The Epidemiological, Clinical and Radiological (Echography, Mammography) Characteristics of Breast Pathologies at the Diagnostic Imaging Center (C.I.D) “Teriya” in Bamako

Breast pathology is varied, bringing together tumor and non-tumor lesions. Objective: To study the contribution of the ultrasound-mammography pair in the diagnosis of breast pathologies. Materials and Method: This was a retrospective descriptive study, carried out over a period of 3 years (from January 2018 to December 2020) at the Diagnostic Imaging Center (C.I.D) “TERIYA” in BAMAKO. It concerned all patients who came for a mammogram/ultrasound examination of the breast. All women admitted for mammogram or breast ultrasound who were diagnosed with a breast injury during the study period were included. Incomplete records and radiological checks were not included. The variables analyzed were age, sex, clinical data, and ultrasound and mammography aspects. The devices used are: a Voluson 730 PRO ultrasound machine and a G 600T type mammography machine. Results: At the end of our study, we collected 254 breast pathologies on a number of 382 women, i.e. a frequency of 66.49%. The average age of our patients was 41 years old. The dominant clinical data were mastodynia (41.88%) and mammary nodule (21.70%). On imaging (mammo-ultrasound) the lesions predominated on the left in 36% of cases, bilateral in 28% of cases and in the upper-outer quadrants in 31.5% of cases. Tumor pathologies represented 66.54% of which 45.27% were benign mainly composed of fibro-adenoma (20.88%) and cyst (18.50%), 11.8% of suspected cases and 9.45% of cancers. Non-tumor pathologies represented 33.46%, mainly mastitis (16.14%), galactophoric dilations (11.02%) and abscesses (5.51%). These pathologies were classified in 50.3% in ACR2, 17.75% in ACR3 and 4, and in 14.20% in ACR5. Lymphadenopathy was present in 73.21% of cases.

Ductal carcinoma in situ within a fibroadenoma:A case report and review of literature

BACKGROUND Fibroadenoma(FA)is the most common tumor found in young women,although it can occur in any age group.Ductal carcinoma in situ(DCIS)that is confined in a FA is rare;it is most frequently reported as an incidental finding.CASE SUMMARY We report a case of DCIS within a FA in a 46-year-old female without cancerrelated personal and family histories.The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year.In the current control image study,we found suspicious microcalcification,as a new finding,within one of the nodules.Consequently,a core biopsy of the tumor,which appeared hypoechoic,oval,and circumscribed,was performed.The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion.The patient underwent breastconserving surgery and received radiotherapy as well as endocrine therapy(tamoxifen).CONCLUSION We recommend a multidisciplinary approach for adequate treatment and followup.

Reversible lesions in the brain parenchyma in Wilson's disease confirmed by magnetic resonance imaging:earlier administration of chelating therapy can reduce the damage to the brain

The aim of this study was to evaluate the resolution of brain lesions in patients with Wilson’s disease during the long-term chelating therapy using magnetic resonance imaging and a possible signiifcance of the time latency between the initial symptoms of the disease and the introduction of this therapy. Initial magnetic resonance examination was performed in 37 patients with proven neurological form of Wilson’s disease with cerebellar, parkinsonian and dystonic presentation. Magnetic resonance reexamination was done 5.7 ± 1.3 years later in 14 patients. Patients were divided into： group A, where chelating therapy was initiated 〈 24 months from the ifrst symp-toms and group B, where the therapy started≥ 24 months after the initial symptoms. Symmetry of the lesions was seen in 100% of patients. There was a signiifcant difference between groups A and B regarding complete resolution of brain stem and putaminal lesions （P= 0.005 andP=0.024, respectively）. If the correct diagnosis and adequate treatment are not established less than 24 months after onset of the symptoms, irreversible lesions in the brain parenchyma could be ex-pected. Signal abnormalities on magnetic resonance imaging might therefore, at least in the early stages, represent reversible myelinolisis or cytotoxic edema associated with copper toxicity.

Single-Center Study of 83 Horses with Suspensory Injuries Treated with Adipose-Derived Stem and Regenerative Cells

Adipose-derived stem and regenerative cells (ADRCs), concentrated from autologous fat tissue, have the ability to differentiate into various specific cell types including tenocytes. In this retrospective study, clinical data are presented from 83 horses with 176 suspensory ligament injuries, treated with ADRCs, given a strictly enforced standardized rehabilitation program, and followed up for at least one year after returning to work. Assessment for a successful outcome was return to full work (RFW) at a previous or higher level of performance for one year or more without re-injury. RFW numbers were 84.6% for horses with fore-limb ligament injuries and 82.1% for horses with hind-limb injuries. RFW outcomes were slightly better in cases with proximal suspensory ligament desmitis (86.7%) compared to horses with lesions of the body and branches. The ADRC injection procedure was well tolerated;no treatment-related adverse events, including injection flares, were detected in any of the 83 horses. The demonstrated long term stability of healed lesions strongly supports the therapeutic use of regenerative cells extracted from adipose tissue for treatment of acute and chronic, fore- and hind-limb suspensory ligament injuries in horses of various athletic sport disciplines.

Contrast-Enhanced Mammogram: A New Game-Changer in Breast Imaging. Indications with Case-Based Experience

Mammograms are the mainstay of diagnostic breast imaging and cancer screening. Despite advances in technology such as Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT), these imaging techniques are purely structural, and are unable to overcome shortcomings in mammography posed by dense breast parenchyma. Magnetic Resonance Imaging (MRI) is the most sensitive modality in breast imaging, due to its functional aspects in addition to structural imaging with this modality. The use of MRI is however constrained by cost and availability. The utilization of intravenous contrast with mammograms introduces a functional element to imaging. This greatly improves the sensitivity of the examination, approaching sensitivity levels of Magnetic Resonance Imaging (MRI) in the detection of primary breast cancer. With increased sensitivity afforded by assessment of tumor neo-vascularity, as well as its low cost, low energy imaging that is more readily available than MRI, Contrast-Enhanced Mammography (CEM) if more readily available than MRI, this imaging modality is a potential game-changer in breast imaging. In this article, we share our experience in the use of CEM, for indications previously reserved for MRI, with the literature review of these indications. In resonance with prior studies, we echo the ease of performing and reporting of CEM as well as greater patient comfort as the distinct advantages of CEM. In spite of slightly higher radiation dose and some risks related to contrast media, functional results at a significantly lower cost may change how we practice breast imaging in the future using CEM.

Prognostic Value of Semi-Quantitative 18F-FDG PET/CT Parameters in Hodgkin’s Lymphoma

Objective:To assess the prognostic value of maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),and total lesion glycolysis(TLG)determined by 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET/CT)imaging in Hodgkin’s lymphoma patients.Methods:A total of 148 Hodgkin’s lymphoma patients diagnosed with lymph node biopsy from October 2014 to October 2015 were retrospectively analyzed followed by categorizing into good(125 cases)and poor(23 cases)prognosis groups.The chi-squared test was used to analyze the clinicopathological characteristics of Hodgkin’s lymphoma patients with the semi-quantitative 18F-FDG PET/CT parameters;the Spearman method was used to analyze the correlation between the semi-quantitative parameters and clinicopathological features of Hodgkin’s lymphoma;receiver operating characteristic curve was used to analyze the predictive value of the semi-quantitative parameters for poor prognosis of Hodgkin’s lymphoma patients.Results:Mean SUVmax,MTV,and TLG of the 148 cases of Hodgkin’s lymphoma were 7.26±2.38,12.46±3.14 cm3,and 76.83±18.56 g,respectively.Significant variations in the Ann Arbor stage and clinical classification were observed with different levels of semi-quantitative parameters(P<0.05).The semi-quantitative parameters were not correlated with age and gender(P>0.05)but positively correlated with Ann Arbor stage and clinical classification(P<0.05).These parameters in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The area under the curve(AUC)of SUVmax,MTV,and TLG in predicting the poor prognosis group was 0.881,0.875,and 0.838,with cut-off values of 7.264,12.898 cm3,and 74.580g,as well as specificity of 88.8%,84.0%,and 78.4%,and sensitivity of 87.0%,87.0%,and 78.3%,respectively;the AUC of the combined prediction was 0.986,with a specificity of 97.6%and sensitivity of 86.3%.Conclusion:The semi-quantitative 18F-FDG PET/CT parameters provide valuable insights for Hodgkin’s lymphoma prognosis assessment.

Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology

BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness.Virtual touch imaging quantification(VTIQ)based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children.AIM To determine the standard value in healthy children,and to identify possible factors that might influence the VTIQ measurement.METHODS With the ethical approval,202 children between 1 month and 15 years old were included in this study.None of them had any liver or systematic diseases.All children had a normal ultrasound scan and normal body mass index(BMI)range.The subjects were divided into four age and BMI groups.The effects of gender,age,liver lobe,measurement depth,and BMI on liver elasticity were investigated.RESULTS A significant correlation was found between age and shear wave velocity(SWV)value.At measurement depths of 1.5 cm and 2.0 cm in the left lobe,there were significant differences among the age groups.SWV values were significantly negatively correlated with the measurement depth.Gender,liver lobe,and BMI showed no significant effect on the SWV values.Age and BMI may influence the quality of the elastogram.CONCLUSION VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children.The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.

Practical Clinical Application of Cardiac Computed Tomography– Derived Fractional Flow Reserve

In the past decade,advances in coronary computed tomography angiography(CTA)technology have resulted in high sensitivity and negative predictive value in detecting coronary artery disease(CAD)compared with invasive coronary angiography,particularly for patients with mild or severe stenosis.However,anatomical evaluation of CAD by CTA has modest specifi city for patients with intermediate-grade stenoses.The recent development of the use of cardiac computed tomography– derived fractional fl ow reserve(FFR-CT)seeks to address this gap as a proposed method of functional assessment of CAD by CTA.In this article we aim to mix common clinical cases with the current technical methods,validation,outcomes,and registry studies as well as the technical,fi nancial and research limitations of FFRCT analysis to guide the cardiac imaging specialist in evaluating this technique.FFR-CT analysis may help reduce additive functional testing for the smaller proportion of patients with intermediate stenosis undergoing coronary CTA where the atherosclerosis signifi cance is uncertain.

Phosphoglyceride crystal deposition disease requiring differential diagnosis from malignant tumors and confirmed by Raman spectroscopy: A case report

BACKGROUND Phosphoglyceride crystal deposition disease(PCDD)is a rare acquired disease in which phospholipid crystals deposit in bone and soft tissue long after surgery,trauma,or repeated injections.CASE SUMMARY A 60-year-old-woman was referred to our department because of multiple abdominal masses after open splenectomy for idiopathic thrombocytopenic purpura 29 years earlier.All the masses showed marked fluorodeoxyglucose(FDG)uptake on ^(18)F-fluorodeoxyglucose positron emission tomography(^(18)F-FDGPET)and were strongly suspected to be malignant tumors.Surgical biopsies were performed,and the abdominal masses were found to be aligned vertically,three in a row,along the tissue layers cut in the patient’s previous surgery.Pathological finding of the specimens showed foreign body granuloma consisting of histiocytes and multinucleated giant cells accumulating around needle-like crystals.The crystals were confirmed as phosphoglyceride by Raman spectroscopy,and PCDD was diagnosed.To our knowledge,this is the first report of PCDD diagnosed by Raman spectroscopy.CONCLUSION We made a definitive diagnosis of PCDD in a patient with multiple tumors showing marked FDG uptake on ^(18)F-FDG-PET by incisional biopsy and composition analysis using Raman spectroscopy,a method that has not previously been reported for the diagnosis of PCDD.

Value of CT scan in the diagnosis of primary large bowel lymphoma

Objective: To study the CT imaging of primary large bowel lymphoma and evaluate the value of CT scan. Methods: CT reports of 8 patients with proven primary large bowel lymphoma were retrospectively reviewed. Plain CT scans were done on all patients, enhanced CT scans simultaneously with 5-10 mm section thickness, and 5-10 mm table increments in 6 cases. Results: Primary involved sites were on the cecum (n=3), the ascending colon (n=2), and the rectum (n=1). The tumor was found in multiple areas of the large bowel in 2 cases. CT appearance fell into 3 typical patterns in our study. The first was focal mass type in 2 cases, with one combined with intussusception and retroperitoneal adenopathy; the second was segmental annular involvement type in 3 cases, with one of them combined with mesenteric adenopathy; the last was diffuse involvement type in 2 cases. Multiple nodules were seen in the rectum in 1 case. Conclusion: CT was found to be accurate in detecting the primary sites and complications of lymphoma, and evaluating invasion of adjacent structures; Focal mass type, segmental annular involvement type and diffuse involvement type are the main patterns of CT features in the primary large bowel lymphoma; The features revealed by CT scan are suggestive of primary large bowel lymphoma in some cases.

遗传性根髓动脉或胸腹主动脉动脉瘤的显示:64层CT血管成像中最佳对比剂的应用

本研究的目的是前瞻性地研究对比剂的浓度及注射速度．以获得使用64层螺旋CT显示根髓动脉的最佳影像。该实验将80例病人平均分为4组：A，100mL对比剂，浓度300mgI／mL，注射速度5．0mL／s；B，100mL对比剂，浓度350mgI／mL，注射速度5．0mL／s；C，100mL对比剂，浓度300mgI／mL，注射速度3．5mL／s；D，100mL对比剂，浓度350mgI／mL，注射速度3．5mL／s。测量胸5～腰3平面主动脉的CT值并计算其平均值，进行定量评价。

Early Life Stress as Factor for Use of Psychoactive Substances: Integrative Review

Purpose: To identify, analyze and synthetize the scientific evidences that support Early Life Stress (ELS) diagnosis using the Childhood Trauma Questionnaire (CTQ), since it assumes the use of psychoactive substances later in adolescence and adulthood. Individuals that experienced some form of childhood stress may present, in adulthood, consequences that manifest into mental disorders such as problematic use of psychoactive substances. Methods: An integrative review of the literature on the subject in the databases: PubMed, Web of Science, LILACS and Psycinfo, regards studies that have been indexed in the last ten years (2003-2014). Combination of controlled and uncontrolled factors in the use and abuse of psychoactive substances, CTQ and ELS adapted to each database. Findings: The alcohol was the most used drug by the participating subjects of these research;mostly, the use of psychoactive drugs, started when they were still in adolescence;ELS and the later use of psychoactive drugs can be found more frequently in female;the lack of internal resources for dealing with stress in adulthood after ELS occurrence may have as a consequence the use of psychoactive drugs as a coping mechanism. Conclusions: It was possible to identify scientific evidences that support the ELS diagnosis, measured by the CTQ, as a determining factor for the use and abuse of alcohol and/or other psychoactive drugs in adolescence and adulthood. Implications: Investigate the ELS as a strategy to improve the therapeutic project of patients in nursing care, which will be built based on scientific evidence, so it can be more effective.

Trichoblastic Fibroma of the Skin Mimicking Primary or Secondary Breast Cancer

We report a case of a 71 -year- old female with trichoblastic fibroma, a rare benign tumor of the skin, found in the left breast, associated with an invasive contralateral breast cancer. On clinical examination, a solitary, firm nodule was found in the subcutaneous tissue of the left breast with no changes in the overlying skin. Radiological examination showed disconcordant results. Conventional mammography and ultrasound suggested benign nature, while magnetic resonance mammography and spectroscopy raised the presumption of the malignant nature of the lesion. After performing excisional biopsy, the diagnosis of trichoblastic fibroma was established. Microscopically, it was composed of fibrous stroma, basaloid germs and strands and lace-like epithelial components, with no obvious connection with overlying epithelium or adjacent adnexal structures.

IS There A Role of 18F-FDG PET/CT for Initial Staging of Rectal Cancer？

Background： The management of the rectal cancer requires accurate initial staging. Besides routinely performed conventional imaging, during the last decade 18F-FDG PET/CT became a popular whole-body metabolic imaging for preoperative TNM classification. The purpose of the study was to evaluate the role of 18F-FDG PET/CT in the rectal cancer staging. Patients and methods： 45 patients with rectal cancer who preoperatively underwent 18F-FDG PET/CT imaging in the period from 2011 to 2014 were analyzed. All patients were referred to the surgery afterwards. Histopathologic findings were used as a standard of reference. Descriptive techniques were used for frequency analyses and sensitivity calculations. The X2 test was used for significance calculation of the contingency tables while Monte Carlo simulation and Fisher＇s exact test were used for the table fields where number of cases was smaller than demanded. Results： The average SUVmax value of the primary tumor for all T stages was 26.02 gm/mL. The average SUVmax values of the lymph nodes in N1 stage and N2 stage were 6.04 gm/mL and 6.33 gm/mL, respectively. PET/CT detected benign lesions in 17 （28.3%） patients with average SUVmax of 15.4 mg/mL. The vaginal wall infiltration was detected in 2 （4.4%） patients. Penetration of mesorectal fascia was detected in 21 （46.7%） of patients. Four patients （8.9%） had liver metastases identified by lSF-FDG PET/CT. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT in T staging was 90.7%, 91.9%, and 90.5%, respectively. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT in detection of metastatic lymph node was 85.8%, 89.8%, and 89%, respectively. PET/CT shows low sensitivity （77.3%） and specificity （25%） in analyzing mesorectal fascia involvement. The overall sensitivity of 18F-FDG PET/CT in M staging was 100%. Conclusions： 18F-FDG PET/CT is highly sensitive for initial T staging of rectal cancer especially in advanced disease. This imaging modality is highly accurate in detection of metastatic lymph nodes and liver metastases, but it has no role in defining ofmesorectal fascia involvement. Therefore, 18F-FDG PET/CT should be incorporated routinely in preoperative staging together with conventional imaging.

Ultrasonographic diagnosis of urinary calculus caused by melamine in children

Background Intake of melamine can cause renal and ureteral lithiasis in infants and children. The present study aimed to understand the value of ultrasonography in the diagnosis of renal and ureteral lithiasis in infants and young children caused by melamine, and the characteristics of ultrasonograms of melamine-associated calculi. Methods Ultrasonographic examination on the urinary system was performed for 28 332 children who ingested milk powder that was possibly tainted with melamine; 395 of the children were diagnosed by ultrasonography as having urinary calculus, and 231 cases had lump-like calculi and 164 cases had sand gravel-like calculi. The features of the calculi, the sites of obstruction and the status of hydronephrosis and hydroureterosis were analyzed. Ultrasonographic reexamination was performed for 116 patients and the findings were compared with those of the first ultrasonography, and the short-term expulsion of the calculi was evaluated. Results Most of the 395 patients with urinary lithiasis, except for those who developed renal failure, had no symptoms. The whole profile of the calculi could be seen in most of the cases, because the echogenicity of the calculi with no sharp or absent acoustical shadowing, was weaker as compared with those from calcium-containing calculi. Comet tail sign could be seen behind the echogenicity of single gravel calculus. The rate of diagnostic consistency of ureteral lithiasis between the ultrasound and the results of clinical observation （including stones expelled spontaneously or after cystoscopic intervention） in 51 cases for 76 ureters was 100%. Percutaneous renal biopsy was performed for one case, and histopathological examination showed flocculent, fine strip-like, ellipse and circular deeply stained sand gravel-like material in the renal tubules, and the circular calculi were found to be attached to the walls of the tubules. Chemical analysis of the calculi expelled from 12 cases showed that the main contents of the calculi were uric acid and melamine. Short-term ultrasound reexamination in 116 patients showed that gravel-like calculi disappeared in 80.4% of the cases; in 26 non-hospitalized cases who had lump-like calculi without hydronephrosis or hydroureterosis, none of the lump-like calculi were expelled. Conclusions The ultrasonograpic findings of urinary calculi in children caused by ingestion of melamine-tainted milk powder have a certain features as compared to the calculi containing calcium. Careful ultrasound examination can avoid missed diagnoses of ureteral calculi. Most of the gravel-like calculi can be expelled within a short period of term, while lump-like calculi can hardly be expelled. Ultrasonography is an accurate and reliable method of diagnosis of urinary calculus caused by melamine intake in children and it can be used as diagnostic method of choice although abdominal X-ray plain film can also visualize some of larger calculi.

Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children

Background Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk. Methods Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children＇s Hospital Affiliated to the Capital Medical University and the Xuzhou Children＇s Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies. Results All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen （BUN） was （24.1±8.2） mmol/L and creatinine （Cr） was （384.2±201.2） umol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was （3.5±1.9） days for cystoscopy group, （2.7±1.1） days for lithotomy group, （3.8±2.3） days for dialysis group, and （2.7±1.6） days for medical treatment group, which had no statistically significant difference （P=-0.508）. Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging （3.00±1.78） days. Conclusions Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as possible. It was observed that the short-term prognosis was satisfactory.