Adjacent Parenchyma Research Articles

Is a Close Follow-Up Computed Tomography Necessary for Acute Falcine and Tentorial Subdural Hematoma?

This study aimed to assess the changes and values on follow-up computed tomography (F/U-CT) for isolated falcine (F-SDH) and tentorial (T-SDH) subdural hematomas (SDHs). Fifty-four cases of isolated F-SDH and/or T-SDH were retrospectively reviewed. Subdural hematoma morphology, mass effect on the adjacent parenchyma, and interval change at F/U-CT were evaluated. Subdural hematoma size was measured parallel and perpendicular to the falx/tentorium (long or short axis, respectively). Short-axis increase on F/U-CT was seen only in 5 F-SDHs (16%) and 7 T-SDHs (19%), with a maximum of a 2-mm increase. Long-axis growth was more prominent and frequent, seen in 18 F-SDH patients (56.2%) and 19 T-SDH patients (51.4%), with maximum change of up to 43 mm. Falcine SDH and T-SDH were ipsilateral and contiguous in 77.8% of patients. Minimal mass effect was seen in 13 patients (24.1%), which was resolved or stable on F/U-CT. Anticoagulation did not affect SDH size. No patients required neurosurgery or died. Based on our limited data, the current standard of F/U-CT may be unnecessary in patients with isolated F-SDH and/or T-SDH, which expand minimally along the short axis without a significant mass effect. Characteristic anatomic structure of the tentorium and falx, and their connectivity may direct SDH expansion and limit mass effect as well as injury to the adjacent parenchyma.

Comparative study of the histopathologic changes within and around fibroadenomas

Objective: Fibroadenoma is the most common benign breast tumor but there are a few studies in the literature that describe the histological features of inner and adjacent tissues of fibroadenomas. The aim of the present study is to examine the histological features of the epithelial and stromal tissues within and around fibroadenomas. Materials and Metods: In this study, 52 patients with histopathologically diagnosed fibroadenoma from excisional breast biopsy were retrospectively screened and all hematoxylin eosin stained slides were reevaluated by two pathologists. All data were analyzed with SPSS v.21.0 software package. Results: A statistically significant correlation was detected between complex fibroadenoma and usual ductal hyperplasia (p <0.001), usual ductal hyperplasia was present in 55.9 % of the complex fibroadenomas. No significant association was detected between presence of usual ductal hyperplasia in the surrounding parenchyma and fibroadenoma (p= 0.132). In 26.3 % of fibroadenomas containing usual ductal hyperplasia, usual ductal hyperplasia was present in the adjacent breast parenchyma. There was no significant correlation between complex fibroadenoma and usual ductal hyperplasia or fibrocystic changes in the surrounding parenchyma (p= 0.438 and p= 0.523, respectively). Conclusion: The rates of the proliferative changes that create a risk for breast cancer in and around the fibroadenoma in the younger ages were found similar with the older ages. The examination of the complex and proliferative changes in the fibroadenoma and the proliferative changes in the surrounding breast parenchyma meticulously and specification of all those changes in the report will allow determination of the risk for development of breast cancer more accurately.

Autofluorescence imaging within the liver: a promising tool for the detection and characterization of primary liver tumors.

To assess the performance of 405nm-induced autofluorescence for the characterization of primary liver nodules on ex vivo resected specimens. Forty resected liver specimens bearing 53 primary liver nodules were included in this IRB-approved prospective study. Intratissular spectroscopic measurements were performed using a 25-G fibered-needle on all ex vivo specimens: 5 autofluorescence measurements were performed in both nodules and adjacent parenchyma. The spectra derivatives of the 635 and 670nm autofluorescence peaks observed in nodules and in adjacent liver parenchyma were compared (Kruskal-Wallis and Mann-Whitney when appropriate). A total of 42 potentially evolutive primary liver nodules-34 hepatocellular carcinomas, 4 intrahepatic cholangiocarcinomas, 4 hepatocellular adenomas-and 11 benign nodules-5 focal nodular hyperplasias, 6 regenerative nodules-were included. Both 635 and 670nm Δderivatives were significantly higher in benign as compared to potentially evolutive (PEV) nodules (respectively 32.9 ± 4.5 vs 15.3 ± 1.4; p < 0.0001 and 5.7 ± 0.6 vs 2.5 ± 0.1; p < 0.0001) with respective sensitivity and specificity of 78% and 91% for distinguishing PEV from benign nodules. 405nm-induced autofluorescence enables the discrimination of benign from PEV primary liver nodules, suggesting that autofluorescence imaging could be used to optimize US targeted liver biopsies. • 405nm-induced autofluorescence can distinguish liver tumors from the adjacent liver parenchyma. • The analysis of autofluorescence imaging observed within primary liver tumors can discriminate benign tumors from those requiring follow-up or targeted liver biopsy. • In current practice, autofluorescence imaging could be embedded within biopsy needle, to enable, in addition to ultrasound guidance, optimal targeting of liver nodules which could optimize tissue sampling.

Value of 18F-FDG PET/MR Imaging in the Early Evaluation of Treatment Response following Radiofrequency Ablation of Liver Cancer in a Rabbit Model

PurposeTo test the hypothesis that 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and magnetic resonance (MR) imaging can detect early residual tumor following radiofrequency (RF) ablation of liver cancer using a VX2 tumor model. Materials and MethodsTwenty-four rabbits with VX2 liver tumors were randomly divided into 3 groups (n = 8/group): Group 1 without RF ablation treatment, Group 2 with complete ablation, and Group 3 with partial ablation. An 18F-FDG PET/MR imaging scan was obtained within 2 hours after RF ablation. The maximum standardized uptake values (SUV) of the nontreated liver tumor, benign periablational enhancement (BPE), residual tumor, ablated tumor, and adjacent liver parenchyma and mean SUV of the normal liver were measured. The ratios of maximum SUV for these targets to the mean SUV of the normal liver (TNR) were calculated and compared. ResultsThe mean TNR of the nontreated liver tumors in Group 1 was significantly greater than that of the adjacent liver parenchyma (8.68 ± 0.71 vs 1.89 ± 0.26, P < .001). In Group 2, the mean TNR of BPE was significantly greater than that of the adjacent liver parenchyma (2.85 ± 0.20 vs 1.86 ± 0.25, P < .001). In Group 3, the mean TNR of the residual tumor was significantly greater than that of BPE (8.64 ± 0.59 vs 2.78 ± 0.23, P < .001), which was significantly greater than that of completely ablated tumor (2.78 ± 0.23 vs 0.50 ± 0.06, P < .001). Conclusions18F-FDG PET/MR imaging may serve as a promising imaging tool for the early detection of viable residual tumors due to incomplete tumor ablation.

Periaqueductal gray matter (PAG) in migraine: Transcranial sonography study

Periaqueductal gray (PAG) plays an important role in the modulation of descending pain control. Previous MRI studies showed that increased PAG iron levels in both episodic and chronic migraine patients correlated with disease duration. Transcranial sonography (TCS) is an imaging technique that allows visualization of heavy metals in the brain parenchyma as an area of hyperecogenicity. The PAG is the gray matter located around the cerebral aqueduct and usually ecographic signal of this region is indistinguishable from the adjacent parenchyma.

S2623 Chronic Lymphoid Leukemia With Extensive Liver Infiltration in the Absence of Leukemic Transformation

Introduction: Chronic lymphoid leukemia (CLL) is the most common hematologic cancer diagnosed in the elderly. Its association with liver dysfunction secondary to leukemic infiltration ranges from mild elevations in liver enzymes (LE) to acute liver failure. Severe hepatic infiltration is typically associated with acute leukemic transformation. Here we report an atypical manifestation of CLL with rising LE and white blood cell (WBC) count mimicking leukemic transformation. Case Description/Methods: 62-year-old male with history of CLL not on therapy presented to clinic for abnormal LE and rising leukocytosis. Patient reported fatigued, jaundice, right upper quadrant pain and 25lb weight loss over five months attributed to dietary modifications. Patient reported taking glimepiride, atorvastatin and herbal supplements (GNC50+ multivitamin, fertility and prostate multivitamin) that were stopped five months prior to encounter due to concerns of drug-induced liver injury (DILI). Labs were significant for absolute lymphocytosis >53,000/uL, AST 156U/L, ALT 336U/L, total bilirubin 4.4 mg/dl, direct bilirubin 3.57mg/dl and gamma-glutamyl transferase of 94U/L from previously normal LE. Additional work up was negative for viral and autoimmune etiologies. NASH Fibrosure was consistent with F4 Fibrosis. Computer tomography (CT) of abdomen did not demonstrate fatty changes but did show significant abdominal lymphadenopathy. Patient was hospitalized for rapidly rising WBC and LE. Abdominal ultrasound doppler showed patent liver vasculature. Transjugular liver biopsy was negative for acute leukemic transformation, but did identify extensive, >60% sinusoidal infiltration by CLL with hepatic venous pressure gradient (HVPG) of 11 mmHG attributed to periportal and peripancreatic adenopathy observed on CT imaging (Imaging A-D). Patient was initiated on Venetoclax and Obinutuzumab as an outpatient. LE peaked two months after chemotherapy initiation. Liver synthetic function remained normal (Table 1). Discussion: After ruling out DILI with failed improvement upon discontinuation of suspected agents and liver biopsy, extensive CLL extranodal liver involvement was attributed to have caused liver dysfunction and subsequent portal hypertension. Severe pattern of involvement is rare without Richter Transformation, which can be seen in 8% of CLL patients. Due to severe pattern of liver infiltration, worsening LE, portal hypertension, and hepatosplenomegaly it was ultimately decided to start patient on chemotherapy.Figure 1.: Image A:CT abdomen and pelvis with IV contrast depicting an enlarged 33.4x42.9mm periportal lymph node Image B: CT abdomen and pelvis with IV contrast depicting 11.7x18.3mm pancreatic lymph node Image C: : H&E (400x) section demonstrates an atypical lymphoid follicle surrounding bile ductules, with adjacent liver parenchyma. Characteristic immunohistochemical staining of the neoplastic cells shows positivity for CD20 (dim), CD5, CD23, and is negative for CD3 Image D: ZAP 70 (400x) staining (brown) of neoplastic cells has been associated with a poor prognosis.Table 1.: Patient laboratory information from date of diagnosis to most recent outpatient follow up. Footnote: *Represents laboratory data for time of hospital admission for elevated liver enzyme work up **Represents the laboratory data prior to initiation of chemotherapy ***Represents peak liver enzyme abnormality ****Represents most recent outpatient follow up laboratory data.

Revisiting Intraoperative 2D USG with Saline-Air Mixture as Contrast for Resection of Eloquent Area Glioma in Resource-Deficient Countries.

Background Advanced ultrasound, intraoperative magnetic resonance imaging (MRI), neuromonitoring, and aminolevulenic acid have improved the resection and safety of eloquent area gliomas. However, availability of these modern gadgets is a major concern in resource-deficient countries. A two-dimensional ultrasonography 2D USG is cheaper, provides real-time imaging, and is already established but underutilized instrument. Objective Here, we revisited the principles of 2D USG and used it for eloquent-area glioma surgery. Materials and Methods Fifty-eight patients with eloquent area gliomas were operated in last 2 years with the aid of 2D USG with 6-13 MHz curvilinear probe. Preoperative diagnosis was high-grade glioma in 38 and low-grade glioma (LGG) in 20 patients. Tumors were categorized as predominantly hyperechoic (27), uniformly hyperechoic (7), mixed echogenicity (21), and cystic (3). Results Intraoperatively, 2D USG could define the tumor margins in 46 cases. Of these, USG suggested gross total excision in 38 patients and subtotal in 8 patients. The findings matched with follow-up MRI in 34 patients who showed hyperechogenicity (predominant/uniform). Injecting saline with air in to the resection cavity and insinuating through adjacent brain parenchyma helped in detecting residual lesion in three cystic gliomas and in two LGG where the tumor cavity collapsed. Conclusion 2D USG is a helpful tool in eloquent area glioma surgery, especially in resource-limited countries. Visualization through adjacent parenchyma and injection of saline–air mixture in to the resection cavity helped in delineating residual lesion. Extent of resection is best monitored by 2D USG when tumor appeared hyperechoic (predominant/uniform).

Effect of bead size and doxorubicin loading on tumor cellular injury after transarterial embolization and chemoembolization in a rat model of hepatocellular carcinoma

Embolic agents used in transarterial embolization for intermediate stage hepatocellular carcinoma reduce blood flow into tumors and can deliver anticancer drugs. Tumor blood supply can be interrupted using doxorubicin-eluting beads (DEB-TACE) or non-loaded beads (TAE) of different calibers. In this preclinical study, we characterized the extent of remaining stressed tumor cells after treatment, hypoxia within the surviving tumor regions, and inflammatory immune cell infiltrates after embolization with 40-60 or 70-150 μm with non-loaded or doxorubicin-loaded beads at 3 and 7 days after treatment. TAE-treated tumors had more stressed and surviving tumor cells after 3 days, irrespective of bead size, compared with DEB-TACE-treated tumors. Hypoxic stress of residual cells increased after treatment with 70-150 μm beads without or with doxorubicin. Treatment with DEB-TACE of 70-150 μm resulted in increased inflammation and proliferation in the adjacent parenchyma. Inflammatory cell infiltrates were reduced at the periphery of tumors treated with 40-60 μm DEB-TACE.

Nodular regenerative hyperplasia of liver caused by chemotherapy: magnetic resonance imaging features

Objective: To investigate the MRI features of hepatic nodular regenerative hyperplasia (NRH) induced by chemotherapy. Methods: The clinical data and MRI of 20 cases with hepatic NRH induced by chemotherapy and confirmed by pathology in Zhongshan Hospital Fudan University from August 2014 to May 2019 were retrospectively analyzed. There were 13 males and 7 females, with an average age of 49.8 ± 9.7 years. Contrast-enhanced MR scan with Gd-DTPA was performed eighteen patients, and two patients underwent contrast-enhanced MR scan with hepatobiliary specific contrast (Gd-EOB-DTPA). The image analysis includes the number, location, size, shape, signal intensity in plain scan and enhancement pattern of lesions. The apparent diffusion coefficient (ADC) values of the lesions and adjacent hepatic parenchyma were measured on the ADC map, and the difference was compared with paired sample t test. Results: A total of 36 lesions in 20 patients were rounded or oval, including 23 (63.9%) lesions in the right lobe, 12 (33.3%) in the left lobe and 1 (2.8%) in the caudate lobe. The average diameter of all lesions was 15.4 ± 6.4 (7.0-37.0) mm. The boundary was clear in 9 (25.0%) lesions and blurred in 27 (75%) lesions. In T1WI, 35 (97.2%) lesions showed slightly hypointensity, and in 1 (2.8%) lesion was iosintensity. All 36 lesions showed slightly hyperintensity in T2WI. 33 (91.7%) lesions showed slightly hyperintensity in DWI, and 3 (8.3%) lesions showed iosintensity. 31 lesions with Gd-DTPA enhanced MR scan were significantly enhanced in the arterial phase and showed slightly high signal intensity in early portal vein phase, late portal vein phase and equilibrium phase. 5 lesions with Gd-EOB-DTPA enhanced MR scan were also significantly enhanced in the arterial phase and showed slightly high signal intensity in early portal vein phase, late portal vein phase and equilibrium phase, then all lesions showed circular high signal intensity in hepatobiliary specific phase. The average ADC value of 29 lesions was (1.471 ± 0.253) × 10(-3) mm(2)/s, and that of adjacent liver parenchyma was (1.460 ± 0.235) ×10(-3) mm(2)/s. There was no significant difference between the two groups (P > 0.05). Conclusion: MR findings of NRH induced by chemotherapy have certain characteristics, and the morphological manifestations, diffusion-weighted imaging, enhanced imaging and hepatobiliary specific phase features of the lesions can help to diagnose the disease.

Shear-wave elastography for the assessment of testicular involvement of hematologic malignancies in children and young adults: a feasibility study.

PurposeThis study aimed to assess the feasibility of shear-wave elastography (SWE) for assessing the testicular involvement of hematologic malignancies in children and young adults.MethodsEight patients (mean age, 11.0 years; range, 0.8 to 20 years) with biopsy-confirmed testicular involvement of hematologic malignancy between January 2018 and December 2020 were retrospectively evaluated. Multiparametric ultrasound examinations, including grayscale, color Doppler ultrasonography (CDUS), and SWE, were performed. Stiffness was measured in the involved testicular area and contralateral normal parenchyma. If there was bilateral testicular involvement, the stiffness of the involved area and the adjacent normal echoic parenchyma was measured on one testis. The Mann-Whitney U test was used to compare stiffness values.ResultsOn grayscale, the testicular lesions were noted as a solitary mass in one patient, multiple lesions in four patients, and diffuse involvement in three patients. On CDUS and SWE, all patients demonstrated increased vascularity, and the stiffness of the involved area was higher than the values of normal parenchyma (the involved area vs. normal parenchyma, 11.6 kPa [3.9-20.2 kPa] vs. 2.9 kPa [1.1-3.7 kPa], P=0.003). The ratio of stiffness between the involved area and normal parenchyma was 3.4, ranging from 1.9 to 5.1. One patient showed decreased stiffness on follow-up SWE after treatment (affected testis vs. normal testis: initial, 13.8 vs. 3.2 kPa; 1 year later, 2.2 vs. 2.4 kPa).ConclusionIncreased testicular stiffness on SWE in children and young adults with hematologic malignancies suggests the possibility of testicular involvement.

In Situ Preservation of Parathyroid Gland With Vasculature for Papillary Thyroid Carcinoma Is Associated With Higher PTH Levels After Total Thyroidectomy.

To evaluate the impact of parathyroid gland vasculature preservation in-situ technique (PGVPIST) on postoperative parathyroid hormone (PTH) and calcium plasma levels in thyroid patients undergoing total thyroidectomy for papillary thyroid carcinoma (PTC). Retrospective cohort study. Patients with PTC who underwent total thyroidectomy by either the conventional technique (group 1, January 2019 to January 2020) or PGVPIST (group 2, January 2020 to January 2021) were compared. Postoperative blood calcium levels and PTH levels were assessed in these groups. Totally 149 patients with consecutive PTC underwent total thyroidectomy, including 60 patients in group 1 and 89 patients in group 2. Postoperative serum calcium levels in group 1 were insignificantly lower than in group 2 at day 1 (2.18 ± 0.02 vs 2.15 ± 0.01 mmol/L) and day 30 (2.27 ± 0.02 vs 2.38 ± 0.11) after surgery. But postoperative serum PTH levels in group 1 were significantly lower than that in group 2 at day 1 (23.68 ± 2.54 vs 31.46 ± 2.11 pg/mL) and day 30 (45.63 ± 3.21 vs 55.65 ± 2.89 pg/mL) after surgery. Parathyroid gland vasculature preservation in-situ technique for PTC is associated with higher PTH level after total thyroidectomy. The parathyroid gland vasculature mostly strongly adheres with adjacent thyroid parenchyma. Therefore, deferred processing of tiny thyroid parenchyma of parathyroid gland vessels is essential to prevent devascularization.

Insulin-Like Growth Factor-1 Receptor Targeted Fluorescent Imaging for Gallbladder Cancer in Orthotopic Mouse Models.

Background/AimsGallbladder cancer is fatal, but fluorescent imaging technology can facilitate timely diagnosis and improve patient outcomes. Fluorophore-conjugated insulin-like growth factor-1 receptor (IGF-1R) targeted antibodies were used to visualize gallbladder cancer in orthotopic tumor mouse models.MethodsWestern blotting, flow cytometric analysis, and confocal microscopy detected the expression of IGF-1R in SNU-308, SNU-478, and SNU-1196 bile duct cancer cells. In vivo imaging of SNU-478 and SNU-1196 subcutaneous tumors and orthotopic gallbladder tumor models of SNU-478 were performed after injection with DyLight 650-conjugated IGF-1R antibody.ResultsWestern blotting and flow cytometric analysis showed that IGF-1R was expressed in bile duct cancer cells, and confocal microscopy demonstrated that IGF-1R antibody was able to bind to IGF-1R on the cell membrane. Fluorescent IGF-1R antibody injected into the mouse tail vein made subcutaneous tumors and orthotopic tumors become fluorescent. The intensity of fluorescence from the tumor was stronger than that from surrounding normal tissues. Histochemical examination confirmed that the tumor was located inside the gallbladder and adjacent liver parenchyma of mice.ConclusionsOur study showed that a fluorescent IGF-1R-targeted antibody could help detect gallbladder tumors. Tumor-specific imaging technology can be applied to endoscopy, laparoscopy, and robotic surgery for better management of gallbladder cancer.

MP49-13 INTRA-RENAL PATHOLOGY OF NON-NEOPLASTIC KIDNEY IS ASSOCIATED WITH LONG TERM RENAL DETERIORATION AFTER PARTIAL AND RADICAL NEPHRECTOMY: A SINGLE INSTITUTION EXPERIENCE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-13 INTRA-RENAL PATHOLOGY OF NON-NEOPLASTIC KIDNEY IS ASSOCIATED WITH LONG TERM RENAL DETERIORATION AFTER PARTIAL AND RADICAL NEPHRECTOMY: A SINGLE INSTITUTION EXPERIENCE Jiping Zeng, Grant Pollock, and Benjamin Lee Jiping ZengJiping Zeng More articles by this author , Grant PollockGrant Pollock More articles by this author , and Benjamin LeeBenjamin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medical diseases such as diabetes and hypertension, both of which remain the leading causes for ESRD in the US, may exert overt kidney pathology by examining the adjacent normal kidney tissue. In this study, we aim to investigate the impact of medical comorbidities on kidney pathology and renal function decline after nephrectomy. METHODS: We retrospectively reviewed 139 nephrectomies (partial=86, radical=53, all robotic) which were performed by a single surgeon in a tertiary referral center between January 2017 and May 2019. Thirty-five patients were excluded due to ESRD or atrophic kidney (n=18), lack of normal adjacent kidney parenchyma for examination (n=6), and incomplete follow up (n=11). Patient BMI and history of small vessel diseases, and final pathology of renal mass and adjacent non-neoplastic kidney were recorded. Creatinine and EGFR were tracked on POD#1, and on post-op visits at 3 and 12 months. Cox proportional hazards model was used to identify the risk factors for kidney function decline. RESULTS: A total of 104 patients were included in the analysis. The median age was 61 (25-85). The average BMI was 32.1 (19.1-69), and the most common comorbidity was hypertension (n=55, 62.5%) followed by diabetes (n=34, 32.7%). For partial nephrectomy, the average ischemia time was 17.8 minutes and ranged from 8 to 29 minutes. Intra-renal pathology was present in 78 (75%) patients when examining the non-neoplastic kidney, which varied from arteriosclerosis (vascular) and/or interstitial fibrosis (tubulointerstitial) and/or glomerulosclerosis (glomerular). In immediate postoperative period, the average EGFR decreased 16.7 and 9.06 mL/min/1.73 m2 in patients with and without intra-renal pathology, respectively. Intra-renal pathology score is associated with >15 mL/min/1.73 m2 decline in EGFR at one-year follow-up. After adjusting for covariates, the presence of intra-renal pathology remains a significant risk factor for EGFR decline (HR 1.77, 95% CI 1.58 - 2.25). CONCLUSIONS: Medical conditions including hypertension and diabetes that leads to small vessel disease are associated with renal pathology, which is a significant risk factor for decreased functional reserve and long term renal deterioration after nephrectomy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e880-e881 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jiping Zeng More articles by this author Grant Pollock More articles by this author Benjamin Lee More articles by this author Expand All Advertisement Loading ...

Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome.

Objective: To compare the metabolites of in vivo 1H- MRS in pancreatic cancer with normal pancreas, and correlate these metabolites with Positron Emission Tomography (PET) metabolic activity, clinical stages, and survival outcomes. Methods: The prospective study included 58 patients (mean age 62.7 ± 12.1 years, range 34–81 years; 36 men, 22 women) with pathological proof of pancreatic adenocarcinoma, and all of them received 18F-fluorodeoxyglucose (FDG) PET/MRI before treatment. The single-voxel MRS with a point-resolved selective spectroscopy sequence was used to measure metabolites (creatine, Glx (glutamine and glutamate), N-acetylaspartate (NAA), and lipid) of pancreatic cancer and adjacent normal parenchyma, respectively. FDG-PET parameters included SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Non-parametric tests were used to evaluate the differences of MRS metabolites between pancreatic cancer and those in normal pancreas, and their correlation with PET parameters and clinical stages. The correlation with progression-free survival (PFS) and overall survival (OS) was measured using the Kaplan–Meier and Cox proportional hazard models. Results: When compared with normal pancreas, the Glx, NAA, and lipid levels were significantly decreased in pancreatic cancer (all p < 0.05). Creatine, Glx, and lipid levels were all inversely correlated with both MTV (rho = −0.405~−0.454) and TLG (rho = −0.331~−0.441). For correlation with clinical stages, lower lipid levels were found in patients with T4 (vs. <T4, p = 0.038) and lower creatine levels were found in N1 (vs. N0, p = 0.019). Regarding survival outcomes, high TNM stage, low creatine, low Glx, and low lipid levels were associated with both poor PFS and OS (all p < 0.05). Additionally, creatine remained an independent factor for PFS and OS after adjusting for age, sex, tumor size, stages, and other metabolites levels. Conclusions: Decreased MRS metabolites in pancreatic cancer were associated with poor survival outcome, and may be used as prognostic image biomarkers for these patients.

Warning with chronic subdural hematomas in the elderly

Chronic subdural hematoma (cSDH) is a disorder in which blood collects between the dura and arachnoid mater of meninges around the brain. It's more common among the elderly and usually triggered by a head injury. We report a case of a 78-year-old male patient who had previously been diagnosed with a left hemisphere subdural hematoma for no apparent reason with a history of hypertension. Two days before hospitalizing, he had a symptom of weakness in the right extremities. Non-contrast CT of head reveals a crescent-shaped, heterodense lesion over the lateral aspect of the left hemisphere measuring 11x5x1 cm with mass effect to the adjacent brain parenchyma. Burr hole drainage was performed for the patient. His symptoms improved after the surgery.

Metanephric adenoma: association between the imaging features of contrast-enhanced ultrasound and clinicopathological characteristics.

This study aimed to improve the understanding of metanephric adenoma (MA) by retrospective analysis of contrast-enhanced ultrasound (CEUS) findings and clinicopathological characteristics of MAs. Gray-scale ultrasound (US) and CEUS findings of 7 adult MA patients, confirmed by postoperative pathology, were summarized via collection of clinicopathological and ultrasonographic imaging data, including tumor location, size, echo intensity, color flow, presence or absence of calcification, and liquefactive necrosis, contrast-enhanced pattern, enhancement characteristics, and contrast wash-out compared with adjacent parenchyma, and the presence or absence of a pseudocapsule. Histopathological analyses, including hematoxylin and eosin (HE) and immunohistochemical (IHC) staining, were conducted with the EnVision method. All 7 participants were female, aged 29-73 years (mean age, 54 years), with flank pain (3/7). All tumors were solid (7/7) with sizes of 2.0-5.0 cm (mean diameter, 3.07 cm), including 4 in the left kidney, 3 in the right kidney, 2 in the renal pelvis, and 5 in the renal parenchyma. On the gray-scale US, MA was shown as hypoechoic (4/7), slightly hyperechoic (2/7), isoechoic (1/7), and with a defined border. The morphology was regular and rounded (7/7), internal echogenicity was homogeneous (5/7), and no calcification was seen (7/7). The CEUS showed clear boundaries (7/7), homogeneous isodensity (5/7), with calcification (0/7), necrosis (2/11), heterogeneous hyperattenuation (2/7), pseudocapsule (2/7), and medullary phase fast wash-out (7/7). The surgical methods were radical nephrectomy (4/7) and partial nephrectomy (3/7). The duration of follow-up period for all participants was 3-74 months, and no local or distant recurrences were found. The IHC staining showed that most tumor cells were positive for WT1, cytokeratins AE1/AE3, vimentin, and CD57, and exhibited focal positivity for CK7, while negative for CD10, AMACR, and CK720. The proliferative index (Ki-67) was 2-3%. On gray-scale US, MA appears as a solid nodule with a well-defined boundary, regular morphology, and homogeneous echogenicity; CEUS shows slow progression and slightly lower homogeneous enhancement and fast wash-out in the medullary phase. These findings may provide insight into the progression of MA and aid in the development of diagnostic and therapeutic strategies.

Metastatic melanoma in a Saanen goat: clinical, ultrasonographic and anatomopathological aspects - case report

ABSTRACT This report describes clinical, ultrasonographic and anatomopathological findings in a case of metastatic melanoma in an adult Saanen goat. Clinically, the goat had apathy, an intra-abdominal palpable firm structure, and exophytic keratinized areas on the skin of the udder. Ultrasound revealed non-encapsulated oval structures, with heterogeneous echogenicity and marked central and peripheral vascularization, and hypoechoic hepatic multifocal to coalescent areas. In the udder, there were non-encapsulated oval structures with heterogeneous echogenicity and hyperechoic center surrounded by hypoechogenic tissue. Grossly, there were black multifocal to coalescent areas in the liver, as well as black nodules in mammary and mesenteric lymph nodes, uterus, spleen, and myocardium. Microscopically, multifocal melanocytic neoplastic proliferation was observed in the dermis and junction of the udder epidermis. Most of the neoplastic cells had cytoplasmic granules of melanin. In the liver there were areas of neoplastic tissue compressing the adjacent parenchyma, with central foci of necrosis, mild desmoplasia, and multifocal infiltration of malignant cells into the adjacent tissues. Similar findings were observed in the mammary and mesenteric lymph nodes, uterus, spleen, and myocardium, which characterized metastatic melanoma. Ultrasonography played a key role for establishing the diagnosis of a metastatic melanoma and helped establish a proper clinical management protocol.

Image-Guided Thermal Ablation in De Novo Renal Tumor Arising in Kidney Allograft: 3-Year Follow-Up. A Case Report

De novo tumors in renal allograft recipients are a severe complication during long-term follow-up after transplantation and may require transplantectomy. Herein we present a case of de novo renal tumor arising in the renal allograft, treated with the less invasive image-guided radiofrequency ablation (RFA) with long-term follow-up. A tumor was detected during the routine annual follow-up in a patient with good renal function who underwent renal transplantation in 1989. Computed tomography (CT) showed a mass in the allograft whose shape, vascularization, and density suggested the presence of a solid, malignant mass, located in the upper renal pole, that measured 17 mm. CT-guided RFA was performed successfully, and the outcome was verified by an immediate control CT after the intervention. No residual pathologic tissue, major bleeding, or damage to the adjacent parenchyma was evidenced. The patient was discharged with stable renal function. CT scan and ultrasound were performed 3, 6, 12, 18, 24, and 36 months after RFA. No signs of change in renal function, recurrence, neovascularization, or damage to the adjacent microcirculation were observed during the 3-year follow-up. In conclusion, percutaneous RFA of small renal tumors occurring in renal allografts can be considered a function-sparing, safe, and effective therapeutic option when difficult surgical removal may be anticipated. Our experience also supports the need for yearly renal allograft ultrasound follow-up for early identification of small neoplasm than can be treated less invasively.

Unidentified bright objects of spleen on arterial phase CT: mimicker of splenic vascular injury in blunt abdominal trauma.

We have described unidentified bright objects of spleen (UBOS), a hitherto undescribed entity, as hyperdense areas on arterial phase (AP) computed tomography (CT) seen in relation to splenic lacerations and are isodense to the normal parenchyma on portal venous phase with no correlate on digital subtraction angiography (DSA). UBOS mimic splenic vascular injuries like active contrast extravasation and pseudoaneurysm and need to be differentiated from them as it would have implications on patient management. We undertook this study to identify CT features of UBOS that can differentiate them from splenic vascular injuries and to calculate their diagnostic accuracy. This retrospective study was approved by the institutional ethical committee and the need for informed consent was waived. Patients with splenic injury who had undergone dual-phase CT and DSA were included. All the lesions that were hyperdense on AP were evaluated for their outline, their relation to the adjacent/parallel margins of a laceration (margin sign), string of beads appearance, and the presence of adjacent normal parenchyma (adjacent parenchyma sign). The Hounsfield unit (HU) of the lesion and the aorta on the AP were also noted. The diagnostic accuracy of various signs for distinguishing UBOS from splenic vascular injuries was calculated using DSA as the reference standard. Of 48 patients, 5 were excluded due to suboptimal quality of the examination or a time difference of more than 6 hours between the CT and DSA. A total of 54 hyperdense lesions were detected on AP in 43 patients. These were classified as vascular injuries (pseudoaneurysm, n=11; active contrast extravasation, n=11) and UBOS (n=32) based on DSA. The margin sign, string of beads appearance, and ill-defined outline had high specificity (95%, 86%, and 82%, respectively) but low sensitivity (50%, 65%, and 63%, respectively). The adjacent parenchyma sign had a moderate sensitivity and specificity of 84% and 77%, respectively. ROC analysis showed that a difference of 50 HU between the aorta and the lesion had a high sensitivity and specificity of 88.9% and 90.6%, respectively, with an area under the curve of 0.90. An attenuation difference of over 50 HU between the aorta and the lesion and the presence of normal adjacent parenchyma had the highest diagnostic accuracy, while an ill-defined outline, string of beads appearance, and margin sign had high specificity but low sensitivity for differentiating UBOS from splenic vascular injuries.

The impact of lung parenchyma attenuation on nodule volumetry in lung cancer screening

BackgroundRecent recommendations for lung nodule management include volumetric analysis using tools that present intrinsic measurement variability, with possible impacts on clinical decisions and patient safety. This study was conducted to evaluate whether changes in the attenuation of the lung parenchyma adjacent to a nodule affect the performance of nodule segmentation using computed tomography (CT) studies and volumetric tools.MethodsTwo radiologists retrospectively applied two commercially available volumetric tools for the assessment of lung nodules with diameters of 5–8 mm detected by low-dose chest CT during a lung cancer screening program. The radiologists recorded the success and adequacy of nodule segmentation, nodule volume, manually and automatically (or semi-automatically) obtained long- and short-axis measurements, mean attenuation of adjacent lung parenchyma, and presence of interstitial lung abnormalities or disease, emphysema, pleural plaques, and linear atelectasis. Regression analysis was performed to identify predictors of good nodule segmentation using the volumetric tools. Interobserver and intersoftware agreement on good nodule segmentation was assessed using the intraclass correlation coefficient.ResultsIn total, data on 1265 nodules (mean patient age, 68.3 ± 5.1 years; 70.2% male) were included in the study. In the regression model, attenuation of the adjacent lung parenchyma was highly significant (odds ratio 0.987, p < 0.001), with a large effect size. Interobserver and intersoftware agreement on good segmentation was good, although one software package performed better and measurements differed consistently between software packages.ConclusionFor lung nodules with diameters of 5–8 mm, the likelihood of good segmentation declines with increasing attenuation of the adjacent parenchyma.