Evaluation of sarcopenia as a prognostic biomarker in locally advanced head and neck squamous cell carcinoma.

Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival and overall survival were compared according to cervical computed tomography for radiotherapy in 123 sarcopenic and non-sarcopenic patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiotherapy with weekly cisplatin. Results: In multivariate analyses, pretreatment sarcopenia was associated with lower disease-free survival (hazard ratio: 2.60; 95% CI: 1.38-4.87; p = 0.003) and overall survival (hazard ratio: 2.86; 95% CI: 1.40-5.85; p = 0.004). Sarcopenic patients experienced more frequent radiotherapy-related toxicities and platinum-related side effects than non-sarcopenic patients. Conclusion: Sarcopenia could be a potential biomarker to predict prognosis and treatment toxicity in head and neck squamous cell carcinoma.

Head and neck cancer is one of the main causes of cancer-related death worldwide. Most patients are diagnosed in the advanced stage. Muscle wasting with significant weight loss occurs in nearly half of the patients at the initial diagnosis. In oncology research, sarcopenia has often been described as the loss of skeletal muscle mass. In this study, we evaluated the effect of sarcopenia on survival in head and neck cancer patients. Muscle mass was calculated using information from head and neck computed tomography before radiotherapy treatment in patients. We showed that patients with low muscle mass had significantly worse survival rates and were more susceptible to treatment-related side effects. Sarcopenia may function as a marker showing the course of disease in patients with head and neck cancer.

Falciform Ligament Torsion Caused by Omental Hernia Through the Foramen of Morgagni.

INTRODUCTION: Torsion of the falciform ligament, one of the rarest causes of acute abdominal pain, often presents with pain in the right upper quadrant and epigastrium. CASE PRESENTATION: In this case, we present the Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings of torsion of the falciform ligament that occurred in the presence of omental fat herniation through the foramen of Morgagni in an 88-year-old female patient who presented to the emergency department with acute epigastric pain. CONCLUSION: Torsion of the falciform ligament may develop secondary to omental hernia in the setting of Morgagni hernia and should be taken into consideration as one of the rarest causes of acute abdominal pain, even in elderly patients.

Imaging findings of splenic emergencies: a pictorial review.

UNLABELLED: Although traumatic injuries are the cause of common splenic emergencies in the emergency room, various nontraumatic conditions may also affect the spleen with possible life-threatening results. In this pictorial review, we present imaging findings of usual and unusual splenic emergencies. It is essential to be familiar with key imaging findings and advantages of different modalities to reach a definitive diagnosis. TEACHING POINTS: • Delayed splenic rupture is commonly related to subcapsular hematoma. • Subtle haemorrhage is commonly restricted to the site of injury "sentinel clot sign". • The whorled appearance is the key imaging feature of splenic torsion.

Evaluation of left renal vein entrapment using multidetector computed tomography.

BACKGROUND: Nutcracker syndrome, also called left renal vein entrapment syndrome, is a cause of non-glomerular hematuria with difficulties in diagnosis. Multidetector computed tomography (MDCT) is a powerful tool to prevent unnecessary diagnostic procedures. PURPOSE: To retrospectively determine the prevalence of nutcracker phenomenon and nutcracker syndrome seen in MDCT in consecutive patients. MATERIAL AND METHODS: The institutional review board approved the study and waived the requirement for informed consent. Abdominal contrast-enhanced MDCT scans were reviewed from 1000 consecutive patients. MDCT scan assessment included renal vein diameter measurements and evaluation for the presence of anterior or posterior left renal vein entrapment. Electronic medical records and urine analysis reports of patients with left renal vein entrapment were reviewed. Student's t test was used to assess differences in renal vein diameter in patients with left renal vein entrapment. RESULTS: Left renal vein entrapment was observed in 10.9% (109), retro-aortic left renal vein in 6.5% (65), entrapment of left renal vein between superior mesenteric artery and aorta in 4.1% (41), and circumaortic left renal vein in 0.3% (3) of patients. Mean diameters of right (8.8 ± 1.9 mm) and unentrapped left (8.9 ± 1.8 mm) renal veins were not significantly different (P = 0.1). The mean diameter of anterior entrapped left renal veins (10.3 ± 2 mm) was significantly greater (P = 0.04) than contralateral renal veins (8.6 ± 2.1 mm) in their widest portion. In 8.8% of patients with the left renal vein entrapment, urine analysis showed isomorphic hematuria or proteinuria with no other known cause. Varicocele and pelvic congestion were seen in 5.5% of patients with the left renal vein entrapment. CONCLUSION: Left renal vein entrapment is not a rare entity and renal nutcracker phenomenon might be underdiagnosed.

Radiological Imaging Features of Fasciola hepatica Infection - A Pictorial Review.

Fascioliasis refers to a zoonosis caused by Fasciola hepatica, a trematode infecting herbivores, but also occurs in humans who ingest the metacercaria found in fresh water plants. Infection in humans is common in developing countries and is also not uncommon in Europe. Diagnosis of this infection is difficult, as the history and symptoms are nonspecific and stool analysis for eggs is negative until the disease is in an advanced state by when the parasite has reached the biliary system. The clinical course consists of two phases; first a hepatic parenchymal phase in which immature larvae invade the liver parenchyma, followed by a ductal phase characterized by the excretion of larvae into the bile ducts. Parenchymal Phase: Ultrasonography (US) findings are nonspecific in this early phase. Computerized tomography (CT) may demonstrate subcapsular low attenuation regions in the liver. Magnetic Resonance imaging (MRI) can also be utilized to establish liver parenchymal involvement, and is better than CT in characterizing hemorrhagic lesions, as well as identifying more lesions relative to CT. Ductal Phase: US examination is most useful at this stage, with its ability to demonstrate the live movement of the worms within the dilated ducts. A CT demonstrates dilated central biliary ducts with periportal tracking, whereas, mild ductal dilatation is poorly appreciated under MRI. Therefore, familiarity with the multimodality imaging features of fascioliasis, in combination with an available confirmatory enzyme-linked immunoassay, would be most helpful for early diagnosis.

Diffusion-weighted MRI of fatty liver.

PURPOSE: To investigate the effect of fat infiltration on the apparent diffusion coefficient (ADC) of liver, and assess the relationship between ADC and hepatic fat fraction (HFF). MATERIALS AND METHODS: MRI scans of 120 consecutive patients were included in this retrospective study. Of these, 42 patients were included in the fatty liver group and 78 in the control group. ADC values were measured from a pair of diffusion-weighted (DW) images (b = 0 mm(2) /s and 1000 mm(2) /s). HFFs were measured using T1W GRE dual-echo images. The difference between the ADCs of the two groups was assessed with the t-test. The relationship between HFF and ADC was determined using linear regression analysis and the Pearson correlation coefficient (r). RESULTS: Mean HFFs were 0.85 ± 2.86 and 13.67 ± 8.62 in the control and fatty liver groups, respectively. The mean ADC of fatty liver group 1.20 ± 0.22 × 10(-3) mm(2) /s was significantly lower than that of the control group 1.32 ± 0.23 × 10(-3) mm(2) /s (P = 0.02). Linear regression analysis revealed an inverse relationship between ADC and HFF (r = -0.39, P < 0.0001). CONCLUSION: ADC significantly decreases in patients with >5% HFF, and ADC and HFF exhibit an inverse relationship.