The Diagnostic Value of CEUS in Assessing Non-Ossified Thyroid Cartilage Invasion in Patients with Laryngeal Squamous Cell Carcinoma.

Background: Accurate assessment of thyroid cartilage invasion in squamous cell carcinoma (SCC) of the larynx remains a challenge in clinical practice. The aim of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CECT), and magnetic resonance imaging (MRI) in the detection of non-ossified thyroid cartilage invasion in patients with SCC. Methods: CEUS, CECT, and MRI scans of 27 male patients with histologically proven SCC were evaluated and compared. A total of 31 cases were assessed via CEUS and CECT. The MR images of five patients and six cases were excluded (one patient had two suspected sites), leaving twenty-five cases for analysis via MRI. Results: CEUS showed the highest accuracy and specificity compared with CECT and MRI (87.1% vs. 64.5% and 76.0% as well as 84.0% vs. 64.0% and 72.7%, respectively). The sensitivity and negative predictive value of CEUS and MRI were the same (100%). CEUS yielded four false-positive findings. However, there were no statistically significant differences among the imaging modalities (p > 0.05). Conclusions: CEUS showed better diagnostic performance than CECT and MRI. Therefore, CEUS has the potential to accurately assess non-ossified thyroid cartilage invasion and guide appropriate treatment decisions, hopefully leading to improved patient outcomes.

Leiomyosarcoma of the inferior vena cava.

Leiomyosarcoma is a rare tumor of mesenchymal origin usually affecting the inferior vena cava. Early diagnosis is essential before surgical resection, which is the only therapeutic modality that prolongs patients' survival. Ultrasonography, computer tomography, and magnetic resonance imaging are the main imaging modalities in this case. Combined with guided biopsies, they form the mainstay of reliable diagnosis. We report a case with retroperitoneal tumor arising from the middle segment of the inferior vena cava. Radiological examination revealed retroperitoneal tumor and helped to choose surgical treatment. Histopathological examination confirmed the diagnosis of leiomyosarcoma of the inferior vena cava.

Hepatic venous pressure gradient measurement in patients with liver cirrhosis: a correlation with disease severity and variceal bleeding.

UNLABELLED: The aim of present study was to evaluate relationships between degree of portal hypertension, severity of the disease, and bleeding status in patients with liver cirrhosis. PATIENTS AND METHODS: All study patients with liver cirrhosis underwent hepatic venous pressure gradient measurements, endoscopy, clinical and biochemical evaluation. Liver function was evaluated according to Child-Turcotte-Pugh (Child's) scoring system. Patients with decompensated cirrhosis (presence of severe ascites, acute variceal bleeding occurring within 14 days, hepatorenal syndrome, cardiopulmonary disorders, transaminase levels >10 times higher the upper normal limit), active alcohol intake, use of antiviral therapy and/or beta-blockers were excluded from the study. RESULTS: One hundred twenty-eight patients with liver cirrhosis (male/female, 67/61; mean age, 53.8+/-12.7 years) were included into the study. Etiology of cirrhosis was viral hepatitis, alcoholic liver disease, cryptogenic and miscellaneous reasons in 57, 49, 14, and 8 patients, respectively. Child's stages A, B, and C of liver cirrhosis were established in 28 (21.9%), 70 (54.9%), and 30 (23.4%) patients, respectively. The mean hepatic venous pressure gradient significantly differed among patients with different Child's classes: 13.8+/-5.3 mm Hg, 17.3+/-4.6 mm Hg, and 17.7+/-5.05 mm Hg in Child's A, B, and C classes, respectively (P=0.003). The mean hepatic venous pressure gradient in patients with grade I, II, and III varices was 14.8+/-4.5, 16.1+/-4.3, and 19.3+/-4.7 mm Hg, respectively (P=0.0001). Since nonbleeders had both small and large esophageal varices, patients with large varices were analyzed separately. The mean hepatic venous pressure gradient in patients with large (grade II and III) varices was significantly higher than that in patients with small (grade I) varices (17.8+/-4.8 mm Hg vs 14.6+/-4.8 mm Hg, P=0.007). Thirty-four (26.6%) patients had a history of previous variceal bleeding; all of them had large (20.6% - grade II, and 79.4% - grade III) varices. In patients with large varices, the mean hepatic venous pressure gradient was significantly higher in bleeders than in nonbleeders (18.7+/-4.7 mm Hg vs 15.9+/-4.7 mm Hg, P=0.006). CONCLUSIONS: Hepatic venous pressure gradient correlates with severity of liver disease, size of varices, and bleeding status. Among cirrhotics with large esophageal varices, bleeders have a significantly higher hepatic venous pressure gradient than nonbleeders. Hepatic venous pressure gradient measurement is useful in clinical practice selecting cirrhotic patients at the highest risk of variceal bleeding and guiding to specific therapy.

[The possibility of the investigation of portal vein thrombosis by means of ultrasonography]. / Kepenu vartu venos trombozes ultragarsinio tyrimo galimybes.

Doppler-based sonography investigation of liver blood circulation plays major role in the modern diagnosis of portal hypertension that is frequently caused by portal vein thrombosis. Eight patients with portal vein thrombosis have been investigated. During the sonographic investigation we evaluated the size of liver, focal changes in liver, the diameters of the portal vein and its both branches, of the spleen vein, of the superior mesenteric vein, the direction and the characteristics of the blood flow, portaportic and portasystemic collaterals, and the size of spleen. The thrombosis of the trunk and both branches of the portal vein was detected in 4 patients, out of which there was one case of additional thrombosis of the spleen and the superior mesenteric veins, while in another case there was partial thrombosis of the spleen vein. A separate thrombus of the portal vein trunk was noticed in 1 patient. The thrombosis of the portal vein trunk and the right branch was diagnosed in 1 case. There were 2 cases of thrombosis of only left branch of the portal vein. The cause of the portal vein thrombosis remained undetected in 6 cases. The thrombosis of the portal vein developed as a consequence of pancreatitis in one patient, the cause of another case was hepatocellular carcinoma. In comparison to CT, sonography is able to determine additionally the direction of the blood flow and to record a variety of different sections in detecting the above-mentioned pathology. Doppler-based sonography investigation of liver blood circulation, especially the color-coded, is non-invasive, it can be carried out quickly and does not need expensive contrast medium.