MRI for Advanced Gastric Cancer : Especially for Scirrhous Cancer of the Stomach

We conducted MRI examinations in 92 patients with advanced gastric cancer, and evaluated the clinical potential of MRI for diagnosis of scirrhous cancer of the stomach. The feature of scirrhous cancer of stomach by MRI are ; 1) thick-ened gastric wall, 2) shortening of T1 and T2 values ; and 3) clear contrast between the gastric mucosae and cancer areas found in the T1 and T2 weighted images (preservation of the mucosae). MRI for scirrhous cancer of the stomach is thought a useful image diagnosis as an adjunct method to gastric X-ray and gastric endoscopy

Focal Hepatic Tumors Using Inversion Recovery Sequence of 0.1-T MRI - Basic : Clinical Evaluation Gray Scale Vs T1 Values

Optimum conditions for image quality contrast were studied with phantom method by means of MRI system (of constant conduction type ; 0.1-T) in order to detect tumor lesions of liver that show no distinct contrast by usual roentgeno-graphic methods. Signal intensity of liver, fat and muscle were maximally suppressed at 1000 ms of TR and 100 ms of TI by the short inversion time inversion recovery (STIR) method, resulting in distinct visualization of liver tumor with extremely good contrast. Clinical investigation with the usual T1- and T2- weighted images under the same conditions identified hepatocellular carcinoma in 22 out of 31 patients (37 of 58 nodules, 64%), cholangiocellular carcinoma 3 of 5 (3 of 6 nodules, 50%), metastatic liver cancer in 55 out of 68 (111 of 143 nodules, 78%), hepatic hemangioma in 32 out of 36 (41 of 47 nodules, 87%) and liver cyst in 8 out of 8 (100%). In contrast, hepatocellular carcinoma was visualized in 30 out of 31 patients (54 of 58 nodules, 93%), cholangiocellular carcinoma in 5 out of 5 (6 of 6 nodules, 100%), metastatic liver cancer in 66 out of 68 (139 of 143 nod-ules, 97%), hepatic hemangioma in 36 out of 36 (47 of 47 nodules, 100%) and liver cyst in 8 out of 8 (100%). The results suggest that STIR (TR : 1000 ms, TI : 100 ms, TE : 18 ms) is extremely useful in screening tumor lesions of the liver

Hemobilia-a rare complication after laparoscopic cholecystectomy

Background Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC). Case presentation A man in his 60s underwent a LC. He was taking a direct Xa inhibitor for paroxysmal atrial fibrillation (pAf) and had a history of thrombectomy. There was variation in the bifurcation of the hepatic artery and cystic artery. The right hepatic artery branches from the common hepatic artery by itself, and the cystic artery is double. He complained of right upper quadrant pain, nausea, and vomiting on the third postoperative day (3POD). Non-contrast computed tomography (CT) showed that a high absorption area was found to fill the common bile duct. Contrast CT showed no pseudoaneurysm formation. Ultimately, he was diagnosed with postoperative hemobilia. Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent and a micro-pseudoaneurysm. Conclusions We encountered a case of hemobilia after LC. In this case, it was presumed that in addition to the chronic inflammatory changes of the gallbladder wall, extraordinary bifurcation of the hepatic artery and the cystic arteries and easy bleeding due to resumption of a direct Xa inhibitor synergistically caused a micro-pseudoaneurysm and postoperative hemobilia. It was difficult to identify the cause of hemobilia by contrast CT alone. Angiographic examination was useful for identifying and treating the causative artery and needs to perform aggressively