Application of low-dose hydro-CT using SAFIRE in the evaluation of esophageal cancer.

BACKGROUND: The esophageal cancer treatment strategy depends on the tumor stage according to the tumor, node and metastasis (TNM) classification. One of the methods recommended for esophageal cancer assessment is computed tomography (CT). The CT imaging is especially important for patients with contraindications for gastroscopy, which is the primary method used for assessing esophageal diseases. OBJECTIVES: The aim of this retrospective study was to evaluate the inter-rater reliability of low-dose hydro-CT with a sinogram-affirmed iterative reconstruction algorithm (SAFIRE) used for the staging of esophageal cancer by 2 independent radiologists. We also evaluated the application of this method for the diagnosis of esophageal cancer. MATERIAL AND METHODS: Low-dose hydro-CT was performed in 65 patients, and the raw data were reconstructed with SAFIRE. Obtained images were retrospectively interpreted by 2 independent and experienced radiologists. Histopathological results were used as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in the diagnosis of esophageal cancer were calculated for hydro-CT. The examination of the inter-rater reliability level in the assessment of the esophageal cancer stage in the TNM classification was performed by calculating Cohen's kappa coefficient (κ) with square weights and standard errors (SEs) for kappa. Independence tests were also performed (Fisher's exact test - two-tailed, and Pearson's χ2 test). RESULTS: For the diagnosis of esophageal cancer with hydro-CT, a sensitivity of 93%, a specificity of 100%, a PPV of 100%, and a NPV of 88% were observed. In the statistical analyses for the T, N and M stages, κ values greater than 0.90 and significance levels of p < 0.001 were obtained. CONCLUSIONS: Hydro-CT using low-dose techniques may be a valuable diagnostic method for staging and diagnosis of esophageal cancer, especially in patients with contraindications for invasive procedures.

Atypical Enhancement of Gd-BOPTA on the Hepatobiliary Phase in Hepatic Metastasis from Carcinoid Tumor - Case Report.

BACKGROUND Carcinoid tumor is the most frequent neuroendocrine tumor (NET) that causes liver metastases. One of the best methods to assess this type of pathology is magnetic resonance imaging with hepatocyte-specific contrast media with low molecular weight gadolinium chelate Gd-BOPTA. As these lesions do not contain hepatocytes, they present as hypointense on MRI in comparison with liver tissue which enhances this type of contrast. CASE REPORT In this article, we present a case of a 65-year-old female patient who was admitted to the Emergency Department with abdominal pain. Computed tomography revealed a single focal lesion in her liver. The patient underwent further evaluation using magnetic resonance imaging (MRI). The hepatobiliary phase MRI showed an unspecific homogenous enhancement of the hepatobiliary agent Gd-BOPTA. Since the lesion was interpreted as a non-characteristic lesion, the patient was discharged from the hospital with a recommendation for early follow-up. The follow-up MRI 6 months after discharge disclosed multiple liver metastases. CONCLUSIONS Liver metastases generally demonstrate enhancement of hepatobiliary contrast agents in the T1-weighted hepatocellular phase. Metastasis from a carcinoid tumor may also demonstrate this enhancement.

The Use of Basket and Cross Shell Reinforcement in Revision Acetabulum Arthroplasty.

BACKGROUND: In spite of many decades of experience and huge data resources to evaluate the results of increasingly difficult and extensive acetabulum revision operations, it is not possible to obtain fully satisfactory results. This article presents the indications for use, surgical technique, and distant and intermediate-range results in the operation of replacing a loosened acetabular component of an endoprosthesis with accompanying extensive cavitary or segmental floor defects. MATERIAL AND METHODS: A retrospective evaluation was performed on 65 hips in 55 patients, including bila-teral procedures in 8 women and 2 men, operated on between 1994 and 2012. The mean age of the patients at the time of surgery was 66 +/- 16 years. The average duration of follow-up was 9 years and 3 months. RESULTS: Clinical results at 36 months from the surgery showed that the Harris Hip Score had increased by a mean of 47.2 HHS points and the WOMAC index had increased by 37.7 points. CONCLUSIONS: 1. The use of the method described in the article in selected cases produces good and excellent results, especially with the use of double reinforcement. 2. A basic prerequisite for the use of the basket is stable support for at least 3 arms of the basket on the acetabular bone reinforcement ring and good protection of grafts in the bone stock with sufficient biological capacity.

Clinical applications of spleen ultrasound elastography - a review.

In the last few years, notable technical progress has taken place in ultrasound elastography. Qualitative methods have been replaced by quantitative ones, such as: transient elastography, acoustic radiation force impulse and shear wave elastography. Owing to the fact that the spleen is superficially located, it is possible to obtain reliable measuring accuracy of its hardness using sonoelastography. Lately, many researchers have been investigating how spleen elasticity changes in patients infected with hepatitis B virus or hepatitis C virus and in patients suffering from liver fibrosis, portal hypertension, esophageal varices or myelofibrosis. In this article, we review the role and current status of accessible qualitative ultrasound elastography methods, including recent advances in the evaluation of spleen stiffness and its clinical utility. As study results demonstrate, spleen stiffness correlates with liver fibrosis and is helpful in determining the level of fibrosis in the METAVIR scoring system. In patients infected with hepatitis B virus or hepatitis C virus, spleen stiffness increases even when liver elasticity remains unaltered. Furthermore, it is useful in diagnosing portal hypertension or predicting existence of esophageal varices. Moreover, in patients suffering from biliary atresia after Kasai portoenterostomy, spleen sonoelastography may be helpful in selecting patients for liver transplantation as well as for choosing the best strategy for portal vein reconstruction before liver transplantation. In myelofibrosis, spleen stiffness correlates with bone marrow fibrosis and may be used to assess the response to treatment. Spleen sonoelastography is also useful in the monitoring of transjugular intrahepatic portosystemic shunt function.