Abstract Objective To study whether the CT features of treatment-naïve gastric GIST may be used to assess metastatic risk. Methods In this IRB approved retrospective study, with informed consent ...waived, contrast enhanced CT images of 143 patients with pathologically confirmed treatment-naïve gastric GIST (74 men, 69 women; mean age 61 years, SD ± 14) were reviewed in consensus by two oncoradiologists blinded to clinicopathologic features and clinical outcome and morphologic features were recorded. The metastatic spread was recorded using available imaging studies and electronic medical records (median follow up 40 months, interquartile range, IQR, 21–61). The association of maximum size in any plane (≤10 cm or >10 cm), outline (smooth or irregular/lobulated), cystic areas (≤50% or >50%), exophytic component (≤50% or >50%), and enhancing solid component (present or absent) with metastatic disease were analyzed using univariate (Fisher's exact test) and multivariate (logistic regression) analysis. Results Metastatic disease developed in 42 (29%) patients (28 at presentation, 14 during follow-up); 23 (16%) patients died. On multivariate analysis, tumor size >10 cm (p = 0.0001, OR 9.9), irregular/lobulated outline (p = 0.001, OR 5.6) and presence of a enhancing solid component (p < 0.0001, OR 9.1) were independent predictors of metastatic disease. On subgroup analysis, an irregular/lobulated outline and an enhancing solid component were more frequently associated with metastases in tumors ≤5 cm and >5–≤10 cm (p < 0.05). Conclusion CT morphologic features can be used to assess the metastatic risk of treatment-naïve gastric GIST. Risk assessment based on pretreatment CT is especially useful for patients receiving neoadjuvant tyrosine kinase inhibitors and those with tumors <5 cm in size.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
There is increasing focus on intrahepatic cholangiocarcinoma (IHCC) due to its rising incidence worldwide and relatively poor prognosis, with the revised TNM classification (2009) introducing a ...separate staging system for IHCC for the first time. In this article, we comprehensively review the current role of the radiologist in the diagnosis and management of patients with IHCC.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
To describe imaging features of primary and metastatic alveolar soft part sarcoma (ASPS).
In this institutional review board-approved and Health Insurance Portability and Accountability Act-compliant ...retrospective study, 25 patients (14 males; mean age, 25 years; range, 18-40 years) with pathologically proven ASPS seen at our institute between 1995 and 2013 were included. Imaging of primary tumours in 5 patients and follow-up imaging in 25 patients were reviewed by 2 radiologists in consensus. Clinical information was obtained from electronic medical records.
The most common sites for the primary tumour were extremities (17/25, 68%) and torso (6/25, 24%). Primary tumours (n = 5) were well circumscribed, compared with skeletal muscle, were isodense on CT, hyperintense on T1 and T2 weighted images with intense post-contrast enhancement, prominent feeders on CT and flow voids on MRI. Metastases developed in 23/25 (92%) patients, 18 at presentation. The most common sites of metastases were the lungs (100%), lymph nodes (74%), bones (57%) and brain (43%). Visceral and nodal metastases were hypervascular. At the time of reporting the results, 15 patients have died, 6 are alive and 4 were lost to follow-up. Median survival was 74 months for those without brain metastases (n = 8) and 60 months for those with brain metastases (n = 7). Median survival was shorter for patients with metastases at presentation.
ASPS most commonly involves the lower extremities of young adults, is hypervascular on imaging, often metastasizes at presentation, frequently to lung, nodes, bones and brain, and has an indolent course despite metastases. Brain metastases and high tumour burden (number of metastatic sites) at presentation decreased survival in our study.
ASPS has an unusual pattern of metastases to the brain and nodes in addition to lung and bones. It has an indolent course despite metastases.
To study the appearance of primary and metastatic extremity synovial sarcoma (SS) on cross-sectional imaging.
In this institutional review board-approved, Health Insurance Portability and ...Accountability Act-compliant retrospective study, the imaging features of 78 patients (42 males and 36 females; mean age, 40 years) with primary and metastatic extremity SS on MRI and multidetector CT were reviewed, with baseline MRI of the primary available in 31 patients.
Primary SSs were predominantly well-circumscribed (27/31) and heterogeneously enhancing solid (18/31) or solid-cystic (13/31) tumours. Imaging features visualized included the presence of perilesional oedema (14/31), interfascial (15/31) and intercompartmental extension (7/31), triple sign (11/31), intratumoral haemorrhage (10/31), calcification (6/31), bowl of grapes appearance (5/31) and bone involvement (3/31). Smaller T1 stage tumours (8/31) appeared as heterogeneously enhancing lesions, with some lesions demonstrating interfascial and intercompartmental extension and perilesional oedema. Recurrent/metastatic disease developed in 49/78 (63%) patients. Of these, 20/78 (26%) had metastasis at presentation, while the remaining developed metastatic disease at a median interval of 27 months (range, 3-161 months). Pleuropulmonary metastases (46/78) were the most common sites, with most of the metastases being pleural based. On univariate analysis, larger tumour size, the presence of perilesional oedema, intercompartmental extension, the presence of intralesional haemorrhage and bowl of grapes appearance on MRI were associated with a significantly higher incidence of metastatic disease.
Certain imaging features of primary SS predict the risk of development of metastatic disease. Imaging features of T1 stage tumours included heterogeneous enhancement, interfascial extension and perilesional oedema. Pleural-based metastases are commonly seen in SSs.
Imaging features of primary SS correlate with metastatic disease. Pleural-based metastases are often present in SSs.
Small bowel (SB) is the second most common site of gastrointestinal stromal tumours (GISTs). We evaluated clinical presentation, pathology, imaging features and metastatic pattern of SB GIST.
Imaging ...and clinicopathological data of 102 patients with jejunal/ileal GIST treated at Dana-Farber Cancer Institute and Brigham and Women's Hospital (Boston, MA) between 2002 and 2013 were evaluated. Imaging of treatment-naive primary tumour (41 patients) and follow-up imaging in all patients was reviewed.
90/102 patients were symptomatic at presentation, abdominal pain and lower gastrointestinal blood loss being the most common symptoms. On pathology, 21 GISTs were low risk, 17 were intermediate and 64 were high risk. The mean tumour size was 8.5 cm. On baseline CT (n = 41), tumours were predominantly well circumscribed, exophytic and smooth/mildly lobulated in contour. Of 41 tumours, 16 (39%) were homogeneous, whereas 25 (61%) were heterogeneous. Of the 41 tumours, cystic/necrotic areas (Hounsfield units < 20) were seen in 16 (39%) and calcifications in 9 (22%). CT demonstrated complications in 13/41 (32%) patients in the form of tumour-bowel fistula (TBF) (7/41), bowel obstruction (4/41) and intraperitoneal rupture (2/41). Amongst 102 total patients, metastases developed in 51 (50%) patients (27 at presentation), predominantly involving peritoneum (40/102) and liver (32/102). 7/8 (87%) patients having intraperitoneal rupture at presentation developed metastases. Metastases elsewhere were always associated with hepatic/peritoneal metastases. At last follow-up, 28 patients were deceased (median survival, 65 months).
SB GISTs were predominantly large, well-circumscribed, exophytic tumours with or without cystic/necrotic areas. Complications such as TBF, bowel obstruction and intraperitoneal perforation were visualized at presentation, with patients with perforation demonstrating a high risk of metastatic disease. Exophytic eccentric bowel wall involvement and lack of associated adenopathy are useful indicators to help differentiate GISTs from other SB neoplasms.
SB GISTs are predominantly large, well-circumscribed, exophytic tumours, and may present with complications. They often are symptomatic at presentation, are high risk on pathology and metastasize to the peritoneum more commonly than the liver.
The recent emergence of pink bollworm (PBW), Pectinophora gossypiella (Saunders) has posed serious ecological and economic implications for cotton production in India since 2017. The project ...“Insecticide Resistance Management (IRM): Dissemination of pink bollworm management strategies in Bt-cotton” was implemented consecutively for four years from 2018 -19, 2019–20, 2020-21 and 2021-22 in 21 districts across three cotton growing zones of the country. In each year, field demonstrations were conducted on 1050 acres of cotton area and mass awareness was created through outreach activities. With concerted and focused efforts, the PBW infestations could be brought down by 42.75% in 2018–19, 43.49% in 2019–20, 35.55% in 2020-21 and 33.77% in 2021-22 in the demonstration plots over the farmer practices. An increased benefit: cost ratios of 2.16:1, 2:1, 1.89:1 and 2.24:1 were realized during 2018–19, 2019–20, 2020-21 and 2021–22, respectively. Similarly, the average number of sprays for the control of cotton pests during the season was reduced to 5.02, 4.94, 5.19 and 5.18 in integrated pest management (IPM) fields as compared to 6.98, 7.66, 8.07 and 8.20 in non-integrated pest management (NIPM) fields in the corresponding years. Reduction in pesticide usage in IPM vs NIPM fields was 46.39% in terms of cost, and 38.96% in terms of volume during 2019-20 while concurrent percent reduction in pesticide usage was 41.03 & 39.33 during 2020-21 and 40.70 & 39.38 in 2021–22. Comparatively more seed cotton was harvested from IPM than NIPM fields i.e. 2190 vs 1820 kg/ha in 2018–19, 2049 vs 1715 kg/ha in 2019–20, 1881 vs 1585 kg/ha in 2020-21 and 1901 vs 1607 kg/ha in 2021–22. Significant success in reducing PBW infestation, pesticide usage and corresponding improvement in yield, economic benefits and environmental quality in terms of reduced EIQFUR has been achieved through IPM demonstrations. This area-wide success was achieved through collective efforts and active involvement of all concerned stakeholders.
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•Pink bollworm has emerged as serious threat to Indian cotton production.•Areawide IPM strategies disseminated & mass awareness created through outreach.•Significant reduction in pest infestation and pesticide usage was achieved.•Realization of economic benefits to cotton growers was demonstrated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Different severity scores are being used to assess outcomes in intensive care unit, but variable data had been reported so far per their performance. Main objective of this study is to compare ...performance of acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and modified nutrition risk in critically ill (mNUTRIC) scoring systems regarding the outcomes in the form of morbidity and mortality in medical intensive care unit (MICU) at rural tertiary-care health center.
In this cross-sectional study, 1,990 patients older than 18 years admitted in the ICU were enrolled. Age, gender, diagnosis, intubation, comorbidities, APACHE II, SOFA scores, m NUTRIC score, MICU stays in days, and need of mechanical ventilation were noted.
When we compared different score with mortality, APACHE-II was having sensitivity of 89.9% and specificity of 97.6%; SOFA had 90.1% sensitivity and 96.6% specificity; while mNUTRIC score had 97.2% sensitivity and 74.0% specificity. APACHE-II score had sensitivity of 93.4%, SOFA had 90.5%, and mNUTRIC score 92.3% with low specificity of 76.5% in predicting requirement of mechanical ventilation. mNUTRIC score and ICU length of stay showed moderate positive correlation (
value = <0.001).
All the three scores were comparable in sensitivity and specificity in predicting outcomes in the form of mortality, need of mechanical ventilation, and length of ICU stays. mNUTRIC score was more sensitive than others, and as it was based on nutritional status, hence more weightage should be given on this score.
Kumar S, Gattani SC, Baheti AH, Dubey A. Comparison of the Performance of APACHE II, SOFA, and mNUTRIC Scoring Systems in Critically Ill Patients: A 2-year Cross-sectional Study. Indian J Crit Care Med 2020;24(11):1057-1061.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
OBJECTIVE. The purpose of this article is to review the classification, clinical presentation, and histopathologic and MRI features of myxoid soft-tissue neoplasms. CONCLUSION. MRI is the modality of ...choice for characterization of myxoid soft-tissue tumors. A combination of imaging features (including certain characteristic signs), clinical features, and patient demographics can help the radiologist in coming to a specific diagnosis or in narrowing down the differential diagnoses.
Introduction: Viral infections of the central nervous system (CNS) are the most common cause of hospital admission in worldwide and remain a challenging disease for diagnosis and treatment. The most ...common infectious agents associated with viral CNS infections are cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), Japanese encephalitis virus (JEV), Dengue virus (DENV),West Nile virus(WNV), and Chandipura virus(CHPV). The aim of the present work was to find the etiology of CNS viral infection in the Central India population by transcriptase PCR (RT-PCR) comparing real-time polymerase chain reaction (PCR) method one-step and two-step reverse transcriptase (RT-PCR) in cerebrospinal fluid (CSF) and blood samples of CNS viral infections patients.
Materials and Methods: One-step and two-step real-time PCR assays were evaluated in CSF and parallel blood samples from patients with viral CNS infections for detection of DNA and RNA viruses. A comparative analysis was also done between gDNA, gRNA, cDNA, and plasmid-based real-time PCR methods for an efficient quantitation of viral particles in clinical samples for determination of viral etiology.
Result: On evaluation of 150 CSF and 50 parallel blood samples from suspected cases of viral CNS infections, a viral etiology was confirmed in 21 (14%) cases, including 3% for EBV, 1% of CMV, and 5% for VZV and JEV. The one-step RT-PCR has a higher detection limit for detection and quantitation of viral RNA in comparison to two-step RT-PCR.
Conclusion: Our result reveals that VZV and JEV are the most usual cases of CNS viral infection in hospitalized patients in the Central India population and one-step RT-PCR shows higher viral load detection limits for quantitation of viral genome and more sensitivity in comparison to two-step RT-PCR.
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10.
Reproductive surgery Simsek, E.; Kilicdag, E. B.; Haydardedeoglu, B. ...
Human reproduction (Oxford),
06/2013, Volume:
28, Issue:
suppl_1
Journal Article
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