Utility of pelvic CT in patients undergoing surveillance for hepatocellular carcinoma: A retrospective multi-institutional study.

OBJECTIVE: To determine the frequency, characteristics and clinical significance of incidental pelvic findings reported on abdominopelvic CT performed for hepatocellular carcinoma (HCC) surveillance in at-risk patients. MATERIAL AND METHODS: This two-center retrospective study received institutional review board approval with a waiver of informed consent. The radiologic reports of the CT exams performed 1/1/2010-2/28/2023 for HCC surveillance were reviewed. Exams were obtained with intravenous contrast material and included hepatic arterial and portal venous phases of the abdomen; images of the pelvis were acquired during the portal venous phase. Reported imaging findings and imaging-related recommendations either by the radiologists or the corresponding caregiver, if present, were retrospectively tabulated. The patient's medical records were reviewed to determine if there were any recommendations that were considered clinically important and culminated in any further interventions or treatments. RESULTS: 259 adults (1st center: mean age, 60 ± 11 years, 49% male and 2nd center: 56.26 ± 6.2 years, 48% male) at risk for HCC underwent 327 abdominopelvic CT exams for HCC surveillance at two centers. A total of 622 pelvic findings (mean, 2.2/ exam) were reported, including 131 bladder, 120 alimentary tract, 133 vascular, 51 gynecologic, 37 prostate, 33 lymph node, 27 inguinal, 44 peritoneal, and 46 skeletal. 52 of 622 reported findings (8.3%) were associated with actionable recommendations. 24 of the 52 actionable recommendations/clinical suggestions were implemented as follows: five complimentary imaging, ten additional laboratory tests, and nine non-imaging recommendations. Of note, only eight applied recommendations culminated in a clinical outcome, which included four urinary tract infection treatments. CONCLUSION: Pelvic CT findings were associated with a clinical benefit to the patient in 1.3% of exams. These results suggest that pelvic imaging should be omitted from CT-based HCC surveillance. CLINICAL RELEVANCE: Without compromising valuable information, patients undergoing HCC surveillance-CT may not require additional pelvic coverage.

Screening for exclusion of high-risk bleeding features of esophageal varices in cirrhosis through CT and MRI.

BACKGROUND & AIM: Esophageal varices (EV) screening guidelines have evolved with improved risk stratification to avoid unnecessary esophagogastroduodenoscopy (EGD) in individuals with low bleeding risks. However, uncertainties persist in the recommendations for certain patient groups, particularly those with hepatocellular carcinoma (HCC) and/or receiving non-selective beta-blockers (NSBB) without prior endoscopy. This study assessed the efficacy of imaging in ruling out EVs and their high-risk features associated with bleeding in patients with cirrhosis and with HCC. We also evaluated the impact of NSBB on the detection of these characteristics. METHODS: A total of 119 patients undergoing EGD with CT and/or MRI within 90 days of the procedure were included. 87 patients had HCC. A new imaging grading system was developed utilizing the size of EVs and the extent of their protrusion into the esophagus lumen. The negative predictive value (NPV) of EVimaging(-) versus EVimaging (+) (grades 1-3) in ruling out the presence of EV and/or high-risk features by EGD was calculated. The predictive performance of imaging was determined by logistic regression. RESULTS: The NPV of imaging for detecting EV and high-risk features was 81 % and 92 %, respectively. Among HCC patients, the NPV for EV and high-risk features was 80 % and 64 %, respectively. Being on NSBB didn't statistically impact the imaging detection of EV. Imaging was a better predictor of high-risk EGD findings than Child-Turcotte-Pugh scores. CONCLUSIONS: Our results suggest that imaging can effectively rule out the presence of EV and high-risk features during EGD, even in patients with HCC and/or receiving NSBB.

Spectrum of Imaging Findings and Complications After Hepatic Transarterial Chemoembolization for Liver Tumors.

ABSTRACT: This study reviews the spectrum of imaging findings and complications after transarterial chemoembolization (TACE) for the treatment of primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma) and liver metastases. The review encompasses a spectrum of imaging criteria for assessing treatment response, including the modified Response Evaluation Criteria in Solid Tumors guidelines, tumor enhancement, and apparent diffusion coefficient alterations.We discuss the expected posttreatment changes and imaging responses to TACE, describing favorable and poor responses. Moreover, we present cases that demonstrate potential complications post-TACE, including biloma formation, acute cholecystitis, abscesses, duodenal perforation, arterial injury, and nontarget embolization. Each complication is described in detail, considering its causes, risk factors, clinical presentation, and imaging characteristics.To illustrate these findings, a series of clinical cases is presented, featuring diverse imaging modalities including computed tomography, magnetic resonance imaging, and digital subtraction angiography.

Predicting survival of patients with advanced hepatocellular carcinoma receiving combination targeted immunotherapy: an evaluation of volumetric imaging parameters.

PURPOSE: To evaluate the potential of volumetric imaging in predicting survival of advanced hepatocellular carcinoma (HCC) patients receiving immunotherapy. METHODS: Retrospective analysis included 40 patients with advanced HCC who received targeted immunotherapy. Baseline and follow-up contrast-enhanced abdominal computed tomography (CT) scans were analyzed. The largest tumor was chosen as the index lesion. Viable tumor volume (qViable) and percentage tumor viability (%Viability) were calculated. Response Evaluation Criteria in Solid Tumors (RECIST) and Tumor volume change after treatment (qRECIST) were measured. Associations with overall survival (OS) were assessed. Cox regression analysis assessed the association between variables and overall survival (OS). A new prognostic stratification system was attempted to categorize patients based on significant predictors of OS. Patients with a baseline %viability > 69% and %viability reduction ≥ 8% were classified as better prognosis. Patients were stratified into better, intermediate and worse prognosis groups based on baseline %viability > 69% and ≥ 8% %viability reduction (better prognosis); baseline %viability ≤ 69% and < 8% %viability reduction (worse prognosis); remainder were intermediate prognosis. RESULTS: Patients with baseline %Viability > 69% and %Viability reduction ≥ 8% showed significantly higher OS. Multivariate analysis confirmed %Viability and %Viability reduction as significant predictors of OS. A prognostic stratification system using these parameters stratified patients into better, intermediate and worse prognosis groups, with the better prognosis showing highest OS. Most patients (97.5%) had stable disease by RECIST while the prognostic model re-classified 47.5% as better prognosis, 37.5% intermediate prognosis, and 15% worse prognosis. CONCLUSION: Volumetric parameters of %Viability and %Viability reduction predict OS in HCC patients undergoing immunotherapy.

Incremental value of volumetric multiparametric MRI over Fudan score for prognosis of unresectable intrahepatic cholangiocarcinoma treated with systemic chemotherapy.

BACKGROUND: Individualized patient care requires prognostic models customized to a tumor and an individual's disease profile for reliable survival prediction. MRI has prognostic value for intrahepatic cholangiocarcinoma (ICCA). Existing prognostic models for ICCA exclude imaging-based information about an individual's tumor that may reflect important aspects of tumor's biology. Fudan score, a prognostic model applicable to unresectable ICCA, is limited by subjective morphologic imaging parameters. OBJECTIVES: To assess the prognostic value of baseline volumetric multiparametric MRI in unresectable intrahepatic cholangiocarcinoma (ICCA) treated with systemic chemotherapy and the incremental value of MRI over the Fudan score. METHODS: This retrospective study included 114 ICCA patients treated with systemic chemotherapy between 2007 and 2021 after a baseline MRI. The single largest tumor was volumetrically assessed for anatomic (total tumor volume and diameter) and functional parameters (viable tumor volume, percentage-viable tumor volume, viable tumor burden, and ADC). A derivation cohort of 30 patients was utilized to identify MRI parameters associated with overall survival (OS) using Cox regression analysis. The incremental value of MRI over Fudan score was assessed on an independent sub-cohort of 84 patients using Kaplan-Meier analysis and C-index. RESULTS: 114 patients (64 years +/- 11; 61 women) were evaluated. Pre-treatment high (>1350x10-6 mm2/sec) ADC was the only independent predictor of OS (HR, 8.07; P < 0.001). Replacing subjective tumor boundary with objective ADC value, and using modified biochemical thresholds increased the prognostic stratification for the risk groups in the modified ADC-Fudan model compared to the original Fudan model (median survival 12 and 4.5 months; P = 0.055; vs. 11 and 3 months; P < 0.001). The modified ADC-Fudan model demonstrated an 11 % improvement over the original Fudan model (c-index: 0.80 vs. 0.69; P = 0.044) for survival prediction. CONCLUSIONS: High pre-treatment volumetric ADC was associated with unfavorable prognosis in patients with unresectable intrahepatic cholangiocarcinoma treated with systemic chemotherapy. Supplementing the original Fudan model with ADC and modified serum marker thresholds improved the survival prediction performance by 11% in the resulting modified ADC-Fudan model. CLINICAL IMPACT: Volumetric MRI could improve the survival prediction among ICCA patients prior to receiving potentially toxic and expensive palliative chemotherapies. This could potentially guide individualized therapy for this patient cohort.

Utilization of Radiomics Features Extracted From Preoperative Medical Images to Detect Metastatic Lymph Nodes in Cholangiocarcinoma and Gallbladder Cancer Patients: A Systemic Review and Meta-analysis.

OBJECTIVES: This study aimed to determine the methodological quality and evaluate the diagnostic performance of radiomics features in detecting lymph node metastasis on preoperative images in patients with cholangiocarcinoma and gallbladder cancer. METHODS: Publications between January 2005 and October 2022 were considered for inclusion. Databases such as Pubmed/Medline, Scopus, Embase, and Google Scholar were searched for relevant studies. The quality of the methodology of the manuscripts was determined using the Radiomics Quality Score and Quality Assessment of Diagnostic Accuracy Studies 2. Pooled results with corresponding 95% confidence intervals (CIs) were calculated using the DerSimonian-Liard method (random-effect model). Forest plots were used to visually represent the diagnostic profile of radiomics signature in each of the data sets pertaining to each study. Fagan plot was used to determine clinical applicability. RESULTS: Overall sensitivity was 0.748 (95% CI, 0.703-0.789). Overall specificity was 0.795 (95% CI, 0.742-0.839). The combined negative likelihood ratio was 0.299 (95% CI, 0.266-0.350), and the positive likelihood ratio was 3.545 (95% CI, 2.850-4.409). The combined odds ratio of the studies was 12.184 (95% CI, 8.477-17.514). The overall summary receiver operating characteristics area under the curve was 0.83 (95% CI, 0.80-0.86). Three studies applied nomograms to 8 data sets and achieved a higher pooled sensitivity and specificity (0.85 [0.80-0.89] and 0.85 [0.71-0.93], respectively). CONCLUSIONS: The pooled analysis showed that predictive models fed with radiomics features achieve good sensitivity and specificity in detecting lymph node metastasis in computed tomography and magnetic resonance imaging images. Supplementation of the models with biological correlates increased sensitivity and specificity in all data sets.

Outcome prediction for symptomatic patients with fibroids who underwent uterine artery embolization.

PURPOSE: To predict the clinical outcome of symptomatic patients with uterine leiomyomas who underwent uterine artery embolization (UAE), based on clinical and radiological features. METHODS: Patients with symptomatic uterine leiomyomas who underwent UAE from March 2010 to September 2019 were consecutively included in this retrospective study. Patients with persistent or recurrent symptoms and those who needed repeated UAE, myomectomy, or hysterectomy following the initial treatment were considered to have a poor outcome after UAE. The total and enhancing volume of the dominant leiomyoma in each location and uterine volume were obtained before and after UAE. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the parameters that could predict poor outcome. RESULTS: A total of 116 patients (mean age, 45 ± 5 years) were included. Forty-six patients (46/116, 39.7%) showed poor outcome. Cox regression analysis showed higher hazard of poor outcome for younger patients vs. older patients (HR: 0.92, p-value: 0.01), patients with adenomyosis vs. patients without adenomyosis (HR: 2.47, p-value < 0.01), patients with adenomyosis thickness > 2.5 cm before UAE vs. patients without adenomyosis (HR: 4.2, p-value < 0.01) and for patients with intramural fibroid enhancement volume > 440 cm3 compared to patients with no intramural fibroids (p-value: 0.06). Multivariate Cox regression analysis including age, the thickness of adenomyosis, and intramural leiomyoma volume of enhancement before UAE was chosen as the best model to predict the outcome. CONCLUSIONS: Pretreatment clinical and MRI features could identify patients with a higher risk for poor outcome after UAE.

Multimodality imaging of hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

Hepatocellular carcinoma and intrahepatic cholangiocarcinoma are the two most common primary malignant tumors of the liver. The similarities and variations in imaging characteristics that may aid in distinguishing between these two primary tumors will be discussed and outlined in this review. Knowledge of imaging techniques that are currently available would assist in the differentiation between these primary malignancies.

Diffuse large B-cell lymphoma presenting as sternal mass in a patient with ankylosing spondylitis: a case report study.

Primary bone lymphoma is a rare entity that constitutes less than 1% of all non-Hodgkin lymphomas and 3-5% of malignant bone tumors. Chronic immune and inflammatory diseases carry a level of risk for the development of malignancies that is correlated with the disease severity. There is conflicting evidence regarding the risk of lymphoma in spondyloarthritis. Case presentation: The authors present a rare case of primary diffuse large B-cell lymphoma of the sternum in a 41-year-old Iranian woman with ankylosing spondylitis (AS). Physical examination revealed a 7×7.5 cm firm swelling of the anterior midline chest wall above the breasts, and MRI showed a lesion within the sternal marrow with an associated soft-tissue mass in the anterior aspect of the sternum. Following core-needle biopsy under ultrasound guidance, a histopathological study demonstrated diffuse sheets of large noncleaved atypical cells with large multilobated prominent nuclei and fine chromatin compatible with diffuse large B-cell lymphoma. Clinical discussion: Primary and exclusive involvement of the sternum is an uncommon presentation of lymphoma. Radiological, histological, and clinical characteristics of primary bone lymphoma can resemble those of other medical disorders. Although infrequent, existing evidence shows that AS seems to be associated with a small but significant risk for malignancy. Conclusion: Even though inflammatory involvement of the anterior chest wall could be a common clinical finding in patients with AS, it is recommended that anterior chest wall pain or any mass almost always needs comprehensive assessment and imaging evaluation in such patients to avoid any delayed diagnosis, misdiagnosis, and ensuing morbidity or mortality.

Comparison between Gradient-Echo and Spin-Echo EPI MR Elastography at 3 T in quantifying liver stiffness of patients with and without iron overload; a prospective study.

OBJECTIVES: To compare the maximum axial area of the confidence mask and the calculated liver stiffness (LS) on gradient-echo (GRE) and spin-echo echo planar imaging (SE-EPI) MR elastography (MRE) in patients with and without iron deposition. METHODS: 104 patients underwent MRE by GRE and SE-EPI sequences at 3 T. R2* values >88 Hz in the liver were categorized in the iron overload group. The maximum axial area and the corresponding LS values were measured by manually contouring the whole area on one slice with the largest confidence mask at both GRE and SE-EPI sequences. RESULTS: In patients with iron overload, SE-EPI provided larger maximum axial confidence area in unfailed images (57.6 ± 41.7 cm2) compared to GRE (45.7 ± 29.1 cm2) (p-value = 0.007). In five patients with iron overload, imaging failed at GRE sequence, whereas at the SE-EPI sequence the maximum area of the confidence mask had a mean value of 33.5 ± 54.9 cm2. In livers without iron overload (R2*: 50.7 ± 13.1 Hz), the maximum area on the confidence mask was larger at SE-EPI (118.3 ± 41.2 cm2) than on GRE (105.1 ± 31.7 cm2) (P-value = 0.003). There was no significant difference in mean LS between SE-EPI (2.0 ± 0.3 kPa) and GRE (2.1 ± 0.5 kPa) in livers with iron overload (P value = 0.24). Similarly, in the group without iron overload, mean LS was 2.3 ± 0.7 kPa at SE-EPI and 2.4 ± 0.8 kPa at GRE sequences (P-value = 0.11). CONCLUSIONS: SE-EPI MRE can successfully provide similar LS measurements as GRE MRE. Furthermore, it provides a larger measurable area on the confidence mask in both groups with and without iron overload.

Predictive role of radiomics features extracted from preoperative cross-sectional imaging of pancreatic ductal adenocarcinoma in detecting lymph node metastasis: a systemic review and meta-analysis.

Lymph node metastases are associated with poor clinical outcomes in pancreatic ductal adenocarcinoma (PDAC). In preoperative imaging, conventional diagnostic modalities do not provide the desired accuracy in diagnosing lymph node metastasis. The current review aims to determine the pooled diagnostic profile of studies examining the role of radiomics features in detecting lymph node metastasis in PDAC. PubMed, Google Scholar, and Embase databases were searched for relevant articles. The quality of the studies was examined using the Radiomics Quality Score and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tools. Pooled results for sensitivity, specificity, likelihood, and odds ratios with the corresponding 95% confidence intervals (CIs) were calculated using a random-effect model (DerSimonian-Liard method). No significant publication bias was detected among the studies included in this meta-analysis. The pooled sensitivity of the validation datasets included in the study was 77.4% (72.7%, 81.5%) and pooled specificity was 72.4% (63.8, 79.6%). The diagnostic odds ratio of the validation datasets was 9.6 (6.0, 15.2). No statistically significant heterogeneity was detected for sensitivity and odds ratio (P values of 0.3 and 0.08, respectively). However, there was significant heterogeneity concerning specificity (P = 0.003). The pretest probability of having lymph node metastasis in the pooled databases was 52% and a positive post-test probability was 76% after the radiomics features were used, showing a net benefit of 24%. Classifiers trained on radiomics features extracted from preoperative images can improve the sensitivity and specificity of conventional cross-sectional imaging in detecting lymph node metastasis in PDAC.

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature.

OBJECTIVE: To investigate the outcomes of ventilation/perfusion scintigraphy on the diagnosis of pulmonary embolism in coronavirus disease 2019 (COVID-19) patients, we performed a systematic review of the available literature. MATERIALS AND METHODS: PubMed and Scopus were systematically searched up to 4 June 2022, for relevant studies. We included studies on patients with COVID-19 who have performed ventilation/perfusion scintigraphy for diagnosis of pulmonary embolism to describe any diagnosis outcome. Irrelevant and non-English articles were excluded. RESULTS: Overall, 27 articles were included in our review. The database search yielded studies from PubMed, Scopus, and studies identified through reviewing the reference list of included studies. Extracted information from the included studies could be categorized into several aspects: Diagnosis of pulmonary embolism with Q single-photon emission computed tomography (SPECT) CT, Tracheobronchial uptake, Diagnostic value of V/Q rather than Q at diagnosis pulmonary embolism, Different characteristics (morphological alterations) of COVID-19 in ventilation orperfusion scan, the prevalence of pulmonary embolism with Q or V/Q criteria, and Design of radiotherapy planning in lung cancer patients with COVID-19. CONCLUSION: Different perfusion patterns in COVID-19 are challenging but can be alleviated by adding SPECT/computed tomography (CT) to lung perfusion scans. Although perfusion only SPECT/CT can rule out or rule in others in considerable number of patients, ventilation scan is still needed in certain patients.

The Additive Value of Radiomics Features Extracted from Baseline MR Images to the Barcelona Clinic Liver Cancer (BCLC) Staging System in Predicting Transplant-Free Survival in Patients with Hepatocellular Carcinoma: A Single-Center Retrospective Analysis.

BACKGROUND: To study the additive value of radiomics features to the BCLC staging system in clustering HCC patients. METHODS: A total of 266 patients with HCC were included in this retrospective study. All patients had undergone baseline MR imaging, and 95 radiomics features were extracted from 3D segmentations representative of lesions on the venous phase and apparent diffusion coefficient maps. A random forest algorithm was utilized to extract the most relevant features to transplant-free survival. The selected features were used alongside BCLC staging to construct Kaplan-Meier curves. RESULTS: Out of 95 extracted features, the three most relevant features were incorporated into random forest classifiers. The Integrated Brier score of the prediction error curve was 0.135, 0.072, and 0.048 for the BCLC, radiomics, and combined models, respectively. The mean area under the receiver operating curve (ROC curve) over time for the three models was 81.1%, 77.3%, and 56.2% for the combined radiomics and BCLC models, respectively. CONCLUSIONS: Radiomics features outperformed the BCLC staging system in determining prognosis in HCC patients. The addition of a radiomics classifier increased the classification capability of the BCLC model. Texture analysis features could be considered as possible biomarkers in predicting transplant-free survival in HCC patients.

Jejunal web as the cause of bowel obstruction in a toddler: Case report and brief literature review.

INTRODUCTION AND IMPORTANCE: Intestinal webs which are categorized under type-1 intestinal atresia rarely occur in the jejunum. These webs are occasionally diagnosed late because their central fenestration allows the passage of food. CASE PRESENTATION: We report a toddler who presented with atypical symptoms of bowel obstruction and non-specific plain radiograph and ultrasound findings. The diagnosis of jejunal obstruction was made possible with contrast-enhanced computed tomography and obstruction was found to be the result of a jejunal web at the surgery. CLINICAL DISCUSSION: Few cases of jejunal webs are reported in the literature. The jejunum is the site of only 8% of webs and 33% of jejunal webs are associated with other congenital anomalies and/or prematurity. CONCLUSION: Jejunal web needs a high degree of suspicion to be diagnosed and should be kept in mind as a differential diagnosis in the setting of unexplained persistent non-bilious emesis in otherwise normal toddlers.

Correlation of apparent diffusion coefficient values and peritumoral edema with pathologic biomarkers in patients with breast cancer.

PURPOSE: To investigate the relationship between breast cancer imaging features on magnetic resonance imaging (MRI) and histopathological characteristics. METHODS AND MATERIALS: We prospectively enrolled 46 patients who underwent 1.5-T MRI with 68 breast malignant lesions from 2017 until 2019. Peritumoral edema was determined based on visual assessment on T2 weighted imaging. Lesions were categorized into two groups: A: with edema (48 lesions) and B: without edema (20 lesions). RESULTS: The tumor size was not different among two groups but multifocal-multicentric lesions were more common in the group A (70% vs. 35%). The axillary lymph nodes are most involved in group A. ER and PR positive lesions were more common in group B (90% vs. 56.3%) but in the group A, HER2 positive lesions were found to be more common (31.3% vs. 15%). The mean ADC value in tumors and peritumoral regions were lower (0.97 × 10-3 mm2/s, P = 0.023) and higher (1.85 × 10-3 mm2/s, P < 0.0001) in group A, respectively. Peritumoral ADC value was significantly higher in HER2-positive group. CONCLUSION: Breast carcinomas with peritumoral edema were found to be more multifocal-multicentric, with higher prevalence of axillary lymph node involvement, more HER 2-positive, with lower prevalence of ER/PR-positive, lower tumoral ADC and higher peritumoral ADC values.

The Effect of Suspension and Conventional Core Stability Exercises on Characteristics of Intervertebral Disc and Chronic Pain in Office Staff Due to Lumbar Herniated Disc.

BACKGROUND: The purpose of this study was to identify the effects of eight weeks of conventional and suspension core stability exercises by use of the designed device on characteristic of intervertebral discs in low back pain. METHODS: A total of 27 men with chronic low back (CLB) pain due to lumbar disc herniation in L4-L5 and L5-S1 regions were enrolled in this quasi-experimental study. After assessing the pain intensity using a visual analog scale (VAS) and determining the disc herniation index using MRI, each group of patients were asked to perform either conventional or suspension exercises for eight weeks, each week consisting of three training sessions. The pain intensity was assessed at the end of the first, second, third, fourth and eighth weeks and the disc hernia index was determined again at the end of the eight weeks of exercises. RESULTS: The results indicated significant changes in the intensity of pain in both groups through the period of eight weeks of exercise with a remarkable pain relief. In relation to the structural characteristics of the intervertebral disc, data analysis did not reveal any significant change between the pre- and post-test. CONCLUSION: Considering the beneficial effects of the stability exercises and specially suspension stability exercises with respect to pain alleviation and reduced use of sedatives and anti-inflammatory drugs, this method can be helpful at early stages of treatment for chronic pains.

Medicinal, Nutritional, and Cosmetic Values of Macrofungi Distributed in Mazandaran Province of Northern Iran (Review).

A total of 82 species and 2 variations of medicinal and edible macrofungi (Basidiomycota and Ascomy-cota) have been collected and identified in Mazandaran Province of Northern Iran. Among these species, 58 possess medicinal and culinary properties, whereas 21 possess only medicinal properties (antiinflammatory, antimicrobial, an-timutagenic, antioxidant, antitumor, antiplatelet, hypoglycemic, hypocholesterolemic, neurotropic, hypotensive, insec-ticidal, immunomodulating, mitogenic/regenerative, spasmolytic, etc.). No medicinal effect has yet been reported for 4 species (Cantharellus infundibuliformis, Mycena inclinata, Suillus collinitus, Xerocomus porosporus) and 2 variations (Pluteus cervinus var. albus, Russula cyanoxantha var. variata) of edible species. Among the listed species, 15 (such as Auricularia auricula-judae, Hericium erinaceus, Fomes fomentarius, Flammulina velutipes, Ganoderma lucidum, Lyophyllum decastes, Pleurotus ostreatus, Tremella mesenterica) are currently used for manufacturing organic cosmetic products. The well-known mushrooms with medicinal properties (e.g., Auricularia auricula-judae, Flammulina velutipes, Hericium erinaceus, Ganoderma lucidum, G. tsugae, G. adspersum, Trametes versicolor) and excellent edibility (e.g., Boletus edulis, Cantharellus cibarius, Morchella esculenta, Pleurotus ostreatus) are widely distributed in the studied area. The biological resources of macrofungi growing in Mazandaran Province of Northern Iran possess medicinal, nutritional, and cosmetic values and could be further used for biotechnological exploitation to develop mushroom-derived pharmaceuticals, nutriceuticals, nutraceuticals, and cosmeceuticals.

Percutaneous Sclerotherapy for Giant Symptomatic Liver Hemangiomas: A Pilot Study.

This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%-71.1% lesion volume reduction and a 12.9%-41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.

Whether HER2-positive non-breast cancers are candidates for treatment with Ado-trastuzumab emtansine?

The National Comprehensive Cancer Network (NCCN) has recommended Ado-trastuzumab emtansine (T-DM1) as a preferred agent for patients with human epidermal growth factor receptor-2 (HER2)-positive metastatic breast cancer and prior trastuzumab therapy. Overexpression of HER2 was reported in other cancer types such as bladder, gastric and urogenital carcinosarcomas similar to what is discovered in breast cancer. Some preclinical studies demonstrated the potential anti-tumor effects of T-DM1 in HER2-positive non-breast cancers. There is a paucity of data over the clinical evaluation of T-DM1 in human studies of non-breast cancer patients. We review some preclinical and ongoing clinical studies that assessed the efficacy of T-DM1 administration in the treatment of non-breast HER2 positive malignancies. Performing large and well-designed trials in this area is matter of interest and highly recommended.

Pretreatment Evaluation of Glioma.

Glioma is considered the most common type of primary central nervous system (CNS) tumor. Imaging is crucial for diagnosis, characterization, grading, and therapeutic planning of CNS gliomas. Along with a brief description of conventional computed tomography and magnetic resonance imaging techniques, this article reviews the ever-developing role of modern imaging techniques in preoperative management of CNS gliomas. It discusses current clinical applications, promising features, and limitations of each imaging method.