Purpose

To compare the features of hepatocellular adenoma subtypes (HCAs) in B-mode and contrast-enhanced US (CEUS).

Material and methods

Thirty-four patients (31 women (91%), median age 43.5 years [27-67]) with 45 pathologically proven and subtyped HCAs (including 29 inflammatory HCAs (I-HCA) and 15 HNF1-α-inactivated HCAs (H-HCA)) who underwent CEUS were included. The features of HCA on B-mode and CEUS were independently reviewed by two radiologists and compared between HCA subtypes.

Results

I-HCAs were either hypoechoic (23/29, 79%) or isoechoic (4/29, 14%) with B-mode and 12 (41.4%) were heterogeneous. All H-HCAs except one demonstrated homogeneous hyperechogenicity (93%) (p=0.001). Moderate or marked liver steatosis was only observed in I-HCAs (12/29, 41%) (p=0.001). Arterial hyperenhancement was observed on CEUS in 27/29 (93%) I-HCAs and in 14/15 (93%) H-HCAs (p=0.98). Washout was present in 6/29 (21%) I-HCAs and 1/15 (7%) H-HCAs (p=0.27). A total of 23/29 (79%) I-HCAs and 15/15 (100%) HCAs were homogeneous on portal and delayed phase acquisitions (p=0.04). The positive predictive value for identifying an H-HCA was 100% when the lesion was homogeneous and hyperechoic on B-mode, and the negative predictive value was 100% if neither of these two features was present in a liver with obvious steatosis.

Conclusion

Most CEUS features, especially enhancement patterns, do not significantly differ between HCAs. CEUS does not seem to provide additional information from B-mode US. The combination of B-mode lesion hyperechogenicity, homogeneity and the absence of obvious liver steatosis is useful to distinguish H-HCAs from I-HCAs.

Objectives

- Describing the normal anatomy and its imaging appearance of gastrointestinal tract after the major forms of endoscopic bariatric procedures and surgical bariatric procedures

- Describing the imaging of the main complications after endoscopic and surgical bariatric procedures

Background

Obesity is a worldwide problem, responsible for an increase in the death hazard ratio. The medical and diet treatment can be more effective if combined with invasive procedures. The main bariatric procedures are surgical (bypass, sleeve gastrectomy) but, recently, endoscopic bariatric treatment has also emerged as sleeve gastroplasty. The aim is to detail and compare the normal and pathological aspects of these procedures.

Imaging findings OR Procedure findings

Normal appearance after endoscopic bariatric treatment

Normal appearance after surgical bariatric treatment

Atypical but non- pathologic appearance after endoscopic and surgical bariatric treatments

Gastric emptying scan after endoscopic sleeve gastroplasty

Imaging of complications after endoscopic bariatric treatments

Imaging of complications after surgery bariatric treatments

Conclusion

Knowing the gastrointestinal imaging after bariatric procedures helps radiologists to recognize normal, atypical but non-pathologic or pathological conditions that may rise after such procedures, helping an accurate management of the patients.

Objectives

To present all etiologies of cystic liver lesions from the common to the rare disease; and to categorize them

To describe the imaging appearances and typical features of cystic liver lesions

Background

Cystic liver lesion is characterised by a cystic component, mostly found incidentally by imaging. This imaging pattern may be observed in a wide spectrum of common and uncommon non-neoplastic or neoplastic diseases.

Some lesions have a typical imaging pattern, allowing a non-invasive diagnosis. Some other lesions are more uncommon and typical radiological features should be known and recognized to provide adapted cares to the patient.

Imaging findings OR Procedure findings

1) Ductal abnormalities

a) Bile duct cyst

b) Biliary hamartoma

c) Caroli disease

d) Caroli syndrome

e) Polycystic liver disease

f) Peribiliary cyst

2) Cystic tumors

a) Primary cystic lesion

i) Hepatic lymphangioma

ii) Cystic cavernous hemangioma

iii) Ciliated hepatic foregut duplication cyst

iv) Biliary cystadenoma

v) Biliary cystadenocarcinoma

vi) Intraductal papillary neoplasms

vii) Inflammatory pseudotumor as cystic appearance

viii) Mucinous cholangiocarcinoma

b) Secondary cystic lesion

i) Neuroendocrine tumor

ii) Melanoma

iii) Mucinous adenocarcinoma

3) Infectious cystic lesion

a) Pyogenic abscess

b) Hydatid cyst

c) Echinoccocal cyst

4) Other

a) Pseudocyst

b) Post-traumatic cyst

i) Biloma

ii) Seroma and hematoma

c) Endometrial cyst

d) Rarities

Conclusion

Cystic liver lesions have a wide semiologic range from benign lesions to rare malignant lesions. The knowledge of typical imaging features helps radiologists to guide physicians for therapeutic management.

Purpose

Porto-mesenteric venous gas (PMVG) is associated with mesenteric ischemia in 40-60% of cases with a high mortality rate requiring emergency surgery. Studies reported a decrease in the mortality rate with the identification on CT of non-ischemic underlying causes and unnecessary surgery. The aim of this study was to identify prognostic factors of mortality in patients with PMVG and to assess factors leading to unnecessary surgery in these patients.

Material and methods

88 patients with PMVG diagnosed by CT from January 2008 to December 2017 were retrospectively included. Clinical, biological and radiological findings were collected and their association with mortality and unnecessary surgery was assessed.

Results

The overall mortality rate was 45.5%. Etiologies of PMVG were bowel ischemia (42%), gastrointestinal (GIT) obstruction or dilatation (16%), post-abdominal surgery (14.7%), GIT infection or sepsis (8%), trauma (6.8%), unspecified (6.8%) and malignancy (5.7%). Mortality was significantly associated with bowel ischemia (p<0.001) and with radiological findings of bowel ischemia (lack of wall enhancement (p=0.005), pneumatosis intestinalis (p=0.001), arterial occlusion (p=0.021) and solid organ infarction (p=0.046)). In multivariate analysis, the absence of acidosis was the only sign associated with a reduction of mortality [OR=0.09; 95% CI: 0.02-0.52]. No independent factor was significantly associated with unnecessary surgery.

Conclusion

PMVG remains serious, especially when revealing bowel ischemia and when associated with acidosis. Unfortunately, no specific sign is associated with unnecessary surgery that can orientate the physician toward the decision or not of surgical management.

Purpose

To compare the features of hepatocellular adenoma subtypes (HCAs) in B-mode and contrast-enhanced US (CEUS).

Material and methods

Thirty-four patients (31 women (91%), median age 43.5 years [27-67]) with 45 pathologically proven and subtyped HCAs (including 29 inflammatory HCAs (I-HCA) and 15 HNF1-α-inactivated HCAs (H-HCA)) who underwent CEUS were included. The features of HCA on B-mode and CEUS were independently reviewed by two radiologists and compared between HCA subtypes.

Results

I-HCAs were either hypoechoic (23/29, 79%) or isoechoic (4/29, 14%) with B-mode and 12 (41.4%) were heterogeneous. All H-HCAs except one demonstrated homogeneous hyperechogenicity (93%) (p=0.001). Moderate or marked liver steatosis was only observed in I-HCAs (12/29, 41%) (p=0.001). Arterial hyperenhancement was observed on CEUS in 27/29 (93%) I-HCAs and in 14/15 (93%) H-HCAs (p=0.98). Washout was present in 6/29 (21%) I-HCAs and 1/15 (7%) H-HCAs (p=0.27). A total of 23/29 (79%) I-HCAs and 15/15 (100%) HCAs were homogeneous on portal and delayed phase acquisitions (p=0.04). The positive predictive value for identifying an H-HCA was 100% when the lesion was homogeneous and hyperechoic on B-mode, and the negative predictive value was 100% if neither of these two features was present in a liver with obvious steatosis.

Conclusion

Most CEUS features, especially enhancement patterns, do not significantly differ between HCAs. CEUS does not seem to provide additional information from B-mode US. The combination of B-mode lesion hyperechogenicity, homogeneity and the absence of obvious liver steatosis is useful to distinguish H-HCAs from I-HCAs.