In the last few years, notable technical progress has taken place in ultrasound elastography. Qualitative methods have been replaced by quantitative ones, such as: transient elastography, acoustic radiation force impulse and shear wave elastography. Owing to the fact that the spleen is superficially located, it is possible to obtain reliable measuring accuracy of its hardness using sonoelastography. Lately, many researchers have been investigating how spleen elasticity changes in patients infected with hepatitis B virus or hepatitis C virus and in patients suffering from liver fibrosis, portal hypertension, esophageal varices or myelofibrosis. In this article, we review the role and current status of accessible qualitative ultrasound elastography methods, including recent advances in the evaluation of spleen stiffness and its clinical utility. As study results demonstrate, spleen stiffness correlates with liver fibrosis and is helpful in determining the level of fibrosis in the METAVIR scoring system. In patients infected with hepatitis B virus or hepatitis C virus, spleen stiffness increases even when liver elasticity remains unaltered. Furthermore, it is useful in diagnosing portal hypertension or predicting existence of esophageal varices. Moreover, in patients suffering from biliary atresia after Kasai portoenterostomy, spleen sonoelastography may be helpful in selecting patients for liver transplantation as well as for choosing the best strategy for portal vein reconstruction before liver transplantation. In myelofibrosis, spleen stiffness correlates with bone marrow fibrosis and may be used to assess the response to treatment. Spleen sonoelastography is also useful in the monitoring of transjugular intrahepatic portosystemic shunt function.
Hemodialyzed patients are at risk of multiple catheterizations. Nephrologists performing such procedures need to be familiar with congenital and acquired vascular abnormalities. We describe a successful insertion and use of a cuffed-tunneled catheter in a patient with unusual anatomy of the central venous system. Computed tomography angiography revealed thrombosis of the right subclavian vein and bilateral occlusion of innominate veins. The left internal jugular and subclavian veins joined to form a large vessel that drained through the accessory hemiazygos and azygos veins into the superior vena cava. The catheter was implanted through the left internal jugular vein into the accessory hemiazygos vein. The presented case demonstrates that the catheter can be implanted into distended collateral, especially when no other location is possible.
SummaryBackgroundMRCP is the method of choice in diagnosing pathologies of the biliary system. One of them is bile fistulae. They are uncommon but tend to cause many diagnostic problems. The possible way to improve MRCP is using it with intravenous injection of hepatobiliary-specific contrast agents. As it is eliminated via the hepatobiliary system, it can be visualized in the bile ducts and may help to reveal disorders undetected by a standard MRCP.Case ReportWe report a case of a 36-year-old woman with leakage in the biliary system which led to creation of a subcutaneous bile reservoir. By means of a regular MRCP protocol it was impossible to reveal any disorders of the biliary system and thus a decision to inject Gd-EOB-DTPA was taken. As a result, a fistula with its opening in the fundus of the gall bladder was revealed. Patient was qualified for treatment with somatostatin analogues in order to stop bile secretion.ConclusionsThe Gd-EOB-DTPA in combination with regular T2-weighted MRCP may be helpful in detecting anomalies of the biliary system. Although a high price of the procedure restricts its accessibility, such advantages as lower risk of complications, lower costs of hospitalization, and less traumatic nature make it a technique that may take precedence over ERCP in ambiguous cases.
Objective: The aim of this retrospective study was to evaluate the application of hydro-CT using sinogram-affirmed iterative reconstruction (SAFIRE) in the diagnosis of gastric cancer. Material/Methods: Low-dose hydro-CT was performed on 30 patients with suspicion of gastric cancer in gastroscopy. The raw data were reconstructed with SAFIRE. Images were retrospectively analyzed by two experienced radiologists in tandem who were blinded to the gastroscopy results. The results of the gastric biopsy were treated as a standard of reference. We compared the diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric cancer using the chi-square test with Yates’ correction. A P value of less than 0.05 was considered statistically significant. Results: The diagnosis of gastric cancer was confirmed in a histopathological examination in 25 (83.3%) patients, while in the remaining 5 cases (16.7%) benign gastric ulceration or gastritis was diagnosed. In 23 cases (92%) a correct diagnosis of gastric cancer was made in hydro-CT. The accuracy of endoscopy was at the level of 83.3%. There was no significant difference in the correctness of the diagnosis of gastric cancer in endoscopy and hydro-CT (p>0.05). For the diagnosis of gastric cancer with hydro-CT, sensitivity of 100%, specificity of 80%, a positive predictive value of 95.8%, and a negative predictive value of 100% were calculated. Conclusions: Low-dose hydro-CT using SAFIRE may be considered as a valuable diagnostic method for the diagnosis of gastric cancer, especially for patients who have contraindications to endoscopy or gastric biopsy.
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