Is it useful to perform a (67)gallium scintigraphy in the follow-up of patients with gastric lymphoma?

Gastric (67)gallium uptake in patients with peptic ulcer has been described in many publications literature. We present the case of a jejunal (67)gallium uptake in a patient with a background of total gastrectomy due to a diffuse large B cell gastric lymphoma, associated to benign peptic ulcer which had been identified by endoscopy. We have not found any similar cases in regards to (67)gallium reported in the literature. This study aims to present a review of the causes of gastrointestinal uptake of (67)gallium and of the utility of the radiotracer in patients with gastric lymphoma.     

Is diffusion-weighted imaging useful in grading and differentiating histopathological subtypes of meningiomas?

Purpose

Meningiomas are mostly benign, however atypical or malignant subtypes with more aggressive clinical course and higher recurrence rates can also be seen. The purpose of this study was to determine whether histopathological subtypes of meningiomas could be assessed preoperatively using apparent diffusion coefficient (ADC) values.

Materials and methods

Conventional magnetic resonance (MR) and diffusion-weighted (DW) imaging of 177 adult patients with pathologically proven meningiomas were retrospectively evaluated. Tumor size and the degree of associated edema were noted. The signal intensity of the lesions on DW imaging was evaluated and graded. Mean ADC values were obtained as the mean of measurements from three regions of interests within the mass. ADC ratios of meningioma/contralateral normal appearing subcortical parietal white matter were also calculated.

Results

The histopathological analysis revealed 135 benign, 37 atypical and 5 malignant lesions. With classification according to the subtype, the mean ADC values and ratios of benign meningiomas were as 0.99 ± 0.12 × 10⁻³ mm²/s and 1.22 ± 0.07, respectively. ADC values for atypical and malignant groups were both 0.84 ± 0.1 × 10⁻³ mm²/s. The ADC ratios were 1.05 ± 0.1 and 0.96 ± 0.2 for atypical and malignant subtypes, respectively. There was no statistically significant difference between the mean ADC ratios of the three subtypes (ANOVA test; P ≥ 0.05). Gender, age of the patients and tumor size showed no statistically significant difference between the different histological groups.

Conclusion

DW MR imaging was not found to have any additional value in determining histological behaviour nor in differentiating histopathological subtypes of meningiomas.     

Is IV contrast necessary for MRI follow-up in children with abdominal neuroblastoma?

PurposeThe safety of multiple doses of gadolinium-based MRI IV contrast has recently been called in to question. While the long-term safety is being investigated, here, we seek to determine if there is added value to the use of IV contrast for improving detection of tumoral recurrences in children with a history of abdominal neuroblastoma.MethodsThis is a retrospective review of children who underwent abdominal MRI with gadolinium contrast. One radiologist reviewer determined presence or absence of tumor, both before and after administration of IV contrast material and documented level of confidence when a finding was encountered. Change in reader confidence after the use of contrast was measured and fraction of missed lesions on pre-contrast was calculated. Liver and spleen lesions were documented separately.Results453 MRI scans in 110 unique patients were reviewed. 65 patients were documented to have a total of 125 lesions, excluding liver, spleen and bones. There were 23 instances of contrast altering the radiologist's confidence and one lesion was missed without the use of contrast. Among liver and spleen, several hepatic lesions were seen only after contrast, but all were benign lesions.ConclusionIn selected patients who are undergoing MRI for neuroblastoma, it may be reasonable to forgo the use of IV contrast.     

Is transvaginal elastography useful in pre-operative diagnosis of cervical cancer?

Objective

To evaluate the clinical value of transvaginal elastography (TVES) in diagnosing cervical malignancies by detecting changes of tissue stiffness.

Methods

One hundred and ten consecutive patients with cervical lesions were enrolled. Pathological results were used as the gold standards. TVES was employed to detect the stiffness changes of the cervix. Strain ratio was calculated and compared between the benign and malignant lesions. Depth of invasion into stromas of 56 cases of cervical cancers measured by TVES were recorded and compared with the pathological results. Interclass correlation coefficient (ICC) was used to analyze the reproducibility.

Results

Strain ratio of malignant lesions were much higher than that of the benign lesions (8.19 ± 5.66 vs. 2.81 ± 2.24, P < 0.01). Area under the curve (AUC) was 0.905 with a 95% CI (0.835–0.976). The best cut-off point of strain ratio value was 4.53. Specificity and sensitivity for the best cut-off point were 0.788 and 0.897, respectively. Mean depth of the 56 malignant lesions was 17.8 ± 7.4 mm measured by TVES (range 5.4–43.1 mm) and 11.5 ± 8.8 mm measured by pathological samples (range 3.7–38.4 mm). ICC of the 2 methods were 0.87 (95% CI 0.863–0.947) and 0.931 (95% CI 0.902–0.952) for the 2 observers.

Conclusions

TVES was a useful technique in confirming the diagnoses of cervical cancer and in estimating the infiltrating region. When the strain ratio of a cervical lesion was higher than 4.53, it is confidential to be diagnosed as malignant.     

What is the role of plain radiography in patients with foreign bodies in the gastrointestinal tract?

Foreign bodies (FBs) in the gastrointestinal (GI) tract can show a wide range of clinical manifestations ranging from spontaneous evacuation to severe complication. Plain radiography is a straightforward and important initial imaging modality in cases of FB ingestion or insertion and is also helpful for follow-up purposes. Careful evaluations of the plain radiographs can determine the presence and nature of FBs, and help predict their precise locations and facilitate risk assessment. In this review, a wide variety of FBs in the GI tract are illustrated, and the role of plain radiography in patient management is discussed.     

Is low cardiorespiratory fitness a feature of metabolic syndrome in children and adults?

ObjectivesCardiorespiratory fitness has been inversely associated with risk of cardiometabolic diseases. However, there are no studies comparing the independent associations of cardiorespiratory fitness scaled by body size and composition using different approaches with cardiometabolic risk factors between children and adults. We therefore investigated these associations in children and adults using same measures for cardiorespiratory fitness and cardiometabolic risk factors.DesignCross-sectional.MethodsA total of 352 children (47.2 % girls) and 572 men were included in the study. Peak oxygen uptake (V?O_2peak) was measured during a maximal exercise test on a cycle ergometer and was scaled by total body mass, total fat free mass, and allometrically modelled body mass, fat free mass, and stature. Insulin, glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were assessed from fasting blood samples and systolic blood pressure and diastolic blood pressure were measured. Homeostatic model assessment for insulin resistance and continuous metabolic risk score were computed.ResultsV?O_2peak scaled by body mass was inversely associated with insulin, homeostatic model assessment for insulin resistance, triglycerides, diastolic blood pressure, the cardiometabolic risk score and the number of cardiometabolic risk factors in children and adults. However, these associations attenuated remarkably when V?O_2peak was scaled by total fat free mass or allometrically modelled body mass, fat free mass, or stature. V?O_2peak was consistently and positively associated with high-density lipoprotein cholesterol in children and adults irrespective of the scaling approach.ConclusionsThe inverse associations of cardiorespiratory fitness with cardiometabolic risk factors among children and adults attenuated remarkably when body size and composition were appropriately controlled for. However, the positive association between cardiorespiratory fitness and high-density lipoprotein cholesterol was consistent irrespective of the scaling approach.     

Is high-resolution ultrasonography suitable for the detection of temporomandibular joint involvement in children with juvenile idiopathic arthritis?

Objectives:

The purpose of this study was to determine the potential of high-resolution ultrasonography for the detection of temporomandibular joint (TMJ) changes in children with juvenile idiopathic arthritis (JIA).

Methods:

We investigated prospectively 20 children (17 female and 3 male; mean age 11.06 years, standard deviation 3.43 years) with TMJ disorders caused by JIA, over a period of 16 months. Using a 12 MHz array transducer, four images in each TMJ (160 images) were acquired. Each image was analysed with regard to five different aspects (condylar erosion, thickness of the condylar disc, synovial thickness, joint effusion and enlargement of the intra-articular space).

Results:

Diagnosis of JIA was ensured for every child and involvement of the TMJ was proven by MRI. Overall 287 changes (35.9%) were detected by using high-resolution ultrasonography. On 124 images (77.5%) condylar erosions were diagnosed; on 55 images (34.4%) synovial thickness was abnormal; on 48 images (30%) we could see higher thickness of the condylar disc; on 40 images (25%) irregularities of the bony surface were detected; and on 20 images (12.5%) we found joint effusion.

Conclusion:

High-resolution ultrasonography could be a sufficient diagnostic method, especially for the detection of condylar involvement in children with JIA, even if not all parts of the TMJ are visible for ultrasonography. High-resolution ultrasonography is a valuable tool in particular situations: (i) when MRI examination is not available; (ii) when children fear MRI examination; (iii) in more advanced stages of JIA; and (iv) for monitoring the progression of TMJ involvement and response of therapy.     

Is sentinel node mapping useful in anorectal melanoma?

Anorectal melanoma (AM) is a rare disease and few guidelines have been established regarding its therapeutic management. Wide local excision, or less frequently, abdominoperineal resection is the treatment of choice. We present a female patient with an excised AM who was submitted to our Nuclear Medicine department for sentinel lymph node (SLN) mapping of the area. Under rigid proctoscopy the anal scar received four submucosal injections of technetium-99m-sulfur nanocolloid of 29.6 MBq each. Lymphoscintigraphy and intraoperative gamma-probe guided detection of the SLNs followed. SLNs were localized in the inguinal basins bilaterally and were negative on histology. A wide local excision followed the above test. Thirty months postoperatively the patient developed distant metastases, underwent radiotherapy and died six months later. Without changing prognosis sentinel lymph node detection, excision and histology were important in sparing the patient a futile inguinal lymph node dissection.     

Is brain SPECT useful in degenerative dementia diagnosis?

Cerebral blood flow assessment performed by single-photon emission computed tomography (SPECT) of the brain is used to detect early neuronal dysfunction associated with degenerative dementia. Patterns of perfusion abnormalities are different across dementia syndromes. These differences could be used for differential diagnoses and early detection of amnesic mild cognitive impairment in patients with a high risk of conversion to Alzheimer disease. This paper aimed to summarize the expected benefits of single-photon emission computed tomography of the brain in the exploration of degenerative dementias.     

Mangafodipir trisodium‐enhanced MRI for the detection and characterization of focal hepatic lesions: Is delayed imaging useful?

PURPOSE: To investigate the usefulness of early and delayed hepatic MRI after mangafodipir trisodium (Mn-DPDP) administration for the detection and characterization of focal hepatic lesions. MATERIALS AND METHODS: Forty-five patients (31 males and 14 females, mean age = 61 years) with a total of 113 hepatic lesions (mean size = 3.5 cm) were included in this study (15 with hepatocellular carcinoma (HCC, N = 35), 20 with hepatic metastasis (N = 63), five with hemangioma (N = 10), three with cholangiocarcinoma (CC, N = 3), and two with liver abscess (N = 2)). T1-weighted gradient-echo MR images were obtained before and after Mn-DPDP administration, with a mean 18-hour delayed imaging. A qualitative analysis (including the size and signal intensity (SI)) and quantitative analysis (including enhancement and lesion-liver contrast-to-noise ratio (CNR)) were performed on pre- and postcontrast early and delayed MR images. RESULTS: Compared to postcontrast early imaging, 17 (48.6%) of 35 HCCs showed higher SI, 16 (45.7%) showed no SI change, and two (5.7%) showed lower SI on delayed imaging. All 63 metastases, 10 hemangiomas, three CCs, and two abscesses showed no SI change. On delayed imaging, ring enhancement was noted in 53 metastases (84.1%), three hemangiomas (30.0%), and one abscess (50.0%), but was not seen in HCCs or CCs. Eight metastases (12.7%) also showed ring enhancement on postcontrast early imaging. No newly detected hepatic lesions were revealed on postcontrast delayed MR images compared to postcontrast early images. Regarding CNR, the HCCs showed a significant increase in CNR from postcontrast early to delayed images after administration of Mn-DPDP (P < 0.01). However, none of the metastases, hemangiomas, CCs, and abscesses showed a significant increase of CNR from postcontrast early to delayed images. CONCLUSION: Postcontrast delayed MR images after Mn-DPDP administration were helpful in distinguishing hepatocellular from nonhepatocellular lesions, but were not useful for lesion detection and had limited utility for lesion characterization, since benign and malignant hepatic lesions looked the same.     

Is the nasopharynx warmer in children than in adults?

Recent studies on the aetiology of the Sudden Infant Death Syndrome (SIDS) have suggested that some of these deaths are the consequence of an overwhelming inflammatory response to the production of pyrogenic toxins from bacteria colonizing the upper respiratory tract, particularly the nasopharynx. The pyrogenic toxins of Staphlococcus aureus, one of the likelier bacterial candidates, are only produced in temperatures of over 37 degrees C. This study examined nasopharyngeal temperatures in children. It is a preliminary study to develop an accurate means to measure how close to 37 degrees C the nasopharyngeal temperature lies in infants at the age when SIDS deaths occur. Following a pilot study and power calculation, measurements of nasopharyngeal temperature were made on 30 apyrexial children aged 4-10 years and 30 adults with no nasal pathology, undergoing surgery under general anaesthesia, using an accurately sited thermocouple probe. The mean temperature in children (35.64 degrees C) was significantly higher than in adults (34.01 degrees C). Comparable measurements attempted with the same subjects awake gave similar results.     

Evaluation of the agonal stress: can immunohistochemical detection of ubiquitin in the locus coeruleus be useful?

The determination of the survival time after a crime as well as the concomitant physical and mental load of the victim is an important task for the forensic pathologist. The heat shock protein, ubiquitin, exerts an essential role in the cellular response to stress. We aimed to investigate the usefulness of the ubiquitin expression in the locus coeruleus as a marker for the evaluation of agonal stress. Is the amount of ubiquitin in this brain locus an indication of the length and/or intensity of the agonal period following various causes of death? The immunohistochemical (IHC) expression of ubiquitin is examined in formalin-fixed, paraffin-embedded slides of the human locus coeruleus (n?=?48). The evaluation of the IHC staining is blindly performed, prior to the study of the medico-legal files. According to the length of agony, a division into subgroups is made. Three possible IHC staining patterns are observed: a staining of the neuronal nucleus or the cytoplasm or both. In addition, the number of neurons with ubiquitin expression per μm² is calculated in each locus coeruleus. Significant differences in the number of ubiquitin-immunoreactive neurons are noticed with respect to the length of the agony: A higher density of positive neurons is seen in case of a pronounced and extended death struggle.     

Is the appearance of microcalcifications on mammography useful in predicting histological grade of malignancy in ductal cancer in situ?

It has been proposed that the grade of malignancy of ductal carcinoma in situ (DCIS) of the breast can be estimated by the morphology of microcalcifications found on mammography. We correlated microcalcifications and histopathology in a retrospective blinded review. We reviewed all patients who underwent excisional breast biopsy over a 5 1/2-year period. Mammograms and pathology slides of all patients (n = 49) with DCIS of the breast were included in a blinded retrospective analysis. Mammographic microcalcifications were divided into four categories, "linear branching", "coarse granular", "fine granular" or "no microcalcification". Independently, pathology specimens were assigned to poorly, intermediately and well differentiated categories according to the consensus classification of DCIS introduced by the European Organisation for the Research and Treatment of Cancer. Two patients had no microcalcifications. 25 (53%) of the remaining 47 patients had "linear branching" microcalcifications, 10 (21%) had "coarse granular" and 12 (25.5%) had "fine granular" microcalcifications. 19 patients (40%) had poorly differentiated, 23 (49%) intermediately differentiated and 5 (11%) well differentiated subtypes of DCIS. 14 (56%) of the 25 patients with "linear branching" microcalcifications had poorly differentiated DCIS, 10 (40%) had intermediately differentiated and 1 (4%) had well differentiated DCIS. 3 (30%) of 10 patients with "coarse granular" microcalcifications had poorly differentiated DCIS, 5 (50%) had intermediately differentiated and 2 (20%) had well differentiated DCIS. 2 (17%) of 12 patients with "fine granular" microcalcifications had poorly differentiated DCIS, 8 (67%) had intermediately differentiated and 2 (17%) had well differentiated DCIS. These findings were not statistically significant. In conclusion, "linear branching" microcalcifications tended to be associated with higher pathological grading. However, correlation was poor and there was considerable overlap between categories. Histological type of DCIS cannot be predicted prospectively on mammographic appearances.     

Aluminum foreign bodies: do they show up on x-ray?

The objective of this study is to evaluate the utility of radiographs in the detection of aluminum foreign bodies (FB). Aluminum can tabs were placed at the upper esophagus/posterior pharyngeal area in ten randomly selected cadavers. Anterior–posterior (AP) and lateral (LAT) radiographies were performed before and after placement. Twenty sets of randomly ordered radiographs were assessed by two blinded radiologists for the presence of radio-opaque FB. For any positive reading on an AP or a LAT radiograph, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for radiologist A were 80, 90, 89, and 82%, respectively, and for radiologist B were 90, 100, 100, and 91%, respectively. These values were also calculated using only AP and LAT views. Aluminum FB can often be visualized on radiographs. The sensitivity of this method, however, is not adequate to completely rule out their presence. Additional testing in these cases is warranted. Conversely, a high PPV suggests that therapy based on this finding alone is a logical choice.