Table Of ContentCONTRASTAGENTS INLIVERIMAGING
SERIES IN RADIOLOGY
VOLUME 25
The titlespublishedinthisseriesarelistedattheendofthis volume.
CONTRAST AGENTS IN
LIVER IMAGING
Edited by
DR. T. BALZER
Clinical Development Diagnostics, Magnetic Resonance and Ultrasound Contrast Media,
Schering AG, Berlin, Germany
PROF. DR. B. HAMM
Department of Radiology, Charite Hospital, Humboldt University, Schumannstr. 20/21,
D-I0098 Berlin, Germany
and
DR. H.-P. NIENDORF
Clinical Development Diagnostics, Magnetic Resonance and Ultrasound Contrast Media,
Schering AG, Berlin, Germany
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
A catalogue record for this book is available from the British Library
ISBN 978-94-010-4213-0
Library of Congress Cataloging-in-Publication Data
Contrast agents in liver imaging / edited by Th. Balzer, B. Hamm
and H.-P. Niendorf.
p. cm. - (Series in radiology; v. 25)
Includes index.
ISBN 978-94-010-4213-0 ISBN 978-94-011-0477-7 (eBook)
DOI 10.1007/978-94-011-0477-7
1. Liver-Imaging-Congresses. 2. Contrast media-Congresses.
1. Balzer, Th .. II. Hamm, Bernd, Prof. Dr. III. Niendorf, H.- P.
IV. Series: Series in Radiolgy; 25.
[DNLM: 1. Liver Diseases-diagnosis-congresses. 2. Liver
pathology-congresses. 3. Diagnostic Imaging-methods-congresses.
4. Contrast Media-congresses. Wl SE719 v. 25 1995 / WI 700 C763
1995J
RC847.5.142C66 1995
616.3'620754-dc20
DN LM/DLC 94-34131
for Library of Congresses CIP
Copyright
© 1995 by Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1995
Softcover reprint ofthe hardcover lst edition 1995
AII rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, without prior permis sion from the publishers, Springer Science+Business Media, B.V.
Typeset by EXPO Holdings, Malaysia.
v
CONTENTS
ListofContributors VII
Introduction IX
1 Functionalcytoarchitecture ofthe normal liverandfocal liverlesions I
F. Borchard
2 Sonography offocal liverlesions 13
S. Delorme
3 Spiral CTofthe liver 27
G.T. Sica andM. Polger
4 Imaging ofhepatic neoplasms in patients withdiffuse liverdisease 33
u.p SchmiedlandPc. Freeny
5 Detection ofliverlesions: CT-arterialportography vs contrast-enhanced CT orMRI 45
M.E. Bernardino
6 Surgical aspects inthe imaging offocal hepatic lesions 51
B. Ringe, A. Weimann andR. Pichlmayr
7 Potentials ofnew MRIcontrastagents in the characterizationoflivermalignancies 59
G. Marchal and Y. Ni
8 Focal liverlesions: magnetic resonance imaging-pathological correlation 67
PRo Ros
9 Use ofcontrastagents in the detection and differentiationoffocal liverlesions
by MR imaging: Gd-DTPA, Mn-DPDP and iron oxide 85
B. Hamm andM. Taupitz
1t) Future techniques in MRimaging ofthe liver: echo planarimaging 91
J. Gaa andS. Saini
Index 97
VII
LIST OF CONTRIBUTORS
T.BALZER B.HAMM
ClinicalDevelopmentDiagnostics DepartmentofRadiology
MagneticResonanceandUltrasoundContrastMedia ChariteHospital, HumboldtUniversity
ScheringAG Schumannstr. 20/21
Berlin D-I0098Berlin
Germany Germany
M.E. BERNARDINO G.MARCHAL
DepartmentofRadiology DepartmentofRadiology
Emory University Hospital University Hospitals
1364CliftonRoadNE Herestraat49
Atlanta B-3000Leuven
GA30322 Belgium
USA
Y.NI
F.BORCHARD
DepartmentofRadiology
InstitutfUrPathologiederHeinrich-Heine-UniversiHit
UniversityHospitals
Postfach 101007
Herestraat49
D-40001 Dusseldorf
B-3000Leuven
Germany
Belgium
S.DELORME
H.-I'. NIENDORF
DeutschesKrebsforschungszentrum
Clinical DevelopmentDiagnostics
ForschungsschwerpunktRadiologischeDiagnostik
Magnetic ResonanceandUltrasound Contrast
undTherapie
Media
1mNeuenheimerFeld280
ScheringAG
D-69120Heidelberg
Berlin
Germany
Germany
p.C.FREENY
DepartmentofRadiology R. pICHLMAYR
UniversityofWashington Medical Center MedizinischeHochschuleHannover
Seattle KlinikfUrAbdominalundTransplantationschirurgie
WA98034 Konstanty-Gutschow-Str.8
USA D-30625 Hannover
Germany
J.GAA
DepartmentofRadiology B.RINGE
MassachusettsGeneral Hospital Georg-August-Universitat
HarvardMedical School AbteilungTransplantationschirurgie
Boston Robert-Koch-Str. 40
MA02114 D-37075 Gottingen
USA Germany
VIII
P.R.ROS G.T. SICA
DivisionofAbdominalImagingand Magnetic DepartmentofRadiology
ResonanceImaging BrighamandWomen's Hospital
UniversityofFloridaCollegeofMedicine 75 Francis Street
Gainesville Boston
Florida MA02115
USA USA
S.SAINI M.TAUPITZ
DepartmentofRadiology DepartmentofRadiology
MassachusettsGeneralHospital ChariteHospital
HarvardMedical School HumboldtUniversity
Boston Schumannstr. 20121
MA02114 D-10098 Berlin
USA Germany
U.P.SCHMIEDL A. WEIMANN
DepartmentofRadiology MedizinischeHochschuleHannover
UniversityofWashington MedicalCenter KlinikfurAbdominal undTransplantationschirurgie
Seattle Konstanty-Gutschow-Str.8
WA98034 D-30625 Hannover
USA Germany
currentlyworkingat:
DiagnosticImagingSciences
UniversityofSeattle
IX
INTRODUCTION
Recent advances in surgical procedures for the man thosewhoare inabetterpositiontojudgethesensitiv
agement of focal liver disease, ranging from an ityandspecificityofamethod.
improved andextendedresection strategy to the gen Thechaptersin this bookarepresentedin thesame
eral availability oflivertransplantation, have greatly order as the lectures. The pathologist's introductory
increased the demand for diagnostic accuracy. and general overview is followed by other chapters
Unfortunately, so far these demands have been only on the individual imaging procedures such as ultra
partially met by further technical developments such sound, CT and MR!, so that each ofthe three can be
as colour-coded duplex sonography, spiral CT and giventhe closeattentionitdeserves.
marked improvements in magnetic resonance imag All the authors and the discussionparticipants we
ing. It is becoming increasingly clear that liver were fortunate enough to engage have at least one
specific contrast media are essential for utilizing thing in common - they are widely known within
these technical developments to their fullest advan their disciplines for their outstanding scientific
tage inpatientcare. work. We would like to thank themagainfor giving
Against the background of diverse endeavours to up so much of their valuable time to participate in
develop such contrast media for all three imaging the workshop and for contributing so much to its
modalities,aworkshopwas heldtoexplorethecurrent success.
methodsofdiagnosticimagingoftheliverandtotryto We are also indebted to the staff of Kluwer
establish aprofilefor the future liver-specific contrast Academic Publishers for processing the manuscripts
media.The idea behind the workshop was not only to soexpertly.
allow radiologists from the various spheres to voice
their opinions, but also to enter into an interdiscipli Th.Balzer
narydiscussion withboththose whoplanandperform B.Hamm
therapies - particularly surgeons and internists - and H.-P. Niendorf
1
FUNCTIONAL CYTOARCHITECTURE OF THE
NORMAL LIVER AND FOCAL LIVER LESIONS
F. BORCHARD
2 FUNCTIONAL CYTOARCHITECTURE
Introduction Fenestratedsinusoidalendothelia
Themaincomponentistheflat 'fenestrated' sinusoidal
The following paper focuses on two aspects ofliver
endothelialcellwhichhasclustersofsmallporesinits
pathology, namely the presentation of functional
cytoplasm; these pores, with a mean diameter of 100
cytoarchitecture ofthe liver relevant to the uptake or
nm (range 50-300 nm) are called sieve platesl.
processing of contrast media and the description of
Although influenced by preparative methods, the size
the mainfocal liverlesions.
ofthefenestrae maybeinfluencedbyanumberoffac
tors in vivol. Fenestratedendothelial cells separateall
liversheetsfromthesinusoidallumen(Figure 1.1)and
Functionalcytoarchitecture
constituteabout60% ofthesinusoidalcells2•Thefen
estratedendotheliaperformanumberoffunctions asa
The architecture of the liver is well known and has
graded barrier for exchange of fluid and particulate
been studied by many methods, including transmis
substances, clearance ofmacromolecules by endocy
sionandscanningelectronmicroscopy,immunohisto
tosis,removalofharmfulpathogens,enzymesandcol
chemistryandcellculture.Inthispaper,thefunctional
lagen, as well as binding and uptake of lipoprotein.
role ofvarious cell types in the normal and diseased
The fenestrated endothelial cells have receptors for
liverwill beelucidated.
hyaluronidase, chondroitin sulphate, mannose-termi
Besides vascular components, connective tissue
nated glycoprotein, Fc-fragment of IgG, and for
cells, nerves and a few inflammatory cells, there are
seven main cell types in the liver, 3ofepithelial and lipopolysaccharide-bindingproteins3.
These fenestrated endothelia are unique in the
4ofsinusoidalorigin(Table 1.1).
human body and do not react with antibodies or
lectins which stain ordinary, non-fenestrated
Epithelialcells
endothelial cells (e.g. antibodies directed to CD 34
The epithelial cells include hepatocytes, bile duct andFVIII-associatedantigen, orUEAI-lectin). Such
epithelia and oval cells. The functions ofthese cells non-fenestratedendotheliaoccurin the vesselsofthe
are manifoldand will not bereviewed ingreatdetail. portaltractand within thecentralvein (Figure 1.2a).
Hepatocytes show an expression of various plasma The specialized fenestrated endothelia express the
proteins, synthesis ofcholesterol and bile, glyconeo intercellularadhesion molecularICAM 1and are the
genesis, glycolysis, and uptake of fatty acids. Bile
duct epithelial cells form the lining ofbile transport
channels within the portal tracts and larger ducts.
Oval cells are regenerative cells occurring in the
peripheryofthe lobuleafternecrosis.
Mesenchymalcells
Thesewillbediscussed inmoredetail.
Table1.1 Maincelltypesintheliver
Epithelialcells
Hepatocytes
Bileductepithelia
Smallcells(oval,hepatoid,cholangioid)
Sinusoidalcells
Fenestratedendothelia
Kupffercells(stellatecells)
Fatstoringcells(Itocells,lipocytes) Figure 1.1 The cellular composition of the sinusoidal wall.
Pitcells E=fenestrated endothelia,FSC =fat storingcell, KC =Kupffer
cell
