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The objective of our study was to catalog the anatomic features shown on preoperative CT that precluded living-donor liver donation.We retrospectively reviewed the records of 159 consecutive candidates who were evaluated for potential right or left lobe liver donation from November 2007 to January 2012 using MDCT angiography and cholangiography. For the potential donors who were excluded secondary to findings depicted on preoperative imaging, we determined which findings precluded donation.In two (1%) patients who had no prohibitive preoperative imaging findings, anatomic abnormalities were detected intraoperatively that precluded transplantation. Sixty-one (38%) candidates were excluded from liver donation on the basis of imaging findings. Of these patients, 40 (66%) had inadequate liver volume, 14 (23%) had vascular or biliary variants, five (8%) had steatosis, and two (3%) were found to have renal cell carcinoma. Arterial and biliary variants were the most common reason for exclusion based on anatomic findings.Inadequate liver volume was the most common reason for exclusion based on preoperative imaging. Arterial and biliary anatomic variants precluded both right and left lobe transplantation in a number of cases.

Quantitative image quality assessment in terms of image noise (IN), contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) in relation to required radiation dose (RD) for dual-energy (DE), standard and low-kVp contrast-enhanced computed-tomography (CT) cholangiography.For each of 22 DECT-cholangiography examinations, 3 image datasets were analyzed as independent single-source CT-acquisitions at different tube potential, i.e. 80 kVp, 120 kVp-equivalent (linear blended dataset M0.3: 30% 80 kVp, 70% 140 kVp), and 140 kVp. Analysis comprised determination of IN, CNR and SNR in regions of interest (ROI) placed in liver parenchyma and contrasted bile ducts. IN was evaluated as mean standard deviation of 3 ROI placed within liver parenchyma (segments 6/7, 5/8, 2/3); CNR was assessed as bile duct-to-liver parenchyma ratio, and SNR as bile duct-to-image noise ratio. RD in terms of CT dose index (CTDI(vol)), dose-length product (DLP) and effective dose (ED) has been determined for each of the datasets, and compared to console prediction and scan summary values. Using phantom measurements of CTDI(vol), a method for separating comprehensive RD values of DE-acquisitions into the original RD contribution of each tube (80 kVp/140 kVp) has been developed, enabling comparison of all 3 datasets as if independently acquired using single-source "single-energy" technique.Highest IN was detected for 80 kVp- (38.6 ± 5.1HU), lowest for 120 kVp-equivalent linear blended M0.3-datasets (23.1 ± 3.4HU) with significant differences between all datasets (P0.001). Highest SNR and CNR were measured for M0.3- (SNR: 14.8 ± 4.1; CNR: 11.6 ± 3.8) and 80 kVp-datasets (SNR: 13.8 ± 4.8; CNR: 11.2 ± 4.5); lowest for 140 kVp-datasets (SNR: 9.5 ± 2.5; CNR: 7.1 ± 2.3) with significant differences between M0.3- and 140 kVp-datasets as well as between 80 kVp- and 140 kVp-datasets (both P0.001 for both CNR, SNR). CTDI(vol), DLP and ED were reduced by 50% for low-kilovoltage acquisitions (CTDI(vol): 5.5 ± 1.4 mGy; DLP: 127.8 ± 40.1 mGy cm; ED: 1.9 ± 0.6 mSv) compared to comprehensive DE-acquisitions (CTDI(vol): 11.0 ± 2.3 mGy; DLP: 253.8 ± 67.5 mGy cm; ED: 3.8 ± 1.0 mSv, tube contribution: 80 kVp: 44.5%; 140 kVp: 55.5%), and by 20% compared to conventional acquisitions at 120 kVp (CTDI(vol): 6.71 mGy; DLP: 153.5 ± 16.9 mGy cm; ED: 2.3 ± 0.3 mSv).Despite higher IN, low-kilovoltage CT-cholangiography reveals no significant difference with respect to CNR and SNR when compared to linear blended images yielded by DECT. Compared to DECT or conventional CT at 120 kVp, contrast-enhanced low-kVp CT cholangiography potentially allows reduction of patient dose by up to 50% or 20%, respectively. Therefore, CT-cholangiography at 80 kVp should be considered as an alternative to DECT-cholangiography whenever DECT is unavailable, or if increased image quality of DECT regarding quantitative bile duct evaluation is not needed for diagnosis.

OBJECTIVE: To determine factors affecting liver and bile duct contrast enhancement during computed tomographic cholangiography (CTC) in living-donor transplant candidates. METHODS: Forty-four candidates underwent preoperative triphasic CT followed by intravenous infusion of 20 mL of iodipamide for CTC. Body size indices and liver volume were correlated to parenchymal and biliary enhancement. Bile duct visibility was compared to duct enhancement. RESULTS: Poorly visualized first- and second-order bile ducts demonstrated diminished enhancement (P < 0.015). Both CTC parenchymal and biliary enhancement correlated inversely with body surface area, height, and weight (P < 0.001); inverse correlation was also seen between liver volume and parenchymal enhancement (P < 0.001). A moderately positive correlation was noted between CTC biliary and parenchymal portal venous enhancement (r = 0.421; P = 0.004). CONCLUSIONS: Computed tomographic cholangiography parenchymal and biliary enhancement diminishes with increased body size and liver volume, supporting a need for adjustable contrast dosing. Portal venous parenchymal enhancement may serve as a preinfusion indicator.

Blunt gallbladder injury is rare, and bleeding from the cystic artery due to blunt trauma is even rarer. We report herein a case of extraluminal bleeding of the gallbladder in a patient following blunt abdominal trauma. Contrast-enhanced computed tomography revealed pericholecystic fluid and extravasation of contrast material in the subcapsular liver space adjacent to the gallbladder. Abdominal digital subtraction angiography revealed pseudoaneurysm originating from a branch of the cystic artery. Successful treatment was achieved using selective transcatheter embolization, and cholecystectomy was not required.

Seventeen probenecid congeners were tested as inhibitors of the simultaneous uptake of labelled o-iodohippurate and iodipamide into slices of rabbit renal cortex. Compounds with small substituents on the nitrogen were more inhibitory for o-iodohippurate, while compounds with larger lipophilic substituents were more inhibitory for iodipamide uptake. The results are interpreted in terms of differential inhibition of two transport systems: the classical hippurate or H-system and the liver-like L-system.

Blood pressure (BP), plasma prekallikrein (PK), and the extent of activation of factor XII (XII-ACT) were studied after the intravenous injection into rats of dextran (Macrodex®), the ionic radiographic contrast substance iodipamide (Biligrafin®), or the non-ionic contrast substance iohexol (Omnipaque®). After acetone activation plasma kallikrein was assayed as plasminogen activator, BAEe esterase or S-2302 amidase, and factor XIIa was assayed as kaolin-activated prekallikrein activator. Dextran induced a strong and lasting hypotension, preceded by significant lowerings in PK and XII-ACT. Iodipamide induced a rapid and dose dependent BP fall, no change in plasma PK, but a slightly reduced XII-ACT. Iohexol induced no significant alterations, neither in BP, nor in plasma parameters. Pretreatments of the rats with iodipamide abolished the dextran-induced reductions in PK and XII-ACT, and almost blocked the fall in BP. We conclude that the ionic contrast substance iodipamide is capable of blocking dextran shock in the rat by preventing an activation of the contact activating system in plasma.

A simple and effective method was developed for determining binding sites of drugs on human serum albumin (HSA) by independent binding or competitive displacement of bilirubin using flow injection analysis-quartz crystal microbalance (FIA-QCM) system. Both independent and competitive bindings were entirely monitored in real time. Bilirubin as a site I-binding ligand was pre-bound to HSA sensor so as to occupy the drug-binding site I. When the model site II-binding drugs (ibuprofen, ketoprofen and flurbiprofen) were injected into the bilirubin pre-bound HSA system, the frequency continuously decreased by 6 Hz, 4 Hz and 5 Hz, respectively, which was the same as that of their individual binding to HSA sensor. It indicated that the drug binding to site II was independent and did not interfere with bilirubin binding. However, when the model site I-binding drugs (iodipamide and magnesium salicylate) were introduced into the system, the frequency remained unchanged in the initial several minutes and then rapidly decreased by 4 Hz for iodipamide and increased by 4 Hz for magnesium salicylate. This phenomenon revealed site I-binding drugs competitively bound to HSA against bilirubin and displaced the pre-bound bilirubin. The results demonstrate FIA-QCM can be a valid approach for monitoring the dynamic interaction between drugs and HSA in real time further identifying drug-binding sites without the need of labels.

Iodinated contrast media (ICM), which are used for radiological visualization of human tissue and cardiovascular system, are poorly biodegradable; hence, new methods of their removal are sought. In this study, the effectiveness of selected X-ray ICM removal by means of UV and UV/TiO2 pretreatment processes from synthetic hospital wastewater was demonstrated. The following compounds were investigated: iodipamide, iohexol, and diatrizoate. The experiments were as follows: (i) estimated susceptibility of the ICM to decay by UV radiation in different aquatic matrices, (ii) determined an optimal retention time of hospital wastewater in the UV reactor, (iii) determined optimum TiO2 concentration to improve the effectiveness of the UV pretreatment, and (iv) investigated removal of ICM by combination of the photochemical and biological treatment methods. The quantum yields of selected ICM decay in deionized water (pH = 7.0) were established as 0.006, 0.004, and 0.029 for iohexol, diatrizoate, and iodipamide, respectively. Furthermore, the experiments revealed that diatrizoate and iohexol removal in the UV/TiO2 process is more efficient than in UV process alone. For diatrizoate, the removal efficiency equaled to 40 and 30 %, respectively, and for iohexol, the efficiency was 38 and 27 %, respectively. No significant increase in iodipamide removal in UV and UV/TiO2 processes was observed (29 and 28 %, respectively). However, highest removal efficiency was demonstrated in synthetic hospital wastewater with the combined photochemical and biological treatment method. The removal of diatrizoate and iohexol increased to at least 90 %, and for iodipamide, to at least 50 %.

This study aimed to assess the ability of CT-i.v. cholangiography to show the perihilar biliary and cystic duct anatomy and to assess the relative performance of axial, maximum intensity projection and surface rendered displays. We also assessed the correlation between serum bilirubin levels and adequacy of biliary opacification. Spiral CT was carried out following infusion of 100 mL of Biliscopin in 181 patients with suspected biliary disease. The display of biliary anatomy was of high quality, with 91% of patients having good opacification of at least first-order bile ducts and 84% having good opacification of at least third-order right and left hepatic ducts. The quality of biliary opacification correlated inversely to serum bilirubin levels, with levels above two to three times the normal value being associated with lower rates of good opacification. Maximum intensity projection and surface rendered reformats aided anatomical interpretation to a similar degree. The relative frequency of types of perihilar branching patterns and cystic duct junctional anatomy correlated closely to those reported from previous anatomical studies.

We sought to investigate the concordance between second-order portal venous and biliary tract anatomies using MDCT angiography and MDCT cholangiography.We retrospectively identified 56 living related potential liver donors who underwent both MDCT angiography and MDCT cholangiography. Two reviewers independently rated axial images and 3D reconstructions of MDCT angiograms and cholangiograms as diagnostic or nondiagnostic with respect to depiction of second-order portal venous and biliary tract anatomies. In images rated as diagnostic, second-order portal venous and biliary tract anatomies were categorized as conventional or variant. The concordance between portal venous and biliary tract anatomies was analyzed using McNemar exact chi-square test.All examinations were diagnostic. Second-order portal venous variants were seen in 10 (18%) and biliary branch variants were seen in 23 (41%) of the 56 patients. Patients with variant portal venous anatomy (6/10, 60%) were more likely to have variant biliary tract anatomy than patients with conventional portal venous anatomy (17/46, 37%; p0.01). The sensitivity of variant portal venous anatomy as a marker for variant biliary anatomy was 26% (6/23 patients).Concordance between second-order portal venous and biliary tract anatomies is statistically significant. However, in our series, a number of patients with conventional portal venous anatomy had variant biliary anatomy; therefore, the finding of conventional portal venous anatomy does not obviate preoperative biliary tract imaging in patients before liver donation.

To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten wereor=5 mm and eight wereor=4 mm. The bilirubin level in positive cases was within normal in 20. Maximum intensity projection (MIP) reformats showed stones in only 27% of cases and surface rendered (SR) reformats in none. CT-IVC is highly accurate for detection of ductal calculi, including single small calculi, with a normal or near normal serum bilirubin. Axial images should be used for interpretation rather than MIP or SR reformats.

OBJECTIVE: We describe the use of helical CT cholangiography or helical CT after administration of biliary i.v. contrast material to verify and localize bile duct leakage. CONCLUSION: Helical CT cholangiography revealed bile leaks in seven patients after penetrating trauma or liver or gallbladder surgery and excluded bile leaks in two patients with blunt liver trauma. Endoscopic retrograde cholangiography was performed in only one of seven patients with bile leakage and was avoided in an additional two patients in whom CT cholangiography excluded leakage. The method is a feasible, noninvasive tool for the detection and localization of bile leaks and may help avoid endoscopic retrograde cholangiography.

Objective: to compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder Material and Methods: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated Results: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p Conclusion: Both MRC and CTC provided anatomical and pathological information about the biliary system. with both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. the gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because it depicts RAS clearly

A Nano Crystal™ dispersion of the iodinated x-ray contrast agent iodipamide was prepared by wet milling the drug substance in the presence of Pluronic® F127 stabilizer. The mean particle size of the formulation was 98 nm and all drug particles in the formulation were smaller than 220 nm as determined by dynamic light scattering. Approximately 1 liter of dispersion was filtered through a sterile 0.2-μm disposable capsule filter (Supor® 200 DCF™, 0.I m2 effective filtration area [EFA], Gelman Sciences) to condition the capsule. No drug concentration or size distribution changes were detected after the filtration process. The microbiological validation tests were performed using Pseudomonas diminuta organisms to challenge the capsule under simulated worst-case process conditions. The results showed that the Supor 200 DCF was able to retain 100% Pseudomonas diminuta organisms (≥107 organisms per cm2 of effective filtration area). Thus, this study demonstrated that terminal filtration is a feasible pro...

The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects.In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed.Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient ≥ 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7%). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37% and 23% of patients at baseline and 40 minutes, respectively, versus in 3% of control subjects at both times (p ≤ 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33%) and four control subjects (13%) (p = 0.13).Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.

OBJECTIVE The objective of this study was to compare the radiation exposure and image quality of contrast-enhanced multidetector computed tomography angiography (CTA) and computed tomography cholangiography (CTC) performed for living liver donor evaluation using 80 and 120 kVp. METHODS Ninety-three potential liver donors who underwent preoperative contrast-enhanced 64 multidetector CTA and CTC were retrospectively divided into 2 groups: at 80 and at 120 kVp. An institutional review board waiver was obtained. Signal-to-noise ratio and contrast-to-noise ratio of the hepatic artery and common bile duct were obtained. The dose-length product was recorded. Image quality and visibility of hepatic artery and biliary tract anatomy were evaluated. Mann-Whitney U test was used for statistical evaluation. RESULTS Mean hepatic artery/common bile duct signal-to-noise ratio was 28.9/28.6 (SD, 14.2/10.0) at 80 kVp and 27.6/25.8 (SD, 8.0/6.2) at 120 kVp (P = 0.61/0.099). Mean hepatic artery/common bile duct contrast-to-noise ratio was 24.8/23.3 (SD, 12.9/8.6) at 80 kVp and 22.2/19.3 (SD, 7.7/5.0) at 120 kVp (P = 0.76/0.005). Mean CTA/CTC dose-length product was 279/281 (SD, 42/52) mGy-cm at 80 kVp and 407/451 (SD, 208/243) mGy-cm at 120 kVp (P = 0.026/0.002). Computed tomography cholangiography image quality and visibility of biliary tract anatomy were not significantly different at 80 versus 120 kVp (all P > 0.13). Computed tomography angiography image quality was significantly lower (P < 0.01), and the noise scores significantly higher (P < 0.01) at 80 versus 120 kVp, but diagnostic. CONCLUSIONS Contrast-enhanced CTA and CTC performed at 80 kVp result in comparable image quality and anatomical evaluation with reduced radiation exposure when compared with 120 kVp.

Object Multidetector computed tomographic angiography (MDCTA) has played an increasing role in detecting cerebral aneurysms. This study was performed to investigate the diagnostic accuracy of the upgraded 256-row MDCTA in the detection of cerebral aneurysms. Methods We identified 93 patients who had undergone both MDCTA and digital subtraction angiography (DSA) before surgery for the detection of cerebral aneurysms. Two and one independent blinded readers reviewed the MDCTA images and DSA images, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for the image interpretation from the two CTA readers and one DSA reader using the combination of DSA and intraoperative findings as the reference standard. Results A total of 77 intracranial aneurysms were detected in 67 of the 93 patients. The overall sensitivity, specificity, and accuracy of the 256-row MDCTA in the detection of cerebral aneurysms were 96.10%, 92.31%, and 94.23%, respectively. For aneurysms larger than 5 mm, the overall sensitivity, specificity, and accuracy were 100%, 92.31%, and 96.83%, respectively. For aneurysms smaller than 5 mm, the overall sensitivity, specificity, and accuracy were 92.50%, 92.31%, and 92.42%, respectively. There was no significant difference for the sensitivity, specificity, and accuracy of 256-row MDCTA to detect cerebral aneurysm according to the conscious level of the patients. Conclusions To detect cerebral aneurysms larger than 5 mm, 256-row MDCTA is an imaging method with a satisfactory diagnostic performance equal to that of DSA. However, its diagnostic performance for aneurysms smaller than 5 mm is still inferior to that of DSA.

Purpose To study the feasibility of using an iodinated particulate contrast agent, iodipamide ethyl ester (IDE), for angiography. Materials and Methods IDE at doses of 40–100 mg of iodine per kilogram was diluted to a total volume of 5–20 mL and used for digital subtraction angiography in nine dogs under general anesthesia. Equivalent images were obtained by using water-soluble contrast medium (WSCM) for comparison (iohexol) in seven animals. All images were reviewed by blinded reviewers and graded subjectively on a five-point scale. Results Angiographic studies of multiple vascular territories performed with IDE yielded images of slightly lower overall quality compared with images obtained with WSCM ( P = .14, Mann-Whitney U test). Arterial phase images were subjectively superior with WSCM when compared with IDE ( P x 2 ). Depiction of the corresponding veins during the venous phase on the IDE angiograms was superior to that on WSCM angiograms in 12 of 21 cases, although this did not reach statistical significance ( P > .05 x 2 ). Images of the renal vein and portal vein achieved with IDE were graded as superior to those achieved with WSCM in eight of 10 reviews. Conclusion Angiography is feasible with IDE. Compared with WSCM, IDE produced images of lesser quality during the arterial phase, but of equal or superior quality in the venous phase depending on the vessel studied. Because it is excreted slowly in bile and is isotonic, it may prove useful in patients with renal insufficiency, diabetes, multiple myeloma, or severe coronary disease.

The movement of carboxyfluorescein (CF) across the isolated retinal pigment epithelium (RPE)-choroid of the albino rabbit was studied using an Ussing chamber under short-circuit conditions with CF concentrations ranging from 15 to 300 microM. The inward (from the choroid to vitreous side) permeability of the tissue to CF showed no significant change over the concentration range tested, averaging 2.2 x 10(-6) cm sec-1. Neither ouabain (1.0 microM), low external sodium concentration nor probenecid (100 microM) had significant effect on the inward movement of CF. The outward (from the vitreous to the choroid side) permeability of the tissue to CF gradually decreased as the concentration increased (ANOVA, P < 0.01: Scheffe's test, P < 0.05), averaging 3.7 x 10(-6) cm sec-1 at 75 microM. Further, it was always significantly greater than the inward permeability at the corresponding concentration (unpaired t-test, P < 0.05-0.01). The outward movement of CF was significantly inhibited by 2,4-dinitrophenol (10 microM), ouabain (1.0 microM), probenecid (100 microM), iodipamide (5.0 mM), hippurate (30 mM) or low external sodium concentration (25 mM). The net outward movement of CF became saturated as concentration was increased and a Lineweaver-Burk plot gave an apparent Km of 237 microM and Vmax of 1.8 nmol hr-1 cm-2. The results indicated that part of the outward movement of CF across the RPE-choroid depends on carrier mediated active transport, but to a much lesser extent than that of fluorescein. The inward movement of CF was thought to occur almost exclusively by passive diffusion through the paracellular spaces.

We conducted a pilot study to determine the potential advantages of using liver-specific targeted computed tomography (CT) contrast agents for lesion detection.Eight dogs had liver infarcts created by percutaneous injections of ethanol. Each dog underwent CT scans with four imaging techniques: unenhanced, intravenous contrast enhanced (IVCE), CT arterial portography (CTAP), and targeted liver enhancement with iodipamide ethylester (IDE) particles. Lesions were assessed quantitatively to determine liver-to-lesion density differences and the drop in density across liver edge as a quantitative measure of edge sharpness. Expert readers subjectively analyzed data to determine lesion visibility and edge sharpness.Liver-to-lesion density differences were greatest with CTAP (56.4 +/- 35.5 Hounsfield units [H]) followed by IDE (41.1 +/- 7.0 H), i.v. (22.7 +/- 6.0 H), and unenhanced scans (13.6 +/- 4.1 H; ps.05 for CTAP versus unenhanced and IDE versus unenhanced). Edges were best defined both subjectively and quantitatively on IDE-enhanced scans.Targeted liver-specific contrast agents have potential to increase lesion visibility when compared with standard i.v. contrast enhancement of the liver by increasing lesion edge definition and liver-to-lesion attenuation differences. Further work in animal tumor models, and clinical trials as agents become available, appears justified.

In the present article, I remind what I presented, in a symposium performed in our Society on the constipation syndrome, in relation with the definition and the determinant factors of this syndrome, and, in addition, with the methods we have created to determine physiologically the velocity of the intestinal transit, specially colonic.

To determine whether helical computed tomography (CT) performed during intravenous cholangiography can provide useful images of the biliary tree and to compare this technique with endoscopic retrograde cholangiography (ERC).Eighteen adult patients with clinically suspected biliary disease who were referred for ERC were first examined with helical CT cholangiography performed 75 minutes after intravenous infusion of 100 mL of 10.3% iodipamide meglumine.Helical CT cholangiography revealed good opacification of the biliary tree in 13 of 14 patients with serum bilirubin levels less than 2 mg/dL (34 mumol/L) and poor opacification in three of four patients with levels greater than 2 mg/dL. In six of seven patients with choledocholithiasis, the diagnosis was made by means of helical CT cholangiography.Helical CT cholangiography may be a clinically useful method for visualization of the biliary tree in some patients with suspected biliary disease with normal bilirubin levels and in patients in whom attempts at ERC fail.

OBJECTIVE: The purpose of this study was to determine the feasibility of using three-dimensional spiral CT after IV administration of a cholangiographic agent for noninvasive detection of anatomic variations of the bile ducts and common bile duct stones before or after laparoscopic cholecystectomy. SUBJECTS AND METHODS: Three-dimensional spiral CT cholangiography was performed before laparoscopic cholecystectomy in 24 patients and after surgery in two patients who had recurrent symptoms. After slow infusion of 250 ml of iodipamide, spiral CT was performed. Three-dimensional images of the bile ducts and a secondary reformation through the long axis of the common bile duct were obtained. Visualization of the biliary tract was evaluated by two observers. Detection of anatomic variations and common bile duct stones was assessed in 19 patients for whom a gold standard (operative or retrograde cholangiogram) was available. RESULTS: In all 26 patients, the common bile duct and the confluence of the hepatic ducts were seen on three-dimensional spiral CT cholangiograms, and in 21 patients second- or higher-order branches were also seen. Seven patients had anatomic variations and two had common bile duct stones. These anomalies were proved by operative cholangiography in each case, except for a low junction of the cystic duct and a common bile duct stone, which were shown by retrograde cholangiography. Six of the seven anatomic variations were adequately detected with spiral CT cholangiography, as were the two cases of common bile duct stones. CONCLUSION: Three-dimensional spiral CT cholangiography is a feasible method for noninvasive detection of biliary anatomic variations and common bile duct stones before or after laparoscopic cholecystectomy.

RATIONALE AND OBJECTIVES Contrast-enhanced computed tomography (CT) images of canine renal cortex were analyzed to determine if the heterogeneous pixel intensity patterns met the requirements for fractal analysis and if the heterogeneity could be quantified by a fractal dimension, Df. METHODS Contrast-enhanced CT images were obtained after injection of iodipamide ethyl ester (IDE), a vascular marker, or iohexol, a freely filtered interstitial marker, into the catheterized renal artery of an anesthetized dog. Images were mounted on a graphics workstation for analysis. A computer program was written to determine the fractal dimension of the pixel-intensity pattern within selected regions. RESULTS All regions of renal cortex examined met the requirements for fractal analysis. Three seconds after injection of IDE, the mean fractal dimension decreased significantly from 1.21 +/- 0.05 to 1.12 +/- 0.06 (P < .05). Although the mean fractal dimensions were not significantly different, the variation in the fractal dimension around the renal cortex was significantly different with IDE as compared with iohexol at 3 seconds (P < .05). Differences in the change in fractal dimension over time were also observed with IDE as compared with iohexol. CONCLUSIONS Fractal dimension measurement provides a new means to examine the in-vivo organization of renal vascular perfusion by quantifying pixel heterogeneity in contrast-enhanced CT. This may prove useful in understanding and quantifying the pathophysiologic changes in renal disease.

Dynamic contrast-enhanced magnetic resonance imaging (MRI) is a technique used to study and track contrast kinetics in an area of interest in the body over time. Reconstruction of images with high contrast and sharp edges from undersampled data is a challenge. While good results have been reported using a radial acquisition and a spatiotemporal constrained reconstruction (STCR) method, we propose improvements from using spatially adaptive weighting and an additional edge-based constraint. The new method uses intensity gradients from a sliding window reference image to improve the sharpness of edges in the reconstructed image. The method was tested on eight radial cardiac perfusion data sets with 24 rays and compared to the STCR method. The reconstructions showed that the new method, termed edge-enhanced spatiotemporal constrained reconstruction, was able to reconstruct images with sharper edges, and there were a 36%±13.7% increase in contrast-to-noise ratio and a 24%±11% increase in contrast near the edges when compared to STCR. The novelty of this paper is the combination of spatially adaptive weighting for spatial total variation (TV) constraint along with a gradient matching term to improve the sharpness of edges. The edge map from a reference image allows the reconstruction to trade-off between TV and edge enhancement, depending on the spatially varying weighting provided by the edge map.

In previous work with the method of multiple indicator dilution (MID), we have established that a spatially distributed model of transcapillary exchange proposed by Goresky, Ziegler, and Bach (GZB) accurately describes, at the in vivo whole-organ level, the handling of extracellular indicators in the canine renal cortex. To date, however, it has not been possible to assess the key hypothesis that GZB corresponds to the actual local mechanism of exchange in vivo and is not just a compact summary of the kidney's average whole-organ behavior. By adapting the MID method to high speed computed tomography (CT), we are now able to report that the GZB mechanism is an accurate description of renal cortical transcapillary exchange down to volumes of cortical tissue comprising no more than a few per cent of the total cortical mass, i.e., containing no more than a few thousand nephrons. A small bolus of iohexol (radiopaque extracellular indicator) or iodipamide ethyl ester microparticles (radiopaque plasma indicator) injected into the renal artery was followed by CT as it passed through the kidney and into the renal vein. Time-attenuation value curves of the two contrast media obtained from the renal vein and from regions of interest in the cortex were then modeled with the GZB mechanism and with a more complex formulation that includes GZB as a limiting case. When applied to the data, the models converged to GZB as the best fit for each region examined. The GZB mechanism is found to provide excellent agreement with the regional data.

To evaluate whether virtual non-enhanced imaging (VNI) is effective to replace true non-enhanced imaging (TNI) applying iodine removal in intravenous dual-energy CT-cholangiography.From April 2009 until February 2010, fifteen potential donors for living-related liver transplantation (mean age 37.6±10.8 years) were included. Potential donors underwent a two-phase CT-examination of the liver. The first phase consisted of a single-energy non-enhanced CT-acquisition that provided TNI. After administration of hepatobiliary contrast agent, the second phase was performed as a dual-energy cholangiographic CT-acquisition. This provided VNI. Objective image quality (attenuation values [bile ducts and liver parenchyma] and contrast-to-noise ratio) and subjective overall image quality (1 - excellent; 5 - non diagnostic) were evaluated. Effective radiation dose was compared.For TNI and VNI, attenuation values for bile ducts were 16.8±11.2HU and 5.5±17.0HU (p0.05) and for liver parenchyma 55.3±8.4HU and 58.1±10.6HU (n.s.). For TNI and VNI, contrast-to-noise ratio was 2.6±0.6HU and 6.9±2.1HU (p0.001). For VNI, subjective overall image quality was 1 in ten datasets, 2 in four datasets and 3 in one dataset. Effective radiation dose for the dual-energy cholangiographic CT-acquisition was 3.6±0.9mSv and for two-phase single-energy CT-cholangiography 5.1±1.3mSv (p0.001).In this study on iodine removal in intravenous dual-energy CT-cholangiography, subjective image quality is equivalent, contrast-to-noise ratio is improved and effective radiation dose is reduced when VNI is performed. The differences between TNI and VNI with respect to attenuation values seem to have limited clinical relevance and therefore we consider VNI as effective to replace TNI.

The functional molecular mass of the cholate, phallotoxin, iodipamide, and ouabain transport proteins in isolated basolateral plasma membrane vesicles was determined by radiation inactivation. Purified basolateral plasma membrane vesicles were irradiated (-90 to -120 degrees C) with high energy electrons from a 10-MeV linear accelerator at doses from 0 to 30 megarads. After each dose, the initial uptake, the equilibrium binding, and the binding of the substrates at 4 degrees C were checked. The size of the transporting function was, for cholate, 107 +/- 8.9 kDa; for phallotoxin, 104 +/- 7 kDa; and for ouabain, 120 +/- 4.7 kDa. The target size for the binding proteins was 56 +/- 4.2, 57 +/- 5, and 47.2 +/- 1.95 kDa for cholate, phallotoxin, and taurocholate, respectively. In the case of iodipamide, the functional molecular mass for both the transport and binding proteins was 54 +/- 4.8 kDa.

To assess the feasibility of intravenous 64-multi-detector row computed tomography (CT)-cholangiography of porcine livers with definition of the temporal window for optimal bile duct delineation.Six healthy Landrace pigs, each weighing 28.97 +/- 2.99 kg, underwent 64-multi-detector row CT-cholangiography. Each pig was infused with 50 ml of meglumine iotroxate continuously over a period of 20 min and, starting with the initiation of the infusion, 18 consecutive CT scans of the abdomen at 2-min intervals were acquired. All series were evaluated for bile duct visualization scores and maximum bile duct diameters as primary study goals and bile duct attenuation and liver enhancement as secondary study goals.Of the 16 analyzed biliary tract segments, maximum bile duct visualization scores ranged between 4.00 +/- 0.00 and 2.83 +/- 1.47. Time to maximum bile duct visualization scores ranged between 10 and 34 min. Average bile duct visualization scores for the 10- to 34-min interval ranged between 3.99 +/- 0.05 and 2.78 +/- 0.10. Maximum bile duct diameters ranged between 6.47 +/- 1.05 and 2.65 +/- 2.23 mm. Time to maximum bile duct diameters ranged between 24 and 34 min. Average bile duct diameters for the 10- to 34-min interval ranged between 6.00 +/- 0.38 and 2.40 +/- 0.13 mm.Intravenous 64-multi-detector row CT-cholangiography of non-diseased porcine liver is feasible, with the best bile duct delineation acquired between 10 and 34 min after initiation of the contrast agent infusion.

The postnatal development of bilirubin accumulation by the choroid plexus was studied in vitro. Choroid plexus of the fourth and lateral cerebral ventricles from adult or 1-, 7-, 15- or 21-day-old rabbits were incubated in a potassium-rich medium with 70 nmol/l of 3H-bilirubin for 5 min. The tissue/medium (T/M) ratio for 3H-bilirubin was considerable even 1 day post partum and increased during the next 2–3 weeks of life. In adults the 3H-bilirubin T/M ratio returned to the level of 1-day-old rabbits. The biliary excreted contrast agent iodipamide, added as a transport inhibitor, reduced the 3H-bilirubin T/M ratio in the choroid plexus, but to a relatively lesser extent in the 1-day-old rabbits than in the older ones.

To retrospectively determine whether premedication with intravenously administered morphine improves bile duct caliber and visualization in potential liver donors undergoing computed tomographic (CT) cholangiography.This was a retrospective single institution study approved by the institutional review board and compliant with requirements of the HIPAA. Multidetector CT cholangiography was performed after slow infusion of 20 mL of iodipamide meglumine 52% diluted in 80 mL of normal saline in 143 consecutive potential liver donors (81 men and 62 women; mean age, 37 years); 43 received premedication with intravenous morphine sulfate (0.04 mg per kilogram of body weight) and 100 did not. Two independent readers recorded common bile duct diameter and area on axial CT images. Readers also scored bile duct visualization, including all second-order biliary branches, on a four-point scale (0, not seen; 3, excellent visualization).For scans obtained without and those obtained with morphine, there was no significant difference in the mean common bile duct diameter (4.1 vs 4.3 mm for reader 1 and 4.4 vs 4.6 mm for reader 2, respectively; P.39 for both readers), in common bile duct area (20.7 vs 21.5 mm(2), for reader 1 and 21.3 vs 20.2 mm(2) for reader 2, respectively, P.60 for both), or in second-order bile duct visualization score (2.34 vs 2.36 for reader 1 and 2.58 vs 2.50 for reader 2, respectively; P.5 for both).The results suggest that premedication with intravenous morphine prior to CT cholangiography in potential liver donors does not increase bile duct caliber or improve biliary visualization.

Cholecystoenteric fistulas are often not diagnosed preoperatively and delineation of fistula can have an influence on surgical planning. We report a case of cholecystocolonic fistula diagnosed preoperatively using CT-i.v. cholangiography and review the published reports.

The purpose of this study was to evaluate the diagnostic potential of prolonged drip infusion CT cholangiography (DIC-CT) using meglumine iotroxate (BiliscopinH) and 3D volume rendering in patients with suspected obstructive biliary disease. From a material of 142 patients who had undergone a drip infusion CT, all cases with a verified surgical or endoscopic retrograde cholangiography (ERC) diagnosis (n533) were selected. Age-matched controls were selected from the remaining examinations. Three radiologists reviewed all 66 examinations in retrospect, independently as well as in consensus. The image quality and the estimated diagnostic quality were rated as good or moderate in 91% of the 198 reviews. The consensus sensitivity and specificity for diagnosing biliary stones was 88% and 94%, respectively (with sensitivities ranging from 88% to 94% for individual observers, and specificities from 86% to 96%). Two out of three strictures were observed. No false positive strictures were described. The use of volume rendering technique (VRT) improved diagnostic certainty in 28/198 (14%) of the evaluations. The visualization of ductal stones was improved in 18/48 (38%). No differences in diagnostic quality between single and multislice CT were observed. We conclude that a detailed image of the biliary tree with good sensitivity and specificity can be obtained by means of bilirubin-governed infusion time DIC-CT with volume rendering reconstruction. Suspected biliary tract disease is a common clinical problem. A full radiological evaluation of the biliary tract should not only provide information regarding the presence of an obstruction, but also define the level and the cause of the obstruction. Advances in ultrasound, CT and MR technology over the past decade have greatly improved our ability to make this evaluation. In spite of the indisputable success of ultrasound and MRI, an alternative non-invasive diagnostic method is still required in those cases with inconclusive ultrasound findings or contraindications to MRI. In patients with unclear abdominal pain, CT is often used. However, CT without contrast administration often fails to resolve the non- dilated bile duct from the surrounding tissue. Also, stones in the common bile duct (CBD) are isodense with bile in up to 80% of cases (1). When an intravenous biliary contrast agent is used, however, gallstones are more easily detected. material, meglumine iotroxate (BiliscopinH; Schering AG, Berlin, Germany), with a new scheme of prolonged drip infusion CT cholangiography (DIC-CT) in patients with suspected obstructive biliary disease.

Summary Objective: To assess the stability of doxorubicin combined with Radioselectan®. Methods: Solutions of doxorubicin 5 mg/mL were prepared from commercially available 50 mg powder with 10 mL of Radioselectan®. They were stored in glass syringes at 4, 25 and 45 °C. The concentrations of doxorubicin were determined using a stability-indicating high-performance liquid chromatography method. The initial and final pHs of solutions were compared. The times (t90) needed for doxorubicin to fall to 90% of its initial concentration were calculated by a linear regression analysis. Results: The t90 [95% confidence limits] were 79 [75–83], 56 [53–59] and 22 [21–23] hours for the solutions stored at 4, 25 and 40 °C respectively. The initial pH of the solutions stored at 4, 25 and 40 °C were 6·52, 6·50 and 6·51 respectively. The final pH of solutions stored at 25 and 40 °C decreased significantly by 0·3 and 0·9 respectively. No change of pH solution stored at 4 °C was observed. Conclusion: Doxorubicin combined with Radioselectan® stored at room temperature is stable for 48 h.

The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP.

It is important to recognize the distribution of the bile ducts in the caudate lobe of the liver for the hepato-biliary surgery. To map the spatial relationship between the bile ducts and the liver parenchyma under physiological conditions, we performed an anatomical analysis of them using computed tomography combined with drip infusion cholangiography (DIC-CT).We identified the bile ducts in the caudate lobe, which was divided into the Spiegel lobe, paracaval portion, and caudate process, with DIC-CT. We then investigated their number and confluence pattern in 132 patients without any abnormality in the hilar bile ducts.The mean number of the bile ducts in the caudate lobe was 2.68 per liver. In the Spiegel lobe, the branches drained into the left hepatic duct system in about 83%. The confluence of the paracaval branch was the left hepatic duct, right hepatic duct, and posterior segmental branch, all with the same frequency of approximately 30%. Almost all of the caudate process branches (92.4%) drained into the posterior segmental branch.DIC-CT is a useful method for the anatomical analysis of the intrahepatic bile ducts under physiological conditions, and we obtained novel and important findings for surgery.

To compare biliary tract depiction in living potential liver donors at conventional magnetic resonance (MR), mangafodipir trisodium-enhanced excretory MR, and multi-detector row computed tomographic (CT) cholangiography.Eight living potential liver donors underwent iodipamide meglumine-enhanced CT cholangiography. Eight different potential liver donors then underwent conventional MR cholangiography and mangafodipir trisodium-enhanced excretory MR cholangiography. Two readers independently scored all first-, second-, and third-order biliary branches with a four-point scale from 0 (not seen) to 3 (excellent visualization). Interobserver agreement was calculated by using the weighted kappa statistic. Scores were compared between imaging modalities by using generalized estimating equations. Imaging findings of second-order biliary tract anatomy were compared with intraoperative findings for nine patients.Interobserver agreement for overall biliary tract visualization was good for CT, conventional MR, and excretory MR cholangiography (with weighted kappa values of 0.76, 0.66, and 0.79, respectively). The mean second-order biliary branch visualization scores for readers 1 and 2, respectively, were significantly higher at CT cholangiography (2.81 and 2.75) than at conventional MR (1.84 and 1.75, P.001), excretory MR (2.00 and 2.06, P.001), and combined conventional and excretory MR cholangiography (2.31 and 2.25, P.01). At CT, conventional MR, and excretory MR cholangiography, respectively, second-order biliary branching anatomy was discernible in eight, five, and seven patients, with second-order biliary branch variants seen in three, two, and two patients. Surgical findings confirmed the pattern of second-order biliary branching seen at CT in five patients, that seen at conventional MR imaging in one patient, and that seen at excretory MR cholangiography in three patients. At surgery, one case of variant biliary anatomy was found to have been missed at CT cholangiography.In living potential liver donors, CT cholangiography enables significantly better biliary tract visualization than conventional or excretory MR cholangiography either alone or in combination.

To validate multi-slice three-dimensional spiral CT cholangiography (3-D CTC) in clinical diagnosis of biliary diseases.This study included 146 patients with biliary diseases, involving 73 cases of biliary tumor, 87 cases of radioparent calculus, 12 cases of post cholangio-jejunostomy and one case of congenital choledochocyst. The data of thin-slice volumetric CT scan were sent to the workstation (GE Advantage Windows 3.1). Rational 3-D CTC including maximum intensity projection, minimum intensity projection, surface shaded display, CT virtual endoscopy and ray sumption was performed. The diagnostic accuracy of 3-D CTC was compared with that of conventional CT, ultrasonography and endoscopic retrograde cholangiopancreaticography (ERCP).Different biliary diseases showed distinct imaging manifestations on 3-D CTC. As a new technique for assessing the status of post cholangio-jejunostomy, 3-D CTC was superior to conventional CT, ultrasonography and ERCP in diagnosis of negative biliary calculus, extrahepatic cholangiocarcinoma, cancer embolus of the biliary duct, carcinoma of the pancreas head and periampullar carcinoma. It was also superior to conventional CT, ultrasonography or equal to ERCP in diagnosis of hilar cholangiocarcinoma, but inferior to conventional CT and ultrasonography in diagnosis of gallbladder cancer.3-D CTC as a non-invasive and sensitive technique for the diagnosis of biliary diseases with high diagnostic accuracy will greatly increase the detection rate of biliary diseases.

We evaluated the feasibility and accuracy of virtual computed tomographic cholangiography (VCTC) in detecting choledocholithiasis and imaging anatomic variations of the biliary tree.Thirty-three consecutive patients with clinical and biological signs of choledocholithiasis underwent spiral CT after intravenous infusion of iotroxindimeglumine. Patients with total serum bilirubin levels above 3 mg/dL were not included in this study. Spiral data sets were used to construct intralumenal images of the biliary tree. The images were reviewed by two abdominal radiologists. The biliary ducts were divided into three segments, so the analysis was based on 99 segments. The diagnosis obtained by VCTC was compared with the final diagnosis established by endoscopic retrograde cholangiography or intraoperative cholangiography.VCTC correctly depicted biliary stones in nine of 10 patients and anatomic variations in all five patients, and no false-positive cases were observed. VCTC showed excellent endolumenal visualization of 87 of 99 segments of the biliary tree. The processing time (9.3 +/- 2.1 min) was particularly short.VCTC with intravenous infusion of iotroxindimeglumine may be a feasible clinical tool, with acceptable accuracy in selected cases.

A 57-year-old man was admitted to our hospital because of high fever and generalized tonic seizure. Brain magnetic resonance imaging (MRI) delineated multiple abnormal intensity areas. Thallium-201 (201Tl) scintigraphy revealed abnormal uptake in the brain. The imaging findings did not allow definitive exclusion of brain tumor, even though brain abscess was the more strongly suspected diagnosis. As the patient improved, the multiple abnormal intensity areas in the brain on MRI and the abnormal areas of accumulation on 201Tl scintigraphy were reduced, and eventually completely disappeared. A final diagnosis of brain abscess was therefore made. Since relatively few studies have reported 201Tl accumulation in cases of brain abscess, we report here our patient in whom the changes in the accumulation of 201Tl in a brain abscess were observed over time.

With the advent of laparoscopic cholecystectomy, pre-operative identification of calculi in the common bile duct has become increasingly important. In patients without clinical or biochemical evidence of common bile duct calculi, debate continues as to the value of intravenous cholangiography (IVC) as a screening modality for the detection of unsuspected choledocholithiasis. In a prospective series of 180 patients, IVC was used to assess the common bile duct in 113 patients at low risk of choledocholithiasis, 51 patients at high risk underwent endoscopic retrograde cholangiography (ERC) and sphincterotomy if indicated, and in 16 patients, for a variety of reasons, no pre-operative cholangiography was performed. 31% of those who had ERC and two (1.8%) of those who had IVC had duct calculi. These data do not support the routine use of IVC in patients with no evidence of common bile duct calculi and its routine use has been discontinued.

The aim of this study was to demonstrate three-dimensional biliary anatomy by using spiral CT scanning for patients prior to laparoscopic cholecystectomy.We studied 22 patients (11 men, 11 women; mean age, 60 years) with preoperative imaging. All patients had normal serum bilirubin levels. Either 50 ml (in 10 cases) or 100 ml (in 12 cases) of meglumine iotroxate was infused intravenously over 30 minutes. Spiral CT scanning was started immediately after the infusion was finished. Volumetric data through the entire biliary tracts were obtained during one breath-hold. The data were reconstructed by using a maximum intensity projection algorithm and three-dimensional shaded surface rendering.In all patients, the anatomical relationship between the cystic duct and the common bile duct was clearly depicted, including one with junctional anomaly. The intrahepatic biliary ducts and the confluence of the hepatic ducts were displayed from all angles. The third or higher intrahepatic branches were delineated in 11 of the 12 (92%) patients with the use of 100 ml of the cholangiographic agent and in seven of the 10 (70%) with 50 ml.Three-dimensional CT cholangiography was able to provide adequate information about precise biliary anatomy.