Procjena tumora jetre kvantitativnom ultrazvučnom elastografijom [Assessment of liver tumours using quantitative sonoelastography]

Real-time two-dimensional shear-wave elastography (RT-2D-SWE) is a quantitative ultrasound elastography method for measuring tissue stiffness. The aim of this study was to analyse elastographic characteristics of the most common liver tumours and to evaluate the potential of RT-2D-SWE to differentiate benign and malignant focal liver lesions (FLL). Consecutive patients with ultrasonically detected FLL were included and elastographic evaluation of FLL and non-infiltrated liver was undertaken. The nature of the FLL was defined through a standard diagnostic workup, including contrast enhanced multi-slice CT and MRI and cytology/histology, as applicable. We analysed 159 FLL, 53 in each group (HCCs, metastases and haemangioma). Malignant lesions were stiffer (p<0.001) with higher variability of intralesional stiffness (p=0.001). The best performing cut-off for lesion stiffness was 22,04 kPa (sensitivity 78.3%, specificity 94,34, positive predictive value (PPV) 96,5% negative predictive value (NPV) 68,5%.). Predication of malignancy based on logistic regression and artificial neural networks was excellent (AUROC for regression and 0.986 for ANN). In conclusion, according to results of the study RT-2D-SWE appears to be very accurate for the differentiation of malignant and benign FLL based on tumour elasticity parameters and stiffness of liver parenchyma easily measurable during ultrasound examination with elastography

Indeks ALBI kao prediktor preživljenja nakon resekcije hepatocelularnog karcinoma u bolesnika s kompenziranom cirozom jetre: usporedba s indeksima PALBI i MELD

The aim of the study was to explore predictive value of the ALBI, PALBI and MELD scores on survival in patients resected for hepatocellular carcinoma with compensated liver cirrhosis and no macrovascular infi ltration. In this retrospective study, longitudinal survival analysis was performed. We analyzed patient/tumor characteristics and MELD, ALBI and PALBI scores as liver function tests for predicting survival outcome. Survival was analyzed from the date of liver resection until death, liver transplantation, or end of follow-up. Patients were stratifi ed for age, cirrhosis etiology, presence of esophageal varices, hepatocellular carcinoma stage, microvascular invasion, histologic diff erentiation, and resection margins. We identifi ed 38 patients (alcoholic cirrhosis in 84.2% of patients) resected over an 8-year period. Median preoperative MELD score was 8, ALBI score -2.63, and PALBI score -2.38. During the follow-up period, 24 patients died. Estimated median survival time was 36 months. Microvascular invasion was observed in 33 patients. Higher ALBI score was associated with 23.1% higher relative risk of death. PALBI score was associated with 12.1% higher relative risk of death, whereas MELD score was not associated with the risk of death. In conclusion, ALBI score demonstrated signifi cant predictive capabilities for survival in patients with compensated cirrhosis resected for hepatocellular carcinoma.Cilj je bio istražiti prediktivnu vrijednost zbira ALBI, PALBI i MELD za preživljenje bolesnika s kompenziranom cirozom reseciranih zbog hepatocelularnog karcinoma bez makrovaskularne invazije. Provedena je retrospektivna longitudinalna analiza preživljenja. Testirane su karakteristike bolesnika/tumora kao i jetreni funkcijski testovi MELD, ALBI i PALBI za predviđanje preživljenja. Bolesnici su praćeni nakon resekcije jetre do smrti, transplantacije jetre odnosno do kraja vremena praćenja. Bolesnici su kategorizirani po dobi, etiologiji ciroze, prisutnosti varikoziteta jednjaka, stadiju karcinoma, mikrovaskularnoj invaziji, histološkom stadiju i resekcijskim rubovima. Identifi cirali smo 38 bolesnika (alkoholna ciroza kod 84,2% bolenika) reseciranih kroz razdoblje od 8 godina. Medijan prijeoperacijskog zbira MELD bio je 8, zbira ALBI -2,63 i zbira PALBI -2,38. Tijekom praćenja 24 bolesnika su umrla. Očekivani medijan preživljenja iznosio je 36 mjeseci. Mikrovaskularna invazija pronađena je u 33 bolesnika. Veći ALBI je bio povezan s 23,1%, a PALBI s 12,1% većim relativnim rizikom od smrtnog ishoda. MELD nije bio povezan sa smrtnim ishodom. Zbir ALBI je pokazao značajnu prediktivnu vrijednost preživljenja u skupini bolesnika s kompenziranom cirozom reseciranih zbog hepatocelularnog karcinoma

Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis

Aim Primary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV). Methods Predictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV. Results In the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients. Conclusion This is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients

Importance of early detection of colorectal cancer

SAŽETAK. Tijekom posljednjih dvadesetak godina zabilježen je značajan porast učestalosti i smrtnosti od kolorektalnog karcinoma. Unatoč stručnom i znanstvenom napretku medicine, nije se bitno promijenila činjenica da bolesnici žive dulje od pet godina. Spoznaja da je adekvatnom organizacijom zdravstvene skrbi i prevencijom moguće umanjiti ove poražavajuće podatke, potaknula je pokretanje nacionalnih programa s ciljem ranog otkrivanja karcinoma debelog crijeva. Nova saznanja na području dijagnostike i endoskopije omogućuju brže i sigurnije postavljanje dijagnoze. Osnovu liječenja čini kirurško liječenje poduprto stalnim tehničkim napretkom, a dodatnu i ne manje bitnu ulogu ima nova i sve učinkovitija kemoterapija i radioterapija. Navedene metode i saznanja ukazuju na mogućnost izlječenja sve većeg broja bolesnika i uspjeh u borbi protiv karcinoma debelog crijeva.ABSTRACT. A significant increase in the incidence and mortality of colorectal cancer has been detected during the last twenty years. Despite the progress in medical practice and science there has been no indicative change in the 5-year survival of patients. The knowledge that an adequate health care organization and prevention can decrease these defeating data, prompted the start of national programs for early detection of colorectal cancer. New cognitions in the fields of diagnostics and endoscopy make diagnosis faster and more accurate. Surgical therapy, which is supported by constant technical progress, represents the basis of cancer treatment, while the new and more effective chemotherapy and radiotherapy have an additional and important therapeutical role. The above mentioned methods and knowledge indicate that there is a possibilty in curing a large number of patients and succeeding in the struggle against colorectal cancer

Use of biochemical parameters for non-invasive screening of oesophageal varices in comparison to elastography-based approach in patients with compensated advanced chronic liver disease

Oesophageal varices are routinely diagnosed by esophagogastroduodenoscopy (EGD), and their bleeding has high mortality. We aimed to evaluate diagnostic performance of biochemical tests in comparison to elastography-based approaches, as non-invasive alternatives to EGD, for ruling-out high risk oesophageal varices (HRV). Retrospective analysis of patients (N = 861) who underwent liver stiffness measurement (LSM) by transient elastography (TE) in a single centre over 5-year period, with available results of EGD (within 3 months from LSM). Only patients with suspicion of compensated advanced chronic liver disease (cACLD) defined by LSM ≥ 10 kPa were included comprising the final cohort of 73 subjects. Original and expanded Baveno VI criteria (B6C), controlled attenuation parameter (CAP), platelet count (PLT), aspartate aminotransferase to PLT ratio index (APRI), Fibrosis-4 index (FIB4), model for end stage liver disease (MELD) score were evaluated against the results of EGD that served as the reference method. Analysed patients had median age 62 years, 59/73 (0.81) were males, 54/73 (0.74) had alcoholic/non-alcoholic fatty liver disease, and 21/73 (0.29) had HRV. In multivariate logistic regression analysis only LSM and PLT were independently associated with HRV. The best performing tests for ruling-out HRV (% of spared EGD; % of missed HRV) were respectively: LSM 214x109/L (21.9%; 0%); FIB4 ≤ 1.8 (21.4%; 0%), APRI ≤ 0.34 (12.3%; 0%). CAP, MELD = 6 alone or combined with PLT > 150(x109/L) did not show acceptable performance. The best performing biochemical tests for ruling-out HRV in our cohort of patients were PLT and FIB-4, but they were still outperformed by elastography-based approaches

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Aziz Sheikh and colleagues report the findings of their systematic overview that assessed the impact of eHealth solutions on the quality and safety of health care

Assessment of liver tumours using quantitative sonoelastography

Uvod i ciljevi: S obzirom da različite vrste tumora u jetri imaju različitu tvrdoću, kvantitativne ultrazvučne elastografske metode koje mjere tvrdoću tkiva potencijalno se mogu koristiti za diferencijaciju različitih vrsta tumora u jetri. Ciljevi ovog rada su: 1) analizirati elastografske značajke najčešćih vrsta tumora u jetri primjenom dvodimenzionalne kvantitativne ultrazvučne elastografije u stvarnom vremenu (engl. real-time 2-dimensional Shear wave elastography - RT-2D-SWE); 2) utvrditi može li se na temelju elastografskih značajki neinvazivno razlikovati pojedine vrste tumora te kakva je dijagnostička izvedba RT-2D-SWE. Metode: Istraživanjem su obuhvaćeni bolesnici kojima je ultrazvukom detektirana žarišna leziju u jetri. Za svaku analiziranu žarišnu leziju provedeno je minimalno pet elastografskih mjerenja, a također je provedeno pet mjerenja tvrdoće parenhima jetre. Izračunate su prosječna srednja, minimalna i maksimalna tvrdoća tumora, koeficijent varijabilnosti tvrdoće tumora, prosječna tvrdoća parenhima jetre i prosječni omjer tvrdoće tumora i parenhima te su se ove varijable korištene u daljnjoj analizi podataka. Priroda žarišne lezije u daljnjem tijeku utvrđena je temeljem provedenog standardnog dijagnostičkog postupka sukladno važećim smjernicama, koji je uključivao slikovne radiološke pretrage (kontrastni CT i/ili MRI) te histološku/citološku verifikaciju gdje je to bilo potrebno. U finalnu analizu su uključene najčešće maligne i benigne žarišne lezije u jetri: HCC, metastaze i hemangiomi, dok su ostale vrste tumora isključene iz analize. Rezultati: Analizirano je ukupno 159 lezija: 53 HCC-a, 53 metastaze i 53 hemangioma. Prosječna srednja vrijednost tvrdoće HCC-a, metastaza i hemangioma bila je redom 28,46 kPa (SD 11,05), 36,17 kPa (SD 9,42) i 13,68 kPa (SD 6,29) te su se grupe među sobom statistički značajno razlikovale u srednjoj tvrdoći tumora. Također je razlika u srednjoj tvrdoći između malignih i benignih tumora bila statistički značajna (p<0,001), a kod prijelomne vrijednosti srednje tvrdoće od 22,04 kPa moglo se sa 78.3%-tnom senzitivnošću (95% CI 69,2-85,7) i 94,34%-tnom specifičnošću (95% CI 84,3-98,8) razlikovati maligne i benigne tumore, uz PPV 96,5% i NPV 68,5%. Konstruirani prediktivni alati na bazi logističke regresije i umjetne neuronske mreže (engl. artificial neural networks, ANN) za diferencijaciju malignih i benignih lezija bili su vrlo točni (AUROC za regresiju 0.990 i AUROC za ANN 0.986). Zaključak: Rezultati ovog istraživanja ukazuju na moguću visoku dijagnostičku vrijednost metode RT-2D-SWE u razlikovanju malignih i benignih tumora jetre. S obzirom na ograničenja koja proizlaze iz inicijalnog dizajna studije potrebna su daljnja istraživanja radi validacije ovih rezultata na većem uzorku.Real-time two-dimensional shear-wave elastography (RT-2D-SWE) is a quantitative ultrasound elastography method for measuring tissue stiffness. The aim of this study was to analyse elastographic characteristics of the most common liver tumours and to evaluate the potential of RT-2D-SWE to differentiate benign and malignant focal liver lesions (FLL). Consecutive patients with ultrasonically detected FLL were included and elastographic evaluation of FLL and non-infiltrated liver was undertaken. The nature of the FLL was defined through a standard diagnostic workup, including contrast enhanced multi-slice CT and MRI and cytology/histology, as applicable. We analysed 159 FLL, 53 in each group (HCCs, metastases and haemangioma). Malignant lesions were stiffer (p<0.001) with higher variability of intralesional stiffness (p=0.001). The best performing cut-off for lesion stiffness was 22,04 kPa (sensitivity 78.3%, specificity 94,34, positive predictive value (PPV) 96,5% negative predictive value (NPV) 68,5%.). Predication of malignancy based on logistic regression and artificial neural networks was excellent (AUROC for regression and 0.986 for ANN). In conclusion, according to results of the study RT-2D-SWE appears to be very accurate for the differentiation of malignant and benign FLL based on tumour elasticity parameters and stiffness of liver parenchyma easily measurable during ultrasound examination with elastography

Assessment of liver tumours using quantitative sonoelastography

Uvod i ciljevi: S obzirom da različite vrste tumora u jetri imaju različitu tvrdoću, kvantitativne ultrazvučne elastografske metode koje mjere tvrdoću tkiva potencijalno se mogu koristiti za diferencijaciju različitih vrsta tumora u jetri. Ciljevi ovog rada su: 1) analizirati elastografske značajke najčešćih vrsta tumora u jetri primjenom dvodimenzionalne kvantitativne ultrazvučne elastografije u stvarnom vremenu (engl. real-time 2-dimensional Shear wave elastography - RT-2D-SWE); 2) utvrditi može li se na temelju elastografskih značajki neinvazivno razlikovati pojedine vrste tumora te kakva je dijagnostička izvedba RT-2D-SWE. Metode: Istraživanjem su obuhvaćeni bolesnici kojima je ultrazvukom detektirana žarišna leziju u jetri. Za svaku analiziranu žarišnu leziju provedeno je minimalno pet elastografskih mjerenja, a također je provedeno pet mjerenja tvrdoće parenhima jetre. Izračunate su prosječna srednja, minimalna i maksimalna tvrdoća tumora, koeficijent varijabilnosti tvrdoće tumora, prosječna tvrdoća parenhima jetre i prosječni omjer tvrdoće tumora i parenhima te su se ove varijable korištene u daljnjoj analizi podataka. Priroda žarišne lezije u daljnjem tijeku utvrđena je temeljem provedenog standardnog dijagnostičkog postupka sukladno važećim smjernicama, koji je uključivao slikovne radiološke pretrage (kontrastni CT i/ili MRI) te histološku/citološku verifikaciju gdje je to bilo potrebno. U finalnu analizu su uključene najčešće maligne i benigne žarišne lezije u jetri: HCC, metastaze i hemangiomi, dok su ostale vrste tumora isključene iz analize. Rezultati: Analizirano je ukupno 159 lezija: 53 HCC-a, 53 metastaze i 53 hemangioma. Prosječna srednja vrijednost tvrdoće HCC-a, metastaza i hemangioma bila je redom 28,46 kPa (SD 11,05), 36,17 kPa (SD 9,42) i 13,68 kPa (SD 6,29) te su se grupe među sobom statistički značajno razlikovale u srednjoj tvrdoći tumora. Također je razlika u srednjoj tvrdoći između malignih i benignih tumora bila statistički značajna (p<0,001), a kod prijelomne vrijednosti srednje tvrdoće od 22,04 kPa moglo se sa 78.3%-tnom senzitivnošću (95% CI 69,2-85,7) i 94,34%-tnom specifičnošću (95% CI 84,3-98,8) razlikovati maligne i benigne tumore, uz PPV 96,5% i NPV 68,5%. Konstruirani prediktivni alati na bazi logističke regresije i umjetne neuronske mreže (engl. artificial neural networks, ANN) za diferencijaciju malignih i benignih lezija bili su vrlo točni (AUROC za regresiju 0.990 i AUROC za ANN 0.986). Zaključak: Rezultati ovog istraživanja ukazuju na moguću visoku dijagnostičku vrijednost metode RT-2D-SWE u razlikovanju malignih i benignih tumora jetre. S obzirom na ograničenja koja proizlaze iz inicijalnog dizajna studije potrebna su daljnja istraživanja radi validacije ovih rezultata na većem uzorku.Real-time two-dimensional shear-wave elastography (RT-2D-SWE) is a quantitative ultrasound elastography method for measuring tissue stiffness. The aim of this study was to analyse elastographic characteristics of the most common liver tumours and to evaluate the potential of RT-2D-SWE to differentiate benign and malignant focal liver lesions (FLL). Consecutive patients with ultrasonically detected FLL were included and elastographic evaluation of FLL and non-infiltrated liver was undertaken. The nature of the FLL was defined through a standard diagnostic workup, including contrast enhanced multi-slice CT and MRI and cytology/histology, as applicable. We analysed 159 FLL, 53 in each group (HCCs, metastases and haemangioma). Malignant lesions were stiffer (p<0.001) with higher variability of intralesional stiffness (p=0.001). The best performing cut-off for lesion stiffness was 22,04 kPa (sensitivity 78.3%, specificity 94,34, positive predictive value (PPV) 96,5% negative predictive value (NPV) 68,5%.). Predication of malignancy based on logistic regression and artificial neural networks was excellent (AUROC for regression and 0.986 for ANN). In conclusion, according to results of the study RT-2D-SWE appears to be very accurate for the differentiation of malignant and benign FLL based on tumour elasticity parameters and stiffness of liver parenchyma easily measurable during ultrasound examination with elastography

Assessment of liver tumours using quantitative sonoelastography

Uvod i ciljevi: S obzirom da različite vrste tumora u jetri imaju različitu tvrdoću, kvantitativne ultrazvučne elastografske metode koje mjere tvrdoću tkiva potencijalno se mogu koristiti za diferencijaciju različitih vrsta tumora u jetri. Ciljevi ovog rada su: 1) analizirati elastografske značajke najčešćih vrsta tumora u jetri primjenom dvodimenzionalne kvantitativne ultrazvučne elastografije u stvarnom vremenu (engl. real-time 2-dimensional Shear wave elastography - RT-2D-SWE); 2) utvrditi može li se na temelju elastografskih značajki neinvazivno razlikovati pojedine vrste tumora te kakva je dijagnostička izvedba RT-2D-SWE. Metode: Istraživanjem su obuhvaćeni bolesnici kojima je ultrazvukom detektirana žarišna leziju u jetri. Za svaku analiziranu žarišnu leziju provedeno je minimalno pet elastografskih mjerenja, a također je provedeno pet mjerenja tvrdoće parenhima jetre. Izračunate su prosječna srednja, minimalna i maksimalna tvrdoća tumora, koeficijent varijabilnosti tvrdoće tumora, prosječna tvrdoća parenhima jetre i prosječni omjer tvrdoće tumora i parenhima te su se ove varijable korištene u daljnjoj analizi podataka. Priroda žarišne lezije u daljnjem tijeku utvrđena je temeljem provedenog standardnog dijagnostičkog postupka sukladno važećim smjernicama, koji je uključivao slikovne radiološke pretrage (kontrastni CT i/ili MRI) te histološku/citološku verifikaciju gdje je to bilo potrebno. U finalnu analizu su uključene najčešće maligne i benigne žarišne lezije u jetri: HCC, metastaze i hemangiomi, dok su ostale vrste tumora isključene iz analize. Rezultati: Analizirano je ukupno 159 lezija: 53 HCC-a, 53 metastaze i 53 hemangioma. Prosječna srednja vrijednost tvrdoće HCC-a, metastaza i hemangioma bila je redom 28,46 kPa (SD 11,05), 36,17 kPa (SD 9,42) i 13,68 kPa (SD 6,29) te su se grupe među sobom statistički značajno razlikovale u srednjoj tvrdoći tumora. Također je razlika u srednjoj tvrdoći između malignih i benignih tumora bila statistički značajna (p<0,001), a kod prijelomne vrijednosti srednje tvrdoće od 22,04 kPa moglo se sa 78.3%-tnom senzitivnošću (95% CI 69,2-85,7) i 94,34%-tnom specifičnošću (95% CI 84,3-98,8) razlikovati maligne i benigne tumore, uz PPV 96,5% i NPV 68,5%. Konstruirani prediktivni alati na bazi logističke regresije i umjetne neuronske mreže (engl. artificial neural networks, ANN) za diferencijaciju malignih i benignih lezija bili su vrlo točni (AUROC za regresiju 0.990 i AUROC za ANN 0.986). Zaključak: Rezultati ovog istraživanja ukazuju na moguću visoku dijagnostičku vrijednost metode RT-2D-SWE u razlikovanju malignih i benignih tumora jetre. S obzirom na ograničenja koja proizlaze iz inicijalnog dizajna studije potrebna su daljnja istraživanja radi validacije ovih rezultata na većem uzorku.Real-time two-dimensional shear-wave elastography (RT-2D-SWE) is a quantitative ultrasound elastography method for measuring tissue stiffness. The aim of this study was to analyse elastographic characteristics of the most common liver tumours and to evaluate the potential of RT-2D-SWE to differentiate benign and malignant focal liver lesions (FLL). Consecutive patients with ultrasonically detected FLL were included and elastographic evaluation of FLL and non-infiltrated liver was undertaken. The nature of the FLL was defined through a standard diagnostic workup, including contrast enhanced multi-slice CT and MRI and cytology/histology, as applicable. We analysed 159 FLL, 53 in each group (HCCs, metastases and haemangioma). Malignant lesions were stiffer (p<0.001) with higher variability of intralesional stiffness (p=0.001). The best performing cut-off for lesion stiffness was 22,04 kPa (sensitivity 78.3%, specificity 94,34, positive predictive value (PPV) 96,5% negative predictive value (NPV) 68,5%.). Predication of malignancy based on logistic regression and artificial neural networks was excellent (AUROC for regression and 0.986 for ANN). In conclusion, according to results of the study RT-2D-SWE appears to be very accurate for the differentiation of malignant and benign FLL based on tumour elasticity parameters and stiffness of liver parenchyma easily measurable during ultrasound examination with elastography

Gastroesophageal reflux disease, Barrett esophagus, and esophageal adenocarcinoma – where do we stand?

Almost 25% of all human cancers are located in the gastrointestinal tract (GIT), making it the dominant cancer-affected site. The reason for this could be constant GIT exposure to organ damage and chronic inflammation (1). Despite all medical breakthroughs, less than half of patients survive one year after the esophageal adenocarcinoma (EAC) diagnosis (2). Most malignancies, including most GIT malignancies, are preceded by precursor/premalignant lesions. Premalignant condition for EAC development is Barrett esophagus (BE), a disorder characterized by abnormal transformation of the squamous epithelium. BE is strongly associated with prolonged gastro-esophageal reflux of gastric and bile acids (1,3,4). Since patients with BE carry 30-40 times higher risk for EAC than general population, it is not surprising that in the last 10-20 years the research interest in BE has been growing (3