Current status of radiology in China

INTRODUCTIONRadiology has been greatly advanced in China sinceits founding in 1949 and has been developed fasterand further more since China adopted the policy ofsocioeconomic reform in 1978.It plays anincreasingly important role in the medical healthcare and treatment in the country and has reachedthe world’s advanced level in certain fields.We nowbriefly review the history of China’s radiology so asto give a clear picture of its development.

Radiological diagnosis of duodenocaval fistula:A case report and literature review

Duodenocaval fistula(DCF) is an uncommon but lethal clinical entity.The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy.In this case report,we describe a patient with a series of computed tomography(CT) examinations over a 2-mo period in hospital.A low-density air bubble appeared in the inferior vena cava(IVC) on the second day in hospital and became clear on day 19,and gradually enlarged.Magnetic resonance imaging(MRI) also clearly demonstrated a high-signal enteric contrast medium or thrombus and signal-void air bubbles in the IVC.However,cavography did not show the filling defect.We suggest that noninvasive CT and MRI should be chosen as a first-line investigation,and IVC,including the surrounding structures,should be carefully reviewed on images if DCF is clinically considered.

Multi-slice spiral CT angiography in evaluating donors of living-related liver transplantation

BACKGROUND:During the past years,the number of liver transplantation has increased greatly,but the number of available organs has not increased. In view of the critical shortage of organs,the indications for living related liver transplantation(LRLT) have broadened since experience with the procedure has been achieved. This study was undertaken to assess the value of multi-slice spiral CT(MSCT) angiography in evaluating the hepatic arterial and veinous anatomy of potential donors for LRLT METHODS:MSCT was performed after intravenous injection of contrast material at 3 ml/s. The total dose was calculated as 2 ml/kg. Twenty LRLT donors(2 men and 18 women) were subjected to MSCT angiography of hepatic blood vessels. These were generated by volume rendering and maximum intensity projection,while curved planar reformation was added in 5 patients. RESULTS:We identified 10 important hepatic vascular variants in 9 of the 20 donors(4 arterial,4 venous,and 2 portal venous variants). In hepatic arterial variants two had a replaced right hepatic artery arising from the superior mesenteric artery,an accessory right hepatic artery from the superior mesenteric artery and a replaced left hepatic artery arising from the left gastric artery. In hepatic venous variants,three had an accessory inferior right hepatic vein and one had two accessory inferior right hepatic veins. In hepatic portal venous variants,two had trifurcation of the main portal vein.CONCLUSIONS:As a non-invasive and reliable method,MSCT angiography is of value in the clinical evaluation of LRLT donors. MSCT angiography should be recommended as a routine preoperative examination for potential LRLT donors.

CT and MRI diagnosis of hepatic epithelioid hemangioendothelioma

BACKGROUND:Hepatic epithelioid hemangioendothelioma (EHE)is a rare,low-grade malignant vascular tumor.Although its unusual imaging and pathologic findings are being recognized with increasing frequency,diagnosis is still difficult.This study aimed to analyze the CT and MRI features of hepatic EHE with a pathological study in order to improve the diagnostic accuracy and knowledge of this disease in daily practice. METHODS:Nine patients with hepatic EHE confirmed pathologi- cally underwent plain and dynamic contrast-enhanced multi- detector row CT examination.Of these patients,four under- went additional MRI(plain T1-weighted imaging(T1WI),T2- weighted imaging(T2WI),and dynamic contrast-enhanced scanning)and one had selective hepatic arteriography.The imaging findings were reviewed retrospectively together with the pathological results. RESULTS:A total of 79 lesions,ranging from 3.0 to 44.6 mm in maximum diameter,with an average of 16.8±7.1 mm,were found in various segments of the liver.Thirty of the 79 lesions grew adjacent to the hepatic capsule.In the 4 patients receiving MRI,39 lesions were found with low signal intensity on unenhanced T1WI and intermediate to high signal intensity on T2WI.The"capsular retraction"sign was found in all the 4 patients.Nine of the 39 lesions showed the"halo"sign after contrast enhancement on MRI.Of the 79 lesions(hypodense nodules)in the 9 patients shown by unenhanced plain CT,26 were confluent.Calcification was found in 2 patients and the "capsular retraction"sign in 7.Thirty-eight of the 79 lesions demonstrated the"halo"sign after contrast enhancement on CT,and this sign was more clearly demonstrated in the portal venous phase.In one patient,selective hepatic arteriography showed patchy stain in the peripheral liver parenchyma with small vessels around them.Histology in all patients revealed proliferation of abnormal fibrous tissue and vessel-like structures scattered with irregular epithelioid cells having a signet ring-like structure.Immunohistochemically,all patients were positive for CD34,4 were positive for CD31,and 3 were positive for factorⅧ-related antigen. CONCLUSIONS:Hepatic EHE may manifest as solitary or diffuse nodular lesions with a predilection for peripheral subcapsular growth and nodular confluence,together with the "halo"and"capsular retraction"signs.These imaging findings can help to improve the diagnostic accuracy of this rare hepatic tumor.

Primary hepatic neuroendocrine carcinoma:clinical analysis of 11 cases

BACKGROUND:Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare,and fewer than 300 cases have been reported in the English/Chinese-language literature,therefore it is difficult to make a proper diagnosis and determine a therapeutic approach.METHODS:Eleven PHNEC patients were admitted to our hospital between January 1996 and May 2008.Laboratory examination,digestive endoscopy,B-ultrasonography,CT,MRI,or PET-CT were performed on the patients for preoperative diagnosis.All patients received liver resection.Some patients received transcatheter arterial chemoembolization (TACE),percutaneous ethanol injection treatment (PEIT),or octreotide injection when a recurrence was found.The patients' clinical data were recorded and all patients were followed up.RESULTS:The patients were confirmed pathologically as having PHNEC.Their median follow-up time was 33 months (12-107 months).All patients survived,and the longest postoperative survival time was 107 months,the longest diseasefree survival time was 98 months,the 1-year survival rate was 100%,and the 1-year recurrence rate was 45.5% (5/11).CONCLUSIONS:Since PHNEC is easy to confuse with hepatocellular carcinoma,careful screening of symptoms is needed to avoid misdiagnosis.Resection is the first choice of treatment for PHNEC and provides the most favorable outcomes including long-term survival.Other treatment such as TACE and PEIT can be considered as well,especially when a tumor recurs.

Magnetic resonance imaging for local complications of acute pancreatitis: A pictorial review

Acute pancreatitis is a common disease characterized by sudden upper abdominal pain and vomiting. Alcoholism and choledocholithiasis are the most common factors for this disease. The choice of treatment for acute pancreatitis might be affected by local complications, such as local hemorrhage in or around the pancreas, and peripancreatic infection or pseudoaneurysm. Diagnostic imaging modalities for acute pancreatitis have a significant role in confirming the diagnosis of the disease, helping detect the extent of pancreatic necrosis, and for diagnosing local complications. Magnetic resonance imaging (MRI) might be indicated in acute pancreatitis for detecting and characterizing local complications of acute pancreatitis that involve necrotic, hemorrhagic, infectious, vascular, and pseudocyst disorders. The general MRI sequences for pancreatitis require the combined use of T1-weighted, T2-weighted sequences, and magnetic resonance chol-angiopancreatography. For imaging of pancreatic necrosis, the combination of T1-weighted and T2-weighted findings with dynamic contrast-enhanced imaging gives a comprehensive evaluation of the extent of necrosis and full range of inflammatory extension. For imaging of infectious complications, dynamic contrast-enhanced examinations might help differentiate pancreatic cellulitis or abscesses, from pancreatic fluid collection or simple pseudocysts. For vascular abnormalities, the combination of cross-sectional pancreatic parenchyma imaging with MRA represents a single diagnostic modality for the full evaluation of peripancreatic artery and vein involvement, such as arterial pseudoaneurysms and venous thromboses. The purpose of this pictorial review is to examine the MRI appearances of various local complications of acute pancreatitis and to discuss the practical setup of MRI in local complications of acute pancreatitis.

CT volume measurement for prognostic evaluation of unresectable hepatocellular carcinoma after TACE

AIM:To analyze the value of computed tomography(CT) volume measurements for evaluation of the survival rate of unresectable hepatocellular carcinoma(HCC) patients after transcatheter arterial chemoembolization(TACE).METHODS:One hundred and sixty-six unresectable HCC patients after TACE were involved in this retrospective study.Hepatic CT scan was performed for all patients before and 4 wk to 2 mo after TACE to def ine the morphologic features of HCC including its largest diameter,volume,product of the greatest axial dimension,tumor to liver volume ratio(TTLVR),and tumor shrinkage ratio.Clinical variables used in the study included gender,age,pattern of tumor growth,number of lesions,Child-Pugh classif ication of liver function,repeated TACE times,pre-or post-treatment α-fetoprotein(AFP) level,portal vein cancerous thrombus,tumor metastasis,degree of lipiodol retention within the tumor,and percutaneous ethanol injection.The correlation between survival time and clinical variables of patients or lesions was analyzed by combining morphologic features with the corresponding clinical and general data as input.A Cox proportional hazard model was used to analyze prognostic factors.The Kaplan-Meier method was used to calculate the cumulative survival time.In? uence of the parameters on prognosis was analyzed by the log-rank test.RESULTS:The overall 6,12,24,36 and 60 mo cumulative survival rates were 78.92%,49.85%,23.82%,15.60% and 8.92%,respectively.The median survival time was 12 mo.Univariate and multivariate analysis showed that only 4 parameters were the independent prognostic factors including TTLVR(χ2 = 14.328,P < 0.001),portal vein cancerous thrombus(χ2 = 5.643,P = 0.018),repeated TACE times(χ2 = 8.746,P = 0.003),and post-treatment serum AFP level(χ2 = 5.416,P = 0.020).When the TTLVR value was less than 70%,the survival time was inversely correlated with the TTLVR value.CONCLUSION:CT volume measurement technique can predict the prognosis of unresectable HCC patients after TACE.

64-row multidetector computed tomography portal venography of gastric variceal collateral circulation

AIM:To study characteristics of collateral circulation of gastric varices (GVs) with 64-row multidetector computer tomography portal venography (MDCTPV).METHODS:64-row MDCTPV with a slice thickness of 0.625 mm and a scanning field from 2 cm above the tracheal bifurcation to the lower edge of the kidney was performed in 86 patients with GVS diagnosed by endoscopy. The computed tomography protocol included unenhanced,arterial and portal vein phases. The MDCTPV was performed on an AW4.3 workstation. GVs were classified into three types according to Sarin's Classification. The afferent and efferent veins of each type of GV were observed.RESULTS:The afferent venous drainage originated mostly from the left gastric vein alone (LGV) (28/86,32.59%),or the LGV more than the posterior gastric vein/short gastric vein [LGV > posterior gastric vein/short gastric vein (PGV/SGV)] (22/86,25.58%),as seen by MDCTPV. The most common efferent venousdrainage was via the azygos vein to the superior vena cava (53/86,61.63%),or via the gastric/splenorenal shunt (37/86,43.02%) or inferior phrenic vein (8/86,9.30%) to the inferior vena cava. In patients with gastroesophageal varices type 1,the afferent venous drainage of GV mainly originated from the LGV or LGV > PGV/SGV (43/48,89.58%),and the efferent venous drainage was mainly via the azygos vein to the super vena cava (43/48,89.58%),as well as via the gastric/splenorenal shunt (8/48,16.67%) or inferior phrenic vein (3/48,6.25%) to the inferior vena cava. In patients with gastroesophageal varices type 2,the afferent venous drainage of the GV mostly came from the PGV/SGV more than the LGV (PGV/SGV > LGV) (8/16,50%),and the efferent venous drainage was via the azygos vein (10/16,62.50%) and gastric/splenorenal shunt (9/16,56.25%). In patients with isolated gastric varices,the main afferent venous drainage was via the PGV/SGV alone (16/22,72.73%),and the efferent venous drainage was mainly via the gastric/splenorenal shunt (20/22,90.91%),as well as the inferior phrenic vein (3/23) to the inferior vena cava. CONCLUSION:MDCTPV can clearly display the afferent and efferent veins of all types of GV,and it could provide useful reference information for the clinical management of GV bleeding.

Magnetic resonance imaging-guided percutaneous cryoablation of hepatocellular carcinoma in special regions

BACKGROUND: Local cryoablation guided by CT or ultrasound has been widely applied in the treatment of hepatocellular carcinoma. However, it is still difficult to apply this technique in certain regions such as the diaphragm dome, the first hepatic hilum, and regions adjacent to the gallbladder. This study aimed to evaluate the safety and efficacy of using magnetic resonance imaging (MRI)-guided percutaneous cryoablation as well as the effect of using an open MRI system in guiding and monitoring the treatment of hepatocellular carcinoma in these regions. METHODS: Cryoablation, guided by an open 0.35T MRI scanner and with the assistance of an MRI-compatible optical navigation system, was performed on 32 patients with hepatocellular carcinoma at the diaphragm dome, the first hepatic hilum, and regions adjacent to the gallbladder. Each patient had one or two tumors. The total number of tumors treated was 36. The tumor diameters ranged from 2.5 to 10.0 cm (mean 4.7±1.8 cm). The cryosurgical system was MRI-compatible and equipped with cryoprobes 1.47 mm in outside diameter. Under the guidance of MRI in combination with the optical navigation system, the cryoprobes were introduced percutaneously into a tumor at the planned targeting points while critical organs or tissues were avoided. Each cryoablation procedure included two freezing-thawing cycles, and MRI images were acquired dynamically to monitor the ablation of the tumor from time to time during the operation. In order to investigate the therapeutic effects of a cryoablation procedure, AFP measurements and liver- enhanced MRI or CT-enhanced scans were performed at regular times.RESULTS: MRI and optical navigation system-guided cryoablation procedures were successfully performed on all 32 patients (36 tumor sites) and no serious complications occurred. The follow-up period ranged from 5 to 12 months. The 6- and 12-month overall survival rates were 96.8% and 90.6%, respectively. According to the diagnosis of liver- enhanced MRI scans, 10 patients (31.3%) had complete ablation, 18 (56.3%) partial ablation (>80%), 3 (9.4%) stable disease (>50% ablation), and 1 (3.1%) progressive disease (a new tumor site in the liver). The overall efficacy was 87.5%. CONCLUSIONS: MR-guided percutaneous cryoablation using optical navigation is a safe and effective minimally invasive procedure for the treatment of hepatocellular carcinoma at certain special regions, which is difficult to treat with other imaging guidance approaches. With its unique and superb imaging functions, MRI plays an important role in the display, guidance, and monitoring of the cryoablation procedure in treating hepatocellular carcinoma at these special regions. Equipped with an MRI-compatible optical navigation system, MRI-guided therapy makes the cryoablation procedure more precise and safe.

New progress in CT and MRI examination and diagnosis of small intestinal tumors

Precise examination and diagnosis of small intestinal tumors is difficult because of the curved course and overlapping canal of the small intestine. Traditional technology for intestinal canal examination and endoscopy cannot exhibit the intestinal wall and extra-luminal structure well. With the development and advancement of multi-slice spiral computed tomography and magnetic resonance imaging (MRI), computed tomography enteroclysis (CTE) and magnetic resonance enteroclysis (MRE) are widely used in the examination and diagnosis of small intestinal tumors. CTE and MRE, with three-dimensional imaging capabilities and excellent soft-tissue contrast, can analyze the abnormalities of peripheral intestinal structure as well as the tunica mucosa. In addition, these two technologies can clearly reveal the localization, appearance, degree of mesenteric infiltration and remote tumor metastasis, which increases our cognition of the imaging diagnosis for intestinal tumors. Here we review recent progress in imaging (CT and MRI) examination and diagnosis of small intestinal tumors.

Three-dimensional dynamic contrast-enhanced MR angiography for evaluating recipient vessels in orthotopic liver transplantation

BACKGROUND:With the improvement of MR technology, three-dimensional dynamic contrast-enhanced MR angiography(3D-DCE-MRA)may be the optimal vascular imaging method for preoperative evaluation of liver transplantation candidates.This study was undertaken to determine the value of 3D-DCE-MRA in the assessment of recipient vessels in orthotopic liver transplantation(OLT). METHODS:The surgical and pathological records were taken as the"gold standards".Eighteen cases of OLT were retrospectively analyzed to assess the image quality of MRA,including the signal-to-noise ratio(SNR)in arteries and veins,depiction of vascular variation and vessel disease, and the accuracy of vascular diameter measurement. RESULTS:3D-DCE-MRA of 34 cases was carried out before OLT.The rates(excellent and good)showing hepatic arteries and portal vein for 3D-DCE-MRA were 94.1%(32/34)and 88.2%(30/34),respectively.The SNRs of the celiac axis and portal vein measurements from 3D-DCE-MRA were 20.58±3.74 and 13.43±4.12, and the mean diameters were 3.4±0.3 mm and 13.1±3.2 mm,respectively.There were 5 cases of vessel variation according to the Michel's classification.Of the 34 patients, 18 were compared radiologically and pathologically.The accuracy of depiction of the hepatic artery and portal vein with 3D-DCE-MRA was 100%for both;3D-DCE-MRA precisely assessed 4 cases of more than moderate stenosis in hepatic arteries,2 cases of small-caliber hepatic artery 3 cases of venous stenosis at the second porta hepatis, 6 cases of collateral vasculature,1 case of portal vein thrombosis and 1 case of portal vein aneurysm;all were confirmed pathologically.CONCLUSION:3D-DCE-MRA may be the first choice for recipient vascular assessment before OLT.

DSA analysis of hepatic arteriovenous fistula concurrent with hepatic cancer and its clinical significance

INTRODUCTIONIntervention therapy has become one of the maintherapies of hepatic cancer.Theintroduction of hepatic arterial perfusion andembolization has provided opportunities for asecondary operation on patients with intermediateand advanced cancer,thus

Diagnostic value of the fluoroscopic triggering 3D LAVA technique for primary liver cancer

BACKGROUND:Primary liver cancer(PLC)is one of the common malignant tumors.Liver acquisition with acceleration volume acquisition(LAVA),which allows simultaneous dynamic enhancement of the hepatic parenchyma and vascu- lature imaging,is of great help in the diagnosis of PLC.This study aimed to evaluate application of the fluoroscopic triggering 3D LAVA technique in the imaging of PLC and liver vasculature. METHODS:The clinical data and imaging findings of 38 adults with PLC(22 men and 16 women;average age 52 years),pathologically confirmed by surgical resection or biopsy,were collected and analyzed.All magnetic resonance images were obtained with a 1.5-T system(General Electrics Medical Systems) with an eight-element body array coil and application of the fluoroscopic triggering 3D LAVA technique.Overall image quality was assessed on a 5-point scale by two experienced radiologists. All the nodules and blood vessel were recorded and compared. The diagnostic accuracy and feasibility of LAVA were evaluated. RESULTS:Thirty-eight patients gave high quality images of 72 nodules in the liver for diagnosis.The accuracy of LAVA was 97.2%(70/72),and the coincidence rate between the extent of tumor judged by dynamic enhancement and pathological examination was 87.5%(63/72).Displayed by the maximum intensity projection reconstruction,nearly all cases gave satisfactory images of branchesⅢandⅣof the hepatic artery. Furthermore,small early-stage enhancing hepatic lesions and the parallel portal vein were also well displayed. CONCLUSIONS:Sequence of LAVA provides good multi-phase dynamic enhancement scanning of hepatic lesions.Combined with conventional scanning technology,LAVA effectively and safely displays focal hepatic lesions and the relationship between tumor and normal tissues,especially blood vessels.

Detection and characterization of hepatocellular carcinoma in rats with liver cirrhosis:diagnostic value of combined use of MR positive and negative contrast agents

BACKGROUND:Gadolinium-enhanced multi-phase dynamic imaging has improved the accuracy of the diagnosis of hypervascular hepatocellular carcinoma (HCC),but using gadolinium-enhanced dynamic imaging alone is problematic in evaluating hypovascular HCC.This work aimed at evaluating the combined use of superparamagnetic iron oxide(SPIO)-enhanced and gadolinium set in distinguishing HCCs from regenerative nodules(RNs)in a rat model induced by diethylnitrosamine(DEN). METHODS:DEN-induced HCC model rats(n=40)and control rats(n=10)were studied.From weeks 16 to 19 after DEN administration,4 animals were scanned every week. The hepatic changes were tested with a 1.5 Tesla magnet, and MR images of SPIO-enhanced and gadolinium set were obtained.According to the pathologic changes,the tumorigenesis was divided into HCC and RN(diameter of nodules≥3 mm).Diagnostic accuracy of the combined SPIO-enhanced and gadolinium set and the gadolinium set alone was evaluated using receiver-operating characteristic curves.Sensitivity and specificity of the combined SPIO- enhanced and gadolinium set and the gadolinium set alone were calculated.RESULTS:The listed tests were completed in 29 rats(21 treated and 8 controls).One hundred and six nodules(82 HCCs,24 RNs)were analyzed.The Az value and sensitivity with the combined SPIO-enhanced and gadolinium set(Az 0.94,sensitivity 0.96)were higher than those with the gadolinium set alone(Az 0.92,sensitivity 0.89). Using the combined SPIO-enhanced and gadolinium set led to detection of 6 nodules which were negative in the gadolinium set alone and 3 nodules were correctly characterized. CONCLUSION:Using the combined SPIO-enhanced and gadolinium set improved the detectability of HCCs and the SPIO-enhanced imaging compensated for the gadolinium set in differentiating HCCs from RNs in a rat model.

Clinicopathological features and prognosis assessment of extranodal follicular dendritic cell sarcoma

AIM: To establish a model for prognosis assessment of extranodal follicular dendritic cell (FDC) sarcoma.METHODS: Nine lesions were examined by routine and molecular approaches.Clinicopathological factors from the new cases and 97 reported cases were analyzed for their prognostic values.RESULTS: The current lesions were found in f ive male and four female patients,located mainly in the head and neck area and averaging 7.2 cm in size.Six patients had recurrence or metastasis and three remained free of disease.The 106 patients (male/female ratio,1.1:1) were aged from 9 to 82 years (median,44 years).The tumor sizes ranged from 1.5 to 21 cm (mean,7.4 cm).Abdominal/pelvic region was affected most frequently (43%).Surgical resection was performed in 100 patients,followed by radiation and/or chemotherapy in 35 of them.Follow-up data were available in 91 cases,covering a period of 3-324 mo (mean,27 mo;median,19 mo).Of the informative cases,38 (42%) had recurrence or metastasis,and 12 (13%) died of the disease.These tumors were classif ied histologically into lowand high-grade lesions.A size ≥ 5 cm (P = 0.003),highgrade histology (P = 0.046) and a mitotic count ≥ 5/10 HPF (P = 0.013) were associated with tumor recurrence.The lesions were def ined as low-,intermediateand high-risk tumors,and their recurrence rates were 16%,46% and 73%,and their mortality rates 0%,4% and 45%,respectively.CONCLUSION: Extranodal FDC tumors behave like soft tissue sarcomas.Their clinical outcomes are variable and can be evaluated according to their sizes and grades.

Small intestinal lipomas:Diagnostic value of multi-slice CT enterography

AIM:To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography(CT) enterography.METHODS:Fourteen cases(one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed.The location,size,clinical and radiological aspects were discussed.RESULTS:Twelve patients presented with abdominal pain,of whom three complained of paroxysmal colic.Melena or bloody stools was mentioned in five cases.One lesion was detected incidentally during routine physical examination.One lesion was found unexpectedly during the preoperational evaluation for cholecystitis.Examination of the abdomen revealed palpable masses in four cases.Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from-130 HU to-60 HU.On contrast enhancement CT scan,no striking enhancement was seen.CONCLUSION:The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations,while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.

Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma

Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC). The authors present a case of CLE that occurred after the second hepatic arterial chemoembolization for HCC, and attempt to introduce several plausible mechanisms of CLE, after reporting the clinical and radiological findings and reviewing the medical literature.

A case of occult insulinoma localized by pancreatic dynamic enhanced spiral CT

Insulinomas are the most common category of pancreatic endocrine tumors,with an annual incidence of 1-4 cases per million people.Most are intrapancreatic,benign and solitary.Therefore,they have an excellent prognosis after surgical resection.However,the localization diagnosis of insulinomas still poses a challenge to surgeons and radiologists.In this case,the tumor was occult and could not be found by either abdominal enhanced spiral computed tomography(CT)or ultrasonography.Therefore,we tried a new method of CT scanning and localized the tumor.

Hepatic adenylate energy charge levels in patients with hepatoma after hepatic artery embolization

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