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Masatoshi Kudo

Publications and source records attributed to Masatoshi Kudo.

At least 55 records · Page 3Linked to original sources
PubMed2004

Hepatocellular carcinoma with nodule-in-nodule appearance: demonstration by contrast-enhanced coded phase inversion harmonic imaging.

OBJECTIVE: A nodule-in-nodule hemodynamic pattern, namely a vascular spot in a hypovascular nodule, is specific for the diagnosis of early-stage hepatocellular carcinoma (HCC). The purpose of this study was to assess whether this unique hemodynamic pattern can be detected by contrast-enhanced coded phase inversion harmonic imaging (PIHI). METHODS: 159 consecutive patients with HCC who underwent contrast-enhanced coded PIHI were retrospectively reviewed. Cases with nodule-in-nodule patterns were selected, and findings were compared with those on computed tomography (CT) angiography (CTA) and intraarterial contrast-enhanced ultrasonography (US angiography). RESULTS: Contrast-enhanced coded PIHI successfully displayed the nodule-in-nodule hemodynamic pattern in two cases of histologically proven HCC and the hemodynamic transition in one of the two cases, which corresponded well with findings on CTA and US angiography. CONCLUSIONS: Contrast-enhanced coded PIHI can demonstrate the special nodule-in-nodule hemodynamic pattern. It is useful in the diagnosis and follow-up of early-stage HCC or suspected nodules because of its noninvasiveness and easy performance.

Aged↗
PubMed2004

Atypical large well-differentiated hepatocellular carcinoma with benign nature: a new clinical entity.

Based on intranodular hemodynamic studies of nodular lesions associated with liver cirrhosis using computed tomography (CT) during arteriography, CT during arterial portography (CTAP) and angiography under ultrasonography, relatively large hepatocellular nodules with portal perfusion have been depicted. We report 17 such nodules in a total of 663 patients who underwent CTAP. Large well-differentiated hepatocellular carcinomas (HCCs) are characterized by the presence of intranodular portal perfusion even if they measure more than 2.5 cm in diameter. Such nodules display a benign nature clinically as well as pathologically. These nodules, called 'atypical large well-differentiated HCC or dysplastic nodules', show extremely slow growth. Pathological study showed extremely peculiar findings; the nodules consisted of homogeneously hyperplastic or well-differentiated HCC without the component of moderately or poorly differentiated HCC, and without fibrous capsules, vessel invasion or intrahepatic metastasis, all of which are commonly found in typical overt HCC. The incidence of such nodules is not rare; it was 2.6% (17/663) in our HCC patients who underwent CTAP over a period of 7 years. During the 7-year observation period, none of 10 such nodules developed into arterial supply-dominant overt HCC. The recognition of these benign-nature nodules (or large low-grade malignant nodules) is extremely important for the following three reasons. First, the knowledge that such large atypical nodular lesions exist is important for clinicians. Second, regarding the treatment strategy for such nodular lesions, it should be kept in mind that these nodules show a benign nature, and rarely cause death. Finally, considering the etiology and clinical significance of such atypical large benign-nature nodules, the recognition of these nodules provides an important suggestion regarding the pathogenesis of progression from dysplastic nodule to early HCC and finally to overt HCC during multistep human hepatocarcinogenesis. These atypical large benign-nature nodules do not seem to be the nodules in a sequence of multistep progression. The early step of hepatocarcinogenesis includes mainly hyperplastic change, whereas the late step includes mainly an angiogenic process. Although the detailed molecular pathogenesis of both the early and late steps of hepatocarcinogenesis is not clear, it is speculated that these atypical benign-nature nodules do not undergo the phenotypic change of late-step hepatocarcinogenesis. In that sense, these atypical benign-nature nodules are suggestive for the clarification of the mechanism of multistep human hepatocarcinogenesis based on the intranodular vascular supply or hemodynamics. From the viewpoint of clinical practice as well as pathogenesis of human hepatocarcinogenesis, these nodular lesions should be managed as a different disease from overt HCCs; atypical large HCCs or dysplastic nodules with benign nature should be regarded as a new clinical entity.

Angiography↗
PubMed2004

Characterization of hepatic tumors: value of contrast-enhanced coded phase-inversion harmonic angio.

OBJECTIVE: Our purpose was to evaluate the value of contrast-enhanced coded phase-inversion harmonic imaging in showing the characteristic intranodular hemodynamics of hepatic tumors. SUBJECTS AND METHODS. Using a microbubble contrast agent we performed coded harmonic angio in 163 patients with 192 hepatic tumor nodules: 153 hepatocellular carcinomas, 13 metastases, 14 hemangiomas, eight dysplastic nodules, and four focal nodular hyperplasias. After injecting Levovist, we performed real-time scanning, interval-delay fast low-angle shot imaging, and sweep scanning in the early arterial phase, late vascular phase, and postvascular phase, respectively. RESULTS: On contrast-enhanced coded harmonic angio, the typical hemodynamic pattern of hepatocellular carcinomas was shown as abundant tumor vessels supplied from the periphery to the center of the tumor and dense parenchymal tumor staining with fast washout (sensitivity, 92.8%; specificity, 92.3%). The characteristic hemodynamic pattern of metastases was peripheral tumor vessels with a rim parenchymal stain in the vascular phase followed by a perfusion defect in the postvascular phase (sensitivity, 69.2%; specificity, 100%). Hemangiomas were hypovascular in the early arterial phase with gradual spotty or cotton-wool pooling continuing to the late vascular phase (sensitivity, 92.9%; specificity, 100%). Dysplastic nodules were shown as having no early arterial supply with isovascularity in the late vascular phase (sensitivity, 75%; specificity, 100%). Focal nodular hyperplasias were shown to have a spoked wheel pattern of blood vessels accompanied by dense staining in interval-delay scanning (sensitivity, 100%; specificity, 100%). CONCLUSION: Contrast-enhanced coded harmonic angio is a promising method to provide useful information for the differential diagnosis of hepatic tumors.

Adult↗
PubMed2004

Treatment of hepatocellular carcinoma with percutaneous radiofrequency ablation: usefulness of contrast harmonic sonography for lesions poorly defined with B-mode sonography.

OBJECTIVE: The purpose of this study was to assess the usefulness of contrast harmonic sonography guidance in percutaneous radiofrequency ablation of hepatocellular carcinomas that could not be adequately depicted by B-mode sonography. SUBJECTS AND METHODS. Twenty-one patients with 21 hepatocellular carcinomas prospectively underwent radiofrequency ablation treatment with contrast harmonic sonography as guidance. Twenty-five patients with 25 hepatocellular carcinomas were retrospectively selected as the historical control group under the same conditions as the study group; the control group patients were treated under B-mode sonography guidance. RESULTS: Twenty (95.2%) of the 21 patients were successfully treated during a single treatment session, and the remaining patient (4.8%) required two treatment sessions with contrast harmonic guidance. On the other hand, only eight (32%) of the 25 control subjects were successfully treated during a single treatment session using B-mode sonographic guidance without contrast imaging. The difference between these two groups was statistically significant (p = 0.002). CONCLUSION: Contrast harmonic sonography helps in the placement of radiofrequency ablation electrodes in hypervascular hepatocellular carcinomas that cannot be adequately depicted by B-mode sonography.

Aged↗
PubMed2004

[Comparison of treatment methods for hepatocellular carcinoma--based on JIS score].

It is well known that prognosis of patients with hepatocellular carcinoma (HCC) depends not only cancer spread, but also on liver disease stage. The Japan Integrated Staging (JIS) scoring system, which combines TNM stage and Child-Pugh stage, is superior to CLIP Score in the discriminatory ability of the prognosis in 3,934 patients with HCC. Therefore, it is also useful in the comparison of the treatment results between treatment modalities or between institutions. It is thus recommended that the JIS score be used in the comparison of treatment results of patients with HCC.

Carcinoma, Hepatocellular↗
PubMed2003

Scintigraphic study of regenerative nodules due to fulminant hepatic failure.

We report the case of a 25-year-old woman with fulminant hepatic failure (FHF). Liver scintigraphy using (99m)Tc-galactosyl human serum albumin (GSA) and (99m)Tc-phytate produced interesting findings; regenerative nodules appeared as nodules of increased accumulation of (99m)Tc-GSA, whereas these nodules were expressed as defects of accumulation of (99m)Tc-phytate. These scintigraphic findings suggested that the functions of hepatocytes in regenerative nodules were maintained, whereas those of Kupffer cells were impaired. Although (99m)Tc-GSA scintigraphy indicated hepatic functional reserve enough to survive, she died despite intensive therapy including plasma exchange. Based on this case, it is recommended that not only (99m)Tc-GSA scintigraphy but also (99m)Tc-phytate scintigraphy is required to evaluate the prognosis of patients with FHF.

Adult↗
PubMed2003

Risk of HCV transmission after needlestick injury, and the efficacy of short-duration interferon administration to prevent HCV transmission to medical personnel.

BACKGROUND: We carried out this study to assess the risk of hepatitis C virus (HCV) transmission after needlestick injuries in medical personnel, and to evaluate the efficacy of short-duration interferon administration to prevent HCV transmission. METHODS: A total of 684 personnel who had been occupationally exposed to an anti-HCV-positive source and followed for more than 3 months were retrospectively examined. RESULTS: Of the 684 subjects, 279 (41%) were treated with 1 to 3 days of interferon either just after or 1 to 12 days after the injury. One case of HCV infection was found in each of the treated (1/279; 0.4%) and nontreated (1/405; 0.2%) groups. There was no significant difference in the transmission of HCV between the two groups. Both infected patients were treated with interferon after developing acute hepatitis, and HCV was subsequently cleared. CONCLUSIONS: There is a lower risk of HCV transmission after needlestick accident than previously reported, and short-duration interferon administration at an early stage after the needlestick injury, to prevent HCV transmission, is unnecessary.

Antiviral Agents↗
PubMed2003

Percutaneous ultrasound-guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome.

BACKGROUND: Nodules of hepatocellular carcinoma (HCC) located in the hepatic dome cannot be depicted on ultrasography because of pulmonary air. Therefore, percutaneous treatment is not possible in such cases. The purpose of this study was to clarify the feasibility and safety of percutaneous sonographically guided radiofrequency (RF) ablation with the concurrent use of artificial pleural effusion for HCC located in the right subphrenic region. METHODS: Between May 2001 and June 2002, 24 patients with 28 HCC nodules located directly below the diaphragm were enrolled in this study. The patient population included 17 men and 7 women (age range, 51-87 years; mean age, 66.5 years). The maximum diameter of the HCC nodules ranged from 1.0 cm to 4 cm (mean +/- SD, 2.1 +/- 0.8 cm). RESULTS: We infused 200-1100 ml of 5% glucose solution intrathoracically to separate the lung and liver; thus, obtaining an image of the whole tumor was impossible on gray-scale sonography. Complete tumor necrosis was achieved in a single session of RF ablation in 27 (96.4%) of the 28 lesions, while two sessions of RF ablation were required for the remaining lesion (3.6%). During treatment, no dyspnea or other complications concerned with the respiratory system were observed. Clinical courses have been satisfactory without recurrences at 1-13 months after treatment (mean, 7.9 months). CONCLUSIONS: Percutaneous RF ablation with artificial pleural effusion in patients with HCC in the hepatic dome may be a safe and feasible therapy.

Aged↗
PubMed2003

Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score).

A clinical staging system for cancer patients provides guidance for patient assessment and making therapeutic decisions. It is useful in deciding whether to treat a patient aggressively, and in avoiding the overtreatment of patients who would not tolerate the treatment or patients whose life expectancy rules out any chance of treatment. Clinical staging is also an essential tool for comparison between groups in therapeutic trials and for comparison between different studies. The current classifications most commonly used for hepatocellular carcinoma (HCC) are the Okuda stages, the Child-Pugh staging system, tumor node metastasis (TNM) staging, and the Cancer of the Liver Italian Program (CLIP) score. Among these, the CLIP score is currently the most commonly used integrated staging score, including both tumor stage and liver disease stage. Although the CLIP score has been well validated by many authors in terms of its prognostic value in HCC patients, this score has some problems and limitations when applied to currently diagnosed HCC patients, who are diagnosed in the early stage of disease. First, the CLIP score can discriminate score 0- to 3-patient populations, but it is not able to discriminate score 4- to 6-patient groups. Second, the definition of tumor morphology in the best prognostic group is too advanced, i.e., uninodular and a tumor extent of less than 50% of the liver. As a result, the prognosis of the CLIP system best prognostic group is not so good. In other words, this system cannot identify the best prognostic group who would benefit from curative and aggressive treatment. Third, nearly 80% of the patient population is classified as having a CLIP score of 0-2, as confirmed by many studies, which shows poor stratification ability. In contrast, a new staging system based on the Liver Cancer Study Group of Japan (LCSGJ), the Japan Integrated Staging (JIS) score is currently proposed in Japan. This staging system combines Child-Pugh grade (grade A, score 0; grade B, score 1; grade C, score 2) and TNM staging by the LCSGJ criteria (stage I, score 0; stage II, score 1; stage III, score 2; stage IV, score 3). The stratification ability of the JIS scoring system is much better than that of the CLIP scoring system. The JIS scoring system also performed better than the CLIP scoring system in selecting the best prognostic patient group. The cumulative 10-year survival rates of the best prognostic groups in the CLIP staging system (CLIP score 0) and JIS staging system (JIS score 0) were 23% and 65%, respectively (P < 0.01). All scoring systems arise as a compromise between simplicity and discriminatory ability. We confirmed that the JIS score increases predictive efficacy, while remaining simple compared with the CLIP score. Because the JIS score is quite easily obtained and is objective, we strongly propose it for widespread use as a prognostic staging system for HCC in clinical practice.

Carcinoma, Hepatocellular↗
PubMed2003

Spontaneous regurgitation of portal blood flow normalized by meal intake in a patient with alcoholic liver cirrhosis.

We report a case with spontaneous regurgitation of portal blood flow (SRPBF) that was normalized by meal intake. A 41-year-old man with long-term alcohol abuse was admitted with a chief complaint of general fatigue. He was diagnosed as having alcoholic liver cirrhosis since his laboratory tests showed the abnormal liver function. Dynamic computed tomography detected numerous portosystemic shunts. Hepatic arterial portography showed the portal vein was narrow and irregular. Color Doppler imaging portrayed the direction of the blood flows in the branches of the portal vein to be retrograde. However, 30 min after meal intake on the same day, color Doppler study showed the direction of the blood flow in the first branch of right and left portal vein became normal. Color Doppler imaging is a useful technique to detect SRPBF and hemodynamic change in portal venous system after meal intake in patient under a completely physiologic condition.

Journal Article↗
PubMed2003

Hepatocellular carcinoma mimicking cavernous hemangioma on angiography and contrast enhanced harmonic ultrasonography. A case report.

A 73-year-old man with chronic hepatitis due to hepatitis C virus was referred to our hospital for close examination of hepatic nodule. An abdominal ultrasonography revealed a mosaic pattern nodule with 3.7 cm in diameter. Arterial phase of dynamic CT revealed the small caudal part and marginal area of cranial part of the tumor were enhanced. The enhancement of marginal area of cranial part of the tumor continued up to portal phase and equilibrium phase and enhanced area was gradually filling in to the central area. On the other hand, the caudal part of the tumor was less enhanced compared with surrounding normal hepatic area in portal phase and equilibrium phase. An abdominal angiography revealed spotty tumor staining mimicking cotton-wool appearance, which is a typical finding for cavernous hemangioma. Contrast enhanced harmonic ultrasonography also showed hemangioma like finding (peripheral globular enhancing pattern). Because of these discrepancies on imagings, it was difficult to make final diagnosis of this tumor to be hepatocellular carcinoma since cavernous hemangioma cannot be completely ruled out. The pathological study of the specimen taken by US-guided percutaneous needle biopsy finally confirmed this nodule as hepatocellular carcinoma. In conclusion, we must keep in mind that some hepatocellular carcinomas could mimic hemangioma due to peliotic change or large acinar formation, therefore, needle liver biopsy may be essential for correct diagnosis if there is a discrepancy in several imaging findings.

Journal Article↗
PubMed2003

Hepatocellular carcinoma associated with secondary haemochromatosis in non-cirrhotic liver: a case report.

We describe one case of hepatocellular carcinoma (HCC) arising in secondary haemochromatosis in a non-cirrhotic liver. The patient was a 40-year-old male. He had severe pancytopenia due to myelodysplastic syndrome (MDS) and developed secondary haemochromatosis as a result of a large amount of erythrocyte transfusion. Multiple nodules of the liver appeared about 6 years after the diagnosis of MDS. Needle biopsy of the nodules histologically confirmed them to be moderately differentiated HCCs. The liver parenchyma was shown to be non-cirrhotic and a deposit of hemosiderin was also identified, consistent with a finding of haemochromatosis of the liver. Transarterial chemoembolization was performed to treat multiple HCCs. There are a number of reports describing HCC occurrence in non-cirrhotic patients with hereditary haemochromatosis. However, HCC in secondary haemochromatosis without cirrhosis is extremely rare.

Journal Article↗