The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown.
The purpose of this study was to evaluate the value of IVIM ...related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM).
Seventy-four prospectively enrolled patients (21 IMC, and 53 HLM) underwent 1.5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0-800 s/mm2). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver reliability was tested using a intraclass correlation coefficient. ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating characteristic (ROC) curve analysis.
The interobserver agreement was good for ADC (0.802), and excellent for D, D*, and ƒ (0.911, 0.927, and 0.942, respectively). ADC, and D values were significantly different among IMC and HLM (both p < 0.05), while there was no significant difference among these lesions for ƒ and D* (p = 0.101, and p = 0.612, respectively). ROC analysis showed higher diagnostic performance of D in comparison to ADC (AUC = 0.879 vs 0.821).
IVIM-derived parameters in particular D, in addition to ADC, could help in differentiation between most common hypovascular malignant liver lesions, intrahepatic mass-forming cholangiocarcinoma and hypovascular liver metastases.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy, with mass-forming growth pattern being the most common. The typical imaging appearance of mass-forming ICC ...(mICC) consists of irregular ring enhancement in the arterial phase followed by the progressive central enhancement on portal venous and delayed phases. However, atypical imaging presentation in the form of hypervascular mICC might also be seen, which can be attributed to distinct pathological characteristics. Ancillary imaging features such as lobular shape, capsular retraction, segmental biliary dilatation, and vascular encasement favor the diagnosis of mICC. Nevertheless, these radiological findings may also be present in certain benign conditions such as focal confluent fibrosis, sclerosing hemangioma, organizing hepatic abscess, or the pseudosolid form of hydatid disease. In addition, a few malignant lesions including primary liver lymphoma, hemangioendothelioma, solitary hypovascular liver metastases, and atypical forms of hepatocellular carcinoma (HCC), such as scirrhous HCC, infiltrative HCC, and poorly differentiated HCC, may also pose a diagnostic dilemma by simulating mICC in imaging studies. Diffusion-weighted imaging and the use of hepatobiliary contrast agents might be helpful for differential diagnosis in certain cases. The aim of this manuscript is to provide a comprehensive overview of mICC imaging features and to describe useful tips for differential diagnosis with its potential mimickers.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
Istok Hrvatske danas se suočava sa sve većim valom iseljavanja koji, uz već više desetljeća snažnu depopulaciju, ove krajeve stavlja u vrlo nepovoljnu situaciju. U prvom dijelu rada analiziraju se ...stoga migracijski trendovi i razmjeri depopulacije kao i najvažniji uzroci koji su doveli do ove situacije te se ističu i neke nužne pronatalitetne i gospodarske mjere. Naime, u razdoblju od 2011. do 2018. godine istočnohrvatske županije ostvarile su negativan saldo vanjske migracije od (najmanje) 46.606 stanovnika, što je u odnosu na ukupan broj stanovnika 2011. godine 5,8 %, pri čemu, očekivano, prednjače Osječko-baranjska i Vukovarsko-srijemska županija. Međutim, neka istraživanja pokazuju da je stvarni broj iseljenih iz Hrvatske u inozemstvo možda i do tri puta veći od službenoga broja. U drugom dijelu rada ističe se važnost moralno-pastoralnog i socijalno-karitativnog djelovanja Crkve, osobito u pronalaženju odgovora na sve češće obiteljske migracije, ali i u iznalaženju novih oblika pastoralne skrbi za iseljene. Crkva je pozvana, s jedne strane, duhovno-pastoralno pratiti one koji su otišli u inozemstvo te im poručiti kako nisu zaboravljeni i da se s radošću čeka njihov povratak, a s druge, pozivati mlade ljude i obitelji da ostanu u svojoj zemlji i tu grade svoju budućnost. Osim toga, u situaciji snažne depopulacije Crkva ima zadaću, snagom svoga proročko-evangelizacijskog poslanja, promicati „evanđelje obitelji” i poticati mentalitet u kojem se dijete promatra kao dar, a ne teret za obitelj. Reorganizacija pastorala braka i obitelji te iznalaženje novih oblika karitativnog djelovanja, nameću se kao prioriteti moralno-pastoralnog djelovanja Crkve.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
A coexistance of liver cystic echinococcosis (CE) and hepatocellular carcinoma (HCC) is very rare. HCC is the leading cause of cancer-related mortality worldwide, while CE is a globally endemic ...zoonosis caused by the cestode tapeworm Echinococcus granulosus. The association between these two diseases is still not well-defined. A preoperative diagnosis may be challenging, especially if HCC and CE present as a single lesion and if atypical imaging features are present. Herein, we present a case of the patient that was initially diagnosed as an extensive necrotic tumor in the left liver lobe and highly suspicious of being HCC associated with peritumoral hematoma. Left hemihepatectomy was performed, and the histopathological findings showed the collision of two lesions: a hydatid cyst and HCC.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Pancreatic adenocarcinoma is a highly lethal disease even in initially resectable patients. Functional imaging procedures such as diffusion-weighted imaging (DWI) and computed tomography ...(CT)-perfusion might facilitate preoperative prediction of factors influencing prognosis in patients with pancreatic adenocarcinoma.
Purpose
To evaluate CT-perfusion and DWI quantitative parameters of pancreatic adenocarcinoma and to assess their correlation with clinicopathological features.
Material and Methods
Forty-four patients with histopathologically proven pancreatic adenocarcinoma underwent CT-perfusion and DWI for estimating blood volume (BV), blood perfusion (BF), mean transit time (MTT), time to peak (TTP), and apparent diffusion coefficient (ADC) values. The statistical analysis was performed using Wilcoxon matched-pairs test, t-test for independent samples, Spearman’s rank correlation coefficient (rs), and receiver operating characteristic analysis.
Results
The mean CT-perfusion parameters and ADCs were significantly different in pancreatic adenocarcinoma versus healthy parenchyma. BV (2.66 ± 0.98 mL/100g), BF (17.45 ± 4.06 mL/min/100g), and ADCs (0.91 ± 0.15 × 10−3mm/s2) in high-grade tumors were significantly lower in comparison to low-grade tumors (BV = 5.35 ± 1.36 mL/100g, BF = 28.51 ± 7.73 mL/min/100g, ADC = 1.07 ± 0.21 × 10−3mm/s2). For prediction of high-grade tumors, the sensitivity and specificity were 79.2% and 82.4% for BF and 87.5% and 88.2% for BV, respectively. A significant negative correlation was found between BV and tumor size (rs = −0.445, P = 0.029), MTT and tumor size (rs = −0.330, P = 0.043), BV and M-stage (rs = −0.286, P = 0.049), and ADC and M-stage (rs = −0.274, P = 0.038). Moreover, BF and BV values were significantly associated with ADCs.
Conclusion
CT-perfusion parameters and ADC values could improve preoperative assessment of pancreatic adenocarcinoma with possibility of tumor grade prediction.
Introduction. The radical antegrade modular pancreatosplenectomy (RAMPS) procedure was introduced as a modification of standard retrograde pancreatosplenectomy (SRPS). It was designed to establish a ...new surgical approach, with intension to increase possibility of achieving negative posterior (retroperitoneal) resection margin, as well as to provide complete N1 lymph node clearance. Outline of cases. We present two cases with diagnosed left-sided pancreatic tumors, who were surgically treated in our hepato-pancreato-biliary department. Both patients underwent posterior RAMPS procedure. Postoperative course was uneventful in both patients. Conclusion. RAMPS is a safe procedure because it provides complete vascular and bleeding control. It is a superior procedure in oncologic terms compared to SRPS, as it increases the rate of R0 resection, and provides larger number of lymph nodes harvested. Furthermore, RAMPS is associated with better overall survival.
Biskup Strossmayer ostavio je značajan trag u očuvanju hrvatske kulture, osobito promičući duhovno-odgojnu dimenziju umjetnosti. Rad stoga donosi rezultate internoga istraživanja koje je provedeno ...pomoću Googleova obrasca među 54 studenta prve i pete godine studija Povijesti i Hrvatskoga jezika i književnosti na Filozofskom fakultetu Sveučilišta J. J. Strossmayera u Osijeku te Likovne kulture na Akademiji za umjetnost i kulturu osječkoga sveučilišta. Oni su potvrdili početnu hipotezu da su studenti najviše upoznati s podatcima koji se odnose na njihovo uže područje studija, a da je izostalo šire poznavanje biskupova djelovanja, osobito njegove vizije umjetnosti. Iznenađujući je međutim podatak da su na određena pitanja bolje odgovorili studenti prve godine od ispitanih studenata pete godine studija, što nameće zaključak da je potrebna veća međupredmetna korelacija kako bi današnji studenti bolje razumjeli djelovanje biskupa Strossmayera. Istodobno to upućuje i na zaključak da studenti veće znanje o osobi i djelovanju biskupa Strossmayera stječu tijekom srednjoškolskoga obrazovanja te da ga ne proširuju dovoljno tijekom svoga studija.
Bishop Strossmayer left a significant mark in the preservation of Croatian culture, especially by promoting the spiritual and educational dimension of art. Therefore, the paper presents the results of internal research conducted using Google Form among 54 first and fifth-year students of History and Croatian Language and Literature at the Faculty of Humanities and Social Sciences and students of Fine Arts at the Academy of Arts and Culture of the J.J. Strossmayer University of Osijek. They confirmed the initial hypothesis that students are most familiar with data related to their specific field of study and lack broader knowledge of the bishop’s work, especially his vision of art. It is surprising, however, that some questions were answered better by first-year students than by fifth-year students, which leads to the conclusion that a greater cross-curricular correlation is needed for today’s students to better understand the work of Bishop Strossmayer. At the same time, this also leads to the conclusion that students acquire greater knowledge about the person and work of Bishop Strossmayer during their secondary education and that they do not expand it enough during their studies.
AIM:To determine predictors of clinically relevant pancreatic fistulas(CRPF)by measuring drain fluid amylase(DFA)in the early postoperative period.METHODS:This prospective clinical study included382 ...patients with periampullary tumors that were surgically resected at our department between March 2005and October 2012.A cephalic duodenopancreatectomy (DP)was performed on all patients.Two closed suction drains were placed at the end of the surgery.The highest postoperative DFA value was recorded and analyzed during the first three postoperative days and on subsequent days if the drains were kept longer.Pancreatic fistula(PF)was classified according to the International Study Group of Pancreatic Fistula(ISGPF)criteria.Postoperative complications were defined according to the Dindo-Clavien classification.All data were statistically analyzed.The optimal thresholds of DFA levels on the first,second and third postoperative days were estimated by constructing receiver operating curves,generated by calculating the sensitivities and specificities of the DFA levels.The DFA level limits were used to differentiate between the group without PF and the groups with biochemical pancreatic fistula(BPF)and CRPF.RESULTS:Pylorus-preserving duodenopancreatectomy was performed on 289(75.6%)patients,while the remaining patients underwent a classic Whipple procedure(CW).The total incidence of PF was 37.7%(grade A22.8%,grade B 11.0%and grade C 3.9%).Soft pancreatic texture(SPT)was present in 58.3%of patients who developed PF.Mortality was 4.2%.The median DFA value on the first postoperative day(DFA1)in patients who developed PF was 4520 U/L(range 350-99000 U/L)for grade A fistula(BPF)with a SPT and a diameter of the main pancreatic duct(MPD)of≤3 mm.For grade B/C(CRPF),the median DFA1 value was 8501 U/L(range377-92060 U/L)with a SPT and MPD of≤3 mm.These values were significantly higher when compared to the patients who did not have PF(122;range 5-37875 U/L).The upper limit of DFA values for the first 3 postoperative days in the examined stages of PF were:DFA1 1200U/L for the BPF and CRPF;DFA3 350 U/L for BPF and DFA3 800 U/L for CRPF.The determined values were highly significant and demonstrated a reliable diagnostic test for both BPF and CRPF.CONCLUSION:DFA1≥1200 U/L is an important predictive factor for PF of any degree.The trend of DFA3(decrease of<50%)compared to DFA1 is a significant factor in the differentiation of CRPF from transient BPF.
Accessory spleens can be found in up to 10% of the population, and their intrapancreatic occurrence is considered uncommon. When present, the intrapancreatic accessory spleen is usually found in the ...tail of the pancreas in about 1.7% of adult individuals. The infrequent presence of the accessory spleen in the pancreatic tissue could lead to inappropriate diagnosis and hence therapeutic approach, as they are commonly presented as a hypervascular node in the tail of the pancreas on abdominal CT and MRI, mimicking a well differentiated tumor of the pancreas or non-functioning pancreatic neuroendocrine tumor.
We present a 70-year-old female in whom a preoperative evaluation finding was highly suggestive of a non-functioning neuroendocrine tumor of the pancreatic tail. We performed spleen preserving laparoscopic distal pancreatectomy, and histopathological examination revealed the intrapancreatic accessory spleen.
Although infrequent, the presence of the intrapancreatic accessory spleen must be considered in the differential diagnosis of pancreatic tail tumors.
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy, which usually arises in cirrhotic liver. When the typical enhancement pattern, consisting of late arterial ...hyperenhancement followed by washout, is present in nodules larger than 1 cm, HCC can be confidently diagnosed without the need for tissue biopsy. Nevertheless, HCC can display an atypical enhancement pattern, either as iso or hypovascular lesion, or hypervascular lesion without washout. Not only the enhancement pattern of HCC could be atypical, but also a variety of histological types of HCC, such as steatotic, scirrhous, fibrolamellar, or combined hepatocellular-cholangiocellular carcinoma could raise diagnostic dilemmas. In addition, distinct morphological types of HCC or different growth pattern can occur. Awareness of these atypical and rare HCC presentations on magnetic resonance imaging is important for accurate differentiation from other focal liver lesions and timely diagnosis, which allows optimal treatment of patients.
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