Single Focal Lesion Research Articles

Comparative Study between Radiofrequency Ablation Combined with either Percutaneous Ethanol Injection or Percutaneous Acetic Acid Injection in the Management of Hepatocellular Carcinoma.

Background and study aim: Radio-frequency ablation (RFA) has attracted the greatest interest because of its effectiveness and safety. However, complete tumor necrosis rate with RFA for tumors larger than 5 cm is less favorable. Acetic acid, which has the ability to penetrate cells with the property of extracting collagen and dissolving lipids, has a stronger killing effect on hepatocytes than ethanol. The aim of this study was to compare two percutaneous combined therapies, RFA plus percutaneous ethanol injection (PEI) and RFA plus percutaneous acetic acid injection (PAI) in hepatocellular carcinoma (HCC) treatment in patients having single focal lesions more than five and up to seven cm in diameter. Patients and Methods: The patients were selected according to the triphasic CT scanning characteristics of HCC. They were randomly allocated into 2 groups: GI included 30 patients who were candidates for 1 setting of RFA then PEI in the same setting. GII included 30 patients ;they were ablated by 1 setting of RFA with 2 overlaps to decrease the size of the remaining unablated areas, then PAI in the same setting. Results: Evaluation of the response one month later using triphasic CT showed significant better responses in GII compared to GI (83.3% vs 60%) with P value <0.05. The response 3 months later was not changed significantly compared to the response after one month of the procedure (56.7% in GI and 80% in GII) Conclusion: Ablation of inoperable large HCC 5.1-7cm can be done with combined techniques. RFA plus acetic acid was compared to RFA plus ethyl alcohol. Complete ablation was superior when acetic acid was used.

Risk factors of central neck lymph node metastasis following solitary papillary thyroid carcinoma

Objective To evaluate the risk factors in terms of clinical characteristics, serological indicators and sonographic features regarding thyroid papillary carcinoma (PTC) for the central neck lymph node metastasis. Methods One thousand one hundred and seventy-four patients accepted thyroid cancer surgery at Fudan University Shanghai Cancer Center from January to September 2016 were enrolled. All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy.Meanwhile, the status of central neck lymph node metastasis was determined referring to postoperative pathology. All features of the PTC lesion in terms of clinical, serological and sonographic features were evaluated for the association with central neck lymph node metastasis using univariate and multivariate logistic regression analysis. Meanwhile, a nomogram model was established for the determined risk factors. Results Out of 1 174 patients, 469 patients (39.9%) presented central neck lymph node metastasis, univariate analysis showed that age, gender, preoperative thyroglobulin(Tg) and thyroid peroxidase antibody(TPOAb), maximum diameter, location, close to the thyroid capsule, AP/TR, echo, acoustic halo, and presence of microcalcification were related with CLNM (P<0.05). Multivariate logistic regression analysis demonstrated that less than 55 years-old, male, Tg higher than 20 μg/L, TPOAb less than 1 kU/L, maximum diameter larger than 10 mm, and presence of microcalcification were independent risk factors for CLNM. The nomogram was established based on independent risk factors determined by the logistic regression with the AUC 0.714, specificity 73.1%, and sensitivity 59.7%. Conclusions For patients with single focal PTC lesion, younger age, male, higher Tg, lower TPOAb, and larger lesions containing microcalcificatin on ultrasound are associated with central neck lymph node metastasis. Key words: Ultrasonography; Papillary thyroid carcinoma; Lymph node metastasis; Nomogram

Towards multi-focal orhcestrated neuromoduation to enhance recovery

Motor stroke, although defined by its single focal lesion in the motor system, is a network disorder with significant functional and structural changes within the large bilateral motor network involved in the implementation of movements (Koch&Hummel, 2017). During the recovery process there is also significant reorganization within the motor cortical network depending on the site and size of the lesions and the phase of the recovery process from the acute to the chronic stage. In the present presentation, structural and functional changes relevant for the process of functional reorganization and recovery will be discussed with the focus to determine novel targets for neuromodulation (such as premotor cortex or cerebellum) and leverage these factors for phenotyping of patients towards patient-tailored interventions.

Tuberculosis of the central nervous system in cattle in Paraíba, Brazil

ABSTRACT: This paper describes six cases of tuberculosis in the central nervous system (CNS) of cattle in the state of Paraíba in northeastern Brazil. We reviewed the autopsy reports of 851 bovine necropsies performed from 2003 to 2016. Seventy-three (8.6%) cattle were diagnosed with tuberculosis and six showed lesions in the CNS. Three cases affected cattle up to two-year-old and other three affected adults. Three cattle presented exclusively nervous signs, two had respiratory signs and weight loss and one did not present any clinical signs. At necropsy, five cattle had thickening of the leptomeninges of the cerebellum, pons, obex, spinal cord and cortex, mainly, in the region near the brain basilar Willis´ circle. Another animal, presented a single focal lesion in the cerebellum. Microscopically we observed moderate to severe granulomatous meningitis and encephalitis. Five cattle presented lesions in the lungs and mediastinal lymph nodes and three of them had disseminated lesions in other organs. In all cattle acid-fast bacilli were observed in the lesions and marked positive for immunohistochemistry with polyclonal antibody anti-Mycobacterium tuberculosis. It is concluded that bovine tuberculosis of central nervous system occurs sporadically in Paraíba, in cattle of different ages, most of them with disseminate lesions in other organs. The location of the lesions suggests that the agent invaded the brain by hematogenous route through the circle of Willis.

Evaluation of central lymph node dissection for papillary thyroid carcinoma in cN0 T1/T2

Objective: To evaluate the application of the central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) in cN0 T1/T2. Methods: Retrospective analysis of 532 cases with PTC in cN0 T1/T2 who underwent CLND between October 2014 and September 2016 in the Department of Thyroid Surgery, the First Affiliated Hospital of the Kunming Medical University. The incidence of central lymph node (CLN) metastasis and risk factors were analyzed. Results: CLN metastasis rates: 41.2% (42/102) in males vs 34.9% (150/430) in females, P=0.252; 33.9% (116/342) in single focal carcinoma vs 40.4% (74/183) in multifocal carcinoma, P=0.157; 44.0% (125/284) in patients with 45 years old or less vs 27.0% (67/248) in patients more than 45 years old, P=0.000; 30.3% (113/373) in microcarcinoma vs 50.9% (81/159) in non-microcarcinoma, P=0.000.In unilateral lesions, ipsilateral CLN metastasis was correlated with the tumor diameter (P=0.012), but not with the number of lesions (P=0.653). also contralateral CLN metastasis was correlated with the tumor diameter (P=0.000), but not with the number of lesions (P=0.815). For the left or right unilateral single focal lesion, the tumor diameter was not correlated with the metastasis of the posterior to right recurrent laryngeal nerve central lymph nodes (LN-prRLN-CLN) (P=0.652, P=0.088). But in bilateral multifocal carcinoma the tumor diameter was correlated with metastasis of LN-prRLN-CLN (P=0.039). Conclusions: Prophylactic CLND is reasonable for PTC in cN0 T1/T2. A bilateral CLND should be conducted for patients with bilateral multi-focus cancer and unilateral or bilateral non-microcarcinoma, especially in patients more than 45 years old. For unilateral single focal microcarcinoma on the right, the content of CLND should be from laryngeal nerve on right center to posterior branche; for unilateral single focal microcarcinoma on the left side, the left CLND should be conducted. An ipsilateral CLND can be considered in patients with unilateral multifocal microcarcinoma, and generally a routine dissection of the LN-prRLN-CLN is not required, however for bilateral non-microcarcinoma and the the non-microcarcinoma on the right side, the LN-prRLN-CLN dissection should be conducted.

Contrast-Enhanced Magnetic Resonance Imaging with Magnetic Transfer Effect in Differential Diagnosis of Hemangiomas and Metastases of Liver

Objective: to investigate the operating characteristics of contrast MRI of the liver using magnetization transfer effect in the differential diagnosis of hemangiomas and metastatic lesions in comparison with dynamic contrast.Material and methods. The material of the study were dynamic contrast MRI images of 25 patients with diagnosis of direction of focal liver lesion. Inclusion criteria were detection of typical MR-semiotic for hemangioma (n = 10 to 40% of cases) or multiple liver metastases (n = 15 to 60% of cases).In the group with metastases exclusion criteria was the primary detection of obscure single focal lesions, as well as the diagnosis of other primary tumors, in particular cholangiocellular cancer (n = 1). All MRI studies were performed using MRI Toshiba Titan Octave with of 1.5 Tesla magnetic field. T1-weighted static contrast MRI investigation of liver performed after 3–5 minutes after a series of dynamic contrast MRI with modes: T1-FE-FSat and T1-TSEMTS (Δf = -210 Hz, FA = 600°). The magnevist at a dose of 0.1 mmol/kg was used as a contrast agent. Each focal liver lesion differentiated between hemangiomaand metastasis with the calculation of contrast ratio (CR) for each lesion. Statistical analysis of CR was performed using T-test and T-test Welch. The sensitivity and specificity parameters were compared during the ROC-analysis.Results. In our statistical analysis groups formed not from patients, because we were compared results about focal lesions of a liver referred to metastasis or hemangiomas. All the patients included in a research had focal lesions mostly multiple and in the comparative analysis of contrast ratio in the T1-FE-FSat and T1-TSE-MTC was carried out on 21 (20%) hemangiomas and 84 (80%) metastasises. The significant (p &lt; 10–4) contrast enhancement using T1-TSE-MTS, as in the case of hemangiomas and in metastatic lesions relative to T1-FE-FSat revealed by comparing the CRs. No significant differences were found in the differentiation of hemangiomas and liver metastases in modes T1-FE-FSat and T1-TSE-MTS when paired comparison of ROC-curves (p &gt; 0.18). No significant differences were found when paired comparison of CRs between hemangiomas in T1-FE-FSat mode and metastases in T1-TSEMTSimages (p &gt; 0.8). An additive effect (sensitivity and specificity – 98.8% and 85.7%) occurs when we used to CRcomm=35.7% in T1-FE-FSat modes and T1-TSE-MTS.Conclusions. 1. Contrast MRI using magnetization transfer effect allows significantly increase the contrast of focal liver formations on the type of hemangiomas and metastases. 2. The achieved contrast level in 2D TSE images with magnetization transfer effect of liver metastatic foci corresponds to that of hemangiomas in 2D FE mode. 3. Maximum parameters of sensitivity and specificity in the differential diagnosis of hemangiomas and liver metastases obtained by using 2D-FE-FSat and 2D-TSE-MTC in post contrast phase.

The utility of 64-multidetector computed tomography in the diagnosis and staging of hepatoblastoma patients

ObjectiveTo assess the utility of 64 MDCT in the diagnosis, staging and follow-up of HB patients. Patients & methodsThis study included 17 children, 9 males and 8 females with HB from multiple centers aged 6months- 3years. Patients were subjected to complete clinical examination and laboratory investigations at presentation and during follow-up. Patients were evaluated, staged and treated according to SIOPEL HB protocols for management. Imaging evaluation was conducted using abdominal U/S, bone scan and MDCT for chest and abdomen. ResultsAll patients were presented with abdominal mass and elevated AFP level, Jaundice seen in only 1 patient. On MDCT, 13 patients had single focal lesion, 2 patients had multiple foci and 2 patients showed diffuse disease. MDCT was more accurate than US in detecting site, multiplicity, density and lymph nodes (LNs). Regarding tumor staging, MDCT findings were confirmed surgically. In follow-up of patients MDCT was detected with accuracy residual or recurrent lesions in 3 cases. ConclusionMDCT in children with HB accurately displayed the extent of hepatic involvement by tumor, tumor staging and its proximity to vascular structures that help the surgeon to identify the tumor resectability and can be used in follow-up.

Hepatocellular carcinoma in Egypt: epidemiological and histopathological properties

Objectives To study the epidemiological and pathological properties of hepatocellular carcinoma (HCC) cases eligible for surgical resection. Background HCC is the sixth most common cancer worldwide and the third most common cause of cancer death. In Egypt, liver cancer forms 1.68% of the total malignancies. HCC constitutes 70.48% of all liver tumors among Egyptians. HCC represents the main complication of cirrhosis. Materials and methods This longitudinal study included 92 HCC patients who had undergone surgical intervention. Clinical and demographic data were collected from medical records, and paraffin blocks were retrieved from the Archives of the Pathology Department, National Liver Institute, Menoufia University, during the period between March 2007 and October 2014. Results revealed that 51.1% of the studied HCC patients were at least 58 years old, 81.5% male and 18.5% female, 51.2% of the patients had an a-fetoprotein level of at least 200 ng/ml and 95.7% were positive for hepatitis viral infection. Revision of the pathological data revealed that 82.6% of the HCC cases presented as a single focal lesion with a median size of 5 cm. About 76.1% were on top of a cirrhotic liver and 44.5% showed dysplastic changes and 96.7% of the cases were of the classic type. About 57.6% of the cases presented with stage T1 and 34.8% of the cases had lymphovascular invasion. Conclusion On the basis of 92 surgical specimens of HCC, most of the HCC in Egypt occurred in men who developed a cirrhotic liver due to HCV infection. Epidemiological and histopathological data of HCC highlight the importance of an integrated strategy for the prevention and the treatment of viral hepatitis infections and chronic liver disease.

Free-Drawing from Memory in Constructional Apraxia: A Case Series

Constructional apraxia is a neuropsychological and neurological impairment in activities such as building, assembling, and drawing. In this study data is presented on the performance of left and right hemisphere single focal stroke lesion participants on drawing tasks of houses, trees, and persons. Forty-one participants completed a comprehensive neuropsychological battery including the house-tree-person drawing task. The drawings were then rated as exhibiting signs of neurological impairment or non-impairment by three evaluators without knowledge of the medical condition of the patient. There was 72% agreement between the three evaluators of the 123 drawings. Both an analysis of variance and case series analysis was used to examine the data. Patterns of concordance with a previously outlined detailed neuropsychological model of constructional apraxia were found and the implications of the results are analyzed in the context of the current neuropsychological literature.

Short apraxia screening test

Background: Limb apraxia comprises many different and common disorders, which are largely unrecognized essentially because there is no easy-to-use screening test sensitive enough to identify all types of limb praxis deficits. Method: We evaluated 70 right-handed patients with limb apraxia due to a single focal lesion of the left hemisphere and 40 normal controls, using a new apraxia screening test. The test covered 12 items including: intransitive gestures, transitive gestures elicited under verbal, visual, and tactile modalities, imitation of meaningful and meaningless postures and movements, and a multiple object test. Results: Interrater reliability was maximum for a cutoff of >2 positive items identifying apraxia on the short battery (Cohen’s kappa .918, p < .0001), and somewhat less for >3 items (Cohen’s kappa .768, p < .0001). Although both results were statistically significant, >2 was higher, indicating greater apraxia diagnosis agreement between raters at this cutoff value. Conclusions: The screening test proved to have high specificity and sensitivity to diagnose every type of upper limb praxis deficit, thus showing advantages over previously published tests.

Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults

Brief potentially ictal rhythmic discharges, termed B(I)RDs, have been described mainly in neonates, and their significance in adults remains unclear. To describe the incidence of B(I)RDs in critically ill patients and investigate their association with seizures and outcome. We reviewed the records of prospectively identified patients with B(I)RDs and patients serving as controls matched for age (±5 years) and primary diagnosis. The prevalence of seizures during continuous electroencephalography and functional outcome, as measured by the Glasgow Outcome Scale, were determined. We identified B(I)RDs in 20 patients (2%). The pattern most often consisted of very brief (1-3 seconds) runs of sharply contoured theta activity without obvious evolution. All patients with B(I)RDs had cerebral injury, and in cases with a single focal lesion (11 [55%]), B(I)RDs were localized in the same region in all but 2 cases (18%). Patients with B(I)RDs were more likely to have seizures during continuous electroencephalography than were patients without B(I)RDs (15 of 20 [75%] vs 10 of 40 [25%]; P < .001), and 9 patients with B(I)RDs (60%) had only subclinical seizures. Brief potentially ictal rhythmic discharges were identified before seizures in all but 1 case (93%) and ceased in all 12 cases (80%) in which seizures were controlled. Patients with B(I)RDs tended to have a worse outcome than controls (16 [80%] vs 25 [63%]); however, this finding was not statistically significant. Brief potentially ictal rhythmic discharges in critically ill patients are associated with a high prevalence (75%) of electrographic seizures and might serve as an early predictor of seizures during subsequent monitoring. A larger prospective study is needed to better understand their clinical and prognostic significance.

Single hypovascular focal splenic lesion from Bartonella henselae infection

Cat scratch disease is an infectious disease caused by Bartonella henselae generally characterized by self-limited regional lymphadenopathy [1, 2]. Rarely a blood-borne disseminated infection develops with secondary visceral organ involvement [3, 4]. Indeed, isolated multinodular splenomegaly is a rare finding. Multiple lesions of the spleen are reported at computed tomography [5, 6], which after contrast injection remain low in attenuation or become isodense to surrounding tissue or may demonstrate marginal enhancement [7]. We report a case of B. henselae infection occurring in a 72-year-old female otherwise healthy patient without any known immunodeficiency. The patient was admitted to our hospital for fever. The gray scale abdominal sonography revealed a single hypoechoic focal lesion of the splenic upper portion, 45 mm in diameter; the spleen resulted normal in size. The focal splenic lesion resulted hypovascular in all the vascular phases at the contrast-enhanced ultrasound (CEUS) and at the magnetic resonance examination (Figs. 1, ​,2).2). The patient had a kitten for a few months. The IgG serology resulted positive for B. henselae with a title of 1/1024, while the IgM tested negative. Criteria for the diagnosis of cat scratch diseases were satisfied [8] and the patient was treated with a 14-day course of azytromicin. The CEUS at the third month of follow-up demonstrated a shrinkage of the lesion and the patient was completely asymptomatic. The patient gave informed written consent for all the images examinations. Fig. 1 CEUS of the spleen; longitudinal view of the spleen. Evaluation at the third month of follow-up. The images are displayed on a split screen: on the left-hand side the CEUS in the venous phase (about 1 min after the intravenous injection and for ... Fig. 2 Magnetic resonance of the abdomen in the late phase after contrast injection. Evaluation at the onset. A single hypovascular lesion with a longitudinal diameter of 45 mm in the upper portion of the spleen is seen This is the first case of splenic involvement by B. henselae manifesting as a single wide hypovascular lesion. Therefore, not only in the case of multiple splenic lesions but even for a single hypovascular lesion, together with the clinical suspect of cat scratch disease, the serology for B. henselae and a close contact with cats should be investigated to avoid unnecessary invasive procedures since malignant causes are included in the differential diagnosis.

Irreversible electroporation of a liver metastasis

A 70 year old Caucasian man with a history of recently resected moderately-differentiated invasive adenocarcinoma of the colon presented with a 1.8 cm focal liver lesion in segment V (white arrow in Figs. a and b) newly diagnosed at MRI. No other metastatic lesions were detected at PET-CT. After discussing treatment options including resection and ablation, a decision was made to proceed with ablation of this single metastasis. An MRI performed the day after the procedure demonstrates a large area of ablation at the site of the metastasis before contrast administration (white arrow in Fig. c). The ablated area demonstrated no contrast enhancement and was surrounded by an enhancing rim after contrast medium administration (white arrow in Figs. d and e), this findings are consistent with successful metastatic lesion ablation. In Figs. 1d and 1e (black arrow), a contrast-filled vessel is clearly identified crossing the area of ablation. The vessel is not seen before contrast medium administration (black arrow in Fig. c). Irreversible electroporation causes an area of necrosis/apoptosis demonstrating no enhancement on post-contrast images (Figs. d and e) (1–3). While peripheral enhancement surrounding a zone of necrosis has been reported following chemoembolization, the significance of the post-IRE MRI changes has not been adequately studied (Figs. 1d and 1e), in this case the peripheral enhancing area demonstrates high signal intensity on diffusion weighted images (Fig. 1f) (1–3). Thirty days later, in the area of ablation, there has been complete radiological liver parenchyma regeneration (Fig. g), and only a mild perfusion abnormality is noted, the vessel spared by IRE is still patent. Metastatic colorectal carcinoma to the liver is common and treatment of single focal metastatic lesions may be achieved with multiple techniques such as surgical resection, radiofrequency ablation, cryoablation, highly focused ultrasound, microwave ablation and irreversible electroporation (IRE) (1). Each of these techniques has its specifics indications, benefits and risks. Stemming from its non-thermal nature, irreversible electroporation has the peculiar characteristic of ablating cells while sparing structural elements of the biliary ducts and vessels (1, 2). IRE consists of targeted delivery of electrical pulses to modify cell membrane permeability, either temporarily or permanently, depending on the electric field magnitude, pulse duration, and number of pulses applied (1, 2). IRE causes tissue necrosis and apoptosis through the formation of nanometer-scale pores in the cell membrane (1, 2). MRI characteristics of treated lesions have been described in rats (2), but the experience in humans is still limited. These images represent early changes following IRE with demonstration of vessel sparring by IRE.

Cerebellar Toxoplasmosis in HIV/AIDS: A Case Report

Toxoplasma encephalitis is a common presentation of Toxoplasma gondii infection of the central nervous system in the late stage of human immunodeficiency viral (HIV) infection. The definitive diagnosis requires demonstration of toxoplasma in brain tissue. However, neuroradiologic demonstration (using Computed Tomography or Magnetic Resonance Imaging) of ring-enhanced multiple or single focal intracranial lesions in the presence of immunosuppression and prompt response to presumptive therapy are diagnostic in the absence of histological facilities. The rarity of toxoplasma lesions in the cerebellum prompts a high index of clinical suspicion and early institution of presumptive therapy in poor resource sub-Saharan countries like Nigeria. To illustrate the presentation of recurrent cerebellar toxoplasmosis in a patient with HIV/AIDS. A 34-year-old previously diagnosed HIV/AIDS male patient with right-sided cerebellar signs on neurological evaluation and a ring-enhancing lesion in the right cerebellar hemisphere on CT brain scan. An initial response to antitoxoplasmic drugs was short-lived due to poor compliance resulting in recurrence of lesion. On initial evaluation a diagnosis of cerebellar space occupying lesion in a patient with HIV/AIDS was made. He responded to treatment with clindamycin, pyremethamine and pyridoxine. Following default in treatment for three months he represented with florid cerebellar features, but again responded rapidly to treatment. Cerebellar toxoplasmosis is an infrequent complication of HIV/AIDS. Early diagnosis with neuro-imaging techniques and prompt institution of appropriate therapy results in remarkable improvement.

A population‐based study of long‐term outcome of epilepsy in childhood with a focal or hemispheric lesion on neuroimaging

To evaluate long-term seizure outcome in children with epilepsy and a focal or hemispheric neuroimaging abnormality. All children (<18 years and residing in Olmsted County, Minnesota) with new-onset epilepsy diagnosed between 1980 and 2004 and a single focal lesion on neuroimaging were identified by review of the Rochester Epidemiologic Project database. Outcomes were divided into three categories: (1) seizure freedom for 1 or more years at last follow-up, (2) ongoing seizures but not medically intractable epilepsy, and (3) medically intractable epilepsy or undergoing epilepsy surgery. We also evaluated the proportion who achieved seizure control without surgical intervention and whether lesion type predicted intractability. Of the 359 children with newly diagnosed epilepsy, 37 (10%) had a focal or hemispheric lesion on neuroimaging. Median age of diagnosis was 89 months (25th percentile 26 months, 75th percentile 142 months) and at follow-up was 137 months (25th percentile 95 months, 75th percentile 211 months). Eighty-three percent of children with malformations of cortical development, 67% with mesial temporal sclerosis, 33% with encephalomalacia, and 50% with vascular malformations had intractable epilepsy at follow-up or underwent resective surgery for medically intractable epilepsy. Among the different etiologies, presence of encephalomalacia predicted the lowest likelihood of medical intractability or undergoing surgery (p < 0.01). At final follow-up, 24 (65%) of our entire cohort was seizure free. Following surgery, seizure freedom was achieved in 80% with mesial temporal sclerosis, 67% with encephalomalacia, 67% with vascular malformation, and 50% with malformations of cortical development. There was no statistically significant difference between the different etiologies on neuroimaging and seizure freedom after surgery. Twelve children (32%) achieved seizure freedom with medical management alone. Focal lesions on neuroimaging confer a high risk of medical intractability among children with new-onset epilepsy. However, 32% of this cohort achieved seizure remission with medical management alone, including 58% with encephalomalacia and 33% with mesial temporal sclerosis.

Contrast-Enhanced Ultrasonography for Characterization of Focal Splenic Lesions in Dogs

Contrast-enhanced ultrasonography with perflubutane microbubbles improves the diagnostic accuracy to differentiate benign and malignant focal liver lesions in dogs. Perflubutane microbubbles-enhanced ultrasonography is useful for differentiation of benign from malignant focal splenic lesions in dogs. Twenty-nine clinical dogs with single or multiple focal splenic lesions detected by conventional ultrasonography. Prospective clinical observational study. Perflubutane microbubbles-enhanced ultrasonography was performed in 29 dogs with focal splenic lesions. Qualitative assessment of the enhancement pattern was performed in the early vascular, late vascular, and parenchymal phases. In the early vascular phase, a hypoechoic pattern was significantly associated with malignancy (P=.02) with sensitivity of 38% (95% confidence interval [CI], 25-38%) and specificity of 100% (95% CI, 84-100%). In the late vascular phase, a hypoechoic pattern was significantly associated with malignancy (P=.001) with sensitivity of 81% (95% CI, 66-90%) and specificity of 85% (95% CI, 65-95%). There was no significant difference between malignant and benign lesions during the parenchymal phase. Hypoechoic splenic nodules in the early and late vascular phases with perflubutane microbubbles-enhanced ultrasonography are strongly suggestive of malignancy in dogs.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

Untreated Asymptomatic Deep Cartilage Lesions Associated with Anterior Cruciate Ligament Injury

Background Chondral lesions are often documented at the time of anterior cruciate ligament reconstruction. They are usually asymptomatic. It is not known if these lesions change the outcome of current ACL treatments. Hypothesis Untreated deep cartilage lesions incidentally found during anterior cruciate ligament reconstruction do not affect clinical and radiological results. Study Design Case control study; Level of evidence, 3. Methods From 1991 to 1995, 586 anterior cruciate ligament reconstructions were performed; 51 of these were in patients with a concomitant single focal chondral lesion of Outerbridge grade 3 or 4. The mean defect size was 2.1 cm2 (range, 0.5-4.0 cm2). The control group (anterior cruciate ligament injury only) was matched for sex, age, and operation time. Outcomes were reported at 10- and 15-year follow-up using International Knee Documentation Committee criteria, Lysholm score, and Tegner activity scale. Results Forty-two patients were evaluated at 10-year follow-up and 36 at 15-year follow-up. At 10-year follow-up according to Lysholm, Tegner, and International Knee Documentation Committee objective scores, no statistical differences were noted between the groups. The mean total International Knee Documentation Committee subjective score was significantly lower in the defect group than in the control group (mean, 79.6 points vs 83.7; P = .031). At 15 years, there were no statistical differences according to Lysholm, Tegner, and either objective or subjective International Knee Documentation Committee scores. Conclusion Deep cartilage lesions found during anterior cruciate ligament reconstruction, left with no treatment, do not appear to affect clinical outcome at 10- and 15-year follow-up.

CT and MR Imaging Features of Primary Central Nervous System Lymphoma in Norway, 1989–2003

Studying imaging findings of non-acquired immunodeficiency syndrome (AIDS) primary central nervous system lymphoma (PCNSL), we hypothesized that the imaging presentation has changed with the increasing incidence of PCNSL and is related to clinical factors (eg, time to diagnosis and the patient's being diagnosed alive or at postmortem examination). Chart and histologic reviews of patients recorded as having PCNSL during 1989-2003 in the Norwegian Cancer Registry identified 98 patients with non-AIDS PCNSL; 75 had available imaging. CT and MR images from the first diagnostic work-up after onset of symptoms but before histologic diagnosis were reviewed. CT and/or MR imaging in the 75 patients revealed no lesion in 10 (13%), a single focal lesion in 34 (45%), multiple focal lesions in 26 (35%), and disseminated lesions in 5 (7%) patients. All together, we identified 103 focal lesions (single/multiple): 63% in white matter, 56% abutting the ventricular surface, and 43% in the frontal lobes); 100% (102/102 lesions evaluated with contrast) showed contrast enhancement. The median time from imaging to diagnosis for patients with no, single, multiple, or disseminated lesions was 32, 3, 5, and 3 weeks, respectively (P = .01). Patients with no or disseminated lesions were more often diagnosed at postmortem examination (P = .06). Imaging findings were practically unchanged during the consecutive 5-year periods. White matter periventricular contrast-enhancing single or multiple focal lesions were typical of non-AIDS PCNSL. No or disseminated lesions heightened the risk of delayed or postmortem diagnosis. Although the incidence of non-AIDS PCNSL has increased, its presentation at imaging remains unchanged.

Single focal hepatic lesion in patient with colorectal cancer: what imaging is better?

Purpose: To evaluate the relative roles of ultrasound (US) and helical computed tomography (CT) in the definition of nature of single focal hepatic lesions in patients with colorectal cancer.