Evaluation of the positive predictive value (PPV3) of ACR BI-RADS category 4 and 5 based on the outcomes of Invasive Diagnostic Office in an outpatient clinic

Purpose: The American College of Radiology (ACR) BI-RADS classification is the applicable for breast lesion assessment. BI-RADS categories 4 and 5 need to be followed by biopsy. The aim of our study was to evaluate the tissue biopsy-proven positive predictive value (PPV3) for BI-RADS 4 (and its subcategories) and for BI-RADS 5, and BI-RADS distribution, in comparison to ACR assumptions and literature. Material and methods: We retrospectively analysed biopsies performed in our outpatient clinic in 2017. Our target group of patients consisted of 797 patients at the average age of 52 years. Results: BI-RADS 5 constituted 12% of cases (95 cases), and BI-RADS 4 88% (698 cases). Within BI-RADS 4 subdivisions there were 359 cases in 4a (45.3%), 215 in 4b (27%), and 124 in 4c (15.6%). Overall PPV3 was 34.8%. BI-RADS 5 category PPV3 number was 97.89%. In category BI-RADS 4 the values of PPV3 equalled 26.22% without subdivision and 3.6%, 27.9%, and 88.7% for subcategories BI-RADS 4a, 4b, and 4c, respectively. Conclusions: BI-RADS categorisation by radiologists in the studied group matches the literature data according to achieved PPV and BI-RADS percentage distribution. The stratification of cancer risk among categories was proven with Mann-Whitney U test p value < 0.005. There was a statistically important unaccepted difference of PPV3 between core biopsy and vacuum-assisted biopsy, which needs further investigation

Obrazowanie metodą rezonansu magnetycznego — nowa jakość w pomiarze prędkości fali tętna

Arterial stiffness assessed by measuring the speed of propagation of the pulse wave (PWV) is now widely recognized as an independent predictor of morbidity and mortality on diseases of the cardiovascular system.Due to the simplicity and high predictive value of PWV, this parameter was incorporated into the recommendations of the European Society of Hypertension, and the value of PWV above 12 m/s has been added to the list of exponents of subclinical organ damage. Widely used non-invasive techniques are subject to errors arising primarily winding course of the aorta in the elderly and the overstatement of measurement in obese people.Magnetic resonance imaging (MRI) is considered optimal, non-invasive method of imaging the aorta and large vessels elective. The main limitations of the method is the high cost and the relatively long duration of the study.The advantage of the method of magnetic resonance imaging over other techniques is the direct measurement of the test and the possibility of aortic PWV assessment on any of its level. MRI can also specify a range of other parameters, such as the susceptibility of the vessel, or elasticity.Pulse wave velocity measurement of the magnetic resonance is carried out using phase-coding sequences (PC), which allows imaging of the flow in the vessel.Due to the limited availability of this technique are still difficult to study in large groups of patients that allow users to standardize the procedure, especially for the PWV in healthy subjects.Sztywność tętnic oceniana za pomocą pomiaru prędkości rozchodzenia się fali tętna (PWV) jest obecnie powszechnie uznawana za niezależny predyktor zachorowalności i umieralności dotyczącej chorób układu sercowo-naczyniowego.Ze względu na łatwość wykonania badania i dużą wartość predykcyjną, PWV zostało włączone do zaleceń European Society of Hypertension, a wartość PWV powyżej 12 m/s dołączono do listy wykładników subklinicznego uszkodzenia narządów. Stosowane powszechnie techniki nieinwazyjne obarczone są błędami wynikającymi przede wszystkim krętym przebiegiem aorty u osób starszych oraz zawyżeniem pomiaru u osób otyłych.Badanie metodą rezonansu magnetycznego (MRI) jest uznawane za optymalną, nieinwazyjną metodę obrazowania aorty i dużych naczyń w trybie planowym.Główne ograniczenia metody stanowią wysoki koszt i stosunkowo długi czas badania.Przewagą metody rezonansu magnetycznego nad innymi technikami jest bezpośredni pomiar badanego odcinka aorty oraz możliwość oceny PWV na dowolnym jej poziomie. W badaniu MR możliwe jest również określenie wielu innych parametrów naczynia, takich jak podatność, elastyczność czy moduł sprężystości.Pomiar PWV metodą MRI wykonuje się przy użyciu sekwencji kodowania fazowego (PC), która umożliwia zobrazowanie przepływu w naczyniu.Ze względu na ograniczoną dostępność tej techniki, nadal trudne są badania z udziałem dużych grup chorych, które pozwoliłyby na standaryzację tej procedury, zwłaszcza dotyczących wartości PWV u osób zdrowych

Home parenteral nutrition a life-saving therapy in a primary intestinal lymphangiectasia patient affecting the entire GI tract - 3 year follow-up case report

Introduction and Importance: Primary intestinal lymphangiectasia (PIL) is a rare protein-losing gastroenteropathy of unknown etiology, characterized by impaired lymphatic vessels drainage. The pathological changes in PIL result in usually localized or diffuse dilatation of intestinal lacteals, leading to leakage of lymphatic fluid rich of proteins, lymphocytes, and immunoglobulins into the intestinal lumen. PIL may be asymptomatic or mildly symptomatic in moderate forms of the disease. In some patients, though, the outcome may be poor or even life-threatening. This case report demonstrates the severity of protein malnutrition, in some cases, and the extent of GI tract affected, requiring to start PN early and the need for its continuation as home parenteral nutrition (HPN). Case presentation: We present a case of 39-year-old male with Factor V Leiden deficiency, who presented initially with symptoms of malnutrition and anasarca. The diagnosis was confirmed by histopathological findings pathognomonic for PIL from biopsies of the stomach, small intestine and colon. Clinical discussion: The patient was started on low fat, high protein parenteral nutrition from the beginning of the treatment and required a long-term HPN for 3 years, because trials of tapering off and discontinuation of PN led to worsening of the biochemical results and recurrence of symptoms. Patient gradually improved and stabilized with persistent nutritional support. Conclusions: The presented case report shows the magnitude of nutritional support (HPN) needed for severe PIL patients. HPN offers PIL patients with poor outcome and life-threatening complications a chance to improve and lead a normal life

Guidelines of the Polish Medical Society of radiology for the routinely used MRI protocol in patients with multiple sclerosis

Magnetic resonance imaging is widely used in diagnosing multiple sclerosis as a basic method for detecting and monitoring the disease. Introduction: Polish Medical Society of Radiology presents the second version of the recommendations for the routinely conducted MRI in multiple sclerosis, which include new data and practical remarks for radiographers and radiologists. The recommended protocol aims to improve the imaging procedure and, most importantly, to standardize conducting MRI scans in all MRI departments. This is crucial for monitoring the patients with MS, which directly contributes to essential clinical decisions. Aim of the guidelines: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system (CNS) with its etiology still unknown. The fundamental requirement of the disease is the CNS destruction process disseminated in time (DIT) and space (DIS). MR imaging detects focal lesions in white and gray matter with high sensitivity and is the best way to assessbrainatrophy in MS patients. It isunquestionably the best diagnostic tool to follow-up the clinical course of the disease and treatment of MS patients. However, to achieve a diagnosis based on MRI scans, and follow-up MS patients according to the latest standards, an MRI scan has to meet certainquality criteria that are the subject of this work

Distinct clinical picture of Cushing’s syndrome in a patient with Morris’ syndrome — first literature report

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Rak pęcherzykowy tarczycy z przerzutami do wątroby — diagnostyka, leczenie i prognoza

  Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer (TC) and accounts for approximately 10% of all TC cases. Liver metastases are a rare presentation in 0.5–1% of follicular thyroid cancers, usually occurring in the setting of widely disseminated FTC disease, and their presence is associated with poor prognosis. Until now, there have been only 30 cases of FTC liver metastases described in the literature. Herein, we review publications and describe diagnostic tools that may be used in the diagnosis and follow-up of FTC metastases to the liver, including biopsy and imaging techniques like US, CT, MRI, SPECT, PET, and radioiodine scintigraphy. We also present and discuss current methods of treatment, e.g. TSH suppressive therapy with levothyroxine, surgery, radiofrequency ablation (RFA), transarterial embolisation (TAE), liver transarterial chemoembolisation (TACE), chemotherapy with cisplatin and doxorubicin, treatment with Indium- 111-octreotide (or its analogues), and tyrosine kinase inhibitors (sorafenib, sunitinib). At the end we describe the course, results of diagnostics, and treatment in a patient with large multiple FTC metastases to the liver. (Endokrynol Pol 2016; 67 (3): 332–347)    Rak pęcherzykowy tarczycy (FTC) jest drugim najczęstszym typem raka tarczycy (TC) i stanowi około 10% wszystkich TC. Przerzuty do wątroby występują w 0,5–1% przypadków FTC, zwykle w przypadku znacznie zaawansowanej choroby nowotworowej i wiążą się ze złą prognozą. Do tej pory, tylko 30 przypadków FTC z przerzutami do wątroby zostało opisanych w literaturze. W niniejszej pracy dokonano przeglądu literatury i opisu metod diagnostycznych jakie mogą być użyte w badaniu i kontroli przerzutów FTC do wątroby, w tym biopsji, technik obrazowych, takich jak: USG, KT, MRI, SPECT, PET i scyntygrafii jodowej. Zaprezentowano i omówiono aktualne metody leczenia: terapię L-tyroksyną w dawce supresyjnej, leczenie operacyjne, ablację prądem o częstotliwości fal radiowych (RFA), embolizację przeztętniczą (TAE), przeztętniczą chemoembolizację, chemioterapię z użyciem cisplatyny i doksyrubicyny, leczenie z użyciem analogów somatostatyny w tym octreotydu znakowanego izotopem indu 111In, czy terapię z użyciem inhibitorów kinazy tyrozynowej (sorafenib, sunitynib). Na końcu opisano przebieg choroby, wyniki badań diagnostycznych i podjęte leczenie u chorej z ogromnymi mnogimi przerzutami FTC do wątroby. (Endokrynol Pol 2016; 67 (3): 332–347)

MRI utility in predicting extraprostatic extension of prostate cancer and biochemical recurrence after radical prostatectomy

Introduction. The study aimed to evaluate the performance of multiparametric magnetic resonance imaging (mpMRI) and the Martini model to predict extraprostatic extension (EPE) and biochemical recurrence (BCR) of prostate cancer (PCa). Materials and methods. 61 patients underwent a radical laparoscopic prostatectomy. The preoperative risk of EPE was determined using mpMRI and the Martini model. Results. MpMRI predicts the presence of EPE of PCa with a sensitivity and specificity of 47.4% and 85.7%, respectively (AUC 0.66, 95% CI: 0.51–0.82, p = 0.046). The Martini model’s sensitivity was higher, but the specificity was lower than that of mpMRI and was 84.2% and 66.7%, respectively (AUC 0.78, 95% CI: 0.66–0.89, p &lt; 0.001). Univariate and multivariate Cox analysis indicated that EPE in mpMRI (HR 6.6, 95% CI: 1.8–24.1), and the presence of positive surgical margins (PSM) (HR 7.1, 95% CI: 1.9–26.7) are independent factors increasing the probability of BCR. Conclusions. MpMRI and Martini model are valuable tools in local staging of PCa, managing and predicting the oncological treatment outcomes of patients with PCa

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

The abdominal aortic aneurysm is tenth most common cause of death in Western countries. Since maximal transverse diameter as indication for surgical interventions is often criticized, biomechanics of the aneurysm has been studied to develop new criteria for a treatment. The Finite Element Method is being utilized to predict vessel stability. Computer simulations are proven to have high accuracy of rupture risk assessment, although the impact of all incorporated factors is still not fully known. The objective of this paper is to review the most commonly used biomechanical components of computer analysis, including geometry of the vessel, mechanical properties of the wall, thrombus and calcification, their impact on rupture risk, and methods of modelling blood pressure. Comprehension and precise assessment of biomechanics of aneurysm in terms of Finite Element Analysis have high potential in clinical management of abdominal aortic aneurysm