Percutaneous CT fluoroscopy-guided core biopsy of pancreatic lesions: technical and clinical outcome of 104 procedures during a 10-year period

Background: In unclear pancreatic lesions, a tissue sample can confirm or exclude the suspected diagnosis and help to provide an optimal treatment strategy to each patient. To date only one small study reported on the outcome of computed tomography (CT) fluoroscopy-guided biopsies of the pancreas. Purpose: To evaluate technical success and diagnostic rate of all CT fluoroscopy-guided core biopsies of the pancreas performed in a single university center during a 10-year period. Material and Methods: In this retrospective study we included all patients who underwent a CT fluoroscopy-guided biopsy of a pancreatic mass at our comprehensive cancer center between 2005 and 2014. All interventions were performed under local anesthesia on a 16-row or 128-row CT scanner. Technical success and diagnostic rates as well as complications and effective patient radiation dose were analyzed. Results: One hundred and one patients (54 women;mean age, 63.912.6 years) underwent a total of 104 CT fluoroscopy-guided biopsies of the pancreas. Ninety-eight of 104 interventions (94.2%) could be performed with technical success and at least one tissue sample could be obtained. In 88 of these 98 samples, a definitive pathological diagnosis, consistent with clinical success could be achieved (89.8%). Overall 19 minor and three major complications occurred during the intra- or 30-day post-interventional period and all other interventions could be performed without complications;there was no death attributable to the intervention. Conclusion: CT fluoroscopy-guided biopsy of pancreatic lesions is an effective procedure characterized by a low major complication and a high diagnostic rate

Dual-source CT for chest pain assessment

Comprehensive CT angiography protocols offering a simultaneous evaluation of pulmonary embolism, coronary stenoses and aortic disease are gaining attractiveness with recent CT technology. The aim of this study was to assess the diagnostic accuracy of a specific dual-source CT protocol for chest pain assessment. One hundred nine patients suffering from acute chest pain were examined on a dual-source CT scanner with ECG gating at a temporal resolution of 83 ms using a body-weight-adapted contrast material injection regimen. The images were evaluated for the cause of chest pain, and the coronary findings were correlated to invasive coronary angiography in 29 patients (27%). The files of patients with negative CT examinations were reviewed for further diagnoses. Technical limitations were insufficient contrast opacification in six and artifacts from respiration in three patients. The most frequent diagnoses were coronary stenoses, valvular and myocardial disease, pulmonary embolism, aortic aneurysm and dissection. Overall sensitivity for the identification of the cause of chest pain was 98%. Correlation to invasive coronary angiography showed 100% sensitivity and negative predictive value for coronary stenoses. Dual-source CT offers a comprehensive, robust and fast chest pain assessment

Diffusion-weighted MRI of metastatic liver lesions: is there a difference between hypervascular and hypovascular metastases?

Background Different perfusion characteristics and histopathologic features of liver metastasis may potentially lead to different diffusion-weighted magnetic resonance imaging (DW-MRI) characteristics which can affect the performance of DW-MRI in their diagnosis. Purpose To compare ADC values of hypervascular and hypovascular metastases and the added value of DW-MRI to T2-weighted (T2-w) images in their detection. Material and Methods In this retrospective study, 46 patients (21 with hypervascular, 25 with hypovascular liver metastases) who had undergone abdominal MRI were included. Two independent observers first reviewed T2-w images only and then T2-w + DW-MR images and recorded number of metastases in each session. Lesion detection rate was compared using McNemar test. ADC of metastases in each patient was measured and compared between hypo- and hypervascular lesions using t-test. Results A total of 153 hypervascular and 187 hypovascular metastases were detected at consensus review. Two observers detected significantly more hypervascular metastases on T2-w + DW-MR image review session compared to T2-w image only review session (reader 1: 148 [96.7%] vs. 129 [84.3%], P = 0.002; reader 2: 125 [81.9%] vs. 113 [73.8%], P = 0.004). Detection rate of hypovascular metastases was similar between two sessions for both observers (reader 1: 180 [96.2%] vs. 184 [98.4%]; reader 2: 176 [94.1%] vs. 180 [96.2%], P > 0.05). The mean ADC value of hypervascular metastases was significantly lower than mean ADC value of hypovascular metastases (1.23+/−0.31 × 10−3 mm2/s vs. 1.49+/−0.19 × 10−3 mm2/s) (P = 0.001). Conclusion Liver metastases are not a homogenous group of lesions with uniform DW-MRI features. Hypervascular metastases demonstrate significantly lower ADC values compared to hypovascular metastases. DW-MRI improved detection of hypervascular metastases compared to T2-w images alone and is a useful adjunct to T2-w images for their detection

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD.Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals.Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables.Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.publishe

Elektronische Tagebücher optimieren die Kognitive Verhaltenstherapie bei Krankheitsängsten : eine randomisiert-kontrollierte Studie

Zentrale Komponenten in kognitiv-behavioralen Erklärungsmodellen der Hypochondrie und den daraus abgeleiteten Behandlungen sind eine selektive Aufmerksamkeitslenkung auf körperliche Empfindungen und ein katastrophisierender Symptominterpretationsbias. Wir untersuchten, ob sich die Effektivität einer störungsspezifischen Kognitiven Verhaltenstherapie (KVT) für Patienten mit Hypochondrie durch ein zusätzliches zweiwöchiges elektronisches Tagebuchtraining (TBT), das auf eine Korrektur der Symptominterpretationen abzielt, verbessern lässt. Zu diesem Zweck wurden 35 Patienten mit Hypochondrie randomisiert zwei Interventionsformen zugewiesen: Gruppe 1 (N = 16) erhielt vor der KVT (16 Einzelsitzungen) ein zweiwöchiges TBT unter therapeutischer Anleitung (4 Sitzungen). Gruppe 2 (N = 19) erhielt vor der KVT vier Therapiegespräche ohne TBT. Das Ausmaß der Krankheitsangst wurde mit dem Short Health Anxiety Inventory erfasst. Beide Gruppen zeigten nach der Therapie eine signifikante Reduktion der Krankheitsangst. In der Gruppe mit TBT verbesserte sich die Krankheitsangst jedoch schneller (d = .75) und stärker (d = .76) als in der Kontrollgruppe. Zudem zeigte die Gruppe mit TBT eine stärkere Habituation an bedrohliche Symptomstimuli als die Kontrollgruppe. Weitere Studien an größeren Stichproben sowie die Untersuchung von Langzeiteffekten sind notwendig, um die Wirksamkeit des vorgestellten TBT zu belegen.publishe

Cognitive Biases in Pathological Health Anxiety : The Contribution of Attention, Memory, and Evaluation Processes

Pathological health anxiety refers to the medically unfounded fear of suffering from a severe illness. Differences in cognitive processes related to attention, memory, and evaluation of health threat have been hypothesized to underlie pathological health anxiety. In no study, however, have researchers systematically and simultaneously assessed different cognitive biases. On the basis of the idea that multiple cognitive biases simultaneously contribute to psychopathology (the combined-cognitive-bias hypothesis), we compared 88 patients with pathological health anxiety, 52 patients with depressive disorder, and 52 healthy participants on their performance in several cognitive tasks involving healththreatening content. Individuals with pathological health anxiety showed a stronger attentional bias to health-threatrelated information, more negative explicit (but not implicit) evaluations of health threat, and biased response behavior in light of health threat. The results suggest that stronger bindings between feelings of arousal and health-threatening information in working memory might be crucial for the higher salience of health-threatening contents in pathological health anxiety.publishe

Cough Is Dangerous : Neural Correlates of Implicit Body Symptoms Associations

The negative interpretation of body sensations (e.g., as sign of a severe illness) is a crucial cognitive process in pathological health anxiety (HA). However, little is known about the nature and the degree of automaticity of this interpretation bias. We applied an implicit association test (IAT) in 20 subjects during functional magnetic resonance imaging (fMRI) to investigate behavioral and neural correlates of implicit attitudes toward symptom words. On the behavioral level, body symptom words elicited strong negative implicit association effects, as indexed by slowed reaction times, when symptom words were paired with the attribute "harmless" (incongruent condition). fMRI revealed increased activation in the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex for the comparison of incongruent words with control words, as well as with a lower significance threshold also in comparison to congruent words. Moreover, activation in the DLPFC, posterior parietal cortex, nucleus accumbens, and cerebellum varied with individual levels of HA (again, in comparison to control words, as well as with a lower significance threshold also in comparison to congruent words). Slowed reaction times as well as increased activation in dorsolateral prefrontal and posterior parietal cortex point to increased inhibitory demands during the incongruent IAT condition. The positive association between HA severity and neural activity in nucleus accumbens, dorsolateral prefrontal, and posterior parietal cortex suggests that HA is characterized by both intensified negative implicit attitudes and hampered cognitive control mechanisms when confronted with body symptoms.publishe

Structured Reporting of Rectal Magnetic Resonance Imaging in Suspected Primary Rectal Cancer

Objectives: The aim of this study was to evaluate the effect of structured reports (SRs) in comparison to nonstructured, free-text (FT) rectal magnetic resonance imaging (MRI) reports in patients with histologically proven rectal cancer and potential effects of both types of reporting on referring surgeons' satisfaction, interdisciplinary communication, and further clinical decision making. Materials and Methods: The institutional review board approved this retrospective study with waiver of informed consent. Forty-nine patients with histologically proven rectal cancer were included in this study. All patients underwent rectal MRI for local rectal cancer staging before surgery. Free-text reports and SRs for local MR staging of rectal cancer were generated for all subjects by radiologists. Two experienced abdominal surgeons evaluated a questionnaire that included 9 questions regarding satisfaction with content, presence of reported key features, effort for information extraction, and report quality. Results: Structured reports achieved significantly higher satisfaction rates with report content and clarity, and included significantly more of the 13 predefined key features compared with FT reports (SRs: mean +/- SD, 12.2 +/- 4.6 [range, 9-13] versus FT reports: mean +/- SD, 9.2 +/- 10.8 [range, 5-13]) (P < 0.001). Definite further clinical decision making (surgery vs neoadjuvant radiochemotherapy) was possible in 96% of SRs and only in 60% of FT reports (P < 0.001). In case of surgery, the reported information was considered to be sufficient for surgical planning in 94% of SRs versus only 38% in FT reports (P < 0.001). Structured report received a significantly higher overall report quality rated on a Likert scale from 1 to 6 (1, insufficient; 6, excellent) with a mean of 5.8 +/- 0.42 (range, 5-6) in comparison to FT reports with 3.6 +/- 1.19 (range, 1-5) (P < 0.001). Conclusions: Structured reporting of rectal MRI in patients with rectal cancer facilitates surgical planning and leads to a higher satisfaction level of referring surgeons in comparison to FT reports. Abdominal surgeons were more confident about report correctness and further clinical decision making on the basis of SRs