3D Imaging in Unilateral Primary Pulmonary Hypoplasia in an Adult: A Case Report

Unilateral primary pulmonary hypoplasia is rare in adulthood (UPHA); it is characterized by a decreased number of bronchial segmentation and decreased/absent alveolar air space. Classical chest X-ray may be confusing, and the biological tests are unspecific. We present a case of UPHA in a 60-year-old female, smoker, with 3 term normal deliveries, who presented with late recurrent pneumonias and bronchiectasis-type symptomathology, arterial hypertension, and obesity. Chest X-rays revealed opacity in the left lower pulmonary zone, an apparent hypoaerated upper left lobe and left deviation of the mediastinum. Preoperatory multidetector computer tomography (MDCT) presented a small retrocardiac left lung with 5-6 bronchial segmentation range and cystic appearance. After pneumonectomy the gross specimen showed a small lung with multiple bronchiectasis and small cysts, lined by hyperplasic epithelium, surrounded by stromal fibrosclerosis. We concluded that this UPHA occurred in the 4–7 embryonic weeks, and the 3D MDCT reconstructions offered the best noninvasive diagnosis

Quantitative evaluation of fatty liver using spectroscopic sequence – correlation between Magnetic Resonance Spectroscopy and histopathology

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: La stéatose hépatique entraîne l’accumulation des lipides dans les hépatocytes. La tomographie computerisée (CT) et l’échographie (US) peuvent évaluer qualitativement la graisse du foie. La technique d’imagerie la plus précise en termes de quantification de la stéatose hépatique est la Spectroscopie par Résonance Magnétique (MRS). L’objectif de l’étude était de valider le rôle de MRS 3T dans l’évaluation quantitative de la stéatose hépatique. Matériel et méthodes: Le foie de 33 patients a été évalué qualitativement par des tests de laboratoire et d’échographie. Tous les patients ont été étudiés avec une 3T haute résolution IRM, constituée de séquences en phase, déphasées et de séquences spécifiques pour la steatose en T1 pondérées, ainsi que des séquences en T2 pondérées et de séquences de spectroscopie. L’évaluation qualitative a été réalisée en utilisant la fraction de graisse calculée manuellement après l’analyse par spectroscopie. La stéatose a été classée 0 = jusqu’à 10%, grade 1 = 10-33%, grade 2 = 34-66%, grade 3 = ≥67%. La biopsie hépatique a été réalisée chez des patients opérés pour différentes pathologies. Résultats: Limitée par un petit nombre de patients et par les manoeuvres chirurgicales invasives de la biopsie hépatique, l’étude montre que cinq patients présentaient une stéatose classée en grade 0, treize – en grade 1, six – en grade 2 et un – en grade 3, offrant une bonne corrélation entre MRS et histopathologie. Conclusions: En dépit d’être une étude pilote, nous pouvons conclure que MRS est une technique non invasive efficace qui peut être extrêmement utile dans le diagnostic et la quantification de la stéatose hépatique.Background: Hepatic steatosis results in the accumulation of lipids within hepatocytes. Computed Tomography (CT) and Ultrasound (US) can qualitatively assess liver fat. The most accurate imaging technique in terms of quantifying hepatic steatosis is Magnetic Resonance Spectroscopy (MRS). The study aimed to validate the role of 3T MRS in quantitative assessment of liver steatosis. Material and methods: The liver of 33 patients was qualitatively assessed through lab and ultrasound tests. All patients were investigated with a 3T high resolution MRI consisting of T1 weighted sequences with in-phase, out-of-phase and fat specific phases and also T2 weighted and spectroscopy sequences. The qualitative assessment was carried out using the fat fraction calculated manually after spectroscopy computer analysis. The steatosis was graded as grade 0 = up to 10%, grade 1 = 10-33%, grade 2 = 34-66%, grade 3 = ≥ 67%. Liver biopsy was performed in patients who underwent surgery for different pathologies. Results: Limited by a small number of patients and surgical invasiveness of liver biopsy, the study shows that five patients had grade 0 steatosis, thirteen had grade 1, six patients – grade 2 and one patient – grade 3, offering a good correlation between MRS and histopathology. Conclusions: Despite being a pilot study, we can conclude that MRS is an effective noninvasive technique that can be extremely useful in diagnosing and quantifying hepatic steatosis

Role of gadoxetic-acid enhanced 3T MRI and diffusion in liver nodules diagnosis

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: La capacité multiparamétrique et l’imagerie par résonance magnétique (IRM) 3T à haute résolution jouent un rôle clé dans la caractérisation non invasive des lésions hépatiques focales (LHF). Certaines LHF ont des caractéristiques atypiques. De nouvelles techniques telles que les séquences à diffusion pondérée et les agents de contraste spécifiques aux hépatocytes sont actuellement utilisées en pratique clinique pour améliorer la détection et la caractérisation des LHF. L’étude visait à valider un protocole d’imagerie hépatique de haute qualité en utilisant une IRM à haute résolution combinée à un milieu de contraste spécifique à la diffusion et à l’hépatocyte pour le diagnostic de la LHF. Matériel et méthodes: 110 patients hépatiques ont été étudiés en utilisant une IRM à haute résolution de 3T (Phillips Ingenia) en utilisant une bobine de matrice en phase de corps. Le protocole inclue les séquences Dixon-all T1, T2, SPAIR et de diffusion. L’IRM améliorée a supposé l’utilisation des séquences Dixon-T1 de l’acide gadoxétique (PRIMOVIST), y compris la phase hépatobiliaire à 20 minutes et 30 minutes. Résultats: 65 patients ont été diagnostiqués avec précision des lésions bénignes, y compris les hémangiomes, les kystes, l’hyperplasie nodulaire focale et les adénomes. Parmi 45 lésions malignes, nous avons trouvé des métastases, un carcinome hépatocellulaire (CHC) et une pseudotumeur inflammatoire. Les lésions ont été suivies ou une pathologie a été obtenue. Conclusions: L’IRM est capable de fournir des informations diagnostiques complètes et très précises, avec l’avantage supplémentaire de l’absence de rayonnements ionisants nocifs. Un protocole IRM de haute qualité pour le foie est également nécessaire pour établir un diagnostic correct.Background: The multiparametric ability and high-resolution 3T magnetic resonance imaging (MRI) plays a key role in non-invasive characterization of focal liver lesions (FLL). Some FLL have atypical features. New techniques such as diffusion-weighted sequences and hepatocyte-specific contrast agents are being currently used in clinical practice improving the detection and characterization of FLL. The study aimed to validate a high-quality hepatic imaging protocol using high-resolution MRI combined with diffusion and hepatocyte-specific contrast media for FLL diagnosis. Material and methods: 110 patients were liver investigated using a 3T high-resolution MRI (Phillips Ingenia) using body-phase array coil. The protocol included Dixon-all T1, T2, SPAIR and diffusion sequences. The enhanced MRI assumed the use of gadoxetic-acid (PRIMOVIST) Dixon-T1 sequences, including the hepatobiliary phase at 20 minutes and 30 minutes. Results: 65 patients were accurately diagnosed with benign lesions, including hemangiomas, cysts, focal nodular hyperplasia and adenomas. Among 45 malignant lesions we found metastasis, hepatocellular carcinoma (HCC) and one inflammatory pseudotumor. The lesions were followed-up or pathology was obtained. Conclusions: MRI is able to provide comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. Also a high-quality liver MRI protocol is needed in order to establish a correct diagnosis

Radioimaging aspects in knee degenerative pathology

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Gonarthrosis represents one of the most frequent knee conditions, most commonly found in the 5th-6th life decades and not only, mainly in women, being the main cause of motoric disability in Europe, with a high impact on the social and economic status. The aim of the presentation is to aid the interdisciplinary team in interconnecting the imaging and clinical diagnosis of the osteo-articular system pathology. Content: The presentation reviews the radioimaging aspects of knee degenerative pathology. The imaging findings of a 35-year-old patient, known with right femur-coxal congenital subluxation, secondary left gonarthrosis and motoric disability are also presented as an illustration. The imaging technique included the pangonogram (hip-knee-ankle), which is an x-ray of the entire lower limb in orthostatism. The pangonogram allowed us to measure the hip-knee-ankle (HKA) angle, the internal mechanic alpha-femur angle, the Calton index – kneecap height, the beta – internal mechanic tibial angle and the gamma angle – tibial chute. Based on the imaging technique, there were highlighted changes in the bone structure of the left femural head, with a suspicious aspect of an aseptic necrosis, an internally curved tibia and peroneum on the left and secondary left gonarthrosis. The patient was admitted to the Orthopedics Department and underwent the necessary measurements for receiving a personalized knee prosthesis. Conclusions: This presentation highlights the challenging presentations of gonarthrosis and the modern techniques of diagnosis and treatment

Differential diagnosis of breast lesions using ultrasound elastography

Context: The recent introduction of elastography has increased the specificity of USG and enabled early diagnosis of breast cancer. Quantitative elastography, especially with strain ratio (SR) index, improves diagnostic accuracy and decreased number of biopsies. Aims: The purpose of this study was to assess the role of USG elastography in the differential diagnosis of breast lesions. Settings and Design: This prospective study was conducted in the University of Medicine and Pharmacy Research Centre of Craiova. Materials and Methods: Fifty-eight patients diagnosed with breast lesions between January 2009 and January 2010 were included in this prospective study. All the patients were examined in the supine position, and the B-mode USG image was displayed alongside the elastography strain image. For obtaining the elastography images we used a EUS Hitachi EUB 8500 ultrasound system with a 6.5-MHz linear probe. The elastography strain images were scored according to the Tsukuba elasticity score. Statistical Analysis: We performed receiver operator characteristic (ROC) analysis for assessment of the role of USG elastography in the diagnosis of breast lesions. Results: We obtained a sensitivity of 86.7% and a specificity of 92.9% for elasticity score and a sensitivity of 93.3% and a specificity of 92.9% for SR (when a cutoff point of 3.67 was used). There was very good correlation between SR and elasticity score (Spearman coefficient of 0.911). Conclusions: Elastography is a fast, simple method that can complement conventional USG examination. This method has the lowest cost/efficiency ratio and it is also the most noninvasive and accessible imaging method, with an accuracy comparable to MRI

The Analysis of Blood Inflammation Markers as Prognostic Factors in Parkinson’s Disease

Parkinson’s disease is a chronic, progressive, and neurodegenerative disease, and yet with an imprecise etiopathogenesis. Although neuroinflammation was initially thought to be a secondary condition, it is now believed that microglia-induced inflammation could also contribute to the degeneration of the nigrostriatal pathway. Here, we aimed to establish the feasibility of basic inflammatory biomarkers as prognostic factors in PD. The study was based on retrospective analyses of blood samples taken from patients diagnosed with PD, as well as from healthy subjects. Complete medical records, total leukocyte count with subpopulations, and erythrocyte sedimentation rate (ESR) were analyzed. We calculated the serum neutrophils-to-lymphocytes ratio (NLR) and platelet-to lymphocytes ratio (PLR), and also compared the laboratory data between the PD group and the control group. Only PLR and NLR showed statistically significant differences (p < 0.001 and 0.04, respectively). In our study, ESR did not show statistically significant correlations with motor score or with disability. In our research, ESR was correlated with the disease duration (p = 0.04), and PLR showed a significant correlation with disease stage (p = 0.027) and disease duration (p = 0.001), but not with motor state. These biomarkers could prove to be effective tools for a primary evaluation of inflammation in PD, but further tests are required to properly investigate the neuroinflammatory status of these patients

Chronic Calcifying Pancreatitis Associated with Secondary Diabetes Mellitus and Hepatosplenic Abscesses in a Young Male Patient: A Case Report

Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic autoimmune pancreatitis (steroid-sensitive pancreatitis), chronic obstructive pancreatitis, and chronic calcific pancreatitis, the latter being closely related to excessive alcohol consumption for one or even two decades before the onset of symptoms. Case report: We present the case of a 29 year old man who required medical attention for a significant unintentional weight loss and a history of upper abdominal pain. Blood tests revealed substantial abnormalities, and the patient was admitted for further investigation. CT and MRI confirmed the presence of a pancreatic pseudocyst and extensive pancreatic parenchymal calcifications and revealed multiple hepatosplenic microabscesses of fungal etiology. Conclusions: Chronic calcifying pancreatitis is a complex clinical entity that can lead to secondary diabetes due to progressive destruction of the pancreatic parenchyma. Protein malnutrition, caused by malabsorption syndrome, immune cell dysfunction, and a high glucose environment caused by diabetes mellitus, may create a state of immunodeficiency, predisposing the patient to opportunistic infections

The Importance of Accurate Early Diagnosis and Eradication in <i>Helicobacter pylori</i> Infection: Pictorial Summary Review in Children and Adults

Among the most widespread childhood infections, Helicobacter pylori (H. pylori) develops potentially life-threatening conditions in adults if not appropriately treated. Helicobacter pylori is a common human pathogen that was first described in the stomach many years ago. The discovery of H. pylori was crucial in gastroenterology; this bacterium is associated with chronic gastritis, peptic ulcers, gastric cancer, and lymphoid tissue lymphoma related to the gastric mucosa. Studies published so far estimate that approximately 10% of subjects infected with H. pylori develop a peptic ulcer, and 1–3% of subjects develop gastric cancer. The clinical manifestations are variable and characteristically depend on the individual factors of the host. Various methods of detection and diagnosis of H. pylori infection have been developed, each with advantages, disadvantages, and/or limitations. Available diagnostic tests are usually performed using invasive (endoscopy, biopsy, rapid urease test, cultures, and molecular tests) and noninvasive methods (urea breath test, stool antigen examination, and serological and molecular tests). Although there is extensive accessibility for diagnosing and treating H. pylori infection, the prevalence of antibiotic resistance is not negligible. Thus, numerous studies and meta-analyses are focused on a new orientation of gastroenterologists in diagnosing and treating H. pylori infections. A fascinating perspective hypothesis is the administration of probiotics to reduce H. pylori adhesion to gastric epithelial cells, preventing H. pylori colonization, especially in children, or reinfection with H. pylori in high-risk adult patients