LWBK1006-15 LWW-Govindan-Review December 7, 2011 19:5
Chapter 15•Advances in Diagnostics and Intervention 175without the need for reoperation. Postoperative leaks may result from
urine leaks, bile leaks, bowel leaks, pancreatic leaks, or lymphatic obstruc-
tion. These may warrant drainage if infection is suspected, leak is sus-
pected, mass effect is symptomatic, or the fluid requires further character-
ization. Cross-sectional imaging has made tremendous strides with recent
advances in CT but does not always allow for adequate characterization of
fluid collections with standard protocols. An example is a urinoma, which
may be overlooked unless delayed images are obtained, and small bowel
leaks, which may be confused with ascites if oral contrast is not admin-
istered. Bilomas can be another confusing fluid collection, which may be
suspected in patients with a history of hepatobiliary surgery. Because of
communication with the bowel via the bile ducts, these fluid collections
can lead to peritonitis and should be drained. Pancreatic leaks should be
suspected when the amylase is elevated (three to five times serum levels).Answer 15.19. The answer is A.
Hepatic tumor embolotherapy is a promising tool for the treatment of
hepatic lesions. This therapy relies on the increased reliance of tumors
on hepatic arterial perfusion compared with normal liver. The result is
that various agents can be used intraarterially to cause in situ tumor
death. Hypervascular tumors are known to be sensitive to ischemia, which
has given rise to hepatic particle embolization with very small particles.
Because of their larger size, coils are not used for hepatic embolotherapy.
In patients with hepatocellular carcinoma (HCC), the goal of emboliza-
tion is to prolong survival. In patients with neuroendocrine tumor, the
control of symptoms is the more common end point. When tumors are
bulky, pain control may be the main goal of treatment. Occasionally,
postembolization syndrome may be witnessed and is marked by pain,
fever, nausea, and vomiting; its course is usually self-limited.Answer 15.20. The answer is C.
The main contraindications for transarterial chemoembolization are
Child-Pugh C cirrhosis, uncorrectable bleeding diathesis, ECOG perfor-
mance status 3, total bilirubin greater than 4 mg/dL, and significant
encephalopathy.Answer 15.21. The answer is A.
Recent years have seen great advances in anatomic imaging. Among these
is faster scanning techniques with MRI and faster CT. The advent of
MDCT has resulted in improved temporal resolution and the ability to
scan a targeted region in many phases of enhancement. The improved spa-
tial resolution of MDCT has resulted in improved reconstructions in both
coronal and sagittal plains. Although acquired axially, these images can
rival MRI in their depiction of complex nonaxial anatomy. MRI remains
superior to CT in its ability to create functional images (spectroscopy,
perfusion, and cine images). Ultrasound also has seen dramatic improve-
ments with better probes and more sophisticated techniques of scanning
(tissue harmonics, extended field of view). Although not traditionally used