Abdominal Ultrasound Imaging Research Articles

Health gains, costs and cost-effectiveness of a population-based screening programme for abdominal aortic aneurysms.

Abdominal aortic aneurysm (AAA) rupture carries a high fatality rate. AAAs can be detected before rupture by abdominal ultrasound imaging, allowing elective repair. Population-based screening for AAA in older men reduces AAA-related mortality by about 40 per cent. The UK began an AAA screening programme offering one-off scans to men aged 65 years in 2009. Sweden has a similar programme. Currently, there is no AAA screening programme in New Zealand. This cost-utility analysis aimed to assess the cost-effectiveness of a UK-style screening programme in the New Zealand setting. The analysis compared a formal AAA screening programme (one-off abdominal ultrasound imaging for about 20 000 men aged 65 years in 2011) with no systematic screening. A Markov macrosimulation model was adapted to estimate the health gains (in quality-adjusted life-years, QALYs), health system costs and cost-effectiveness in New Zealand. A health system perspective and lifetime horizon was adopted. With New Zealand-specific inputs, the adapted model produced an estimate of about NZ $15 300 (€7746) per QALY gained, with a 95 per cent uncertainty interval (UI) of NZ $8700 to 31 000 (€4405 to 15 694) per QALY gained. Health gains were estimated at 117 (95 per cent UI 53 to 212) QALYs. Health system costs were NZ $1·68 million (€850 535), with a 95 per cent UI of NZ $820 200 to 3·24 million (€415 243 to €1·65 million). Using New Zealand's gross domestic product per capita (about NZ $45 000 or €22 100) as a cost-effectiveness threshold, a UK-style AAA screening programme would be cost-effective in New Zealand.

Transient periportal hyperechogenicity in feverish patients: a novel ultrasonographic finding.

Periportal hyperechogenicity has been recorded in many inflammatory and infectious diseases, including viral hepatitis, inflammatory bowel diseases, toxic shock syndrome of staphylococcus infection, typhoid fever, and schistosomiasis.We aimed to evaluate the echogenicity of the portal tracts of the liver by abdominal ultrasound imaging in patients with fever irrespective of the cause. Abdominalultrasound examination was performed in 277 consecutive patients presented with fever at their first visit and repeated 2weeks later after their recovery. Transient periportal hyperechogenicity was present in 39% (108 patients) of the feverish patients studied irrespective of the cause of the fever. Transient periportal hyperechogenicity is a frequent ultrasonographic finding in feverish patients irrespective of the cause of fever, and hence should not be misdiagnosed as liver disease or chronic periportal fibrosis unless the hyperechogenicity persists after recovery from the febrile or inflammatory condition.

Exacerbation of Cushing's syndrome during pregnancy: stimulation of a cortisol-secreting adrenocortical adenoma by ACTH originating from the foeto-placental unit.

SummaryA 29-year-old G4A3 woman presented at 25 weeks of pregnancy with progressive signs of Cushing’s syndrome (CS), gestational diabetes requiring insulin and hypertension. A 3.4 × 3.3 cm right adrenal adenoma was identified during abdominal ultrasound imaging for nephrolithiasis. Investigation revealed elevated levels of plasma cortisol, 24 h urinary free cortisol (UFC) and late-night salivary cortisol (LNSC). Serum ACTH levels were not fully suppressed (4 and 5 pmol/L (N: 2–11)). One month post-partum, CS regressed, 24-h UFC had normalised while ACTH levels were now less than 2 pmol/L; however, dexamethasone failed to suppress cortisol levels. Tests performed in vivo 6 weeks post-partum to identify aberrant hormone receptors showed no cortisol stimulation by various tests (including 300 IU hLH i.v.) except after administration of 250 µg i.v. Cosyntropin 1–24. Right adrenalectomy demonstrated an adrenocortical adenoma and atrophy of adjacent cortex. Quantitative RT-PCR analysis of the adenoma revealed the presence of ACTH (MC2) receptor mRNA, while LHCG receptor mRNA was almost undetectable. This case reveals that CS exacerbation in the context of pregnancy can result from the placental-derived ACTH stimulation of MC2 receptors on the adrenocortical adenoma. Possible contribution of other placental-derived factors such as oestrogens, CRH or CRH-like peptides cannot be ruled out.Learning points:Diagnosis of Cushing’s syndrome during pregnancy is complicated by several physiological alterations in hypothalamic–pituitary–adrenal axis regulation occurring in normal pregnancy.Cushing’s syndrome (CS) exacerbation during pregnancy can be associated with aberrant expression of LHCG receptor on primary adrenocortical tumour or hyperplasia in some cases, but not in this patient.Placental-derived ACTH, which is not subject to glucocorticoid negative feedback, stimulated cortisol secretion from this adrenal adenoma causing transient CS exacerbation during pregnancy.Following delivery and tumour removal, suppression of HPA axis can require several months to recover and requires glucocorticoid replacement therapy.

Ultrassonografia abdominal como método complementar no estadiamento do linfoma canino

Canine lymphoma is one of the most frequent neoplasms in veterinary medicine and it can affect several organs. Ultrasound examination has shown great sensitivity in detecting parenchymal abnormalities even before laboratory tests change, and it is considered an important advent to help staging diseases and to guide material collection. The main objective of this study was to investigate the contribution of ultrasonographic examination canine lymphoma in 70 animals and to propose staging between stages I to V, based on abdominal lesions of dogs with cytological or histopathological diagnosis of lymphoma. In this study, through a modified World Health Organization clinical classification, it could be determined that 28.6% of the animals were within stage I, 1.4% stage II, 41.4% in stage IV and 28.6% stage V and no stage III animals were observed. Despite the great variation of the ultrasonographic appearance of these lesions in lymphoid organs, the involvement of medial iliac lymph nodes was statistically significant and proved to be an important sentinel sign of the presence of lymphoma in these animals. Therefore, abdominal ultrasound imaging is of extreme relevance in clinical routine, as it allows staging abdominal lymphoma, its prognosis, as well as monitoring the treatment stablished.

Lymph node imaging of pediatric renal and suprarenal malignancies.

Pediatric renal and suprarenal cancers are relatively rare malignancies, but are not without significant consequence to both the patient and caretakers. These tumors are often found incidentally and present as large abdominal masses. Standard of care management involves surgical excision of the mass, but contemporary treatment guidelines advocate for use of neoadjuvant or adjuvant chemotherapy for advanced stage disease, such as those cases with lymph node involvement (LNI). However, LNI detection is based primarily on surgical pathology and performing extended lymph node dissection can add significant morbidity to a surgical case. In this review, we focus on the use and performance of imaging modalities to detect LNI in Wilms’ tumor (WT), neuroblastoma, and pediatric renal cell carcinoma (RCC). We report on how imaging impacts management of these cases and the clinical implications of LNI. A literature search was conducted for studies published on imaging-based detection of LNI in pediatric renal and suprarenal cancers. Further review focused on surgical and medical management of those cases with suspected LNI. Current imaging protocols assisting in diagnosis and staging of pediatric renal and suprarenal cancers are generally limited to abdominal ultrasound and cross-sectional imaging, mainly computed tomography (CT). Recent research has investigated the role of more advance modalities, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), in the management of these malignancies. Special consideration must be made for pediatric patients who are more vulnerable to ionizing radiation and have characteristic imaging features different from adult controls. Management of pediatric renal and suprarenal cancers is influenced by LNI, but the rarity of these conditions has limited the volume of clinical research regarding imaging-based staging. As such, standardized criteria for LNI on imaging are lacking. Nevertheless, advanced imaging modalities are being investigated and potentially represent more accurate and safer options.

The endoscopic ultrasound diagnosis of pancreatic ductal adenocarcinoma with cystic degeneration

Here, we present the case of an 87‐year‐old man who had dull upper abdominal pain for a month. Abdominal ultrasound and magnetic resonance imaging (MRI) demonstrated a cystic tumor in the pancreatic tail. Endoscopic ultrasound (EUS) showed a solid tumor with cystic degeneration, and fine‐needle aspiration (FNA) confirmed it was a pancreatic adenocarcinoma with tumor hemorrhage. The patient underwent a laparoscopic distal partial pancreatectomy and splenectomy. In this report, we emphasize that tumor hemorrhage‐related cystic degeneration is an uncommon manifestation of pancreatic ductal adenocarcinoma, and EUS with FNA may be more suitable for differential diagnosis than computed tomography or MRI.

Profile of exhaled-breath volatile organic compounds to diagnose pancreatic cancer.

Pancreatic cancer has a very poor prognosis as most patients are diagnosed at an advanced stage when curative treatments are not possible. Breath volatile organic compounds (VOCs) have shown potential as novel biomarkers to detect cancer. The aim of the study was to quantify differences in exhaled breath VOCs of patients with pancreatic cancers compared with cohorts without cancer. Patients were recruited to an initial development cohort and a second validation cohort. The cancer group included patients with localized and metastatic cancers, whereas the control group included patients with benign pancreatic disease or normal pancreas. The reference test for comparison was radiological imaging using abdominal CT, ultrasound imaging or endoscopic ultrasonography, confirmed by histopathological examination as appropriate. Breath was collected from the development cohort with steel bags, and from the validation cohort using the ReCIVA™ system. Analysis was performed using gas chromatography-mass spectrometry. A total of 68 patients were recruited to the development cohort (25 with cancer, 43 no cancer) and 64 to the validation cohort (32 with cancer, 32 no cancer). Of 66 VOCs identified, 12 were significantly different between groups in the development cohort on univariable analysis. Receiver operating characteristic (ROC) curve analysis using significant volatile compounds and the validation cohort produced an area under the curve of 0·736 (sensitivity 81 per cent, specificity 58 per cent) for differentiating cancer from no cancer, and 0·744 (sensitivity 70 per cent, specificity 74 per cent) for differentiating adenocarcinoma from no cancer. Breath VOCs may distinguish patients with pancreatic cancer from those without cancer.

Clinical analysis of enteral nutrition therapy in the treatment of complications of Crohn′s disease

Objective To investigate the therapeutic value of enteral nutrition in disease activity, nutritional status and complications of patients with Crohn′s disease (CD). Methods From January 2015 to February 2017, 64 CD patients with malnutrition in the First Affiliated Hospital of Soochow University were selected and received basic treatment with enteral nutrition. Before enteral nutrition and three months after therapy, white blood cell (WBC), red blood cell (RBC), hemoglobin, platelet, total protein, albumin, erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) were examined; Crohn′s disease activity index (CDAI) was calculated; abdominal and perianorectal lesions of patients were observed by small intestinal computed tomography (CT), abdominal ultrasound and anus magnetic resonance imaging (MRI). Paired t test and McNemar test were performed for statistical analysis. Results Compared with those before enteral nutrition treatment, who received enteral nutrition for three months, the levels of WBC, platelet, ESR, CRP and CDAI scores of CD patients were lowered ((7.83±3.61)×109/L vs. (4.82±2.26)×109/L, (272.52±191.79)×109/L vs. (166.17±67.18)×109/L, 33.5 mm/1 h vs. 5.5 mm/1 h, 21.70 mg/L vs. 1.97 mg/L, 220.75±119.71 vs. 33.48±20.22), and the differences were statistically significant (t=13.14 and 10.02; Z=501.50 and 57.80; t=25.44, all P<0.01). The levels of RBC, hemoglobin, total protein, albumin increased ((4.17±0.97)×1012/L vs. (4.97±0.98)×1012/L, (115.33±40.38) g/L vs. (133.88±43.87) g/L, (57.82±19.46) g/L vs. (69.68±16.53) g/L, (34.32±16.85) g/L vs. (43.29±17.57) g/L), and the differences were statistically significant (t=-10.45, -7.12, -11.44 and -6.87, all P<0.01). The CDAI scores of patients with remission of abdominal pelvic diseases and intestinal stenosis were both lower than those of patients without remission (214.3±113.54 vs. 296.77±60.24, 219.31±104.74 vs. 221.04±121.47), and the differences were statistically significant (both t=28.91, both P<0.05). Three months after enteral nutrition treatment, the remission patients of perianal lesions, abdominal pelvic diseases and intestinal stenosis were 28, 14 and 18 cases, respectively. Conclusion CD patients can achieve clinical remission with enteral nutrition treatment, which also prevent and treat CD related malnutrition and may prove to be a safe and first-line therapeutic approach. Key words: Crohn disease; Enternal nutrition; Perianal lesions; Abdominal pelvic lesions; Stenosis; Clinical significance

Performance Evaluation of Adaptive Imaging Based on Multiphase Apodization with Cross-correlation: A Pilot Study in Abdominal Ultrasound.

Degradation of image contrast caused by phase aberration, off-axis clutter, and reverberation clutter remains one of the most important problems in abdominal ultrasound imaging. Multiphase apodization with cross-correlation (MPAX) is a novel beamforming technique that enhances ultrasound image contrast by adaptively suppressing unwanted acoustic clutter. MPAX employs multiple pairs of complementary sinusoidal phase apodizations to intentionally introduce grating lobes that can be used to derive a weighting matrix, which mostly preserves the on-axis signals from tissue but reduces acoustic clutter contributions when multiplied with the beamformed radio-frequency (RF) signals. In this paper, in vivo performance of the MPAX technique was evaluated in abdominal ultrasound using data sets obtained from 10 human subjects referred for abdominal ultrasound at the USC Keck School of Medicine. Improvement in image contrast was quantified, first, by the contrast-to-noise ratio (CNR) and, second, by the rating of two experienced radiologists. The MPAX technique was evaluated for longitudinal and transverse views of the abdominal aorta, the inferior vena cava, the gallbladder, and the portal vein. Our in vivo results and analyses demonstrate the feasibility of the MPAX technique in enhancing image contrast in abdominal ultrasound and show potential for creating high contrast ultrasound images with improved target detectability and diagnostic confidence.

The Value of Complete Ultrasonography Diagnosis in the Management of Selected Patients with Abdominal Trauma

Patients who have sustained blunt abdominal trauma (BAT) pose a diagnostic challenge. Intraabdominal injuries may lead to increased morbidity and mortality. Abdominal computed tomography (CT) is the gold standard for identifying abdominal injuries, but is associated with radiation exposure and longer emergency hospital stay and increased health care costs. The aim of this study was to correlate the initial abdominal ultrasound (U/S) imaging findings with CT findings and clinical outcome in patients with BAT. The study population consisted of 61 adult trauma patients. The inclusion criteria were suspected BAT, hemodynamic stability and a score on the Glasgow coma scale (GCS) of ≥14. Patients requiring immediate surgical intervention were excluded. Of the 61 patients in the study, 18 (29.6%) were female and 43 (70.4%) were male, with a mean age of 54.8 years and 39.6 years, respectively. The mechanism of injury included: motor vehicle collision 16 (26.2%), motorcycle related 23 (37.7%), falls 18 (29.5%), pedestrian road traffic accident 3 (4.9%), and one (1.6%) assault. All the patients were hemodynamically stable, had a GCS ≥14 and had a suspicion of BAT. All the study patients underwent abdominal CT and U/S. The focused assessment with sonography (FAST) was negative for free fluid in 23 patients, in 9 of which minor visceral injuries were revealed on CT, but none needed surgical intervention. In 28 patients, free fluid or parenchymal injury was detected on abdominal U/S, which was confirmed on CT in 22 patients. In this group, 6/28 patients required surgical intervention due to clinical deterioration. Finally, when both fluid and parenchymal organ injuries were detected on U/S, the CT scan was positive in every case (10/10), but only 2 of these patients required surgical intervention. All of the study patients made a good recovery. Patients with BAT that meet certain clinical criteria and have a negative complete abdominal U/S imaging can be safely managed and discharged without the need for a CT scan.

A Practical Approach to Quantitative Grayscale Ultrasound Analysis of Hepatic Steatosis in Pediatric Patients Using a Picture Archiving and Communication System-Based Tool.

To evaluate the efficacy of a picture archiving and communication system (PACS)-based ultrasound (US) quantification technique for diagnosis of hepatic steatosis in a pediatric population. Abdominal US images of 49 pediatric patients (≤18 years) with histopathologically proven diagnoses of hepatic steatosis (n = 17), nonsteatotic liver disease (n = 19), and a normal liver (n = 13) were retrospectively reviewed. Patient demographics, the fibrosis stage, and the steatosis grade were obtained from the database. Quantitative grayscale measurements of the echo intensity level of the liver and kidneys were performed on the US images using the PACS measuring tool. The hepatorenal ratio was obtained by dividing mean liver by mean kidney values. The heterogeneity index for the liver was calculated by dividing the liver standard deviation by mean liver values. Hepatorenal ratio and heterogeneity index values of the 3 groups were correlated with pathologic results and compared by a 1-way analysis of variance. A receiver operating characteristic curve analysis was performed, and cutoff values were determined. The hepatorenal ratio of the hepatic steatosis group was significantly greater than those of the control and nonsteatotic liver disease groups (P < .001). The heterogeneity index of the hepatic steatosis group was significantly greater than that of the control group (P = .046). For a hepatorenal ratio cutoff value of 1.5, 88.2% sensitivity, 91.4% specificity, 88.3% positive predictive value, and 94.1% negative predictive value were obtained for predicting hepatic steatosis. PACS-based quantitative grayscale US quantification is a safe, accurate, and easily applicable objective method for the diagnosis of hepatic steatosis in children. A hepatorenal ratio of greater than 1.5 can be used as a conservative parameter, permitting increased confidence in discriminating hepatic steatosis from other conditions.

A topo-graph model for indistinct target boundary definition from anatomical images

Background and Objective: It can be challenging to delineate the target object in anatomical imaging when the object boundaries are difficult to discern due to the low contrast or overlapping intensity distributions from adjacent tissues. Methods: We propose a topo-graph model to address this issue. The first step is to extract a topographic representation that reflects multiple levels of topographic information in an input image. We then define two types of node connections - nesting branches (NBs) and geodesic edges (GEs). NBs connect nodes corresponding to initial topographic regions and GEs link the nodes at a detailed level. The weights for NBs are defined to measure the similarity of regional appearance, and weights for GEs are defined with geodesic and local constraints. NBs contribute to the separation of topographic regions and the GEs assist the delineation of uncertain boundaries. Final segmentation is achieved by calculating the relevance of the unlabeled nodes to the labels by the optimization of a graph-based energy function. We test our model on 47 low contrast CT studies of patients with non-small cell lung cancer (NSCLC), 10 contrast-enhanced CT liver cases and 50 breast and abdominal ultrasound images. The validation criteria are the Dice's similarity coefficient and the Hausdorff distance. Results: Student's t-test show that our model outperformed the graph models with pixel-only, pixel and regional, neighboring and radial connections (p-values <0.05). Conclusions: Our findings show that the topographic representation and topo-graph model provides improved delineation and separation of objects from adjacent tissues compared to the tested models.

Effect of stem cell transplantation of premature ovarian failure in animal models and patients: A meta-analysis and case report.

Stem cell transplantation has been considered a promising therapeutic approach for premature ovarian failure (POF). However, to date, no quantitative data analysis of stem cell therapy for POF has been performed. Therefore, the present study performed a meta-analysis to assess the efficacy of stem cell transplantation in improving ovarian function in animal models of POF. In addition, a case report of a patient with POF subjected to stem cell treatment was included to demonstrate that stem cell therapy also contributes to the recovery of ovarian function in patients. Published studies were identified by a systematic review of the PubMed, Embase, and Cochrane's library databases, and references cited in associated reviews were also considered. Data regarding follicle-stimulating hormone (FSH), estradiol (E2), ovarian weight, follicle count, the number of pregnancies and other parameters, including delivery route and cell type, were extracted. Pooled analysis, sensitivity analyses, subgroup analyses and meta-regression were performed. In the case of POF, transvaginal ultrasound (TVS), abdominal ultrasound (TAS) and color Doppler flow imaging (CDFI) were performed to observe the endometrial morphology and blood flow signals in the patient. Overall, pooled results from 16 pre-clinical studies demonstrated that stem cell-based therapy significantly improved FSH levels [standardized mean difference (SMD)=−1.330; 95% confidence interval (CI), -(2.095–0.565); P=0.001], E2 levels (SMD=2.334; 95% CI, 1.350–3.319; P<0.001), ovarian weight (SMD=1.310; 95% CI, 0.157–2.463; P=0.026), follicle count (SMD=1.871; 95% CI, 1.226–2.516; P<0.001), and the number of pregnancies (risk ratio=1.715, 95% CI, 1.213–2.424; P=0.002). The results of TVS and TAS demonstrated improved ovarian size and endometrial thickness in the patient with POF after MSC treatment. Of note, a rich blood flow signal in the endometrium was observed on CDFI. It appeared that stem cell-based therapy may be an effective method for the resumption of ovarian function in a patient and in animal models of POF; however, large-scale and high-quality future studies are required to confirm the present findings due to heterogeneity.

A rare presentation of pheochromocytoma in pregnancy: a case report

BackgroundEarly diagnosis of pheochromocytoma and its proper management can lessen its mortality and morbidity. This case report describes a 24-year-old pregnant woman with an unusual presentation of pheochromocytoma.Case presentationAn Iranian 24-year-old primigravid woman from Kordistan province was referred to our center with left flank pain at 37 weeks of gestation. She had a history of gestational diabetes mellitus since the 12th week of gestation which was managed by insulin administration. She also had a history of pulsatile bi-temporal headache for 2 years prior to her referral to us. She underwent complete abdominal and pelvic ultrasound imaging for her flank pain. This examination revealed a heterogeneous mass of 119 × 87 × 79 mm above her left kidney, highly suspicious of being an adrenal-originating tumor. Subsequently, we consulted an endocrinologist. She underwent abdominopelvic magnetic resonance imaging and her 24-hour urine metanephrine, normetanephrine, and vanillylmandelic acid were assessed. Finally, the diagnosis of pheochromocytoma was confirmed. She underwent a cesarean section and adrenal mass excision at the 40th week of gestation. This timely diagnosis resulted in her proper management and good maternal and neonatal treatment outcomes.ConclusionsOur patient had pheochromocytoma during pregnancy. She had no complaints about hypertension before or during pregnancy until giving birth to her child; her only symptoms were a vague left flank pain, gestational diabetes, and headaches for the past 2 years. The unusual symptom of flank pain led to timely diagnosis and a good treatment outcome.

Association between grades of Hydronephrosis and detection of urinary stones by ultrasound imaging.

Objective:To correlate between hydronephrosis grades and detection of urinary stones by B-mode ultrasound imaging.Methods:This study included 210 ultrasound reports of patients who underwent abdominal ultrasound imaging in the period from 1st January 2016 to 31st October 2017, and diagnosed as hydronephrosis. Data collected from the ultrasound reports. The detection rates of stones using B-mode ultrasound imaging compared in different grades of hydronephrosis. Chi-square test and Odds Ratio (OR) were performed to assess the relationship between variables.Results:Of 210 patients, hydronephrosis was unilateral in 91.8% of patients and bilateral in 8.1%. It was distributed in grade 2, grade 3, grade 1 and grade 4 in 58.57%, 20%, 12.38% and 9.1% of the patients respectively. B-mode ultrasound imaging determined the cause of hydronephrosis in 65.2% of cases. Urinary stones were the cause in 60% of the patients. The detection rate of urinary stones was 50%, 61% and 71.4% for grades 1, 2 and 3 hydronephroses respectively. On simple logistic regression analysis, urinary stones detected in Grade-3 were four times more compared to that in grade 4 (P=0.016) (OR 4.125, 95% CI 1.29-13.136%).Conclusion:Detection of urinary stones as the cause of hydronephrosis increases with increasing the grade of hydronephrosis from Grade-I to Grade-III and decrease in Grade-IV. Urinary stones were the cause of hydronephrosis in 60% of the patients in this study.

Accurate Identification of Fatty Liver Disease in Data Warehouse Utilizing Natural Language Processing.

Natural language processing is a powerful technique of machine learning capable of maximizing data extraction from complex electronic medical records. We utilized this technique to develop algorithms capable of "reading" full-text radiology reports to accurately identify the presence of fatty liver disease. Abdominal ultrasound, computerized tomography, and magnetic resonance imaging reports were retrieved from the Veterans Affairs Corporate Data Warehouse from a random national sample of 652 patients. Radiographic fatty liver disease was determined by manual review by two physicians and verified with an expert radiologist. A split validation method was utilized for algorithm development. For all three imaging modalities, the algorithms could identify fatty liver disease with >90% recall and precision, with F-measures >90%. These algorithms could be used to rapidly screen patient records to establish a large cohort to facilitate epidemiological and clinical studies and examine the clinic course and outcomes of patients with radiographic hepatic steatosis.

Detection of distant metastases in patients with locally advanced breast cancer: role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging with computed tomography scans

ObjectiveTo evaluate positron emission tomography/computed tomography (PET/CT) and conventional imaging tests for the detection of distant metastases in patients with locally advanced breast cancer.Materials and methodsWe included 81 patients with breast cancer who had undergone 18F-fluorodeoxyglucose (FDG) PET/CT before treatment. Conventional imaging included the following: bone scintigraphy; chest X-ray (in 14.5%) or CT (in 85.5%); and abdominal ultrasound (in 10.8%), CT (in 87.8%), or magnetic resonance imaging (in 1.4%). Histopathology and clinical/imaging follow-up served as reference.ResultsDistant metastases were observed in nine patients (11.1%). On patient-based analysis, conventional imaging identified distant metastases in all 9 patients. In one patient, the initial 18F-FDG PET/CT failed to demonstrate bone metastases that was evident on bone scintigraphy. In two patients, the CT scan failed to show extra-axillary lymph node metastases that were identified on 18F-FDG PET/CT. There was no significant difference between 18F-FDG PET/CT and conventional imaging in terms of their sensitivity for the detection of distant metastases in patients with locally advanced breast cancer.ConclusionThis study showed that 18F-FDG PET/CT and conventional imaging with CT scans had similar sensitivity for the diagnosis of distant metastases in patients with locally advanced breast cancer. 18F-FDG PET/CT can add information about extra-axillary lymph node involvements.

복부초음파 영상에서 담낭담석을 예측하는 혈액학적 수치의 분석

복부초음파 영상에서 담낭담석을 예측하는 혈액학적 수치의 분석

An Unusual Cause of Recurrent Vomiting

Question: A 28-year-old man was admitted for postprandial epigastric pain, and chronic vomiting for 6 months, associated with a 6-kg weight loss. He had no relevant medical or family history. Physical examination and laboratory workup were normal. An anechoic lesion located in the second part of the duodenum wall was revealed on abdominal ultrasound imaging, and a submucosal mass was diagnosed in the same region, using an upper endoscopy technique (Figure A). Furthermore, endoscopic ultrasound imaging (Figure B) and magnetic resonance imaging with dynamic sequences (Figure C) showed a 25 × 26-mm cystic duodenal lesion. There was no connection between the lesion and the biliary and pancreatic ducts, which seemed to be normal. What is your diagnosis? How should the patient be treated? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Endoscopic ultrasound imaging showed an anechoic duodenal lesion with an inner echogenic ring and an outer hypoechoic ring. Abdominal magnetic resonance imaging found a consistent appearance of a duodenal cyst protruding into the duodenal lumen, in the second part of the duodenum. These findings are specific to an enteric duplication cyst. We performed an endoscopic treatment of the cyst. The cyst's roof was first punctured using a needle-knife papillotome. The wall of the cyst was then incised using a polypectomy snare. Pathologic examination showed a double muscle layer with both mucosal and submucosal layers (Figure D), confirming the diagnosis of duodenal duplication cyst. The patient was discharged of hospital 24 hours later. Follow-up was uneventful. Duodenal duplication cyst is a rare congenital malformation.1Chen J.-J. Lee H.-C. Yeung C.-Y. et al.Meta-analysis: the clinical features of the duodenal duplication cyst.J Pediatr Surg. 2010; 45: 1598-1606Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 2Antaki F. Tringali A. Deprez P. et al.A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video).Gastrointest Endosc. 2008; 67: 163-168Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar Although exceptional malignant tumor developments have been described, duodenal duplication is usually associated with a good prognosis. Before the era of therapeutic endoscopy, surgical resection was performed in symptomatic patients, with significant morbidity. Various straightforward, safe, and effective endoscopic techniques have since been described, including cyst puncture, snare resection, and cyst needle aspiration/ligation, as suggested by Gjeorgjievski et al.3Gjeorgjievski M. Manickam P. Ghaith G. et al.Safety and efficacy of endoscopic therapy for nonmalignant duodenal duplication cysts.Medicine (Baltimore). 2016; 95: e3799Crossref PubMed Scopus (12) Google Scholar Long-term clinical outcomes are excellent, making therapeutic endoscopy a valid, minimally invasive alternative to surgical resection.

Predictors Associated With Increased Prevalence of Abdominal Aortic Aneurysm in Chinese Patients with Atherosclerotic Risk Factors

Epidemiological screening studies have demonstrated that the prevalence of abdominal aortic aneurysm (AAA) of Asian origin appears to be low and so increases uncertainty about the cost effectiveness of screening for AAAs in Chinese people. Some studies have demonstrated a higher prevalence of AAA in patients with atherosclerotic risk factors. The purpose of the study was to determine the prevalence of AAA and to explore the high risk group of AAA in Chinese patients with atherosclerotic risk factors. From November 2014 to July 2015, a prospective observational study was conducted in Guangdong General Hospital. In total, 1582 consecutive patients with atherosclerotic risk factors and undergoing coronary angiography for suspected or known coronary artery disease were enrolled to be screened for AAA by abdominal aortic ultrasound. Because of inadequate ultrasound image quality, the analysis was based on the 1541 (97.4%) patients whose abdominal aortic ultrasound images were adequate. The prevalence of AAA was 1.6% in the whole study population and 2.9% in male patients aged over 65 years. In multivariate analysis, age ≥ 65 years (p=.029), smoking (p=.037), hypertension (p=.026), and aortic root diameter>30mm (p=.003) were independent predictors of AAA. The prevalence of AAA was 0% (0/153) in patients without any independent predictor, 0.6% (3/502) in patients with one predictor, 1.0% (6/597) in patients with two predictors, 4.8% (12/249) in patients with three predictors, and up to 10% (4/40) in patients with four predictors (p<.001; p value for trend<.001). Age≥65 years, smoking, hypertension, and aortic root diameter>30mm emerged as independent predictors of AAA in Chinese patients. Stepwise increases in the prevalence of AAA were found to depend on the number of independent predictors. Ultrasound screening for AAA could be considered in these high risk patients, especially those with three or four predictors.