Enhanced CT Scan Research Articles

Utilization of Radiomics to Predict Radiation Associated Cardiovascular Morbidity in Lung SBRT

<h3>Purpose/Objective(s)</h3> SBRT for early lung cancers is now considered standard of care for some patients, but there is increasing evidence linking long-term cardiac toxicity with cardiovascular dose. While the dose constraints for aortic radiation exposure are still unclear, there is accumulating data that higher aortic doses can be associated with mortality. Our study explores the link between central thoracic radiation and early radiomic changes, determining if these radiomic changes are associated with relevant cardiovascular toxicity. This information will allow us to identify the most relevant dosing information for a variety of central thoracic organs in predicting cardiovascular toxicity from SBRT to lung. <h3>Materials/Methods</h3> We analyzed 27 patients who received SBRT to lung tumors with curative intent. Pretreatment and post treatment contrast enhanced diagnostic CT scans were accessed. The following structures were manually contoured by a medical student and reviewed by an MD: aorta, vena cava, pulmonary artery, heart, L atrium, R atrium, L ventricle, R Ventricle, and septum. For this analysis, the aorta was divided in to 10 equal sections along the inferior/superior direction. 1) 168 radiomic features were extracted for each section of the aorta wall for all 27 patients. (Mean value /standard deviation >10) between patients was used as a criterion to determine the useful and stable features. 2) dose dependent aortic wall volumes for 26 pre and post (up to 4.5 years post) treatment contrast enhanced CT scans were evaluated for the radiomic feature changes with dose. <h3>Results</h3> 1) Only 13 radiomic features were deemed stable according to our radiomic feature analysis between patients across all 10 sections of the aortic wall. These include 4 Gray-Level Co-occurrence Matrix (GLCM) features, 1 Gray Level Dependence Matrix (GLDM) feature, 5 Gray-Level Run-Length Matrix (GLRLM) features, and 3 Gray Level Size Zone Matrix (GLSZM) feature. 2) Early results indicate that no statistically significant radiomic changes of these 13 parameters were observed post SBRT to lung up to 4.5 years even with a dose of 55 Gy to the aorta. These observations were confirmed by the patient's clinical status. <h3>Conclusion</h3> Preliminary analysis suggests that radiomic features for contrast enhanced CTs could be used to evaluate the absence of radiation damage to cardiovascular structures.

The value of a nomogram based on clinical data and contrast enhanced CT radiomics in the preoperative prediction of Epstein-Barr virus-associated gastric carcinoma

Objective: To explore the value of a nomogram based on clinical data and enhanced CT radiomics in the prediction of Epstein-Barr virus-associated gastric carcinoma(EBVaGC). Methods: The data of 136 patients, including 100 males and 36 females, aged [M (Q1, Q3)] 65 (53, 71) years, with gastric cancer confirmed by surgery and pathology were retrospectively analyzed. According to Epstein-Barr virus-encoded small RNA (EBER) in situ hybridization, those patients were divided into Epstein-Barr virus (EBV) positive group (n=32) and EBV negative group (n=104). All patients underwent multi-phase enhanced CT scanning before surgery and randomly assigned to the training group (n=95) and validation group (n=41) in a ratio of 7︰3. MaZda software was used to extract radiomics features of enhanced CT images. The intra-group correlation coefficient (ICC), variance analysis and minimum absolute shrinkage and selection algorithm (LASSO) regression were used to reduce the dimensionality of the radiomics features, and then the radiomics score (Radscore) was calculated. The nomogram model was based on combined clinical data, morphological features and Radscore. The predictive power of the nomogram was evaluated according to the area under the receiver operating characteristic curve (AUC), and the net clinical benefit of the nomogram was evaluated by the decision curve and calibration curves were drawn according to the data of the training group and the validation group to analyze the consistency of the nomogram model. Results: After selection, six optimal radiomics features were obtained, including Mean, Skewness, S(1, 0) Sum entropy, S(1, 1) Contrast, 99% percentile and S(2, 2)Angular second moment. Radscore of EBV positive group were higher than that of the EBV negative group (training group: 3.78±0.83 vs 2.80±0.98; validation group: 3.81±0.47 vs 2.94±0.95) (both P<0.05) both in the training group and validation group. The AUC of the radiomics model in training group and validation group were 0.773(95%CI:0.612-0.962)and 0.792(95%CI:0.597-0.927)respectively,and the sensitivity and specificity were 63.6% and 93.1%, 70.0% and 87.1%, respectively. The AUC of the nomogram model based on clinical data and radiomics in the training group and the validation group were 0.883(95%CI:0.644-0.984) and 0.851(95%CI:0.715-0.996), respectively. The nomogram model showed superior predictive performance (both P<0.05). Conclusion: The nomogram model based on clinical data and radiomics has better efficacy in the prediction of Epstein-Barr virus associated gastric cancer.

Spectral CT for preoperative prediction of lymphovascular invasion in resectable gastric cancer: With external prospective validation.

ObjectivesTo develop and externally validate a spectral CT based nomogram for the preoperative prediction of LVI in patients with resectable GC.MethodsThe two centered study contained a retrospective primary dataset of 224 pathologically confirmed gastric adenocarcinomas (161 males, 63 females; mean age: 60.57 ± 10.81 years, range: 20-86 years) and an external prospective validation dataset from the second hospital (77 males and 35 females; mean age, 61.05 ± 10.51 years, range, 31 to 86 years). Triple-phase enhanced CT scans with gemstone spectral imaging mode were performed within one week before surgery. The clinicopathological characteristics were collected, the iodine concentration (IC) of the primary tumours at arterial phase (AP), venous phase (VP), and delayed phase (DP) were measured and then normalized to aorta (nICs). Univariable analysis was used to compare the differences of clinicopathological and IC values between LVI positive and negative groups. Independent predictors for LVI were screened by multivariable logistic regression analysis in primary dataset and used to develop a nomogram, and its performance was evaluated by using ROC analysis and tested in validation dataset. Its clinical use was evaluated by decision curve analysis (DCA).ResultsTumor thickness, Borrmann classification, CT reported lymph node (LN) status and nICDP were independent predictors for LVI, and the nomogram based on these indicators was significantly associated with LVI (P<0.001). It yielded an AUC of 0.825 (95% confidence interval [95% CI], 0.769-0.872) and 0.802 (95% CI, 0.716-0.871) in primary and validation datasets (all P<0.05), with promising clinical utility by DCA.ConclusionThis study presented a dual energy CT quantification based nomogram, which enables preferable preoperative individualized prediction of LVI in patients with GC.

S2900 Abdominal Lymphadenopathy from AL Amyloidosis Diagnosed via Endoscopic Ultrasound

Introduction: Amyloidosis refers to extracellular tissue deposition of protein fibrils which can affect a variety of organ systems. AL (primary) amyloidosis is a disease caused by the deposition of immunoglobulin light chain fragments and often occurs in the setting of an underlying plasma cell dyscrasia. We describe the diagnosis of AL amyloidosis manifesting as diffuse lymphadenopathy via the use of endoscopic ultrasound (EUS)-guided biopsy. Case Description/Methods: A 66-year-old African American female presented with complaints of fatigue and enlarged cervical lymph nodes. No associated weight loss or night sweats was reported. Past medical history was significant for metabolic syndrome and anxiety. Comprehensive work-up, including flow cytometry and tumor markers, was unremarkable. A contrast enhanced CT scan of the neck, chest, abdomen and pelvis showed mediastinal and peripancreatic lymphadenopathy (largest diameter of 20-mm). An endoscopic ultrasound (EUS) showed few round hypoechoic peri-pancreatic/aortocaval lymph nodes. Fine needle biopsy (FNB) was performed with a 22-gauge needle using a trans-gastric approach. Cytopathologic examination revealed abundant lymphocytes, and cell block showed hyalinized eosinophilic fragments which showed strong Congophilia with focal apple-green birefringence on Congo-red stain consistent with amyloidosis. Liquid chromatography tandem mass spectrometry was performed on peptides extracted from Congo red positive areas of the sample via microdissection and a peptide profile consistent with AL (kappa)-type amyloid deposition was identified. Patient is undergoing workup for an underlying plasma cell dyscrasia and for sites of end organ involvement. (Figure) Discussion: Amyloidosis is a systemic disease which affects many organs, but rarely presents as abdominal lymphadenopathy. EUS-FNB is an important diagnostic modality that allows for tissue diagnosis of Amyloidosis and ruling out malignancy. Our patient presented with diffuse lymphadenopathy, and tissue obtained from a lymph node sampled via EUS-FNB led to the diagnosis of AL amyloidosis.Figure 1.: EUS images demonstrating FNB of an intraabdominal lymph node

Hysterectomy in Local Recurrent Carcinoma Cervix following Concurrent Chemoradiaton

Concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer. However, residual or subsequent local recurrence is 10 to 30%. Several studies have reported the usefulness of salvage simple total hysterectomy, and efforts have been made to reduce complications. This is a case report of 64 years para 5 postmenopausal lady diagnosed as squamous cell carcinoma of cervix stage II B, had received concurrent chemoradiation. After 6 weeks of its completion, MRI revealed no residual disease. However, 6 months of no residual, USG and MRI revealed cervical lesion. With the suspicion of local recurrence, patient underwent total abdominal hysterectomy with bilateral salpingo-ophorectomy. She developed wound infection and per rectal bleeding which were treated. During her subsequent follow up visit, vault smear was negative and enhanced CT scan revealed no recurrence.

Proceedings of the 28th European Paediatric Rheumatology Congress (PReS 2022)

Proceedings of the 28th European Paediatric Rheumatology Congress (PReS 2022)

A case of laparoscopic distal gastrectomy and median arcuate ligament release for a gastric cancer patient with median arcuate ligament syndrome

BackgroundThe median arcuate ligament syndrome (MALS) is a disease in which the celiac artery is compressed by the arcuate ligament and causes stenosis. If abdominal pain or an aneurysm is observed in the head of the pancreas, it is necessary to release the arcuate ligament, and recently laparoscopic surgery has been reported. However, the indication for treatment in asymptomatic cases is unknown. The treatment for asymptomatic MALS in patients with gastric cancer who are indicated for surgery is also novel.Case presentationA 70-year-old female was found with early gastric cancer in the middle body of the stomach. An enhanced CT scan showed no metastasis, but a gallstone and stenosis of the celiac artery due to the MALS were found. The patient underwent releasing median arcuate ligament after lymph node dissection. A median arcuate ligament was located on the ventral side of the left gastric artery stump, and the celiac artery was exposed when cutting it off. The operation time was 4 h and 59 min, and the bleeding was 6 ml. It took about 5 min to dissect the medial arcuate ligament. The postoperative course was satisfactory, and the patient was discharged 7 days after the operation. CT scan and 3-D CT angiography were performed about 2 months after the operation, and the findings revealed that the celiac artery's stenosis resolved.ConclusionThe patient underwent laparoscopic gastrectomy and simultaneously the median arcuate ligament release under an excellent visual field. Therefore, median arcuate ligament release may be considered if MALS is found in a gastrectomy case.

Primary hepatic neuroendocrine tumor with sarcoid like granulomas: A case report

Primary hepatic neuroendocrine tumor (PHNET) is a rare entity comprising 0.3% of all neuroendocrine tumors. Tumors coexisting with granulomas are occasionally noted with malignancies in the lymph nodes draining the tumor or within the primary tumor itself. Tumor-related sarcoid reactions are noted only in carcinomas and its association with a NET has been extremely rare.: We report a case of PHNET in a 63-year male who presented with various comorbidities who was incidentally detected with a liver space-occupying lesion (SOL). Contrast enhanced CT scan of the abdomen revealed a well-defined exophytic mass in the liver involving segment 6. Subsequently, 68Ga DOTANOC PET/CT scanning revealed somatostatin receptor-expressing well-defined lesion measuring 5.1 x 5.0 cm in segment 6 (SUV MAX 19). A diagnosis of either a primary or a metastatic neuroendocrine tumor was made and non-anatomical wedge resection of the tumor was done with a detailed exploration of the abdominal cavity to look for a primary focus that did not reveal any other lesion or mass. Histologically, the tumor was confirmed to be a Neuroendocrine Tumor along with the presence of tumor-related sarcoid like granulomas in the adjoining hepatic parenchyma.: Diagnosis of a PHNET requires a combination of a negative abdominal survey at the time of the operative procedure, pathologic evaluation of specimen, and a negative imaging workup for extrahepatic NET in both the pre and postoperative settings.

Management of Tracheal Stent Granulations: A Novel Approach

This is a case of a 29 year old female, diagnosed with adenoid cystic carcinoma of trachea who had previously undergone bronchoscopy, de-bulking of the tumour, stenting of trachea with a metallic stent followed by a course of chemo-radiotherapy. She then presented to our hospital with complaints of breathing difficulty. On rigid telescopy of larynx, a metallic stent was visualised below the level of the vocal cords with a mass lesion over it narrowing the airway. Contrast enhanced CT scan of neck and thorax showed a tracheal stent with soft tissue thickening at proximal and distal ends. By using VV-ECMO, in this patient we were able to perform satisfactory airway evaluation, biopsy of mass at upper and lower end of tracheal stent using a rigid bronchoscope with Hopkins telescope and optical forceps and KTP laser assisted excision of granulation tissue with full endoscopic visualisation and without any complications.

CHRONIC MYELOID LEUKEMIA IN A PATIENT WITH ABDOMINAL COCOON SYNDROME: A RARE CLINICAL PRESENTATION

Described for the rst time almost a century ago, Sclerosing Encapsulating Peritonitis (SEP) is characterized by development of membrane like structure around abdominal viscera, especially small bowel. It is a recognized, rare cause of intestinal obstruction. Though several malignancies have been described as risk factors for SEP, contribution of these are on the lower side and most of these are abdominal malignancies if not all. Association of leukemias or lymphomas with SEP could not be found in literature. Our patient is an 18-year-old boy, who presented with complaints of abdominal pain and vomiting. He was managed conservatively, and relevant blood investigations and imaging was done. Ultrasound of abdomen and subsequent Contrast Enhanced CT scan of abdomen conrmed SEP, whereas blood investigations conrmed diagnosis of Chronic Myeloid Leukemia. Chronic myeloid leukemia predominantly occurs in elderly males with mean age of 65 or more. CML in young patient is a rare occurrence, that coupled with occurrence of SEP makes this case unique.

Image Features of Dynamic Enhanced Computed Tomography Scanning Combined with Digestive Endoscopy in the Treatment of Gastroesophageal Varices and Nursing of Esophagogastric Gastric Varices Bleeding.

The objective of this study was to investigate the application of dynamic contrast-enhanced CT images in the nursing of patients with gastroesophageal varices (GOV) treated by digestive endoscopy and its role in relieving bleeding symptoms. A total of 60 patients with liver cirrhosis and GOV were selected as the research objects. According to whether CT was used to evaluate the position of tissue adhesion embolism, the patients were divided into the control group (24 cases) and the observation group (36 cases). The treatment effect and bleeding situation of patients in the two groups were analyzed and compared. The results showed that the main portal vein pressure (17.24 ± 1.02 cmH2O), liver function recovery effect (2.84 ± 0.45 points), and total effective rate (100%) in observation group were better than those in control group (9.70 ± 1.22 cmH2O, 0.95 ± 0.72 points, and 79.17%, respectively) (P < 0.05). In addition, the bleeding rate in observation group (0%) was significantly lower than that in control group (16.67%) (P < 0.05). In conclusion, dynamically enhanced CT scan images combined with digestive endoscopy can help improve the therapeutic effect of GOV and reduce postoperative bleeding, which was worthy of clinical application and promotion.

Construction of a Nomogram Model for Predicting Peritoneal Dissemination in Gastric Cancer Based on Clinicopathologic Features and Preoperative Serum Tumor Markers.

BackgroundPeritoneal dissemination (PD) is the most common mode of metastasis for advanced gastric cancer (GC) with poor prognosis. It is of great significance to accurately predict preoperative PD and develop optimal treatment strategies for GC patients. Our study assessed the diagnostic potential of serum tumor markers and clinicopathologic features, to improve the accuracy of predicting the presence of PD in GC patients.MethodsIn our study, 1264 patients with GC at Fudan University Shanghai Cancer Center and Wenzhou people’s hospital from 2018 to 2020 were retrospectively analyzed, including 316 cases of PD and 948 cases without PD. All patients underwent enhanced CT scan or magnetic resonance imaging (MRI) before surgery and treatment. Clinicopathological features, including tumor diameter and tumor stage (depth of tumor invasion, nearby lymph node metastasis and distant metastasis), were obtained by imaging examination. The independent risk factors for PD were screened through univariate and multivariate logistic regression analyses, and the results were expressed with 95% confidence intervals (CIs). A model of PD diagnosis and prediction was established by using Cox proportional hazards regression model of training set. Furthermore, the accuracy of the prediction model was verified by ROC curve and calibration plots.ResultsUnivariate analysis showed that PD in GC was significantly related to tumor diameter (odds ratio (OR)=12.06, p<0.0006), depth of invasion (OR=14.55, p<0.0001), lymph node metastases (OR=5.89, p<0.0001), carcinoembryonic antigen (CEA) (OR=2.50, p<0.0001), CA125 (OR=11.46, p<0.0001), CA72-4 (OR=4.09, p<0.0001), CA19-9 (OR=2.74, p<0.0001), CA50 (OR=5.20, p<0.0001) and CA242 (OR=3.83, p<0.0001). Multivariate analysis revealed that clinical invasion depth and serum marker of CA125 and CA72-4 were independent risk factors for PD. The prediction model was established based on the risk factors using the R program. The area under the curve (AUC) of the receiver operating characteristics (ROC) was 0.931 (95% CI: 0.900–0.960), with the accuracy, sensitivity and specificity values of 90.5%, 86.2% and 82.2%, respectively.ConclusionThe nomogram model constructed using CA125, CA72-4 and depth of invasion increases the accuracy and sensitivity in predicting the incidence of PD in GC patients and can be used as an important tool for preoperative diagnosis.

Diagnostic Value of Spiral CT and Magnetic Resonance Imaging Scanning in Gastric Cancer and Precancerous Lesions.

In order to explore the diagnostic value of spiral CT and magnetic resonance imaging scanning in gastric cancer and precancerous lesions, the author selected 56 gastric cancer patients treated in a medical center (group) as the experimental subjects, and all patients underwent MRI, multislice spiral CT scan, and enhanced CT scan two weeks before surgery; at the same time, the gastric cancer staging results of patients were diagnosed according to surgical pathology. All patients were examined under the condition of knowledge and performed breath-holding exercise before examination. The status, location, and extent of tumor lesions were evaluated. In comparison of T staging of gastric cancer patients with magnetic resonance scanning imaging and postoperative pathological examination results, among them, T staging of 3 patients did not match the results of pathological examination, the accuracy rates of T staging on magnetic resonance scanning imaging were T1 = 94.7%, T2 = 87.6%, T3 = 91.2%, and T4 = 94.7%, and the total accuracy was 92.1%. Comparison of helical CT scan imaging and postoperative pathological examination results is as follows. Among them, T staging of 8 patients did not match the results of pathological examination, 3 patients were ulcerative, 5 were protuberance, the accuracy rates of T staging in spiral CT scan imaging were T1 = 90.8%, T2 = 82.2%, T3 = 76.9%, and T4 = 87.6%, and the total accuracy was 84.5%. The total accuracy rate of imaging N staging was 77.5%, and the total accuracy rate of spiral CT scanning imaging N staging was 80.8%. The accuracy rates of M0 and M1 staging in magnetic resonance imaging were 100.0% and 96.5%, respectively, and the accuracy rates of M0 and M1 staging in spiral CT scan imaging were 96.5% and 96.5%, respectively. The accuracy rate of magnetic resonance imaging for the diagnosis of gastric cancer N staging was 77.4%, and the reason for the low accuracy rate was mainly because the enhancement effect was not obvious due to insufficient enhancement. The accuracy rate of spiral CT in diagnosing N staging of gastric cancer was 80.9%, which was mainly due to the small diameter of the middle celiac artery lymph nodes. Magnetic resonance and spiral CT scans have high value in the early diagnosis and staging of gastric cancer.

The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single-Phase and Dual-Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation.

Objective The accuracy of left atrial pulmonary vein CT enhanced single-phase and dual-phase scanning in the detection of left atrial appendage (LAA) thrombosis and spontaneous echo contrast (SEC) before radio frequency ablation was compared in atrial fibrillation patients, so as to optimize the scanning scheme. Methods 78 patients with atrial fibrillation who were admitted to Cangzhou Central Hospital from October 2020 to September 2021 and underwent bilateral enhanced CT scan of left atrial pulmonary vein and transesophageal echocardiography (TEE) examination for planned frequency ablation were selected. TEE results were used as the “gold standard” to compare the diagnostic efficacy of the first phase, second phase, and double-phase comprehensive mode of enhanced left atrial pulmonary vein CT in detecting left atrial thrombosis and SEC. Results The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the first phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 22.2%, 98.6%, 66.6%, and 90.7%, respectively, in the detection of left atrial thrombosis and SEC by the second phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the double-phase comprehensive mode of CT enhanced scan. There was no statistically significant difference in the accuracy of CT diagnosis of left atrial appendage thrombosis and SEC between the three modes of the first phase, the second phase, and the double-phase comprehensive CT (P > 0.05). The mean effective radiation dose of double-phase enhanced scan was 7.49 ± 1.02 mSv. Conclusion Single-phase enhanced CT scan of left atrial pulmonary vein can meet clinical requirements and significantly reduce the radiation dose compared with double-phase enhanced CT scan. Therefore, it is recommended as an initial screening examination for patients with atrial fibrillation before radiofrequency ablation.

Liver transplantation for metastatic non-resectable gastrointestinal stromal tumor after molecular targeted therapies: A case report.

Introduction and importanceMetastatic GIST (gastrointestinal stromal tumor) is most commonly seen in the liver. Surgical resection and Imatinib administration are the preferred treatment for localized and potentially resectable GIST. However, it is still a matter of debate about the optimal therapeutic management for unresectable, liver-confined, metastatic GIST even after the administration of imatinib. The present case illustrates the possibility of LT surgery maybe for unresectable GIST.Case presentationA 56-year-old man revealed clinical symptoms such as abdominal pain, eating little, fullness of abdomen, and fatigue. A 6.0 cm tumor in the fundus of the stomach was found by gastroscopy, which was confirmed to be GIST by pathological biopsy and molecular testing. Abdominal enhanced CT scanning showed multiple hepatic mass occupying synchronous. Then the patient initiated on targeted drug therapy of Imatinib (400 mg daily). A year later, a follow-up abdominal enhanced CT scanning showed that no tumor was found in the gastric fundus except the thickened gastric wall with poor dilatation, and the liver tumors were significantly smaller than before. When the patient showed symptoms of drug resistance, he was refered to our hospital for LT. The surgery was very successful, and the patient is disease-free and there is no evidence of recurrence until the paper was finished.Discussion and conclusionMetastatic GIST to the whole liver is a rare clinical entity requiring unique considerations for treatment. Treatment based on LT might be the last resort therapy for unresectable, liver-confined, metastatic GIST in transplant oncology.

V10-06 ROBOTIZED 3D LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RIGHT RENAL MIDPOLE MASS LESION

You have accessJournal of UrologyCME1 May 2022V10-06 ROBOTIZED 3D LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RIGHT RENAL MIDPOLE MASS LESION Krishna mohan Ramaswami, Pankaj Bhirud, and Harigovind Podiyedath Krishna mohan RamaswamiKrishna mohan Ramaswami More articles by this author , Pankaj BhirudPankaj Bhirud More articles by this author , and Harigovind PodiyedathHarigovind Podiyedath More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique using Robotized 3 dimension laparoscopic approach for nephron sparing surgery.Oncological principle, organ preservation and maximum comfort to the surgeon while doing this complicated surgery which involves precise excision of mass and reconstruction was the aim. METHODS: Forty two years old male patient presented with incidentally detected Right renal mass lesion. He was evaluated with contrast enhanced CT scan of abdomen and found to have right renal midpole mass lesion, features suggestive of renal cell carcinoma. Patient was planned for robotized 3D laparoscopic partial nephrectomy. Four ports transperitoneal approach was made. Right kidney was exposed. Gerota’s fascia was opened and all perinephric fat was removed exposing the parenchyma preserving the fat over tumor site. Renal artery was secured with vascular loop. Partial nephrectomy was done ensuring gross tumor free margin status with robotized scissors. The 360 degree rotation and various angular movement of scissors which was controlled from switches in ergonomic robotic handle which was hassle free and precise. Renorrhapy done with V-LOC continuous suture using Robotized needle holder with same features of scissors gave a perfect renorrhaphy and pressure maintenance by haemolock clips. No stent was placed. Kidney was covered with perinephric fat. The specimen was kept in the bag and retrieved out after extending the port incision. Peritoneal toileting done and drain placed. RESULTS: Operative time was 68minutes and ischemic time was 24 minutes. Blood loss was minimal. Oral intake was started on post operative day 1 and hospital stay was 4 days. There were no intraoperative and postoperative complications. CONCLUSIONS: Robotized 3 Dimension laparoscopy is feasible at an affordable cost with good oncological outcome, nephron preservation with maximum comfort to the surgeon and minimal morbidity to patient. Robotized laparoscopic suturing is faster compared to conventional methods allowing least ischemic time. Source of Funding: Self © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e850 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Krishna mohan Ramaswami More articles by this author Pankaj Bhirud More articles by this author Harigovind Podiyedath More articles by this author Expand All Advertisement PDF DownloadLoading ...

A rare case of malignant pancreatic non-functional neuroendocrine tumor presenting as huge abdominal lump

We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor (PNET) in a young female. The tumor occupied the whole abdomen and pelvis and was clinically masqueraded as an ovarian tumor. Imaging with contrast enhanced CT scan and magnetic resonance imaging of the abdomen aided in preoperative diagnosis of origin of the tumor from the pancreas. Distal pancreatectomy with splenectomy and left hemicolectomy was done. Primary colocolic anastomosis was done for reconstruction. Postop course was uneventful, and patient was discharged with advice to undergo adjuvant chemotherapy. Surgical excision of large size locally advanced non-functional PNET should be done with curative intention/ to treat symptoms and improve patient survival

Application of frozen Thiel-embalmed specimens for radiotherapy delineation guideline development: amethod to create accurate MRI-enhanced CT datasets.

Thiel embalming followed by freezing in the desired position and acquiring CT + MRI scans is expected to be the ideal approach to obtain accurate, enhanced CT data for delineation guideline development. The effect of Thiel embalming and freezing on MRI image quality is not known. This study evaluates the above-described process to obtain enhanced CT datasets, focusing on the integration of MRI data obtained from frozen, Thiel-embalmed specimens. Three Thiel-embalmed specimens were frozen in prone crawl position and MRI scanning protocols were evaluated based on contrast detail and structural conformity between 3Drenderings from corresponding structures, segmented on corresponding MRI and CT scans. The measurement error of the dataset registration procedure was also assessed. Scanning protocol T1VIBE FS enabled swift differentiation of soft tissues based on contrast detail, even allowing afully detailed segmentation of the brachial plexus. Structural conformity between the reconstructed structures on CT and MRI was excellent, with nerves and blood vessels imported into the CT scan never intersecting with the bones. The mean measurement error for the image registration procedure was consistently in the submillimeter range (range 0.77-0.94 mm). Based on the excellent MRI image quality and the submillimeter error margin, the procedure of scanning frozen Thiel-embalmed specimens in the treatment position to obtain enhanced CT scans is recommended. The procedure can be used to support the postulation of delineation guidelines, or for training deep learning algorithms, considering automated segmentations.

Application Value of Serum TK1 and PCDGF, CYFRA21-1, NSE, and CEA plus Enhanced CT Scan in the Diagnosis of Nonsmall Cell Lung Cancer and Chemotherapy Monitoring

Objective To assess the application value of serum thymidine kinase 1 (TK1) and PC cell-derived growth factor (PCDGF), cytokeratin 19 fragment 21-1 (CYFRA21-1), neuron-specific enolase (NSE), and carcinoembryonic antigen (CEA) plus enhanced CT scan in the diagnosis of nonsmall cell lung cancer (NSCLC) and chemotherapy monitoring. Methods Between April 2019 and April 2021, 30 patients with NSCLC assessed for eligibility treated in our institution were included in the experimental group, and 30 healthy individuals screened out from physical examinations were recruited in the control group. The chemotherapy regimens included gemcitabine plus cisplatin, pemetrexed disodium plus cisplatin, and vinorelbine plus cisplatin. The application value of serum TK1, PCDGF, CYFRA21-1, NSE, CEA, and enhanced CT scan in the diagnosis and chemotherapy monitoring of NSCLC was analyzed. Results Before treatment, the eligible patients had significantly higher serum levels of TK1, PCDGF, CYFRA21-1, NSE, and CEA than those of the healthy individuals included (P < 0.05). Clinical efficacy was categorized into good and poor, and the good efficacy included complete response and partial response, with the poor efficacy including stable disease and progressive disease. Patients with good clinical efficacy had lower levels of serum TK1, PCDGF, CYFRA21-1, NSE, and CEA than those with poor efficacy (P < 0.05). Joint detection showed a larger area under the curve (AUC) (0.900; 95%CI, 0.812-0.988), a higher sensitivity, and a superior detection outcome to the stand-alone detection (P < 0.05). Diagnostic results were similar between joint detection and pathological examination (P > 0.05). Conclusion The application of serum TK1, PCDGF, CYFRA21-1, NSE, and CEA assay plus enhanced CT scan shows high sensitivity and diagnostic accuracy in the diagnosis and chemotherapy monitoring of nonsmall cell lung cancer and thus provides a diagnostic reference basis.

The Role of Chest CT Radiomics in Diagnosis of Lung Cancer or Tuberculosis: A Pilot Study.

In many low-income countries, the poor availability of lung biopsy leads to delayed diagnosis of lung cancer (LC), which can appear radiologically similar to tuberculosis (TB). To assess the ability of CT Radiomics in differentiating between TB and LC, and to evaluate the potential predictive role of clinical parameters, from March 2020 to September 2021, patients with histological diagnosis of TB or LC underwent chest CT evaluation and were retrospectively enrolled. Exclusion criteria were: availability of only enhanced CT scans, previous lung surgery and significant CT motion artefacts. After manual 3D segmentation of enhanced CT, two radiologists, in consensus, extracted and compared radiomics features (T-test or Mann–Whitney), and they tested their performance, in differentiating LC from TB, via Receiver operating characteristic (ROC) curves. Forty patients (28 LC and 12 TB) were finally enrolled, and 31 were male, with a mean age of 59 ± 13 years. Significant differences were found in normal WBC count (p < 0.019) and age (p < 0.001), in favor of the LC group (89% vs. 58%) and with an older population in LC group, respectively. Significant differences were found in 16/107 radiomic features (all p < 0.05). LargeDependenceEmphasis and LargeAreaLowGrayLevelEmphasis showed the best performance in discriminating LC from TB, (AUC: 0.92, sensitivity: 85.7%, specificity: 91.7%, p < 0.0001; AUC: 0.92, sensitivity: 75%, specificity: 100%, p < 0.0001, respectively). Radiomics may be a non-invasive imaging tool in many poor nations, for differentiating LC from TB, with a pivotal role in improving oncological patients’ management; however, future prospective studies will be necessary to validate these initial findings.