Differentiation of benign and malignant ampullary obstruction by multi-row detector CT.

PURPOSE: To determine useful CT parameters to differentiate ampullary carcinomas from benign ampullary obstruction. MATERIALS AND METHODS: This study included 93 patients who underwent abdominal CT, 31 patients with ampullary carcinomas, and 62 patients with benign ampullary obstruction. Two radiologists independently evaluated CT parameters then reached consensus decisions. Statistically significant CT parameters were identified through univariate and multivariate analyses. RESULTS: In univariate analysis, the presence of ampullary mass, asymmetric, abrupt narrowing of distal common bile duct (CBD), dilated intrahepatic bile duct (IHD), dilated pancreatic duct (PD), peripancreatic lymphadenopathy, duodenal wall thickening, and delayed enhancement were more frequently in ampullary carcinomas observed (P < 0.05). Multivariate logistic regression analysis using significant CT parameters and clinical data from univariate analysis, and clinical symptom with jaundice (P = 0.005) was an independent predictor of ampullary carcinomas. For multivariate analysis using only significant CT parameters, abrupt narrowing of distal CBD was an independent predictor of ampullary carcinomas (P = 0.019). Among various CT criteria, abrupt narrowing of distal CBD and dilated IHD had highest sensitivity (77.4%) and highest accuracy (90.3%). CONCLUSION: The abrupt narrowing of distal CBD and dilated IHD is useful for differentiation of ampullary carcinomas from benign entity in patients without the presence of mass.

Bevacizumab, Carboplatin and Paclitaxel Combination Treatment in Advanced Stage Ovarian Cancer: The First Experience in Thammasat University Hospital, Thailand: A Case Report.

BACKGROUND: Bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growthfactor (VEGF), has been approvedfor concurrent treatment with first line chemotherapy in advanced epithelial ovarian cancer. CASE REPORT: A case of an advanced stage epithelial ovarian cancer (EOC) receiving a combination of bevacizumab, carboplatin andpaclitaxel chemotherapy was reported. A 44-year-old woman was presented with abdominal discomfort and distention for 4 months. Bilateral 12 cm diameter ovarian tumors were diagnosed as FIGO stage IIIc after surgical staging operation. Histopathology report showed the mixed type of serous and endometriod adenocarcinoma. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery every 3 weeks. Bevacizumab (7.5 mg/ m2) was concurrently administered with chemotherapy every 3 weeks startingfrom the 2nd cycle. A complete remission was achieved after the end of the chemotherapy treatment. Bevacizumab was continued for one year after the completion of the standard chemotherapy. Bone marrow suppression, hypertension and proteinuria were not found during Bevacizumab treatment. At bevacizumab treatment completion, a platinum-sensitive recurrent ovarian cancer was diagnosed at the two weeks postprogram routine check-up. The patient was counseled to start second line chemotherapy treatment and has yet to come back with her decision. CONCLUSION: Combination of bevacizumab, carboplatin and paclitaxelfor first line chemotherapy in advanced EOC in this case had no serious side effects and need further study.

CT findings of KUB injury in hemodynamically stable blunt abdominal injury patients with microscopic hematuria.

BACKGROUND: According to controversial guideline for management in case of hemodynamically stable blunt abdominal injury with microscopic hematuria. Most ofthe patients could be omittedfor abdominal computed tomography (CT). Despite high sensitivity and specificity ofabdominal CT, in addition to high medical cost, there are risks from radiation exposure and adverse reaction from use of contrast media. OBJECTIVE: To evaluate the prevalence ofKUB injury on abdominal CT in case of hemodynamically stable blunt abdominal injury with microscopic hematuria. MATERIAL AND METHOD: Forty-one studies of abdominal CT performed during 1 January 2010 and 30 June 2012 were retrospectively reviewed for KUB injury (categorized byAAST organ injury scale) by consensus oftwo experienced radiologists. RESULTS: KUB injury was found in 36.6%from all selected CTstudies. Almost all cases could be managed conservatively. The cutoffpoint of microscopic hematuria at 20 cells/hpfhas sensitivity 80% and specificity 46.15%. CONCLUSION: One-third ofthe patients have KUB injury but almost all ofthem could be conservatively managed. We proposed that the cutoffpoint of hematuria be equivalent to or greater than 20 cells/hpf to be one of the indicators for predicting KUB injury that needs radiological evaluation; but it should be carefully considered along with clinical information.

In-phase signal intensity loss in solid renal masses on dual-echo gradient-echo MRI: association with malignancy and pathologic classification.

OBJECTIVE: The purposes of this study were to determine the prevalence of in-phase signal intensity loss on dual-echo gradient-echo MRI in solid renal masses using visual and quantitative techniques and to test for any association between in-phase signal intensity loss and pathologic classification. MATERIALS AND METHODS: The renal MRI studies of 177 patients (192 solid masses consisting of 166 renal cell carcinomas [RCCs], four malignant non-RCCs, and 22 benign tumors) were qualitatively reviewed by two blinded readers for visual evidence of relative in-phase signal intensity loss. For lesions without visual evidence, whole-lesion ROIs were used to attempt quantification of subtle signal intensity loss between opposed- and in-phase images (signal intensity loss index). RESULTS: Visual in-phase signal intensity loss was noted in 18% of clear cell RCC, 42% of papillary RCC, and no benign lesions. There was significant correlation between malignancy and visual signal intensity loss (Fisher exact test, p = 0.0092). Visual signal intensity loss was predictive of papillary RCC over clear cell RCC (odds ratio, 5.79; p = 0.0002) in logistic regression analysis of all RCCs, controlling for size. Quantitative assessment of remaining lesions provided no additional diagnostic benefit. CONCLUSION: Visible in-phase signal intensity loss is relatively common within solid renal masses and was associated with RCC and particularly papillary RCC (among all RCCs) in our population. Quantitative analysis in lesions without visible signal intensity loss was not predictive of RCC. Further work should be performed to validate the usefulness of this additional imaging parameter to help characterize renal masses and to determine the impact of this finding on imaging techniques potentially sensitive to susceptibility effects.

Computed tomography-guided renal tumor biopsies: tumor imaging features affecting sample adequacy.

OBJECTIVE: The aim of this study was to derive a model that predicts when a computed tomography (CT)-guided renal tumor biopsy will be diagnostic based on the tumor's unenhanced imaging characteristics. METHODS: The CT images used to guide percutaneous biopsy and the pathology reports of 276 consecutive patients undergoing renal tumor biopsy were retrospectively reviewed. The effect of tumor size, growth pattern, location, and CT attenuation on the diagnostic biopsy rate was assessed using univariate and multivariate techniques. A model was derived using logistic regression, and its discrimination was evaluated using receiver operator characteristic curves. RESULTS: The diagnostic rate for all masses was 76.8% (212/276). Univariate and multivariate analyses revealed that increasing size and solid tumor attenuation were associated with diagnostic biopsies. The model demonstrates a discrimination of 0.71. CONCLUSIONS: The likelihood of a diagnostic biopsy of a solid tumor smaller than 1 cm and of any cystic tumor is significantly less than for larger solid renal tumors. The predictive model demonstrates moderate discrimination.