To assess the impact of a Liver Imaging Reporting and Data System (LI-RADS) structured template on quality of reports for hepatocellular carcinoma (HCC).
A departmental structured LI-RADS template ...was adopted in April 2015. CT and MRI reports from September 2014 to February 2016 with probable or definite HCC were reviewed. Reporting of the following was recorded for each lesion and compared between template and free-text reports: (1) LI-RADS category, (2) Couinaud segment, and (3) unequivocal description of presence or absence of major LI-RADS HCC features: arterial phase hyperenhancement, "washout," diameter, threshold growth, and "capsule."
There were 306 definite or probable HCCs, 125 (40.8%) reported with free text and 181 (59.2%) with the template. LI-RADS category was reported in 23 of 125 (18.4%) HCCs with free text and in 178 of 181 (98.3%) HCCs with the template (P < .001). Couinaud segment was reported in 102 of 125 (81.6%) HCCs with free text and in 181 of 181 (100%) HCCs with the template (P < .001). Diameter was reported in 118 of 125 (94.4%) HCCs with free text and in 181 of 181 (100%) HCCs with the template (P = .001). Threshold growth was reported in 36 of 125 (28.8%) HCCs with free text and in 169 of 181 (93.4%) HCCs with the template (P < .001). Arterial phase hyperenhancement was reported in 101 of 125 (80.8%) HCCs with free text and in 177 of 181 (97.8%) HCCs with the template (P < .001). Washout was reported in 93 of 125 (74.4%) HCCs with free text and in 178 of 181 (98.3%) HCCs with the template (P < .001). Capsule was reported in 24 of 125 (19.2%) HCCs with free text and in 176 of 181 (97.2%) HCCs with the template (P < .001).
Use of structured LI-RADS template resulted in more comprehensive and consistent reporting of major HCC features and LI-RADS category compared with free-text reporting.
Abstract Obesity has become an epidemic in the United States, and bariatric surgery is being increasingly performed for its management. There has been an increased number of laparoscopic sleeve ...gastrectomies performed for the treatment of morbid obesity due to its efficacy and lower complication rate compared to other bariatric surgical techniques. The authors discuss the surgical technique, review the imaging of normal and complicated sleeve gastrectomy, and highlight radiographic pitfalls.
Colostomies are commonly created in conjunction with colorectal surgery performed for both malignant and benign indications. Familiarity with the different types of colostomies and their normal ...imaging appearance will improve radiologic detection and characterization of colostomy complications. The radiologist plays a large role in assessment of colostomy patients either via fluoroscopic technique or multidetector computed tomography (CT) in order to help identify ostomy complications or to aid the surgeon prior to colostomy reversal. In this article, we will review: (1) the types of colostomies and indications for their creation; (2) the proper radiographic technique of ostomy evaluation; and (3) the potential complications of colostomies and their imaging manifestations.
•Types of colostomies include end, loop, double barrel and end colostomy with mucous fistula•Ostomy evaluation is usually performed via fluoroscopy•Earlostomy complications include infection, abscess, leak, ischemia, stomal retraction and obstruction.•Delayed ostomy complications include hernia, prolapse, colitis, stenosis, and peristomal varices.
Aim: Mechanical jaundice may lead to adverse metabolic effects in surgical patients. Our aim was to investigate the effects of octreotid and allopurinol on liver histology and functions in rats with ...experimantally created mechanical jaundice.
Methods: The subjects were divided into five main groups. The rats in Group I (Control) received no interventions. In Group II, common bile duct ligation (CBDL) was performed. In Group III, the same ligation procedure was performed followed by the administration of octreotid. In Group IV, the rats received allopurinol following CBDL and in Group V (Sham), the common bile duct was dissected and left intact. After sacrification of each rat on the seventh postoperative day, blood samples were collected for serum hematocrit, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, and albumin measurements in addition to the histopathologic examinations of the collected tissue specimens from the liver, terminal ileum, and pancreas. According to statistical analysis, a value of p<0.05 was considered as significant.
Results: The direct bilirubin, AST and ALT levels were detected to be significantly elevated in the groups II, III and IV, in which CBDL was performed (p<0.05). While significant reductions of serum direct bilirubin, AST and ALT levels were detected in the octreotide group, these parameters were significantly elevated in the allopurinol group (p<0.05 and p<0.05, respectively). There was no significant difference of hematocrit and albumine levels among the study groups (p>0.05). Additionally, in the allopurinol group four rats were found to have increased serum amylase levels and the histopathologic evaluations of their pancreatic samples revealed findings of pancreatitis. According to the histopathologic examinations, significant alterations were detected between the control and sham groups (groups I, V) and the CBDL groups (groups II, III, IV). However, these histopathological findings revealed no significant differences within the subgroup of subjects including CBDL alone (Group II), and CBDL along with the administration of either octreotide (Group III), or allopurinol (Group IV).
Conclusion: The use of octreotide in mehanical jaundice may have protective metabolic effects. Further studies are considered necessary to be carried to support these findings.
Aim: Mechanical jaundice may lead to adverse metabolic effects in surgical patients. Our aim was to investigate the effects of octreotid and allopurinol on liver histology and functions in rats with ...experimantally created mechanical jaundice. Methods: The subjects were divided into five main groups. The rats in Group I (Control) received no interventions. In Group II, common bile duct ligation (CBDL) was performed. In Group III, the same ligation procedure was performed followed by the administration of octreotid. In Group IV, the rats received allopurinol following CBDL and in Group V (Sham), the common bile duct was dissected and left intact. After sacrification of each rat on the seventh postoperative day, blood samples were collected for serum hematocrit, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, and albumin measurements in addition to the histopathologic examinations of the collected tissue specimens from the liver, terminal ileum, and pancreas. According to statistical analysis, a value of p<0.05 was considered as significant. Results: The direct bilirubin, AST and ALT levels were detected to be significantly elevated in the groups II, III and IV, in which CBDL was performed (p<0.05). While significant reductions of serum direct bilirubin, AST and ALT levels were detected in the octreotide group, these parameters were significantly elevated in the allopurinol group (p<0.05 and p<0.05, respectively). There was no significant difference of hematocrit and albumine levels among the study groups (p>0.05). Additionally, in the allopurinol group four rats were found to have increased serum amylase levels and the histopathologic evaluations of their pancreatic samples revealed findings of pancreatitis. According to the histopathologic examinations, significant alterations were detected between the control and sham groups (groups I, V) and the CBDL groups (groups II, III, IV). However, these histopathological findings revealed no significant differences within the subgroup of subjects including CBDL alone (Group II), and CBDL along with the administration of either octreotide (Group III), or allopurinol (Group IV). Conclusion: The use of octreotide in mehanical jaundice may have protective metabolic effects. Further studies are considered necessary to be carried to support these findings.
Highlights ► The prolongation of cauda equina motor conduction time was statistically significant in the lumbar spinal stenosis (LSS) group. ► Lumbar laminar electrical stimulation is an easy and ...reliable method to demonstrate motor conduction delay in cauda equina. ► In LSS, chronic compression may occur earlier in the cauda equina root fibers within the spinal canal.
Background
The development of brain metastases (BMs) was associated with poor prognosis in melanoma patients. Patients with BMs have a median survival of <6 months. Melanoma is the third most common ...tumor to metastasize to the brain with a reported incidence of 10–40 %. Our aim was to identify factors predicting development of BMs and survival.
Patients and methods
We performed a retrospective analysis of 470 melanoma patients between 2000 and 2012. The logistic regression analyses were used to identify the clinicopathological features of primary melanoma that are predictive of BMs development and survival after a diagnosis of brain metastases.
Results
There were 52 patients (11.1 %) who developed melanoma BMs during the study period. The analysis of post-BMs with Kaplan–Meier curves has resulted in a median survival rate of 4.1 months (range 2.9–5.1 months). On logistic regression analysis site of the primary tumor on the head and neck (
p
= 0.002), primary tumor thickness (Breslow >4 mm) (
p
= 0.008), ulceration (
p
= 0.007), and pathologically N2 and N3 diseases (
p
= 0.001) were found to be significantly associated with the development of BMs. In univariate analysis, tumor thickness and performance status had a significant influence on post-BMs survival. In multivariate analysis, these clinicopathologic factors were not remained as significant predictive factors.
Conclusions
Our results revealed the importance of primary tumor characteristics associated with the development of BMs. Ulceration, primary tumor thickness, anatomic site, and pathologic ≥N2 disease were found to be significant predictors of BMs development.
To describe the structural changes in the pituitary gland and accompanying pituitary hormonal problems in patients with Bardet-Biedl syndrome (BBS), 11 patients with BBS (median age: 12.8 years, ...range: 2.5-17.8 years; four boys and seven girls) have been examined for the anomalies of the pituitary region detected by MRI. Accompanying clinical, biochemical, and hormonal profiles concerning the pituitary function of the patients have also been investigated. We have found a high incidence of pituitary anomalies on MRI (63%) and a considerable percentage of hormonal derangements (45%) accompanying these. Among the structural pituitary abnormalities, tumoral changes (n=2), hypoplastic hypophysis, and/or sella (n=4) and rathke cleft cyst (n=2) were detected, whereas disturbances of the pituitary hormones such as growth hormone deficiency, hyperprolactinemia, hypogonadotrophic hypogonadism, and central precocious puberty accompanied the pituitary anomalies in these patients. Pituitary abnormalities and pituitary hormonal dysfunction are common findings and, therefore, should be included in the diagnostic criteria of BBS.
We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma (PAC).
A total of 563 patients who were curatively resected for PAC were retrospectively analyzed ...between 2003 and 2013.
Of 563 patients, 472 received adjuvant chemotherapy (CT) alone, chemoradiotherapy (CRT) alone, and chemoradiotherapy plus chemotherapy (CRT-CT) were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant difference between groups when patients with node-negative disease or patients with or without positive surgical margins were considered.
Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.
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