Radiology-pathology correlation in staging of liver fibrosis using superb microvascular imaging

PURPOSEProgression of liver fibrosis to end-stage disease can potentially be prevented with antiviral treatment. Thus, diagnosis of fibrosis is important in determining treatment protocols. This study aims first, to determine the sensitivity of a novel Doppler method, superb microvascular imaging (SMI), in detecting small vascular structures of the liver compared with other Doppler methods; and second, to choose the best method among these Doppler applications to determine the morphologic changes that occur due to chronic fibrosis. By doing so, the study would be able to provide an ultrasound grading that might differentiate and predict mild and severe liver fibrosis, thus giving rise to a possible alternative to biopsy.METHODSA total of 43 patients diagnosed with chronic hepatitis and scheduled for liver biopsy were included. Color Doppler, power Doppler, advanced dynamic flow (ADF) Doppler, color SMI (cSMI) and monochrome SMI (mSMI) Doppler were performed in subcapsular areas of right anterior lobe. Depth from the capsule of the most peripherally located detectable vessel was measured for each Doppler subgroup. Appearance of the vascular tree was categorized into four groups and correlated with pathology results. ROC curve analysis was used to determine if this Doppler classification was statistically significant in differentiating mild and severe forms of fibrosis. Finally, multiple regression analysis was used to determine which Doppler parameter can significantly predict severity.RESULTSmSMI and cSMI were found to be superior to other Doppler techniques in detecting the most superficially located vessels of the liver, 4.4 mm and 3.3 mm deep from the capsule, respectively (P < 0.001). Among the changes identified in the vascular tree, small vessel blunting was the most prevalent finding in predicting the presence of severe fibrosis (multiple regression test, t=5.969, P < 0.0001). ROC analysis identified that the presence of at least two pathologic findings in the vascular tree was highly predictive of severe fibrosis (AUC=0.881, sensitivity 86.67%, specificity 89.29%, positive and negative predictive values 8.09 and 0.15, respectively).CONCLUSIONOur study proves that SMI is superior to other Doppler techniques in detecting the smallest vessels visible to ultrasound. Using this method, it is possible to determine the vascular changes in terms of blunting and tortuosity and thus predict the severity of fibrosis. This method might be a practical alternative to biopsy

Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients

Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n=56) and 4-day diet group (n=45). Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring <6 mm and ≥6 mm. We graded the residual fluid, tagging quality for solid stool, and fluid per bowel segment. We performed a questionnaire to assess patient compliance. Results. 604 bowel segments were evaluated. There was no significant difference between 2-day and 4-day diet groups with respect to residual solid stool, residual fluid, tagging quality for stool, and fluid observed in fecal tag CT colonography (P>0.05). The prevalence of moderate discomfort was significantly higher in 4-day group (P<0.001). Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients

Prognostic markers for metastatic colon cancer patients undergoing multiple metastasectomies

WOS: 000361693500005PubMed ID: 26215062Background/Aims: Following metastasis resection, 5-year survival rate has been reported as approximately 40%. There is no consensus regarding prognostic factors related to progression-free survival after repeated metastasectomies. Materials and Methods: A total of 21 patients with metastatic colorectal cancer who underwent repeated metastasectomies were retrospectively analyzed. The periods between the first and second metastasectomies and that between the second metastasectomy and progression were defined as metastasis-free survival 1 (MFS1) and metastasis-free survival 2 (MFS2), respectively. Univariate analysis was used to analyze factors related to MFS1 and MFS2. Results: Approximately two-thirds of the patients had synchronous metastasis, which were localized mostly in the liver (90%). During a 49-months follow-up, MFS1 was 15.7 (8.4- 23) months and MFS2 was 26.3 (12.3-40.4) months. Systemic chemotherapy followed the first metastasectomy (p=0.01), and the recurrence site (p=0.03) was found to be related to MFS1. Furthermore, the number of metastases during the first metastasectomy (p=0.02), the type of the chemotherapy regimen administered following the first metastasectomy (p=0.04), and the number of metastases before the second metastasectomy ( p=0.03) were significantly related to MFS2. Conclusion: Surgical resection is currently the most effective and curative form of therapy for colorectal metastasis, whenever possible. Repeated metastasectomies can be achieved safely in experienced centers; thus, the operability of the patients should be evaluated by a multidisciplinary approach during treatment

Contribution of diffusion weighted MRI to the differential diagnosis of renal masses

Introduction and aim. We aimed to assess the usefulness of diffusion weighted imaging (DWI) and apparent diffusion coefficients (ADCs) for characterizing renal masses. Material and methods. In this retrospective study we measured the ADC values of renal masses at b=0, b=500 and b=1000. Measurements were made by placing a circular region of interest with a diameter of 1 cm. ADC values from normal renal parenchyma were taken to define the ADC and to compare with the ADC values of the lesions. Results. A total of 72 lesions of 54 patients were included.40 of the masses were benign and 32 were malignant. The ADC values of benign lesions at both b values were significantly higher than malignant lesions. We found the lowest values in angiomyolipomas (AMLs) and oncocytomas and the highest values in Bosniac type I cysts. Similarities was found between the ADC values of some AMLs and the RCCs. In terms of statistical results, the inclusion of AMLs in the analysis did not significantly affect the difference between malignant and benign lesions. Conclusion. In our study, the ADC values of benign renal masses were higher than those of normal renal parenchyme, which is higher than those of malignant renal masses.The lowest ADC values were observed in AMLs and oncocytomas

The relationship between positron emission tomography-computed tomography imaging and histopathological features of thyroid incidentalomas detected during follow-up for primary malignancy

WOS: 000470851300023PubMed ID: 31169225Aim of the Study: While the rate of thyroid incidentaloma detected on positron emission tomography (PET) was reported as 4%, the malignancy rate was 14%u50%. We evaluated the thyroid nodules which were detected by PET-computerized tomography (CT) in cancer patients and analyzed the pathological results of those thyroid nodules diagnosed by fine needle aspiration biopsy (FNAB) and their correlation with the maximum standardized uptake (SUVmax) value and PET imaging features. Materials and Methods: FNAB were performed for 40 thyroid incidentalomas. We analyzed the relationship between the histopathological findings and radiological features by Pearson's correlations and Chi-square-Fisher's exact tests to evaluate the factors associated with SUVmax. Results: The median SUVmax values were 5.4 for thyroid nodules. Totally, 14 malignancies were detected by FNAB (35%).The sensitivity and specificity of SUVmax value for diagnosis of malignancy were 87.5% and 52%, respectively. Positive and negative predictive values were 36.8% and 92.8%. The most common malignant and benign pathologies were classic variant papillary carcinoma and benign colloidal nodule. The median SUVmax was the higher in colon cancer thyroid metastasis and oncocytic neoplasia (SUVmax 14.5 and 13.6, respectively). Histopathological type was not related with nodule size but positively associated with categorical SUVmax(r = 0.318, P = 0.04) and negatively correlated with both the density of the thyroid nodule in PET-CT (r = 0.0042, P = 0.01) and density of nodule in ultrasound (USG) (r = 0.305, P = 0.05). Margin of the thyroid nodule in USG (P = 0.007) and internal component of the nodule in PET (P = 0.03) were found to be important factors to differentiate benign or malignant lesion. Conclusion: If the thyroid nodule is detected with flouro-2-deoxy-D-glucose uptake, to differentiate benign nodule from malignant, cytological examination is noteworthy to diagnose the more aggressive type of thyroid nodule and also thyroid metastasis from primary cancer

Comparison of morphological and kinetic parameters in distinction of benign and malignant breast lesions in dynamic contrast enhanced magnetic resonance imaging

Objective: To evaluate the value of qualitative morphologicaland kinetic data and quantitative kinetic data indistinction of malignancy in dynamic contrast enhancedmagnetic resonance imaging (DCE-MRI) of the breast.Methods: DCE-MRIs of 49 subjects were evaluated.Morphological and contrast enhancement parameters of95 lesions were recorded in these subjects. Post-contrastkinetic behavior of these lesions were also investigated.Among the quantitative parameters, relative enhancements(E1, E2, Epeak), time-to-peak (Tpeak), slope ofcurve (Slope), signal enhancement ratio (SER), and maximumintensity time ratio (MITR) were calculated. Theseresults were compared with the pathological diagnosis.Results: Spiculated contour (100%), rim enhancement(97.87%), irregular shape (95.74%), and irregular margin(91.49%) were the most specific morphological featuresof malignancy in mass lesions. In non-mass lesions, focalzone (91.49%) was the most specific feature of malignancy.74.5% of the benign lesions showed type 1, 77.1%of the malignant lesions showed type 2 and 3 curves accordingto the kinetic curve evaluation. All quantitativeparameters except Epeak were found to be statisticallysignificant in distinction of malignancy.Conclusion: None of the morphological features of thebenign lesions were found to be significantly specific.More specific features can be described for malignantlesions. Early behavior of the kinetic curve is not usefulfor diagnosis of malignancy but the intermediate and latebehavior gives useful information. Quantitative data involvedin this study might be promising.Key words: Morphological, kinetic, breast lesions, magnetic resonance imaging, dynami

The relationship between PET-CT images and histopathological features of thyroid incidenteloma, detected during follow-up of primary malignancy

Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) -- JUN 03-07, 2016 -- Chicago, ILWOS: 000404711503032Aim of the Study: While the rate of thyroid incidentaloma detected on positron emission tomography (PET) was reported as 4%, the malignancy rate was 14%–50%. We evaluated the thyroid nodules which were detected by PET computerized tomography (CT) in cancer patients and analyzed the pathological results of those thyroid nodules diagnosed by fine needle aspiration biopsy (FNAB) and their correlation with the maximum standardized uptake (SUVmax) value and PET imaging features. Materials and Methods: FNAB were performed for 40 thyroid incidentalomas. We analyzed the relationship between the histopathological findings and radiological features by Pearson’s correlations and Chi square Fisher’s exact tests to evaluate the factors associated with SUVmAmerican Society of Clinical Oncolog