Malignant Focal Lesions Research Articles

The role of magnetic resonance diffusion tensor imaging in differentiation of benign from malignant focal renal lesions

Amac: Fokal bobrek lezyonlarinin benign, malign ayiriminda gorunusteki difuzyon katsayisi (apparent diffusion coefficient - ADC) ve fraksiyonel anizotropi (Fa) olcumlerinin diagnostik performanslarinin belirlenmesi. Gerec ve Yontem: Calismamiza, bilgisayarli tomografi (BT) ve ultrason (US) gibi degisik goruntuleme modaliteleri ile tani konulan ve manyetik rezonans diffuzyon tensor goruntulemesi (DTI) yapilmis 21 hastada (9 kadin and 12 erkek ; ortalama yas 54,1 ), 25 fokal renal lezyon dahil edildi. Lezyonlar 6 solid renal hucreli karsinom (RCC), 1 kistik RCC, 1 anjiomyolipom (AML) ve 17 kistik lezyondan ( 16 Bosniak tip I kist, 1 Bosniak tip II kist) olusmaktaydi. ADC ve Fa olcumleri iki radyolog tarafindan, konsensusa varilarak yapildi. Malign ve benign lezyonlara ait ADC ve Fa degerleri ANOVA ve Tukey testleri kullanilarak karsilastirildi. ROC analizi kullanildi; sensitivite ve spesifite hesaplandi. Bulgular: Malign lezyonlarin ortalama ADC ve Fa degerleri sirasiyla 1.29±0.4 mm2/sn ve 0.34±0.1 olculdu. Benign lezyonlarin ortalama ADC ve Fa degerleri sirasiyla 2.6±0.7 mm2/sn ve 0.19±0.12 olculdu. Aralarindaki fark istatistiksel olarak anlamli idi (P<0.05). Malign lezyonlari, benign lezyonlardan ayirmada ADC ve Fa olcumlerinin, Az degerleri sirasiyla 0.95 ve 0.83 bulundu. ADC ve Fa olcumlerinin sensitivite ve spesifite degerleri sirasiyla 100%-83.3% ve 100%-77.8% bulundu. Sonuc: Malign ve benign fokal renal lezyonlarin ADC ve Fa olcumleri degerleri arasinda istatistiksel anlamli farklar mevcuttur. Malign renal lezyonlarda dusuk ADC ve yuksek Fa degerleri izlenirken, benign renal lezyonlarda yuksek ADC ve dusuk Fa degerleri izlenir.

Use of strain sonoelastography in differentiation of focal testicular lesions

PurposeWe aimed to assess potential role of strain sonoelastography in diagnosing focal testicular lesions. Patient & methods21 patients with 23 focal testicular lesions were subjected to sonoelastography. Compression was performed manually by the transducer upon the testis and monitored on the compression graph on the machine. Diagnosis was reached either by surgical resection, or follow-up. Result23 focal testicular lesions were included. 10 lesions were in the right and 9 in the left, and 2 lesions are bilateral. Cases included 7 focal orchitis (30.5%), two hematomas (8.7%), 7 scar tissue (30.5%), 4 seminomas (17.4%), one choriocrcinoma (4.3%), one epidermoid cyst (4.3%), and one hydatid cyst (4.3%). On strain Sonoelastography; all four seminomas and 7 scars were of low strain, also the epidermoid cyst and the two hematomas were hard, while the 7 cases of focal orchitis showed high strain. The cases of choriocarcinoma and the hydatid cyst showed mixed strain patterns. Statistical analyses showed a sensitivity of 100% in identifying neoplastic lesions, with a specificity of 40%, a negative predictive value of 100%, and a positive predictive value of 37.5%. ConclusionStrain Sonoelastography is useful adjunct method to differentiate benign from malignant focal testicular lesions.

The role of different PI-RADS versions in prostate multiparametric magnetic resonance tomography assessment.

Background. Standardised Prostate Imaging Reporting and Data System (PI-RADS) guidelines for the assessment of prostate alterations were designed for the assessment of prostate pathology. Published by the ESUR in 2012, PI-RADS v1 was based on the total score of different MRI sequences with subsequent calculation. PI-RADS v2 was published by the American College of Radiology in 2015 and featured different assessment criteria for prostate peripheral and transitory zones.Aim. To assess the correlations of PI-RADS v1 and PI-RADS v2 with Gleason score values and to define their predictive values of the diagnosis of prostate cancer.Materials and methods. A retrospective analysis of 66 patients. Prostate specific antigen (PSA) value and the Gleason score (GS) were assessed. One the most malignant focal lesion was selected in the peripheral zone of each lobe of the prostate (91 in total). Statistical analysis was carried out applying SPSS software, v.23, p < 0.05.Results. Focal lesions assessed by PI-RADS v1 score: 10% – 1, 12% – 2, 41% – 3, 23% – 4, 14% – 5. Assessment applying PI-RADS v.2: 20% – 1, 7.5% – 2, 26%, 29.5%, and 17% were assessed by 3, 4, and 5 scores. Statistically relevant correlation was found only between GS and PI-RADS (p = 0.033).The positive predictive value of both versions of PI-RADS – 75%, negative predictive value of PI-RADS v1 – 46%, PI-RADS v2 – 43%.Conclusions. PI-RADS v1 was more statistically relevant in assessing the grade of tumour. Prediction values were similar in both versions

THE SIGNIFICANCE OF THE METHOD OF ULTRASONIC RESEARCH OF A THYROID GLAND WITH CONTRAST ENHANCEMENT IN THE DIFFERENTIAL DIAGNOSIS OF FOCAL NODULAR FORMATIONS

Introduction . Currently thyroid nodules are a widespread problem in clinical oncology and head and neck cancer, malignant focal lesions constitute more than 15–20 %. Accurate diagnosis is very important and determines treatment, as well as the volume of surgical intervention. Objective – determination of the diagnostic value of the method of contrast-enhanced ultrasound in the diagnosis of thyroid cancer. Reference materials were the results of the histological study of surgical specimens. Method. Performed a retrospective analysis of medical records of 42 patients who underwent surgery at the surgical department of head and neck tumors on the verified thyroid cancer in the N.N. Petrov Research Institute of Oncology at the Ministry of Health of Russia. The number of female patients was 36 persons (85.5 %), the number of men was 6 people (14.5 %). The average age of patients among men was 55.5 years, women – 46 years. All patients underwent surgical treatment in the amount of extirpation of the thyroid gland – 16 patients (37.5 %), hemithyroidectomy – 26 patients (62.5 %). Results. The sensitivity of ultrasound with contrast in the diagnosis of cancer of the thyroid gland was 94.11 %, specificity was 87.5 %, diagnostic accuracy – 92.8 %. Conclusions. The technique of ultrasound nodules thyroid with intravenous contrast enhancement has an excellent diagnostic properties, allowing to identify and verify thyroid cancer is 8 % more accurately in comparison with standard ultrasound technique.

The value of contrast-enhanced dynamic and diffusion-weighted MR imaging for distinguishing benign and malignant splenic masses.

To assess the value of contrast-enhanced dynamic and diffusion-weighted (DW) MR imaging for differentiating malignant from benign splenic lesions. This retrospective study included 51 patients with 35 benign and 16 malignant focal splenic lesions. All patients underwent contrast-enhanced dynamic and DW MR imaging. Two radiologists evaluated the MR images in consensus. Significant imaging findings on univariate and multivariate analyses were identified and their diagnostic performance for predicting the malignant splenic lesion was analyzed. Using receiver-operating characteristic analysis, the optimal cut-off of the apparent diffusion coefficient (ADC) value corresponding to the maximal Youden's index (J) for differentiating the two groups was determined. In univariate analysis, low signal intensity (SI) on the arterial, portal and 3-min delayed-phase images, high or iso SI on the DW image, iso or low SI on the ADC map, the presence of diffusion restriction and arterial hypovascularity with a progressive enhancement pattern were more frequently observed (p < 0.05) in malignant splenic lesions. The ADC value was significantly lower for malignancy than for benignancy (0.78 ± 0.24 vs 1.16 ± 0.53 × 10(-3) mm(2) s(-1); p < 0.001). The optimal cut-off ADC value for differentiating the two groups was 0.995 × 10(-3) mm(2) s(-1). In multivariate analysis, findings that differentiated malignant from benign splenic lesions were low SI on the 3-min delayed-phase image [odds ratio (OR), 27.68; p = 0.006] and the presence of diffusion restriction (OR, 48.01; p = 0.002). When two of these criteria were combined, 12 (75.0%) of 16 malignant splenic masses were identified with a specificity of 100%. Contrast-enhanced dynamic and DW MR imaging may be helpful for differentiating malignant from benign splenic lesions. A low SI on the 3-min delayed phase and diffusion restriction are the most reliable findings for the differentiation of malignant from benign splenic lesions. Dynamic and DW MR imaging help in distinguishing malignant from benign splenic lesions. A low SI on the 3-min delayed phase and diffusion restriction are the most reliable findings for the differentiation of malignant from benign splenic lesions.

Elastographic Strain Index in the Evaluation of Focal Lesions Detected With Transrectal Sonography of the Prostate Gland.

The purpose of this study was to evaluate the value of elastography in evaluating focal lesions detected by transrectal sonography and to suggest a reference strain index. Sixty-nine patients with focal lesions on transrectal sonography were referred to our department for prostate biopsy. Focal lesions were classified as either highly or less suspicious lesions by our criteria. A strain index from elastography was calculated for the focal lesions. Systematic 12-core randomized biopsies plus 2 targeted biopsies were performed. The mean strain indices for malignant and benign focal lesions were compared, and a cutoff strain index was attained to maximize the sensitivity and specificity for prostate cancer. Strain indices were correlated with Gleason scores. The mean strain index ± SD for malignant focal lesions (3.26 ± 1.77) was significantly higher than that for benign focal lesions (2.16 ± 1.52; P = .008). The sensitivity, specificity, and area under the receiver operating characteristic curve for diagnosing cancer were 66.7%, 71.1%, and 0.701, respectively, at a strain index cutoff value of greater than 2.4. The strain index showed a moderate linear correlation with the Gleason score (r = 0.441; P = .013). Any focal lesion on transrectal sonography with a strain index of greater than 2.4 is at risk for prostate cancer.

Ultrasound imaging of the liver and bile ducts - expectations of a clinician.

Since diseases of the liver and bile ducts are common, a clinician is faced by the need to implement an appropriate diagnostic process. It is necessary to apply diagnostic methods that enable appropriate assessment of the most common pathologies of the liver, i.e. fibrosis, steatosis and focal lesions, as well as initial assessment of the bile ducts. These goals can be achieved using ultrasound methods based on conventional sonography, contrast-enhanced sonography and elastography. The assessment of fatty liver and bile duct dilatation using ultrasound reaches satisfactory levels of sensitivity and specificity. The usage of contrast agents enables unambiguous differentiation between benign and malignant focal lesions, frequently allowing them to be identified accurately without the assistance of other imaging modalities. Elastography has enabled reliable assessment of liver fibrosis. Its results are comparable to those of the standard method, i.e. liver biopsy.

Cell Block and IHC: A New Weapon in Diagnostic Armamentarium in Differentiating Liver Sol

Background: The diagnosis of hepatic lesion often requires characteristic cytologic features in dearth of which the diagnosis may not be clear. Cell block and immunohistochemistry (IHC) have emerged as a new weapon in diagnostic armamentarium. Objective: This study was planned to investigate the cytomorphological features of distinctive non-neoplastic and neoplastic lesions of the liver and to evaluate the sensitivity, specificity and diagnostic accuracy of ultrasound-guided FNAC and cell block in the diagnosis of liver sol. Method: This study was conducted during the period of February 2010 to March 2013. One hundred and fifty-one cytological materials were collected from patients with focal liver lesions who were referred after initial clinical and radiological assessment for ultrasound-guided fine needle aspiration cytology (USG-FNAC). Results: Age of patients ranged from 10 to 61 years and 75 (71%) of these patients were males. out of 151 investigated samples 106 (70%) and 45 (30%) were malignant by cytology and cell block respectively. 91 patients were investigated by both cytology and cell blocks and were included in the final analyses of the FNAC in comparison to cell block. IHC markers were used in 41 patients. The sensitivity, specificity, positive predictive value and negative predictive value of the cytology were 95% (90.0–99%), 60.3% (43.2–76.0%), 73.8% (59–78.3%) and 0 (0–13.3%), respectively. the malignant focal lesions were hepatocellular carcinoma (35.7%), metastatic adenocarcinoma (32%), spindle cell sarcoma (3.3%) and hepatoblastoma (1.2%). IHC was able to give an add-on diagnosis in 31 (20.3%) adding to overall sensitivity and specificity. Conclusion: Cell block and IHC are useful adjunct in making differential diagnosis of liver space occupying lesions. These can increase both the sensitivity and specificity of FNAC in liver sol.

Incidental Breast Lesions Identified by (18)F-FDG PET/CT: Which Clinical Variables Differentiate between Benign and Malignant Breast Lesions?

PurposeThe aim of our study was to evaluate the risk of malignancy and to determine which clinical variables differentiate between benign and malignant focal breast lesions found incidentally on 18F-flourodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT).MethodsFrom March 2005 to October 2011, 21,224 women with no history of breast cancer underwent FDG PET/CT at three university-affiliated hospitals. We retrospectively identified 214 patients with incidental focal hypermetabolic breast lesions and grouped them into benign and malignant lesion groups. Of the 214 patients, 82 patients with 91 lesions were included in this study. All lesions were confirmed histologically or were assessed by follow-up imaging for greater than 2 years. The patient age, maximum standardized uptake value (SUVmax), lesion size on ultrasonography (US), and Breast Imaging-Reporting and Data System (BI-RADS) category on US in conjunction with mammography were compared between the groups. Multivariate logistic regression analysis was used to identify independent factors associated with malignancy.ResultsThe risk of malignancy was 29.7% (27/91) in breast incidentalomas detected by FDG PET/CT. The univariate analysis showed that the patient age, SUVmax, tumor size, and BI-RADS category differed significantly between the malignant and benign groups. The multivariate analysis showed that the BI-RADS category was the only significant factor differentiating benign from malignant lesions (p=0.002).ConclusionBIRADS category based on US in conjunction with mammography was the only useful tool to differentiate between malignant and benign lesions in breast incidentalomas on FDG PET/CT.

Результаты резекционных вмешательств на печени на фоне хронической диффузной гепатопатии

Relevance Improvement of the technical aspects of performing liver resections allowed to neutralize the risk of many specific postresection complications. However, among the last until now, post-resection hepatic failure (PHF) remains a difficult problem, which on the background of diffuse changes in the liver, significantly complicates the postoperative period. The purpose of the study To evaluate an influence of concomitant chronic diffuse liver disease on the results of resections performed for benign and malignant focal lesions of the liver. Materials and methods To assess the impact of chronic diffuse liver process in the frequency of complications of liver resections analyzed a control group of patients (81 patients), operated in the department of surgery of the liver and biliary tract and in the department of surgery of portal hypertension and pancreatoduodenal zone during the period from 1998 to 2009. Patients were divided into a group with concomitant diffuse liver disease (chronic viral hepatitis and steatosis) - 53 patients (65.4%) and a group of 28 patients without concomitant liver pathology. Results and their discussion Study the frequency of PHF showed that the development of severe complications in the early postoperative period is clearly correlated with the presence of diffuse liver disease. Thus, in patients without chronic liver diseasePHF occurred in 2 cases against the background of extensive liver resections, which amounted to 7.1% (2/28). In patients with hepatic pathology, the incidence of PHF of varying severity amounted to 18.9% (10/53). The overall incidence of PHF in the study group was 14.8% (12/81). On the background of extensive liver resections PHF complicated the postoperative period, more than twice as often in the presence of chronic liver disease, 28.6% versus 13.3% (8/28 vs. 2/13). At segmental resections PHF occurred only in patients with chronic pathologies in the liver and was 8.0%. The presence of concomitant chronic diffuse liver disease causes a significant decrease in functional status of hepatocytes, which represents a decline of hepatic extraction fraction at 17,1% (67,5 ± 2,3% against 81,4 ± 1,9%) and an increase in half-life of the radiopharmaceutical drop to 26 5% (37,2 ± 1,7 min vs. 29,4 ± 1,2 m) (P <0,001) relative to the group without parenchymatous processes. Conclusion Performing of resection interventions in focal liver disease with chronic diffuse pathology of a liver increases the risk of PHF, which is associated with reduced functional reserve of hepatocytes and slowing compensatory regeneration process.

Ocena przydatności obrazowania dyfuzji metodą rezonansu magnetycznego w diagnostyce różnicowej łagodnych i złośliwych zmian ogniskowych w wątrobie

Introduction. Despite the use of multiple diagnostic imaging techniques, a non-invasive differential diagnosis of focal lesions in the liver is still a challenging task. It is even more significant, considering the risk of complications related to liver biopsy. On the other hand, the availability of non-invasive radiological and diagnostic imaging methods has resulted in the increased detectability of incidental hepatic lesions. Therefore, further investigation of newer and more effective methods of differentiating benign from malignant hepatic lesions is extremely useful. The aim of the study was to assess the diagnostic value of Diffusion-Weighted Magnetic Resonance Imaging (DW MRI) in differentiating benign from malignant focal lesions in the liver. Material and methods. Fifty one patients with hepatic lesions detected by magnetic resonance (MR) examination were enrolled in the study. Each lesion was then verified histopathologically, cytologically, or by observation. Ninety five (71 malignant and 24 benign) hepatic focal lesions were analysed. Apart from a standard MR liver examination, an echo planar imaging spin echo diffusion weighted sequence was performed, with a slice thickness of 5 or 6 mm. The maximal b-value was 1000 s/mm 2 and the minimal 0 s/mm 2 .In the study, the following were assessed: the presence of restricted diffusion, an absolute ADC (apparent diffusion coefficient) value, the decrease of signal intensity in DW MRI with an increase in the b-value. Results. Confirming or ruling out the restricted diffusion is usually the first effective step in differentiating benign from malignant hepatic lesions, as indicated in the study results. In the material analysed, the diffusion restriction occurred statistically significantly more frequently in malignant (87.3 %) compared to benign lesions (12.5%), (p 1.04 × 10 -3 mm2/s to be benign and lesions with ADC value ≤ 1.04 × 10 -3 mm 2 /s to be malignant, 75.8% lesions were correctly classified. Conclusions. The results obtained indicate that restricted diffusion, as a marker for malignant lesions, has the highest value in DW MRI in differentiating benign from malignant lesions in the liver.

Malignant focal brain lesions. Value of MRS tumour biomarkers in preoperative prediction of grades of malignancy

PurposeOur aim is to describe the spectrum of proton-MR spectroscopy in malignant focal brain lesions and to detect grade of malignancy using MRS tumor biomarkers. Materials and methods87 patients (63 males and 24 females) with focal brain lesion(s) are included in this study. All had a brain tumor recently diagnosed by MRI and had received no previous treatment. They were referred to MRS examination before surgical biopsy and/or resection or radiotherapy. ResultsIn malignant brain tumors, average Cho/NAA ratio was 3.3±0.22, Cho/Cr ratio was 2.95±0.21, MI/NAA ratio was 1.5±0.12, MI/Cr was 0.53±0.11 with lower MI levels and higher choline levels in more malignant tumours, lipid/lactate peak was detected in brain metastasis and high grade malignant brain tumors. ConclusionHigher Cho/NAA, Cho/Cr and MI/NAA ratios with lower MI/Cr, and high lipid/lactate peak, were most likely to be in high grade malignant brain tumors.

Contrast-enhanced harmonic endoscopic ultrasound imaging: basic principles, present situation and future perspectives.

Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound (EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS (CH-EUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration (EUS-FNA) can not only render EUS more accurate but may also assist physicians in making decisions when EUS-FNA is inconclusive, increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the vascularity. The development of CH-EUS has also opened up exciting possibilities in other research areas, including monitoring responses to anticancer chemotherapy or to ethanol-induced pancreatic tissue ablation, anticancer therapies based on ultrasound-triggered drug and gene delivery, and therapeutic adjuvants by contrast ultrasound-induced apoptosis. Contrast harmonic imaging is gaining popularity because of its efficacy, simplicity and non-invasive nature, and many expectations are currently resting on this technique. If its potential is confirmed in the near future, contrast harmonic imaging will become a standard practice in EUS.

Quantitative low mechanical index contrast-enhanced endoscopic ultrasound for the differential diagnosis of chronic pseudotumoral pancreatitis and pancreatic cancer

BackgroundSecond-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, as well as improved staging and guidance of therapeutic procedures.MethodsThe aim of our study was to prospectively compare the vascularisation patterns in chronic pseudotumoral pancreatitis and pancreatic cancer using quantitative low mechanical index (MI) contrast-enhanced EUS. We included 51 patients with chronic pseudotumoral pancreatitis (n = 19) and pancreatic cancer (n = 32). Perfusion imaging started with a bolus injection of Sonovue (2.4 ml), followed by analysis in the early arterial (wash-in) and late venous (wash-out) phase. Perfusion analysis was performed by post-processing of the raw data (time intensity curve [TIC] analysis). TIC analysis was performed inside the tumor and the pancreatic parenchyma, with depiction of the dynamic vascular pattern generated by specific software. Statistical analysis was performed on raw data extracted from the TIC analysis. Final diagnosis was based on a combination of EUS-FNA, surgery and follow-up of minimum 6 months in negative cases.ResultsThe sensitivity and specificity of low MI contrast enhanced EUS using TIC were sensitivity and specificity of low MI contrast enhanced EUS using TIC analysis were 93.75% (95% CI = 77.77 - 98.91%) and 89.47% (95% CI = 65.46 - 98.15%), respectively. Pseudotumoral chronic pancreatitis showed in the majority of cases a hypervascular appearance in the early arterial phase of contrast-enhancement, with a dynamic enhancement pattern similar with the rest of the parenchyma. Statistical analysis of the resulting series of individual intensities revealed no statistically relevant differences (p = .78). Pancreatic adenocarcinoma was usually a hypovascular lesion, showing low contrast-enhancement during the early arterial and also during the late venous phase of contrast-enhancement, also lower than the normal surrounding parenchyma. We found statistically significant differences in values during TIC analysis (p < .001).ConclusionsLow MI contrast enhanced EUS technique is expected to improve the differential diagnosis of focal pancreatic lesions. However, further multicentric randomized studies will confirm the exact role of the technique and its place in imaging assessment of focal pancreatic lesions.

Ultrasonography of the feline kidney: Technique, anatomy and changes associated with disease.

Ultrasonography is an important tool for the detection of kidney disorders, which are among the most common health problems suffered by cats. It is more accurate than radiography for this purpose and is considered to be the reference modality for imaging the feline kidney, providing excellent visualisation of renal size, shape and internal architecture. Compared with more advanced imaging modalities, such as computed tomography or magnetic resonance imaging, ultrasonography is more accessible, less expensive, does not require general anaesthesia and allows real-time procedures to be performed. On ultrasound examination, focal or multifocal disorders may be readily identified, but diffuse changes are more challenging. B-mode ultrasonography is of limited use for differentiating between benign and malignant focal lesions. However, based on the presence and pattern of vascularity as an indicator of malignancy, contrast-enhanced ultrasonography allows distinction between benign and malignant focal renal lesions. This review provides a framework for the ultrasonographic approach to feline renal and perirenal disorders for the general practitioner. Drawing on current literature relating to ultrasonographic examination of feline kidneys, the aim is to summarise ultrasonographic technique, anatomy and changes associated with renal and perirenal diseases.

Contrast-enhanced harmonic endoscopic ultrasound

Second-generation intravenous blood-pool ultrasound contrast agents are increasingly used in endoscopic ultrasound (EUS) for characterization of microvascularization, differential diagnosis of benign and malignant focal lesions, and improving staging and guidance of therapeutic procedures. Although initially used as Doppler signal enhancers, second-generation microbubble contrast agents are now used with specific contrast harmonic imaging techniques, which benefit from the highly nonlinear behavior of the microbubbles. Contrast-specific modes based on multi-pulse technology are used to perform contrast-enhanced harmonic EUS based on a very low mechanical index (0.08 - 0.12). Quantification techniques based on dynamic contrast-enhanced ultrasound have been recommended for perfusion imaging and monitoring of anti-angiogenic treatment, mainly based on time-intensity curve analysis. Most of the clinical applications include the differential diagnosis of focal pancreatic masses, with adenocarcinoma having a distinct hypovascular (hypo-enhanced) appearance compared with neuroendocrine tumors, which are hypervascular (with strong arterial hyper-enhancement). However, pseudotumoral chronic pancreatitis and autoimmune pancreatitis also have an iso- or hypervascular appearance, making the differential diagnosis difficult. Even more promising is the use of dynamic contrast-enhanced harmonic EUS for the longitudinal monitoring of the effects of chemotherapy and/or anti-angiogenic therapy in advanced digestive cancers, which are difficult to examine by conventional cross-sectional imaging techniques.

¿Influye la experiencia del operador en la rentabilidad de la broncoscopia en el diagnóstico de lesiones pulmonares focales malignas?

IntroductionThe fiberoptic bronchoscopy (FB) is a useful technique in the diagnosis of focal pulmonary nodules and masses. The profitability of the FB and transbronchial biopsy (TB) is variable and depends on different factors such as the operator's experience. The aim of this study was to determine if the diagnostic profitability of these techniques, in the diagnosis of malignant focal pulmonary lesions (FPL), changed with the incorporation of a new medical staff compared with previous data of our center. Material and methodsA FPL was defined as an intra - parenchymatous pulmonary lesion that is well circumscribed and completely surrounded by healthy lung.We analyzed all the FBs between 02/2008 and 08/2009 in patients with a FPL with a definitive diagnosis of malignancy. 85 patients were included. ResultsThe diagnostic profitability of the TB was 0.55; it was higher when the FPL was > 2cm (≤ 2cm vs > 2cm; 0.38 vs 0.62; p=0.02) but no difference was found by site (central vs. peripheral; 0.67 vs 0.54; p=0.16). The previous profitability of TB was 0.76 without differences by size (≤ 2cm vs > 2cm; 0.72 vs 0,78; p=0,48) or site (central vs peripheral; 0.83 vs 0.74; p=0,39). ConclusionWe conclude that the operator's experience influences in the diagnostic profitability of the TB, in the malignant FPL.

Thyroid incidentalomas in FDG-PET/CT: prevalence and clinical impact

To evaluate the prevalence of thyroid FDG-PET/CT incidentalomas and the risk of malignancy in focal findings. A retrospective study of 3,062 PET scans was performed between 05/2006 and 09/2009. Prevalence of thyroid incidentalomas, risk of malignancy and correlation between standard uptake value (SUV) and cancer risk were analysed. The overall prevalence of thyroid incidentalomas was 2.4%. 71% showed a focal and 29% a diffuse uptake. In the focal uptake group, the diagnosis was clarified in 79% with cytology/histology. In 23.8% of the patients with a focal uptake, a malignant lesion was found. Diffuse uptake was predominantly associated with autoimmune thyroiditis. There was no statistically significant difference in the SUVmax between benign and malignant focal lesions (p = 0.0982). Patients with incidental focal uptake in the thyroid during FDG-PET/CT bear a considerable risk of malignancy and should undergo cytologic clarification of the diagnosis.

Role of ultrasound in the diagnosis of testicular lesions

Ultrasound is the main imaging technique in the assessment of the scrotal contents, providing unparalleled imaging of exquisite resolution. Ultrasound is effectively the sole scrotal imaging technique that a patient will undergo prior to definitive surgery. The accurate assessment of focal intratesticular lesions in the adult patient is of paramount importance, although most focal lesions will be malignant and require an orchidectomy, the recognition of the benign entity is essential to the individual patient. This article covers the salient features of benign and malignant focal intratesticular lesions to allow a confident diagnosis and to prevent unnecessary orchidectomy. We detail the range of intratesticular malignancies from germ cell tumors to lymphoma and metastases. Operator confidence is necessary to establish a benign diagnosis and we highlight important benign lesions that may benefit from a ‘watch and wait’ policy, such as infarction, abscess formation, focal orchitis, rete testis; as well as ...

Confident non-invasive diagnosis of pseudolesions of the liver using diffusion-weighted imaging at 3T MRI

Pseudolesions of the liver including focal steatosis or non-steatosis and THID (transient hepatic intensity differences) are often challenging, especially when imaging patients with underlying malignant disease. We evaluated the efficacy of diffusion-weighted imaging (DWI) in the diagnostic work-up of pseudolesions. Forty-eight patients with pseudolesions of the liver were consecutively examined and the images were retrospectively analyzed. MRI was performed on a clinical 3T scanner using T1-GRE in-phase and opposed phase images, T2-TSE-FS, diffusion-weighted sequences (b-value 50, 300, 600), ADC mapping, and dynamic post-contrast T1-VIBE-FS sequences (32 patients received Gd-EB-DTPA and 16 patients received gadolinium chelates). All images were analyzed by two experienced radiologists in consensus. As a standard of reference, we used the T1-w GRE, in-phase and out of phase, and the contrast enhanced series, as well as long-term follow-up. In the 48 patients, a total of 116 liver lesions were found. Of these, 40 were benign and eleven were malignant focal lesions. Benign lesions included one FNH, 26 simple cysts, and twelve hemangiomas. In addition, 65 pseudolesions (20 focal steatosis, 13 focal non-steatosis, and 32 THIDs) were found. All pseudolesions could be identified either on the T1-GRE in-phase and opposed phase images or on the contrast-enhanced series, or on both. However, none of them were visible on the diffusion-weighted images. Pseudolesions are invisible on DWI (negative predictive value = 1); therefore, DWI can be used as an additional sequence to significantly increase diagnostic confidence in the differentiation between pseudolesions and other focal liver lesions.