Elastography in the Diagnosis of Pancreatic Malignancies.

The study aimed to determine the usefulness of the elastography in the diagnosis of malignancy of solid pancreatic tumors. There were 123 patients (F/M; 51/72, aged 62 ± 14) enrolled into the study with the diagnosis of pancreatic masses. Malignant pancreatic adenocarcinoma was identified in 78 patients and an inflammatory mass corresponding to chronic pancreatitis in the remaining 45 patients. The mass elasticity of a tumor (A-elasticity) and a reference zone (B-elasticity) and the B/A strain ratio were measured. All these elastographic parameters differed between groups and correlated significantly with malignancies (r = 0.841; r = -0.834; r = 0.487, respectively). Receiver operating characteristic (ROC) analysis showed that A-elasticity between 0.05% and 0.14% alone, as well as the B/A strain ratio between 7.87 and 18.23 alone, enabled the recognition of all malignant pancreatic tumors with 100% sensitivity and ≥ 97.8% specificity. Surprisingly, B-elasticity alone also was helpful in recognizing malignant tumors (71% sensitivity, 80% specificity, 0.74 accuracy, and 0.792 area under the curve), although it appeared worse than A-elasticity and B/A strain ratio (p < 0.001). In multivariable regression analysis, A-elasticity identified 89.5% of malignancies (p < 0.001). A-elasticity and B-elasticity were the only significant independent factors influencing the tumor identification (r2 = 0.927; p < 0.001). The assessment of tumor elasticity appears sufficient to identify malignant tumors of the pancreas.

[Conditions and limits of radiological examinations of the digestive tract]. / Warunki i ograniczenia badan radiologicznych przewodu pokarmowego.

The rising incidence of alimentary tract diseases forces imaging metod development. Developing radiologic diagnostics changed imaging methods role and increased quality demand. X-ray based methods are still used in diagnosing many illnesses. Basic abdominal x-ray in nightshift condition is necessary to diagnose perforation or obstruction. Ultrasonographic, computed tomography and magnetic resonance imaging methods are the most important nowadays. The most popular and non-invasive method of imaging is ultrasonography. It is irreplaceable thanks to its availability and precision diagnosing many internal organs. One of the newest method is magnetic resonance and imaging in all possible scans. Complimentary method is computed tomography. It is based on human body layers analysis. Method is based on x-rays and assessing all tissues absorption. It can produce three dimensional imaging. The newest software can produce virtual imaging of all body cavities as well as colon. Basic and highly specialistic methods should be carefully planned in diagnostic-therapeutic process. In decision making what method should be used, medical doctor and patient should take part, taking into account all indication and cotraindications as well as method limitations.

Doppler tissue perfusion measurement is a sensitive and specific tool for a differentiation between malignant and inflammatory pancreatic tumors.

Differentiation between pancreatic malignant and inflammatory tumors presents an important diagnostic problem. The ability to recognize pancreatic malignant tumors using Doppler evaluation of tissue perfusion has been recently demonstrated. The aim of the study was to assess the diagnostic value of Dynamic Tissue Perfusion Measurement (DTPM) in the differentiation between malignant and inflammatory pancreatic tumors. The study included 60 patients (35M, 25F, age 60.9 ± 2.3 years) with a malignant (Group 1, n = 30) or inflammatory (Group 2, n = 30) pancreatic tumor undergoing endoscopic ultrasound with the evaluation of tissue perfusion by Color Doppler and a simultaneous biopsy of lesions for cytological evaluation. In 20 patients the diagnosis was verified in the postoperative histopathological examination. Flow velocity (FV) and percentiles of the distribution of perfusion intensity (PR) evaluated by DTPM were analyzed with regard to receiver-operator-characteristics. FV as well as PR were significantly higher in Group 2 compared to Group 1. A threshold of 2.0 cm/sec for FV identified patients with malignancies with a sensitivity of 83% and specificity of 86%. In multivariable regression analysis, the best PR parameter for differentiating between malignant and inflammatory tumors was 97.5% percentile, whose value of 0.922 allowed for the recognition of pancreatic malignant tumors with a sensitivity of 62% and specificity of 83% (p < 0.001). In conclusion, Color Doppler ultrasound tissue perfusion parameters are a sensitive and specific tool in the differentiation between malignant and inflammatory pancreatic tumors.

The use of endoscopic ultrasonography in the detection and differentiation of pathology in the wall of the upper gastrointestinal tract.

INTRODUCTION: The growing incidence of gastrointestinal diseases forces to improve imaging techniques. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography. AIM: To assess the usefulness of endosonography (EUS) in the differentiation between compression from the outside and intramural lesions of the upper gastrointestinal tract. MATERIAL AND METHODS: For 4 years 20,012 patients with performed gastroscopies were enrolled in the study. One hundred and ninety-nine patients (96 females, 103 males; age 62.2 ±14.1 years) with pathology of the wall of the upper gastrointestinal tract qualified for further diagnosis. Endosonography and computed tomography (CT) were performed in each patient. A chest CT was performed in patients with a lesion in the oesophagus. An abdomen CT was performed in patients with pathology in the stomach or duodenum. Based on the results of EUS, histopathology, and imaging, each patient qualified for treatment, endoscopic observation, surgery, or cancer treatment. RESULTS: In EUS 129 (64.8%) intramural lesions were identified. Five (2.5%) diagnoses were false negative. In 62 (31.2%) patients no intramural changes were recognised and three (1.5%) results were false positive. The sensitivity and specificity of EUS was 96.3% and 95.4%, respectively, with positive predictive value 90.7%, negative predictive value 97.8%, and overall accuracy 95% (p < 0.05). Endoscopic therapy was performed in 31 (15.6%) patients, and 99 (49.8%) were classified for endoscopic observation. Surgery was performed in 50 (25.1%) patients, and 19 (9.5%) patients required oncologic treatment. CONCLUSIONS: Endosonography exceeds computed tomography in differentiating compression from the outside and intramural lesions of the upper gastrointestinal tract.

The impact of age and sex on the occurrence of pathology in the wall of the upper gastrointestinal tract.

INTRODUCTION: The growing incidence of gastrointestinal diseases forces to improve both imaging techniques and the identification of the population with a greater risk of a disease. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography. AIM: The study was a retrospective evaluation of the occurrence of submucosal lesions (SML) and thickened wall (TW) of the upper gastrointestinal tract (UGIT) depending on age and sex. MATERIAL AND METHODS: Out of 20012 gastroscopies during the 4-year follow-up study, we enrolled 199 patients with pathological lesions in the wall of the UGIT. All patients underwent computed tomography and endoscopic ultrasound (EUS). RESULTS: We analysed a total of 122 (78 males, 44 females, age: 64.0 ±12.9 years) out of 187 patients. 23.91% of SML in the oesophagus, 56.52% in the stomach, and 19.57% in the duodenum. A higher number of SMLs was found in men than in women (57.14% vs. 40.45%, p = 0.023), and the difference was greater over 50 years of age (85.71% vs. 40.00%, p = 0.031). We found less malignant SMLs compared to benign (35.87% vs. 64.13%, p = 0.026), especially in women (22.86% vs. 47.46%, p = 0.006). 26.67% of TW were in the oesophagus, 66.67% in the stomach, and 6.67% in the duodenum. There was a tendency towards increased incidence of TW over 50 years of age (8.58% vs. 18.30%, p = 0.074), which concerned men in particular (24.10% vs. 11.43%, p = 0.043). Until 65 years of age, these differences were significant for the oesophagus (27.27% vs. 0.00%, p = 0.044) and the stomach (25.93% vs. 4.00%, p = 0.029). As many as 70% of TW pathologies were malignant. CONCLUSIONS: Submucosal lesions and TW of the upper gastrointestinal tract account for 0.61% of performed gastroscopies. They occur in men and usually over 50 years of age.

US in preoperative evaluation of parotid gland neoplasms.

Salivary gland neoplasms account for only 3% of all tumors of the head and neck area, but as they represent a wide variety of histological types, they are a big diagnostic challenge. The cornerstone of salivary gland neoplasm treatment, both for the benign and malignant lesions, is surgery. The main goal of the therapy is not only to achieve complete surgical tumor resection, but also to preserve adjacent structures (facial nerve, parapharyngeal space structures). Ultrasonography is an examination commonly used in the preoperative diagnosis of the lesions localized within salivary glands. Very often it is the only diagnostic imaging method used in these cases. The aim of the study was to establish diagnostic value of US examination and its parameters for the assessment of parotid gland tumors. A prospective study was performed on a group of 51 patients with parotid gland neoplasms, who over a period of 3 years underwent surgery in Otolaryngology and Laryngological Oncology Department with Craniomaxillofacial Surgery Department of Central Clinical Hospital of Ministry of Defence in Warsaw. All the included patients underwent US examination in the preoperative period. The parameters selected for the assessment were: ill-defined tumor margins, tumor vascularity and the presence of enlarged regional lymph nodes. The results of imaging examination were compared to the final diagnosis based on pathological examination of the surgical specimen. The parameters of the US examination such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the evaluation of parotid gland tumors were established based on the examination results. An analysis was performed and ill-defined parotid tumor margins turned out to be a US parameter with higher diagnostic value for differentiating benign and malignant lesions than increased tumor vascularity. The presence of enlarged regional lymph nodes with blurred echostructure on the US examination had little value for differentiating lesions. The sensitivity of the US examination in terms of detecting malignant parotid gland neoplasms increased significantly in the setting of simultaneous assessment of several parameters.