Our purpose was to correlate different intravoxel incoherent motion (IVIM), histopathological and clinical parameters in rectal cancer. 17 patients with histologically proven rectal cancer ...investigated on a 3.T device were included into the study. DWI was performed using a multi-slice single-shot echo-planar imaging sequence with b values of 0, 50, 200, 500 and 1000 s/mm.2 A polygonal region of interest was drawn within the tumors on every b image. The following parameters were retrieved from IVIM: apparent diffusion coefficient (ADC), true diffusion (D), pseudo diffusion coefficient (D*), perfusion factor (f), and relative perfusion f·D*. In every case, cell count, nucleic areas, proliferation index KI 67, and microvessel density were estimated on histopathological specimens. Pearson's correlation coefficient was used to analyze the association between the parameters. ADC correlated well with KI 67 index and D tended to correlate with cell count and KI 67. ADC and D tended to correlate with total nucleic area. The perfusion factor f correlated well with stained vessel area, total vessel area, and vessel count. D* and fD* correlated with mean vessel diameter. Distant metastasized tumors had higher D* and fD* values. IVIM parameter reflected different clinical and histopathological features in rectal cancer.
Pulmonary embolism (PE) is a common cause of morbidity and mortality in oncologic patients. Furthermore, PE is an unsuspected finding in many cases.
To determine the frequency and embolus burden of ...PE in a consecutive oncologic patient group including symptomatic as well as incidental and initially unreported events.
In a retrospective, single-center study from June 2005 to January 2010 all patients with an oncologic disease (ICD-10 code C00 to C96) that received at least one contrast-enhanced computed tomography (CT) examination of the chest were reviewed. The study group included 3270 patients with 6780 examinations. A validated pulmonary artery obstruction index (Mastora score) was used to assess embolus burden.
PE was found in 240 of 3270 (7.3%) oncologic patients. The frequency was highly variable among different malignancies ranging from 0% to 25%. In the present study about half of all PE were unsuspected. The mean embolus burden was significantly higher in symptomatic PE than in unsuspected PE (P <0.001). The risk of developing a PE was 1.5 times higher in patients with metastases compared to patients without metastases (P <0.005). Age and sex had no influence on PE risk and embolus burden.
PE is a frequent unsuspected finding in staging examinations: particularly in patients with malignancies of the ovary, brain, and pancreas, and in patients with metastases. Therefore, the status of the pulmonary vasculature should be assessed in every staging examination that includes the chest. The effect of therapeutic actions on PE events and the unsuspected finding of PE in follow-up CT examinations require further prospective studies.
Background: Intravascular embolization of device fragments is a
rare but potentially serious complication. Method: A systematic
search of the PubMed and MEDLINE databases for all articles pertaining ...to
central catheter related embolization published in English between 1985 and
2007 was made. Results: A total of 215 cases of intravenous catheter
embolization were identified. There were 143 totally implanted venous devices
(TIVD) or port catheters and 72 percutaneous venous catheters (PVC). Sites of
catheter fragments following embolization were the superior vena cava or
peripheral veins (15.4%), the right atrium (27.6%), right ventricle (22%), and
pulmonary arteries (35%). Clinical signs of catheter embolization included
catheter malfunction (56.3%), arrhythmia (13%), pulmonary symptoms (4.7%), and
septic syndromes (1.8%), but 24.2% of cases were asymptomatic. The causes of
intravascular catheter embolization were pinch-off syndrome (40.9%), catheter
injury during explantation (17.7%), catheter disconnection (10.7%), and
catheter rupture (11.6%). In 19.1% of cases, the cause of catheter
embolization could not be identified. Most embolized catheter fragments
(93.5%) were removed percutaneously. In 4.2% of cases, fragments were retained
in the vascular bed; in 2.3%, embolized fragments were removed surgically via
thoracotomy. Conclusion: Intravascular catheter embolization can go
undiagnosed for prolonged periods. Patients might be asymptomatic or may
develop severe systemic clinical signs. The mortality rate is 1.8%. There were
no significant differences in clinical features of embolization between TIVD
and PVC groups.
Severe congenital diaphragmatic hernia (CDH) remains a significant challenge for neonatal specialists. In order to reduce complications during extraction of the surgical balloon after fetoscopic ...tracheal occlusion (FETO) CDH, we have developed a FETO with a ‘long tail balloon’ of 2.5 mL volume. Here we describe two successful uses of the device with observed/expected total fetal lung volume (o/e TFLV) of 15% and with o/e TFLV of 24% and ‘liver up’. The o/e TFLV increased to 134% in first case and to 47% in second fetus. The balloon was successfully extracted at 34 weeks' gestation by pulling the long tail suture during second fetoscopy. In the second case the fetus pulled out the balloon from trachea itself by traction onto the balloon's long tail. Both neonates were operated on for their CDH with a good outcome. This work showed the feasibility of this long tail balloon for FETO to reduce the technical difficulty of the balloon extraction and the possibility that fetuses are able to extract the balloon by itself by pulling the balloons' long tail. Further development of long tail balloon for FETO could facilitate its extraction thereby reducing neonatal complications.
Abstract BACKGROUND: Thyroid carcinomas represent the most frequent endocrine malignancies. Recent studies were able to distinguish malignant from benign nodules of the thyroid gland with ...diffusion-weighted imaging (DWI). Although this differentiation is undoubtedly helpful, presurgical discrimination between well-differentiated and undifferentiated carcinomas would be crucial to define the optimal treatment algorithm. Therefore, the aim of this study was to investigate if readout-segmented multishot echo planar DWI is able to differentiate between differentiated and undifferentiated subtypes of thyroid carcinomas. PATIENTS AND METHODS: Fourteen patients with different types of thyroid carcinomas who received preoperative DWI were included in our study. In all lesions, apparent diffusion coefficient (ADC)min, ADCmean, ADCmax, and D were estimated on the basis of region of interest measurements after coregistration with T1-weighted, postcontrast images. All tumors were resected and analyzed histopathologically. Ki-67 index, p53 synthesis, cellularity, and total and average nucleic areas were estimated using ImageJ version 1.48. RESULTS: Analysis of variance revealed a statistically significant difference in ADCmean values between differentiated and undifferentiated thyroid carcinomas ( P = .022). Spearman Rho calculation identified significant correlations between ADCmax and cell count ( r = 0.541, P = .046) as well as between ADCmax and total nuclei area ( r = 0.605, P = .022). CONCLUSION: DWI can distinguish between differentiated and undifferentiated thyroid carcinomas.
Abstract Nonthrombotic pulmonary embolism is defined as embolization to the pulmonary circulation caused by a wide range of substances of endogenous and exogenous biological and nonbiological origin ...and foreign bodies. It is an underestimated cause of acute and chronic embolism. Symptoms cover the entire spectrum from asymptomatic patients to sudden death. In addition to obstruction of the pulmonary vasculature there may be an inflammatory cascade that deteriorates vascular, pulmonary and cardiac function. In most cases the patient history and radiological imaging reveals the true nature of the patient's condition. The purpose of this article is to give the reader a survey on pathophysiology, typical clinical and radiological findings in different forms of nonthrombotic pulmonary embolism. The spectrum of forms presented here includes pulmonary embolism with biological materials (amniotic fluid, trophoblast material, endogenous tissue like bone and brain, fat, Echinococcus granulosus , septic emboli and tumor cells); nonbiological materials (cement, gas, iodinated oil, glue, metallic mercury, radiotracer, silicone, talc, cotton, and hyaluronic acid); and foreign bodies (lost intravascular objects, bullets, catheter fragments, intraoperative material, radioactive seeds, and ventriculoperitoneal shunts).
Abstract From January 2005 to January 2010, 668 consecutive patients with lymphoproliferative disease were retrospectively identified. Hepatic infiltration was present at initial staging in patients ...with non-Hodgkin's lymphoma 12 of 364=3.3%; age median=45; male:female (M:F)=10:2 but also Hodgkin's disease (5 of 41=12.2%; age median=19; M:F=0:5) and multiple myeloma (3 of 162=1.8%; age median=60; M:F=2:1). There were no cases of hepatic infiltration in 101 patients with leukemia. There are typical radiological patterns of hepatic involvement in lymphoproliferative disease with typical lesions characteristics.
Objective
Muscle lymphoma (ML) is a relatively uncommon condition. On magnetic resonance imaging (MRI), ML can manifest with a broad spectrum of radiological features. The aim of this study was to ...demonstrate the features of DW images of muscle lymphoma (ML).
Materials and methods
In our database, ten patients (six women and four men) with ML were identified who were investigated by magnetic resonance imaging including acquisition of DW images. DW images were obtained using a multi-shot SE-EPI pulse sequence. Apparent diffusion constant (ADC) maps were also calculated. Furthermore, fusion images were generated manually from DW and HASTE or T2W images.
Results
On T2W images, all recognized lesions were hyperintense in comparison to unaffected musculature and on T1W images they were homogeneously hypointense. All lesions demonstrated low signal intensity on ADC images. The calculated ADC values ranged from 0.60 to 0.90 mm
2
s
−1
(mean value 0.76 ± 0.10; median value 0.78). On fusion images, all lesions showed high signal intensity.
Conclusions
ML demonstrated low ADC values and high signal intensity on fusion images suggesting high cellularity of the lesions.
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