Hepatic involvement in hypereosinophilic syndrome: value of portal venous phase imaging

H., S.; Park, C. M.; H., I.; Kim, H. J.; Lee, D. H.; Baek, Seung Yon; Kim, P. N.; Ha, Hyun Kwon

doi:10.1007/s002619900310

Cited by 15 publications

(7 citation statements)

References 9 publications

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“…Most radiologic reports, however, have focused on hypereosinophilic syndrome (5-9), a clinically distinct entity from FEN affecting patients with mild eosinophilia (1) such as those described in this study. As FEN is in most cases detected incidentally and usually manifests at CT as multiple hypoattenuating lesions, differentiation from metastasis has been a problem, particularly in patients with underlying extrahepatic malignancies.…”

Section: Discussionmentioning

confidence: 98%

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

Jang

Lee

et al. 2002

Korean J Radiol

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ObjectiveTo 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 MethodsIn 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.ResultsFEN 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 (κ= 0.66).ConclusionWhen 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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Section: Discussionmentioning

confidence: 98%

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

Jang

Lee

et al. 2002

Korean J Radiol

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“…1F,G). [6][7][8] Others have postulated that the contrast material diffused more easily into small, low-attenuating foci and that the lesions were more indistinct during the equilibrium phase of the CT scan. We suggest that this discrepancy occurred because MR is superior to CT with respect to soft tissue contrast resolution, and thus MR can discriminate enhancing focal lesions from hepatic parenchyma based on differences in the lesion-to-liver contrast enhancement during both the delayed and portal phases.…”

Section: Discussionmentioning

confidence: 99%

MR Findings in Eosinophilic Infiltration of the Liver

Sun¹,

Kim²,

Won³

et al. 2005

Journal of Computer Assisted Tomography

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Objective: This study describes the findings of magnetic resonance imaging (MRI) of focal eosinophilic infiltration of the liver.Methods: Contrast-enhanced MR images of 8 patients with focal hepatic eosinophilic infiltration were reviewed retrospectively. We evaluated the signal intensity of focal lesions in T1-weighted and T2-weighted images and the pattern of enhancement in a dynamic contrast study.Results: A total 22 focal hepatic lesions were observed; the lesions were isointense (55%) or hypointense (45%) on T1-weighted images and isointense (14%) or hyperintense (86%) on T2-weighted images. The arterial phase of the contrast study revealed 11 hyperintense lesions (50%). During the portal and delayed phases, 18 (82%) and 17 lesions (77%) were hyperintense, respectively. Conclusion:The focal eosinophilic infiltrations showed homogeneous enhancement in the portal and delayed phases in the dynamic contrast MR study. These findings should help to distinguish focal eosinophilic infiltration, especially from metastasis in patients with malignancy.

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“…This uncommon entity is associated with various conditions inducing peripheral eosinophilia, including parasite infestations, allergic reaction, connective tissue disease, hypereosinophilic syndrome, and malignant tumors. 2,5,6 Although the mechanisms of an eosinophil-related tissue damage are not fully elucidated, the process might occur as follows: infiltration of eosinophils into the tissue (especially the periportal space), damage caused by the function of eosinophils and products including the eosinophil major basic protein followed by endothelial injury, and thromboembolic change of small vessels. 15,16 Although its pathologic features are not clearly defined, imaging findings of FEN are gaining more attention because it often gives rise to a diagnostic dilemma.…”

Section: Discussionmentioning

confidence: 99%

Differentiating Focal Eosinophilic Necrosis of the Liver From Hepatic Metastases Using Unenhanced and Portal Venous Phase Computed Tomographic Imagings

Choi¹,

Lee²,

Kim³

et al. 2009

Journal of Computer Assisted Tomography

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Hepatic involvement in hypereosinophilic syndrome: value of portal venous phase imaging

Cited by 15 publications

References 9 publications

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

MR Findings in Eosinophilic Infiltration of the Liver

Differentiating Focal Eosinophilic Necrosis of the Liver From Hepatic Metastases Using Unenhanced and Portal Venous Phase Computed Tomographic Imagings

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