The Efficiency of Fractional Anisotropy, Apparent Diffusion Coefficient, and Contrast Enhancement Index in Liver Fibrosis Staging.

Objectives: Even though magnetic resonance imaging has been described as the most effective imaging method for the diagnosis of liver fibrosis, an accepted magnetic resonance imaging (MRI) technique is yet to be defined. The aim of this study is to determine the efficiency of MRI in the staging of liver fibrosis. Methods: Patients with chronic hepatitis B infection and had upper abdominal MRI with hepatocyte specific contrast agent were evaluated. Twenty-nine patients that had undergone liver biopsy were included in the study. ADC, FA, and signal intensity values of liver parenchyma were measured by two observers and contrast enhancement index (CEI) was calculated as well. Patients were grouped as early (A) and late fibrosis(B) according to Ishak grading system and then the correlations between the stage and MRI findings were analysed. The intraclass correlation coefficient was used to analyze the inter-rater agreements. ADC, FA, and CEI were compared with Student t-test between early and late fibrosis groups. Pearson's correlation was used to assess the correlation between ADC and FA values. Spearman correlation was used to evaluate the relationship between pathologic fibrosis grade and MRI parameters that were measured. Results: Twenty-two patients were staged as 1 and 2 (group A), seven patients were staged as 3 and above fibrosis(group B). Statistically, there was a strong, negative correlation between the FA values and the degree of fibrosis (r=-0.582, p=0.001). There was no correlation between the CEI and hepatocyte activity index (r=-0.88, p=0.655) and degree of fibrosis (r=0.0001, p=0.997). In terms of FA values, there was a statistically significant difference between two groups (group A=0.429 ± 0.06, group B=0.349 ± 0.06) (p=0.004). Conclusion: Correlation of FA values with fibrosis stage and significant difference in FA values between early-late stage fibrosis patients shows that diffusion tensor imaging can be a promising technique in the staging and follow-up of liver fibrosis.

A practical approach for the management of small thyroid nodules referred for biopsy.

OBJECTIVE: Current guidelines recommend against routine ultrasound (US) guided fine-needle aspiration biopsy (FNAB) of small (<1 cm) thyroid nodules and suggest follow-up of ≥5 mm small nodules only if they are TI-RADS-5. This study aims to determine the best suspicious ultrasound features related to cytology results in patients referred for FNAB of small thyroid nodules and construct an algorithm for declining unnecessary biopsies and selection of patients to be followed up. METHODS: This prospective observational study enrolled patients referred for US-guided biopsy of ≤1 cm thyroid nodules. Ultrasound features including composition, echogenicity, shape, margin, echogenic focus, hypoechoic rim, vascularity were assessed. The cytology results were dichotomised as either benign or malignant/high risk. The features with excellent interobserver reliability and more than 90% sensitivity were selected. RESULTS: Overall, 95 patients [82 (86.3%) females, mean age 48.5 ± 11.9 years] with 95 small (≤1 cm) thyroid nodules were biopsied. Cytology revealed 15 (15.8%) malignant nodules. Pure solid composition, hypoechogenicity, taller than wide shape and irregular margin of the nodules were significantly associated with malignancy. Hypoechogenicity (100%) and pure solid composition (93%) had very high sensitivity and excellent interobserver agreement (Cohen's Kappa 0.83, P = .003 for both) for predicting high risk/malignant nodule. In the absence of these two features, 48 (50.5%) nodules either would not require FNAB or follow-up. CONCLUSION: The presence of cyst or iso/hyperechogenicity within a small thyroid nodule in patients already referred for invasive sampling safely allows for declining a decision of FNAB or follow-up without the concern of missing malignancy.

Endometrial adenocarcinoma recurrence presenting with tibial metastasis: Report of a case.

INTRODUCTION: Metastatic bone disease at extremities is mostly associated with lung, liver, prostat, thyriod or breast malignancies. There for surgeons generally tends to seek for a primary tumor originating from these organs. Herein a case of endometrial adenocarcinoma recurrence that presented with symptoms of tibial pain is described. PRESENTATION OF CASE: 59 year-old woman was admitted to our orthopaedic oncology unit with pain, swelling and tenderness at right cruris for two weeks without any trauma history. Her medical history revealed that she had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During follow-ups no recurrence had been detected. Initial X-rays of the right tibia showed a lytic and expansile mass located at the shaft of the tibia suggesting metastasis. A wide resection of the lesion with clear margins was performed two weeks after first admittance. Resected area was replaced by fresh frozen femoral shaft allograft. At postoperative 17th month. X-rays obtained at last follow-up demostrated full healing and integration of allograft. DISCUSSION: Endometrial adenocarcinoma is a disease of postmenapousal women with 95% of the cases occurring after the age of 40 years. Patients with advanced or recurrent endometrial cancer often have distant metastases found within the lymph nodes, liver, and/or lung. CONCLUSION: Recurrence of endometrial cancer as a solitary bone lesion is a rare situation. Wide resection and reconstruction with an allograft or an intercalar prosthesis might be an option to increase survival and possible cure of the patient.