Benign gallbladder diseases:Imaging techniques and tips for differentiating with malignant gallbladder diseases

Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening.Intraluminal lesions of the gallbladder include gallstones,cholesterol polyps,adenomas,or sludge and polypoid type of gallbladder cancer must subsequently be excluded.Polyp size,stalk width,and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer.Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis,although infiltrative cancer may present similarly.Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis.The layered pattern,degree of enhancement,and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer.High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall.A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder.Nevertheless,it is important to check for coexistent cancer in instances of acute cholecystitis.Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography.In chronic cholecystitis,preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy.Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction.Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.

Short-term interval combined chemoembolization and radiofrequency ablation for hepatocellular carcinoma

AIM: To investigate hepatic function after combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with a short-term interval (0-2 d).

Assessing significant fibrosis using imaging-based elastography in chronic hepatitis B patients: Pilot study

BACKGROUND Accurate detection of significant fibrosis(fibrosis stage 2 or higher on the METAVIR scale)is important especially for chronic hepatitis B(CHB)patients with high viral loads but with normal or mildly elevated alanine aminotransferase(ALT)levels because the presence of significant fibrosis is accepted as the indication for antiviral treatment.Liver biopsy is the reference standard for diagnosing significant fibrosis,but it is an invasive procedure.Consequently,noninvasive imaging-based measurements,such as magnetic resonance elastography(MRE)or two-dimensional shear-wave elastography(2DSWE),have been proposed for the quantitative assessment of liver fibrosis.AIM To explore MRE and 2D-SWE to identify fibrosis stage,and to compare their performance with that of serum-based indices.METHODS The study enrolled 63 treatment-na?ve CHB patients with high viral loads but with normal or mildly elevated ALT levels who underwent liver biopsy before a decision was made to initiate antiviral therapy.MRE and 2D-SWE were performed,and serum-based indices,such as FIB-4 and aspartate transaminase to platelet ratio index(APRI),were calculated.The diagnostic performances of MRE,2D-SWE,FIB-4,and APRI for assessing significant fibrosis(≥F2)and cirrhosis(F4)were evaluated with liver histology as the reference standard,using receiver operating characteristic analyses.RESULTS The liver fibrosis stage was F0/F1 in 19,F2 in 14,F3 in 14,and F4 in 16 patients,respectively.MRE significantly discriminated F2 from F0/1(P=0.022),whereas 2D-SWE showed a broad overlap in distinguishing those stages.MRE showed a higher correlation coefficient value with fibrosis stage than 2D-SWE with fibrosis stage(0.869 vs 0.649,Spearman test;P<0.001).Multivariate linear regression analyses showed that fibrosis stage was the only factor affecting the values of MRE(P<0.001),whereas body mass index(P=0.042)and fibrosis stage(P<0.001)were independent factors affecting 2D-SWE values.MRE performance for diagnosing significant fibrosis was better[area under the curve(AUC)=0.906,positive predictive value(PPV)97.3%,negative predictive value(NPV)69.2%]than that of FIB-4(AUC=0.697,P=0.002)and APRI(AUC=0.717,P=0.010),whereas the performance of 2D-SWE(AUC=0.843,PPV 86%,NPV 65%)was not significantly different from that of FIB-4 or APRI.CONCLUSION Compared to SWE,MRE might be more precise non-invasive assessment for depicting significant fibrosis and for making-decision to initiate antiviral-therapy in treatment-na?ve CHB patients with normal or mildly-elevated ALT levels.

Three-Tesla magnetic resonance elastography for hepatic fibrosis:Comparison with diffusion-weighted imaging and gadoxetic acid-enhanced magnetic resonance imaging

AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.

Pemetrexed in Previously Treated Non-small Cell Lung Cancer Patients with Poor Performance Status

Background and objective Pemetrexed have been approved for the treatment of patients affected by advanced non-small cell lung cancner(NSCLC) in progression after first-line chemotherapy.We evaluated the activity and feasibility of pemetrexed in previously treated NSCLC.Methods Patients with histologically or cytologically confirmed NSCLC were evaluated from April 2007 to March 2009.The patients had relapsed or progressed after prior chemotherapy treatment.Pemetrexed(500 mg/m2) was administered intravenously once every 3 weeks after progression to prior chemotherapy.The tumor response was evaluated according to RECIST criteria by chest CT at every 2 cycles of chemotherapy.Results A total 61 patients were eligible for analysis.Performance status of them(100%) was over 2.The response rate and disease control rate were 14.7% and 37.7% respectively.Non-squamous cell carcinoma histology was significantly associated with a superior response rate(P=0.045) and disease control rate(P=0.008).The median survival time and the median progression free survival(PFS) time were 6.11 months and 2.17 months,respectively.Comparing the efficacy of pemetrexed in these two settings [second-line versus(12/61) more than third(49/61)],there was no significant difference in regard to median survival(11.18 months vs 11.46 months,P=0.922,5),but PFS was more longer in third-or further-line groups than second-line group(1.39 months vs 2.25 months,P=0.015,3).Conclusion Pemetrexed is a feasible regimen in previously treated NSCLC with poor performance status.

Expression Pattern of the Hippo Pathway Effector TAZ in Cellular and Fibrotic Nonspecific Interstitial Pneumonia

Interstitial lung disease （ILD） is a comprehensive term referring to a group of lung diseases affecting the interstitium of the lung. Idiopathic pulmonary fibrosis （IPF） is the most common idiopathic ILD, and nonspecific interstitial pneumonia （NSIP） is the second most common. As the name suggests, NSIP is diagnosed atter many other diseases are excluded. The main pathological finding in NSIP is homogeneous interstitial inflammation with or without fibrosis. NSIP can be categorized by cellular type or fibrotic type, according to the grade of inflammation and fibrosis. The cellular type has mostly inflammatory lesions with good responses to steroid, but the fibrotic type has a large proportion of fibrosis mixed with inflammatory lesions and a relatively poor response to steroid treatment So far, the exact mechanism underlying idiopathic lED has not been clarified. Determining key regulators of these ILDs will be helpful in the diagnosis and development of novel drugs for ILD.