The purposes of this study were to investigate the frequency and clinical relevance of the incidental finding of renal masses at low-dose unenhanced CT and to analyze the results for features that ...can be used to guide evaluation.
Images from unenhanced CT colonographic examinations of 3001 consecutively registered adults without symptoms (1667 women, 1334 men; mean age, 57 years) were retrospectively reviewed for the presence of cystic and solid renal masses 1 cm in diameter or larger. An index mass, that is, the most complex or concerning, in each patient was assessed for size, mean attenuation, and morphologic features. Masses containing fat or with attenuation less than 20 HU or greater than 70 HU were considered benign if they did not contain thickened walls or septations, three or more septations, mural nodules, or thick calcifications. Masses with attenuation between 20 and 70 HU or any of these features were considered indeterminate. The performance of CT colonography in the detection of renal cell carcinoma was calculated for masses with 2 or more years of follow-up.
At least one renal mass was identified in 433 (14.4%) patients. The mean size of the index masses was 25 ± 16 mm; 376 (86.8%) masses were classified as benign and 57 (13.2%) as indeterminate. The 20- to 70-HU attenuation criterion alone was used for classification of 53 indeterminate lesions. Follow-up data (mean follow-up period, 4.4 years; range, 2-6.3 years) were available for 353 (81.5%) patients with masses (41 indeterminate, 312 benign). Four of the 41 indeterminate masses were diagnosed as renal cell carcinoma. The sensitivity and specificity for renal cell carcinoma on the basis of the indeterminate criteria were 100% and 89.4%. The positive and negative predictive values were 9.8% and 100%.
The incidental finding of a renal mass is relatively common at unenhanced CT, but imaging criteria can be used for reliable identification of most of these lesions as benign without further workup. Mean attenuation alone appears reliable for determining which renal masses need further evaluation.
We evaluated the safety of the universal use of the nonionic iodinated contrast agent iopromide in patients undergoing CT in a large urban teaching hospital.
For 2 years, we prospectively recorded ...all adverse events temporally associated with the administration of iopromide in 29,508 consecutive patients undergoing contrast-enhanced CT at our institution. The types, intensities, treatments, and outcomes of adverse events were recorded along with relevant patient history, including risk factors. Descriptive analyses of the variables, comparisons of means, and proportions using Student's t and chi-square tests, and logistic regressions were conducted.
Adverse events were observed in 211 patients (0.7%) and were categorized as follows: urticaria (n = 161), facial or laryngeal edema (n = 13), bronchospasm (n = 8), severe nausea or vomiting (n = 10), or other (n = 19). One hundred eighty-eight adverse events (89%) were rated mild, 19 moderate (9%), and four severe (2%), including one fatality. Adverse events required treatment in 89 patients (42%). A history of allergy was present in 92 patients (44%), and 29 (14%) had a prior contrast reaction. Other relevant risk factors were identified in 63 patients (30%). No relationship existed between the occurrence of adverse events and any of the following: patient age, dose of iodine administered, or time of study (i.e., month, season, and year). Women (p < 0.001) and outpatients (p < 0.001) had a statistically significant higher incidence of adverse events.
The universal use of iopromide as an IV CT contrast agent has a favorable safety profile.
Objective
To evaluate the acceptability, tolerability, and effects on vulvovaginitis symptoms and signs of a non-soap, herbal-based intimate solution (Zelesse®).
Methods
We conducted a prospective, ...observational, multicenter study including adult women with symptoms and signs of vulvovaginitis with various etiologies, including candidiasis, trichomoniasis, bacterial vaginosis, and atrophic and irritative vaginitis. The presence and intensity of signs (edema, erythema, vaginal discharge) and symptoms (pruritus) of vulvovaginitis were evaluated before and after 5–15 days of daily use of Zelesse® alone or as a coadjuvant in antimicrobial therapy. Variables following a normal distribution and categorical variables were analyzed using the Student t-test and chi-square or Fisher’s exact test, respectively.
Results
A total 137 women were enrolled in the study; 87 (63.5%) women received concomitant antimicrobials and 50 (36.5%) used Zelesse® only. Global symptom scores and frequency of patients with vulvovaginitis signs and symptoms, and their mean intensity, decreased after treatment in both patient groups. Vaginal pH and (in the Zelesse®-only group) vaginal flora remained unaltered. The product was safe, well tolerated, and highly accepted by patients.
Conclusions
Zelesse®, the non-soap herbal-based solution in this study, may represent a safe and effective option for symptomatic relief of vulvovaginitis.
We conducted this study to evaluate whether CT scans could be used to differentiate hepatic venoocclusive disease from hepatic graft-versus-host disease in patients treated with hematopoietic stem ...cell transplantation.
We retrospectively evaluated 18 patients (eight women, 10 men; mean age, 42.4 years) after hematopoietic stem cell transplantation with biopsy-proven hepatic venoocclusive disease (n = 5), hepatic graft-versus-host disease (n = 6), or both (n = 7). Two radiologists reviewed abdominal and pelvic CT scans for hepatomegaly (> 18 cm), splenomegaly (> 13 cm), size of main portal and right hepatic veins, presence of periportal edema, gallbladder wall edema, hydropic gallbladder, ascites, and small-bowel wall thickening. CT and histopathology findings were correlated using analysis of variance and Fisher-Free-man-Holton tests.
Ascites and periportal edema were present in all five patients with venoocclusive disease, but of six patients with graft-versus-host disease, ascites was seen in two (p < 0.05) and periportal edema in only one (p < 0.05). Small-bowel wall thickening was encountered in five patients with graft-versus-host disease and in none with venoocclusive disease (p < 0.05). The right hepatic vein diameter in patients with venoocclusive disease (mean, 0.27 cm) was significantly smaller than the right hepatic vein diameter in patients with graft-versus-host disease (mean, 0.87 cm; p < 0.05).
In patients treated with hematopoietic stem cell transplantation, CT findings of periportal edema, ascites, and a narrow right hepatic vein suggest venoocclusive disease rather than graft-versus-host disease. Small-bowel wall thickening suggests graft-versus-host disease.
Liver imaging in patients with a history of known or suspected malignancy is important because the liver is a common site of metastatic spread, especially tumours from the colon, lung, pancreas and ...stomach, and in patients with chronic liver disease who are at risk for developing hepatocellular carcinoma. Since benign liver lesions are common, liverimaging strategies should incorporate liver lesion detection and characterisation. Survey examination in patients with a known extra-hepatic malignancy to exclude the presence of hepatic and extra-hepatic involvement is normally undertaken with a contrast-enhanced computed tomography examination. When patients with hepatic metastases are being considered for metastasesectomy, they undergo a staging examination with contrast-enhanced magnetic resonance imaging (MRI) using tissue-specific contrast agents. Patients with chronic liver disease who are at risk for hepatocellular carcinoma undergo periodic liver screening for focal liver detection, usually with ultrasonography (US) with MRI being used when US is equivocal. Finally, contrast-enhanced MRI with extra-cellular gadolinium chelates is preferred for characterisation of indeterminate hepatic masses with liver biopsy used when tissue diagnosis is needed.
The objective of our study was to describe the T1 and T2 signal intensity characteristics of papillary renal cell carcinoma (RCC) and clear cell RCC with pathologic correlation.
Of 539 RCCs, 49 ...tumors (21 papillary RCCs and 28 clear cell RCCs) in 45 patients were examined with MRI. Two radiologists retrospectively and independently assessed each tumor's T1 and T2 signal intensity qualitatively and quantitatively (i.e., the signal intensity SI ratio tumor SI / renal cortex SI). Of the 49 tumors, 37 (76%) were assessed for pathology features including tumor architecture and the presence of hemosiderin, ferritin, necrosis, and fibrosis. MRI findings and pathology features were correlated. Statistical methods included summary statistics and Wilcoxon's rank sum test for signal intensity, contingency tables for assessing reader agreement, concordance rate between the two readers with 95% CIs, and Fisher's exact test for independence, all stratified by RCC type.
Papillary RCCs and clear cell RCCs had a similar appearance and signal intensity ratio on T1-weighted images. On T2-weighted images, most papillary RCCs were hypointense (reader 1, 13/21; reader 2, 14/21), with an average mean signal intensity ratio for both readers of 0.67 +/- 0.2, and none was hyperintense, whereas most clear cell RCCs were hyperintense (reader 1, 21/28; reader 2, 17/28), with an average mean signal intensity ratio for both readers of 1.41 +/- 0.4 (p < 0.05). A tumor T2 signal intensity ratio of < or = 0.66 had a specificity of 100% and sensitivity of 54% for papillary RCC. Most T2 hypointense tumors exhibited predominant papillary architecture; most T2 hyperintense tumors had a predominant nested architecture (p < 0.05).
On T2-weighted images, most papillary RCCs are hypointense and clear cell RCCs, hyperintense. The T2 hypointense appearance of papillary RCCs correlated with a predominant papillary architecture at pathology.
Abstract only
Background
Although the consumption of sweetened drinks contributes to the energy requirements of children, high consumption of sugary drinks have been linked to the risk of chronic, ...non‐communicable diseases.
Objective
To describe the sources, volumes and costs of sugar‐sweetened beverages in a convenience sample of school‐aged children from public schools in a suburban setting in the greater metropolitan Guatemala City area.
Methods
We recruited a total of 150 schoolchildren, 67 boys and 83 girls, from grades 1 to 6 in 4 elementary schools in the municipality of Amatitlán, 27 km south of Guatemala City. They were given crayons and a pre‐formatted work booklet, along with instructions to make a pictorial record of each meal and snack over the following 24 h. Upon returning the booklets, participants were interviewed concerning the portion size of all items consumed. A full analysis of 24‐h energy intake from all sources was compiled. With a focus on liquid items, they were classified into subgroups, and the packaging and nutrition labeling on each sugary drink reported was consulted to determine energy content and sales price.
Results
Median 1‐day consumption of all liquids was 1628 mL, providing 479 kcal of energy, with 390 mL as non‐caloric drinking water. Caloric density varied widely according to beverage group. The mean contribution of sweetened drinks was 428±237 kcal, representing 20.2% of the total daily energy intake. There were no significant differences in the pattern of drinks consumption between boys and girls. The most common beverage packaging was plastic bottles and Tetra Pak® cartons. The unit price by retail presentation ranged from Q.0.40 to 21.00. ($0.05 to 2.76 USD).
Conclusions
Pictorial recording of diet is a promising approach for child nutrition. Carbonated soda beverages were not the major sweetened drink in this sample, but the calories from all sugar‐containing drinks constitute a fifth of the reported energy for the single‐day records.
Objectives
To assess the incidence and degree of MRI contrast enhancement in liver tumours following successful percutaneous cryoablation.
Methods
Thirty-eight patients with liver metastases (
n
= ...29) or hepatocellular carcinoma (
n
= 9) underwent percutaneous cryoablation of 45 tumours between March 2004 and June 2009, with complete ablation zone coverage of the tumour and no local recurrence on follow-up imaging to date (range 3–60 months, mean 16). Contrast-enhanced MRI was used to assess 45 tumours at 24 h, 32 tumours at 2–4 months, and 21 tumours at 5–7 months. Percentage of tumours with contrast enhancement was assessed using dynamic spoiled gradient echo T1-weighted images.
Results
Twenty-four hours post-cryoablation, 23 out of 45 tumours (51%) enhanced compared with 42 out of 43 (98%) pre-ablation (
p
< 0.001). Mean percentage tumour enhancement decreased from 157% (range 26–745%) pre-ablation, to 107% (27–260%) at 24 h (
p
= 0.003), and 43% (24–103%) at 2–4 months (
p
< 0.001). The incidence and degree of tumour enhancement decreased through 5–7 months.
Conclusions
Unlike previously reported studies of radiofrequency ablation, successful cryoablation of liver tumours is often associated with persistent tumour contrast enhancement on MRI performed at 24 h and decreasing over 2–7 months.
Key Points
•
Liver neoplasms often demonstrate MRI contrast enhancement following successful percutaneous cryoablation
.
•
This differs from radiofrequency ablation techniques where contrast enhancement suggests residual tumour
•
This difference could potentially lead to important errors in follow up strategies
.
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