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Does sevoflurane sedation in pediatric patients lead to "pseudo" leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging? 儿童患者的七氟醚镇静是否会导致3特斯拉磁共振成像中大脑中的“伪”软脑膜增强?
IF 2.5 Pub Date : 2023-04-28 DOI: 10.4329/wjr.v15.i4.127
Kiran Hilal, Kumail Khandwala, Saima Rashid, Faheemullah Khan, Shayan Sirat Maheen Anwar

Background: Prominent leptomeningeal contrast enhancement (LMCE) in the brain is observed in some pediatric patients during sedation for imaging. However, based on clinical history and cerebrospinal fluid analysis, the patients are not acutely ill and do not exhibit meningeal signs. Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of 'pseudo' LMCE (pLMCE) on 3 Tesla magnetic resonance imaging (MRI).

Aim: To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports.

Methods: A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted. The patients underwent enhanced brain MRI under inhaled sevoflurane. The LMCE grade was determined by two radiologists, and interobserver variability of the grade was calculated using Cohen's kappa. The LMCE grade was correlated with duration of sedation, age and weight using the Spearman rho rank correlation.

Results: A total of 63 patients were included. Fourteen (22.2%) cases showed mild LMCE, 48 (76.1%) cases showed moderate LMCE, and 1 case (1.6%) showed severe LMCE. We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging (kappa value = 0.61; P < 0.001). Additionally, we found statistically significant inverse and moderate correlations between patient weight and age. There was no correlation between duration of sedation and pLMCE.

Conclusion: pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature. It should not be misinterpreted for meningeal pathology. Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations.

背景:在一些儿童患者镇静成像期间,观察到大脑中明显的软脑膜对比增强(LMCE)。然而,根据临床病史和脑脊液分析,这些患者没有急性疾病,也没有出现脑膜症状。我们的研究确定了儿童患者吸入七氟醚是否导致3特斯拉磁共振成像(MRI)上的这种“伪”LMCE(pLMCE)模式。目的:强调pLMCE在儿童患者在镇静状态下接受增强脑MRI检查中的意义,以避免报告中的误解。方法:对0-8岁的儿科患者进行回顾性横断面评估。患者在吸入七氟醚的情况下接受了增强的脑部MRI检查。LMCE等级由两名放射科医生确定,并使用Cohen’s kappa计算等级的观察者间变异性。LMCE等级与镇静持续时间、年龄和体重使用Spearman rho秩相关。结果:共纳入63例患者。14例(22.2%)表现为轻度LMCE,48例(76.1%)表现为中度LMCE,1例(1.6%)表现为重度LMCE。我们发现两位放射科医生在对比后T1成像中检测pLMCE方面基本一致(kappa值=0.61;P<0.001)。此外,我们发现患者体重和年龄之间存在统计学上显著的负相关和中度相关性。镇静持续时间与pLMCE之间没有相关性。结论:pLMCE在七氟烷镇静儿童患者的对比后自旋回波T1加权MRI上相对常见,因为他们的血管系统脆弱且不成熟。不应将其误解为脑膜病理。了解儿童的相关临床病史是避免放射学过度呼叫和随后额外调查负担的重要先决条件。
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引用次数: 0
Detection of tracheal branching with computerized tomography: The relationship between the angles and age-gender. 计算机断层扫描检测气管分支:角度与年龄性别的关系。
IF 2.5 Pub Date : 2023-04-28 DOI: 10.4329/wjr.v15.i4.118
Şevket Kahraman, Mesut Furkan Yazar, Hüseyin Aydemir, Mecit Kantarci, Sonay Aydin

Background: The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis, treatment and interventional interventions in areas such as anesthesia, thoracic surgery, pulmonary physiology.

Aim: To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography (CT) and minimum intensity projection (MinIP) technique, which is a non-invasive method.

Methods: Our study was carried out retrospectively. Patients who underwent contrast and non-contrast CT examination, whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained, were included in the study. Measurements were made in the coronal plane of the lung parenchyma. In the coronal plane, right main bronchus-left main bronchus angle, right upper lobe bronchus-intermedius bronchus angle, right middle lobe bronchus-right lower lobe bronchus angle, left upper lobe bronchus-left lower lobe bronchus angle were measured.

Results: The study population consisted of 1511 patients, 753 pediatric (mean age: 13.4 ± 4.3; range: 1-18 years) and 758 adults (mean age: 54.3 ± 17.3; range: 19-94 years). In our study, tracheal bifurcation angle was found to be 73.3° ± 13.7° (59.6°-87°) in the whole population. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls (74.6° ± 12.9° vs 71.2° ± 13.9°, P = 0.001). In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9° ± 12.9° vs 75.8° ± 14.7°, P < 0.001).

Conclusions: Our study, with the number of 1511 patients, is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data, measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique. Study data will not only be a guide during invasive procedures, but it can also guide studies to be done with imaging methods.

背景:获得的气管支气管系统解剖知识的数据可用于麻醉、胸外科、肺生理学等领域的诊断、治疗和介入干预。目的:应用多层计算机断层扫描(CT)和最小强度投影(MinIP)技术,这是一种非侵入性方法,确定儿童和成人人群的气管支气管分支角度。方法:我们的研究是回顾性的。接受对比和非对比CT检查的患者,其解剖和病理生理良好的气管支气管系统和肺实质图像均被纳入研究。测量是在肺实质的冠状面上进行的。冠状面测量右主支气管左主支气管角、右上叶支气管中间支气管角、右中叶支气管右下叶支气管角、左上叶支气管左下叶支气管角度。结果:研究人群包括1511名患者,753名儿科患者(平均年龄:13.4±4.3;范围:1-18岁)和758名成人患者(平均岁:54.3±17.3;范围:19-94岁)。在我们的研究中,整个人群的气管分叉角为73.3°±13.7°(59.6°-87°)。在儿童组中,男孩的左右主冠状面水平高于女孩(74.6°±12.9°vs 71.2°±13.9°,P=0.001)。在成年组中,男性的左右主冠面水平低于女性(71.9°±12.90°vs 75.8°±14.7°,P<0.001)。结论:我们的研究共有1511名患者,是文献中第一项拥有最多患者群体的研究,包括儿科和成人人口统计数据,使用多层CT和MinIP技术测量气管支气管系统的角度值。研究数据不仅可以指导侵入性手术,还可以指导使用成像方法进行的研究。
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引用次数: 0
Multi-modality parathyroid imaging: A shifting paradigm. 多模态甲状旁腺成像:一个转变的范式。
IF 2.5 Pub Date : 2023-03-28 DOI: 10.4329/wjr.v15.i3.69
Shrea Gulati, Sunil Chumber, Gopal Puri, Stanzin Spalkit, N A Damle, C J Das

The goal of parathyroid imaging in hyperparathyroidism is not diagnosis, rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach. Hence, the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration. The common causes include solitary parathyroid adenoma, multiple parathyroid adenomas, parathyroid hyperplasia and parathyroid carcinoma. It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging. The various imaging modalities available include high resolution ultrasound of the neck, nuclear imaging studies, four-dimensional computed tomography (4D CT) and magnetic resonance imaging. Contrast enhanced ultrasound is a novel technique which has been recently added to the armamentarium to differentiate between parathyroid adenomas and its mimics. Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.

甲状旁腺成像在甲状旁腺功能亢进中的目的不是诊断,而是定位甲状旁腺功能亢进的原因,以便制定最佳的治疗方案。因此,影像学准确定位异常甲状旁腺组织的作用比以往任何时候都更重要,以促进双侧颈部微创甲状旁腺切除术。常见病因包括单发甲状旁腺瘤、多发甲状旁腺瘤、甲状旁腺增生和甲状旁腺癌。对于放射科医生来说,警惕类似甲状旁腺病变的甲状腺结节和淋巴结,并能够在影像学上区分它们是非常必要的。各种可用的成像方式包括高分辨率颈部超声,核成像研究,四维计算机断层扫描(4D CT)和磁共振成像。对比增强超声是一种新技术,最近被加入到鉴别甲状旁腺瘤及其模拟。通过这篇综述文章,我们希望回顾甲状旁腺病变在各种成像方式上的成像特征,并提出一种算法来指导其与模拟的放射学鉴别。
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引用次数: 0
Magnetic resonance imaging findings of spontaneous pyomyoma in a premenopausal woman managed with myomectomy: A case report. 经子宫肌瘤切除术的绝经前妇女自发性子宫肌瘤的磁共振成像结果:1例报告。
IF 2.5 Pub Date : 2023-03-28 DOI: 10.4329/wjr.v15.i3.83
David Martínez, Gustavo E Sanchez, Jhonatan Gómez, Luis J Sonda, Luis D Suárez, Carlos S López, Juan J Vega, Daniel A Cepeda

Background: Acute fibroid complications are rare. However, failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic, even deadly, complications. Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct, hematogenous, or lymphatic dissemination. Even though the diagnosis is established through clinical and laboratory findings, imaging is an important complementary method to support the suspected diagnosis.

Case summary: Herein, we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings. The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics. After a week of persistent pain, she developed sepsis without any identifiable foci. Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration, and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient's clinical features. We decided to perform myomectomy (which is an infrequently performed surgical treatment due to the procedure's intrinsic implications) due to the patient's desire to preserve fertility. Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis, while the tissue culture showed gram-negative cocci bacteria, which were successfully treated using antibiotic therapy. The patient's health status improved after several days.

Conclusion: The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures. Nonetheless, magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.

背景:急性肌瘤并发症是罕见的。然而,如果不能在急性并发症发生时迅速识别和治疗,可能会导致灾难性甚至致命的并发症。脓肌瘤是一种罕见但潜在致命的疾病,由肌瘤梗死和感染引起,通过细菌播种和直接、血液或淋巴传播。尽管诊断是通过临床和实验室结果建立的,但影像学是支持疑似诊断的重要补充方法。病例总结:在此,我们报告一例子宫肌瘤,在未生育妇女以前诊断为子宫平滑肌瘤病根据超声检查。患者曾因胃下疼痛对镇痛药无反应而进过急诊室。持续疼痛一周后,她发展为败血症,没有任何可识别的病灶。磁共振成像显示符合子宫肌瘤病伴红色变性,根据影像学表现及患者临床特征,诊断为子宫肌瘤。由于患者希望保留生育能力,我们决定进行子宫肌瘤切除术(由于手术的内在含义,这是一种很少进行的手术治疗)。组织病理学结果显示子宫平滑肌瘤伴凝固性和液化性坏死,组织培养显示革兰氏阴性球菌,经抗生素治疗成功。几天后病人的健康状况有所改善。结论:评价子宫肌瘤的主要诊断手段是临床和实验室检查以及组织培养。尽管如此,磁共振成像可以帮助证实这些发现,并更好地表征肌瘤及其不同的并发症。
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引用次数: 0
Hepatocellular carcinoma: State of the art diagnostic imaging. 肝细胞癌:最新诊断影像。
IF 2.5 Pub Date : 2023-03-28 DOI: 10.4329/wjr.v15.i3.56
Cody Criss, Arpit M Nagar, Mina S Makary

Primary liver cancer is the fourth most common malignancy worldwide, with hepatocellular carcinoma (HCC) comprising up to 90% of cases. Imaging is a staple for surveillance and diagnostic criteria for HCC in current guidelines. Because early diagnosis can impact treatment approaches, utilizing new imaging methods and protocols to aid in differentiation and tumor grading provides a unique opportunity to drastically impact patient prognosis. Within this review manuscript, we provide an overview of imaging modalities used to screen and evaluate HCC. We also briefly discuss emerging uses of new imaging techniques that offer the potential for improving current paradigms for HCC characterization, management, and treatment monitoring.

原发性肝癌是世界上第四大最常见的恶性肿瘤,肝细胞癌(HCC)占病例的90%。在目前的指南中,影像学是HCC监测和诊断标准的主要内容。由于早期诊断可以影响治疗方法,因此利用新的成像方法和方案来帮助区分和肿瘤分级提供了一个独特的机会,可以极大地影响患者的预后。在这篇综述中,我们概述了用于筛查和评估HCC的成像方式。我们还简要讨论了新成像技术的新应用,这些技术有可能改善HCC表征、管理和治疗监测的现有范例。
{"title":"Hepatocellular carcinoma: State of the art diagnostic imaging.","authors":"Cody Criss,&nbsp;Arpit M Nagar,&nbsp;Mina S Makary","doi":"10.4329/wjr.v15.i3.56","DOIUrl":"https://doi.org/10.4329/wjr.v15.i3.56","url":null,"abstract":"<p><p>Primary liver cancer is the fourth most common malignancy worldwide, with hepatocellular carcinoma (HCC) comprising up to 90% of cases. Imaging is a staple for surveillance and diagnostic criteria for HCC in current guidelines. Because early diagnosis can impact treatment approaches, utilizing new imaging methods and protocols to aid in differentiation and tumor grading provides a unique opportunity to drastically impact patient prognosis. Within this review manuscript, we provide an overview of imaging modalities used to screen and evaluate HCC. We also briefly discuss emerging uses of new imaging techniques that offer the potential for improving current paradigms for HCC characterization, management, and treatment monitoring.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/29/WJR-15-56.PMC10080581.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Effects of combining multiple dose reduction techniques on coronary computed tomography angiography. 多重减剂量技术对冠状动脉计算机断层造影的影响。
IF 2.5 Pub Date : 2023-02-28 DOI: 10.4329/wjr.v15.i2.32
Xiao-Lu Hu, Pei-Kai Huang, Meng Zhang, Jun Chen, Meng-Qiang Xiao

Background: Coronary computed tomography angiography (CCTA) is the preferred non-invasive examination method for coronary heart disease. However, the radiation from computed tomography has become a concern since public awareness of radiation hazards continue to increase.

Aim: To explore the value of multiple dose reduction techniques for CCTA.

Methods: Consecutive normal and overweight patients were prospectively divided into two groups: Group A1, patients who received multiple dose reduction scans (n = 82); and group A2, patients who received conventional scans (n = 39). The scan parameters for group A1 were as follows: Isocentric scan, tube voltage = 80 kV, and tube current control using 80% smart milliampere. The scan parameters for group A2 were as follows: Normal position, tube voltage = 100 kV, and smart milliampere.

Results: The average effective doses (EDs) for groups A1 and A2 were 1.13 ± 0.35 and 3.36 ± 1.30 mSv, respectively. There was a statistically significant difference in ED between the two groups (P < 0.01). Furthermore, noise was significantly lower, and both signal-to-noise ratio and contrast signal-to-noise ratio were higher in group A2 when compared to group A1 (P < 0.01). Moreover, the subjective image quality (IQ) scores were excellent in both groups, in which there was no significant difference in subjective IQ score between the two groups (P = 0.12).

Conclusion: Multiple dose reduction scan techniques can significantly decrease the ED of patients receiving CCTA examinations for clinical diagnosis.

背景:冠状动脉ct血管造影(CCTA)是冠心病首选的无创检查方法。然而,由于公众对辐射危害的认识不断提高,计算机断层扫描的辐射已成为一个令人担忧的问题。目的:探讨多重减剂量技术在CCTA中的应用价值。方法:连续正常和超重患者前瞻性分为两组:A1组,接受多次减剂量扫描的患者(n = 82);A2组为接受常规扫描的患者(n = 39)。A1组的扫描参数为:等心扫描,管电压为80 kV,管电流控制为80%智能毫安。A2组的扫描参数为:正常位置,管电压= 100 kV,智能毫安。结果:A1组和A2组的平均有效剂量(EDs)分别为1.13±0.35和3.36±1.30 mSv。两组患者ED评分差异有统计学意义(P < 0.01)。A2组的噪声显著低于A1组,信噪比和对比信噪比均高于A1组(P < 0.01)。此外,两组的主观图像质量(IQ)得分均为优秀,其中两组的主观智商得分无显著差异(P = 0.12)。结论:多次减剂量扫描技术可显著降低临床诊断CCTA检查患者的ED。
{"title":"Effects of combining multiple dose reduction techniques on coronary computed tomography angiography.","authors":"Xiao-Lu Hu,&nbsp;Pei-Kai Huang,&nbsp;Meng Zhang,&nbsp;Jun Chen,&nbsp;Meng-Qiang Xiao","doi":"10.4329/wjr.v15.i2.32","DOIUrl":"https://doi.org/10.4329/wjr.v15.i2.32","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) is the preferred non-invasive examination method for coronary heart disease. However, the radiation from computed tomography has become a concern since public awareness of radiation hazards continue to increase.</p><p><strong>Aim: </strong>To explore the value of multiple dose reduction techniques for CCTA.</p><p><strong>Methods: </strong>Consecutive normal and overweight patients were prospectively divided into two groups: Group A<sub>1</sub>, patients who received multiple dose reduction scans (<i>n</i> = 82); and group A<sub>2</sub>, patients who received conventional scans (<i>n</i> = 39). The scan parameters for group A<sub>1</sub> were as follows: Isocentric scan, tube voltage = 80 kV, and tube current control using 80% smart milliampere. The scan parameters for group A<sub>2</sub> were as follows: Normal position, tube voltage = 100 kV, and smart milliampere.</p><p><strong>Results: </strong>The average effective doses (EDs) for groups A<sub>1</sub> and A<sub>2</sub> were 1.13 ± 0.35 and 3.36 ± 1.30 mSv, respectively. There was a statistically significant difference in ED between the two groups (<i>P</i> < 0.01). Furthermore, noise was significantly lower, and both signal-to-noise ratio and contrast signal-to-noise ratio were higher in group A<sub>2</sub> when compared to group A<sub>1</sub> (<i>P</i> < 0.01). Moreover, the subjective image quality (IQ) scores were excellent in both groups, in which there was no significant difference in subjective IQ score between the two groups (<i>P</i> = 0.12).</p><p><strong>Conclusion: </strong>Multiple dose reduction scan techniques can significantly decrease the ED of patients receiving CCTA examinations for clinical diagnosis.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/2a/WJR-15-32.PMC9979190.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9394833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Imaging of paraduodenal pancreatitis: A systematic review. 十二指肠旁胰腺炎的影像学:系统回顾。
IF 2.5 Pub Date : 2023-02-28 DOI: 10.4329/wjr.v15.i2.42
Matteo Bonatti, Nicolò De Pretis, Giulia A Zamboni, Alessandro Brillo, Stefano Francesco Crinò, Riccardo Valletta, Fabio Lombardo, Giancarlo Mansueto, Luca Frulloni

Background: Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with pancreatic cancer. There are two main histological variants of PP, the cystic and the solid, with slightly different imaging appearances. Moreover, imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition, namely alcohol intake and smoking.

Aim: To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer.

Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines. A Literature search was performed on PubMed, Embase and Cochrane Library using (groove pancreatitis [Title/Abstract]) OR (PP [Title/Abstract]) as key words. A total of 593 articles were considered for inclusion. After eliminating duplicates, and title and abstract screening, 53 full-text articles were assessed for eligibility. Eligibility criteria were: Original studies including 8 or more patients, fully written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard. Finally, 14 studies were included in our systematic review.

Results: Computed tomography (CT) findings were described in 292 patients, magnetic resonance imaging (MRI) findings in 231 and endoscopic ultrasound (EUS) findings in 115. Duodenal wall thickening was observed in 88.8% of the cases: Detection rate was 96.5% at EUS, 91.0% at MRI and 84.1% at CT. Second duodenal portion increased enhancement was recognizable in 76.3% of the cases: Detection rate was 84.4% at MRI and 72.1% at CT. Cysts within the duodenal wall were detected in 82.6% of the cases: Detection rate was 94.4% at EUS, 81.9% at MRI and 75.7% at CT. A solid mass in the groove region was described in 40.9% of the cases; in 78.3% of the cases, it showed patchy enhancement in the portal venous phase, and in 100% appeared iso/hyperintense during delayed phase imaging. Only 3.6% of the lesions showed restricted diffusion. The prevalence of radiological signs of chronic obstructive pancreatitis, namely main pancreatic duct dilatation, pancreatic calcifications, and pancreatic cysts, was extremely variable in the different articles.

Conclusion: PP has peculiar imaging findings. MRI is the best radiological imaging modality for diagnosing PP, but EUS is more accurate than MRI in depicting duodenal wall alterations.

背景:十二指肠旁性胰腺炎(PP)是一种诊断挑战,特别是在非转诊中心,因为其潜在的影像学与胰腺癌重叠。PP有两种主要的组织学变异,囊性和实性,影像学表现略有不同。此外,由于疾病进展和/或其危险因素暴露(即饮酒和吸烟)的影响,PP的影像学表现可能随着时间的推移而改变。目的:探讨胰腺癌患者的多模态影像学表现,以帮助临床医生鉴别诊断胰腺癌。方法:根据2009年系统评价和meta分析指南的首选报告项目进行系统评价。以(沟状胰腺炎[Title/Abstract])或(PP [Title/Abstract])为关键词在PubMed、Embase和Cochrane Library进行文献检索。总共审议了593篇文章。在消除重复、标题和摘要筛选后,评估了53篇全文文章的合格性。入选标准为:包括8例及以上患者的原始研究,完整的英文写作,描述PP的影像学表现,以病理证实或临床放射随访为金标准。最后,我们的系统综述纳入了14项研究。结果:292例患者有CT表现,231例有MRI表现,115例有超声内镜表现。88.8%的病例出现十二指肠壁增厚,其中EUS、MRI和CT检出率分别为96.5%、91.0%和84.1%。76.3%的病例可识别第二十二指肠增强部分,MRI和CT的检出率分别为84.4%和72.1%。十二指肠壁囊肿检出率为82.6%,EUS检出率94.4%,MRI检出率81.9%,CT检出率75.7%。40.9%的病例在沟槽区出现固体肿块;78.3%的病例在门静脉期表现为斑片状强化,100%的病例在延迟期表现为等/高强度。仅3.6%的病变表现为弥散受限。慢性阻塞性胰腺炎的影像学征象,即主胰管扩张、胰腺钙化和胰腺囊肿的发生率在不同的文章中有很大的差异。结论:PP具有特殊的影像学表现。MRI是诊断PP的最佳放射成像方式,但EUS在描述十二指肠壁改变方面比MRI更准确。
{"title":"Imaging of paraduodenal pancreatitis: A systematic review.","authors":"Matteo Bonatti,&nbsp;Nicolò De Pretis,&nbsp;Giulia A Zamboni,&nbsp;Alessandro Brillo,&nbsp;Stefano Francesco Crinò,&nbsp;Riccardo Valletta,&nbsp;Fabio Lombardo,&nbsp;Giancarlo Mansueto,&nbsp;Luca Frulloni","doi":"10.4329/wjr.v15.i2.42","DOIUrl":"https://doi.org/10.4329/wjr.v15.i2.42","url":null,"abstract":"<p><strong>Background: </strong>Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with pancreatic cancer. There are two main histological variants of PP, the cystic and the solid, with slightly different imaging appearances. Moreover, imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition, namely alcohol intake and smoking.</p><p><strong>Aim: </strong>To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer.</p><p><strong>Methods: </strong>The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines. A Literature search was performed on PubMed, Embase and Cochrane Library using (groove pancreatitis [Title/Abstract]) OR (PP [Title/Abstract]) as key words. A total of 593 articles were considered for inclusion. After eliminating duplicates, and title and abstract screening, 53 full-text articles were assessed for eligibility. Eligibility criteria were: Original studies including 8 or more patients, fully written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard. Finally, 14 studies were included in our systematic review.</p><p><strong>Results: </strong>Computed tomography (CT) findings were described in 292 patients, magnetic resonance imaging (MRI) findings in 231 and endoscopic ultrasound (EUS) findings in 115. Duodenal wall thickening was observed in 88.8% of the cases: Detection rate was 96.5% at EUS, 91.0% at MRI and 84.1% at CT. Second duodenal portion increased enhancement was recognizable in 76.3% of the cases: Detection rate was 84.4% at MRI and 72.1% at CT. Cysts within the duodenal wall were detected in 82.6% of the cases: Detection rate was 94.4% at EUS, 81.9% at MRI and 75.7% at CT. A solid mass in the groove region was described in 40.9% of the cases; in 78.3% of the cases, it showed patchy enhancement in the portal venous phase, and in 100% appeared iso/hyperintense during delayed phase imaging. Only 3.6% of the lesions showed restricted diffusion. The prevalence of radiological signs of chronic obstructive pancreatitis, namely main pancreatic duct dilatation, pancreatic calcifications, and pancreatic cysts, was extremely variable in the different articles.</p><p><strong>Conclusion: </strong>PP has peculiar imaging findings. MRI is the best radiological imaging modality for diagnosing PP, but EUS is more accurate than MRI in depicting duodenal wall alterations.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9b/37/WJR-15-42.PMC9979191.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9394830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors. 弥散加权成像和半定量、定量动态磁共振增强成像对唾液腺肿瘤的诊断价值。
IF 2.5 Pub Date : 2023-01-28 DOI: 10.4329/wjr.v15.i1.20
Erkan Gökçe, Murat Beyhan

Background: Increased use of functional magnetic resonance imaging (MRI) methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI consisting of sequential contrast series, allows us to obtain more information on the microstructure, cellularity, interstitial distance, and vascularity of tumors, which has increased the discrimination power for benign and malignant salivary gland tumors (SGTs). In the last few years, quantitative DCE MRI data containing T1 perfusion parameters (Ktrans, Kep and Ve), were reported to contribute to the differentiation of benign or malignant subtypes in SGTs.

Aim: To evaluate the diagnostic efficacy of DWI and semiquantitative and quantitative perfusion MRI parameters in SGTs.

Methods: Diffusion MRI [apparent diffusion coefficient (ADC) value] with a 1.5 T MR machine, semiquantitative perfusion MRI [time intensity curve (TIC) pattern], and quantitative perfusion MRI examinations (Ktrans, Kep and Ve) of 73 tumors in 67 patients with histopathological diagnosis performed from 2017 to 2021 were retrospectively evaluated. In the ADC value and semiquantitative perfusion MRI measurements, cystic components of the tumors were not considered, and the region of interest (ROI) was manually placed through the widest axial section of the tumor. TIC patterns were divided into four groups: Type A = Tpeak > 120 s; type B = Tpeak ≤ 120 s, washout ratio (WR) ≥ 30%; type C = Tpeak ≤ 120 s, WR < 30%; and type D = flat TIC. For the quantitative perfusion MRI analysis, a 3D ROI was placed in the largest solid component of the tumor, and the Ktrans, Kep and Ve values were automatically generated.

Results: The majority of SGTs were located in the parotid glands (86.3%). Of all the SGTs, 68.5% were benign and 31.5% were malignant. Significant differences were found for ADC values among pleomorphic adenomas (PMAs), Warthin's tumors (WTs), and malignant tumors (MTs) (P < 0.001). PMAs had type A and WTs had type B TIC pattern while the vast majority of MTs and other benign tumors (OBTs) (54.5% and 45.5%, respectively) displayed type C TIC pattern. PMAs showed no washout, while the highest mean WR was observed in WTs (59% ± 11%). Ktrans values of PMAs, WTs, OBTs, and MTs were not significantly different. Kep values of PMAs and WTs were significantly different from those of OBTs and MTs. Mean Ve value of WTs was significantly different from those of PMAs, OBTs, and MTs (P < 0.001).

Conclusion: The use of quantitative DCE parameters along with diffusion MRI and semiquantitative contrast-enhanced MRI in SGTs could improve the diagnostic accuracy.

背景:越来越多地使用功能性磁共振成像(MRI)方法,如弥散加权成像(DWI)和动态对比增强(DCE) MRI,包括序列对比系列,使我们能够获得更多关于肿瘤的微观结构,细胞结构,间质距离和血管分布的信息,这增加了对良性和恶性唾液腺肿瘤(sts)的鉴别能力。在过去的几年里,定量DCE MRI数据包含T1灌注参数(Ktrans, Kep和Ve),被报道有助于sgt良性或恶性亚型的区分。目的:评价DWI及MRI半定量、定量灌注参数对sgt的诊断价值。方法:回顾性分析2017年~ 2021年对67例组织病理诊断的73例肿瘤患者行1.5 T MR弥散MRI[表观弥散系数(ADC)值]、半定量灌注MRI[时间强度曲线(TIC)模式]及定量灌注MRI检查(Ktrans、Kep、Ve)。在ADC值和半定量灌注MRI测量中,不考虑肿瘤的囊性成分,并且通过肿瘤最宽的轴向切片手动放置感兴趣区域(ROI)。TIC型分为4组:A型= Tpeak > 120s;B型=峰值≤120s,冲刷比(WR)≥30%;C型=峰值≤120s, WR < 30%;D型=扁平TIC。在定量灌注MRI分析中,将3D ROI放置在肿瘤最大的实体部分,并自动生成Ktrans, Kep和Ve值。结果:绝大多数sgt位于腮腺(86.3%)。68.5%为良性,31.5%为恶性。多形性腺瘤(PMAs)、沃辛氏瘤(WTs)和恶性肿瘤(MTs)的ADC值差异有统计学意义(P < 0.001)。pma为A型TIC, WTs为B型TIC,绝大多数MTs和其他良性肿瘤(OBTs)(分别为54.5%和45.5%)为C型TIC。pma未出现洗脱,而WTs的平均WR最高(59%±11%)。pma、WTs、OBTs和MTs的Ktrans值无显著差异。pma、WTs的P值与OBTs、MTs的P值差异有统计学意义,WTs的平均Ve值与pma、OBTs、MTs的P值差异有统计学意义(P < 0.001)。结论:定量DCE参数与扩散MRI、半定量增强MRI联合应用可提高sgt的诊断准确性。
{"title":"Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors.","authors":"Erkan Gökçe,&nbsp;Murat Beyhan","doi":"10.4329/wjr.v15.i1.20","DOIUrl":"https://doi.org/10.4329/wjr.v15.i1.20","url":null,"abstract":"<p><strong>Background: </strong>Increased use of functional magnetic resonance imaging (MRI) methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI consisting of sequential contrast series, allows us to obtain more information on the microstructure, cellularity, interstitial distance, and vascularity of tumors, which has increased the discrimination power for benign and malignant salivary gland tumors (SGTs). In the last few years, quantitative DCE MRI data containing T1 perfusion parameters (K<sub>trans</sub>, K<sub>ep</sub> and V<sub>e</sub>), were reported to contribute to the differentiation of benign or malignant subtypes in SGTs.</p><p><strong>Aim: </strong>To evaluate the diagnostic efficacy of DWI and semiquantitative and quantitative perfusion MRI parameters in SGTs.</p><p><strong>Methods: </strong>Diffusion MRI [apparent diffusion coefficient (ADC) value] with a 1.5 T MR machine, semiquantitative perfusion MRI [time intensity curve (TIC) pattern], and quantitative perfusion MRI examinations (K<sub>trans</sub>, K<sub>ep</sub> and V<sub>e</sub>) of 73 tumors in 67 patients with histopathological diagnosis performed from 2017 to 2021 were retrospectively evaluated. In the ADC value and semiquantitative perfusion MRI measurements, cystic components of the tumors were not considered, and the region of interest (ROI) was manually placed through the widest axial section of the tumor. TIC patterns were divided into four groups: Type A = T<sub>peak</sub> > 120 s; type B = T<sub>peak</sub> ≤ 120 s, washout ratio (WR) ≥ 30%; type C = T<sub>peak</sub> ≤ 120 s, WR < 30%; and type D = flat TIC. For the quantitative perfusion MRI analysis, a 3D ROI was placed in the largest solid component of the tumor, and the K<sub>trans</sub>, K<sub>ep</sub> and V<sub>e</sub> values were automatically generated.</p><p><strong>Results: </strong>The majority of SGTs were located in the parotid glands (86.3%). Of all the SGTs, 68.5% were benign and 31.5% were malignant. Significant differences were found for ADC values among pleomorphic adenomas (PMAs), Warthin's tumors (WTs), and malignant tumors (MTs) (<i>P</i> < 0.001). PMAs had type A and WTs had type B TIC pattern while the vast majority of MTs and other benign tumors (OBTs) (54.5% and 45.5%, respectively) displayed type C TIC pattern. PMAs showed no washout, while the highest mean WR was observed in WTs (59% ± 11%). K<sub>trans</sub> values of PMAs, WTs, OBTs, and MTs were not significantly different. K<sub>ep</sub> values of PMAs and WTs were significantly different from those of OBTs and MTs. Mean V<sub>e</sub> value of WTs was significantly different from those of PMAs, OBTs, and MTs (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The use of quantitative DCE parameters along with diffusion MRI and semiquantitative contrast-enhanced MRI in SGTs could improve the diagnostic accuracy.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/ad/WJR-15-20.PMC9884336.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9170113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview. 肝血管计算机断层摄影的临床解剖:综述。
IF 2.5 Pub Date : 2023-01-28 DOI: 10.4329/wjr.v15.i1.1
Aysegul Firat, Tugce Taskindere Abbasoglu, Musturay Karcaaltincaba, Yasemin H Balaban

The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.

肝脏具有复杂的血管解剖结构和独特的双血供。肝脏的临床状况变化很大,包括起源于血管和胆道系统以及实质的疾病。在大多数血管疾病中,对肝脏的影响通常是亚临床的,因为它有丰富的血液供应。然而,这些血管疾病的早期诊断可以显著降低患者的发病率和死亡率。由于血管疾病的影像学表现并不总是很明显,诊断可能很困难。计算机断层血管造影是一种很好的成像方式,可以可视化患者的血管解剖结构,以制定治疗计划。在这篇综述文章中,我们重点介绍肝脏血管解剖和一些急性肝脏血管疾病的影像学表现。
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引用次数: 0
Advancements of molecular imaging and radiomics in pancreatic carcinoma. 胰腺癌分子影像学和放射组学研究进展。
IF 2.5 Pub Date : 2023-01-28 DOI: 10.4329/wjr.v15.i1.10
Xiao-Xi Pang, Liang Xie, Wen-Jun Yao, Xiu-Xia Liu, Bo Pan, Ni Chen

Despite the recent progress of medical technology in the diagnosis and treatment of tumors, pancreatic carcinoma remains one of the most malignant tumors, with extremely poor prognosis partly due to the difficulty in early and accurate imaging evaluation. This paper focuses on the research progress of magnetic resonance imaging, nuclear medicine molecular imaging and radiomics in the diagnosis of pancreatic carcinoma. We also briefly described the achievements of our team in this field, to facilitate future research and explore new technologies to optimize diagnosis of pancreatic carcinoma.

尽管近年来医学技术在肿瘤的诊断和治疗方面取得了进步,但胰腺癌仍然是最恶性的肿瘤之一,其预后极差的部分原因是难以早期准确的影像学评价。本文综述了磁共振成像、核医学分子成像和放射组学在胰腺癌诊断中的研究进展。我们也简要介绍了我们团队在该领域的研究成果,以促进未来的研究和探索优化胰腺癌诊断的新技术。
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引用次数: 1
期刊
World journal of radiology
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