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Background The purpose of this study was to describe the ultrasonographic (US) and mammographic (MX) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in the surgical cavity and their size variations in follow-up. Materials and Methods We retrospectively reviewed 417 MX and 743 US images performed between January 2009 and January 2014 for 262 women who underwent breast-conserving surgery. All patients underwent US, only 203 women underwent MX examination. Results In 170 of 262 patients, US examinations showed abnormal findings. Three main US patterns were identified: (1) complex masses: well-encapsulated ipoisoechoic lesions with circumscribed margins with internal hyperechoic nodules (56%); (2) hypoanechoic lesions without internal hyperechoic nodules (24%); and (3) completely anechoic collections (20%). Moreover, Doppler ultrasound examination was performed on all of the patients. In 95 of 203 patients, MX examinations showed abnormalities. Four main MX patterns were identified: (1) round or oval opacity with circumscribed margins (58%); (2) round or oval opacity with indistinct or ill-defined margins (17%); (3) irregular opacity with indistinct or spiculated margins (9%); and (4) architectural distortion or focal asymmetry (15%). Most of the lesions showed a decrease in size at US and MX follow-up examination and the decrease was statistically significant (P Conclusion When applied to the surgical residual cavity, ORC aids to control local hemorrhage and reduce the risk of postoperative infections, but can lead to alterations in surgical scar. Thus, knowledge of the radiological findings might allow avoidance of misdiagnosis of tumor recurrence or unnecessary diagnostic examinations.

Purpose To correlate the degree of plaque vulnerability as determined by contrast-enhanced ultrasound (CEUS) with histological findings. Secondary objectives were to optimize the CEUS acquisition technique and image evaluation methods. Materials and methods Fifty consecutive patients, either symptomatic and asymptomatic referring to our department in order to perform carotid endarterectomy (TEA), were enrolled. Each patient provided informed consent before undergoing CEUS. Ultrasound examination was performed using high-frequency (8–14 MHz) linear probe and a non-linear pulse inversion technique (mechanical index: 0.09–1.3). A double contrast media injection (Sonovue, 2 mL and 4 mL; Bracco, Italy) was performed. Two videotapes were recorded for every injection: early “dynamic” phase and late “flash” phase, performed with 6 high mechanical index impulses. Movies were quantitatively and qualitatively evaluated. Qualitative and quantitative evaluation were statistically compared to immunohistological diagnosis of vulnerable plaque, considered as gold standard. Results Qualitative CEUS evaluation obtained high statistical results when compared to immunohistological results, with values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 94%, 68%, 87%, 85% and 86%, respectively, which became higher if considering only asymptomatic patient, with a NPV of 91%. Nevertheless, quantitative software evaluation proved less effective and could not reach similar results. Conclusion Carotid plaque enhancement assessed with CEUS well correlates with histological assessment of plaque instability. CEUS may provide valuable information for plaque risk stratification and may play a role in the indication to treatment of patients with carotid stenoses, particularly in asymptomatic population.

In the past, thoracic and cardiac imaging were two distinct specialties of radiology. The technical evolution, however, has changed their boundaries with an important impact on CT imaging practices and has opened the new era of "cardiothoracic" imaging, due to the strong anatomic, mechanical, physiologic, physiopathologic, and therapeutic cardiopulmonary correlations. Modern thoracic radiologists can no longer avoid the assessment of heart and coronary arteries, as they used to do with earlier generations of CT scanner. The advent of ECG gating and state-of-art CT scanner faster rotation speed, high spatial and temporal resolution, high-pitch mode, shorter acquisition time, and dedicated cardiac reconstruction algorithms has opened new possibilities for chest imaging, integrating cardiac morphologic and even functional information within a diagnostic chest CT scan. The aim of this review is to briefly show and summarize the concept of integrated cardiothoracic imaging, which redefines the boundaries of chest CT imaging, opening the door to a new radiologic specialty.

The estimation of response to neoadjuvant chemotherapy (NAC) is useful in the surgical decision in breast cancer. We addressed the diagnostic reliability of conventional MRI, of diffusion weighted imaging (DWI) and of a merged criterion coupling morphological MRI and DWI. Diagnostic performance was analysed separately in different tumor subtypes, including HER2+ (human epidermal growth factor receptor 2)/HR+ (hormone receptor) (hybrid phenotype).Two-hundred and twenty-five patients underwent MRI before and after NAC. The response to treatment was defined according to the RECIST classification and the evaluation of DWI with apparent diffusion coefficient (ADC). The complete pathological response - pCR was assessed (Mandard classification).Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), HER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of cases. Average ADC was statistically higher after NAC (p0.001) among patients showing pCR vs. those who had not pCR. The RECIST classification showed adequate performance in predicting the pCR in Triple Negative (area under the receiver operating characteristic curve, ROC AUC=0.9) and in the HER2+ subgroup (AUC=0.826). Lower performance was found in the Luminal and Hybrid subgroups (AUC 0.693 and 0.611, respectively), where the ADC criterion yielded an improved performance (AUC=0.787 and 0.722). The coupling of morphological and DWI criteria yielded maximally improved performance in the Luminal and Hybrid subgroups (AUC=0.797 and 0.761).The diagnostic reliability of MRI in predicting the pCR to NAC depends on the tumor phenotype, particularly in the Luminal and Hybrid subgroups. In these cases, the coupling of morphological MRI evaluation and DWI assessment may facilitate the diagnosis.

Purpose To prospectively assess the technical feasibility and reproducibility of quantitative foot perfusion multidetector-row computed tomography (MDCT) in patients with peripheral occlusive artery disease (PAOD) and to evaluate perfusion parameters changes after endovascular treatment. Materials and methods Institutional review board approval and informed patient consent were obtained. 10 patients older than 65 years (mean 74.1 years, range 66–95 years) with PAOD and who were referred to our department for single-limb endovascular treatment were enrolled prospectively. All patients underwent foot CT perfusion examinations before and within 72 h after endovascular treatment. A 64-row CT lightspeed VCT scanner (GE Medical Systems) was used with acquisition of eight contiguous 5-mm reconstructed sections (60-s acquisition time; 40 mL Iomeprol 400 mgI/mL, @4 mL/s). Data were analyzed by two blinded readers using commercially available software to calculate perfusion parameters. Inter-observer and intra-observer agreement of perfusion CT analysis was assessed using Bland–Altman analyses and intra-class correlation coefficient (ICC). Changes in perfusion parameters after endovascular treatment were assessed using Wilcoxon's test. Results Good inter-observer and intra-observer agreement was obtained in all patients. Good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. By comparing perfusion parameters in the treated foot, a significantly shorter mean transit time (MTT) was obtained. Conclusions Foot CT perfusion is a feasible and reproducible technique. A significant decrease of MTT between pre- and post-revascularization suggests improved flow in the below-the-knee arteries.

Aim To describe the radiological appearance of normal and pathological findings resulting from mammary autologous fat injections (lipofilling). Materials and methods Informed consent and institutional review board approval were obtained. From January 2008 to December 2010, all patients that had undergone breast lipofilling at our institution (Catholic University) were consecutively enrolled. The site and amount of autologous fat injections were known. Mammography, ultrasonography, and magnetic resonance imaging (MRI) were prospectively obtained preoperatively, and 6 and 12 months after the procedure. Normal and pathological findings were described. Results Twenty-four patients (mean age 50.8 ± 10.5 years; range 26–70 years) were included. Fourteen patients underwent lipofilling after mastectomy, eight after wide local excision, one as a treatment for a congenital asymmetry, and one as a treatment for Poland syndrome. No severe complications were observed after treatment. Normal findings due to lipofilling (“oil cysts”) were identified in 23 cases using ultrasound and in 16 using MRI. Liponecrosis, the most frequently observed complication, was detected in four cases using ultrasound and in eight by MRI. In one case mammography showed calcific fat necrosis. Mean amount of fat injected was 114.8 ± 55 ml. The average amount of fat grafted in patients who developed liponecrosis was 158.4 ± 42.7 versus 104.6 ± 52.3 ml (p = 0.0043, t-test). In one case breast cancer recurrence was diagnosed. Conclusion Normal findings due to lipofilling are better identified by ultrasound, and pathological findings are best identified using MRI. Liponecrosis most frequently occurs when large amounts of fat are injected. In the authors' experience lipofilling does not interfere with breast cancer early diagnosis.

Despite the increased use of CT imaging, chest radiography remains a very important diagnostic modality in the evaluation of lung parenchymal and mediastinal diseases, providing a vast amount of useful information. This information is generally derived from the relationships among the normal anatomic structures of the mediastinum, pleura, and lungs, which represent the basis of the "cardiac silhouette" and "mediastinal lines-and-stripes" concepts that potentially play an important role in the establishment of a diagnosis or a spectrum of diagnoses before proceeding to CT imaging. The capability of recognizing an abnormal chest radiograph on the basis of the displacement, deformation, or obscuration of one of these structures when compared with those in normal findings is often mandatory prior to requesting a potentially useful CT scan examination. Therefore, radiologists, trainees, and physicians must be familiar with the anatomic basis of those findings to be able to recognize the normal and abnormal appearance of structures when developing an appropriate differential diagnosis. In this review, we briefly describe the cardiac silhouette concepts and the mediastinal lines-and-stripes configurations as they relate to the radiographic and CT scan appearance of structures for a spectrum of pathologic diseases and list the possible underlying causes of the displacement, deformation, or obscuration of the structures.

The aim of this study was to evaluate clinical correlations of CT signs in proven Crohn's disease. Fifty patients were studied by means of multidetector CT. Clinical activity was assessed using Crohn's disease activity index (CDAI) score and some laboratory parameters. All patients with CDAI>150 had CT study scored as pathological. Seventy-nine percent of patients with CDAI

We evaluated the reliability of a rotational angiographic unit (RA) with flat-panel detector as a single technique to guide percutaneous vertebroplasty (PVP) and for post-procedure assessment by 2D and 3D reformatted images. Fifty-five consecutive patients (104 vertebral bodies) were treated under RA fluoroscopy. Rotational acquisitions with 2D and 3D reconstruction were obtained in all patients for immediate post-procedure assessment. In complex cases, this technique was also used to evaluate the needle position during the procedure. All patients underwent CT scan after the procedure. RA and CT findings were compared. In all cases, a safe trans-pedicular access and an accurate control of the bone-cement injection were successfully performed with high-quality fluoroscopy, even at the thoracic levels and in case of vertebra plana. 2D and 3D rotational reconstructions permitted CT-like images that clearly showed needle position and were similar to CT findings in depicting intrasomatic implant-distribution. RA detected 40 cement leakages compared to 42 demonstrated by CT and showed overall 95% sensitivity and 100% specificity compared to CT for final post-procedure assessment. Our preliminary results suggest that high-quality RA is reliable and safe as a single technique for PVP guidance, control and post-procedure assessment. It permits fast and cost-effective procedures avoiding multi-modality imaging.

In the elderly, the chest without evident pathology is characterized by findings that occupy a sort of "no man's land" between the normal and the pathologic. Aging results in physiologic modifications that must be recognized so as not to be interpreted erroneously as pathologies. On the other hand, the elderly tend to become ill more frequently and multipathologies are more frequent. Image diagnostics is a key element in the clarification of often blurry clinical pictures, which may make early diagnosis possible, a great advantage to timely treatment. In this sense, knowledge of heart/lung interactions makes it possible to obtain, from the onset, radiologic and clinical signs of the two physiopathologic models prevalent in the elderly, the "cardiac lung" and the "pulmonary heart."

To assess the accuracy of magnetic resonance imaging (MRI) in evaluating residual disease after neoadjuvant chemotherapy in patients with large breast cancers.Forty-five women with large breast cancers underwent MRI mammography before and after neoadjuvant chemotherapy (three or six cycles). Dynamic MRI was performed using a 1.5 T unit using three-dimensional FSPGR sequences. For each patient tumour size, tumour volume and dynamic curve were obtained before and after neoadjuvant treatment. Residual tumour sizes obtained using MRI were compared with pathological findings to assess the accuracy of MRI in detecting and in measuring residual tumour.The sensitivity, specificity and accuracy of MRI in detecting residual disease was 90.5, 100, and 91.3%, respectively. The mean of largest diameters measured at histology and at MRI were 26 and 28.2mm, respectively. The tumour size correlation coefficient between MRI and pathology measurements was very high: r(2)=0.9657 (p0.0001). The interclass correlation coefficient between preoperative imaging measurements and pathological measurements of residual disease was 0.944 (95% CI: 0.906-0.982).The presence and size of residual disease in breast patients treated with neoadjuvant chemotherapy could be accurately evaluated using MRI.

Multidetector row CT scanners with submillimeter spatial resolution and high temporal resolution are now available and are increasingly used for noninvasive assessment of vascular disease including coronary arteries and grafts. The entire heart and graft course can be scanned within a single breath-hold, and contrast-enhanced images are reconstructed through retrospective ECG gating. In this pictorial review, we describe the CT findings of the most commonly used coronary artery bypass grafts on both axial images and two-dimensional and three-dimensional images providing a correlation with conventional coronary angiography

Chronic venous insufficiency (CVI) is a pathologic condition caused by valvular incompetence, with or without associated venous outflow obstruction, which may affect both the superficial and the deep venous system, causing venous hypertension and stasis. The most common form of CVI is primary varicose veins due to the insufficiency of the saphenous system. Color-Doppler sonography (CDS) is actually the main diagnostic technique of imaging for CVI. In this article, we describe the anatomy, the technique, and the information necessary to the radiologist to perform CDS in chronic venous insufficiency. The knowledge of the venous anatomy is the cornerstone for an adequate sonographic examination. The venous network in the lower extremities is divided into three systems: superficial, deep, and perforating veins. Deep veins are "comitantes" to the corresponding arteries and run under the muscular fascia. Superficial veins course into the subcutaneous fat, superficially to the deep muscular fascia; the main superficial veins are the greater and lesser saphenous and their tributaries. Connection between the saphenous veins are defined as communicating veins. Superficial and deep veins are connected by perforating veins, with flow directed, under normal circumstances, from the superficial to the deep system. The main perforating are the Hunter in the mid thigh, the Dodd in the lower thigh, the Boyd in the upper calf, and the Cockett's in the middle and lower calf. Sonographic examination must be performed in the upright and supine position. Compression sonography and color and PW Doppler are systematically employed to assess the absence of deep venous thrombosis. Femoro-popliteal veins are evaluated with color and PW Doppler for valvular insufficiency with reflux by performing Valsalva maneuver and calf compression. The sapheno-femoral and sapheno-popliteal junctions are examined to identify type of junction, continence, accessory saphenous, and incompetent collaterals. Perforating veins are usually identified at the medial aspect of the thigh and at the medial, lateral, and posterior aspects of the leg. Outward flow (lasting more than 500 ms) in the perforating veins should be considered a sign of their incompetence. Several surgical and interventional procedures are now available for the treatment of the CVI, as follows: vein ligation and stripping, stab avulsion, endoluminal occlusion of the saphenous trunks, subfascial endoscopic perforator surgery, and valvuloplasty.

The regional activity of the contralateral primary (SI) and the bilateral secondary (SII) somatosensory areas during median nerve stimulations at five intensity levels (ranging from nonpainful motor threshold to moderate pain) was studied by means of functional magnetic resonance imaging (fMRI). The aim was to characterize the functional topography of SII compared to SI as a function of the stimulus intensity. Results showed that the galvanic stimulation of the median nerve activated the contralateral SI at all stimulus intensities. When considered as a single region, SII was more strongly activated in the contralateral than in the ipsilateral hemisphere. When a finer spatial analysis of the SII responses was performed, the activity for the painful stimulation was localized more posteriorly compared to that for the nonpainful stimulation. This is the first report on such a SII segregation for transient galvanic stimulations. The activity (relative signal intensity) of this posterior area increased with the increase of the stimulus intensity. These results suggest a spatial segregation of the neural populations that process signals conveyed by dorsal column-medial lemniscus (nonpainful signals) and neospinothalamic (painful signals) pathways. Further fMRI experiments should evaluate the functional properties of these two SII subregions during tasks involving sensorimotor integration, learning, and memory demands.

We studied MEG and fMRI responses to electric median and tibial nerve stimulation in five healthy volunteers. The aim was to compare the results with those of a previous study using only fMRI on the primary and secondary somatosensory cortices in which the somatotopic organization of SII was observed with fMRI. In the present work we focus on the comparison between fMRI activation and MEG equivalent current dipole (ECD) localizations in the SII area. The somatotopic organization of SII was confirmed by MEG, with the upper limb areas located more anteriorly and more inferiorly than the lower limb areas. In addition a substantial consistency of the ECD locations with the areas of fMRI activation was observed, with an average mismatch of about 1 cm. MEG ECDs and fMRI activation areas showed comparable differences in SI.

Widespread plaque inflammation has been demonstrated in acute coronary syndromes (ACS). We evaluated signs of plaque inflammation in carotid arteries of patients with ACS by contrast-enhanced magnetic resonance imaging (MRI). Carotid MRI was performed in 13 patients with ACS and in 9 controls having at least 1 carotid plaque with a stenosis ≥40%. MRI criteria of plaque inflammation were: increased T2 signal >50% of the plaque areas (tissue oedema) and/or enhancement after gadolinium injection (neo-vascularization). MRI signs of inflammation were found in 95% and in 33% of patients with ACS and controls, respectively ( p Carotid artery MRI may serve as a window to the entire cardiovascular system, to identify "vulnerable" patients.

We describe the case of a 10 years old true hermaphrodite in which a scrotal mullerian derivative and ovarian and testicular tissue within the same gonad were detected preoperatively by ultrasound.

Purpose: To compare the accuracy of three different magnetic resonance angiography (MRA) techniques for studying steno-occlusive disease of carotid arteries. Methods: 64 patients were evaluated with three MRA techniques- three-dimensional (3D) time-of-flight (TOF), two-dimensional (2D) TOF, and 3D Phase-Contrast (PC); the acquisition was in the axial plane, the volume included the carotid bifurcation. Digital subtraction angiography (DSA) was considered the `gold standard'. The MRA images were reprojected with a maximum intensity pixel ray-tracing (MIP) algorithm. The three MRA techniques were blindly graded as normal, mildly stenotic (0–29%), moderately stenotic (30–49%), severely stenotic (70–99%), or occluded. Results: DSA provided 128 diagnostic judgments: 92 were negatives and 36 positives. 2D TOF was in agreement with angiography in 116 of 128 cases (90%), but overestimated the results in seven cases and underestimated in five cases. 3D TOF agreed with angiography in 125 of 128 cases (97%), with one overestimation and two under estimations. 3D PC was concordant in 116 of 128 cases (90%), overestimating in six cases, underestimating in six cases. The sensitivity, specificity and diagnostic accuracy for 2D TOF was, respectively 84%, 94%, and 92%, while for 3D TOF was 94%, 100%, and 98%, and for 3D PC 86%, 98%, and 95%. The comparison of the three different MRA techniques provided no statistically significant difference (Friedman test P Conclusion: The high degree of diagnostic accuracy of MRA found in the study of the steno-occlusive disease of the carotid arteries confirms the high degree of reliability of this methodology carried out with the 3D TOF technique, compared to 2D TOF and 3D PC.

Magnetic resonance imaging of optic nerves was obtained in 13 patients with acute optic neuritis and in 13 patients with a previous history of optic neuritis (ON), assessed by clinical, visual fields and visual evoked potentials evaluations. Results of the conventional short tau inversion recovery (STIR) sequence obtained with short time echo (STE-STIR: 22 ms) were compared with long time echo (LTE-STIR: 80 ms) sequence. The conventional STE-STIR sequence revealed lesions in 78.5% of acute ON and in 58.8% of optic nerves affected by previous ON. The LTE-STIR sequence was diagnostic in 92.8% of acutely symptomatic nerves, in 94.1% of nerves with previous ON. The calculated length of optic nerve lesions was significantly longer in imaging obtained with the LTE-STIR sequence than with the conventional STE-STIR sequences, both in acute and previous ON.

Spiral computed tomography (CT) allows very satisfactory temporal resolution for the detection and analysis of changes in contrast medium density, so that volumes of contrast material smaller than those recommended for conventional CT can be used. The present double-blind, parallel group study was designed to compare image quality and diagnostic efficacy obtained with two different iodine strengths (200 and 300 mgI/ml) and two different flow rates (2 and 3 ml/s) of a fixed volume (70 ml) of iomeprol in adult consenting patients requiring spiral CT of the mediastinum. Imaging was performed during suspended respiration and, a 15-s delay to scan. Spiral CT was initiated 1 cm above the aortic arch and continued inferiorly for 24 cm in all patients. Two independent readers blindly graded image quality, opacification of the superior vena cava, thoracic aorta and pulmonary arteries, and overall diagnostic quality of the CT examination. CT density measurements were performed over the level of the aortic arch, left and right pulmonary arteries, left atrium, and descending aorta. Opacification of the mediastinal vessels was better in the patients injected at 3 ml/s flow rate and was independent of the iodine strength used, except in the case of the thoracic aorta, which was better opacified by injecting iomeprol 300 mgI/ml at 3 ml/s. The highest diagnostic efficacy of the spiral CT examination was obtained with iomeprol 300 mgI/ml at 3 ml/s infusion rate, which seems to represent the administration scheme of choice.

Polymorphonuclear cell (PMN) chemotaxis, phagocytosis, killing, superoxide anion (O 2 − ) generation and enzyme release were evaluated in 20 malnourished aged individuals. PMN from malnourished elderly exhibited a significant reduction of their functional capacities, while no differences in terms of enzyme release by the same cell suspensions were observed in comparison to young well-nourished donors. By contrast, a diminished total cell myeloperoxidase amount and high level of O 2 − generation were detected. In vitro vitamin and/or trace element pretreatment of cells from aged subjects gave rise to a significant enhancement of their chemotactic, phagocytic and killing capacities. In addition, such an experimental approach led to an augmented total cell myeloperoxidase level and to an O 2 − generation which fell within normal values. Taken together, these findings suggest that malnutrition may represent an additional factor involved in the decline of PMN responsiveness in the elderly.

The effects of isocaloric carbohydrate-based vs. fat-based total parenteral nutrition (TPN) regimens on cancer cell proliferation and host nutritional status were evaluated in 27 patients with tumours of the gastro intestinal tract consecutively assigned to receive for 14 days: a glucose-based (A) or a lipid-based (B) TPN formula, or an oral diet (C) isocaloric and isonitrogenous to A and B. Cancer cell replication rate was evaluated by thymidine labelling index (LI) on tumour samples before and at the end of each nutritional regimen. The number of replicating cells increased by 32.2% in patients receiving regimen A. LI decreased by 24.3% in patients given regimen B. LI values were slightly increased (+15%) in patients maintained on regimen C. Nutritional status remained within normal limits. None of the LI changes observed between and within the three arms of the trial were found to be statistically significant. Thus we failed to prove that glucose consistently stimulates or lipids inhibit tumour proliferation despite a trend in this sense.

ig. 1. The frontal chest radiograph showing the anomalous vascular tructure coursing to the right cardiophrenic angle (“scimitar sign”). below the diaphragmatic shape had also been reported (“scimitar sign”). Contrast-enhanced multidetector-row computed tomography (MDCT) was performed (Fig. 2a and b). The MDCT examination confirmed the dilatation of right heart chambers and the increased size of the pulmonary arteries. An anomalous pulmonary vein return draining the entire right lung into the inferior vena cava was also demonstrated. The normal main pulmonary veins of the right lung connecting to the left atrium were not shown (total return). The supradiaphragmatic vena cava was enlarged and showed early filling with contrast medium. The diagnosis of total anomalous pulmonary venous return was made and the patient was referred to surgical evaluation. Anomalous pulmonary venous returns (APVRs) are rare and complex congenital malformations that lead to left-to-right blood shunt and pulmonary hypertension [1–5]. When diagnosed in adults they manifest with respiratory insufficiency and recurrent pulmonary infections. Chest radiograph may be indicative of the

Background/Aims: Hepatolithiasis is a well known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. Methods: Among a total of 257 patients who received treatment for hepatolithiasis from 2002 to 2011 at Korea University Anam and Guro Hospital, 236 patients were eligible for analysis; 92 patients underwent liver resection (resection group) and 144 patients did not (non-resection group). The data were retrospectively collected and analyzed. Results: The incidence of cholangiocarcinoma was 6.8% (16/236) during follow-up period (mean 41±41 months). The median tumor occurrence time was 28 (13-111) months. Cholangiocarcinoma occurred 6.5% (6/92) and 6.9% (10/144) in resection and non-resection group respectively (P=0.425). In resection group, cholangiocarcinoma occurred in 3.6% (2/56) of patients with complete stone removal, and in 13.3% (4/ 30) of patients with incomplete stone removal (p=0.591). In non-resection group, cholangiocarcinoma occurred in 5.7% (3/53) of patients with complete stone removal, and in 8.9% (7/79) of patient with incomplete stone removal (p=0.738). When analyzed according to completeness of stone removal regardless of treatment modality, cholangiocarcinoma occurred in 4.6% (5/109) of patients with complete stone removal, and in 10.1% (11/109) of patients with incomplete stone removal (p=0.429). Although the site of stone and tumor occurrence concurred in 10/16 patients (3/6 patients in the resection group, 7/10 patient in the non-resection group), it did not match in 6 patients. On univariate analysis, none of the factors (age, gender, abdominal pain, bile duct stenosis, bile duct dilatation, liver atrophy, residual stone, stone recurrence and liver resection) showed relationship with the incidence of cholangiocarcinoma. Conclusion: There was no difference in the incidence of cholangiocarcinoma according to the treatment modality or completeness of stone removal. Therefore, patients with hepatolithiasis should carefully be followed-up to detect cholangiocarcinoma even after treatment.

Background : Endoscopic ultrasonography (EUS) is considered to be the best modality to predict the neoplastic polyps of the gallbladder. However, EUS has several limitations following as 1) the considerable experience of investigators, 2) presence of the interobserver variations and 3) unavailability of EUS in some centers. Multidetector computed tomography (MDCT) provides fine section image of gallbladder and allows to reduce the interobserver variations. We evaluated the accuracy of MDCT combined with high resolution ultrasonography (HRUS) for gallbladder polyps smaller than 2cm compared with EUS. Methods : From Dec 2005 to June 2010, 109 patients who underwent cholecystectomy due to gallbladder polyps were enrolled. Subjects were divided in two groups (reference group : 63 patients who were performed MDCT and HRUS vs. validation group : 46 patients who underwent MDCT, HRUS, and EUS). New scoring system was developed from reference group, and applied to validation group, while previously reported EUS scoring system was applied to the same validation group. Results : In reference group, size (p,0.001), number (p=0.015), shape (p=0.001), and CT/US size ratio of polyps (p=0.008) were significant variables in univariate analysis. Area under the ROC curve draw by new scoring system was 0.859 and cut-off value was set to 3. In validation group, new scoring system showed comparable accuracy (65.2%) with previously reported EUS scoring system(73.9%, p=0.434). Conclusion : MDCT combined with HRUS provide comparatively high accuracy in small gallbladder polyps in distinguishing between neoplastic and non-neoplastic polyps as preoperative diagnostic modality.

Background/Aims: Hepatolithiasis is a well known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. Methods: Among a total of 257 patients who received treatment for hepatolithiasis from 2002 to 2011 at Korea University Anam and Guro Hospital, 236 patients were eligible for analysis; 92 patients underwent liver resection (resection group) and 144 patients did not (non-resection group). The data were retrospectively collected and analyzed. Results: The incidence of cholangiocarcinoma was 6.8% (16/236) during follow-up period (mean 41±41 months). The median tumor occurrence time was 28 (13-111) months. Cholangiocarcinoma occurred 6.5% (6/92) and 6.9% (10/144) in resection and non-resection group respectively (P=0.425). In resection group, cholangiocarcinoma occurred in 3.6% (2/56) of patients with complete stone removal, and in 13.3% (4/ 30) of patients with incomplete stone removal (p=0.591). In non-resection group, cholangiocarcinoma occurred in 5.7% (3/53) of patients with complete stone removal, and in 8.9% (7/79) of patient with incomplete stone removal (p=0.738). When analyzed according to completeness of stone removal regardless of treatment modality, cholangiocarcinoma occurred in 4.6% (5/109) of patients with complete stone removal, and in 10.1% (11/109) of patients with incomplete stone removal (p=0.429). Although the site of stone and tumor occurrence concurred in 10/16 patients (3/6 patients in the resection group, 7/10 patient in the non-resection group), it did not match in 6 patients. On univariate analysis, none of the factors (age, gender, abdominal pain, bile duct stenosis, bile duct dilatation, liver atrophy, residual stone, stone recurrence and liver resection) showed relationship with the incidence of cholangiocarcinoma. Conclusion: There was no difference in the incidence of cholangiocarcinoma according to the treatment modality or completeness of stone removal. Therefore, patients with hepatolithiasis should carefully be followed-up to detect cholangiocarcinoma even after treatment.

New Therapeutic Perspectives for Management of Advanced Hepatocellular Carcinoma With Hepatic Arteriovenous Fistula: Balloon-Occluded Percutaneous Radio-Frequency Thermal Ablation (RFA) Plus Transcatheter Arterial Chemoembolization (TACE) Roberto Iezzi, Valentina Cesario, Mariachiara Campanale, Silvia Pecere, Federico Barbaro, Emanuele Rinninella, Francesca Romana Ponziani, Michele La Torre, Brigida E. Annicchiarico, Massimo Siciliano, Maurizio Pompili, Antonio Grieco, Luca Miele, Gian Ludovico Rapaccini, Laura Riccardi, Maria Assunta Zocco, Alessandro Milani, Anna Maria De Gaetano, Giovanni B. Gasbarrini, Lorenzo Bonomo, Antonio Gasbarrini

NEW THERAPEUTIC PERSPECTIVES FORMANAGEMENT OF ADVANCED HEPATOCELLULAR CARCINOMAWITH HEPATIC ARTERIOVENOUS FISTULA: BALLOON-OCCLUDED PERCUTANEOUS RADIO-FREQUENCY THERMAL ABLATION (RFA) PLUS TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION (TACE) V. Cesario ∗ ,1, R. Iezzi 2, M.C. Campanale1 , E. Rinninella1 , F.R. Ponziani1, T.A. Di Rienzo1, F. Barbaro1 , B.E. Annicchiarico1 , M. Siciliano1 , M. Pompili 1, G.L. Rapaccini 1 , A. Grieco1, L. Miele1 , A. Milani 1 , L. Riccardi 1 , M.A. Zocco1, M. Santoro2, M. La Torre2, A.M. De Gaetano2 , G.B. Gasbarrini 3 , L. Bonomo2, A. Gasbarrini 1 1Medicina Interna, Ucsc, Policlinico Gemelli, Roma, Italy; 2Radiologia, Ucsc, Policlinico Gemelli, Roma, Italy; 3Fondazione Ricerca In Medicina, Bologna, Italy