CT Imaging Patterns in Major Histological Types of Lung Cancer.

Lung cancer ranks as the second most prevalent cancer globally and is the primary contributor to neoplastic-related deaths. The approach to its treatment relies on both tumour staging and histological type determination. Data indicate that the prognosis of lung cancer is strongly linked to its clinical stage, underscoring the importance of early diagnosis in enhancing patient outcomes. Consequently, the choice of an appropriate diagnostic method holds significant importance in elevating both the early detection rate and prognosis of lung cancer. This paper aims to assess computer tomography features specific to the most common lung cancer types (adenocarcinoma, squamous cell carcinomas and small cell lung cancer). Data were collected retrospectively from CT scans of 58 patients pathologically diagnosed with lung cancer. The following CT features were evaluated and recorded for each case: location, margins, structure, lymph node involvement, cavitation, vascular bundle-thickening, bronchial obstruction, and pleural involvement. Squamous cell carcinoma (SQCC) and small cell lung cancer (SCLC) showed a higher incidence of central location, while adenocarcinoma (ADC) showed a significant predilection for a peripheral location. Internal cavitation was mostly observed in SQCC, and a solid structure was observed in almost all cases of ADC. These features can provide information about the prognosis of the patient, considering that NSCLCs are more frequent but tend to demonstrate positive results for targetable driver mutations, such as EGFR, thereby increasing the overall survival. In addition, SCLC presents with early distant spreads, which limits the opportunity to investigate the evolution of tumorigenesis and gene alterations at early stages but can have a rapidly positively response to chemotherapy. The location of the lung cancer exhibits distinct forecasts, with several studies suggesting that peripheral lung tumours offer a more favourable prognosis. Cavity formation appears correlate with a poorer prognosis. Histopathological analysis is the gold standard for diagnosing the type of lung cancer; however, using CT scanning for the purpose of a rough, but fast, preliminary diagnosis has the potential to shorten the waiting time for treatment by helping clinicians and patients to know more about the diagnosis and prognosis.

Refined Detection and Classification of Knee Ligament Injury Based on ResNet Convolutional Neural Networks.

Currently, medical imaging has largely supplanted traditional methods in the realm of diagnosis and treatment planning. This shift is primarily attributable to the non-invasive nature, rapidity, and user-friendliness of medical-imaging techniques. The widespread adoption of medical imaging, however, has shifted the bottleneck to healthcare professionals who must analyze each case post-image acquisition. This process is characterized by its sluggishness and subjectivity, making it susceptible to errors. The anterior cruciate ligament (ACL), a frequently injured knee ligament, predominantly affects a youthful and sports-active demographic. ACL injuries often leave patients with substantial disabilities and alter knee mechanics. Since some of these cases necessitate surgery, it is crucial to accurately classify and detect ACL injury. This paper investigates the utilization of pre-trained convolutional neural networks featuring residual connections (ResNet) along with image-processing methods to identify ACL injury and differentiate between various tear levels. The ResNet employed in this study is not the standard ResNet but rather an adapted version capable of processing 3D volumes constructed from 2D image slices. Achieving a peak accuracy of 97.15% with a custom split, 96.32% through Monte-Carlo cross-validation, and 93.22% via five-fold cross-validation, our approach enhances the performance of three-class classifiers by over 7% in terms of raw accuracy. Moreover, we achieved an improvement of more than 1% across all types of evaluation. It is quite clear that the model's output can effectively serve as an initial diagnostic baseline for radiologists with minimal effort and nearly instantaneous results. This advancement underscores the paper's focus on harnessing deep learning for the nuanced detection and classification of ACL tears, demonstrating a significant leap toward automating and refining diagnostic accuracy in sports medicine and orthopedics.

Can MRI Accurately Diagnose and Stage Endometrial Adenocarcinoma?

Background and Objectives: Endometrial carcinoma is one of the most common gynecological cancers, and benign lesions such as endometrial hyperplasia, polyps, adenomyosis and leiomyomas should be included in the differential diagnosis. Magnetic resonance imaging has an important role in evaluating endometrial cancer and assessing the depth of myometrial invasion, and it closely correlates with the prognosis of the patient. The purpose of this study is to evaluate the MRI semiology of the endometrial carcinomas that mimic benign lesions, the main factors that may affect the correct diagnosis and the feasibility of magnetic resonance imaging to evaluate the depth of the myometrial invasion of endometrial cancer. Materials and Methods: This is a retrospective analysis of 45 patients that underwent MRI examinations and the lesions were pathologically diagnosed as endometrial carcinoma after surgical resection. This study evaluated the staging accuracy of T2-weighted imaging, diffusion-weighted imaging (DWI), ADC mapping and T1-weighted imaging with fat saturation before and after gadolinium injection. Results: In 36 of the 45 cases, the MRI of the lesion showed the characteristics of endometrial cancer and the diagnosis was certain. Nine lesions (20%) were described as unequivocal and had unspecific MR appearance. In eight of the nine cases (89%), the histopathologic report revealed the presence of leiomyomas and two of these cases (22%) were also associated with adenomyosis. The cause of underestimation in these patients was coexisting lesions exhibiting heterogenous intensity and contrast enhancement, which made it difficult to detect the margins of the lesions. The depth of the myometrial invasion was underestimated in nine cases and overestimated in three cases. The staging accuracy with MRI was 74%. There was a significant correlation between MR imaging and histopathologic finding in the assessment of myometrial invasion (p < 0.001). Cervical extension was noted in eight cases (18%), but was missed on MR imaging in two patients and overstaged in none. Six of them were associated with myometrial invasion in more than 50% of the thickness. There was a significant correlation between MR imaging and histopathologic finding in the assessment of cervical extension (p < 0.001). Conclusions: Our data confirm the high accuracy of MRI in the diagnosis and local staging of endometrial carcinoma. The information provided by MRI has an important role in planning the treatment and the prognosis of the patients.

Correlation of the Pro-Inflammatory Cytokines IL-1ß, IL-6, and TNF-α, Inflammatory Markers, and Tumor Markers with the Diagnosis and Prognosis of Colorectal Cancer.

Colorectal cancer (CRC) remains one of the most important global health problems, being in the top 3 neoplasms in terms of the number of cases worldwide. Although CRC develops predominantly from the adenoma-adenocarcinoma sequence through APC gene mutations, in recent years, studies have demonstrated the role of chronic inflammation in this neoplasia pathogenesis. Cytokines are important components of chronic inflammation, being some of the host regulators in response to inflammation. The pro-inflammatory cytokines IL-1ß, IL-6, and TNF-α are involved in tumor cell proliferation, angiogenesis, and metastasis and seem to strengthen each other's mode of action, these being stimulated by the same mediators. In our study, we collected data on 68 patients with CRC and 20 healthy patients from the Gastroenterology Department of Craiova County Emergency Clinical Hospital, who were assessed between January 2022 and February 2023. The main purpose of this study was to investigate the correlation between increased plasma levels of the cytokines and the extent of the tumor, lymph nodes, and metastasis-(TNM stage), as well as the patients' prognoses. We also compared the plasma levels of cytokines and acute inflammatory markers, namely, the erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and fibrinogen, along with the tumor markers, carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA 19.9), in CRC patients. We showed that all the pro-inflammatory cytokines studied had higher levels in patients with CRC in comparison with the control group. We also showed that the acute inflammatory markers of erythrocyte sedimentation rate, C-reactive protein, and fibrinogen, and the tumor markers of CEA and CA 19.9 can be useful in diagnosis and prognosis in patients with CRC. Considering the association between pro-inflammatory cytokines and CRC, the development of new targeted therapies against IL-1ß, IL-6, and TNF-α can improve patient care and the CRC survival rate.

Assessment of Ileal Crohn's Disease Activity by Gastrointestinal Ultrasound and MR Enterography: A Pilot Study.

INTRODUCTION: In some cases, there may be a discrepancy between the symptomatology alleged by Crohn's disease (CD) patients and the results of laboratory tests or imaging investigations. Ileocolonoscopy with biopsy is the primary investigation for diagnosing and monitoring CD patients. Cross-sectional imaging techniques such as CT or MR enterography (MRE) and intestinal ultrasonography (IUS) have been proposed as complementary methods to colonoscopy for a complete evaluation of this category of patients. This study aims to identify the role of IUS, contrast-enhanced ultrasound (CEUS) and MRE in evaluating ileal CD activity, using clinical severity scores (Crohn's disease activity index-CDAI, Harvey-Bradshaw index-HBI) and faecal calprotectin or C-reactive protein (CRP) levels as reference methods. MATERIALS AND METHODS: A total of 44 adult patients with ileal CD confirmed using an ileocolonoscopy with biopsy and histopathological examination were assessed by IUS, CEUS and MRE. The evaluation of the disease activity based on the results obtained from the cross-sectional imaging tests was carried out by using some severity scores available in the literature. The sensitivity and specificity of IUS + CEUS and MRE for differentiating active from inactive forms of CD were determined using CDAI, HBI, faecal calprotectin and CRP as reference methods. The accuracy of the results was assessed by the receiver operating characteristics method. The Pearson correlation coefficient was used to determine the types of correlation. A p-value less than 0.05 suggested a statistically significant relationship. RESULTS: Compared to CDAI, the best correlation was identified for Limberg score (r = 0.667, 95% confidence interval (CI) [0.46, 0.8], p < 0.001), followed by MaRIAs score (r = 0.614, 95% CI [0.39, 0.77], p < 0.001). A sensitivity of 93.33% and a specificity of 71.43% (AUC = 0.98) were demonstrated in the case of Limberg score for differentiating patients with active disease from those in remission and for MaRIAs score a sensitivity of 100.00% and a specificity of 57.14% (AUC = 0.97). Regarding HBI, the best correlation was observed for MaRIAs score (r = 0.594, 95% CI [0.36, 0.76], p < 0.001). Also, faecal calprotectin showed the best correlation with MaRIAs score (r = 0.697, 95% CI [0.46, 0.84], p < 0.001), but in the case of CRP, there was only a weak correlation for all evaluated scores. CONCLUSIONS: Although magnetic resonance imaging does not appear to be superior to ultrasonography in terms of accuracy for differentiating active forms of CD from those in remission, the results of our study suggest that MRE associates a better correlation with clinical severity scores and faecal calprotectin levels compared to ultrasonography. More studies are needed to validate these results.

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion.

Prostate cancer is among the most frequently diagnosed cancers and a leading cause of cancer-related death in men. Currently, the most reliable and widely used imaging test for prostate cancer diagnosis is multiparametric pelvic magnetic resonance imaging (mpMRI). Modern biopsy techniques are based on the computerised merging of ultrasound and MRI images to provide better vision during the biopsy procedure (Fusion Biopsy). However, the method is expensive due to high equipment cost. Cognitive fusion of ultrasound and MRI images has recently emerged as a cheaper and easier alternative to computerised fusion. The aim of this prospective study is to perform an in-patient comparison of the systematic prostate biopsy procedure (SB) vs. cognitive fusion (CF) guided prostate biopsy method in terms of safety, ease of use, cancer detection rate and clinically significant cancer detection. We enrolled 103 patients with suspected prostate cancer that were biopsy naive, with PSA > 4 ng/dL and PIRADS score of 3, 4 or 5. All patients received a transperineal standard 12-18 cores systematic biopsy (SB) and a four-cores targeted cognitive fusion (CF) biopsy. Following the prostate biopsy, 68% of the patients were diagnosed with prostate cancer (70/103 patients). SB diagnosis rate was 62% while CF biopsy was slightly better with a 66% rate. There was a significant 20% increase in clinically significant prostate cancer detection rate for the CF compared to SB (p < 0.05) and a significant prostate cancer risk upgrade from the low to the intermediate risk category (13%, p = 0.041). Transperineal cognitive fusion targeted prostate biopsy is a straightforward biopsy method that is easy to perform and is a safe alternative to standard systematic biopsy with improved significant cancer detection accuracy. A combined targeted and systematic approach should be used for the best diagnostic results.

Tumor Area Highlighting Using T2WI, ADC Map, and DWI Sequence Fusion on bpMRI Images for Better Prostate Cancer Diagnosis.

Prostate cancer is the second most common cancer in men worldwide. The results obtained in magnetic resonance imaging examinations are used to decide the indication, type, and location of a prostate biopsy and contribute information about the characterization or aggressiveness of detected cancers, including tumor progression over time. This study proposes a method to highlight prostate lesions with a high and very high risk of being malignant by overlaying a T2-weighted image, apparent diffusion coefficient map, and diffusion-weighted image sequences using 204 pairs of slices from 80 examined patients. It was reviewed by two radiologists who segmented suspicious lesions and labeled them according to the prostate imaging-reporting and data system (PI-RADS) score. Both radiologists found the algorithm to be useful as a "first opinion", and they gave an average score on the quality of the highlight of 9.2 and 9.3, with an agreement of 0.96.

Is the Ellipsoid Formula Reliable in Prostate MRI?

Our study seeks to study the accuracy of the ellipsoidal formula in prostate MRI of different sizes and to establish the limits of its use. The study included 31 patients with a well-visualized, intact prostatic capsule, excluding malignantly transformed prostates, as well as treated prostates, in which the contrast between the prostatic capsule and parenchyma is reduced. Each patient's prostatic volume was recalculated according to the ellipsoidal formula, and then it was compared with the prostatic volume calculated by the segmentation method. The two calculated volumes were similar, in some cases almost identical, with a slight tendency to underestimate prostate volume below 100cm3, in total in 18 cases, on average by 7.6% (+/-6%), overestimation of those with a volume over 100cm3, a total of 13 cases, on average by 3.2% (+/-2.5%), and of all, in 4 cases the difference between the two formulas was below 1%. There was no statistical difference between the two variables, Student's t-test p-value=0.039. With a precision of 92% (+/-6%), the ellipsoidal formula can be considered accurate when it is correctly performed, but if we take into account the importance that PSA density is starting to have in diagnosis, treatment and follow-up, the calculation of a secondary value through the segmentation method or high-precision software can be motivated when the ellipsoidal formula returns a value close to a threshold.

Should PI-RADS 3 be Subclassified According to ADC Values in the Transition Zone?

The premise of this paper starts from the fact that a more precise definition related to the intensity of the lesions on the ADC sequence can lead to a new subclassification of PI-RADS 3 lesions in the transitional zone and to an improvement of the specificity of the PI-RADS classification. The study was retrospective and included only patients who, based on prostate MRI examinations, contained exclusively PI-RADS 3 lesions, without other PI-RADS 4 or 5 lesions. The number of cases that meet all these conditions was reduced to 18, where a series of characteristics were noted for each one: PI-RADS 3 lesion area on the ADC sequence, the minimum and average ADC value of the lesion, the average ADC value of the transitional zone outside the lesion, PSA, prostatic volume, PSA density and biopsy result. The average ADC value of the negative lesions was 865(165) m2/sec, and of the positive ones was 869(118) m2/sec, which denies the hypothesis that there could be a value limit ADC to delimit PI-RADS 3 from PI-RADS 2 or 4 in this sample of patients. Furthermore, we reported the average ADC value of each such lesion to the adjacent unchanged transitional zone and obtained a greater difference of 432(163) m2/sec between the negative lesions and their adjacent transitional zone, compared to the difference of 399(127) m2/sec between the positive lesions and their adjacent ones.

Computer-Aided Diagnosis of Pulmonary Nodules in Rheumatoid Arthritis.

(1) Background: Rheumatoid arthritis (RA) is considered a systemic inflammatory pathology characterized by symmetric polyarthritis associated with extra-articular manifestations, such as lung disease. The purpose of the present study is to use CAD in the detection of rheumatoid pulmonary nodules. In addition, we aim to identify the characteristics and associations between clinical, laboratory and imaging data in patients with rheumatoid arthritis and lung nodules. (2) Methods: The study included a number of 42 patients diagnosed with rheumatoid arthritis according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria, examined from January 2017 to November 2022 in the Departments of Rheumatology and Radiology and Medical Imaging of the University of Medicine and Pharmacy of Craiova. Medical records were reviewed. A retrospective blinded review of CT for biopsy-proven pulmonary nodules in RA using Veolity LungCAD software was performed (MeVis Medical Solutions AG, Bremen, Germany). Imaging was also reviewed by a senior radiologist. (3) Results: The interobserver agreement proved to be moderate (κ = 0.478) for the overall examined cases. CAD interpretation resulted in false positive results in the case of 12 lung nodules, whereas false negative results were reported in the case of 8 lung nodules. The mean time it took for the detection of lung nodules using CAD was 4.2 min per patient, whereas the detection of lung nodules by the radiologist was 8.1 min per patient. This resulted in a faster interpretation of lung CT scans, almost reducing the detection time by half (p < 0.001). (4) Conclusions: The CAD software is useful in identifying lung nodules, in shortening the interpretation time of the CT examination and also in aiding the radiologist in better assessing all the pulmonary lung nodules. However, the CAD software cannot replace the human eye yet due to the relative high rate of false positive and false negative results.

Novel Biomarkers, Diagnostic and Therapeutic Approach in Rheumatoid Arthritis Interstitial Lung Disease-A Narrative Review.

Rheumatoid arthritis (RA) is considered a systemic inflammatory disease marked by polyarthritis which affects the joints symmetrically, leading to progressive damage of the bone structure and eventually joint deformity. Lung involvement is the most prevalent extra-articular feature of RA, affecting 10-60% of patients with this disease. In this review, we aim to discuss the patterns of RA interstitial lung disease (ILD), the molecular mechanisms involved in the pathogenesis of ILD in RA, and also the therapeutic challenges in this particular extra-articular manifestation. The pathophysiology of RA-ILD has been linked to biomarkers such as anti-citrullinated protein antibodies (ACPAs), MUC5B mutation, Krebs von den Lungen 6 (KL-6), and other environmental factors such as smoking. Patients at the highest risk for RA-ILD and those most likely to advance will be identified using biomarkers. The hope is that finding biomarkers with good performance characteristics would help researchers better understand the pathophysiology of RA-ILD and, in turn, lead to the development of tailored therapeutics for this severe RA manifestation.

Diagnostic Value of Artificial Intelligence-Assisted Endoscopic Ultrasound for Pancreatic Cancer: A Systematic Review and Meta-Analysis.

We performed a meta-analysis of published data to investigate the diagnostic value of artificial intelligence for pancreatic cancer. Systematic research was conducted in the following databases: PubMed, Embase, and Web of Science to identify relevant studies up to October 2021. We extracted or calculated the number of true positives, false positives true negatives, and false negatives from the selected publications. In total, 10 studies, featuring 1871 patients, met our inclusion criteria. The risk of bias in the included studies was assessed using the QUADAS-2 tool. R and RevMan 5.4.1 software were used for calculations and statistical analysis. The studies included in the meta-analysis did not show an overall heterogeneity (I2 = 0%), and no significant differences were found from the subgroup analysis. The pooled diagnostic sensitivity and specificity were 0.92 (95% CI, 0.89-0.95) and 0.9 (95% CI, 0.83-0.94), respectively. The area under the summary receiver operating characteristics curve was 0.95, and the diagnostic odds ratio was 128.9 (95% CI, 71.2-233.8), indicating very good diagnostic accuracy for the detection of pancreatic cancer. Based on these promising preliminary results and further testing on a larger dataset, artificial intelligence-assisted endoscopic ultrasound could become an important tool for the computer-aided diagnosis of pancreatic cancer.

Imaging Features of Rare Breast Lesions in Young Women.

Rare breast tumors, such as, pseudoangiomatous stromal hyperplasia, granulomatous mastitis, tubular adenoma, myofibroblastoma and xanthogranulomatous mastitis, sarcomas, neuroendocrine tumors can sometimes be misdiagnosed because of the similarities in their imagistic characteristics. The main objective of our report is to emphasize the importance of performing ultrasound-guided breast biopsies of suspect lesions in young patients. We performed an US-guided breast biopsy instead of an excisional biopsy because breast surgery has a huge psychological impact. We selected 3 atypical breast tumors in young women, with different clinical signs and symptoms, some of which similar to other breast lesions, but with rapid growth, which needed a different and multiple imaging approach.

Deep Learning: a Promising Method for Histological Class Prediction of Breast Tumors in Mammography.

The objective of the study was to determine if the pathology depicted on a mammogram is either benign or malignant (ductal or non-ductal carcinoma) using deep learning and artificial intelligence techniques. A total of 559 patients underwent breast ultrasound, mammography, and ultrasound-guided breast biopsy. Based on the histopathological results, the patients were divided into three categories: benign, ductal carcinomas, and non-ductal carcinomas. The mammograms in the cranio-caudal view underwent pre-processing and segmentation. Given the large variability of the areola, an algorithm was used to remove it and the adjacent skin. Therefore, patients with breast lesions close to the skin were removed. The remaining breast image was resized on the Y axis to a square image and then resized to 512 × 512 pixels. A variable square of 322,622 pixels was searched inside every image to identify the lesion. Each image was rotated with no information loss. For data augmentation, each image was rotated 360 times and a crop of 227 × 227 pixels was saved, resulting in a total of 201,240 images. The reason why our images were cropped at this size is because the deep learning algorithm transfer learning used from AlexNet network has an input image size of 227 × 227. The mean accuracy was 95.8344% ± 6.3720% and mean AUC 0.9910% ± 0.0366%, computed on 100 runs of the algorithm. Based on the results, the proposed solution can be used as a non-invasive and highly accurate computer-aided system based on deep learning that can classify breast lesions based on changes identified on mammograms in the cranio-caudal view.

An extremely uncommon case of pancreatic extragastrointestinal stromal tumor in a 53-year-old female patient.

Gastrointestinal stromal tumors (GISTs) are the most frequently encountered mesenchymal tumors that develop anywhere along the gastrointestinal (GI) tract, but they account for less than 1% of all GI tumors. However, GISTs can also develop outside the GI tract. They are referred to as extragastrointestinal stromal tumors (EGISTs) and represent around 5-10% of all GISTs. In this latter case, the tumor itself is not connected to the GI tract and can affect the omentum, mesentery, and retroperitoneum. EGISTs can also originate from the pancreas, but they are extremely uncommon. It is estimated that pancreatic EGISTs account for about 5% of all EGISTs, with around 30 cases being reported in the literature so far. The current report presents an extremely rare case of pancreatic EGIST encountered in a 53-year-old woman with no remarkable personal or family medical history. Surgical resection of the pancreatic head tumor through pancreaticoduodenectomy using Whipple procedure combined with negative resection margins and adjuvant Imatinib mesylate treatment led to a favorable postoperative evolution. The follow-up at six months after surgery did not reveal any malignant changes.

Covid-19 Pandemic Impact on Breast Cancer Detection-The Major Effects Over an Early Diagnosis.

The COVID-19 pandemic has disrupted medical care systems, by decreasing patient addressability to outpatient care. The main objective of this study was to compare the patient's addressability to breast imaging techniques for diagnosis, and follow-up in the Clinical Emergency County Hospital of Craiova, Romania. We selected the mammographies performed over a period of 4 years (2018-2021) in our clinic. We divided the patients into four groups, one for each year (2018, 2019, 2020, 2021). Furtherly, we merged the data into two groups, one group for the pre-pandemic years (2018 and 2019) and one for the pandemic years (2020 and 2021). In our clinic, the number of mammographies plummeted to 0 during the month of April 2020 due to the lockdown and closure of non-urgent outpatient services in hospitals treating COVID-19 patients, and slowly creeped to 11 in the month of May and peaked to 160 in July (for the rest of the year). There was a huge difference regarding the patient's addressability to mammography immediately after the lockdown, with a 95.2% less addressability compared to the pre-pandemic period (May 2020 compared to May 2018). As an overall, by comparing both pre-pandemic years included in the study with the pandemic years, we obtained an addressability reduced with 37.3% suggesting the possible future delays in diagnosing breast tumors.

MR spectroscopy of the liver - a reliable non-invasive alternative for evaluating non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common conditions worldwide that targets the liver parenchyma. NAFLD represents an intrahepatic triglyceride accumulation in the absence of excessive alcohol consumption and other diseases that affect the liver parenchyma. The current "gold standard" for evaluating the amount of intrahepatic fat is represented by liver biopsy, but many patients are reluctant and hardly accept undergoing this procedure due to its invasive nature. The current study addresses this aspect by evaluating the reliability of liver magnetic resonance spectroscopy (MRS) in diagnosing NAFLD, compared to the traditional invasive liver biopsy. The present study included a total of 38 patients based on several well-defined inclusion and exclusion criteria. We used the same NAFLD grading system for both liver MRS and liver biopsy: grade 0: <5% hepatocytes are affected; grade I: 5-33% hepatocytes are affected; grade II: 34-66% hepatocytes are affected; grade III: >66% hepatocytes are affected. Regarding the NAFLD grade, over three-quarters of patients were classified as grade I and grade II, with a strong predilection for men. The current results indicated a significant association between the NAFLD grade indicated by liver MRS and the NAFLD grade indicated by liver biopsy. At the end of our study, we recommend using liver MRS for evaluating and grading NAFLD in association with other parameters like serum triglycerides and body mass index grade as this protocol can enhance early detection and provide an accurate grading that will lead to a proper management of this disease.

An extremely rare case of distal common bile duct adenocarcinoma in a 65-year-old male patient.

Cholangiocarcinoma is an extremely rare and highly aggressive primary malignancy of the biliary tract. The current report illustrates a rare case of distal common bile duct adenocarcinoma encountered in a 65-year-old male patient who was thoroughly investigated after presenting with a two weeks history of pain in the right hypochondrium, jaundice and unintentional weight loss (6 kg in two weeks). The medical team opted for a pancreaticoduodenectomy (Whipple procedure) managing to obtain negative resection margins of the tumor with a favorable immediate postoperative evolution. However, the surgical team was forced to reintervene twice due to complications caused mainly by the patient's disregard.