Differentiation of Breast Lesions and Distinguishing Their Histological Subtypes Using Diffusion-Weighted Imaging and ADC Values.

Diffusion-weighted imaging (DWI) has not been well explored in differentiation of malignant from benign breast lesions. The aims of this study were to examine the role of apparent diffusion coefficient (ADC) values in differentiation of malignant from benign tumors and distinguishing histological subtypes of malignant lesions, and to determine correlations between ADC values and breast tumors structure. This cohort-study included 174 female patients who underwent contrast-enhanced breast MR examination on a 3T scanner and were divided into two groups: patient group (114 patients with proven tumors) and control group (60 healthy patients). One-hundred-thirty-nine lesions (67 malignant and 72 benign) were detected and pathohistologically analyzed. Differences between variables were tested using chi-square test; correlations were determined using Pearson's correlation test. For determination of cut off values for diagnostic potential, Receiver Operating Characteristic curves were constructed. Statistical significance was set at p < 0.05. Mean ADC values were significantly lower in malignant compared to benign lesions (0.68 × 10-3mm2/s vs. 1.12 × 10-3mm2/s, p < 0.001). The cut off value of ADC for benign lesions was 0.792 × 10-3mm2/s (sensitivity 98.6%, specificity 65.7%), and for malignant 0.993 × 10-3mm2/s (98.5, 80.6%). There were no significant correlations between malignant lesion subtypes and ADC values. DWI is a clinically useful tool for differentiation of malignant from benign lesions based on mean ADC values. The cut off value for benign lesions was higher than reported recently, due to high amount of fibrosis in included benign lesions. Finally, ADC values might have implications in determination of the biological nature of the malignant lesions.

Dynamic simulation and Doppler Ultrasonography validation of blood flow behavior in Abdominal Aortic Aneurysm.

Criteria for rupture prediction of Abdominal Aortic Aneurysm (AAA) are based only on the diameter of AAA. This method does not consider complex hemodynamic forces exerted on AAA wall. The methodology used in our study combines Computer-Aided Design (CAD) with Computational Fluid Dynamics (CFD). Three-dimensional vascular structures reconstructions were based on Computed Tomography (CT) images and CAD. CFD theory was used for mathematical modeling and simulations. In this way, dynamic behavior of blood flow in bounded three-dimensional space was described. Doppler Ultrasonography (US) was used for model results validation. All simulations were based on medical investigation of 4 patients (male older than 65years) with diagnosed AAA. Good correspondence between computed velocities in AAA and measured values with Doppler US (Patient 1 0.60m·s-1 versus 0.61m·s-1, Patient 2 0.80m·s-1 versus 0.80m·s-1, Patient 3 0.75m·s-1 versus 0.78m·s-1, Patient 4 0.50m·s-1 versus 0.49m·s-1) was noticed. The good agreement between measured and simulated velocities validates our methodology and the other data available from simulations (eg. von Misses stress) could be used to provide useful information about the possibility of AAA rupture.

Cystatin C, vascular biomarkers and measured glomerular filtration rate in patients with unresponsive hypertensive phenotype: a pilot study.

BACKGROUND: Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease (CVD) in patients with essential arterial hypertension (HT). In addition to known association between cystatin C and glomerular filtration rate (GFR), elucidating the association between cystatin C and vascular biomarkers (intima-media thickness of common carotid arteries (CCIMT), carotid plaque and renal artery resistance index (RRI)) in patients with unresponsive hypertensive phenotype could be of significant clinical interest. METHODS: Participants (n = 200, median age 58 (52-64) years, 49% female) under treatment with antihypertensive drugs were stratified into two subgroups based on their blood pressure level as having responsive hypertension (RHT - compliant and responsive to treatment, n = 100), or nonresponsive (URHT - compliant but nonresponsive to treatment, n = 100). GFR was measured by isotopic (slope-intercept) method (99m Tc diethylene triamine penta-acetic acid - mGFR). RESULTS: The URHT group had significantly higher median cystatin C serum concentration (p = 0.02) and CCIMT (p = 0.00) compared to the RHT group, with no significant difference in RRI (p = 0.51) and mGFR among subgroups [69.9 ± 28.2 vs 76.74 ± 23.61 ml/min/1.73m2, p = 0.27]. In the URHT group, cystatin C was found to be associated with CCIMT (p = 0.02), hsCRP (p = 0.01) and duration of HT (p = 0.02), independently of mGFR and age. Independent predictors of URHT phenotype were CCIMT (p= 0.02) and hsCRP (p= 0.04). CONCLUSION: In addition to GFR, cystatin C serum concentration is positively and independently associated with CCIMT in patient with URHT phenotype and subclinical CVD. Prospective larger studies should further investigate the clinical importance of this relationship.

The role of the color Doppler ultrasonography and computed tomography in estimation of portal hypertension.

Introduction: Liver diseases with disturbances of hepatic and splanchnic circulation lead to the portal hypertension, with or without a portal vein thrombosis. Objective: This study was based on the testing of hypothesis that more data and more precise diagnosis in patients with disorders of portal circulation can be obtained by using color Doppler ultrasonography (CDU) and computed tomography (CT) with contrast. Methods: The study was conducted from February 2011 to May 2014 and it comprised 120 patients who were suspected to have portal hypertension or already had clinical confirmation of the portal hypertension, patients with hepatitis, and some patients with hematological diseases. The first group of 40 patients was examined by conventional ultrasonography and CDU, the second group by contrast CT, and the third group of patients was examined by both methods (CDU and contrast CT). After six months of adequate therapy, the patients had control examinations with the same diagnostic technique used during their first examination. Results: Retrospective analysis showed that CDU is more sensitive than CT in the assessment of presence and age of thrombi (CDU 93.9%; CT 86.1%). CT gives precise data in detection of portosystemic collaterals. Sensitivity of CT is 100% and its specificity is 67%. Cumulative sensitivity and specificity for most parameters were increased in patients with portal hypertension when both methods were applied. Conclusion: This study emphasizes the possibility of early and more accurate diagnosis achieved when combining two radiological techniques (CDU and contrast CT scan), which is not the case when these methods are used separately.

Dirofilariasis of the breast: sonographic appearance.

Human dirofilarial infections characteristically manifest as pulmonary "coin" lesions or as subcutaneous nodules. A case of subcutaneous Dirofilaria infection of the breast involving a 25-year-old woman with a painful breast lump is presented. The patient had not traveled anywhere and did not have any animals, but provided a history of being bitten by mosquitoes. The suspicion of a parasitic infection was raised by the presence of rod-like structures within a hypoechoic nodule on sonography; movement within the nodule was detected during the examination. Histopathological examination revealed viable, adult female Dirofilaria repens, a nematode that is commonly found in dogs, cats, and wild mammals throughout parts of Europe, Africa, and Asia. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:433-435, 2014.

Blunt trauma of bone structures of the chest--computed tomography vs multidetector computed tomography.

BACKGROUND/AIM: Computerized tomography (CT), especially multidetector CT (MDCT), has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT) examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR). METHODS: This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists inde pendently and separately described the findings for 5-mm-thick axial CT slices (5 mm CT) as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thin-slice examination together which was ultimately considered as a real, true finding. RESULTS: No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05). Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p < 0.05) in favor of better display of injury by MDCT examination. CONCLUSION: MDCT is a powerful diagnostic tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

Color Doppler ultrasonography and multislice computer tomography angiography in carotid plaque detection and characterization.

BACKGROUND/AIM: Cerebrovascular diseases are the third leading cause of mortality in the world, following malignant and cardiovascular diseases. Therefore, their timely and precise diagnostics is of great importance. The aim of this study was to compare duplex scan Color Doppler ultrasonography (CDU) with multislice computed tomography angiography (MSCTA) in detection of morphological and functional disorders at extracranial level of carotid arteries. METHODS: The study included 75 patients with 150 carotid arteries examined in the period from January 2008 to April 2009. The patients were firstly examined by CDU, then MSCTA, followed by the surgery of extracranial segment of carotid arteries. In 10 patients, the obtained material was referred for histopathological (HP) examination. We used both CDU and MSCT in the analysis of: plaque surface, plaque structure, degree of stenosis, and the presence of in-traplaque hemorrhage. RESULTS: The results obtained by CDU and MSCTA were first compared between themselves, and then to intraoperative findings. Retrospective analysis showed that MSCTA is more sensitive than CDU in assessment of plaque surface (for smooth plaques CDU 89%: MSCTA 97%; for plaques with irregular surface CDU 75% : MSCTA 87%; for ulcerations CDU 54%: MSCTA 87%). Regarding determination of plaque structure (mixed plaque CDU 66% : MSCTA 70%; correlation with HP findings CDU 94% : MSCTA 96%) and localization (CDU 63%: MSCTA 65%), and in terms of sensitivity and specificity, both methods showed almost the same results. Also, there is no statistical difference between these two methods for the degree of stenosis (CDU 96%: MSCTA 98%). CONCLUSION: Atherosclerotic disease of extracranial part of carotid arteries primarily affects population of middle-aged and elderly, showing more associated risk factors. Sensitivity and specificity of CDU and MSCTA regarding plaque composition, the degree of stenosis and plaque localization are almost the same. These results and the fact that there are no adverse effects (high radiation dose) compared to MSCTA indicate that CDU should be the initial method in diagnostic algorythm for carotid arteries.

[Chest computed tomography in the localisation of pathologic processes in lymphomas].

INTRODUCTION: The anatomic localisation of Hodgkin disease and Non-Hodgkin lymphoma is very important in the disease prognosis and therapy treatment. Intrathoracic localisation in Hodgkin disease is very frequent and usually occurs in the form of lymph node enlargement. The most frequent manifestation of the thoracic Non-Hodgkin lymphoma is mediastinal and hilarlympha-denomegalia. The purpose of this research study is to analyse chest computed tomography findings in patients suffering from Hodgkin disease and Non-Hodgkin lymphoma prior to any applied therapy. MATERIAL AND METHODS: This retrospective study encompassed 73 patients diagnosed as having Hodgkin disease or Non-Hodgkin lymphoma. They were subjected to III chest CT examinations. The initial occurrence of the disease was found in 35 patients (24 patients suffering from Hodgkin disease and 11 suffering from Non-Hodgkin lymphoma). Simultaneously, analyses of the pretherapy chest CT findings were made. RESULTS AND DISCUSSION: Positive findings were reported in 66.66% patients suffering from Hodgkin disease and 45.45% patients suffering from Non-Hodgkin lymphoma. Enlarged lymphnodes were found in the region of the upper mediastinum (parathracheal and prevascular group) in more than 55% of the patients suffering from Hodgkin disease and in more than 35% of the patients suffering Non-Hodgkin lymphoma. CONCLUSION: The findings of this study coincide to a great extent with the findings presented in world literature.

[Blunt injuries of the lungs, pleura and chest bone structures: computed tomography contribution].

INTRODUCTION: The most frequent incidences of blunt chest injuries occur due to motorvehicle accidents, falls and work-related traumas. Chest computed tomography is usually associated with examination of the subsequent regions with the aim to enable a more efficient diagnostic procedure. The purpose of this research study is to define the contribution of the chest CT in blunt injury patients. MATERIAL AND METHODS: This retrospective study encompasses the results of CT examination of 36 patients with one or more injuries of the thoracic wall, pleura, lungs and spinal column suspected to suffer chest organs traumas. Chest CT survey was performed in 30 patients, while thoracic spine CT survey was performed in 11 patients. RESULTS AND DISCUSSION: The most frequent incidences of injuries were due to motor vehicle accidents (22 patients--61.11%). Falls were the reason of injuries in 11 patients--17.46%. Chest injuries are usually associated with injuries of the surrounding regions, but occurred in isolated form, too (27.78%). Rib fractures and lungs parenchyma traumas were evidenced by CT examination in more than 60% of the patients. Thoracic spine fractures were most frequently reported at the 10-th, 11-th and 12-th vertebra and made more than 70% of the thoracic spine fractures. CONCLUSION: The findings of this study coincide to a great extent with the findings presented in world literature.

Renal colic--radiological approach.

Acute flank pain is commonly caused by urolithiasis. This paper discusses advantages and disadvantages of procedures used for evaluation of acute flank pain. In our institution, the diagnostic algorithm includes ultrasonography and plain film radiography, and unenhanced spiral CT in equivocal cases.

[Duplex Doppler ultrasonography in the diagnosis of deep venous thrombosis of the lower extremities].

INTRODUCTION: The aim of this study was to investigate the role of duplex Doppler ultrasonography in diagnosis of deep venous thrombosis (DVT) of the lower extremities. MATERIAL AND METHODS: During a 2-year period, 860 patients were examined by duplex Doppler sonography. Among these, 619 (72%) were women and 241 (28%) men, with the age-range of 16-91; (mean 56,2) years. Siemens Versa Pro colour doppler was used, with 7MHz transducers. Findings were categorized into four categories: 1. deep venous thrombosis (DVT); 2. pathology predominantly related to superficial veins without DVT; 3. pathology of superficial and deep veins; 4. normal findings. RESULTS: 185 (21%) patients had DVT, 366 (42.5%) patients had predominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 128 (14.9%) patients had pathology of superficial and deep veins. Normal findings were found in 181 (21.1%) patients. COCNCLUSIONS: Various vascular and nonvascular diseases may mimic deep venous thrombosis, and that is why US should be used whenever possible to avoid unnecessary anticoagulant therapy.

[Basic characteristics of duplex sonography in the assessment of lower limb arterial circulation].

INTRODUCTION: Dulpex and color duplex ultrasonography of lower limb arteries are valuable non-invasive diagnostic methods in the pathology of vascular diseases and a major step in diagnostics and in follow-up of hemodynamic and morphologic characteristics. COLOR DUPLEX SONOGRAPHY: The method consists of image analysis and analysis of Doppler information. Real-time-B mode is used to visualize the anatomy of blood vessels and other pathological lesions. Doppler information based on the Doppler effect determine the pulse wave i.e. the shape of flow velocity--hemodynamic characteristics. Spectral analysis is the most important element of Doppler examination of the lower limb peripheral arteries. Based on the spectral analysis, there are four stages of lower limb arterial disease: normal findings--1% - 19% diameter reduction; medium stenosis--artery diameter reduction of 20% - 49%; high level stenosis--artery diameter reduction of 50% - 100%; occlusion--no flow detected within the imaged arterial segment. In the first place, both iliac arteries are examined, which is followed with femoral, popliteal and crural arteries. The examination of iliac arteries is carried out with a 3.5 MHz transducer, and other peripheral arteries of the lower limbs are examined with a 7, 5 or 5 MHz transducer. CONCLUSION: Color Doppler is an extremely valuable diagnostic method in detecting pathology of the lower limb arteries. With high reliability level arterial insufficiency and pathological arterial segments are diagnosed by a duplex-Doppler.