Parenchymal Density Research Articles

Effect of patient age and breast parenchymal density on Breast Imaging-Reporting and Data System (BIRADS-4) Subcategorization

Background & Objectives: BI-RADS (Breast Imaging-Reporting and Data System) is a standard radiological risk assessment for breast lesions, including six categories, of which category four is the widest range of likelihood cancer risk (2% to 95%). This study aimed to evaluate the effect of patient age and ACR breast density on the positive predictive value (PPV) of BI-RADS 4 subcategorization (4A, 4B, and 4C). Methods: A retrospective study was conducted at King Fahed Hospital (KFH) between September 1, 2021, and June 30, 2022. PPV was calculated based on a histopathological report for all lesions. The correlation was made with patients’ age groups ranging from < 45 years, 45-55 years, and > 55 years and four types of breast density on mammography. We used IBM-SPSS for data synthesis. The Chi-square test was used to assess any correlation between variables. A p-value < 0.05 was considered statistically significant. Results: The mean age was 44.62 ±14.32. Of the 248 cases, 81% were benign, 17% were malignant, and 2% were high-risk lesions. The age-related PPV of each BI-RADS category showed no significant differences among all age groups. However, the breast composition-related PPV cases with BI-RADS categories differed significantly within subcategory 4C (p-value<0.001). Conclusions: There were no positive relationships between increasing age and PPV in BI-RADS 4 subcategories 4A, B, and C. Breast composition-related PPV showed significant differences with BI-RADS 4C subcategories. doi: https://doi.org/10.12669/pjms.40.10.9552 How to cite this: Ghunaim HA. Effect of patient age and breast parenchymal density on Breast Imaging-Reporting and Data System (BIRADS-4) Subcategorization. Pak J Med Sci. 2024;40(10):2356-2362. doi: https://doi.org/10.12669/pjms.40.10.9552 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The neuronal biomarker NSE correlates with the volume of lung contusion in polytraumatized patients.

Severe injuries caused by accidents, like traumatic brain injury (TBI) or thoracic trauma (TT) continue to be the leading cause of death in younger people with relevant socio-economic impact. Fast and targeted diagnostics is essential for further therapy decisions and prognosis. The following study investigates NSE as a potential biomarker for lung injury after blunt TT. This is a retrospective analysis of prospectively collected data in a level-1 trauma center from 2014 to 2020. Serum levels of Neuron-specific Enolase (NSE) and Interleukins (IL-6, IL-10) in injured patients (n = 41) with isolated TT (AISthorax ≥ 3) compared to isolated TBI (AIShead ≥ 3) were assessed from day 0 to 5 after trauma. The extend of lung injury was quantified by Hounsfield scale in CT scans. 30 patients with TT (ISSmed = 20, age 50y ± 17, 83,3% male) and 11 patients with TBI (ISSmed = 25, age 54y ± 17,27,3% male) were included. After TT, NSE concentration increased initially after trauma with a peak value on the day of admission (8.51 ± 3.68 ng/ml) compared to healthy controls (4.51 ± 1.504 ng/ml, p < 0.001). Isolated thoracic trauma and TBI lead to equally strong NSE release ad the day of admission. There is a significant linear relationship (r = 0.636, p = 0.035) between serum NSE levels and severity of pulmonary contusion at the time of admission and after 24 hours. A significant NSE release after isolated thoracic trauma peaks on the day of admission. The extent of lung contusion volume (defined as alveolar parenchymal density) correlates with NSE serum concentration. Thus, NSE has predictive value for the extent of pulmonary contusion. However, according to these data, NSE seems to have no diagnostic value as a TBI biomarker in concomitant TT.

Oxytocin: A Shield against Radiation-Induced Lung Injury in Rats.

Radiation-induced lung injury (RILI), a serious side effect of thoracic radiotherapy, can lead to acute radiation pneumonitis (RP) and chronic pulmonary fibrosis (PF). Despite various interventions, no effective protocol exists to prevent pneumonitis. Oxytocin (OT), known for its anti-inflammatory, antiapoptotic, and antioxidant properties, has not been explored for its potential in mitigating RILI. This study involved 24 female Wistar albino rats, divided into three groups: control group, radiation (RAD) + saline, and RAD + OT. The RAD groups received 18 Gy of whole-thorax irradiation. The RAD + OT group was treated with OT (0.1 mg/kg/day) intraperitoneally for 16 weeks. Computerizing tomography (CT) imaging and histopathological, biochemical, and blood gas analyses were performed to assess lung tissue damage and inflammation. Histopathological examination showed significant reduction in alveolar wall thickening, inflammation, and vascular changes in the RAD + OT group compared to the RAD + saline group. Biochemical analysis revealed decreased levels of TGF-beta, VEGF, and PDGF, and increased BMP-7 and prostacyclin in the RAD + oxytocin group (p < 0.05). Morphometric analysis indicated significant reductions in fibrosis, edema, and immune cell infiltration. CT imaging demonstrated near-normal lung parenchyma density in the RAD + oxytocin group (p < 0.001). Oxytocin administration significantly mitigates radiation-induced pneumonitis in rats, implying that is has potential as a therapeutic agent for preventing and treating RILI.

Intrapulmonary T Cells Are Sufficient for Schistosoma-Induced Pulmonary Hypertension.

Schistosomiasis is a parasitic infection that can cause pulmonary hypertension (PH). Th2 CD4 T cells are necessary for experimental Schistosoma-PH. However, if T cells migrate to the lung to initiate, the localized inflammation that drives vascular remodeling and PH is unknown. Mice were sensitized to Schistosoma mansoni eggs intraperitoneally and then challenged using tail vein injection. FTY720 was administered, which blocks lymphocyte egress from lymph nodes. T cells were quantified using flow cytometry, PH severity via heart catheterization, and cytokine concentration through ELISA. FTY720 decreased T cells in the peripheral blood, and increased T cells in the mediastinal lymph nodes. However, FTY720 treatment resulted in no change in PH or type 2 inflammation severity in mice sensitized and challenged with S. mansoni eggs, and the number of memory and effector CD4 T cells in the lung parenchyma was also unchanged. Notably, intraperitoneal Schistosoma egg sensitization alone resulted in a significant increase in intravascular lymphocytes and T cells, including memory T cells, although there was no significant change in parenchymal cell density, IL-4 or IL-13 expression, or PH. Blocking T cell migration did not suppress PH following Schistosoma egg challenge. Memory CD4 T cells, located in the lung intravascular space following egg sensitization, appear sufficient to cause type 2 inflammation and PH.

Use of Densitometric Indicators Free DICOM-Viewer’s and Digital Data Processing Programs in Surgical Treatment of Patients with Pulmonary Tuberculosis

Objective — to determine the potential of using freely distributed specialised digital data processing programs and free DICOM-viewers for assessing densitometric indicators obtained from computed tomogra­phy of the thoracic organs. This aims to facilitate the planning of surgical treatment for patients with pulmonary tuberculosis and to substantiate methods for preventing pulmonary-pleural complications. Materials and methods. A retrospective analysis was conducted on the examination and treatment results of 103 patients with specific tuberculous lesions of the lungs. Histological examination of the resected material determined the degree of the specific inflammatory process in the affected tissue, based on which patients were categorised into groups. Group I included 32 patients with low activity of the specific inflammatory process, Group II comprised 37 patients with moderate activity and Group III included 34 patients with high activity. Using five common digital processing programs, densitometric indicators of the thoracic organs' structures were obtained. The accuracy of density indicators displayed by these programs was analysed in comparison with the results of histological examinations. Results and discussion. According to our data, the densitometric indicators obtained using free DICOM-viewers and digital data processing programs show a strong correlation with the reference standard and among themselves. The determined density indicators have a strong association with histological findings of emphysema and fibrosis of the lung parenchyma. These indicators are reliably identified both in cases of high activity of specific inflammation in the lung parenchyma and in inactive processes, allowing for patient stratification. It was found that the average density values of the mediastinal lymph nodes in cases of inactive specific inflammatory processes in 80 % of cases were (54.4 ± 17.8) HU. Values of (15.0 ± 2.5) HU characteri­sed high activity of specific inflammatory processes and the progressive phase of the disease. Clinically, 89 (86.4 %) of the patients with significant deviations in the densitometric density indicators of the lung parenchyma from the norm experienced prolonged air leakage in the postoperative period. In 96 (93.2 %) patients with altered density of mediastinal lymph nodes, prolonged postoperative exudation through pleural drains was noted. Patients with altered densitometric indicators had complicated intraoperative and postoperative courses. Changes in the density of the lung parenchyma detected on computed tomography of the thoracic organs were confirmed in 96.1 % of cases by histological examination of the resected material. These changes were reliably detected by all the programs studied. Conclusions. Densitometric indicators obtained using DICOM-viewers and digital data processing programs enable the planning of surgical treatment for patients with pulmonary tuberculosis and the reasoned application of methods to prevent pulmonary-pleural complications.

Investigation of the Relationship Between Cervical Vertebral Column Degeneration and Posterior Circulation Perfusion Area Ischemia

Aim: The primary objective of this study was to establish whether degeneration of the cervical vertebrae and paravertebral structures serves as a predisposing factor for ischemic processes by disrupting hemodynamics in the posterior system through mechanical effects on the vertebral arteries. Material and Method: We conducted a retrospective analysis of 180 patients who underwent various imaging tests between January 2017 and October 2023. These tests included cervical magnetic resonance imaging (MRI), cervical computed tomography (CT), carotid-vertebral neck CT angiography (CTA), cranial CT, and cranial MRI. Of the 180 patients, 90 had mild degeneration or no significant degeneration, with a mean age of 58 years, and 90 had significant cervical spondylosis (CS) with a mean age of 64 years. The radiological findings were statistically analyzed, and a p-value of less than 0.05 was considered statistically significant. Results: There was no significant difference between age and parenchymal density in the control group (p=0.09). There was no statistically significant difference between the age and parenchymal density in the CS group (p=0.07). As CS became more severe, there was a statistically significant increase in the incidence of atrophic enlargement of the cerebellar folia and loss of density in the posterior fossa (p=0.03) and posterior circulation infarcts (POCI) (p=0.04). Conclusion: When severe, CS can adversely affect vascular hemodynamics in the posterior system, predisposing perfused neural parenchyma to ischemia.

Clinical and laboratory features of COVID-19 in newborns. Analysis of a severe clinical case

Background. Since the onset of the coronavirus disease 2019 (COVID-19) epidemic until January 1, 2024, more than 5.5 million confirmed cases of COVID-19 have been detected in Ukraine according to official data, approximately 6 % of them among children under 18 years old. Aim: to improve the management of newborns based on studies of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with different course. Materials and methods. Eleven newborns (7 boys and 4 girls) diagnosed with SARS-CoV-2 confirmed by polymerase chain reaction were observed. Disease progression, results of laboratory and instrumental studies were analyzed. Results. An analysis of clinical data and the results of laboratory and instrumental investigations are presented, as well as treatment outcomes in newborns with confirmed COVID-19. It was found that in all cases, children were infected from mothers with SARS-CoV-2. The frequency of clinical symptoms is provided, revealing discrepancies between respiratory symptoms and changes identified on lung ultrasound. Most children exhibited anemia, elevated D-dimer levels in the blood, yet experienced a mild course of the disease. The average duration of illness prior to hospitalization was 3.70 ± 1.48 days, with a hospital stay of 4.01 ± 1.22 days. An exception was in case of patient N., characterized by a severe condition necessitating prolonged oxygen therapy, mechanical ventilation, and administration of remdesivir. This particular case is detailed in the article. Conclusions. In most infants under one month of age observed in this study, the course of ­COVID-19 caused by SARS-CoV-2 was characterized by symptoms such as lethargy, hyperthermia, nasal congestion, diarrhea, and changes detected only through laboratory and instrumental stu­dies: anemia, abnormalities in the coagulation system, and increased lung parenchymal density. Ho­wever, the disease course in infants of this age can also be very severe, with lung parenchymal involvement, pneumonia, COVID-19-associated coagulopathy, complicated by generalized bacterial infection, as presented in the clinical case.

The SGLT2 inhibitor Empagliflozin promotes post-stroke functional recovery in diabetic mice

Type-2 diabetes (T2D) worsens stroke recovery, amplifying post-stroke disabilities. Currently, there are no therapies targeting this important clinical problem. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are potent anti-diabetic drugs that also efficiently reduce cardiovascular death and heart failure. In addition, SGLT2i facilitate several processes implicated in stroke recovery. However, the potential efficacy of SGLT2i to improve stroke recovery in T2D has not been investigated. Therefore, we determined whether a post-stroke intervention with the SGLT2i Empagliflozin could improve stroke recovery in T2D mice. T2D was induced in C57BL6J mice by 8 months of high-fat diet feeding. Hereafter, animals were subjected to transient middle cerebral artery occlusion and treated with vehicle or the SGLTi Empagliflozin (10 mg/kg/day) starting from 3 days after stroke. A similar study in non diabetic mice was also conducted. Stroke recovery was assessed using the forepaw grip strength test. To identify potential mechanisms involved in the Empagliflozin-mediated effects, several metabolic parameters were assessed. Additionally, neuronal survival, neuroinflammation, neurogenesis and cerebral vascularization were analyzed using immunohistochemistry/quantitative microscopy. Empagliflozin significantly improved stroke recovery in T2D but not in non-diabetic mice. Improvement of functional recovery was associated with lowered glycemia, increased serum levels of fibroblast growth factor-21 (FGF-21), and the normalization of T2D-induced aberration of parenchymal pericyte density. The global T2D-epidemic and the fact that T2D is a major risk factor for stroke are drastically increasing the number of people in need of efficacious therapies to improve stroke recovery. Our data provide a strong incentive for the potential use of SGLT2i for the treatment of post-stroke sequelae in T2D.

The value of computed tomography texture analysis in identifying chronic subdural hematoma patients with a good response to polytherapy

This study aimed to investigate the predictive factors of therapeutic efficacy for chronic subdural hematoma (CSDH) patients receiving atorvastatin combined with dexamethasone therapy by using clinical imaging characteristics in conjunction with computed tomography (CT) texture analysis (CTTA). Clinical imaging characteristics and CT texture parameters at admission were retrospectively investigated in 141 CSDH patients who received atorvastatin combined with dexamethasone therapy from June 2019 to December 2022. The patients were divided into a training set (n = 81) and a validation set (n = 60). Patients in the training data were divided into two groups based on the effectiveness of the treatment. Univariate and multivariate analyses were performed to assess the potential factors that could indicate the prognosis of CSDH patients in the training set. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the significant factors in predicting the prognosis of CSDH patients and was validated using a validation set. The multivariate analysis showed that the hematoma density to brain parenchyma density ratio, singal min (minimum) and singal standard deviation of the pixel distribution histogram, and inhomogeneity were independent predictors for the prognosis of CSDH patients based on atorvastatin and dexamethasone therapy. The area under the ROC curve between the two groups was between 0.716 and 0.806. As determined by significant factors, the validation's accuracy range was 0.816 to 0.952. Clinical imaging characteristics in conjunction with CTTA could aid in distinguishing patients with CSDH who responded well to atorvastatin combined with dexamethasone.

Inflammatory myofibroblastic tumor directly invading the right first rib treated with oral steroids: a case report

BackgroundWe present a case of an inflammatory myofibroblastic tumor cured with a short period of steroid administration, a treatment previously unreported for such cases.Case presentationA 49-year-old man had a chief complaint of chest pain for more than 3 days. Computed tomography (CT) revealed a tumoral lesion suspected to have infiltrated into the right first rib and intercostal muscles, with changes in lung parenchymal density around the lesion. The maximal standardized uptake value on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography was high (16.73), consistent with tumor presence. CT-guided biopsy revealed an inflammatory myofibroblastic tumor with no distant metastases. Surgery was indicated based on the disease course. However, he had received an oral steroid before the preoperative contrast-enhanced CT scan due to a history of bronchial asthma, and subsequent CT showed that the tumor shrank in size after administration; he has been recurrence-free for more than a year.ConclusionsSurgery is still the first choice for inflammatory myofibroblastic tumors, as the disease can metastasize and relapse; however, this condition can also be cured with a short period of steroid therapy.

3D tomosynthesis evaluation of breast parenchymal density and its association with malignant lesions and menopausal status

BackgroundBreast cancer that has a high mortality rate is now known to decrease due to early detection with the advent of digital breast tomosynthesis (DBT or 3D tomosynthesis) screening, especially in those with dense breasts. The risk of breast cancer related to 'changes' in breast density over time remains controversial as breast density and age have an inverse relationship. Breast density as an independent risk factor for breast cancer is known, but its association with menopausal status, if any, has not been studied thoroughly. MethodAll patients referred for 3D mammography with breast lesions from June 2022 to January 2023 were considered. Patients were categorized as pre-, peri, and post-menopausal, and each category was further sub-classified based on the breast density as either dense or non-dense and the lesion type, whether benign or malignant. The Statistical analysis was performed using a chi-square test to evaluate whether any association exists between malignancy and menopausal status. ResultA total of 60 patients, with 20 in each category of menopausal stage, were imaged and evaluated. 35% of women had non-dense breasts, while 65% had dense breast parenchyma. Breast density and lesion type were associated significantly (p-value = 0.05) where, out of the 23 benign lesions, 48% occurred in dense women, and 52% in non-dense women respectively. In our study, both benign (N = 7) and malignant (N = 13) lesions occurred in equal numbers in the pre-and peri‑ menopausal women, whereas the number of benign and malignant lesions in the post-menopausal women were 9 (45%) and 11 (55%), respectively. Even though no statistically significant association was found between menopausal status and malignancy in our study, out of the 37 malignant lesions, a majority (76%) of lesions occurred in those having dense breasts (N = 28). ConclusionEarlier, the notion was that older women had a higher risk of breast cancer compared to younger, but this study has shown that malignancy and menopausal status have a p-value of 0.754, which is not statistically significant. However, both malignant and benign lesions were found more in women having high breast density, in keeping with previous literature. Hence, precaution and care should be taken during pre-, peri, and post-menopausal phases, especially in those patients with high breast density. Apart from breast density, many other risk factors for breast cancer exist, therefore breast density alone is not sufficient to govern the need for screening in women.

The role of non-invasive preoperative imaging techniques in predicting the risk of pancreatic fistula development in pancreaticoduodenal tumours

Background. In pancreaticoduodenal tumours, pancreaticoduodenectomy (PDE) is a radical surgical intervention. The most important stage of the operation is the pancreaticojejunoanastomosis (PEA), the admissibility of which depends on many factors: the degree of fibrous changes in the pancreatic parenchyma, the degree of mechanical jaundice, and the operating surgeon’s technique. Identification of factors that reflect changes in the structure of the pancreatic parenchyma and its ductal system, which are important predictors in predicting the risk of developing pancreatic fistula (PF) after PDE, is of great scientific importance. Purpose. Evaluation of changes in the structure of the pancreatic parenchyma and its ductal system using non-invasive preoperative imaging methods in predicting the risk of pancreatic fistula development during pancreaticoduodenectomy. Materials and Methods. This study included 302 patients who underwent pancreaticoduodenectomy. Mechanical jaundice was detected in 246 (81.5%) patients, 56 (18.5%) patients had no jaundice, the age of patients ranged from 31 to 77 years, 178 (58.9%) were men and 124 (41.1%) were women. Ultrasound elastography and multidetector computed tomography were used for preoperative non-invasive visualisation of the degree of changes in the pancreatic parenchyma and its ductal system. The following parameters of visualisation of the pancreatic parenchyma with an assessment of the anatomical features of the isthmus and the duct of Wirsung were identified: diameter and cross-sectional area of the duct of Wirsung (at the level of the isthmus), width and thickness of the pancreas (at the level of the isthmus), cross-sectional area of the pancreatic isthmus (without the area of the duct of Wirsung), native density, and stiffness of the pancreatic parenchyma. Results and discussion. The ROC analysis of the parameters for assessing the state of the parenchyma of the pancreas and the duct of Wirsung obtained from computed tomography made it possible to determine the validity of these indicators in predicting the risk of developing PF. According to the results of the ROC analysis, the following indicators were identified as markers of moderate risk of developing PF: the diameter of the duct of Wirsung is less than 4 mm, the cross-sectional area of the duct of Wirsung is less than 0.23 cm2 , the thickness of the isthmus of the pancreas is greater than 15 mm, the width of the isthmus of the pancreas is greater than 19 mm, the cross-sectional area of the isthmus of the pancreas (without the area of the duct of Wirsung) is greater than 3 cm2 , and the native density is greater than 24 HU. To assess the high risk of developing PF, the use of ROC analysis allowed us to establish the high quality of diagnostic models for such computed tomography parameters as the diameter of the duct of Wirsung – the area under the ROC curve is 0.965, the cross-sectional area of the duct of Wirsung – AUC is 0.894, the cross-sectional area of the isthmus of the pancreas (without the area of the duct of Wirsung) – AUC is 0.873, the width of the isthmus of the pancreas – the area under the ROC curve is 0.859, the native density – AUC is 0.844. Determination of the parameter of stiffness of the pancreatic parenchyma by shear wave elastography in predicting high and moderate risk of developing PF also corresponded to the high quality of the diagnostic model. Conclusions. The use of non-invasive imaging methods allows changes in the structure of the pancreatic parenchyma, anatomical features of the pancreatic isthmus and the duct of Wirsung to be detected at the preoperative stage, the risk of developing a pancreatic fistula to be predicted and the number of complications during pancreaticoduodenectomy to be reduced.

MAMMOGRAPHICALLY DETERMINED ASYMMETRIES OF THE MAMMARY PARENCHYMA: CAUSES AND OPPORTUNITIES OF THEIR MAMMOGRAPHIC AND ULTRASOUND DIFFERENTIAL DIAGNOSIS

The incidence of asymmetries is 1-2% of all mammographic studies performed. However, there is no data in the literature on the prevalence of individual causes for mammographically determined asymmetries, as well as information about the opportunities of mammography and ultrasound examination (U/S) in their differential diagnosis. The aim of the study is to assess the incidence of individual causes for mammographically determined asymmetries and the opportunities of mammography and ultrasound of the mammary glands in their differential diagnosis. Material and methods. The results of mammographic and ultrasound examination of 202 patients were analyzed, in whom zones of asymmetrically distributed breast tissue were detected during mammography. Results. Technical asymmetries were detected in 14 out of 202 cases (6.93%) and could not be adequately analyzed. The true ones were asymmetries without space-occupying lesions caused by asymmetric uneven distribution of glandular (as a rule) or fibrous tissue (161 out of 202; 79.70%), as well as asymmetric edema of the breast parenchyma not associated with edematous infiltrative form of breast cancer (1 out of 202; 0.50%). These cases have always required performing breast ultrasound. The causes of true asymmetries caused by the presence of a space-occupying lesion were malignant neoplasms (breast cancer; 7 out of 202; 3.47%), benign formations (cysts, fibroadenomas, granulomas, abscesses, hematomas, chronic mastitis and other focal benign processes; 11 out of 202; 5.45%). These cases also required to perform breast ultrasound. The cause of the true asymmetries were also postoperative scars (8 out of 202; 3.96%), the differential diagnosis of which did not require ultrasound, but it and/or magnetic resonance mammography were required to assess the condition of the scar for its possible malignant transformation. Conclusions. The largest proportion of mammographically determined asymmetries in the density of mammary parenchyma (79.70%) are physiological variants of asymmetrically distributed tissues of this organ; their differential diagnosis and that of asymmetries caused by space-occupying lesions, according to mammography findings, is difficult, which requires additional ultrasound of the mammary glands. At the same time, mammography makes it possible to confidently identify technical asymmetries of the breast requiring no use of ultrasound, however, the interpretation of such sets of mammograms does not seem correct.

A differentiated approach to the selection of pancreaticojejunostomy during pancreatoduodenectomy

Background. Pancreatoduodenectomy is a radical surgical intervention in case of neoplasms of the pancreatoduodenal zone, which is accompanied by frequent postoperative complications. The critical point of the reconstructive stage of pancreatoduodenectomy is pancreaticojejunostomy (PES), which dictates the importance of improving the techniques of its repair and drainage, as well as the development of a differentiated approach to the choice of PES. The aim of the study: to evaluate the effectiveness of a differentiated approach to the choice of PES technique when performing pancreatoduodenectomy. Materials and methods. The study included 302 patients who underwent pancreatoduodenectomy for pancreatic neoplasms. The age of patients varied from 31 to 77 years, there were 178 (58.9 %) men, and 124 (41.1 %) women. In the comparison group (154 patients), a standard diagnostic and treatment algorithm was used with the choice of PES technique taking into account the intraoperative evaluation of the degree of the pancreatic parenchyma density and the assessment of the ductal system (surgeon’s experience and intuition). In the main group (148 patients), an improved diagnostic and treatment algorithm was used, which included non-invasive preoperative methods of visualization of changes in the pancreatic parenchyma, anatomical features of its isthmus and ductal system, as well as the use of developed methods for repair and drainage of the PES. Results. In the main group, the applied differentiated approach to the selection of PES consisted in the fact that at the preoperative stage, the degree of risk of developing pancreatic fistula (PF) was predicted: in 66 (44.6 %) patients, a low risk was detected, in 42 (28.4 %) — a moderate risk, 40 (27.0 %) people had a high risk. Identification of patients with a high risk of developing PF made it possible to carry out the necessary medical measures not only in the operating room, but also in the pre-operative stage, which affected a decrease in the frequency of severe forms of PF. Specifically, in the compari­son group, type B was noted 2.5 times (χ2 = 3.94; p = 0.047) and type C — 6.4 times (p = 0.034 according to Fisher’s exact test) more often than in the main group. This became the basis for the development of PES techniques with plastic covering of the anastomotic zone and improvement of PES drainage techniques with simultaneous drainage of the biliodigestive anastomosis. The developed differentiated approach to the choice of PES method based on the preoperative assessment of the risk of PF made it possible to reduce the frequency of its development, especially severe forms (types B and C) from 16.2 % of cases in the comparison group to 5.4 % in main group (χ2 = 8.01; p = 0.005). Mortality due to pancreatic fistula in the main group was 0.7 %, in the comparison group — 4.8 % (p = 0.034, Fisher’s exact test). Conclusions. Carrying out a preoperative non-invasive assessment of the degree of changes in the pancreatic parenchyma and the state of the duct of Wirsung by means of fibroelastography and computer tomography made it possible to develop a differentiated approach to the choice of PES technique, taking into account the prediction of the risk of PF in the postoperative period (sensitivity — 90.5 %, specificity — 81, 8 %, diagnostic accuracy — 86.1 %). The use of the developed methods with a falciform ligament wrap and cholangiodrainage to drain PES in soft pancreas made it possible to reduce in half the frequency of PF development (p &lt; 0.05), which led to a decrease in mortality by almost 7 times (p &lt; 0.05).

Effect of bronchodilator therapy on the function of external respiration and lung parenchyma in surgical treatment of patients with non-small cell lung cancer combined with chronic obstructive pulmonary disease

The purpose of the study was to compare the efficacy of regular prolonged inhalation therapy with tiotropium bromide delivered via the Respimat inhaler and short-acting bronchodilator (SAB) therapy with ipratropium bromide/fenoterol in the perioperative period in patients with non-small cell lung cancer (NSCLC) combined with chronic obstructive pulmonary disease (copd).Material and Methods. The study included 66 patients with Nsclc and copd. The patients received tiotropium bromide, 5 mcg/day (TB group) or a combination of ipratropium bromide/fenoterol 20/50 mcg/dose, 2 doses 4 times a day (SAB group) for 6 weeks before and 6 weeks after surgery. The control group consisted of patients who did not receive bronchodilators before surgery, but they received a combination of ipratropium bromide/fenoterol in the postoperative period. All patients underwent tests of pulmonary function (spirometry, body plethysmography), measurement of lung parenchyma density and emphysematous lung areas (high-resolution computed tomography).Results. After preoperative preparation with use of tB or saB, there was a significant improvement in FEV1, FVC, VC, RV, ITGV, and. RV/TLC ratio relative to baseline. In the tB and sad groups, a significant reduction in the severity of total respiratory resistance (Rtot) compared to that in the control group was observed. According to the assessment of lung density and the volume of emphysematous areas on expiration, the results in the TB group were significantly better than those in the sad and control groups. six weeks after surgery, all patients showed a significant decrease in post-FeV1, post-FVC, and post-VC relative to the preoperative values. Bronchodilator therapy resulted in the reduction in Rtot in all groups; however, better results were achieved in the TB group (86 %) compared to sad group (93 %, p=0.03) and control (101.5 %, p=0.02). After surgical treatment, a decrease in the volume of emphysematous areas on inspiration was observed: the parameters were better in the TB group than in the sad and control groups (220 cm3 versus 1025 cm3 and 1002 cm3, p&lt;0.001 and p=0.002, respectively).Conclusion. In patients with Nsclc and copd, longterm inhaled bronchodilator therapy can significantly improve respiratory function. more beneficial results are achieved after using long-acting drugs (tiotropium bromide).

Comparison of mammography and ultrasound findings in the follow-up of patients with breast cancer treated with segmental mastectomy followed by intraoperative electron radiotherapy versus external whole breast radiotherapy

This study aims to describe imaging findings in patients treated with intraoperative electron radiotherapy and compare them with those detected in patients treated with external whole breast radiotherapy (WBRT). The study population consisted of 25 patients who received intraoperative radiotherapy [IORT (21 Gy)] as single-dose radiotherapy and a control group of 25 patients who received WBRT at the same institution. Mammography and ultrasound (US) findings were divided into three groups: minor, intermediate, and advanced. On mammography, mass lesions were considered advanced, and asymmetries or architectural distortions were considered intermediate. Oil cysts, linear scars, and the increase in parenchymal density were considered minor findings. On US, irregular non-mass lesions were considered advanced, and circumscribed hypoechoic lesions or planar irregular scars with shadowing were considered intermediate. Oil cysts, fluid collections, or linear scars were considered minor findings. On mammography, skin thickening (P = 0.001), edema (P < 0.001), increased parenchymal density (P < 0.001), dystrophic calcifications (P = 0.045), and scar/distortion (P = 0.005) were significantly more common in the WBRT group. On US, irregular non-mass lesions, which made interpretation considerably difficult, were significantly more common in the IORT group (P = 0.004). Dominant US findings were fluid collections and postoperative linear or planar scars in the WBRT group. Minor findings were more common in low-density breasts, and major findings (intermediate and advanced) were more common in high-density breasts on both mammographies (P = 0.011) and US (P = 0.027) in the IORT group. Ill-defined non-mass lesions detected on US in the IORT group have not been defined previously. Radiologists should be aware of these lesions because they can be confusing, especially in early follow-up studies. This study has found that minor findings are seen more frequently in low-density breasts, while major findings are more common in high-density breasts in the IORT group. This has not been reported before, and further studies with more cases are needed to verify these results.

Performance of AI-aided mammography in breast cancer diagnosis: Does breast density matter?

BackgroundOne of the top four malignancies affecting women worldwide is breast cancer. Breast density is a risk factor for breast cancer on its own and also a limiting factor for the sensitivity of screening mammography. Tools of artificial intelligence (AI) can help radiologists to make decisions, potentially reducing perceptual and interpretation errors, or as a way to prioritize exams based on the likelihood of malignancy.ObjectivesThe purpose of this study was to assess the impact of breast density on the performance of AI in mammography (MG) for the diagnosis of breast malignancy.MethodsIn total, 110 patients with pathologically proven breast cancer participated in this retrospective study. These patients had full field digital mammography, and the mammogram pictures were exported to the AI software system. Heat maps displaying the location of discovered lesions then highlighted the affected area or areas and also provided abnormality scores indicating the probability of malignancy (POM). The results of the histopathological analysis were correlated with the breast density and AI category.ResultsThe artificial intelligence software gave a breast density score to each patient as well as POM scoring. Both the software and the radiologist agreed on the breast density in 80.00% (N = 88) of the patients. Upon correlation of AI results to the BI-RADS given by radiologist, demonstrated statistically very significant correlation (P value 0.001), indicating that the likelihood of error is less than one in a thousand. Upon correlating the pathology results with the AI abnormality score, the AI showed sensitivity of 93.64% as it detected 103 true positive lesions. AI showed 100% sensitivity in both ACR A and ACR B, and 94.74%, 76.47% in ACR C, ACR D, respectively. False negative results represented 5.26% in ACR C group and the highest with 23.53% in ACR D group of patients. The P value was found less than 0.001. Pearson correlation coefficient was calculated (R = 0.27) which was interpreted as a weak correlation between the decrease in sensitivity of AI and the breast density.ConclusionsOur study showed that there is a slight link between increasing breast density and a relative decline in AI's ability to detect malignant lesions, suggesting that AI can detect breast cancer effectively in breasts of different parenchymal densities, with its effectiveness being highest in breasts with lower parenchymal density.

Magnetic resonance imaging of the lung : State of the art

Due to the low proton density of the lung parenchyma and the rapid signal decay at the air-tissue interfaces, for along time the lungs were difficult to access using magnetic resonance imaging (MRI); however, technical advances could address most of these obstacles. Pulmonary alterations associated with tissue proliferation ("plus pathologies"), can now be detected with high diagnostic accuracy because of the locally increased proton density. Compared to computed tomography (CT), MRI provides acomprehensive range of functional imaging procedures (respiratory mechanics, perfusion and ventilation). In addition, as aradiation-free noninvasive examination modality, it enables repeated examinations for assessment of the course or monitoring of the effects of treatment, even in children. This article discusses the technical aspects, gives suggestions for protocols and explains the role of MRI of the lungs in the routine assessment of various diseases.

Quantitative CT Metrics Associated with Variability in the Diffusion Capacity of the Lung of Post-COVID-19 Patients with Minimal Residual Lung Lesions.

(1) Background: A reduction in the diffusion capacity of the lung for carbon monoxide is a prevalent longer-term consequence of COVID-19 infection. In patients who have zero or minimal residual radiological abnormalities in the lungs, it has been debated whether the cause was mainly due to a reduced alveolar volume or involved diffuse interstitial or vascular abnormalities. (2) Methods: We performed a cross-sectional study of 45 patients with either zero or minimal residual lesions in the lungs (total volume < 7 cc) at two months to one year post COVID-19 infection. There was considerable variability in the diffusion capacity of the lung for carbon monoxide, with 27% of the patients at less than 80% of the predicted reference. We investigated a set of independent variables that may affect the diffusion capacity of the lung, including demographic, pulmonary physiology and CT (computed tomography)-derived variables of vascular volume, parenchymal density and residual lesion volume. (3) Results: The leading three variables that contributed to the variability in the diffusion capacity of the lung for carbon monoxide were the alveolar volume, determined via pulmonary function tests, the blood vessel volume fraction, determined via CT, and the parenchymal radiodensity, also determined via CT. These factors explained 49% of the variance of the diffusion capacity, with p values of 0.031, 0.005 and 0.018, respectively, after adjusting for confounders. A multiple-regression model combining these three variables fit the measured values of the diffusion capacity, with R = 0.70 and p < 0.001. (4) Conclusions: The results are consistent with the notion that in some post-COVID-19 patients, after their pulmonary lesions resolve, diffuse changes in the vascular and parenchymal structures, in addition to a low alveolar volume, could be contributors to a lingering low diffusion capacity.

Analysis of enhanced recovery protocol failure for pancreatic surgery

Introduction. Enhanced recovery protocols (ERP) after surgery are evidence-based perioperative management programs aimed at reducing the response to surgical stress and accelerating recovery. These protocols have shown their effectiveness in various surgical sections, including surgical pancreatology. However, in some patients who have undergone pancreatic surgery, these protocols are not effective. The aim of the study was to analyse risk factors for ERP failure during pancreatic surgery, and to develop a predictive model for assessing the risk of ERP failure. Material and methods. A retrospective - prospective two-center study included 122 patients who underwent surgical interventions on the pancreas. ERP was considered unsuccessful if one or more of the following signs were found in a patient: the duration of postoperative hospitalization exceeding 14 days, in-hospital or 30-day mortality, readmission within 30 days. Patients included in the study were divided into two groups: 1) patients who did not have signs of ERP failure - the enhanced recovery group (ER), 2) patients who had signs of ERP failure (non-ER group). The authors evaluated clinical factors that might be associated with the risk of ERP failure. Results. The non-ER group included 46 patients. Univariate and multivariate logistic analysis allowed specifying independent risk factors for ERP failure: age over 70 years (p=0.01), presence of sarcopenia (odds ratio (OR) 4.75, 95% confidence interval (95% CI) 1.7 - 11.9, p=0.01), ASA III score (OR 1.8, 95% CI 1.1 - 2.6, p=0.04), density of the pancreas parenchyma (OR 5.9, 95 % CI 1.8 15.4, p0.01). To develop a score for the risk of ERP failure, each feature was empirically assigned points from 1 to 3 taking into account its severity (the odds ratio value). With a score of 4, the risk of ERP failure was assessed as high, with a score 4, the risk of ERP failure was assessed as low. The sensitivity, specificity and overall accuracy of the developed model were 84.8%, 82.9% and 83.6%, respectively. Conclusions. Based on the study results, the authors developed a scoring prognostic model to evaluate the risk of ERP failure in patients exposed to pancreatic surgery. This model can be used to stratify patients according to their risk of ERP failure (high or low