Usefulness of combined BI-RADS analysis and Nakagami statistics of ultrasound echoes in the diagnosis of breast lesions.

AIM: To develop a method combining the statistics of the ultrasound backscatter and the Breast Imaging-Reporting and Data System (BI-RADS) classification to enhance the differentiation of breast tumours. MATERIALS AND METHODS: The Nakagami shape parameter m was used to characterise the scatter properties of breast tumours. Raw data from the radiofrequency (RF) echo-signal and B-mode images from 107 (32 malignant and 75 benign) lesions and their surrounding tissue were recorded. Three different characteristic values of the shape parameters of m (maximum [mLmax], minimum [mLmin] and average [mLavg]) and differences between m parameters (Δmmax, Δmmin, Δmavg) of the lesions and their surrounding tissues were assessed. A lesion with a BI-RADS score of 3 was considered benign, while a lesion with a score of 4 was considered malignant (a cut-off of BI-RADS 3/4 was set for all patients). RESULTS: The area under the receiver operating characteristic (ROC) curve (AUC) was equal to 0.966 for BI-RADS, with 100% sensitivity and 54.67% specificity. All malignant lesions were diagnosed correctly, whereas 34 benign lesions were biopsied unnecessarily. In assessing the Nakagami statistics, the sum of the sensitivity and specificity was the best for mLavg (62.5% and 93.33%, respectively). Only four of 20 lesions were found over the cut-off value in BI-RADS of 4a. When comparing the differences in m parameters, Δmavg had the highest sensitivity of 90% (only three of 32 lesions were false negative). These three lesions were classified as BI-RADS category 4c. The combined use of B-mode and mLmin parameter improve the AUC up to 0.978 (p=0.088), compared to BI-RADS alone. CONCLUSION: The combination of the parametric imaging and the BI-RADS assessment does not significantly improve the differentiation of breast lesions, but it has the potential to better identify the group of patients with mainly benign lesions that have a low level of suspicion for malignancy with a BI-RADS score of 4a.

Adhesion, activation, and aggregation of blood platelets and biofilm formation on the surfaces of titanium alloys Ti6Al4V and Ti6Al7Nb.

Titanium alloys are still on the top list of fundamental materials intended for dental, orthopedics, neurological, and cardiovascular implantations. Recently, a special attention has been paid to vanadium-free titanium alloy, Ti6Al7Nb, that seems to represent higher biocompatibility than traditional Ti6Al4V alloy. Surprisingly, these data are not thoroughly elaborated in the literature; particularly there is a lack of comparative experiments conducted simultaneously and at the same conditions. Our study fills these shortcomings in the field of blood contact and microbiological colonization. To observe platelets adhesion and biofilm formation on the surfaces of compared titanium alloys, fluorescence microscope Olympus GX71 and scanning electron microscope HITACHI S-3000N were used. Additionally, flow cytometry analysis of platelets aggregation and activation in the whole blood after contact with sample surface, as an essential tool for biomaterial thrombocompatibility assessment, was proposed. As a result of our study it was demonstrated that polished surfaces of Ti6Al7Nb and Ti6Al4V alloys after contact with whole citrated blood and E. coli bacterial cells exhibit a considerable difference. Overall, it was established that Ti6Al4V has distinct tendency to higher thrombogenicity, more excessive bacterial biofilm formation and notable cytotoxic properties in comparison to Ti6Al7Nb. However, we suggest these studies should be extended for other types of cells and biological objects.

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis().

PURPOSE: To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy. METHODS AND MATERIALS: The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22-84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal). RESULTS: A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III). CONCLUSION: The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy.

3D ultrasound examination of the superficial lymph nodes--does it provide additional information?

PURPOSE: To compare the appearance of superficial lymph nodes on standard two-dimensional (2D) ultrasound examination and on three-dimensional (3D) ultrasound examination. MATERIALS AND METHODS: Fifty two lymph nodes (35 cervical, 16 axillary, 1 inguinal) in 52 patients were examined with ultrasound in 3D mode. In standard 2D grey-scale examination and on a C-plane of 3D mode (parallel to the surface of the probe), the shape of a lymph node and its hilum were assessed. Final histopathological diagnoses included 36 lymphomas, 11 reactive or inflammatory lymph nodes, 3 metastases and 2 plasmocytoma infiltrations. RESULTS: The appearance of hilums and lymph nodes as a whole changed on a C-plane of 3D mode (as compared with 2D presentation) in 28 % and 37 %, respectively. The differences in lymph node shape on 2D and 3D ultrasound were apparent in a comparable percentage of reactive lymph nodes (45 %) and lymphomatous lymph nodes (39 %). The differences in lymph node hilum shape on 2D and 3D ultrasound applied to 56 % of reactive lymph nodes and 20 % of lymphomatous lymph nodes. CONCLUSION: Three-dimensional imaging on a C-plane (parallel to the surface of the probe) may supply the examiner with different information concerning the shape of the lymph node and its hilum in comparison to standard 2D ultrasound. Changes in the shapes of hilum and lymph node occurred in reactive or inflamed lymph nodes as well as in lymphomas. Clinical significance of this fact demands further investigation.

Ultrasonography as the method of incidental detection of mandible lesions.

We present two cases of patients with bone cysts in which the suggestion of a bone lesion was made primarily on the basis of ultrasound examination. Examinations were performed with use of a 7.5 MHz linear probe on Siemens Elegra ultrasound scanner (Siemens, Erlangen, Germany) with application of tissue harmonic imaging (THI) and power Doppler mode. On the basis of such features as uneven and irregular bone surface, widening and distorting of the mandible shape or visualization of the mass inside the bone on ultrasound examination, the presence of the bone tumor was suggested. Ultrasound examination may be the first method suggesting the presence of the unsuspected mandible tumor in patients referred to search for underlying pathology in soft tissues. During the examination of the soft tissues of the head and neck also the surface of bones should be each time carefully evaluated.

Reliability of endosonography in evaluation of anal fistulae and abscesses.

OBJECTIVE: To assess the reliability of anal endosonography (AES) in the diagnosis of anal fistulae and abscesses. MATERIAL AND METHODS: 86 patients with different types of anal fistulae and abscesses were prospectively examined with a 7.0 MHz transducer. Type of anal fistulae, differentiation between simple and complex tracts, and location of their internal openings were defined. In 66 cases with permeable external opening, hydrogen peroxide solution was introduced into the fistula tract. Reliability of AES was defined after surgical treatment of all cases. RESULTS: 74 anal fistulae, including 43 transsphincteric, 11 intersphincteric, 6 suprasphincteric, 3 superficial, and 11 ano-vaginal were found on AES. 27 fistulae were complex, and 47 simple fistulae. In 10 patients a coexisting abscess was found; the remaining 12 abscesses were without any fistula. Surgery confirmed the type of anal fistula in 64 patients (86.5%), and location of internal openings in 60 cases (81.1%). All abscesses were confirmed. CONCLUSION: AES showed high accuracy in diagnosing anal fistulae and abscesses.

Adrenal ganglioneuroblastoma in pregnant woman: diagnosis with three-dimensional ultrasound.

The diagnostic approach for evaluation of adrenal tumour in pregnant women is a problem. This article presents the multifactorial diagnosis of rare, incidentally detected massive adrenal tumour with 2D and 3D US. Grey-scale 2D and 3D US with tissue harmonic imaging showed inhomogeneous, encapsulated, solid tumour of the right adrenal region. Three-dimensional colour Doppler and power Doppler studies showed ample neovascularization in the tumour and the adrenal vein draining to the inferior vena cava similarly to angiographic studies performed in the past.

US-appearance of a Küttner tumour resembling a malignant lesion: US-histopathologic correlation.

We present a case of unilateral Küttner tumour in the right submandibular gland. Its clinical course and ultrasound features inclined us to include a malignant lesion in the differential diagnosis. US-histopathologic correlation explained the ultrasound appearance of the lesion.

[Diagnostic possibilities of anal endosonography in proctology. Part II]. / Mozliwosci diagnostyczne ultrasonografii prezezodbytniczej w proktologii. Czesc II.

In the second part of the paper, we present advantages and drawbacks of transanal endosonography with the use of axial endoprobe in the diagnostics of perianal and perirectal abscesses and fistulas and also for tumours of the rectum. Typical images of the fistula nad abscess were shown. Ultrasonographic staging for the rectum malignancies was presented together with possibilities of assessment perirectal lymph nodes involvement by ultrasonography. Diagnosis of local recurrence by anal endosonography was presented and compared with other methods.

[Transanal ultrasonography for diagnosis of obstetric anal sphincter trauma]. / Mozliwosci ultrasonografii przezodbytniczej w diagnostyce uszkodzen polozniczych zwieraczy odbytu.

Fecal incontinence affects up to 2% of the general population. The major cause of it is related to the birth trauma of the anal sphincters. In this paper the possibilities of transanal endosonography in the assessment of the anal canal muscles defects after deliveries were presented. Anal canal sonographic anatomy together with the technique of the examination with the use of rotating endoprobe were presented. Transanal rotating endoprobe was compared with exoanal probes for visualization of the anal canal. Ultrasonic images of internal and external anal sphincters defects were shown with specific patterns of defects allowing differentiation between morphological and neurological damages of the sphincters. Anal endosonography was compared with clinical examination, electromyography and manometry in the assessment of the integrity of the anal sphincters.

[Diagnostic possibilities of anal endosonography in proctology. Part 1]. / Mozliwosci diagnostyczne ultrasonografii przezodbytniczej w proktologii. Cz. 1.

On the basis of literature and own experience, the usefulness of endosonographic examination with the use of axial endoprobe was presented. The first part was devoted to the description of the endosonographic anatomy of normal rectum, examination technique and its usefulness in diagnosis of anal sphincters disorders. The endosonographic examinations have been performed in Poland for many years, mainly for prostate diagnostics with the use of multiplane transducers. We present a diagnostic possibilities of axial endoprobe of high frequency equipped with hard plastic cone and water balloon.

Anal sphincters defects--verification of the anal ultrasound diagnosis in 'bimanual' examination.

The aim of this is to evaluate the diagnostic value of anal endosonography performed during pressing anterior wall of anal canal with a finger introduced into the lumen of vagina for the identification of anal sphincter defects. Anal ultrasound (AUS) with a finger introduced into the lumen of vagina was performed in a group of 55 women with anal sphincter defects recognized initially in standard AUS. This technique prevented false positive diagnoses of sphincter defects in 12 out of a group of 55 women (21.8%).

[Endosonography of the rectum and other imaging methods in the diagnosis of bowel inflammatory diseases]. / Endosonografia odbytnicy i inne badania obrazowe w rozpoznawaniu nieswoistych zapalnych chorób jelit.

This paper presents the usefulness of rectal endosonography in the diagnostics of the rectal wall and anorectal lesions in patients with inflammatory bowel diseases, mainly with Crohn's disease. Value of endosonography, computed tomography and magnetic resonance imaging were compared.

2,7-dichlorofluorescin oxidation and reactive oxygen species: what does it measure?

Intracellular 2,7-dichlorofluorescin (H(2)DCF) oxidation is often used to measure the production of reactive oxygen species (ROS) within cells. The rate of H(2)DCF oxidation depends on the concentration of glutathione, which is an alternative target for ROS. Our results suggest that increased rate of H(2)DCF oxidation be interpreted as an indication of general oxidative stress due to a variety of reasons, including depletion of antioxidants, rather than as a specific proof of augmented ROS formation.

Color-SieScape imaging of carotid and vertebral arteries.

OBJECTIVE: The aim of this study was to estimate the feasibility and limitations of Color-SieScape imaging of carotid and vertebral arteries in healthy subjects. METHODS: extended field of view procedure was applied during the examination of 80 carotid and 80 vertebral arteries in 40 healthy volunteers. RESULTS: visualisation of a common carotid artery together with a proximal segment of both an internal (ICA) and external carotid artery (ECA) in one Color-SieScape image was possible in nine cases. Clear presentation of a common carotid artery in one Color-SieScape image with a segment of an ICA or ECA of varying length was possible in 49 cases. In 22 cases, visualisation of an ICA was possible only on a minimal length, with major artefacts or completely impossible. Color-SieScape images of vertebral arteries were good or very good in 34 cases and poor or very poor in 46 cases. Artefacts arose due to the pulsatile movements of the arterial wall, especially in vessels lying close to the skin and in the proximal part of a common carotid artery. Tracing a tortuous vessel and ICA coming from common carotid artery at an angle close to 90 degrees produced significant artefacts. CONCLUSIONS: Color-SieScape images of carotid and vertebral arteries of good quality are usually possible to obtain.

Pleomorphic adenoma and adenolymphoma in ultrasonography.

OBJECTIVE: The aim of the study was to define ultrasonographic morphologic features characteristic of pleomorphic adenoma and adenolymphoma (Warthin's tumor). METHODS: Documentation of 31 ultrasonographic examinations of 20 pleomorphic adenomas and 10 Warthin's tumors in 28 patients was analysed. All cases were confirmed by fine needle aspiration biopsy or/and histopathological examination. Estimated ultrasound criteria were: borders (well-defined, predominantly well-defined, ill-defined), shape (lobulated, oval, irregular), echogenicity (increased, decreased), structure (homogeneous, slightly inhomogeneous, inhomogeneous) and presence of irregular anechoic areas within a tumor. RESULTS: 100% of the lesions were hypoechoic. 80.6% of all tumors were well-defined. The remaining 19.4% had predominantly well-defined borders. 55% of pleomorphic adenomas had a lobulated shape. Almost equal percentages of Warthin's tumors were lobulated, had an oval and irregular shape. Irregular echolucent areas were present in six of 11 examinations of Warthin's tumors and in one pleomorphic adenoma. CONCLUSIONS: Ultrasonography is a useful method for the evaluation of pleomorphic adenomas and Warthin's tumors and sometimes it might allow to suggest the nature of a tumor if a certain sonographic pattern is present.

Magnetic resonance urography: initial experience of a low-dose Gd-DTPA-enhanced technique.

Contrast-enhanced magnetic resonance urography (MRU) is a promising tool in the evaluation of the renal collecting system, but it can be limited by T2* effects resulting from hyperconcentrated gadolinium chelates. The aim of this study was to evaluate a low-dose dimeglumine gadopentetate (Gd-DTPA) MRU technique consisting of a dynamic fast low-angle-shot (FLASH) 2D sequence and a static fast imaging in steady state precession (FISP) 3D sequence for depicting the kidneys and urinary tract. The Gd-DTPA dose (0.01 mmol/kg) was established experimentally in a healthy volunteer study. Ninety-one patients presenting with various renal disorders were examined with a low-dose Gd-DTPA MRU and a T2-weighted turbo spin echo (TSE) MRU technique on a 1.5-T system. Image quality and diagnostic value were considered at least satisfactory in 98.9% of the FLASH 2D studies, 83.5% of the FISP 3D studies and 78.5% of the TSE T2-weighted studies. Typical enhancement patterns were established for the renal cell carcinoma and transitional cell carcinoma. The major limitations were motion artefacts and insufficient hydration of the patients. Low-dose Gd-DTPA MRU appears to be a useful technique in the evaluation of the kidneys and urinary tract, especially in cases of renal tumours.

[Progress in imaging diagnostics of adrenal neoplasms]. / Postep w diagnostyce obrazowej guzów nadnerczy.

Computed tomography is the modality of choice in imaging of adrenal glands. Density measurements on images without contrast agent are essential for differentiation of adrenal masses. Application of spiral computed tomography for diagnostics of adrenal masses enables sensitive detection of small adrenal tumors and reliable density measurements by elimination of uneven breath-holds effect and minimization of partial volume effect. Tissue harmonic imaging in ultrasonography is a new technique, which enables visualization of abdominal parenchymal organs with higher tissue contrast with less artifacts and is especially useful in ultrasound imaging of difficult-to-image patients with high body weight. Further comparative research will enable to learn the advantages of using that technique in diagnostics of adrenal masses. Magnetic resonance imaging enables very accurate visualization diagnostics of adrenal masses. It is due to its inherent multiplanar imaging capabilities and high tissue contrast of soft tissues which enables very accurate visualization of anatomical structures in adrenal region. Introduction of new techniques of magnetic resonance imaging as chemical shift imaging and dynamic studies with paramagnetic contrast agent enables accurate differentiation of adrenal cortex adenomas from non-adenomas. In case of difficulties in adrenal diagnostics magnetic resonance imaging is often a problem solving examination in regard to other imaging techniques of adrenal region.

[Magnetic resonance techniques used in the differentiation of adrenal tumors]. / Techniki rezonansu magnetycznego przydatne w róznicowaniu guzów nadnerczy.

Noninvasive differentiation of adrenal masses by imaging studies as computed tomography and magnetic resonance imaging is an accepted diagnostic procedure in patients with extraadrenal neoplasm and discovered on imaging studies adrenal mass or in patients with incidentally discovered adrenal mass. Significant impact on possibilities of differentiation of adrenal masses with magnetic resonance imaging was due to introduction to adrenal imaging such techniques as chemical shift imaging and dynamic imaging with paramagnetic contrast agent. Differentiation of adrenal masses with magnetic resonance imaging involves following parameters: tumor diameter, signal intensity of adrenal mass on T2 weighted images, lipid contents in adrenal tumor evaluated with chemical shift imaging and washout of paramagnetic contrast agent from adrenal mass evaluated with dynamic examination. The best results, reaching 100% sensitivity and 100% specificity in differentiation adrenal adenomas from non-adenomas, can be achieved by combined analysis of all mentioned parameters. In regard to availability and costs computed tomography not magnetic resonance imaging is the examination of choice in visualization of adrenal glands and their pathology and in differentiation of adrenal masses. Adrenal tumors on non-enhanced images with density below 0 Hounsfield units can reliably be diagnosed as adenomas, whereas adrenal tumors with density above 20 Hounsfield units can reliably be diagnosed as non-adenomas. Tumors with density in 0-20 Hounsfield range are ambiguous in character, that in many cases can be determined in magnetic resonance imaging.