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Guo BL, Hu QG, Ouyang FS, Zhang B, Dong YH, Luo XN, Lian ZY, Zhang SX. CT and MRI findings in focal eosinophilic infiltration of the liver. Abdom Radiol (NY) 2017. [PMID: 28634618 DOI: 10.1007/s00261-017-1230-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the findings of computed tomography (CT) and magnetic resonance imaging (MRI) of focal eosinophilic infiltration (FEI) of the liver. METHODS A retrospective study including 29 patients with confirmed FEI of the liver was performed. We evaluated the lesions' number, distribution, size, shape, margin, attenuation or signal intensity characteristics, the enhancement pattern, and some special features. Spearman correlation analysis was used to analyze the correlation between the number of lesions and the eosinophil counts in peripheral blood. RESULTS In all, 108 lesions were detected in 29 cases, including two cases with single lesion and the remaining 27 cases with multiple lesions. The mean size of all lesions was 34 mm (range, from 3 to 61 mm). 95 (88%) lesions were located in subcapsular parenchyma or surrounding the portal vein. Most (66%) subcapsular lesions were wedge shaped and all lesions surrounding portal vein were round shaped. However, the hepatic parenchymal lesions were irregular or round shaped. All lesions showed ill-defined margins. On pre-contrast CT images, the lesions showed slightly low attenuation or iso-attenuating. On T1-weighted and T2-weighted images, the lesions were slightly iso-/hypointense and hyperintense, respectively. A total of 23 (79.3%) cases were gradually enhanced. Branches of portal vein went through the lesions in all cases; 12 had 'stripe sign' and 16 had 'halo ring sign.' Spearman analysis indicated a significant correlation between the number of lesions and the increased eosinophils in peripheral blood (r = 0.627, p = 0.0003). CONCLUSIONS Special CT and MRI features and increased eosinophils may strongly suggest the diagnosis of FEI of the liver.
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Affiliation(s)
- Bao-Liang Guo
- Department of Radiology, The First People's Hospital of Shunde, Foshan, Guangdong, People's Republic of China
| | - Qiu-Gen Hu
- Department of Radiology, The First People's Hospital of Shunde, Foshan, Guangdong, People's Republic of China
| | - Fu-Sheng Ouyang
- Department of Radiology, The First People's Hospital of Shunde, Foshan, Guangdong, People's Republic of China
| | - Bin Zhang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, People's Republic of China
| | - Yu-Hao Dong
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xiao-Ning Luo
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Zhou-Yang Lian
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
| | - Shui-Xing Zhang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China.
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, People's Republic of China.
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Focal eosinophilic necrosis on superparamagnetic iron oxide-enhanced MRI. AJR Am J Roentgenol 2010; 194:1296-302. [PMID: 20410417 DOI: 10.2214/ajr.09.3208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the usefulness of superparamagnetic iron oxide (SPIO)-enhanced MRI for distinguishing focal eosinophilic necrosis (FEN) from hepatic metastasis. MATERIALS AND METHODS Forty-one cases of FEN in 41 patients and 40 hepatic metastases in 40 patients were analyzed on unenhanced and SPIO-enhanced T2-weighted MRI retrospectively. Depending on the extent of the remaining hyperintense area on SPIO-enhanced T2-weighted images compared with the unenhanced images, the lesions were classified into four categories--category 1, less than 25%; category 2, 25-49%; category 3, 50-75%; and category 4, more than 75%--by two independent readers. Contrast-to-noise ratio (CNR) was measured using the same region of interest on unenhanced and SPIO-enhanced T2-weighted images. In three pathologic specimens of FEN, the number of Kupffer cells was compared with that of background hepatic parenchyma. RESULTS All metastases were classified as category 4, whereas FEN showed various distributions overall (category 1, 45.2%; category 2, 24.6%; category 3, 13.4%; category 4, 17.1%). FEN showed a decrease in CNR (from 7.9 +/- 5.8 to 6.1 +/- 5.6, p < 0.05), and metastases showed an increase in CNR (from 33.7 +/- 27.0 to 55.0 +/- 44.3, p < 0.05) after SPIO administration. In biopsy specimens, FEN had many more Kupffer cells (174.7 +/- 120.3 cells/high-power field [hpf]) than background hepatic parenchyma (23.7 +/- 9.8 cells/hpf). When using signal loss categories 1, 2, or 3 or CNR decrease, the accuracy of SPIO enhancement was 88.3%. CONCLUSION Unlike hepatic metastases, most of the cases of FEN showed a reduction in the extent of hyperintense area or a decrease in CNR after SPIO administration on the T2-weighted images. Therefore, SPIO-enhanced T2-weighted MRI can help to differentially diagnose FEN from metastases.
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Differentiating Focal Eosinophilic Necrosis of the Liver From Hepatic Metastases Using Unenhanced and Portal Venous Phase Computed Tomographic Imagings. J Comput Assist Tomogr 2009; 33:705-9. [DOI: 10.1097/rct.0b013e3181949b3b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chang S, Lim JH, Choi D, Park CK, Kwon NH, Cho SY, Choi DC. Hepatic Visceral Larva Migrans ofToxocara canis: CT and Sonographic Findings. AJR Am J Roentgenol 2006; 187:W622-9. [PMID: 17114516 DOI: 10.2214/ajr.05.1416] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to describe the CT and sonographic findings of hepatic visceral larva migrans of Toxocara canis. MATERIALS AND METHODS Fifty-four patients (44 men, 10 women; age range, 30-80 years; mean age, 53 years) with serologically confirmed visceral larva migrans of Toxocara canis underwent evaluation of the liver with CT (n = 25), sonography (n = 48), or both. Two radiologists used consensus for retrospective evaluation of CT and sonographic findings. Correlation between the presence and severity of hepatic abnormalities on images and the degree of peripheral eosinophilia was assessed. RESULTS Seventeen (68%) of 25 patients who underwent CT had single or multiple ill-defined, oval or elongated, small, low-attenuating lesions in the liver. Eighteen (38%) of 48 patients who underwent sonography had single or multiple small, poorly defined, oval or elongated, hypoechoic scattered focal lesions in the liver. In the 19 patients who underwent both CT and sonography, the two techniques had no significant difference in rate of detection of hepatic lesions (p = 0.375, McNemar test). The lesion numbers on CT and sonography showed excellent linear correlation (r = 0.844, p = 0.001) by Pearson's correlation test. An independent samples t test showed that eosinophil count and percentage in the peripheral blood were significantly higher in patients with hepatic lesions on CT and sonography than in patients without lesions. CONCLUSION CT and sonographic findings of hepatic visceral larva migrans of T. canis are multiple, ill-defined, oval or elongated, small, nodular lesions scattered in the liver parenchyma. The presence of hepatic lesions on images was associated with higher peripheral eosinophil count and percentage.
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Affiliation(s)
- Samuel Chang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, South Korea 135-230
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Abstract
OBJECTIVE To compare the findings of magnetic resonance (MR) imaging with those of computed tomography (CT) of focal liver lesions related to peripheral eosinophilia. METHODS For 12 patients with peripheral eosinophilia (>7%) examined with hepatic MR imaging and CT, 52 focal hepatic lesions larger than 0.5 cm, including 31 lesions simultaneously found on the 2 imaging modalities, were subjected to a comparative analysis of their imaging features. RESULTS The total number of lesions distinguished from background liver was 39 (75%) on MR imaging and 44 (85%) on CT scans. On arterial phase images of 10 patients with comparable data, homogeneously hyperintense lesions were demonstrated more frequently (P = 0.006) on MR imaging (16 [50%] of 32 lesions) than on CT scans (4 [13%] of 32 lesions). Only 7 (22%) of the 32 hypoattenuating lesions on portal phase CT were depicted as hypointense lesions on portal phase MR images in 12 patients. On delayed phase images in 8 patients, the number of hyperintense lesions on MR images (9 [56%] of 16) was greater (P = 0.077) than that seen on the CT scans (4 [25%] of 16). CONCLUSIONS For many focal hepatic lesions related to peripheral eosinophilia, dynamic MR imaging more easily demonstrates lesional enhancement on arterial and delayed phases than CT scans. Because of the higher degree of lesional enhancement of MR imaging compared with CT, the lesion-to-liver contrast may not be sufficient to distinguish the lesion from the background liver, resulting in decreased sensitivity of portal phase dynamic MR imaging.
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Affiliation(s)
- Jeong-Sik Yu
- Department of Diagnostic Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, Seoul, South Korea.
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Hur J, Park MS, Yu JS, Lim JS, Hong SW, Kim KW. Focal Eosinophilic Necrosis Versus Metastasis in the Liver: The Usefulness of Two-Phase Dynamic CT. AJR Am J Roentgenol 2005; 184:1085-90. [PMID: 15788577 DOI: 10.2214/ajr.184.4.01841085] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the usefulness of dual-phase dynamic CT in the differentiation of focal eosinophilic necrosis of the liver and metastasis. CONCLUSION Undetected isoattenuating lesions on arterial phase images that have an indistinct margin, a nonspherical shape, and a homogenous enhancement pattern on portal venous phase images suggest focal eosinophilic necrosis rather than metastasis. Two-phase dynamic CT was found to be useful at differentiating focal eosinophilic necrosis from metastasis.
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Affiliation(s)
- Jin Hur
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine and YongDong Severance Hospital, 146-92, Dogok-Dong, Kangnam-Ku, Seoul 135-270, South Korea
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Sun JS, Kim JK, Won JH, Lee KM, Cheong JY, Kim YB. MR Findings in Eosinophilic Infiltration of the Liver. J Comput Assist Tomogr 2005; 29:191-4. [PMID: 15772535 DOI: 10.1097/01.rct.0000159106.93063.6b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study describes the findings of magnetic resonance imaging (MRI) of focal eosinophilic infiltration of the liver. METHODS Contrast-enhanced MR images of 8 patients with focal hepatic eosinophilic infiltration were reviewed retrospectively. We evaluated the signal intensity of focal lesions in T1-weighted and T2-weighted images and the pattern of enhancement in a dynamic contrast study. RESULTS A total 22 focal hepatic lesions were observed; the lesions were isointense (55%) or hypointense (45%) on T1-weighted images and isointense (14%) or hyperintense (86%) on T2-weighted images. The arterial phase of the contrast study revealed 11 hyperintense lesions (50%). During the portal and delayed phases, 18 (82%) and 17 lesions (77%) were hyperintense, respectively. CONCLUSION The focal eosinophilic infiltrations showed homogeneous enhancement in the portal and delayed phases in the dynamic contrast MR study. These findings should help to distinguish focal eosinophilic infiltration, especially from metastasis in patients with malignancy.
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Affiliation(s)
- Joo Sung Sun
- Department of Diagnostic Radiology, Ajou University, College of Medicine, Kyunggido, Korea
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Jang HJ, Lee WJ, Lee SJ, Kim SH, Lim HK, Lim JH. Focal eosinophilic necrosis of the liver in patients with underlying gastric or colorectal cancer: CT differentiation from metastasis. Korean J Radiol 2002; 3:240-4. [PMID: 12514341 PMCID: PMC2713846 DOI: 10.3348/kjr.2002.3.4.240] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the helical CT findings which help differentiate between focal eosinophilic necrosis (FEN) of the liver and metastasis in patients with underlying gastric or colorectal cancer. MATERIALS AND METHODS In 21 patients with underlying gastric and colorectal cancer examined during a recent 18-month period, the presence of FEN (n=90) was proven at CT. The diagnosis was verified by biopsy in eight patients and by the transient nature of the findings related to peripheral eosinophilia (>10%) in the remainder. For comparison, 20 consecutive patients with pathologically proven hepatic metastasis from gastric or colorectal cancer (n=158) were selected. Single-phase helical CT images (7-mm collimation, pitch 1:1) were independently analyzed in a random order by two blinded readers. The parameters evaluated included the margin (depicted border, fuzzy), shape (spherical, non-spherical), attenuation (subtle hypoattenuation, hypoattenuation), and the presence or absence of rim enhancement. RESULTS FEN far more frequently showed a fuzzy margin (81%, 84%), subtle hypoattenuation (89%, 91%), and a non-spherical shape (84% for both readers) than metastasis, for which the respective findings were 6%, 22%; 20%, 39%; and 15%, 23%. Rim enhancement was seldom found in FEN (0%, 2%), but was recognized by both readers in 40% of metastases. For all parameters, the results were statistically significant (p < .01), and showed that both readers correctly differentiated FEN from metastasis in 78% of the patients (32/41). Interobserver agreement was, in addition, excellent (kappa = 0.66). CONCLUSION When focal hepatic lesions with a fuzzy margin, non-spherical shape and subtle hypoattenuation without rim enhancement are found, the possibility of FEN should be considered even in patients with underlying gastrointestinal malignancy.
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Affiliation(s)
- Hyun-Jung Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
- Department of Radiology, Center for Liver Cancer, National Cancer Center, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Soon Jin Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Seung Hoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Hyo K. Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jae Hoon Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Lim JH, Lee WJ, Lee DH, Nam KJ. Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement. Korean J Radiol 2000; 1:98-103. [PMID: 11752937 PMCID: PMC2718171 DOI: 10.3348/kjr.2000.1.2.98] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. MATERIALS AND METHODS Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. RESULTS CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. CONCLUSION Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.
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Affiliation(s)
- J H Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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