Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Measuring Perfusion in Pancreatic Ductal Adenocarcinoma and Different Tumor Grade: A Preliminary Single Center Study.

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging is a noninvasive imaging modality that can supply information regarding the tumor anatomy and physiology. The aim of the study was to analyze DCE-MRI perfusion parameters in normal pancreatic parenchymal tissue and PDAC and to evaluate the efficacy of this diagnostic modality in determining the tumor grade. METHODS: A single-center retrospective study was performed. A total of 28 patients with histologically proven PDAC underwent DCE-MRI; the control group enrolled 14 patients with normal pancreatic parenchymal tissue; the radiological findings were compared with histopathological data. The study patients were further grouped according to the differentiation grade (G value): well- and moderately differentiated and poorly differentiated PDAC. RESULTS: The median values of Ktrans, kep and iAUC were calculated lower in PDAC compared with the normal pancreatic parenchymal tissue (p < 0.05). The mean value of Ve was higher in PDAC, compared with the normal pancreatic tissue (p < 0.05). Ktrans, kep and iAUC were lower in poorly differentiated PDAC, whereas Ve showed no differences between groups. CONCLUSIONS: Ve and iAUC DCE-MRI perfusion parameters are important as independent diagnostic criteria predicting the probability of PDAC; the Ktrans and iAUC DCE-MRI perfusion parameters may serve as effective independent prognosticators preoperatively identifying poorly differentiated PDAC.

Antiphospholipid antibodies and the risk of thrombosis in myeloproliferative neoplasms.

The morbidity and mortality of BCR-ABL-negative myeloproliferative neoplasia (MPN) patients is highly dependent on thrombosis that may be affected by antiphospholipid antibodies (aPLA) and lupus anticoagulant. Our aim was to evaluate the association of the aPLA together with platelet receptor glycoprotein (GP) Ia/IIa c.807C>T CT/TT genotypes and thrombotic complications in patients with MPNs. The study included 108 patients with BCR-ABL-negative MPN with data of previous thrombosis. Two different screening and one confirmatory test for the lupus anticoagulant were performed. Thrombotic complications were present in 59 (54.6%) subjects. aPLA were more frequently found in MPN patients with thrombosis vs no thrombosis (25.4 and 6.1%; p = 0.007). MPN patients with arterial thrombosis were more frequently positive for aPLA vs no arterial thrombosis (38.8 and 11.9%; p = 0.001). aPLA were more frequently found in patients with cerebrovascular events vs other arterial thrombotic complications or no thrombosis, respectively (39.3, 6.1, and 12.9%; p < 0.001). MPN patients with thrombosis were more frequently positive with aPLA and had platelet receptor GP Ia/IIa c.807C>T CT/TT genotypes compared to MPN patients without thrombosis (18.6 and 2.0%; p = 0.006). aPLA alone or with coexistence with platelet receptor GP Ia/IIa c.807C>T CT/TT polymorphism could be associated with thrombotic complications in patients with MPN.

Value of ultrasonography parameters in diagnosing polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women of reproductive age associated with hyperandrogenism, oligo-amenorrhea, and infertility. Symptoms and their severity vary among the individuals. If the manifestation is mild, PCOS may remain undiagnosed. In more severe cases, it results in a spectrum of symptoms of metabolic syndrome, insulin resistance, and cardiovascular diseases. The diagnosis is established after a physical examination and evaluating the patient's hormonal profile. In addition to these required methods, ultrasonographic assessment of the patient's ovaries is another non-invasive, cheap, and time-saving tool, making the examination more profound and leading to the correct diagnosis. Specific ultrasonographic parameters are used to tell the healthy and polycystic ovaries apart: the ovarian volume (OV), ovarian follicle count, follicle distribution pattern, ovarian stromal echogenicity, and the resistance and pulsatility indices assessed using the Doppler function. This review evaluated the selected articles and ascertained the ultrasonographic parameters that accurately predict PCOS. This systematic review showed that the most valuable ultrasonographic parameters in diagnosing PCOS are the OV and follicle number per ovary.

Dynamic perfusion CT - A promising tool to diagnose pancreatic ductal adenocarcinoma.

BACKGROUND AND OBJECTIVE: This study deals with an important issue of setting the role and value of the dynamic computed tomography (CT) perfusion analysis in diagnosing pancreatic ductal adenocarcinoma (PDAC). The study aimed to assess the efficacy of perfusion CT in identifying PDAC, even isodense or hardly depicted in conventional multidetector computed tomography. METHODS: A total of 56 patients with PDAC and 56 control group patients were evaluated in this study. A local perfusion assessment, involving the main perfusion parameters, was evaluated for all the patients. Sensitivity, specificity, positive, and negative predictive values for each perfusion CT parameter were defined using cutoff values calculated using receiver operating characteristic curve analysis. We accomplished logistic regression to identify the probability of PDAC. RESULTS: Blood flow (BF) and blood volume (BV) values were significant independent diagnostic criteria for the presence of PDAC. If both values exceed the determined cutoff point, the estimated probability for the presence of PDAC was 97.69%. CONCLUSIONS: Basic CT perfusion parameters are valuable in providing the radiological diagnosis of PDAC. The estimated BF and BV parameters may serve as independent diagnostic criteria predicting the probability of PDAC.

Dynamic Perfusion Computed Tomography and Apparent Diffusion Coefficient as Potential Markers for Poorly Differentiated Pancreatic Adenocarcinoma.

INTRODUCTION: Tumor grade, one of the most important risk factors for survival, is routinely determined after examining the biopsy material or a surgically removed specimen. The aim of the study was to analyze computed tomography (CT) perfusion parameters and diffusion-weighted imaging apparent diffusion coefficient (ADC) values in pancreatic ductal adenocarcinoma (PDAC) and to establish the diagnostic value of these modalities determining the tumor grade. MATERIALS AND METHODS: A prospective clinical study included 56 subjects with PDAC. All the patients had a local perfusion assessment and ADC measurement of the tumor. For the prediction of poor tumor differentiation sensitivity, specificity, positive, and negative predictive values for each perfusion CT and ADC parameters based on cutoff values from ROC analysis were calculated. RESULTS: Mean transit time (MTT) and ADC values were found to be independent prognosticators for the presence of G3 PDAC. MTT and ADC at the cutoff of 17.37 s and 1.15 × 10-3 mm2/s, respectively, appeared to be significant parameters discriminating against the differentiation grade of PDAC. If both values exceeded the defined cutoff point, the estimated probability for the presence of G3 PDAC was 89.29%. CONCLUSION: The MTT parameter, calculated with the deconvolution method, and the ADC value may serve as effective independent prognosticators identifying poorly differentiated PDAC.

Comparative diagnostic value of contrast-enhanced ultrasonography, computed tomography, and magnetic resonance imaging in diagnosis of hepatic hemangiomas.

AIM: To compare the value of intravenous contrast-enhanced ultrasonography (US), intravenous contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis of hepatic hemangiomas. MATERIAL AND METHODS: The study enrolled 48 patients, aged between 20 and 79 years (35 [72.9%] women, 13 [27.1%] men; mean age, 53.5+/-12.855 years), who were examined and treated in the Departments of Gastroenterology, Surgery, and Oncology, Hospital of Kaunas University of Medicine, in the year 2007. All patients underwent intravenous contrast-enhanced US, intravenous contrast-enhanced CT, and MRI and were diagnosed with hepatic hemangioma according to the findings of these examinations. RESULTS: The size of hemangiomas was < or =2.0 cm in 20 cases (41.7%) and >2.0 cm in 28 (58.3%). No association between hepatic hemangioma and patient's age was found (chi(2)=0.547, df=2, P=0.761). Nearly one-third of hemangiomas were located in the segment IV of the left hepatic lobe. There were a few complicated hemangiomas in the study sample: 2 with calcification and 1 with necrosis. The sensitivity of CT in the diagnosis of hepatic hemangioma was 76.92%; specificity, 33.3%; positive prognostic value, 83.3%; and negative prognostic value, 25.0%. The sensitivity of intravenous contrast-enhanced US in the diagnosis of hepatic hemangioma was 77.8%; specificity, 100%; positive prognostic value, 100%; and negative prognostic value, 23.1%. CONCLUSIONS: Intravenous contrast-enhanced US is more specific than intravenous contrast-enhanced CT in the diagnosis of hepatic hemangioma (P=0.0005) and has a higher positive prognostic value (P=0.001).

[Comparative diagnostic value of computed tomography and contrast-enhanced ultrasonography in diagnosis of focal liver lesions]. / Kontrastiniu ultragarsinio ir kompiuterines tomografijos tyrimu palyginamoji verte diagnozuojant zidininius kepenu pokycius.

OBJECTIVE. The aim of the study was to evaluate focal liver lesions by computed tomography and contrast-enhanced ultrasonography and to compare their diagnostic values. MATERIALS AND METHODS. There were 67 patients, examined and treated in the Departments of Gastroenterology, Surgery, and Oncology, Hospital of Kaunas University of Medicine, during 2007 (study group). All the patients underwent contrast-enhanced ultrasonography and bolus computed tomography. Control group included 73 patients with focal hepatic lesions who were examined and treated in the Hospital of Kaunas University of Medicine during 2006. Focal hepatic lesions were detected and characterized by conventional ultrasonography and bolus computed tomography. The diagnosis was confirmed by biopsy or during surgery in both groups, and hemangiomas were confirmed by magnetic resonance imaging. Patients' age varied from 20 to 80 years (there were 46 [68.7%] women and 21 [31.3%] men with a mean age of 55.85+/-13.417 years). The age of patients in the study group varied from 18 to 91 years (mean age, 60.81+/-16.059 years; out of 73 patients, 46 [63%] were women and 27 [37%] men). RESULTS. The following was determined in the study group: hemangioma (n=18, 26.9%), focal nodular hyperplasia (n=4, 6%), adenoma (n=2, 3%), echinococcosis (n=2, 3%), hepatocellular carcinoma (n=11, 16.4%), cholangiocellular carcinoma (n=1, 1.5%), solitary metastasis (n=13, 19.4%), hepatic cyst (n=3, 4.5%), etc. The sensitivity and specificity of contrast-enhanced ultrasonography as compared with computed tomography in detecting and characterizing focal liver lesions was 44.2% and 46.7%, respectively; positive prognostic value was 74.2% and negative prognostic value was 19.4%. The sensitivity and specificity of conventional ultrasonography as compared with contrast-enhanced ultrasonography in detecting and characterizing focal liver lesions was 34.5% and 100%, respectively; positive prognostic value was 100% and negative prognostic value was 25%. CONCLUSIONS. Ultrasound contrast agents (SonoVue, Bracco(R), Milan, Italy) definitely improve detection and characterization of focal liver lesions. Ultrasonography correlates with computed tomography and magnetic resonance imaging, particularly during arterial phase. The sensitivity of contrast-enhanced ultrasonography as compared with computed tomography in detecting and characterizing focal liver lesions was 74.2% and positive prognostic value was 44.2%; sensitivity of conventional ultrasonography as compared with contrast-enhanced ultrasonography in detecting and characterizing focal liver lesions was 34.5% and positive prognostic value was 100%.