Prevalence and predicting factors of metabolic-associated fatty liver disease diagnosed by transient elastography with controlled attenuation parameters in HIV-positive people.

Metabolic disorders are increasing in people living with HIV (PLWH), and metabolic associated fatty liver disease (MAFLD) has become a common complication. A cross-sectional study was conducted in HIV-positive persons receiving anti-retroviral therapy (ART), in order to determine the prevalence and predicting factors of MAFLD in PLWH. All participants underwent bioelectrical impedance analysis, ultrasonography, and transient elastography with controlled attenuation parameter (CAP). MAFLD was defined as CAP ≥248 dB/m. Significant fibrosis was defined when liver stiffness measurement >7.0 kPa. Predicting factors of MAFLD were determined using logistic regression analysis. Of 150 participants, 48 (32.0%) had MAFLD. Significant fibrosis was diagnosed in 5 (10.4%) participants in the MAFLD group. Blood pressure, waist circumference, body mass index (BMI), percentage of fat, serum transaminases, HbA1c, LDL, and triglycerides levels were significantly higher in the MAFLD group (p < 0.05). High BMI [odds ratio (OR) 1.596; 95% confidence interval (CI), 1.336-1.907, p < 0.001], triglycerides level >150 mg/dl [OR 3.722; 95% CI, 1.508-9.187, p < 0.004], and advanced age [OR 1.076; 95% CI, 1.017-1.139, p < 0.011] were associated with MAFLD in the multivariate analysis. MAFLD is common in PLWH receiving ART, while significant fibrosis is relatively infrequent. High BMI, age, and triglycerides level are the predicting factors of MAFLD in PLWH.

Added value of hepatobiliary phase gadoxetic acid-enhanced MRI for diagnosing hepatocellular carcinoma in high-risk patients.

AIM: To determine the added value of hepatobiliary phase (HBP) gadoxetic acid-enhanced magnetic resonance imaging (MRI) in evaluating hepatic nodules in high-risk patients. METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. This study included 100 patients at high risk for hepatocellular carcinoma (HCC) and 105 hepatic nodules that were larger than 1 cm. A blind review of two MR image sets was performed in a random order: set 1, unenhanced (T1- and T2-weighted) and dynamic images; and set 2, unenhanced, dynamic 20-min and HBP images. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared for the two image sets. Univariate and multivariate analyses were performed on the MR characteristics utilized to diagnose HCC. RESULTS: A total of 105 hepatic nodules were identified in 100 patients. Fifty-nine nodules were confirmed to be HCC. The diameter of the 59 HCCs ranged from 1 to 12 cm (mean: 1.9 cm). The remaining 46 nodules were benign (28 were of hepatocyte origin, nine were hepatic cysts, seven were hemangiomas, one was chronic inflammation, and one was focal fat infiltration). The diagnostic accuracy significantly increased with the addition of HBP images, from 88.7% in set 1 to 95.5% in set 2 (P = 0.002). In set 1 vs set 2, the sensitivity and NPV increased from 79.7% to 93.2% and from 78.9% to 91.8%, respectively, whereas the specificity and PPV were not significantly different. The hypointensity on the HBP images was the most sensitive (93.2%), and typical arterial enhancement followed by washout was the most specific (97.8%). The multivariate analysis revealed that typical arterial enhancement followed by washout, hyperintensity on T2-weighted images, and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC (P < 0.05). CONCLUSION: The addition of HBP gadoxetic acid-enhanced MRI statistically improved the diagnostic accuracy in HCCs larger than 1 cm. Typical arterial enhancement followed by washout and hypointensity on HBP images are useful for diagnosing HCC.

Ultrasound predictors of thyroid cancer.

OBJECTIVE: To identify ultrasound (US) features associated with cancer in thyroid nodules. MATERIAL AND METHOD: During a two and a half-year period, medical charts, US images, and pathological findings in 629 consecutive patients with thyroid nodules who underwent US examination as well as fine needle aspiration biopsy (FNAB) or surgical excision or both were retrospectively reviewed. Clinical and US findings associated with thyroid cancer were identified using statistical models. RESULTS: Unequivocal cytological or pathological findings were available for 578 patients. Forty-eight patients (8%) had thyroid cancer. Independent clinical and US features associated with thyroid cancer included younger age, symptoms other than palpable mass, solid nodules, fewer number of nodules, presence of calcifications, and enlarged cervical lymph nodes. The combination of all these features was most specific for the diagnosis of thyroid cancer. The absence of all these features could rule out all thyroid cancers. CONCLUSION: The risk of the thyroid cancer in patients with thyroid nodules could be estimated by using relevant clinical and US features.

Impact and appropriateness of the emergency ultrasonography in a tertiary care hospital.

OBJECTIVE: To quantify the notion of the impact of ultrasonography (US) on and the appropriateness of its use in, the diagnosis and treatment of emergency conditions. MATERIAL AND METHOD: A prospective study was conducted between September 2006 andApri 2007 at a tertiary care hospital. US was performed or supervised by experienced staff radiologists during the working hours and by final year radiology residents during the off-hours. Data collection forms were filled by radiology residents. The final discharge diagnoses were obtained from medical charts and computerized records. Data collected included age, gender provisional diagnosis, ultrasound findings, the discharge diagnosis, time of ultrasound examination, other radiologic investigations and therapeutic interventions. Outcomes included the impact, appropriateness, and diagnostic accuracy of US. RESULTS: Six hundred eighteen patients underwent 702 emergency ultrasound examinations. The median age was 51 years. Approximately 50% were male. The anatomical region most commonly examined was the abdomen (80%). US had an impact on clinical management in 85% of all examinations. Appropriate use of US was seen in 64% of all examinations. The overall accuracy of US was 90%. Factors associated with higher impact included suspected urological, vascular and musculoskeletal conditions, while vague abdominal conditions were associated with less impact. CONCLUSION: The impact of US on the management of emergency conditions was high and most requests for US were appropriate. However a more efficient use of emergency US is still possible, especially for abdominal conditions.

Supplement value of magnetic resonance imaging in small hepatic lesion (< or = 20 mm) detected on routine computed tomography.

OBJECTIVE: To determine the supplemental MRI value in characterization of small hepatic lesions (< or = 20 mm) indetermined by routine CT scan. MATERIAL AND METHOD: This was a retrospective study. Sixty-four patients with 81 indeterminate small hepatic lesions on the CT scan were included in this study. Two radiologists simultaneously evaluated the CT scan, followed by MRI. Patient history, imaging record, and final diagnosis were blinded. Final diagnoses were made by interpretation of all medical data and defined these lesions as benign or malignancy by using either histology or follow-up imaging combined with laboratory data. RESULTS: In 64 patients, 62 lesions (76.5%) of 81 indeterminate lesions were benign, whereas 19 lesions (23.5%) were malignant. MRI interpreted 55 lesions as benign, 17 lesions as malignant, and 9 as indeterminate lesions. If the indeterminate lesions were assumed as benign lesions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), are 68.4%, 93.6%, 76.5%, and 90.6%, respectively. CONCLUSION: MRI can supplement CT scan in characterization of small hepatic lesion with high specificity and accuracy.

Assessment of gastrointestinal stromal tumors with computed tomography following treatment with imatinib mesylate.

AIM: To evaluate and characterize the patterns of disease progression of metastatic or unresectable gastrointestinal stromal tumor (GIST) treated with imatinib mesylate, and to determine the prognostic significance associated with disease progression. METHODS: Clinical data and computed tomography (CT) images were retrospectively reviewed in 17 GIST patients who were treated with imatinib mesylate from October 2002 to October 2006. Apart from using size measurement for evaluation of tumor response [Response Evaluation Criteria in Solid Tumors (RECIST) criteria], patterns of CT changes during treatment were evaluated and correlated with clinical data. RESULTS: There were eight non-responders and nine responders. Five patterns of CT change during treatment were found: focal progression (FP), generalized progression (GP), generalized cystic change (GC), new cystic lesion (NC) and new solid lesion (NS). At the end of study, all non-responders showed GP, whereas responders showed cystic change (GC and NC) and response according to RECIST criteria. Overall survival was significantly better in patients with cystic change or response within the RECIST criteria compared with GP patients (P = 0.0271). CONCLUSION: Various patterns of CT change in patients with GIST who responded to imatinib mesylate were demonstrated, and might determine the prognosis of the disease. A combination of RECIST criteria and pattern of CT change are proposed for response evaluation in GIST.

Abdominal manifestation and complications in systemic lupus erythematosus: emphasis on CT findings.

OBJECTIVE: To describe computed tomography (CT) features in SLE patients with suspected abdominal involvement or complications. MATERIAL AND METHOD: SLE Patients who presented with suspected abdominal involvement or complications and underwent CT between 2001 and 2005 were retrospectively reviewed. All CT studies were performed within 21 days of the onset of symptoms. RESULTS: Thirty-two SLE patients with 53 CT examinations including imaging findings and clinical data were reviewed. There were 29 cases with abdominal findings related to SLE including gastrointestinal vasculitis (6 cases), acute pancreatitis (8 cases), genitourinary abnormality (13 cases), hepatosplenomegaly, and ascites. Bowel wall thickening with target sign in CT is characteristics of GI vasculitis. Mild pancreatitis by CT scoring index was found in most cases. Five cases had diffuse bladder wall thickening and three cases also had bilateral hydronephrosis and hydroureter. Sixteen cases had other findings not related to SLE including bowel obstruction, splenic infarction, appendicitis, and hematoma. CONCLUSION: The common CT findings and complications in SLE patients who suspected abdominal involvement were presented CT is useful for detecting the primary cause of abdominal symptoms, planning treatment, and monitoring for complication.

Combined hepatocellular and cholangiocarcinoma: CT findings with emphasis on multiphasic helical CT.

OBJECTIVE: To describe CT findings of patients with combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) in correlation with clinical data and histopathological results. MATERIAL AND METHOD: Ten from 31 cases whose CT study was available were reviewed retrospectively in the aspect of imaging findings, clinical data, and pathological results. RESULTS: Most of the tumors were hypodense solitary mass with gradually enhanced after contrast administration. Bile duct dilatation was observed in two cases. The overall CT findings were more similar to CC rather than HCC despite the pathological result showing predominant HCC component. Serum alpha-fetoprotein level was normal or mildly elevated while an elevated concentration of carbohydrate antigen 19-9 was observed. Hepatitis profiles showed positive to hepatitis B virus infection in four cases and hepatitis C virus infection in one case. CONCLUSION: The diagnosis of combined HCC-CC should be considered if the tumor has similar findings to CC without bile duct dilatation on cirrhotic liver and the patient has normal or low rising of the AFP level with or without elevated CA 19-9 level. In non-cirrhotic liver, the finding is non-specific.

Primary hepatic clear cell myomelanocytic tumor. Case report and review of the literature.

A case of hepatic clear cell myomelanocytic tumor in a 31-year-old woman presenting clinically with abdominal pain is reported. Histopathologic examination showed a lesion characterized by a population of large epithelioid cells with clear or eosinophilic granular cytoplasm, rich in glycogen. Immunohistochemically, the tumor cells were positive for HMB-45, Melan-A and muscle-specific actin, but negative for epithelial markers, desmin, S-100 protein, and neuroendocrine markers. Ultrastructurally, the tumor cells had abundant glycogen, well-developed rough endoplasmic reticulum, microtubules and aberrant melanosomes. Clinical and pathologic features with a brief review of the relevant literature for hepatic CCMMT as a variant of perivascular epithelioid cell tumor (PEComa) are discussed.

The efficacy of roselle (Hibicus sabdariffa Linn.) flower tea as oral negative contrast agent for MRCP study.

OBJECTIVE: To evaluate the efficacy of roselle flower tea (RFT) administration as oral negative contrast agent for MRCP study. MATERIAL AND METHOD: Roselle flower tea was prepared by packing 4,000 mg of dry ground roselle flower in a tea bag and soaked with 480 ml of hot distilled water RFT was tested in phantom, volunteer subjects and was studied in patients for MRCP study. Quanlitative analysis was made by evaluation of the conspicuity of biliary system after RFT administration. Quantitative comparison was performed by comparing the contrast-to-noise ratio between each part of the biliary system with stomach and duodenum. RESULTS: Roselle flower tea can effectively reduce signal intensity of the stomach and duodenum. There was statistically significant (p < 0.05) improvement in conspicuity of the common bile duct. There was slight improvement of conspicuity of common hepatic duct, ampulla and main pancreatic duct. Contrast-to-noise ratios were all statistically significantly improved. RFT contains 0.6 mg of iron and 1.28 mg of manganese content. CONCLUSION: Roselle flower tea is a very efficient oral negative contrast agent. It is natural, safe, inexpensive and palatable for oral administration.