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Kyung Jeon S, Young Lee J, Kang HJ, Koo Han J. Additional value of superb microvascular imaging of ultrasound examinations to evaluate focal liver lesions. Eur J Radiol 2022; 152:110332. [DOI: 10.1016/j.ejrad.2022.110332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/17/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
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Jeon SK, Lee JY, Han JK. Superb microvascular imaging technology of ultrasound examinations for the evaluation of tumor vascularity in hepatic hemangiomas. Ultrasonography 2021; 40:538-545. [PMID: 33866773 PMCID: PMC8446495 DOI: 10.14366/usg.20177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose This study aimed to investigate and categorize the diverse features of hepatic hemangiomas on superb microvascular imaging (SMI) in a relatively large prospective study. Methods In this prospective study, 70 patients with 92 hepatic hemangiomas were consecutively enrolled. All nodules were radiologically confirmed with the typical imaging features of hepatic hemangiomas on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). Using SMI, all lesions were evaluated and categorized into subgroups according to the flow pattern on SMI. Differences in the frequencies of SMI patterns according to lesion size and enhancement patterns on dynamic CT or MRI were also compared. Results In 67.4% (62/92) of hemangiomas, tumor vascularity was detected using SMI, while 32.6% (30/92) did not show any signal on the SMI examination, and the absence of an SMI signal was not shown in rapidly enhancing hemangiomas (0% [0/30] vs. 100% [30/30], P=0.002) and was more frequent in lesions <2 cm than in lesions ≥2 cm (44.0% [22/50] vs. 2.7% [8/42], P=0.011). In hepatic hemangiomas in which vascularity was detected (n=62), the strip rim pattern was the most common SMI pattern of hepatic hemangiomas (48.4%, 30/62), followed by the nodular rim pattern involving spotty dot-like engorged vessels (37.1%, 23/62). Conclusion The evaluation of the inner vascularity of hepatic hemangiomas with SMI was feasible for most hemangiomas, especially in larger (≥2 cm) or rapidly enhancing hemangiomas. The most frequent SMI patterns of hepatic hemangiomas were the strip rim pattern and nodular rim pattern.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Bondestam S, Somer K, Hekali P, Takkunen H. Sonography and computed tomography in hepatic haemangioma. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 668:68-75. [PMID: 6963095 DOI: 10.1111/j.0954-6820.1982.tb08524.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Seven patients suffering from hepatic haemangioma were investigated by sonography and computed whole-body tomography (CT). In addition, percutaneous fine-needle biopsy was performed in 3 cases. All the patients had typical angiographic features of hepatic haemangioma. Histological confirmation was obtained in five cases. Sonography showed lesions of sonodense and mixed predominant sonolucent features. CT showed typical peripheral post-contrast enhancement. Fine needle biopsy was successful and diagnostic in two cases. No complications occurred with the procedure. Sonography overlooked one tiny lesion, and CT two. It seems that sonographic appearances are not reliable in the diagnosis of hepatic haemangioma, though CT may be diagnostic. In doubtful situations other diagnostic procedures, such as angiography and/or fine-needle biopsy, may be necessary.
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Abstract
OBJECTIVE The purpose of this study was to review the imaging features of sclerosed hemangioma. CONCLUSION In our series, suggestive features of sclerosed hemangiomas include geographic outline, capsular retraction, decrease in size over time, and loss of previously seen regions of enhancement. Additional features include presence of transient hepatic attenuation difference (THAD), rim enhancement, and nodular regions of intense enhancement as seen in typical hemangiomas. Although not pathognomonic, some features of sclerosed hemangioma can suggest it as a diagnostic possibility and lead to biopsy rather than more extensive intervention.
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Affiliation(s)
- Deirdre J Doyle
- Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 610 University Ave., Toronto, Ontario, M5G 2M9, Canada.
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Urhahn R, Kilbinger M, Drobnitzky M, Mans-Peine G, Neuerburg J, Günther RW. Dynamic Gd-enhanced MR imaging of hepatic hemangioma: is high temporal resolution requisite for characterization? Magn Reson Imaging 1996; 14:31-41. [PMID: 8656988 DOI: 10.1016/0730-725x(95)02042-r] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We assessed the value of high temporal resolution in the dynamic characterization of hepatic hemangioma with use of magnetization-prepared gradient-echo (MP-GRE) imaging. Single-level inversion recovery incremental flip angle MP-GRE images were obtained in 26 patients with 34 hemangiomas before and at a repetition rate of 30 images/min after injection of Gd-DTPA without breath-holding. Enhancement patterns and temporal changes thereof were analyzed. Hemangiomas were categorized as small ( < 2.0 cm), medium (2.0-5.0 cm), and large ( > 5 cm) lesions. Classic early peripheral nodular enhancement (PNE) with progressive hyperintense fill-in was observed in 31 lesions (91%). Two of 10 small and 1 of 20 medium lesions showed complete fill-in within 10 s, and three small and one medium lesions within 45 s after the onset of PNE. In no cases of hemangioma was immediate homogenous hyperintensity observed without preceding PNE. In conclusion, temporal resolution of less than 10 s is a prerequisite for confident dynamic characterization of some hemangiomas, predominantly small hemangiomas.
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Affiliation(s)
- R Urhahn
- Department of Diagnostic Radiology, University of Technology (RWTH) Aachen, Germany
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Honig SC, Klavans MS, Hyde C, Siroky MB. Adrenal hemangioma: an unusual adrenal mass delineated with magnetic resonance imaging. J Urol 1991; 146:400-2. [PMID: 1856940 DOI: 10.1016/s0022-5347(17)37805-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Adrenal hemangioma should be included in the differential diagnosis of any large calcified adrenal mass. We report to our knowledge the eighth surgically removed lesion and describe its appearance on magnetic resonance imaging. This imaging includes features seen in hemangiomas elsewhere, in particular a heterogeneous mass with enhancing peripheral high intensity foci on T1 images.
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Affiliation(s)
- S C Honig
- Department of Urology, Veterans Affairs Medical Center, Boston, Massachusetts
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Hassler W, Zentner J, Petersen D. Cavernous angioma of the optic nerve. Case report. SURGICAL NEUROLOGY 1989; 31:444-7. [PMID: 2718085 DOI: 10.1016/0090-3019(89)90089-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The case of a 24-year-old woman with a cavernoma of the right optic nerve is presented. She suffered recurrent headaches and showed a deficit of the right nasal visual field. A computed tomography scan, a computed tomography cisternography, and magnetic resonance imaging revealed a lesion in projection on the right suprasellar cistern, yet angiography was inconspicuous. On operation, an angiomatous tumor of the right optic nerve with a surrounding hemorrhage was found. Histological examination of the specimen confirmed the intraoperative diagnosis of a cavernoma. Postoperatively, the right nasal visual field deficit increased slightly.
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Affiliation(s)
- W Hassler
- Department of Neurosurgery, University of Tübingen Medical School, Federal Republic of Germany
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Abstract
Cavernous hemangioma of the liver was diagnosed in 12 of 60 patients (20 percent) evaluated for surgery of neoplastic liver disease. All were female, from 29 to 77 years old. Six patients presented with abdominal pain and seven had taken estrogens. Indications for surgery included uncertain diagnosis, symptoms, large lesion greater than or equal to 6 cm, and hypoproliferative anemia. Three right lobectomies, one left lateral segmentectomy, one open biopsy, and one right trisegmentectomy were performed. There were no deaths, one subphrenic abscess, and one bile leak. The remaining seven patients were observed and at 2 to 6 years post operatively had followed a benign course. Resectional therapy may be considered for superficial large or symptomatic lesions in the appropriate patient, but most hepatic hemangiomas follow a benign course.
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Affiliation(s)
- M N Sinanan
- Department of Surgery, University of Washington, Seattle 98195
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Peveretos P, Panoussopoulos D. Giant cavernous hepatic hemangioma: treatment by ligation of the hepatic artery. J Surg Oncol 1986; 31:48-51. [PMID: 3945077 DOI: 10.1002/jso.2930310111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We present a case of a giant hepatic hemangioma. We found it at laparotomy and we decided on the course of treatment on the operating table. As right lobectomy was not feasible, we performed ligation of the hepatic artery. The patient made an uneventful recovery. A selective hepatic angiography and a liver scan were performed 8 months postoperatively and they both showed regression of the tumor. The tumor was not demonstrable in the right hepatic artery. The patient is in excellent health 2 years after the operation; the liver is smaller in palpation and the tumor itself is nonpalpable. In this case the ligation of the hepatic artery was a successful therapeutic procedure.
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Takagi H. Diagnosis and management of cavernous hemangioma of the liver. SEMINARS IN SURGICAL ONCOLOGY 1985; 1:12-22. [PMID: 3887538 DOI: 10.1002/ssu.2980010104] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cavernous hemangiomas are the most common benign tumors of the liver, which are now seen more often thanks to common use of newer imaging techniques. A review of the literature on cavernous hemangiomas of the liver, including our own experience with 14 cases, provides data as a touchstone for discussion of the incidence, etiology, symptoms, pathology, diagnosis including ultrasound, radionuclide imaging, computed tomography and angiography, management including resection, hepatic artery ligation, radiation and corticosteroid, and the natural history of these lesions. The author concludes that surgical resection of cavernous hemangiomas should be undertaken with due concern for the relation between the severity of symptoms and the operative risks involved.
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Abstract
During a 5 year period, we treated 5 patients with giant hemangioma of the liver. There were 4 women and 1 man who ranged in age from 34 to 51 years with an average age of 43.8 years. The symptoms were an abdominal mass with Kasabach-Merritt syndrome in 2 patients, an uncomfortable sensation in the upper abdomen in two patients, and pain in the right upper quadrant in one patient. All five patients underwent surgical treatment with a successful outcome. Three of the patients underwent hepatic lobectomy, one patient underwent left lateral segmentectomy with ligation of the right hepatic artery, and one patient had ligation of the left hepatic artery with radiation. In two of the patients, Kasabach-Merritt syndrome was cured promptly after hepatic lobectomy. We believe that a symptomatic giant hemangioma within one lobe should be treated by hepatectomy, but if it involves both lobes, ligation of the hepatic artery, with or without radiation, should be considered.
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Abstract
Red blood cells labeled with 99mTc constitute a suitable intravascular agent for imaging of vascular abnormalities. Hemangiomas are characterized by low perfusion and a high blood pool. This "perfusion blood-pool mismatch," not encountered in other lesions, may help in the specific diagnosis of this tumor. This is particularly so in cavernous hemangiomas of the liver where three-phase 99mTc-labeled red blood cell scintigraphy should precede liver biopsy. Red cell scintigraphy also is useful for establishing the vascular nature of hemangiomas of the head and neck and the skin and for diagnosis of venous occlusion. Heat-damaged red blood cells provide a specific spleen imaging agent. This should be used when patients with suspected splenic pathology have equivocal colloid scintigraphy.
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Onodera H, Ohta K, Oikawa M, Abe M, Kanno T, Yoda B, Goto Y. Correlation of the real-time ultrasonographic appearance of hepatic hemangiomas with angiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 1983; 11:421-425. [PMID: 6315776 DOI: 10.1002/jcu.1870110803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The ultrasonographic appearance of hepatic hemangiomas was studied in 19 patients (31 lesions). The detectability rate by real-time ultrasonography was 77%. A hyperechoic, sharply-marginated and internally homogeneous lesion is highly suggestive of hemangioma. If the hypoechoic lesion has homogeneous internal echoes and/or strong marginal echoes, it is also suggestive of hemangioma. It is difficult to detect small lesions in the lower lateral part of the right lobe and lesions in the right lobe immediately under the diaphragm. Computed tomography should be the next procedure of choice in the evaluation process. If the computed tomography is not characteristic, angiography should be done to confirm the diagnosis.
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Abstract
The diagnosis of hepatic metastases heralds a grave prognosis in breast cancer patients. The authors describe seven patients with breast cancer who were found to have hepatic defects that were suspected to present metastatic disease on initial screening and investigations. However, these patients were subsequently shown to have benign hepatic lesions after careful history-taking and supplementary diagnostic techniques, in most cases with the aid of hepatic angiographic examinations. The authors believe that thorough investigation is indicated to elucidate the nature of hepatic defects, especially in cancer patients with no other site of metastatic involvement.
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Yamamoto K, Itoshima T, Ito T, Ukida M, Ogawa H, Kitadai M, Hattori S, Mizutani S, Nagashima H. Scanning electron microscopy of a liver cavernous hemangioma. GASTROENTEROLOGIA JAPONICA 1983; 18:15-20. [PMID: 6832546 DOI: 10.1007/bf02774855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A 39-year-old female with a large cavernous hemangioma of the liver was successfully treated by ligation of the left hepatic artery. A wedge biopsy specimen of the hemangioma was obtained after the ligation and was examined by scanning electron microscopy. The hemangioma was demarcated from the surrounding normal liver parenchyma and had a labyrinth of caves 50-150 microns in diameter. The caves were separated by fibrous septa 20-40 microns in width. Endothelial cells of the caves were spindle-shaped and arranged in parallel. The surface property of the caves resembled that of the hepatic artery and differed from that of the portal vein or hepatic vein. These findings support that the cavernous hemangioma of the liver was supplied by the hepatic artery. The labyrinthine structure of the cavernous hemangioma may explain the long standing contrast enhancement of the hemangioma after hepatic arteriography.
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Suramo I, Lähde S, Pamilo M, Myllylä V, Leinonen A, Kairaluoma M. Ultrasound and computed tomography of small asymptomatic haemangiomas of the liver. ACTA RADIOLOGICA: DIAGNOSIS 1982; 23:577-83. [PMID: 7171025 DOI: 10.1177/028418518202300609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Gray-scale ultrasound examinations were performed in 13 patients with 18 small asymptomatic haemangiomas of the liver and computed tomography in 10 of these patients. Different types of ultrasound images were found. One of them appeared as a well-demarcated area of increased echoes with an echo-free halo consisting of vessels, is probably characteristic for haemangioma. The other types of images are considered non-specific. The native CT scans demonstrated a well-demarcated spherical area with low attenuation in 8 cases and an area with attenuation similar to the liver in 4. After contrast medium injection, areas with lower attenuation were found in 7 cases, with irregular accumulation of contrast medium in the periphery in 4, and with distinct vessels in the periphery in one case, 2 haemangiomas had the same attenuation as the liver parenchyma.
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Abstract
Cerebral angiomas consisting of two distinct types of malformations are rare. A case of combined arteriovenous and cavernous angioma is reported. For what is believed to be the first time, the cavernous portion of the angioma was clearly demonstrated by angiography and appeared similar to cavernous malformations occurring outside the central nervous system. This case emphasizes the continuous overlapping spectrum of cerebral vasculature anomalies.
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Affiliation(s)
- Christer Hellekant
- From the Department of Diagnostic Radiology, Malmö General Hospital, University of Lund, Malmö, Sweden
| | - Ulf Nyman
- From the Department of Diagnostic Radiology, Malmö General Hospital, University of Lund, Malmö, Sweden
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Hirner A, Häring R. [Giant cavernous hemangioma of the liver. Case report and review of the literature (author's transl)]. LANGENBECKS ARCHIV FUR CHIRURGIE 1978; 346:25-35. [PMID: 672339 DOI: 10.1007/bf01261767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The cavernous hemangioma of the liver is frequently seen as small tumor without any symptoms, but only rarely its diameter is more than 4 cm (161 cases in world literature). We can report on an additional patient. The peculiarities in this case were the tumor size, the presence of numerous phleboliths and the contrasting of the tumor taking place mainly from the venous part of the vascular bed of the liver. The main indication for a surgical intervention is the danger of rupture, but disturbances of the coagulation as well as intestinal suppression symptoms have also to be taken into consideration. The intraoperative tactics ought to be a standardised resection of the liver. The cavernous hemangioma must be differentiated from the hemangioendothelium: this usually occurs in children, causes cardiac failure due to a. v. shunts, and responds to conservative therapy (corticosteroids, radio-therapy).
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Numaguchi Y, Fukui M, Miyake E, Kishikawa T, Ikeda J, Matsuura K, Tomonaga M, Kitamura K. Angiographic manifestations of intracerebral cavernous hemangioma. Neuroradiology 1977; 14:113-6. [PMID: 593544 DOI: 10.1007/bf00333053] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A case of intraventricular cavernous hemangioma is reported, with a review of the literature, especially that dealing with angiography of intracerebral lesions. Dense venous poolings and a localized area of venous stain were observed in this case.
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Raabe DS, Fischer JC, Brandt RL. Cavernous hemangioma of the right atrium: presumptive diagnosis by coronary angiography. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1976; 2:389-95. [PMID: 1000627 DOI: 10.1002/ccd.1810020413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The angiographic findings in a patient with an interesting vascular tumor of the right atrium are described. The tumor was supplied by vessels from both the right and left coronary arteries and consisted of dilated blood spaces in which contrast material persisted for a prolonged period of time.
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Frey AA, Ranniger K, Roth FJ. Gallbladder visualization following hepatic arteriography for hemangioma. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1974; 19:477-83. [PMID: 4825951 DOI: 10.1007/bf01255612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Stanley RJ, Dehner LP, Hesker AE. Primary malignant mesenchymal tumors (mesenchymoma) of the liver in childhood. An angiographic-pathologic study of three cases. Cancer 1973; 32:973-84. [PMID: 4751928 DOI: 10.1002/1097-0142(197310)32:4<973::aid-cncr2820320432>3.0.co;2-a] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Fortner JG, Beattie EJ, Shiu MH, Howland WS, Watson RC, Gaston JP, Benua RS. Surgery in liver tumors. Curr Probl Surg 1972:1-56. [PMID: 4338676 DOI: 10.1016/s0011-3840(72)80002-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Jonutis AJ, Sondheimer FK, Klein HZ, Wise BL. Intracerebral cavernous hemangioma with angiographically demonstrated pathologic vasculature. Neuroradiology 1971; 3:57-63. [PMID: 5164262 DOI: 10.1007/bf00339895] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Abstract
Vascular radiology of the liver has increased in scope and function in recent years due mainly to the application of new techniques. It is now possible to examine not only the inferior vena cava and the portal venous system, but also the hepatic veins and the coeliac axis and superior mesenteric artery. Hepatic vein occlusion, portal vein patency and collateral veins, as well as space-occupying lesions, can now be diagnosed with a fair degree of accuracy. These techniques have also helped in the understanding of the altered haemodynamics of portal hypertension and can be used for treatment by intra-arterial perfusion of chemotherapeutic substances.
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