Malignitätshinweise bei der intraduktalen papillär muzinösen Neoplasie des Pankreas in der CT-Diagnostik

Problem: Bei bekannter Adenom-Karzinom-Sequenz der IPMN und somit malignem Potential ist eine präoperative, nichtinvasive Dignitätsbeurteilung wünschenswert. Methode: 47 Patienten mit gesicherter IPMN wurden retrospektiv auf präoperative Malignitätshinweise in der abdominellen CT untersucht und dies in Zusammenschau mit der aktuellen Literatur bewertet. Ergebnis: Bei Nachweis folgender Veränderungen fand sich signifikant häufiger eine maligne Entartung der IPMN: Erweiterung des Pankreashauptgangs auf mehr als 10 mm, Gallengangsobstruktion, Vorhandensein kontrastmittelanreichernder Zystenwände oder solider Tumoranteile, abrupte Schwankungen der Pankreasgangweite, vergrößerte Lymphknoten von mehr als 10 mm und erhöhte CA 19-9-Spiegel im Serum. Diskussion: Computertomographische Veränderungen bei IPMN des Pankreas können hinweisgebend für das Vorhandensein von Malignität sein. Aus den untersuchten Parametern wurde ein Punktesystem zur präoperativen Einschätzung der Dignität von IPMN erstellt

Mechanical thrombectomy in a young stroke patient with Duchenne muscular dystrophy

Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive skeletal muscle myopathy which is caused by mutations in the dystrophin gene. Lack of dystrophin also results to cardiomyopathy, which raises significantly the stroke risk in DMD-patients. However, data about therapeutic opportunities in the acute setting are scarce in literature. So far, only two cases receiving IV thrombolysis are described, one of them with fatal outcome. Method: Case report of a case of successful mechanical thrombectomy (MTE) in an acute ischemic stroke (AIS) patient with DMD and associated dilatative cardiomyopathy. Results: A 20-year old DMD-patient was transferred at 08:56 h to our department due to wake up stroke with severe right-sided hemiparesis and aphasia (NIHSS=20). Last-seen-normal was at 03:00 h. Cerebral CT-scan revealed only slight early ischemic changes (ASPECT-Score=8). CT-angiography detected occlusion of left middle cerebral artery (LMCA). MTE started rapidly at 9:23 h and using direct thrombus aspiration (Penumbra System®) complete recanalization was achieved 20 min later (TICI-grade 3). Considering the specific risks of general anesthesia in DMD, the procedure was performed with propofol, remifentanil and rocuronium. The patient recovered quickly from the acute symptoms, due to preexisting hypotonic tetraparesis his NIHSS-score at discharge was 12 points. Conclusions: To the best of our knowledge, this is the first report on MTE in a patient with DMD related cardioembolic stroke. In contrast to the few reports with IV thrombolysis, MTE seems to represent an optimal treatment option. Specific characteristics of DMD-patients like anesthetic regimen should be taken into account

Criteria for determining malignancy in pancreatic intraductal papillary mucinous neoplasm based on computed tomography

$\textit {Introduction:}$ Determining the dignity of intraductal papillary mucinous neoplasms (IPMNs) by imaging procedures is challenging. Various CT-based criteria were evaluated. $\textit {Patients and Methods:}$ Preoperative CT scans from 47 patients with IPMN were analyzed. Predefined criteria of malignancy were compared between patients with benign (bIPMN; $\it n$ = 28) and malignant (mIPMN; $\it n$ = 19) tumors, and a summation score was determined. $\textit {Results:}$ Preoperative carbohydrate-antigen 19-9 levels were higher in patients with mIPMN ($\it p$ = 0.013). The diameter of the main pancreatic duct was greater in patients with mIPMN (($\it p$ < 0.0001). More patients with mIPMN showed bile duct obstruction (($\it p$ = 0.0076), solid tumor components (($\it p$ = 0.0076), contrast enhancement in cystic walls (($\it p$ = 0.0086), peripancreatic lymph nodes (($\it p$ = 0.0076), and abrupt diameter changes of the main pancreatic duct (($\it p$ = 0.0008). The CT density of the cysts was higher in mIPMN (($\it p$ = 0.0063). The diagnostic accuracy of the summation score (sensitivity: 0.84, specificity: 0.96) was greater when compared to each individual CT parameter. $\textit {Conclusions:}$ The prevalence and extent of various CT-based abnormalities are greater in patients with mIPMN, but the wide overlap limits the diagnostic value of each individual parameter. A simple summation score largely enhances the diagnostic accuracy