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Focal eosinophilic necrosis of the liver in patients with underlying gastric or colorectal cancer: CT differentiation from metastasis.

Jang HJ, Lee WJ, Lee SJ, Kim SH, Lim HK, Lim JH - Korean J Radiol (2002 Oct-Dec)

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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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Related in: MedlinePlus

Focal eosinophilic necrosis of the liver in a 51-year-old man with gastric cancer and peripheral eosinophilia (11.7%). Contrast-enhanced CT scan obtained during the portal venous phase shows that in both hepatic lobes, several non-spherical lesions (arrows) with a fuzzy margin are present, and there is subtle hypoattenuation without rim enhancement.
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Figure 1: Focal eosinophilic necrosis of the liver in a 51-year-old man with gastric cancer and peripheral eosinophilia (11.7%). Contrast-enhanced CT scan obtained during the portal venous phase shows that in both hepatic lobes, several non-spherical lesions (arrows) with a fuzzy margin are present, and there is subtle hypoattenuation without rim enhancement.

Mentions: FEN (Fig. 1) far more frequently showed a fuzzy margin (81%, 84%), subtle hypoattenuation (89%, 91%), and non-spherical shape (85%, 84%) than metastasis, for which the corresponding figures were 6%, 22%; 20%, 39%; and 15%, 23%. Rim enhancement was seldom found in FEN (0%, 2%), whereas it was recognized by both readers in 40% of cases involving metastasis. For all four parameters, these results were statistically significant (p < .01), and there was also excellent interobserver agreement (κ > 0.60). Both readers correctly differentiated FEN from metastasis in 78% of patients (32/41).


Focal eosinophilic necrosis of the liver in patients with underlying gastric or colorectal cancer: CT differentiation from metastasis.

Jang HJ, Lee WJ, Lee SJ, Kim SH, Lim HK, Lim JH - Korean J Radiol (2002 Oct-Dec)

Focal eosinophilic necrosis of the liver in a 51-year-old man with gastric cancer and peripheral eosinophilia (11.7%). Contrast-enhanced CT scan obtained during the portal venous phase shows that in both hepatic lobes, several non-spherical lesions (arrows) with a fuzzy margin are present, and there is subtle hypoattenuation without rim enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713846&req=5

Figure 1: Focal eosinophilic necrosis of the liver in a 51-year-old man with gastric cancer and peripheral eosinophilia (11.7%). Contrast-enhanced CT scan obtained during the portal venous phase shows that in both hepatic lobes, several non-spherical lesions (arrows) with a fuzzy margin are present, and there is subtle hypoattenuation without rim enhancement.
Mentions: FEN (Fig. 1) far more frequently showed a fuzzy margin (81%, 84%), subtle hypoattenuation (89%, 91%), and non-spherical shape (85%, 84%) than metastasis, for which the corresponding figures were 6%, 22%; 20%, 39%; and 15%, 23%. Rim enhancement was seldom found in FEN (0%, 2%), whereas it was recognized by both readers in 40% of cases involving metastasis. For all four parameters, these results were statistically significant (p < .01), and there was also excellent interobserver agreement (κ > 0.60). Both readers correctly differentiated FEN from metastasis in 78% of patients (32/41).

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus