Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions.

The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.

Pleural Neoplasms-What Could MRI Change?

The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.

An Equivocal SCC Lesion-Antiepileptic-Induced CLOCC.

We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs).

Endovascular treatment of visceral artery aneurysms and pseudoaneurysms - evaluation of efficacy and safety based on long-term results.

BACKGROUND: With estimated prevalence of 1% of the general population, visceral artery aneurysms are not a frequent pathology, however, their rupture is a life-threatening occurrence with mortality rate ranging from 10% to 25%, up to 75% in case of pregnant women. Therefore, the identification and treatment of visceral artery aneurysms is of great importance in the prevention of early rupture. PURPOSE: To assess the effectiveness and safety of treatment of visceral artery aneurysms with various endovascular methods focusing on technical aspects, complications and long-term clinical outcome. MATERIALS AND METHODS: 60 patients with visceral artery aneurysms were treated percutaneously. Various techniques were used: coiling (23), covered stents (15), thrombin (7), and other mixed techniques. Aneurysm characteristics, size and localization, procedural data, peri-procedural complications, technical success, 90- and 180-day clinical success and follow-up period (aneurysm exclusion, patency of the artery and complications) were prospectively analyzed. RESULTS: The procedure was performed in 57 of 60 patients. In 56 of 57 patients aneurysms ware effectively excluded. The success rate was 93.3% (56 of 60 enrolled patients). Technical success after the intervention was 82.4%, after second 98.2%. Embolization with covered stents was characterized by the highest efficiency. Serious complications occurred in 1.8% of cases. CONCLUSIONS: The minimally invasive endovascular treatment of visceral artery aneurysms is characterized by high efficacy and safety. Good treatment results depend on proper assessment of the aneurysm's morphology as well as on selection of the appropriate vascular approach and endovascular technique.

Visceral artery aneurysms - classification, diagnosis and treatment.

Although visceral artery aneurysms are rare, mortality due to their rupture is high, estimated at even 25-75%. That is why it is significant to detect each such lesion. Visceral artery aneurysms are usually asymptomatic and found incidentally during examinations performed for other indications. Autopsy results suggest that most asymptomatic aneurysms remain undiagnosed during lifetime. Their prevalence in the population is therefore higher. The manifestation of a ruptured aneurysm depends on its location and may involve intraperitoneal hemorrhage, gastrointestinal and portal system bleeding with concomitant portal hypertension and bleeding from esophageal varices. Wide access to diagnostic tests, for example ultrasound, computed tomography or magnetic resonance imaging, helps establish the correct diagnosis and a therapeutic plan as well as select appropriate treatment. After a procedure, the same diagnostic tools enable assessment of treatment efficacy, or are used for the monitoring of aneurysm size and detection of potential complications in cases that are ineligible for treatment. The type of treatment depends on the size of an aneurysm, the course of the disease, risk of rupture and risk associated with surgery or endovascular procedure. Endovascular treatment is preferred in most cases. Aneurysms are excluded from the circulation using embolization coils, ethylene vinyl alcohol, stents, multilayer stents, stent grafts and histoacryl glue (or a combination of these methods).

Doppler ultrasound appearance of neck tumors.

AIM: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. MATERIAL AND METHOD: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. RESULTS: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases - heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. CONCLUSIONS: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.

Embolization of iatrogenic renal arteriovenous fistula - a case report.

Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms.

Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure.

BACKGROUND: Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure. PURPOSE: To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment. MATERIAL AND METHODS: Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils. RESULTS: In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication - 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed. CONCLUSION: Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.

The relationship between carotid intima-media thickness and the activity of rheumatoid arthritis.

BACKGROUND: Cardiovascular (CV) disease, the most common cause of mortality in patients with rheumatoid arthritis (RA), is largely attributable to accelerated atherosclerosis. Carotid intima-media thickness (cIMT) has been approved as a surrogate marker of early atherosclerosis. OBJECTIVES: The aim of the study was to assess cIMT in RA patients lacking concomitant comorbidities potentially influencing cIMT value. METHODS: The study group consisted of 74 RA patients, without diagnosed heart or kidney disease, hypertension, diabetes, obesity, or current smoking (mean age, 46.4 [SD, 10.6] years; range, 19-70 years). Assessment of cIMT was determined by high-resolution B-mode ultrasonography in RA patients and 31 control subjects (mean age, 42.6 [SD, 8.0] years; range, 27-59 years). RESULTS: The mean maximum cIMT value was significantly greater in RA patients than in control subjects (0.73 [SD, 0.14] vs 0.59 [SD, 0.12] mm; P < 0.0001). In RA patients, cIMT correlated positively with a number of immunological and inflammatory parameters and also with amino-terminal pro-brain natriuretic peptide (NT-proBNP), age, metabolic variables (serum cholesterol, creatinine, cystatin C). In multiple linear regression analysis, significant association was found between cIMT and NT-proBNP and age. Patients without atherosclerosis (cIMT <0.6 mm) were younger and had significantly lower concentrations of NT-proBNP and total cholesterol, as well as higher estimated glomerular filtration rate. The course of RA in patients without atherosclerosis was characterized by shorter disease duration, lower tender joint count, and C-reactive protein. CONCLUSIONS: Values of cIMT were significantly greater in RA compared with control subjects. Features of RA, such as extra-articular manifestations, erosions, high inflammatory parameters, and long disease duration, even in the absence of traditional clinical CV risk factors, were associated with greater cIMT, suggesting an unfavorable CV risk profile.

Spatial QRS-T angle in peritoneal dialysis patients: association with carotid artery atherosclerosis, coronary artery calcification and troponin T.

BACKGROUND: Abnormal values of the spatial angle between the directions of ventricular depolarization and repolarization (QRS-T) predict potently arrhythmic events and mortality in various patients groups. The study was designed to estimate QRS-T in a group of peritoneal dialysis (PD) patients, and to assess the possible association between QRS-T and coronary artery calcification (CAC), atherosclerosis, and some biochemical measurements. METHODS: The angular differences between the maximum spatial QRS and T vectors were reconstructed from ECGs in 57 selected PD patients and in 54 controls. In patients CAC score was performed by using multi-row computed tomography. Atherosclerotic disease was assessed by measuring carotid arteries' intima-media thickness (IMT) and plaque score (sum of the maximum thicknesses in mm of all plaques on both sides) by using an ultrasound scanner. RESULTS: QRS-T was higher in patients compared with controls (34.79% B111.97 and 14.95% B17.87 respectively; P < 0.001). Median CAC score equalled 104.5 Agatson units (Au) (range, 0-2478). IMT was 0.832% B10.208, and atherosclerotic plaques were detected in 82.5% of patients. The plaque score was 7.97% B14.49. QRS-T was higher in patients with CAC score >400 Au compared with patients with CAC score <400 Au (P = 0.011). The results of univariate linear regression analysis showed correlation between QRT-T and dialysis duration (r = 0.305, P = 0,020), LVMI (r = 0.311, P = 0.017), HDL (r = -0.361, P = 0.006), cTnT (r = 0.442, P < 0.001), plaque score (r = 0.403, P = 0.001) and CAC score (r = 0.451, P < 0.001). On multivariate analysis, CAC score, plaque score and troponine T were found to be independent predictors of QRS-T values. CONCLUSIONS: QRS-T is high in PD patients and is mainly associated with coronary artery calcium burden, atherosclerosis and troponin T elevation. The possible clinical importance of the higher QRS-T in PD patients remains to be confirmed in further studies.

Chronic mesenteric ischemia: diagnosis and treatment with balloon angioplasty and stenting.

BACKGROUND: The goal of our research was to evaluate the efficacy of endovascular treatment in stenosis of the superior mesenteric artery and the celiac trunk. MATERIAL/METHODS: During the period 1996-2001, 6 patients (1 woman, 5 men, ages 46 to 73) were referred to our department with abdominal angina. Angiograms were performed in order to establish the reasons. All these patients presented with postprandial abdominal pain and weight loss. Angiography showed stenosis in the superior mesenteric artery in 2 patients, in the celiac trunk in 1 patient, and in both vessels in 3 patients. Typical balloon angioplasty (PTA) was performed with a balloon catheter, 5-8 mm in diameter, inflated up to 18 atm. If more than 30% stenosis remained after PTA, the patient was referred for stenting. RESULTS: In 5 of the 6 patients (83%) PTA was successful. In one patient (17%) with poor results from PTA, a Perflex stent (diameter 7 mm) was implanted in the superior mesenteric artery. The follow-up protocol included clinical and Doppler ultrasonographic examination at 6, 12, and 18 months after surgery. A good clinical and ultrasound outcome was found in 6 patients at 6 and 12 months, and in 4 patients at 18 months. CONCLUSIONS: Balloon angioplasty and stent placement seem to be efficient and safe methods of treatment for abdominal angina in stenosis of the superior mesenteric artery and celiac trunk.