Natural history of nonfunctioning adrenal incidentalomas: a 10-year longitudinal follow-up study

Most data on the natural history of nonfunctioning adrenal incidentalomas (NFAI) are provided by follow-ups up to 5 years. We conducted a 10.5 (9.1–11.9)-year prospective follow-up study of NFAI in 67 participants (20 (29.9%) males, 47 (70.1%) females) of mean age 57.9 (52.3–63.9) years and BMI 27.42 (24.07–30.56) kg/m2). We also evaluated the associations between baseline BMI and changes of NFAIs’ characteristics at follow-up. Progression to mild autonomous cortisol excess (MACE) was observed in 15 (22 %) patients, with 14 of them having post overnight dexamethasone suppression test (ODST) cortisol between 50 and138 nmol/L and only one > 138 nmol/L. The progression rate was significantly higher in overweight and obese than in normal-weig ht subjects. Patients that developed MACE had a significantly higher baseline mean cortisol after 1 mg ODST. Tumor enlargement ≥10 mm occurred in 8.9% of patients. In comparison with reports of shorter observational periods, we observed a higher growth rate ≥ 10 mm and higher progression rate from NFAI to MACE, particularly in overweight and obese subjects. All tumors had persistent radiological characteristics typical for adrenal adenoma. We concluded that the duration of the follow-up period is an important factor in characterizing the natural history of NFAI. Higher baseline BMI and higher baseline cortisol after ODST might predict the long-term likelihood of progression in hormonal activity. The magnitudes of observed progressions in growth or hormonal activity were clinically ins ignificant. Our long-term follow-up, therefore, clearly supports the general view that a long-term monitoring of patients with NFAI is not necessary

THE ROLE OF MR DIFFUSION AND PERFUSION TO PREDICT TREATMENT RESPONSE OF LOCOREGIONALLY ADVANCED SQUAMOUS CELL HEAD AND NECK CARCINOMA TREATED WITH CONCOMITANT CHEMORADIOTHERAPY

UVOD. Zdravljenje s sočasno radiokemoterapijo s cisplatinom (RT-KT) je nekirurška metoda izbora za bolnike z lokalno in/ali področno napredovalim ploščatoceličnim karcinomom glave in vratu (PCKGV). Z radiološkimi metodami, s katerimi bi že pred ali zgodaj med zdravljenjem napovedali, kako učinkovito bo to, bi lahko v primeru neodzivnih tumorjev spremenili zdravljenje. Namen naše raziskave je bil oceniti, ali izhodiščne vrednosti parametrov, pridobljenih z MR difuzijskim in perfuzijskim slikanjem, in njihove spremembe med zdravljenjem lahko napovedo odgovor bolnikov s PCKGV na zdravljenje z RT-KT s cisplatinom. METODE. Pri 20 bolnikih z napredovalimi PCKGV smo naredili MR difuzijsko in perfuzijsko slikanje pred zdravljenjem, po 1 tednu (t.j. po prejetih 10 Gy) in po 4 tednih (po prejetih 40 Gy) RT-KT ter 2,5 do 3 mesece po zaključenem zdravljenju. V vsaki časovni točki smo v primarnem tumorju z MR difuzijsko preiskavo merili vrednosti navideznega difuzijskega koeficienta [ADC] in vrednosti treh MR perfuzijskih parametrov (konstanta prostorninskega prenosa med zunajceličnim zunajžilnim prostorom [ZZP] in krvno plazmo [Ktrans], prostornino ZZP na enoto prostornine tkiva [Ve] in prostornino krvne plazme na enoto prostornine tkiva [Vp]). Da bi določili dejavnike, ki napovedujejo odgovor na zdravljenje, smo izhodiščne vrednosti in relativne spremembe vseh parametrov po 10 Gy oz. po 40 Gy (glede na izhodišče) analizirali s Firthovim regresijskim modelom. Korelacijo med prostornino tumorja in MR funkcionalnimi parametri smo izračunali s Spearmanovim koeficientom korelacije. REZULTATI. Relativna sprememba (glede na izhodiščno vrednost) Ktrans po 10 Gy se je pokazala kot statistično značilen dejavnik, ki napoveduje, ali bodo bolniki odgovorili na zdravljenje z RT-KT (p = 0,04795% interval zaupanja (IZ), 0,99 – 0,87srednja relativna sprememba Ktrans glede na izhodiščno vrednost, &#6148550,2 %razpon, od &#6148525,1% do &#6148590,9 %). Pri bolnikih, ki so odgovorili na zdravljenje, se je Ve po10 Gy statistično mejno značilno zmanjšal (p = 0,066&#6148526,9 %, od 76,7 % do &#61485126,8 %). Prav tako se je mejno statistično značilno po 40 Gy povečal ADC (p = 0,07973,4 %od 17,8 % do 121,6%). Nobeden izmed parametrov, izmerjenih pred zdravljenjem, se ni izkazal za statistično značilnega. Analiza korelacij ni pokazala statistično značilne povezave med prostornino tumorja in izmerjenimi MR parametri, ne glede na čas meritve. ZAKLJUČKI. Spremembe Ktrans, Ve in ADC, ugotovljene že zgodaj med zdravljenjem, bi lahko pomagale pri napovedi odgovora PCKGV na zdravljenje s sočasno RT-KT s cisplatinom. MR perfuzijski in difuzijski parametri niso korelirali s spremembo prostornine tumorja, izmerjeno z MR volumetrijo. &#8195INTRODUCTION. Concomitant chemoradiotherapy (CRT) with cisplatin is a non-surgical method of choice for treatment of loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). Radiologic imaging with capacity to predict treatment efficacy before or early during therapy would assisst in changing the therapy in case of non-responsive tumors. The role of our study was to assess wheater MR diffusion and perfusion parameters, measured before treatment or their changes early during treatment could predict treatment response in patients with HNSCC, treated with cisplatin based CRT. METHODS. MR diffusion and perfusion imaging was performed in 20 patients with loco-regionally advanced HNSCC before treatment, after 1 week (e.g. after 10 Gy) and after 4 weeks (e.g. after 40 Gy) of CRT, and 2,5 - 3 months after treatment completion. At each time point, apparent diffusion coefficient [ADC] was measured in the primary tumor with MR diffusion examination, as well as three MR perfusion parameters (volume transfer constant between extracellular extravascular space (EES) and blood plasma [Ktrans], EES volume per unit tissue volume [Ve] and blood plasma volume per unit tissue volume [Vp]). Baseline values and relative changes of all parameters after 10 Gy and 40 Gy (from baseline) were analysed by Firth logistic regression in order to determine predictive factors for treatment response. Spearman\u27s rank correlation coefficient was used to asses the association between tumour volume and MR functional parametrs. RESULTS. Relative change (from baseline) of Ktrans after 10 Gy was found to be a significant factor for prediction whether patients would response to treatment with CRT (p = 0,04795% confidence interval (CI), 0,99 – 0,87median relative change of Ktrans after 10 Gy from baseline, &#6148550,2 %range, &#6148525,1 % to &#6148590,9 %). In patients with complete response to treatment, there was a borderline sginificant decrease of Ve after 10 Gy (p = 0,066&#6148526,9 %, from 76,7 % to &#61485126,8 %). In addition, ADC after 40 Gy increased with a borderline significance (p = 0,07973,4 %from 17,8 % to 121,6 %). None of the parameters measured before treatment appeared to be of statistical significance. Correlation canalysis showed no statistically significant association between tumour volume and measured MR parametrs at any time point during treatment. CONCLUSIONS. Changes of Ktrans, Ve and ADC recognized early during treatment could potentionally help in prediction what would be a response of HNSCC to CRT treatment with cisplatin. MR diffusion and perfusion parametrs did not correlate with changes in volume of volume as measured with MR volumetry

Prognostic role of diffusion weighted and dynamic contrast-enhanced MRI in loco-regionally advanced head and neck cancer treated with concomitant chemoradiotherapy

In the study, the value of pre-treatment dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI-derived parameters as well as their changes early during treatment was evaluated for predicting disease-free survival (DFS) and overall survival (OS) in patients with locoregionally advanced head and neck squamous carcinoma (HNSCC) treated with concomitant chemoradiotherapy (cCRT) with cisplatin

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

The purpose of this retrospective study was to evaluate treatment response, adverse events and survival rates of patients with intermediate stage HCC treated with superselective doxorubicin-loaded DC Bead transarterial chemoembolization (DEBDOX) under cone beam computed tomography (CBCT) control

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Recurrent Variceal Hemorrhage

Purpose. The purpose of this study was to determine the incidence and predictors of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) in the elective treatment of recurrent variceal hemorrhage. Methods. Seventy patients were treated with elective TIPS and fifty-six patients with ET. Median observation time was 46.28 months in the TIPS group and 42.31 months in the ET group. Results. 30 patients (42.8%) developed clinically evident portosystemic encephalopathy in TIPS group and 20 patients (35.6%) in ET group. The difference between the groups was not statistically significant (P=0.542; χ2 test). The incidence of new or worsening portosystemic encephalopathy was 24.3% in TIPS group and 10.7% in ET group. Multivariate analysis showed that ET treatment (P=0.031), age of >65 years (P=0.022), pre-existing HE (P=0.045), and Child's class C (P=0.051) values were independent predictors for the occurrence of HE. Conclusions. Procedure-related HE is a complication in a minority of patients treated with TIPS or ET. Patients with increased age, preexisting HE, and higher Child-Pugh score should be carefully observed after TIPS procedure because the risk of post-TIPS HE in these patients is higher

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Recurrent Variceal Hemorrhage

. Purpose. The purpose of this study was to determine the incidence and predictors of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) in the elective treatment of recurrent variceal hemorrhage. Methods. Seventy patients were treated with elective TIPS and fifty-six patients with ET. Median observation time was 46.28 months in the TIPS group and 42.31 months in the ET group. Results. 30 patients (42.8%) developed clinically evident portosystemic encephalopathy in TIPS group and 20 patients (35.6%) in ET group. The difference between the groups was not statistically significant ( = 0.542; 2 test). The incidence of new or worsening portosystemic encephalopathy was 24.3% in TIPS group and 10.7% in ET group. Multivariate analysis showed that ET treatment ( = 0.031), age of > 65 years ( = 0.022), pre-existing HE ( = 0.045), and Child's class C ( = 0.051) values were independent predictors for the occurrence of HE. Conclusions. Procedurerelated HE is a complication in a minority of patients treated with TIPS or ET. Patients with increased age, preexisting HE, and higher Child-Pugh score should be carefully observed after TIPS procedure because the risk of post-TIPS HE in these patients is higher

Computed tomographic perfusion imaging for the prediction of response and survival to transarterial chemoembolization of hepatocellular carcinoma

The purpose of this retrospective cohort study was to evaluate the clinical value of computed tomographic perfusion imaging (CTPI) parameters in predicting the response to treatment and overall survival in patients with hepatocellular carcinoma (HCC) treated with drug-eluting beads transarterial chemoembolization (DEBTACE)