COLOR FLOW IMAGING OF HEPATIC CARCINOMA

Color flow imaging(CFI)ultrasound technique can discover the tumor vascularity and superimposed it to convontional B-mode ultrasonogram in real-time. The flow velocity on spectral Doppler sonogram can be measured by setting the sample volume to any selected site.One hundred and thirty-six patients with solid hepatic space-occupied lesions had been admitted and 113 cases were confirmed by operation and pathology,23 patients were strongly suspected by hepatic angiography (HAA).Ninety nine patients with 109 nodules were finally diagnosed as hepatic cellular carcinoma(HCC).According to color flow distribution pattern,3 kinds of color configuation had been nominated.Tumor vascularity discovered by CFI,especially the arterial blood flow was easy to be recognized,and its emerge rate was quite different between HCC group(94.5%)and hemangioma(HCH)group(17.07%)(P<0.01).Spectral Doppler studies were also carried out in these cases and the detectability of arterial flow in HCC group(95.41%)was much higher than that to HCH group (21. 95%) (P<0. 005).Resistant index(RI)and pulsatile index(PI)could be used to differentiate HCC (>0. 50 and >0.80 respectively)from HCH (P<0.001 and P<0.001 respectively).Arterial-portal(A-P) shunt could also be detected by CFI and spectral Doppler(mostly its Vmax>0.6m/s).The detection rate of A-P shunt was 64% in HCC group,but no case could be detected in HCH group.

Biliary Cast Syndrome： Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy

Background： BiNary cast syndrome （BCS） was a postoperative complication of orthotopic liver transplantation （OLT）, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index （HARt）, and to observe pathological changes and morphology of biliary casts. Methods： Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks I, 2, 3 shown by color Doppler flow imaging. The compositions ofbiliary casts were analyzed by pathological examination and scanning electron microscopy. Results： HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 （P 〈 0.05）. Odds ratio （OR） analysis of HARI 1, HARI 2, HARI 3 following the operation was 〉1 （OR = 1.300： 1.223 and 1.889, respectively）. The OR of HARI 3 was statistically significant （OR - 1.889; 95% confidence interval - 1.166-7.490; P - 0.024）. The compositions of biliary casts were different when bile duct stones wcrc present. Furthermore, vascular epithelial cells were found by pathological examination in binary casts. Conclusions： HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of binary casts and bile duct stones are different.