Contrast Substance Research Articles

Agreement between different eGFR equations in diagnosing contrast-induced acute kidney injury in patients undergoing elective coronary or peripheral angiography

Abstract Background In the present study, we aimed to compare CKD-EPI, MDRD, CKD-EPI creatinine-cystatin C equations and serum cystatin C and NGAL levels changes in assessing the occurrence of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary and peripheral angiography and to evaluate the agreement between the CKD-EPI formula and the other parameters. Methods A cross-sectional study was performed in patients hospitalized with stable coronary artery disease and/or peripheral vascular disease, who underwent diagnostic and/or therapeutic invasive angiography using iodinated contrast agents. Standard laboratory parameters, NGAL, cystatin C levels, and eGFR were evaluated at admission and 48 hours after contrast substances exposure. Results Per different proposed definitions for CI-AKI, 7 patients (17.5 %) had a more than > 0.3 mg/dl increase in serum creati-nine, 1 (2.5 %) had a > 25 % increase in serum cystatin C and 9 (22.5 %) had a > 25% increase in serum NGAL. The agreement between attributions based on CKD-EPI was excellent with MDRD (K coefficient 0.875), and modest with CKD-EPI creatinine-cystatin, which had also a modest agreement with MDRD (K coefficient 0.285). An increase in cystatinc C of more than 25% from baseline was not in concordance with a significant decrease in eGFR calculated with any equation, and the same was observed for NGAL. Conclusions In the present study, the performance of the CKD-EPI equation in diagnosing CI-AKI was not significantly better or worse than MDRD, CKD-EPI creatinine-cystatin, serum creatinine, NGAL or cystatin C increase.

Magnetic Hyperthermia in Glioblastoma Multiforme Treatment.

Glioblastoma multiforme (GBM) represents one of the most critical oncological diseases in neurological practice, being considered highly aggressive with a dismal prognosis. At a worldwide level, new therapeutic methods are continuously being researched. Magnetic hyperthermia (MHT) has been investigated for more than 30 years as a solution used as a single therapy or combined with others for glioma tumor assessment in preclinical and clinical studies. It is based on magnetic nanoparticles (MNPs) that are injected into the tumor, and, under the effect of an external alternating magnetic field, they produce heat with temperatures higher than 42 °C, which determines cancer cell death. It is well known that iron oxide nanoparticles have received FDA approval for anemia treatment and to be used as contrast substances in the medical imagining domain. Today, energetic, efficient MNPs are developed that are especially dedicated to MHT treatments. In this review, the subject's importance will be emphasized by specifying the number of patients with cancer worldwide, presenting the main features of GBM, and detailing the physical theory accompanying the MHT treatment. Then, synthesis routes for thermally efficient MNP manufacturing, strategies adopted in practice for increasing MHT heat performance, and significant in vitro and in vivo studies are presented. This review paper also includes combined cancer therapies, the main reasons for using these approaches with MHT, and important clinical studies on human subjects found in the literature. This review ends by describing the most critical challenges associated with MHT and future perspectives. It is concluded that MHT can be successfully and regularly applied as a treatment for GBM if specific improvements are made.

Unraveling the Enigma: Huntington’s Disease Masquerading as Treatment-Resistant Psychosis - A Case Study

IntroductionThis unusual case report unfolds a complex and emblematic scenario involving the diagnosis and management of a 46-year-old patient with treatment-resistant psychiatric symptoms, eventually revealing a significant association with Huntington’s Disease (HD). The initial presentation at Obregia Hospital featured early signs of psychosis, such as mood swings, social withdrawal, and mild cognitive impairment. Despite predominant treatment with atypical antipsychotics, significant improvements remained elusive.ObjectivesOur primary objectives were to document the intricate diagnostic journey, the challenges faced in managing the patient’s psychiatric symptoms, and the eventual revelation of an underlying neurological disorder, Huntington’s Disease. We aimed to emphasize the importance of a multidisciplinary approach to such complex cases.MethodsThe patient’s clinical course was closely monitored, and the Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of symptoms upon admission. The patient’s severe psychotic state led to involuntary hospitalization. Clinical observations pointing to an underlying neurological disorder prompted a neurology consultation and further investigations, including brain CT and MRI scans, but also genetic testing.ResultsThe CT scan revealed potential Huntington’s Disease evolution, while genetic testing confirmed the presence of the specific HTT mutation. Brain MRI with contrast substance highlighted characteristic Huntington’s Disease changes, such as cortical atrophy, necrosis, and substantial loss of brain tissue, particularly in the basal ganglia, cortical regions, and thalamic nuclei. The patient was hospitalized for nearly seven weeks, during which various psychiatric medications were trialed with limited success. However, a gradual increase of Trihexyphenidyl dosage, as well as a wash-up with saline solution and vitamin supplements (B1, B6, and C), was initiated. Subsequently, the introduction of oral haloperidol in gradually increasing doses led to significant improvements in psychiatric symptoms, dyskinesia, and overall functionality.ConclusionsThis complex case underscores the paramount importance of a multidisciplinary approach in diagnosing and managing patients with Huntington’s Disease and concurrent psychiatric symptoms. The revelation of a confirmed Huntington’s Disease diagnosis also necessitated genetic testing for the patient’s two adult children, with the son testing positive. This case illustrates the challenges of adapting treatment strategies continuously in such multifaceted scenarios and highlights the compelling need for a collaborative and integrative approach.Disclosure of InterestNone Declared

Kontrastlı BT'nin Karaciğer Lezyonlarının Karakterizasyonunda FDG PET'e Katkısı ve Kantitatif Etkileri

Background: The goals of this study was to evaluate the diagnostic capability of enhanced/unenhanced 18F-FDG-PET/CT scans for identifying primary-secondary liver malignancies in terms of size and localization, to decide the quantitative impact of contrast agent on the SUVmax values of liver lesions and normal liver tissue, and to assess the impact in SUVmax metrics following contrast substance administration. Materials and Methods: This was a prospective research that included patients with suspicious primary and secondary hepatic cancers. Patients had non-enhanced & enhanced regional PET/CT examinations. The dimen-sion, position, densities (HU), visually assessment outcome, and SUVmax values for all pathological lesions were recorded, as well as the HU and SUVmax data of normal hepatic tissue. Results: There were 97 liver lesions in total. Visually assessment outcome of lesions, the introduction of a contrast substance considerably enhanced the HU and SUVmax measurements for normal hepatic tissue. The HU measurements for lesions bigger than 1cm increased statistically significantly, as did the SUVmax levels of centralized lesions bigger than 1cm. The attenuation adjustment procedures, resulted in an average inaccuracy in computed SUVmax values at the ratio of %5 for normal liver tissue and %6 for all hepatic pathologies follow-ing the contrast substance delivery. Conclusions: The inclusion of contrast substance increases the identification, localization, and characterization of the liver lesions with PET/CT substantially.

Improving Chest Monitoring through Magnetic Resonance Angiogram Image Contrast Enhancement.

Magnetic resonance angiography is a medical procedure used to offer an image of the blood vessels and organs of the body. Given the worldwide spread of cardiovascular diseases, more and more resources are invested in treating them. One of the most modern treatments involves the acquisition of images of the heart. Sometimes the contrast of these images is not satisfactory. Injecting invasive enhancement substances to obtain a better view of the cardiac route is not advisable. However, software algorithms can solve the problem. This study proposes and tests a local adaptive contrast-adjustment algorithm using the dual-tree complex wavelet transform. The method has been tested with medical data from a public database to allow comparisons to other methods. The selected algorithm further improved the contrast of images. The performances are given for evaluation, both visually (to help doctors make accurate diagnoses) and in parametric form (to show engineers which parts of the algorithm might need improvement). Compared to other contrast enhancement methods, the proposed wavelet algorithm shows good results and greater stability. Thus, we aim to avoid future pointless complications due to unnecessary contrast substances.

The biophysical modelling of the medical devices in the field of biophysics

In medicine we live the period of enthusiastic use of the models that use, one way or the other, various devices created and invented on the basis of theoretical knowledge of biophysics. Further on we will deal with only three directions: ultrasound application, computer tomography and magnetic resonance. Currently, the widest field of application of the ultrasounds in medicine is the one of exploration and diagnostic. The computer tomography (CT) used X rays to perform detailed images of the structures of the organism. A part of the scanner can be tilted, which allows taking images of the studied are in various positions. The images are memorized in a computer. The images of the computer tomography scanner can be taken before or after the administration of the contrast substance. With the MRI examination, very small lesions (1-2 mm) can be detected and there is the possibility of Multiplan representation. In the case of medical investigations using MRI, the body of the patient is placed on a horizontal table along a very strong magnetic field and with a coil another type of radiofrequency is used which subsequently is recorded. The first uncertainty relation: Living organism cannot be studied in the space, at any small or big dimensions because at the level of those subsystems or extrasystems the characteristics of life disappear. The second uncertainty relation: Living organisms cannot be studied in time, at any long or short intervals, because at the level of these time values the living system do not have the characteristics of life.

#4901 THE EFFECT OF CHRONIC KIDNEY DISEASE IN CONTRAST-ENHANCED ULTRASONOGRAPHY WITH ARRIVAL TIME PARAMETRIC IMAGING

Abstract Background and Aims CEUS is a reliable method to diagnose ischemic renal pathologies such as infarction, identify renal abscesses, discriminate between renal tumors and anatomical variants, describe complex cyst lesions, and monitor non-surgical renal lesions. Few studies explore the relationship between CEUS and the diagnosis or progression of CKD. The aim of this study was to evaluate the relationship between contrast-enhanced ultrasonography with arrival time parametric imaging (CEUS-PAT) and CKD. Method We prospectively evaluated 64 subjects (37 liver cirrhosis patients and 27 healthy volunteers) using CEUS-PAT to detect if the presence of CKD influences the arrival time of the contrast in the kidney. CKD was defined according to KDIGO 2021 guidelines. Ultrasonography was performed using the LOGIQ E9 (GE Healthcare, Chalfont St.Giles-UK) system, probe C1-6. CEUS was performed on each subject using SonoVue (Bracco SpA, Milan, Italy) as a contrast agent (1/2 of a vial). A 2.5 mL contrast substance followed by a 5 mL normal saline solution was infused in the cubital vein. A ratio between the arrival time of the substance in the kidney and liver was calculated. Subjects were in fasting conditions for at least 12 h. Laboratory data were extracted from the patient's GP file. The study was conducted between January -December 2018. All patients provided their informed consent for the procedures. Results The study included 64 subjects, mean age of 58.98 ± 8.90 years, predominantly male gender (56.3%). Of the 64 patients, 13 (20.3%) had chronic kidney disease. All patients with chronic kidney disease had liver cirrhosis. When comparing the two groups, with and without CKD, there was a significant difference between the ratio of the arrival time of the contrast agent into the kidney and liver, 0.85 ± 0.09 vs 0.65 ± 0.19, p = 0.0005. The factors associated with kidney disease were liver steatosis (p<0.0001), age over 60 years (p = 0.01) and low albumin (p<0.0001). Conclusion Our study indicated that the presence of CKD influences the contrast agent arrival time in the kidney. Further studies are needed to establish the predictive significance of CEUS-PAT data in CKD patients.

CyTran: A cycle-consistent transformer with multi-level consistency for non-contrast to contrast CT translation

We propose a novel approach to translate unpaired contrast computed tomography (CT) scans to non-contrast CT scans and the other way around. Solving this task has two important applications: (i) to automatically generate contrast CT scans for patients for whom injecting contrast substance is not an option, and (ii) to enhance the alignment between contrast and non-contrast CT by reducing the differences induced by the contrast substance before registration.Our approach is based on cycle-consistent generative adversarial convolutional transformers, for short, CyTran. Our neural model can be trained on unpaired images, due to the integration of a multi-level cycle-consistency loss. Aside from the standard cycle-consistency loss applied at the image level, we propose to apply additional cycle-consistency losses between intermediate feature representations, which enforces the model to be cycle-consistent at multiple representations levels, leading to superior results. To deal with high-resolution images, we design a hybrid architecture based on convolutional and multi-head attention layers. In addition, we introduce a novel data set, Coltea-Lung-CT-100W, containing 100 3D triphasic lung CT scans (with a total of 37,290 images) collected from 100 female patients (there is one examination per patient). Each scan contains three phases (non-contrast, early portal venous, and late arterial), allowing us to perform experiments to compare our novel approach with state-of-the-art methods for image style transfer.Our empirical results show that CyTran outperforms all competing methods. Moreover, we show that CyTran can be employed as a preliminary step to improve a state-of-the-art medical image alignment method. We release our novel model and data set as open source at: https://github.com/ristea/cycle-transformer.Our qualitative and subjective human evaluations reveal that CyTran is the only approach that does not introduce visual artifacts during the translation process. We believe this is a key advantage in our application domain, where medical images need to precisely represent the scanned body parts.

Suture Failure of Duodenum after Surgery for Complications of Duodenal Ulcer

INTRODUCTION: The incidence of failure of intestinal sutures in the early postoperative period reaches 26%. The failure of the duodenal sutures leads to formation of high duodenal fistulas, the treatment of which is one of the most complicated surgical tasks. The article describes a clinical case of failure of duodenal suture after surgery for a duodenal ulcer complicated with bleeding. The failure of the duodenal suture could be provoked by hypoproteinemia and anemia, despite the attempts of their compensation. The presented case demonstrates complexity of the clinical course of this pathology and the possibility of successful application of draining surgery with creation of a controllable duodenal fistula, the subsequent healing of which led to recovery of the patient. To create the controllable duodenal fistula, we used a method of external-internal triple drainage of the duodenal zone (retrograde duodenostomy, gastroenteroanastomosis with a short loop, nasogastral probe). At the initial stage, after surgery, the patient received full parenteral feeding, after restoration of the intestinal peristalsis, feeding was continued through a nasointestinal probe. Infusion therapy, transfusion of blood components were conducted, drugs suppressing gastric and pancreatic secretion, were used. On the 35th postoperative day, the discharge through the duodenal fistula and the nasogastral probe significantly decreased, and completely stopped on the 54th day (immediately after X-ray of stomach with barium sulfate as contrast substance). The patient was discharged with improvement for outpatient follow-up at the place of residence on the 60th day after surgery. In the follow-up period no complaints, good appetite, rapid gaining of weight, complete rehabilitation. In one-year follow-up, no long-term complications and consequences for health were observed.
 CONCLUSION: A choice of the surgical treatment method of duodenal suture failure remains a subject of discussion. In the presented clinical case, draining surgery with creation of a controllable duodenal fistula proved to be effective. The complete closure of the residual fistula of the duodenum was facilitated by stomach X-ray with use of barium sulfate.

Simulating the impact of iodine as a contrast substance to enhance radiation to the tumor in a brain x-ray phototherapy

The influence of adding iodine as a contrast substance to elevate radiation in a tumor is studied using simulation techniques of Monte-Carlo. The study is carried on a brain cancer by adopting an unsophisticated head phantom. The ionizing radiation source is an external beam of x-rays with energy range of a few tens of keV. The expected radiation dose increment due to adding the iodine is investigated by comparing the radiation in the tumor after and before adding the iodine and calculating the ratio between the two doses. Several concentrations of the contrast substance are used to quantify its impact. The change of the dose increment with the source energy is also examined. It is found that the radiation elevation in the tumor tends to saturate with increasing the iodine concentration, and for the studied domain of energies (30 keV–100 keV), the radiation dose enhancement factors (RDEF) for the different iodine concentrations (1%–9%) show peaked curves, with the peak occurring between 60 keV and 70 keV. For the highest concentration studied, 9%, the peak value is almost 7.

Effect of Iodized contrast substances used in computed tomography examination on kidney apparent diffusion coefficient (ADC) value

Aim: In this prospective study, our goal is to evaluate the effect of iodine-based contrast agent on renal Apparent Diffusion Coefficient (ADC) before and after the contrast agent in patients with normal and abnormal Glomerulary Filtration Rate (GFR) values using computed tomography (CT) imaging.Methods: The patients who applied for CT examination at an age older than 40 years and met the inclusion criteria of patient and control groups were included. DWI was evaluated by two radiologist in the same session. The range of interest (ROI) was adjusted to be less than 1.5 cm².The Spearman correlation test was used for statistical analysis.Results: A total of 48 subjects (23 and 25 subjects for patient and control groups, respectively) with two DWI scans were included. ADC values were compared for both kidneys before and after the administration of the contrast agent and a significant decrease in post-ADC values was observed in the control group (right kidney pre-ADC: 2,11±0,17 x10ˉ³, post-ADC 2,07±0,15 x10ˉ³ mm²/s, p=0,016; left kidney pre-ADC: 2,11±0,17 x10ˉ³ mm²/s, post-ADC 2,04±0,14 x10ˉ³ mm²/s, p=0,011). However, there was no significant difference between the patient groups according to the administration of contrast agent (right kidney pre-ADC: 1,97±0,22 x10ˉ³ mm²/s, post-ADC: 1,97±0,24 x10ˉ³ mm²/s, p=0,95; left kidney pre-ADC: 1,96±0,23 x10ˉ³ mm²/s, post-ADC: 1,98±0,22 x10ˉ³ mm²/s, p=0,64). Moreover, pre-ADC values in the patient group were relatively low. Pre-ADC values in both groups for the right kidney were 1,97±0,22 x10ˉ³ mm²/s and 2,11±0,17 x10ˉ³ mm²/s, respectively (p=0,016). Pre ADC values in both groups for the left kidney were 1,96±0,23 x10ˉ³ mm²/s and 2,11±0,17 x10ˉ³ mm²/s, respectively (p=0,018). No significant differences in the post-ADC values were observed between the two groups.Conclusion: No decrease in ADC values was observed after the administration of iodine-based contrast agent in patients with a GFR less than 60, whereas there was a relatively high decrease in patients with normal GFR.

Colon Targeted Eudragit Coated Beads Loaded with Optimized Fluvastatin-Scorpion Venom Conjugate as a Potential Approach for Colon Cancer Therapy: In Vitro Anticancer Activity and In Vivo Colon Imaging

Preclinical studies suggest that most of statins or 3‑hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors possess pleiotropic anticancer activity. The aim of the present work was to investigate the conjugation of the statin fluvastatin (FLV) with scorpion venom (SV), a natural peptide with proven anticancer properties, to enhance FLV cytotoxic activity and prepare colon targeted FLV-SV nanoconjugate beads for management of colon cancer. Response surface design was applied for the optimization of FLV-SV nanoconjugates. FLV-SV particle size and zeta potential were selected as responses. Cytotoxicity of optimized FLV-SV nanoconjugates was carried out on Caco2 cell line. Colon targeted alginate coated Eudragit S100 (ES100) beads for the optimized formula were prepared with the utilization of barium sulfate (BaSO4) as radiopaque contrast substance. Results revealed that optimized FLV-SV nanoconjugates showed a size of 71.21 nm, while the zeta potential was equal to 29.13 mV. Caco2 cells were considerably more sensitive to the FLV-SV formula (half-maximal inhibitory concentration (IC50) = 11.91 µg/mL) compared to SV and FLV used individually, as shown by values of IC50 equal to 30.23 µg/mL and 47.68 µg/mL, respectively. In vivo imaging of colon targeted beads, carried out by employing real-time X-ray radiography, confirmed the efficiency of colon targeted beads. Overall our results indicate that the optimized FLV-SV nanoconjugate loaded alginate coated ES100 beads could represent a promising approach for colon cancer with efficient colon targeting ability.

In Vivo Contrast Imaging of Rat Heart with Carbon Dioxide Foam.

Widely used classical angiography with the use of iodine contrast agents is highly problematic, particularly in patients with diabetes mellitus, cardiac and pulmonary diseases, or degree III or IV renal insufficiency. Some patients may be susceptible to allergic reaction to the iodine contrast substance. The intravenous injection of a bolus of CO2 (negative contrast) is an alternative method, which is, however, currently only used for imaging blood vessels of the lower limbs. The aim of our project was to design and test on an animal model a methodology for injecting the CO2 foam which would minimize the possibility of embolization of the brain tissue and heart infarction, leading to their damage. This is important research for the further promotion of the use of CO2, which is increasingly important for endovascular diagnosis and treatment, because carbon-dioxide-related complications are extremely rare. CO2 foam was prepared by the rapid mixing in a 2:1 ratio of CO2 and fetal bovine serum (FBS)-enriched Dulbecco’s Modified Eagle Medium (DMEM). Freshly prepared CO2 foam was administered into the catheterized rat tail vein or cannulated rat abdominal aorta and inferior vena cava (IVC). CO2 foam was compared with commercially available microbubbles (lipid shell/gas core). The rat heart in its parasternal long axis was imaged in B-Mode and Non-linear Contrast Mode before/during and after the contrast administration. Samples of the brain, heart and lungs were collected and subjected to histological examination. The non-linear contrast imaging method enables the imaging of micron-sized gas microbubbles inside a rat heart. The significantly shorter lifetime of the prepared CO2 foam is a benefit for avoiding the local ischemia of tissues.

Tumori în pandemie: chistadenom mucinos de ovar gigant.

Tumors in the pandemic era: giant ovarian mucinous cystadenoma. Mucinous cystadenoma is a benign tumor of the ovary originating from the surface epithelium of the ovary, characterized by mucin production. They represent 10-15% of ovarian tumors. The borderline variety represents 10% of mucinous cystadenomas. They can reach very large sizes. We present the case of a patient, aged 65, hospitalized at the end of pandemics with a giant abdominal cystic tumor (diameter 40 cm) with compression disorders. He had a subtotal hysterectomy for uterine fibroids at the age of 25. Laboratory tests are within normal limits except CA19-9 = 398 IU / ml. Abdomino-pelvic ultrasound shows a mid-abdominal liquid formation, inhomogeneous with septa inside that exceeds 30 cm. CT with the contrast substance highlights a multiloculated formation, developed from the left ovary to with iodophilic septa, with mass effect on anatomical elements, with overall dimensions of approx. 230/300/350 mm. With the suspicion of a giant left ovarian cyst suspected of being malignant, a median xipho-umbilical laparotomy was performed and a giant cystic tumor of the left ovary weighing 13 kg, reaching the supramesocolic floor without adhesions, with an ovarian pedicle one cm thick, was removed. Anexectomy was performed on the right side without complications. The postoperative evolution was simple. Histopathological examination determined the diagnosis of borderline mucinous cystadenoma. The epidemiology, clinical signs and imaging diagnosis and surgical treatment of these rare tumors with favorable evolution are discussed.

Contrast enhanced endoscopic ultrasound in the diagnosis of pancreatic metastases.

Less than 5% of pancreatic masses represent metastases and differentiation from primitive tumors using endo-scopic ultrasound (EUS) is difficult. The aim of our work was to assess the diagnostic value of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) for pancreatic metastases. We retrospectively analyzed patients with pancreatic metastasis identified during a 8 year period in a tertiary medical center. We included in the study 20 patients evaluated with EUS and CH-EUS. The primary tumor was localized in the kidney (6 cases), lung (5 cases), colon (3 cases), skin (2 patients) and stomach, breast, ovary and liver (1 patient each). Only 11 patients (55%) (kidney, lung, liver, ovary or skin metastases), presented hypervascularity at EUS and arterial hyperenhancement on CH-EUS, with similar diag-nostic value. All renal metastases were hyperenhanced (the negative predictive value 100%) and the stomach, colon and ovary metastases were hypoenhanced. The fast wash-out of contrast substance was encountered in all cases or renal, pulmonary and digestive metastases, but with 53.3-64.3% specificity for the different origin of pancreatic metastases. The vascularity assessments on conventional EUS or CH-EUS are similar for pancreatic metastases of different origin. EUS tissue acquisition remains mandatory for the diagnosis.

Body and tail pancreatic tumor – A rare location: A case report

This case report focuses on the body and tail pancreatic tumor, one of the rarest locations of a tumor. We describe an interesting case of thirty-year-old women from a rural region presenting with a giant and a life-threatening pancreatic tumor. The information obtained from the patient revealed a modification of the women’s general condition from the previous two weeks – she presented with fatigue, diffused abdominal pain in the upper abdominal floor, and general condition slightly influenced. X-ray Computed Tomography Scan (CT scan) with contrast substance (contrast-enhanced Computed Tomography (CT) scan) and Magnetic Resonance Imaging (MRI) both indicate an intense pancreatic body and tail tumor vascularization, well-delimited, solid, with several necrotic areas in the interior, hyper capture in arterial time in the solid portion and wash-out in the portal and parenchymal time, with a size of 6.82 /4.74/6.3 centimeters - T3N0M0, II-A stage. During the surgery, a tumor of approximately 10/7/4.3 centimeters, of firm consistency, irregular shape, encapsulated, lining the posterior gastric face was discovered in the body and tail of the pancreas. On palpation, no adenopathy was detected, and the rest of the abdominal organs have a normal macroscopic appearance. The splenic artery and vein adhere intimately to the tumor and are separated after careful dissection. Subsequently, the splenic hilum is identified, the caudal splenopancreatectomy is decided, performed, and successfully managed.

Saline infusion sonohysterography in endometrial exploration

Contrast substances have been an extremely important addition in the ultrasonographic examination of the female internal genital organs. Saline infusion sonohysterography consists of the transcervical instillation of fluid into the uterine cavity to improve endometrial visualization while performing a transvaginal ultrasound evaluation. Therefore, benign endometrial pathology such as hyperplasia, but most of all focal lesions like polyps, leiomyomas, or adhesions, as well as suspected malignant pathology such as endometrial cancer, can be better assessed during ultrasound examination. Saline infusion sonohysterography is an important tool for avoiding unnecessary biopsies in postmenopausal women with an apparent thicker endometrium; for women of fertile age, saline infusion sonohysterography can be used to select those females who require further therapeutic procedures, especially in infertility, caused by endometrial pathology. Sonohysterography is very well tolerated by patients, has a minimum degree of discomfort, can be performed without hospitalization and can be easily performed at a reduced cost.

One stop shop approach for the diagnosis of liver hemangioma.

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.

The importance of Nuclear Magnetic Resonance (MRI) in the diagnosis of cerebral cavernomas

Introduction: Cavernomas are one of the four types of vascular malformations which develop in the central nervous system. From an imaging point of view, they are low flow small vessel malformations that cannot be seen on conventional angiography and are rarely visible on CT. They can be seen on MRI because of the para-magnetic haemoglobin break-down products within them.
 Case presentation: A 35 years old male presented at the emergency room following a tonic-clonic seizure, without urine emission. After a clinical exam, it was decided to perform a cerebral MRI with contrast substance and angiographic sequence. Clinical and imagistic results showed a superficial left temporal cavernoma, which showed signs of recent bleeding. After the surgery, the patient has no neurological deficits and is discharged afebrile and without any other symptoms. At 6 weeks after the surgery, the patients returned for neurosurgical reevaluation in perfect neurological condition, without motor deficit or intracranial hypertension.
 Conclusions: Cavernomas are angiographic cryptic vascular lesions that need an MRI investigation in order to appreciate them correctly.

Radiological features of the intracranial extra-skeletal mesenchymal chondrosarcoma

Background: Mesenchymal chondrosarcomas are the most malignant form of chondrosarcomas. They have mostly affected bones. Rarely, these tumors can be intracranial extraskeletal (IEMC) that originates from the meninges or parenchyma.
 Methods and Materials: We presented two IEMC patients who were treated at our institutions and followed up for the long-term. To understand the radiological features of IEMC, we conducted a systematic literature review for previously reported series and cases of IEMCs.
 Results: We surgically treated two young males with IEMC initially diagnosed at their age of 18 and 20 years. The patients initially treated with gross total resection (GTR) and GTR followed by radiotherapy, and followed-up for 218 and 73 months, respectively. With both patients, we obtained 83 reported IEMC patients from the literature. Among them, only 30 cases were reported with their radiological MRI details. The mean age of the reported cases was 24.5±16.0 years (2 months–71 years). Female predominance was 54.2%. The mean progression-free and overall survivals were 27.9 and 39.0 months, respectively. Most IEMCs showed a partially calcified mass on roentgenography and a highly vascular mass on angiography. On T1WIs, IEMCs almost show hypo- to isointensity and intense heterogeneous enhancement after administering a contrast substance. On T2WIs, IEMCs show iso- to hyperintensity.
 Conclusions: IEMCs usually show dural attachment without a net dural tail sign and a well-identified brimmed vascular nodule on TOF-MRA. This nodule appears as a prominent blooming on SWI. TOF-MRA and SWI images can help in the radiological diagnosis of IEMCs.