Measurable and Unmeasurable Features of Ultrasound Lymph Node Images in Detection of Malignant Infiltration.

The aim of the study was to assess diagnostic value and utility of selected morphological features in predicting lymph node (LN) malignancy using B-mode, Doppler ultrasonography and multivariate settings in a tertiary radiological referral center. The study included 123 patients having undergone ultrasound-guided fine-needle aspiration and cytologic analysis (FNAC) of cervical, axillary and inguinal LNs. Each LN was characterized by long/L and short/T-axis, shape, margins, echogenicity, cortical thickness, vascularization, and examiner's subjective impression. Within the limitations of FNAC, altered shape and vascularization had relatively high specificity and positive predictive value (>80%), whereas subjective impression had high sensitivity and negative predictive value (100%) for malignancy. The cut-off levels for different features of LN by ROC analysis were as follows: long-axis 23 mm, short-axis 11 mm, L/T ratio 2.19, and maximal cortical thickness 5.1 mm. On multivariate analysis (adaptive regression splines, n=108), the addition of long-axis, L/T ratio, age and sex considerably improved diagnostic accuracy (88%), sensitivity (margins + vascularization) and specificity (subjective impression) of the diagnostic model. The combination of morphological and demographic features could improve diagnostic accuracy, usually with a trade-off between the sensitivity and specificity of the predictive model. The performance may depend on the level of expertise and institutional settings.

[Rare renal anomalies in childhood]. / Rijetka anomalija bubrega u djecjoj dobi.

Three patients with megacalycosis, a rare ren anomaly which includes dilatation of all ren calices, are presented. The symptoms of acute uroinfection were present in all three patients. The patients underwent clinical observation, laboratory testing, and renal ultrasound. Ultrasound revealed unilateral hydronephrosis in all three patients. Additional examinations included static and dynamic renal scintigraphy, voiding cystourethrography, and intravenous urography which pointed to unilateral megacalycosis. The symptoms of acute uroinfection were probably triggered by urinary stasis in dilated calices. Surgical intervention is not indicated in megacalycosis. The increasing incidence of uroinfection, urolithiasis and hematuria imposed the need of continuous follow-up in these patients.

[The value of Tc99m-DMSA renal scintigraphy in evaluation of severity of parenchymal lesions in children with acute urinary tract infection]. / Vrijednost Tc99m-DMSA scintigrafije bubrega u djece s akutnom uroinfekcijom u procjeni tezine parenhimskih lezija.

INTRODUCTION: Most authors would agree that renal parenchymal defects (scars, hypoplasia, dysplasia) in children are a major risk factor for chronic renal failure, and for development of systemic hypertension in later years. The pathophysiologic changes in acute pyelonephritis include tubulointerstitial inflammation/pus with impairment of the renal microcirculation due to compression of the glomeruli, small peritubular capillaries and vasa recta by interstitial edema. The resulting ischemia has been postulated as one of the mechanisms for the decreased accumulation of DMSA in the areas of pyelonephritis. DMSA scanning has a sensitivity of up to 99%, and specificity of up to 91% for the detection of acute pyelonephritis. AIM OF THE STUDY: The aim of the study was to investigate the value of Tc99m-DMSA scan in children with acute urinary tract infection, to estimate the degree of parenchymal changes, and to assess the relationship with vesicoureteral reflux. PATIENTS: We reviewed 116 infants aged 0-15 years, 100 (86.2%) female and 16 (13.8%) male, who were hospitalized for urinary tract infection during a 5-year period (1996-2000). The mean age at diagnosis was 3.7 years. RESULTS: Escherichia colli was isolated in 52 (44.8%) urine cultures. All patients underwent ultrasonography, which was normal in 57 (49.1%) infants. Tc99m-DMSA was performed after two weeks of therapy. The renal parenchymal pathology was defined as a focal or multifocal defect of low degree in 33 (28.4%), and of high degree in 35 (30%) children. Multifocal defects were mostly found in patients aged < 3 years, and focal lesions in those aged > 3 years. Renal scars were detected in 41 (35.3%) infants with first urinary tract infection. CONCLUSION: We recommend that ultrasound, DMSA and radionuclide cystouretherogram be routinely performed in case of first urinary tract infection in infants aged < 1 year, and voiding cystourethrogram with US and DMSA in those aged > 1 year.