Murat Danaci

Comparison of three-tesla magnetic resonance imaging with pathology in detecting deep myometrial invasion in endometrial cancer and revealing causes of discrepancy - Diagnostic and Interventional Radiology

Objective This study evaluates the results and complications of ultrasound-guided percutaneous core needle biopsies for solid masses of the pancreas performed at our university hospital . Methods Between January 2009 and June 2013 A total of 60 biopsy procedures were performed in 53 patients (30 males, 23 females) and 11 specimens were benign and 45 specimens were malignant according to histopathologic results. Results Sensitivity was 84.9%, specificity was 100% and diagnostic accuracy was 85.7%. No complications were observed during or after biopsy procedures Conclusion This study shows that ultrasound-guided biopsy is a reliable, time- and cost-saving method with a very low complication rate, high diagnostic accuracy and sensitivity, but benign biopsy findings should not be used to exclude the presence of pancreatic malignancy and biopsy should be repeated if there is a high clinical suspicion of malignancy.

Amaç: Çok kesitli bilgisayarlı tomografi kolonografinin kolorektal patolojileri saptamadaki tanısal duyarlılığını video kolonoskopi ile karşılaştırarak belirlemektir.Gereç ve Yöntemler: Çalışmamızda 18 aylık period içerisinde çok kesitli bilgisayarlı tomografi kolonografi ve video kolonoskopi yapılan 70 hasta retrospektif olarak incelendi ve çok kesitli bilgisayarlı tomografi kolonografi bulguları video kolonoskopi bulguları ile karşılaştırıldı.Bulgular: Hastaların %57.1’i erkek (n=40) ve %42.9’u kadın (n=30) olup ortalama yaşları 52.8 /yıl idi. Video kolonoskopi ile toplam 39 polip, 15 kolon tümörü, 5 ülseratif kolit, 4 divertikülozis koli, 1 anjiodisplazi ve 1 nonspesifik proktosigmoidit olmak üzere 38 hastada 65 patoloji saptandı. Saptanan 39 polipten 31’i ≤5 mm, 4’ü 6-9 mm ve 4’ü ≥10 mm idi. Çok kesitli bilgisayarlı tomografi kolonografinin boyut farkı gözetmeksizin tüm poliplerde duyarlılığı %64.1, ≥10 mm poliplerde %100, 6-9 mm arası poliplerde %75, ≤5 mm poliplerde %58.1 idi. Duyarlılık kolon tümörlerinde %100, divertikülozisde %75 ve ülseratif kolitte %80 bulundu.Sonuç: Çok kesitli bilgisayarlı tomografi kolonografinin kolon patolojilerinin tanısında yüksek duyarlılık ve özgüllüğe sahip olması, tarama yöntemi olarak veya kolon patolojilerinin değerlendirilmesinde, video kolonoskopiye ciddi alternatif ve tamamlayıcı bir yöntem olacağını göstermektedir.

The coexistence of gastrointestinal tumors (GIST’s) with other several primary malignant neoplasms has been demonstrated. However, there is no study that reported simultaneous occurrence of primary small bowel adenocarcinoma (SBA) and a GIST located in the stomach. Here, we report the first case of SBA and a synchronous gastric GIST. Surgical resection and clinicopathological characterization were performed for the masses identified through endoscopic and radiologic studies. Computed tomography scan showed a 13 mm mass located at the gastric antrum and another mass lesion partially occluding the jejunum. A biopsy specimen was obtained from the mass at the proximal jejunum by enteroscopy. The tumor was reported as adenocarcinoma. The patient was operated by the general surgery team. The features of the submucosal lesion resected from the antrum were consistent with a diagnosis of a GIST which contained spindle cells and showed positive staining with CD-117 and CD-34. Mitosis was not observed and Ki67 index was below 10%. This is the first case of coexistence of GIST of the stomach and SBA to be reported in English-language literature. The prominent characteristics of our case include its antral localization, male sex, absence of mitosis and incidental diagnosis.

We aimed to evaluate whether rapid kV-switching dual energy CT (rsDECT) can discriminate between papillary renal cell carcinoma (RCC) and benign proteinaceous cysts (BPCs) based on iodine and water content. Twenty-four patients with histopathologically proven papillary RCC and 38 patients with 41 BPCs were retrospectively included. Patients with BPCs were eligible for inclusion when the cysts were stable in size and appearance for at least 2 years or proved to be a cyst on ultrasound or MRI. All patients underwent delayed phase (70–90 s) rsDECT. Iodine and water content of each lesion was measured on the workstation. Of papillary RCC patients, 4 (16%) were female and 20 (84%) were male. Mean tumor size was 39±20 mm. Mean iodine and water content was 2.08±0.7 mg/mL and 1021±14 mg/mL, respectively. Of BPC patients, 9 were female and 29 were male. Mean cyst size was 20±7 mm. Mean iodine and water content was 0.82±0.4 mg/mL and 1012±14 mg/mL, respectively. There were significant differences between iodine and water contents of papillary RCCs and BPCs (P < 0.001). The best cutoff of iodine content for differentiating papillary RCC from BPC was 1.21 mg/mL (area under the curve [AUC]=0.97, P < 0.001, sensitivity 96%, specificity 88%, positive predictive value [PPV] 82%, negative predictive value [NPV] 97%, accuracy 91%,); the best cutoff of water content was 1015.5 mg/mL (AUC=0.68, P = 0.016, sensitivity 83%, specificity 56%, PPV 52%, NPV 85%, accuracy 66%). An iodine content threshold of 1.21 mg/mL accurately differentiates papillary RCC from BPCs on a single postcontrast rsDECT. Despite having a high sensitivity, water content has inferior diagnostic accuracy.

Diagnostic and Interventional Radiology

Purpose To investigate whether iodine content can discriminate between benign or malignant renal tumors, malign tumor subtypes, low-grade and high-grade tumors on rapid kv-switching dual-energy CT (rsDECT). Methods This prospective study enrolled 95 patients with renal tumors who underwent rsDECT for tumor characterization between 2016 and 2018. Attenuation on true and virtual unenhanced images, absolute enhancement and enhancement ratio and iodine content of each lesion on nephrographic phase iodine density images were measured. Histopathological diagnosis was obtained following either surgery or core biopsy. Results Eighty-five tumors were renal cell carcinoma (RCC) (56 clear cell, 20 papillary, 9 chromophobe) and 10 were benign (6 angiomyolipoma,4 oncocytoma). 46 tumors were low-grade and 23 high-grade. There was significant difference between iodine content of clear cell and non-clear cell (papillary + chromophobe) RCC (p < 0.001). However, no significant iodine content differences were found between papillary and chromophobe RCC, benign and malignant tumors, low-grade and high-grade tumors. The best cut-off iodine content for differentiating clear cell from non-clear cell RCC was 3.2 mg/ml and clear cell from papillary RCC was 2.9 mg/ml with a high sensitivity and specificity. Also, significant difference was found between attenuation values of true and virtual unenhanced images (p = 0.007). Mean iodine content, absolute enhancement and enhancement ratio were highly correlated. Conclusion rsDECT contributes to renal tumor characterization by showing higher iodine content in clear cell RCCs compared with non-clear cell RCCs.

Reading the review by Rollhauser and Fleischerl [ 1 ] prompted us to present here our experience with upper gastrointestinal bleeding (UGIB) in the elderly. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in elderly patients to treat fever and pain, both in noninflammatory conditions such as headache and in inflammatory diseases such as rheumatoid arthritis, osteoarthritis, neuromuscular disorders, and musculoskeletal conditions. Gastrointestinal side effects such as ulcers and bleeding are the most prevalent life-threatening problems associated with NSAIDs. Buffum and Buffum have reported that particularly in the elderly, NSAIDs have become a leading cause of hospitalization and may increase the risk of death from ulceration by more than fourfold [ 2 ]. Upper gastrointestinal bleeding (UGIB) in elderly individuals is a frequent cause of hospital admission. Comorbidity and polypharmacy in this steadily growing patient group influence the clinical course and adversely affect the outcome [ 3 ]. In a study conducted at our institution, we aimed to compare the demographic characteristics, clinical and laboratory presentations, blood transfusion requirements, characteristics of endoscopic lesions, and prognosis in NSAID-induced UGIB versus other causes of bleeding in the elderly. Records for 92 of 172 patients aged over 65 years who were hospitalized in the intensive-care unit between January 2000 and January 2001 were studied. Patients were grouped as NSAID users (50 patients, 54 %) or non-NSAID users (42 patients, 46 %). NSAID users were defined as patients who had been exposed to NSAIDs during the week before the onset of bleeding; a similar definition was used by Laszlo and co-workers in a study comparing the clinical features of major upper gastrointestinal bleeding in patients exposed to NSAIDs and those not taking these drugs [ 4 ]. Patients were also included who had had any type of NSAID usage, with a minimum duration of 24 hours of therapeutic dosage as a criterion. Patients with variceal bleeding were excluded from the study. Hemoglobin levels below 9 g/dl were determined as a criterion for blood transfusion. Statistical significance was calculated using the chi-squared test and Student's t-test. Demographic, clinical, and laboratory parameters for the NSAID-positive and NSAID-negative groups were as follows: female/male ratio 0.72 and 0.82; average age 76.9 and 76.8; percentage of melena cases 92 % and 88 %; percentage of hematemesis cases 24 % and 29 %; average arterial blood pressure 123/72 mmHg and 125/69 mmHg; pulse rates 88/min and 90/min; Hb 9.84 g/dl and 10.08 g/dl; Hct 29 % and 30 %; urea 77.3 mg/dl and 66.9 mg/dl; blood transfusion requirements 2.5 units and 2.9 units; length of hospital stay 5.8 and 6.9 days; mortality rates 8 % and 11 %. The endoscopic diagnoses in the NSAID-positive and NSAID-negative groups were: gastric ulcers in seven and five patients; gastric erosions in 15 and 12 patients; duodenal ulcers in seven and 29 patients; and duodenal erosions in eight and seven patients. There were no differences between the two groups in relation to these parameters (P > 0.05). Comorbid diseases such as hypertension (34 % and 36 %), diabetes mellitus (24 % and 12 %), ischemic heart disease (26 % and 27 %), congestive heart disease (15 % and 17 %), and malignancy (7 % and 9 %) showed similar distribution ranges in the NSAID-positive and NSAID-negative groups (P > 0.05). Although low hemoglobin levels, higher blood transfusion requirements, and more gastric lesions were found in the NSAID-positive group than in the NSAID-negative group, the difference between the groups was not statistically significant. Langman [ 5 ] reported that over 40 % of a total of 8528 episodes of ulcer bleeding were seen in patients aged 60 years and over, while over 40 % of the estimated 981 deaths each year appeared to be causally related to the treatments. Substitution of NSAIDs with the lowest level of associated risk could be expected to reduce the frequency of nonaspirin NSAID-associated episodes of ulcer bleeding, and deaths by over 70 %. Using the lowest conventional dose of regular prophylactic aspirin (75mg) could also be expected to reduce the frequency of treatment-related episodes of ulcer bleeding and death by nearly 30 %. The study reported that both strategies employed together could be expected to reduce admissions for NSAID-related and regular aspirin-related ulcer bleeding from 4121 to less than 2184 per year, and deaths from 523 to less than 250 per year [ 5 ].