Research

11 pages, 2824 KiB

Open AccessArticle

Esophagogastroduodenal Findings in Patients with Intraductal Papillary Mucinous Neoplasms

by Dana Zelnik Yovel, Erwin Santo, Majd Khader, Roie Tzadok, Nir Bar, Asaf Aizic, Oren Shibolet and Dana Ben-Ami Shor

Diagnostics 2023, 13(12), 2127; https://doi.org/10.3390/diagnostics13122127 - 20 Jun 2023

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Abstract

The association between intraductal papillary mucinous neoplasms (IPMNs) and extra-pancreatic malignancies is controversial. This cross-sectional study compared esophagogastroduodenal findings in 340 IPMN patients to those of age- and gender-matched controls without known IPMNs who underwent esophagogastroduodenoscopies (EGDs) for similar clinical reasons. The presence [...] Read more.

The association between intraductal papillary mucinous neoplasms (IPMNs) and extra-pancreatic malignancies is controversial. This cross-sectional study compared esophagogastroduodenal findings in 340 IPMN patients to those of age- and gender-matched controls without known IPMNs who underwent esophagogastroduodenoscopies (EGDs) for similar clinical reasons. The presence of gastric and esophageal cancer, Barrett’s esophagus, neuroendocrine tumors (NETs), gastrointestinal stromal tumors (GISTs), gastric adenomas, and ampullary tumors was assessed. The results showed that 4/340 (1.2%) of the IPMN patients had gastric cancer and 1/340 (0.3%) had esophageal cancer. The matched control group had a similar incidence of gastric cancer (5/340) (1.5%), with no esophageal cancer cases (p > 0.999). The overall incidence of other esophagogastroduodenal conditions did not significantly differ between the IPMN patients and the controls. However, the incidence of gastric cancer in the IPMN patients was higher than expected based on national cancer registry data (standardized incidence ratio of 31.39; p < 0.001; CI 8.38–78.76). In conclusion, IPMN patients have a significantly higher incidence of gastric cancer compared to the general population. However, the incidence of esophagogastroduodenal findings, including gastric and esophageal cancer, is similar between IPMN patients and those who undergo an EGD for similar clinical indications. Further research is needed to determine optimal surveillance strategies for IPMN patients regarding their risk of developing gastric cancer. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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Review

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14 pages, 440 KiB

Open AccessReview

Impaired Intestinal Permeability Assessed by Confocal Laser Endomicroscopy—A New Potential Therapeutic Target in Inflammatory Bowel Disease

by Stefan Chiriac, Catalin Victor Sfarti, Horia Minea, Carol Stanciu, Camelia Cojocariu, Ana-Maria Singeap, Irina Girleanu, Tudor Cuciureanu, Oana Petrea, Laura Huiban, Cristina Maria Muzica, Sebastian Zenovia, Robert Nastasa, Remus Stafie, Adrian Rotaru, Ermina Stratina and Anca Trifan

Diagnostics 2023, 13(7), 1230; https://doi.org/10.3390/diagnostics13071230 - 24 Mar 2023

Cited by 3 | Viewed by 1712

Abstract

Inflammatory bowel diseases (IBD) represent a global phenomenon, with a continuously rising prevalence. The strategies concerning IBD management are progressing from clinical monitorization to a targeted approach, and current therapies strive to reduce microscopic mucosal inflammation and stimulate repair of the epithelial barrier [...] Read more.

Inflammatory bowel diseases (IBD) represent a global phenomenon, with a continuously rising prevalence. The strategies concerning IBD management are progressing from clinical monitorization to a targeted approach, and current therapies strive to reduce microscopic mucosal inflammation and stimulate repair of the epithelial barrier function. Intestinal permeability has recently been receiving increased attention, as evidence suggests that it could be related to disease activity in IBD. However, most investigations do not successfully provide adequate information regarding the morphological integrity of the intestinal barrier. In this review, we discuss the advantages of confocal laser endomicroscopy (CLE), which allows in vivo visualization of histological abnormalities and targeted optical biopsies in the setting of IBD. Additionally, CLE has been used to assess vascular permeability and epithelial barrier function that could correlate with prolonged clinical remission, increased resection-free survival, and lower hospitalization rates. Moreover, the dynamic evaluation of the functional characteristics of the intestinal barrier presents an advantage over the endoscopic examination as it has the potential to select patients at risk of relapses. Along with mucosal healing, histological or transmural remission, the recovery of the intestinal barrier function emerges as a possible target that could be included in the future therapeutic strategies for IBD. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

20 pages, 7702 KiB

Open AccessReview

The Role of MRI in the Diagnosis of Solid Pseudopapillary Neoplasm of the Pancreas and Its Mimickers: A Case-Based Review with Emphasis on Differential Diagnosis

by Jelena Djokic Kovac, Aleksandra Djikic-Rom, Aleksandar Bogdanovic, Aleksandra Jankovic, Nikica Grubor, Goran Djuricic and Vladimir Dugalic

Diagnostics 2023, 13(6), 1074; https://doi.org/10.3390/diagnostics13061074 - 13 Mar 2023

Cited by 1 | Viewed by 2936

Abstract

Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. [...] Read more.

Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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15 pages, 2690 KiB

Open AccessReview

Artificial Intelligence—The Rising Star in the Field of Gastroenterology and Hepatology

by Madalina Stan-Ilie, Vasile Sandru, Gabriel Constantinescu, Oana-Mihaela Plotogea, Ecaterina Mihaela Rinja, Iulia Florentina Tincu, Alexandra Jichitu, Adriana Elena Carasel, Andreea Cristina Butuc and Bogdan Popa

Diagnostics 2023, 13(4), 662; https://doi.org/10.3390/diagnostics13040662 - 10 Feb 2023

Cited by 3 | Viewed by 1749

Abstract

Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In [...] Read more.

Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In this field, AI has several applications, such as detecting and classifying polyps, detecting the malignancy in polyps, diagnosing Helicobacter pylori infection, gastritis, inflammatory bowel disease, gastric cancer, esophageal neoplasia, and pancreatic and hepatic lesions. The aim of this mini-review is to analyze the currently available studies regarding AI in the field of gastroenterology and hepatology and to discuss its main applications as well as its main limitations. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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21 pages, 13818 KiB

Open AccessReview

Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines

by Christopher Kloth, Benedikt Haggenmüller, Annika Beck, Martin Wagner, Marko Kornmann, Jochen P. Steinacker, Nora Steinacker-Stanescu, Daniel Vogele, Meinrad Beer, Markus S. Juchems and Stefan A. Schmidt

Diagnostics 2023, 13(3), 454; https://doi.org/10.3390/diagnostics13030454 - 26 Jan 2023

Cited by 1 | Viewed by 2261

Abstract

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The [...] Read more.

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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Other

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4 pages, 2075 KiB

Open AccessInteresting Images

Pseudokidney Sign in Gastric Cancer

by Thomas Ferenc, Jelena Svetec Dvorski, Andro Matković, Maja Mijić, Eva Lovrić and Vinko Vidjak

Diagnostics 2024, 14(9), 896; https://doi.org/10.3390/diagnostics14090896 - 25 Apr 2024

Viewed by 191

Abstract

Pseudokidney sign (PKS) is a characteristic sonographic finding of an abnormal mass with a reniform appearance, and a hyperechoic central region surrounded by a hypoechoic area. It has been seldom documented in gastric cancer. A 75-year-old male patient presented with a palpable abdominal [...] Read more.

Pseudokidney sign (PKS) is a characteristic sonographic finding of an abnormal mass with a reniform appearance, and a hyperechoic central region surrounded by a hypoechoic area. It has been seldom documented in gastric cancer. A 75-year-old male patient presented with a palpable abdominal resistance in the left upper abdominal quadrant and ultrasound evaluation revealed a well-vascularized mass presenting with PKS. Regional lymphadenopathy was also found, and the working diagnosis of gastric cancer was established. The suspected diagnosis was later verified endoscopically and on pathohistological examinations as gastric adenocarcinoma. Computed tomography staging also revealed distant metastases to the lungs, liver, and adrenal glands and abdominal lymphadenopathy. The PKS often indicates gastrointestinal pathology, and it may be seen in benign and malignant conditions due to gastrointestinal wall thickening. Therefore, additional diagnostic examinations are advised for a more definite diagnosis. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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6 pages, 2291 KiB

Open AccessInteresting Images

Ultrasound-Guided Coarse Needle Biopsy Diagnosed Isolated Hepatic Malignant Melanoma with Undetermined Origin in TB Patient: A Case Report

by Kailing Chen, Yi Dong, Weibin Zhang, Hong Han, Feng Mao, Hui Zhang and Wenping Wang

Diagnostics 2023, 13(1), 42; https://doi.org/10.3390/diagnostics13010042 - 23 Dec 2022

Viewed by 1298

Abstract

Isolated hepatic malignant melanoma with undetermined origin is relatively rare and the imaging findings vary significantly in published studies. In this report, we described an elderly male patient with pulmonary tuberculosis who was diagnosed with isolated hepatic malignant melanoma with undetermined origin by [...] Read more.

Isolated hepatic malignant melanoma with undetermined origin is relatively rare and the imaging findings vary significantly in published studies. In this report, we described an elderly male patient with pulmonary tuberculosis who was diagnosed with isolated hepatic malignant melanoma with undetermined origin by ultrasound-guided percutaneous coarse needle biopsy (US-CNB). The hepatic melanoma was detected accidentally on chest CT. On contrast-enhanced ultrasound (CEUS), it presented an enhancement pattern of fast washin and slow washout. However, on magnetic resonance imaging (CEMRI), it showed non-rim hyperenhancement in the arterial phase but hypointensity in the late phase, mimicking hepatocellular carcinoma. With inconsistent results, the patient underwent fluorine-18-fluro-2-deoxy-D-glucose-positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT). The mass showed mild ¹⁸F-FDG uptake with SUVmax of 4.7, and hypermetabolic nodules were observed in the lung, chest wall, thoracic vertebra, and pelvis. Due to the advanced stage of the tumor, US-CNB was performed to acquire a pathological diagnosis. The immunohistochemical staining suggested malignant melanoma. Of note, no primary tumor was revealed. Finally, the patient refused systemic therapy and died from tumor progression seven months later. Hence, CEUS and CEMRI is fundamental in the diagnosis of hepatic melanoma, and PET-CT is helpful in clinical staging. For controversial results, US-CNB is required to establish the pathological diagnosis. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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8 pages, 642 KiB

Open AccessCase Report

Hereditary Hemorrhagic Telangiectasia—A Case Series Experience from a Liver Transplant Center in Romania

by Christopher Pavel, Teodor Cabel, Dragoș Dinuță, Alexandru Zaharia, Simona Olimpia Dima, Vasile Sandru, Mugur Cristian Grasu and Mariana Mihaila

Diagnostics 2022, 12(12), 2959; https://doi.org/10.3390/diagnostics12122959 - 26 Nov 2022

Viewed by 1139

Abstract

Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 [...] Read more.

Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 years). In twelve patients (85.7%), the diagnosis was confirmed by using the Curacao Criteria. The most common reason for admission was epistaxis, with 9 patients (57%) presenting with nosebleed refractory to prolonged self-tamponade. The biochemical abnormalities identified were elevations in AP and gamma-GT; liver synthetic function was generally normal, even though 21% of patients had clinical or imaging findings for cirrhosis. Nosebleeds were the main reason for admission and significantly impacted quality of life through anemia and frequent hospital admissions. However, the visceral manifestations seemed to be more serious. The hepatic arteriovenous malformations (AVMs) appeared to remain asymptomatic or led to minimal changes for the majority of patients; some cases were associated with liver and biliary tract ischemia, necrosis leading to acute liver failure and even death. Hepatic AVMs can also lead to high-output heart failure due to arterio-venous shunting. The most frequent AVM was hepatic artery to hepatic vein, with secondary hepatic vein dilation and hemodynamic consequences. Full article

(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)

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