A Novel Splenic Vein Flow Volume to the Portal Vein Flow Velocity Index as a Predictor for the Degree of Esophageal Varices in Liver Cirrhosis Patients.

Bleeding esophageal varices (EV) have the highest mortality rate from all complications of liver cirrhosis (LC). Several Doppler ultrasound (DUS) studies have been done on the splenic or portal vein (PV) to evaluate the hemodynamic of the esophageal vein. Our study focused on finding a better index using the ratio from two parameters correlated with EV, splenic vein flow volume (SFV), and PV flow velocity. In this study, 28 patients with LC were evaluated using DUS to compare the SFV to PV flow velocity/speed (Sv/Ps) index and other measured DUS parameters with the EV degree. Afterward, the receiver operating characteristic (ROC) curve analysis was performed on statistically significant DUS parameters. Mean Sv/Ps index value in the group of nonvarices was 9.89 ± 3.56; 19.50 ± 5.56 in the small esophageal varices (SEV) and 74.12 ± 29.37 in the large esophageal varices (LEV) group with p < 0.001. ROC curve analysis generated an optimal cutoff point of 16.5 (90% sensitivity and 100% specificity) to predict the presence of EV and the cutoff point of 46.7 (100% sensitivity and specificity) to predict the presence of LEV. In conclusion, the Sv/Ps index measured using DUS can be used as a noninvasive method to predict the presence of EV, especially in predicting LEV.

Evaluation of juxtapapillary duodenal diverticula using multiplanar reformation in MDCT: correlation with ERCP findings.

OBJECTIVE: To determine the ability of multidetector computed tomography (MPR-MDCT) to identify and classify the juxtapapillary duodenal diverticulum (JPDD), with ERCP findings as the gold standard. METHODS: We retrospectively reviewed all ERCP examinations (n: 455) performed between January 2010 to December 2018 and selected 105 patients with JPDD as the inclusion criteria. Of those, 28 patients were excluded because of advanced pancreatic carcinoma, incomplete MDCT examinations and biliary catheter insertion. Finally, MDCT examinations of 77 patients with JPDD were assessed for the presence and type of JPDD. RESULTS: MPR-MDCT was able to identify 71 (92.2%) JPDD in 77 cases with 88.9% accuracy, 83.3% sensitivity, and 91.6% specificity in classifying the type of JPDD. MPR-MDCT performed best in determining type 1 JPDD, with accuracy of 95.4% compared with type 2 (83.3%) and type 3 (87.8%). There was no significant difference between age, gender, incidence of biliary stones and pancreatitis between each type of JPDD. No correlation of sizes with types of JPDD was found. CONCLUSIONS: MPR-MDCT can accurately identify and classify JPDD. This information will be useful in determining the difficulty of ERCP.

Physiological 18F-FDG uptake in the normal adult anal canal: evaluation by PET/CT.

OBJECTIVE: Despite their benefit for detecting primary tumors, data for normal 18F-fluoro-2-deoxy-D-glucose (FDG) uptake in the anal canal are insufficient. Here we used positron emission tomography-computed tomography (PET/CT) to determine the uptake of FDG in the normal adult anal canal (AC) and to evaluate its clinical significance compared with that of anal cancer. METHODS: We conducted a retrospective study of-PET/CT images in the anal region, of 201 consecutive patients without symptoms or pathology taken from January 2015 to August 2019, after excluding two patients (one each with Crohn's disease and hemorrhoid). These patients were included in the normal group, and data of eight patients with anal cancer were collected from January 2011 to August 2019 for comparison. FDG uptake was quantitatively evaluated (compared with the maximum standardized uptake value [SUVmax] to the SUVmax values of liver and distal rectum) and qualitatively (compared with background) in early and delayed phases. Normal grade 3 uptake was qualitatively defined as FDG uptake higher than the surrounding muscles. RESULTS: In the normal group, mean anal canal SUVmax of early phase was: 2.26 (range 1.00-6.30), and delayed phase: 2.52 (range 1.00-8.80). Their ratios to liver SUVmax were early: 0.74 (range 0.24-2.25), and delayed: 0.81 (range 0.23-2.32); ratios to rectal SUVmax were early: 0.87 (range 0.30-1.89), and delayed: 0.90 (range 0.30-1.27). Qualitatively, 25 patients (15.4%) had normal grade 3 uptake during the early and delayed phases. In contrast, qualitative data showed that all patients with anal cancer exhibited high FDG uptake in the anal canal. The mean early- and delayed-phase values of SUVmax of the anal canal and anal cancer group were 11.09 (range 5.40-17.73) and 14.23 (range 6.70-22.85), respectively. There was a significant difference between the mean-early and -delayed anal SUVmax values of the normal grade 3 and anal cancer groups. Furthermore, the ratios to liver SUVmax were significantly different between the two groups. CONCLUSIONS: PET/CT scans occasionally showed high FDG uptake in the anal canal of healthy adults. Comparing the SUVmax values of liver FDG uptake may help differentiate between normal tissue and anal cancer.

18F-FDG uptake in the normal appendix in adults: PET/CT evaluation.

OBJECTIVE: This study aimed to determine the level of 18F fluorodeoxyglucose (18F-FDG) activity in the normal adult appendix using positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS: We performed a retrospective review of PET/CT images using 18F-FDG in 563 consecutive asymptomatic adult patients without appendiceal pathology. We excluded 257 patients for an undetected or obscured appendix and three patients for appendicitis found on CT imaging. FDG uptake in the appendix was qualitatively and quantitatively assessed. The maximum standardized uptake value (SUVmax) was calculated for quantitative analysis with SUVmax of the normal liver for comparison. A total of 303 patients (200 males, 103 females, mean age of 66 years) were included in this study. Medical charts and histories were evaluated for patients who showed positive FDG accumulation. Pearson's correlations between appendiceal SUVmax and age, body mass index, and blood glucose levels were analyzed. RESULTS: The mean appendiceal SUVmax was 1.14 (range 0.52-5.12) with an appendix-to-liver SUVmax ratio of 0.34 (range 0.06-1.28). Three patients qualitatively showed a positive FDG accumulation with appendiceal SUVmax greater than 3.00. There were no correlations between appendiceal SUVmax and age, body mass index, or blood glucose levels. CONCLUSIONS: FDG in the normal adult appendix shows a low activity level and is lower compared with normal liver. However, the normal appendix can rarely show high FDG accumulation. In such cases, differentiation from appendiceal pathology solely by PET/CT images would be difficult.

Asymptomatic Bartholin Cyst: Evaluation With Multidetector Row Computed Tomography.

OBJECTIVE: The aim of this study was to determine the frequency, morphology, and attenuation characteristics of Bartholin cysts on multidetector computed tomography (MDCT) in asymptomatic women. METHODS: A total of 3280 consecutive MDCT examinations were assessed for Bartholin cysts. The diagnosis was based on shape, contrast enhancement, and anatomical location. Age, laterality, size, and attenuation patterns were recorded. Scans from patients with paravaginal-related symptoms were excluded, and any available follow-up MDCT scans or magnetic resonance images were evaluated. RESULTS: Asymptomatic Bartholin cysts were seen in 17 patients (0.52%) (mean age, 56 years). The mean maximum cyst diameter was 21.8 mm. High-attenuation cysts comprised 47% of cases, all in older (≥50 years) patients. Follow-up MDCT scans showed minimal changes over time. CONCLUSIONS: High-attenuation Bartholin cysts are more common than previously thought and are usually seen in older women. The size and attenuation of Bartholin cysts show only minimal changes over time.