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  • 21
    Publication Date: 2018-03-05
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 22
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    Springer
    Publication Date: 2018-03-05
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 23
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    Springer
    Publication Date: 2018-03-05
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 24
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    Springer
    Publication Date: 2018-03-05
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 25
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    Springer
    Publication Date: 2018-03-05
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 26
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    Springer
    Publication Date: 2018-03-05
    Description: Proper pre- and post-transplant diagnostic imaging work-up is fundamental in ensuring a successful outcome for renal transplantation. Despite exposure to ionizing radiation, CT has high spatial resolution and is a widely available and fast imaging technique. CT is performed routinely to delineate the anatomy of the kidney, relevant vasculature, and urinary collecting system in the living donor, to assess the iliac vessels in potential recipients prior to surgery, and to assess early and late-term post-transplant complications. The purpose of this article is to outline the optimal CT protocol and the main reportable findings for both the donor and the recipient diagnostic imaging work-up as well as to point out the main issues regarding ionizing radiation exposure and contrast medium injection in these subjects.
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 27
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    Publication Date: 2018-03-05
    Electronic ISSN: 1432-0509
    Topics: Medicine
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  • 28
    Publication Date: 2018-03-05
    Description: Microbubble ultrasound contrast agents (UCAs) were recently approved by the Food and Drug administration for non-cardiac imaging. The physical principles of UCAs, methods of administration, dosage, adverse effects, and imaging techniques both current and future are described. UCAs consist of microbubbles in suspension which strongly interact with the ultrasound beam and are readily detectable by ultrasound imaging systems. They are confined to the blood pool when administered intravenously, unlike iodinated and gadolinium contrast agents. UCAs have a proven safety record based on over two decades of use, during which they have been used in echocardiography in the U.S. and for non-cardiac imaging in the rest of the world. Adverse effects are less common with UCAs than CT/MR contrast agents. Compared to CT and MR, contrast-enhanced ultrasound has the advantages of real-time imaging, portability, and reduced susceptibility to metal and motion artifact. UCAs are not nephrotoxic and can be used in renal failure. High acoustic amplitudes can cause microbubbles to fragment in a manner that can result in short-term increases in capillary permeability or capillary rupture. These bioeffects can be beneficial and have been used to enhance drug delivery under appropriate conditions. Imaging with a mechanical index of 〈 0.4 preserves the microbubbles and is not typically associated with substantial bioeffects. Molecularly targeted ultrasound contrast agents are created by conjugating the microbubble shell with a peptide, antibody, or other ligand designed to target an endothelial biomarker associated with tumor angiogenesis or inflammation. These microbubbles then accumulate in the microvasculature at target sites where they can be imaged. Ultrasound contrast agents are a valuable addition to the diagnostic imaging toolkit. They will facilitate cross-sectional abdominal imaging in situations where contrast-enhanced CT and MR are contraindicated or impractical.
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 29
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    Publication Date: 2018-03-05
    Description: Purpose The detection rate and the metabolic behavior of 18F-FDG-PET/CT in splenic marginal zone lymphoma (SMZL) are not yet clear. Our aim was to investigate the metabolic behavior of SMZL and whether the tumor stage (acc. Ann Arbor) epidemiological (age, gender), histological (Ki-67 index, plasmacytic differentiation), and morphological (splenic diameter maximum) features might be related to 18F-FDG PET/CT results. Methods Fifty-one patients (34 male, 17 female; average age 70 years) with histologically confirmed SMZL who underwent a 18F-FDG PET/CT for initial staging were included: PET/CT images were analyzed visually and semi-quantitatively (SUVmax, lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio). Splenic uptake was divided as diffuse or focal. Results Thirty-nine patients (76%) had FDG-avid SMZL (7 with focal splenic lesions and 32 with diffuse splenic uptake), while the remaining 12 had no increased splenic uptake. Among patients with FDG-avid lesions, average SUVmax was 4.3, lesion-to-liver SUVmax ratio 2.3, and lesion-to-blood pool SUVmax ratio 3. 18F-FDG avidity was significantly associated with Ki-67 index and not correlated with other features. Semiquantitative PET/CT parameters (SUVmax, lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio) did not correlate significantly with any variable. Progression-free survival time was not influenced by FDG avidity of SMZL. Conclusions 18F-FDG avidity was noted in 76% of SMZL with diffuse splenic uptake as main pattern of presentation and is correlated with Ki-67 score only.
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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  • 30
    Publication Date: 2018-03-05
    Description: Objective The purpose of this study was to compare the sensitivity and specificity of diffusion-weighted liver MRI alone with complete, multiphasic gadoteridol-enhanced MRI for the detection of hepatocellular carcinoma in cirrhotic patients before liver transplant. Materials and methods This single institution retrospective study was performed after IRB approval and was HIPAA compliant. MRI scans of 37 patients who underwent liver transplant were evaluated and findings correlated with liver explant (36) or biopsy (1). All MRI scans were obtained within six months of explant. MRI from 17 patients with liver lesions by report at imaging subsequently proven to be HCC at pathology and 20 controls without liver lesions by imaging and pathology were reviewed in random order on the radiology PACS by three independent readers blinded to the MRI reports and pathology reports in two separate sittings. First, only the diffusion-weighted images (DWI) were interpreted. Second, the complete multiphasic MRI exam with DWI was reviewed. A consensus read was obtained by two separate radiologists who had access to the patients’ explant data in order to map lesions. Reader-specific and pooled classification was assessed using sensitivity, specificity, positive predictive value, and negative predictive values and corresponding 95% confidence intervals (CI) for both DWI and complete MRI examination readings compared to pathology. McNemar’s test and Kappa coefficient were used to assess differences (agreement) in DWI and complete examination readings. Results A total of 37 patients have been studied (25M 12F age range 21–70). Averaged results of the three independent readers demonstrated a sensitivity of 78% (95% CI 65–89%) and specificity of 88% (95% CI 77–95%) for DWI alone for detection of liver lesions, with a positive predictive value of 85% (95% CI 72–94%) and a negative predictive value of 83% (95% CI 71–91%). Review of the complete MRI exam showed a sensitivity of 90% (95% CI 76–97%) and a specificity of 82% (95% CI 66–92%) with a positive predictive value of 83% (95% CI 69–93%) and a negative predictive value of 89% (95% CI 74–97%). McNemar’s agreement test revealed no significant difference between the DWI and complete multiphasic interpretations ( p  = 0.3458), with simple Kappa coefficient of 0.6716 (95% CI 0.5332–0.8110). Lesions identified on DWI ranged in size from 1.5 to 5 cm. Detection of lesions was decreased in the presence of artifact from motion, large ascites, and technical issues. Conclusion Diffusion-weighted MRI has NPV and PPV comparable to complete multiphasic MRI examination for liver lesion detection in cirrhotic patients and may have a role in screening.
    Electronic ISSN: 1432-0509
    Topics: Medicine
    Published by Springer
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