Nodule Enhancement Research Articles

Texture analysis of diffusion-weighted magnetic resonance imaging to identify atypically enhanced small hepatocellular carcinoma and dysplastic nodules under the background of cirrhosis

Objective: To investigate the value of texture analysis based on diffusion-weighted magnetic resonance imaging (DWI) in the differential diagnosis of atypically enhanced small hepatocellular carcinoma (sHCC) and dysplastic nodules (DNs) in liver cirrhosis. Methods: Data of 59 cases with atypical enhancement and solitary cirrhotic nodule (≤2 cm) confirmed by dynamic contrast enhanced MRI and surgical pathology specimen were analyzed retrospectively. Among them, 37 cases were of atypically enhanced sHCC and 22 cases of DNS. The DWI signal characteristics of the lesions were analyzed to measure the average apparent diffusion coefficient (ADC) value of the lesions, and the ADC ratio of the lesion to the liver parenchyma. MaZda software was used to manually draw the region of interest to extract the texture parameters of DWI lesions. The three sets (combination of Fisher coefficient, classification of error probability combined with average correlation coefficient and interactive information) were used to select the thirty optimal texture parameters. Raw data analysis (RDA), principal component analysis (PCA), linear discriminant analysis (LDA) and non-linear discriminant analysis (NDA) were performed for texture classification. The difference of ADC value and ADC ratio between sHCC and DNS group was compared by independent sample t-test, and χ2 test was used to compare the count data (or rate). ROC curve analysis was used to evaluate the diagnostic efficiency. Results: The sensitivity, specificity and accuracy of DWI high-signal in the identification of atypically enhanced sHCC and DNs were 94.6% (35/37), 68.2% (15/22), and 84.7% (50/59), respectively. The ADC ratio of atypically enhanced sHCC was significantly lower than DNs, and the difference was statistically significant (t = 2.99, P = 0.002). The sensitivity, specificity, and accuracy for the diagnosis of atypically enhanced sHCC were 73.0% (27/37), 72.7% (16/22) and 72.9% (43/59), respectively. The sensitivity, specificity and accuracy of DWI texture analysis in diagnosing atypically enhanced sHCC were 94.6% (35/37), 95.5% (21/22) and 94.9% (56/59).The diagnostic efficiency of DWI texture analysis (AUC = 0.94) was significantly higher than DWI high-signal (AUC = 0.81) and ADC ratio (AUC = 0.72). Conclusion: The texture analysis based on DWI can identify atypically enhanced sHCC and dysplastic nodules under the background of cirrhosis, and its efficacy is better than qualitative and quantitative DWI.

94 When the gut affects the heart

Abstract A 59-year-old man came to our attention with progressive shortness of breath associated with lower limb oedema. He complained also of recurrent malar flushing, diarrhea and weight loss (14 kg in the last 8 months). At physical examination, a holosystolic murmur best heard over the fourth left sternal border, intensified upon inspiration, and a palpable tender liver with irregular surface were noted. Transthoracic and transesophageal echocardiogram revealed dilated right chambers. The tricuspid annulus was dilated and the leaflets thickened, shortened and retracted with restricted mobility and incomplete coaptation, leading to severe tricuspid regurgitation (Panels A-B). Moderate pulmonary regurgitation was also detected (Panel C). Cardiac MR confirmed the morphology of the tricuspid valve (Panels D-E, arrows) and the severity of the tricuspid regurgitation (regurgitant fraction 66%). The pulmonary valve leaflets were also thickened and fixed (Panel F, arrow), with moderate pulmonary regurgitation (regurgitant fraction 21%). With the suspicion of carcinoid syndrome, 5-hydroxyindoleacetic acid (5-HITT) was tested by 24-hour urine sample and a value of 929.5 µmol/24h was found (n.v. 10.5-47.1). Whole body 18-F DOPA PET was performed. Axial views and reconstructed images revealed a short segment of mural thickening (2.4 cm and 1.1 cm) in the jejunum with a moderate/high uptake (Panels G, arrow). Adjacent to this lesion, a mesenteric spiculated mass (4.0 x 2.8 cm) with moderate uptake was visible (Panels H, arrow). Multiple enhancing nodules with high uptake were present in the liver (Panel I). One of the liver nodules was biopsied. The biopsy revealed extensive infiltration by well differentiated neuroendocrine tumor (Panel J, blue arrow). The tumor cells were arranged in nests and were composed of cells with round to oval nuclei and eosinophilic cytoplasm (Panel K). The neuroendocrine nature of the tumor was confirmed by strong diffuse positivity with synaptophysin (Panel L), chromogranin and CD 56. Ki-67 showed a proliferative index of less than 3%. The tumor morphology, combined with the immunohistochemical features, was in keeping with a well differentiated neuroendocrine tumor. Carcinoid heart disease is a rare cause of primary tricuspid and pulmonary valve disease leading to significant morbidity and mortality caused by right heart failure. The characteristic pathological findings are endocardial plaques of fibrous tissue that may involve the tricuspid valve and, rarely, the pulmonary valve. The fibrous tissue in the plaques results in distortion of the valves leading to either stenosis, regurgitation, or both. Abstract 94 Figure.

Application value of contrast-enhanced ultrasound in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change

Objective To investigate the value of contrast-enhanced ultrasound(CEUS) in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change(CRCCC). Methods The ultrasonographic datas of 82 lesions in 82 patients with complicated renal cysts or CRCCC confirmed by pathology were analyzed. The characteristics of conventional ultrasound and CEUS were observed and evaluated. The lesions were graded according to Bosniak classification criteria. Results Pathological examination showed that 36 cases were complicated renal cysts and 46 cases were CRCCC. Routine ultrasound showed there were 9 cases (25.0%) with cystic masses and 27 cases (75.0%) with solid and cystic masses in complex renal cysts, of which 14 cases (38.9%) could detect color flow signals. In CRCCC, 2 cases (4.3%) were with cystic masses and 44 cases (95.7%) were with solid and cystic masses, of which 33 cases (75.0%) could detect color flow signals. CEUS showed that only 18 cases (50.0%) of the complex renal cysts showed enhancement of cystic wall or septum, with equal or low enhancement at the peak, 9 cases (50.0%) accompanied by decrease of renal cortex, 35 cases (97.2%) had thin and regular cystic wall, no enhancement of cystic wall in all lesions, and 33 cases (91.7%) had septal thickness less than 1 mm. Forty-five cases (97.8%) of CRCCC showed enhancement of cystic wall or septum, 40 cases (88.9%) showed equal or high enhancement at peak, 30 cases (66.7%) were faster than the decrease of renal cortex, 37 cases (80.4%) showed uneven thickness of cystic wall, 24 cases (52.2%) showed enhancement of cystic wall nodules, and 28 cases (60.9%) showed uneven thickness of septum. After CEUS, 33 cases (91.7%) of complex renal cysts were classified as grade Ⅰ and Ⅱ, while 42 cases (91.3%) of CRCCC were classified as grade Ⅲ and Ⅳ. Conclusions The CEUS manifestations of complex renal cysts are different from those of CRCCC. The application of Bosniak criteria in CEUS is helpful for the differential diagnosis of complex renal cysts and CRCCC. Key words: Contrast-enhanced ultrasound; Complex renal cysts; Clear renal cell carcinoma with cystic change; Differential diagnosis

Endoscopic ultrasonography‐guided ethanol ablation of pancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1 disease following complicated total pancreatectomy

AbstractAlthough pancreatic neuroendocrine tumors (pNETs) account for a small proportion of all pancreatic tumors (1.3%), their incidence is increasing. A 54‐year‐old woman was previously diagnosed with hyperparathyroidism and prolactinoma. A magnetic resonance imaging (MRI) scan showed several oval homogeneous enhancement nodules on the pancreas, with sizes up to 10 mm, and endoscopic ultrasonography (EUS)‐guided fine needle aspiration cytology (FNAC) confirmed the diagnosis of pNETs. Based on her history of primary hyperparathyroidism combined with prolactinoma and her family history of multiple endocrine neoplasia type 1 (MEN1)‐associated tumors, a diagnosis of MEN1 was made. Two months after the surgery, a follow‐up abdominal computed tomography (CT) scan showed a pancreatic remnant that was 15 mm in length, and at the 5‐month follow up, a 6 × 5 mm residual pNET within the pancreatic remnant was detected by EUS, CT, and MRI. Because the patient adamantly refused repeat surgical resection, we decided to ablate the lesion via an EUS‐guided ethanol injection with 1.3 mL and 1.0 mL of 99.5% alcohol in two sessions. At the 4‐month follow up, the contrast‐enhanced MRI showed no residual pNET. Repeated EUS with concurrent FNAC also yielded negative results. We concluded that we achieved a good response after the EUS‐guide ablation. EUS‐guided ethanol ablation is a feasible, safe, and efficient method of treatment when applied for small pNETs in MEN1 disease following complicated total pancreatectomy. However, the long‐term outcomes must be confirmed in future multicenter prospective studies comparing surgical resection and minimally invasive EUS ablation.

A morphological image processing method to improve the visibility of pulmonary nodules on chest radiographic images

A pulmonary nodular shadow on a chest radiographic image is characteristic of lung cancer. However, nodular shadows often appear with very weak contrast. The target nodule shadow often overlaps with a shadow with strong contrast, such as that of the heart or rib; thus, it is difficult to emphasize the target region with ordinary contrast enhancement methods. In this article, a new pulmonary nodule enhancement method using a morphological subtraction method based on a modification of the h-dome transform is described. This method consists of two parts: a preprocessing step and nodule enhancement processing. The former reduces the uneven brightness of the background, and the latter emphasizes the nodule. With this method, the pulmonary nodule region is emphasized with the use of shape information of the nodule, whereas emphasis of the regions surrounding the nodule with different shapes is suppressed. This method also detects the boundary of the nodule as well as the edges of the surrounding anatomically normal structures. The performance of the proposed method has been verified by nodule enhancement experiments using synthetic and actual chest radiographic images from a public database. Furthermore, the efficiency of proposed method was tested by using contrast improvement index (CII), which is an index of improvement in contrast in the nodule region and its surroundings, and the results were quantitatively compared with those obtained from existing contrast emphasis methods. The proposed method has the highest value of CII, thereby confirming the effect of the contrast emphasis with this method.

Automatic lung nodule detection system using image processing techniques in computed tomography

Diagnosing and treating lung cancer at an early stage can improve the survival rate of patients. This study attempted to develop a computer-aided detection (CAD) system. In order to include all nodule types in the detection, this study proposes an image processing method for detecting ground glass opacity (GGO), part solid, and solid nodules in chest computed tomography. The process comprises image preprocessing, lung segmentation, nodule enhancement, candidate detection, and reduction of false positives. For lung segmentation, the edge searching method replaces the computing-intensive iterative hole-filling method. In order to extract nodules with extensively distributed gray levels, image accumulation is used in the nodule enhancement to rapidly enhance the gray level of individual nodules. In order to reduce false positives, the support vector machine (SVM) is applied twice. On the first run, the candidate nodules are obtained by using 4 two-dimensional features, and the classification result is obtained by using 11 three-dimensional features on the second run. This study used 667 lung nodules for experiment and evaluation. The proposed system can detect GGO, part solid, and solid nodules and takes only 0.1 s to process a single image. The total sensitivity of the system is more than 92.05%. The system excels at detecting small nodules in the range of 5 mm–9 mm with a sensitivity of 93.73% and GGO with a sensitivity of 93.02%. The results showed that the proposed rapid detection system has high sensitivity and low false positives, contributing to helping the clinicians’ diagnosis.

Effects of soil temperature and moisture on biological nitrogen fixation in soybean crop

Soil temperature and humidity are the chief determinants for good nodule formation at the time of sowing and emergence. The aim of this study was to estimate the soil temperature and humidity range, at which the Bradyrhizobium spp., and Azospirillum brasilense may have the highest effect on root enhancement and development of nodulation in soybean. Two experiments were conducted, the first of which was done in the seed laboratory performing the treatments listed as non-inoculated; inoculation with Bradyrhizobium; root enhancers; inoculation with Bradyrhizobium + root enhancers; co-inoculation with Bradyrhizobium + Azospirillum brasilense; co-inoculation with Bradyrhizobium + Azospirillum brasilense + root enhancers, and assessed at temperatures of 15, 20, 25, 30 and 35ºC. The experimental design was completely randomized with distribution in a factorial. The second experiment was executed in a greenhouse, employing the same treatments affected in the seed laboratory experiment, but with the addition of non-inoculated control with mineral nitrogen. Tests were done at the soil moisture levels of 25, 50, 75 and 100% water retention capacity, forming a factorial 7 x 4 (only second experiment). All co-inoculated treatments induced the soybean root system to improve, in terms of length, volume, surface area and root diameter, exhibiting superiority to the uninoculated control in the 20 to 30ºC temperature range. The co-inoculation raised nodulation in the soybean crop, when soil water retention capacity was at the range of 56 - 96%, achieving higher means compared to the standard inoculation. The root planter added no improvement to either the root system or nodulation in soybean.

Correlation of CT-scan findings of lung lesions and pathologic diagnosis

Background: we aimed to evaluate the features of lung nodules and masses in Ct scan that help to distinguish malignant lesions from benign ones. Method: The study was performed on 50 pulmonary lesions biopsied at the Shahid Faghih Hospital by an interventional radiologist. CT scan findings were evaluated by a radiologist and compared with pathologic outcomes. Data was entered into SPSS software and by Descriptive statistical methods of frequency and Roc curve analysis and Chi-squared test and T-test at the level of alpha 0.05 was analyzed. Results: The relationship between smoking and malignancy was determined in this study. There was no significance found in mean age and sex, lesion density and enhancement of benign and malignant nodules. Smooth border was mostly seen in benign lesions and lobulated and spiculated borders in malignant lesions. Popcorn calcification was in favor of benignity and calcification in periphery of lesion was in favor of malignancy. Cavity was mostly seen in benign lesions Conclusion: smoking and the spiculated or lobulated margins, calcification in the periphery of the lesion were associated with malignant lesions, and the smooth margin and popcorn calcification and cavity formation were mostly seen in benign lesions. Enhancement showed no significance.

Isolation, screening and application of a potent PGPR for enhancing growth of Chickpea as affected by nitrogen level

ABSTRACT Chickpea (Cicer arietinum L.) can obtain much of its N requirement through nitrogen fixation, but plant productivity also relies on N fertilization. Nitrogen capture from fertilizers by the plant is highly inefficient and can have a negative impact on the environment. Plant growth promoting rhizobacteria (PGPR) can improve efficiency of N fertilizer use and support optimum plant growth under low N input to soil. Chickpea plants were grown in pots and treated with low and optimum N input supplemented with PGPR. Bacteria isolated from chickpea rhizosphere exhibited potential growth promoting production of ammonia, indole acetic acid and phytase and solubilization of inorganic phosphate and zinc. A PGPR strain, identified as Cedecea davisae RS3, was selected by principal component analysis and its effect on plant growth promotion evaluated in chickpea plants under N-appropriate (N+), N-deficit with RS3 (N−RS3) and N-appropriate with RS3 (N+RS3) treatments. Overall performance of chickpea plants grown under N−RS3 was better than that of N+ and N+RS3 plants. The improved performance under N-RS3 could be related to enhancement of root nodulation and nitrogenase activity. The PGPR with N-RS3 might be used to obtain sustainable production of chickpea under reduced N.

Amoebic Encephalitis Caused by Balamuthia mandrillaris.

We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.

Microvascular invasion and grading in hepatocellular carcinoma: correlation with major and ancillary features according to LIRADS.

To assess major and ancillary parameters that could be correlated with Microvascular Invasion (MIV) and with histologic grade of HCC. In this retrospective study, we assessed 62 patients (14 women-48 men; mean age, 63years; range 38-80years) that underwent hepatic resection for HCC. All patients were subject to Multidetector computed tomography (MDCT); 40 to Magnetic Resonance (MR) study. The radiologist assessed major and ancillary features according to LIRADS (v.2018) and reported any radiological accessory findings if detected. No major feature showed statistically significant differences and correlation with grading. Mean ADC value was correlated with grading and with MIV status. No major feature was correlated to MIV; progressive contrast enhancement and satellite nodules showed statistically different percentages with respect to the presence of MIV, so as at the monovariate correlation analysis, satellite nodules were correlated with the presence of MIV. At multivariate regression analysis, no factor proved to be strong predictors of grading while progressive contrast enhancement and satellite nodules were significantly associated with the MIV. Mean ADC value is correlated to HCC grading and MIV status. Progressive contrast enhancement and the presence of satellite nodules are correlated to MIV status.

SAT-324 An Unusual Association between Pheochromocytoma and Hyperparathyroidism in a Patient with Neurofibromatosis Type 1: A Possible Co-Occurrence of Two Hereditary Endocrine Tumor Syndromes

Background: Patients with neurofibromatosis type 1 (NF1) have increased risk of developing various types of endocrine tumors including pheochromocytoma; however, an association with hyperparathyroidism is a rare entity. We present an unusual combination of pheochromocytoma and hyperparathyroidism in a NF-1 patient; a double mutation or digenic inheritance in hereditary endocrine syndromes is proposed. Clinical case: A 66-year-old woman with clinical features of NF1 presented with alteration of consciousness. Physical examination was unremarkable except a large lower abdominal mass and normotension. Severe hypercalcemia (15.02 mg/dL) with markedly elevated parathyroid hormone (PTH 1,550.6 pg/mL; 15-68.3) levels was revealed. A neck ultrasonography showed a 1.6-cm well-defined heterogeneous hypoechoic lesion at postero-inferior aspect of right thyroid lobe corresponding to the result from Tc99m MIBI parathyroid scintigraphy suggestive of parathyroid adenoma. CT whole abdomen revealed a huge uterine myoma and an accidental finding of a 2.5-cm well-defined enhancing nodule at right adrenal gland. Pheochromocytoma was diagnosed by an elevated of 24-h urine metanephrine (771.1 ug; < 276.1) with a normal level of 24 h-urine normetanephrine (273.7 ug; < 668.7). Genetic study showed a heterogeneous mutation at Gly681Ser in exon 11 of RET gene. The co-existence of NF1 and multiple endocrine neoplasia type 2A (MEN2A) was proposed. Laparoscopic right adrenalectomy was performed and its pathological findings confirmed the diagnosis of pheochromocytoma. Subsequently, total parathyroidectomy with thyroidectomy was done with its pathological study showing a parathyroid adenoma, multinodular goiter without the evidence of medullary thyroid carcinoma. The patient refused to perform the treatment for her myoma uteri. During the follow-up period, she has remained asymptomatic with calcium/vitamin D and thyroid hormone replacement without an evidence of pheochromocytoma or hyperparathyroidism recurrence. Conclusion: Our patient has the distinctive features of pheochromocytoma and primary hyperparathyroidism in the patient carrying the double mutations in NF1 and RET gene. This gene-gene interaction may explain the phenotype variability among the affected patients with the hereditary endocrine tumor syndromes.

MR imaging features of spinal pilocytic astrocytoma

BackgroundThe purpose of this retrospective review is to determine the MR imaging features of pilocytic astrocytoma (PA) in the spinal cord to help neuroradiologists preoperatively differentiate PA from other intramedullary tumors.MethodsNeuro-oncology database review revealed 13 consecutive patients with a pathological spinal PA diagnosis and availability of preoperative MR imaging. Three patients had preoperative diffusion-weighted MR imaging. Demographics and conventional and diffusion MR imaging records were retrospectively evaluated.ResultsAmong 13 cases of spinal PA, six PAs were located in the cervical region, 4 in the cervical-thoracic region, and 3 in the thoracic region. The average length of vertebral segments involved for the tumors were 4.7 ± 4.6 segments. Six tumors had associated syringomyelia. Eight PAs were located eccentrically in the spinal cord, and eleven had well-defined margins. Eight tumors (61.5%) were intermixed cystic and solid. All were contrast-enhanced, and 53.8% of all PAs showed focal nodule enhancement of the solid components. Two PAs showed intratumoral hemorrhages, and only one demonstrated cap sign. The ADC values (n = 3) of the tumors were 1.40 ± 0.28 × 10− 3 mm2/s (min–max: 1.17–1.71 × 10− 3 mm2/s).ConclusionsPA should be considered in the differential diagnosis of intramedullary tumors that occur in the cervical and thoracic regions. Eccentric growth pattern, well-defined margin, intermixed cystic and solid appearance, focal nodular enhancement of solid components and syringomyelia are relatively frequent features. Relatively high ADC values compared with normal-appearing spinal cord parenchyma are common in spinal PA.

A young man with progressive jaundice and abdominal distension

Budd-Chiari syndrome (BCS) is a rare, life-threatening disease caused by obstruction of hepatic venous outflow. Common presentations are right upper quadrant pain, ascites, and hepatomegaly. A diagnosis of Budd-Chiari syndrome should be suspected when liver disease occurs in a patient with known risk factors for hypercoagulable state. We report a 22-years old transgender man presented with jaundice, marked ascites and hepatomegaly. Imaging studies showed complete thrombosis of all hepatic veins. Finally, he was diagnosed with Budd-Chiari syndrome with antiphospholipid syndrome.&#x0D; &#x0D; Figure 1 ภาพ CT upper abdomen แสดงให้เห็น marked ascites with heterogeneous liver enhancement, complete obliteration of all hepatic, caudate lobe hypertrophy, small intrahepatic venous collateral และ small arterial enhancing nodules&#x0D;

The diagnostic value of focal liver lesion (≤2 cm) undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound

Objective To evaluate and explore the diagnostic value of focal liver lesion (FLL) (≤2 cm) undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound(CEUS). Methods A total of 50 patients with 65 lesions(≤2 cm) were enrolled. All lesions were undetectable on conventional ultrasound but showed clearly in CT/MRI images. Ultrasound-CT/MRI image fusion with CEUS was performed, and the nodule detection rate and enhancement perfusion mode were analyzed. Results All the 50 patients were matched successfully, 56 lesions (86.2%) were detected by image fusion combined with CEUS, among which 27 lesions (41.5%) were significantly different from surrounding parenchyma on conventional ultrasound, 54 lesions(83.1%) showed different enhancement from the surrounding parenchyma on CEUS. There were 46 lesions that were eventually diagnosed by surgical pathology or clinical comprehensive diagnosis. The diagnostic accuracy of image fusion with CEUS was 91.3% (42/46). According to different groups of MRI matching sequences, the detection rates of T2 sequence group and enhanced sequence group were 87.5% (28/32) and 91.3% (21/23), respectively, there was no statistically significant difference between the two groups (P=0.686). Conclusions CT/MRI image fusion combined with CEUS has high detection rate and diagnosis accuracy for small FLL undetectable on conventional ultrasound. Key words: Contrast-enhanced ultrasound; Image fusion; Focal liver lesion

Significance of contrast-enhanced ultrasonography in differential diagnosis of thyroid nodules.

The present study was aimed to compare the application values between 2-dimensional color Doppler ultrasonography (2DUS) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of thyroid malignant nodules.A total of 124 patients suspectedly diagnosed with malignant thyroid nodules under conventional gray-scale ultrasonography were recruited in this study. All enrolled patients were examined by both 2DUS and CEUS.A total of 153 nodules (94.44%) and 45 cases (90.00%) with malignant nodules were detected by the CEUS. No significant differences were noted in nodule detection rates between 2DUS and CEUS (χ2 = 1.170, P = .279; χ2 = 0.796, P = .372). The aspect ratio, microcalcification, internal echo, borderline, Vmax, resistance index, and total scores of malignant nodules were higher than those of benign nodules (all P < .05) when diagnosed by 2DUS. The peripheral/internal enhancement time, peak intensity, local enhancement, ring enhancement, and total scores of malignant nodules were significantly higher compared with those of benign nodules (all P < .05) by CEUS. Total score of malignant nodules diagnosed by 2DUS was approximately 3.5 and 2.3 points for CEUS. The diagnostic accuracy of 2DUS as observed by area under the curve was 0.821 with the cut-off value of 3.9, the sensitivity was 82.5%, and the specificity was 85.6%. The diagnostic accuracy of CEUS was 0.862 with the cut-off value of 2.8, the sensitivity was 86.7%, and the specificity was 91.3%.Both 2DUS and CEUS are worthy of application values in the differential diagnosis from benign to malignant thyroid nodules.

A Case of Duodenal Traditional Serrated Adenoma Manifested as Gastrointestinal Bleeding

Traditional serrated adenoma(TSA) is one of subtypes of serrated polyp. Although serrated polyps are usually found in colorectum, they are also detected in upper gastrointestinal tracts. Serrated adenomas of duodenum are very rare and asymptomatic in previously reported cases. However, we experienced a case of duodenal serrated adenoma with bleeding which was diagnosed and treated endoscopically. An 80-years-old-female visited the emergency department due to hematochezia. The laboratory result showed that hemoglobin was 4.2g/dl and iron deficiency anemia. For evaluation of gastrointestinal bleeding, the patient underwent esophagogastroduodenoscopy(EGD) and colonoscopy. The result of EGD was atrophic change and intestinal metaplasia. The colonoscopy showed hyperplastic polyps at ascending colon. Abdominal computer tomography(CT) showed a 1.8cm lobular enhancing nodule at duodenojejunal junction. After she underwent capsule endoscopy, we found a pedunculated polyp at distal duodenum. For further evaluation, we used a colonoscopy to approach the duodenojejunal junction because upper endoscopy could not reach the polyp. A 2.5cm sized lobulating pedunculated polyp was found at 4th portion of duodenum and there was fresh blood near the polyp.(Fig. 1) We considered the polyp as the cause of anemia and bleeding, we recommended her to resect the polyp. We planned to use a detachable snare during polypetomy for the prevention of bleeding and successfully removed the polyp without any adverse event.(Fig. 2) The final pathology result was a traditional serrated adenoma.(Fig. 3) After polypectomy, the patient did not show any bleeding sign. The serrated adenomas are precursors of colorectal cancer and serrated pathway is related with 15% of all colorectal cancer. The prevalence of serrated adenomas of small intestine is very rare and their clinical features are insufficiently known. Based on previous report, traditional serrated adenoma of upper digestive tract showed aggressive behavior with high malignant potential and should be resected for the prevention of cancer progression. Serrated lesions of duodenum are usually found in the bulb and 2nd portion. Our case showed a relatively large size and location in the distal part of duodenum that could not be reached by upper endoscopy. A Delay in detection might cause size increasing and bleeding. To our knowledge, this is the first case of duodenal traditional serrated adenoma which caused overt bleeding.2035_A Figure 1. Endoscopic findings. (a): A lobulating pedunculated polyp was noted in capsule endoscopy; (b, c): A 2.5cm sized polyp with long stalk and bleeding was found at duodenojejunal junction; (d): A 1.8cm sizxed lobular enhancing nodule at duodenojejunal junction.2035_B Figure 2. Images of the polypectomy. (a): A detachable snare was used for the prevention of bleeding during polypectomy (B) The polyp was removed without complication (c) The resected specimen of duodenal polyp2035_C Figure 3. Microscopic findings. Traditional serrated adenoma; (a): exophytic, tubulovillous or villous polypoid lesion; (b): deep clefts, indentations and slit-like spaces, leading to broad luminal fronds that protrude into the gland lumen or from surface of a papillary frond often in a broad flat-topped, mushroom-like or jigsaw puzzle-like appearance; (c): striking granular eosinophilic cytoplasm, luminal serrations, presence of elongated, penicillate nuclei with evenly dispersed coarse chromatin and small inconspicuous nucleoli

Contrast-enhanced computed tomography combined with Chitosan-Fe3O4 nanoparticles targeting fibroblast growth factor receptor and vascular endothelial growth factor receptor in the screening of early esophageal cancer.

Esophageal cancer is a malignant tumor with a relatively high invasiveness, metastatic potential and worldwide incidence among human cancers. The majority of patients with esophageal cancer are diagnosed in a late tumor stage due to a lack of advanced and sensitive protocols for the diagnosis of patients with early-stage esophageal cancer. In the current study, contrast-enhanced computerized tomography (CECT) combined with Chitosan-Fe3O4 nanoparticles targeting fibroblast growth factor receptor (FGFR) and vascular endothelial growth factor receptor (VEGFR; CECT-CNFV) were used to diagnose patients with suspected esophageal cancer. A Chitosan-Fe3O4-parceled bispecific antibody targeting FGFR and VEGFR was produced and its affinity to esophageal cancer cells was determined both in vitro and in vivo. A total of 320 patients with suspected esophageal cancer were voluntarily recruited to evaluate the efficacy of CECT-CNFV in the diagnosis of early-stage esophageal cancer. All participants were subjected to CT and CECT-CNFV to detect whether tumors were present in the esophageal area. A Chitosan-Fe3O4 nanoparticles contrast agent was orally administered at 20 min prior to CT and CECT-CNFV. The results demonstrated that CECT-CNFV improved diagnostic sensitivity and provided a novel protocol for the diagnosis of tumors in patients with suspected gastric cancer at an early-stage. Furthermore, the resolution ratio of images was enhanced by CECT-CNFV, which enabled the visualization of tiny tumor nodules in esophageal tissue. Clinical data demonstrated that CECT-CNFV diagnosed 200 patients with suspected early-stage esophageal cancer and 120 patients as tumor free. In addition, CECT-CNFV exhibited higher signal enhancement of tumor nodules than CT, suggesting a higher accuracy and accumulation of nanoparticle contrast agent within the tumor nodules of esophageal tissue. Notably, the survival rate of patients with esophageal cancer diagnosed at an early-stage by CECT-CNFV was higher than the mean five-year survival rate (P<0.01). In conclusion, CECT-CNFV enhanced the sensitivity and accuracy of CT in the diagnosis of early-stage esophageal cancer. Thus, CECT-CNFV may improve the accuracy of CT in the diagnosis of mural enhancement in patients with esophageal cancer.

Quantification of solid hypo-echoic thyroid nodule enhancement with contrast-enhanced ultrasound

Background: The purpose of this study was to investigate the value of the quantitative assessment of enhancement on contrast-enhanced ultrasound (CEUS) for diagnosing solid hypo-echoic thyroid nodules (SHTNs).

Quantification of solid hypo-echoic thyroid nodule enhancement with contrast-enhanced ultrasound

Background: The purpose of this study was to investigate the value of the quantitative assessment of enhancement on contrast-enhanced ultrasound (CEUS) for diagnosing solid hypo-echoic thyroid nodules (SHTNs). Methods: A total of 87 SHTNs were imaged by both conventional ultrasound (CUS) and CEUS. The sonographic features, enhancement pattern, and dynamic perfusion changes of the thyroid lesion were evaluated and compared. The final diagnosis was based on histological findings. Results: Of all nodes, 32 were benign, and 55 were malignant. The benign thyroid nodules mainly exhibited diffuse enhancement. The 55 malignant nodules mainly exhibited absent or faint dotted enhancement patterns. Quantitative analysis of CEUS revealed that the Peak enhancement and area under the curve (AUC) of malignant nodules were markedly reduced compared to those of benign nodules. Significant differences between CEUS and CUS were noted with respect to the sensitivity, negative predictive value, false negative rate and accuracy. Conclusions: CEUS is a promising imaging-based approach that can assist in the differential diagnosis of solid hypo-echoic thyroid nodules.