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.

Magnetic resonance imaging evaluation of head and neck involvement in IgG4-related disease

Objective:To evaluate the radiological features of IgG4-related disease(IgG4-RD)in the head and neck region.Methods:In this radiology-based study,radiological features,clinical,laboratory,pathological findings,and prognosis of nine patients with head and neck involvement diagnosed with IgG4-RD were investigated retrospectively.Results:The median age of the patients was 38 years(range:2.5-79 years),and there were six males and three females.The most common symptoms and clinical findings of the patients were eyelid and lacrimal gland swelling,painless exophthalmos,and ophthalmoplegia.The most common site of involvement on MRI was the orbit.Orbital involvement was followed by branches of the trigeminal nerve,sinonasal cavity,cervical lymph nodes,and dural involvement.The most common and remarkable imaging features were T2 hypointensity and diffuse homogeneous contrast enhancement.Conclusions:Head and neck involvement of the IgG4-RD,has specific imaging features that can help with diagnosis.Thus,early diagnosis and better outcomes can be achieved with increasing awareness of these features of this relatively new pathology.

Serum positive cagA in patients with non-ulcer dyspepsia and peptic ulcer disease from two centers in different regions of Turkey

AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia.METHODS: One hundred and eighty Helicobacter pyloripositive patients with peptic ulcer disease or non-ulcer dyspepsia were included in the study. One hundred and fourteen patients had non-ulcer dyspepsia and 66 had peptic ulcer disease (32 with gastric ulcers and/or erosions and 34with duodenal ulcers). Each patient was tested for serum antibody to H. pylori cagA protein by enzyme immunoassay.RESULTS: The total frequency of serum positive cagA in the study group was 97.2 %. The rates in the patients with peptic ulcers and in those with non-ulcer dyspepsia were 100% and 95.6%, respectively. These results were similar to those reported in Asian studies, but higher than those that have been noted in other studies from Turkey and Western countries.CONCLUSION: The high rates of serum positive cagA in these patients with peptic ulcer disease and non-ulcer dyspepsia were similar to results reported in Asia. The fact that there was high seroum prevalence regardless of ulcer status suggests that factors other than cagA might be responsible for ulceration or other types of severe pathology in H. pylori-positive individuals.

Association of ezrin expression in intestinal and diffuse gastric carcinoma with clinicopathological parameters and tumor type

AIM： To investigate the correlation between ezrin expression and types of gastric carcinoma and clinicopathological variables.METHODS： We examined ezrin protein expression in 75 gastric carcinoma （53 intestinal types of adenocarcinoma, 22 diffuse types of carcinoma） tissues by immunohistochemistry. The results were compared with clinicopathological parameters such as tumor type, grade of tumor, clinical stage, presence of metastatic lymph node, and depth of invasion. RESULTS： Ezrin immunostaining was positive in 43 cases （81.1%） of intestinal type and in 9 （40.9%） cases of diffuse type adenocarcinomas （P 〈 0.001）. In gastric carcinomas, the expression of ezrin protein correlated with the status of H py/ori and survival. There was no correlation between expression of ezrin with TNM stage and histological grade of gastric carcinomas （P 〉 0.05）. CONCLUSION： The low expression of ezrin implicates the loss of adhesion in diffuse carcinomas. Furthermore, overexpression of ezrin in carcinomas with H pylori infection may be a genuine specific pathway in which Hpylori may cause/initiate gastric carcinoma.

无针喷注器注射博来霉素治疗瘢痕疙瘩和肥厚性瘢痕的一项初步研究

Background: Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. Objectiv e: The aim of this study was to determine the efficacy and safety of intralesion al jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection. Methods: The study include d 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple j et injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesio n, with injection sites spaced 0.5 mm apart. Injections were repeated each month . Scar height was measured, and scar pliability and erythema were scored at base line and then monthly during the treatment and followup periods. Patients’self -assessments of subjective symptoms (pruritus and pain)were also scored. Clinic al improvementwas defined primarily on the basis of scar height reduction (perce ntage reduction from baseline), and was classified using the following scale: co mplete flattening (100%), highly significant flattening (> 90%), significant f lattening (75-90%), moderate flattening (50-75%), and minimal flattening (< 50%). Preand post-treatment mean values for scar height, scar pliability, eryt hema, pruritus and pain were statistically compared. Results: The number of sess ions required to successfully treat the lesions ranged from two to six. Eleven l esions (73.3%) showed complete flattening, one (6.7%) showed highly significan t flattening, two (13.3%) showed significant flattening, and one scar (6.7%) s howed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the e nd of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean sco res for pruritus and pain also improved significantly (P < 0.001 and P=0.01, res pectively). The observed side-effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months). Conclusions: Intralesional jet injection of bleo mycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy.