Application of immersion B-scan ultrasonography in diagnosis of complex retinal detachment,persistent hyperplastic primary vitreous and intraocular tumors

AIM:To evaluate the diagnostic value of panoramic immersion B-scan ultrasonography(Pano-immersion B-scan,PIB)in complex retinal detachment(RD),persistent hyperplastic primary vitreous(PHPV)and intraocular tumors.METHODS:The clinical data of 44 patients collected from May 2012 to December 2019 in Chinese PLA General Hospital was retrospectively studied.All of these patients underwent PIB of the eye,because it was difficult to diagnose by routine ocular fundus examination,conventional ultrasound or/and ultrasonic biomicroscope(UBM)due to opacity of refractive media,pupillary occlusion,large involvement or special location of the lesion.The imaging features of difficult cases in PIB were analyzed.The diagnosis accuracy rating of PIB were evaluated and contrasted with conventional ultrasound or UBM by the standard of intraoperative diagnosis or/and pathological results.RESULTS:According to intraoperative diagnosis or pathological results as gold standard,among the 44 cases,there were 19 cases missed diagnosis,misdiagnosed or difficult-to-diagnose by conventional ultrasound or UBM,including 4 cases of long-standing RD difficult to diagnose,4 cases misdiagnosed,and 11 cases incompletely observed or miss diagnosed.The diagnostic accuracy rate of PIB and conventional ultrasound or UBM were 100%(44/44)and 56.82%(25/44),and the sensitivity of them were 100%and 56.82%.All the patients underwent PIB and were diagnosed as RD(15 cases),retinal and choroidal detachment(4 cases),subchoroidal hematocele(1 case),vitreous opacity and/or organic membrane formation(4 cases),PHPV(12 cases),iris and/or ciliary body tumors(3 cases),and choroidal tumors(6 cases).According to the intraoperative diagnosis or pathological results,the diagnostic coincidence rate of PIB was 100%,which was significantly higher than conventional ultrasound and UBM.CONCLUSION:PIB can help to accurately diagnose complex RD,PHPV,and intraocular masses with special location or/and excessive size.It has important diagnostic value for patients with equivocal findings at conventional ultrasound examination.

Sex-influenced association of non-alcoholic fatty liver disease with colorectal adenomatous and hyperplastic polyps

AIM To investigate the relationship between non-alcoholic fatty liver disease(NAFLD) and colorectal adenomatous and hyperplastic polyps.METHODS A retrospective cross-sectional study was conducted on 3686 individuals undergoing health checkups(2430 males and 1256 females). All subjects underwent laboratory testing,abdominal ultrasonography,colonoscopy,and an interview to ascertain the baseline characteristics and general state of health. Multinomial logistic regression analysis was performed to examine the association between NAFLD and the prevalence of colorectal adenomatous and hyperplastic polyps.Furthermore,the relationship was analyzed in different sex groups. Subgroup analysis was performed based on number,size,and location of colorectal polyps.RESULTS The prevalence of colorectal polyps was 38.8% in males(16.2% for adenomatous polyps and 9.8% for hyperplastic polyps) and 19.3% in females(8.4% for adenomatous polyps and 3.9% for hyperplastic polyps). When adjusting for confounding variables,NAFLD was significantly associated with the prevalence of adenomatous polyps(OR = 1.28,95%CI: 1.05-1.51,P < 0.05) and hyperplastic polyps(OR = 1.35,95%CI: 1.01-1.82,P < 0.05). However,upon analyzing adenomatous and hyperplastic polyps in different sex groups,the significant association remained in males(OR = 1.53,95%CI: 1.18-2.00,P < 0.05; OR = 1.42,95%CI: 1.04-1.95,P < 0.05) but not in females(OR = 0.44,95%CI: 0.18-1.04,P > 0.05; OR = 1.18,95%CI: 0.50-2.78,P > 0.05). CONCLUSION NAFLD is specifically associated with an increased risk of colorectal adenomatous and hyperplastic polyps in men. However,NAFLD may not be a significant factor in the prevalence of colorectal polyps in women.

A white opaque substance-positive gastric hyperplastic polyp with dysplasia

The endoscopic findings of gastric hyperplastic polyps (HPs) with dysplasia have not been well-defined, and the clinical significance of these lesions, including their malignant potential, is unclear. In this report, we describe a case of a white opaque substance (WOS)positive gastric HP with dysplasia. A 76-year-old woman was referred to our hospital for endoscopic resection of a gastric HP. Upper endoscopy revealed a 25-mm whitish and reddish polypoid lesion on the greater curvature in the lower third of the stomach. The whitish part was diagnosed as a WOS using conventional and magnifying endoscopy with narrow band imaging. An examination of the biopsy specimen indicated that the lesion was a typical gastric HP. However, because of its color and the presence of a WOS, we suspected that this lesion was an atypical gastric HP. Therefore, we performed a polypectomy. Histopathologically, diffuse lowto high-grade dysplasia was found on the surface of the polyp. We performed immunohistochemical staining using a monoclonal antibody specific for adipophilin as a marker of lipid droplets (LDs). LDs were detected in approximately all of the neoplastic cells, especially in the surface epithelium of the intervening apical parts and were located in the subnuclear cytoplasm of the neoplastic cells. According to endoscopic and histopathological findings, the WOS-positive epithelium indicated dysplasia of the gastrointestinal phenotype, which could absorb lipids. The presence of a WOS in a gastric HP may be considered an endoscopic finding that is predictive of the neoplastic transformation of a gastric HP. We suggest that a WOS-positive gastric HP should be resected endoscopically to investigate its neoplastic transformation.

Comparative Study of the Effect of Shugan Shuru Granule (疏肝舒乳颗粒) on Pathology and p53 Gene Expression in Patients with Hyperplastic Disease of Breast

Objective: To study the effect of Shugan Shuru Granule (疏肝舒乳颗粒,SSG) on the p53 gene expression in patients with hyperplastic disease of breast (HDB) to indirectly explore the mechanism of SSG’s effect on HDB on the molecular pathological level. Methods: Sixty-six patients with HDB were allocated in the treated group and the control group,with the former treated with SSG and the latter not. All patients underwent breast operation and their diseased mammary tissues were cut out, sectioned, and observed under microscopy with HE staining and immunohistochemical staining, with ABC method adopted to estimate the degree of hyperplasia and p53 gene expression. The severity of HDB was classified into normal, mild, moderate and severe grades (marked as 0 to Ⅲ), according to the degree of hyperplasia in the mammary gland. Results: Hyperplasia in the control group mostly belonged to grade Ⅰ-Ⅲ before treatment, showing overgrowth of gland and proliferation of glandular epithelial cells, which were high columnar shaped, more stratified, with papillary or substantive dysplasia. While in the treated group, most belonged to grade 0-Ⅰ after SSG treatment, with proliferated gland and dysplasia recovered to normal or disappeared. The positive rate of p53 gene expression in the treated group was 9.09%, and in the control group 39.39%, comparison between the two groups showing significant difference (P<0.01), the intensity in the former was significantly weaker than that in the latter.Conclusion: SSG could not only inhibit the proliferation of mammary duct epithelia and lobuli, but also inhibit the over-expression of P53. Therefore, it could be regarded as an effective remedy for treatment of HDB and prevention of mammary cancer genesis.

Gastric hyperplastic polyps causing upper gastrointestinal hemorrhage in a young adult

Here, we report a case of a young man who presented with a significant upper gastrointestinal bleed treated by endoscopic removal of multiple hyperplastic polyps. Gastric hyperplastic polyps are a relatively uncommon cause of overt gastrointestinal bleeding. While most hyperplastic gastric polyps are asymptomatic, they may present with abdominal pain, iron def iciency anemia or gastric outlet obstruction. These polyps are associated with conditions such as Helicobacter pylori gastritis and atrophic autoimmune gastritis, which predispose the epithelium to chronic inf lammation and epithelial repair.The patient presented to Northwestern Memorial Hospital in July 2011. The polyps were resected by clip-assisted snare polypectomy. Histopathologic assessment of the resected polyps demonstrated multiple, nonulcerative hyperplastic polyps measuring 1.3-1.8 cm in size, without evidence of dysplasia or malignancy. This case describes a young adult patient with multiple, large gastric polyps causing overt gastrointestinal bleeding. This is a rare presentation in a young individual, as these polyps are typically identifi ed in patients older than 60 years of age and less commonly, pediatric populations.

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous

AIM：To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous（PHPV）.METHODS：This retrospective study included patients with cataract and PHPV treated with various strategies.Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization,posterior capsulotomy,anterior vitrectomy,and intraocular lens（IOL）implantation. Posterior PHPV was treated with lensectomy,posterior vitrectomy,retinal photocoagulation,and IOL implantation or silicone oil tamponade. Visual acuity（VA）,pattern visual evoked potential（P-VEP）,anatomic recovery,postoperative complications,and amblyopia outcome were examined.Subjects were followed-up for 3-48 mo after surgery.RESULTS：Of the 30 patients（33 eyes）with congenital cataract and PHPV included（average age,39.30±35.47mo）,9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage（6 eyes）and twostage（3 eyes）implantation. Postoperative complications included retinal detachment（1 eye）and recurrent anterior chamber hemorrhage（1 eye）. In eyes with posterior PHPV,6 and 11 eyes received IOLs in one-and two-stage procedures,respectively. Silicone oil was retained in 2 eyes,and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48 mo of amblyopia treatment. P-VEP P_（100） was improved following surgery in both PHPV types.CONCLUSION：Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.

Colonic lipoma covered by hyperplastic epithelium: Case report

Colonic lipomas are submucosal nonepithelial tumors covered by intact or eroded mucosa. In rare cases, alterations in the mucosa covering a lipoma include hyperplasia, adenoma, atrophy, ulceration, and necrosis. Here, we report a case of a colonic lipoma covered by hyperplastic epithelium in a 68-year-old woman. Based on the colonoscopy findings, a snare polypectomy was performed for a presumptive diagnosis of an epithelial lesion; however, the histological examination revealed a colonic submucosal lipoma with overlying hyperplastic epithelium.

Hyperplastic cholecystoses:efforts should be made to recognize and treat them

Acalculous gallbladder diseases do not draw too much attention from researchers because of their low incidence of malignancy, no symptoms, and good prognosis, and therefore there is even no unanimous terminology. Emerged

DISTINGUISHING BETWEEN HYPERPLASTIC AND ADENOMATOUS POLYPS AND NORMAL COLONIC MUCOSA BY USING MULTIPHOTON LASER SCANNING MICROSCOPY

Precisely distinguishing between hyperplastic and adenomatous polyps and normal human colonic mucosa at the cellular level is of great medical significance.In this work,multiphoton laserscarming microscopy(MPLSM)was used to obtain the high.-contrast images and the morpho-logical characteristics from normal colonic mucosa,hyperplastic polyps and tubular adenoma.Byintegrating the length and area measurement tools and computing tool,we quantified thedifference of crypt morphology and the alteration of nuclei in normal and diseased human colonicmucosa.Our results demonstrated that the morphology of crypts had an obvious tendency tocystic dilatation or elongated in hyperplastic polyps and tubular adenoma.The cont ent andnumber of mucin droplets of the scattered goblet cells had a piecemeal reduction in hyperplastic polyps and a large decrease in tubular adenoma The nuclei of epithelial cells might be elongated and pseudostratified,but overt dysplasia was absent in hyperplastic polyps.Nevertheless,thenuclei showed enlarged,crowded,stratified and a rod-like structure,with loss of polarity intubular adenoma.These results suggest that MPLSM has the capacity to distinguish betweenhyperplastic and adenomat ous polyps and normal human colonic mucosa at the celular level.

Use of power Doppler sonography for differential diagnosis of small hepatocellular carcinoma and adenomatous hyperplastic nodule

To evaluate applicability of power Doppler sonography (PDS) in differential diag nosis of small hepatocellular carcinoma (SHCC) and adenomatous hyperplastic nodu le (AHN) Methods Twenty two cases of SHCC and 15 cases of AHN were investigated by PDS an d the findings were campared with those of digital subtraction angiography (DSA) Results The rates of arterial and portal flow in an afferent tumor vessel were 86 4% a n d 40 9% in SHCCs, respectively The rate of portal flow in an afferent tumor v essel was 60 0% in AHNs, while no arterial flow was detected ( P <0 01) In addition, PDS revealed a constant flow in an efferent tumor vessel (50 0%) c ontinuing to a portal branch in 10 (45 5%) of the 22 SHCCs cases to a hepatic v ein in 1 (4 5%) of the 22 SHCCs, but to nothing else in the AHNs ( P <0 01) Conclusions Power Doppler sonography is of value in distinguishing SHCC from AHN, and arteri al afferent tumor vessels from constant flow efferent tumor vessels at PDS

Syndromic and sporadic inflammatory/hyperplastic small-bowel polyps:a comparative study

Background:Inflammatory/hyperplastic small-bowel polyps(SBPs)occur either sporadically or in patients with a polyposis syndrome;however,comparison between these two settings of the histological features of SBPs has not been reported and the etiology of sporadic inflammatory/hyperplastic SBPs remains unclear.Method:Twenty-eight cases of sporadic inflammatory/hyperplastic SBPs and nine cases of syndromic SBPs were retrieved from the Department of Anatomic Pathology at the Cleveland Clinic.Clinico-demographics and histological features were compared between the two groups.Results:Patients with syndromic inflammatory/hyperplastic SBPs were younger(48 vs.63 years;P=0.007)and had higher rates of hemorrhagic telangiectasia(55.6%vs.0%;P=0.000),gastric polyps(87.5%vs.21.4%;P=0.001),and family history of colon cancer(62.5%vs.11.1%;P=0.014).Sporadic cases were more frequently associated with gastro-esophageal reflux(35.7%vs.0%;P=0.079)and anti-reflux medication use(55.6%vs.11.1%;P=0.026).Histologically,the syndromic SBPs were more often of pure intestinal type(45.4%vs.3.8%;P=0.005)and had prominent vessels(81.8%vs.42.3%;P=0.036).Conclusions:Patients with syndromic SBPs are younger and have higher rates of hemorrhagic telangiectasia,gastric polyps,and family history of colon cancer.Histologically,syndromic inflammatory/hyperplastic SBPs are more likely to be of pure intestinal type and to have prominent vessels.

Unusual clinical presentation of oral pyogenic granuloma with severe alveolar bone loss:A case report and review of literature

BACKGROUND Pyogenic granuloma(PG)is a localized,reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity.In most cases,the presence of this lesion does not show alveolar bone resorption.The pathology is diagnosed clinically with some caution.However,the diagnosis and treatment are usually corroborated with histopathological evidence.CASE SUMMARY Three clinical cases of PG associated with bone loss were described in this study.The three patients presented tumor-like growth which bled on touch,and were associated with local irritant factors.Radiographs showed bone loss.All cases were treated with conservative surgical excision.The scarring was satisfactory,and there was no case of recurrence.The diagnoses were based on clinical findings,and were confirmed histopathologically.CONCLUSION The occurrence of oral PG with bone loss is unusual.Therefore,clinical and radiographic evaluations are important for the diagnosis.

Endoscopic and histologic characteristics of serrated lesions

In recent years , a second pathway for colonic carcinogenesis , distinct from the adenomatous pathway, has been explored. This is referred to as serrated pathway and includes three types of polyp,characterised by a serrated appearance of the crypts:hyperplastic polyps(HP),sessile serrated adenomas(SSA)or lesions,and traditional serrated adenomas.Each lesion has its own genetic,as well as macroscopic and microscopic morphological features.Because of their flat aspect,their detection is easier with chromoendoscopy(carmin indigo or narrow-band imaging).However,as we show in this review,the distinction between SSA and HP is quite difficult.It is now recommended to resect in one piece as it is possible the serrated polyps with a control in a delay depending on the presence or not of dysplasia.These different types of lesion are described in detail in the present review in general population,in polyposis and in inflammatory bowel diseases patients.This review highlights the need to improve characterization and understanding of this way of colorectal cancerogenesis.

Changes in the spectrum of gastric polyps in the Chinese population

AIM: To evaluate the change in spectrum of gastric polyps in the Chinese population in the past ten years.METHODS: A total of 157902 consecutive patients undergoing esophagogastroduodenoscopy(EGD) from 2004 to 2013 in a tertiary hospital were retrospectively reviewed using an EGD database.Endoscopic records of 4043 patients diagnosed with gastric polyps were recalled for analysis.Data including demographics,information on polyps such as location,pathological diagnosis,reflux esophagitis and Helicobacter pylori infection were obtained.We focused on epithelial polyps,especially hyperplastic polyps,fundic gland polyps and adenomas,and histological classification of specimens from biopsy and endoscopic polypectomy was performed by professional pathologists,based on the updated guidelines.To explore the age distribution of gastric polyps over time,we divided patients with polyps into four groups: A(aged < 30 years),B(aged 30-44 years),C(aged 45-59 years) and D(aged > 60 years).Differences in localization,age,and sex distribution of gastric polyps were analyzed by statistical software.RESULTS: A total of 157902 EGD procedures were performed in ten years at our digestive endoscopy center,of which 4043 cases were diagnosed with gastric polyps confirmed by pathology.There were 2574(63%) female and 1469(37%) male patients with an average age of 54.7 years.The overall prevalence of gastric polyps was 2.6%(4043/157902).Our database demonstrated a rising prevalence of gastric polyps over the decade,increasing from 1.0%(80/8025) to 4.70%(828/17787) between 2004 and 2013.There has been a change in the spectrum of gastric polyps with the frequencies of FGPs increasing from 19%(15/80) to 77%(638/828) and hyperplastic polyps decreasing from 65%(52/80) to 15%(123/828).Moreover,data on 1921 polyps in 828 patients diagnosed with gastric polyps in 2013 showed that FGP was the most common type in the current polyp spectrum,making up 81.3%(1562/1921).Location and age distribution of gastric polyps have also altered.The prevalence of polyps located in the antrum decreased from 37.5%(30/80) to 9.30%(77/828),with an increasing prevalence of polyps in the corpus,from 45%(36/80) to 64.25%(532/828).The constituent ratio of older patients(aged > 60 years) in the polyp population decreased from 62.5%(50/80) to 32.13%(266/828),while that of patients aged 45-60 years showed an increased trend.CONCLUSION: There was a shift change in the spectrum of gastric polyps in the Chinese population with altered location and age distribution in the past ten years.

Gastritis cystica profunda in a previously unoperated stomach:A case report

Gastritis cystica profunda is a relatively rare disease, usually observed at anastomotic sites in stomachs of patients that have undergone gastric procedures. We present the rare case of an elevated lesion in the anterior wall of the gastric antrum of a 43-year-old Chinese woman who had never undergone gastric surgery and had no gastrointestinal tract symptoms. Although the physical examination and laboratory data showed no abnormalities, endoscopic ultrasonography revealed an anechoic cystic structure. Abdominalcomputed tomography and magnetic resonance imaging showed the gastric wall of the greater curvature of the antrum was markedly and irregularly thickened, and mild to moderate enhancement was observed around the lesion with no enhancement in the central portion, suggestive of a gastrointestinal stromal tumor. The patient underwent a distal gastric resection of the 2.5 cm × 1.5 cm lesion. A postoperative pathologic examination showed dilated cystic glands in the muscularis mucosa and submucosal layers and erosion of the mucosal surface of the tumor, confirming the diagnosis of gastritis cystica profunda without malignancy.

Serrated polyps of the colon and rectum:Remove or not?

In recent years,the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway.Colorectal serrated polyps are histopathologically classified into hyperplastic polyps(HPs),sessile serrated lesions,and traditional serrated adenomas;in the serrated neoplasia pathway,the latter two are considered to be premalignant.In western countries,all colorectal polyps,including serrated polyps,apart from diminutive rectosigmoid HPs are removed.However,in Asian countries,the treatment strategy for colorectal serrated polyps has remained unestablished.Therefore,in this review,we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions≥6 mm in size,and traditional serrated adenomas of any size.

Endoscopic diagnosis for colorectal sessile serrated lesions

BACKGROUND Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions(SSLs) are precursors of cancer via the ‘‘serrated neoplastic pathway’’. The clinical features of SSLs are tumor size(> 5 mm), location in the proximal colon, coverage with abundant mucus called the ‘‘mucus cap’’, indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often difficult.AIM To develop a diagnostic score system for SSLs.METHODS We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the Toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve analysis.RESULTS Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location(proximal colon), size(> 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size(> 5 mm;P = 0.033), mucus cap(P = 0.005), and indistinct borders(P = 0.033) were independently associated with the diagnosis of SSLs. Size > 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75% sensitivity, 80% specificity, and 78.4% accuracy. The pathological SSL rate for an endoscopic SSL diagnosis score of 3 was significantly higher than that for an endoscopic SSL diagnosis score of 0, 1, or 2(P < 0.001).CONCLUSION Size > 5 mm, mucus cap, and indistinct borders were significant endoscopic features for the diagnosis of SSLs. Serrated polyps with these three features should be removed during colonoscopy.

Serrated pathway:Alternative route to colorectal cancer

Serrated polyps have been an area of intense focus for gastroenterologists over the past several years. Contrary to what was thought before,a growing body of literature indicates that these polyps can be precursors of colorectal cancer(CRC).Most of these lesions, particularly those in the proximal colon,have so far been under-recognized and missed during colonoscopy,qualifying these lesions to be the main cause of interval cancers.It is estimated that 10%-20%of CRCs evolve through this alternative,serrated pathway, with a distinct genetic and epigenetic profile.Aberrant DNA methylation plays a central role in the development of this CRC subtype.This characteristic molecular background is reflected in a unique pathological and clinical manifestation different from cancers arising via the traditional pathway.In this review we would like to highlight morphological,molecular and clinical features of this emerging pathway that are essential for gastroenterologists and may influence their everyday practice.

Serrated lesions:A challenging enemy

The serrated pathway accounts for 30%-35%of colorectal cancer(CRC).Unlike hyperplastic polyps,both sessile serrated lesions(SSLs)and traditional serrated adenomas are premalignant lesions,yet SSLs are considered to be the principal serrated precursor of CRCs.Serrated lesions represent a challenge in detection,classification,and removal–contributing to post-colonoscopy cancer.Therefore,it is of the utmost importance to characterize these lesions properly to ensure complete removal.A retrospective cohort study developed a diagnostic scoring system for SSLs to facilitate their detection endoscopically and subsequent removal.From the study,it can be ascertained that both indistinct border and mucus cap are essential in both recognizing and diagnosing serrated lesions.The proximal colon poses technical challenges for some endoscopists,which is why high-quality colonoscopy plays such an important role.The indistinct border of some SSLs poses another challenge due to difficult complete resection.Overall,it is imperative that gastroenterologists use the key features of mucus cap,indistinct borders,and size of at least five millimeters along with a high-quality colonoscopy and a good bowel preparation to improve the SSL detection rate.

Hepatic pseudolesions caused by alterations in intrahepatic hemodynamics

Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver.The concept of hepatic arterial buffer response(HABR)has become mainstream for the understanding of the mechanism of the reciprocal effect between hepatic arterial and portal venous flow.And HABR is thought to be significantly related to the occurrence of the abnormal imaging findings on arterial phase of contrast enhanced images,such as hepatic arterial-portal vein shunt and transient hepatic attenuation difference,which mimic hypervascular tumor and may cause clinical problems.Third inflow to the liver also cause hepatic pseudolesion,and some of the cases may show histopathologic change such as focal hyperplasia,focal fatty liver,and focal sparing of fatty liver,and called pseudotumor.To understand these phenomena might be valuable for interpreting the liver imaging findings.