Gadobenate dimeglumine (BOPTA) enhanced MR imaging: patterns of enhancement in normal liver and cirrhosis

To determine whether gadobenate dimeglumine (BOPTA) will adequately enhance cirrhotic liver parenchyma, and to document the enhancement patterns in cirrhosis, 14 cirrhotic and 20 non-cirrhotic patients were evaluated before and 60-120 minutes after gadolinium-BOPTA. Proof of liver cirrhosis was biopsy (6), surgical resection (3), and clinical follow-up (5). Enhancement effects were compared quantitatively by determining the liver signal-to-noise ratio (SNR) and signal enhancement in both populations. Qualitatively assessment of the liver enhancement was performed and classified as homogeneous or heterogeneous. Quantitative analysis: cirrhotic liver parenchyma presented a higher increase in SNR values, relative to non-cirrhotic liver parenchyma, on postcontrast images. Likewise the signal enhancement of cirrhotic liver parenchyma was superior to non-cirrhotic liver on T1-weighted SE images (P = .02) and in-phase GRE images (P < .001). There was no statistical difference on out-of-phase GRE images. Qualitative analysis: on T1-weighted SE postcontrast images, cirrhotic liver parenchyma showed a homogeneous enhancement in 7 patients and heterogeneous in 7. Whereas on GRE images, cirrhotic parenchyma showed heterogeneous enhancement in 9 patients and homogeneous in 5 patients. The heterogeneous enhancement was due to the presence of hypointense nodules in 7 patients and hyperintense nodules in 2 patients. In conclusion, our study has shown that the hepatobiliary contrast agent Gd-BOPTA is effective in the cirrhotic liver, demonstrating an increased liver enhancement compared with non-cirrhotic patients.     

Angiotensin-II-induced hypertension chemotherapy: evaluation of hepatic blood flow with oxygen-15 PET

We quantitatively measured blood flow in liver parenchyma and hepatic tumors in two patients using 15O-carbon dioxide (steady state) and 15O-water (dynamic) PET imaging. Images were acquired before and during administration of angiotensin-II to achieve a hypertensive state. Blood flow in the hepatocellular carcinoma was greater than that of the parenchyma. Blood flow in the colon metastasis was similar to that in the parenchyma and lower in the center than in the periphery. During a hypertensive state induced by angiotensin II, blood flow in both the primary and secondary liver tumors did not change, while blood flow in the liver parenchyma decreased. As a result, there was a relative increase in tumor blood flow during the hypertensive state on PET images. Furthermore, blood flow to the spleen decreased to 55% of baseline during the hypertensive state. These findings suggest that hypertensive cancer chemotherapy may protect normal tissue. Furthermore, PET imaging may be able to predict the efficacy of hypertensive cancer chemotherapy in the patients with liver tumors.     

Protective effect of cysteine and vitamin E, Crocus sativus and Nigella sativa extracts on cisplatin-induced toxicity in rats

There are three ways to approach and resect the caudate lobe of the liver, that is; and isolated caudate lobectomy, a combined resection of the liver overlying the caudate lobe, and a transhepatic anterior approach by splitting parenchyma of the liver. We had two patients with neoplasms originating in the caudate lobe who underwent a complete caudate lobectomy. Both patients have been doing well without liver dysfunction. Although after the transhepatic anterior approach we anticipated an adverse effect from splitting the parenchyma of the liver, the postoperative course was uneventful and similar to that of the right side approach.     

Surgical significance of telomerase activity in noncancerous liver tissue from patients with hepatocellular carcinoma

Telomerase activity has been detected in tissue from noncancerous liver of patients with chronic liver disease, but its functional significance remains to be elucidated. We therefore evaluated the telomerase activity in surgically obtained noncancerous liver tissue from 20 hepatocellular carcinoma (HCC) patients. Two samples of noncancerous liver tissue were obtained from each patient: one from the parenchyma adjacent to the HCC nodules of the resected specimen; the other from the parenchyma distant from the HCC nodules of the remnant liver. Telomerase activity was assayed by a non-radioisotope quantitative system based on "TRAP-eze." Five samples from the noncancerous liver tissue adjacent to the HCC nodules (25.0%) were telomerase-positive; all such cases showed high-grade malignant potential, such as intrahepatic metastasis and/or portal vascular invasion and infiltration of the fibrous capsule in the corresponding HCC nodules, and telomerase positivity showed neither a relationship with the histological activity index scores nor a correlation with liver function. Interestingly, no telomerase activity was detected in any of the 20 samples obtained from the parenchyma of the remnant liver. These results indicate that telomerase in noncancerous liver tissue is associated not with the hepatic condition accompanying HCC, but with the biological characteristics of the tumor itself, and may derive from infiltrating cancer cells. Determination of telomerase status may aid in designing more effective surgical procedures.     

Entry and integration of transplanted hepatocytes in rat liver plates occur by disruption of hepatic sinusoidal endothelium

To establish the process by which transplanted cells integrate into the liver parenchyma, we used dipeptidyl peptidase IV-deficient F344 rats as hosts. On intrasplenic injection, transplanted hepatocytes immediately entered liver sinusoids, along with attenuation of portal vein radicles on angiography. However, a large fraction of transplanted cells (>70%) was rapidly cleared from portal spaces by phagocyte/macrophage responses. On the other hand, transplanted hepatocytes entering the hepatic sinusoids showed superior survival. These cells translocated from sinusoids into liver plates between 16 and 20 hours after transplantation, during which electron microscopy showed disruption of the sinusoidal endothelium. Interestingly, production of vascular endothelial growth factor was observed in hepatocytes before endothelial disruptions. Portal hypertension and angiographic changes resulting from cell transplantation resolved promptly. Integration of transplanted hepatocytes in the liver parenchyma required cell membrane regenesis, with hybrid gap junctions and bile canaliculi forming over 3 to 7 days after cell transplantation. We propose that strategies to deposit cells into distal hepatic sinusoids, to disrupt sinusoidal endothelium for facilitating cell entry into liver plates, and to accelerate cell integrations into liver parenchyma will advance applications of hepatocyte transplantation.     

Operative cholangiography and special technical consideration in the management of severe injury of the liver

The majority of hepatic injuries can be adequately managed by control of bleeding locally at the site, debridement and ample drainage. In some instances, severe blunt trauma and high velocity missile wounds may result in the disruption of intrahepatic structures and significant devitalization of the parenchyma of the liver, necessitating hepatic resection. Operative cholangiography was found to be useful in the evaluation and management of this type of severe injury to the liver. It is simple, practical method to recognize and localize a major disruption of the parenchyma of the liver and bile ducts; to help decide whether or not segmental, sublobar or labor hepatectomy should be performed, and to detect bile leaks from the divided bile ducts after resection of the liver. A modified technique for performing hepatic resection during an emergency situation was suggested to be more suitable than the classic technique. This is based on finger dissection along the line of injury and individual ligation of bile ducts and vessels as they are exposed within the parenchyma of the liver instead of isolation and ligation of the main inflow vessels and of the major ducts at the hilus and retrohepatic ligation of the hepatic veins.     

The role of MMP-2 in the invasion and metastasis of hepatocellular carcinoma (HCC)

OBJECTIVES: To get insights into the role of MMP-2 in the invasion and metastasis of hepatocellular carcinoma (HCC), and to find a method to judge the invasion and metastasis of HCC through MMP-2. METHODS: Zymograph and immunohistochemistry were used to study the content and types of positive cells of MMP-2 in the HCC, and statistical methods were used to analyse the association between the content of MMP-2 and the pathological indexes of HCC. RESULTS: MMP-2 was expressed by all the normal liver, HCC and surrounding liver parenchyma. The increase of MMP-2 and the presence of the active type of MMP-2 were related to the invasion and metastasis of HCC. The content of MMP-2 in HCC being higher than that in surrounding liver parenchyma was an important index to judge the invasion and metastasis of the HCC. The positive cells of MMP-2 found in immunohistochemistry were normal hepatocytes, cholangioepithelial cells, Ito cells, regenerated hepatocytes, new generated cholangioepithelial cells, and HCC cells. CONCLUSION: MMP-2 was related to the invasion and me astasis of HCC. The content of MMP-2 in HCC being higher than that in surrounding liver parenchyma could be bused as an important index to judge the invasion and metastasis of HCC.     

Enhancement of computed tomography liver contrast using iomeprol-containing liposomes and detection of small liver tumors in rats

RATIONALE AND OBJECTIVES: We evaluated iomeprol-containing liposomes (Lipiom), a new contrast medium for computed tomography (CT) liver scanning, in an animal model of chemically induced hepatocellular carcinomas and other liver tumors in rats. METHODS: Liver tumors were induced by administration of carcinogens to rats, either 0.55% (w/w) 1'-hydroxysafrole in the diet or induction by 3'-methyl-4-diethylaminoazobenzene followed by promotion with carbon tetrachloride. CT scanning was performed 1-3 hr after intravenous injection of iomeprol-containing liposomes. RESULTS: After injection of iomeprol-containing liposomes at a dose of 70 mg of liposome-entrapped iodine per kilogram of body weight, the normal liver parenchyma showed a contrast enhancement, in Hounsfield units, of more than 60% over the control value before bolus. Liver tumors with no or few Kupffer cells were not enhanced and appeared as dark areas within the normal parenchyma. Tumors and pretumoral lesions devoid of Kupffer cells, as small as 3 mm in diameter, could be distinguished using this non-invasive method. CONCLUSION: CT liver scanning after injection of iomeprol-containing liposomes appears to be promising method for detecting liver tumors and focal liver lesions.     

Jaundice caused by estro-progestinic agents. Description of a case

A case of oestroprogestinic icterus is reported. The potential toxicity of these drugs, which have now been in use for twenty years in medical and non-medical practice, on liver parenchyma is discussed. Such treatment should be carried out only under the attentive, constant control of a physician who should not neglect liver function in his examination.     

Nitrergic innervation of the cat liver

The aim of this work was to study the nitrergic innervation in the liver of the cat using immunocytochemical procedures. At the hepatic hilus, a rich plexus of neuronal nitric oxide synthase immunoreactive (nNOS-IR) nerve fibers and ganglia was detected around the interlobular branch of the bile duct. nNOS-IR nerve fibers were observed running with the components of the intralobular portal triads located close to the hepatic hilus, as well as with a few vessels and ducts of the deeper parenchyma. These latter fibers, beside others located in Glisson's capsule, occasionally showed short ramifications entering the parenchyma itself. The present results suggest that, in the cat liver, nNOS is involved in the autonomic control of hepatic blood flow, with a limited role in the regulation of hepatobiliary excretory activity and hepatocellular metabolic function.     

Bipolar manic-depressives and unipolar depressives distinguished by tests of lateral asymmetry

This light and electron microscopic study demonstrates that the liver of the adult newt, Notophthalmus viridescens, consists of a mass of hepatocytes interrupted by blood sinusoids which allow blood to percolate through the parenchyma. The plates separating adjacent sinusoids are usually two or more cells thick and the bile canaliculi lie between 2-6 neighboring cells. Fine structural characteristics of hepatocytes include abundant lipid and glycogen inclusions. Melanophores with developing melanosomes are situated throughout the hepatic parenchyma.     

Spontaneous splenic rupture due to isolated splenic peliosis

Peliosis is a rare condition in which blood-filled cysts occupy the parenchyma of solid organs. It most commonly involves the liver or liver and spleen, but isolated cases of splenic peliosis have been documented. Spontaneous splenic hemorrhage from splenic peliosis has been reported in the literature only 6 times. We present the seventh known case of spontaneous hemorrhage from a peliotic spleen in an otherwise healthy man.     

Radiogenic responses of normal cells induced by fractionated irradiation--a simulation study. Part II. Late responses

AIM: Based on controlled theory, a computed simulation model has been constructed which describes the time course of slowly responding normal cells after irradiation exposure. Subsequently, different clinical irradiation schemes are compared in regard to their delayed radiogenic responses referred to as late effects in radiological terminology. METHOD: A cybernetic model of a parenchymal tissue consisting of dominantly resting functional cells has been developed and transferred into a computer model. The radiation effects are considered by characteristic cell parameters as well as by the linear-quadratic model. RESULTS: Three kinds of tissue (brain and lung parenchyma of the mouse, liver parenchyma of rat) have been irradiated in the model according to standard-, super-, hyperfractionation and a single high dose per week. The simulation studies indicate that the late reaction of brain parenchyma to hyperfractionation (3 x 1.5 Gy per day) and of lung parenchyma tissue with regard to all fractionation schemes applied is particularly severe. In contrast to these observations the behavior of liver parenchyma is not unique: If Dtotal amounts to 60 Gy there is no evidence for compensation of radiation damages, but if Dtotal is restricted to 30 Gy the corresponding evidence can be expected for all schemes. In the case of a high single dose of 6 Gy a reduction of the recovery time from 1 week to 2...2 days yields also an indication of a severe damage, even if Dtotal amounts only to 30 Gy. CONCLUSIONS: A comparison of the simulation results basing to the survival of cell numbers with clinical experience and practice shows that the clinical reality can qualitatively be represented by the model. This opens the door for connecting side effects to normal tissue with the corresponding tumor efficacy (discussed in previous papers). The model is open to further refinement and to discussions referring to the phenomenon of late effects.     

Hepatic lymphangiomatosis mimicking polycystic liver disease

Hepatic lymphangiomatosis is a rare disorder characterized by cystic dilatation of the lymphatic vessels in the hepatic parenchyma. It can occur in the liver alone, in the liver and spleen, or in multiple organs. Clinically, diagnosis can be difficult because of the rarity and protean manifestations of this disorder. We describe a 53-year-old woman with hepatic lymphangiomatosis in whom polycystic liver disease had been previously diagnosed. In addition, we review 12 cases of hepatic, splenic, and hepatosplenic lymphangiomatosis with or without systemic lymphangiomatosis and discuss the differential diagnosis.     

Noncorrelation between thoracic skeletal injuries and acute traumatic aortic tear

PURPOSE: The aim of the study was to investigate whether moderately to well differentiated hepatocellular carcinomas (HCC) possess the same ability to take up a new lipid emulsion contrast medium, FP 736-03, as do hepatocytes. MATERIAL AND METHODS: A rat model of an experimental HCC was used. CT was performed before and after an i.v. bolus injection of 1.0 ml FP 736-03/kg b.w. Attenuation values of normal liver parenchyma and tumour tissue were measured over time. RESULTS: The contrast medium was taken up by the normal liver parenchyma but not by the tumour tissue for which the attenuation remained virtually constant over the observation period. CONCLUSION: The study demonstrated that FP 736-03 was not taken up by the HCC, thus producing a high lesion-to-liver contrast.     

Unusual US and CT findings in hepatoblastoma: a case report

Hepatoblastoma is the most common primary hepatic tumor in young children and its radiological findings have been well described. We report ultrasound and computer tomography findings in a case of hepatoblastoma diffusely involving the entire liver and presenting as inhomogeneity and numerous cystic lesions in the hepatic parenchyma.     

Experimental toxic liver damage and hepatic plasma clearance of 99mTc-mebrofenin (iminodiacetate derivative). III. Chronic CCl4-induced liver damage with eventual cirrhosis in rabbits

Chronic damage to liver parenchyma was induced in rabbits by the long-term administration of carbon tetrachloride. The animals were serially sacrificed 3, 6 and 9 months after the start of intoxication, and examined histopathologically. The biological response was qualitatively assessed from results of histological studies, and measured utilizing series of typical biochemical indices of liver damage, 99mTc-mebrofenin (an-IDA-derivative) plasma clearance by the liver, and quantified indices of uptake and organ transfer of the compound. It was found that the plasma clearance and transfer parameters show association with chronic liver damage. The reduction of plasma 99mTc-mebrofenin clearance in intoxicated rabbits was also associated with changes in the biochemical indices of liver function and damage.     

Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors

The respective volumes of hepatic tumors and nontumorous parenchyma of 50 patients requiring hepatectomy of more than one segment of Healey for tumor removal were measured using computed tomography (Vol-CT). The volume estimated by Vol-CT was found to correlate with the real weight resected (P < .0001) with a mean absolute error of 64.9 mL. The ratio of the nontumorous parenchymal volume of the resected liver to that of the whole liver (R2) in 15 patients who underwent right or extended right hepatic lobectomy was 43% +/- 15%. Eight of 15 patients with R2s < 60% underwent the procedures without right portal vein embolization (PE). The other seven with R2s exceeding 60% or an indocyanine green retention rate after 15 minutes (ICG15) of 10% to 20% underwent PE: in six of seven, the nontumorous parenchyma of the right hepatic lobe became atrophic and in all seven, the volume of the remaining left hepatic lobe increased with a decrease in the mean R2 from 62% +/- 14% to 55% +/- 8% (P = .0006). In the remaining 35 who underwent other hepatectomy procedures, R2s also remained <60%. Overall, at surgery, in 27 with normal liver function (ICG15 < 10%), R2s exceeded 60% in one, remained at 50% to 60% in five, and <50% in 21, whereas 23 patients except for one with an ICG15 exceeding 10%, had R2s of <50%. The postoperative serum total bilirubin levels in 84% of the patients remained within the normal range and there was no surgery-related mortality. In conclusion, 1) Vol-CT can accurately assess the extent of liver resection, 2) individuals with normal liver function can undergo resection of up to 60% of the nontumorous parenchyma without the need for PE, and 3) PE can be used to reduce the size of the resected tissue and increase the volume of the remnant liver to approximate the target limits in individuals with large tumors or minimally abnormal liver function.     

Reconstruction of saddle nose deformities using porous polyethylene implant

Background: Troglitazone is a new drug for the treatment of type 2 diabetes. Although mild liver injury occurred in 1.9% of participants in controlled trials, the U.S. Food and Drug Administration has received reports of five postmarketing cases of severe liver disease that resulted in death or liver transplantation. OBJECTIVE: To report the clinical and histopathologic characteristics of a patient with troglitazone-associated severe liver injury leading to transplantation. DESIGN: Case report. SETTING: Two university hospitals. PATIENT: A 55-year-old woman taking troglitazone, 400 mg/d, and insulin, 120 U/d. INTERVENTION: Discontinuation of troglitazone therapy, pretransplantation liver biopsy, and liver transplantation. RESULTS: Early nonspecific symptoms were attributed to other causes and were not evaluated. After the patient had used troglitazone for 3.5 months, massive loss of liver parenchyma and symptoms of liver failure developed, necessitating liver transplantation. CONCLUSION: Troglitazone may cause subfulminant liver failure.