Kazuhiko Ueda - Academia.edu (original) (raw)
Papers by Kazuhiko Ueda
International Hepatology Communications
ABSTRACT
Hepatology research : the official journal of the Japan Society of Hepatology, Jan 2, 2018
The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic ... more The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic resonance (MR) elastography can be estimated by a combination of gadoxetate disodium-enhanced MR imaging (EOB-MRI) and ordinary blood tests. We evaluated 33 consecutive patients with suspected liver disease who underwent EOB-MRI using a Differential Subsampling with Cartesian Ordering MR sequence and MR elastography using a 1.5-T MR system in this prospective study. A stepwise multiple linear regression model analysis of LS was performed using various predictive values obtained from two-in-one-uptake, two-compartment model analysis of EOB-MRI (velocity constants of arterial inflow [K ], portal venous inflow [K ], hepatocellular uptake [K ]), and ordinary blood test results (blood platelet count, serum albumin level [ALB], total serum bilirubin level [T-BIL], and prothrombin time [PT%]). Multiple linear regression model analysis revealed that hepatic perfusion-uptake index (HPUI = -K + K...
Hepatology research : the official journal of the Japan Society of Hepatology, Jan 23, 2018
To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-... more To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-enhanced dynamic computed tomography (IV-CT) for evaluating hepatic arterial and portal venous flow using intra-arterial contrast-enhanced CT (IA-CT). We retrospectively evaluated 49 consecutive patients who underwent IV-CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas [HCC], 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k ) and portal venous inflow velocity (k ) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV-CT with various outflow velocity constant (k ) limits using the nonlinear least square method. The correlation coefficient between the norma...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
To compare three-dimensional magnetic resonance cholangiopancreatography (MRCP) with/without part... more To compare three-dimensional magnetic resonance cholangiopancreatography (MRCP) with/without partial maximum intensity projection (MIP) and endoscopic retrograde cholangiopancreatography (ERCP) in patients with autoimmune pancreatitis (AIP). Three-dimensional MRCP and ERCP images were retrospectively analyzed in 24 patients with AIP. We evaluated the narrowing length of the main pancreatic duct (NR-MPD), multiple skipped MPD narrowing (SK-MPD), and side branches arising from the narrowed portion of the MPD (SB-MPD) using four MRCP datasets: 5 original images (MIP5), 10 original images (MIP10), all original images (full-MIP), and a combination of these three datasets (a-MIP). The images were scored using a 3- or 5-point scale. The scores of the four MRCP datasets were statistically analyzed, and the positive rate of each finding was compared between MRCP and ERCP. The median scores for SB-MPD on MIP5 and a-MIP were significantly higher than those on MIP10 and full-MIP. In other words...
Hepatology research : the official journal of the Japan Society of Hepatology, 2017
To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography ... more To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography (CT) and spleen size in assessing the degree of liver fibrosis. We retrospectively studied 133 patients who had undergone dynamic CT before hepatectomy. Fibrosis was histologically established in all. First we calculated splenic perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time; MTT), and K1 /k2 (distribution volume; Vd ), using compartment model analysis. Then we compared the stage of fibrosis with splenic perfusion and spleen size (long axis, R), using the Kruskal-Wallis test and multiple comparisons. After that, we assessed the diagnostic accuracy of the combination of splenic perfusion, spleen size, age, gender, and the presence or absence of hepatitis B and hepatitis C viral infection in detecting liver fibrosis, using stepwise regression and receiver operating characteristic analysis. Significant differences (P < 0.05) in MTT were observed in comparisons be...
International scholarly research notices, 2014
Journal of Clinical Gastroenterology, Oct 1, 2007
The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MD... more The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers. MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination. Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS. CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.
ABSTRACT PURPOSE To determine which can more precisely predict postoperative liver reserve preope... more ABSTRACT PURPOSE To determine which can more precisely predict postoperative liver reserve preoperatively, gadoxetate disodium-enhanced MR imaging or 99mTc-galactosyl serum albumin (99mTc-GSA) scintigraphy. METHOD AND MATERIALS Twelve consecutive patients (4 men, 8 women; mean age 70.3 years) who underwent gadoxetate disodium-enhanced MR imaging and 99mTc-GSA scintigraphy within 2 weeks before hepatectomy as a preoperative evaluation were included in this study. Remnant Hepatocellular Uptake Index: rHUI = rV[(rL20/S20) - 1] was determined from the future remnant liver volume (rV) and mean signal intensities of the future remnant liver (rL20) and the spleen (S20) on contrast enhanced MR images at 20 minutes after gadoxetate disodium administration. Receptor index of the future remnant liver: rLHL15 = rL%[L15/(H15 + L15)] was determined from the uptake ratio of the future remnant liver to the whole liver (rL%) on SPECT and the uptake of the liver (L15) and the heart (H15) on planar image of scintigraphy at 15 minutes after 99mTc-GSA administration. The correlation coefficients and its 95% confidence intervals (95%CIs) between indices for the segmental liver reserve (rHUI and rLHL15) and laboratory data at 1 week after hepatectomy (serum albumin, ALB; logarithm of serum total bilirubin, BIL; prothrombin time, PT) were evaluated. The significance of the correlation was evaluated by test for non-correlation. RESULTS Correlation coefficients and its probability values and 95%CIs were 0.69 (P = 0.012) [0.68, 0.71] for ALB, -0.30 (P = 0.339) [-0.32, -0.28] for BIL, and -0.69 (P = 0.024) [-0.71, -0.68] for PT in rLHL15, respectively. In rHUI, 0.21 (P = 0.508) [0.20, 0.23] for ALB, -0.59 (P = 0.045) [-0.60, -0.57] for BIL, and -0.29 (P = 0.362) [-0.30, -0.28] for PT, respectively. CONCLUSION Quantitative index for segmental liver reserve such as rHUI obtained from preoperative gadoxetate disodium-enhanced MR imaging predicts more precisely postoperative liver reserve in bilirubin metabolism, whereas rLHL15 obtained from preoperative 99mTc-GSA scintigraphy is superior to rHUI in the evaluation of postoperative liver reserve in protein synthesis. CLINICAL RELEVANCE/APPLICATION Postoperative liver failure can be avoided by quantitative indices for segmental liver reserve such as rHUI and rLHL15 obtained from gadoxetate disodium-enhanced MR imaging and 99mTc-GSA scintigraphy.
Nihon Naika Gakkai Zasshi, Jan 10, 2014
ISRN Hepatology, 2014
Tumor hemodynamics of carcinogenic hepatocytes nodules, that is, low grade dysplastic nodules, hi... more Tumor hemodynamics of carcinogenic hepatocytes nodules, that is, low grade dysplastic nodules, high grade dysplastic nodules, early hepatocellular carcinomas (HCCs), and progressed HCCs, change during multistep dedifferentiation of the nodules. Morphometric analyses of inflow vessels of these nodules indicate that the portal veins of carcinogenic hepatocyte nodules monotonically decrease whereas the arteries bitonically change, first decrease and then increase. Findings on imaging techniques depicting these changes in tumor blood inflows, especially intra-arterial contrast-enhanced computed tomography, closely related not only to the histological differentiation of the nodules but also to the outcomes of the nodules. Histological analyses of connections between the vessels within the tumors and those in the surrounding livers and findings on imaging techniques indicate that drainage vessels of HCC change from hepatic veins to hepatic sinusoids and then to portal veins during multist...
PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) c... more PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) clearance test have been considered to be an indicator of the liver reserve. Because the same uptake pathways by hepatocytes have been considered for ICG and gadoxetate disodium, we speculated that the segmental liver reserve can be quantitatively estimated by use of gadoxetate disodium-enhanced MR imaging. The subject of this study was to evaluate the usefulness of computerized estimation of quantitative segmental liver reserve after transcatheter arterial chemoembolization (TACE) by use of gadoxetate-enhanced MR imaging comparing to volumetry. METHOD AND MATERIALS 3D-GRE T1-weighted images with fat suppression at 20 min after gadoxetate disodium administration were obtained from 14 patients prior to TACE using ethiodized oil and gelatin sponge particle. The greatest increase of serum total bilirubin within 1 week after TACE was measured, and increase more than 1 mg/dL was regarded as a ...
PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) c... more PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) clearance test have been considered to be an indicator of the liver reserve. Because the same uptake mechanisms by hepatocytes have been considered for ICG and gadoxetate disodium, we speculated that the segmental liver reserve can be quantitatively estimated by use of gadoxetate disodium-enhanced MR imaging. The subject of this study was to evaluate the usefulness of gadoxetate-enhanced MR imaging in a prediction of a liver dysfunction after transcatheter arterial chemoembolization (TACE) comparing to volumetry. METHOD AND MATERIALS 3D-GRE T1-weighted images with fat suppression at 20 min after gadoxetate disodium administration were obtained from 45 patients prior to TACE using ethiodized oil. The greatest increase of serum total bilirubin within 1 week after TACE was measured, and increase more than 1 mg/dL was regarded as a liver dysfunction. Ethiodized oil-enhanced CT was obtained ri...
The American journal of surgical pathology, 1990
We describe herein the morphologies of three cases of ciliated hepatic cysts and compare them wit... more We describe herein the morphologies of three cases of ciliated hepatic cysts and compare them with those of normal bronchi and intrahepatic bile ducts. Grossly, the hepatic cysts were located in the subcapsular region. They were solitary, unilocular, and rather small (less than 4 cm in diameter). Histologically, the cyst wall consisted of four layers: pseudostratified ciliated columnar epithelia with mucous cells, subepithelial connective tissue, smooth-muscle bundles, and an outermost fibrous capsule. The epithelial cytoplasm contained neutral, carboxylated, and sulfated mucus. We noted moderate immunoreactivity to keratin, epithelial membrane antigen, carcinoembryonic antigen, DU-PAN-2 and secretory component; weak immunoreactivity to cytokeratin CAM 5.2, cytokeratin AE1 + 3, and carbohydrate antigen 19-9; and faint or negative immunoreactivity to IgA and IgM. Cilia were immunoreactive to actin and tubulin; smooth muscles were immunoreactive to actin and desmin. Ultrastructural ob...
European journal of radiology, 2014
We aimed to clarify the usefulness of free-breathing readout-segmented echo-planar imaging (RESOL... more We aimed to clarify the usefulness of free-breathing readout-segmented echo-planar imaging (RESOLVE), which is multi-shot echo-planar imaging based on a 2D-navigator-based reacquisition technique, for detecting malignant liver tumor. In 77 patients with malignant liver tumors, free-breathing RESOLVE and respiratory-triggered single-shot echo-planar imaging (SS-EPI) at 3-T MR unit were performed. We set a scan time up to approximately 5 min (300s) before examination, measured actual scan time and assessed (1) susceptibility and (2) motion artifacts in the right and left liver lobes (3, no artifact; 1, marked), and (3) detectability of malignant liver tumors (3, good; 1, poor) using a 3-point scale. The median actual scan time of RESOLVE/SS-EPI was 365/423s. The median scores of each factor in RESOLVE/SS-EPI were as following in this order: (1) 3/2 (right lobe); 3/3 (left lobe), (2) 2/3 (right lobe); 1/2 (left lobe), and (3) 3/3, respectively. Significant differences were noted betwee...
Japanese journal of radiology, 2012
To identify characteristic magnetic resonance (MR) features of focal autoimmune pancreatitis (f-A... more To identify characteristic magnetic resonance (MR) features of focal autoimmune pancreatitis (f-AIP) useful for differentiation from pancreatic cancer (PC). We retrospectively analyzed MR imaging findings of 20 f-AIP lesions and 40 PC lesions smaller than 40 mm in diameter. On fat-suppressed T2-weighted images and dynamic contrast-enhanced fat-suppressed T1-weighted images (DCE-T1WI), we classified MR features of internal signal intensity for each lesion into homogeneous, speckled, or target type. We assessed the sensitivity, specificity, and accuracy of these findings in the diagnosis of f-AIP. We also investigated the incidence of previously reported findings for differentiation between f-AIP and PC. Speckled enhancement within a hypointense or isointense lesion on pancreatic phase DCE-T1WI (speckled type) was observed more frequently in f-AIP than in PC, with high sensitivity, high specificity, and high accuracy. Hypointensity to hyperintensity surrounding a less enhanced focal a...
Japanese journal of radiology, 2011
We aimed to reveal the difference in contrast enhancement of the abdominal organs and major vesse... more We aimed to reveal the difference in contrast enhancement of the abdominal organs and major vessels on dynamic contrast-enhanced magnetic resonance imaging (DCM-MRI) using gadoxetic sodium (Gd-EOB-DTPA) and gadopentetate dimeglumine (Gd-DTPA) in the same patients. DCM-MRI using Gd-EOBDTPA and Gd-DTPA were performed in the same 17 patients. Precontrast and DCM-MRI images [arterial phase (AP), portal venous phase (PP), hepatic venous phase (HP)] were acquired before and after bolus injection of each contrast agent. The organ-to-muscle ratio [liver (L/M), spleen (S/M), aorta (A/M), portal vein (P/M), hepatic vein (V/M)] were calculated at each phase and analyzed statistically. There was no significant difference between Gd-EOB-DTPA and Gd-DTPA images regarding the L/M or V/M mean on precontrast images or the mean of L/M at AP and L/M at the PP. At the AP, PP, and HP, the means of S/M, A/M, P/M, and V/M with Gd-EOBDTPA were lower than those with Gd-DTPA. On HP, The mean L/M with Gd-EOB-...
Gastroenterologia Japonica, 1992
An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a... more An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic...
Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine, Jan 10, 2014
Virchows Archiv A Pathological Anatomy and Histopathology, 1993
Two nodules of hepatic adenomatous hyperplasia (AH) resembling focal nodular hyperplasia were fou... more Two nodules of hepatic adenomatous hyperplasia (AH) resembling focal nodular hyperplasia were found in two patients with cirrhosis or chronic active hepatitis. Imaging techniques suggested that the nodules were hepatocellular carcinoma. Pathological examination showed that the nodules (approximately 1.0 cm in diameter) were clearly demarcated from the surrounding liver tissue, and contained foci of scar-like fibrosis in the centre of the nodules. Microscopically, they contained portal tracts and fulfilled the criteria of AH. A large number of arteries were present in the central scar-like fibrosis as well as in the parenchyma of the nodules. There were foci of mildly atypical hepatocytes in one nodule but no cellular atypia in the other. Morphometric analysis showed that the cumulative luminal area of arteries per unit area was much greater in the nodules than in the extranodular liver tissues, while the cumulative luminal area of portal veins per unit area was much less in the nodules than in the extranodular liver tissues. Although the pathogenesis is unclear, these nodules might have developed through localized vascular changes associated with chronic liver disease, may have arisen from pre-existing arterial malformation, or may represent the early stages of angiogenesis in hepatocarcinogenesis.
International Hepatology Communications
ABSTRACT
Hepatology research : the official journal of the Japan Society of Hepatology, Jan 2, 2018
The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic ... more The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic resonance (MR) elastography can be estimated by a combination of gadoxetate disodium-enhanced MR imaging (EOB-MRI) and ordinary blood tests. We evaluated 33 consecutive patients with suspected liver disease who underwent EOB-MRI using a Differential Subsampling with Cartesian Ordering MR sequence and MR elastography using a 1.5-T MR system in this prospective study. A stepwise multiple linear regression model analysis of LS was performed using various predictive values obtained from two-in-one-uptake, two-compartment model analysis of EOB-MRI (velocity constants of arterial inflow [K ], portal venous inflow [K ], hepatocellular uptake [K ]), and ordinary blood test results (blood platelet count, serum albumin level [ALB], total serum bilirubin level [T-BIL], and prothrombin time [PT%]). Multiple linear regression model analysis revealed that hepatic perfusion-uptake index (HPUI = -K + K...
Hepatology research : the official journal of the Japan Society of Hepatology, Jan 23, 2018
To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-... more To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-enhanced dynamic computed tomography (IV-CT) for evaluating hepatic arterial and portal venous flow using intra-arterial contrast-enhanced CT (IA-CT). We retrospectively evaluated 49 consecutive patients who underwent IV-CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas [HCC], 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k ) and portal venous inflow velocity (k ) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV-CT with various outflow velocity constant (k ) limits using the nonlinear least square method. The correlation coefficient between the norma...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
To compare three-dimensional magnetic resonance cholangiopancreatography (MRCP) with/without part... more To compare three-dimensional magnetic resonance cholangiopancreatography (MRCP) with/without partial maximum intensity projection (MIP) and endoscopic retrograde cholangiopancreatography (ERCP) in patients with autoimmune pancreatitis (AIP). Three-dimensional MRCP and ERCP images were retrospectively analyzed in 24 patients with AIP. We evaluated the narrowing length of the main pancreatic duct (NR-MPD), multiple skipped MPD narrowing (SK-MPD), and side branches arising from the narrowed portion of the MPD (SB-MPD) using four MRCP datasets: 5 original images (MIP5), 10 original images (MIP10), all original images (full-MIP), and a combination of these three datasets (a-MIP). The images were scored using a 3- or 5-point scale. The scores of the four MRCP datasets were statistically analyzed, and the positive rate of each finding was compared between MRCP and ERCP. The median scores for SB-MPD on MIP5 and a-MIP were significantly higher than those on MIP10 and full-MIP. In other words...
Hepatology research : the official journal of the Japan Society of Hepatology, 2017
To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography ... more To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography (CT) and spleen size in assessing the degree of liver fibrosis. We retrospectively studied 133 patients who had undergone dynamic CT before hepatectomy. Fibrosis was histologically established in all. First we calculated splenic perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time; MTT), and K1 /k2 (distribution volume; Vd ), using compartment model analysis. Then we compared the stage of fibrosis with splenic perfusion and spleen size (long axis, R), using the Kruskal-Wallis test and multiple comparisons. After that, we assessed the diagnostic accuracy of the combination of splenic perfusion, spleen size, age, gender, and the presence or absence of hepatitis B and hepatitis C viral infection in detecting liver fibrosis, using stepwise regression and receiver operating characteristic analysis. Significant differences (P < 0.05) in MTT were observed in comparisons be...
International scholarly research notices, 2014
Journal of Clinical Gastroenterology, Oct 1, 2007
The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MD... more The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers. MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination. Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS. CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.
ABSTRACT PURPOSE To determine which can more precisely predict postoperative liver reserve preope... more ABSTRACT PURPOSE To determine which can more precisely predict postoperative liver reserve preoperatively, gadoxetate disodium-enhanced MR imaging or 99mTc-galactosyl serum albumin (99mTc-GSA) scintigraphy. METHOD AND MATERIALS Twelve consecutive patients (4 men, 8 women; mean age 70.3 years) who underwent gadoxetate disodium-enhanced MR imaging and 99mTc-GSA scintigraphy within 2 weeks before hepatectomy as a preoperative evaluation were included in this study. Remnant Hepatocellular Uptake Index: rHUI = rV[(rL20/S20) - 1] was determined from the future remnant liver volume (rV) and mean signal intensities of the future remnant liver (rL20) and the spleen (S20) on contrast enhanced MR images at 20 minutes after gadoxetate disodium administration. Receptor index of the future remnant liver: rLHL15 = rL%[L15/(H15 + L15)] was determined from the uptake ratio of the future remnant liver to the whole liver (rL%) on SPECT and the uptake of the liver (L15) and the heart (H15) on planar image of scintigraphy at 15 minutes after 99mTc-GSA administration. The correlation coefficients and its 95% confidence intervals (95%CIs) between indices for the segmental liver reserve (rHUI and rLHL15) and laboratory data at 1 week after hepatectomy (serum albumin, ALB; logarithm of serum total bilirubin, BIL; prothrombin time, PT) were evaluated. The significance of the correlation was evaluated by test for non-correlation. RESULTS Correlation coefficients and its probability values and 95%CIs were 0.69 (P = 0.012) [0.68, 0.71] for ALB, -0.30 (P = 0.339) [-0.32, -0.28] for BIL, and -0.69 (P = 0.024) [-0.71, -0.68] for PT in rLHL15, respectively. In rHUI, 0.21 (P = 0.508) [0.20, 0.23] for ALB, -0.59 (P = 0.045) [-0.60, -0.57] for BIL, and -0.29 (P = 0.362) [-0.30, -0.28] for PT, respectively. CONCLUSION Quantitative index for segmental liver reserve such as rHUI obtained from preoperative gadoxetate disodium-enhanced MR imaging predicts more precisely postoperative liver reserve in bilirubin metabolism, whereas rLHL15 obtained from preoperative 99mTc-GSA scintigraphy is superior to rHUI in the evaluation of postoperative liver reserve in protein synthesis. CLINICAL RELEVANCE/APPLICATION Postoperative liver failure can be avoided by quantitative indices for segmental liver reserve such as rHUI and rLHL15 obtained from gadoxetate disodium-enhanced MR imaging and 99mTc-GSA scintigraphy.
Nihon Naika Gakkai Zasshi, Jan 10, 2014
ISRN Hepatology, 2014
Tumor hemodynamics of carcinogenic hepatocytes nodules, that is, low grade dysplastic nodules, hi... more Tumor hemodynamics of carcinogenic hepatocytes nodules, that is, low grade dysplastic nodules, high grade dysplastic nodules, early hepatocellular carcinomas (HCCs), and progressed HCCs, change during multistep dedifferentiation of the nodules. Morphometric analyses of inflow vessels of these nodules indicate that the portal veins of carcinogenic hepatocyte nodules monotonically decrease whereas the arteries bitonically change, first decrease and then increase. Findings on imaging techniques depicting these changes in tumor blood inflows, especially intra-arterial contrast-enhanced computed tomography, closely related not only to the histological differentiation of the nodules but also to the outcomes of the nodules. Histological analyses of connections between the vessels within the tumors and those in the surrounding livers and findings on imaging techniques indicate that drainage vessels of HCC change from hepatic veins to hepatic sinusoids and then to portal veins during multist...
PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) c... more PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) clearance test have been considered to be an indicator of the liver reserve. Because the same uptake pathways by hepatocytes have been considered for ICG and gadoxetate disodium, we speculated that the segmental liver reserve can be quantitatively estimated by use of gadoxetate disodium-enhanced MR imaging. The subject of this study was to evaluate the usefulness of computerized estimation of quantitative segmental liver reserve after transcatheter arterial chemoembolization (TACE) by use of gadoxetate-enhanced MR imaging comparing to volumetry. METHOD AND MATERIALS 3D-GRE T1-weighted images with fat suppression at 20 min after gadoxetate disodium administration were obtained from 14 patients prior to TACE using ethiodized oil and gelatin sponge particle. The greatest increase of serum total bilirubin within 1 week after TACE was measured, and increase more than 1 mg/dL was regarded as a ...
PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) c... more PURPOSE The liver volume and a quantitative liver function test such as indocyanine green (ICG) clearance test have been considered to be an indicator of the liver reserve. Because the same uptake mechanisms by hepatocytes have been considered for ICG and gadoxetate disodium, we speculated that the segmental liver reserve can be quantitatively estimated by use of gadoxetate disodium-enhanced MR imaging. The subject of this study was to evaluate the usefulness of gadoxetate-enhanced MR imaging in a prediction of a liver dysfunction after transcatheter arterial chemoembolization (TACE) comparing to volumetry. METHOD AND MATERIALS 3D-GRE T1-weighted images with fat suppression at 20 min after gadoxetate disodium administration were obtained from 45 patients prior to TACE using ethiodized oil. The greatest increase of serum total bilirubin within 1 week after TACE was measured, and increase more than 1 mg/dL was regarded as a liver dysfunction. Ethiodized oil-enhanced CT was obtained ri...
The American journal of surgical pathology, 1990
We describe herein the morphologies of three cases of ciliated hepatic cysts and compare them wit... more We describe herein the morphologies of three cases of ciliated hepatic cysts and compare them with those of normal bronchi and intrahepatic bile ducts. Grossly, the hepatic cysts were located in the subcapsular region. They were solitary, unilocular, and rather small (less than 4 cm in diameter). Histologically, the cyst wall consisted of four layers: pseudostratified ciliated columnar epithelia with mucous cells, subepithelial connective tissue, smooth-muscle bundles, and an outermost fibrous capsule. The epithelial cytoplasm contained neutral, carboxylated, and sulfated mucus. We noted moderate immunoreactivity to keratin, epithelial membrane antigen, carcinoembryonic antigen, DU-PAN-2 and secretory component; weak immunoreactivity to cytokeratin CAM 5.2, cytokeratin AE1 + 3, and carbohydrate antigen 19-9; and faint or negative immunoreactivity to IgA and IgM. Cilia were immunoreactive to actin and tubulin; smooth muscles were immunoreactive to actin and desmin. Ultrastructural ob...
European journal of radiology, 2014
We aimed to clarify the usefulness of free-breathing readout-segmented echo-planar imaging (RESOL... more We aimed to clarify the usefulness of free-breathing readout-segmented echo-planar imaging (RESOLVE), which is multi-shot echo-planar imaging based on a 2D-navigator-based reacquisition technique, for detecting malignant liver tumor. In 77 patients with malignant liver tumors, free-breathing RESOLVE and respiratory-triggered single-shot echo-planar imaging (SS-EPI) at 3-T MR unit were performed. We set a scan time up to approximately 5 min (300s) before examination, measured actual scan time and assessed (1) susceptibility and (2) motion artifacts in the right and left liver lobes (3, no artifact; 1, marked), and (3) detectability of malignant liver tumors (3, good; 1, poor) using a 3-point scale. The median actual scan time of RESOLVE/SS-EPI was 365/423s. The median scores of each factor in RESOLVE/SS-EPI were as following in this order: (1) 3/2 (right lobe); 3/3 (left lobe), (2) 2/3 (right lobe); 1/2 (left lobe), and (3) 3/3, respectively. Significant differences were noted betwee...
Japanese journal of radiology, 2012
To identify characteristic magnetic resonance (MR) features of focal autoimmune pancreatitis (f-A... more To identify characteristic magnetic resonance (MR) features of focal autoimmune pancreatitis (f-AIP) useful for differentiation from pancreatic cancer (PC). We retrospectively analyzed MR imaging findings of 20 f-AIP lesions and 40 PC lesions smaller than 40 mm in diameter. On fat-suppressed T2-weighted images and dynamic contrast-enhanced fat-suppressed T1-weighted images (DCE-T1WI), we classified MR features of internal signal intensity for each lesion into homogeneous, speckled, or target type. We assessed the sensitivity, specificity, and accuracy of these findings in the diagnosis of f-AIP. We also investigated the incidence of previously reported findings for differentiation between f-AIP and PC. Speckled enhancement within a hypointense or isointense lesion on pancreatic phase DCE-T1WI (speckled type) was observed more frequently in f-AIP than in PC, with high sensitivity, high specificity, and high accuracy. Hypointensity to hyperintensity surrounding a less enhanced focal a...
Japanese journal of radiology, 2011
We aimed to reveal the difference in contrast enhancement of the abdominal organs and major vesse... more We aimed to reveal the difference in contrast enhancement of the abdominal organs and major vessels on dynamic contrast-enhanced magnetic resonance imaging (DCM-MRI) using gadoxetic sodium (Gd-EOB-DTPA) and gadopentetate dimeglumine (Gd-DTPA) in the same patients. DCM-MRI using Gd-EOBDTPA and Gd-DTPA were performed in the same 17 patients. Precontrast and DCM-MRI images [arterial phase (AP), portal venous phase (PP), hepatic venous phase (HP)] were acquired before and after bolus injection of each contrast agent. The organ-to-muscle ratio [liver (L/M), spleen (S/M), aorta (A/M), portal vein (P/M), hepatic vein (V/M)] were calculated at each phase and analyzed statistically. There was no significant difference between Gd-EOB-DTPA and Gd-DTPA images regarding the L/M or V/M mean on precontrast images or the mean of L/M at AP and L/M at the PP. At the AP, PP, and HP, the means of S/M, A/M, P/M, and V/M with Gd-EOBDTPA were lower than those with Gd-DTPA. On HP, The mean L/M with Gd-EOB-...
Gastroenterologia Japonica, 1992
An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a... more An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic...
Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine, Jan 10, 2014
Virchows Archiv A Pathological Anatomy and Histopathology, 1993
Two nodules of hepatic adenomatous hyperplasia (AH) resembling focal nodular hyperplasia were fou... more Two nodules of hepatic adenomatous hyperplasia (AH) resembling focal nodular hyperplasia were found in two patients with cirrhosis or chronic active hepatitis. Imaging techniques suggested that the nodules were hepatocellular carcinoma. Pathological examination showed that the nodules (approximately 1.0 cm in diameter) were clearly demarcated from the surrounding liver tissue, and contained foci of scar-like fibrosis in the centre of the nodules. Microscopically, they contained portal tracts and fulfilled the criteria of AH. A large number of arteries were present in the central scar-like fibrosis as well as in the parenchyma of the nodules. There were foci of mildly atypical hepatocytes in one nodule but no cellular atypia in the other. Morphometric analysis showed that the cumulative luminal area of arteries per unit area was much greater in the nodules than in the extranodular liver tissues, while the cumulative luminal area of portal veins per unit area was much less in the nodules than in the extranodular liver tissues. Although the pathogenesis is unclear, these nodules might have developed through localized vascular changes associated with chronic liver disease, may have arisen from pre-existing arterial malformation, or may represent the early stages of angiogenesis in hepatocarcinogenesis.