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Diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound
Abstracts Result: After meeting the selection criteria, 186 cases of pelvic masses were aspirated. Out of them, 18 turned out to be ovarian abscesses whilst 120 were chocolate cysts (endometriomas). 7 peritoneal abscesses and 4 psoas abscesses were also drained. 28 were found to be ovarian cysts with clear transparent fluid and 9 were found to be ovarian cysts with a tinge of red or dark yellow fluid. On follow-up, recurrance was observed in 28 patients (18.8%), 8 patients (5.4%) complained of mild pain and slight discomfort right after the procedure which was relieved by Panadol. No fluid collection was seen in the cul de sac Conclusion: Ultraound-guided aspiration of pelvic masses is a relatively safe, simple and cost-effective alternative to more invasive methods such as laproscopy and laparotomy. The paper will highlight the sonographic features of different cystic masses with special reference to ovarian abscesses versus endometriomas.
Ruptured Scar Pregnancy secondary to ingestion of Misoprostol Fatima M Hasan, Musarrat Hasan Institute of Ultrasound Imaging, Karachi, Sind, Pakistan Scar pregnancy is a rare form of ectopic pregnancy. If not diagnosed early and managed appropriately, it may lead to serious complications such as uterine rupture and hemorrhage. We present a case of a 29year-old female with a history of prior three cesarean sections who presented to our clinic with abdominal pain. She had taken misoprostol to terminate her 6 weeks pregnancy while being unaware that she had a scar pregnancy. Transvaginal ultrasound revealed a ruptured scar pregnancy with hematoma. Emergency laparotomy was performed and uterus was repaired.
Diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound Masashi Hattori, Ippei Matsuzaki, Chiaki Izumi, Hiroki Yamauchi, Naoya Goto, Yuji Iwata Medical corporation Yamashita Hospital, Ichinomiya, AICHI, Japan Purpose: Effectiveness of differential diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound (CEUS) examination by perflubutane (SonazoidÒ :Daiichi-Sankyo, Tokyo). Material & Methods: CEUS was performed on 183 patients with gallbladder polypoid lesions.It consists of 10 adenocarcinomas, 2 adenomas, 129 benign polyps and 42 adenomyomatosis (fundal type). For benigndiseases, we examined cases where the size was 6 mm or more and could be observed for more than one year. Ultrasound was performed using TUS-A500 (Aplio 500) (Canon MedicalSystems. Tokyo) and prosound alpha10 (Hitachi Aloka Medical,Ltd.Tokyo). First, the largest cross section of a lesion was visualized using Bmode and infusion of Sonazoid. The characteristics and behavior of blood flow in the lesion in the early vascular phase were examined over approximately 30 sec. Thereafter, observation was continued accordingly for about 3 min. Sonazoid infusion using contrast harmonic imaging and real-time perfusion Imaging. Results: Gallbladder carcinoma showed hypervascular staining and “eruption sign” was apparent in 60%. The “eruption sign” showed an image of a vigorously boiling water that was splashing up from the entire lesion. Blood flow imaging revealed irregular size and buckling, including tortuous vessels and erratic blood flow in 70%. Gallbladder adenoma showed “eruption sign” was apparent in 50%. The irregular size, tortuous vessels and eruption signs of blood flow imaging were 83.3% as an index of neoplastic. Gallbladder benign polyp, staining
S93
was scattered within them, and “flicker sign” was observed in 93.8%. The “flicker sign” showed an image of bubbling pre-boiled hot water. Five cases (3.9%) showed a diffused and hypervascular staining pattern. The staining time was shorter than gallbladder carcinoma. Blood flow image showed normal vessels without buckling. Linear blood flow of the stalk of gallbladder polyp was also characteristic. Gallbladder adenomyomatosis (fundal type), staining was scattered and mild flicker signs were observed in 85.7%. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clearity. Conclusions: CEUS can clarify the hemodynamics and blood flow images and are useful for the differential diagnosis of gallbladder polypoid lesions.
Efficacy of radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy in elderly Atsushi Hiraoka,1 Hirofumi Izumoto,1 Taisei Murakami,1 Marie Ochi,1 Tomoyuki Ninomiya,1 Masashi Hirooka,2 Yohei Koizumi,2 Yoichi Hiasa,2 Kojiro Michitaka1 1 Ehime Prefectural Central Hospital, Matsuyama, EHIME, Japan, 2 Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan Background/Aim: In recent aging society, ultrasonography guided radiofrequency ablation (RFA) has been performed as a low invasive treatment against hepatocellular carcinoma (HCC) in elderly patients. We investigated the efficacy of RFA against recurrent HCC after surgical resection in elderly patients, retrospectively. Material/Methods: From 2000 to 2015, 86 patients with recurrent HCC, who were treated with surgical resection as an initial treatment for HCC, were enrolled. HCCs were within Milan criteria and all were treated with RFA. Elderly were defined as 75 years old or more (elderly-group: n = 25 and non-elderly group: n = 61). Clinical background and prognosis were analyzed. Results: Average age of elderly-group were 78.9 § 3.5 years old, while that of non-elderly were 63.9 § 8.9 years old (P < 0.001). Although tumor size was larger in elderly- than non-elderly group (1.8 § 0.4 vs. 1.5 § 0.7cm, P = 0.003), there were no significant differences in Child-Pugh classification, tumor number, tumor node metastasis classification of the Liver Cancer Study Group of Japan 6th, and serum levels of tumor makers (AFP, AFP-L3, PIVKA-II) between both groups. Overall survival rate after recurrence did not show significant difference bet ween both gourps (3yrs-/5yrs-OSR: Elderly vs. nonelderly = 85.6/63.6% vs. 90.4/68.8%, P = 0.731). Conclusion: RFA can be performed as an effective and low invasive therapy against recurrent HCC after surgical resection in elderly patients as well as non-elderly patients.
Clinical utility of multipolar ablation with a threedimensional simulator system for patients with hepatocellular carcinoma Masashi Hirooka,1 Yohei Koizumi,1 Atsushi Hiraoka,2 Takaaki Tanaka,1 Yusuke Imai,1 Koutarou Sunago,1 Atsushi Yukimoto,1 Takao Watanabe,1 Osamu Yoshida,1 Masanori Abe,1 Yoichi Hiasa1 1 Ehime University Graduate School of Medicine, Touon, EHIME, Japan, 2 Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Matsuyama, Ehime, Japan Purpose: Recently, multipolar RFA has been utilized. Multipolar RFA offers the advantage of providing a large volume of ablation, providing more homogeneous necrosis with a higher rate of pathological complete necrosis. Although very encouraging results have been reported
Ruptured Scar Pregnancy secondary to ingestion of Misoprostol Fatima M Hasan, Musarrat Hasan Institute of Ultrasound Imaging, Karachi, Sind, Pakistan Scar pregnancy is a rare form of ectopic pregnancy. If not diagnosed early and managed appropriately, it may lead to serious complications such as uterine rupture and hemorrhage. We present a case of a 29year-old female with a history of prior three cesarean sections who presented to our clinic with abdominal pain. She had taken misoprostol to terminate her 6 weeks pregnancy while being unaware that she had a scar pregnancy. Transvaginal ultrasound revealed a ruptured scar pregnancy with hematoma. Emergency laparotomy was performed and uterus was repaired.
Diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound Masashi Hattori, Ippei Matsuzaki, Chiaki Izumi, Hiroki Yamauchi, Naoya Goto, Yuji Iwata Medical corporation Yamashita Hospital, Ichinomiya, AICHI, Japan Purpose: Effectiveness of differential diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound (CEUS) examination by perflubutane (SonazoidÒ :Daiichi-Sankyo, Tokyo). Material & Methods: CEUS was performed on 183 patients with gallbladder polypoid lesions.It consists of 10 adenocarcinomas, 2 adenomas, 129 benign polyps and 42 adenomyomatosis (fundal type). For benigndiseases, we examined cases where the size was 6 mm or more and could be observed for more than one year. Ultrasound was performed using TUS-A500 (Aplio 500) (Canon MedicalSystems. Tokyo) and prosound alpha10 (Hitachi Aloka Medical,Ltd.Tokyo). First, the largest cross section of a lesion was visualized using Bmode and infusion of Sonazoid. The characteristics and behavior of blood flow in the lesion in the early vascular phase were examined over approximately 30 sec. Thereafter, observation was continued accordingly for about 3 min. Sonazoid infusion using contrast harmonic imaging and real-time perfusion Imaging. Results: Gallbladder carcinoma showed hypervascular staining and “eruption sign” was apparent in 60%. The “eruption sign” showed an image of a vigorously boiling water that was splashing up from the entire lesion. Blood flow imaging revealed irregular size and buckling, including tortuous vessels and erratic blood flow in 70%. Gallbladder adenoma showed “eruption sign” was apparent in 50%. The irregular size, tortuous vessels and eruption signs of blood flow imaging were 83.3% as an index of neoplastic. Gallbladder benign polyp, staining
S93
was scattered within them, and “flicker sign” was observed in 93.8%. The “flicker sign” showed an image of bubbling pre-boiled hot water. Five cases (3.9%) showed a diffused and hypervascular staining pattern. The staining time was shorter than gallbladder carcinoma. Blood flow image showed normal vessels without buckling. Linear blood flow of the stalk of gallbladder polyp was also characteristic. Gallbladder adenomyomatosis (fundal type), staining was scattered and mild flicker signs were observed in 85.7%. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clearity. Conclusions: CEUS can clarify the hemodynamics and blood flow images and are useful for the differential diagnosis of gallbladder polypoid lesions.
Efficacy of radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy in elderly Atsushi Hiraoka,1 Hirofumi Izumoto,1 Taisei Murakami,1 Marie Ochi,1 Tomoyuki Ninomiya,1 Masashi Hirooka,2 Yohei Koizumi,2 Yoichi Hiasa,2 Kojiro Michitaka1 1 Ehime Prefectural Central Hospital, Matsuyama, EHIME, Japan, 2 Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan Background/Aim: In recent aging society, ultrasonography guided radiofrequency ablation (RFA) has been performed as a low invasive treatment against hepatocellular carcinoma (HCC) in elderly patients. We investigated the efficacy of RFA against recurrent HCC after surgical resection in elderly patients, retrospectively. Material/Methods: From 2000 to 2015, 86 patients with recurrent HCC, who were treated with surgical resection as an initial treatment for HCC, were enrolled. HCCs were within Milan criteria and all were treated with RFA. Elderly were defined as 75 years old or more (elderly-group: n = 25 and non-elderly group: n = 61). Clinical background and prognosis were analyzed. Results: Average age of elderly-group were 78.9 § 3.5 years old, while that of non-elderly were 63.9 § 8.9 years old (P < 0.001). Although tumor size was larger in elderly- than non-elderly group (1.8 § 0.4 vs. 1.5 § 0.7cm, P = 0.003), there were no significant differences in Child-Pugh classification, tumor number, tumor node metastasis classification of the Liver Cancer Study Group of Japan 6th, and serum levels of tumor makers (AFP, AFP-L3, PIVKA-II) between both groups. Overall survival rate after recurrence did not show significant difference bet ween both gourps (3yrs-/5yrs-OSR: Elderly vs. nonelderly = 85.6/63.6% vs. 90.4/68.8%, P = 0.731). Conclusion: RFA can be performed as an effective and low invasive therapy against recurrent HCC after surgical resection in elderly patients as well as non-elderly patients.
Clinical utility of multipolar ablation with a threedimensional simulator system for patients with hepatocellular carcinoma Masashi Hirooka,1 Yohei Koizumi,1 Atsushi Hiraoka,2 Takaaki Tanaka,1 Yusuke Imai,1 Koutarou Sunago,1 Atsushi Yukimoto,1 Takao Watanabe,1 Osamu Yoshida,1 Masanori Abe,1 Yoichi Hiasa1 1 Ehime University Graduate School of Medicine, Touon, EHIME, Japan, 2 Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Matsuyama, Ehime, Japan Purpose: Recently, multipolar RFA has been utilized. Multipolar RFA offers the advantage of providing a large volume of ablation, providing more homogeneous necrosis with a higher rate of pathological complete necrosis. Although very encouraging results have been reported