Characterization of tumors of jaw:Additive value of contrast enhancement and dual-energy computed tomography

BACKGROUND Currently,the differentiation of jaw tumors is mainly based on the lesion’s morphology rather than the enhancement characteristics,which are important in the differentiation of neoplasms across the body.There is a paucity of literature on the enhancement characteristics of jaw tumors.This is mainly because,even though computed tomography(CT)is used to evaluate these lesions,they are often imaged without intravenous contrast.This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT,therefore improving the ability to differentiate between various pathologies.AIM To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.METHODS Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT.Morphological analysis of the tumor,including the enhancing solid component,was done,followed by quantitative analysis of iodine concentration(IC),water concentration(WC),HU,and normalized IC.The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma(CGCG),ameloblastoma,odontogenic keratocyst(OKC),and other jaw tumors.A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for nonparametric variables were used.If significant differences were found,a series of independent t-tests or Mann-Whitney U tests were used.RESULTS Ameloblastoma was the most common pathology(n=20),followed by CGCG(n=11)and OKC.CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas(P<0.05).An IC threshold of 31.35×100μg/cm^(3) had the maximum sensitivity(81.8%)and specificity(65%).Between ameloblastomas and OKC,the former showed a higher mean concentration of all quantitative parameters(P<0.001),however when comparing unilocular ameloblastomas with OKCs,the latter showed significantly higher WC.Also,ameloblastoma had a higher IC and lower WC compared to“other jaw tumors”group.CONCLUSION Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.

Epidemiological aspects of Budd-Chiari in Egyptian patients:A single-center study

AIM:To describe the socio-demographic features,etiology,and risk factors for Budd-Chiari syndrome(BCS) in Egyptian patients.METHODS:Ninety-four Egyptian patients with confirmed primary Budd-Chiari syndrome were presented to the Budd-Chiari Study Group(BCSG) and admitted tothe Tropical Medicine Department of Ain Shams University Hospital(Cairo,Egypt) . Complete clinical evaluation and laboratory investigations,including a throm bophiliaworkup and full radiological assessment,were performed to determine underlying disease etiologies.RESULTS:BCS was chronic in 79.8% of patients,acute or subacute in 19.1%,and fulminant in 1.1%.Factor V Leiden mutation(FVLM) was the most common etiological cause of disease(53.1%) ,followed by mutation of the gene encoding methylene tetra-hydrofolate reductase(MTHFR) (51.6%) . Current orrecent hormonal treatment was documented in 15.5%of females,and BCS associated with pregnancy was present in 17.2% of females. Etiology could not be determined in 8.5% of patients. Males had significantly higher rates of MTHFR gene mutation and Beh et's disease,and females had significantly higher ratesof secondary antiphos pholipid antibody syndrome.A highly significant positive relation ship was evident between the presence of Beh et's disease and inferiorven a caval occlusion,either alone or combined with occlusion of the hepatic veins(P < 0.0001) .CONCLUSION:FVLM is the most common disease etiology and MTHFR the second most common in Egyptian BCS patients. BCS etiology tends to vary with geographic region.

Advances in the imaging of gastroenteropancreatic neuroendocrine neoplasms

Gastroenteropancreatic neuroendocrine neoplasms comprise a heterogeneous group of tumors that differ in their pathogenesis,hormonal syndromes produced,biological behavior and consequently,in their requirement for and/or response to specific chemotherapeutic agents and molecular targeted therapies.Various imaging techniques are available for functional and morphological evaluation of these neoplasms and the selection of investigations performed in each patient should be customized to the clinical question.Also,with the increased availability of cross sectional imaging,these neoplasms are increasingly being detected incidentally in routine radiology practice.This article is a review of the various imaging modalities currently used in the evaluation of neuroendocrine neoplasms,along with a discussion of the role of advanced imaging techniques and a glimpse into the newer imaging horizons,mostly in the research stage.

Validation of prognostic indices in Egyptian Budd-Chiari syndrome patients: A single-center study

AIM To compare predictive ability of Budd-Chiari syndrome(BCS) prognostic indices(PIs) for one-year survival and Transjugular intrahepatic portosystemic shunt(TIPS) patency.METHODS This retrospective study enrolled 194 Egyptian patients with primary BCS who presented to the BuddChiari Study Group of Ain Shams University Hospital. Calculation of the available PIs was performed using Child-Pugh and model for end-stage liver disease scores, BCS-specific PIs(Clichy, New Clichy andRotterdam) for all patients, and BCS-TIPS PI only for patients who underwent TIPS. The overall one-year survival rate and the one-year shunt patency rate for TIPS were reported.RESULTS The overall one-year survival rate was 69.6%, and the New Clichy PI revealed the best validity for its prediction at a cut-off value of 3.75, with sensitivity and specificity of 78% and 73.3%, respectively [area under receiver operating characteristic curve(AUC) = 0.806]. The one-year survival rate post-TIPS was 89.7%, and the BCS-TIPS score demonstrated validity for its prediction at a cut-off value of 3.92(sensitivity and specificity were 71.4% and 64.5%, respectively)(AUC = 0.715). Logistic regression analysis revealed that the New Clichy PI(P = 0.030), high serum total bilirubin(P = 0.047) and low albumin(P < 0.001) were independent factors for predicting mortality within one year. The one-year shunt patency rate in TIPS was 80.2%, and none of the PIs exhibited significant validity for its prediction. CONCLUSION The New Clichy score could independently predict the one-year survival in Egyptian BCS patients.

Recent advances in imaging techniques of renal masses

Multiphasic multidetector computed tomography(CT)forms the mainstay for the characterization of renal masses whereas magnetic resonance imaging(MRI)acts as a problem-solving tool in some cases.However,a few of the renal masses remain indeterminate even after evaluation by conventional imaging methods.To overcome the deficiency in current imaging techniques,advanced imaging methods have been devised and are being tested.This review will cover the role of contrast-enhanced ultrasonography,shear wave elastography,dual-energy CT,perfusion CT,MR perfusion,diffusion-weighted MRI,blood oxygen leveldependent MRI,MR spectroscopy,positron emission tomography(PET)/prostate-specific membrane antigen-PET in the characterization of renal masses.

Multi-modality parathyroid imaging:A shifting paradigm

The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.