the Milan criteria or late recurrence, and 92.6%, 46.5%, and 0.05% in patients with early massive recurrence. Multivariable analysis identified older age, Child-Pugh score B or C, and early massive recurrence as predictive of poor overall survival. A tumor size of ≥2 cm and tumor location adjacent to the colon were independent risk factors predictive of early massive recurrence. Conclusions Early massive recurrence is independently predictive of poor overall survival after RFA in patients with a single small HCC. Tumors sized ≥2 cm and located adjacent to the colon appear to be independent risk factors for early massive recurrence.

  18. Diagnostic feasibility and safety of CT-guided core biopsy for lung nodules less than or equal to 8 mm. A single-institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ying-Yueh [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); Chen, Chun-Ku [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China); National Yang-Ming University, Institute of Clinical Medicine, Taipei (China); Yeh, Yi-Chen [National Yang-Ming University, School of Medicine, Taipei (China); Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei (China); Wu, Mei-Han [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China)

    2018-02-15

    This retrospective study evaluated the diagnostic yield and safety of CT-guided core biopsy of pulmonary nodules ≤8 mm. We determined the diagnostic yield and safety profile of CT-guided lung biopsies for 125 pulmonary nodules ≤8 mm. Pathological diagnoses were made by a combination of histopathological examination and imprint cytology. Results were compared with biopsy results for 134 pulmonary nodules >8 and ≤10 mm. Final diagnoses were established in 94 nodules ≤8 mm. The sensitivity, specificity and diagnostic accuracy of CT-guided core biopsy for nodules ≤8 mm were 87.1 % (61/70 nodules), 100 % (24/24) and 90.4 % (85/94), respectively. Diagnostic failure rates were comparable for nodules ≤8 mm and nodules >8 mm and ≤10 mm (9/94, 9.6 % and 7/111, 6.3 %, respectively, P=0.385). The rate of tube thoracostomy for nodules ≤8 mm was comparable to that for nodules >8 and ≤10 mm (1.6 % vs. 0.7 %, P=0.611). Nodules ≤6 mm had a higher non-diagnostic result rate of 15.4 % (6/39) than did nodules >8 and ≤10 mm (3.7 %, 5/134, P=0.017). CT-guided pulmonary biopsy is feasible for lung nodules ≤8 mm, especially those >6 mm, and has an acceptable diagnostic yield and safety profile. (orig.)

  19. Dual time point 18FDG-PET/CT versus single time point 18FDG-PET/CT for the differential diagnosis of pulmonary nodules - A meta-analysis

    International Nuclear Information System (INIS)

    Zhang, Li; Wang, Yinzhong; Lei, Junqiang; Tian, Jinhui; Zhai, Yanan

    2013-01-01

    Background: Lung cancer is one of the most common cancer types in the world. An accurate diagnosis of lung cancer is crucial for early treatment and management. Purpose: To perform a comprehensive meta-analysis to evaluate the diagnostic performance of dual time point 18F-fluorodexyglucose position emission tomography/computed tomography (FDG-PET/CT) and single time point 18FDG-PET/CT in the diagnosis of pulmonary nodules. Material and Methods: PubMed (1966-2011.11), EMBASE (1974-2011.11), Web of Science (1972-2011.11), Cochrane Library (-2011.11), and four Chinese databases; CBM (1978-2011.11), CNKI (1994-2011.11), VIP (1989-2011.11), and Wanfang Database (1994-2011.11) were searched. Summary sensitivity, summary specificity, summary diagnostic odds ratios (DOR), and summary positive likelihood ratios (LR+) and negative likelihood ratios (LR-) were obtained using Meta-Disc software. Summary receiver-operating characteristic (SROC) curves were used to evaluate the diagnostic performance of dual time point 18FDG-PET/CT and single time point 18FDG-PET/CT. Results: The inclusion criteria were fulfilled by eight articles, with a total of 415 patients and 430 pulmonary nodules. Compared with the gold standard (pathology or clinical follow-up), the summary sensitivity of dual time point 18FDG-PET/CT was 79% (95%CI, 74.0 - 84.0%), and its summary specificity was 73% (95%CI, 65.0-79.0%); the summary LR+ was 2.61 (95%CI, 1.96-3.47), and the summary LR- was 0.29 (95%CI, 0.21 - 0.41); the summary DOR was 10.25 (95%CI, 5.79 - 18.14), and the area under the SROC curve (AUC) was 0.8244. The summary sensitivity for single time point 18FDG-PET/CT was 77% (95%CI, 71.9 - 82.3%), and its summary specificity was 59% (95%CI, 50.6 - 66.2%); the summary LR+ was 1.97 (95%CI, 1.32 - 2.93), and the summary LR- was 0.37 (95%CI, 0.29 - 0.49); the summary DOR was 6.39 (95%CI, 3.39 - 12.05), and the AUC was 0.8220. Conclusion: The results indicate that dual time point 18FDG-PET/CT and single

  20. Applicability of the BCLC staging system to patients with hepatocellular carcinoma in Korea: analysis at a single center with a liver transplant center.

    Science.gov (United States)

    Kim, Sung Eun; Lee, Han Chu; Kim, Kang Mo; Lim, Young-Suk; Chung, Young-Hwa; Lee, Yung Sang; Suh, Dong Jin

    2011-06-01

    The Barcelona Clinic Liver Cancer (BCLC) staging system is logical for the staging and treatment of hepatocellular carcinoma (HCC) because it was based on survival data. This study evaluated the applicability of the BCLC staging system and reasons for divergence from BCLC-recommended treatments in Korean HCC patients. One hundred and sixty consecutive HCC patients were prospectively enrolled. Treatments were generally recommended according to the guideline of the American Association for the Study of Liver Diseases, but patients were also informed about alternative treatments. The final decision was made with patient agreement, and was based on the doctor's preferences when a patient was unable to reach a decision. There were 2 (1%), 101 (64%), 20 (12.5%), 34 (21.5%), and 3 (1%) patients with very early-, early-, intermediate-, advanced-, and terminal-stage disease, respectively. Only 64 patients (40%) were treated according to BCLC recommendations. The treatment deviated from BCLC recommendations in 68% (69/101) and 79% (27/34) of patients with early and advanced stage, respectively. The main causes of deviation were refusal to undergo surgery, the presence of an indeterminate malignancy nodule, the absence of a suitable donor, or financial problems. Donor shortage, financial problems, the relatively limited efficacy of molecular targeting agents, and the presence of an indeterminate nodule were the main causes of deviation from BCLC recommendations. Even after excluding cases in which decisions were made by patient preference, only 66% of the HCC patients were treated according to BCLC recommendations. Treatment guidelines that reflect the Korean situation are mandatory for HCC patients.

  1. Root nodule structure in Chamaecytisus podolicus

    Directory of Open Access Journals (Sweden)

    Monika Skawińska

    2017-06-01

    Full Text Available By means of microscopic analyses, it was shown that root nodules formed by Chamaecytisus podolicus exhibited all structural features typical for indeterminate nodules of temperate genistean shrubs: (i apical nodule meristem composed of infected and non-infected domains, (ii parenchymatous bacteroid-containing tissue with infected cells only resulting from mitotic activity of infected meristematic cells, (iii absence of infection threads, and (iv convoluted bacteroids singly enclosed in a symbiosome membrane. For the first time, it was shown that the nodule meristem is organized into longitudinal files of sister cells.

  2. Hepatocellular carcinoma with marginal superparamagnetic iron oxide uptake on T2*-weighted magnetic resonance imaging: Histopathologic correlation

    International Nuclear Information System (INIS)

    Ishigami, Kousei; Tajima, Tsuyoshi; Fujita, Nobuhiro; Nishie, Akihiro; Asayama, Yoshiki; Kakihara, Daisuke; Nakayama, Tomohiro; Okamoto, Daisuke; Taketomi, Akinobu; Shirabe, Ken; Honda, Hiroshi

    2011-01-01

    Purpose: To evaluate the characteristics of hepatocellular carcinomas (HCCs) with marginal superparamagnetic iron oxide (SPIO) uptake on T2*-weighted MRI. Materials and methods: The study group consisted of 73 patients with 83 surgically resected HCCs. Preoperative SPIO-enhanced MRI studies were retrospectively reviewed. Marginal SPIO uptake was considered positive if a rim-like or band-like low intensity area was present on SPIO-enhanced T2*-weighted images. The prevalence of marginal SPIO uptake was evaluated. Pathological specimens with hematoxylin and eosin staining and immunohistochemical staining of CD68 were reviewed in HCCs with marginal SPIO uptake and 33 HCCs without marginal SPIO uptake (control group). Results: Ten of 83 (12%) HCCs showed marginal SPIO uptake. All HCCs were hypervascular, and only one nodule showed a nodule-in-nodule appearance on imaging findings. The pathology specimens suggested possible causes of marginal SPIO uptake, including marginal macrophage infiltration in moderately or poorly differentiated HCC (n = 4), residual normal hepatic tissue at the marginal area of confluent multinodular or single nodular with extranodular growth type HCC (n = 3), and a well-differentiated HCC component in nodule-in-nodule type HCC (n = 3). Marginal macrophage infiltration was not seen in the control group. Conclusion: SPIO-enhanced MRI may be able to demonstrate marginal macrophage infiltration in HCC.

  3. Solitary pulmonary nodule

    Science.gov (United States)

    ... Adenocarcinoma - chest x-ray Pulmonary nodule - front view chest x-ray Pulmonary nodule, solitary - CT scan Respiratory system References Gotway MB, Panse PM, Gruden JF, Elicker BM. Thoracic radiology: noninvasive diagnostic imaging. In: Broaddus VC, Mason RJ, ...

  4. Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency hyperthermia with a 'cooled-tip needle'. A preliminary clinical experience.

    Science.gov (United States)

    Francica, G; Marone, G

    1999-05-01

    Radiofrequency hyperthermia using the newly-developed 'cooled-tip' needle has recently been proposed as a therapeutic modality for hepatocellular carcinoma (HCC). Herein we report our preliminary results on feasibility and effectiveness of the thermal ablation of mono- or pauci-focal hepatocellular carcinoma with the cooled-tip needle. We treated 15 cirrhotic patients (mean age 68.8 years; 12 males; 14 HCV-positive; 13 in Child's Class A and 2 in Class B) with 20 hepatocellular carcinoma nodules (mean diameter 28.1 mm; range 10-43 mm; nine lesions with diameter greater than 3 cm). None of the patients had portal thrombosis and/or extrahepatic spread. We used a radiofrequency generator (100 W of power) connected to a 18 g perfusion electrode needle with an exposed tip of 2-3 cm. The circuit was closed through a dispersive electrode positioned under the patient's thighs. A peristaltic pump infused a chilled (2-5 degrees C) saline solution to guarantee the continuous cooling of the needle tip. The needle was placed into target lesions under US guidance. The interventional procedure was carried out in general anesthesia without intubation. Dynamic helical CT was carried out 15-20 days after thermal ablation to assess therapeutic efficacy. In all, 38 areas of coagulation necrosis (at 1000-1200 mA for 10-15 min) were generated in 24 sessions in the 20 hepatocellular carcinoma nodules (mean 1.9 lesions per nodule and 1.2 sessions per nodule). Complete necrosis as assessed at dynamic CT (lack of enhancement during the arteriographic phase) was achieved in 75% of cases in a single session; after a second RF session success rate was 90% (18 out of 20 nodules). A self-limited pleurisy along with a 5-fold increase in transaminases occurred in one patient; a 3-fold elevation of transaminases was encountered in three other patients. During the follow-up (median 15 months) five patients had recurrent hepatocellular carcinoma with a 1-year disease free interval of 64%. Of the

  5. Hepatocellular calcification

    DEFF Research Database (Denmark)

    Ladefoged, Claus; Frifelt, J J

    1987-01-01

    Autopsy of a twenty year old girl dying from complications of renal and cardiac failure demonstrated severe hepatocellular calcification, a rare finding. The pathogenesis is thought to be a combination of dystrophic calcification caused by severe centrilobular necrosis and metastatic calcificatio...

  6. How to detect hepatocellular carcinoma in cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Ward, Janice; Robinson, Philip J. [Department of Clinical Radiology, St. James' s University Hospital, Beckett Street, Leeds LS9 7TF (United Kingdom)

    2002-09-01

    Cirrhosis predisposes to hepatocellular carcinoma (HCC) which develops by sequential steps of de-differentiation of hepatocytes from regenerative nodules via borderline (dysplastic) nodules to frankly malignant HCC. Effective treatment depends on early recognition of HCC, so the key tasks for imaging are firstly recognising the presence of a suspicious lesion, and secondly differentiating between benign, borderline and malignant nodules. Screening of high-risk cirrhotic patients with sonography and measurement of alpha fetoprotein (AFP) is helpful but will not reliably differentiate small HCC from benign or dysplastic nodules. Large HCCs can usually be recognised by their characteristic morphology on imaging, but the appearances of smaller benign and malignant nodules show considerable overlap on unenhanced sonography, CT and MRI. Increasing degrees of histological malignancy are associated with increasing arterialisation and loss of portal blood supply, so the recognition of HCC requires the use of dynamic imaging with contrast-enhanced CT or T1-weighted MRI with gadolinium enhancement. Sonography with microbubble contrast media now offers another method for detecting arterialised nodules; however, some non-malignant nodules show arterial hypervascularity and a minority of HCCs are hypovascular, so the assessment of perfusion does not conclusively distinguish benign from malignant lesions. Kupffer cell function is another attribute of liver tissue which can be explored using MRI with superparamagnetic iron oxide particles (SPIO). Experience thus far suggests that uptake of SPIO is an effective discriminator between benign and malignant nodules. The combination of SPIO with gadolinium-enhanced MRI offers the opportunity for imaging characterisation of cirrhotic nodules by cellular function as well as by blood supply, and this approach is now proposed as the examination of choice for detecting HCC in cirrhosis. (orig.)

  7. Co-Existence of Thyroid Nodule and Thyroid Cancer in Children and Adolescents with Hashimoto Thyroiditis: A Single-Center Study.

    Science.gov (United States)

    Keskin, Meliksah; Savas-Erdeve, Senay; Aycan, Zehra

    2016-01-01

    Currently, there is an inadequate number of studies on nodule and malignancy development in children and adolescents with Hashimoto thyroiditis (HT). Patients who were diagnosed with HT between 2004 and 2013 were included in the study. The HT diagnosis was made with a heterogeneous appearance on thyroid ultrasonography and the elevation of antithyroid peroxidase and/or anti-thyroglobulin antibodies. Fine-needle aspiration biopsy (FNAB) was performed in cases with a nodule size >1 cm or who had ultrasonography findings indicating malignancy. A total of 39 (13%) thyroid nodules were detected in 300 patients with a diagnosis of HT. Papillary thyroid carcinoma (PTC) was diagnosed in 2 of the 12 cases in whom FNAB was performed. The thyroid nodule was detected at the same time as HT in the 2 cases with malignancy. The PTC diagnosis was made 2 years after the HT diagnosis in the first case and 3 years later in the second case. The largest diameter of the thyroid nodule was 5 mm in both cases. The thyroid nodule rate on an HT background was found to be 13%, and the thyroid malignancy rate was 0.67% in our study. © 2016 S. Karger AG, Basel.

  8. Superselective transcather arterial embolization for hepatocellular carcinoma with a mixture of ethanol and lipiodol

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Han, Joon Koon; Choi, Byung Ihn; Han, Man Chung

    1992-01-01

    To evaluate the effectiveness of superselective transcatheter arterial embolization (STAE) for hepatocellular carcinoma (HCC) with a mixture of ethanol and Lipiodol, STAE was done in 12 male patients with HCC. There were diagnosed clinically with angiographic findings and elevated alphafetprotein levels and three were recurrent tumors after surgery. Sono-guided aspiration biopsy proved the diagnosis of hepatocellular carcinoma in another six patients. The tumor was a small single nodule (2-5cm in diameter) in 11 patients. In one patient, two nodules were found. Superselective catheterization was done using 3F Tracker catheter (Target Therapeutics USA) coaxially through 6F catheter into the feeding hepatic artery, usually the third order branch. One to four cc of 75% ethanol mixed with Lipiodol was infused under fluoroscopy immediately after injection of 2% lidocaine. Immediate angiography and CT after 2 weeks were undertaken. Complete segmental or subsegmental devascularization including feeding arteries and tumor vascularities occurred in all patients. Follow-up angiography after 6 to 15 months revealed the tumor opacified by Lipiodol. The tumor decreased in 5 cases and recurrence was found in three patients. CT taken 2 weeks after STAE showed low density halo around the tumor in 5 cases. Subsequent segmentectomy in four patients revealed total or near total necrosis of the tumor and no evidence of damage in surrounding parenchyma. STAE for HCC with a mixture of ethanol and Lipiodol is an effective and safe measure for small HCC

  9. Value of contrast-enhanced ultrasound in differential diagnosis of single metastatic liver cancer and solitary necrotic nodule of the liver

    Directory of Open Access Journals (Sweden)

    LI Jing

    2016-07-01

    Full Text Available Objective To investigate the value of contrast-enhanced ultrasound (CEUS in the differential diagnosis of single metastatic hepatic carcinoma (MHC and solitary necrotic nodule of the liver (SNNL. MethodsA retrospective analysis was performed for 12 patients with single MHC and 16 patients with SNNL who showed circular enhancement in arterial phase on CEUS. Age, size of lesion, and findings of two-dimensional gray-scale ultrasound and CEUS were compared between the two groups. The two-independent-samples t-test was used for comparison between groups, and the paired t-test was used for comparison within each group. ResultsThe MHC group had a significantly higher mean age than the SNNL group (60.2±11.3 years vs 41.0±9.1 years, t=4.970, P<0.001. The mean diameter of lesion was 2.86±1.22 cm in the MHC group and 2.97±0.96 cm in the SNNL group, and showed no significant difference between the two groups (t=-0.269, P=0.790. In the MHC group, the lesions had complex and uneven echoes and blurred boundaries, while in the SNNL group, most lesions were in the right lobe and were hypoechoic with clear boundaries. No blood flow signals were detected on CDFI in these two groups. Both groups had circular enhancement around the lesions in arterial phase on CEUS, and the mean thickness showed a significant difference between the MHC group and the SNNL group (5.00±1.69 mm vs 2.37±0.87 mm, t=5.374, P<0001. In the MHC group, the area in lesions without enhancement in delayed phase was significantly larger than that in arterial phase (t=-4.508, P=0001, while in the SNNL group, the area in lesions without enhancement showed no significant difference between delayed phase and arterial phase (t=-0.449, P=0.660. ConclusionThe thickness of circular enhancement in arterial phase on CEUS and the presence or absence of the enlargement in the area without enhancement contributes to the differential diagnosis of single MHC and SNNL.

  10. Hemodynamic characteristics of early stage hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kudo, Masatoshi; Tomita, Shusuke; Tochio, Hitoshi

    1992-01-01

    Hemodynamic characteristics were studied by using in vivo vascular imaging techniques in 17 resected early stage hepatocellular carcinoma (e-HCC) by comparing them with 49 resected advanced HCCs (ad-HCC) less than 3 cm in diameter. In this study, e-HCC was defined as the nodule being uniformly composed of well-differentiated HCC or adenomatous hyperplastic nodule containing well-differentiated HCC foci within the nodule. In vivo vascular imaging techniques are as follows; US angiography with intraarterial CO 2 microbubbles were performed to assess the tumor arterial vascularity, and CT during arterial portography (CTAP) was performed to assess the portal perfusion within the nodule. Of 17 e-HCC nodules 5 were hypervascular, 5 were isovascular, 4 were hypovascular, and 3 were vascular spot in hypovascular pattern in contrast to 49 ad-HCC nodules, 43 of which were hypervascular and 6 were isovascular. Of 14 e-HCCs, 9 nodules showed perfusion defect and 5 did not on CTAP, whereas all 37 ad-HCCs on which CTAP was performed, showed perfusion defect. Forty-one percent (7/17) of e-HCC showed fatty metamorphosis in contrast to 8% (4/49) of ad-HCC. In conclusion, hemodynamic characteristics of e-HCC are summarized as follows. (1) Arterial tumor neovascularization is relatively low. (2) Portal perfusion is present in some of e-HCC cases. (3) Hypoperfusion state both from arterial and portal supply is present in some of e-HCC cases. (4) Vascular spot in hypovascular pattern is characteristic arterial pattern in AH containing HCC foci. (5) Fatty metamorphosis may be related with hypoperfusion state of the nodule in e-HCC. (author)

  11. Chemoembolization with drug-eluting microspheres (DEM-TACE for hepatocellular carcinoma: single-center review of safety and efficacy

    Directory of Open Access Journals (Sweden)

    Bishay VL

    2014-11-01

    Full Text Available VL Bishay,1 K Maglione,1 R Khanna,2 KM Lee,1 AM Fischman,1 RA Lookstein,1 E Kim1 1Department of Radiology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, USA; 2Department of Radiology, Queens Hospital Center, Jamaica, NY, USA Purpose: This study examines the safety and efficacy of transarterial chemoembolization using doxorubicin-loaded 30–60 µm QuadraSphere microspheres (DEM-TACE for the treatment of hepatocellular carcinoma. Materials and methods: Over 10 weeks, patients with hepatocellular carcinoma. (Child–Pugh A/B: 65%/35% were embolized with 30–60 µm QuadraSphere microspheres. Excluded patients had previous locoregional therapy, macrovascular invasion, extrahepatic disease, Child–Pugh score >B7, ECOG performance status >0, and total bilirubin >3 mg/dL. Technical success, minor and major complications, 30-day hospital readmission rate, and 30-day mortality were assessed. α-Fetoprotein levels before and after treatment were compared. Local response was evaluated by radiologic tumor response per modified Response Evaluation Criteria in Solid Tumors 1 month after treatment. Results: Thirty tumors (mean size, 2.3 cm; range, 1.0–4.9 cm were treated in 20 patients (16 male and 4 female; mean age, 64.7 years. There were no major complications. Thirty-day mortality was 0%. Minor complications included postembolization syndrome in 16.7% of cases and transient rise in liver enzymes requiring no therapy. Mean a-fetoprotein levels trended down following treatment (71.8±201.9 ng/mL vs 53.4±116.7 ng/mL, but were not statistically significant. Complete response was achieved in 30% of patients, partial response in 35%, stable disease in 30%, and progression of disease in 5%. Overall objective response was 65%. Mean follow-up was 10.4 months (range, 2–16.4 months. Conclusion: DEM-TACE with doxorubicin-loaded 30–60 µm QuadraSpheres is feasible, well tolerated, and associated with promising tumor response in early and

  12. US Diagnosis for Thyroid Nodules with an Indeterminate Cytology

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Jong Geun; Kim, Dong Wook [Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Kang, Tae Woo [Saegyaero Hospital, Busan (Korea, Republic of)

    2011-09-15

    We wanted to assess the diagnostic efficacy of thyroid ultrasound (US) for evaluating thyroid nodules with indeterminate cytology. Among 1865 nodules in 1278 patients who received a prospective US diagnosis of their thyroid nodule(s) and who subsequently underwent US-guided fine-needle aspiration, 130 nodules with indeterminate cytology were enrolled in the study. Each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: 'benign', 'probably benign', 'indeterminate', 'suspicious for malignancy' and 'malignant.' The solid nodules were classified using all 5 categories and the partially cystic nodules classified using 4 categories ('indeterminate' was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the pathology results. Of 130 nodules with indeterminate cytology (130/1865, 7.0%), 62 nodules were surgically removed. Nineteen nodules were assigned to the indeterminate category on US. The malignantly rate of the US-indeterminate category was 56.5% (35/62). The sensitivity, specificity and positive and negative predictive values were 81.0%, 81.8%, 81.0%, 81.8% and 81.4%, respectively, when US-indeterminate nodules were excluded. There was no significant difference of diagnostic efficacy when these nodules were reclassified as malignant, but there was a significant difference of diagnostic efficacy when these nodules were reclassified as benign. Our US classification may be a feasible method for managing thyroid nodules with indeterminate cytology

  13. Management of Pulmonary Nodules

    OpenAIRE

    Arvin Aryan

    2010-01-01

    Pulmonary nodule characterization is currently being redefined as new clinical, radiological and pathological data are reported, necessitating a reevaluation of the clinical management."nIn approach to an incidentally detected pulmonary nodule, we should consider that there are different risk situations, different lesion morphologies, and different sizes with various management options."nIn this session we will review the different risk situations for patients with pulmonary nodules...

  14. Micromonospora is a normal occupant of actinorhizal nodules

    Indian Academy of Sciences (India)

    Supplementary table 1. Number of isolates per nodule. Nodule Colonies Average Nodule Colonies Average. AV1 Nodule 1 2 13 EEM Nodule 1 17 9.4. Nodule 2 O Nodule 2 13. Nodule 3 2 Nodule 3 9. AV2 Nodule 1 19 16.1 Nodule 4 7. Nodule 2 25 Nodule 5 18. Nodule 3 38 Nodule 6 4. AV4 Nodule 1 8 14.0 Nodule 7 12.

  15. Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

    Directory of Open Access Journals (Sweden)

    Mariana Lima

    2018-01-01

    Full Text Available Introduction: Hepatic transarterial chemoembolization is a widely used technique for the treatment of hepatocellular carcinoma. The most common complication of this procedure is postembolization syndrome. The main objective of this study was to assess risk factors for the development of postembolization syndrome. Material and Methods: Single-centre retrospective analysis of 563 hepatic transarterial chemoembolization procedures from January 1st, 2014 – December 31st, 2015. Hepatic transarterial chemoembolization was performed with ½ - 2 vials of 100 - 300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case. Descriptive analysis and multivariate logistic regression were performed. Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial, the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively. Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome. Conclusion: The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic

  16. Hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

    Hepatocellular carcinoma (HCC) is a common cause of cancer mortality. Hepatitis B and C viruses, aflatoxin and alga toxin in the contaminated drinking water are the major etiological factors. Rapidly progressing medical imaging has resulted in the improved treatment results. Surgical resection has a major role for influencing prognosis of HCC. Local cancer therapies based on the advances in early diagnosis are progressing rapidly. Multimodality combination and sequential treatment has proved effective, unfortunately systemic chemotherapy for HCC remains disappointed. All of these have resulted in the improved prognosis of HCC. (author)

  17. Giant hepatic regenerative nodules in Alagille syndrome

    International Nuclear Information System (INIS)

    Rapp, Jordan B.; Bellah, Richard D.; Anupindi, Sudha A.; Maya, Carolina; Pawel, Bruce R.

    2017-01-01

    Children with Alagille syndrome undergo surveillance radiologic examinations as they are at risk for developing cirrhosis and hepatocellular carcinoma. There is limited literature on the imaging of liver masses in Alagille syndrome. We report the ultrasound (US) and magnetic resonance imaging (MRI) appearances of incidental benign giant hepatic regenerative nodules in this population. To describe the imaging findings of giant regenerative nodules in patients with Alagille syndrome. A retrospective search of the hospital database was performed to find all cases of hepatic masses in patients with Alagille syndrome during a 10-year period. Imaging, clinical charts, laboratory data and available pathology were reviewed and analyzed and summarized for each patient. Twenty of 45 patients with confirmed Alagille syndrome had imaging studies. Of those, we identified six with giant focal liver masses. All six patients had large central hepatic masses that were remarkably similar on US and MRI, in addition to having features of cirrhosis. In each case, the mass was located in hepatic segment VIII and imaging showed the mass splaying the main portal venous branches at the hepatic hilum, as well as smaller portal and hepatic venous branches coursing through them. On MRI, signal intensity of the mass was isointense to liver on T1-weighted sequences in four of six patients, but hyperintense on T1 in two of six patients. In all six cases, the mass was hypointense on T2- weighted sequences. The mass post-contrast was isointense to adjacent liver in all phases in five the cases. Five out of six patients had pathological correlation demonstrating preserved ductal architecture confirming the final diagnosis of a regenerative nodule. Giant hepatic regenerative nodules with characteristic US and MR features can occur in patients with Alagille syndrome with underlying cirrhosis. Recognizing these lesions as benign giant hepatic regenerative nodules should, thereby, mitigate any need for

  18. Giant hepatic regenerative nodules in Alagille syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Rapp, Jordan B. [Lewis Katz School of Medicine at Temple University, Department of Radiology, Temple University Hospital, Philadelphia, PA (United States); Bellah, Richard D.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA (United States); Maya, Carolina [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Pawel, Bruce R. [University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA (United States); The Children' s Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA (United States)

    2017-02-15

    Children with Alagille syndrome undergo surveillance radiologic examinations as they are at risk for developing cirrhosis and hepatocellular carcinoma. There is limited literature on the imaging of liver masses in Alagille syndrome. We report the ultrasound (US) and magnetic resonance imaging (MRI) appearances of incidental benign giant hepatic regenerative nodules in this population. To describe the imaging findings of giant regenerative nodules in patients with Alagille syndrome. A retrospective search of the hospital database was performed to find all cases of hepatic masses in patients with Alagille syndrome during a 10-year period. Imaging, clinical charts, laboratory data and available pathology were reviewed and analyzed and summarized for each patient. Twenty of 45 patients with confirmed Alagille syndrome had imaging studies. Of those, we identified six with giant focal liver masses. All six patients had large central hepatic masses that were remarkably similar on US and MRI, in addition to having features of cirrhosis. In each case, the mass was located in hepatic segment VIII and imaging showed the mass splaying the main portal venous branches at the hepatic hilum, as well as smaller portal and hepatic venous branches coursing through them. On MRI, signal intensity of the mass was isointense to liver on T1-weighted sequences in four of six patients, but hyperintense on T1 in two of six patients. In all six cases, the mass was hypointense on T2- weighted sequences. The mass post-contrast was isointense to adjacent liver in all phases in five the cases. Five out of six patients had pathological correlation demonstrating preserved ductal architecture confirming the final diagnosis of a regenerative nodule. Giant hepatic regenerative nodules with characteristic US and MR features can occur in patients with Alagille syndrome with underlying cirrhosis. Recognizing these lesions as benign giant hepatic regenerative nodules should, thereby, mitigate any need for

  19. Prevalence of hepatocellular carcinoma in chronic hepatitis C patients in Mid Delta, Egypt: A single center study

    International Nuclear Information System (INIS)

    Ziada, D.H.; El Sadany, S.; Soliman, H.; Abd-Elsalam, S.; Salama, M.; Hawash, N.; Amal Selim, A.; Manal Hamisa, M.; Elsabagh, H.M.; El Sadany, S.

    2016-01-01

    Background and aim: Hepatocellular carcinoma (HCC) has an increasing incidence worldwide. In this study we aimed to assess the prevalence of HCC among HCV patients in our center in Mid Delta, Egypt. Patients and methods: During the period between April 2013 and January 2015, we screened sequentially chronic HCV patients attending inpatient wards or outpatient Clinic of Tropical Medicine Department in Tanta University Hospital for HCC. Individuals with focal lesion in Ultra- sound (US) and/or serum α -fetoprotein (AFP) level >200 ng/ml were examined by triphasic computed tomography scanning (CT), and/or magnetic resonance imaging (MRI). Results: Among 514 HCV patients interviewed and accepted sharing in this study, 90 (17.5%), 144 (28%), and 280 (54.5%) were Child A, B, and C, respectively. We found that 108/514 patients (21%) had focal lesion detected by US. Also, 89/514 (17.3%) had elevated AFP >200, 13 of them (14.6%) had no focal lesion on US, but further work up showed HCC in 2 of them. Overall HCC diagnosis was confirmed in 103 cases, 94 of them (91.3%) were Child B or C. Occurrence of HCC was significantly higher in smokers, diabetics, patients with decompensated liver and those with positive family history of HCC. Only 20/103 (19.4%) were candidates to curative treatments, 8 of them were Child A asymptomatic and discovered accidentally during screening. Conclusion: The high prevalence of HCC in our HCV patients (22%) was mainly associated with decompensated cirrhosis. A national surveillance program for the detection of HCC in cirrhotic HCV Egyptian patients by combining ultrasound examination and AFP is highly recommended.

  20. HATT: a phase IV, single-arm, open-label study of sorafenib in Taiwanese patients with advanced hepatocellular carcinoma.

    Science.gov (United States)

    Lin, Shi-Ming; Lu, Sheng-Nan; Chen, Ping-Tsung; Jeng, Long-Bin; Chen, Shinn-Cherng; Hu, Chi-Tan; Yang, Sien-Sing; Le Berre, Marie-Aude; Liu, Xuan; Mitchell, David Y; Prins, Klaas; Grevel, Joachim; Peña, Carol A E; Meinhardt, Gerold

    2017-03-01

    Sorafenib significantly improves survival in patients with advanced hepatocellular carcinoma (HCC). This phase IV study assessed sorafenib efficacy/safety in Taiwanese patients with advanced HCC and Child-Pugh A status. All patients received 400 mg sorafenib BID. Safety, efficacy, sorafenib pharmacokinetics, and Child-Pugh progression were evaluated. A hand-foot skin reaction (HFSR) prevention substudy assessed HFSR incidence and grade/severity and time to HFSR in 29 and 34 patients randomized to corticosteroid and noncorticosteroid ointments, respectively, and in 88 nonrandomized patients. The 151 patients included 120 (80%) male patients and 81 (54%) with stage IV disease. Mean sorafenib dose was 626 mg/day, and median treatment duration was 4.2 months. Median overall survival (OS), progression-free survival, and time to progression (TTP) were 8.6, 2.7, and 3.8 months, respectively. Disease control and response rates (partial responses only) were 48 and 6.6%, respectively. Median TTP from Child-Pugh A to B/C was 88 days. Drug-related adverse events (AEs) occurred in 89.4% of patients; none were new or unexpected. The most frequent grade ≥3 drug-related, treatment-emergent AEs were HFSR (13.2%), diarrhea (11.9%), and hypertension (6.6%). Corticosteroid ointment tended to reduce the severity and incidence of all HFSR-associated parameters. Pharmacokinetic exposure was unaltered by Child-Pugh progression. The final pharmacokinetic model predicted 13.1 and 33.8% reductions in sorafenib exposure over 6 and 12 months, respectively. There was a trend of longer OS and TTP in Taiwanese patients with advanced HCC compared with patients with advanced HCC in the Asia-Pacific trial. Sorafenib exposure did not correlate with liver function. Reduced pharmacokinetic exposure over time was unrelated to reduced or interrupted dosing.

  1. Can Lung Nodules Be Cancerous?

    Science.gov (United States)

    ... lung nodules be cancerous? Answers from Eric J. Olson, M.D. Yes, lung nodules can be cancerous, ... to determine if it's cancerous. With Eric J. Olson, M.D. AskMayoExpert. Pulmonary nodules. Rochester, Minn.: Mayo ...

  2. Proton MR spectroscopy in solitary pulmonary nodules: a preliminary study

    International Nuclear Information System (INIS)

    Yang Chunshan; Xiao Xiangsheng; Li Huimin; Liu Shiyuan; Li Chengzhou; Li Shenjiang

    2005-01-01

    Objective: To study the characteristics and the regularities of the metabolites in solitary pulmonary nodules with proton MR spectroscopy, and to investigate the clinical value of MR spectroscopy in differentiating benign from malignant pulmonary nodules. Methods: Sixty-nine patients with solitary pulmonary nodules underwent routine MRI and single-voxel MR spectroscopy using Siemens Vision 1.5 T MR system. MR spectroscopy characteristics and parameters of the metabolites were observed and recorded. Ten pathologic specimens were examined with single-voxel MR spectroscopy. The MR spectroscopy results of the pathologic specimens were compared with those of the solitary pulmonary nodules in vivo. Results: The Cho peak (2.86 ± 1.89) of the malignant nodules was higher than that of the inflammatory (0.87 ± 0.74), tuberculous nodules (0.97 ± 1.09), and hamartoma (0.42 ± 0.53) (P 0.05). Conclusion: MR spectroscopy is reliable in evaluating pulmonary nodules in vivo. The Cho peak, Cho/Cr, and Lac peak of the malignant nodules were higher than those of inflammatory, tuberculous nodules, and hamartoma. MR spectroscopy is helpful in differentiating benign from malignant pulmonary nodules. (authors)

  3. Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Sano, Katsuhiro; Ichikawa, Tomoaki; Morisaka, Hiroyuki [University of Yamanashi, Department of Radiology, Chuo-City, Yamanashi (Japan); Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka-City, Saitama (Japan); Motosugi, Utaroh; Ichikawa, Shintaro [University of Yamanashi, Department of Radiology, Chuo-City, Yamanashi (Japan); Enomoto, Nobuyuki [University of Yamanashi, First Department of Internal Medicine, Yamanashi (Japan); Matsuda, Masanori; Fujii, Hideki [University of Yamanashi, First Department of Surgery, Yamanashi (Japan)

    2017-02-15

    To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images. In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules. The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule's initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p < 0.01). Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination. (orig.)

  4. Prognostic Factors for Tumor Recurrence after a 12-Year, Single-Center Experience of Liver Transplantations in Patients with Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Matteo Cescon

    2010-01-01

    Full Text Available Background. Factors affecting outcomes after orthotopic liver transplantation (OLT for hepatocellular carcinoma (HCC have been extensively studied, but some of them have only recently been discovered or reassessed. Methods. We analyzed classical and more recently emerging variables with a hypothetical impact on recurrence-free survival (RFS in a single-center series of 283 patients transplanted for HCC between 1997 and 2009. Results. Five-year patient survival and RFS were 75% and 86%, respectively. Thirty-four (12% patients had HCC recurrence. Elevated preoperative alpha-fetoprotein (AFP levels, preoperative treatments of HCC, unfulfilled Milan and up-to-seven criteria at final histology, poor tumor differentiation, and tumor microvascular invasion negatively affected RFS by univariate analysis. Milan and up-to-seven criteria applied preoperatively, and the use of m-TOR inhibitors did not reach statistical significance. Cox's proportional hazard model showed that only elevated AFP levels (Odds Ratio=2.88; 95% C.I.=1.43–5.80; =.003, preoperative tumor treatments (Odds Ratio=4.84; 95% C.I.=1.42–16.42; =.01, and microvascular invasion (Odds Ratio=4.82; 95% C.I.=1.87–12.41; =.001 were predictors of lower RFS. Conclusions. Biological aggressiveness and preoperative tumor treatment, rather than traditional and expanded dimensional criteria, conditioned the outcomes in patients transplanted for HCC.

  5. Single Nucleotide Polymorphisms in STAT3 and STAT4 and Risk of Hepatocellular Carcinoma in Thai Patients with Chronic Hepatitis B.

    Science.gov (United States)

    Chanthra, Nawin; Payungporn, Sunchai; Chuaypen, Natthaya; Piratanantatavorn, Kesmanee; Pinjaroen, Nutcha; Poovorawan, Yong; Tangkijvanich, Pisit

    2015-01-01

    Hepatitis B virus (HBV) infection is the leading cause of hepatocellular carcinoma (HCC) development. Recent studies demonstrated that single nucleotide polymorphisms (SNPs) rs2293152 in signal transducer and activator of transcription 3 (STAT3) and rs7574865 in signal transducer and activator of transcription 4 (STAT4) are associated with chronic hepatitis B (CHB)-related HCC in the Chinese population. We hypothesized that these polymorphisms might be related to HCC susceptibility in Thai population as well. Study subjects were divided into 3 groups consisting of CHB-related HCC (n=192), CHB without HCC (n=200) and healthy controls (n=190). The studied SNPs were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results showed that the distribution of different genotypes for both polymorphisms were in Hardy-Weinberg equilibrium (P>0.05). Our data demonstrated positive association of rs7574865 with HCC risk when compared to healthy controls under an additive model (GG versus TT: odds ratio (OR) =2.07, 95% confidence interval (CI)=1.06-4.03, P=0.033). This correlation remained significant under allelic and recessive models (OR=1.46, 95% CI=1.09-1.96, P=0.012 and OR=1.71, 95% CI=1.13-2.59, P=0.011, respectively). However, no significant association between rs2293152 and HCC development was observed. These data suggest that SNP rs7574865 in STAT4 might contribute to progression to HCC in the Thai population.

  6. Elevated serum levels of Chromogranin A in hepatocellular carcinoma.

    Science.gov (United States)

    Biondi, Antonio; Malaguarnera, Giulia; Vacante, Marco; Berretta, Massimiliano; D'Agata, Velia; Malaguarnera, Michele; Basile, Francesco; Drago, Filippo; Bertino, Gaetano

    2012-01-01

    During the past three decades, the incidence of hepatocellular carcinoma in the United States has tripled. The neuroendocrine character has been observed in some tumor cells within some hepatocellular carcinoma nodules and elevated serum chromogranin A also been reported in patients with hepatocellular carcinoma. The aim of this work was to investigate the role of serum concentration of chromogranin A in patients with hepatocellular carcinoma at different stages. The study population consisted of 96 patients (63 males and 33 females age range 52-84) at their first hospital admission for hepatocellular carcinoma. The control group consisted of 35 volunteers (20 males and 15 females age range 50-80). The hepatocellular carcinoma patients were stratified according the Barcelona-Clinic Liver Cancer classification. Venous blood samples were collected before treatment from each patients before surgery, centrifuged to obtain serum samples and stored at -80° C until assayed. The chromogranin A serum levels were elevated (> 100 ng/ml) in 72/96 patients with hepatocellular carcinoma. The serum levels of chromogranin A were significantly correlated (p<0.05) with alpha-fetoprotein. In comparison with controls, the hepatocellular carcinoma patients showed a significant increase (p<0.001) vs controls. The chromogranin A levels in the Barcelona staging of hepatocellular carcinoma was higher in stage D compared to stage C (p<0.01), to stage B (p<0.001), and to stage A (p<0.001). Molecular markers, such as chromogranin A, could be very useful tools for hepatocellular carcinoma diagnosis. However the molecular classification should be incorporated into a staging scheme, which effectively separated patients into groups with homogeneous prognosis and response to treatment, and thus serves to aid in the selection of appropriate therapy.

  7. Detection of pulmonary nodules

    International Nuclear Information System (INIS)

    Vanzulli, A.; Zanello, A.; DelMaschio, M.; Paesano, P.; Panizza, P.; DelMaschio, A.

    1989-01-01

    The authors have prospectively studied 203 pulmonary nodules in 91 patients, selected by CT (gold standard), with both subtraction digital radiography (SDR) and conventional plain film. Subtracted images were obtained by using copper filter inserted between two photostimulable imaging plates. Five radiologists randomly analyzed all conventional and subtracted images. The authors calculated sensitivity, specificity, and positive and negative predictive values for both conventional radiography and SDR. Receiver operating characteristics (ROC) curves were calculated by plotting the number of nodules detected with different degrees of confidence. SDR detected 12% more nodules than conventional radiography. ROC curves demonstrated that the level of confidence was better for SDR (P <.05)

  8. Liver (Hepatocellular) Cancer Screening

    Science.gov (United States)

    ... Treatment Liver Cancer Prevention Liver Cancer Screening Research Liver (Hepatocellular) Cancer Screening (PDQ®)–Patient Version What is ... These are called diagnostic tests . General Information About Liver (Hepatocellular) Cancer Key Points Liver cancer is a ...

  9. Giant hepatocellular adenoma; case report

    Energy Technology Data Exchange (ETDEWEB)

    Pitella, F.A.; Coutinho, A.M.N.; Coura Filho, G.B.; Costa, P.L.A.; Ono, C.R.; Watanabe, T.; Sapienza, M.T.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Inst. de Radiologia. Servico de Medicina Nuclear

    2008-07-01

    Full text: Introduction: Hepatocellular adenoma is a benign hepatic tumor identified mainly in women during fertility age, with estimated incidence of 4/1000 inhabitants. It is usually unique, well circumscribed, with or without a capsule, size varying from 1 to 30 cm, with possible central areas of necrosis and hemorrhage. Case Report: A 37-year-old female patient presenting with no comorbities, use of hormonal birth control pills for 18 years, a condition of reduction in the consistency of feces, increase in number of daily defecations, abdominal cramps, and a stuffed sensation after meals for two years. A palpable abdominal mass extending from the right hypochondriac to the right iliac fossa was noticed four months ago. A computerized tomography (CT) showed an extensive hepatic mass on the right which was considered, within the diagnostic hypotheses, hepatic adenomatosis, without ruling out secondary lesions. A hepatic scintillography with {sup 99m}Tc-DISIDA showed an extensive exophytic area from segment V to the right iliac fossa with arterialized blood flow and hepatocytic activity, as well as a hepatic nodule in segment VII with hepatocytic activity consistent with the hepatic adenomas hypothesis. The biopsy confirmed the hepatic adenoma diagnosis and the patient was submitted to a partial hepatectomy and cholecystectomy with good clinical evolution. Conclusion: Nuclear Medicine may supplement the assessment of hepatic nodules, including giant masses, thus suggesting new hypotheses and direction to therapeutic conduct. (author)

  10. Examinations of Factors Influencing Survival of Liver Transplantation for Hepatocellular Carcinoma: A Single-Center Experience From Budapest.

    Science.gov (United States)

    Piros, L; Fehérvári, I; Görög, D; Nemes, B; Szabó, J; Gerlei, Z; Végső, G; Kóbori, L; Máthé, Z

    2015-09-01

    Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide. Orthotopic liver transplantation (OLT) is the best therapy of choice for early, unresectable HCC. The Hungarian Liver Transplantation Program was launched in 1995 at the Department of Transplantation and Surgery, Semmelweis University, Budapest. From that time more than 60 patients underwent OLT for hepatic tumors, which in most cases were HCC. Our clinical examination was undertaken to analyze the possible influential factors of outcomes for our series of patients who received OLT for HCC. We performed a review of all patients who underwent OLT for HCC at our department from 1996 to October 1, 2013. Disease extent was determined by preoperative computed tomography or magnetic resonance images. All explants were examined and categorized based on tumor number, size, distribution, HCC histologic grade, and vascular invasion. Patients with HCC were classified as having tumors either meeting Milan criteria, beyond Milan criteria but within UCSF criteria, or exceeding UCSF criteria. OLT was performed using standard techniques including orthotopic implantation with cross-clamp technique or with the piggyback technique. Postoperative immunosuppression included a triple drug regimen of calcineurin inhibitor (CNI), mycophenolate mofetil (MMF), and prednisone. mTOR inhibitors have been available since 2004. HCC most commonly occurs in the presence of cirrhosis as a result of longstanding chronic liver disease. Most of our patients who underwent OLT for HCC are 56 to 60 years old, and most also had underlying HCV cirrhosis. As of October 1, 2013, 21 of 49 (42.85%) patients had died after OLT for HCC. The main cause was the recurrence of the HCC in 38%, followed by sepsis in 33%, and HCV recurrence in 19%. One death each (4.7% of the total number of deaths) was caused by primary nonfunction of the graft, acute myocardial infarct, and de novo malignancy, respectively. Overall

  11. Angiogenesis in hepatocellular carcinoma: correlation of single-level dynamic spiral CT scans in arterial phase and expression of α-smooth muscle actin

    International Nuclear Information System (INIS)

    Liu Yan; Min Pengqiu; Chen Weixia; Zhang Lin

    2005-01-01

    Objective: To investigate the correlation between the single-level dynamic spiral CT scans (SDCT) of hepatocellular carcinoma (HCC) in arterial phase (AP) and the immunohistochemistry expression of α-smooth muscle actin (ASMA). Methods: 33 cases of suspected HCC undergoing spiral CT plain scan of the whole liver, the single-level dynamic scan of the target level of lesion in AP and finally the whole liver scan in portal-venous phase before operations and proved after were included into the study. After the SDCT, a time-density curve (T-DC) was drawn according to the density change of the region of interest (ROI) of the tumor parenchyma with some parameters calculated, and signs of enhancement evaluated. Slices of post-operation specimen underwent hemotoxylin-eosin (HE) and ASMA immunohistochemistry staining. Then the slices were evaluated with emphases on the ASMA-positive neovasculatures in the parenchyma and mesenchyma of carcinomas, and the average count in a low microscopic field (x 100) was recorded (5 low microscopic field were observed and then an average was calculated.). Finally the immunohistochemistry and histologic results were correlated with image findings. Results: According to the PV of the tumor parenchyma, T-DC was divided into type I, II and III in which the criteria were PV>80, 40 HU< PV< 80 HU and PV<40 HU respectively. In the 33 cases, type I, II and III of T-DC were 3, 17 and 13 cases with PV of 103.30, 57.65 and 33.55 HU respectively. In ASMA immunohistochemistry study, ASMA-positive neovasculatures were devided into type A with a thick wall and B with a thin wall. The mean count of neovasculatures of tumor parenchyma in type I, II and III of T-DC were 10, 4.59 and 1 respectively. Statistically, different types of T-DC were significantly correlated with the count of neovasculatures in the parenchyma of carcinomas (r=-0.567, P<0.01). Homogeneous and inhomogeneous enhancement of carcinomas during SDCT in AP were correlated with the

  12. 3D Quantitative tumour burden analysis in patients with hepatocellular carcinoma before TACE: comparing single-lesion vs. multi-lesion imaging biomarkers as predictors of patient survival

    International Nuclear Information System (INIS)

    Fleckenstein, Florian N.; Schernthaner, Ruediger E.; Duran, Rafael; Sohn, Jae Ho; Sahu, Sonia; Zhao, Yan; Hamm, Bernd; Gebauer, Bernhard; Lin, MingDe; Geschwind, Jean-Francois; Chapiro, Julius

    2016-01-01

    To compare the ability of single- vs. multi-lesion assessment on baseline MRI using 1D- and 3D-based measurements to predict overall survival (OS) in patients with hepatocellular carcinoma (HCC) before transarterial chemoembolization (TACE). This retrospective analysis included 122 patients. A quantitative 3D analysis was performed on baseline MRI to calculate enhancing tumour volume (ETV [cm 3 ]) and enhancing tumour burden (ETB [%]) (ratio between ETV [cm 3 ] and liver volume). Furthermore, enhancing and overall tumour diameters were measured. Patients were stratified into two groups using thresholds derived from the BCLC staging system. Statistical analysis included Kaplan-Meier plots, uni- and multivariate cox proportional hazard ratios (HR) and concordances. All methods achieved good separation of the survival curves (p < 0.05). Multivariate analysis showed an HR of 5.2 (95 % CI 3.1-8.8, p < 0.001) for ETV [cm 3 ] and HR 6.6 (95 % CI 3.7-11.5, p < 0.001) for ETB [%] vs. HR 2.6 (95 % CI 1.2-5.6, p = 0.012) for overall diameter and HR 3.0 (95 % CI 1.5-6.3, p = 0.003) for enhancing diameter. Concordances were highest for ETB [%], with no added predictive power for multi-lesion assessment (difference between concordances not significant). 3D quantitative assessment is a stronger predictor of survival as compared to diameter-based measurements. Assessing multiple lesions provides no substantial improvement in predicting OS than evaluating the dominant lesion alone. (orig.)

  13. Fusariosis as solitary pulmonary nodule

    International Nuclear Information System (INIS)

    Moreno, Nelson; Saavedra R, Alfredo; Sanchez Edgar A

    2008-01-01

    Invasive fungal infections are common cause of morbidity and mortality in immunocompromised patients. Of these the most frequents are: aspergillosis and Fusariosis, both grouped under the term Hyalohyphomycosis. One of the organs most commonly affected is the lung.Unfortunately the clinical manifestations as cough, pain and bleeding pleuritic such are none specific. The chest Rx may show since alveolar infiltration, or nodular lesions until cavitaciones. This is the first report on Colombia of a single pulmonary nodule by Fusarium fungi in an immunocompetent patient.

  14. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Park, Chang Min; Song, Yong Sub; Kim, Hyungjin; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kim, Young Tae [Seoul National University College of Medicine, Department of Thoracic and Cardiovascular Surgery, Seoul (Korea, Republic of); Park, Young Sik [Seoul National University Hospital, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Internal Medicine, Seoul (Korea, Republic of)

    2017-12-15

    To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. (orig.)

  15. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital

    International Nuclear Information System (INIS)

    Lee, Sang Min; Park, Chang Min; Song, Yong Sub; Kim, Hyungjin; Goo, Jin Mo; Kim, Young Tae; Park, Young Sik

    2017-01-01

    To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. (orig.)

  16. Edmondson-Steiner grade: A crucial predictor of recurrence and survival in hepatocellular carcinoma without microvascular invasio.

    Science.gov (United States)

    Zhou, Li; Rui, Jing-An; Zhou, Wei-Xun; Wang, Shao-Bin; Chen, Shu-Guang; Qu, Qiang

    2017-07-01

    Microvascular invasion (MVI), an important pathologic parameter, has been proven to be a powerful predictor of long-term prognosis in hepatocellular carcinoma (HCC). However, prognostic factors in HCC without MVI remain unknown. The present study aimed to identify the risk factors of recurrence and poor post-resectional survival in this type of HCC. A total of 109 patients with MVI-absent HCC underwent radical hepatectomy were enrolled. The influence of clinicopathologic variables on recurrence and patient survival was assessed using univariate and multivariate analyses. Chi-square test found that Edmondson-Steiner grade and satellite nodule were significantly associated with recurrence, while the former was the single marker for early recurrence. Stepwise logistic regression analysis demonstrated the independent predictive role of Edmondson-Steiner grade for recurrence. On the other hand, Edmondson-Steiner grade, serum AFP level and satellite nodule were significant for overall and disease-free survival in univariate analysis, whereas tumor size was linked to disease-free survival. Of the variables, Edmondson-Steiner grade, serum AFP level and satellite nodule were independent indicators. Edmondson-Steiner grade, a histological classification, carries robust prognostic implications for all the endpoints for prognosis, thus being potential to be a crucial prognosticator in HCC without MVI. Copyright © 2017 Elsevier GmbH. All rights reserved.

  17. Study on Association between Single Nucleotide Polymorphisms in Murine Double Minute 2 and Susceptibility of Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Xia Wang

    2014-03-01

    Full Text Available Objective: To investigate the relationship between single nucleotide polymorphisms (SNP in murine double minute 2 (MDM2 and susceptibility and biological behavior of hepatocellularcarcinoma (HCC. Methods: MDM2 (rs2279744 site polymorphism in peripheral blood from 166 patients with HCC and 157 healthy controls were detected by SYBR GREEN PCR method and the relationship between MDM2 polymorphism and susceptibility and biological behavior of HCC was analyzed by comparing the differences of genotypes in two populations. Results: There was no statistical significance between two groups in terms of MDM2 allele distribution in research population (P = 0.753. The risk of HCC onset in individuals with GG+ TG genotype was 1.698 times of those with TT genotype in case group (95%CI = 1.027 -2.808. MDM2 SNP was associated with HBV infection and the degree of tumor differentiation (P< 0.05. The incidence of alleles in experimental group (T, 0.49; G, 0.51 was very different from that in control group (T, 0.59; G, 0.41 (P = 0.015. The incidence of GG genotype in patients with HCC (22.29% was significantly higher than those without HCC (13.38%. Compared with TT genotype, G allele or GG genotype had more correlation with HCC onset. Conclusion: Compared with TT genotype, MDM2 promoter SNP309 G allele or GG genotype is more associated with HCC onset in Chinese population.

  18. Computerized detection of lung nodules in digital chest radiographs

    International Nuclear Information System (INIS)

    Giger, M.L.; Doi, K.; MacMahon, H.

    1987-01-01

    Detection of cancerous lung nodules in chest radiographs is one of the more important tasks performed by a radiologist. In addition, the ''miss rate'' associated with the radiographic detection of lung nodules is approximately 30%. A computerized scheme that alerts the radiologist to possible locations of lung nodules should allow this number of false-negative diagnoses to be reduced. The authors are developing a computer-aided nodule detection scheme based on a difference image approach. They attempt to eliminate the camouflaging background structure of the normal lung anatomy by creating, from a single-projection chest image, two images: one in which the signal-to-noise ratio (SNR) of the nodule is maximized and another in which that SNR is suppressed while the processed background remains essentially the same. Thus, the difference between these two processed images should consist of the nodule superimposed on a relatively uniform background in which the detection task may be simplified. This difference image approach is fundamentally different from conventional subtraction techniques (e.g., temporal or dual-energy subtraction) in that the two images which are subtracted arise from the same single-projection chest radiograph. Once the difference image is obtained, thresholding is performed along with tests for circularity, size and growth in order to extract the nodules. It should be noted that once an original chest image is input to the computer the nodule detection process is totally automated

  19. Risk factors for the leakage of chemotherapeutic agents into systemic circulation after transcatheter arterial chemoembolization of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Ming-Yen Hsieh

    2011-10-01

    Full Text Available This prospective study was to investigate the possible risk factors for the leakage of chemotherapeutic agent into the systemic circulation after transcatheter arterial chemoembolization (TACE of hepatocellular carcinoma (HCC. Peripheral plasma concentrations of chemotherapeutic agents were determined at 1 hour and 72 hours after TACE by high-performance liquid chromatography in 53 patients. HCC were divided into three types namely single nodule (<5 cm, multiple nodules (all <5 cm, and main nodule measuring 5 cm or more. Forty-four patients (83% showed detectable chemotherapeutic concentrations within 72 hours after TACE. Patients with single nodular-type HCC had lower incidence of detectable plasma chemotherapeutic agents after TACE than the other two groups (all p<0.05. The injected doses of lipiodol, epirubicin, and mitomycin C were lower in patients without detection than in patients with detectable chemotherapeutic agents (all p<0.05. Multivariate logistic regression showed that tumor type and injected dose of lipiodol were two independent risk factors for the leakage of mitomycin C at 1 hour after TACE (all p<0.05, and the injected dose of mitomycin C was the risk factor for the leakage of epirubicin at 1 hour after TACE (p<0.05. In conclusion, multiple nodular type and large nodule measuring 5 cm or more have a risk of leakage of mitomycin C after TACE. Injected dose of lipiodol and mitomycin C as risk factor for the leakage of mitomycin C and epirubicin respectively may be because of competition of their injected volume within the limited space of target.

  20. Nodules size: An important factor in nodule mining?

    Digital Repository Service at National Institute of Oceanography (India)

    Valsangkar, A.B.

    A study of about 850 different sized nodules from 234 sites in the Central Indian Basin (CIB) showed a clear inverse relationship between size and grade of nodules. Among the different sized nodules, only the small (less than 2 cm) and medium (2...

  1. Computed tomography of pulmonary nodules

    International Nuclear Information System (INIS)

    Nakata, Hajime; Honda, Hiroshi; Nakayama, Chikashi; Kimoto, Tatsuya; Nakayama, Takashi

    1983-01-01

    We have evaluated the value of computed tomography (CT) in distinguishing benign and malignant pulmonary nodules. CT was performed on 30 cases of solitary pulmonary nodules consisting of 17 primary lung cancers, 3 metastatic tumors and 10 benign nodules. The CT number was calculated for each lesion. Three benign nodules showed CT numbers well above the range of malignant nodules, and only in one of them was calcification visible on conventional tomography. In 6 benign nodules, the CT numbers overlapped those of malignant lesion and could not be differentiated. Thus the measurement of CT number can be useful to confirm the benign nature of certain nodules when calcification is unclear or not visible on conventional tomography. As for the morphological observation of the nodule, CT was not superior to conventional tomography and its value seems to be limited. (author)

  2. Clinical utility of imaging for evaluation of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Murakami T

    2014-07-01

    Full Text Available Takamichi Murakami,1 Masakatsu Tsurusaki,1 Tomoko Hyodo,1 Yasuharu Imai2 1Department of Radiology, Kinki University Faculty of Medicine, 2Department of Hepatology and Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan Abstract: The hemodynamics of a hepatocellular nodule is the most important imaging parameter used to characterize various hepatocellular nodules in liver cirrhosis, because sequential changes occur in the feeding vessels and hemodynamic status during hepatocarcinogenesis. Therefore, the imaging criteria for hepatocellular carcinoma (HCC are also usually based on vascular findings, eg, early arterial uptake followed by washout in the portal venous and equilibrium phases. Contrast-enhanced ultrasonography, dynamic multidetector-row computed tomography (MDCT, and dynamic magnetic resonance (MR imaging with gadopentetate dimeglumine (Gd-DTPA are useful for detecting hypervascular HCC on the basis of vascular criteria but are not as useful for hypovascular HCC. Contrast-enhanced MR imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA, a hepatocyte-specific MR contrast agent, is superior to dynamic MDCT and dynamic MR imaging with Gd-DTPA in detecting both hypervascular and hypovascular HCC. Moreover, Gd-EOB-DTPA-enhanced MR imaging can display each histologically differentiated HCC as hypointense relative to the liver parenchyma. 18F-fluorodeoxyglucose positron emission tomography imaging might not be suitable for the screening and detection of HCC, given its lower diagnostic performance. However, this technique plays an important role in determining whether HCC has spread beyond the liver. Keywords: hepatocellular carcinoma, evaluation, imaging, clinical utility

  3. Diagnostic Value of Early-Phase-Enhanced Computed Tomography for the Differentiation of Pulmonary Metastases from Hepatocellular Carcinoma and Primary Lung Cancer

    International Nuclear Information System (INIS)

    Choi, Joon-Il; Jung, Dae Chul; Kim, Min-Ju; Hong, Eun Kyung; Park, Joong-Won; Kim, Chang-Min; Choi, Hyuck Jae; Jang, Yun-Jin

    2009-01-01

    Background: The lung is the most common site of distant metastases from hepatocellular carcinoma. Correct differentiation between metastatic hepatocellular carcinoma of the lung and primary lung cancer is sometimes difficult without biopsy. Purpose: To evaluate the usefulness of measuring the attenuations of pulmonary nodules on early-phase contrast-enhanced computed tomography (CT) for the differentiation of pulmonary metastases from hepatocellular carcinoma and primary lung cancer. Material and Methods: Thirteen patients with pulmonary metastases from hepatocellular carcinoma (nine men, four women; age 53.9±14.2 years, range 16-70 years) and 25 patients with primary lung cancer (14 men, 11 women; age 62.2±9.4 years, range 43-72 years) were retrospectively evaluated. Contrast-enhanced scans were obtained 35 s after commencing intravenous injection of contrast medium. Attenuation values and the size of the pulmonary nodules were measured on contrast-enhanced CT scans. CT and clinical features were analyzed with regard to age, sex, body surface area of the patients, the attenuation values and size of the nodules, and CT machines using univariate analysis (Fisher's exact test for binary data sets and the Mann-Whitney U test for continuous data sets). Multiple linear regression analysis was used to eliminate confounding factors. Results: The mean attenuation value of metastatic pulmonary nodules from hepatocellular carcinoma (75.7±24.9 HU) was higher than that of primary lung cancer nodules (45.8±14.4 HU) (P<0.01). Other variables such as age, sex, body surface area of the patients, CT device, and nodule size were not significant variables on multiple regression analysis. When a cut-off value of 75 HU was applied, the positive predictive value for diagnosing metastatic nodules from hepatocellular carcinoma was 100%. Conclusion: Pending confirmation in a large study, our findings suggest that there is a difference in contrast enhancement between pulmonary

  4. Vasculature surrounding a nodule: A novel lung cancer biomarker.

    Science.gov (United States)

    Wang, Xiaohua; Leader, Joseph K; Wang, Renwei; Wilson, David; Herman, James; Yuan, Jian-Min; Pu, Jiantao

    2017-12-01

    To investigate whether the vessels surrounding a nodule depicted on non-contrast, low-dose computed tomography (LDCT) can discriminate benign and malignant screen detected nodules. We collected a dataset consisting of LDCT scans acquired on 100 subjects from the Pittsburgh Lung Screening study (PLuSS). Fifty subjects were diagnosed with lung cancer and 50 subjects had suspicious nodules later proven benign. For the lung cancer cases, the location of the malignant nodule in the LDCT scans was known; while for the benign cases, the largest nodule in the LDCT scan was used in the analysis. A computer algorithm was developed to identify surrounding vessels and quantify the number and volume of vessels that were connected or near the nodule. A nonparametric receiver operating characteristic (ROC) analysis was performed based on a single nodule per subject to assess the discriminability of the surrounding vessels to provide a lung cancer diagnosis. Odds ratio (OR) were computed to determine the probability of a nodule being lung cancer based on the vessel features. The areas under the ROC curves (AUCs) for vessel count and vessel volume were 0.722 (95% CI=0.616-0.811, plung cancer group 9.7 (±9.6) compared to the non-lung cancer group 4.0 (±4.3) CONCLUSION: Our preliminary results showed that malignant nodules are often surrounded by more vessels compared to benign nodules, suggesting that the surrounding vessel characteristics could serve as lung cancer biomarker for indeterminate nodules detected during LDCT lung cancer screening using only the information collected during the initial visit. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Diffusion-weighted MR imaging of thyroid nodules

    International Nuclear Information System (INIS)

    Bozgeyik, Zulkif; Coskun, Sonay; Ogur, Erkin; Dagli, A.F.; Ozkan, Yusuf; Sahpaz, Fatih

    2009-01-01

    The purpose of our study was to determine the diagnostic role of diffusion-weighted imaging (DWI) in the differentiating of malignant and benign thyroid nodules by using fine needle aspiration biopsy cytology criteria as a reference standard. The apparent diffusion coefficient (ADC) values of the normal-looking thyroid parenchyma were also evaluated both in normal patients and in patients with nodules. Between March 2007 and February 2008, 76 consecutive patients with ultrasound-diagnosed thyroid nodules and 20 healthy subjects underwent diffusion-weighted MR imaging by using single-shot spin echo, echo planar imaging. A total of 93 nodules were included in the study using the following b factors 100, 200, and 300 mm 2 /s. ADC values of thyroid nodules and normal area in all subjects were calculated and compared using suitable statistical analysis. Mean ADC values for malignant and benign nodules were 0.96±0.65 x 10 -3 and 3.06±0.71 x 10 -3 mm 2 /s. for b-300 factor, 0.56±0.43 x 10 -3 and 1.80±0.60 x 10 -3 mm 2 /s for b-200, and 0.30±0.20 x 10 -3 and 1.15±0.43 x 10 -3 mm 2 /s, for b-300, respectively. Mean ADC values of malignant nodules were lower than benign nodules. There were significant differences in ADC values between benign and malignant nodules. ADC values among normal-appearing thyroid parenchyma of patients and normal-appearing thyroid parenchyma of healthy subjects were insignificant at all b factors. Benign nodules have higher ADC values than malignant ones. DWI may be helpful in differentiating malign and benign thyroid nodules. (orig.)

  6. Hepatocellular Carcinoma Supplied From the Short Gastric Artery: Treatment With Chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Ung Bae, E-mail: junwb73@pnuyh.co.kr; Lee, Jun Woo, E-mail: jwlee@pusan.ac.kr; Baik, Seung Kug, E-mail: skbaik9@gmail.com; Kim, Tae Un, E-mail: kimtaeun78@hanmail.net; Choo, Ki Seok, E-mail: kschoo0618@naver.com; Kim, Kun Il, E-mail: kikim@pusan.ac.kr; Kim, Yong-Woo, E-mail: kyw47914@yahoo.co.kr; Moon, Tae-Yong, E-mail: tymn@pusan.ac.kr [Pusan National University Yangsan Hospital, Department of Radiology (Korea, Republic of)

    2012-12-15

    We report a case of transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) that was supplied by the short gastric artery. A 67-year-old woman with two nodular HCCs underwent repeated TACE. One of the nodules was supplied by the short gastric artery.

  7. Hepatocellular Carcinoma Supplied From the Short Gastric Artery: Treatment With Chemoembolization

    International Nuclear Information System (INIS)

    Jeon, Ung Bae; Lee, Jun Woo; Baik, Seung Kug; Kim, Tae Un; Choo, Ki Seok; Kim, Kun Il; Kim, Yong-Woo; Moon, Tae-Yong

    2012-01-01

    We report a case of transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) that was supplied by the short gastric artery. A 67-year-old woman with two nodular HCCs underwent repeated TACE. One of the nodules was supplied by the short gastric artery.

  8. Cold thyroid nodules show a marked increase in proliferation markers.

    Science.gov (United States)

    Krohn, Knut; Stricker, Ingo; Emmrich, Peter; Paschke, Ralf

    2003-06-01

    Thyroid follicular adenomas and adenomatous thyroid nodules are a frequent finding in geographical areas with iodine deficiency. They occur as hypofunctioning (scintigraphically cold) or hyperfunctioning (scintigraphically hot) nodules. Their predominant clonal origin suggests that they result from clonal expansion of a single cell, which is very likely the result of a prolonged increase in proliferation compared with non-affected surrounding cells. To test whether increased cell proliferation is detectable in cold thyroid nodules, we studied paraffin-embedded tissue from 40 cold thyroid nodules and their surrounding normal thyroid tissue for the occurrence of the proliferating cell nuclear antigen (PCNA) and Ki-67 (MIB-1 antibody) epitopes as markers for cell proliferation. All 40 thyroid nodules were histologically well characterized and have been studied for molecular characteristics before. The labeling index (number of labeled cells versus total cell number) for nodular and surrounding tissue was calculated. In 33 cold thyroid nodules a significant (p thyroid nodules a significant (p thyroid epithelial cell proliferation is a uniform feature common to most cold nodules. However, the increase of proliferation markers shows a heterogeneity that is not correlated with histopathologic, molecular, or clinical characteristics.

  9. Efficacy and safety of sorafenib in combination with gemcitabine in patients with advanced hepatocellular carcinoma: a multicenter, open-label, single-arm phase II study.

    Science.gov (United States)

    Srimuninnimit, Vichien; Sriuranpong, Virote; Suwanvecho, Suthida

    2014-09-01

    Currently, the only standard systemic treatment for advanced hepatocellular carcinoma is sorafenib monotherapy. The study was conducted to assess the efficacy and safety of the novel combination of sorafenib and gemcitabine in the treatment of advanced hepatocellular carcinoma. Between March 2008 and October 2010, patients with advanced pathologically proven hepatocellular carcinoma who had not received previous systemic therapy and had Child-Pugh liver function class A or B received sorafenib plus gemcitabine. Treatment included 4-week cycle of gemcitabine (1000 mg/m(2) days 1, 8, 15) to the maximum of six cycles together with sorafenib (400 mg twice daily). Patient continued sorafenib until disease progression or withdrawal from other reasons. The primary end point is progression-free survival. Forty-five patients were enrolled in this study. The median progression-free survival was 3.7 months (95% CI 3.5-3.8). The overall response rate was 4% with no complete responses and the disease control rate was 66%. The median overall survival (OS) was 11.6 months (95% CI 7.4-15.9). The median time to progression was 3.6 months (95% CI 3.4-3.7). The most frequently reported grade 3/4 treatment-related adverse events included thrombocytopenia 33%, neutropenia 16% and hand-foot skin reaction 13%. The study regimen was well tolerated. The combination of sorafenib and gemcitabine in advanced hepatocellular carcinoma is generally well tolerated and has modest clinical efficacy. The median OS is up to 1 year. However, well-designed randomized controlled trials with a sorafenib alone comparator arm are needed to confirm this finding. © 2014 Wiley Publishing Asia Pty Ltd.

  10. Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation

    International Nuclear Information System (INIS)

    Pompili, Maurizio; Pacella, Claudio Maurizio; Francica, Giampiero; Angelico, Mario; Tisone, Giuseppe; Craboledda, Paolo; Nicolardi, Erica; Rapaccini, Gian Ludovico; Gasbarrini, Giovanni

    2010-01-01

    Objective: The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. Materials and methods: The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. Results: No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. Conclusion: In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.

  11. Qualitative diagnosis of small hepatocellular carcinoma by MRI

    International Nuclear Information System (INIS)

    Inoue, Etsuo; Kuroda, Chikazumi; Fujita, Makoto

    1994-01-01

    This study evaluated the usefulness of magnetic resonance imaging (MRI) in the qualitative diagnosis of small hepatocellular carcinoma (HCC). A total of 20 nodules were examined in 18 patients who had HCC 2 cm or less in diameter. Pathological examination classified them into two groups: homogeneous lesions (n=14: grade I, 5; grade I+II, 3; grade III, 4; grade II+III, 2) and heterogeneous lesions (n=6). T1-weighted imaging in the group of homogeneous lesions revealed a higher signal intensity in HCC nodules of grade I than the surrounding hepatic tissue and various signal intensities in those of the other grades. T2-weighted imaging, on the other hand, revealed iso-intensity in 4 nodules of grade I and hypo-intensity in the other; and hyper-intensity in all nodules of the other grades. In the group of heterogeneous lesions, 2 nodules (focal fatty change) were shown as mixed intensity on T1-weighted images and homogenous intensity on T2-weighted images. The other four nodules (grade II within grade I) were shown as homogenous intensity on T1-weighted images; one was shown as iso-intensity, two as hyper-intensity, and one as mixed intensity on T2-weighted images. The tumor-liver contrast and the contrast-to-noise ratio were significantly higher on T1-weighted images than on T2-weighted images in 5 HCC nodules of grade I. In the other nodules, including grade II or greater, on the contrary, these parameters were significantly higher on T2-weighted images than T1-weighted images. (N.K.)

  12. Usefulness of computed tomography in diagnosis of hepatocellular carcinoma with special reference to visualization of its capsule

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Y; Hirai, K; Nagasaki, Y [Kurume Univ., Fukuoka (Japan). School of Medicine; Sakami, T; Motokawa, M

    1981-05-01

    Diagnostic significance of computed tomography was studied in 45 cases with hepatocellular carcinoma. The diagnosis was correct in 95.6%, and in 66.6% of 21 cases with encapsulated hepatoma which shows expanding growth, its capsules were demonstrated by simple or contrast enhanced CT. Capsules surrounding tumor nodules were showed characteristic features; low density area by plain CT, and markedly enhanced high density or iso-density area around tumor nodules (called ''corona sign'') by contrast medium injection.

  13. Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis.

    Science.gov (United States)

    Kim, Tae Kyoung; Jang, Hyun-Jung

    2014-04-07

    Contrast-enhanced ultrasound (CEUS) using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis. CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography (CT) or magnetic resonance imaging (MRI) or as an initial diagnostic test for small newly detected liver nodules. CEUS has unique advantages over CT and MRI including no renal excretion of contrast, real-time imaging capability, and purely intravascular contrast. Hepatocellular carcinoma (HCC) is characterized by arterial-phase hypervascularity and later washout (negative enhancement). Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase. However, there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout. Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rim-like or diffuse hypervascularity followed by rapid washout. Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS. CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance. CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.

  14. Hepatocellular carcinoma: computed tomography assessment after invasive treatment

    International Nuclear Information System (INIS)

    Kozima, Shigeru; Larranaga, Nebil; Wulfson, Gabriela; Eisele, Guillermo; Ridruejo, Ezequiel; Mando, Oscar; Perazzo, Florencia

    2008-01-01

    Objective: To show the computed tomography (CT) usefulness after treatment with transcatheter arterial quimioembolization and radiofrequency ablation of hepatocellular carcinoma. Material and methods: In a period between march 2006 to april 2008 a total of 90 patient presenting 148 nodular lesions with diagnosis of hepatocellular carcinoma were controlled with triphasic CT. All the lesions were treated with minimally invasive procedure. For the treatment, the patients were classified in two groups following Milan criteria. The first group, constituted by 75 patients with 109 nodules, was treated with quimioembolization. The second group, of 15 patients with 25 nodules, was treated with radiofrequency ablation. In our population, a subgroup of 10 patients was treated with both methods. Results: Of 90 patients after CT control on a month, 3 months and for each 3 months during 2 years, on 63 cases (70%) was observed homogeneous accumulation of iodized oil, partial defect without enhancement or absence of enhancement on treated lesions. In these patients a new treatment after initial one was not performed. The remaining 27 patients (30%) underwent new treatment because we founded partial defect or absence of iodized oil with enhancement or peripheral enhancement on arterial phase in treated lesions. In this last group, 16 treated patients (17.7%) had new nodular enhancement on the remaining hepatic parenquimal. Conclusion: The CT unenhanced and the arterial phase on a month and for each 3 months, allow monitoring the effectiveness, residual disease and/or relapse of hepatocellular carcinoma after minimally invasive treatment. (authors) [es

  15. Qualitative ultrasound elastography assessment of benign thyroid nodules: Patterns and intra-observer acquisition variability

    International Nuclear Information System (INIS)

    Lacout, Alexis; Chevenet, Carole; Thariat, Juliette; Figl, Andrea; Marcy, Pierre-Yves

    2013-01-01

    To report and evaluate qualitative elastography patterns by using gray-scale and Doppler ultrasound (US) in patients presenting with benign thyroid nodules and to evaluate the reproducibility of US elastography examinations. Institutional review board approval was obtained, and all patients provided informed consent. Over a 3-month time period, all consecutive adult patients were referred to our institution to undergo a thyroid nodule fine-needle aspiration biopsy (FNAB) procedure. Patients presenting with benign cytology according to the Bethesda 2008 classification were prospectively enrolled in the study. Each thyroid nodule was assessed by using gray-scale, Doppler US, and elastography acquisitions by a single operator (A. L.). Multiple elastography acquisitions per thyroid nodule were performed and elastography scorings of the nodules were compared with each other. Nineteen patients (16 women and 3 men, mean age 58 years) with 22 thyroid nodules were included in the present study. Elastographic patterns 1, 2, and 3 were reported (23% nodules showed pattern 3). The elastography pattern showed a strong variability in 13 nodules (59%). The elastography acquisition result variability involved the “malignant” pattern 3 in 36% of cases. Almost one-third of benign thyroid nodules displayed pattern 3 on qualitative US elastography. The intra-observer variability of the benign thyroid elastography scoring is wide, thus limiting the thyroid nodule US examination accuracy. In FNAB-proven benign thyroid nodules, elastography pattern 3 is frequent and cannot be used as a strong indicator of thyroid malignancy

  16. Radiosensitivity of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hennequin, C.; Quero, L.; Rivera, S.

    2011-01-01

    The frequency of hepatocellular carcinoma (HCC) is increasing in the western world and the role of radiotherapy is more and more discussed. Classically, hepatocellular carcinoma was considered as a radioresistant tumour: in fact, modern radio-biologic studies, performed on cell lines directly established from patients, showed that hepatocellular carcinoma has the same radiosensitivity than the other epithelial tumours. From clinical studies, its α/β ratio has been estimated to be around 15 Gy. Radiosensitivity of normal hepatic parenchyma is now well evaluated and some accurate NTCP models are available to guide hepatic irradiation. The biology of hepatocellular carcinoma is also better described: the combination of radiotherapy and targeted therapies will be a promising approach in the near future. (authors)

  17. Cryotherapy for hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Awad, Tahany; Thorlund, Kristian; Gluud, Christian

    2009-01-01

    BACKGROUND: Hepatocellular carcinoma is the most common primary malignant cancer of the liver. Evidence for the role of cryotherapy in the treatment of hepatocellular carcinoma is controversial. OBJECTIVES: The aim of this review is to evaluate the potential benefits and harms of cryotherapy...... for the treatment of hepatocellular carcinoma. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS until June 2009. We identified further studies by searching...... of benefit but included for the assessment of harm. Both severe and non-severe adverse events were reported, but the true nature and extent of harm was difficult to asses. AUTHORS' CONCLUSIONS: At present, there is no evidence to recommend or refute cryotherapy for patients with hepatocellular carcinoma...

  18. Multiphasic helical CT of hepatocellular carcinoma. Evaluation after chemo embolization

    International Nuclear Information System (INIS)

    Catalano, O.; Esposito, M.; Sandomenico, F.; Siani, A.; Nunziata, A.

    2000-01-01

    The main purpose of this work is to report the personal experience with addition of contrast-enhanced multiphase helical CT to unenhanced CT (Lipiodol CT) in the evaluation of patients with hepatocellular carcinoma treated with chemoembolization and to analyze the present role of oily agent CT. It has been retrospectively reviewed the examinations of 42 consecutive patients submitted to globla chemoembolization over a 2-year period. CT was performed 18-30 days after the treatment. The Lipiodol CT study was carried out with volume acquisitions. It has been considered as nodules all well-defined areas with dense oily agent uptake; uptake itself was classified as: 0=absent, I=lower tha 10% of the tumor volume; II=lower than 50%, III=50%, IV=homogeneous. Contrast-enhanced helical CT was performed with the 2-phase technique in 28 patients and with the 3-phase technique in 14; it has been considered as nodules all well-defined and relatively homogeneous areas with hyperattenuation in the arterial phase and hypo-isoattenuation in the portal and/or delayed phase, or with hypo-isoattenuation in the arterial phase and in the portal and/or delayed phase. Lipiodol CT permitted to recognize 65 nodules (1-5/patient, mean 1.5), namely 15 grade I, 21 grade II, 20 grade III and 9 grade IV. Multiphase CT identified 6 additional nodules in 5 patients, 5 hypervascular and 1 hypovascular, and better assessed the correct morphology and volume of grade I nodules. Only 4 of 6 nodules missed on Lipiodol CT showed oily agent uptake after a new chemoembolization session. Moreover after retreatment, carried out in 6 of 9 patients with grade I uptake (11 nodules in all), it has been found persistence of the grade I pattern in 5 nodules, grade II in 5, and grade III in 1. Lipiodol CT may miss liver nodules and underestimate the volume of nodules with poor uptake. Though Lipiodol CT should still be considered slightly more sensitive than multiphase CT, in the general opinion this technique has

  19. Imaging findings of mimickers of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Tae Kyoung Kim

    2015-12-01

    Full Text Available Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis.

  20. Diagnosis of small hepatocellular carcinoma by incremental dynamic CT

    International Nuclear Information System (INIS)

    Uchida, Masafumi; Kumabe, Tsutomu; Edamitsu, Osamu

    1993-01-01

    Thirty cases of pathologically confirmed small hepatocellular carcinoma were examined by Incremental Dynamic CT (ICT). ICT scanned the whole liver with single-breath-hold technique; therefore, effective early contrast enhancement could be obtained for diagnosis. Among the 30 tumors, 26 were detected. The detection rate was 87%. A high detection rate was obtained in tumors more than 20 mm in diameter. Twenty-two of 26 tumors could be diagnosed correctly. ICT examination was useful for detection of small hepatocellular carcinoma. (author)

  1. Computer-aided detection of lung nodules in digital chest radiographs

    International Nuclear Information System (INIS)

    Giger, M.L.; Doi, K.; MacMahon, H.M.

    1986-01-01

    The authors are developing an automated method to detect lung nodules by eliminating the ''camouflaging: effect of the lung background. In order to increase the conspicuity of the nodules, we created, from a single chest radiograph, two images: one in which the signal-to-noise ratio (S/N) of the nodule is maximized and another in which that S/N is suppressed. The difference between these two processed images was subjected to feature-extraction technique in order to isolate the nodules. The detection accuracy of the computer-aided detection scheme, as compared with unaided radiologists' performance, was determined using receiver operating characteristic curve analysis

  2. Complete response in 5 out of 38 patients with advanced hepatocellular carcinoma treated with stem cell differentiation stage factors: case reports from a single centre.

    Science.gov (United States)

    Livraghi, Tito; Ceriani, R; Palmisano, A; Pedicini, V; Pich, M G; Tommasini, M A; Torzilli, G

    2011-02-01

    Hepatocellular carcinoma (HCC) represents the third cause of cancer-related death. Because HCC is multi-centric with time, excluding the few transplanted patients, sooner or later it becomes untreatable with loco-regional therapies and, until some years ago, it was not responsive to systemic therapies. In 2005 a randomized trial indicated the efficacy of a product containing stem cell differentiation stage factors (SCDSF) taken from zebra fish embryos during the stage in which the totipotent stem cells are differentiating into the pluripotent adult stem cells. In such a trial the patients, with "intermediate" and "advanced" HCC according to BCLC/AASLD guidelines, presented benefit in terms of performance status (PS) and objective tumoral response, with some cases (2.4%) of complete response (CR). The aim of this cohort study is to report the experience of a tertiary referral center on the evidence of cases of CR in patients with "advanced" stage HCC treated with SCDSF as supportive care. CR was regarded as sustained disappearance of the neoplastic areas or blood supply therein, accompanied by normalization of AFP levels. Out of 49 patients consecutively recruited and retrospectively evaluated, 38 had "advanced" stage and 11 "terminal" stage. In 5 patients with "advanced" stage a sustained CR was reported (13.1%). Improvement on PS was obtained in 17 patients (34.6%). No side effects occurred. SCDSF treatment confirmed its efficacy in patients with "advanced" HCC, in terms of PS and tumoral response.

  3. Hyperfunctioning thyroid nodules in toxic multinodular goiter share activating thyrotropin receptor mutations with solitary toxic adenoma.

    Science.gov (United States)

    Tonacchera, M; Chiovato, L; Pinchera, A; Agretti, P; Fiore, E; Cetani, F; Rocchi, R; Viacava, P; Miccoli, P; Vitti, P

    1998-02-01

    Toxic multinodular goiter is a cause of nonautoimmune hyperthyroidism and is believed to differ in its nature and pathogenesis from toxic adenoma. Gain-of-function mutations of the TSH receptor gene have been identified as a cause of toxic adenoma. The pathogenesis at the molecular level of hyperfunctioning nodules in toxic multinodular goiter has yet not been reported. Six patients with a single hot nodule within a multinodular goiter and 11 patients with toxic thyroid adenoma were enrolled in our study. At histology five hyperfunctioning nodules in multinodular goiters showed the features of adenomas, and one was identified as a hyperplastic nodule. The entire exon 10 of the TSH receptor gene was directly sequenced after PCR amplification from genomic DNA obtained from surgical specimens. Functional studies of mutated receptors were performed in COS-7 cells. Five out of 6 (83%) hyperfunctioning nodules within toxic multinodular goiters harbored a TSH receptor mutation. A TSH receptor mutation was also evident in the hyperfunctioning nodule that at histology had the features of noncapsulated hyperplastic nodule. Among toxic adenomas, 8 out of 11 (72%) nodules harbored a TSH receptor mutation. All the mutations were heterozygotic and somatic. Nonfunctioning nodules, whether adenomas or hyperplastic nodules present in association with hyperfunctioning nodules in the same multinodular goiters, had no TSH receptor mutation. All the mutations identified had constitutive activity as assessed by cAMP production after expression in COS-7 cells. Hyperfunctioning thyroid nodules in multinodular goiters recognize the same pathogenetic event (TSH receptor mutation) as toxic adenoma. Other mechanisms are implicated in the growth of nonfunctioning thyroid nodules coexistent in the same gland.

  4. [Nodulation competitiveness of nodule bacteria: Genetic control and adaptive significance].

    Science.gov (United States)

    Onishchuk, O P; Vorobyov, N I; Provorov, N A

    2017-01-01

    The most recent data on the system of cmp (competitiveness) genes that determine the nodulation competitiveness of rhizobial strains, i.e., the ability to compete for nodule formation in leguminous plants, is analyzed. Three genetic approaches for the construction of economically valuable strains of rhizobia are proposed: the amplification of positive regulators of competitiveness, the inactivation of the negative regulators of this trait, and the introduction of efficient competitiveness factors into strains capable of active nitrogen fixation.

  5. Ring-Like Enhancement of Hepatocellular Carcinoma in Gadoxetic Acid-Enhanced Multiphasic Hepatic Arterial Phase Imaging With Differential Subsampling With Cartesian Ordering.

    Science.gov (United States)

    Ichikawa, Shintaro; Motosugi, Utaroh; Oishi, Naoki; Shimizu, Tatsuya; Wakayama, Tetsuya; Enomoto, Nobuyuki; Matsuda, Masanori; Onishi, Hiroshi

    2018-04-01

    The aim of this study was to evaluate the efficacy of multiphasic hepatic arterial phase (HAP) imaging using DISCO (differential subsampling with Cartesian ordering) in increasing the confidence of diagnosis of hepatocellular carcinoma (HCC). This retrospective study was approved by the institutional review board, and the requirement for informed patient consent was waived. Consecutive patients (from 2 study periods) with malignant liver nodules were examined by gadoxetic acid-enhanced magnetic resonance imaging using either multiphasic (6 phases; n = 135) or single (n = 230) HAP imaging, which revealed 519 liver nodules other than benign ones (HCC, 497; cholangiocarcinoma, 11; metastases, 10; and malignant lymphoma, 1). All nodules were scored in accordance with the Liver Imaging Reporting and Data System (LI-RADS v2014), with or without consideration of ring-like enhancement in multiphasic HAP images as a major feature. In the multiphasic HAP group, 178 of 191 HCCs were scored as LR-3 to LR-5 (3 [1.69%], 85 [47.8%], and 90 [50.6%], respectively). Upon considering ring-like enhancement in multiphasic HAP images as a major feature, 5 more HCCs were scored as LR-5 (95 [53.4%]), which was a significantly more confident diagnosis than that with single HAP images (295 of 306 HCCs scored as LR-3 to LR-5: 13 [4.41%], 147 [49.8%], and 135 [45.8%], respectively; P = 0.0296). There was no significant difference in false-positive or false-negative diagnoses between the multiphasic and single HAP groups (P = 0.8400 and 0.1043, respectively). Multiphasic HAP imaging can improve the confidence of diagnosis of HCCs in gadoxetic acid-enhanced magnetic resonance imaging.

  6. Hyperfunctioning thyroid nodules in children.

    Science.gov (United States)

    Abe, K; Konno, M; Sato, T; Matsuura, N

    1980-10-01

    We studied two cases of hyperfunctioning thyroid nodules in children. A 9-year-old girl and an 11-year-old girl had thyroid masses in otherwise nonpalpable thyroid glands. Scintiscan showed hyperfunctioning thyroid nodules. The former patient had elevated values for T4 and T3, and plasma thyrotropin (TSH) level failed to respond to stimulation with thyrotropin releasing hormone (TRH), whereas the latter patient had normal values for T4, and T3 and plasma TSH response to TRH was normal. After the surgical removal of nodules, scintiscan exhibited radioactivity in the contralateral lobe of the thyroid gland in the former and in the ectopic thyroid tissue in the latter. Results of microscopic examinations of thyroid nodules were consistent with adenomatous goiter.

  7. Do manganese nodules grow or dissolve after burial? Results from the Central Indian Ocean Basin

    Science.gov (United States)

    Pattan, J. N.; Parthiban, G.

    2007-07-01

    Fifty buried manganese nodules at different depth intervals were recovered in 12 sediment cores from the Central Indian Ocean Basin (CIOB). A maximum of 15 buried nodules were encountered in one sediment core (AAS-22/GC-07) and the deepest nodule was recovered at 5.50 m below seafloor in core AAS-04/GC-5A. Approximately 80% of the buried nodules are small in size (˜2 cm diameter) in contrast to the Atlantic Ocean and Peru Basin (Pacific Ocean) where the majority of the buried nodules are large, ˜8 cm and >6 cm, respectively. Buried nodule size decreases with core depth and this distribution appears to be similar to the phenomenon of "Brazil Nut Effect". Buried nodules exhibit both smooth and rough surface textures and are ellipsoidal, elongated, rounded, sub rounded, irregular and polynucleated. Buried nodules from siliceous ooze are enriched in Mn, Cu, Ni, Zn, Mo, Ga, V and Rb whereas those from red clay are enriched in Fe, Co, Ti, U, Th, Y, Cr, Nb and Rare Earth Elements (REE). Buried nodules from siliceous ooze suggest their formation under hydrogenetic, early digenetic and diagenetic processes whereas those from red clay are of hydrogenetic origin. REE are enriched more than 1.5 times in buried nodules from red clay compared to siliceous ooze. However, the mode of incorporation of REE into buried nodules from both sedimentary environments is by a single authigenic phase consisting of Fe-Ti-P. Shale-normalized REE patterns and Ce anomalies suggest that nodules from siliceous ooze formed under more oxidizing conditions than those from red clay. Nodules buried at depths between 1.5 and 2.5 m are diagenetic (Mn/Fe ratio 10-15), formed in highly oxic environments (large positive Ce anomalies) and record aeolian dust (high Eu anomalies). Chemical composition, surface texture and morphology of buried nodules are similar to those of surface nodules from the same basin. Furthermore, buried nodule compositions do not exhibit any distinct patterns within the core depth

  8. Multiple infarcted regenerative nodules in liver cirrhosis after decompensation of cirrhosis: a case series

    Directory of Open Access Journals (Sweden)

    Müllhaupt Beat

    2010-11-01

    Full Text Available Abstract Introduction Liver cirrhosis is a common disease with many known complications. Cirrhosis represents a clinical spectrum, ranging from asymptomatic liver disease to hepatic decompensation. Manifestations of hepatic decompensation include variceal bleeding, ascites, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma. There are reports about infarcted regenerative nodules in cirrhotic livers after gastrointestinal hemorrhage. Case presentation We report three Caucasian patients (one female and two male patients; ages: 52, 54 and 60 years with decompensated liver cirrhosis, who showed newly infarcted regenerative nodules at necropsy. Two of them suffered from gastric variceal bleeding. Histopathology showed extensive infarction in all three cases. Hemorrhage and inflammatory changes were also observed around the infarcted regenerative nodules. Conclusion These patients showed focal liver lesions, to be considered in the differential diagnosis of cirrhotic livers. Infarcted regenerative nodules may be underdiagnosed in patients with decompensation of cirrhosis. In order to differentiate these lesions from malignant tumors, serial imaging seems to be helpful. However, the main differential diagnosis should be an abscess. It is important to know the wide spectrum of image appearances of these lesions. Hypotension can lead to a reduction of portal and arterial liver flow. Since variceal bleeding or septic shock can induce hypotension - as observed in our patients - we conclude that this leads to infarction of such nodules.

  9. Is exposure to Agent Orange a risk factor for hepatocellular cancer?-A single-center retrospective study in the U.S. veteran population.

    Science.gov (United States)

    Krishnamurthy, Padmini; Hazratjee, Nyla; Opris, Dan; Agrawal, Sangeeta; Markert, Ronald

    2016-06-01

    Approximately 15% to 35% of those with chronic hepatitis C (CHC) related cirrhosis will develop hepatocellular cancer (HCC). With this burden increasing across the globe, identification of risk factors for HCC has become imperative. Exposure to Agent Orange has been implicated as a possible risk factor for liver cancer in a study from the Republic of Korea. However, there has been no study in U.S. veterans with CHC and cirrhosis that has evaluated exposure to Agent Orange as a risk factor for HCC. We conducted a retrospective study of U.S. military veterans diagnosed with CHC and cirrhosis over a period of 14 years to evaluate potential risk factors for HCC including exposure to Agent Orange. We retrospectively reviewed 390 patients with confirmed CHC-related cirrhosis between 2000 and 2013 and identified patients with HCC. We compared demographic, laboratory, and other clinical characteristics of patients with and without HCC. The mean age of the cohort was 51 years (SD =7.5), with the majority being male (98.5%). Seventy-nine of 390 (20.2%) patients developed HCC, diagnosed on average 8 (SD =4.8) years after diagnosis of CHC. Nearly half (49.4%) were Childs A, 40.5% were Childs B, and 10.1% were Childs C. HCC patients were more likely to be African American than non-HCC patients (40.5% vs. 25.4%, P=0.009) and to be addicted to alcohol (86.1% vs. 74.3%, P=0.027). A trend toward significance was seen in the HCC group for exposure to Agent Orange (16.5% vs. 10.0%, P=0.10) and smoking addiction (88.6% vs. 80.7%, P=0.10). Consequently, race, alcohol addiction, Agent Orange exposure, and smoking addiction were included in the multivariable logistic regression (MLR) analysis. Alcohol addiction [odds ratio (OR) =2.17; 95% confidence interval (CI), 1.07-4.43] and African American race (OR =2.07; 95% CI, 1.22-3.51) were found to be the only two definitive independent risk factors for HCC in our sample. African American race and alcohol addiction were independent risk

  10. Chondroitin sulfate iron colloid as MR contrast agent in differentiation between hepatocellular carcinoma and adenomatous hyperplasia

    Energy Technology Data Exchange (ETDEWEB)

    Suto, Y. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Kato, T. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Matsuo, T. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Kamba, M. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Shimatani, Y. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Ohuchi, Y. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Nakamura, K. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan)); Ohta, Y. (Department of Radiology, Tottori Univ. School of Medicine, Yonago (Japan))

    1993-05-01

    Using a 1.5 T MR imaging unit, T1- and T2-weighted images were obtained before and after i.v. administration of chondroitin sulfate iron colloid (CSIC) in order to differentiate hepatocellular carcinoma (n=20) from adenomatous hyperplasia without atypia (n=16). Differentiation was made from the tumor-liver contrast to noise ratio (CNR) and visual evaluation of the nodule, with reference to signal intensity relative to that of the surrounding liver. The CNR of adenomatous hyperplasia was on T1-weighted images significantly decreased after CSIC administration (p<0.01). On T2-weighted images, there was no significant difference in CNR after CSIC administration. On the other hand, the CNR of hepatocellular carcinoma was significantly increased after CSIC administration on both T1- and T2-weighted images (p<0.01). CSIC reflects intratumor reticuloendothelial cellular functions, and is therefore useful in differentiating hepatocellular carcinoma from adenomatous hyperplasia without atypia. (orig.).

  11. Micro CT based truth estimation of nodule volume

    Science.gov (United States)

    Kinnard, L. M.; Gavrielides, M. A.; Myers, K. J.; Zeng, R.; Whiting, B.; Lin-Gibson, S.; Petrick, N.

    2010-03-01

    With the advent of high-resolution CT, three-dimensional (3D) methods for nodule volumetry have been introduced, with the hope that such methods will be more accurate and consistent than currently used planar measures of size. However, the error associated with volume estimation methods still needs to be quantified. Volume estimation error is multi-faceted in the sense that there is variability associated with the patient, the software tool and the CT system. A primary goal of our current research efforts is to quantify the various sources of measurement error and, when possible, minimize their effects. In order to assess the bias of an estimate, the actual value, or "truth," must be known. In this work we investigate the reliability of micro CT to determine the "true" volume of synthetic nodules. The advantage of micro CT over other truthing methods is that it can provide both absolute volume and shape information in a single measurement. In the current study we compare micro CT volume truth to weight-density truth for spherical, elliptical, spiculated and lobulated nodules with diameters from 5 to 40 mm, and densities of -630 and +100 HU. The percent differences between micro CT and weight-density volume for -630 HU nodules range from [-21.7%, -0.6%] (mean= -11.9%) and the differences for +100 HU nodules range from [-0.9%, 3.0%] (mean=1.7%).

  12. Correlation between chondroitin sulfate iron colloid - enhanced MR imaging and the histological grade of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Suto, Y. [Dept. of Radiology, Tottori University School of Medcine, Yonago (Japan); Kodama, F. [Dept. of Radiology, Tottori University School of Medcine, Yonago (Japan); Kamba, M. [Dept. of Radiology, Tottori University School of Medcine, Yonago (Japan); Ohta, Y. [Dept. of Radiology, Tottori University School of Medcine, Yonago (Japan)

    1995-01-01

    The association between contrast enhancement by chondroitin sulfate iron colloid (CSIC) and the histological grade of hepatocellular carcinoma (HCC) was evaluated in 24 patients diagnosed by histological examination of surgical specimens (26 nodules: 11 well-differentiated and 15 poorly-moderately-differentiated nodules). In the well-differentiated HCC nodules, the tumor-liver contrast to noise ratio (CNR) was not significantly increased after i.v. CSIC injection on both T1-weighted and T2-weighted images. In the moderately-poorly-differentiated HCC, CNR was significantly increased after CSIC administration on both T1-weighted and T2-weighted images (p<0.01). MR imaging using CSIC may be useful for diagnosing the degree of HCC differentiation. (orig.).

  13. Correlation between chondroitin sulfate iron colloid - enhanced MR imaging and the histological grade of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Suto, Y.; Kodama, F.; Kamba, M.; Ohta, Y.

    1995-01-01

    The association between contrast enhancement by chondroitin sulfate iron colloid (CSIC) and the histological grade of hepatocellular carcinoma (HCC) was evaluated in 24 patients diagnosed by histological examination of surgical specimens (26 nodules: 11 well-differentiated and 15 poorly-moderately-differentiated nodules). In the well-differentiated HCC nodules, the tumor-liver contrast to noise ratio (CNR) was not significantly increased after i.v. CSIC injection on both T1-weighted and T2-weighted images. In the moderately-poorly-differentiated HCC, CNR was significantly increased after CSIC administration on both T1-weighted and T2-weighted images (p<0.01). MR imaging using CSIC may be useful for diagnosing the degree of HCC differentiation. (orig.)

  14. Dynamic CT of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Fujita, Nobuyuki; Shirato, Hiroki; Shinohara, Masahiro; Miyasaka, Kazuo; Morita, Yutaka; Irie, Goro

    1983-03-01

    We performed dynamic CT in 30 cases of hepatocellular carcinoma, and concluded as below. Detecting the stain in the early phase of the dynamic series, it is possible to make a diagnosis of hepatocellular carcinoma. The dynamic CT is effective in a case of small hepatocellular carcinoma in which it is difficult to gain an accurate diagnosis in the routine CT study. The dynamic CT is also effective in the differential diagnosis of hepatic lesions, as other hepatic lesions such as hemangioma and metastatic liver cancer show different patterns compared with hepatocellular carcinoma.

  15. Dynamic CT of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Fujita, Nobuyuki; Shirato, Hiroki; Shinohara, Masahiro; Miyasaka, Kazuo; Morita, Yutaka; Irie, Goro

    1983-01-01

    We performed dynamic CT in 30 cases of hepatocellular carcinoma, and concluded as below. 1 Decting the stain in the early phase of the dynamic series, it is possible to make a diagnosis of hepatocellular carcinoma. 2 The dinamic CT is effective in a case of small hepatocellular carcinoma in which it is difficult to gain an accurate diagnosis in the routine CT study. 3 The dynamic CT is also effective in the differential diagnosis of hepatic lesions, as other hepatic lesions such as hemangioma and metastatic liver cancer show different patterns compared with hepatocellular carcinoma. (author)

  16. Management of an incidentally discovered pulmonary nodule

    International Nuclear Information System (INIS)

    Beigelman-Aubry, Catherine; Hill, Catherine; Grenier, Philippe A.

    2007-01-01

    The incidental finding of a pulmonary nodule on computed tomography (CT) is becoming an increasingly frequent event. The discovery of such a nodule should evoke the possibility of a small bronchogenic carcinoma, for which excision is indicated without delay. However, invasive diagnostic procedures should be avoided in the case of a benign lesion. The objectives of this review article are: (1) to analyze the CT criteria defining benign nodules, nodules of high suspicion of malignancy and indeterminate nodules, (2) to analyze the diagnostic performances and limitations of complementary investigations requested to characterize indeterminate lung nodules, (3) to review the criteria permitting to assess the probability of malignancy of indeterminate nodules and (4) to report on the new guidelines provided by the Fleischner Society for the management of small indeterminate pulmonary nodules, according to their prior probability of malignancy. (orig.)

  17. Usefulness of high-resolution sonography for assessement of hepatocellular carcinoma in the transgenic mice expressing hepatitis B virus X-protein; A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Kwon-Ha; Park, Sung Hoon; Kim, Chang Guhn; Won, Jong Jin; Moon, Hyung Bae [Wonkwang Univ. School of Medicine, Iksan (Korea, Republic of); Yu, Dae Yeul [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    2000-11-01

    To determine the value of high resolution ultrasonography (US) for the detection of hepatocellular carcinoma in the HBx transgenic mice. Forty-two HBx transgenic mice aged 8-20 (mean, 14) months underwent high-resolution ultrasound using a 10-12 MHz linear transducer. US findings indication the presence or absence, number, size and echogenicity of each hepatic tumor were analyzed, and in addition, color or power Doppler US was used to analyse tumoral vascularity. In each animal, sacrificed less than five hours after US examination, sonographic and pathologic findings were correlated. On gross pathologic examination, 20 hepatocellular carcinomas measuring 1.5-15 (mean, 4.7) mm in diameter were found in 16 mice; US revealed that 17 of the tumors were homogeneous hypoechoic nodules. With regard to tumor detection, sensitivity was 85%, specificity 96%, positive predictive value 0.944, negative predictive value 0.897, and overall accuracy 90%. Doppler US revealed that in three nodules, intratumoral vessels were present. In the other 26 mice, gross examination showed that no mass was present; microscopically, however, four nodules measuring 0.3-1.2 mm were found in four of these animals. Tumoral vascularity detected by color Doppler US corresponded to the intratumoral vessel within the nodules. One peritoneal nodule, confirmed as a metastatic tumor, was found at the greater omentum. In HBx transgenic mice, high-resolution US is valuable for the detection of hepatocellular carcinoma.

  18. High intensity focused ultrasound (HIFU) therapy for local treatment of hepatocellular carcinoma: Role of partial rib resection

    International Nuclear Information System (INIS)

    Zhu Hui; Zhou Kun; Zhang Lian; Jin Chengbin; Peng Song; Yang Wei; Li Kequan; Su Haibing; Chen Wenzhi; Bai Jin; Wu Feng; Wang, Zhibiao

    2009-01-01

    Objective: It has long been known that high intensity focused ultrasound (HIFU) can kill tissue through coagulative necrosis. However, it is only in recent years that practical clinical applications are becoming possible. Since the ribs have strong reflections to ultrasonic beams, they may affect the deposition of ultrasound energy, decreasing the efficacy of HIFU treatment and increasing the chance of adverse events when the intra-abdominal tumours concealed by ribs are treated. The aim of this study was to evaluate the influence of partial rib resection on the efficacy and safety of HIFU treatment. Methods: This prospective study was approved by the ethics committee at Chongqing University of Medical Sciences. An informed consent form was obtained from each patient and family member. A total of 16 patients with hepatocellular carcinoma (HCC), consisting of 13 males and 3 females, were studied. All patients had the successful HIFU treatment. To create a better acoustic pathway for HIFU treatment, all of the 16 patients had the ribs that shield the tumour mass to be removed. Magnetic resonance imaging (MRI) was used to evaluate the efficacy of HIFU treatment. Results: Sixteen cases had 23 nodules, including 12 cases with a single nodule, 1 case with 2 nodules, 3 cases with 3 nodules. The mean diameter of tumours was 7.0 ± 2.1 cm (5-10 cm). According to TNM classification, 9 patients were diagnosed as stage II, 4 patients were stage III, and 3 patients were stage IV. Follow-up imaging showed an absence of tumour blood supply and shrinkage of all treated lesions. The survival rates at 1, 2, 3, 4, and 5 years were 100%, 83.3%, 69.4%, 55.6%, and 55.6%, respectively. No serious complications were observed in the patients treated with HIFU. Conclusion: Partial rib resection can create a better acoustic pathway of HIFU therapy. Even though it is an invasive treatment, this measure offers patients an improved prospect of complete tumour ablation when no other treatment is

  19. Host range, symbiotic effectiveness and nodulation competitiveness ...

    African Journals Online (AJOL)

    ERIC-PCR DNA fingerprinting patterns were used to identify the isolates occupying nodules. All the isolates nodulated cowpea, groundnut (Arachis hypogeae) and mungbean (Vigna radiata), but only AII-2-1, AII-3-4 and BIII-2-2 nodulated soybean (Glycine max). Apart from cowpea where all the isolates were effective, there ...

  20. Viral hepatitis and hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Juei-Low, Sung [ed.; National Taiwan University College of Medicine, Taipei (Republic of China Taiwan). Department of Internal Medicine; Ding-Shinn, Chen [ed.; National Taiwan University College of Medicine, Taipei (Republic of China Taiwan). Hepatitis Research Center National Taiwan University College of Medicine, Taipei (Republic of China Taiwan). Graduate Institute of Clinical Medicine

    1990-01-01

    Two papers in this volume are in INIS scope, respectively dealing with MRI in the study of viral hepatitis and hepatocellular carcinoma, and The use of {sup 131}I-labeled Lipidol in the diagnosis of hepato-cellular carcinoma. (H.W.). refs.; figs.; tabs.

  1. Viral hepatitis and hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Sung Juei-Low; Chen Ding-Shinn

    1990-01-01

    Two papers in this volume are in INIS scope, respectively dealing with MRI in the study of viral hepatitis and hepatocellular carcinoma, and The use of 131 I-labeled Lipidol in the diagnosis of hepato-cellular carcinoma. (H.W.). refs.; figs.; tabs

  2. Changes in tumor vascularity precede microbubble contrast accumulation deficit in the process of dedifferentiation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Maruyama, Hitoshi; Takahashi, Masanori; Ishibashi, Hiroyuki; Okabe, Shinichiro; Yoshikawa, Masaharu; Yokosuka, Osamu

    2010-01-01

    Purpose: To elucidate the changes in tumor vascularity and microbubble accumulation on contrast-enhanced sonograms, in relation to the dedifferentiation of hepatocellular carcinoma (HCC). Materials and methods: This prospective study enrolled 10 patients with histologically proven HCC (14.4-39.0 mm, 26.1 ± 7.4) showing nodule-in-nodule appearance upon contrast-enhanced computed tomography. Contrast-enhanced ultrasound was performed by harmonic imaging under a low mechanical index (0.22-0.25) during the vascular phase (agent injection to 1 min) and late phase (15 min) following the injection of Sonazoid TM (0.0075 ml/kg). Contrast enhancement in the inner and outer nodules was assessed in comparison with that in adjacent liver parenchyma as hyper-, iso-, or hypo-enhanced. Results: Vascular-phase enhancement of all 10 inner nodules was hyper-enhanced, and that of outer nodules was hyper-enhanced in 3, iso-enhanced in 2, and hypo-enhanced in 5. Late-phase enhancement of inner nodules was hypo-enhanced in 8 and iso-enhanced in 2. Furthermore, late-phase enhancement of outer nodules was iso-enhanced in the 7 lesions that showed iso- or hypo-enhancement in the vascular phase, and hypo-enhanced in the 3 with hyper-enhancement in the vascular phase. Late-phase hypo-enhancement was significantly more frequent in the nodules showing early-phase hyper-enhancement (11/13) than in the nodules showing early-phase iso- or hypo-enhancement (0/7) in both the inner and outer nodules. Conclusion: Dedifferentiation of HCC may be accompanied by changes in tumor vascularity prior to a reduction in microbubble accumulation. Observation of the vascular phase may be more useful than late-phase imaging for the early recognition of HCC dedifferentiation when using contrast-enhanced ultrasound with Sonazoid.

  3. Tissue specific MR contrast media role in the differential diagnosis of cirrhotic liver nodules.

    Science.gov (United States)

    Lupescu, Ioana Gabriela; Capsa, Razvan A; Gheorghe, Liana; Herlea, Vlad; Georgescu, Serban A

    2008-09-01

    State-of-the-art magnetic resonance (MR) imaging using tissue specific contrast media facilitates detection and characterization in most cases of hepatic nodules. According to the currently used nomenclature, in liver cirrhosis there are only two major types of hepatocellular nodular lesions: regenerative lesions and dysplastic or neoplastic lesions. The purpose of this clinical imaging review is to provide information on the properties of tissue-specific MR contrast agents and on their usefulness in the demonstration of the pathologic changes that take place at the level of the hepatobiliary and reticuloendothelial systems during the carcinogenesis in liver cirrhosis.

  4. Distribution of Functional Liver Volume in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus in the 1st Branch and Main Trunk Using Single Photon Emission Computed Tomography—Application to Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Akira Ikoma

    2011-10-01

    Full Text Available Purpose: To analyze the distribution of functional liver volume (FLV in the margin volume (MV surrounding hepatocellular carcinoma (HCC with portal vein tumor thrombus (PVTT before radiation therapy (RT and to verify the safety of single photon emission computed tomography-based three-dimensional conformal radiotherapy (SPECT-B3DCRT by exploring the relation of FLV in MV to radiation-induced liver disease (RILD. Methods and Materials: Clinical target volume (CTV included main tumor and PVTT, and planning target volume (PTV included CTV with a 10 mm margin. MV was defined as PTV–CTV. FLV ratio in MV was calculated as FLV in MV/MV × 100 (%. The two high-dose beams were planned to irradiate FLV as little as possible. Fifty-seven cases of HCC (26/57, 46%; Child–Pugh grade B with PVTT underwent SPECT-B3DCRT which targeted the CTV to a total dose of 45 Gy/18 fractions. The destructive ratio was defined as radiation induced dysfunctional volume/FLV × 100 (%. Results: We observed a significant negative correlation between FLV ratio in MV and CTV (p < 0.001. Three cases with CTVs of 287, 587 and 1184 cm3 experienced transient RILD. The FLV ratio in MV was highest in patients with RILD: nine patients with CTV of 200–300 cm3, three with CTV of 500–600 cm3, and two with CTV of 1100–1200 cm3. The destructive ratio yielded a mean value of 24.2 ± 1.5%. Conclusions: Radiation planning that takes into account the distribution of FLV appears to result in the least possible RILD.

  5. Design and preliminary assessment of 99mTc-labeled ultrasmall superparamagnetic iron oxide-conjugated bevacizumab for single photon emission computed tomography/magnetic resonance imaging of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Yanzhao Zhao; Hui Tan; Bing Wu; Pengcheng Hu; Pengyue Wu; Yushen Gu; Dengfeng Cheng; Hongcheng Shi; Qi Yao; Chunfu Zhang

    2014-01-01

    Hepatocellular carcinoma (HCC) has a very high incidence and mortality. Early diagnosis and timely treatments are therefore required to improve the quality of life and survival rate of HCC patients. Here, we developed a vascular endothelial growth factor (VEGF)-based multimodality imaging agent for single photon emission computed tomography (SPECT), computed tomography (CT) and magnetic resonance imaging (MRI) and used it to assess HCC mice and explore the combinative value of CT/MRI-based morphological imaging and SPECT functional imaging. HCC targeting with 125 I-labeled bevacizumab monoclonal antibody (mAb) was examined using SPECT/CT in HepG2 tumor-bearing mice after intravenous mAb injection. Based on this, an integrated, bimodal, VEGF-targeted, ultrasmall superparamagnetic iron oxide (USPIO)-conjugated 99m Tc-labeled bevacizumab mAb was synthesized to increase tumor penetration and accumulations. The in vivo pharmacokinetics and HepG2 tumor targeting were explored through in vivo planar imaging and SPECT/CT using a mouse model of HepG2 liver cancer. The specificity of the radiolabeled nanoparticles for HepG2 HCC was verified using in vitro immunohistochemistry and Prussian blue staining. With diethylenetriamine pentaacetic acid as a bifunctional chelating agent, USPIO-bevacizumab achieved a 99m Tc labeling efficiency of >90 %. The in vivo imaging results also exhibited the targeting of USPIO on HepG2 HCC. The specificity of these results was confirmed using in vitro immunohistochemistry and Prussian blue staining. Our preliminary findings showed the potential of USPIO as an imaging agent for the SPECT/MRI of HepG2 HCC. (author)

  6. Thyroid Nodule Imaging. Status and Limitations.

    Directory of Open Access Journals (Sweden)

    Durre Sabih

    2015-01-01

    Full Text Available Thyroid nodules are common, occurring in almost two-thirds of some populations; among these only about 7% are malignant. The most important question with any new discovered thyroid nodule is, “is this malignant?” The main arbiter of malignancy or benignity remains fine needle aspiration and the mainstay of treatment surgery. But given the resources involved, doing an FNAC or surgery in every discovered nodule would be prohibitive to impossible. The clinician must decide which nodule to investigate and which to watch in the hope that this will never turn out to be malignant. FNACs are used basically to decide which nodule to operate upon (or more importantly which to not operate upon and clinical and imaging features are used to decide which nodule to investigate by FNAC and which to leave alone. This paper describes the various imaging options for looking at thyroid nodules and briefly discusses the advantages and disadvantages with each.

  7. Diagnosis and management of solitary pulmonary nodules.

    Science.gov (United States)

    Jeong, Yeon Joo; Lee, Kyung Soo; Kwon, O Jung

    2008-12-01

    The advent of computed tomography (CT) screening with or without the help of computer-aided detection systems has increased the detection rate of solitary pulmonary nodules (SPNs), including that of early peripheral lung cancer. Helical dynamic (HD)CT, providing the information on morphologic and hemodynamic characteristics with high specificity and reasonably high accuracy, can be used for the initial assessment of SPNs. (18)F-fluorodeoxyglucose PET/CT is more sensitive at detecting malignancy than HDCT. Therefore, PET/CT may be selectively performed to characterize SPNs when HDCT gives an inconclusive diagnosis. Serial volume measurements are currently the most reliable methods for the tissue characterization of subcentimeter nodules. When malignant nodule is highly suspected for subcentimeter nodules, video-assisted thoracoscopic surgery nodule removal after nodule localization using the pulmonary nodule-marker system may be performed for diagnosis and treatment.

  8. Evaluation of radiographic imaging techniques in lung nodule detection

    International Nuclear Information System (INIS)

    Ho, J.T.; Kruger, R.A.

    1989-01-01

    Dual-energy radiography appears to be the most effective technique to address bone superposition that compromises conventional chest radiography. A dual-energy, single-exposure, film-based technique was compared with a dual-energy, dual-exposure technique and conventional chest radiography in a simulated lung nodule detection study. Observers detected more nodules on images produced by dual-energy techniques than on images produced by conventional chest radiography. The difference between dual-energy and conventional chest radiography is statistically significant and the difference between dual-energy, dual-exposure and single-exposure techniques is statistically insignificant. The single-exposure technique has the potential to replace the dual-exposure technique in future clinical application

  9. Automated lung nodule classification following automated nodule detection on CT: A serial approach

    International Nuclear Information System (INIS)

    Armato, Samuel G. III; Altman, Michael B.; Wilkie, Joel; Sone, Shusuke; Li, Feng; Doi, Kunio; Roy, Arunabha S.

    2003-01-01

    We have evaluated the performance of an automated classifier applied to the task of differentiating malignant and benign lung nodules in low-dose helical computed tomography (CT) scans acquired as part of a lung cancer screening program. The nodules classified in this manner were initially identified by our automated lung nodule detection method, so that the output of automated lung nodule detection was used as input to automated lung nodule classification. This study begins to narrow the distinction between the 'detection task' and the 'classification task'. Automated lung nodule detection is based on two- and three-dimensional analyses of the CT image data. Gray-level-thresholding techniques are used to identify initial lung nodule candidates, for which morphological and gray-level features are computed. A rule-based approach is applied to reduce the number of nodule candidates that correspond to non-nodules, and the features of remaining candidates are merged through linear discriminant analysis to obtain final detection results. Automated lung nodule classification merges the features of the lung nodule candidates identified by the detection algorithm that correspond to actual nodules through another linear discriminant classifier to distinguish between malignant and benign nodules. The automated classification method was applied to the computerized detection results obtained from a database of 393 low-dose thoracic CT scans containing 470 confirmed lung nodules (69 malignant and 401 benign nodules). Receiver operating characteristic (ROC) analysis was used to evaluate the ability of the classifier to differentiate between nodule candidates that correspond to malignant nodules and nodule candidates that correspond to benign lesions. The area under the ROC curve for this classification task attained a value of 0.79 during a leave-one-out evaluation

  10. Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival

    Science.gov (United States)

    Kikuchi, Luciana; Menezes, Marcos; Chagas, Aline L; Tani, Claudia M; Alencar, Regiane SSM; Diniz, Marcio A; Alves, Venâncio AF; D’Albuquerque, Luiz Augusto Carneiro; Carrilho, Flair José

    2014-01-01

    AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors. METHODS: Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of ≤ 5 cm, or multi- (up to 3) nodules of ≤ 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Câncer do Estado de São Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model. RESULTS: A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation

  11. Ultrasound manifestation of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, M S; Yoo, H S; Park, C Y; Choi, H J; Moon, Y M; Lee, S I [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1982-06-15

    With the advent of gray scale ultrasonographic equipment, the parenchymal disease of liver is more easily evaluated. Ultrasonography is a non-invasive technique, different from angiography, and performed without discomfort to patient. And also ultrasonography can be used in assessing the liver in cases showing equivocal scintigraphy and in differentiation of solid and cystic masses, first detected on scintigrams. Therefore, the complementary use of ultrasonography, Tc-99m-sulfur colloid scan and angiography provides better diagnostic accuracy for the detection of hepatocellular carcinoma, and moreover, sequential ultrasonographic studies in the same patient are valuable of following the course of hepatocellular carcinoma and monitoring the effectiveness of therapy for hepatocellular carcinoma. In thirty patients with histologically proven hepatocellular carcinoma, an analysis of ultrasound manifestation is made and the results are as follows; 1. Ultrasound manifestation of hepatocellular carcinoma by gray scale showed four different sonographic patterns including discrete echo free, discrete echogenic, ill defined echogenic and mixed patterns. 2. The size of hepatocellular carcinoma by ultrasonographic measurement was larger than 5 cm in diameter in 28 cases. 3. In 7 cases performed with angiography, all echogenicities of hepatocellualr carcinoma were correlated with the findings of vascularity of angiography. 4. In cases combined with liver cirrhosis, the sonographic pattern of hepatocellular carcinoma appeared to be discrete or ill defined echogenic patterns.

  12. Ultrasound manifestation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hwang, M. S.; Yoo, H. S.; Park, C. Y.; Choi, H. J.; Moon, Y. M.; Lee, S. I.

    1982-01-01

    With the advent of gray scale ultrasonographic equipment, the parenchymal disease of liver is more easily evaluated. Ultrasonography is a non-invasive technique, different from angiography, and performed without discomfort to patient. And also ultrasonography can be used in assessing the liver in cases showing equivocal scintigraphy and in differentiation of solid and cystic masses, first detected on scintigrams. Therefore, the complementary use of ultrasonography, Tc-99m-sulfur colloid scan and angiography provides better diagnostic accuracy for the detection of hepatocellular carcinoma, and moreover, sequential ultrasonographic studies in the same patient are valuable of following the course of hepatocellular carcinoma and monitoring the effectiveness of therapy for hepatocellular carcinoma. In thirty patients with histologically proven hepatocellular carcinoma, an analysis of ultrasound manifestation is made and the results are as follows; 1. Ultrasound manifestation of hepatocellular carcinoma by gray scale showed four different sonographic patterns including discrete echo free, discrete echogenic, ill defined echogenic and mixed patterns. 2. The size of hepatocellular carcinoma by ultrasonographic measurement was larger than 5 cm in diameter in 28 cases. 3. In 7 cases performed with angiography, all echogenicities of hepatocellualr carcinoma were correlated with the findings of vascularity of angiography. 4. In cases combined with liver cirrhosis, the sonographic pattern of hepatocellular carcinoma appeared to be discrete or ill defined echogenic patterns

  13. Impact of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance on the non-invasive diagnosis of small hepatocellular carcinoma: a prospective study.

    Science.gov (United States)

    Granito, A; Galassi, M; Piscaglia, F; Romanini, L; Lucidi, V; Renzulli, M; Borghi, A; Grazioli, L; Golfieri, R; Bolondi, L

    2013-02-01

    Gadoxetic acid (Gd-EOB-DTPA) is a 'hepatocyte-specific' contrast agent for magnetic resonance (MR) in both the vascular and the hepatobiliary phases. To evaluate the contribution of the hepatobiliary phase of Gd-EOB-DTPA MR in the diagnosis of small hepatocellular carcinoma (HCC) in cirrhotic patients under surveillance. Between 2008 and 2011, 48 consecutive small (10-30 mm) liver nodules were detected in 33 patients, who prospectively underwent contrast-enhanced ultrasound (CEUS), Gd-EOB-DTPA-enhanced MR and helical-computed tomography (CT) in a blind study. The diagnosis of HCC was established according to AASLD 2005 criteria. Of the 48 nodules, 38 (79%) were diagnosed as HCC, 24 (63%) of them based on AASLD non-invasive criteria, 11 diagnosed at histology and 3 during follow-up. The typical vascular pattern (arterial hypervascularisation and venous/late washout) was detected in 30 (79%) HCC nodules by MR, in 22 (58%) by CT and in 17 (45%) by CEUS. Hypointensity during the MR hepatobiliary phase was observed in all HCC nodules and in 3 nonmalignant nodules (sensitivity 100%, specificity 70%, positive predictive value 93%, negative predictive value 100%, positive likelihood ratio 3.33, negative likelihood ratio 0). Eight (21%) of the 38 HCC nodules, 7 of which lacked the typical vascular features at any of the imaging modalities, showed washout in the portal/venous phase and hypointensity in the hepatobiliary phase at MRI, while this pattern was not detected in any nonmalignant lesion. Gadoxetic acid magnetic resonance may enhance the sensitivity of the non-invasive diagnosis of small hepatocellular carcinoma nodules in cirrhotic patients under surveillance. Double hypointensity in the portal/venous and hepatobiliary phases could be considered a new magnetic resonance pattern, highly suggestive of hypovascular hepatocellular carcinoma. © 2012 Blackwell Publishing Ltd.

  14. Resultados do transplante hepático em portadores de hepatocarcinoma Results of orthotopic liver transplantation for hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Mônica Beatriz PAROLIN

    2001-10-01

    hepatocarcinoma em fase inicial. Com seleção adequada, o transplante hepático oferece excelentes índices de sobrevida livre de recurrência tumoral.Background - Hepatocellular carcinoma is one of the most common malignancies worldwide. Liver transplantation has emerged as a good option for early-stage hepatocellular carcinoma yielding survival rates as good as for recipients without this type of tumor. Objective - To assess the outcome of cirrhotic patients with hepatocellular carcinoma undergoing liver transplantation at the Liver Transplantation Service of the "Hospital de Clínicas", Federal University of Paraná, Curitiba, PR, Brazil. Methods - Retrospective study of cirrhotic patients with hepatocellular carcinoma undergoing orthotopic liver transplantation at the mentioned Institution between September 1991 and September 2000. The diagnosis of hepatocellular carcinoma was established during the pretransplant workup in five patients and the tumor was an incidental finding in the native liver in three. The indication for liver transplantation was restricted to solitary tumor equal to or less than 5 cm or up to 3 nodules, with each nodule measuring less than 3 cm, and no evidence of vascular invasion or extrahepatic spread. Patient survival and evidence of tumoral recurrence posttransplant were evaluated. Results - The most common cause for pretransplantation liver disease was hepatitis C virus (50%. On examination of the explanted liver, the majority of patients (6/8, 75% had a single lesion; one patient had two nodules and one had a multifocal hepatocellular carcinoma found incidentally in the native liver. Tumor size ranged from 0,2 to 5,0 cm. All cases had neither vascular invasion nor linfonodal envolvement. All patients remained alive and free of tumor recurrence at the time of the study with a mean follow-up of 18,5 months (range, 5-29 months. Conclusion - Liver transplantation is a good therapeutic option for early stage hepatocellular carcinoma arising in

  15. CT of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, H; Tanaka, T; Sai, H; Kawamoto, S; Morimoto, K [Osaka Univ. (Japan). Faculty of Medicine

    1982-06-01

    CT was investigated in 125 cases of hepatocelluar carcinoma and 47 cases of metastatic hepatic neoplasm. The entire contour of each tumor was traced and the average CT value in the tumor was estimated. As a result, the CT value for hepatocellular carcinoma tended to be higher on plain CT and also after contrast enhancement. The CT findings seen frequently were as follows: capsule in 76 cases (60.8%) and septum in 67 cases (53.6%); tumor thrombus in portal vein in 39 cases (31.2%) and that in inferior vena cava in 3 cases (2.4%); localized enlargement of hepatic bile duct in 24 cases (19.2%). These findings were rarely seen in the cases of metastatic hepatic neoplasm. As a relatively outstanding feature of hepatic metastases, a double contour, like concentric circles or contour lines, with a relatively large inner circle or contour line, was found in 21 cases (44.7%). By paying attention to the change of CT value on contrast enhancement and the characteristic image of each case, hepatocellular carcinoma could be differentiated from metastatic hepatic neoplasm with high probability.

  16. Histopathology of hepatocellular carcinoma.

    Science.gov (United States)

    Schlageter, Manuel; Terracciano, Luigi Maria; D'Angelo, Salvatore; Sorrentino, Paolo

    2014-11-21

    Hepatocellular carcinoma (HCC) is currently the sixth most common type of cancer with a high mortality rate and an increasing incidence worldwide. Its etiology is usually linked to environmental, dietary or life-style factors. HCC most commonly arises in a cirrhotic liver but interestingly an increasing proportion of HCCs develop in the non-fibrotic or minimal fibrotic liver and a shift in the underlying etiology can be observed. Although this process is yet to be completely understood, this changing scenario also has impact on the material seen by pathologists, presenting them with new diagnostic dilemmas. Histopathologic criteria for diagnosing classical, progressed HCC are well established and known, but with an increase in detection of small and early HCCs due to routine screening programs, the diagnosis of these small lesions in core needle biopsies poses a difficult challenge. These lesions can be far more difficult to distinguish from one another than progressed HCC, which is usually a clear cut hematoxylin and eosin diagnosis. Furthermore lesions thought to derive from progenitor cells have recently been reclassified in the WHO. This review summarizes recent developments and tries to put new HCC biomarkers in context with the WHOs reclassification. Furthermore it also addresses the group of tumors known as combined hepatocellular-cholangiocellular carcinomas.

  17. 10Be in manganese nodules

    International Nuclear Information System (INIS)

    Thomas, J.; Parker, P.; Mangini, A.; Cochran, K.; Turekian, K.; Krishnaswami, S.; Sharma, P.

    1981-01-01

    10 Be (t/sub 1/2) = 1.5 MY) is(formed in the upper atmosphere by cosmic ray spallation on nitrogen and oxygen. It is transported to the earth's surface via precipitation. In the oceans it is eventually associated with solid phases depositing on the ocean floor such as manganese nodules and deep-sea sediments. One of the assumptions that is normally made in analysis of such processes is that 10 Be has been produced at a relatively uniform rate over the pat several million years. If we assume, in addition, that the initial specific concentration of 10 Be as it precipitates with a solid phase is invariant with time, then we would expect that the decrease of the 10 Be concentration as a function of depth in a deep-sea core or in a manganese nodule would provide a record of sediment accumulation rate in the former and of growth rate in the latter. The possibility of using cosmic-ray produced 10 Be for the dating of marine deposits had been proposed 25 years ago by Arnold and Goel et al. The method of analysis used by these investigators, and those subsequently pursuing the problem, was low-level β counting. Though the potential of using 10 Be for dating manganese nodules was explored more than a decade ago, only a few measurements of 10 Be in nodules exist in date. This is largely because of the 10 Be measurements in environmental samples have gained considerable momentum during the past 3 to 4 years, after the development of accelerator mass spectrometry for its determination

  18. Strategy for polymetallic nodule mining

    Digital Repository Service at National Institute of Oceanography (India)

    Sharma, R.

    in industrializing their economies. Of the known mineral reselVcs these countries have nearly 50% of the nickel resclVcs, over 50% ofcopper reselVcs, 75% ofcobalt reserves, and aboul 25% of manganese reserves, and are major suppliers to the world markets... of these minerals. These counlries face the comhined effect oflosl markets and reduced price levels broughlabout by deep seabed nodule production. They depend on revenue earned from mineral exports more than do developed nations and have less flexibility...

  19. Low dose iodine-131 therapy in solitary toxic thyroid nodules

    International Nuclear Information System (INIS)

    Prakash, Rajeev

    1999-01-01

    Forty patients with solitary hyperfunctioning thyroid nodules were treated with relatively low dose radioiodine therapy, 131 I doses were calculated taking into account thyroid mass and radioiodine kinetics to deliver 100 μCi/g of estimated nodule weight corrected for uptake. Patients remaining persistently hyperthyroid at four months after the initial therapy were retreated with a similarly calculated dose. Cure of the hyperthyroid state was achieved in all patients, total administered dose in individual cases ranging from 3-17 mCi. 28 of the 40 patients required a single therapy dose. 36 patients were euthyroid after a 4.5 year mean follow-up period. Four cases developed post therapy hypothyroidism requiring replacement therapy. Nodules regressed completely in nine cases following 131 I treatment, with partial regression in size in 19 patients. Control of hyperthyroid state in cases of solitary toxic thyroid nodules can be satisfactorily achieved using relatively low dose radioiodine therapy with low incidence of post therapy hypothyroidism. (author)

  20. Hepatitis C Virus and Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Masao Omata

    2013-01-01

    Full Text Available Hepatitis C virus (HCV, a hepatotropic virus, is a single stranded-positive RNA virus of ~9,600 nt. length belonging to the Flaviviridae family. HCV infection causes acute hepatitis, chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC. It has been reported that HCV-coding proteins interact with host-cell factors that are involved in cell cycle regulation, transcriptional regulation, cell proliferation and apoptosis. Severe inflammation and advanced liver fibrosis in the liver background are also associated with the incidence of HCV-related HCC. In this review, we discuss the mechanism of hepatocarcinogenesis in HCV-related liver diseases.

  1. Hepatocellular carcinoma. Comparison between gadolinium and ironoxide enhanced MR imaging

    International Nuclear Information System (INIS)

    Castoldi, M.C.; Fauda, V.; Scaramuzza, D.; Vergnaghi, D.

    2000-01-01

    Purpose of this work is to compare prospectively dynamic gadolinium (Gd)-enhanced with superparamagnetic iron oxide (SPIO)-enhanced MRI for the detection of hepatocellular carcinoma (HCC). Twenty-five patients with histologically proven HCC and liver cirrhosis (28% of them in B or C Child class) underwent dynamic Gd-enhanced MRI and, a few days later, (mean interval: three days) SPIO-enhanced MRI. Only patients with availability of clinical and imaging follow-up for at least seven months were enrolled in this prospective study. MR images were reviewed by two independent radiologists. The readers scored each lesion for the presence of HCC and assigned confidence levels based on a five-grade scale: 1, definitely or almost definitely absent; 2, possibly present; 3, probably present; 4, definitely present; 5, definitely present with optimal liver/lesion contrast or good liver/lesion contrast and morphological signs (intact capsule, intranodular septa, extracapsular infiltration), useful for locoregional treatment planning. A positive diagnostic value was assessed for scores of 3 or higher. Gd-enhanced and SPIO-enhanced MRI found 44 lesions. Eight of twelve lesions visible with a single contrast agent measured less than 1 cm in diameter. HCC detectability was 75% with Gd-enhanced MRI and 97.7% with SPIO-enhanced MRI. SPIO-enhanced T2-weighted TSE images showed significantly higher diagnostic value than SPIO-enhanced T1-T2*GRE images only in three cases, while nodule morphological characteristics (capsule, septa, different cell differentiation components) were better depicted by TSE images. In thi study the combined use of SPIO-enhanced T2-weighted TSE and T1-T2*-weighted GRE sequences showed higher sensitivity than gadolinium-enhanced GRE dynamic imaging (97.7% versus 75%). These results are at least partly related to our study conditions, that is: 1)MRI was performed with a 1T system, 2) both axial and sagittal SPIO-enhanced imaging were performed with respiratory

  2. Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up.

    Science.gov (United States)

    Kohlhase, Konstantin David; Korkusuz, Yücel; Gröner, Daniel; Erbelding, Christian; Happel, Christian; Luboldt, Wolfgang; Grünwald, Frank

    2016-08-01

    Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique ('MOST'). Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (nodule volume (ΔV), median 5.3 mL (range 0.13-43.1 mL), corresponding to a relative reduction in mean of 56 ± 17.9%. Median initial volume was 8 mL (range 0.48-62 mL); 3 months after ablation a median volume of 2.3 mL (range 0.3-32 mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1). Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.

  3. Benign metastasizing leiomyoma presenting as multiple cystic pulmonary nodules: a case report.

    Science.gov (United States)

    Choe, Yeong Hun; Jeon, So Yeon; Lee, Yoon Chae; Chung, Myung Ja; Park, Seung Yong; Lee, Yong Chul; Kim, So Ri

    2017-09-12

    Benign metastatic leiomyoma (BML) is an extremely rare disease. Although uterine leiomyomas are benign histologically, they can metastasize to distant sites. While the incidence is very low, the lung is the organ most frequently affected by BML. Pulmonary BML usually presents as numerous well-defined nodules of various sizes, while the cavitary or cystic features in the nodules are rarely observed on radiologic images. A 52-year-old woman complained of cough and dyspnea for one month. She had been previously diagnosed with uterine leiomyoma and had undergone total hysterectomy about 14 years prior. High-resolution computed tomography (CT) images showed that there were multiple cystic nodules of various sizes in both lungs. Pathologic examination revealed that the pulmonary nodule had complex branching glandular structures lined by a single layer of simple cuboidal to columnar epithelium that was surrounded by abundant spindle cells. Additional immunohistochemistry data suggested that pulmonary nodule diagnosis was BML-associated uterine leiomyoma. In this report, we introduce an interesting case of pulmonary BML that presented as a combination of various kinds of nodules including simple round nodules, simple cysts, and cysts with a solid portion, which are very rare radiologic features of BML in lung. In addition, when the patient is a woman of reproductive age, physicians should meticulously review the gynecological history and suspect BML when there are various cystic pulmonary lesions.

  4. Clinical significance of computed tomographic arteriography for minute hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, H; Matsui, O; Suzuki, M; Ida, M; Kitagawa, K [Kanazawa Univ. (Japan). School of Medicine

    1982-03-01

    Computed tomographic arteriography (CTA) can clearly demonstrate minute hepatocellular carcinoma (H.C.C.) more than 2 cm in diameter as an enhanced mass lesion. In this case the precise localization of H.C.C. becomes so obvious that CTA plays an important role to evaluate its resectability. However, H.C.C. of the size from 2 cm to 1 cm indiameter, which is visualized with celiac and infusion hepatic angiography, becomes more difficult in detection, and particularly H.C.C. of less than 1 cm in diameter can hardly be recognized, nor be diagnosed as a malignant nodule by CTA, therefore it appears that in these sizes of H.C.C. the detectability of CTA is not superior to the hepatic angiography.

  5. Morphologic Subtypes of Hepatocellular Carcinoma.

    Science.gov (United States)

    Torbenson, Michael S

    2017-06-01

    Hepatocellular carcinomas can be further divided into distinct subtypes that provide important clinical information and biological insights. These subtypes are distinct from growth patterns and are on based on morphologic and molecular findings. There are 12 reasonably well-defined subtypes as well as 6 provisional subtypes, together making up 35% of all hepatocellular carcinomas. These subtypes are discussed, with an emphasis on their definitions and the key morphologic findings. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Evaluation of pathological features of hepatocellular carcinoma by contrast-enhanced ultrasonography: Comparison with pathology on resected specimen

    International Nuclear Information System (INIS)

    Ogawa, Sadanobu; Kumada, Takashi; Toyoda, Hidenori; Ichikawa, Hideo; Kawachi, Toshiaki; Otobe, Katsuhiko; Hibi, Toshio; Takeshima, Kenji; Kiriyama, Seiki; Sone, Yasuhiro; Tanikawa, Makoto; Hisanaga, Yasuhiro; Yamaguchi, Akihiro; Isogai, Masatoshi; Kaneoka, Yuji; Washizu, Junji

    2006-01-01

    Features of hepatocellular carcinoma (HCC) observed by contrast-enhanced ultrasonography (CEUS) were compared to pathological features of corresponding resected HCC specimens, to evaluate the ability of CEUS to depict the pathological features of HCC. We investigated 50 HCC nodules that were treated by surgical resection. All nodules had been examined by CEUS with intravenous contrast agent (Levovist) before surgery. CEUS findings were divided into three phases for evaluation and classification of enhancement patterns: two vascular phases (arterial phase and portal venous phase) and the delayed phase. Pathological examination focused on differentiation and on the presence or absence of a tumor capsule, intratumoral septum, and intratumoral necrosis. All 21 nodules that showed a linear or annular vessel around the tumor margin in the arterial phase had capsular formation. Of the 27 nodules that showed heterogeneous perfusion in the portal venous phase, 21 (77.8%) had an intratumoral septum and 23 (85.2%) showed intratumoral necrosis. All nodules that were depicted as a defect with an unclear margin in the delayed phase were well-differentiated HCCs, whereas all nodules that were depicted as a defect with a clear margin were moderately or poorly differentiated HCCs. From our observations, the arterial, portal venous, and delayed phases of CEUS could reflect different pathological aspects of HCC. Some pathological characteristics of HCC might be evaluated preoperatively and non-invasively, by means of combined analysis of three phases of CEUS findings

  7. Multiphasic helical Computed Tomography of hepatocellular carcinoma. Evaluation after various percutaneous ablation procedures; Tomografia Computerizzata spirale multifasica dell'epatocarcinoma. Valutazione dopo differenti procedure ablative percutanee

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, O.; Esposito, M.; Lobianco, R.; Cusati, B.; Altei, F.; Siani, A. [Ospedale S. Maria delle Grazie, Pozzuoli, NA (Italy). Servizio di Radiologia

    1999-12-01

    The purpose of this paper is to report the personal experience with helical CT evaluation of hepatocellular carcinoma treated with various percutaneous interventional procedures. From December 1996 to September 1998 it were examined with helical CT 41 patients (73 nodules in all) with hepatocellular carcinoma treated with percutaneous ablation therapies: conventional ethanol injection in 18 subjects (31 nodules), one-shot ethanol injection 3 (8 nodules), radiofrequency thermal ablation in 16 (25 nodules), and combined chemo embolization and ethanol injection in 4 (9 nodules). CT performed was 4-27 days after the last session, acquiring biphasic volumetric images in 14 patients and triphasic volumetric images in 27. A second treatment with subsequent CT study was performed for 28 lesions; 15 underwent 3 serial studies and 6 underwent 4 studies. Compared with pretreatment findings, the diameter was unchanged in 62% of the nodules and increased in 38%. Morphology was unchanged in 63% of the lesions while in 37% a mild deformation toward the needle path or a more regular and round shape was evident. Borders were unchanged in 37% of the cases and modified in 63%, appearing well-defined in 73% and ill-defined in 27%. The necrotic portion had a low attenuation with a nodule-to-parenchyma gradient more evident on delayed than on venous and finally arterial acquisitions; 8% of the lesions were not recognizable on unenhanced scans. During the arterial phase the residual tumor appeared hyperdense in 97% of the nodules and isodense in 3%, while during the portal phase it was hyperdense in 22%, isodense in 28% and hypodense in 50%, and during the delayed phase hypodense in 100%. Residual viable tissue was identified in 44% of the nodules and quantified as 100% in 1% of all lesions, > 75% in 3%, > 50% in 4%, > 25% in 23%. In conclusion, multiple-phase helical CT allows optimal depiction of primitive liver nodules treated with percutaneous interventional procedures and has a

  8. Auxin transport, metabolism, and signalling during nodule initiation: indeterminate and determinate nodules

    NARCIS (Netherlands)

    Kohlen, W.; Ng, Jason Liang Pin; Deinum, E.E.; Mathesius, Ulrike

    2018-01-01

    Most legumes can form a unique type of lateral organ on their roots: root nodules. These structures host symbiotic nitrogen-fixing bacteria called rhizobia. Several different types of nodules can be found in nature, but the two best-studied types are called indeterminate and determinate nodules.

  9. Small nodules (1-2 cm) in liver cirrhosis: Characterization with contrast-enhanced ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyun-Jung [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada); Kim, Tae Kyoung [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada)], E-mail: taekyoung.kim@uhn.on.ca; Wilson, Stephanie R. [Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2 (Canada)

    2009-12-15

    Objective: To determine the diagnostic efficacy of arterial phase contrast-enhanced ultrasound (CEUS) for characterizing small hepatic nodules (1-2 cm) in patients with high-risk for hepatocellular carcinoma (HCC). Materials and methods: Over 12 months, CEUS was performed in 59 patients at high-risk for HCC with small hepatic nodules (1-2 cm; mean, 1.5 cm). Based only on arterial phase (<45 s) vascular intensity and pattern, lesions were prospectively diagnosed as HCC if there was hypervascularity without known features of hemangioma. The diagnosis of HCC was made regardless of the presence or absence of washout. Verification of diagnosis was made by liver transplantation (n = 13), biopsy (n = 12), resection (n = 3) or clinical and imaging follow-up for at least 12 months (n = 31). Results: At of the time of CEUS, the 59 nodules were diagnosed as HCC in 26 and benign lesions in 33, including 20 regenerative/dysplastic nodules (RN/DN), 11 hemangiomas, and 2 focal fat sparing. All 26 nodules with arterial phase hypervascularity without hemangioma-like features were HCC. However, CEUS misdiagnosed HCC as RN/DN in 4 cases with arterial iso- (n = 3) or hypovascularity (n = 1). CEUS correctly diagnosed all 11 hemangiomas. The sensitivity, specificity, and accuracy of CEUS for diagnosing HCC were 86.7, 100, and 93.2%. Conclusions: Arterial phase vascular intensity and pattern of CEUS are highly accurate for the diagnosis of small (1-2 cm) HCC and hemangioma in liver cirrhosis. On CEUS, arterial phase hypervascularity without a hemangioma-pattern alone may be sufficient for diagnosis of small HCC. Infrequent iso/hypovascular HCC may erroneously suggest RN/DN necessitating biopsy or close follow-up.

  10. Consistent interactive segmentation of pulmonary ground glass nodules identified in CT studies

    Science.gov (United States)

    Zhang, Li; Fang, Ming; Naidich, David P.; Novak, Carol L.

    2004-05-01

    Ground glass nodules (GGNs) have proved especially problematic in lung cancer diagnosis, as despite frequently being malignant they characteristically have extremely slow rates of growth. This problem is further magnified by the small size of many of these lesions now being routinely detected following the introduction of multislice CT scanners capable of acquiring contiguous high resolution 1 to 1.25 mm sections throughout the thorax in a single breathhold period. Although segmentation of solid nodules can be used clinically to determine volume doubling times quantitatively, reliable methods for segmentation of pure ground glass nodules have yet to be introduced. Our purpose is to evaluate a newly developed computer-based segmentation method for rapid and reproducible measurements of pure ground glass nodules. 23 pure or mixed ground glass nodules were identified in a total of 8 patients by a radiologist and subsequently segmented by our computer-based method using Markov random field and shape analysis. The computer-based segmentation was initialized by a click point. Methodological consistency was assessed using the overlap ratio between 3 segmentations initialized by 3 different click points for each nodule. The 95% confidence interval on the mean of the overlap ratios proved to be [0.984, 0.998]. The computer-based method failed on two nodules that were difficult to segment even manually either due to especially low contrast or markedly irregular margins. While achieving consistent manual segmentation of ground glass nodules has proven problematic most often due to indistinct boundaries and interobserver variability, our proposed method introduces a powerful new tool for obtaining reproducible quantitative measurements of these lesions. It is our intention to further document the value of this approach with a still larger set of ground glass nodules.

  11. Diaphragmatic Hernia After Radiofrequency Ablation for Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Yamagami, Takuji; Yoshimatsu, Rika; Matsushima, Shigenori; Tanaka, Osamu; Miura, Hiroshi; Nishimura, Tsunehiko

    2011-01-01

    We describe a 71-year-old woman with a hepatocellular carcinoma who underwent percutaneous radiofrequency ablation (RF) with a single internally cooled electrode under computed tomography (CT) fluoroscopic guidance. Nine months after the procedure, CT images showed herniation of the large intestine into the right pleural cavity. To our knowledge this complication of RF performed with a single internally cooled electrode under CT guidance has not been previously reported.

  12. Correlation between the Quantifiable Parameters of Whole Solitary Pulmonary Nodules Perfusion Imaging Derived with Dynamic CT and Nodules Size

    Directory of Open Access Journals (Sweden)

    Shiyuan LIU

    2009-05-01

    Full Text Available Background and objective The solitary pulmonary nodules (SPNs is one of the most common findings on chest radiographs. The blood flow patterns of the biggest single SPNs level has been studied. This assessment may be only a limited sample of the entire region of interest (ROI and is unrepresentative of the SPNs as a volume. Ideally, SPNs volume perfusion should be measured. The aim of this study is to evaluate the correlation between the quantifiableparameters of SPNs volume perfusion imaging derived with 16-slice spiral CT and 64-slice spiral CT and nodules size. Methods Sixty-five patients with SPNs (diameter≤3 cm; 42 malignant; 12 active inflammatory; 11 benign underwent multi-location dynamic contrast material-enhanced serial CT scanning mode with stable table were performed; The mean values of valid sections were calculated, as the quantifiable parameters of volume SPNs perfusion imaging derived with16-slice spiral CT and 64-slice spiral CT. The correlation between the quantifiable parameters of SPNs volume perfusion imaging derived with 16-slice spiral CT and 64-slice spiral CT and nodules size were assessed by means of linear regression analysis. Results No significant correlations were found between the nodules size and each of the peak height (PHSPN (32.15 Hu±14.55 Hu,ratio of peak height of the SPN to that of the aorta (SPN-to-A ratio(13.20±6.18%, perfusion(PSPN (29.79±19.12 mLmin-1100 g-1 and mean transit time (12.95±6.53 s (r =0.081, P =0.419; r =0.089, P =0.487; r =0.167, P =0.077; r =0.023, P =0.880. Conclusion No significant correlations were found between the quantifiable parameters of SPNs volume perfusion imaging derived with 16-slice spiral CT and 64-slice spiral CT and nodules size.

  13. Management of solid pulmonary nodules

    International Nuclear Information System (INIS)

    Poschenrieder, F.; Beyer, L.; Stroszczynski, C.; Hamer, O.W.; Rehbock, B.; Diederich, S.; Wormanns, D.

    2014-01-01

    The increasing availability of computed tomography has meant that the number of incidentally detected solitary pulmonary nodules (SPN) has greatly increased in recent years. A reasonable management of these SPN is necessary in order to firstly be able to detect malignant lesions early on and secondly to avoid upsetting the patient unnecessarily or carrying out further stressful diagnostic procedures. This review article shows how the dignity of SPNs can be estimated and based on this how the management can be accomplished taking established guidelines into consideration. (orig.) [de

  14. Role of baseline nodule density and changes in density and nodule features in the discrimination between benign and malignant solid indeterminate pulmonary nodules

    NARCIS (Netherlands)

    Xu, D.M.; van Klaveren, R.J.; de Bock, G.H.; Leusveld, A.L.M.; Dorrius, M.D.; Zhao, Y.; Wang, Y.; de Koning, H.J.; Scholten, E.T.; Verschakelen, J.; Prokop, M.; Oudkerk, M.

    Purpose: To retrospectively evaluate whether baseline nodule density or changes in density or nodule features could be used to discriminate between benign and malignant solid indeterminate nodules. Materials and methods: Solid indeterminate nodules between 50 and 500 mm(3) (4.6-9.8 mm) were assessed

  15. Value of infusion-DSA (Digital Subtraction Angiography) in diagnosis of primary hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kwon, Jeong Mi; Kim, So Sun; Huh, Jin Do; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk

    1991-01-01

    In order to evaluate diagnostic effectiveness of the infusion-study, the authors prospectively evaluated hepatic digital subtraction angiography of bolus and infusion studies in 71 patients with hepatocellular carcinoma. In contrast to Bolus-DSA, which involves a 2 second injection of 10cc of contrast medium, the Infusion-DSA uses a protracted (10sec) injection, a lower injection rate, and larger total dose of contrast medium (20cc). The information yield of arterial and capillary phases of Infusion-DSA was compared with that of Bolus-DSA and graded as 'improved(+)', 'equivalent( ± )', or 'poor(-)'. Also, the contribution of Infusion-DSA to the diagnosis was classified into one of five in a graded system. In 29 hepatocellular patients, the Infusion-DSA was helpful in detecting daughter nodules, fibrous capsule and arteriovenous shunt. Infusion-DSA is a useful complementary technique in the diagnosis of hepatocellular carcinoma and was also helpful in determining the selection of the therapeutic modality of hepatocellular carcinoma

  16. Systems biology analysis of hepatitis C virus infection reveals the role of copy number increases in regions of chromosome 1q in hepatocellular carcinoma metabolism

    DEFF Research Database (Denmark)

    Elsemman, Ibrahim; Mardinoglu, Adil; Shoaie, Saeed

    2016-01-01

    on hepatocellular metabolism. Here, we integrated HCV assembly reactions with a genome-scale hepatocyte metabolic model to identify metabolic targets for HCV assembly and metabolic alterations that occur between different HCV progression states (cirrhosis, dysplastic nodule, and early and advanced hepatocellular...... carcinoma (HCC)) and healthy liver tissue. We found that diacylglycerolipids were essential for HCV assembly. In addition, the metabolism of keratan sulfate and chondroitin sulfate was significantly changed in the cirrhosis stage, whereas the metabolism of acyl-carnitine was significantly changed...

  17. Indeterminate Pulmonary Nodules at Colorectal Cancer Staging

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas; Wille-Jørgensen, Peer A; Jorgensen, Lars N

    2013-01-01

    This study aimed to estimate the prevalence of indeterminate pulmonary nodules and specific radiological and clinical characteristics that predict malignancy of these at initial staging chest computed tomography (CT) in patients with colorectal cancer. A considerable number of indeterminate...... pulmonary nodules, which cannot readily be classified as either benign or malignant, are detected at initial staging chest CT in colorectal cancer patients....

  18. Position of solitary thyroid nodules by gammagraphy

    International Nuclear Information System (INIS)

    Basteris M, J.; Gomez D, R.

    2007-01-01

    In this work it is presented which it is the position more frequent of the solitary thyroid nodules. It was used the method of retrospective longitudinal observational investigation in 125 patients that went to the laboratory for realization of detection of thyroid nodules in the years 2004 and 2005 through gammagraphy. (Author)

  19. Computer-aided detection of pulmonary nodules: influence of nodule characteristics on detection performance

    International Nuclear Information System (INIS)

    Marten, K.; Engelke, C.; Seyfarth, T.; Grillhoesl, A.; Obenauer, S.; Rummeny, E.J.

    2005-01-01

    AIM: To evaluate prospectively the influence of pulmonary nodule characteristics on detection performances of a computer-aided diagnosis (CAD) tool and experienced chest radiologists using multislice CT (MSCT). MATERIALS AND METHODS: MSCT scans of 20 consecutive patients were evaluated by a CAD system and two independent chest radiologists for presence of pulmonary nodules. Nodule size, position, margin, matrix characteristics, vascular and pleural attachments and reader confidence were recorded and data compared with an independent standard of reference. Statistical analysis for predictors influencing nodule detection or reader performance included chi-squared, retrograde stepwise conditional logistic regression with odds ratios and nodule detection proportion estimates (DPE), and ROC analysis. RESULTS: For 135 nodules, detection rates for CAD and readers were 76.3, 52.6 and 52.6%, respectively; false-positive rates were 0.55, 0.25 and 0.15 per examination, respectively. In consensus with CAD the reader detection rate increased to 93.3%, and the false-positive rate dropped to 0.1/scan. DPEs for nodules ≤5 mm were significantly higher for ICAD than for the readers (p<0.05). Absence of vascular attachment was the only significant predictor of nodule detection by CAD (p=0.0006-0.008). There were no predictors of nodule detection for reader consensus with CAD. In contrast, vascular attachment predicted nodule detection by the readers (p=0.0001-0.003). Reader sensitivity was higher for nodules with vascular attachment than for unattached nodules (sensitivities 0.768 and 0.369; 95% confidence intervals=0.651-0.861 and 0.253-0.498, respectively). CONCLUSION: CAD increases nodule detection rates, decreases false-positive rates and compensates for deficient reader performance in detection of smallest lesions and of nodules without vascular attachment

  20. Hepatocellular carcinoma: a review

    Directory of Open Access Journals (Sweden)

    Balogh J

    2016-10-01

    Full Text Available Julius Balogh,1,2 David Victor III,1,3,4 Emad H Asham,1,2 Sherilyn Gordon Burroughs,1,2 Maha Boktour,1,2 Ashish Saharia,1,2 Xian Li,1,2 R Mark Ghobrial,1,2 Howard P Monsour Jr,1,3,4 1Sherrie and Alan Conover Center for Liver Disease and Transplantation, 2Division of Transplantation, Department of Surgery, 3Department of Gastroenterology and Transplant Hepatology, 4Department of Medicine, Houston Methodist Hospital, Houston, TX, USA Abstract: Hepatocellular carcinoma (HCC is the most common primary liver malignancy and is a leading cause of cancer-related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, incidence and mortality continue to rise. Cirrhosis remains the most important risk factor for the development of HCC regardless of etiology. Hepatitis B and C are independent risk factors for the development of cirrhosis. Alcohol consumption remains an important additional risk factor in the United States as alcohol abuse is five times higher than hepatitis C. Diagnosis is confirmed without pathologic confirmation. Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as α-fetoprotein at 6-month intervals. Multiple treatment modalities exist; however, only orthotopic liver transplantation (OLT or surgical resection is curative. OLT is available for patients who meet or are downstaged into the Milan or University of San Francisco criteria. Additional treatment modalities include transarterial chemoembolization, radiofrequency ablation, microwave ablation, percutaneous ethanol injection, cryoablation, radiation therapy, systemic chemotherapy, and molecularly targeted therapies. Selection of a treatment modality is based on tumor size, location, extrahepatic spread, and underlying liver function. HCC is an

  1. Real time elastography - a non-invasive diagnostic method of small hepatocellular carcinoma in cirrhosis.

    Science.gov (United States)

    Gheorghe, Liana; Iacob, Speranta; Iacob, Razvan; Dumbrava, Mona; Becheanu, Gabriel; Herlea, Vlad; Gheorghe, Cristian; Lupescu, Ioana; Popescu, Irinel

    2009-12-01

    Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4 +/- 0.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value under 108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value greater than 128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color over 128.9 at sonoelastography and hypervascular appearance at Doppler US. US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC.

  2. Is Local Radiotherapy Still Valuable for Patients With Multiple Intrahepatic Hepatocellular Carcinomas?

    International Nuclear Information System (INIS)

    Koom, Woong Sub; Seong, Jinsil; Han, Kwang Hyub; Lee, Do Yun; Lee, Jong Tae

    2010-01-01

    Purpose: To investigate whether local radiotherapy (RT) is valuable for patients with multiple hepatocellular carcinomas (HCCs). Methods and Materials: From July 1992 to August 2006, 107 patients with unresectable HCC were treated with local RT after incomplete transcatheter arterial chemoembolization (TACE). The RT field included a main tumor with or without other tumor nodules, depending on the effectiveness of TACE. The median RT dose was 50.4Gy in conventional fractionation. Patients were categorized into four groups: Group 1, single tumor (39 patients); Group 2, multiple tumors within the RT field (25 patients); Group 3, controlled tumors out of the RT field (19 patients); and Group 4, tumors that remained viable out of the RT field (24 patients). Results: Group 1 showed the best survival rate (MST, 35 months; 2-year OS, 60%) and Group 4 the worst (MST, 5 months; 2-year OS, 16%). Group 2 and Group 3 showed similar survival (MST, 13 vs. 19 months; 2-year OS, 35% vs. 46%; p = 0.698). Significantly worse intrahepatic control in Group 4 was observed. The survival in Groups 2 and 3 (MST, 16 months) was significantly different from that in Group 4 (p = 0.004), and was marginally significant compared with that in Group 1 (p = 0.051). Conclusions: Local RT to the main tumor could be applicable in well-controlled intrahepatic tumors out of the RT field. Patients with viable intrahepatic tumors out of the RT field showed worse survival. In future clinical trials, these patients need to be excluded.

  3. Digital tomosynthesis for evaluating metastatic lung nodules: nodule visibility, learning curves, and reading times.

    Science.gov (United States)

    Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyungjin; Song, Yong Sub; Hwang, Eui Jin

    2015-01-01

    To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, ≤ 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

  4. Digital tomosynthesis for evaluating metastatic lung nodules: Nodule visibility, learning curves, and reading times

    International Nuclear Information System (INIS)

    Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyung Jin; Song, Yong Sub; Hwang, Eui Jin

    2015-01-01

    To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

  5. Digital tomosynthesis for evaluating metastatic lung nodules: Nodule visibility, learning curves, and reading times

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Hee; Goo, Jin Mo; Lee, Sang Min; Park, Chang Min; Bahn, Young Eun; Kim, Hyung Jin; Song, Yong Sub; Hwang, Eui Jin [Dept. of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)

    2015-04-15

    To evaluate nodule visibility, learning curves, and reading times for digital tomosynthesis (DT). We included 80 patients who underwent computed tomography (CT) and DT before pulmonary metastasectomy. One experienced chest radiologist annotated all visible nodules on thin-section CT scans using computer-aided detection software. Two radiologists used CT as the reference standard and retrospectively graded the visibility of nodules on DT. Nodule detection performance was evaluated in four sessions of 20 cases each by six readers. After each session, readers were unblinded to the DT images by revealing the true-positive markings and were instructed to self-analyze their own misreads. Receiver-operating-characteristic curves were determined. Among 414 nodules on CT, 53.3% (221/414) were visible on DT. The main reason for not seeing a nodule on DT was small size (93.3%, < or = 5 mm). DT revealed a substantial number of malignant nodules (84.1%, 143/170). The proportion of malignant nodules among visible nodules on DT was significantly higher (64.7%, 143/221) than that on CT (41.1%, 170/414) (p < 0.001). Area under the curve (AUC) values at the initial session were > 0.8, and the average detection rate for malignant nodules was 85% (210/246). The inter-session analysis of the AUC showed no significant differences among the readers, and the detection rate for malignant nodules did not differ across sessions. A slight improvement in reading times was observed. Most malignant nodules > 5 mm were visible on DT. As nodule detection performance was high from the initial session, DT may be readily applicable for radiology residents and board-certified radiologists.

  6. Nitrogen assimilation in soybean nodules, 1

    International Nuclear Information System (INIS)

    Ohyama, Takuji; Kumazawa, Kikuo

    1980-01-01

    In order to elucidate the pathways to assimilate the ammonia produced by N 2 -fixation in soybean nodules, 15 N-labeled compounds were administered to intact nodules or nodule slices pretreated with various inhibitors of nitrogen assimilation. After exposure to 15 N 2 , 15 N-incorporation into various nitrogenous compounds was investigated in attached nodules injected with methionine sulfoximine (MSX) or azaserine (AS). MSX treatment increased the 15 N content of ammonia more than 6 times, however, depressed 15 N content of most of amides and amino acids. AS treatment enhanced 15 N content of amido-N of glutamine as well as ammonia, but decreased amino-N of glutamine and most of amino acids. Experiments with nodule slices pretreated with MSX or AS solution and then fed with 15 N-labeled ammonia or amido- 15 N of glutamine showed the same trends. Aminooxyacetate inhibited nitrogen flow from glutamic acid to other amino acids. These results strongly indicate that the ammonia produced by N 2 -fixation is assimilated by GS/GOGAT system to glutamic acid and then transaminated to various amino acids in situ. 15 N-incorporation patterns in nodule slices fed with 15 N-labeled ammonia, hydroxylamine, nitrite were similar, but nitrate seemed to be reduced in a definite compartment and assimilated similarly as in intact nodules fed with 15 N 2 (author)

  7. Spatial resolution and chest nodule detection: an interesting incidental finding

    Science.gov (United States)

    Toomey, R. J.; McEntee, M. F.; Ryan, J. T.; Evanoff, M. G.; Hayes, A.; Brennan, P. C.

    2010-02-01

    This study reports an incidental finding from a larger work. It examines the relationship between spatial resolution and nodule detection for chest radiographs. Twelve examining radiologists with the American Board of Radiology read thirty chest radiographs in two conditions - full (1500 × 1500 pixel) resolution, and 300 × 300 pixel resolution linearly interpolated to 1500 × 1500 pixels. All images were surrounded by a 10-pixel sharp grey border to aid in focussing the observer's eye when viewing the comparatively unsharp interpolated images. Fifteen of the images contained a single simulated pulmonary nodule. Observers were asked to rate their confidence that a nodule was present on each radiograph on a scale of 1 (least confidence, certain no lesion is present) to 6 (most confidence, certain a lesion was present). All other abnormalities were to be ignored. No windowing, levelling or magnification of the images was permitted and viewing distance was constrained to approximately 70cm. Images were displayed on a 3 megapixel greyscale monitor. Receiver operating characteristic (ROC) analysis was applied to the results of the readings using the Dorfman-Berbaum-Metz multiplereader, multiple-case method. No statistically significant differences were found with either readers and cases treated as random or with cases treated as fixed. Low spatial frequency information appears to be sufficient for the detection of chest lesion of the type used in this study.

  8. Bean nodulation patterns in soils of different texture at Morogoro ...

    African Journals Online (AJOL)

    Thus, nodulation success by the inoculum was total in the clay but only dismal in the sandy soil. The unexpected discrepancy between inoculum success on the one hand and nodulation plus plant growth response on the other, is discussed. Keywords: Bean nodulation, ELISA typing of nodules, phaseolus vulgaris

  9. Management of thyroid nodules in children and adolescents

    NARCIS (Netherlands)

    Wiersinga, Wilmar M.

    2007-01-01

    Thyroid nodules in childhood and adolescence are less prevalent but more often malignant than in adulthood. Malignant nodules are predominantly papillary cancers; benign nodules are mostly solid colloid nodules/adenomas, but can be cystic or due lymphocytic thyroiditis. Previous neck irradiation

  10. Management of a solitary thyroid nodule

    International Nuclear Information System (INIS)

    Rao, R.S.

    1999-01-01

    Solitary nodule in the thyroid is a common clinical entity. A careful clinical assessment is the crucial first step in deciding the modality of treatment. The only worthwhile investigation is FNAC. Other investigations are done merely for the sake of a complete academic work up and can usually be dispensed with in most of the cases. Not every solitary nodule requires surgery. The optimum surgery for a solitary nodule is a total lobectomy. The specimen should be subjected to histological examination before recommending further treatment

  11. Activation of cell divisions in legume nodulation

    DEFF Research Database (Denmark)

    Nadzieja, Marcin

    organogenesis. Coordination of these two interdependent processes results in formation of nodules - bacterial accommodating structures where fixation of atmospheric nitrogen takes place. Plant hormones such as auxin and cytokinin play important roles in nodulation. In some legumes the infection process...... of auxin transport inhibitors or cytokinin alone was shown to induce cortical cell divisions in the absence of rhizobia in certain legume species. While the roles of auxin and cytokinin in nodulation have been studied extensively, the precise timing, location and means of molecular crosstalk between...

  12. [Nodules on localized scleroderma or morphea].

    Science.gov (United States)

    Bayle, P; Bazex, J; Marguery, M-C; Lamant, L

    2005-02-01

    Localized scleroderma or morphea usually appears as flat or depressed lesions. We report 3 cases of morphea with atypical appearance, alternating pigmented and depigmented patches with nodules or sclerous bands, occurring in adult men. The occurrence of nodular elements on generalized or localized scleroderma, although rare, was first reported in the literature by Addisson in 1884. These nodules usually appear during evolution. These scleroderma are then described as being keloidal or nodular. We report 3 cases of nodules on localized scleroderma which appeared at the beginning of the dermatosis and where the scleroderma had a similar unusual irregularly pigmented appearance.

  13. Radioembolization of hepatocellular carcinoma.

    Science.gov (United States)

    Van de Wiele, Christophe

    2010-12-01

    In this review paper, available data on radioembolization of unresectable hepatocellular carcinoma (HCC) using commercially available radiopharmaceuticals, respectively (131)I-Lipiodol, Therasphere (glass-microspheres) and SIRspheres (resin-microspheres) are reviewed. In the palliative setting, (131)I-Lipiodol was shown to yield response rates of 17-92% which in patients with portal vein thrombosis (PVT) translate into a survival benefit as evidenced by a phase III randomized trial. Furthermore, in terms of efficacy, (131)I-Lipiodol is as efficacious as trans-arterial chemoembolization (TACE) but far better tolerated. In the adjuvant setting, improved recurrence-free and overall survival when compared to surgery alone have been reported but these results warrant confirmation by randomized prospective trials. Similar to (131)I-Lipiodol, when administered in a palliative setting, radioembolization using (90)Y microspheres was proven effective for selected cases of non-resectable HCC and well tolerated. Available data suggest that Therasphere treatment outperforms TACE both in terms of response as in terms of event-free survival in unresectable HCC. However, this finding needs confirmation by randomized prospective trials. Therasphere treatment was also shown to limit progression of HCC allowing potential candidates for orthotopic liver transplantation (OLT) more time to wait for donor organs as well as to downstage the HCC disease to such an extent that patients that were initially not, as yet become eligible for OLT with a gain in survival. Finally, Therasphere was shown to be safe and efficacious in HCC patients presenting with PVT, reason for which approval was granted for this indication by the FDA.

  14. Hepatocellular carcinoma in Danish patients

    DEFF Research Database (Denmark)

    Stefansdottir, Jenna; Christensen, Erik; Schiødt, Frank Vinholt

    2017-01-01

    OBJECTIVE: Hepatocellular carcinoma (HCC) is a common cause of cancer, and most HCC patients have underlying cirrhosis. Retrospectively, we aimed to characterize patients with newly diagnosed HCC at a Danish hospital and to investigate survival and identify predictive factors for survival. METHODS...

  15. Glutathione treatment of hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Dalhoff, K; Ranek, L; Mantoni, M

    1992-01-01

    This prospective study was undertaken to substantiate observations that glutathione (GSH) inhibits or reverses tumor growth in humans with hepatocellular carcinoma (HCC), a neoplasm with an extremely poor prognosis. Eight patients with biopsy-proven HCC not amenable to surgery were given 5 g of GSH...

  16. Real-time elastography in autonomously functioning thyroid nodules: relationship with TSH levels, scintigraphy, and ultrasound patterns.

    Science.gov (United States)

    Trimboli, Pierpaolo; Paone, Gaetano; Zatelli, Maria Chiara; Ceriani, Luca; Giovanella, Luca

    2017-12-01

    Real-time elastography has been proposed to increase the sensitivity of ultrasound and improve the detection of thyroid nodules at risk of malignancy. To date sparse data on real-time elastography assessment of autonomously functioning thyroid nodules exist. Here, we investigated the potential role of real-time elastography in autonomously functioning thyroid nodule assessment. Specifically, the correlation between serum hormones and real-time elastography score, as well as other clinical and ultrasound features, was analyzed. Patients with autonomously functioning thyroid nodule identified by I-123 scintigraphy from September 2015 to July 2016 and undergoing ultrasound, real-time elastography, and thyroid function evaluation were selected. All autonomously functioning thyroid nodule were classified as RTE I (prevalence of red or green color with blue in up to 25% of the nodule area), RTE II (blue in 25-75%), or RTE III (blue in more than 75%). The association between suppressed thyroid stimulating hormone and patient's age, nodule's size, ultrasound presentation, and real-time elastography scoring was analyzed by Odds Ratio in univariate fashion and multivariate model. A number of 47 subjects with single autonomously functioning thyroid nodule were enrolled. Median age of 63 years, median size of 2.0 cm, and suppressed thyroid stimulating hormone levels in 32% of cases were found. Those nodules classified by ultrasound at high risk underwent fine-needle aspiration cytology and cancer was excluded. At real-time elastography evaluation, a 45% of autonomously functioning thyroid nodule had a hard appearance (RTE III) and had thyroid stimulating hormone significantly lower than the other (p < 0.0001). A model of multivariate logistic regression including nodule's size, ultrasound characteristics, and elastographic presentation showed that only RTE III was significantly associated with suppressed thyroid stimulating hormone (Odds Ratio of 50). Autonomously

  17. Pulmonary nodules secondary to total parenteral alimentation

    International Nuclear Information System (INIS)

    Landry, B.A.; Melhem, R.E.

    1989-01-01

    A seven-year-old male, who had a retroperitoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed muliple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy. (orig.)

  18. Actinorhizal nitrogen fixing nodules: infection process, molecular ...

    African Journals Online (AJOL)

    Actinorhizal nitrogen fixing nodules: infection process, molecular biology and genomics. Mariana Obertello, Mame Oureye SY, Laurent Laplaze, Carole Santi, Sergio Svistoonoff, Florence Auguy, Didier Bogusz, Claudine Franche ...

  19. Nodule bottom backscattering study using multibeam echosounder

    Digital Repository Service at National Institute of Oceanography (India)

    Chakraborty, B.; Raju, Y.S.N.; Nair, R.R.

    A study is carried out to observe the angular dependence of backscattering strength at nodule area where grab sample and photographic data is available. Theoretical study along with the experimentally observed data shows that the backscattering...

  20. Isolate pulmonary nodule. CT-guided biopsy

    International Nuclear Information System (INIS)

    Bruneton, J.N.; Ettore, F.; Rogopoulos, A.; Geoffray, A.; Balu-Maestro, C.; Le Houcq, M.

    1989-01-01

    Transparietal CT-guided biopsy location can be successfully performed for isolate pulmonary nodules, defined as lesions with a maximal diameter of 3 cm, without any other parenchymal or mediastinal abnormality. A 21 G needle has been used according to an identical protocole in 64 cases (10 benign, 54 malignant). The biopsy was successful in 77.7% of the malignant cases. In relation to the diameter of the nodules, biopsy was successful in 66.7% of the nodules smaller than 2 cm and in 76% of the nodules ranging from 2 to 3 cm. The complications observed were rare (1 case of pneumothorax requiring drainage, 9 cases of pneumothorax without clinical signs and simply followed up, 4 cases of minor hemoptysis requiring no treatment and 5 cases of hematomas smaller than 5 cm on CT) [fr

  1. Hypovascular hypointense nodules on hepatobiliary phase without T2 hyperintensity on gadoxetic acid-enhanced MR images in patients with chronic liver disease: long-term outcomes and risk factors for hypervascular transformation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Seek [Chonbuk National University Medical School and Hospital, Department of Radiology, Jeonju-si, Chonbuk (Korea, Republic of); Song, Ji Soo; Lee, Hyun Kyung; Han, Young Min [Chonbuk National University Medical School and Hospital, Department of Radiology, Jeonju-si, Chonbuk (Korea, Republic of); Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Research Institute of Clinical Medicine, Chonbuk (Korea, Republic of)

    2016-10-15

    To evaluate the long-term outcomes and imaging features associated with hypervascularization of hypovascular nodules that show T2 iso-/hypointensity and hypointensity on hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) images in patients with chronic liver disease. Sixty patients and 114 nodules, which were hypovascular and iso-/hypointense on T2-weighted images and hypointense on HBP of gadoxetic acid-enhanced MRI, were included. We evaluated the effect of baseline clinical features, baseline MR features and growth rate on subsequent hypervascularization. Twenty-seven nodules in 21 patients transformed to hypervascular hepatocellular carcinoma (HCC). Using multivariate Cox analysis, T1 hyperintensity (hazard ratio [HR] = 2.69, P = 0.021), previous history of HCC (HR = 2.64, P = 0.021), and initial nodule size (HR = 1.09, P = 0.046) were identified to be associated with hypervascularization. The growth rate of nodules was a more powerful determinant of subsequent hypervascularization than baseline clinical and MR features. At long-term follow-up after >3 years, only one nodule with T1 isointensity showed hypervascularization. Careful follow-up or diagnostic procedures, such as biopsy, should be considered for up to 3 years after detection of hypointense nodules on HBP with T1 hyperintensity or a higher growth rate. (orig.)

  2. Small nodule detectability evaluation using a generalized scan-statistic model

    International Nuclear Information System (INIS)

    Popescu, Lucretiu M; Lewitt, Robert M

    2006-01-01

    In this paper is investigated the use of the scan statistic for evaluating the detectability of small nodules in medical images. The scan-statistic method is often used in applications in which random fields must be searched for abnormal local features. Several results of the detection with localization theory are reviewed and a generalization is presented using the noise nodule distribution obtained by scanning arbitrary areas. One benefit of the noise nodule model is that it enables determination of the scan-statistic distribution by using only a few image samples in a way suitable both for simulation and experimental setups. Also, based on the noise nodule model, the case of multiple targets per image is addressed and an image abnormality test using the likelihood ratio and an alternative test using multiple decision thresholds are derived. The results obtained reveal that in the case of low contrast nodules or multiple nodules the usual test strategy based on a single decision threshold underperforms compared with the alternative tests. That is a consequence of the fact that not only the contrast or the size, but also the number of suspicious nodules is a clue indicating the image abnormality. In the case of the likelihood ratio test, the multiple clues are unified in a single decision variable. Other tests that process multiple clues differently do not necessarily produce a unique ROC curve, as shown in examples using a test involving two decision thresholds. We present examples with two-dimensional time-of-flight (TOF) and non-TOF PET image sets analysed using the scan statistic for different search areas, as well as the fixed position observer

  3. Usage of adenovirus expressing thymidine kinase mediated hepatocellular damage for enabling mouse liver repopulation with allogenic or xenogenic hepatocytes.

    Directory of Open Access Journals (Sweden)

    Daniel Moreno

    Full Text Available It has been shown that the liver of immunodeficient mice can be efficiently repopulated with human hepatocytes when subjected to chronic hepatocellular damage. Mice with such chimeric livers represent useful reagents for medical and clinical studies. However all previously reported models of humanized livers are difficult to implement as they involve cross-breeding of immunodeficient mice with mice exhibiting genetic alterations causing sustained hepatic injury. In this paper we attempted to create chimeric livers by inducing persistent hepatocellular damage in immunodeficient Rag2(-/- γc(-/- mice using an adenovirus encoding herpes virus thymidine kinase (AdTk and two consecutive doses of ganciclovir (GCV. We found that this treatment resulted in hepatocellular damage persisting for at least 10 weeks and enabled efficient engraftment and proliferation within the liver of either human or allogenic hepatocytes. Interestingly, while the nodules generated from the transplanted mouse hepatocytes were well vascularized, the human hepatocytes experienced progressive depolarization and exhibited reduced numbers of murine endothelial cells inside the nodules. In conclusion, AdTk/GCV-induced liver damage licenses the liver of immunodeficient mice for allogenic and xenogenic hepatocyte repopulation. This approach represents a simple alternative strategy for chimeric liver generation using immunodeficient mice without additional genetic manipulation of the germ line.

  4. Early nodule senescence is activated in symbiotic mutants of pea (Pisum sativum L.) forming ineffective nodules blocked at different nodule developmental stages.

    Science.gov (United States)

    Serova, Tatiana A; Tsyganova, Anna V; Tsyganov, Viktor E

    2018-04-03

    Plant symbiotic mutants are useful tool to uncover the molecular-genetic mechanisms of nodule senescence. The pea (Pisum sativum L.) mutants SGEFix - -1 (sym40), SGEFix - -3 (sym26), and SGEFix - -7 (sym27) display an early nodule senescence phenotype, whereas the mutant SGEFix - -2 (sym33) does not show premature degradation of symbiotic structures, but its nodules show an enhanced immune response. The nodules of these mutants were compared with each other and with those of the wild-type SGE line using seven marker genes that are known to be activated during nodule senescence. In wild-type SGE nodules, transcript levels of all of the senescence-associated genes were highest at 6 weeks after inoculation (WAI). The senescence-associated genes showed higher transcript abundance in mutant nodules than in wild-type nodules at 2 WAI and attained maximum levels in the mutant nodules at 4 WAI. Immunolocalization analyses showed that the ethylene precursor 1-aminocyclopropane-1-carboxylate accumulated earlier in the mutant nodules than in wild-type nodules. Together, these results showed that nodule senescence was activated in ineffective nodules blocked at different developmental stages in pea lines that harbor mutations in four symbiotic genes.

  5. Scintigraphy of the functioning thyroid nodule

    International Nuclear Information System (INIS)

    Mahlstedt, J.

    2008-01-01

    The evaluation of functioning thyroid nodules is achieved by use of several Iodine isotopes, while in clinical routine 99m Tc-Pertechnetate is dominating. For classification the terms hyperfunctional, isofunctional (normal) and hypofunctional are useful in comparison to the surrounding normally functioning thyroid tissue, which can be stimulated or suppressed. Therefore, autonomous functioning thyroid nodules can vary the scintigraphic appearance. For precise description the terms 'compensation' and 'decompensation' have to be used in relation to scintigraphy or thyroidal metabolism (regulation). (orig.)

  6. Atypical Localized Rheumatoid Nodule: Case Report

    Directory of Open Access Journals (Sweden)

    KORHAN BARIS BAYRAM

    2015-01-01

    Full Text Available Rheumatoid nodules can be seen in about 30% of patiens with rheumatoid arthritis. They are occasionally localized subcutaneous, but they can rarely seen in visceral organs. Their appearance can be confused with many clinical conditions when they have atypical localizations. To exclude the presence of a malignancy, these lesions should always be investigated. We aimed to discuss a patient with rheumatoid nodule localized in close neighborhood of hyoid bone, presumed as malignancy.

  7. Dose establishing a safety margin reduce local recurrence in subsegmental transarterial chemoembolization for small nodular hepatocellular carcinomas?

    International Nuclear Information System (INIS)

    Kang, Hyo Jin; Kim, Young Il; Kim, Hyo Cheol; Jae, Hwan Jun; Hur, Sae Beam; Chung, Jin Wook

    2015-01-01

    To test the hypothesis that a safety margin may affect local tumor recurrence (LTR) in subsegmental chemoembolization. In 101 patients with 128 hepatocellular carcinoma (HCC) nodules (1-3 cm in size and ≤ 3 in number), cone-beam CT-assisted subsegmental lipiodol chemoembolization was performed. Immediately thereafter, a non-contrast thin-section CT image was obtained to evaluate the presence or absence of intra-tumoral lipiodol uptake defect and safety margin. The effect of lipiodol uptake defect and safety margin on LTR was evaluated. Univariate and multivariate analyses were performed to indentify determinant factors of LTR. Of the 128 HCC nodules in 101 patients, 49 (38.3%) nodules in 40 patients showed LTR during follow-up period (median, 34.1 months). Cumulative 1- and 2-year LTR rates of nodules with lipiodol uptake defect (n = 27) and those without defect (n = 101) were 58.1% vs. 10.1% and 72.1% vs. 19.5%, respectively (p < 0.001). Among the 101 nodules without a defect, the 1- and 2-year cumulative LTR rates for nodules with complete safety margin (n = 52) and those with incomplete safety margin (n = 49) were 9.8% vs. 12.8% and 18.9% vs. 19.0% (p = 0.912). In multivariate analyses, ascites (p = 0.035), indistinct tumor margin on cone-beam CT (p = 0.039), heterogeneous lipiodol uptake (p = 0.023), and intra-tumoral lipiodol uptake defect (p < 0.001) were determinant factors of higher LTR. In lipiodol chemoembolization, the safety margin in completely lipiodolized nodule without defect will not affect LTR in small nodular HCCs

  8. Pathological Diagnosis of Hepatocellular Cellular Adenoma according to the Clinical Context

    Directory of Open Access Journals (Sweden)

    Paulette Bioulac-Sage

    2013-01-01

    Full Text Available In Europe and North America, hepatocellular adenomas (HCA occur, classically, in middle-aged woman taking oral contraceptives. Twenty percent of women, however, are not exposed to oral contraceptives; HCA can more rarely occur in men, children, and women over 65 years. HCA have been observed in many pathological conditions such as glycogenosis, familial adenomatous polyposis, MODY3, after male hormone administration, and in vascular diseases. Obesity is frequent particularly in inflammatory HCA. The background liver is often normal, but steatosis is a frequent finding particularly in inflammatory HCA. The diagnosis of HCA is more difficult when the background liver is fibrotic, notably in vascular diseases. HCA can be solitary, or multiple or in great number (adenomatosis. When nodules are multiple, they are usually of the same subtype. HNF1α-inactivated HCA occur almost exclusively in woman. The most important point of the classification is the identification of β-catenin mutated HCA, a strong argument to identify patients at risk of malignant transformation. Some HCA already present criteria indicating malignant transformation. When the whole nodule is a hepatocellular carcinoma, it is extremely difficult to prove that it is the consequence of a former HCA. It is occasionally difficult to identify HCA remodeled by necrosis or hemorrhage.

  9. Hepatobiliary effects of 90yttrium microsphere therapy for unresectable hepatocellular carcinoma.

    Science.gov (United States)

    Nalesnik, Michael A; Federle, Michael; Buck, David; Fontes, Paulo; Carr, Brian I

    2009-01-01

    (90)Yttrium (Therasphere) microspheres administered via hepatic artery are a valuable option for treatment of hepatocellular carcinoma. This therapy targets tumor nodules while largely sparing hepatic parenchyma. This retrospective study examines liver explants from 13 adult patients with hepatocellular carcinoma who received intrahepatic Theraspheres and subsequently underwent liver transplantation. Histopathologic and laboratory reviews are performed. Theraspheres preferentially migrated to the lobe(s) supplied by the injected artery branches and frequently localized to tumors. Tumors showed a chronology of changes beginning with confluent necrosis typically accompanied by hemorrhage and later by fibrinoid change. This was followed by fibrosis with regenerative activity at tumor peripheries. Adjacent hepatic parenchyma went through a similar sequence of injury and repair that could lead to markedly fibrotic cirrhotic nodules in the vicinity of treated tumors. No consistent pattern of thrombomodulin loss was seen in endothelial cells of the tumors or adjacent parenchyma, suggesting that direct endothelial cell injury was likely not a major contributor to the necrotic process. However, the pattern of injury and repair is suggestive of a localized and subclinical form of radiation-induced liver disease. The pathologist should be aware of these changes to distinguish them from the diffuse "radiation hepatitis" associated with older forms of radiotherapy.

  10. Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Morla, Olivier; Liberge, Renan; Arrigoni, Pierre Paul; Frampas, Eric [Service de Radiologie Centrale, C.H.U. Hotel Dieu, Nantes (France)

    2014-09-15

    The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies. This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution. Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50 %) were due to infections, one (17 %) to organizing pneumonia, and two (33 %) remained of undetermined origin. Among the multiple lesions, 14 (78 %) were due to infection, three to post-transplant lymphoproliferative disorder (17 %), and one to bronchogenic carcinoma (5 %). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules > 1 cm, four (33 %) were due to malignancy: three post-transplant lymphoproliferative disorders (25 %), and one bronchogenic carcinoma (8 %). Among five cavitary nodules four (80 %) were due to aspergillosis. Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered. (orig.)

  11. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

    1981-09-15

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

  12. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

    International Nuclear Information System (INIS)

    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo

    1981-01-01

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

  13. Analysis of nodule meristem persistence and ENOD40 functioning in Medicago truncatula nodule formation

    NARCIS (Netherlands)

    Wan Xi,

    2007-01-01

    Medicago root nodules are formed as a result of the interaction of the plant with the soil-borne bacterium Sinorhizobium meliloti. Several plant genes are induced during nodule formation and MtENOD40 is one of the earliest genes activated. The precise function as well as the molecule

  14. Benign and malignant hepatocellular tumors: evaluation of tumoral enhancement after mangafodipir trisodium injection on MR imaging

    International Nuclear Information System (INIS)

    Coffin, C.M.; Diche, T.; Mahfouz, A.E.; Alexandre, M.; Caseiro-Alves, F.; Rahmouni, A.; Vasile, N.; Mathieu, D.

    1999-01-01

    The aim of this work was to study the ability of mangafodipir trisodium (Mn-DPDP)-enhanced MR imaging in differentiating malignant from benign hepatocellular tumors. Eleven patients with pathologically proved hepatocellular carcinomas, six with focal nodular hyperplasias, and one with a single hepatocellular adenoma were examined by spin-echo and gradient-echo T1-weighted sequences before, 1 h after, and 24 h after intravenous injection of Mn-DPDP (5 μmol/kg). Quantitative analysis including enhancement and lesion-to-liver contrast-to-noise ratio, and qualitative analysis including the presence of a central area and a capsule were done on pre- and post-Mn-DPDP-enhanced images. Enhancement was observed in all the tumors with significant improvement (p < 0.05) in contrast-to-noise ratio 1 h after, and 24 h after intravenous injection of Mn-DPDP. There were no significant differences in the mean enhancement and the mean contrast-to-noise ratio (CNR) between benign and malignant tumors. No enhancement was seen within internal areas observed in 7 hepatocellular carcinomas, and in 5 focal nodular hyperplasias, and within capsules which were observed in 9 hepatocellular carcinomas. In our study, Mn-DPDP increased CNR of both benign and malignant tumors but did not enable differentiation between benign and malignant tumors of hepatocellular nature. (orig.)

  15. Laryngeal ultrasound and pediatric vocal fold nodules.

    Science.gov (United States)

    Ongkasuwan, Julina; Devore, Danielle; Hollas, Sarah; Jones, Jeremy; Tran, Brandon

    2017-03-01

    The term vocal fold nodules refers to bilateral thickening of the membranous folds with minimal impairment of the vibratory properties of the mucosa. Nodules are thought to be related to repetitive mechanical stress, associated with voice use patterns. Diagnosis is typically made in the office via either rigid or flexible laryngeal stroboscopy. Depending on the individual child, obtaining an optimal view of the larynx can be difficult if not impossible. Recent advances in high-frequency ultrasonography allows for transcervical examination of laryngeal structures. The goal of this project was to determine if laryngeal ultrasound (LUS) can be used to identify vocal fold nodules in dysphonic children. Prospective case-control study in which the patient acted as his or her own control. Forty-six pediatric patients were recruited for participation in this study; the mean age was 4.8 years. Twenty-three did not have any vocal fold lesions and 23 had a diagnosis of vocal fold nodules on laryngeal stroboscopy. Recorded LUSs were reviewed by two pediatric radiologists who were blinded to the nodule status. There was substantial inter-rater agreement (κ = 0.70, 95% confidence interval [CI]: 0.50-0.89) between the two radiologists regarding the presence of nodules. There was also substantial agreement (κ = 0.87, 95% CI: 0.72-1) between LUS and laryngeal stroboscopy. Sensitivity of LUS was 100% (95% CI: 85%-100%) and specificity was 87% (95% CI: 66%-97%). LUS can be used to identify vocal fold nodules in children with substantial agreement with laryngeal stroboscopy. 3b Laryngoscope, 127:676-678, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  16. ROLE OF MOLECULAR MARKERS IN THYROID NODULE MANAGEMENT: THEN AND NOW.

    Science.gov (United States)

    Nikiforov, Yuri E

    2017-08-01

    To describe the evolution and clinical utility of molecular testing for thyroid nodules and cancer achieved over the last 2 decades. Scientific reports on thyroid cancer genetics and molecular diagnostics in thyroid nodules. Over the last 2 decades, our understanding of the genetic mechanisms of thyroid cancer has dramatically expanded, such that most thyroid cancers now have known gene driver events. This knowledge provides the basis for establishing and further improving molecular tests for thyroid nodules and cancer and for the introduction of new entities such as noninvasive follicular thyroid neoplasm with papillary-like nuclear features. The progress with molecular tests for thyroid nodules started in the 1990s from demonstrating feasibility of detecting various molecular alterations in fine-needle aspiration (FNA) material collected from thyroid nodules. It was followed by the introduction of the first single-gene mutational markers, such as BRAF, and a small mutational panel into clinical practice in the mid 2000s. Currently, several more advanced molecular tests are available for clinical use. They are based on multiple molecular markers and have increasing impact on the clinical management of patients with thyroid nodules. The evolution of molecular tests for thyroid nodules followed the discovery of various diagnostic and prognostic molecular markers of thyroid cancer that can be applied to thyroid FNA samples to inform more individualized management of these patients. FNA = fine-needle aspiration miRNA = micro RNA NGS = next-generation sequencing NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features NPV = negative predictive value PPV = positive predictive value PTC = papillary thyroid carcinoma RAI = radioactive iodine.

  17. Diagnostic Accuracy of MRI-guided Percutaneous Transthoracic Needle Biopsy of Solitary Pulmonary Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Shangang, E-mail: 1198685580@qq.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China); Li, Chengli, E-mail: chenglilichina@yeah.net [Shandong University, Department of Interventional MRI, Shandong Medical Imaging Research Institute (China); Yu, Xuejuan, E-mail: yuxuejuan2011@126.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China); Liu, Ming, E-mail: mingliuyxs@163.com [Shandong University, Department of Interventional MRI, Shandong Medical Imaging Research Institute (China); Fan, Tingyong, E-mail: FTY681105@sohu.com; Chen, Dong, E-mail: 857984870@qq.com; Zhang, Pinliang, E-mail: zhangpinliang@163.com; Ren, Ruimei, E-mail: liusg708@qq.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China)

    2015-04-15

    ObjectiveThe purpose of our study was to evaluate the diagnostic accuracy of MRI-guided percutaneous transthoracic needle biopsy (PTNB) of solitary pulmonary nodules (SPNs).MethodsRetrospective review of 69 patients who underwent MR-guided PTNB of SPNs was performed. Each case was reviewed for complications. The final diagnosis was established by surgical pathology of the nodule or clinical and imaging follow-up. Pneumothorax rate and diagnostic accuracy were compared between two groups according to nodule diameter (≤2 vs. >2 cm) using χ{sup 2} chest and Fisher’s exact test, respectively.ResultsThe success rate of single puncture was 95.6 %. Twelve (17.4 %) patients had pneumothorax, with 1 (1.4 %) requiring chest tube insertion. Mild hemoptysis occurred in 7 (7.2 %) patients. All of the sample material was sufficient for histological diagnostic evaluation. Pathological analysis of biopsy specimens showed 46 malignant, 22 benign, and 1 nondiagnostic nodule. The final diagnoses were 49 malignant nodules and 20 benign nodules basing on postoperative histopathology and clinical follow-up data. One nondiagnostic sample was excluded from calculating diagnostic performance. A sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in diagnosing SPNs were 95.8, 100, 97.0, 100, and 90.9 %, respectively. Pneumothorax rate, diagnostic sensitivity, and accuracy were not significantly different between the two groups (P > 0.05).ConclusionsMRI-guided PTNB is safe, feasible, and high accurate diagnostic technique for pathologic diagnosis of pulmonary nodules.

  18. Diagnostic value of contrast-enhanced dynamic CT in predicting the malignancy of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Song, Koun Sik; Lee, Eun Hye; Kim, Ji Hoon; Lee, Jin Seong; Lim, Tae Hwan

    1997-01-01

    To determine whether the maximal enhancement time in dynamic CT is different between benign and malignant solitary pulmonary nodules (SPN)s, and to evaluate the value of densitometry on dynamic CT in predicting the malignancy of SPN. Fifty-six patients with SPN of less than 4cm in diameter as seen on chest radiograph and SPN without benign pattern of calcification or fat, as seen on pre-enhance-ment spiral CT scans were included in this study. SPN with small cavitation sufficient to measure CT density, were also included. Thirty-four SPNs were diagnosed pathologically or radiologically as 20 malignant nodules and 14 benign nodules. Dynamic CT was performed by two techniques after injection of 50ml of nonionic contrast media at the rate of 2ml/sec. In 28 patients, incremental dynamic CT was performed before and of 15 seconds, 1 minute, 2 minutes, 3 minutes, and 4 minutes after injection of contrast media during shallow respiration. In 28 patients, double spiral CT was performed 2 minutes and 3 minutes after injection of contrast media during single breath hold. CT readings were taken at the central portion of SPNs, with a circular region of interest. The degree and time of maximal enhancement were recorded. In dynamic CT the maximal enhancement time of SPNs was not significantly different between malignant (2.73±1.27 minute) and benign nodules (2.56±1.24 minute). The enhancement of malignant nodules was significantly greater (21.42±12.17 HU) than of benign nodules (5.15±5.25 HU) (p<.0001). In dynamic CT of SPNs, there is no difference in maximal enhancement time between benign and malignant nodules;enhancement of the latter is significantly greater than that of the former. Maximal enhancement greater than 15 HU can be a good predictor of malignancy of SPNs

  19. X-ray Digital Linear Tomosynthesis Imaging for Artificial Pulmonary Nodule Detection

    Directory of Open Access Journals (Sweden)

    Tsutomu Gomi

    2011-01-01

    Full Text Available The purpose of this paper is to identify indications for volumetric X-ray digital linear tomosynthesis (DLT with single- and dual-energy subtraction techniques for artificial pulmonary nodule detection and compare X-ray DLT, X-ray digital radiography, and computed tomography.

  20. Rare-earth elements and uranium in phosphatic nodules from the continental margins of India

    Digital Repository Service at National Institute of Oceanography (India)

    Nath, B.N.; Rao, B.R.; Rao, K.M.; Rao, Ch.M.

    of Pleistocene age. They are less than 1-5 cm in size, have carbonate flourapatite (CFA) as a single authigenic mineral phase, are free of detrital inclusions, and have very high P sub(2) O sub(5) contents (> 30%). In addition, soft and hard phosphatic nodules...

  1. Non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI as a predictor of outcomes for early-stage HCC.

    Science.gov (United States)

    Toyoda, Hidenori; Kumada, Takashi; Tada, Toshifumi; Sone, Yasuhiro; Maeda, Atsuyuki; Kaneoka, Yuji

    2015-01-01

    In patients with hepatocellular carcinoma (HCC), gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) often identifies non-hypervascular hypointense hepatic nodules during the hepatobiliary phase, but their prognostic significance is unclear. We conducted a prospective observational study to investigate the impact of non-hypervascular hypointense hepatic nodules detected by Gd-EOB-DTPA-enhanced MRI on the outcome of patients with early-stage HCC. Post-treatment recurrence and survival rates were analyzed in 138 patients with non-recurrent, early-stage HCC [Barcelona Clinic Liver Cancer (BCLC) stage 0 or A] and Child-Pugh A liver function according to the presence of non-hypervascular hypointense nodules on pretreatment Gd-EOB-DTPA-enhanced MRI. Non-hypervascular hypointense hepatic nodules were detected in 51 (37.0%) patients with early-stage HCC on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrence rates were significantly higher in patients with non-hypervascular hypointense nodules (p DTPA-enhanced MRI was independently associated with an increased recurrence rate, independent of tumor progression or treatment (p = 0.0005). The survival rate was significantly lower in patients with non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI (p = 0.0108). In patients with early-stage typical HCC (BCLC 0 or A), the presence of concurrent non-hypervascular hypointense hepatic nodules in the hepatobiliary phase of pretreatment Gd-EOB-DTPA-enhanced MRI is an indicator of higher likelihood of recurrence after treatment and may be a marker for unfavorable outcome.

  2. Pulmonary nodule characterization: A comparison of conventional with quantitative and visual semi-quantitative analyses using contrast enhancement maps

    International Nuclear Information System (INIS)

    Petkovska, Iva; Shah, Sumit K.; McNitt-Gray, Michael F.; Goldin, Jonathan G.; Brown, Matthew S.; Kim, Hyun J.; Brown, Kathleen; Aberle, Denise R.

    2006-01-01

    Purpose: To determine whether conventional nodule densitometry or analysis based on contrast enhancement maps of indeterminate lung nodules imaged with contrast-enhanced CT can distinguish benign from malignant lung nodules. Materials and method: Thin section, contrast-enhanced CT (baseline, and post-contrast series acquired at 45, 90,180, and 360 s) was performed on 29 patients with indeterminate lung nodules (14 benign, 15 malignant). A thoracic radiologist identified the boundary of each nodule using semi-automated contouring to form a 3D region-of-interest (ROI) on each image series. The post-contrast series having the maximum mean enhancement was then volumetrically registered to the baseline series. The two series were subtracted volumetrically and the subtracted voxels were quantized into seven color-coded bins, forming a contrast enhancement map (CEM). Conventional nodule densitometry was performed to obtain the maximum difference in mean enhancement values for each nodule from a circular ROI. Three thoracic radiologists performed visual semi-quantitative analysis of each nodule, scoring each map for: (a) magnitude and (b) heterogeneity of enhancement throughout the entire volume of the nodule on a five-point scale. Receiver operator characteristic (ROC) analysis was conducted on these features to evaluate their diagnostic efficacy. Finally, 14 quantitative texture features were calculated for each map. A statistical analysis was performed to combine the 14 texture features to a single factor. ROC analysis of the derived aggregate factor was done as an indicator of malignancy. All features were analyzed for differences between benign and malignant nodules. Results: Using 15 HU as a threshold, 93% (14/15) of malignant and 79% (11/14) of benign nodules demonstrated enhancement. The ROC curve when higher values of enhancement indicate malignancy was generated and area under the curve (AUC) was 0.76. The visually scored magnitude of enhancement was found to be

  3. Lung Nodule Image Classification Based on Local Difference Pattern and Combined Classifier.

    Science.gov (United States)

    Mao, Keming; Deng, Zhuofu

    2016-01-01

    This paper proposes a novel lung nodule classification method for low-dose CT images. The method includes two stages. First, Local Difference Pattern (LDP) is proposed to encode the feature representation, which is extracted by comparing intensity difference along circular regions centered at the lung nodule. Then, the single-center classifier is trained based on LDP. Due to the diversity of feature distribution for different class, the training images are further clustered into multiple cores and the multicenter classifier is constructed. The two classifiers are combined to make the final decision. Experimental results on public dataset show the superior performance of LDP and the combined classifier.

  4. Lung Nodule Image Classification Based on Local Difference Pattern and Combined Classifier

    Directory of Open Access Journals (Sweden)

    Keming Mao

    2016-01-01

    Full Text Available This paper proposes a novel lung nodule classification method for low-dose CT images. The method includes two stages. First, Local Difference Pattern (LDP is proposed to encode the feature representation, which is extracted by comparing intensity difference along circular regions centered at the lung nodule. Then, the single-center classifier is trained based on LDP. Due to the diversity of feature distribution for different class, the training images are further clustered into multiple cores and the multicenter classifier is constructed. The two classifiers are combined to make the final decision. Experimental results on public dataset show the superior performance of LDP and the combined classifier.

  5. Do manganese nodules grow or dissolve after burial? Results from the Central Indian Ocean Basin

    Digital Repository Service at National Institute of Oceanography (India)

    Pattan, J.N.; Parthiban, G.P.S.

    (Elderfield et al., 1981; Glasby et al., 1987). We considered La as a representative element of the REE group because all of the 14 naturally occurring elements were not analysed in all of the studied samples. The mean La content in the buried nodules from red... carrier phase in buried nodules, we plotted La (representing REE group) against combined Fe+Ti+P contents, which shows a strong positive correlation (r = 0.88), suggesting a single REE carrier phase (Fig. 3). This is similar to the earlier observation...

  6. INFLUENCE OF HEPATOCELLULAR CARCINOMA ETIOLOGY IN THE SURVIVAL AFTER RESECTION.

    Science.gov (United States)

    Lopes, Felipe de Lucena Moreira; Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirolla; Fonseca, Gilton Marques; Araujo, Raphael Leonardo Cunha de; Jeismann, Vagner Birk; Herman, Paulo

    2016-01-01

    Hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer and its incidence is increasing around the world in the last decades, making it the third cause of death by cancer in the world. Hepatic resection is one of the most effective treatments for HCC with five-year survival rates from 50-70%, especially for patients with a single nodule and preserved liver function. Some studies have shown a worse prognosis for HCC patients whose etiology is viral. That brings us to the question about the existence of a difference between the various causes of HCC and its prognosis. To compare the prognosis (overall and disease-free survival at five years) of patients undergoing hepatectomy for the treatment of HCC with respect to various causes of liver disease. Was performed a review of medical records of patients undergoing hepatectomy between 2000 and 2014 for the treatment of HCC. They were divided into groups according to the cause of liver disease, followed by overall and disease-free survival analysis for comparison. There was no statistically significant difference in the outcomes of the groups of patients divided according to the etiology of HCC. Overall and disease-free survival at five years of the patients in this sample were 49.9% and 40.7%, respectively. From the data of this sample, was verified that there was no prognostic differences among the groups of HCC patients of the various etiologies. O carcinoma hepatocelular (CHC) é o mais frequente tipo de câncer primário do fígado e a sua incidência vem aumentando nas últimas décadas, tornando-o hoje a terceira causa de morte por câncer no mundo. A ressecção hepática é um dos tratamentos mais eficazes para ele com taxas de sobrevida em cinco anos de 50-70%, especialmente para pacientes com nódulo único e função hepática preservada. Alguns estudos mostraram pior prognóstico para os pacientes com CHC cuja causa é a infecção por vírus B ou C. Isso leva à questão sobre a

  7. Crowdsourcing the nodulation gene network discovery environment.

    Science.gov (United States)

    Li, Yupeng; Jackson, Scott A

    2016-05-26

    The Legumes (Fabaceae) are an economically and ecologically important group of plant species with the conspicuous capacity for symbiotic nitrogen fixation in root nodules, specialized plant organs containing symbiotic microbes. With the aim of understanding the underlying molecular mechanisms leading to nodulation, many efforts are underway to identify nodulation-related genes and determine how these genes interact with each other. In order to accurately and efficiently reconstruct nodulation gene network, a crowdsourcing platform, CrowdNodNet, was created. The platform implements the jQuery and vis.js JavaScript libraries, so that users are able to interactively visualize and edit the gene network, and easily access the information about the network, e.g. gene lists, gene interactions and gene functional annotations. In addition, all the gene information is written on MediaWiki pages, enabling users to edit and contribute to the network curation. Utilizing the continuously updated, collaboratively written, and community-reviewed Wikipedia model, the platform could, in a short time, become a comprehensive knowledge base of nodulation-related pathways. The platform could also be used for other biological processes, and thus has great potential for integrating and advancing our understanding of the functional genomics and systems biology of any process for any species. The platform is available at http://crowd.bioops.info/ , and the source code can be openly accessed at https://github.com/bioops/crowdnodnet under MIT License.

  8. Thyroid nodules with isolated macrocalcification: Malignancy and diagnostic efficacy of fine-needle aspiration and core needle biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Na, Dong Gyu; Kim, Dae Sik; Kim, Soo Jin [Dept. of Radiology, Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of); Ryoo, Jae Wook [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jung, So Lyung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2016-07-15

    This study was performed to determine the malignancy risk of thyroid nodules with isolated macrocalcification and to evaluate the diagnostic efficacy of fine-needle aspiration (FNA) and core needle biopsy (CNB). From May 2008 to December 2014, a total of 44 patients with isolated macrocalcifications were enrolled from 4,081 consecutive patients who underwent FNA or CNB at a single institution. We assessed the malignancy risk of nodules with isolated macrocalcification. We compared the diagnostic results between FNA and CNB, and the diagnostic efficacy of each procedure was evaluated by the rate of inconclusive results. We compared the diagnostic performance for malignancy between FNA and CNB with a criterion of malignant or atypia/follicular lesion of undetermined significance (indeterminate) diagnostic results. We investigated whether the ultrasonographic feature of isolated macrocalcification was predictive of malignancy. The malignancy risk of nodules with isolated macrocalcification was 16.1% in 31 nodules with final diagnoses and 11.4% in all nodules. CNB demonstrated a significantly lower rate of nondiagnostic and inconclusive results than FNA (7.7% vs. 53.8%, P=0.002 and 15.4% vs. 57.7%, P=0.003, respectively) in 26 nodules that underwent both FNA and CNB. CNB showed a marginally higher diagnostic performance for identifying malignancy than FNA (P=0.067). The ultrasonographic features of the anterior margin of isolated macrocalcification were not predictive of malignancy (P>0.999). Thyroid nodules with isolated macrocalcification had a low to intermediate malignancy risk and should not be considered benign nodules. CNB showed a higher diagnostic efficacy than FNA in these nodules.

  9. Thyroid nodules with isolated macrocalcification: Malignancy and diagnostic efficacy of fine-needle aspiration and core needle biopsy

    International Nuclear Information System (INIS)

    Na, Dong Gyu; Kim, Dae Sik; Kim, Soo Jin; Ryoo, Jae Wook; Jung, So Lyung

    2016-01-01

    This study was performed to determine the malignancy risk of thyroid nodules with isolated macrocalcification and to evaluate the diagnostic efficacy of fine-needle aspiration (FNA) and core needle biopsy (CNB). From May 2008 to December 2014, a total of 44 patients with isolated macrocalcifications were enrolled from 4,081 consecutive patients who underwent FNA or CNB at a single institution. We assessed the malignancy risk of nodules with isolated macrocalcification. We compared the diagnostic results between FNA and CNB, and the diagnostic efficacy of each procedure was evaluated by the rate of inconclusive results. We compared the diagnostic performance for malignancy between FNA and CNB with a criterion of malignant or atypia/follicular lesion of undetermined significance (indeterminate) diagnostic results. We investigated whether the ultrasonographic feature of isolated macrocalcification was predictive of malignancy. The malignancy risk of nodules with isolated macrocalcification was 16.1% in 31 nodules with final diagnoses and 11.4% in all nodules. CNB demonstrated a significantly lower rate of nondiagnostic and inconclusive results than FNA (7.7% vs. 53.8%, P=0.002 and 15.4% vs. 57.7%, P=0.003, respectively) in 26 nodules that underwent both FNA and CNB. CNB showed a marginally higher diagnostic performance for identifying malignancy than FNA (P=0.067). The ultrasonographic features of the anterior margin of isolated macrocalcification were not predictive of malignancy (P>0.999). Thyroid nodules with isolated macrocalcification had a low to intermediate malignancy risk and should not be considered benign nodules. CNB showed a higher diagnostic efficacy than FNA in these nodules

  10. US Findings of Small Hepatocellular Carcinoma : Analysis of 274 cases

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hye Weon; Lee, Hak Jong; Kim, Tae Kyung; Han, Joon Koo; Choi, Byung Ihn [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1996-12-15

    The prognosis of hepatocellular carcinoma (HCC) is very poor because of the difficulty in early detection and association with the liver cirrhosis. Because the surgical resection or transarterial chemoembolization is the most effective treatment, the detection of the small HCCs is important. The purpose of this study was to assess the frequencies of a suggestive sonographic morphology of small HCC. In 222 patients with small HCCs less than 5 cm in diameter, each sonographic feature of 274 nodules was analyzed. HCCs were diagnosed pathologically (n = 83) or by elevated serum alpha-fetoprotein levels and characteristic angiographic {delta} Lipiodol CT findings (n = 191). The diameters of the tumors were as follows : {<=} 2 cm (n = 90),2{approx}3 cm (n = 87), and 3{approx}5 cm (n = 97). The frequencies of sonographic morphology of small HCCs including echo pattern, peripheral hypoechoic halo, lateral shadow, posterior acoustic enhancement, and the mosaic pattern were assessed. For statistical analysis of the differences of echo pattern, Chi-square test was used and for evaluation of the differences of the sonographic characteristics according to the tumor size, Friedman Two-Way ANOVA test was used. Overall, characteristics of small HCCs less than 5 cm were peripheral halo (70%), posterior enhancement (43%), and mosaic pattern (39%). In small HCCs less than 3 cm hyper echoic masses are more common than hypoechoic masses, which is different from previous peports. The smaller the mass, the more frequent the incidence of high or low echo pattern. Mixed echo pattern, peripheral halo, and mosaic pattern increased isoecho, lateral shadow, and posterior acoustic enhancement between 2 cm, 2{approx}3 cm, and 3{approx}5 cm size nodules.The understanding about the sonographic characteristics of small HCCs according to the size may be useful for the detection and characterization of the small HCCs

  11. Subsolid pulmonary nodule morphology and associated patient characteristics in a routine clinical population

    International Nuclear Information System (INIS)

    Mets, Onno M.; Jong, Pim A. de; Scholten, Ernst T.; Chung, Kaman; Ginneken, Bram van; Schaefer-Prokop, Cornelia M.

    2017-01-01

    To determine the presence and morphology of subsolid pulmonary nodules (SSNs) in a non-screening setting and relate them to clinical and patient characteristics. A total of 16,890 reports of clinically obtained chest CT (06/2011 to 11/2014, single-centre) were searched describing an SSN. Subjects with a visually confirmed SSN and at least two thin-slice CTs were included. Nodule volumes were measured. Progression was defined as volume increase exceeding the software interscan variation. Nodule morphology, location, and patient characteristics were evaluated. Fifteen transient and 74 persistent SSNs were included (median follow-up 19.6 [8.3-36.8] months). Subjects with an SSN were slightly older than those without (62 vs. 58 years; p = 0.01), but no gender predilection was found. SSNs were mostly located in the upper lobes. Women showed significantly more often persistent lesions than men (94 % vs. 69 %; p = 0.002). Part-solid lesions were larger (1638 vs. 383 mm"3; p < 0.001) and more often progressive (68 % vs. 38 %; p = 0.02), compared to pure ground-glass nodules. Progressive SSNs were rare under the age of 50 years. Logistic regression analysis did not identify additional nodule parameters of future progression, apart from part-solid nature. This study confirms previously reported characteristics of SSNs and associated factors in a European, routine clinical population. (orig.)

  12. Subsolid pulmonary nodule morphology and associated patient characteristics in a routine clinical population

    Energy Technology Data Exchange (ETDEWEB)

    Mets, Onno M.; Jong, Pim A. de [University Medical Center Utrecht, Radiology, Utrecht (Netherlands); Scholten, Ernst T.; Chung, Kaman; Ginneken, Bram van [Radboud University Nijmegen Medical Centre, Diagnostic Imaging Analysis Group, Nijmegen (Netherlands); Schaefer-Prokop, Cornelia M. [Radboud University Nijmegen Medical Centre, Diagnostic Imaging Analysis Group, Nijmegen (Netherlands); Meander Medical Center, Radiology, Amersfoort (Netherlands)

    2017-02-15

    To determine the presence and morphology of subsolid pulmonary nodules (SSNs) in a non-screening setting and relate them to clinical and patient characteristics. A total of 16,890 reports of clinically obtained chest CT (06/2011 to 11/2014, single-centre) were searched describing an SSN. Subjects with a visually confirmed SSN and at least two thin-slice CTs were included. Nodule volumes were measured. Progression was defined as volume increase exceeding the software interscan variation. Nodule morphology, location, and patient characteristics were evaluated. Fifteen transient and 74 persistent SSNs were included (median follow-up 19.6 [8.3-36.8] months). Subjects with an SSN were slightly older than those without (62 vs. 58 years; p = 0.01), but no gender predilection was found. SSNs were mostly located in the upper lobes. Women showed significantly more often persistent lesions than men (94 % vs. 69 %; p = 0.002). Part-solid lesions were larger (1638 vs. 383 mm{sup 3}; p < 0.001) and more often progressive (68 % vs. 38 %; p = 0.02), compared to pure ground-glass nodules. Progressive SSNs were rare under the age of 50 years. Logistic regression analysis did not identify additional nodule parameters of future progression, apart from part-solid nature. This study confirms previously reported characteristics of SSNs and associated factors in a European, routine clinical population. (orig.)

  13. Outcome of radioiodine-131 therapy in hyperfunctioning thyroid nodules: a 20 years' retrospective study.

    Science.gov (United States)

    Ceccarelli, Claudia; Bencivelli, Walter; Vitti, Paolo; Grasso, Lucia; Pinchera, Aldo

    2005-03-01

    To investigate the risk of hypothyroidism after radioiodine (131I) treatment for hyperfunctioning thyroid nodules. Retrospective analysis of patients treated with 131I for hyperfunctioning thyroid nodules and followed up for a maximum of 20 years. A total of 346 patients treated with 131I in the years 1975-95, for a single hyperfunctioning nodule. Hypothyroidism was defined as TSH levels > 3.7 mU/l. Kaplan-Meier survival analysis was used to analyse permanence of euthyroidism after 131I. A stepwise Cox proportional hazard model was used to identify factors influencing the progression to hypothyroidism. The cumulative incidence of hypothyroidism was 7.6% at 1 year, 28% at 5 years, 46% at 10 years and 60% at 20 years. Age (P thyroid and nodule size, thyroid status at diagnosis and degree of extranodular thyroid parenchymal suppression had no influence. In hyperthyroid patients with partial parenchymal suppression, however, previous MMI treatment was the most important prognostic factor (P hyperfunctioning nodule are hypothyroid. Factors increasing the risk of hypothyroidism are age, 131I uptake and MMI pretreatment. The prognostic value of this last factor, however, depends on the degree of suppression of the extranodular thyroid parenchyma at the scan.

  14. Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy.

    Science.gov (United States)

    Miki, Izumi; Murata, Satoru; Uchiyama, Fumio; Yasui, Daisuke; Ueda, Tatsuo; Sugihara, Fumie; Saito, Hidemasa; Yamaguchi, Hidenori; Murakami, Ryusuke; Kawamoto, Chiaki; Uchida, Eiji; Kumita, Shin-Ichiro

    2017-09-21

    To evaluate the relationship between the location of hepatocellular carcinoma (HCC) and the efficacy of transarterial chemoembolization (TACE). We evaluated 115 patients (127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to mRECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center (mm)/liver diameter (mm) on multiplanar reconstruction images rendered (MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response (CR) and non-CR groups in Child-Pugh grade A and B patients. The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients (0.82 vs 0.62, P location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups (0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups. Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.

  15. Contrast-enhanced harmonic ultrasound imaging in ablation therapy for primary hepatocellular carcinoma.

    Science.gov (United States)

    Minami, Yasunori; Kudo, Masatoshi

    2009-12-31

    The success rate of percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) depends on correct targeting via an imaging technique. However, RF electrode insertion is not completely accurate for residual HCC nodules because B-mode ultrasound (US), color Doppler, and power Doppler US findings cannot adequately differentiate between treated and viable residual tumor tissue. Electrode insertion is also difficult when we must identify the true HCC nodule among many large regenerated nodules in cirrhotic liver. Two breakthroughs in the field of US technology, harmonic imaging and the development of second-generation contrast agents, have recently been described and have demonstrated the potential to dramatically broaden the scope of US diagnosis of hepatic lesions. Contrast-enhanced harmonic US imaging with an intravenous contrast agent can evaluate small hypervascular HCC even when B-mode US cannot adequately characterize tumor. Therefore, contrast-enhanced harmonic US can facilitate RF ablation electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of contrast-enhanced harmonic US in ablation therapy for liver cancer is an efficient approach.

  16. Research on a Pulmonary Nodule Segmentation Method Combining Fast Self-Adaptive FCM and Classification

    Directory of Open Access Journals (Sweden)

    Hui Liu

    2015-01-01

    Full Text Available The key problem of computer-aided diagnosis (CAD of lung cancer is to segment pathologically changed tissues fast and accurately. As pulmonary nodules are potential manifestation of lung cancer, we propose a fast and self-adaptive pulmonary nodules segmentation method based on a combination of FCM clustering and classification learning. The enhanced spatial function considers contributions to fuzzy membership from both the grayscale similarity between central pixels and single neighboring pixels and the spatial similarity between central pixels and neighborhood and improves effectively the convergence rate and self-adaptivity of the algorithm. Experimental results show that the proposed method can achieve more accurate segmentation of vascular adhesion, pleural adhesion, and ground glass opacity (GGO pulmonary nodules than other typical algorithms.

  17. Efficacy of microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma in patients with chronic liver disease: a randomised controlled phase 2 trial.

    Science.gov (United States)

    Vietti Violi, Naïk; Duran, Rafael; Guiu, Boris; Cercueil, Jean-Pierre; Aubé, Christophe; Digklia, Antonia; Pache, Isabelle; Deltenre, Pierre; Knebel, Jean-François; Denys, Alban

    2018-05-01

    Radiofrequency ablation is the recommended treatment for patients with hepatocellular carcinoma who have lesions smaller than 3 cm and are therefore not candidates for surgery. Microwave ablation is a more recent technique with certain theoretical advantages that have not yet been confirmed clinically. We aimed to compare the efficacy of both techniques in the treatment of hepatocellular carcinoma lesions of 4 cm or smaller. We did a randomised controlled, single-blinded phase 2 trial at four tertiary university centres in France and Switzerland. Patients with chronic liver disease and hepatocellular carcinoma with up to three lesions of 4 cm or smaller who were not eligible for surgery were randomised to receive microwave ablation (experimental group) or radiofrequency ablation (control group). Randomisation was centralised and done by use of a fixed block method (block size 4). Patients were randomly assigned by a co-investigator by use of the sealed opaque envelope method and were masked to the treatment; physicians were not masked to treatment, since the devices used were different. The primary outcome was the proportion of lesions with local tumour progression at 2 years of follow-up. Local tumour progression was defined as the appearance of a new nodule with features typical of hepatocellular carcinoma in the edge of the ablation zone. All analyses were done in the per-protocol population. The study is completed, but patients will continue to be followed up for 5 years. This study is registered with ClinicalTrials.gov, number NCT02859753. Between Nov 15, 2011, and Feb 27, 2015, 152 patients were randomly assigned: 76 patients to receive microwave ablation and 76 patients to receive radiofrequency ablation. For the per-protocol analysis, five patients were excluded from the microwave ablation group as were three patients from the radiofrequency ablation group. Median follow-up was 26 months (IQR 18-29) in the microwave ablation group and 25 months (18-34) in

  18. Inflammatory nodule mimicking a phrenic neoplasm.

    Science.gov (United States)

    Vannucci, Jacopo; Scarnecchia, Elisa; Del Sordo, Rachele; Cagini, Lucio; Puma, Francesco

    2016-05-01

    Isolated phrenic nerve nodule is usually a primitive tumour. Surgery is diagnostic and therapeutic at the same time. We report the case of a completely serum-negative Caucasian male with a right diaphragmatic relaxation associated to an isolated small nodule of the phrenic nerve. The patient was referred to our unit complaining shortness of breath and progressive fatigue. A standard chest X-ray showed right diaphragmatic palsy; chest scanning revealed a nodular lesion belonging to the right phrenic nerve. Positron emission tomography was negative for glucose uptake. The preoperative diagnosis of primitive neurogenic tumour was thus supposed, and the patient treated by the lesion's surgical resection along with diaphragmatic plication. Histopathological examination revealed an idiopathic inflammatory nodule of the phrenic nerve. Such condition has not previously been reported in the literature among the possible aetiology of a diaphragmatic relaxation. © 2014 John Wiley & Sons Ltd.

  19. Using YOLO based deep learning network for real time detection and localization of lung nodules from low dose CT scans

    Science.gov (United States)

    Ramachandran S., Sindhu; George, Jose; Skaria, Shibon; V. V., Varun

    2018-02-01

    Lung cancer is the leading cause of cancer related deaths in the world. The survival rate can be improved if the presence of lung nodules are detected early. This has also led to more focus being given to computer aided detection (CAD) and diagnosis of lung nodules. The arbitrariness of shape, size and texture of lung nodules is a challenge to be faced when developing these detection systems. In the proposed work we use convolutional neural networks to learn the features for nodule detection, replacing the traditional method of handcrafting features like geometric shape or texture. Our network uses the DetectNet architecture based on YOLO (You Only Look Once) to detect the nodules in CT scans of lung. In this architecture, object detection is treated as a regression problem with a single convolutional network simultaneously predicting multiple bounding boxes and class probabilities for those boxes. By performing training using chest CT scans from Lung Image Database Consortium (LIDC), NVIDIA DIGITS and Caffe deep learning framework, we show that nodule detection using this single neural network can result in reasonably low false positive rates with high sensitivity and precision.

  20. Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules.

    Science.gov (United States)

    Amabile, Gerardo; Rotondi, Mario; Pirali, Barbara; Dionisio, Rosa; Agozzino, Lucio; Lanza, Michele; Buonanno, Luciano; Di Filippo, Bruno; Fonte, Rodolfo; Chiovato, Luca

    2011-09-01

    Interstitial laser photocoagulation (ILP) is a new therapeutic option for the ablation of non-functioning and hyper-functioning benign thyroid nodules. Amelioration of the ablation procedure currently allows treating large nodules. Aim of this study was to evaluate the therapeutic efficacy of ILP, performed according to a modified protocol of ablation, in patients with large functioning and non-functioning thyroid nodules and to identify the best parameters for predicting successful outcome in hyperthyroid patients. Fifty-one patients with non-functioning thyroid nodules (group 1) and 26 patients with hyperfunctioning thyroid nodules (group 2) were enrolled. All patients had a nodular volume ≥40 ml. Patients were addressed to 1-3 cycles of ILP. A cycle consisted of three ILP sessions, each lasting 5-10 minutes repeated at an interval of 1 month. After each cycle of ILP patients underwent thyroid evaluation. A nodule volume reduction, expressed as percentage of the basal volume, significantly occurred in both groups (F = 190.4; P nodule volume; (iii) total amount of energy delivered expressed in Joule. ROC curves identified the percentage of volume reduction as the best parameter predicting a normalized serum TSH (area under the curve 0.962; P thyroid nodules, both in terms of nodule size reduction and cure of hyperthyroidism (87% of cured patients after the last ILP cycle). ILP should not be limited to patients refusing or being ineligible for surgery and/or radioiodine. Copyright © 2011 Wiley-Liss, Inc.

  1. Lung Nodule Detection via Deep Reinforcement Learning

    Directory of Open Access Journals (Sweden)

    Issa Ali

    2018-04-01

    Full Text Available Lung cancer is the most common cause of cancer-related death globally. As a preventive measure, the United States Preventive Services Task Force (USPSTF recommends annual screening of high risk individuals with low-dose computed tomography (CT. The resulting volume of CT scans from millions of people will pose a significant challenge for radiologists to interpret. To fill this gap, computer-aided detection (CAD algorithms may prove to be the most promising solution. A crucial first step in the analysis of lung cancer screening results using CAD is the detection of pulmonary nodules, which may represent early-stage lung cancer. The objective of this work is to develop and validate a reinforcement learning model based on deep artificial neural networks for early detection of lung nodules in thoracic CT images. Inspired by the AlphaGo system, our deep learning algorithm takes a raw CT image as input and views it as a collection of states, and output a classification of whether a nodule is present or not. The dataset used to train our model is the LIDC/IDRI database hosted by the lung nodule analysis (LUNA challenge. In total, there are 888 CT scans with annotations based on agreement from at least three out of four radiologists. As a result, there are 590 individuals having one or more nodules, and 298 having none. Our training results yielded an overall accuracy of 99.1% [sensitivity 99.2%, specificity 99.1%, positive predictive value (PPV 99.1%, negative predictive value (NPV 99.2%]. In our test, the results yielded an overall accuracy of 64.4% (sensitivity 58.9%, specificity 55.3%, PPV 54.2%, and NPV 60.0%. These early results show promise in solving the major issue of false positives in CT screening of lung nodules, and may help to save unnecessary follow-up tests and expenditures.

  2. Evaluation of subjectively assessed nodule traits of ostrich skins as ...

    African Journals Online (AJOL)

    Schalk Cloete

    leather quality (Sales, 1999). No formal ... Both traits are clearly age-dependent, with nodule size increasing and nodule density decreasing with an increase in .... E stim ated ag e (m o n th s). Producers. Graders. Marketers. Agents. Managers.

  3. Relation between grade and abundance of manganese nodules

    Digital Repository Service at National Institute of Oceanography (India)

    Sudhakar, M.

    Data from more than 1000 locations in the Central Indian Ocean Basin (CIOB) where both bulk nodule chemistry and abundance were determined and utilized to study the relationship between grade and abundance of manganese nodule deposits. Grade...

  4. Grade distributions in manganese nodules of Central Indian Ocean Basin

    Digital Repository Service at National Institute of Oceanography (India)

    Sudhakar, M.

    Data concerning to geological setting physical characteristics and bulk chemical composition of the nodules sampled from CIOB were stored in the Computer Data Bank of this Institute. Bulk chemical composition of nodules, in which grade is expressed...

  5. Massive training artificial neural network (MTANN) for reduction of false positives in computerized detection of lung nodules in low-dose computed tomography

    International Nuclear Information System (INIS)

    Suzuki, Kenji; Armato, Samuel G. III; Li, Feng; Sone, Shusuke; Doi, Kunio

    2003-01-01

    In this study, we investigated a pattern-recognition technique based on an artificial neural network (ANN), which is called a massive training artificial neural network (MTANN), for reduction of false positives in computerized detection of lung nodules in low-dose computed tomography (CT) images. The MTANN consists of a modified multilayer ANN, which is capable of operating on image data directly. The MTANN is trained by use of a large number of subregions extracted from input images together with the teacher images containing the distribution for the 'likelihood of being a nodule'. The output image is obtained by scanning an input image with the MTANN. The distinction between a nodule and a non-nodule is made by use of a score which is defined from the output image of the trained MTANN. In order to eliminate various types of non-nodules, we extended the capability of a single MTANN, and developed a multiple MTANN (Multi-MTANN). The Multi-MTANN consists of plural MTANNs that are arranged in parallel. Each MTANN is trained by using the same nodules, but with a different type of non-nodule. Each MTANN acts as an expert for a specific type of non-nodule, e.g., five different MTANNs were trained to distinguish nodules from various-sized vessels; four other MTANNs were applied to eliminate some other opacities. The outputs of the MTANNs were combined by using the logical AND operation such that each of the trained MTANNs eliminated none of the nodules, but removed the specific type of non-nodule with which the MTANN was trained, and thus removed various types of non-nodules. The Multi-MTANN consisting of nine MTANNs was trained with 10 typical nodules and 10 non-nodules representing each of nine different non-nodule types (90 training non-nodules overall) in a training set. The trained Multi-MTANN was applied to the reduction of false positives reported by our current computerized scheme for lung nodule detection based on a database of 63 low-dose CT scans (1765

  6. Targeted Next Generation Sequencing with ThyroSeq v2.1 for Indeterminate Thyroid Nodules in Clinical Practice.

    Science.gov (United States)

    Witt, Robert L

    2016-12-01

    To determine if patients elect molecular testing over diagnostic surgery or repeat fine needle aspiration for indeterminate thyroid nodules. Can ThyroSeq v2.1 molecular testing reduce diagnostic thyroid surgery and rule out cancer? Retrospective review Setting: Single institution, single-practice surgeon. Fifteen month retrospective review of indeterminate thyroid nodules that went on to ThyroSeq v2.1 testing. 286 patients met American Thyroid Association guideline criteria for surgeon- performed, ultrasound-guided fine needle aspiration for a thyroid nodule with on-site cytopathology. The indeterminate (Bethesda III or IV) fine needle aspiration cytology rate was 9.1 percent. Prevalence of malignancy in indeterminate nodules was 19 percent. 26/26 (100 percent) patients with indeterminate thyroid nodules elected molecular testing. 16 patients had no mutation, 9 had one or more mutations, and I had no result. 16 of 25 (64 percent) patients with no mutation elected not to undergo diagnostic surgery for indeterminate thyroid nodules. Patients demonstrated a strong preference for molecular testing instead of diagnostic thyroid surgery for indeterminate thyroid nodules. All patients in this series, 25/25 (100 percent) with indeterminate thyroid nodules elected molecular testing instead of repeat biopsy or diagnostic thyroid surgery. 16 of 25 (64 percent) patients tested had no mutation. All 16/16 (100 percent) patients with no mutation on ThyroSeq "rule out" testing elected active surveillance rather than surgery or biopsy, reducing diagnostic surgery. The risk of malignancy among mutation negative patients was not definitively established. There are a number of factors currently that may mute the power of "rule in" testing.

  7. Pretreatment Evaluation with Contrast-Enhanced Ultrasonography for Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas with Poor Conspicuity on Conventional Ultrasonography

    International Nuclear Information System (INIS)

    Kim, Ah Yeong; Lee, Min Woo; Rhim, Hyunchul; Cha, Dong Ik; Choi, Dongil; Kim, Young-sun; Lim, Hyo Keun; Cho, Seong Whi

    2013-01-01

    To determine whether pretreatment evaluation with contrast-enhanced ultrasonography (CEUS) is effective for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) with poor conspicuity on conventional ultrasonography (US). This retrospective study was approved by the institutional review board and informed consent was waived. From June 2008 to July 2011, 82 patients having HCCs (1.2 ± 0.4 cm) with poor conspicuity on planning US for RFA were evaluated with CEUS prior to percutaneous RFA. We analyzed our database, radiologic reports, and US images in order to determine whether the location of HCC candidates on planning US coincide with that on CEUS. To avoid incomplete ablation, percutaneous RFA was performed only when HCC nodules were identified on CEUS. The rate of technical success was assessed. The cumulative rate of local tumor progression was estimated with the use of the Kaplan-Meier method (mean follow-up: 24.0 ± 13.0 months). Among 82 patients, 73 (89%) HCCs were identified on CEUS, whereas 9 (11%) were not. Of 73 identifiable HCCs on CEUS, the location of HCC on planning US corresponded with that on CEUS in 64 (87.7%), whereas the location did not correspond in 9 (12.3%) HCCs. Technical success was achieved for all 73 identifiable HCCs on CEUS in a single (n = 72) or two (n = 1) RFA sessions. Cumulative rates of local tumor progression were estimated as 1.9% and 15.4% at 1 and 3 years, respectively. Pretreatment evaluation with CEUS is effective for percutaneous RFA of HCCs with poor conspicuity on conventional US

  8. Current status of fine needle aspiration for thyroid nodules.

    Science.gov (United States)

    Ogilvie, Jennifer B; Piatigorsky, Eli J; Clark, Orlo H

    2006-01-01

    When not to perform fine needle aspiration of a thyroid nodule In summary, FNA of thyroid nodules has become one of the most useful, safe, and accurate tools in the diagnosis of thyroid pathology. Thyroid nodules that should be considered for FNA include any firm, palpable, solitary nodule or nodule associated with worrisome clinical features (rapid growth, attachment to adjacent tissues, new hoarseness, or palpable lymphadenopathy). FNA should also be performed on nodules with suspicious ultrasonographic features (microcalcifications, rounded shape, predominantly solid composition); dominant or atypical nodules in multinodular goiter; complex or recurrent cystic nodules; or any nodule associated with palpable or ultrasonographically abnormal cervical lymph nodes. Finally, FNA should be performed on any abnormal-appearing or palpable cervical lymph nodes. The management of thyroid nodules based on FNA findings is summarized in Table 2. It can be argued that in certain circumstances the results of thyroid FNA do not change the surgical management of a thyroid nodule, and thus preoperative FNA may be unnecessary. These cases include solitary nodules in patients who have a strong family history of thyroid cancer, multiple endocrine neoplasia type II, or radiation to the head and neck. These patients when they have thyroid nodules have at least a 40% risk for thyroid cancer and frequent multifocal or bilateral disease and should undergo total thyroidectomy with or without central neck lymph node dissection. Patients who have multinodular goiter and compressive symptoms, patients who have Graves disease and a thyroid nodule, or patients who have large (greater than 4 cm) or symptomatic unilateral thyroid nodules could also be considered for total thyroidectomy or lobectomy as indicated without preoperative FNA. Finally, patients who have a solitary hyperfunctioning nodule on radioiodine scan and a suppressed TSH have an extremely low incidence of malignancy and may be

  9. Improved pulmonary nodule classification utilizing quantitative lung parenchyma features.

    Science.gov (United States)

    Dilger, Samantha K N; Uthoff, Johanna; Judisch, Alexandra; Hammond, Emily; Mott, Sarah L; Smith, Brian J; Newell, John D; Hoffman, Eric A; Sieren, Jessica C

    2015-10-01

    Current computer-aided diagnosis (CAD) models for determining pulmonary nodule malignancy characterize nodule shape, density, and border in computed tomography (CT) data. Analyzing the lung parenchyma surrounding the nodule has been minimally explored. We hypothesize that improved nodule classification is achievable by including features quantified from the surrounding lung tissue. To explore this hypothesis, we have developed expanded quantitative CT feature extraction techniques, including volumetric Laws texture energy measures for the parenchyma and nodule, border descriptors using ray-casting and rubber-band straightening, histogram features characterizing densities, and global lung measurements. Using stepwise forward selection and leave-one-case-out cross-validation, a neural network was used for classification. When applied to 50 nodules (22 malignant and 28 benign) from high-resolution CT scans, 52 features (8 nodule, 39 parenchymal, and 5 global) were statistically significant. Nodule-only features yielded an area under the ROC curve of 0.918 (including nodule size) and 0.872 (excluding nodule size). Performance was improved through inclusion of parenchymal (0.938) and global features (0.932). These results show a trend toward increased performance when the parenchyma is included, coupled with the large number of significant parenchymal features that support our hypothesis: the pulmonary parenchyma is influenced differentially by malignant versus benign nodules, assisting CAD-based nodule characterizations.

  10. A case of cyclist's nodule in a female patient

    African Journals Online (AJOL)

    origin (Fig. 1). e nodule measured 12 mm × 7 mm × 15 mm and showed no flow on Doppler. A magnetic resonance image (MRI) of the pelvis was also performed and showed a poorly circumscribed nodule, isointense to muscle on all sequences, in the right perineum (Fig. 2). A diagnosis of a cyclist's nodule was made ...

  11. Compact-Morphology-based poly-metallic Nodule Delineation.

    Science.gov (United States)

    Schoening, Timm; Jones, Daniel O B; Greinert, Jens

    2017-10-17

    Poly-metallic nodules are a marine resource considered for deep sea mining. Assessing nodule abundance is of interest for mining companies and to monitor potential environmental impact. Optical seafloor imaging allows quantifying poly-metallic nodule abundance at spatial scales from centimetres to square kilometres. Towed cameras and diving robots acquire high-resolution imagery that allow detecting individual nodules and measure their sizes. Spatial abundance statistics can be computed from these size measurements, providing e.g. seafloor coverage in percent and the nodule size distribution. Detecting nodules requires segmentation of nodule pixels from pixels showing sediment background. Semi-supervised pattern recognition has been proposed to automate this task. Existing nodule segmentation algorithms employ machine learning that trains a classifier to segment the nodules in a high-dimensional feature space. Here, a rapid nodule segmentation algorithm is presented. It omits computation-intense feature-based classification and employs image processing only. It exploits a nodule compactness heuristic to delineate individual nodules. Complex machine learning methods are avoided to keep the algorithm simple and fast. The algorithm has successfully been applied to different image datasets. These data sets were acquired by different cameras, camera platforms and in varying illumination conditions. Their successful analysis shows the broad applicability of the proposed method.

  12. Root developmental programs shape the Medicago truncatula nodule meristem

    NARCIS (Netherlands)

    Franssen, H.; Xiao, T.T.; Kulikova, O.; Wan, X.; Bisseling, T.; Scheres, B.; Heidstra, R.

    2015-01-01

    Nodules on the roots of legume plants host nitrogen-fixing Rhizobium bacteria. Several lines of evidence indicate that nodules are evolutionarily related to roots. We determined whether developmental control of the Medicago truncatula nodule meristem bears resemblance to that in root meristems

  13. Use of Volumetry for Lung Nodule Management: Theory and Practice

    NARCIS (Netherlands)

    Devaraj, A.; Ginneken, B. van; Nair, A.; Baldwin, D.

    2017-01-01

    A consistent feature of many lung nodule management guidelines is the recommendation to evaluate nodule size by using diameter measurements and electronic calipers. Traditionally, the use of nodule volumetry applications has primarily been reserved for certain lung cancer screening trials rather

  14. Hepatic tumours in children with biliary atresia: Single-centre experience in 13 cases and review of the literature

    International Nuclear Information System (INIS)

    Yoon, H.J.; Jeon, T.Y.; Yoo, S.-Y.; Kim, J.H.; Eo, H.; Lee, S.-K.; Kim, J.S.

    2014-01-01

    Aim: To establish the risks of developing of hepatic tumours and to investigate their clinical and imaging findings in children with biliary atresia (BA) after Kasai portoenterostomy (Kasai). Materials and methods: Among 157 children who had undergone Kasai for BA over an 18 year period, patients who had newly developed hepatic tumours were identified. Patient demographics, clinical features, and imaging findings were retrospectively reviewed. Results: Three male and 10 female patients (mean age 3.9 years) all (8%, of 157) had single hepatic tumours, which were confirmed in 10 explanted and three non-explanted livers. Ten (77%) were benign and three (23%) were malignant. Of the benign hepatic tumours, focal nodular hyperplasia (FNH; n = 6) was the most common, followed by regenerative nodules (n = 3) and adenoma (n = 1). All FNH appeared in young children <1 year of age and showed a subcapsular location, bulging contour, and lack of central scar. Malignant tumours included two hepatocellular carcinomas and one cholangiocarcinoma. Conclusion: Hepatic tumours developed in approximately 8% of children with BA after Kasai. Although benign tumours, including FNHs and regenerative nodules, were more common than malignant tumours, screening with alpha-foetoprotein (AFP) levels and regular imaging studies are the mainstay of malignant tumour detection

  15. Factors predicting aggressiveness of non-hypervascular hepatic nodules detected on hepatobiliary phase of gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid magnetic resonance imaging.

    Science.gov (United States)

    Kanefuji, Tsutomu; Takano, Toru; Suda, Takeshi; Akazawa, Kouhei; Yokoo, Takeshi; Kamimura, Hiroteru; Kamimura, Kenya; Tsuchiya, Atsunori; Takamura, Masaaki; Kawai, Hirokazu; Yamagiwa, Satoshi; Aoyama, Hidefumi; Nomoto, Minoru; Terai, Shuji

    2015-04-21

    To establish a prognostic formula that distinguishes non-hypervascular hepatic nodules (NHNs) with higher aggressiveness from less hazardous one. Seventy-three NHNs were detected in gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid magnetic resonance imaging (Gd-EOB-DTPA-MRI) study and confirmed to change 2 mm or more in size and/or to gain hypervascularity. All images were interpreted independently by an experienced, board-certified abdominal radiologist and hepatologist; both knew that the patients were at risk for hepatocellular carcinoma development but were blinded to the clinical information. A formula predicting NHN destiny was developed using a generalized estimating equation model with thirteen explanatory variables: age, gender, background liver diseases, Child-Pugh class, NHN diameter, T1-weighted imaging/T2-weighted imaging detectability, fat deposition, lower signal intensity in arterial phase, lower signal intensity in equilibrium phase, α-fetoprotein, des-γ-carboxy prothrombin, α-fetoprotein-L3, and coexistence of classical hepatocellular carcinoma. The accuracy of the formula was validated in bootstrap samples that were created by resampling of 1000 iterations. During a median follow-up period of 504 d, 73 NHNs with a median diameter of 9 mm (interquartile range: 8-12 mm) grew or shrank by 68.5% (fifty nodules) or 20.5% (fifteen nodules), respectively, whereas hypervascularity developed in 38.4% (twenty eight nodules). In the fifteen shrank nodules, twelve nodules disappeared, while 11.0% (eight nodules) were stable in size but acquired vascularity. A generalized estimating equation analysis selected five explanatories from the thirteen variables as significant factors to predict NHN progression. The estimated regression coefficients were 0.36 for age, 6.51 for lower signal intensity in arterial phase, 8.70 or 6.03 for positivity of hepatitis B virus or hepatitis C virus, 9.37 for des-γ-carboxy prothrombin, and -4.05 for fat

  16. Nodules of the Central Indian Ocean Basin

    Digital Repository Service at National Institute of Oceanography (India)

    Banakar, V.K.; Kodagali, V.N.

    of calcareous sediments within, and pelagic sediments south of 15 degrees S latitude Prior to the launching of the project, very little data was available on the Indian Ocean nodules compared to those of Pacific This chapter summaries the findings of the project...

  17. Histoplasmosis presenting with solitary pulmonary nodule: Two ...

    African Journals Online (AJOL)

    Pulmonary histoplasmosis is a granulomatous disease, whose diagnosis is not always easy, as it may simulate metastatic lesions due to similar radiographic findings. We herein report two cases of histoplasmosis with solitary pulmonary nodule in asymptomatic patients with histories of cancer surgeries, whose diagnoses ...

  18. A rapid method of ferromanganese nodule mounting

    Digital Repository Service at National Institute of Oceanography (India)

    Mukhopadhyay, S.; Banerjee, R.

    (Fig. 1). Then the mixture in the cast (5) with nodules inside, is kept undisturbed for 30 minutes in sunlight or at room temperature to cure and to allow it to get very hard. Once hardened, the sample can be sawed to the required size by any normal...

  19. Large philipsite crystal as ferromanganese nodule nucleus

    Digital Repository Service at National Institute of Oceanography (India)

    Ghosh, A.K.; Mukhopadhyay, R.

    nodule accretion as approximately 2 mm/Ma and that of phillipsite growth as approximately 0.65 mm/Ka, the nucleus material appears to have been growing for approximately 4.5-5 Ma. Originally surfaced as a rock fragment from late Miocene volcanism...

  20. Early nodulins in root nodule development

    NARCIS (Netherlands)

    Scheres, B.

    1990-01-01

    The symbiotic interaction between bacteria of the genus Rhizobium and leguminous plants leads to the formation of root nodules, which are specific nitrogen-fixing organs on the roots of plants. Bacteria enter the root by infection threads, and concomitantly cell

  1. The hyperfunctioning nodules of the thyroid

    International Nuclear Information System (INIS)

    Rosenthal, D.

    1975-01-01

    Iodine kinetic studies, using a double label ( 131 I - and T 4 -125 I), were performed on 8 patients with hot thyroid nodules, 3 diffuse toxic goiters and one normal control. This investigation was complemented by partial kinetic studies done on 62 other subjetcs, including normal controls and euthyroid or hyperthyroid patients with diffuse or nodular goiter [pt

  2. Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

    Science.gov (United States)

    Feng, Kai; Ma, Kuan-Sheng

    2014-01-01

    Hepatocellular carcinoma (HCC) is a malignant disease that substantially affects public health worldwide. It is especially prevalent in east Asia and sub-Saharan Africa, where the main etiology is the endemic status of chronic hepatitis B. Effective treatments with curative intent for early HCC include liver transplantation, liver resection (LR), and radiofrequency ablation (RFA). RFA has become the most widely used local thermal ablation method in recent years because of its technical ease, safety, satisfactory local tumor control, and minimally invasive nature. This technique has also emerged as an important treatment strategy for HCC in recent years. RFA, liver transplantation, and hepatectomy can be complementary to one another in the treatment of HCC, and the outcome benefits have been demonstrated by numerous clinical studies. As a pretransplantation bridge therapy, RFA extends the average waiting time without increasing the risk of dropout or death. In contrast to LR, RFA causes almost no intra-abdominal adhesion, thus producing favorable conditions for subsequent liver transplantation. Many studies have demonstrated mutual interactions between RFA and hepatectomy, effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches. However, treated tumor tissue remains within the body after RFA, and residual tumors or satellite nodules can limit the effectiveness of this treatment. Therefore, future research should focus on this issue. PMID:24876721

  3. Noninvasive imaging of hepatocellular carcinoma: From diagnosis to prognosis

    Science.gov (United States)

    Jiang, Han-Yu; Chen, Jie; Xia, Chun-Chao; Cao, Li-Kun; Duan, Ting; Song, Bin

    2018-01-01

    Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with key alterations that can be revealed by noninvasive imaging modalities. Therefore, imaging techniques play pivotal roles in the detection, characterization, staging, surveillance, and prognosis evaluation of HCC. Currently, ultrasound is the first-line imaging modality for screening and surveillance purposes. While based on conclusive enhancement patterns comprising arterial phase hyperenhancement and portal venous and/or delayed phase wash-out, contrast enhanced dynamic computed tomography and magnetic resonance imaging (MRI) are the diagnostic tools for HCC without requirements for histopathologic confirmation. Functional MRI techniques, including diffusion-weighted imaging, MRI with hepatobiliary contrast agents, perfusion imaging, and magnetic resonance elastography, show promise in providing further important information regarding tumor biological behaviors. In addition, evaluation of tumor imaging characteristics, including nodule size, margin, number, vascular invasion, and growth patterns, allows preoperative prediction of tumor microvascular invasion and patient prognosis. Therefore, the aim of this article is to review the current state-of-the-art and recent advances in the comprehensive noninvasive imaging evaluation of HCC. We also provide the basic key concepts of HCC development and an overview of the current practice guidelines. PMID:29904242

  4. Radiotherapy for hepatocellular carcinoma. Regarding solitary tumor on radiologic examinations

    International Nuclear Information System (INIS)

    Kawashima, Mitsuhiko; Tokuuye, Koichi; Sumi, Minako; Kagami, Yashikazu; Murayama, Shigeyuki; Nakayama, Hidetsugu; Imai, Atsushi; Ando, Kou; Ikeda, Hiroshi

    1997-01-01

    To evaluate the effect of radiotherapy (RT) on hepatocellular carcinoma (HCC) that appears as a solitary nodule on radiologic studies. We irradiated 17 patients with solitary HCC lesions (25-150 mm in diameter) with approximately 60 Gy (range 50-70 Gy). Patients underwent dynamic CT and/or ultrasound imaging at 3-month intervals after treatment. Patients were classified based on lesion size, degree of cirrhosis (Child A. 6; Child B, 6; Child C, 5), and whether they had received other therapy such as transarterial chemoembolization (TACE). The responses were classified as complete, partial, no change, or progression. The median survival was 12.8 months for all 17 patients, with 1-, 2-, and 3-year cumulative survival rates of 59%, 35% and 24%, respectively. Patients classified as Child A showed significantly longer survival than those classified as either Child B (p<0.04) or C (p<0.01). Four of the five Child C patients died of liver failure within 6 months after RT despite the absence of tumor recurrence. The initial tumor diameter, concurrent treatment with TACE, and radiation dose showed no significant effect on survival. Survival in patients with solitary HCC lesions appears to be affected mainly by the degree of liver dysfunction, and not the initial tumor diameter, radiation dose, or concurrent use of TACE. (author)

  5. Combined Primary Neuroendocrine Carcinoma and Hepatocellular Carcinoma of the Liver

    Directory of Open Access Journals (Sweden)

    Chii-Shuenn Yang

    2009-08-01

    Full Text Available We report a unique case of combined primary neuroendocrine carcinoma (NEC and hepatocellular carcinoma (HCC of the liver in a 65-year-old male patient. The patient underwent segmental resection of the liver and regional lymph node dissection for a tumor mass that measured 7.5 cm in diameter in the right lobe, with regional lymphadenopathy. Histologically, the hepatic tumor was composed of predominantly small-cell NEC, but admixed with a small island of moderately differentiated HCC. We speculate that the NEC originated from a poorly differentiated tumor clone of an HCC that underwent neuroendocrine differentiation, and that this tumor was now at the end stage of the transitional period from HCC to NEC, based on the small amount of disappearing HCC. Ki-67 and p53 expression were higher in the NEC than in the HCC, and the lymph nodes showed only metastatic NEC. Therefore, this kind of tumor had a more aggressive clinical course in accordance with being an NEC rather than a conventional HCC. Three months after operation, the patient had multiple recurrent tumor nodules within the liver, spreading the metastasis to the adrenal glands and para-aortic lymph nodes. The patient died 1 year after operation.

  6. Expression of nodule-specific genes in alfalfa root nodules blocked at an early stage of development.

    NARCIS (Netherlands)

    Dickstein, R.; Bisseling, T.; Reinhold, V.N.; Ausubel, F.M.

    1988-01-01

    To help dissect the molecular basis of the Rhizobium-legume symbiosis, we used in vitro translation and Northern blot analysis of nodule RNA to examine alfalfa-specific genes (nodulins) expressed in two types of developmentally defective root nodules elicited by Rhizobium meliloti. Fix- nodules were

  7. Current management of hepatocellular carcinoma

    Science.gov (United States)

    Tabrizian, Parissa; Roayaie, Sasan; Schwartz, Myron E

    2014-01-01

    Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and leading cause of death among patients with cirrhosis. Treatment guidelines are based according to the Barcelona Clinic Liver Cancer staging system. The choice among therapeutic options that include liver resection, liver transplantation, locoregional, and systemic treatments must be individualized for each patient. The aim of this paper is to review the outcomes that can be achieved in the treatment of HCC with the heterogeneous therapeutic options currently available in clinical practice. PMID:25132740

  8. Transhemangioma Ablation of Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Pua, Uei

    2012-01-01

    Radiofrequency ablation (RFA) is a well-established treatment modality in the treatment of early hepatocellular carcinoma (HCC) [1]. Safe trajectory of the RFA probe is crucial in decreasing collateral tissue damage and unwarranted probe transgression. As a percutaneous technique, however, the trajectory of the needle is sometimes constrained by the available imaging plane. The presence of a hemangioma beside an HCC is uncommon but poses the question of safety related to probe transgression. We hereby describe a case of transhemangioma ablation of a dome HCC.

  9. Transhemangioma Ablation of Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2012-12-15

    Radiofrequency ablation (RFA) is a well-established treatment modality in the treatment of early hepatocellular carcinoma (HCC) [1]. Safe trajectory of the RFA probe is crucial in decreasing collateral tissue damage and unwarranted probe transgression. As a percutaneous technique, however, the trajectory of the needle is sometimes constrained by the available imaging plane. The presence of a hemangioma beside an HCC is uncommon but poses the question of safety related to probe transgression. We hereby describe a case of transhemangioma ablation of a dome HCC.

  10. Synergistic growth inhibition by sorafenib and vitamin K2 in human hepatocellular carcinoma cells.

    Science.gov (United States)

    Zhang, Yafei; Zhang, Bicheng; Zhang, Anran; Zhao, Yong; Zhao, Jie; Liu, Jian; Gao, Jianfei; Fang, Dianchun; Rao, Zhiguo

    2012-09-01

    Sorafenib is an oral multikinase inhibitor that has been proven effective as a single-agent therapy in hepatocellular carcinoma, and there is a strong rationale for investigating its use in combination with other agents. Vitamin K2 is nearly non-toxic to humans and has been shown to inhibit the growth of hepatocellular carcinoma. In this study, we evaluated the effects of a combination of sorafenib and vitamin K2 on the growth of hepatocellular carcinoma cells. Flow cytometry, 3-(4,5-dimethyl-2-thiazolyl-2,5-diphenyl-2H-tetrazolium bromide) and nude mouse xenograft assays were used to examine the effects of sorafenib and vitamin K2 on the growth of hepatocellular carcinoma cells. Western blotting was used to elucidate the possible mechanisms underlying these effects. Assays for 3-(4,5-dimethyl-2-thiazolyl-2,5-diphenyl-2H-tetrazolium bromide) revealed a strong synergistic growth-inhibitory effect between sorafenib and vitamin K2. Flow cytometry showed an increase in cell cycle arrest and apoptosis after treatment with a combination of these two drugs at low concentrations. Sorafenib-mediated inhibition of extracellular signal-regulated kinase phosphorylation was promoted by vitamin K2, and downregulation of Mcl-1, which is required for sorafenib-induced apoptosis, was observed after combined treatment. Vitamin K2 also attenuated the downregulation of p21 expression induced by sorafenib, which may represent the mechanism by which vitamin K2 promotes the inhibitory effects of sorafenib on cell proliferation. Moreover, the combination of sorafenib and vitamin K2 significantly inhibited the growth of hepatocellular carcinoma xenografts in nude mice. Our results determined that combined treatment with sorafenib and vitamin K2 can work synergistically to inhibit the growth of hepatocellular carcinoma cells. This finding raises the possibility that this combined treatment strategy might be promising as a new therapy against hepatocellular carcinoma, especially for patients

  11. Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule

    Directory of Open Access Journals (Sweden)

    Krunal Bharat Patel

    2016-01-01

    Full Text Available Pneumocystis pneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatous Pneumocystis pneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatous Pneumocystis pneumonia infection. This case is the third documented report of Pneumocystis pneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. Although Pneumocystis pneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present.

  12. The impact of faceplate surface characteristics on detection of pulmonary nodules

    Science.gov (United States)

    Toomey, R. J.; Ryan, J. T.; McEntee, M. F.; McNulty, J.; Evanoff, M. G.; Cuffe, F.; Yoneda, T.; Stowe, J.; Brennan, P. C.

    2009-02-01

    Introduction In order to prevent specular reflections, many monitor faceplates have features such as tiny dimples on their surface to diffuse ambient light incident on the monitor, however, this "anti-glare" surface may also diffuse the image itself. The purpose of the study was to determine whether the surface characteristics of monitor faceplates influence the detection of pulmonary nodules under low and high ambient lighting conditions. Methods and Materials Separate observer performance studies were conducted at each of two light levels (250 lux). Twelve examining radiologists with the American Board of Radiology participated in the darker condition and eleven in the brighter condition. All observers read on both smooth "glare" and dimpled "anti-glare" faceplates in a single lighting condition. A counterbalanced methodology was utilized to minimise memory effects. In each reading, observers were presented with thirty chest images in random order, of which half contained a single simulated pulmonary nodule. They were asked to give their confidence that each image did or did not contain a nodule and to mark the suspicious location. ROC analysis was applied to resultant data. Results No statistically significant differences were seen in the trapezoidal area under the ROC curve (AUC), sensitivity, specificity or average time per case at either light level for chest specialists or radiologists from other specialities. Conclusion The characteristics of the faceplate surfaces do not appear to affect detection of pulmonary nodules. Further work into other image types is being conducted.

  13. Mycotoxins’ Activity at Toxic and Sub-Toxic Concentrations: Differential Cytotoxic and Genotoxic Effects of Single and Combined Administration of Sterigmatocystin, Ochratoxin A and Citrinin on the Hepatocellular Cancer Cell Line Hep3B

    Directory of Open Access Journals (Sweden)

    Nikolia Αnninou

    2014-02-01

    Full Text Available Food safety organizations indicate the likelihood of constant human and animal exposure to mycotoxin mixtures as a possible negative public health impact. Risk assessment demonstrates that certain mycotoxins of Aspergillus and Penicillium spp. are toxic and hold a significant genotoxic efficacy at nanomolar concentrations. The aim of the current study was to investigate the potential cytogenetic effects of sterigmatocystin (STER, ochratoxin A (OTA and citrinin (CTN alone or in combination, at pM to μΜ concentrations, on the human hepatocellular cancer cell line Hep3B. MTT reduction, mitotic divisions, cell cycle delays and sister chromatid exchange rates (SCE were determined as endpoints of metabolic activity, cytotoxicity, cytostaticity, and genotoxicity, respectively. All mycotoxin treatments induce SCE rates from 10−12 M, while their cytotoxic and cytostatic potential varies. In PRI and MI assays, but not at MTT, STER alone or in combination with OTA + CTN appeared cytostatic and cytotoxic, even at 10−12 M, while CTN alone and all other combinations displayed substantial cellular survival inhibition in doses ≥ 10−8 M. Co-administration of STER + OTA or STER + CTN in concentrations ≤ 10−1 M, increased the MI and MTT activity, while it did not affect the PRI. Mycotoxin co-treatments revealed in general similar-to-additive or antagonistic genotoxic and cytotoxic effects. Our results for the first time describe that STER alone or in combination with OTA and/or CTN share a cytotoxic and cytogenetic potential even at picoMolar concentrations on human hepatoma cells in vitro.

  14. Effect of Irradiation on Apoptosis, Cell Cycle Arrest and Calcified Nodule Formation of Rat Calvarial Osteoblast

    International Nuclear Information System (INIS)

    Lee, Young Mi; Choi, Hang Moon; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul; Park, Tae Won

    2000-01-01

    The study was aimed to detect the induction of apoptosis, cell cycle arrest and calcified nodule formation after irradiation on primarily cultured osteoblasts. Using rat calvarial osteoblasts, the effects of irradiation on apoptosis, cell cycle arrest, and calcified nodule formation were studied. The single irradiation of 10, 20 Gy was done with 5.38 Gy/min dose rate using the 137 Cs cell irradiator at 4th and 14th day of culture. Apoptosis induction and cell cycle arrest were assayed by the flow cytometry at 1, 2, 3, and 4 days after irradiation. The formation of calcified nodules was observed by alizarin red staining at 1, 3, 10, 14 days after irradiation at 4th day of culture, and at 1, 4, 5 days after irradiation at 14th day of culture. Apoptosis was not induced by 10 or 20 Gy independent of irradiation and culture period. Irradiation did not induced G1 arrest in post-irradiated osteoblasts. After irradiation at 4th-day of culture, G2 arrest was induced but it was not statistically significant after irradiation at 14th-day of culture. In the case of irradiated cells at 4th day of culture, calcified nodules were not formed and at 14th-day of culture after irradiation, calcified nodule formation did not affected. Taken together, these results suggest that irradiation at the dose of 10-20 Gy would not affect apoptosis induction of osteoblasts. Cell cycle and calcified nodule formation were influenced by the level of differentiation of osteblasts.

  15. Nodulation in Dimorphandra wilsonii Rizz. (Caesalpinioideae), a Threatened Species Native to the Brazilian Cerrado

    Science.gov (United States)

    Fonseca, Márcia Bacelar; Peix, Alvaro; de Faria, Sergio Miana; Mateos, Pedro F.; Rivera, Lina P.; Simões-Araujo, Jean L.; França, Marcel Giovanni Costa; dos Santos Isaias, Rosy Mary; Cruz, Cristina; Velázquez, Encarna; Scotti, Maria Rita; Sprent, Janet I.; James, Euan K.

    2012-01-01

    The threatened caesalpinioid legume Dimorphandra wilsonii, which is native to the Cerrado biome in Brazil, was examined for its nodulation and N2-fixing ability, and was compared with another, less-threatened species, D. jorgei. Nodulation and potential N2 fixation was shown on seedlings that had been inoculated singly with five bradyrhizobial isolates from mature D. wilsonii nodules. The infection of D. wilsonii by two of these strains (Dw10.1, Dw12.5) was followed in detail using light and transmission electron microscopy, and was compared with that of D. jorgei by Bradyrhizobium strain SEMIA6099. The roots of D. wilsonii were infected via small transient root hairs at 42 d after inoculation (dai), and nodules were sufficiently mature at 63 dai to express nitrogenase protein. Similar infection and nodule developmental processes were observed in D. jorgei. The bacteroids in mature Dimorphandra nodules were enclosed in plant cell wall material containing a homogalacturonan (pectic) epitope that was recognized by the monoclonal antibody JIM5. Analysis of sequences of their rrs (16S rRNA) genes and their ITS regions showed that the five D. wilsonii strains, although related to SEMIA6099, may constitute five undescribed species of genus Bradyrhizobium, whilst their nodD and nifH gene sequences showed that they formed clearly separated branches from other rhizobial strains. This is the first study to describe in full the N2-fixing symbiotic interaction between defined rhizobial strains and legumes in the sub-family Caesalpinioideae. This information will hopefully assist in the conservation of the threatened species D. wilsonii. PMID:23185349

  16. Pulmonary nodule: new concepts of an Old Problem

    International Nuclear Information System (INIS)

    Diederich, S.; Wormanns, D.

    2003-01-01

    In the past, a pulmonary nodule was considered malignant until proven otherwise, usually histologically, which frequently required invasive diagnostic procedures. The nodule was mostly detected on conventional chest radiographs and usually larger than 10 mm. Recently, modern (multi-slice) helical CT detects an increasing number of very small (≤ 10 mm) nodules, which are benign in > 95%. Consequently, the exclusion of malignancy demands different diagnostic procedures, which should be predominantly non-invasive. This article presents the current data as well as imaging techniques for the determination of the nature of pulmonary nodules and suggests concepts for the diagnostic approach to small pulmonary nodules. (orig.) [de

  17. Diagnostic accuracy of medical imagings and an integrated statistical approach to diagnosis. With special attention to hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kawahira, Kosaburo

    1985-05-01

    Twenty-two patients with hepatocellular carcinoma and 36 without were clinically studied using angiography, computed tomography (CT), ultrasound (US) and Tc-99m phytate scintigraphy (RI). Diagnoses were confirmed by biopsy, surgery or autopsy, in all 58 patients. The judgement of multi-readers was obtained, independently. For a diagnosis of hepatocellular carcinoma, angiography was the most useful. Sensitivity, specificity and accuracy of this modality were 0.67, 0.85 and 0.78, respectively. Specificity and accuracy of US were 0.84 and 0.67, respectively, thereby US was the second best modality. CT was more useful than than RI for a diagnosis of hepatocellular carcinoma, in this series. Diagnostic accuracy of the 4 modalities in the diagnosis of liver mass were also discussed. To integrate these 4 images for a diagnosis of hepatocellular carcinoma, a multivariate analysis was made. The diagnostic accuracy of the system was considerably higher than that of any single modality.

  18. Two novel mutations in the sixth transmembrane segment of the thyrotropin receptor gene causing hyperfunctioning thyroid nodules.

    Science.gov (United States)

    Gozu, Hulya; Avsar, Melike; Bircan, Rifat; Claus, Maren; Sahin, Serap; Sezgin, Ozlem; Deyneli, Oguzhan; Paschke, Ralf; Cirakoglu, Beyazit; Akalin, Sema

    2005-04-01

    Autonomously functioning thyroid nodules (AFTNs) can present as hyperfunctioning adenomas or toxic multinodular goiters. In the last decade, a large number of activating mutations have been identified in the thyrotropin receptor (TSHR) gene in autonomously functioning thyroid nodules. Most have been situated close to, or within the sixth transmembrane segment and third intracellular loop of the TSHR where the receptor interacts with the Gs protein. In this study we describe two novel mutations in the sixth transmembrane segment of the TSHR causing hyperfunctioning thyroid nodules. Genomic DNAs were isolated from four hyperfunctioning thyroid nodules, normal tissues and peripheral leukocytes of two patients with toxic multinodular goiter. After amplifying the related regions, TSHR and G(s)alpha genes were analyzed by single-strand conformation polymorphism (SSCP) analysis. The precise localization of the mutations was identified by automatic DNA sequence analysis. Functional studies were done by site-directed mutagenesis and transfection of a mutant construct into COS-7 cells. We identified two novel TSHR mutations in two hyperfunctioning thyroid nodules: Phe631Val in the first patient and Iso630Met in the second patient. Both mutant receptors display an increase in constitutive stimulation of basal cyclic adenosine monophosphate (cAMP) levels compared to the wild-type receptor. This confirms that these mutant receptors cause hyperfunctioning thyroid nodules.

  19. Uranium in Pacific deep-sea sediments and manganese nodules

    International Nuclear Information System (INIS)

    Kunzendorf, H.; Plueger, W.L.; Friedrich, G.H.

    1983-01-01

    A total of 1344 manganese nodules and 187 pelagic sediments from 9 areas in the North and the South Pacific were analyzed for U by the delayed-neutron counting technique. A strong positive correlation between U and Fe in nodules and sediments suggests a co-precipitative removal from sea water into the Fe-rich (ferromanganese mineral phase MnO 2 . Enrichment of U and Fe in nodules from the northwestern slopes of two submarine hills (U between 6 and 9 ppm) in the equatorial nodule belt is thought to be caused by directional bottom water flow creating elevated oxygenized conditions in areas opposed to the flow. Economically important nodule deposits from the nodule belt and the Peru Basin have generally low U contents, between 3 and 5 ppm. Insignificant resources of U of about 4 x 10 5 in the Pacific manganese nodules are estimated. (orig.)

  20. Use of Volumetry for Lung Nodule Management: Theory and Practice.

    Science.gov (United States)

    Devaraj, Anand; van Ginneken, Bram; Nair, Arjun; Baldwin, David

    2017-09-01

    A consistent feature of many lung nodule management guidelines is the recommendation to evaluate nodule size by using diameter measurements and electronic calipers. Traditionally, the use of nodule volumetry applications has primarily been reserved for certain lung cancer screening trials rather than clinical practice. However, even before the first nodule management guidelines were published more than a decade ago, research has been ongoing into the use of nodule volumetry as a means of measuring nodule size, and this research has accelerated in recent years. This article aims to provide radiologists with an up-to-date review of the most recent literature on volumetry and volume doubling times in lung nodule management, outlining their benefits and drawbacks. A brief technical review of typical volumetry applications is also provided. © RSNA, 2017.

  1. Ultrasonographic finding of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Han Soo; Woo, Seong Ku; Lim, Jae Hoon; Ko, Young Tae; Kim, Ho Kyun; Kim, Soon Yong [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1983-12-15

    With the development of gray scale ultrasonography, detection and evaluation of hepatic parenchymal disease including space occupying lesion are easily performed and frequently used in the world. Thrity five cases of histopathologically proven and ultrasonographically suggested hepatocellular carcinoma are retrospectively studied. The results were as follows; 1. Ultrasonographic findings of hepatocellular carcinoma show hyperechoic pattern in 22 cases (63%), hypoechoic pattern in 2 cases (6%), and mixed pattern in 11 cases (31%). 2. The margin of tumor is ill-defined in 19 cases (54%) and well defined in16 cases (46%). 3. The size of tumor by sonographic measurement was large than 5 cm in diameter in 33 cases (94%). 4. The number of tumor is solitary in 19 cases and multiple in 16 cases. The sites of involved lobe were right lobe in 22 cases (63%), left lobe in 2 cases (6%), and both lobes in 11 cases (31%). 5. Associated sonographic findings were hepatomegaly with focal contour change in 25 cases (71%), splenomegaly in 16 cases (46%), cirrhosis of liver in 15 cases (43%), ascites in 11 cases (31%) and tumoral thrombosis in portal vein in 8 cases (23%). 6. The sex ratio is 6 : 1 male predominence and the age ranges from 32 to 76 years with highest incidence in 5th and 6th decades.

  2. Synchronous gastric neuroendocrine carcinoma and hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Ewertsen, Caroline; Henriksen, Birthe Merete; Hansen, Carsten Palnæs

    2009-01-01

    of synchronous gastric NEC and hepatocellular carcinoma in a patient with several other precancerous lesions is presented. The patient had anaemia, and a gastric tumour and two duodenal polyps were identified on upper endoscopy. A CT scan of the abdomen revealed several lesions in the liver. The lesions were...... invisible on B-mode sonography and real-time sonography fused with CT was used to identify and biopsy one of the lesions. Histology showed hepatocellular carcinoma. A literature search showed that only one case of a hepatocellular carcinoma synchronous with a gastric NEC has been reported previously. TRIAL...

  3. Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Xu, H.-X.; Xie, X.-Y.; Lu, M.-D. E-mail: lumd@21cn.com; Chen, J.-W.; Yin, X.-Y.; Xu, Z.-F.; Liu, G.-J

    2004-01-01

    AIM: To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS: A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS: Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours{<=}2.0, 2.1-3.9 and {>=}4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours{<=}2.0, 2.1-3.9 and {>=}4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION: Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.

  4. Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation

    International Nuclear Information System (INIS)

    Xu, H.-X.; Xie, X.-Y.; Lu, M.-D.; Chen, J.-W.; Yin, X.-Y.; Xu, Z.-F.; Liu, G.-J.

    2004-01-01

    AIM: To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS: A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS: Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours≤2.0, 2.1-3.9 and ≥4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours≤2.0, 2.1-3.9 and ≥4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION: Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up

  5. Findings in multidetector computed tomography in the diagnosis of hepatocellular carcinoma in patients with cirrhosis and correlation with pathology of liver explants

    International Nuclear Information System (INIS)

    Haberman, D.; Castignola, M.; Mela, M.; Paladini, H.; Santilli, J.P.; Gruz, F.; Gondolesi, G.

    2013-01-01

    Objectives: To describe the imagenological behavior of hepatocellular carcinoma in cirrhotic patients using a dynamic multidetector computed tomography (MDCT) technique, and correlate these findings with histological tumor grades. Materials and methods: A retrospective, descriptive observational study was conducted to evaluate 51 nodules in 32 liver transplant patients diagnosed with liver cirrhosis. The pathology of liver explants was used as a reference. Nodules with hepatocellular carcinoma histopathology were retrospectively analyzed by computed tomography scans performed pre-transplant. Using a dynamic multidetector computed tomography technique, we evaluated the most common imagenological behavior reported in the literature: arterial enhancement, washout, capsule, and intratumoral arterial vessels. Results: Forty-six of 51 (90%) tumors showed arterial enhancement. Of the 46 tumors with arterial enhancement, 39 (85%) had washout in portal-late phase. Five of 51 (10%) were hypovascular. Twenty-two of 51 (43%) had capsule and 12 of 51 (24%) showed intratumoral arterial vessels. The more frequent image combination was the combination of arterial enhancement and washout (39 of 51 tumors or 76%). The most frequent histological grade was II (35 of 51 tumors or 69%). Statistically significant relationships were found between histological grade tumors and imagenological behavior: arterial enhancement and hypovascular. Conclusion: In our population, arterial enhancement with washout in portal-late phases was observed in most of the tumors. Our results are consistent with previously reported studies, demonstrating the high reliability of this imaging pattern for the diagnosis of hepatocellular carcinoma. (authors) [es

  6. Search for Nodulation and Nodule Development-related cystatin genes in the genome of Soybean (Glycine max

    Directory of Open Access Journals (Sweden)

    Songli Yuan

    2016-10-01

    Full Text Available Nodulation, nodule development and senescence directly affects nitrogen fixation efficiency, and previous studies have shown that inhibition of some cysteine proteases delay nodule senescence, so their nature inhibitors, cystatin genes, are very important in nodulation, nodule development and senescence. Although several cystatins are actively transcribed in soybean nodules, their exact roles and functional diversities in legume have not been well explored in genome-wide survey studies. In this report, we performed a genome-wide survey of cystatin family genes to explore their relationship to nodulation and nodule development in soybean and identified 20 cystatin genes that encode peptides with 97~245 amino acid residues, different isoelectric points (pI and structure characteristics, and various putative plant regulatory elements in 3000 bp putative promoter fragments upstream of the 20 soybean cystatins in response to different abiotic/biotic stresses, hormone signals and symbiosis signals. The expression profiles of these cystatin genes in soybean symbiosis with rhizobium strain Bradyrhizobium japonicum strain 113-2 revealed that 7 cystatin family genes play different roles in nodulation as well as nodule development and senescence. However, these genes were not root nodule symbiosis (RNS - specific and did not encode special clade cystatin protein with structures related to nodulation and nodule development. Besides, only two of these soybean cystatins were not upregulated in symbiosis after ABA treatment. The functional analysis showed that a candidate gene Glyma.15G227500 (GmCYS16 was likely to play a positive role in soybean nodulation. Besides, evolutionary relationships analysis divided the cystatin genes from Arabidopsis thaliana, Nicotiana tabacum, rice, barley and four legume plants into three groups. Interestingly, Group A cystatins are special in legume plants, but only include one of the above-mentioned 7 cystatin genes related to

  7. Genetic alterations in hepatocellular carcinoma: An update

    Science.gov (United States)

    Niu, Zhao-Shan; Niu, Xiao-Jun; Wang, Wen-Hong

    2016-01-01

    Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. Although recent advances in therapeutic approaches for treating HCC have improved the prognoses of patients with HCC, this cancer is still associated with a poor survival rate mainly due to late diagnosis. Therefore, a diagnosis must be made sufficiently early to perform curative and effective treatments. There is a need for a deeper understanding of the molecular mechanisms underlying the initiation and progression of HCC because these mechanisms are critical for making early diagnoses and developing novel therapeutic strategies. Over the past decade, much progress has been made in elucidating the molecular mechanisms underlying hepatocarcinogenesis. In particular, recent advances in next-generation sequencing technologies have revealed numerous genetic alterations, including recurrently mutated genes and dysregulated signaling pathways in HCC. A better understanding of the genetic alterations in HCC could contribute to identifying potential driver mutations and discovering novel therapeutic targets in the future. In this article, we summarize the current advances in research on the genetic alterations, including genomic instability, single-nucleotide polymorphisms, somatic mutations and deregulated signaling pathways, implicated in the initiation and progression of HCC. We also attempt to elucidate some of the genetic mechanisms that contribute to making early diagnoses of and developing molecularly targeted therapies for HCC. PMID:27895396

  8. Risks of Liver (Hepatocellular) Cancer Screening

    Science.gov (United States)

    ... cancer. Having hepatitis or cirrhosis can increase the risk of developing liver cancer. Anything that increases the ... clinical trials is available from the NCI website . Risks of Liver (Hepatocellular) Cancer Screening Key Points Screening ...

  9. Retrospective evaluation of focal hypermetabolic thyroid nodules incidentally identified by 18F-FDG PET/CT in a large population

    International Nuclear Information System (INIS)

    Guan Zhiwei; Xu Baixuan; Chen Yingmao; Zhang Jinming; Tian Jiahe

    2012-01-01

    Objective: To investigate the prevalence of focal hypermetabolic thyroid nodules incidentally detected by 18 F-FDG PET/CT in a relatively large population and explore its value in differentiating malignancy from benign thyroid nodules. Methods: During August 2007 to March 2010, 8463 patients with no history of thyroid cancer or thyroidectomy underwent 18 F-FDG PET/CT. Among them, 145 patients were found to have abnormal hypermetabolic thyroid nodules. Sixty-eight patients were conformed with histopathological or clinical follow-up, including 37 with malignancy and 31 with benign nodules (male 21, female 47, average age (53.66 ± 10.85)y). The SUV max , nodule size, single or multiple nodules, with or without calcification and patient's age were chosen as the parameters for predicting malignancy in hypermetabolic thyroid nodules. Univariate analysis was performed using t test, χ 2 test and Fisher exact test. Binary logistic regression was performed for multi-variate analysis. The AUCs of SUV max and logistic regression analysis were compared. Results: The incidence of focal hypermetabolic thyroid nodules was 1.71% (145/8463), with malignancy rate 54.41% (37/68). The SUV max of benign and malignant nodules were 5.13 ±4.02 and 7.61 ± 4.78, respectively (t=2.235, P=0.029). Logistic regression indicated that SUV max , with or without calcification, single or multiple nodules, nodule size and patient's age were all the predictors for malignancy in hypermetabolic thyroid nodules. The AUC of logistic regressive model (AUC L ) and SUV max (AUC S )were 0.878 ±0.043 (95% CI: 0.793-0.962, P<0.05) and 0.694 ±0.067 (95% CI: 0.562-0.825, P<0.05), respectively (P<0.05). Conclusions: Focal hypermetabolic thyroid nodules incidentally identified by 18 F-FDG PET/CT come with high rate of thyroid malignancy. Differential diagnosis could be improved significantly using SUV max and logistic regressive model aided by other parameters from 18 F-FDG PET/CT as well as patient

  10. Pulmonary nodule registration in serial CT scans based on rib anatomy and nodule template matching

    International Nuclear Information System (INIS)

    Shi Jiazheng; Sahiner, Berkman; Chan, H.-P.; Hadjiiski, Lubomir; Zhou, C.; Cascade, Philip N.; Bogot, Naama; Kazerooni, Ella A.; Wu, Y.-T.; Wei, J.

    2007-01-01

    An automated method is being developed in order to identify corresponding nodules in serial thoracic CT scans for interval change analysis. The method uses the rib centerlines as the reference for initial nodule registration. A spatially adaptive rib segmentation method first locates the regions where the ribs join the spine, which define the starting locations for rib tracking. Each rib is tracked and locally segmented by expectation-maximization. The ribs are automatically labeled, and the centerlines are estimated using skeletonization. For a given nodule in the source scan, the closest three ribs are identified. A three-dimensional (3D) rigid affine transformation guided by simplex optimization aligns the centerlines of each of the three rib pairs in the source and target CT volumes. Automatically defined control points along the centerlines of the three ribs in the source scan and the registered ribs in the target scan are used to guide an initial registration using a second 3D rigid affine transformation. A search volume of interest (VOI) is then located in the target scan. Nodule candidate locations within the search VOI are identified as regions with high Hessian responses. The initial registration is refined by searching for the maximum cross-correlation between the nodule template from the source scan and the candidate locations. The method was evaluated on 48 CT scans from 20 patients. Experienced radiologists identified 101 pairs of corresponding nodules. Three metrics were used for performance evaluation. The first metric was the Euclidean distance between the nodule centers identified by the radiologist and the computer registration, the second metric was a volume overlap measure between the nodule VOIs identified by the radiologist and the computer registration, and the third metric was the hit rate, which measures the fraction of nodules whose centroid computed by the computer registration in the target scan falls within the VOI identified by the

  11. Management of small hepatocellular carcinoma in cirrhosis: Focus on portal hypertension

    Science.gov (United States)

    Hernandez-Gea, Virginia; Turon, Fanny; Berzigotti, Annalisa; Villanueva, Augusto

    2013-01-01

    The incidence of hepatocellular carcinoma (HCC) is rising worldwide being currently the fifth most common cancer and third cause of cancer-related mortality. Early detection of HCC through surveillance programs have enabled the identification of small nodules with higher frequency, and nowadays account for 10%-15% of patients diagnosed in the West and almost 30% in Japan. Patients with small HCC can be candidates for potential curative treatments: liver transplantation, surgical resection and percutaneous ablation, depending on the presence of portal hypertension and co-morbidities. This review will analyze recent advancements in the clinical management of these individuals, focusing on issues related to the role of portal hypertension, the debate between resection and ablative therapies and the future impact of molecular technologies. PMID:23482437

  12. Segmentation of nodules on chest computed tomography for growth assessment

    International Nuclear Information System (INIS)

    Mullally, William; Betke, Margrit; Wang Jingbin; Ko, Jane P.

    2004-01-01

    Several segmentation methods to evaluate growth of small isolated pulmonary nodules on chest computed tomography (CT) are presented. The segmentation methods are based on adaptively thresholding attenuation levels and use measures of nodule shape. The segmentation methods were first tested on a realistic chest phantom to evaluate their performance with respect to specific nodule characteristics. The segmentation methods were also tested on sequential CT scans of patients. The methods' estimation of nodule growth were compared to the volume change calculated by a chest radiologist. The best method segmented nodules on average 43% smaller or larger than the actual nodule when errors were computed across all nodule variations on the phantom. Some methods achieved smaller errors when examined with respect to certain nodule properties. In particular, on the phantom individual methods segmented solid nodules to within 23% of their actual size and nodules with 60.7 mm3 volumes to within 14%. On the clinical data, none of the methods examined showed a statistically significant difference in growth estimation from the radiologist

  13. Thyroid nodule classification using ultrasound elastography via linear discriminant analysis.

    Science.gov (United States)

    Luo, Si; Kim, Eung-Hun; Dighe, Manjiri; Kim, Yongmin

    2011-05-01

    The non-surgical diagnosis of thyroid nodules is currently made via a fine needle aspiration (FNA) biopsy. It is estimated that somewhere between 250,000 and 300,000 thyroid FNA biopsies are performed in the United States annually. However, a large percentage (approximately 70%) of these biopsies turn out to be benign. Since the aggressive FNA management of thyroid nodules is costly, quantitative risk assessment and stratification of a nodule's malignancy is of value in triage and more appropriate healthcare resources utilization. In this paper, we introduce a new method for classifying the thyroid nodules based on the ultrasound (US) elastography features. Unlike approaches to assess the stiffness of a thyroid nodule by visually inspecting the pseudo-color pattern in the strain image, we use a classification algorithm to stratify the nodule by using the power spectrum of strain rate waveform extracted from the US elastography image sequence. Pulsation from the carotid artery was used to compress the thyroid nodules. Ultrasound data previously acquired from 98 thyroid nodules were used in this retrospective study to evaluate our classification algorithm. A classifier was developed based on the linear discriminant analysis (LDA) and used to differentiate the thyroid nodules into two types: (I) no FNA (observation-only) and (II) FNA. Using our method, 62 nodules were classified as type I, all of which were benign, while 36 nodules were classified as Type-II, 16 malignant and 20 benign, resulting in a sensitivity of 100% and specificity of 75.6% in detecting malignant thyroid nodules. This indicates that our triage method based on US elastography has the potential to substantially reduce the number of FNA biopsies (63.3%) by detecting benign nodules and managing them via follow-up observations rather than an FNA biopsy. Published by Elsevier B.V.

  14. TIRADS for sonographic assessment of hypofunctioning and indifferent thyroid nodules.

    Science.gov (United States)

    Schenke, Simone; Rink, T; Zimny, M

    2015-01-01

    To test the feasibility of the Thyroid Imaging Reporting And Data System (TIRADS) according to Horvath and Kwak for the assessment of thyroid nodules. Retrospective analysis of patients with thyroid nodules applying the following inclusion criteria: B-mode-ultrasound, surgery and histological results. Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, 4C, 5 and 6. A total of 172 patients were included (133 women, 48 ± 13 years, 39 men, 49 ± 11 years) with 222 thyroid nodules (24.9 ± 11.5 mm). Final histological diagnosis revealed 203 benign nodules (91%) and 19 malignant nodules (9%; 18 papillary thyroid carcinoma, PTC, and one medullary thyroid carcinoma, MTC). One hundred and sixty thyroid nodules were hypofunctioning in 99mTc-pertechnetate-scintigraphy, 14 nodules were hyperfunctioning and 46 nodules were classified as indifferent. In two cases with small carcinoma nodules (39%) were not clearly classifiable, including 3 carcinoma (4.1%). According to Kwak, the prevalence of malignancy was 6.9% in TIRADS 2, 0% in 3, 2% in 4A, 4.1% in 4B, 23.1% in 4C, and 100% in 5 and 6, respectively. Notably, in the subgroup of hot nodules, 11 (79%) were graded as TIRADS 4A or higher, and thus advisable for fine-needle aspiration biopsy in both TIRADS. The TIRADS described by Horvath is not practicable due to numerous unclassifiable nodules. The revised TIRADS published by Kwak is feasible and suitable to assess the prevalence of malignancy, but it cannot replace scintigraphic imaging. Fine-needle-biopsy is not necessary in nodules categorized as (K)TIRADS 3, 4A and 5.

  15. The detection of magnetotactic bacteria in deep sea sediments from the east Pacific Manganese Nodule Province.

    Science.gov (United States)

    Dong, Yi; Li, Jinhua; Zhang, Wuchang; Zhang, Wenyan; Zhao, Yuan; Xiao, Tian; Wu, Long-Fei; Pan, Hongmiao

    2016-04-01

    Magnetotactic bacteria (MTB) are distributed ubiquitously in sediments from coastal environments to the deep sea. The Pacific Manganese Nodule Province contains numerous polymetallic nodules mainly composed of manganese, iron, cobalt, copper and nickel. In the present study we used Illumina MiSeq sequencing technology to assess the communities of putative MTB in deep sea surface sediments at nine stations in the east Pacific Manganese Nodule Province. A total of 402 sequence reads from MTB were classified into six operational taxonomic units (OTUs). Among these, OTU113 and OTU759 were affiliated with the genus Magnetospira, OTU2224 and OTU2794 were affiliated with the genus Magnetococcus and Magnetovibrio, respectively, OTU3017 had no known genus affiliation, and OTU2556 was most similar to Candidatus Magnetananas. Interestingly, OTU759 was widely distributed, occurring at all study sites. Magnetism measurements revealed that all sediments were dominated by low coercivity, non-interacting single domain magnetic minerals. Transmission electron microscopy confirmed that the magnetic minerals were magnetosomes. Our data suggest that diverse putative MTB are widely distributed in deep sea surface sediments from the east Pacific Manganese Nodule Province. © 2016 Society for Applied Microbiology and John Wiley & Sons Ltd.

  16. Pemphigus Vulgaris with Solitary Toxic Thyroid Nodule

    Directory of Open Access Journals (Sweden)

    Mostafa Alfishawy

    2014-01-01

    Full Text Available Background. Pemphigus vulgaris is an autoimmune vesiculobullous disease, affecting the skin and mucous membranes. It is reported to be associated with other autoimmune diseases including autoimmune thyroid diseases. However we report herein a case of pemphigus vulgaris associated with autonomous toxic nodule. Case Presentation. A 51-year-old woman was evaluated for blisters and erosions that develop on her trunk, face, and extremities, with a five-year history of progressively enlarging neck mass, and a past medical history of pemphigus vulgaris seven years ago. The condition was associated with palpitation, dyspnea, and heat intolerance. Thyroid function tests and thyroid scan were compatible with the diagnosis of thyrotoxicosis due to autonomous toxic nodule. Exacerbation of pemphigus vulgaris was proved by skin biopsy from the patient which revealed histologic picture of pemphigus vulgaris. Conclusion. Autoimmune thyroid diseases are reported to associate pemphigus vulgaris. To our knowledge, this case is the first in the English literature to report association between pemphigus vulgaris and autonomous toxic nodule and highlights the possibility of occurrence of pemphigus vulgaris with a nonautoimmune thyroid disease raising the question: is it just a coincidence or is there an explanation for the occurrence of both conditions together?

  17. Computed tomographic findings of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Jo, In Su; Jong, Woo Yung; Lee, Jong Yul; Choi, Han Yong; Kim, Bong Ki

    1987-01-01

    With Development of Computed Tomography, detection of the Hepatocellular Carcinoma are easily performed and frequently used in the world. During 15 months, from December 1985 to February 1987, 59 patients with hepatocellular carcinoma were evaluated with computed tomography in department of radiology at Wallace Memorial Baptist Hospital. The results were as follow: 1. The most prevalent age group was 5th to 7th decades, male to female ratio was 4.9:1. 2. Classification with incidence of computed tomographic appearance of the hepatocellular carcinoma were solitary type 28 cases (48%), multinodular type 24 cases (40%), and diffuse type 7 cases (12%), Association with liver cirrhosis was noted in 22 cases (38%). 3. Inhomogenous internal consistency of hepatocellular carcinoma due to central necrosis were 35 cases (60%). Portal vein invasion by hepatocellular carcinoma was noted in 15 cases (25%), and particularly most common in diffuse type 4 cases (55%). 4. On precontrast scan, all hepatocellular carcinoma were seen as area of low density except for 3 cases(0.5%) of near isodensity which turned out to be remarkable low density on postcontrast scan. 5. In solitary type, posterior segment of right lobe was most common site of involvement 12 cases (43%). In diffuse type, bilobar involvement was most common, 6 cases (85%)

  18. Percutaneous cryoablation for hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Kyoung Doo Song

    2016-12-01

    Full Text Available Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC. Although radiofrequency (RF ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct tissue destruction and vascular-related injury. A few recent comparative studies have shown that percutaneous cryoablation for HCCs is comparable to percutaneous RF ablation in terms of long term therapeutic outcomes and complications. Cryoablation has several advantages over RF ablation such as well visualization of iceball, no causation of severe pain, and lack of severe damage to great vessels and gallbladder. It is important to know the advantages and disadvantages of cryoablation compared with RF ablation for improvement of therapeutic efficacy and safety.

  19. Medical treatment of hepatocellular carcinoma.

    Science.gov (United States)

    Granito, Alessandro; Bolondi, Luigi

    2009-12-16

    Hepatocellular carcinoma (HCC) is the fifth most common neoplasm and the third leading cause of cancer-related deaths worldwide. Cirrhosis, most often due to viral hepatitis, is the predominant risk factors for HCC and geographical differences in both risk factors and incidence are largely due to epidemiological variations in hepatitis B and C infection. Hepatic function is a relevant parameter in selecting therapy in HCC. The current clinical classification of HCC split patients into 5 stages, with a specific treatment schedule for any stage. As patients with early stages can receive curative treatments, such as surgical resection, liver transplantation or local ablation, surveillance program in high-risk populations has become mandatory. Sorafenib, a multikinase inhibitor, has recently shown survival benefits in patients at advanced stage of disease. Hopefully, new molecular targeted therapies and their combination with sorafenib or interventional and surgical procedures, should expand the therapeutic armamentarium against HCC.

  20. [Radiofrequency ablation of hepatocellular carcinoma].

    Science.gov (United States)

    Widmann, Gerlig; Schullian, Peter; Bale, Reto

    2013-03-01

    Percutaneous radiofrequency ablation (RFA) is well established in the treatment of hepatocellular carcinoma (HCC). Due to its curative potential, it is the method of choice for non resectable BCLC (Barcelona Liver Clinic) 0 and A. RFA challenges surgical resection for small HCC and is the method of choice in bridging for transplantation and recurrence after resection or transplantation. The technical feasibility of RFA depends on the size and location of the HCC and the availability of ablation techniques (one needle techniques, multi-needle techniques). More recently, stereotactic multi-needle techniques with 3D trajectory planning and guided needle placement substantially improve the spectrum of treatable lesions including large volume tumors. Treatment success depends on the realization of ablations with large intentional margins of tumor free tissue (A0 ablation in analogy to R0 resection), which has to be documented by fusion of post- with pre-ablation images, and confirmed during follow-up imaging.

  1. Gene mutations in hepatocellular adenomas

    DEFF Research Database (Denmark)

    Raft, Marie B; Jørgensen, Ernö N; Vainer, Ben

    2015-01-01

    is associated with bi-allelic mutations in the TCF1 gene and morphologically has marked steatosis. β-catenin activating HCA has increased activity of the Wnt/β-catenin pathway and is associated with possible malignant transformation. Inflammatory HCA is characterized by an oncogene-induced inflammation due...... to alterations in the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. In the diagnostic setting, sub classification of HCA is based primarily on immunohistochemical analyzes, and has had an increasing impact on choice of treatment and individual prognostic assessment....... This review offers an overview of the reported gene mutations associated with hepatocellular adenomas together with a discussion of the diagnostic and prognostic value....

  2. Angiographic findings of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Han, Man Chung; Cho, Byung Jae; Huh, Seung Jae; Bae, Sang Hoon; Kim, Ung Jin; Kim, Chung Yong; Kim, Noe Kyeong [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1985-12-15

    From March 1977 to July 1979, 69 cases of angiograms of hepatocellular carcinoma were observed in Seoul National University Hospital. The findings of selective celiac and/or hepatic arteriography in total 69 cases of confirmed hepatocellular carcinoma, with clinical and laboratory findings, were analyzed. The summarized results are as follows; 1. Among 69 cases od hepatoma, 62 were male and 7 were female with sex ratio of 8.9 : 1. Peak incidence is 5th to 7th decades (72.5%). Epigastric pain, indigestion, and palpable mass in right upper quadrant were common symptoms and sign. Laboratory findings showed elevated serum alkaline phosphatase more than 5 Bodansky unit in 75.4%. Alpha-feto protein was positive in 65.2% of all the patients. 2 All 69 cases were classified into 31 cases of massive type, 22 cases of diffuse type, and 16 cases of nodular type, in accordance with angiographic gross anatomy. The frequency of angiographic findings were hypervascularities and tumor vessels (100%), tumor stainings (98.5%), arteriovenous shunt (71.0%), displacement of intrahepatic arteries (66.7%), vascular lakes and channel (59.4%). Encasement of hepatic artery and portal vein regurgitation was respectively 4 cases. Tumor mass in portal vein were 6 cases and tumor mass in hepatic vein was 1 case. 3. Intraarterial infusion of 5-FU was performed in 15 hepatoma patients, and the results were that angiographic improvement was demonstrated in 3 cases, no improvement in 8 cases, and incomplete infusion in 4 cases. 4. The selective celiac and/or hepatic angiograms are excellent diagnostic tools as well as therapeutic management for intraarterial infusion of anticancerous drugs.

  3. Angiographic findings of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Han, Man Chung; Cho, Byung Jae; Huh, Seung Jae; Bae, Sang Hoon; Kim, Ung Jin; Kim, Chung Yong; Kim, Noe Kyeong

    1985-01-01

    From March 1977 to July 1979, 69 cases of angiograms of hepatocellular carcinoma were observed in Seoul National University Hospital. The findings of selective celiac and/or hepatic arteriography in total 69 cases of confirmed hepatocellular carcinoma, with clinical and laboratory findings, were analyzed. The summarized results are as follows; 1. Among 69 cases od hepatoma, 62 were male and 7 were female with sex ratio of 8.9 : 1. Peak incidence is 5th to 7th decades (72.5%). Epigastric pain, indigestion, and palpable mass in right upper quadrant were common symptoms and sign. Laboratory findings showed elevated serum alkaline phosphatase more than 5 Bodansky unit in 75.4%. Alpha-feto protein was positive in 65.2% of all the patients. 2 All 69 cases were classified into 31 cases of massive type, 22 cases of diffuse type, and 16 cases of nodular type, in accordance with angiographic gross anatomy. The frequency of angiographic findings were hypervascularities and tumor vessels (100%), tumor stainings (98.5%), arteriovenous shunt (71.0%), displacement of intrahepatic arteries (66.7%), vascular lakes and channel (59.4%). Encasement of hepatic artery and portal vein regurgitation was respectively 4 cases. Tumor mass in portal vein were 6 cases and tumor mass in hepatic vein was 1 case. 3. Intraarterial infusion of 5-FU was performed in 15 hepatoma patients, and the results were that angiographic improvement was demonstrated in 3 cases, no improvement in 8 cases, and incomplete infusion in 4 cases. 4. The selective celiac and/or hepatic angiograms are excellent diagnostic tools as well as therapeutic management for intraarterial infusion of anticancerous drugs.

  4. Comparison of quantitatively analyzed dynamic area-detector CT using various mathematic methods with FDG PET/CT in management of solitary pulmonary nodules.

    Science.gov (United States)

    Ohno, Yoshiharu; Nishio, Mizuho; Koyama, Hisanobu; Fujisawa, Yasuko; Yoshikawa, Takeshi; Matsumoto, Sumiaki; Sugimura, Kazuro

    2013-06-01

    The objective of our study was to prospectively compare the capability of dynamic area-detector CT analyzed with different mathematic methods and PET/CT in the management of pulmonary nodules. Fifty-two consecutive patients with 96 pulmonary nodules underwent dynamic area-detector CT, PET/CT, and microbacterial or pathologic examinations. All nodules were classified into the following groups: malignant nodules (n = 57), benign nodules with low biologic activity (n = 15), and benign nodules with high biologic activity (n = 24). On dynamic area-detector CT, the total, pulmonary arterial, and systemic arterial perfusions were calculated using the dual-input maximum slope method; perfusion was calculated using the single-input maximum slope method; and extraction fraction and blood volume (BV) were calculated using the Patlak plot method. All indexes were statistically compared among the three nodule groups. Then, receiver operating characteristic analyses were used to compare the diagnostic capabilities of the maximum standardized uptake value (SUVmax) and each perfusion parameter having a significant difference between malignant and benign nodules. Finally, the diagnostic performances of the indexes were compared by means of the McNemar test. No adverse effects were observed in this study. All indexes except extraction fraction and BV, both of which were calculated using the Patlak plot method, showed significant differences among the three groups (p method, pulmonary arterial perfusion calculated using the dual-input method, and perfusion calculated using the single-input method were significantly larger than that of SUVmax (p method (69.8%, p method has better potential for the diagnosis of pulmonary nodules than dynamic area-detector CT analyzed using other methods and than PET/CT.

  5. Lung nodule volumetry: segmentation algorithms within the same software package cannot be used interchangeably.

    NARCIS (Netherlands)

    Ashraf, H.; Hoop, B.J. de; Shaker, S.B.; Dirksen, A.; Bach, K.S.; Hansen, H.; Prokop, M.; Pedersen, J.H.

    2010-01-01

    OBJECTIVE: We examined the reproducibility of lung nodule volumetry software that offers three different volumetry algorithms. METHODS: In a lung cancer screening trial, 188 baseline nodules >5 mm were identified. Including follow-ups, these nodules formed a study-set of 545 nodules. Nodules were

  6. Botulinum toxin in the treatment of vocal fold nodules.

    Science.gov (United States)

    Allen, Jacqui E; Belafsky, Peter C

    2009-12-01

    Promising new techniques in the management of vocal fold nodules have been developed in the past 2 years. Simultaneously, the therapeutic use of botulinum toxin has rapidly expanded. This review explores the use of botulinum toxin in treatment of vocal nodules and summarizes current therapeutic concepts. New microsurgical instruments and techniques, refinements in laser technology, radiosurgical excision and steroid intralesional injections are all promising new techniques in the management of vocal nodules. Botulinum toxin-induced 'voice rest' is a new technique we have employed in patients with recalcitrant nodules. Successful resolution of nodules is possible with this technique, without the risk of vocal fold scarring inherent in dissection/excision techniques. Botulinum toxin usage is exponentially increasing, and large-scale, long-term studies demonstrate its safety profile. Targeted vocal fold temporary paralysis induced by botulinum toxin injection is a new, well tolerated and efficacious treatment in patients with persistent vocal fold nodules.

  7. CT SCAN EVALUATION OF PULMONARY NODULE

    Directory of Open Access Journals (Sweden)

    A. Ravi Kumar

    2016-06-01

    Full Text Available BACKGROUND Lung carcinomas are quite commonly diagnosed. Thanks to the ever increasing smokers’ population. Majority of the city dwellers are at a higher risk of having this disease when compared to the village counterparts. The stigma through which the person and the family have to undergo before confirming the diagnosis is enormous. So the radiographic methods of diagnosing the malignancies have to improve. Before confirming the diagnosis, the radiologists, the treating physicians should be somewhat confident about the diagnosis so as to prepare the patients and their relatives for the most probable diagnosis before the confirmatory report. The confirmatory procedures include the PET scan and the Histopathology. Both are time consuming procedures and in an economy like ours, finding a PET scanning centre is rather difficult. So the most probable diagnosis has to be thought of using minimal resource. This study puts in a sincere effort to understand and evaluate the pulmonary nodule when identified by a CT scan. This paper is intended to help the practicing radiologists and also make life easy for a practicing physician to identify correctly the lesions and also help the patients to prevent further progression of the disease. METHODS The study was a cross-sectional study. The sample size of the study consisted of thirty patients. CT scan was done in thirty patients who were identified to have lung nodules either by other mode of radiological studies or first time identified in a CT scan itself. The study was conducted in Fathima Institute of Medical Sciences, Kadapa. The study was conducted from 2014 to 2015. RESULT Non-solid nodules were more in number when compared to the solid nodules. All the non-solid nodules were confirmed to be adenomas. Eighty percent of the nodules which were more than 8 mm in size were confirmed to be malignant. One hundred percent of the spiculated border on CT was confirmed to be malignant. In the present study

  8. Percutaneous radiofrequency ablation for benign nodules of the thyroid gland

    International Nuclear Information System (INIS)

    Baek, Jung Hwan; Jeong, Hyun Jo; Kim, Yoon Suk; Kwak, Min Sook; Chang, Sun Hee; Rhim, Hyun Chul

    2005-01-01

    We wanted to evaluate the efficacy and safety of using ultrasound guided percutaneous radiofrequency ablation for the benign nodules of the thyroid gland. We studied 148 patients with benign thyroid nodules (200 total nodules) that were confirmed histopathologically, and we performed ultrasound guided radiofrequency ablation. The radiofrequency ablation was done 1 to 5 times per one nodule, and follow-up ultrasonography was performed one to nineteen months after the ablation procedures. The physical changes and the decrease of volume of the nodules were evaluated, and the complications related to radiofrequency ablation were observed. The mean initial nodule volume was 0.01-95.61 ml (mean; 6.83 ± SD of 10.63 ml) and the nodule volume after radiofrequency ablation was decreased to 0.00-46.56 ml (mean; 1.83 ± SD of 4.69 ml). The mean volume reduction rate was 73.2%. Reduction of more than 50% was noted in 90% of all cases. For 180 nodules (90%), the decrease was 50% or more, in 20 nodules (10%), the decrease was 49% or less. On gray-scale ultrasonogram obtained after ablation, the echogenicity of the nodules changed to darker, and on the doppler-sonogram, the vascular flow within the nodules disappeared in all cases. Most patients complained pain during or right after the procedure, but the pain was transient and subsided after medication. Two patients developed hoarseness that was improved in 1 week and 2 months, respectively. Sonoguided percutaneous radiofrequency ablation can be one of the treatments for benign nodules of the thyroid gland

  9. Multimodal imaging of choroidal nodules in neurofibromatosis type-1

    Directory of Open Access Journals (Sweden)

    Vinod Kumar

    2018-01-01

    Full Text Available Choroidal nodules in neurofibromatosis type-1 are common and are best imaged with near-infrared reflectance (NIR imaging. The authors describe swept-source optical coherence tomography angiography (SSOCTA of choroidal nodules. These nodules are seen as hyperflow areas on SSOCTA and correlate well to bright patches on NIR imaging. The utility of multicolor scanning laser imaging in detecting these abnormalities is also described.

  10. Evaluation of diffuse thyroid diseases and thyroid nodules by CT

    International Nuclear Information System (INIS)

    Okamoto, Kyoko; Imanishi, Yoshimasa; Nakaji, Shunsuke; Shinagawa, Toshihito

    2007-01-01

    Imanishi et al. have previously reported that the changes in CT values reveal not only the change in iodine concentration in thyroid follicles, but also represent secondary changes in follicular content and follicular cells and/or interstitial structures. Thus, we performed thyroid CT without contrast material in 138 controls, 417 cases with diffuse thyroid diseases, and 279 cases with thyroid nodules, and evaluated the CT images based on the relation between the change in CT values and pathological changes. In 89% of the controls and 43% of patients with diffuse thyroid diseases, the thyroid CT revealed diffuse high density. In contrast, the 94% of thyroids that demonstrated diffuse low density were from patients with diffuse thyroid diseases. Eighty-four percent of malignant nodules and 64% of benign nodules had inhomogeneous densities, and only 26% of benign thyroid nodules had homogeneous density. However, 71% of nodules that showed high and low densities with regular and clear borders, and 82% of nodules that showed papillary proliferation in a cyst pattern were benign. Although only 58% of nodules with calcification were malignant, 66% of nodules with calcification in the central portion, and 86% of nodules with calcification of a disseminated and convergent pattern in distribution were malignant. Sixty-two percent of thyroids that surrounded nodules had chronic thyroiditis, hypoplasia and/or adenomatous goiter. Thus, unclear borders between a nodule and the surrounding thyroid tissue did not increase the possibility of malignancy. However, the unclear and/or lobulated border between a nodule and extra thyroid tissue increased the possibility of malignancy. We concluded that thyroid CT without contrast material is useful for the diagnosis of thyroid diseases. (author)

  11. Promise and pitfalls of molecular markers of thyroid nodules

    OpenAIRE

    Jadhav, S.; Lila, Anurag; Bandgar, Tushar; Shah, Nalini

    2012-01-01

    Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG) and fine needle aspiration biopsy (FNAB). The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly ...

  12. Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection

    OpenAIRE

    Larijani, Bagher; Pajouhi, Mohammad; Ghanaati, Hossein; Bastanhagh, Mohammad-Hassan; Abbasvandi, Fereshteh; Firooznia, Kazem; Shirzad, Mahmood; Amini, Mohammad-Reza; Sarai, Maryam; Abbasvandi, Nasreen; Baradar-Jalili, Reza

    2002-01-01

    Abstract Background Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. Methods 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH ...

  13. Thermal Ablation for Benign Thyroid Nodules: Radiofrequency and Laser

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jung Hwan; Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Valcavi, Roberto [Endocrinology Division and Thyroid Disease Center, Arcispedale Santa Maria Nuova, Reggio Emilia (Italy); Pacella, Claudio M. [Diagnostic Imaging and Interventional Radiology Department, Ospedale Regina Apostolorum, Albano Laziale-Rome (IT); Rhim, Hyun Chul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Na, Dong Kyu [Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of)

    2011-10-15

    Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation.

  14. Correlation of emphysema score with perceived malignancy of pulmonary nodules: a multi-observer study using the LIDC-IDRI CT lung database

    Science.gov (United States)

    Wiemker, Rafael; Bülow, Thomas; Blaffert, Thomas; Dharaiya, Ekta

    2009-02-01

    Presence of emphysema is recognized to be one of the single most significant risk factors in risk models for the prediction of lung cancer. Therefore, an automatically computed emphysema score would be a prime candidate as an additional numerical feature for computer aided diagnosis (CADx) for indeterminate pulmonary nodules. We have applied several histogram-based emphysema scores to 460 thoracic CT scans from the IDRI CT lung image database, and analyzed the emphysema scores in conjunction with 3000 nodule malignancy ratings of 1232 pulmonary nodules made by expert observers. Despite the emphysema being a known risk factor, we have not found any impact on the readers' malignancy rating of nodules found in a patient with higher emphysema score. We have also not found any correlation between the number of expert-detected nodules in a patient and his emphysema score, or the relative craniocaudal location of the nodules and their malignancy rating. The inter-observer agreement of the expert ratings was excellent on nodule diameter (as derived from manual delineations), good for calcification, and only modest for malignancy and shape descriptions such as spiculation, lobulation, margin, etc.

  15. Preclinical evaluation of transcriptional targeting strategy for human hepatocellular carcinoma in an orthotopic xenograft mouse model.

    Science.gov (United States)

    Sia, Kian Chuan; Huynh, Hung; Chung, Alexander Yaw Fui; Ooi, London Lucien Peng Jin; Lim, Kiat Hon; Hui, Kam Man; Lam, Paula Yeng Po

    2013-08-01

    Gene regulation of many key cell-cycle players in S-, G(2) phase, and mitosis results from transcriptional repression in their respective promoter regions during the G(0) and G(1) phases of cell cycle. Within these promoter regions are phylogenetically conserved sequences known as the cell-cycle-dependent element (CDE) and cell-cycle genes homology regions (CHR) sites. Thus, we hypothesize that transcriptional regulation of cell-cycle regulation via the CDE/CHR region together with liver-specific apolipoprotein E (apoE)-hAAT promoter could bring about a selective transgene expression in proliferating human hepatocellular carcinoma. We show that the newly generated vector AH-6CC-L2C could mediate hepatocyte-targeted luciferase gene expression in tumor cells and freshly isolated short-term hepatocellular carcinoma cultures from patient biopsy. In contrast, normal murine and human hepatocytes infected with AH-6CC-L2C expressed minimal or low luciferase activities. In the presence of prodrug 5-fluorocytosine (5-FC), AH-6CC-L2C effectively suppressed the growth of orthotopic hepatocellular carcinoma patient-derived xenograft mouse model via the expression of yeast cytosine deaminase (yCD) that converts 5-FC to anticancer metabolite 5-fluoruracil. More importantly, we show that combination treatment of AH-6CC-L2C with an EZH2 inhibitor, DZNep, that targets EpCAM-positive hepatocellular carcinoma, can bring about a greater therapeutic efficacy compared with a single treatment of virus or inhibitor. Our study showed that targeting proliferating human hepatocellular carcinoma cells through the transcriptional control of therapeutic gene could represent a feasible approach against hepatocellular carcinoma.

  16. Differential biodistribution of oncolytic poxvirus administered systemically in an autochthonous model of hepatocellular carcinoma.

    Science.gov (United States)

    Baril, Patrick; Touchefeu, Yann; Cany, Jeannette; Cherel, Yan; Thorne, Steve H; Tran, Lucile; Conchon, Sophie; Vassaux, Georges

    2011-12-01

    Preclinical studies have demonstrated that, unlike oncolytic adenoviruses, oncolytic vaccinia viruses can reach implanted tumors upon systemic injection. However, the biodistribution of this oncolytic agent in in situ autochthonous tumor models remains poorly characterized. In the present study, we assessed this biodistribution in a model of mouse hepatocellular carcinoma (HCC) obtained after injection of the carcinogen diethylnitrosamine (DEN). Twelve months after DEN administration, histology, quantitative reverse transcription-polymerase chain reaction, in situ hybridization and viral titration were used to characterize tumors, as well as to assess the viral load of the livers upon either intravenous or intraperitoineal injection. The results obtained showed that the architecture of the liver was lost, with a noticeable absence of sinusoids, as well as the presence of steatosis and α-fetoprotein-positive HCC tumor nodules. Bioluminescence imaging and measures of the infective virus load demonstrated that intravenous injection of 10(8)  plaque-forming units of the recombinant vaccinia virus led to a predominant transduction of the liver, whereas intraperitoneal injection resulted in a lower level of liver transduction accompanied by an increased infection of the lungs, spleen, kidneys and bowels. Immunohistochemical analysis of liver sections of animals injected intravenously with the virus revealed a preferential localization of vaccinia-specific immunoreactivity in the tumors. The findings of the present study emphasize the importance of the route of administration of the vector and highlight the relevance of systemic injection of oncolytic vaccinia virus in the context of hepatocellular carcinoma. Copyright © 2011 John Wiley & Sons, Ltd.

  17. Radiofrequency ablation of hepatocellular carcinoma located in the liver dome under intermittent CT fluoroscopy guidance

    Energy Technology Data Exchange (ETDEWEB)

    Park, Darlene; Cho, Yun Ku; Cho, Hyun Je; KIm, Mi Young [Dept. of Radiology, VHS Medical Center, Seoul (Korea, Republic of)

    2014-02-15

    To evaluate the clinical effectiveness of an intermittent computed tomography (CT) fluoroscopy-guided radiofrequency (RF) ablation of hepatocellular carcinoma located in the liver dome. Between 2005 and 2010 23 patients with hepatocellular carcinoma (HCC) nodules located in the liver dome underwent an intermittent CT fluoroscopy-guided RF ablation. The primary endpoint was the local tumor progression. Procedure-related complications occurred in 3 of 23 patients. To evaluate the prognostic factors for the local tumor progression, univariate and multivariate analyses were performed using the Cox proportional hazards model. The chi-squared test was performed to evaluate the association of access route and procedure-related complication. The study was approved by the Institutional Review Board of our hospital. The Tumor sizes ranged between 1.0 and 2.9 cm. An initial complete ablation was achieved in all patients. The median follow-up period was 31 months and the major complication rate was 4.3%. The cumulative rate of local tumor progression at 3 years was 20%. The univariate analysis revealed that only serum total bilirubin level (p = 0.048) and prior chemoembolization were statistically significant (p = 0.044), but there was no independently significant prognostic factor on multivariate analysis. Procedure-related complications occurred in 3 of 23 patients. For HCC located in the liver dome an intermittent CT fluoroscopy-guided RF ablation could be performed safely and effectively.

  18. Significance of angio-CT on diagnosis for hepatocellular carcinoma and precancerous lesions

    International Nuclear Information System (INIS)

    Hatsuse, Kazuo; Aoki, Hideki; Murayama, Michinori; Aihara, Tsukasa; Tsuboi, Kenji; Kakihara, Minoru; Tamakuma, Syoetsu; Irie, Toshiyuki; Terahata, Shintarou

    1994-01-01

    Fifteen patients with space occupying lesions detected by ultrasonography or computed tomography during angiography (angio-CT). Detectability and diagnostic value of angio-CT for intrahepatic tumor were evaluated in comparison with conventional imaging techniques including digital subtraction angiography (DSA), magnetic resonance imaging (MRI) and lipiodol CT (Lp-CT). Twenty-three lesions detected in 15 patients were as follows: 14 hepatocellular carcinoma (HCC), 3 adenomatous hyperplasia (AH), one early hepatocellular carcinoma (eHCC), one atypical adenomatous hyperplasia (AAH), one regenerative nodule, and 3 miscellaneous lesions. With regard to 8 patients with 2 lesions, there were 2 AHs in one patient and 4 patients with advanced HCC had small HCC, eHCC, AH and AAH, respectively. These findings are suggestive of the presence of multicentric carcinogenesis in cirrhosis. The detection rate for intrahepatic tumors was 86.9% with angio-CT, 56.5% with DSA, 71.4% with MRI and 50% with Lp-CT. The detection rate for eHCC, AH and AAH was 80% with angio-CT, and 20% with DSA, MRI and Lp-CT. Angio-CT visualized AH regarded as a precancerous lesion and eHCC more frequently than other imaging techniques. The above mentioned data suggested that there was such a frequent occurrence of multicentric carcinogenesis that recognition of precancerous lesion by angio-CT was important in surgical intervention for HCC with liver cirrhosis. (author)

  19. Hyper-functioning Thyroid Nodule with Scintigraphic Owl's Eye Appearance

    International Nuclear Information System (INIS)

    Al-Kordi, R.S.; Elgazzar, A.H.

    2006-01-01

    Hyper-functioning thyroid nodules may produce various scintigraphic appearances on thyroid scans. Autonomously hyper functioning thyroid nodules invariably demonstrate degenerative changes. These changes may give rise to central or less commonly peripheral photopenic areas on a thyroid scan within otherwise a hot nodule. In this report we present a case of hyper functioning autonomous nodule with peripheral degeneration and residual central functioning tissue giving the appearance of an owl's eye. Although rare, this pattern can be seen in a variety of benign and malignant thyroid conditions. (author)

  20. Visualization of pulmonary nodules with magnetic resonance imaging (MRI)

    International Nuclear Information System (INIS)

    Plathow, C.; Deutsches Krebsforschungszentrum; Meinzer, H.-P.; Kauczor, H.-U.

    2006-01-01

    Visualization of pulmonary nodules using magnetic resonance imaging (MRI) plays a minor role compared with computed tomography (CT). Technical developments made it possible to apply MRI more and more frequently in functional imaging. Imaging of the motion of pulmonary nodules during respiration, e.g., to optimize high precision therapy techniques, is a new field of research. This paper describes developments in analysis and visualization of pulmonary nodules during respiration using MRI. Besides actual 2D techniques new 3D techniques to quantify motion of pulmonary nodules during respiration are presented. (orig.) [de

  1. Automatic Solitary Lung Nodule Detection in Computed Tomography Images Slices

    Science.gov (United States)

    Sentana, I. W. B.; Jawas, N.; Asri, S. A.

    2018-01-01

    Lung nodule is an early indicator of some lung diseases, including lung cancer. In Computed Tomography (CT) based image, nodule is known as a shape that appears brighter than lung surrounding. This research aim to develop an application that automatically detect lung nodule in CT images. There are some steps in algorithm such as image acquisition and conversion, image binarization, lung segmentation, blob detection, and classification. Data acquisition is a step to taking image slice by slice from the original *.dicom format and then each image slices is converted into *.tif image format. Binarization that tailoring Otsu algorithm, than separated the background and foreground part of each image slices. After removing the background part, the next step is to segment part of the lung only so the nodule can localized easier. Once again Otsu algorithm is use to detect nodule blob in localized lung area. The final step is tailoring Support Vector Machine (SVM) to classify the nodule. The application has succeed detecting near round nodule with a certain threshold of size. Those detecting result shows drawback in part of thresholding size and shape of nodule that need to enhance in the next part of the research. The algorithm also cannot detect nodule that attached to wall and Lung Chanel, since it depend the searching only on colour differences.

  2. Initial application of digital tomosynthesis for detection of pulmonary nodules

    International Nuclear Information System (INIS)

    Sun Zhiyuan; Su Hong; Zhao Yane; Ju Bing; Chang Shuanghui; Hu Qiuju; Lu Guangming

    2010-01-01

    Objective: To discuss the value of digital tomosynthesis for detection of pulmonary nodules. Methods: Thirty patients suspected of having pulmonary nodules underwent chest radiography, digital tomosynthesis and CT examination. Above image data were transferred to postprocessing work station and were reviewed by 2 radiologists with 3 years of chest-radiology diagnosis experience in a double-blind method. The number, location and size of nodules were recorded. Then, 2 radiologists reviewed the all images once more, and discuss in consensus. The sensitivities of chest radiography and digital tomosynthesis for detection of pulmonary nodules were respectively calculated according to the CT results. Chi-square test was used for radiography, digital tomosynthesis and CT examination. Results: Of 30 patients, 21 were detected having pulmonary nodules by X-ray radiography and 9 were negative, the total number of 40 nodules was detected, while 89 nodules in 26 patients were detected by digital tomosynthesis, and only 4 patients were negative. CT demonstrated 102 nodules in 27 patients, and 3 patients were negative. Taking CT as 'gold standard', the sensitivities of X-ray radiography and digital tomosynthesis were 27.4%(28/102)and 87.2%(89/102), X 2 =4.35, P<0.05, respectively. Conclusion: Digital tomosynthesis has a high sensitivity for detection of pulmonary nodules compared with X-ray radiography, and could be an excellent and necessary supplementary technique of X-ray radiography. (authors)

  3. Subsolid pulmonary nodules: imaging evaluation and strategic management.

    Science.gov (United States)

    Godoy, Myrna C B; Sabloff, Bradley; Naidich, David P

    2012-07-01

    Given the higher rate of malignancy of subsolid pulmonary nodules and the considerably lower growth rate of ground-glass nodules (GGNs), dedicated standardized guidelines for management of these nodules have been proposed, including long-term low-dose computed tomography (CT) follow-up (≥3 years). Physicians must be familiar with the strategic management of subsolid pulmonary nodules, and should be able to identify imaging features that suggest invasive adenocarcinoma requiring a more aggressive management. Low-dose CT screening studies for early detection of lung cancer have increased our knowledge of pulmonary nodules, and in particular our understanding of the strong although imperfect correlation of the subsolid pulmonary nodules, including pure GGNs and part-solid nodules, with the spectrum of preinvasive to invasive lung adenocarcinoma. Serial CT imaging has shown stepwise progression in a subset of these nodules, characterized by increase in size and density of pure GGNs and development of a solid component, the latter usually indicating invasive adenocarcinoma. There is close correlation between the CT features of subsolid nodules (SSNs) and the spectrum of lung adenocarcinoma. Standardized guidelines are suggested for management of SSNs.

  4. Outcomes of Stereotactic Body Radiotherapy (SBRT) treatment of multiple synchronous and recurrent lung nodules

    International Nuclear Information System (INIS)

    Owen, Dawn; Olivier, Kenneth R; Mayo, Charles S; Miller, Robert C; Nelson, Kathryn; Bauer, Heather; Brown, Paul D; Park, Sean S; Ma, Daniel J; Garces, Yolanda I

    2015-01-01

    Stereotactic body radiotherapy (SBRT) is evolving into a standard of care for unresectable lung nodules. Local control has been shown to be in excess of 90% at 3 years. However, some patients present with synchronous lung nodules in the ipsilateral or contralateral lobe or metasynchronous disease. In these cases, patients may receive multiple courses of lung SBRT or a single course for synchronous nodules. The toxicity of such treatment is currently unknown. Between 2006 and 2012, 63 subjects with 128 metasynchronous and synchronous lung nodules were treated at the Mayo Clinic with SBRT. Demographic patient data and dosimetric data regarding SBRT treatments were collected. Acute toxicity (defined as toxicity < 90 days) and late toxicity (defined as toxicity > = 90 days) were reported and graded as per standardized CTCAE 4.0 criteria. Local control, progression free survival and overall survival were also described. The median age of patients treated was 73 years. Sixty five percent were primary or recurrent lung cancers with the remainder metastatic lung nodules of varying histologies. Of 63 patients, 18 had prior high dose external beam radiation to the mediastinum or chest. Dose and fractionation varied but the most common prescriptions were 48 Gy/4 fractions, 54 Gy/3 fractions, and 50 Gy/5 fractions. Only 6 patients demonstrated local recurrence. With a median follow up of 12.6 months, median SBRT specific overall survival and progression free survival were 35.7 months and 10.7 months respectively. Fifty one percent (32/63 patients) experienced acute toxicity, predominantly grade 1 and 2 fatigue. One patient developed acute grade 3 radiation pneumonitis at 75 days. Forty six percent (29/63 patients) developed late effects. Most were grade 1 dyspnea. There was one patient with grade 5 pneumonitis. Multiple courses of SBRT and SBRT delivery after external beam radiotherapy appear to be feasible and safe. Most toxicity was grade 1 and 2 but the risk was

  5. Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program.

    Science.gov (United States)

    Veronesi, Giulia; Bellomi, Massimo; Scanagatta, Paolo; Preda, Lorenzo; Rampinelli, Cristiano; Guarize, Juliana; Pelosi, Giuseppe; Maisonneuve, Patrick; Leo, Francesco; Solli, Piergiorgio; Masullo, Michele; Spaggiari, Lorenzo

    2008-09-01

    The main challenge of screening a healthy population with low-dose computed tomography is to balance the excessive use of diagnostic procedures with the risk of delayed cancer detection. We evaluated the pitfalls, difficulties, and sources of mistakes in the management of lung nodules detected in volunteers in the Cosmos single-center screening trial. A total of 5201 asymptomatic high-risk volunteers underwent screening with multidetector low-dose computed tomography. Nodules detected at baseline or new nodules at annual screening received repeat low-dose computed tomography at 1 year if less than 5 mm, repeat low-dose computed tomography 3 to 6 months later if between 5 and 8 mm, and fluorodeoxyglucose positron emission tomography if more than 8 mm. Growing nodules at the annual screening received low-dose computed tomography at 6 months and computed tomography-positron emission tomography or surgical biopsy according to doubling time, type, and size. During the first year of screening, 106 patients underwent lung biopsy and 91 lung cancers were identified (70% were stage I). Diagnosis was delayed (false-negative) in 6 patients (stage IIB in 1 patient, stage IIIA in 3 patients, and stage IV in 2 patients), including 2 small cell cancers and 1 central lesion. Surgical biopsy revealed benign disease (false-positives) in 15 cases (14%). Positron emission tomography sensitivity was 88% for prevalent cancers and 70% for cancers diagnosed after first annual screening. No needle biopsy procedures were performed in this cohort of patients. Low-dose computed tomography screening is effective for the early detection of lung cancers, but nodule management remains a challenge. Computed tomography-positron emission tomography is useful at baseline, but its sensitivity decreases significantly the subsequent year. Multidisciplinary management and experience are crucial for minimizing misdiagnoses.

  6. Microwave ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma undetectable by conventional ultrasonography

    International Nuclear Information System (INIS)

    Liu Fangyi; Yu Xiaoling; Liang Ping; Cheng Zhigang; Han Zhiyu; Dong Baowei; Zhang Xiaohong

    2012-01-01

    Objectives: To evaluate the efficiency and feasibility of microwave (MW) ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma (HCC) undetectable by conventional ultrasonography. Methods: 18 patients with 18 HCC nodules (undetectable on conventional US but detectable by intravenous contrast-enhanced CT or MRI) were enrolled in this study. Before MW ablation, US images and MRI or CT images were synchronized using the internal markers at the best timing of the inspiration. Thereafter, MW ablation was performed under real-time virtual navigation system guidance. Therapeutic efficacy was assessed by the result of contrast-enhanced imagings after the treatment. Results: The target HCC nodules could be detected with fusion images in all patients. The time required for image fusion was 8–30 min (mean, 13.3 ± 5.7 min). 17 nodules were successfully ablated according to the contrast enhanced imagings 1 month after ablation. The technique effectiveness rate was 94.44% (17/18). The follow-up time was 3–12 months (median, 6 months) in our study. No severe complications occurred. No local recurrence was observed in any patients. Conclusions: MW ablation assisted by a real-time virtual navigation system is a feasible and efficient treatment of patients with HCC undetectable by conventional ultrasonography.

  7. Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Tsuneyoshi [Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558 (Japan); Kawamoto, Hirofumi [Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558 (Japan)], E-mail: h-kawamo@md.okayama-u.ac.jp; Kobayashi, Yoshiyuki; Nakamura, Shinichiro; Miyatake, Hirokazu; Harada, Ryo; Tsutsumi, Koichiro; Fujii, Masakuni; Kurihara, Naoko; Kato, Hironari; Hirao, Ken; Mizuno, Osamu; Ishida, Etsuji; Okada, Hiroyuki; Yamamoto, Kazuhide [Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558 (Japan)

    2010-02-15

    Background and study aims: Biliary stricture after radiofrequency ablation (RFA) for nodules of hepatocellular carcinoma (HCC) close to major bile ducts sometimes causes septic complications and liver failure. Therefore, it may require interventional drainage for decompression during the follow-up period. The purpose of this study is to clarify the feasibility and safety of bile duct cooling using an endoscopic nasobiliary drainage (ENBD) tube in RFA for HCC close to major bile ducts. Patients and methods: Between August 2003 and July 2007, 14 consecutive patients (14 nodules) undergoing RFA with cooling by an ENBD tube for HCCs close to major bile ducts were enrolled in this study. We infused chilled saline solution via the ENBD tube at 1 ml/s to prevent heat damage during RFA. As controls, 11 patients (13 nodules) undergoing RFA without cooling close to major bile ducts between April 2001 and August 2003 were reviewed. The major outcomes for evaluation were biliary complications and the secondary outcome was local tumor recurrence. Results: There were no significant differences in tumor recurrence between the two groups. However, the rate of biliary complications was significantly lower in the cooling group than in the non-cooling group (0% vs. 39%, P = 0.02). Conclusions: Cooling of bile ducts via an ENBD tube can prevent biliary complications induced by RFA of HCC close to major bile ducts without increasing local recurrence. This technique increases indication of RFA in difficult cases.

  8. Utility of Gd-EOB-DTPA-Enhanced MRI in Diagnosing Small Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Soo Ryang Kim

    2009-07-01

    Full Text Available We describe an 8-mm hepatocellular carcinoma (HCC with hepatitis C virus-related cirrhosis in a 74-year-old woman. Ultrasound (US revealed an 8-mm hyperechoic nodule in segment 6 of the liver. Contrast-enhanced computed tomography (CT and US revealed no hypervascularity in the early phase and no washout in the late phase and the Kupffer phase, respectively. CT during arteriography revealed no hypervascularity and CT during arterial portography disclosed no perfusion defect. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI revealed no hypervascularity in the early phase, but disclosed a defect in the hepatobiliary phase. Histologically, the nodule was diagnosed as well-differentiated HCC characterized by more than two-fold the cellularity of the non-tumorous area, with a high nuclear:cytoplasmic ratio, increased cytoplasmic eosinophilia, fatty change, and slight cell atypia with an irregular thin trabecular pattern. Our case demonstrates the utility of Gd-EOB-DTPA-enhanced MRI in the diagnosis of small HCC.

  9. Hürthle cell tumor dwelling in hot thyroid nodules: preoperative detection with technetium-99m-MIBI dual-phase scintigraphy.

    Science.gov (United States)

    Vattimo, A; Bertelli, P; Cintorino, M; Burroni, L; Volterrani, D; Vella, A; Lazzi, S

    1998-05-01

    Single injection dual-phase scintigraphy (early and late acquisitions) with 99mTc-MIBI was used to differentiate benign and malignant hot thyroid nodules. Thirteen euthyroid and two hyperthyroid patients displaying a hot thyroid nodule on the 99mTc scan due to an autonomously functioning thyroid nodule (AFTN) underwent early (15-30 min) and late (3-4 hr) thyroid scintigraphy after the administration of 740-1000 MBq 99mTc-MIBI. Visual scoring was done to assess nodular tracer uptake and retention. In addition, the nodular-to-thyroid (N/T) uptake ratio in the early and late image and the washout rates (WO) from the nodule and thyroidal tissue were measured. All patients underwent thyroid surgery. Histopathology revealed a Hürthle cell tumor in three nodules, a benign adenoma with oxyphilic metaplasia in two nodules and a benign adenoma without oxyphilic cells in the remaining 10 nodules. The Hürthle cell tumor nodules displayed intense and persistent uptake of 99mTc-MIBI (N/T was 2.81 +/- 0.52 and 5.53 +/- 1.06 in early and late images, respectively; WO from the nodule was 12.33 +/- 0.47, WO from the thyroidal tissue was 22.00 +/- 3.56). The benign nodules showed intense uptake in the early image and intense uptake to absent retention in the late image (N/T was 2.94 +/- 1.31 and 1.62 +/- 0.50 in the early and late images, respectively; WO from the nodule was 20.25 +/- 2.92, WO from the thyroidal tissue was 20.33 +/- 2.92). Single injection dual-phase 99mTc-MIBI scintigraphy of the thyroid with AFTN can identify nodules as a result of the activity of a Hürthle cell tumor, since these tumors cause intense and persistent tracer uptake in contrast with a benign AFTN.

  10. Graphite nodule count and size distribution in thin-walled ductile cast iron

    DEFF Research Database (Denmark)

    Pedersen, Karl Martin; Tiedje, Niels Skat

    2008-01-01

    Graphite nodule count and size distribution have been analysed in thin walled ductile cast iron. The 2D nodule counts have been converted into 3D nodule count by using Finite Difference Method (FDM). Particles having a diameter smaller than 5 µm should be neglected in the nodule count as these ar......Graphite nodule count and size distribution have been analysed in thin walled ductile cast iron. The 2D nodule counts have been converted into 3D nodule count by using Finite Difference Method (FDM). Particles having a diameter smaller than 5 µm should be neglected in the nodule count...... as these are inclusions and micro porosities that do not influence the solidification morphology. If there are many small graphite nodules as in thin walled castings only 3D nodule count calculated by FDM will give reliable results. 2D nodule count and 3D nodule count calculated by simple equations will give too low...

  11. Surgical management of spontaneous ruptured hepatocellular adenoma

    Directory of Open Access Journals (Sweden)

    Marcelo Augusto Fontenelle Ribeiro Junior

    2009-01-01

    Full Text Available AIMS: Spontaneous ruptured hepatocellular adenoma (SRHA is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS: We reviewed medical records and radiology files of 28 patients (from 1989 to 2006 with a proven diagnosis of hepatocellular adenoma (HA. Three (10.7% of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS: The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation, as well as intraperitoneal abscess (re-operation and pleural effusion. CONCLUSION: Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.

  12. Ultrasound stratification of the FDG-avid thyroid nodule

    International Nuclear Information System (INIS)

    Beech, P.; Lavender, I.; Jong, I.; Soo, G.; Ramdave, S.; Chong, A.; Nandurkar, D.

    2016-01-01

    Aim: To determine whether the malignancy risk in an 2-["1"8F]-fluoro-2-deoxy-D-glucose (FDG)-avid thyroid nodule can be stratified according to the presence or absence of suspicious ultrasound features and thereby identify which nodules require further cytological assessment. Materials and methods: A retrospective review of FDG-positron-emission tomography (PET) combined with computed tomography (CT) studies with FDG-avid thyroid nodules (defined as FDG uptake greater than blood pool) that were further assessed with ultrasound and fine-needle aspiration cytology or surgery was performed. FDG-avid thyroid nodules were classified as having either suspicious ultrasound features (marked hypo-echogenicity, irregular margins, microcalcifications, marked hypervascularity, or nodules that were taller than they were wide) or no suspicious ultrasound features and these findings were correlated with the subsequent cytological results. Results: Forty-eight FDG-avid thyroid nodules were assessed. On cytological assessment five nodules were malignant (10.4%), nine were indeterminate (18.75%), and 34 were benign (70.8%). On ultrasound, 24 (50%) had no suspicious features and 24 (50%) had one or more suspicious features. Of the nodules with no suspicious features, 22 (91.6%) were benign, two (8.3%) were indeterminate, and none were malignant. Of the nodules with suspicious features, five (20.8%) were malignant, seven (29.1%) were indeterminate, and 12 (50%) were benign. The absence of suspicious ultrasound features demonstrated a strong association with benign cytology (p=0.009). Out of the suspicious sonographic features, marked hypoechoic appearance (p=0.02), irregular margins (p=0.009), and taller than wide morphology (p=0.04) were statistically most significantly associated with malignancy. Conclusion: The rate of malignancy in FDG-avid thyroid nodules is low in the absence of specific suspicious ultrasound features. The SUV values are non-discriminatory to differentiate

  13. Ultrasound assistance in differentiating malignant thyroid nodules from benign ones

    International Nuclear Information System (INIS)

    Zahir, S.T.; Sefidrokh, S.; Heidari, F.; Vakili, M.; Ghaneei, A.

    2017-01-01

    The search is ongoing for simple, effective ways to identify and differentiate thyroid nodules in order to avoid invasive procedures. This study aims to perform an ultrasound assessment of clinically suspected patients with malignant nodules, to perform a fine needle biopsy on them, and to compare the results obtained. Methods: In total, 135 patients with thyroid nodules suspected to be malignant in the ultrasound underwent ultrasound-guided fine needle biopsies. The patients' gender, age, ultrasound views (echogenicity, shape, and calcification type), nodule size, number of nodules, and needle biopsy results were retrospectively evaluated. Results: Of the 135 patients, 117 (86.7 percent) were female and 18 (13.3 percent) were male. In terms of age, 67 (49.16 percent) were younger than 40 and the rest were older. According to the Chi-square test, a significant relationship was found between the type of nodule and calcification found in the ultrasound views (p=0.001). The nodule type was not significantly related to gender (p=0.563) or to the number of nodules (p=0.128); however, there was a significant relationship between nodule size and type (p=0.001). Ultrasound specificity, sensitivity, positive and negative predictive values, and accuracy for differentiating benign from malignant nodules were 93.2 percent, 93.8 percent, 81.1 percent, 98 percent, and 93.3 percent, respectively. Conclusions: Ultrasound views (comet tail artefact and linear echogenic foci) were better predictors of benign nodules than of malignant ones, while round, echogenic foci, brighter and larger than typical micro-calcifications without any visible echoes and multiple punctuate round echogenic foci were better predicted malignancy. (author)

  14. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

    Directory of Open Access Journals (Sweden)

    Boutros Cherif

    2008-03-01

    Full Text Available Abstract Introduction Video-assisted thoracic surgery (VATS has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule. Case description This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection. Methods In two patients with peripherally located lung nodules (n = 3 scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion. Results Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity. Conclusion

  15. Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation of benign and malignant thyroid nodules: Which one should we use?

    Energy Technology Data Exchange (ETDEWEB)

    Aydin, Ramazan, E-mail: raydin1984@hotmail.com [Department of Radiology, Samsun Education and Research Hospital, Samsun (Turkey); Elmali, Muzaffer, E-mail: muzafel@yahoo.com.tr [Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey); Polat, Ahmet Veysel, E-mail: veyselp@hotmail.com [Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey); Danaci, Murat, E-mail: danacim55@yahoo.com [Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey); Akpolat, Ilkser, E-mail: ilkserakpolat@yahoo.com [Department of Pathology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey)

    2014-03-15

    Objective: The aim of this study is to investigate the diagnostic accuracy of muscle-to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid nodules and to see if there was a difference between MNSR and parenchyma-to-nodule strain ratios (PNSR) in diagnosis. Methods: A total of 106 consecutive patients (88 women and 18 men; age range 19–79 years) with thyroid nodules were prospectively examined using ultrasound and sonoelastography before the fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for each nodule and the elasticity score was determined according to four-point scoring system. Results: According to the four-point scoring system, 44 of the 83 benign nodules had a score of one or two while 22 of the 23 malignant nodules had a score of three or four (p < 0.001). Using ROC analysis, the best cutoff point for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%, respectively, when the best cutoff points were used (p < 0.001). The κ value for the PNSR and MNSR methods was 0.87, which indicated an almost perfect agreement (p < 0.001). Conclusions: Sonoelastography has a high diagnostic accuracy in the differentiation of benign and malignant thyroid nodules. There was no significant difference between MNSR and PNSR in the differentiation of benign and malignant thyroid nodules. Therefore, we think that MNSR could safely be used in situations where PNSR could not be used.

  16. Hepatocellular carcinoma: illustrated guide to systematic radiologic diagnosis and staging according to guidelines of the American Association for the Study of Liver Diseases.

    LENUS (Irish Health Repository)

    McEvoy, Sinead H

    2013-10-01

    Hepatocellular carcinoma is a malignancy that predominantly occurs in the setting of cirrhosis. Its incidence is rising worldwide. Hepatocellular carcinoma differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The guidelines from the American Association for the Study of Liver Diseases (AASLD) are a leading statement for the diagnosis and staging of hepatocellular carcinoma, and they have recently been updated, incorporating several important changes. AASLD advocates the use of the Barcelona Clinic Liver Cancer (BCLC) staging system, which combines validated imaging and clinical predictors of survival to determine stage and which links staging with treatment options. Each stage of the BCLC system is outlined clearly, with emphasis on case examples. Focal liver lesions identified at ultrasonographic surveillance in patients with cirrhosis require further investigation. Lesions larger than 1 cm should be assessed with multiphasic computed tomography or magnetic resonance imaging. Use of proper equipment and protocols is essential. Lesions larger than 1 cm can be diagnosed as hepatocellular carcinoma from a single study if the characteristic dynamic perfusion pattern of arterial hyperenhancement and venous or delayed phase washout is demonstrated. If the imaging characteristics of hepatocellular carcinoma are not met, the alternate modality should be performed. Biopsy should be used if neither modality is diagnostic of hepatocellular carcinoma. Once the diagnosis has been made, the cancer should be assigned a BCLC stage, which will help determine suitable treatment options. Radiologists require a systematic approach to diagnose and stage hepatocellular carcinoma with appropriate accuracy and precision.

  17. Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma

    Science.gov (United States)

    Wang, Chun-Ping; Wang, Hong; Qu, Jian-Hui; Lu, Yin-Ying; Bai, Wen-Lin; Dong, Zheng; Gao, Xu-Dong; Rong, Guang-Hua; Zeng, Zhen; Yang, Yong-Ping

    2012-01-01

    AIM: To assess the rate and risk factors for tumour seeding in a large cohort of patients. METHODS: Over an 8-year period, 1436 hepatocellular carcinoma (HCC) patients with 2423 tumour nodules underwent 3015 image-guided percutaneous cryoablation sessions [1215 guided by ultrasonography and 221 by spiral computed tomography (CT)]. Follow-up CT or magnetic resonance imaging was performed every 3 mo. The detailed clinical data were recorded to analyse the risk factors for seeding. RESULTS: The median follow-up time was 18 (range 1-90) mo. Seeding was detected in 11 patients (0.76%) at 1-24 (median 6.0) mo after cryoablation. Seeding occurred along the needle tract in 10 patients and at a distant location in 1 patient. Seeded tumours usually showed similar imaging and histopathological features to the primary HCCs. Univariate analyses identified subcapsular tumour location and direct subcapsular needle insertion as risk factors for seeding. Multivariate analysis showed that only direct subcapsular needle insertion was an independent risk factor for seeding (P = 0.017; odds ratio 2.57; 95%CI: 1.47-3.65). Seeding after cryoablation occurred earlier in patients with poorly differentiated HCC than those with well or moderately differentiated HCC [1.33 ± 0.577 mo vs 11.12 ± 6.896 mo; P = 0.042; 95%CI: (-19.115)-(-0.468)]. CONCLUSION: The risk of seeding after cryoablation for HCC is small. Direct puncture of subcapsular tumours should be avoided to minimise seeding. PMID:23236233

  18. Assessment of ablative margin after radiofrequency ablation for hepatocellular carcinoma; comparison between magnetic resonance imaging with ferucarbotran and enhanced CT with iodized oil deposition

    International Nuclear Information System (INIS)

    Koda, Masahiko; Tokunaga, Shiho; Fujise, Yuki; Kato, Jun; Matono, Tomomitsu; Sugihara, Takaaki; Nagahara, Takakazu; Ueki, Masaru; Murawaki, Yoshikazu; Kakite, Suguru; Yamashita, Eijiro

    2012-01-01

    Background and purpose: Our aim was to investigate whether magnetic resonance imaging (MRI) with ferucarbotran administered prior to radiofrequency ablation could accurately assess ablative margin when compared with enhanced computed tomography (CT) with iodized oil marking. Materials and methods: We enrolled 27 patients with 32 hepatocellular carcinomas in which iodized oil deposits were visible throughout the nodule after transcatheter arterial chemoembolization. For these nodules, radiofrequency ablation was performed after ferucarbotran administration. We then performed T2-weighted MRI after 1 week and enhanced CT after 1 month. T2-weighted MRI demonstrated the ablative margin as a low-intensity rim. We classified the margin into three grades; margin (+): high-intensity area with a continuous low-intensity rim; margin zero: high-intensity area with a discontinuous low-intensity rim; and margin (−): high-intensity area extending beyond the low-intensity rim. Results: In 28 (86%) of 32 nodules, there was agreement between MRI and CT. The overall agreement between for the two modalities in the assessment of ablative margin was good (κ = 0.759, 95% confidence interval: 0.480–1.000, p < 0.001). In four nodules, ablative margins on MRI were underestimated by one grade compared with CT. Conclusion: MRI using ferucarbotran is less invasive and allows earlier assessment than CT. The MRI technique performed similarly to enhanced CT with iodized oil marking in evaluating the ablative margin after radiofrequency ablation.

  19. Autonomous nodule of the thyroid: correlation of patient age, nodule size, and functional status

    International Nuclear Information System (INIS)

    Blum, M.; Shenkman, L.; Hollander, C.S.

    1975-01-01

    In light of new techniques for measuring circulating thyroid hormones and for studying the thyroid gland, we present our experience with 35 patients with solitary autonomous nodules of the thyroid to define more precisely the clinical course of patients with this disorder. The patients ranged in age from 19 to 80 years and 31 of the 35 were female. Younger patients were generally euthyroid and sought attention because of a thyroid mass; virtually all older patients were hyperthyroid. Eighteen had obvious clinical features of hyperthyroidism and 5 over age 70 had apathetic hyperthyroidism; all 5 of the elderly and 13 of the 18 under age 70 had elevated thyroxine (T 4 ) and triiodothyronine (T 3 ) levels. Isolated elevation of T 3 and elevated basal metabolic rate were observed in 5 previously untreated clinically hyperthyroid young patients. In each of these, thyroid uptake of 131 I was not suppressible with exogenous T 3 and BMR was elevated in those tested. Two elderly patients, who had previously been treated for conventional hyperthyroidism with radioactive iodine, had T 3 toxicosis when hyperthyroidism recurred. There was a strong positive correlation between the age of the patient, the size of the nodule and the thyroid functional state. The mean area of the nodules projected on 131 I rectilinear scan for euthyroid patients was 5.1 cm 2 . The mean area of the nodules in hyperthyroid subjects was significantly higher, 13.4 cm 2 in patients with T 3 toxicosis and 19.3 cm 2 in subjects with conventional hyperthyroidism. Progression from a euthyroid state to hyperthyroidism was observed in four patients. One of these became thyrotoxic within days after an injection of iodinated contrast medium. Spontaneous resolution of nodules occurred in two patients

  20. Treatment options for hepatocellular carcinoma.

    Science.gov (United States)

    Sandhu, Dalbir S; Tharayil, Vivek S; Lai, Jin-Ping; Roberts, Lewis R

    2008-02-01

    Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages and has a high mortality rate. With improved survival of patients with cirrhotic liver disease and increased prevalence of chronic hepatitis C viral infections, a rise in the number of HCC cases is being reported worldwide. Early diagnosis and treatment can significantly improve the prognosis of patients with HCC. Although surgical resection is an important potentially curative therapy for liver tumors, in appropriately selected patients, liver transplantation has been shown to achieve excellent survival rates for a solid tumor. Locally ablative and locoregional therapies in the form of percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial chemoembolization and transcatheter arterial radioembolization (TheraSphere) are viable options in patients with unresectable HCC. Unfortunately, the role of systemic therapy has been very limited in the treatment of these patients. Novel treatment options based on an improved understanding of the molecular pathogenesis of HCC are being explored. These targeted molecular therapies are aimed at growth factors and their receptors, intracellular signal transduction and cell cycle control. A substantial improvement in outcomes of intermediate and advanced stage HCC is expected with the advent of these targeted therapies, used in combination with surgical or locoregional therapies. Recent positive results from a large Phase III study of the receptor tyrosine kinase inhibitor, sorafenib, hold great promise in the treatment of HCC.

  1. VEGFR-2 expression in HCC, dysplastic and regenerative liver nodules, and correlation with pre-biopsy Dynamic Contrast Enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Thaiss, W.M., E-mail: wolfgang.thaiss@med.uni-tuebingen.de [Eberhard Karls University, Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tuebingen (Germany); Kaufmann, S., E-mail: sascha.kaufmann@med.uni-tuebingen.de [Eberhard Karls University, Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tuebingen (Germany); Kloth, C., E-mail: christopher.kloth@med.uni-tuebingen.de [Eberhard Karls University, Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tuebingen (Germany); Nikolaou, K., E-mail: konstantin.nikolaou@med.uni-tuebingen.de [Eberhard Karls University, Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tuebingen (Germany); Bösmüller, H., E-mail: hans.boesmueller@med.uni-tuebingen.de [Eberhard Karls University, Department of Pathology, Liebermeisterstraße 8, D-72076 Tuebingen (Germany); Horger, M., E-mail: Marius.Horger@med.uni-tuebingen.de [Eberhard Karls University, Department of Radiology, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tuebingen (Germany)

    2016-11-15

    Highlights: • VEGFR-2-expression levels vary between HCC, dysplastic and regenerative liver nodules. • Perfusion parameters vary between these groups in blood flow, blood volume and HPI. • Strong correlations were observed between perfusion parameters and VEGFR-2-expression. • The results might influence diagnosis and therapy of anti-vascular therapeutic regimes. - Abstract: Purpose: To evaluate whether VEGFR-2-expression in hepatocellular carcinoma (HCC), dysplastic (DLN) and regenerative liver nodules (RLN) correlates with pre-histology, in vivo Dynamic Contrast Enhanced-Computed Tomography (DCE-CT) data as VEGFR-2-expression affects prognosis and therapeutic options. Materials and methods: 34 patients (63.6 ± 8.9 years, 7 females) underwent liver biopsy or surgery due to suspected HCC or dysplastic nodules after DCE-CT between 2009 and 2015 with no previous chemo- or interventional therapy. Immunohistochemistry staining for VEGFR-2 was performed using Immunoreactive-Remmele-Stegner-Score (IRS) for quantification. A 128-row CT-scanner was used for DCE-CT with assessment of perfusion parameters blood flow (BF), blood volume (BV), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI). Results: Histology confirmed HCC (n = 10), DLN (n = 7) and RLN (n = 34). Mean IRS for VEGFR-2 in HCCs was 9.1 ± 3.0, 7.3 ± 1.6 for DLN and 5.2 ± 2.8 for RLN (p = 0.0004 for HCC vs. RLN). Perfusion values varied significantly between all three groups for BF and HPI (p < 0.001 and p < 0.0001) and for BV in HCC vs. RLN (p < 0.0001) and DLN vs. RLN (p = 0.0019). Strong correlations between VEGFR-2-IRS and perfusion parameters were observed for BF in HCC (r = 0.88, p < 0.01) and HPI in HCC and DLN (r = 0.85, p < 0.04; r = 0.9, p < 0.01). Conclusion: Immunostaining revealed different VEGFR-2-expression levels in HCC, dysplastic and regenerative liver nodules. Perfusion markers blood flow, blood volume and hepatic perfusion index

  2. Surgical and Pathological Changes after Radiofrequency Ablation of Thyroid Nodules

    Directory of Open Access Journals (Sweden)

    Chiara Dobrinja

    2015-01-01

    Full Text Available Background. Radiofrequency ablation (RFA has been recently advocated as an effective technique for the treatment of symptomatic benign thyroid nodules. It is not known to what extent it may affect any subsequent thyroid surgery and/or histological diagnosis. Materials and Methods. RFA was performed on 64 symptomatic Thy2 nodules (benign nodules and 6 symptomatic Thy3 nodules (follicular lesions/follicular neoplasms. Two Thy3 nodules regrew after the procedure, and these patients accepted to undergo a total thyroidectomy. Here we present how RFA has affected the operation and the final pathological features of the surgically removed nodules. Results and Conclusions. RFA is effective for the treatment of Thy2 nodules, but it should not be recommended as first-line therapy for the treatment of Thy3 nodules (irrespective of their mutational status, as it delays surgery in case of malignancy. Moreover, it is unknown whether RFA might promote residual tumor progression or neoplastic progression of Thy3 lesions. Nevertheless, here we show for the first time that one session of RFA does not affect subsequent thyroid surgery and/or histological diagnosis.

  3. Effect of exogenous application of rhizopine on lucerne root nodulation

    African Journals Online (AJOL)

    Rhizopine, 3-0 -methyl scyllo-inosamine was applied to the roots of luceme seedling inoculated with either rhizopine synthesizing Sinorhizobium meliloti strain L530 or the non-rhizopine synthesizing strain Rm 1021 . There was an initial delay in nodule formation. A significant increase in the number of nodules formed in ...

  4. Partially Cystic Thyroid Nodules: Ultrasound Findings of Malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jang Mi; Choi, Yoon Jung; Kwag, Hyon Joo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    To seek for the ultrasound (US) findings of partially cystic thyroid nodules that are associated with malignancy. We reviewed the US characteristics of 22 surgically confirmed partially cystic papillary carcinomas, and compared them with those of 80 benign partially cystic nodules. The review cases were selected in a random order from a total of 1029 partially cystic nodules that were diagnosed with an US-guided fine needle aspiration biopsy over a period of 8 years (June 2003 to October 2010) at our institution. In partially cystic thyroid nodules, a taller-than-wide shape (100%, p<0.001) and spiculated or microlobulated margin (58.3%, p 0.003) were significantly associated with malignancy. In terms of internal solid portion of the nodule, eccentric configuration (68.0%, p<0.001), non-smooth margin (81.3%, p<0.001), hypoechogenecity (30.0%, p<0.042), and microcalcification (89.5%, p<0.001) were more frequently demonstrated in malignant nodules than benign ones. In partially cystic thyroid nodules, understanding the characteristics of US findings is important to make a precise diagnosis of malignant nodules.

  5. Geochemistry of polymetallic nodules from the Central Indian Ocean basin

    Digital Repository Service at National Institute of Oceanography (India)

    Valsangkar, A.B.; Khadge, N.H.; Desa, J.A.E.

    ) In the CCD model, the smaller nodules ( 4 cm) are formed at or near the CCD and are influencEd. by diagenesis and high biological productivity; they are enriched in Mn, Cu and Ni, and todorokite is present. (2) In the deep-sea environment model, large nodules...

  6. Internal microfeatures of manganese nodules from the Central Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Pattan, J.N.

    are more common in abyssal hill nodules. Compositional studies of layers within the nodules show that Mn, Ni, Cu and Zn increase from the nucleus to the outer layer, while Fe and Co are inclined to decrease. The innermost layer adjacent to the nucleus...

  7. Nodulin gene expression during soybean (Glycine max) nodule development.

    NARCIS (Netherlands)

    Gloudemans, T.; Vries, de S.; Bussink, H.J.; Malik, N.S.A.; Franssen, H.; Louwerse, J.; Bisseling, T.

    1987-01-01

    In vitro translation products of total RNA isolated from soybean nodules at successive stages of nodule development were analyzed by two-dimensional gel electrophoresis. In that way the occurrence of over 20 mRNAs specifically transcribed from nodulin genes was detected. The nodulin genes could be

  8. Uranium in Pacific Deep-Sea Sediments and Manganese Nodules

    DEFF Research Database (Denmark)

    Kunzendorf, Helmar; Pluger, W. L.; Friedrich, G. H.

    1983-01-01

    A total of 1344 manganese nodules and 187 pelagic sediments from 9 areas in the North and the South Pacific were analyzed for U by the delayed-neutron counting technique. A strong positive correlation between U and Fe in nodules and sediments suggests a co-precipitative removal from sea water int...

  9. Malignancy risk estimation of pulmonary nodules in screening CTs

    DEFF Research Database (Denmark)

    van Riel, Sarah J; Ciompi, Francesco; Winkler Wille, Mathilde M

    2017-01-01

    model (PanCan) assigned a malignancy probability score to each nodule. Performances were expressed by area under the ROC curve (AUC). Performance differences were tested using the Dorfman, Berbaum and Metz method. Seven observers assessed morphological nodule characteristics using a predefined list...

  10. Solitary pulmonary nodule: radiologic features and diagnostic approach

    International Nuclear Information System (INIS)

    Rodriguez Cambronero, Luis Enrique

    2012-01-01

    A literature review is conducted on the solitary pulmonary nodule, to determine the diagnostic methods and specific characteristics. The diagnostic methods used have been: chest radiography, computed tomography, positron emission tomography and magnetic resonance imaging. The radiological features are defined: location, size, definition of contours or edges (margins), densitometric and attenuation characteristics, cavitation, air bronchogram, growth, doubling time, satellite nodules, nutrient vessels [es

  11. Buried nodules from the central Indian Ocean basin

    Digital Repository Service at National Institute of Oceanography (India)

    Pattan, J.N.; Parthiban, G.

    . Of these, 13 buried nodules are from two sediment cores in siliceous ooze and seven from two sediment cores in a red clay area. The morphology, size, surface texture and chemical composition of buried nodules from two different sediment type have been...

  12. Vocal nodules in a colombian teachers group with dysphonia

    Directory of Open Access Journals (Sweden)

    Andrés Felipe Alvarado Díaz

    2013-12-01

    Full Text Available Objectives: This study determined the prevalence of vocal nodules associated with dysphonia in teachers aged from 35 to 65 years, taking into consideration both individual and occupational variables. Methodology: Descriptive study that included the information contained in 262 medical records of teachers diagnosed with dysphonia in occupational health consultations at the institutions that provide health services in Bogotá, Colombia from March 2009 to March 2012. The presence of laryngeal nodules was based on the findings of a nasofibrolaryngoscopy procedure. Results: Nodules were found in 67 teachers, which corresponded to a rate of 25.5%, being apparently (highest observed rates associated primarily with the following variables: females, ages from 45 to 54 years, bilateral nodules, and teaching position (preschool and physical education. Of the teachers with nodules, 76.1% had fewer than five doctor's appointments, and 75% had more than 90 days of sick leave. Conclusion: A high percentage of teachers have vocal nodules associated with dysphonia. This may be apparently related to different variables such as sex, type of nodule, area and teaching position. Was observed only a statistically significant association among presence of nodules and age (p=0.018. In addition this disorder generates a large number of incapacities and employee absenteeism.

  13. System for automatic detection of lung nodules exhibiting growth

    Science.gov (United States)

    Novak, Carol L.; Shen, Hong; Odry, Benjamin L.; Ko, Jane P.; Naidich, David P.

    2004-05-01

    Lung nodules that exhibit growth over time are considered highly suspicious for malignancy. We present a completely automated system for detection of growing lung nodules, using initial and follow-up multi-slice CT studies. The system begins with automatic detection of lung nodules in the later CT study, generating a preliminary list of candidate nodules. Next an automatic system for registering locations in two studies matches each candidate in the later study to its corresponding position in the earlier study. Then a method for automatic segmentation of lung nodules is applied to each candidate and its matching location, and the computed volumes are compared. The output of the system is a list of nodule candidates that are new or have exhibited volumetric growth since the previous scan. In a preliminary test of 10 patients examined by two radiologists, the automatic system identified 18 candidates as growing nodules. 7 (39%) of these corresponded to validated nodules or other focal abnormalities that exhibited growth. 4 of the 7 true detections had not been identified by either of the radiologists during their initial examinations of the studies. This technique represents a powerful method of surveillance that may reduce the probability of missing subtle or early malignant disease.

  14. Carcinoma in hyperfunctioning thyroid nodule in recurrent hyperthyroidism

    International Nuclear Information System (INIS)

    Hoving, J.; Piers, D.A.; Vermey, A.; Oosterhuis, J.W.

    1981-01-01

    A patient with an invasive thyroid carcinoma located within a hot thyroid nodule is reported. Only four similar cases have been described in the literature. It is emphasized that a hot thyroid nodule per se should not be used as an argument against the diagnosis of thyroid carcinoma. (orig.) [de

  15. Percutaneous ethanol injection therapy of autonomous (toxic) thyroid nodules

    International Nuclear Information System (INIS)

    Dieter Erich Apitzsch, M. D.; Staedtische Paracelsusklinik

    2005-01-01

    In Europe, 9-10% of hyperfunctioning thyroid glands have toxic, autonomous thyroid nodules (ATN). Since 1994, in the Municipal hospital of Marl, Germany, 186 patients have performed percutaneous ethanol ablation of toxic thyroid nodules with very good or at least sufficient results. In this article, the ablation technique is described in detail and the costs of therapy of ATN are given.(authors)

  16. 3D pulmonary nodules detection using fast marching segmentation ...

    African Journals Online (AJOL)

    This paper proposes an automated computer aided diagnosis system for detection of pulmonary nodules based on three dimensional (3D) structures. Lung ... The proposed detection methodology can give the accuracy of 92%. Keywords: lung cancer; pulmonary nodule; fast marching; 3D features; random forest classifier.

  17. Preoperative Molecular Markers in Thyroid Nodules.

    Science.gov (United States)

    Sahli, Zeyad T; Smith, Philip W; Umbricht, Christopher B; Zeiger, Martha A

    2018-01-01

    The need for distinguishing benign from malignant thyroid nodules has led to the pursuit of differentiating molecular markers. The most common molecular tests in clinical use are Afirma ® Gene Expression Classifier (GEC) and Thyroseq ® V2. Despite the rapidly developing field of molecular markers, several limitations exist. These challenges include the recent introduction of the histopathological diagnosis "Non-Invasive Follicular Thyroid neoplasm with Papillary-like nuclear features", the correlation of genetic mutations within both benign and malignant pathologic diagnoses, the lack of follow-up of molecular marker negative nodules, and the cost-effectiveness of molecular markers. In this manuscript, we review the current published literature surrounding the diagnostic value of Afirma ® GEC and Thyroseq ® V2. Among Afirma ® GEC studies, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) ranged from 75 to 100%, 5 to 53%, 13 to 100%, and 20 to 100%, respectively. Among Thyroseq ® V2 studies, Se, Sp, PPV, and NPV ranged from 40 to 100%, 56 to 93%, 13 to 90%, and 48 to 97%, respectively. We also discuss current challenges to Afirma ® GEC and Thyroseq ® V2 utility and clinical application, and preview the future directions of these rapidly developing technologies.

  18. Hyperfunctioning thyroid nodules in children and adolescents.

    Science.gov (United States)

    de Luca, F; Chaussain, J L; Job, J C

    1986-01-01

    Eight children and adolescents, seven female and one male, aged 7.1 to 15.0 years, referred over a 12-year period for a solitary mass in an otherwise normal thyroid gland, exhibited a hyperfunctioning nodule on thyroid scintiscan. Tracer uptake in the surrounding thyroid tissue was reduced or completely suppressed, but could be restored after TSH stimulation. Only one patient had mild clinical hyperthyroidism with normal T4 but increased T3 serum levels and blunted TSH responsiveness to TRH. A similar hormonal pattern suggestive of subclinical hyperthyroidism was found in three other subjects who were clinically euthyroid. One patient initially euthyroid progressed to subclinical hyperthyroidism two years later. In the whole group a significant negative relationship was found between serum T3 level and TRH-stimulated TSH peak (r = -0.829, p less than 0.02). All the patients underwent selective surgery after a 3-month to 2-year period of follow-up. Microscopic examination was consistent with adenoma in seven patients, while in one case a well-encapsulated papillary adenocarcinoma was found. Though hyperfunctioning nodules are seldom malignant, their surgical removal must be recommended when they become thyrotoxic, exceed 3 cm or show progressive enlargement.

  19. Standard dose 131I therapy for hyperthyroidism caused by autonomously functioning thyroid nodules

    International Nuclear Information System (INIS)

    Fui, S.C.N.T.; Maisey, M.N.

    1979-01-01

    Thirty-one patients with hyperthyroidism shown on scintigrams to have autonomously functioning thyroid nodules were treated with a standard dose of 15mCi of 131 I. Of thirty patients who have been followed up for at least 6 months to over 3 years, all but one patient were euthyroid after a single dose. Repeat scintigram and Thyrotropin Releasing Hormone test after therapy confirmed that twenty-five patients were cured of the disease. Only one patient developed hypothyroidism. This simplified dose regimen of radioiodine is effective in the treatment of hyperthyroidism caused by autonomously functioning nodules and is not complicated by the high incidence of hyperthyroidism that is observed following radioiodine therapy of Grave's disease. (author)

  20. Gamma radiation induced and natural variability for nodulation in legumes

    Energy Technology Data Exchange (ETDEWEB)

    Maherchandani, N; Rana, O P.S. [Haryana Agricultural Univ., Hissar (India). Dept. of Genetics

    1977-09-01

    Gamma radiation induced variability for nodulation was studied in 112 M4 mutant lines of cowpea variety C-15-2. Ten lines superior in nodulation to the original variety have been identified. Natural variability for nodulation and plant growth was investigated in 75 genotypes of chickpea. A number of genotype were found to be superior to cultivated variety C-235 for nodulation characters. Nodule characters were found to be related to dry matter accumulation but not to grain yield. Another experiment on 10 varieties of chick pea conducted under aseptic conditions revealed that host genotypes showed specificity for Rhizobial strains and different Rhizobial strains differed in their effectiveness on different host genotypes. H 551 and H 355 were the most responsive varieties.

  1. Direct detection of radicals in intact soybean nodules

    DEFF Research Database (Denmark)

    Mathieu, C; Moreau, S; Frendo, P

    1998-01-01

    Electron paramagnetic resonance spectroscopy has been employed to examine the nature of the metal ions and radicals present in intact root nodules of soybean plants grown in the absence of nitrate. The spectra obtained from nodules of different ages using this non-invasive technique show dramatic...... differences, suggesting that there are both qualitative and quantitative changes in the metal ion and radical species present. A major component of the spectra obtained from young nodules is assigned to a complex (Lb-NO) of nitric oxide (NO.) with the heme protein leghemoglobin (Lb). This Lb-NO species, which...... has not been previously detected in intact root nodules of plants grown in the absence of nitrate, is thought to be formed by reaction of nitric oxide with iron(II) leghemoglobin. The nitric oxide may be generated from arginine via a nitric oxide synthase-like activity present in the nodules...

  2. The thyroid nodule. Thyrotropin and peripheral thyroid hormones

    International Nuclear Information System (INIS)

    Zimny, M.

    2008-01-01

    Thyrotropin, free triodothyronine and thyroxine represent the standard serological parameters for the diagnostic work-up of the thyroid but only a minority of thyroid nodules present with subclinical or overt thyroid disorders. Besides a review of the regulation and principle of function of thyroid hormones as well as the effects of subclinical or overt hyperthyroidism, the significant role of these parameters beyond the assessment of hyperthyroidism in thyroid nodules is discussed. There is evidence that the level of thyrotropin within the normal range is predictive for the relevance of autonomous functioning nodules and the risk of malignancy of non-functioning thyroid nodules. Furthermore, the ratio of triodothyronine and thyroxine indicates the etiology of hyperthyroidism. Thyrotropin represents the main parameter to determine the adequate dose of thyroid hormone therapy of thyroid nodules. (orig.)

  3. Current radiologic interventions in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Masoud, I.; Naeem, M.Q.T.; Saeed, F.; Mirza, S.A.M.; Khan, A.; Bhatti, M.A.

    2006-01-01

    With the rising incidence of chronic liver disease caused by viral hepatitis, hepatocellular carcinoma is showing a corresponding rise worldwide. Surgery remains the mainstay of treatment, but patients unfit for surgery or liver transplantation form the bulk of those presenting with this disease. Palliative treatments are being used to treat those and radiological modalities form the mainstay of the treatment. Radiology plays a major role in the diagnosis, treatment and follow-up of hepatocellular carcinoma. Current radiological treatment modalities include percutaneous ethanol ablation, radiofrequency ablation and trans-arterial chemoembolization. This update highlights the recent advancements in the field and compares their relative merits and demerits. (author)

  4. Impact of overexpression of cytosolic isoform of O-acetylserine sulfhydrylase on soybean nodulation and nodule metabolome

    Science.gov (United States)

    Nitrogen-fixing nodules, which are also major sites of sulfur assimilation, contribute significantly to the sulfur needs of the whole soybean plants. Nodules are the predominant sites for cysteine accumulation and the activity of O-acetylserine sulfhydrylase (OASS; also known as O-acetylserine(thio...

  5. Persistent pulmonary subsolid nodules: model-based iterative reconstruction for nodule classification and measurement variability on low-dose CT

    International Nuclear Information System (INIS)

    Kim, Hyungjin; Kim, Seong Ho; Lee, Sang Min; Lee, Kyung Hee; Park, Chang Min; Park, Sang Joon; Goo, Jin Mo

    2014-01-01

    To compare the pulmonary subsolid nodule (SSN) classification agreement and measurement variability between filtered back projection (FBP) and model-based iterative reconstruction (MBIR). Low-dose CTs were reconstructed using FBP and MBIR for 47 patients with 47 SSNs. Two readers independently classified SSNs into pure or part-solid ground-glass nodules, and measured the size of the whole nodule and solid portion twice on both reconstruction algorithms. Nodule classification agreement was analyzed using Cohen's kappa and compared between reconstruction algorithms using McNemar's test. Measurement variability was investigated using Bland-Altman analysis and compared with the paired t-test. Cohen's kappa for inter-reader SSN classification agreement was 0.541-0.662 on FBP and 0.778-0.866 on MBIR. Between the two readers, nodule classification was consistent in 79.8 % (75/94) with FBP and 91.5 % (86/94) with MBIR (p = 0.027). Inter-reader measurement variability range was -5.0-2.1 mm on FBP and -3.3-1.8 mm on MBIR for whole nodule size, and was -6.5-0.9 mm on FBP and -5.5-1.5 mm on MBIR for solid portion size. Inter-reader measurement differences were significantly smaller on MBIR (p = 0.027, whole nodule; p = 0.011, solid portion). MBIR significantly improved SSN classification agreement and reduced measurement variability of both whole nodules and solid portions between readers. (orig.)

  6. Predictive factors for malignancy in incidental pulmonary nodules detected in breast cancer patients at baseline CT

    Energy Technology Data Exchange (ETDEWEB)

    Hammer, Mark M.; Mortani Barbosa, Eduardo J. [University of Pennsylvania, Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, Philadelphia, PA (United States)

    2017-07-15

    Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain. We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 - 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules. The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis. We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules. (orig.)

  7. Surgical Treatment of Hepatocellular Carcinoma

    Science.gov (United States)

    Zamora-Valdes, Daniel; Taner, Timucin; Nagorney, David M.

    2017-01-01

    Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1) review the current American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines on the surgical management of HCC and (2) review the proposed changes to these guidelines and analyze the strength of evidence underlying these proposals. Three authors identified the most relevant publications in the literature on liver resection and transplantation for HCC and analyzed the strength of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. In the United States, the liver allocation system provides priority for liver transplantation to patients with HCC within the Milan criteria. Current evidence suggests that liver transplantation may also be indicated in certain patient groups beyond Milan criteria, such as pediatric patients with large tumor burden or adult patients who are successfully downstaged. Patients with no underlying liver disease may also benefit from liver transplantation if the HCC is unresectable. In patients with no or minimal (compensated) liver disease and solitary HCC ≥2 cm, liver resection is warranted. If liver transplantation is not available or contraindicated, liver resection can be offered to patients with multinodular HCC, provided that the underlying liver disease is not decompensated. Many patients may benefit from surgical strategies adapted to local resources and policies (hepatitis B prevalence, organ availability, etc). Although current low-quality evidence shows better overall survival with aggressive surgical strategies, this approach is limited to select patients. Larger and well-designed prospective studies are needed to better define the benefits and limits of such approach. PMID:28975836

  8. New advances in hepatocellular carcinoma

    Science.gov (United States)

    Pascual, Sonia; Herrera, Iván; Irurzun, Javier

    2016-01-01

    Hepatocellular carcinoma (HCC) is the leading cause of deaths in cirrhotic patients and the third cause of cancer related deaths. Most HCC are associated with well known underlying risk factors, in fact, HCC arise in cirrhotic patients in up to 90% of cases, mainly due to chronic viral hepatitis and alcohol abuse. The worldwide prevention strategies are conducted to avoid the infection of new subjects and to minimize the risk of liver disease progression in infected patients. HCC is a condition which lends itself to surveillance as at-risk individuals can readily be identified. The American and European guidelines recommended implementation of surveillance programs with ultrasound every six months in patient at-risk for developing HCC. The diagnosis of HCC can be based on non-invasive criteria (only in cirrhotic patient) or pathology. Accurately staging patients is essential to oncology practice. The ideal tumour staging system in HCC needs to account for both tumour characteristics and liver function. Treatment allocation is based on several factors: Liver function, size and number of tumours, macrovascular invasion or extrahepatic spread. The recommendations in terms of selection for different treatment strategies must be based on evidence-based data. Resection, liver transplant and interventional radiology treatment are mainstays of HCC therapy and achieve the best outcomes in well-selected candidates. Chemoembolization is the most widely used treatment for unresectable HCC or progression after curative treatment. Finally, in patients with advanced HCC with preserved liver function, sorafenib is the only approved systemic drug that has demonstrated a survival benefit and is the standard of care in this group of patients. PMID:27028578

  9. Development of a clinical decision model for thyroid nodules

    Directory of Open Access Journals (Sweden)

    Eberhardt John

    2009-08-01

    Full Text Available Abstract Background Thyroid nodules represent a common problem brought to medical attention. Four to seven percent of the United States adult population (10–18 million people has a palpable thyroid nodule, however the majority (>95% of thyroid nodules are benign. While, fine needle aspiration remains the most cost effective and accurate diagnostic tool for thyroid nodules in current practice, over 20% of patients undergoing FNA of a thyroid nodule have indeterminate cytology (follicular neoplasm with associated malignancy risk prevalence of 20–30%. These patients require thyroid lobectomy/isthmusectomy purely for the purpose of attaining a definitive diagnosis. Given that the majority (70–80% of these patients have benign surgical pathology, thyroidectomy in these patients is conducted principally with diagnostic intent. Clinical models predictive of malignancy risk are needed to support treatment decisions in patients with thyroid nodules in order to reduce morbidity associated with unnecessary diagnostic surgery. Methods Data were analyzed from a completed prospective cohort trial conducted over a 4-year period involving 216 patients with thyroid nodules undergoing ultrasound (US, electrical impedance scanning (EIS and fine needle aspiration cytology (FNA prior to thyroidectomy. A Bayesian model was designed to predict malignancy in thyroid nodules based on multivariate dependence relationships between independent covariates. Ten-fold cross-validation was performed to estimate classifier error wherein the data set was randomized into ten separate and unique train and test sets consisting of a training set (90% of records and a test set (10% of records. A receiver-operating-characteristics (ROC curve of these predictions and area under the curve (AUC were calculated to determine model robustness for predicting malignancy in thyroid nodules. Results Thyroid nodule size, FNA cytology, US and EIS characteristics were highly predictive of

  10. Pulmonary nodule size evaluation with chest tomosynthesis.

    Science.gov (United States)

    Johnsson, Åse A; Fagman, Erika; Vikgren, Jenny; Fisichella, Valeria A; Boijsen, Marianne; Flinck, Agneta; Kheddache, Susanne; Svalkvist, Angelica; Båth, Magnus

    2012-10-01

    To evaluate intra- and interobserver variability, as well as agreement for nodule size measurements on chest tomosynthesis and computed tomographic (CT) images. The Regional Ethical Review Board approved this study, and all participants gave written informed consent. Thirty-six segmented nodules in 20 patients were included in the study. Eight observers measured the left-to-right, inferior-to-superior, and longest nodule diameters on chest tomosynthesis and CT images. Intra- and interobserver repeatability, as well as agreement between measurements on chest tomosynthesis and CT images, were assessed as recommended by Bland and Altman. The difference between the mean manual and the segmented diameter was -2.2 and -2.3 mm for left-to-right and -2.6 and -2.2 mm for the inferior-to-superior diameter for measurements on chest tomosynthesis and CT images, respectively. Intraobserver 95% limits of agreement (LOA) for the longest diameter ranged from a lower limit of -1.1 mm and an upper limit of 1.0 mm to -1.8 and 1.8 mm for chest tomosynthesis and from -0.6 and 0.9 mm to -3.1 and 2.2 mm for axial CT. Interobserver 95% LOA ranged from -1.3 and 1.5 mm to -2.0 and 2.1 mm for chest tomosynthesis and from -1.8 and 1.1 mm to -2.2 and 3.1 mm for axial CT. The 95% LOA concerning the mean of the observers' measurements of the longest diameter at chest tomosynthesis and axial CT were ±2.1 mm (mean measurement error, 0 mm). For the different observers, the 95% LOA between the modalities ranged from -2.2 and 1.6 mm to -3.2 and 2.8 mm. Measurements on chest tomosynthesis and CT images are comparable, because there is no evident bias between the modalities and the repeatability is similar. The LOA between measurements for the two modalities raise concern if measurements from chest tomosynthesis and CT were to be used interchangeably. © RSNA, 2012.

  11. Hyperkalaemia after radiofrequency ablation of hepatocellular carcinoma

    NARCIS (Netherlands)

    Verhoevena, BH; Haagsma, EB; Appeltans, BMG; Slooff, MJH; de Jong, KP

    Radiofrequency ablation of liver tumours is a useful therapy for otherwise unresectable tumours. The complication rate is said to be low. In this case report we describe hyperkalaemia after radiofrequency ablation of a hepatocellular carcinoma in a patient with end-stage renal insufficiency. (C)

  12. Radioembolisation for treatment of pediatric hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hawkins, Clifford Matthew; Kukreja, Kamlesh [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Geller, James I. [Cincinnati Children' s Hospital Medical Center, Department of Hematology/Oncology, Cincinnati, OH (United States); Schatzman, Carmen; Ristagno, Ross [University of Cincinnati, UC Health, Department of Radiology, Division of Interventional Radiology, Cincinnati, OH (United States)

    2013-07-15

    Transarterial radioembolisation with yttrium-90 (TARE-Y90), a catheter-directed therapy, has been used extensively in adults to treat primary and secondary hepatic malignancies. To our knowledge, the use of this palliative technique has not been described in children. We present two children with unresectable hepatocellular carcinoma (HCC) treated with TARE-Y90. (orig.)

  13. Small hepatocellular carcinoma versus small cavernous hemangioma

    International Nuclear Information System (INIS)

    Choi, B.I.; Park, H.W.; Kim, S.H.; Han, M.C.; Kim, C.W.

    1989-01-01

    To determine the optimal pulse sequence for detection and differential diagnosis of small hepatocellular carcinomas and cavernous hemangiomas less than 5 cm in diameter, the authors have analyzed spin-echo (SE) images of 15 small hepatocellular carcinomas and 31 small cavernous hemangiomas obtained at 2.0 T. Pulse sequences used included repetition times (TRs) of 500 and 2,000 msec and echo times (TEs) of 30,60,90,120,150, and 180 msec. Mean tumor-liver contrast-to-noise ratios on the SE 2,000/60 (TR msec/TE msec) sequence were 23.90 ± 16.33 and 62.10 ± 25.94 for small hepatocellular carcinomas and hemangiomas, respectively, and were significantly greater than for all other pulse sequences. Mean tumor-liver signal intensity ratios on the SE 2,000/150 sequence were 2.34 ± 1.72 and 6.04 ± 2.72 for small hepatocellular carcinomas and hemangiomas, respectively, and were significantly greater than for all other pulse sequences in hemangiomas

  14. Liver transplantation in patients with hepatocellular carcinoma

    NARCIS (Netherlands)

    Polak, Wojciech G.; Soyama, Akihiko; Slooff, Maarten J. H.

    2008-01-01

    Liver transplantation has a definitive place in the treatment of patients with hepatocellular carcinoma (HCC) in a cirrhotic liver. Patients with a tumor load within the Milan criteria have excellent survival comparable to survival in patients with benign indications. When tumor load exceeds the

  15. Delayed presentation and diagnosis of metastatic hepatocellular ...

    African Journals Online (AJOL)

    Hepatocellular carcinoma (HCC) is rarely diagnosed in women of reproductive age. ... an adverse effect on HCC, and that high levels of oestrogen associated with pregnancy may ... A 30-year-old pregnant woman presented at 23 weeks' gestation and was diagnosed as HIV-infected, with anaemia. She was initiated on.

  16. Hepatocellular carcinoma: risk groups, surveillance and outcome

    NARCIS (Netherlands)

    van Meer, S

    2016-01-01

    The burden of hepatocellular carcinoma (HCC) has changed in the past few decades. Although the majority of HCC cases develops in East Asia and Sub-Saharan Africa, HCC has become an increasing problem in Western countries such as the Netherlands. Surveillance for HCC is controversial because of

  17. Proof that Burkholderia Strains Form Effective Symbioses with Legumes: a Study of Novel Mimosa-Nodulating Strains from South America

    Science.gov (United States)

    Chen, Wen-Ming; de Faria, Sergio M.; Straliotto, Rosângela; Pitard, Rosa M.; Simões-Araùjo, Jean L.; Chou, Jui-Hsing; Chou, Yi-Ju; Barrios, Edmundo; Prescott, Alan R.; Elliott, Geoffrey N.; Sprent, Janet I.; Young, J. Peter W.; James, Euan K.

    2005-01-01

    Twenty Mimosa-nodulating bacterial strains from Brazil and Venezuela, together with eight reference Mimosa-nodulating rhizobial strains and two other β-rhizobial strains, were examined by amplified rRNA gene restriction analysis. They fell into 16 patterns and formed a single cluster together with the known β-rhizobia, Burkholderia caribensis, Burkholderia phymatum, and Burkholderia tuberum. The 16S rRNA gene sequences of 15 of the 20 strains were determined, and all were shown to belong to the genus Burkholderia; four distinct clusters could be discerned, with strains isolated from the same host species usually clustering very closely. Five of the strains (MAP3-5, Br3407, Br3454, Br3461, and Br3469) were selected for further studies of the symbiosis-related genes nodA, the NodD-dependent regulatory consensus sequences (nod box), and nifH. The nodA and nifH sequences were very close to each other and to those of B. phymatum STM815, B. caribensis TJ182, and Cupriavidus taiwanensis LMG19424 but were relatively distant from those of B. tuberum STM678. In addition to nodulating their original hosts, all five strains could also nodulate other Mimosa spp., and all produced nodules on Mimosa pudica that had nitrogenase (acetylene reduction) activities and structures typical of effective N2-fixing symbioses. Finally, both wild-type and green fluorescent protein-expressing transconjugant strains of Br3461 and MAP3-5 produced N2-fixing nodules on their original hosts, Mimosa bimucronata (Br3461) and Mimosa pigra (MAP3-5), and hence this confirms strongly that Burkholderia strains can form effective symbioses with legumes. PMID:16269788

  18. Indeterminate Pulmonary Nodules in Colorectal-Cancer

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas; Jorgensen, Lars N; Wille-Jørgensen, Peer A

    2015-01-01

    BACKGROUND: The clinical significance of indeterminate pulmonary nodules (IPN) at staging computed tomography (CT) for colorectal cancer (CRC), and the optimal diagnostic approach, are debated. This study aimed to analyse variability in radiologists' detection of IPN at staging CT for CRC. METHODS......: All patients with CRC referred to our center between 2006 and 2011 were included. Primary staging CT scans were re-evaluated by an experienced thoracic radiologist whose findings were entered into a dedicated database and merged with data from the Danish Colorectal Cancer Group database, the National...... investigated radiological characteristics or clinicopathological factors were significantly associated with malignancy of IPN. CONCLUSION: The characterization of pulmonary findings on staging CT for CRC varied greatly between the radiologists, and double-reading of scans with IPN is recommended prior...

  19. Fusobacterium necrophorum presenting as isolated lung nodules

    Directory of Open Access Journals (Sweden)

    Rajiv Sonti

    2015-01-01

    Full Text Available Fusobacterium necrophorum causes Lemierre's syndrome - a dramatic and distinct condition beginning with pharyngitis before proceeding to internal jugular vein septic thrombophlebitis and respiratory tract infection in otherwise healthy individuals. It is rare, but by far the most common pathway to parenchymal lung disease with this organism. Here we describe we a 34 year old healthy lady who was nontoxic without any antecedent illness who presented with lung nodules due to fusobacterium necrophorum as the sole manifestation of disease. Leading diagnostic consideration prior to culture data was pulmonary vasculitis. Identifying her disease process was a somewhat chance occurrence, and it began to resolve prior to antibiotic therapy. Though it would be difficult to recommend keen awareness of this organism given its rarity, it is important to consider that its scope may be broader than traditionally considered.

  20. Quantitative CT: technique dependence of volume estimation on pulmonary nodules

    Science.gov (United States)

    Chen, Baiyu; Barnhart, Huiman; Richard, Samuel; Colsher, James; Amurao, Maxwell; Samei, Ehsan

    2012-03-01

    Current estimation of lung nodule size typically relies on uni- or bi-dimensional techniques. While new three-dimensional volume estimation techniques using MDCT have improved size estimation of nodules with irregular shapes, the effect of acquisition and reconstruction parameters on accuracy (bias) and precision (variance) of the new techniques has not been fully investigated. To characterize the volume estimation performance dependence on these parameters, an anthropomorphic chest phantom containing synthetic nodules was scanned and reconstructed with protocols across various acquisition and reconstruction parameters. Nodule volumes were estimated by a clinical lung analysis software package, LungVCAR. Precision and accuracy of the volume assessment were calculated across the nodules and compared between protocols via a generalized estimating equation analysis. Results showed that the precision and accuracy of nodule volume quantifications were dependent on slice thickness, with different dependences for different nodule characteristics. Other parameters including kVp, pitch, and reconstruction kernel had lower impact. Determining these technique dependences enables better volume quantification via protocol optimization and highlights the importance of consistent imaging parameters in sequential examinations.

  1. Pulmonary nodule characterization, including computer analysis and quantitative features.

    Science.gov (United States)

    Bartholmai, Brian J; Koo, Chi Wan; Johnson, Geoffrey B; White, Darin B; Raghunath, Sushravya M; Rajagopalan, Srinivasan; Moynagh, Michael R; Lindell, Rebecca M; Hartman, Thomas E

    2015-03-01

    Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. Change in size, attenuation, and morphology on serial follow-up CT, or features on other modalities such as nuclear medicine studies or MRI, can also contribute to the characterization of lung nodules. Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.

  2. Frequency of Thyroid Nodules among Patients with Colonic Polyps

    Directory of Open Access Journals (Sweden)

    Cevdet Duran

    2012-01-01

    Full Text Available Aim. Colonic polyps and thyroid nodules are common diseases and their frequency increases with age. In the literature, there is no study investigating the coexistence of colonic polyps and thyroid nodules. Therefore, this study was designed to investigate thyroid nodule prevalence in patients with colonic polyps. Material and Methods. Sixty-six patients with colonic polyps and 146 patients without colonic polyps enrolled into the study. Age and sex matched control group was composed from patients without colonic polyps. Colonoscopic examinations, thyroid ultrasonographies were performed in all patients, and TSH were measured. Results. Male/female ratio in polyp and control groups were 40/26 versus 68/78, respectively (P=0.058. Mean ages were similar in both groups (53.3±11.4 versus, 51.8±11.4, P=0.373. Thyroid nodule was detected in 44 (66.7% patients with polyps and in 61 (41.8% controls (P=0.001. Patients with adenomatous polyps had 5 or more thyroid nodules compared to patients with hyperplastic polyps (P=0.03. Thyroid nodules were more prevalent among patients aged 50 or older compared to 50 years or less (P=0.023. Conclusion. Thyroid nodules were detected more common in patients with colonic polyps. Further studies are needed to clarify this coexistence.

  3. Monitoring Cu nodule formation using Ni marker layers

    Energy Technology Data Exchange (ETDEWEB)

    Lafouresse, M.C., E-mail: mlafouresse@gmail.co [Department of Civil and Earth Resources Engineering, Kyoto University, Katsura, Kyoto 615-8540 (Japan); Fukunaka, Y. [Institute for Nanoscience and Nanotechnology, Waseda University, Shinjuku Ku, Tokyo 169-8555 (Japan); ISS Science Project Office, JAXA, Tsukuba-shi, Ibaraki 305-8505 (Japan); Matsuoka, T. [Department of Civil and Earth Resources Engineering, Kyoto University, Katsura, Kyoto 615-8540 (Japan); Schwarzacher, W. [H. H. Wills Physics Laboratory, Tyndall Avenue, Bristol BS8 1TL (United Kingdom)

    2011-04-30

    Highlights: {yields} Ni marker layers to monitor electrodeposited Cu nodule morphological evolution. {yields} The edges of the nodules trace out a straight line. {yields} Difference in growth between spheres and hemispheres. {yields} Nodule on nodule growth at high overpotential. {yields} No dramatic effect of the diffusion layer thickness on the film morphology. - Abstract: We have used Ni marker layers to study the evolution of the characteristic spheroidal nodule morphology in electrodeposited Cu films. Ultrathin Ni layers were electrodeposited in-between Cu layers, and cross sections prepared by electrochemical polishing. During growth of a typical spheroidal feature, the edge (i.e. where there is a discontinuity in the surface slope) traces out a straight line in the cross-sectional image. At high overpotential, the cross-sections show nodule-on-nodule growth, giving rise to the well known cauliflower morphology. Rotating disk electrode studies reveal that, surprisingly, the absolute diffusion layer thickness does not appear to play a major role in the development of spheres.

  4. Monitoring Cu nodule formation using Ni marker layers

    International Nuclear Information System (INIS)

    Lafouresse, M.C.; Fukunaka, Y.; Matsuoka, T.; Schwarzacher, W.

    2011-01-01

    Highlights: → Ni marker layers to monitor electrodeposited Cu nodule morphological evolution. → The edges of the nodules trace out a straight line. → Difference in growth between spheres and hemispheres. → Nodule on nodule growth at high overpotential. → No dramatic effect of the diffusion layer thickness on the film morphology. - Abstract: We have used Ni marker layers to study the evolution of the characteristic spheroidal nodule morphology in electrodeposited Cu films. Ultrathin Ni layers were electrodeposited in-between Cu layers, and cross sections prepared by electrochemical polishing. During growth of a typical spheroidal feature, the edge (i.e. where there is a discontinuity in the surface slope) traces out a straight line in the cross-sectional image. At high overpotential, the cross-sections show nodule-on-nodule growth, giving rise to the well known cauliflower morphology. Rotating disk electrode studies reveal that, surprisingly, the absolute diffusion layer thickness does not appear to play a major role in the development of spheres.

  5. Downstaging therapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria.

    Science.gov (United States)

    Kim, Young; Stahl, Christopher C; Makramalla, Abouelmagd; Olowokure, Olugbenga O; Ristagno, Ross L; Dhar, Vikrom K; Schoech, Michael R; Chadalavada, Seetharam; Latif, Tahir; Kharofa, Jordan; Bari, Khurram; Shah, Shimul A

    2017-12-01

    Orthotopic liver transplantation is a curative treatment for hepatocellular carcinoma within Milan criteria, but these criteria preclude many patients from transplant candidacy. Recent studies have demonstrated that downstaging therapy can reduce tumor burden to meet conventional criteria. The present study reports a single-center experience with tumor downstaging and its effects on post-orthotopic liver transplantation outcomes. All patients with hepatocellular carcinoma who were evaluated by our multidisciplinary liver services team from 2012 to 2016 were identified (N = 214). Orthotopic liver transplantation candidates presenting outside of Milan criteria at initial radiographic diagnosis and/or an initial alpha-fetoprotein >400 ng/mL were categorized as at high risk for tumor recurrence and post-transplant mortality. Of the 214 patients newly diagnosed with hepatocellular carcinoma, 73 (34.1%) eventually underwent orthotopic liver transplantation. The majority of patients who did not undergo orthotopic liver transplantation were deceased or lost to follow-up (47.5%), with 14 of 141 (9.9%) currently listed for transplantation. Among transplanted patients, 21 of 73 (28.8%) were considered high-risk candidates. All 21 patients were downstaged to within Milan criteria with an alpha-fetoprotein hepatocellular carcinoma was higher but acceptable between downstaged high-risk and traditional candidates (9.5% vs 1.9%; P > .05) at a median follow-up period of 17 months. Downstaged high-risk candidates had a similar overall survival compared with those transplanted within Milan criteria (log-rank P > .05). In highly selected cases, patients with hepatocellular carcinoma outside of traditional criteria for orthotopic liver transplantation may undergo downstaging therapy in a multidisciplinary fashion with excellent post-transplant outcomes. These data support an aggressive downstaging approach for selected patients who would otherwise be deemed ineligible for

  6. MicroRNA gene polymorphisms and environmental factors increase patient susceptibility to hepatocellular carcinoma.

    Directory of Open Access Journals (Sweden)

    Yin-Hung Chu

    Full Text Available BACKGROUND: Micro RNAs (miRNAs are small RNA fragments that naturally exist in the human body. Through various physiological mechanisms, miRNAs can generate different functions for regulating RNA protein levels and balancing abnormalities. Abnormal miRNA expression has been reported to be highly related to several diseases and cancers. Single-nucleotide polymorphisms (SNPs in miRNAs have been reported to increase patient susceptibility and affect patient prognosis and survival. We adopted a case-control research design to verify the relationship between miRNAs and hepatocellular carcinoma. METHODOLOGY/PRINCIPAL FINDINGS: A total of 525 subjects, including 377 controls and 188 hepatocellular carcinoma patients, were selected. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP and real-time PCR were used to analyze miRNA146a (rs2910164, miRNA149 (rs2292832, miRNA196 (rs11614913, and miRNA499 (rs3746444 genetic polymorphisms between the control group and the case group. The results indicate that people who carry the rs3746444 CT or CC genotypes may have a significantly increased susceptibility to hepatocellular carcinoma (adjusted odds ratio [AOR] = 2.84, 95% confidence interval [CI] = 1.88-4.30. In addition, when combined with environmental risk factors, such as smoking and alcohol consumption, interaction effects were observed between gene polymorphisms and environmental factors (odds ratio [OR] = 4.69, 95% CI = 2.52-8.70; AOR = 3.38, 95% CI = 1.68-6.80. CONCLUSIONS: These results suggest that a significant association exists between miRNA499 SNPs and hepatocellular carcinoma. Gene-environment interactions of miRNA499 polymorphisms, smoking, and alcohol consumption might alter hepatocellular carcinoma susceptibility.

  7. Transcription reprogramming during root nodule development in Medicago truncatula.

    Directory of Open Access Journals (Sweden)

    Sandra Moreau

    Full Text Available Many genes which are associated with root nodule development and activity in the model legume Medicago truncatula have been described. However information on precise stages of activation of these genes and their corresponding transcriptional regulators is often lacking. Whether these regulators are shared with other plant developmental programs also remains an open question. Here detailed microarray analyses have been used to study the transcriptome of root nodules induced by either wild type or mutant strains of Sinorhizobium meliloti. In this way we have defined eight major activation patterns in nodules and identified associated potential regulatory genes. We have shown that transcription reprogramming during consecutive stages of nodule differentiation occurs in four major phases, respectively associated with (i early signalling events and/or bacterial infection; plant cell differentiation that is either (ii independent or (iii dependent on bacteroid differentiation; (iv nitrogen fixation. Differential expression of several genes involved in cytokinin biosynthesis was observed in early symbiotic nodule zones, suggesting that cytokinin levels are actively controlled in this region. Taking advantage of databases recently developed for M. truncatula, we identified a small subset of gene expression regulators that were exclusively or predominantly expressed in nodules, whereas most other regulators were also activated under other conditions, and notably in response to abiotic or biotic stresses. We found evidence suggesting the activation of the jasmonate pathway in both wild type and mutant nodules, thus raising questions about the role of jasmonate during nodule development. Finally, quantitative RT-PCR was used to analyse the expression of a series of nodule regulator and marker genes at early symbiotic stages in roots and allowed us to distinguish several early stages of gene expression activation or repression.

  8. Evaluation of percutaneous ethanol injections in benign thyroid nodules.

    Science.gov (United States)

    Perez, Camila Luhm Silva; Fighera, Tayane Muniz; Miasaki, Fabiola; Mesa Junior, Cleo Otaviano; Paz Filho, Gilberto Jorge da; Graf, Hans; Carvalho, Gisah Amaral de

    2014-12-01

    The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of nodules were evaluated for normalization of TSH levels. Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function.

  9. Dissecting the Root Nodule Transcriptome of Chickpea (Cicer arietinum L..

    Directory of Open Access Journals (Sweden)

    Chandra Kant

    Full Text Available A hallmark trait of chickpea (Cicer arietinum L., like other legumes, is the capability to convert atmospheric nitrogen (N2 into ammonia (NH3 in symbiotic association with Mesorhizobium ciceri. However, the complexity of molecular networks associated with the dynamics of nodule development in chickpea need to be analyzed in depth. Hence, in order to gain insights into the chickpea nodule development, the transcriptomes of nodules at early, middle and late stages of development were sequenced using the Roche 454 platform. This generated 490.84 Mb sequence data comprising 1,360,251 reads which were assembled into 83,405 unigenes. Transcripts were annotated using Gene Ontology (GO, Cluster of Orthologous Groups (COG and Kyoto Encyclopedia of Genes and Genomes (KEGG metabolic pathways analysis. Differential expression analysis revealed that a total of 3760 transcripts were differentially expressed in at least one of three stages, whereas 935, 117 and 2707 transcripts were found to be differentially expressed in the early, middle and late stages of nodule development respectively. MapMan analysis revealed enrichment of metabolic pathways such as transport, protein synthesis, signaling and carbohydrate metabolism during root nodulation. Transcription factors were predicted and analyzed for their differential expression during nodule development. Putative nodule specific transcripts were identified and enriched for GO categories using BiNGO which revealed many categories to be enriched during nodule development, including transcription regulators and transporters. Further, the assembled transcriptome was also used to mine for genic SSR markers. In conclusion, this study will help in enriching the transcriptomic resources implicated in understanding of root nodulation events in chickpea.

  10. Dissecting the Root Nodule Transcriptome of Chickpea (Cicer arietinum L.).

    Science.gov (United States)

    Kant, Chandra; Pradhan, Seema; Bhatia, Sabhyata

    2016-01-01

    A hallmark trait of chickpea (Cicer arietinum L.), like other legumes, is the capability to convert atmospheric nitrogen (N2) into ammonia (NH3) in symbiotic association with Mesorhizobium ciceri. However, the complexity of molecular networks associated with the dynamics of nodule development in chickpea need to be analyzed in depth. Hence, in order to gain insights into the chickpea nodule development, the transcriptomes of nodules at early, middle and late stages of development were sequenced using the Roche 454 platform. This generated 490.84 Mb sequence data comprising 1,360,251 reads which were assembled into 83,405 unigenes. Transcripts were annotated using Gene Ontology (GO), Cluster of Orthologous Groups (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathways analysis. Differential expression analysis revealed that a total of 3760 transcripts were differentially expressed in at least one of three stages, whereas 935, 117 and 2707 transcripts were found to be differentially expressed in the early, middle and late stages of nodule development respectively. MapMan analysis revealed enrichment of metabolic pathways such as transport, protein synthesis, signaling and carbohydrate metabolism during root nodulation. Transcription factors were predicted and analyzed for their differential expression during nodule development. Putative nodule specific transcripts were identified and enriched for GO categories using BiNGO which revealed many categories to be enriched during nodule development, including transcription regulators and transporters. Further, the assembled transcriptome was also used to mine for genic SSR markers. In conclusion, this study will help in enriching the transcriptomic resources implicated in understanding of root nodulation events in chickpea.

  11. Hepatocellular carcinoma: a clinico pathological study

    International Nuclear Information System (INIS)

    Abbasi, A.; Butt, N.; Bhutto, A.R.; Gulzar, K.; Munir, S.M.

    2010-01-01

    To describe the clinico-pathological and radiological profile of hepatocellular carcinoma. All consecutive patients suspected of having hepatocellular carcinoma (HCC), were admitted and included in this study. Diagnosis of HCC was established by clinical, biochemical, ultrasonographic and histopathologic findings. Patients with primary carcinoma elsewhere in the body, metastatic in the liver, fibrolamellar carcinoma and benign tumours were excluded from the study. At ultrasonography, the details of tumour size and number, portal vein thrombosis and presence of ascites were recorded. Patients were staged according to Okuda staging system. Results were described in mean and percentage values. There were 82 patients with hepatocellular carcinoma including 58 males and 24 females, with male to female ratio of 2.8:1. The mean age of patients was 56.24 +- 13.65 years. Right hypochondrial pain was the main symptom in 52 (63.4%) patients. The duration of symptoms varied from 1 month to 2 years. Tumour size was larger than 50% of liver size in 42 (51.2%) with portal vein thrombosis in 10 (12.19%). Anti HCV was positive in 44 (53.7%), HBsAg in 26 (31.7%) and both were found positive in 2 (2.44%) patients. Ten patients (12.2/%) found negative both for anti-HCV and HBsAg. According to Okuda staging system 18 patients had stage 1, 50 had stage 2 and 14 had stage 3 hepatocellular carcinoma. The mean age of presentation of hepatocellular carcinoma was younger as compared to western countries with potentially large non-resectable lesions. Chronic hepatitis C and B was found to be the major known factors. Patients with chronic hepatitis C and B should undergo vigorous HCC surveillance to detect early, potentially respectable HCC. (author)

  12. Evaluation of thyroid nodules by 123I thyroid scintigraphy and computed tomography

    International Nuclear Information System (INIS)

    Kurihara, Yoshiko; Imanishi, Yoshimasa; Ehara, Norishige

    1991-01-01

    We have already reported that computed tomography (CT) could be used to quantify iodine concentration in the thyroid. Correlation between CT value and iodine concentration in thyroid tissues was represented by the following formula (n=31, r=0.96): iodine concentration=(CT value-65)/104 (mg/g). In this study, we evaluated thyroid nodules by 123 I thyroid scintigraphy and histograms of CT values in the nodules. Radioiodine accumulation and the histograms on CT of the thyroid nodules were correlated with the histopathology of 35 thyroid nodules (22 benign nodules, 13 malignant nodules) of 27 patients. Results showed no definite correlation between radioiodine accumulation in the thyroid nodule and the pattern on CT reflecting iodine concentration in the nodule. Some nodules with little radioiodine accumulation had considerable iodine concentration. Benign thyroid nodules tended to have lower iodine concentration than malignant nodules. Fifteen (94%) of 16 nodules showing only minimal iodine concentration were benign. We conclude that the function and/or differentiation of tumor cells in the thyroid nodule must be evaluated not only radioiodine accumulation in the nodule but also by iodine concentration in the nodule and that thyroid nodules with only minimal iodine concentration are most likely benign. (author)

  13. Genetic variation in nodule size at different sites on the skins of ...

    African Journals Online (AJOL)

    Apart from the limitations evident from these results, the objective measurement of nodules on ostrich skins is tedious when done manually, with little prospect for automation. The number of nodules per dm² (nodule density) was considered within skin sites as an indirect criterion for the improvement of nodule size. However ...

  14. Proteome reference maps of the Lotus japonicus nodule and root

    DEFF Research Database (Denmark)

    Dam, Svend Secher; Dyrlund, Thomas F.; Ussatjuk, Anna

    2014-01-01

    formation mutant (snf1) was determined. From nodules and roots, 780 and 790 protein spots from 2D gels were identified and approximately 45% of the corresponding unique gene accessions were common. Including a previous proteomics set from Lotus pod and seed, the common gene accessions were decreased to 7...... stress level at this developmental stage. In contrast, protein spots corresponding to nodulins such as leghemoglobin, asparagine synthetase, sucrose synthase, and glutamine synthetase were prevalent in red nodules. The distinct biochemical state of nodules was further highlighted by the conspicuous...

  15. File list: Unc.Liv.05.AllAg.Carcinoma,_Hepatocellular [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available Unc.Liv.05.AllAg.Carcinoma,_Hepatocellular mm9 Unclassified Liver Carcinoma, Hepato...cellular http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/Unc.Liv.05.AllAg.Carcinoma,_Hepatocellular.bed ...

  16. File list: His.Liv.10.AllAg.Carcinoma,_Hepatocellular [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available His.Liv.10.AllAg.Carcinoma,_Hepatocellular mm9 Histone Liver Carcinoma, Hepatocellu...lar http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/His.Liv.10.AllAg.Carcinoma,_Hepatocellular.bed ...

  17. Persistent pulmonary subsolid nodules: model-based iterative reconstruction for nodule classification and measurement variability on low-dose CT.

    Science.gov (United States)

    Kim, Hyungjin; Park, Chang Min; Kim, Seong Ho; Lee, Sang Min; Park, Sang Joon; Lee, Kyung Hee; Goo, Jin Mo

    2014-11-01

    To compare the pulmonary subsolid nodule (SSN) classification agreement and measurement variability between filtered back projection (FBP) and model-based iterative reconstruction (MBIR). Low-dose CTs were reconstructed using FBP and MBIR for 47 patients with 47 SSNs. Two readers independently classified SSNs into pure or part-solid ground-glass nodules, and measured the size of the whole nodule and solid portion twice on both reconstruction algorithms. Nodule classification agreement was analyzed using Cohen's kappa and compared between reconstruction algorithms using McNemar's test. Measurement variability was investigated using Bland-Altman analysis and compared with the paired t-test. Cohen's kappa for inter-reader SSN classification agreement was 0.541-0.662 on FBP and 0.778-0.866 on MBIR. Between the two readers, nodule classification was consistent in 79.8 % (75/94) with FBP and 91.5 % (86/94) with MBIR (p = 0.027). Inter-reader measurement variability range was -5.0-2.1 mm on FBP and -3.3-1.8 mm on MBIR for whole nodule size, and was -6.5-0.9 mm on FBP and -5.5-1.5 mm on MBIR for solid portion size. Inter-reader measurement differences were significantly smaller on MBIR (p = 0.027, whole nodule; p = 0.011, solid portion). MBIR significantly improved SSN classification agreement and reduced measurement variability of both whole nodules and solid portions between readers. • Low-dose CT using MBIR algorithm improves reproducibility in the classification of SSNs. • MBIR would enable more confident clinical planning according to the SSN type. • Reduced measurement variability on MBIR allows earlier detection of potentially malignant nodules.

  18. Nodule-Enriched GRETCHEN HAGEN 3 Enzymes Have Distinct Substrate Specificities and Are Important for Proper Soybean Nodule Development

    Directory of Open Access Journals (Sweden)

    Suresh Damodaran

    2017-11-01

    Full Text Available Legume root nodules develop as a result of a symbiotic relationship between the plant and nitrogen-fixing rhizobia bacteria in soil. Auxin activity is detected in different cell types at different stages of nodule development; as well as an enhanced sensitivity to auxin inhibits, which could affect nodule development. While some transport and signaling mechanisms that achieve precise spatiotemporal auxin output are known, the role of auxin metabolism during nodule development is unclear. Using a soybean root lateral organ transcriptome data set, we identified distinct nodule enrichment of three genes encoding auxin-deactivating GRETCHEN HAGEN 3 (GH3 indole-3-acetic acid (IAA amido transferase enzymes: GmGH3-11/12, GmGH3-14 and GmGH3-15. In vitro enzymatic assays showed that each of these GH3 proteins preferred IAA and aspartate as acyl and amino acid substrates, respectively. GmGH3-15 showed a broad substrate preference, especially with different forms of auxin. Promoter:GUS expression analysis indicated that GmGH3-14 acts primarily in the root epidermis and the nodule primordium where as GmGH3-15 might act in the vasculature. Silencing the expression of these GH3 genes in soybean composite plants led to altered nodule numbers, maturity, and size. Our results indicate that these GH3s are needed for proper nodule maturation in soybean, but the precise mechanism by which they regulate nodule development remains to be explained.

  19. Fossil manganese nodules from Timor: geochemical and radiochemical evidence for deep-sea origin

    International Nuclear Information System (INIS)

    Margolis, S.V.; Fein, C.D.; Glasby, G.P.; Audley-Charles, M.G.

    1978-01-01

    Fossil Mn nodules of Cretaceous age from western Timor exhibit chemical, structural and radioisotope compositions consistent with their being of deep-sea origin. These nodules show characteristics similar to nodules now found at depths of 3,500-5,000 m in the Pacific and Indian Oceans. Slight differences in the fine structure and chemistry of these nodules and modern deep-sea nodules are attributed to diagenetic alteration after uplift of enclosing sediments

  20. The Indian Ocean nodule field: Geology and resource potential

    Digital Repository Service at National Institute of Oceanography (India)

    Mukhopadhyay, R.; Ghosh, A; Iyer, S.D.

    This book briefly accounts for the physiography, geology, biology, physics and chemistry of the nodule field, and discusses in detail the aspects of structure, tectonic and volcanism in the field. The role of the ocean floor sediment that hosts...

  1. Scripps Institution of Oceanography Ferromanganese Nodule Analysis File - IDOE Portion

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Scripps Institution of Oceanography (SIO) compiled data on the geochemistry of marine ferromanganese nodules, funded by the U.S. National Science Foundation...

  2. Manganese nodules in the Exclusive Economic Zone of Mauritius

    Digital Repository Service at National Institute of Oceanography (India)

    Nath, B.N.; ShyamPrasad, M.

    The distribution of manganese nodules in the Exclusive Economic Zone of the island nation Mauritius was delineated during cruise SK-35 of ORV Sagar Kanya in 1987. The areas surveyed included Saya de Malha and Nazareth Banks, the Cargados Carajos...

  3. Development of manganese nodule resources in the Central Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Sharma, R.

    Resources evalution on grade and abundance of nodules using statistical methods for grab samples and photography data, combined with bathymetric and structural mapping, were carried out for delineation of the potential area of Central Indian Ocean...

  4. Initial results of India's environmental impact assessment of nodule mining

    Digital Repository Service at National Institute of Oceanography (India)

    Desa, E.

    The Indian Deepsea Experiment (INDEX) was intiated in 1995, with the objective of predicting the environmental impact of nodule mining, in the Central Indian Basin. More than 20 scientists and technical staff of the National Institute...

  5. Germination, growth and nodulation of Trigonella foenum graecum ...

    African Journals Online (AJOL)

    STORAGESEVER

    2009-06-03

    Jun 3, 2009 ... In this work, we analyzed the effects of salinity on seed germination, growth and nodulation of fenugreek ..... metabolic activities in function, such as the accumulation .... stress: possible role of trehalose in osmoregulation. Lett.

  6. India's manganese nodule mine site in the Central Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Banakar, V.K.

    This commentary highlights the activities of massive exploration programme for manganese nodule deposits in the Central Indian Basin located 5 km below the ocean surface and India's claim for mine site development and registration with UNCLOS...

  7. Ferromanganese nodules from the Central Indian Ocean Basin

    Digital Repository Service at National Institute of Oceanography (India)

    Jauhari, P.; Pattan, J.N.

    In order to delineate a mine site for ferromanganese nodules, extensive surveys were conducted in Central Indian Ocean Basin. Mapping of the basin by multibeam swath bathymetry (Hydrosweep) has revealed many new bottom relief features...

  8. Undercooling and nodule count in thin walled ductile iron castings

    DEFF Research Database (Denmark)

    Pedersen, Karl Martin; Tiedje, Niels Skat

    2007-01-01

    Casting experiments have been performed with eutectic and hypereutectic castings with plate thicknesses from 2 to 8 mm involving both temperature measurements during solidification and microstructural examination afterwards. The nodule count was the same for the eutectic and hypereutectic casting...

  9. Genesis and growth of internal microstructures of manganese nodule

    Digital Repository Service at National Institute of Oceanography (India)

    Banakar, V.K.; Tarkian, M.

    tension of the 2 adjacent colloidal precipitate surfaces which have a tendency to grow into a spheroid, probably similar to phenomenon of drop formation. Detrital components within the nodule material identified include heavy titanium minerals, viz...

  10. The aluminosilicate fraction of North Pacific manganese nodules

    Science.gov (United States)

    Bischoff, J.L.; Piper, D.Z.; Leong, K.

    1981-01-01

    Nine nodules collected from throughout the deep North Pacific were analyzed for their mineralogy and major-element composition before and after leaching with Chester-Hughes solution. Data indicate that the mineral phillipsite accounts for the major part (> 75%) of the aluminosilicate fraction of all nodules. It is suggested that formation of phillipsite takes place on growing nodule surfaces coupled with the oxidation of absorbed manganous ion. All the nodules could be described as ternary mixtures of amorphous iron fraction (Fe-Ti-P), manganese oxide fraction (Mn-Mg Cu-Ni), and phillipsite fraction (Al-Si-K-Na), these fractions accounting for 96% of the variability of the chemical composition. ?? 1981.

  11. Promise and pitfalls of molecular markers of thyroid nodules

    Science.gov (United States)

    Jadhav, S.; Lila, Anurag; Bandgar, Tushar; Shah, Nalini

    2012-01-01

    Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG) and fine needle aspiration biopsy (FNAB). The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly being studied for their diagnostic utility in assessing thyroid nodules. The various molecular markers consist of gene mutations, gene re arrangements, RNA based assays and immunohistochemical markers. The molecular markers definitely would help to optimise the management of such patients. PMID:23565369

  12. Promise and pitfalls of molecular markers of thyroid nodules

    Directory of Open Access Journals (Sweden)

    S Jadhav

    2012-01-01

    Full Text Available Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG and fine needle aspiration biopsy (FNAB. The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly being studied for their diagnostic utility in assessing thyroid nodules. The various molecular markers consist of gene mutations, gene re arrangements, RNA based assays and immunohistochemical markers. The molecular markers definitely would help to optimise the management of such patients.

  13. Radiographic test phantom for computed tomographic lung nodule analysis

    International Nuclear Information System (INIS)

    Zerhouni, E.A.

    1987-01-01

    This patent describes a method for evaluating a computed tomograph scan of a nodule in a lung of a human or non-human animal. The method comprises generating a computer tomograph of a transverse section of the animal containing lung and nodule tissue, and generating a second computer tomograph of a test phantom comprising a device which simulates the transverse section of the animal. The tissue simulating portions of the device are constructed of materials having radiographic densities substantially identical to those of the corresponding tissue in the simulated transverse section of the animal and have voids therein which simulate, in size and shape, the lung cavities in the transverse section and which contain a test reference nodule constructed of a material of predetermined radiographic density which simulates in size, shape and position within a lung cavity void of the test phantom the nodule in the transverse section of the animal and comparing the respective tomographs

  14. Peritoneal carcinomatosis: an unusual presentation of fibrolamellar hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Vicente, R.; Garcia-Gutierrez, J. A.; Fernandez, A.; Santalla, F.

    2001-01-01

    Fibrolamellar hepatocellular carcinoma is an uncommon malignant tumor with characteristic clinical, radiological and histopathological features that is usually associated with a more favorable natural course and greater survival than more common variants of hepatocellular carcinoma. We describe an atypical case of a fibrolamellar hepatocellular carcinomas sowing aggressive behaviour in a 20-year-old woman. The lesion presented with massive ascites, and imaging studies revealed extensive peritoneal metastatic spread. (Author) 8 refs

  15. Effect of transarterial chemoembolization with miriplatin plus epirubicin on local control of hepatocellular carcinoma: a retrospective comparison with miriplatin monotherapy

    Directory of Open Access Journals (Sweden)

    Hashimoto N

    2013-08-01

    Full Text Available Naoko Hashimoto,1 Jin Iwazawa,1 Shoichi Ohue,2 Takashi Mitani11Department of Radiology, Nissay Hospital, Nishiku, Osaka, Japan; 2Department of Radiology, Komatsu Hospital, Neyagawa, JapanObjective: We aimed to evaluate local tumor control after transarterial chemoembolization (TACE for hepatocellular carcinoma using miriplatin and low-dose epirubicin combination therapy.Methods: We retrospectively analyzed the records of patients who underwent TACE using miriplatin plus low-dose epirubicin (30 patients, 61 nodules, August 2011–March 2012 and control patients who underwent TACE using miriplatin alone (36 patients, 70 nodules, June 2010–July 2011. The local control rate was compared between the two groups using the Kaplan–Meier estimator and the log-rank test. Factors affecting local tumor recurrence were analyzed using multivariate logistic regression analysis. Treatment-related toxicity was evaluated using the Common Terminology Criteria for Adverse Events.Results: The local control rates at 6 months and 1 year were 87% and 65% for the miriplatin plus low-dose epirubicin group, and 61% and 43% for the miriplatin group, respectively. Local tumor control rates were significantly better in the miriplatin plus low-dose epirubicin group than in the miriplatin group (P = 0.038. Multivariate analysis showed that the addition of epirubicin was an independent factor associated with better local tumor control (hazard ratio 0.2, P = 0.001. Overall incidence rates for adverse events were not significantly different between the two groups.Conclusion: Additional usage of low-dose epirubicin for TACE using miriplatin improved local tumor control of hepatocellular carcinoma with adverse effects comparable to those observed with TACE using miriplatin alone.Keywords: combination therapy, local recurrence, liver, embolization, comparative study

  16. Assessment of arterial hypervascularity of hepatocellular carcinoma: comparison of contrast-enhanced US and gadoxetate disodium-enhanced MR imaging

    International Nuclear Information System (INIS)

    Sugimoto, Katsutoshi; Moriyasu, Fuminori; Taira, Junichi; Imai, Yasuharu; Shiraishi, Junji; Saito, Kazuhiro; Saguchi, Toru

    2012-01-01

    To compare contrast-enhanced (CE) ultrasound with gadoxetate disodium-enhanced magnetic resonance (MR) imaging in the assessment of arterial hypervascularity of hepatocellular carcinoma (HCC) and dysplastic nodule (DN), with CT during hepatic arteriography (CTHA) as the reference standard. This study included 54 consecutively diagnosed patients, with 57 histologically confirmed HCCs and 3 DNs (high-grade). All patients underwent CE ultrasound, gadoxetate disodium-enhanced MR imaging and CTHA. Two trained diagnostic radiologists interpreted the CTHA images and rated the degree of intratumoral arterial vascularity by consensus using a five-point confidence scale as the reference standard. In the observer study, the degrees of vascularity on CE ultrasound and gadoxetate disodium-enhanced MR images were qualitatively analysed by four independent readers using a five-point confidence scale. Diagnostic accuracy was analysed by receiver-operating characteristic (ROC) analysis. The diagnostic accuracies of the average area under the ROC curve (AUC) were significantly greater with CE ultrasound (average AUC: 0.94; 95% confidence interval [CI]: 0.88-1.00) than with gadoxetate disodium-enhanced MR imaging (average AUC 0.84, 95% CI 0.74-0.93, P = 0.0014). Contrast-enhanced ultrasound yields a significantly higher AUC value than gadoxetate disodium-enhanced MR imaging in the assessment of arterial hypervascularity of HCC and DN. Key Points circle Arterial hypervascularity is an important feature determining treatment options in hepatocellular carcinoma. circle It can be assessed by contrast-enhanced (CE) ultrasound or magnetic resonance (MR) imaging. circle CE ultrasound was more accurate than Gd-EOB-DTPA MRI in assessing intratumoral vascularity. circle Hypovascular hepatic nodules should be further investigated using CE ultrasound. (orig.)

  17. Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules.

    Science.gov (United States)

    Ambrogi, Marcello Carlo; Melfi, Franca; Zirafa, Carmelina; Lucchi, Marco; De Liperi, Annalisa; Mariani, Giuliano; Fanucchi, Olivia; Mussi, Alfredo

    2012-04-01

    The demand for adequate tissue sampling to determine individual tumor behavior is increasing the number of lung nodule resections, even when the diagnosis is already recognized. Video-assisted thoracic surgery (VATS) is the procedure of choice for diagnosis and treatment of small pulmonary nodules. Difficulties in localizing smaller and deeper nodules have been approached with different techniques. Herein we report our 13-years' experience with radio-guided thoracoscopic resection. Patients with pulmonary nodules smaller than 1 cm and/or deeper than 1 cm, below the visceral pleura, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml (99)Tc-labeled human serum albumin microspheres and 0.1 ml nonionic contrast, into the nodule. During the VATS procedure, an 11-mm-diameter collimated probe connected to a gamma ray detector was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected. From 1997 to 2009, 573 patients underwent thoracoscopic resection of small pulmonary nodules, 211 with the radio-guided technique. There were 159 men and 52 women, with an average age of 60.6 years (range = 12-83). The mean duration of the surgical procedure was 41 min (range = 20-100). The procedure was successful in 208/211 cases. Three patients (0.5%) required conversion to a minithoracotomy. The mean length of pleural drainage and hospital stay was 2.3 and 3.7 days, respectively. Histological examination showed 98 benign lesions and 113 malignant lesions (61 metastases and 52 primary lung cancers). This study confirms that radio-guided localization of small pulmonary nodules is a feasible, safe, and quick procedure, with a high rate of success. The spread of the sentinel lymph node technique has increased the availability of technology required for RGTS.

  18. Multiple Pulmonary Nodules in an Immunocompetent Adolescent with Infectious Mononucleosis.

    Science.gov (United States)

    Bhaskaran, Praveena Nediyara; Puliyel, Mammen; Myers, Melissa; Abughali, Nazha

    2018-02-15

    Infectious mononucleosis is usually a self-limiting illness, but can be rarely associated with complications. A 17-year-old boy with Epstein-Barr virus related infectious mononucleosis and cold antibody-mediated autoimmune hemolytic anemia with incidentally noted multiple pulmonary nodules. Nodules regressed over the next few weeks without specific therapy. Pediatricians need to be aware of this rare clinical presentation of infectious mononucleosis so that further invasive testing can be avoided.

  19. Subcentimeter Pulmonary Nodules Detected in Patients with Sarcoma

    Directory of Open Access Journals (Sweden)

    Michelle S. Ginsberg

    2000-01-01

    Full Text Available Background. Subcentimeter pulmonary nodules are being detected with increasing frequency in patients with sarcoma due to the greater use of chest CT, the advent of helical (spiral CT scanning and multidetector scanners, and the attendant decrease in image section thickness.Assessing the clinical significance of these pulmonary nodules is of particular importance in sarcoma patients, due to the frequent occurrence of pulmonary metastasis from sarcomas.

  20. Indian exploration for polymetallic nodules in the central Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    ShyamPrasad, M.

    measuring 18,400 km 2 has been earmarked for this purpose wherein close-grid sampling, detailed resource evaluation, and high resolution mapping is being carried out. While the abundance of nodules and grades are now known in all the allocated areas... by the Glomar Challenger expedition. The nodules were christened ‘manganese nodules’ in view of the largest component being manganese. However, since it was discovered that they contain many more important metals (although in lower percentages) the term...

  1. Effect of Bradyrhizobium photosynthesis on stem nodulation of Aeschynomene sensitiva

    OpenAIRE

    Giraud, Eric; Hannibal, Laure; Fardoux, Joël; Verméglio, A.; Dreyfus, Bernard

    2000-01-01

    Some leguminous species of the genus #Aeschynomene$ are specifically stem-nodulated by photosynthetic bradyrhizobia. To study the effect of bacterial photosynthesis during symbiosis, we generated a photosynthesis-negative mutant of the #Bradyrhizobium$ sp. strain ORS278 symbiont of #Aeschynomene sensitiva$. The presence of a functional photosynthetic unit in bacterioids and the high expression of the photosynthetic genes observed in stem nodules demonstrate that the bacteria are photosyntheti...

  2. Pulmonary Nodules with Cutaneous Manifestations: A Case Report and Discussion

    Directory of Open Access Journals (Sweden)

    Ardiles T

    2012-04-01

    Full Text Available The differential diagnosis of multiple pulmonary nodules is large and includes congenital and inherited disorders, malignancy, infectious etiologies, noninfectious granulomatous and inflammatory conditions,among many others. Diagnostic evaluation is aided by attention to extrapulmonary symptoms and features. We herein describe an unusual case of multiple pulmonary nodules attributed to cysticercosis and present a discussion of pathophysiologic changes related to medications and highlight the diagnostic value of extrapulmonary cutaneous features.

  3. Diagnostic Approaches to Metastatic Hepatocellular Carcinoma of the Orbit.

    Science.gov (United States)

    Geske, Michael J; Bloomer, Michele M; Kersten, Robert C; Vagefi, M Reza

    Orbital metastasis of hepatocellular carcinoma is exceedingly rare and caries a grave prognosis. Three cases of metastatic orbital hepatocellular carcinoma in which the primary tumor was initially unknown and the diagnostic challenges encountered are presented. With hepatocellular carcinoma, open biopsy and palliative tumor debulking has an increased bleeding risk due to the highly vascular nature of the tumor and coagulopathy associated with chronic liver disease. As an alternative, fine needle aspiration biopsy should be considered for hepatocellular carcinoma with a readily accessible mass and the availability of an experienced cytopathologist.

  4. Research progress of vascular change after TACE in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kang Zhen; Xiao Enhua

    2013-01-01

    Mortality rate of hepatocellular carcinoma is high. The majority of the patients are diagnosed in advanced stage and lose surgical opportunities. Many studies have reported transcatheter arterial chemoembolization (TACE) is an effective treatment for unresectable hepatocellular carcinoma, and recommended TACE as a standard treatment for hepatocellular carcinoma of Barcelona Clinical Liver Cancer staging (BCLC staging) B. However, TACE can hardly fully embolize tumor blood supply, TACE postoperative hemodynamics and angiogenesis can induce tumor recurrence and metastasis. This paper reviewed characteristics of vascular changes, mechanisms, diagnosis and treatment methods, new progress in the field of hepatocellular carcinoma after TACE. (authors)

  5. Computed tomography diagnosis of hepatocellular carcinoma rupture haemorrhage

    International Nuclear Information System (INIS)

    Zhi Weike; Jiang Bin; Liu Jinquan; Li Sixia; Zhu Zhichang

    2004-01-01

    Objective: To evaluate the diagnostic value of hepatocellular carcinoma rupture hemorrhage using Computed Tomography. Methods: Six cases diagnosed hepatocellular carcinoma rupture hemorrhage were analyzed by morphic and histologic method and investigated the key point of scan in diagnosis. Result: The correct rate of hepatocellular carcinoma rupture hemorrhage by Computed Tomography is above 83 percent, it characteristic representation is strip and would high-density shadow after enhancement. Conclusion: The characteristic representation of hepatocellular carcinoma rupture hemorrhage is attain by Computed Tomography, which provides effective operation evidences for clinical operation. (authors)

  6. On the computed tomographic diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Higashi, Yuuichirou

    1988-01-01

    Computed tomography (CT) was used to examine 53 pulmonary nodules which were considered not definitely calcified on plain radiographs or conventional tomograms. An average CT number was calculate for each lesion. For the primary lung cancers, the average CT number was 36 HU with a standard deviation of 6.6 HU, while the benign lesions had the mean CT number of 69 HU, with a standard deviation of 42.8 HU. The mean CT number separating lung malignancies from benign lesions was 78.8 HU. To evaluate the attenuation values within each nodule, iso-CT value map was obtained by using Siemens therapy planning system, MEVAPLAN. Nodules were classified into five categories, Type I to V. All of three nodules classified as Type IV were benign. Iso-CT value map was effective in establishing the benignancy of nodules. The quantitative computed tomographic analysis of pulmonary nodules was evaluated by dual-energy CT. Dual-energy CT has the potential to eliminate the effect of spectral hardening by use of monoenergic images derived from dual-kV data and to separate high CT numbers due to calcium from those due to high density organic material. (author)

  7. Benign and malignant thyroid nodules after neck irradiation

    International Nuclear Information System (INIS)

    Fjaelling, M.T.; Tisell, L.E.; Carlsson, S.; Hansson, G.; Lundberg, L.M.; Oden, A.

    1986-01-01

    A total of 444 persons were examined for the presence of thyroid nodules on average of 43 years after having been treated with x-rays for cervical tuberculous adenitis. Of this total, 101 subjects had undergone surgery for thyroid nodules: 25 for carcinoma (6%) and 76 for benign nodules (17%). Carcinoma occurred with the same frequency in multinodular and uninodular glands. Because of the uneven age distribution in the current series, it could not be decided whether there was a higher susceptibility of the young thyroid to the induction of thyroid carcinoma or benign nodules. The dosage range for the whole series was 0.40 to 50.90 Gy (40-5090 rad). There was a positive correlation between the absorbed radiation dose and the probability of developing benign and malignant thyroid nodules, even after doses of 20 Gy or more. The risk of developing thyroid carcinoma was equal for men and women, while the female-to-male ratio for benign nodules was 2.9:1, indicating that risk factors associated with females are of less importance in irradiated than in nonirradiated populations. The median latency for carcinoma was 40 years, suggesting that the increased risk of thyroid carcinoma after irradiation remains for the rest of the patient's life

  8. Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules.

    Science.gov (United States)

    Tarantino, L; Giorgio, A; Mariniello, N; de Stefano, G; Perrotta, A; Aloisio, V; Tamasi, S; Forestieri, M C; Esposito, F; Esposito, F; Finizia, L; Voza, A

    2000-01-01

    To verify the effectiveness of percutaneous ethanol injection (PEI) in the treatment of large (>30-mL) hyperfunctioning thyroid nodules. Twelve patients (eight women, four men; age range, 26-76 years) with a large hyperfunctioning thyroid nodule (volume range, 33-90 mL; mean, 46.08 mL) underwent PEI treatment under ultrasonographic (US) guidance. US was used to calculate the volume of the nodules and to assess the diffusion of the ethanol in the lesions during the procedure. When incomplete necrosis of the nodule was depicted at scintigraphy performed 3 months after treatment, additional PEI sessions were performed. Four to 11 PEI sessions (mean, seven) were performed in each patient, with an injection of 3-14 mL of 99.8% ethanol per session (total amount of ethanol per patient, 30-108 mL; mean, 48.5 mL). At scintigraphy after treatment in all patients, recovery of extranodular uptake, absence of uptake in the nodule, and normalization of thyroid-stimulating hormone (thyrotropin) levels were observed. In all patients, US showed volume reductions of 30%-50% after 3 months and 40%-80% after 6-9 months. Side effects were self-limiting in all patients. During the 6-48-month follow-up, no recurrence was observed. PEI is an effective and safe technique for the treatment of large hyperfunctioning thyroid nodules.

  9. Survey of management of solitary thyroid nodules in Germany.

    Science.gov (United States)

    Dietlein, M; Wegscheider, K; Vaupel, R; Schmidt, M; Schicha, H

    2008-01-01

    To compare the opinions of practitioners in primary care with those of thyroid specialists in Germany on the management of solitary thyroid nodules (Papillon 2005). Questionnaires were filled in by 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The test cases and their modifications described a solitary thyroid nodule of 2-3 cm with different levels of thyroid function and a hypoechogenic nodule of 1 cm in diameter. TSH determination and sonography were found to be standard procedures, followed by scintigraphy (selected by 84.7% of practitioners and 95.1% of specialists, p nodule calcitonin determination was advocated by 54.0% of endocrinologists and by 32.2% of nuclear medicine physicians (p thyroid nodule would be treated medically by 77.8% of practitioners and by 85.7% of specialists, the combination of levothyroxine and iodine being clearly preferred (60.9% of practitioners and 67.1% of specialists). For a hyperfunctioning nodule the preference of radioiodine therapy was significantly higher in the specialist group (88.8%) than among the practitioners (52.2%). The main differences of opinion between practitioners and specialists focused on calcitonin screening and referral to radioiodine therapy.

  10. Relation between nodule size and 18F-FDG-PET SUV for malignant and benign pulmonary nodules.

    Directory of Open Access Journals (Sweden)

    Shao Yiping

    2008-09-01

    Full Text Available Abstract The most common semiquantitative method of evaluation of pulmonary lesions using 18F-FDG PET is FDG standardized uptake value (SUV. An SUV cutoff of 2.5 or greater has been used to differentiate between benign and malignant nodules. The goal of our study was to investigate the correlation between the size of pulmonary nodules and the SUV for benign as well as for malignant nodules. Methods Retrospectively, 173 patients were selected from 420 referrals for evaluation of pulmonary lesions. All patients selected had a positive CT and PET scans and histopathology biopsy. A linear regression equation was fitted to a scatter plot of size and SUVmax for malignant and benign nodules together. A dot diagram was created to calculate the sensitivity, specificity, and accuracy using an SUVmax cutoff of 2.5. Results The linear regression equations and (R2s as well as the trendlines for malignant and benign nodules demonstrated that the slope of the regression line is greater for malignant than for benign nodules. Twenty-eight nodules of group one (≤ 1.0 cm are plotted in a dot diagram using an SUVmax cutoff of 2.5. The sensitivity, specificity, and accuracy were calculated to be 85%, 36% and 54% respectively. Similarly, sensitivity, specificity, and accuracy were calculated for an SUVmax cutoff of 2.5 and found to be 91%, 47%, and 79% respectively for group 2 (1.1–2.0 cm; 94%, 23%, and 76%, respectively for group 3 (2.1–3.0 cm; and 100%, 17%, and 82%,, respectively for group 4 (> 3.0 cm. The previous results of the dot diagram indicating that the sensitivity and the accuracy of the test using an SUVmax cutoff of 2.5 are increased with an increase in the diameter of pulmonary nodules. Conclusion The slope of the regression line is greater for malignant than for benign nodules. Although, the SUVmax cutoff of 2.5 is a useful tool in the evaluation of large pulmonary nodules (> 1.0 cm, it has no or minimal value in the evaluation of small

  11. Radio-embolization for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Raoul, J.L.; Edeline, J.; Pracht, M.; Boucher, E.; Rolland, Y.; Garin, E.

    2011-01-01

    Hepatocellular carcinoma is now a major public health concern. In intermediate stages (one third of hepatocellular carcinoma patients), chemo-embolization is the standard of care despite a poor tolerance and a moderate efficacy. Moreover, despite recent improvements, this technique seems in a dead end. Radio-embolization could be an excellent tool for such patients. Currently 131 I-Lipiodol, 188 Re-Lipiodol, 90 Y-glass or resin microspheres are available. More recent and promising data come from microspheres, but phase II and III studies are needed before drawing any conclusion. In the future, the combination of radio-embolization with systemic chemotherapy or targeted agents (particularly anti-angiogenic drugs) seems very promising. (authors)

  12. The Role of Nuclear Medicine in The Diagnosis and Management of Solitary Pulmonary Nodules

    Directory of Open Access Journals (Sweden)

    Farzaneh Shariati

    2013-10-01

    Full Text Available   Solitary pulmonary nodule (SPN is a frequent finding on the chest x-ray and computed tomography. Nuclear medicine techniques play an important role in the diagnosis and management of SPN. In the current review, we briefly will explain the different nuclear medicine modalities in this regard including positron emission tomography (PET using 18-F-FDG, and 11-C-Methionine, and single photon emission computerized tomography (SPECT using somatostatin receptor scintigraphy, 201-Thallium, and 99m-Tc-MIBI.  

  13. Competitive nodulation blocking of cv. Afghanistan pea is related to high levels of nodulation factors made by some strains of Rhizobium leguminosarum bv. viciae

    NARCIS (Netherlands)

    Hogg, B.; Davies, A.E.; Wilson, K.E.; Bisseling, T.; Downie, J.A.

    2002-01-01

    Cultivar Afghanistan peas are resistant to nodulation by many strains of Rhizobium leguminosarum bv. viciae but are nodulated by strain TOM, which carries the host specificity gene nodX. Some strains that lack nodX can inhibit nodulation of cv. Afghanistan by strain TOM. We present evidence that

  14. Comparison of the nodule vs. root transcriptome of the actinorhizal plant Datisca glomerata: actinorhizal nodules contain a specific class of defensins.

    Directory of Open Access Journals (Sweden)

    Irina V Demina

    Full Text Available Actinorhizal root nodule symbioses are very diverse, and the symbiosis of Datisca glomerata has previously been shown to have many unusual aspects. In order to gain molecular information on the infection mechanism, nodule development and nodule metabolism, we compared the transcriptomes of D. glomerata roots and nodules. Root and nodule libraries representing the 3'-ends of cDNAs were subjected to high-throughput parallel 454 sequencing. To identify the corresponding genes and to improve the assembly, Illumina sequencing of the nodule transcriptome was performed as well. The evaluation revealed 406 differentially regulated genes, 295 of which (72.7% could be assigned a function based on homology. Analysis of the nodule transcriptome showed that genes encoding components of the common symbiosis signaling pathway were present in nodules of D. glomerata, which in combination with the previously established function of SymRK in D. glomerata nodulation suggests that this pathway is also active in actinorhizal Cucurbitales. Furthermore, comparison of the D. glomerata nodule transcriptome with nodule transcriptomes from actinorhizal Fagales revealed a new subgroup of nodule-specific defensins that might play a role specific to actinorhizal symbioses. The D. glomerata members of this defensin subgroup contain an acidic C-terminal domain that was never found in plant defensins before.

  15. Diagnostic procedures of the solitary pulmonary nodule

    International Nuclear Information System (INIS)

    Aoe, Keisuke; Hiraki, Akio; Kohara, Hiroyuki

    2003-01-01

    The spread of computed tomography (CT) brought the frequent further examinations of the solitary pulmonary nodules (SPN). To aim the evaluation of initial data on examinations of SPN for differential diagnosis, we studied retrospective cases. Thirty-one cases of SPN less than 20 mm in diameter were compared in clinical findings and CT image findings and were examined the diagnostic procedures in recent three years in National Sanyo Hospital. The 31 patients consisted of 14 males and 17 females ranging 44 to 79 years old, median 65 years old. The causes of SPN were lung cancer (11 patients), cryptococcosis (4 patients), tuberculoma (3 patients), non-tuberculous mycobacteria (2 patients), pneumoconiosis (2 patients), pneumonia scar (one patient), hamartoma (one patient), and unknown (7 patients). There were no significant differences in laboratory findings between lung cancer and the others. CT findings showed significant differences in four categories. All patients underwent fiberoptic bronchoscopy (FB) examinations and 12 patients were determined the diagnosis initial FB. Five patients were established their diagnosis using videoassociated thoracoscopic surgeries. (author)

  16. Increased thyrotropin binding in hyperfunctioning thyroid nodules.

    Science.gov (United States)

    Müller-Gärtner, H W; Schneider, C; Bay, V; Tadt, A; Rehpenning, W; de Heer, K; Jessel, M

    1987-08-01

    The object of this study was to investigate TSH receptors in hyperfunctioning thyroid nodules (HFN). In HFN, obtained from seven patients, 125-I-TSH binding as determined by equilibrium binding analysis on particulate membrane preparations, was found to be significantly increased as compared with normal thyroid tissues (five patients; P less than 0.001). Scatchard analysis of TSH-binding revealed two kinds of binding sites for both normal thyroid tissue and HFN, and displayed significantly increased association constants of high- and low-affinity binding sites in HFN (Ka = 11.75 +/- 6.8 10(9) M-1, P less than 0.001 and Ka = 2.1 +/- 1.0 10(7) M-1, P less than 0.025; x +/- SEM) as compared with normal thyroid tissue (Ka = 0.25 +/- 0.06 10(9) M-1, Ka = 0.14 +/- 0.03 10(7) M-1; x +/- SEM). The capacity of the high-affinity binding sites in HFN was found to be decreased (1.8 +/- 1.1 pmol/mg protein, x +/- SEM) in comparison with normal thyroid tissue (4.26 +/- 1.27 pmol/mg protein; x +/- SEM). TSH-receptor autoradiography applied to cryostatic tissue sections confirmed increased TSH binding of the follicular epithelium in HFN. These data suggest that an increased affinity of TSH-receptor sites in HFN in iodine deficient areas may be an important event in thyroid autonomy.

  17. Three-dimensional display by computer graphics method of hepatocellular carcinoma using seen with the hepatic arteriogram

    International Nuclear Information System (INIS)

    Itsubo, Mariko; Kameda, Haruo; Suzuki, Naoki; Okamura, Tetsuo

    1989-01-01

    The method of three-dimensional display of hepatocellular carcinoma using conventional hepatic arteriogram by computer graphics method was newly exploited and applied in clinical use. Three-dimensional models were reconstructed from contour lines of tumors demonstrated as hypervascular lesions by hepatic arteriography. Although objects were limited by angiographic images in which tumors need to be demonstrated as nodules with hypervascularity, this method of three-dimensional display was not worse on accuracy than that using computed tomographic images. According to this method property of the tumor expressed by vascularity was demonstrated clear and in addition volume of the tumor was calculated easily. When the tumor arose in necrotic changes in which demonstrated as a vascular lesion by hepatic arteriography with reduction of size in usual by conservative treatment such as transcathter arterial embolization therapy, this three-dimensional display was able to demonstrate such changes clear. This preliminary study demonstrates the feasibility and clinical usefulness of three-dimensional display of hepatocellular carcinoma using hepatic arteriogram by computer graphics method. (author)

  18. Hepatocellular Carcinoma after Sustained Viral Response to Interferon and Ribavirin Therapy in Cirrhosis Secondary to Chronic Hepatitis C

    International Nuclear Information System (INIS)

    Khokhar, N.; Qureshi, M.U.; Niazi, T.K.

    2013-01-01

    Objective: To determine the frequency of development of hepatocellular carcinoma in patients with chronic liver disease secondary to hepatitis C who had achieved sustained virological response with Interferon and Ribavirin therapy. Study Design: Retrospective descriptive study. Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, from January 2007 to January 2012. Methodology: Hepatitis C related chronic liver disease patients who were treated with interferon and ribavirin, after they achieved sustained virological response, they were followed for a mean of 42 A+- 17 months. During this time, development of hepatocellular carcinoma was ascertained. All underwent surveillance with alpha-feto-protein and ultrasonography every 6 months. Results: Out of the 58 patients who had achieved sustained virological response, 3 developed hepatocellular carcinoma after a mean follow-up of 38 A+- 14 months. It was multifocal in 2 cases and was single lesion in the 3rd. Two patients ultimately died, one with upper GI bleeding and the other with hepatic encephalopathy, while 3rd patient with single lesion is still surviving. Conclusion: Three out of 58 patients of hepatitis C related chronic liver disease developed hepatocellular carcinoma during follow-up in patients who had achieved sustained virological response. These patients need closer follow-up, for development of complications, even if they have achieved sustained viral response. (author)

  19. Serum immunoreactive calcitonin concentration in hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Dugard, J; Kew, M C; Da Fonseca, M; Levin, J [University of the Witwatersrand, Johannesburg (South Africa)

    1982-08-21

    Having found raised serum calcitonin concentrations in 94% of patients with hepatocellular carcinoma when using a dextran-coated-charcoal radio-immunoassay, we have now repeated the study, using a double-antibody radio-immunoassay, in 102 further patients with hepatocellular carcinoma and 35 matched controls. Serum immunoreactive calcitonin concentrations (iCT) in the controls ranged from 10 to 310 pg/ml (mean 154,6 pg/ml). Values in the tumour patients ranged from 10 to 1,650 pg/ml (mean 302,6 pg/ml). The mean figures were significantly higher in the tumour patients (P smaller than 0,001), 35.5% of them having values above 310 pg/ml. In 65 of the patients serum iCT concentrations were also determined by dextran-coated-charcoal radio-immunoassay. Values ranged from 10 to 10780 pg/ml (mean 2,179 pg/ml). If 1,000 pg/ml is taken as the upper limit of normal, 69% of the patients had raised iCT concentrations. There was a good correlation (r=0,67; P smaller than 0,001) between serum iCT values measured with both methods in 50 patients. If measured by the double-antibody radio-immunoassay method, the serum calcitonin value is not useful as a marker for hepatocellular carcinoma.

  20. Serum immunoreactive calcitonin concentration in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Dugard, J.; Kew, M.C.; Da Fonseca, M.; Levin, J.

    1982-01-01

    Having found raised serum calcitonin concentrations is 94% of patients with hepatocellular carcinoma when using a dextran-coated-charcoal radio-immunoassay, we have now repeated the study, using a double-antibody radio-immunoassay, in 102 further patients with hepatocellular carcinoma and 35 matched controls. Serum immunoreactive calcitonin concentrations (iCT) in the controls ranged from 10 to 310 pg/ml (mean 154,6 pg/ml). Values in the tumour patients ranged from 10 to 1 650 pg/ml (mean 302,6 pg/ml). The mean figures were significantly higher in the tumour patients (P smaller than 0,001), 35,5% of them having values above 310 pg/ml. In 65 of the patients serum iCT concentrations were also determined by dextran-coated-charcoal radio-immunoassay. Values ranged from 10 to 10780 pg/ml (mean 2 179 pg/ml). If 1 000 pg/ml is taken as the upper limit of normal, 69% of the patients had raised iCT concentrations. There was a good correlation (r=0,67; P smaller than 0,001) between serum iCT values measured with both methods in 50 patients. If measured by the double-antibody radio-immunoassay method, the serum calcitonin value is not useful as a marker for hepatocellular carcinoma

  1. Hepatocellular carcinoma with bile duct involvement : computed Tomographic (CT) findings

    International Nuclear Information System (INIS)

    Lee, Joon Woo; Han, Joon Koo; Kim, Tae Kyoung; And others

    2000-01-01

    To describe the radiologic features of computed tomography (CT) in hepatocellular carcinoma (HCC) with bile duct involvement. We retrospectively analyzed the two phase spiral CT findings of 31 patients in whom HCC with bile duct invasion (n=3D28) or compression (n=3D3), was diagnosed. Eight of these underwent follow up CT after transarterial chemoembolization. We analyzed the size, type, location, enhancement pattern, and lipiodol retention of parenchymal and intraductal masses, as well as their lymphadenopathy. In all patients with bile duct invasion, single or multiple masses were demonstrated in the bile ducts. Intraductal masses showed the same enhancement characteristics as the parenchymal mass (kappa 0.550, p less than 0.001), and were contiguous to this mass. In 14 of 28 patients, intraductal masses filled the peripheral intrahepatic bile ducts and extended to the common bile ducts. In the other 14, the parenchymal mass extended to the area of the porta hepatis and then directly invaded the large ducts. In nine of the 28 patients, there was a hypoattenuated cleft between the intraductal mass and ductal wall. In six, a parenchymal mass was not apparent (n=3D2), or was smaller than 2cm (n=3D4). In five of eight patients (62.5%), follow-up CT after transarterial chemoembolization showed compact or partial lipiodol retention within the intraductal mass. In patients with bile duct compression, perihilar lymph nodes were noted along with the dilated intrahepatic duct but no intra ductal mass was demonstrated in the duct. Hepatocellular carcinomas cause bile duct dilatation either by direct invasion or by extrinsic compression of the bile duct with surrounding enlarged nodes. For the diagnosis of this condition, CT is helpful. (author)

  2. Hepatocellular carcinoma arising from hepatocellular adenoma in a hepatitis B virus-associated cirrhotic liver

    International Nuclear Information System (INIS)

    Seo, J.M.; Lee, S.J.; Kim, S.H.; Park, C.K.; Ha, S.Y.

    2012-01-01

    Hepatocellular adenoma (HCA) is a rare, benign proliferation of hepatocytes that occurs mostly in a normal liver and in extreme rare cases, occurs in a cirrhotic liver. Hepatocellular carcinomas (HCC) arising within HCA through malignant transformation is rare. The specific incidence and mechanism of malignant transformation has not been established, but the long term use of oral contraceptives is considered a causative agent. We report a case of HCC arising from HCA detected in a hepatitis B-related cirrhotic liver with serial radiologic images.

  3. Hepatocellular carcinoma arising from hepatocellular adenoma in a hepatitis B virus-associated cirrhotic liver

    Energy Technology Data Exchange (ETDEWEB)

    Seo, J.M. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, S.J., E-mail: lucia@skku.edu [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, S.H. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Park, C.K.; Ha, S.Y. [Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2012-04-15

    Hepatocellular adenoma (HCA) is a rare, benign proliferation of hepatocytes that occurs mostly in a normal liver and in extreme rare cases, occurs in a cirrhotic liver. Hepatocellular carcinomas (HCC) arising within HCA through malignant transformation is rare. The specific incidence and mechanism of malignant transformation has not been established, but the long term use of oral contraceptives is considered a causative agent. We report a case of HCC arising from HCA detected in a hepatitis B-related cirrhotic liver with serial radiologic images.

  4. Transarterial chemoembolization versus resection for intermediate-stage (BCLC B hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Jun Young Kim

    2016-06-01

    Full Text Available Background/Aims: Several studies have suggested that surgical resection (SR can provide a survival benefit over transarterial chemoembolization (TACE for hepatocellular carcinoma (HCC at the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC staging system. However, the criteria for SR remain to be determined. This study compared the long-term outcome of intermediate-stage HCC patients treated by either TACE or SR as a primary treatment modality, with the aim of identifying the patient subgroup that gained a survival benefit by either modality. Methods: In total, 277 BCLC intermediate-stage HCC patients treated by either TACE (N=225 or SR (N=52 were analyzed. Results: The overall median survival time was significantly better for SR than TACE (61 vs. 30 months, P=0.002. Decision-tree analysis divided patients into seven nodes based on tumor size and number, serum alpha-fetoprotein (AFP level, and Child-Pugh score, and these were then simplified into four subgroups (B1–B4 based on similarities in the overall hazard rate. SR provided a significant survival benefit in subgroup B2, characterized by ‘oligo’ (2–4 nodules of intermediate size (5–10 cm when the AFP levels was <400 ng/ml, or ‘oligo’ (2–4 nodules of small to intermediate size (<10 cm plus a Child-Pugh score of 5 when the AFP level was ≥400 ng/mL (median survival 73 vs. 28 months for SR vs. TACE respectively; P=0.014. The survival rate did not differ significantly between SR and TACE in the other subgroups (B1 and B3. Conclusion: SR provided a survival benefit over TACE in intermediate-stage HCC, especially for patients meeting certain criteria. Re-establishing the criteria for optimal treatment modalities in this stage of HCC is needed to improve survival rates.

  5. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE.

    Science.gov (United States)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R; Duick, Daniel S; Harrell, R Mack; Hegedüs, Laszlo; Paschke, Ralf; Valcavi, Roberto; Vitti, Paolo

    2016-05-01

    Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for

  6. Chondroitin sulfate iron colloid-enhanced MR imaging of hepatocellular carcinoma; Correlation between histologic grade and detectability

    Energy Technology Data Exchange (ETDEWEB)

    Kamba, Masayuki; Suto, Yuji; Kodama, Fumiko; Kato, Terumi; Ohta, Yoshio; Horie, Yasushi; Hamazoe, Ryuichi; Kawasaki, Hironaka (Tottori Univ., Yonago (Japan). School of Medicine)

    1994-03-01

    We applied chondroitin sulfate iron colloid (CSIC) as an MR contrast agent to detect hepatocellular carcinoma (HCC). The MR and pathologic findings of 25 HCCs in 21 patients were analyzed. MR imaging was performed with a superconducting system operating at 1.5 T. Proton density-weighted (PDW), T[sub 2]-weighted (T[sub 2]W) and T[sub 1]-weighted (T[sub 1]W) images were obtained before and after an intravenous injection of 23.6 [mu]mol Fe/kg of CSIC. In moderately to poorly differentiated and moderately differentiated HCCs (n=15), all the lesions except a 5-mm satellite nodule were detectable with unenhanced T[sub 2]W images as well as CSIC-enhanced PDW, T[sub 2]W and T[sub 1]W images. In well to moderately differentiated HCCs (n=6), two to four lesions were detectable with unenhanced images. All the lesions except a 3-mm satellite nodule were detectable with CSIC-enhanced PDW, T[sub 2]W and T[sub 1]W images. In well differentiated HCCs (n=4), one or two lesions were detectable with unenhanced images. All the lesions were detectable with CSIC-enhanced T[sub 1]W images, while only two lesions were detectable with CSIC-enhanced PDW or T[sub 2]W images. CSIC administration improves detection rates, and is especially useful in detecting small foci of well to moderately or well differentiated HCC. (author).

  7. Cooled microwave ablation of thyroid nodules: Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Korkusuz, Yücel [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); Mader, Oscar Maximilian, E-mail: info@dzta.de [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); Kromen, Wolfgang [Department of Neuro Radiology University Hospital (Germany); Happel, Christian [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); German Centre for Thermoablation of Thyroid Nodules, University Hospital, Frankfurt (Germany); Ahmad, Shadi [Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt (Germany); Gröner, Daniel; Koca, Mithat; Mader, Alexander [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); Grünwald, Frank; Korkusuz, Hüdayi [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); German Centre for Thermoablation of Thyroid Nodules, University Hospital, Frankfurt (Germany)

    2016-11-15

    Highlights: • cMWA is a safe and effective treatment for thyroid nodules. • Ultrasound imaging allows guidance during microwave ablation. • Pain level during cMWA treatment is reduced in comparison to RFA. - Abstract: Objective: To evaluate if internally cooled microwave ablation (cMWA) is a safe and effective method for treatment of benign and malign thyroid nodules. Methods: 9 patients with 11 symptomatic cold benign thyroid nodules and 1 recurrent thyroid carcinoma ranging in volume from 9.1 to 197 ml (mean size 52 ±  57 ml) were treated with cMWA. The mean age of the patients was 59 years. Pain during the treatment was measured on a 10-point scale. Side effects revealed by ultrasound or patients’ complaints were documented. Periablative efficacy was measured 24 h after cMWA as change (Δ) in serum thyreoglobulin (Tg). Nodule elasticity was measured on a 4-point scale, blood circulation and echogenicity on a 3-point scale. Results: All patients tolerated cMWA well. Median pain intensity averaged 2.1 ± 0.8 (range: 1–3). Postablative hematoma was observed in all cases. In no cases ablation led to hoarseness, superficial burns, nodule ruptures, vagal reactions or dysphagia. cMWA lead to a significant decrease of blood circulation, nodule echogenicity and a significant increase of elasticity (Δ  =  1.1  ±  0.33; 0.8  ±  0.4 and 1.1  ±  0.6 points)(p < 0.05). An average increase of 4495 ng/ml Tg was measured (p < 0.05). Conclusions: cMWA is an effective and secure method for treatment of thyroid nodules.

  8. Retrospective Evaluation of Safety, Efficacy and Risk Factors for Pneumothorax in Simultaneous Localizations of Multiple Pulmonary Nodules Using Hook Wire System.

    Science.gov (United States)

    Zhong, Yan; Xu, Xiao-Quan; Pan, Xiang-Long; Zhang, Wei; Xu, Hai; Yuan, Mei; Kong, Ling-Yan; Pu, Xue-Hui; Chen, Liang; Yu, Tong-Fu

    2017-09-01

    To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure. Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure. All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p pneumothorax. Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.

  9. Follicular variant of papillary thyroid carcinoma presenting as toxic nodule in an adolescent: coexistent polymorphism of the TSHR and Gsα genes.

    Science.gov (United States)

    Ruggeri, Rosaria Maddalena; Campennì, Alfredo; Giovinazzo, Salvatore; Saraceno, Giovanna; Vicchio, Teresa Manuela; Carlotta, Dario; Cucinotta, Maria Paola; Micali, Carmelo; Trimarchi, Francesco; Tuccari, Giovanni; Baldari, Sergio; Benvenga, Salvatore

    2013-02-01

    Autonomously functioning, "hot", thyroid nodules are not common in children and adolescents. Such nodules are not considered alarming because they are assumed to be benign adenomas. Herein, we present a 15-year-old girl with a papillary thyroid carcinoma of 3.5 cm in diameter, which was functionally autonomous and scintigraphically hot. The patient, initially referred to our Endocrine Unit because of a thyroid nodule, returned 6 months later for symptoms of hyperthyroidism. Hyperthyroidism was confirmed biochemically. Radioactive iodine ((131)I) thyroid scintigraphy was consistent with an autonomous thyroid nodule. As per guidelines, the patient underwent surgery and a pathological examination revealed papillary carcinoma, follicular variant. The excised nodule was examined for activating mutations of the thyrotropin receptor (TSHR), Gsα (GNAS1), H-RAS, N-RAS, K-RAS, and BRAF genes by direct sequencing. No mutations were found. Nevertheless, two combined nonfunctioning mutations were detected: a single-nucleotide polymorphism (SNP) of the TSHR gene, in exon 7, at codon 187 (AAT→AAC, both encoding asparagine), and a SNP within exon 8 of the Gsα gene at codon 185 (ATC→ATT, both encoding isoleucine). Both SNPs were also identified in the germline DNA of the patient. The same SNPs were sought in the parents and brother of our patient. Her father was heterozygous for the TSHR SNP, her mother heterozygous for the Gsα SNP, and her brother was wild type. This case demonstrates that the presence of hyperfunctioning thyroid nodule(s) does not rule out cancer and warrants careful evaluation, especially in childhood and adolescence to overlook malignancy.

  10. Usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules intraoperatively

    International Nuclear Information System (INIS)

    Kambayashi, Takatoyo

    2011-01-01

    The objective of this study was to assess the usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules intraoperatively. We examined 12 cases with 12 peripheral small pulmonary nodules between 2008 and 2010. All lesions were predicted to be difficult to identify during surgery, and virtual images of the visceral pleura were made and evaluated before surgery. We predicted the usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules. The mean maximum dimensions were 10.5±4.36 mm. The mean depth from the visceral pleura was 4.0±4.67 mm. The lesions were the solid type in 6 cases and the ground-glass opacity type in 6 cases. In 7 cases primary lung cancer was present, while the other 5 cases had only benign lesions. In all cases, changes in the visceral pleura could be identified with virtual images of the visceral pleura before surgery. We identified 7 lesions out of 12 intraoperatively. The reasons for the failure to identify the lesions were an inability to adequately observe the visceral pleura because of pleural adhesion, or failure to perform single lung ventilation in 3 cases. Another reason was that the changes in the visceral pleura were too minor to identify intraoperatively (2 cases). Virtual images of the visceral pleura may be useful for identifying the localization of peripheral small pulmonary nodules, and the prediction of whether or not the identification of lesions is possible intraoperatively, without preoperative marking in order to identify peripheral pulmonary nodules. (author)

  11. MIBI-SPECT in hypofunctioning thyroid nodules for detection of thyroid carcinoma; MIBI-SPECT bei kalten Knoten zur Schilddruesenkarzinomdetektion

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, M.; Schicha, H. [Universitaetsklinikum Koeln (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2010-12-15

    The clinical usefulness of Tc-99m-MIBI in hypofunctioning thyroid nodules for detection of thyroid carcinoma is presented. Tc-99m-MIBI is a lipophilic cation and a non-specific radiopharmaceutical for tumour imaging. It has become an important imaging technique for the assessment of hypofunctioning thyroid nodules because of its high negative predictive value excluding malignant thyroid tumours. After injection of Tc-99m-MIBI either a single-phase protocol with late planar and SPECT images about 1-2 h post injection or a double-phase protocol with early (about 15-30 min p.i.) and late images (about 2 h p.i.) were reported. Findings include a reduced, an isointense or an increased Tc-99m-MIBI accumulation in the thyroid nodule in comparison to the paranodular thyroid tissue and in comparison to pertechnetate thyroid scintigraphy. A 'Match' between pertechnetate and Tc-99m-MIBI scintigraphy is a concordantly decreased uptake in the thyroid nodule in comparison to the normal thyroid gland. This finding has a negative predictive value of >97% to exclude differentiated thyroid cancer. A definite 'Mismatch' means a cold thyroid nodule on pertechnetate scintigraphy and an increased uptake of Tc-99m-MIBI in comparison to the MIBI-uptake of the paranodular thyroid tissue. The positive predictive value of this finding for malignancy varies between studies and is in the range of <10-65% (Cologne data: 19%) depending on the prevalence of malignant thyroid tumours in the patient population studied. An isointense uptake was not associated with thyroid malignancy according to 'Cologne' data. Further studies are desirable for better characterization of the method. (orig.)

  12. Computed tomographic diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Onoue, Masataka

    1986-01-01

    One hundred and fifty-two pulmonary nodules (PNs) were examined by thin-section computed tomography (CT) and conventional tomography (tomography). In this study, 109 PNs were analyzed to assess tissue density by calculating the representative CT number (RCT no.) from a computer printout. For the primary malignancies, the mean RCT no. was 72 HU, with a standard deviation (SD) of 21 HU, and for metastases, it was 66 ± 19 HU. The RCT no. separating primary malignancy from benign lesions was 157 HU, the one including metastasis was 183 HU. In addition, dual-energy CT scan was performed to evaluate capability of diagnosing calcification in 35 PNs. Dual-energy CT scan had increased the reliability of CT diagnosis for PNs with RCT no. between 100 HU and 300 HU. The descriptive criteria of CT and tomography for 127 PNs were analyzed and statistical diagnoses by CT and tomography were compared with the results of their final diagnoses. CT and tomography had domonstrated similar sensitivities in the evaluation of primary malignancies; 86 % in CT and 90 % in tomography, and the same sensitivities (86 %) in diagnosing metastases. In evaluating benign PNs, CT was superior to tomography with capability to detect minimal calcification and fat density; the specificity was 80 % with CT, and 52 % with tomography (p < 0.025). Overall accuracy in the diagnosis for PNs was 82 % with CT, and 73 % with tomography, which was not different statistically. It can be concluded that CT is a reliable examination in the evaluation of PNs, and there is an advantage to the use of CT over tomography in diagnosing benign lesions. (author)

  13. Nódulo de tiroides Thyroid nodule

    Directory of Open Access Journals (Sweden)

    Silvia Elena Turcios Tristá

    2012-12-01

    Full Text Available En los últimos años se ha incrementado la frecuencia diagnóstica del nódulo de tiroides. Un adecuado método clínico y algunos exámenes complementarios, serán los factores a tener en cuenta para definir la naturaleza de la lesión y su funcionalidad. En la actualidad se adicionan nuevos elementos en los estudios por imagen que ayudan a predecir, en alguna medida, el riesgo de malignidad de estas lesiones, y se trata de que el resultado citológico sea más uniforme y orientador. Las conductas se adecuan al tipo de enfermedad tiroidea y a sus riesgos, pero es imprescindible la unión de las especialidades que tienen que ver con la enfermedad nodular tiroidea, para unificar criterios que favorezcan un adecuado y eficiente proceso diagnóstico-terapéutico, que reduzcan los riesgos y los costos que implica la adopción de conductas inadecuadas e innecesarias.In the last few years, the frequency of diagnosis of the thyroid nodule has increased. A correct clinical method and some supplementary tests are the factors to be taken into account to define the nature of lesion and functionality. At present, new elements are added to the imaging studies, which help to predict somehow the risk of malignancy of these lesions, and it is intended to reach a more uniform and guiding cytological result. The behaviors should adapt to the type of thyroid disease and to the risks, but the combination of those specialties that have to do with the nodular thyroid disease is indispensable in order to uniform criteria favoring adequate and efficient diagnostic and therapeutic processes, and reducing the risks and costs of the adoption of inadequate and unnecessary behaviors.

  14. Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations

    Directory of Open Access Journals (Sweden)

    Cheng-Han Lee

    2015-08-01

    Full Text Available Radiofrequency ablation (RFA is an effective and real-time targeting modality for small hepatocellular carcinomas (HCCs. However, mistargeting may occur when the target tumor is confused with cirrhotic nodules or because of the poor conspicuity of the index tumor under ultrasonography (US. Real-time virtual sonography (RVS can provide the same reconstruction computed tomography images as US images. The aim of this study is to investigate the usefulness of RVS-assisted RFA for HCCs that are inconspicuous or conspicuous under US. A total of 21 patients with 28 HCC tumors—divided into US inconspicuous and high-risk subgroup (3 tumors in 3 patients, US inconspicuous and nonhigh-risk subgroup (5 tumors in 4 patients, US conspicuous and high-risk subgroup (16 tumors in 14 patients, and US conspicuous and nonhigh-risk subgroup (4 tumors in 3 patients—underwent RVS-assisted RFA between May 2012 and June 2014 in our institution. The mean diameter of the nodules was 2.0 ± 1.1 cm. The results showed that the complete ablation rate is 87.5% (7/8 in the US undetectable group and 75% (15/20 in the US detectable group. A comparison between six tumors with incomplete ablation and 22 tumors with complete ablation showed higher alpha-fetoprotein level (mean, 1912 ng/mL vs. 112 ng/mL and larger tumor size (mean diameter, 26 mm vs. 16 mm in the incomplete ablation nodules (both p < 0.05. In conclusion, RVS-assisted RFA is useful for tumors that are difficult to detect under conventional US and may also be useful for tumors in high-risk locations because it may prevent complication induced by mistargeting.

  15. Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Oliveri, Roberto S; Wetterslev, Jørn; Gluud, Christian

    2011-01-01

    Hepatocellular carcinoma (HCC) results in more than 600,000 deaths per year. Transarterial embolisation (TAE) and transarterial chemoembolisation (TACE) have become standard loco-regional treatments for unresectable HCC.......Hepatocellular carcinoma (HCC) results in more than 600,000 deaths per year. Transarterial embolisation (TAE) and transarterial chemoembolisation (TACE) have become standard loco-regional treatments for unresectable HCC....

  16. Selective angiography in fifty patients with primary hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Shou-Zhong, Wang; Xing-Rong, Chen; Gong-Xian, Wang

    1983-06-01

    Selective angiography is of great importance in the diagnosis of primary hepatocellular carcinoma. It offers information on the findings, multicentricity, localisation, extension, and type of growth. This paper discusses angiography from the methodical point of view, the findings to be obtained, the types of hepatocellular carcinoma, and the diagnostic efficiency of selective angiography in the evaluation of this type of tumour.

  17. Orbital Metastasis of Hepatocellular Carcinoma: A Case Report ...

    African Journals Online (AJOL)

    Background: Hepatocellular carcinoma is one of the commonest malignancies in Nigeria, however metastasis to the orbit is a rare presentation. Objective: To present a rare case of orbital metastasis of hepatocellular carcinoma. Case Report: A 25-year-old man presented with a 3-month history of pain, progressive swelling ...

  18. Chinese herbal medicines for benign thyroid nodules in adults.

    Science.gov (United States)

    Wu, Wenxun; Yin, Detao; Yang, Weimin; Kan, Quancheng; Liu, Zhangsuo; Ren, Xiaoyan; Zhai, Chenguang; Zhang, Shengjun

    2014-03-04

    A thyroid nodule is a discrete lesion within the thyroid gland that might be palpable and is ultrasonographically distinct from the surrounding thyroid parenchyma. Thyroid nodules are more common as age increases and occur more frequently in women. Benign thyroid nodules often cause pressure symptoms and cosmetic complaints. In China and many other countries, doctors use Chinese herbal medicines (CHM) to treat thyroid nodules. To assess the effects of Chinese herbal medicines in the treatment of benign thyroid nodules in adults. Review authors searched the following electronic databases: The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), VIP information (a Chinese database), WANFANG Data (a Chinese database), the Chinese Conference Papers Database and the Chinese Dissertation Database (all searched up to April 2013). Randomised controlled trials comparing CHM or CHM plus levothyroxine versus levothyroxine, placebo or no treatment in adults with benign thyroid nodules. Two review authors independently extracted data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation), with differences resolved by consensus. We included one randomised trial involving 152 participants with a randomisation ratio of 2:1 (CHM vs no treatment). The trial applied adequate sequence generation; however, allocation concealment was unclear. Duration of treatment was three months, and follow-up six months. Our a priori defined outcomes of interest (i.e. nodule volume reduction ≥ 50%; pressure symptoms, cosmetic complaints or both; health-related quality of life; all-cause mortality; cancer occurrence; changes in number and size of thyroid nodules; changes in thyroid volume; and socioeconomic effects) were not investigated in the included study. Thyrotropin (TSH), thyroxine (T4) and tri

  19. Metastases of Hepatocellular Carcinoma Misdiagnosed as Isolated Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Greco, Assunta; De Masi, Roberto; Orlando, Stefania; Metrangolo, Antonio; Zecca, Vittorio; Morciano, Giancarlo; De Donno, Antonella; Bagordo, Francesco; Piccinni, Giancarlo

    At present, cardiac metastasis of hepatocellular carcinoma is rarely mentioned in the literature. We report a hepatocellular carcinoma patient with cardiac metastasis misdiagnosed as hypertrophic cardiomyopathy in 2011. Two years later, on presentation of syncope, an abnormal ventricular septal size was recorded by ultrasound scan, and was subsequently shown by magnetic resonance imaging to be a tumour lesion. A myocardial biopsy confirmed infiltration of hepatocellular carcinoma. This observation underlines the risk of hepatocellular carcinoma cardiac metastasis, manifested in its infiltrative form as hypertrophic cardiomyopathy. In conclusion, we suggest that the ultrasound appearance of hypertrophic cardiomyopathy in hepatocellular carcinoma patients should be seen as a "red flag" and recommend the introduction of magnetic resonance imaging assessment of transplant candidates.

  20. Diffuse Anterior Retinoblastoma with Sarcoidosis-Like Nodule

    Directory of Open Access Journals (Sweden)

    Koji Kitazawa

    2015-12-01

    Full Text Available Background: Retinoblastomas account for 4% of malignancies in children, 1-2% of which are diffuse infiltrating retinoblastomas. Diffuse anterior retinoblastoma is rare and does not involve the retina. Here, we report on a diffuse anterior retinoblastoma with large sarcoidosis-like nodules on the iris that were responsive to anti-inflammatory therapy. Case: We present a 6-year-old girl who had anterior uveitis with white nodules on the iris and posterior surface of the cornea in her right eye. The nodules initially responded well to anti-inflammatory treatment. However, anterior segment optical coherence tomography (AS-OCT showed that the nodules gradually grew, shrinking the iris. We then collected the aqueous humor for diagnosis. A biopsy revealed clusters of small cells with a high nuclear-to-cytoplasm ratio with partial rosette formation. Therefore, we diagnosed diffuse anterior retinoblastoma without retinal involvement and performed enucleation of the right eye. The histopathology demonstrated undifferentiated cells similar to those seen on the biopsy, and tumor cells invaded the iris stroma, posterior surface of the cornea, ciliary body, and sclera. After the enucleation, she underwent chemotherapy and remains alive. Conclusion: A differential diagnosis of retinoblastoma should be considered when white nodules refractory to anti-inflammatory therapy occur in the eye, even in the absence of obvious retinal masses. AS-OCT findings are useful in assessing retinoblastoma.

  1. Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection

    Directory of Open Access Journals (Sweden)

    Sarai Maryam

    2002-12-01

    Full Text Available Abstract Background Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. Methods 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (3, T4 and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. Results Average pre-treatment nodule volume [18.2 ± 12.7 ml] decreased to 5.7 ± 4.6 ml at 6 months follow-up [P 4 and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. Conclusion Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.

  2. Parasitic thyroid nodule in a patient with Hashimoto's chronic thyroiditis

    International Nuclear Information System (INIS)

    Santos, Vitorino Modesto dos; Lima, Marcus Aurelho de; Marinho, Euripedes Oliveira; Marinho, Marco Aurelio de Oliveira; Santos, Lister Arruda Modesto dos; Raphael, Cristiane Mendes

    2000-01-01

    A case of parasitic thyroid nodule is presented. The patient was a non symptomatic 53-year-old white woman, on irregular course of L-thyroxine to treat hypothyroidism due to Hashimoto's thyroiditis. Without a history of thyroid trauma or surgery, she presented a 1.6 x 0.7 x 0.5 cm right pre-laryngeal lymph node-like mass which, on ultrasonography, appeared distinct from the gland. TSH, thyroid peroxidase antibody and thyroglobulin antibody serum levels were elevated and T4-free level was normal. Thyroid and total body 99m Tc isonitrile scintiscan showed a topic thyroid without radionuclide uptake in the nodule. Fine-needle aspiration of the nodule showed epithelial cells with nuclear atypia and oncocitic changes plus intense lymphoid infiltration and germinative center formation, simulating lymph node metastasis of papillary thyroid carcinoma. Conventional biopsy revealed a parasitic thyroid nodule with Hashimoto's chronic thyroiditis. Parasitic thyroid nodule must always be remembered so that unnecessary surgical assessment and undesirable sequels may be avoided. (author)

  3. Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection.

    Science.gov (United States)

    Larijani, Bagher; Pajouhi, Mohammad; Ghanaati, Hossein; Bastanhagh, Mohammad-Hassan; Abbasvandi, Fereshteh; Firooznia, Kazem; Shirzad, Mahmood; Amini, Mohammad-Reza; Sarai, Maryam; Abbasvandi, Nasreen; Baradar-Jalili, Reza

    2002-12-06

    BACKGROUND: Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. METHODS: 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (thyroid hormone levels. Ethanol injections were performed once every 1-4 weeks. Ethanol injections were stopped when serum T3, T4 and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. RESULTS: Average pre-treatment nodule volume [18.2 PlusMinus; 12.7 ml] decreased to 5.7 PlusMinus; 4.6 ml at 6 months follow-up [P thyroid hormone levels at 3 and 6 months follow-up [P 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. CONCLUSION: Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.

  4. [Role of MRI for detection and characterization of pulmonary nodules].

    Science.gov (United States)

    Sommer, G; Koenigkam-Santos, M; Biederer, J; Puderbach, M

    2014-05-01

    Due to physical and technical limitations, magnetic resonance imaging (MRI) has hitherto played only a minor role in image-based diagnostics of the lungs. However, as a consequence of important methodological developments during recent years, MRI has developed into a technically mature and clinically well-proven method for specific pulmonary questions. The purpose of this article is to provide an overview on the currently available sequences and techniques for assessment of pulmonary nodules and analyzes the clinical significance according to the current literature. The main focus is on the detection of lung metastases, the detection of primary pulmonary malignancies in high-risk individuals and the differentiation between pulmonary nodules of benign and malignant character. The MRI technique has a sensitivity of approximately 80 % for detection of malignant pulmonary nodules compared to the reference standard low-dose computed tomography (CT) and is thus somewhat inferior to CT. Advantages of MRI on the other hand are a higher specificity in differentiating malignant and benign pulmonary nodules and the absence of ionizing radiation exposure. A systematic use of MRI as a primary tool for detection and characterization of pulmonary nodules is currently not recommended due to insufficient data. The diagnostic potential of MRI for early detection and staging of malignant pulmonary diseases, however, seems promising. Therefore, further evaluation of MRI as a secondary imaging modality in clinical trials is highly warranted.

  5. Determination of nodule coverage parameters using multibeam normal incidence echo characteristics: A study in the Indian Ocean

    Digital Repository Service at National Institute of Oceanography (India)

    Chakraborty, B.; Pathak, D.; Sudhakar, M.; Raju, Y.S.N.

    A study of the echo peak amplitudes from known nodule areas is initiated to observe the acoustic response for varying nodule abundances and number densities. A statistical study of the peak amplitudes from different nodule areas confirms...

  6. Brazilian society of hepatology recommendations for the diagnosis and treatment of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Flair J Carrilho

    Full Text Available ABSTRACT Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB. All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.

  7. A novel panel of biomarkers in distinction of small well-differentiated HCC from dysplastic nodules and outcome values

    International Nuclear Information System (INIS)

    Jin, Guang-Zhi; Cong, Wen-Ming; Wu, Meng-Chao; Dong, Hui; Yu, Wen-Long; Li, Yan; Lu, Xin-Yuan; Yu, Hua; Xian, Zhi-Hong; Dong, Wei; Liu, Yin-Kun

    2013-01-01

    Differential diagnosis of high-grade dysplastic nodules (HGDN) and well-differentiated hepatocellular carcinoma (WDHCC) represents a challenge to experienced hepatic clinicians, radiologists and hepatopathologists. The expression profiles of aminoacylase-1 (ACY1), sequestosome-1 (SQSTM1) and glypican-3 (GPC3) in low-grade dysplastic nodules (LGDN), HGDN and WDHCC were assessed by immunohistochemistry. The differential diagnostic performances of these three markers alone and in combination for HGDN and WDHCC were investigated by logistic regression models (HGDN = 21; WDHCC = 32) and validated in an independent test set (HGDN, n = 21; WDHCC n = 24). Postoperative overall survival and time to recurrence were evaluated by univariate and multivariate analyses in an independent set of 500 patients. ACY1, SQSTM1 and GPC3 were differentially expressed in each group. For the differential diagnosis of WDHCC from HGDN, the sensitivity and specificity of the combination of ACY1 + SQSTM1 + GPC3 for detecting WDHCC were 93.8% and 95.2% respectively in the training set, which were higher than any of the three two-marker combinations. The validities of the four diagnostic models were further confirmed in an independent test set, and corresponding good sensitivity and specificity were observed. Interestingly, GPC3 expression in HCC tissues combined with serum α-fetoprotein (AFP) was found to be an independent predictor for overall survival and time to recurrence. ACY1 + SQSTM1 + GPC3 combination represents a potentially valuable biomarker for distinguishing between WDHCC and HGDN using immunohistochemistry. Meanwhile, low GPC3 staining combined with positive serum AFP may play a practical role in predicting poor postoperative outcome and high tumor recurrence risk

  8. Thyroid nodules with nondiagnostic results on repeat fine-needle aspiration biopsy: which nodules should be considered for repeat biopsy or surgery rather than follow-up?

    Energy Technology Data Exchange (ETDEWEB)

    Eun, Na Lae; Chang, Hang Seok; Gweon, Hye Mi; Kim, Jeong Ah; Youk, Ji Hyun; Son, Eun Jun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Yoo, Mi Ri [Dept. of Radiology, Dongjak Kyunghee Hospital, Seoul (Korea, Republic of); Park, Ah Young [Dept. of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of); Moon, Hee Jung [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-07-15

    The goal of this study was to assess the clinicopathologic and ultrasonographic features of thyroid nodules with nondiagnostic results on repeat ultrasonography (US)-guided fineneedle aspiration biopsy (FNAB) according to size and the number of suspicious findings and to determine the proper management of nodules with consecutive nondiagnostic results. This retrospective study included 297 nodules with nondiagnostic results on repeat FNAB that were evaluated by US over the course of at least 12 months of follow-up, a follow-up biopsy, or an operation. We compared clinical and US variables between benign and malignant nodules in thyroid nodules with repeat nondiagnostic results. The comparison of benign and malignant nodules with repeat nondiagnostic results revealed that age, marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, and nonparallel shape were significantly associated with malignancy. Multivariate logistic regression analysis in malignant nodules revealed that microcalcifications and irregular or microlobulated margins were independently associated with malignancy. Among them, only irregular or microlobulated margins were independently significant as a predictor of malignancy in repeatedly nondiagnostic nodules measuring >10 mm. Using receiver operating characteristic analysis, the best cutoff value for the “number of suspicious findings” between benign and malignant nodules was three in nodules of all sizes, three in nodules measuring ≤10 mm, and two in nodules measuring >10 mm. Irregular or microlobulated margins may be the most frequent US features in repeatedly nondiagnostic nodules >10 mm. The presence of “two or more suspicious findings” can be used as the cutoff for distinguishing benign and malignant nodules.

  9. The pseudocapsule in hepatocellular carcinoma: correlation between dynamic MR imaging and pathology

    International Nuclear Information System (INIS)

    Grazioli, L.; Stanga, C.; Dettori, E.; Gallo, C.; Matricardi, L.; Chiesa, A.; Olivetti, L.; Fugazzola, C.; Giacobbe, A.; Benetti, A.

    1999-01-01

    Nodular hepatocellular carcinoma (HCC) is characterized by the presence of a pseudocapsule (constructed usually from connective fibrous tissue) that appears hypointense on T1- and T2-weighted spin-echo (SE) and gradient-echo (GE) MR imaging sequences without a contrast medium. The presence of vascular structures inside the tumor, which are verified by histological exam, affects enhancement of the PC after administrating the contrast medium: The impregnation is more evident in the dynamic study but also persists on the delayed T1-weighted SE images. The accuracy of MR in detecting the pseudocapsule of HCC and contrast enhancement of the pseudocapsule during dynamic studies were evaluated and related to pathological findings. Thirty-seven HCC were examined in 33 patients and afterwards resected. In capsulated nodules, besides usual hematoxylin, eosin, and trichrome stainings, histochemical and immunohistochemical methods were performed. On a 1.5-T MR unit, T1- and T2-weighted SE and GE FLASH 2D sequences after intravenous injection of Gd-DTPA (dynamic study) were used. In a later phase, T1-weighted SE sequences were repeated. Histologically, the pseudocapsule (thickness 0.2-6 mm) was present in 26 of 37 nodules (70 %). The dynamic study was the most suitable technique to show the pseudocapsule, which was recognized in 80.7 % (21 of 26 nodules). In 5 of 26 cases, the pseudocapsule, not demonstrated by MR, was thinner than 0.4 mm. In 16 of 21 cases, in the early portal phase (30-60 s), the pseudocapsule had an early enhancement, which was more evident later; in 5 of 21 cases the enhancement was observed only in the late portal phase (1-2 min). At histological examination, 14 of 16 pseudocapsules with early enhancement showed a more prominent vasculature than those with enhancement in the equilibrium phase. Magnetic resonance was a reliable tool in demonstrating the pseudocapsule of HCC. The histological examination demonstrated a good correlation between the

  10. CT diagnosis of rare histological variant of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Li Huaibo; Feng Zhipeng; Duan Shaoyin; Zhaugn Xiangrong

    2009-01-01

    Objective: To explore and understand the CT findings of 5 rare histological variants of hepatocellular carcinoma. Methods: CT findings of 31 cases of rare histological variants confirmed by surgery and pathology were analyzed retrospectively. Results: 13 cases were clear cell hepatocellular carcinoma. 3 cases of them showed patchy fat density in plain scans. Enhanced CT showed features of 'fast in fast out' which was similar to the common hepatocellular carcinoma. 4 cases belonged to sclerosis hepatocellular carcinoma. They appeared as heterogeneous, slowly enhancement on arterial phase images, and delay enhancement on portal venous phase and delay phase images. 9 cases belonged to mixed hepatocellular carcinoma. 5 cases of them showed inhomogeneous enhancement and 4 without enhancement during arterial phase, 3 cases showed delay enhancement and 4 without during portal venous and delay phase. 3 cases were fibrolamellar hepatocellular carcinoma. All showed obvious and fastly enhancement on arterial phase images, subsided slowly on the portal venous and delay phase images, showing features of 'fast in slow out', no enhancement was seen in the central scar. Shrinkage phenomenon on the surface of liver could be seen on the CT plain scans in sclerosis, mixed and fibrolamellar hepatocellular carcinoma. 2 cases were the type of dense hepatocellular carcinoma. The surrounding part in the 2 cases were slightly enhanced, while the most part of the center were not enhanced similar to necrosis. Conclusion: The CT findings of rate histological variant of hepatocellular carcinoma are characteristic. Analyzing the CT plain and enhancement finding is helpful to the diagnosis of these types of hepatocellular carcinoma. (authors)

  11. Nodulation and nitrogen uptake characteristics as selection indices for promiscuous soybean breeding in Africa

    International Nuclear Information System (INIS)

    Ababio, R.C.; Sanginga, K.E.; Dashiell, K.E.

    2001-01-01

    Selection for atmospheric dinitrogen fixation in promiscuous soybeans by indigenous rhizobia populations is usually determined indirectly based on visual assessment of nodulation. As the method has been criticized extensively, we have examined this assay in relation to other N 2 fixation indices by evaluating growth of promiscuous soybeans in four ecological zones of Nigeria. Nodulation was affected considerably by rainfall indigenous, rhizobia populations and soil P. The N 2 fixation indices measured, nodule development, apparent effectiveness, total N accumulation and N derived from fixation, varied among soybean genotypes. The visual nodule assessment index correlated with nodule weight (r = 0.74; P = 0.01), but had no significant correlation (r = 0.13) with proportion of apparent effective nodules. All nodule parameters, however, correlated significantly (r = 0.16-0.71; P=0.05) with total N accumulation and seed yield. The percent apparent effectiveness of nodules was a superior index to nodule score and nodule number but inferior to nodule mass. Total N accumulation patterns in the genotypes indicated that N 2 fixation in some genotypes could be substantial during the reproductive growth phase and may serve as suitable criteria for selection. Therefore, in low N soils, percent nodule effectiveness and total N accumulation may be used to augment the visual scores particularly for genotypes, which seem to nodulate profusely with indigenous rhizohia populations (author)

  12. Usefulness of the CAD System for Detecting Pulmonary Nodule in Real Clinical Practice

    International Nuclear Information System (INIS)

    Song, Kyoung Doo; Chung, Myung Jin; Kim, Hee Cheol; Lee, Kyung Soo; Jeong, Sun Young

    2011-01-01

    We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micro nodules (MN, diameter < 4 mm) and significant nodules (SN, 4 ≤ diameter ≤ 10 mm). The radiologic reports and CAD results were compared. The CAD system helped detect 426 nodules: 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance

  13. Prognosis of thyroid nodules in individuals living in the Zhitomir region of Ukraine.

    Directory of Open Access Journals (Sweden)

    Naomi Hayashida

    Full Text Available After the accident at the Chernobyl Nuclear Power Plant (CNPP, the incidence of thyroid cancer increased among children. Recently, a strong relationship between solid thyroid nodules and the incidence of thyroid cancer was shown in atomic bomb survivors. To assess the prognosis of benign thyroid nodules in individuals living in the Zhitomir region of Ukraine, around the CNPP, we conducted a follow-up investigation of screening data from 1991 to 2000 in the Ukraine.Participants of this study were 160 inhabitants with thyroid nodules (nodule group and 160 inhabitants without thyroid nodules (normal control group intially identified by ultrasonography from 1991 to 2000. All participants were aged 0 to 10 years old and lived in the same area at the time of the accident. We performed follow-up screening of participants and assessed thyroid nodules by fine needle aspiration biopsy.Among the nodule group participants, the number and size of nodules were significantly increased at the follow-up screening compared with the initial screening. No thyroid nodules were observed among the normal control group participants. The prevalence of thyroid abnormality, especially nodules that could be cancerous (malignant or suspicious by fine needle aspiration biopsy, was 7.5% in the nodule group and 0% in the normal control group (P<0.001.Our study indicated that a thyroid nodule in childhood is a prognostic factor associated with an increase in the number and size of nodules in individuals living in the Zhitomir region of Ukraine.

  14. South African Papilionoid Legumes Are Nodulated by Diverse Burkholderia with Unique Nodulation and Nitrogen-Fixation Loci

    Science.gov (United States)

    Beukes, Chrizelle W.; Venter, Stephanus N.; Law, Ian J.; Phalane, Francina L.; Steenkamp, Emma T.

    2013-01-01

    The root-nodule bacteria of legumes endemic to the Cape Floristic Region are largely understudied, even though recent reports suggest the occurrence of nodulating Burkholderia species unique to the region. In this study, we considered the diversity and evolution of nodulating Burkholderia associated with the endemic papilionoid tribes Hypocalypteae and Podalyrieae. We identified distinct groups from verified rhizobial isolates by phylogenetic analyses of the 16S rRNA and recA housekeeping gene regions. In order to gain insight into the evolution of the nodulation and diazotrophy of these rhizobia we analysed the genes encoding NifH and NodA. The majority of these 69 isolates appeared to be unique, potentially representing novel species. Evidence of horizontal gene transfer determining the symbiotic ability of these Cape Floristic Region isolates indicate evolutionary origins distinct from those of nodulating Burkholderia from elsewhere in the world. Overall, our findings suggest that Burkholderia species associated with fynbos legumes are highly diverse and their symbiotic abilities have unique ancestries. It is therefore possible that the evolution of these bacteria is closely linked to the diversification and establishment of legumes characteristic of the Cape Floristic Region. PMID:23874611

  15. Studies on zinc nodules electrodeposited from acid electrolytes

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Rolfe [Univ. of California, Berkeley, CA (United States); Tobias, Charles W. [Univ. of California, Berkeley, CA (United States)

    1984-12-01

    The development of morphology of electrodeposited zinc was investigated by studying the initial stages of deposition. Zinc was deposited galvanostatically from 1.0 M ZnCl2 electrolyte (0.7 < pH < 4.6) on rotating disc electrodes at current densities from 5 to 130 ma/cm2. Pine glassy carbon, Union Carbide pyrolytic graphite, Gould pyrolytic graphite, Exxon graphite loaded polymer, and platinum substrates were used. The number densities of nodules (diameter greater than 1 μm), typically encountered during incipient morphological development, were measured using scanning electron microscopy and image analysis. Nodule densities up to 7 x 104 nodules/mm2 were measured.

  16. Mucoid impaction presenting as multiple pulmonary nodules in cystic fibrosis

    International Nuclear Information System (INIS)

    Carpenter, L.D.; Lambie, N.K.; Wilsher, M.L.

    1996-01-01

    Mucoid impaction has been described as a complication of asthma and more commonly in patients with allergic bronchopulmonary aspergillosis. In such cases, the impacted pools of mucus may present as discrete nodules on chest X-ray and hence simulate the appearance of metastatic malignancy. A case of mucoid impaction presenting as multiple pulmonary nodules in a patient with cystic fibrosis is described. The chest X-ray showed hyperinfiltration and scattered changes consistent with bronchiectasis. Computed tomography scan confirmed these and additional intra-pulmonary nodular densities. This report illustrates that mucus impaction as a cause of pulmonary nodules should be considered in any patient with chronic lung disease characterised by excess mucus production. 6 refs., 3 figs

  17. What to Do with All of These Lung Nodules?

    Directory of Open Access Journals (Sweden)

    Dmitry Rozenberg

    2014-01-01

    Full Text Available Caplan syndrome is a rare entity that is specific to rheumatoid arthritis and presents with multiple, well-defined necrotic nodules in patients with occupational dust exposure. The present report describes a case of Caplan syndrome involving a 71-year-old man with a known diagnosis of seropositive rheumatoid arthritis who presented to the authors’ centre with a five-year history of multiple, bilateral cavitary lung nodules with mild dyspnea on exertion. He was an ex-smoker (30 pack-years and had previously worked with silica. The case highlights the clinical, radiological and pathological features of this syndrome and outlines the importance of considering a broad differential in the management of pulmonary nodules, especially in patients with rheumatoid arthritis.

  18. Lung Nodule Detection in CT Images using Neuro Fuzzy Classifier

    Directory of Open Access Journals (Sweden)

    M. Usman Akram

    2013-07-01

    Full Text Available Automated lung cancer detection using computer aided diagnosis (CAD is an important area in clinical applications. As the manual nodule detection is very time consuming and costly so computerized systems can be helpful for this purpose. In this paper, we propose a computerized system for lung nodule detection in CT scan images. The automated system consists of two stages i.e. lung segmentation and enhancement, feature extraction and classification. The segmentation process will result in separating lung tissue from rest of the image, and only the lung tissues under examination are considered as candidate regions for detecting malignant nodules in lung portion. A feature vector for possible abnormal regions is calculated and regions are classified using neuro fuzzy classifier. It is a fully automatic system that does not require any manual intervention and experimental results show the validity of our system.

  19. Solitary pulmonary nodule by pulmonary hematoma under warfarin therapy

    International Nuclear Information System (INIS)

    Scheppach, W.; Kulke, H.; Liebau, G.; Braun, H.; Wuerzburg Univ.

    1983-01-01

    Pulmonary hematoma is a rare cause of a pulmonary nodule. Mostly it results from penetrating or blunt chest injuries. The case of a patient is reported, whose chest X-ray showed a pulmonary nodule suspected of malignancy. This patient was maintained permanently on anticoagulants (warfarin derivates) after cardiac valve replacement with a prosthesis. A definite diagnosis could not be established by non-invasive methods. A needle biopsy of the lung was impracticable because of the location of the pulmonary lesion; an exploratory thoracotomy could not be carried out due to a general indication of nonoperability. Control examinations showed that the pulmonary nodule had vanished completely within four months. In consideration of the patient's clinical situation it can be concluded that the pulmonary lesion was caused by a hematoma of the lung. (orig.) [d