Imaging features and management of focal liver lesions

Notably,the number of incidentally detected focal liver lesions(FLLs)has increa-sed dramatically in recent years due to the increased use of radiological imaging.The diagnosis of FLLs can be made through a well-documented medical history,physical examination,laboratory tests,and appropriate imaging methods.Although benign FLLs are more common than malignant ones in adults,even in patients with primary malignancy,accurate diagnosis of incidental FLLs is of utmost clinical significance.In clinical practice,FLLs are frequently evaluated non-invasively using ultrasound(US),computed tomography(CT),and magnetic resonance imaging(MRI).Although US is a cost-effective and widely used imaging method,its diagnostic specificity and sensitivity for FLL characterization are limited.FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI.MRI is a problem-solving method with high specificity and sensitivity,commonly used for the evaluation of FLLs that cannot be characterized by US or CT.Recent technical advancements in MRI,along with the use of hepatobiliary-specific MRI contrast agents,have significantly improved the success of FLL characterization and reduced unnece-ssary biopsies.The American College of Radiology(ACR)appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients.ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommend-ations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios.The American College of Gastroenterology(ACG)Clinical Guideline offers evidence-based recommend-ations for both the diagnosis and management of FLL.American Association for the Study of Liver Diseases(AASLD)Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma.In this article,FLLs are reviewed with a comprehensive analysis of ACR Appropri-ateness Criteria,ACG Clinical Guideline,AASLD Practice Guidance,and current medical literature from peer-reviewed journals.The article includes a discussion of imaging methods used for the assessment of FLL,current recommended imaging techniques,innovations in liver imaging,contrast agents,imaging features of common nonmetastatic benign and malignant FLL,as well as current management recommendations.

Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital

Objective:To retrospectively analyze patients aged 65 years and over,who were admitted to a level Ⅱ trauma center in Turkey due to minor spinal trauma in a period of 4 years.Methods:The study included 64 patients aged 65 years and over,who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma.The information of the patients was obtained from the medical records.The clinical characteristics of patients including localizafions and types of fracture,presence of additional system injuries and treatment options were investigated.Results:The most common cause was fall,accounting for 51 (79.7%),with 7 (10.9%) due to intra-vehicle traffic accident,and 6 (9.4%) due to out-of-vehicle pedestrian injury.The most common site of trauma was the lumbar region.Of the fractures,46.9% (n=30) were in the lumbar region,37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region.Fourteen (21.9%) patients had an additional injury.Given the fracture types,47 fractures (74.6%) were compression,14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures.Twenty patients (31.2%) had multilevel vertebral fractures.Conclusions:The results of our study demonstrated the importance of vertebral fractures in the geriatric age group.In this age group,falls and motor vehicle accidents are the leading causes of vertebral traumas.Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.