Dynamic contrast-enhanced magnetic resonance imaging; a useful tool for characterization and assessment of ovarian masses

Objectives: To evaluate the diagnostic performance of dynamic contrast enhanced magnetic resonance imaging [DCE-MRI] for the characterization of complex ovarian tumors, by using histologic findings as the reference standard

Patients and methods: 25 patients [age range from 24 to 60] with complex ovarian masses underwent DCE-MRI before surgical excision. The study included 8 benign, 3 borderline and 14 malignant masses. The following kinetic parameters were analyzed: enhancement amplitude [EA] in the form of MRE%, time to peak in the form of T max and maximal slope [MS] and correlated with histopathological results

Results: DCE-MRI achieved higher overall accuracy [85.7%] and specificity [86.5%] than conventional MRI. MRE% was higher for malignant than for benign [p0.001] and borderline masses [p0.002]. T max was of shorter duration in malignant than in benign [p, < 0.001] and borderline [p, 0.018] masses. Type III curve was specific for invasive malignant tumors

Conclusion: DCE-MRI can be a useful tool in characterization of complex ovarian masses and in differentiating between borderline and invasive malignant neoplasms

Role of magnetic resonance cholangio-pancreaticography in differentiating between benign and malignant causes of biliary obstruction

Background: the initial evaluation of obstructive jaundice involves distinguishing between intra and extra hepatic biliary obstruction. The goal of any radiologic procedure is to confirm the presence of biliary obstructive by detecting biliary dilatation, its exact location, extent and probable cause

Aim of the Study: to evaluate the role of Magnetic Resonance Cholangio-Pancreatography in differentiating benign from malignant causes of biliary obstruction using surgical, ERCP or histopathological findings as a gold standard

Patients and Methods: a prospective study done on 20 patients with clinical and laboratory finding suggestive of biliary obstruction. All patients underwent non enhanced MRCP on 1.5 Tesla machine [Philips]. The final diagnosis of MRCP was correlated with results of ERCP in addition to biopsy and histological diagnosis to those patients had neoplasms

Results: Out of 20 cases, there were 11 benign and 9 malignant cases. Mean age of patients with malignant obstruction was more than benign with slight female preponderance. The diagnostic accuracy of MRCP in differentiating benign from malignant biliary obstructive diseases in correlation with surgical, ERCP and histopathological outcome was85.7%, 96.3%, and 93.3% respectively. It was found that irregular, asymmetric and long segment narrowing was more common in malignant stricture

Conclusion: MRCP is a rapid and non-invasive, procedure in assessing cases with suspicions biliary obstructions. It offered a diagnostic accuracy nearly equivocal to ERCP. MRCP can also replace the diagnostic part of ERCP procedure, so that time is spent only on its th erapeutic part, and hence decreasing complications of a lengthy ERCP

Recommendations: benign or malignant nature of biliary obstruction can be assured by MRCP by observation of stricture margin, dilatation, and length and accordingly proceed to next step in management. MRCP is an efficient diagnostic procedure for detection of presence, level, cause of obstruction and routinely advocated before any intervention is planned

How to Improve Eating Behaviour during Early Childhood / 대한소아소화기영양학회지

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.