Enhancement In Venous Phase Research Articles

Unveiling Tim-3 immune checkpoint expression in hepatocellular carcinoma through abdominal contrast-enhanced CT habitat radiomics.

Immune checkpoint inhibitors (ICIs) are important systemic therapeutic agents for hepatocellular carcinoma (HCC), among which T-cell immunoglobulin and mucin-domain containing protein 3 (Tim-3) is considered an emerging target for ICI therapy. This study aims to evaluate the prognostic value of Tim-3 expression and develop a predictive model for Tim-3 infiltration in HCC. We collected data from 424 HCC patients in The Cancer Genome Atlas (TCGA) and data from 102 pathologically confirmed HCC patients from our center for prognostic analysis. Multivariate Cox regression analyses were performed on both datasets to determine the prognostic significance of Tim-3 expression. In radiomics analysis, we used the K-means algorithm to cluster regions of interest in arterial phase enhancement and venous phase enhancement images from patients at our center. Radiomic features were extracted from three subregions as well as the entire tumor using pyradiomics. Five machine learning methods were employed to construct Habitat models based on habitat features and Rad models based on traditional radiomic features. The predictive performance of the models was compared using ROC curves, DCA curves, and calibration curves. Multivariate Cox analyses from both our center and the TCGA database indicated that high Tim-3 expression is an independent risk factor for poor prognosis in HCC patients. Higher levels of Tim-3 expression were significantly associated with worse prognosis. Among the ten models evaluated, the Habitat model constructed using the LightGBM algorithm showed the best performance in predicting Tim-3 expression status (training set vs. test set AUC 0.866 vs. 0.824). This study confirmed the importance of Tim-3 as a prognostic marker in HCC. The habitat radiomics model we developed effectively predicted intratumoral Tim-3 infiltration, providing valuable insights for the evaluation of ICI therapy in HCC patients.

Predicting angiogenesis in adrenal pheochromocytoma: the role of modified parameters from contrast-enhanced CT

ObjectiveThe aim of this study is to investigate the value of modified parameters derived from dual-phase contrast-enhanced computed tomography (CT) in predicting angiogenesis within pheochromocytoma.MethodA total of 31 patients with pathologically confirmed pheochromocytoma underwent preoperative dual-phase contrast-enhanced CT scanning, wherein modified CT enhancement parameters, namely maximum enhancement difference (∆H) and maximum enhancement velocity (V), were quantified. Subsequently, postoperative specimens were evaluated by pathological section, while microvessel density (MVD) and vascular endothelial growth factor (VEGF) levels were counted. We conducted comparative analyses to assess disparities in maximum enhancement difference and enhancement velocity between groups characterized by high and low VEGF expression. Furthermore, correlations between maximum enhancement difference, enhancement velocity, and MVD were examined, along with an assessment of the association between maximum enhancement difference, VEGF expression, and MVD at the point of maximal enhancement difference occurrence.ResultsIn the study group, unilateral pheochromocytoma was observed in 31 cases, with 19 cases of arterial phase enhancement and 12 cases displaying venous phase enhancement. The range of maximum enhancement difference (ΔH) spanned from 24 to 102 HU, while the range of maximum enhancement velocity (V) extended from 0.40 HU/s to 4.08 HU/s. Analysis revealed a significant elevation in MVD value within the arterial phase enhancement group compared to the venous phase enhancement group. Additionally, a positive correlation was discerned between the maximum enhancement difference, V, and MVD. Notably, both ∆H and V exhibited statistically significant elevations in the high VEGF expression group relative to the low VEGF expression group. Furthermore, a positive correlation was observed between both ΔH and V and VEGF expression levels.ConclusionIncreased values of ∆H and V are indicative of heightened MVD and VEGF expression. Consequently, the modified parameters derived from dual-phase contrast-enhanced CT scanning serve as predictive markers for angiogenesis in adrenal pheochromocytoma.

The value of predicting the invasiveness and degree of infiltration of pulmonary ground-glass nodules based on computed tomography features and enhanced quantitative analysis.

The incidence and mortality rate of lung cancer are the highest in the world among all malignant tumors. Accurate assessment of ground-glass nodules (GGNs) is crucial in reducing lung cancer mortality. This study aimed to explore the value of computed tomography (CT) features and quantitative parameters in predicting the invasiveness and degree of infiltration of GGNs. Lesions were classified into three groups based on pathological types: the precursor glandular lesion (PGL) group, including atypical adenomatoid hyperplasia and adenocarcinoma in situ; the minimally invasive adenocarcinoma group; and the invasive adenocarcinoma group. Quantitative and qualitative data of the nodules were compared, and receiver operating characteristic (ROC) curve analysis was performed for each quantitative parameter. Binary logistic regression analysis was used to evaluate independent predictors of GGN invasiveness. There were significant differences in lesion size, morphology, nodule type, bronchial abnormality, internal vascular sign and pleural retraction among the three groups (P<0.05). There were significant differences in all CT quantitative parameters (CT attenuation value in the plain phase, CT attenuation value in the arterial phase, CT attenuation value in the venous phase, arterial phase enhancement difference, venous phase enhancement difference, arterial phase enhancement index and venous phase enhancement index) among the three groups (P<0.001). The ROC curve analysis showed that the CT attenuation value in the plain phase, CT attenuation value in each enhanced phase, enhancement difference and enhancement index had good discriminatory power. Binary logistic regression analysis revealed that nodule type and internal vascular sign were independent risk factors for GGN invasiveness. CT features combined with enhanced scanning and quantitative analysis have important value in predicting the invasiveness of GGNs. The type of pulmonary nodule detected on CT (pure GGN or mixed GGN) and the presence of internal vascular signs are independent risk factors for GGN invasiveness.

Enhancement Patterns in Differentiated and Undifferentiated Gastric Carcinoma: Multiphasic Contrast-Enhanced Computed Tomography Versus Histopathology.

Background Gastric adenocarcinoma (GCA) poses a significant global health burden due to its prevalence and high morbidity and mortality rates. GCA is classified into three main histological types: well-differentiated (intestinal type), poorly differentiated (diffuse type), and mixed or indeterminate forms. These types vary in causes, epidemiology, and genetics, with the diffuse type often associated with the worst prognosis. Endoscopic biopsy is the primary method for characterization, but it has its limitations. There is potential in using contrast-enhanced computed tomography (CT) to differentiate between histological subtypes of gastric adenocarcinoma, which could aid subtype differentiation. Building on this, our study aims to assess CT's effectiveness in distinguishing between broad histological groups of gastric adenocarcinoma based on enhancement patterns, contributing to improved diagnostic accuracy Objective Our research focuses on evaluating the effectiveness of multiphasic contrast-enhanced computed tomography (CECT) in distinguishing between the three broad histopathological subtypes of gastrointestinal cancers. Methods This study was a prospective, analytical observational study that was approvedand carried out in our institutional tertiary care hospital. Consecutive individuals who had undergone endoscopic-guided biopsy and demonstrated histological evidence of GCA were taken into consideration for participation in the study. In order to complete the clinical staging process, further multiphasic CT scans were carried out on each of the fifty patients and were categorised accordingly based on the findings of histopathology. Results In the differentiated type, segmental distribution was: 5.5% upper segment, 16.7% middle segment, 66.7% lower segment, and 11.1% diffuse type. Esophageal involvement was 5.6%, duodenal involvement was similar, and lymph node involvement was approximately 38.8%. TNM staging: 38.8% IIIB, 22.2% III, 27.8% IVA, and 11.1% IVB. In the undifferentiated type, segmental distribution: 6.2% upper segment, 31.2% middle segment, 50.0% lower segment, and 12.5% diffuse type. Esophageal involvement was around 6.25%, duodenal involvement was 18.75%, and lymph node involvement was about 71.8%. TNM staging: 34.4% IIIB, 21.8% III, 28.1% IVA, and 15.6% IVB. Conclusion Multiphasic CT evaluations provide valuable insights into the prognostic aspects of gastric carcinomas by assessing peak enhancement. Differentiated tumors typically exhibit arterial phase enhancement, while undifferentiated tumors show venous phase enhancement, reflecting their microvascular architecture. Recent studies emphasize the importance of understanding gastric carcinoma characteristics for diagnosis and prognosis. Our research aligns with this, revealing distinct contrast enhancement patterns between differentiated and undifferentiated types. However, discrepancies in histological classifications and contrast enhancement patterns across studies warrant further investigation. Integrating histopathological and radiological insights is essential for accurate diagnosis and treatment planning.

Computed tomographic manifestations of celiac ganglia between hypertensive and non-hypertensive population.

The celiac ganglion (CG) is associated with the sympathetic nervous system (SNS) and plays an important role in the pathogenesis of hypertension. The characteristics of the CG in patients with hypertension remain unknown. The aim of our study was to explore the differences in celiac ganglia (CGs) characteristics between hypertensive and non-hypertensive populations using computed tomography (CT). CGs manifestations on multidetector row CT in 1003 patients with and without hypertension were retrospectively analyzed. The morphological characteristics and CT values of the left CGs were recorded. The CT values of the ipsilateral adrenal gland (AG) and crus of the diaphragm (CD) were also measured. The left CG was located between the left AG and CD, and most CGs were long strips. The frequency of visualization of the left CGs was higher in the hypertension group than in the non-hypertension group (p<.05). There were no significant differences in the maximum diameter, size, and shape ratio of the left CGs between the two groups (p>.05). Except for the left CG in the arterial phase, the CT values of the left CG and AG in the non-hypertensive group were higher than those in the hypertension group (p<.05). The venous phase enhancement of the left CG in the non-hypertension group was significantly higher than that in the hypertension group (p<.05). Our findings reveal that CGs have characteristic manifestations in the hypertensive population. As important targets of the SNS, CGs have the potential to regulate blood pressure.

Analysis of influencing factors of nerve invasion in locally advanced gastric cancer.

Accurate preoperative diagnosis of locally advanced gastric cancer (GC) with nerve invasion is very important for guiding the clinical formulation of a reasonable treatment plan, improving treatment efficacy, and improving prognosis. The present study sought to analyze and evaluate the clinicopathological features of locally advanced GC, and to explore the risk factors associated with the state of nerve invasion. The clinicopathological data of 296 patients with locally advanced GC were retrospectively analyzed in our hospital from July 2011 to December 2020 who underwent radical gastrectomy. PNI is defined as a tumor close to the nerve and involving at least 33% of its circumference or tumor cells within any of the 3 layers of the nerve sheath. The patient's age, gender, tumor location, T stage, N stage, TNM stage, degree of differentiation, Lauren classification, microvascular invasion, as well as TAP, AFP, CEA, CA125, CA199, CA724, CA153, tumor thickness, longest diameter, and plain CT value, arterial phase CT value, venous phase CT value, arterial phase enhancement rate, venous phase enhancement rate were assessed. A total of 296 patients with locally advanced GC were included, and 226 (76.35%) were positive for nerve invasion. Univariate analysis showed that tumor T stage, N stage, TNM stage, Lauren classification, tumor thickness, and longest diameter were related to the state of nerve invasion (P<0.05). Multivariate analysis showed that tumor TNM stage was an independent risk factor for nerve invasion (OR0.393, 95%CI 0.165-0.939, P=0.036). Tumor TNM stage is an independent risk factor for nerve invasion (+) in patients with locally advanced GC. Patients at high risk of nerve invasion should be followed closely and, if necessary, performed pathological examinations.

Can angiogenesis inhibitor therapy cause changes in imaging features of hepatic hemangioma- Initial study.

To observe whether anti-angiogenesis therapy can induce changes in size and enhancement characteristics of hepatic hemangioma. 133 patients with hepatic hemangioma lesions were analyzed and classified into a Bevacizumab group (n=65) and the control group (n=68). The parameters (Volume, CT enhancement ratio, enhancement patterns) of pre-and post-treatment in the bevacizumab and control groups independently calculated and compared by two radiologists. Correlation among the systolic blood pressure, diastolic blood pressure, heart rate with the hemangioma volume was evaluated using Pearson's correlation analysis. The hepatic hemangioma volume was significantly decreased after treatment in the Bevacizumab group (8.6 ± 18.7mL vs.7.3 ± 16.3mL, P<0.05), and there was no significant change in the control group (15.1 ± 19.8mL vs.15.4 ± 20.7mL, P = 0.504). A significant difference in enhancement patterns of hepatic hemangiomas was observed after treatment with Bevacizumab (P<0.01). There was no significant difference in arterial phase (AP)enhancement rate and arterial phase-portal venous phase (AP-PVP) enhancement ratios after treatment in the Bevacizumab and control groups (Ps>0.05).The Pearson correlation results showed that blood pressure, heart rate, and hemangioma volume were unrelated or weakly related before and after bevacizumab treatment under the control of factors including weight, contrast injection scheme and CT scanning scheme. Anti-angiogenesis therapy can cause changes in enhancement pattern and volume of hepatic hemangioma. Radiologists should pay more attention to the reexamination of tumor patients treated with anti-angiogenesis therapy.

Computed tomography features and clinical characteristics of gastritis cystica profunda

BackgroundThe diagnostic evidence of gastritis cystica profunda (GCP) are not adequately described due to its extremely low morbidity. This study aimed to analyze and summarize the comprehensive CT features and clinical characteristics of patients with GCP.ResultsNineteen patients were enrolled, including eight men and eleven women, with a mean age of 55.53 years. Only one patient had the history of gastric polypectomy. Among the nineteen cases, two cases were in the gastric cardia, four in the gastric fundus, eight in the gastric body and five in the gastric antrum. The shapes were sphere in thirteen patients, hemisphere in five patients and diffuse in one patient. The mean size of eighteen local lesions was 1.63 cm. The cystic changes in submucosa were detected in fifteen patients. Compared with the pancreas, most GCP lesions were hypo-attenuated on unenhanced CT (n = 8), in arterial phase (AP) (n = 17) and venous phase (VP) (n = 11). Fifteen patients had the peak enhancement in VP and two in AP. The rim-like enhancement with central low attenuation was clearly observed in thirteen patients. For the GCP accompanied by adenocarcinoma, the enhancement peak was present in AP and the gradual expansion of enhancement area was in VP. All patients underwent surgical or endoscopic resection. Sixteen cases had remission of symptoms and no recurrence.ConclusionsThe careful analysis of CT features and clinical characteristics can provide support for deepening the understanding of the GCP. However, a more accurate diagnosis depends on histopathological features.

Enhancement patterns in the venous phase of contrast-enhanced ultrasounds: diagnostic value for patients with solid pancreatic lesions.

To observe and assess the diagnostic value of the venous phase enhancement patterns of contrast-enhanced ultrasounds (CEUS) in patients with solid pancreatic lesions that show iso- to hyperenhancement in the arterial phase of the CEUS. Patients who underwent CEUS for pancreatic lesions in the Peking Union Medical College Hospital between April 2017 and August 2019 were identified from the dynamic CEUS imaging database in the hospital. A total of 57 patients with pathologically or clinically diagnosed pancreatic lesions were retrospectively included in this study, and the CEUS images from these patients were evaluated. The enhancement patterns in each phase were analyzed, and each lesion was classified as malignant or benign using a five-point scale of confidence based on morphology, boundary, vascular invasion, blood flow, and enhancement patterns in ultrasound (US) and CEUS images. Rapid washout in the venous phase of CEUS images was detected in 30 malignant lesions and 4 benign lesions with malignant potential. The specificity for determining malignancy was 77.8%. Continuous isoenhancement with normal pancreatic tissues in the venous phase achieved a high specificity of 95.0% for determining benign lesions. Early hyperenhancement in the arterial phase followed by slow washout in the venous phase showed high specificity of 98.1% for determining metastasis. The diagnostic confidence improved after reviewing CEUS scans (area under the receiver operating characteristic curve was 0.737 for baseline US and 0.910 for CEUS; P=0.056). Enhancement patterns in the venous phase of CEUS images were beneficial in the differential diagnosis of solid pancreatic lesions with iso- to hyperenhancement in the arterial phase on CEUS.

Evaluation of dual‐energy and perfusion CT parameters for diagnosing solitary pulmonary nodules

BackgroundTo evaluate the correlation and accuracy of dual‐energy CT (DECT) (70/Sn150) and low‐dose volume perfusion CT (VPCT) parameters for the diagnosis of solitary pulmonary nodules (SPN).MethodsA total of 15 patients with benign SPN (mean age 56 ± 7 years) and 34 patients with malignant SPN and clinical indication for surgery (mean age 58 ± 6 years) were enrolled from July 2017 to September 2019 at a single institution. All the patients underwent low‐dose VPCT with a scan volume of 114 mm on the z‐axis and a venous phase enhancement DECT (70/150 Sn) scan just before surgery on the same day. All CT findings were studied in comparison with the pathological results after surgery. Perfusion and dual‐energy CT parameters such as blood flow (BF), blood volume (BV), mean transit time (MTT), flow extraction product (FED), pulmonary nodule enhancement peak (PPnod) and iodine concentration (IC) were evaluated as well as t‐test, chi‐square test, Pearson correlation analysis, and ROC curve analysis to determine the significance of study parameters.ResultsThe effective radiation dosage of the VPCT and DECT scans were 4.67 ± 0.26 mSv and 0.32 ± 0.10 mSv, respectively. Significant correlations were found between iodine concentration from DECT and VPCT parameters (r = 0.376–0.533, p < 0.05). The sensitivity and specificity of IC to differentiate the SPN were 86.67% and 72.73%, which was slightly lower than that of BV (94.44%, 73.33%), FED (88.89%, 80.00%) and PPnod (94.44%, 80.00%).ConclusionsVPCT scans have low radiation dosage achieved by shortening the z‐axis scan range for assessment of SPN. IC from DECT is significantly correlated with VPCT parameters, and VPCT parameters have better diagnostic performance for SPN than DECT parameters.

Diagnostic performance of multi-parametric MRI to differentiate benign sex cord stromal tumors from malignant (non-stromal and stromal) testicular neoplasms.

Testicular stromal tumors are uncommon, although mostly benign. The purpose of this study is to assess the role of multi-parametric MRI in differentiating benign testicular stromal tumors from malignant testicular neoplasms (non-stromal and stromal). A single-center retrospective study comparing benign stromal tumors (STs) to malignant testicular neoplasms (MTNs) was conducted. MR imaging assessment included tumor size, T2- and T1-weighted signal intensity, T2- and T1-weighted texture pattern, diffusion restriction, presence of hemorrhage and/or necrosis, and measurement of apparent diffusion coefficient and dynamic contrast enhancement (DCE). Inter-observer agreement was assessed using Cohen's kappa and Bland-Altman and data were compared using independent t-tests or χ2. Receiver operating characteristic curve analysis was used to test models incorporating various imaging features. Radical orchiectomy and histopathology revealed 20 testicular neoplasms: seven STs (35%) and thirteen MTNs (65%). MTNs were significantly larger in size than STs (5.1 ± 2.36cm vs. 1.27 ± 0.56cm; p-value < 0.001). STs demonstrated more hypointense T2W signal (85.7% vs. 46.2%; p-value < 0.09), less T2W heterogeneous texture (14.3% vs. 61.5%; p-value < 0.04), and less diffusion restriction (16.7% vs. 83.3%; p-value < 0.01) in comparison to MTNs. STs demonstrated mainly homogenous post-contrast enhancement pattern (71.4% vs. 7.7%; p-value < 0.004), while MTNs showed primarily heterogeneous enhancement pattern (77% vs. 14.3%; p-value < 0.02). STs revealed greater corrected venous phase enhancement (STs: 0.59 ± 0.29; MTNs: 0.25 ± 0.25; p-value < 0.03). STs showed higher ADC values, though the difference was not statistically significant (p-value < 0.25). A model combining T2W, DWI, and DCE features showed the best overall diagnostic accuracy with area under ROC curve of 0.99 and confidence interval ranging from 0.94 to 1. Multi-parametric MRI can potentially differentiate benign stromal tumors from malignant testicular neoplasms, which can help to avoid radical orchiectomy. However, future studies using larger sample sizes are needed to validate our results.

Comparative analysis of ultrasonographic characteristics between pancreatic neuroendocrine tumor and pancreatic ductal denocarcinoma

Objective To compare the characteristics of ultrasonic imaging between pancreatic neuroendocrine tumor (pNET) and pancreatic ductal adenocarcinoma (pDAC), and to identify the ultrasonic characteristics in different pathological grades of pNETs. Methods The ultrasonic imaging data of 67 patients with pathologically confirmed pNETs and 82 patients with pathologically confirmed pDACs from the First Affiliated Hospital of Sun Yat-sen University from January 2010 to March 2019 were retrospectively analyzed. Differences in conventional ultrasonic characteristics and CEUS manifestations between the two groups were compared. Fifty pNET lesions were confirmed with pathological grades G1, G2 and G3.Ultrasonic characteristics of the 3 pathological grades were also compared. Results ①Comparison of ultrasonic imaging characteristics between pNET and pDAC showed that: there were statistically significant differences between the two groups in lesion distribution, lesion size, echo, boundary, signal of blood flow, calcification, dilatation of main pancreatic duct, liver metastasis, vascular involvement, CEUS enhancement in the three phases and non-enhancement area of necrosis (all P<0.05). The binary logistic regression model was built including the signal of blood flow, dilation of main pancreatic duct, liver metastasis and enhancementin arterial and venous phases. The diagnostic model for pNET had 0.988 in sensitivity, 0.791 in specificity, and the area under the ROC curve at 0.951, 95%CI being (0.920, 0.983). ②Comparison of the characteristics of ultrasonic imaging between the pNETs derived from the three pathological grades: there were statistically significant differences among the three groups with the liver metastasis and the enhancement in venous phase (both P<0.05). Only 10.5% (2/19) of G1 pNETs had liver metastasis, while 47.8% (11/23) of G2 and 62.5% (5/8) of G3 pNETs had liver metastasis. In venous phase, 78.9% (15/19) of G1 pNETs showed hyper- or iso- enhancement, while 100% (8/8) of G3 lesions showed hypo-enhancement. Conclusions The combination of features from multiple ultrasonic imaging may help to differentiate pNET from pDAC. There are certain differences in ultrasonic imaging features in pNETs at different pathological grades. Key words: Ultrasonography; Contrast-enhanced ultrasound; Pancreatic neuroendocrine tumor; Pancreatic ductal denocarcinoma

Contrast-Enhanced Ultrasound of Congenital and Infantile Hemangiomas: Preliminary Results From a Case Series.

OBJECTIVE. The contrast-enhanced ultrasound (CEUS) imaging features of hepatic vascular tumors in infants, including infantile hemangioma (IH) and congenital hemangioma (CH), are not well reported. Frequent inaccurate use of lesion terminology in the literature has created diagnostic confusion. The purpose of this study is to describe the CEUS features of IH and CH. MATERIALS AND METHODS. Ten patients, ranging in age from 8 days to 16 months, with hepatic vascular tumors were included for retrospective analysis. Gray-scale ultrasound, color Doppler ultrasound, and CEUS features were reviewed, and interobserver kappa coefficients were calculated. Final diagnoses were clinically determined by a pediatrician with expertise in vascular anomalies except in one patient who underwent surgical excision. RESULTS. Of the 10 patients, five had CHs and five had IHs. All 10 lesions were hyperenhancing in the early arterial phase. In the portal venous phase, four of five (80%) CHs showed hyperenhancement relative to normal liver parenchyma, whereas four of five (80%) IHs showed isoenhancement. In the late phase, washout of contrast material was seen in three of five (60%) IHs, whereas one IH remained isoenhancing and one IH was hyperenhancing. None of the CHs showed late washout. Interobserver kappa coefficients for CEUS features ranged from 0.60 to 1.00. CONCLUSION. Except for the CEUS feature portal venous phase enhancement (κ = 0.60), good to excellent (κ = 0.74-1.00) agreement about CEUS features of IHs and CHs was observed. A significant proportion of IHs (60%) showed washout at delayed phase imaging, which has also been reported with malignancies. Recognition of the overlap in imaging appearance of these two entities is vital to preventing misdiagnosis of malignancy.

A rare case of pancreatic neuroendocrine tumor

Pancreatic neuroendocrine tumors (PNETs) are a group of endocrine neoplasms that exhibit neuroendocrine phenotypes. These include the production of neuropeptides, large dense-core secretory vesicles, and a lack of neural structures. They arise in the pancreas and are among the most common neuroendocrine tumors. A case of 38 years old female presented with a painless progressive swelling in the right upper abdomen since one month which is insidious in onset, gradually increasing in size with a history of significant weight loss and patient is not a known diabetic. On Examination, a swelling of size 5x7cm noted involving epigastric and right hypochondrium, which is not moving with respiration and dull on percussion. Plane of swelling is Intra-abdominal& retroperitoneal. Computed tomography abdomen (CECT) showed well defined rounded iso dense lesion showing heterogeneous enhancement in arterial and venous phase. Magnetic resonance cholangiopancreatography (MRCP) showed well defined lobulated heterogeneous solid lesion with central areas of necrosis seen in the pancreaticoduodenal groove (PDG) involving main pancreatic duct (MPD) and loss of fat planes with surrounding structures most likely malignant etiology. The patient underwent pancreaticoduodenectomy surgery (Whipple procedure) and had an uneventful recovery. Post-operative biopsy report confirmed pancreatic neuroendocrine tumor grade II (well-differentiated type), stage II a – pT3 N0 Mx.

2340 Almost Fatal: An Unusual Case of Focal Nodular Hyperplasia in Cirrhotic Liver Mimicking Cholangiocarcinoma

INTRODUCTION: Focal nodular hyperplasia is a benign tumor of the liver, second most common after hemangioma. Most commonly, it is incidentally found in reproductive-aged women. It accounts for 8% of all primary liver tumors. Radiologically these regenerative nodules closely mimic intrahepatic cholangiocarcinoma and may be misdiagnosed leading to fatal outcomes. In most cases, the histopathological examination of a biopsy specimen establishes a definitive diagnosis. It is a rare entity for FNH to present in cirrhotic liver and as multiple nodular lesions (&gt;5 in number). CASE DESCRIPTION/METHODS: An obese 66-year-old woman with a past medical history of diabetes presented with recurrent episodes of hematemesis and melena. Physical examination revealed a soft abdomen with hepatomegaly. Laboratory examination revealed microcytic anemia with hemoglobin of 7.1 g/dL and MCV of 73 fL. Liver function tests were within normal limits. Esophagogastroduodenoscopy revealed bleeding medium sized gastric body ulcer which was clipped. Abdominal computed tomography (Fig. A) and Magnetic resonance imaging (Fig. B) revealed multiple ( &gt;5) ill-defined slow enhancing liver lesions, the largest of which measured 5.7 × 7.8 × 7.4 cm mass. Hepatitis screen and tumor markers including CA 19-9, CEA, AFP were negative. Liver cirrhosis was thought to be secondary to nonalcoholic steatosis as her work up did not reveal any other cause. Magnetic resonance cholangiopancreatography (Fig. C) revealed cirrhotic liver and multifocal lesions including a 9 × 8.1 × 11.9 cm mass in the right lobe and additional multiple small lesions in the left lobe all showing a rim of enhancement in the arterial phase, centripetal enhancement in venous phase, delayed washout in late phase and with associated overlying capsular retraction. Biopsy of the liver lesions revealed focal nodular hyperplasia with underlying fibrosis (Fig. D, E). with no evidence of malignancy. Our case is a very rare mimic of multifocal cholangiocarcinoma due to similarities radiologically which without a biopsy could have led to a misdiagnosis and wrong management. DISCUSSION: FNH usually presents as a single lesion in a normal liver parenchymal tissue. When diagnosed and symptomatic, treatment modalities include surgical removal or in some cases, trans-arterial chemoembolization. Our patient is a very unique case of FNH presenting as multinodular lesions in a cirrhotic liver. Since she remains asymptomatic, she will be actively monitored with a regular ultrasound screening.

Preoperative Computed Tomography Features of Intrahepatic Cholangiocarcinoma for Predicting Lymph Node Metastasis and Overall Survival.

The aims of this study were to compare the difference of computed tomography (CT) features between intrahepatic cholangiocarcinomas (ICCs) with and without lymph node metastasis (LNM) and to construct a nomogram to predict LNM and overall survival preoperatively. Clinicopathological and contrast-enhanced CT features of 63 patients with ICC were analyzed. Multivariate logistic regression analysis was performed to construct a nomogram to predict LNM preoperatively. Survival curves were drawn with the Kaplan-Meier method, and survival difference was compared. Intrahepatic cholangiocarcinomas with and without LNM differed significantly in clinical symptoms, tumor location, morphologic classification, arterial phase enhancement degree-mean, arterial phase enhancement degree-max, portal venous phase enhancement degree-max, equilibrium phase (EP) enhancement ratio, EP CT value-max, and EP CT value-max/liver. A nomogram based on morphologic classification, EP CT value-max, and EP enhancement ratio was constructed to predict LNM with an area under curve of 0.814 (P < 0.001). Patients with ICC with LNM risk of 0.20 or greater based on the nomogram showed a significantly poorer overall survival than those with LNM risk less than 0.20 (39.5 ± 5.2 vs 51.1 ± 4.7 months). Preoperative CT features of ICCs differed significantly between those with and without LNM. Nomogram based on those features could predict LNM and overall survival even better than the N stage.

Paraneoplastic pemphigus and myasthenia gravis as the first manifestations of a rare case of pancreatic follicular dendritic cell sarcoma: CT findings and review of literature

BackgroundFollicular dendritic cell sarcoma (FDCS) is a rare neoplasm that originates from follicular dendritic cells in lymphoid tissue while paraneoplastic pemphigus (PNP) is an autoimmune blistering disease associated with neoplasms. Pancreatic FDCS associated with PNP and myasthenia gravis (MG) is even rarer and highly malignant. We present the clinical data, pathological materials and computed tomography (CT) features of a rare case of this disease.Case presentationA 49-year-old woman presented with repeated ptosis of both eyelids, oral ulcers and erosions. Her laboratory results showed a slight elevation of CA125 and positivity of some autoimmune antibodies. CT revealed a round solid mass with central necrosis in the pancreatic tail. The solid component of the mass showed slight enhancement and serpentine feeding arteries in the arterial phase, moderate enhancement with a draining vein around the tumor in the portal venous phase and persistent enhancement in the delayed phase. Surgical resection was performed, and the pathological diagnosis was FDCS. However, the patient died of inability to excrete sputum and occlusion of the respiratory tract.ConclusionsPancreatic FDCS manifested as PNP and MG is very rare. Its CT features are not specific, and the disease should be differentiated from neuroendocrine tumors, solid pseudopapillary neoplasms and acinar cell carcinoma.

Hepatic nontuberculous mycobacterial granulomas in patients with cancer mimicking metastases: an analysis of three cases

Hepatic granulomas caused by nontuberculous mycobacteria (NTM) are an uncommon, insidious, and indolent disease. Making an accurate diagnosis of a hepatic nontuberculous granuloma is challenging because of nonspecific clinical presentations and radiological appearances, especially in patients with a history of malignant tumors, as these lesions may mimic metastases and make a dilemma for decision-making in treatment. Herein, we report three cases of hepatic nontuberculous granulomas following operations for malignant tumors, including colon cancer, ovarian adenocarcinoma, and both rectal and renal carcinoma, respectively. Two patients presented with multiple hepatic lesions and the third had a solitary nodule in the liver. Computed tomography (CT) showed low attenuating nodules without early enhancement in the arterial phase but a slight peripheral enhancement in the portal venous phase after the intravenous administration of contrast agent. Magnetic resonance imaging (MRI) showed high signal intensity on T2-weighted image, rim enhancement in the venous phase and no contrast agent of Gd-EOB-DTPA uptake in the hepatobiliary phase. The biopsy was performed, and histopathological examinations revealed the chronic granulomas composed of epithelioid histiocytes, inflammatory cells, and Langhans giant cells. The results of nested polymerase chain reaction (PCR) were positive for NTM.

Pheochromocytomas Versus Adenoma: Role of Venous Phase CT Enhancement.

Our objective was to investigate whether the quantitative measurement of venous phase enhancement on CT can distinguish a pheochromocytoma from an adrenal adenoma. A pathology database was retrospectively appraised over a period of 7 years and revealed 43 histopathologically proven adrenal adenomas and 34 pheochromocytomas. The lesion densities were measured on the 60-second venous phase CT on all adrenal lesions to assess venous phase enhancement values. Venous phase enhancement of 85 HU or greater afforded a sensitivity, specificity, positive predictive value, and negative predictive value of 88.2%, 83.7%, 81.1%, and 90%, respectively (p < 0.0001). The positive likelihood ratio was 5.42. Venous phase enhancement of ≥ 85 HU was detected in 30 (88.2%) pheochromocytomas (p < 0.001) and in seven (16.3%) adenomas. Venous phase enhancement of < 85 HU was detected in four (11.8%) pheochromocytomas and in 36 (83.7%) adenomas. Of the pheochromocytomas imaged with a triphasic protocol (n = 15), 66.7% (n = 10) met both absolute and relative percentage washout criteria for the diagnosis of a lipid-poor adenoma (p > 0.1). A significant subset of pheochromocytomas mimics adenomas on absolute or relative percentage washout calculations. However, nodules with venous phase enhancement of 85 HU or more are much more likely to be pheochromocytomas than adenomas, regardless of whether the lesion shows absolute or relative percentage washout compatible with a lipid-poor adenoma. The typical values of absolute and relative percentage washout of adrenal adenoma should be interpreted along with the venous phase enhancement value to avoid potential misdiagnoses.

Solid non-functioning endocrine tumors of the pancreas: correlating computed tomography and pathology

BackgroundSince prognosis and treatment of pancreatic endocrine tumors (pNET) are based on tumor grade, contrast-enhanced multidetector computed tomography (MDCT) features of solid non-functioning pNETs were studied and correlated with pathology tumor grading. MethodsMDCTs of diagnosed pNETs were reviewed retrospectively. Each tumor was analyzed for location, size, homogeneity, margins, arterial and venous phase enhancement, main pancreatic duct diameter, calcifications, vascular invasion, lymph-nodes enlargement, and liver metastases. ResultsOf 154 pNETs presenting between January 2000 and May 2016 with available histology from resected specimen or biopsy, there were 65 G1, 72 G2 and 17 G3 pNETs. Tumor diameter varied significantly between the three groups. Tumors >20 mm were more frequently malignant and non-homogeneous than smaller tumors. G1 tumors were more commonly hypervascular and G3 tumors more often non-hypervascular in the arterial phase. Arterial phase non-hyperdensity and tumor non-homogeneity had a higher rate of metastatic lesions. Vascular invasion correlated with presence of metastases and histological grade. G3 tumors were all >20 mm (p = 0.007), more often non-hypervascular in the arterial phase (p = 0.0025), and non-hyperdense in the venous phase (p = 0.009), and showed more often vascular invasion (p = 0.0198). ConclusionCT correlated with tumor grade; differentiating low-grade and high-grade pNETs through routine CT imaging might improve patient management.