Characterization Of Cystic Lesions Research Articles

Contribution of Endoscopic Ultrasound (EUS) in Biliopancreatic Pathology: Experience of the Hepato Gastroenterology Moroccan Department

Introduction: Endoscopic ultrasound (EUS) is a method of exploration in gastroenterology, it combines ultrasound and endoscopy for the examination of the digestive tract and nearby structures. It is an ultrasound technique that allows the use of high-definition ultrasound transducers. Materials and methods: It is a descriptive retrospective study covering a period of 34 months, from 01/2019 to 10/2021. It concerned 100 patients who had endoscopic ultrasound for biliopancreatic pathology, in the and the university hospital Sheikh Khalifa. We noted the demographic, clinical and morphological data, such as transcutaneous ultrasound, abdominal CT scan and MRI as well as the EUS. The results of the EUS were compared with the imaging and histology data when performed. We were therefore able to evaluate the reliability of each examination and thus its strong and weak points. Results: The average age of our patients was 58 years, with a sex ratio: 1.05. The symptomatology was dominated by abdominal pain and jaundice, the biology by cytolysis and biological cholestasis syndrome. We noted a predominance of tumor pathology with 42% followed by inflammatory pathology: acute pancreatitis as part of the etiological assessment. The reliability of EUS in the diagnosis of pancreatic cancer is 88% with a reliability of abdominal CT of 68%. Our study also allowed us to evaluate with precision the reliability of detection of lymph node and vascular invasion of biliopancreatic cancers, which was 88%. We also noted other pathologies for which EUS was a good diagnostic tool, main bile duct stones but also cystic lesions of the pancreas. Conclusion: In view of the comparative study of these results with the other types of explorations, of which the EUS, proved to be more effective in the exploration of the pancreatic region especially in for the assessment of tumor extension and diagnosis of choledocholithiasis and characterization of cystic lesions. The EUS has a therapeutic interest ....

Evaluation of Cystic and Solid Renal Lesions with Contrast-Enhanced Ultrasound: A Retrospective Study.

Purpose Renal lesions are frequent random findings on CT, MRI, and conventional ultrasound. Since they are usually found accidentally, the respective examinations have not been performed optimally to provide a conclusive diagnosis, making additional multiphase contrast-enhanced examinations necessary. The aim of the study is to correlate CEUS findings with the final diagnosis and to determine whether it is a suitable method for the conclusive characterization of undetermined renal lesions. Materials and Methods All CEUS examinations of focal renal lesions performed at our institute between 2007 and 2014 were retrospectively examined. 437 patients with a total of 491 lesions and 543 examinations were included. 54 patients had bilateral lesions. One patient had three lesions in one kidney. Histology was available in 49 cases and follow-ups in 124 cases. The sensitivity, specificity, positive and negative predictive value as well as positive and negative likelihood ratios were calculated. Results There were 54 malignant and 437 benign lesions. The sensitivity and specificity were 0.981/0.954 overall, 1.000/0.956 for cystic lesions, 0.977/0.906 for solid lesions, and 0.971/0.071 for the histologically confirmed lesions. Bosniak classification was consistent in 289 of 301 lesions (96%). Only 12 lesions (3.9%) were falsely assessed as malignant. Conclusion CEUS is an appropriate method for the clarification of undetermined renal lesions. The characterization of cystic lesions according to Bosniak is adequately possible, especially for potentially malignant lesions (types III and IV).

Improved detectability of hypoattenuating focal pancreatic lesions by dual-layer computed tomography using virtual monoenergetic images

BackgroundMultidetector CT is the mainstay for radiologic evaluation of pancreatic pathology. Still, imaging of focal pancreatic lesions using MDCT is faced by a number of challenges that are related to the limited contrast between the lesion and surrounding parenchyma, such as detecting early-stage pancreatic cancer and subtle features of cystic lesions that point to malignancy. Dual-layer CT is the first dual-energy CT machine based on separation of high- and low-energy photons at the detector level. If improved contrast between the lesions and normal pancreatic parenchyma could be achieved on CT images, we may expect enhanced CT detection of pancreatic lesions. The purpose of this study was to evaluate whether virtual monoenergetic reconstructions generated using contrast-enhanced dual-layer CT could improve detectability of hypoattenuating focal pancreatic lesions compared to conventional polyenergetic reconstructions.ResultsFifty-four lesions were identified and verified by histopathology or follow-up CT, MRCP, and/or EUS along with clinical data. Across the virtual monoenergetic spectrum, 40 KeV images had the highest contrast-to-noise and signal-to-noise ratios (p < 0.001, p < 0.001) and were significantly higher than conventional images (p < 0.001). Subjective scores for lesion visibility at low kiloelectron volt monoenergetic (40 and 50 KeV) images greatly exceeded conventional images (p < 0.001).ConclusionLow kiloelectron volt monoenergetic reconstructions of contrast-enhanced dual-layer CT significantly improve detectability of hypoattenuating focal pancreatic lesions compared to conventional polyenergetic reconstructions.

English

English

Cistos renais em macaco-prego (Sapajus libidinosus) – relato de caso

Cystic lesions in the renal parenchyma can be attributed to several types of pathologic conditions, such as acquired renal cysts and polycystic kidney disease. Some clinical criteria are used to distinguish between these two diseases. Ultrasonography aids in the characterization of cystic lesions in the abdominal organs, allowing the diagnosis of these diseases. We hereby report the case of a young adult female capuchin monkey (Sapajus libidinosus) submitted to clinical and sonographic examination in order to evaluate its health prior to reintroducing the animal in nature. Physical examination did not reveal any type of alteration. However, the ultrasonogram disclosed the presence of some renal cysts in the right kidney, as well as a hepatic cyst. There are very few reports in the literature of the presence of renal cysts in primates.

Clinical decision making in the management of pancreatic cystic neoplasms

Pancreatic cystic lesions continue to pose diagnostic and management dilemmas for physicians. This may be related, in part, to the fact that these lesions represent a range of diagnostic possibilities, from inflammatory cysts and nonmucinous cysts to mucinous cysts, which may or may not have foci of invasive malignancy. Adequate characterization of cystic lesions is necessary to help devise a management plan. Moreover, patient-related factors such as comorbid conditions are often essential in deciding whether patients should be managed by a conservative approach of watchful waiting versus surgical resection, if so indicated. This review summarizes the recent advances in the management of pancreatic cystic neoplasms.

The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology

By using a microbubble contrast agent and contrast-specific imaging software, the contrast-enhanced ultrasound (CEUS) is able to depict the micro and macrocirculation of the target organ. A review of the peer reviewed literature was done regarding the current role of ultrasound CEUS imaging in the evaluation of renal pathology with reference to the diagnosis of renal ischaemia, in the characterization of complex cystic lesions and in those with equivocal enhancement at CT. CEUS provides information on tissue perfusion and may play a role in kidney mass characterization similar to the role of contrast-enhanced CT and MRI. In this context, the characterization of cystic lesions is probably the most consolidated field of application of contrast agents on kidney ultrasound imaging. Finally, CEUS provides a good alternative to CT, especially in patients with contraindications to iodinated contrast agents. The usefulness of CEUS in these applications is confirmed by extensive literature production and this article focuses on the potential clinical applications of recent advances in CEUS technology in urology.

Cystic tumors of the pancreas

Physicians are increasingly being confronted with the diagnosis, differential diagnosis, and management of cystic lesions of the pancreas. Owing to recent refinements in cross sectional imaging, an increasing number of cystic lesions have been identified in asymptomatic patients as well as in patients presenting with abdominal pain, pancreatitis, or jaundice. Therefore, there has been a significant increase in awareness of cystic lesions of the pancreas. In the clinical setting, it is crucial to differentiate between benign and malignant lesions as the management of these conditions is entirely different. Recently, increasing experience with these lesions has come to a refinement of the pathological classification of cystic neoplasms and of their natural history. These tumors encompass a spectrum of benign, malignant, and borderline neoplasms that either are primarily cystic or result from the cystic degeneration of solid tumors. Among these neoplasms, serous cystadenomas, intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms, and solid pseudopapillary neoplasms represent the majority of the cases encountered in practice. Serous cystadenoma, also referred to as microcystic cystadenoma, is typically found in women over the age of 60 years with unspecific complaints of abdominal pain. Typical serous cystadenomas are composed of honey-comb like microcysts varying in size from 0,2 to 2,0cm. Oligocystic variants have also been reported. The presence of a central scar is a highly diagnostic feature that is found in about 20% of these tumors. Lobulated contours have been demonstrated to be a specific finding in comparison with pseudocysts. IPMNs typically occur in elderly patients and are more common in men. IPMN is characterized by cystic dilatation of a main or a side branch duct that contains thick mucoid material. These tumors are classified into the main duct type, branch duct type, and combined type. The demonstration of a communication with the pancreatic ductal system is a key feature of IPMN. The presence of mural nodes and a segmental or diffuse dilatation of the main pancreatic duct greater than 15mm in diameter has been reported as indicative of the development of malignant disease. Mucinous cystic neoplasms, also known as macrocystic adenomas/cystadenocarcinomas occur most frequently in women in their sixth decade. Mucinous cystic neoplasms are typically large lesions at the time of diagnosis, are usually multilocular with well-defined borders and have thick fibrous walls. Characteristically, they lack a communication with the pancreatic ductal system. Solid pseudopapillary neoplasms are found most commonly in young females. The tumor tends to be a large, well-circumscribed, and slowly growing mass with a variety of internal appearances, from purely cystic to completely solid. The appearance of the tumor typically depends on the degree of internal hemorrhage or necrosis. Imaging is indispensable in the evaluation of patients with cystic pancreatic lesions. Multidetector row CT has become the preferred method for both initial detection and characterization of cystic lesion of the pancreas. Magnetic resonance imaging including MRCP accurately depicts the morphologic features of the cysts and has the advantage of demonstrating the relationship of the cystic lesion to the pancreatic duct. Based on morphologic features, pancreatic cystic lesions can be classified into four subtypes: unilocular cysts, microcystic lesions, macrocystic lesions, and lesions with a solid component. Lernziele: Familiarity with the range of imaging features is important for accurate diagnosis and management of cystic pancreatic lesions. Korrespondierender Autor: Brambs HJ Universitatsklinikum Ulm, Klinik fur diagnostische und interventionelle Radiologie, Steinhovelstrase 9, 89075 Ulm E-Mail: hans-juergen.brambs@medizin.uni-ulm.de

MRI of the pancreas: tumours and tumour-simulating processes

The most important issues in pancreatic imaging are the detection and staging of pancreatic cancer, differentiation between cancer and focal pancreatitis, the characterization of cystic lesions and the search for neuroendocrine tumours. Magnetic resonance (MR) units (1.5 T) with strong gradients and a phased-array torso coil should be used, making breath-hold imaging possible in order to avoid motion artifacts. Standard imaging sequences are T1-weighted (T1w) gradient recalled-echo (GRE) with and without fat saturation. For T2-weighted (T2w) imaging, axial single-shot turbo spin-echo (TSE) and coronal/oblique MR cholangio-pancreatography (MRCP) pulse sequences are preferable. As contrast agents either gadolinium agents or mangafodipir trisodium are used. Dynamic gadolinium-enhanced T1w fatsat 3D GRE images are helpful to delineate vessel infiltration by adenocarcinoma and to assess the aetiology of cystic masses. Mangafodipir-enhanced MRI has been found to be superior to helical computed tomography (CT) in the detection of small cancers and in the delineation of liver metastases. In cases of an equivocal pancreatic mass the presence of the “duct penetrating sign” at MRCP (i.e., the duct traversing the mass) is suggestive of an inflammatory pseudotumour. Hypoattenuation due to focal fatty infiltration may mimic a tumour at CT, but in-phase and opposed-phased T1w imaging readily depicts the fat. Multi-detector CT has gained increasing popularity for pancreatic imaging because of the 3D visualization of the peripancreatic vessels. However, MR imaging is excellent in the delineation of small pancreatic tumours. Due to its superior soft tissue contrast, MR imaging is also the method of choice in the differential diagnosis between tumours and tumour-simulating conditions in patients with equivocal CT and to assess cystic lesions.