Gastric cancer preoperative staging is of outmost importance to assure proper management of the d... more Gastric cancer preoperative staging is of outmost importance to assure proper management of the disease. Providing a relevant clinical stage relies on different imaging methods such as computed tomography (CT) or endoscopic ultrasound (EUS). We aimed to perform a network meta-analysis for gastric cancer clinical stage diagnostic tests, thus comparing the diagnostic accuracy of EUS vs. multidetector CT (MDCT) and EUS vs. EUS + MDCT. We plotted study estimates of pooled sensitivity and specificity on forest plots and summary receiver operating characteristic space to explore between-study variation in the performance of EUS, MDCT and EUS + MDCT for T1–T4, N0–N3, M0–M1 when data were available. Exploratory analyses were undertaken in RevMan 5. We included twelve studies with 2047 patients. Our results suggest that EUS was superior to MDCT in preoperative T1 and N staging. MDCT is more specific for the M stage but no significant difference in sensitivity was obtained. When comparing EUS...
Ultraschall in der Medizin (Stuttgart, Germany : 1980), Jan 6, 2018
The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ... more The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and st... more Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and staging of focal pancreatic masses. The method has a high sensitivity and specificity for the diagnosis of pancreatic adenocarcinoma which is visualized as hypo-enhanced as compared to the rest of the parenchyma while chronic pancreatitis and neuroendocrine tumors are generally either iso-enhanced or hyper-enhanced. The development of contrast-enhanced low mechanical index harmonic imaging techniques used in real time during endoscopic ultrasound (EUS) allowed perfusion imaging and the quantification of intensity of the contrast signal through time-intensity curve analysis. Thus, contrast harmonic imaging-EUS has been used to differentiate pancreatic adenocarcinoma based on lower values of the peak enhancement. Future applications of CE-EUS in pancreatic adenocarcinoma include not only use of targeted contrast agents for early detection, tridimensional and fusion techniques for enhanced st...
To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epitheli... more To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL). Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus. HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01). CEUS allows for chara...
Recently, the European Society of Gastrointestinal Endoscopy (ESGE) published recommendations on ... more Recently, the European Society of Gastrointestinal Endoscopy (ESGE) published recommendations on EUS-guided sampling made for various settings, including LNs. [13,14] Although the specificity of EUS-FNAB is close to 100%, [9,15-20] it potentially misses microinvasion of malignancy into LNs. [21] Also, it requires experience and it is associated with a risk
Ultraschall in der Medizin - European Journal of Ultrasound, 2005
Endoscopic ultrasound is considered the method of choice for evaluation of submucosal tumours. En... more Endoscopic ultrasound is considered the method of choice for evaluation of submucosal tumours. Endoscopic therapy of selected lesions represents a useful mini-invasive approach. The aim of this study was to assess the endoscopic management of submucosal tumours of the upper gastrointestinal tract (GIST), with emphasis on the use of colour and power Doppler endoscopic ultrasound. The study included 35 consecutive patients referred to endoscopic ultrasound with submucosal tumours of the upper gastrointestinal tract. Colour and power Doppler imaging were performed with radial or linear instruments in all patients and allowed a better characterisation of the submucosal lesions. Histology was obtained in 22 patients and permitted a correct diagnosis, as well as confirmation or exclusion of malignancy. In 18 patients (51.4%) there was discrepancy between the suspected endoscopic diagnosis and the diagnosis made by endoscopic ultrasound. Most of the malignant GISTs had significant intratumoural vessels detected by colour or power Doppler EUS (5 out of 6 patients, 83.3%), as compared with the benign GISTs (2 out of 7 patients, 28.6%). Colour Doppler EUS was essential, both to diagnose and to direct therapy in vascular submucosal lesions (two haemangiomas). The same technique was useful to better characterise lipomas or cysts. Endoscopic ultrasound management of submucosal tumours was enhanced by the use of colour and power Doppler imaging. A precise management plan, supported by colour and power Doppler findings improved the diagnostic options and increased the feasibility and safety of endoscopic ultrasound guided therapeutic interventions.
Journal of gastrointestinal and liver diseases : JGLD, 2013
Real time elastography has very good results in differentiating tumors of the breast, thyroid, pr... more Real time elastography has very good results in differentiating tumors of the breast, thyroid, prostate, pancreas and lymph nodes. Because liver biopsy is invasive and has complications, the method has been tried in diffuse or localized liver pathology in the hope of similar results. However, the published studies are isolated and performed on small groups of patients and the working methodology differs from author to author, without a consensus regarding the establishing of the area of interest, the recording and data analysis. The appearance of the elastography software on the convex probe with high penetration, the possibility for elastography to visualize the liver entirely and the development of elastography measurement information programs opened new perspectives in the noninvasive assessment of liver pathology.
Journal of gastrointestinal and liver diseases : JGLD, 2011
As therapeutic regimens for rectal cancer have seen considerable changes, an accurate staging is ... more As therapeutic regimens for rectal cancer have seen considerable changes, an accurate staging is mandatory for choosing the adequate strategy. Locoregional staging is the decisive factor in selecting patients for neoadjuvant chemoradiation therapy and for determining the extent of surgery. Endoscopic ultrasound (endorectal ultrasound--ERUS) is a very effective method for assessing the local extent of rectal cancer, especially regarding the depth of tumor infiltration. Although a significant limitation is represented by its lower accuracy for diagnosis of lymph node metastases, this is still a point of concern for other imaging tests as well. In this review we report the current data on ERUS, presenting both its advantages and limitations, and making a comparison to other staging methods. Recent developments of the technology that might enhance staging accuracy are also discussed.
Journal of gastrointestinal and liver diseases : JGLD, 2006
Endoscopic ultrasound (EUS) elastography is an imaging procedure used for the visualization of ti... more Endoscopic ultrasound (EUS) elastography is an imaging procedure used for the visualization of tissue elasticity during usual EUS examinations. EUS elastography can be accomplished real-time with state-of-the-art ultrasound systems, with the images being represented in transparent color superimposed on the conventional gray-scale B-mode scans. The aim of this review was to introduce the potential range of applications of EUS elastography. EUS elastography might be useful for the differentiation of benign and malignant lymph nodes, with a qualitative pattern analysis and a quantitative histogram analysis of the color images being used to adequately classify the lesions. Mapping of the tissue elasticity distribution might be useful for the differential diagnosis of focal pancreatic masses, especially in the setting of chronic pancreatitis where the accuracy of EUS-guided fine needle aspiration is also low. EUS elastography might also enhance the detection and differentiation of variou...
Journal of gastrointestinal and liver diseases : JGLD, 2012
Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) ha... more Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact. A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology. Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or non-diagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediasti...
Journal of gastrointestinal and liver diseases : JGLD, 2008
Imaging techniques, in particular ultrasonography, have led to great advances in clinical hepatol... more Imaging techniques, in particular ultrasonography, have led to great advances in clinical hepatology in the past few decades. The introduction of second-generation contrast agents and the development of contrast specific techniques have opened new prospects in the detection and characterization of liver lesions. New hybrid imaging techniques that combine in real-time transabdominal ultrasound with other cross-sectional imaging techniques (CT or MR) might add even more valuable information in the cases with focal lesions. The aim of this review is to describe the role of real-time contrast-enhanced and real-time virtual sonography in the assessment of benign liver lesions.
Video Journal and Encyclopedia of GI Endoscopy, 2013
Endoscopic ultrasonography (EUS) is the most efficient diagnostic method for local staging of gas... more Endoscopic ultrasonography (EUS) is the most efficient diagnostic method for local staging of gastric cancer, being able to differentiate between early and advanced primary gastric tumors with high performance rates. Although the accuracy of EUS for node (N) staging is lower than for the tumor (T) stage, ultrasound elastography could be used as a complementary method for the characterization and differentiation of benign and malignant lymph nodes in real time. EUS-guided fineneedle aspiration is indicated in gastric cancer if the positive result has a special impact on the clinical management of the patient. This article is part of an expert video encyclopedia.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary ... more Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary lung cancer staging. We describe a 66-year-old male who underwent EUS-FNA for the diagnosis of recurrent lung cancer. Two years after initial radiation therapy followed by complete remission, routine follow-up imaging study revealed a mass in the right hilum. Trans-esophageal EUS revealed a 1.3-cm mass and the result of EUS-FNA was consistent with non-small lung cancer. EUS-FNA can play an important role in diagnosis of recurrent lung cancer as well as primary staging avoiding the more invasive diagnostic technique.
Romania is an eastern European country that is undergoing rapid reform of its medical system. We ... more Romania is an eastern European country that is undergoing rapid reform of its medical system. We conducted an assessment of the potential for telemedicine in the country, through a literature review, personal visits to Romania and discussions with individuals from academia, the Ministry of Health and Family, and businesses. The results suggest that telemedicine has the potential to accelerate health-care reform. The main hospitals and universities could promote the wider distribution and development of telemedicine within Romania, which in turn would bring benefits to the Romanian people, 46% of whom live in rural areas.
Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe pro... more Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe prognosis and high mortality. Angiography is usually required for confirmation of the diagnosis, but transabdominal ultrasound and CT angiography are useful noninvasive diagnostic methods. We present the case of a 66-year-old patient with a large pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. Transabdominal ultrasound with color and power Doppler showed a large pancreatic head pseudoaneurysm that communicated directly to the superior mesenteric artery. Presence of a spinning blood flow inside the pseudoaneurysm was visualized by color Doppler, with evidence of bidirectional flow in the pseudoaneurysm neck that was showed by Doppler spectral analysis. The contrast-enhanced helical computer tomography with multiplanar sagittal and the 3D reconstruction of coronal images confirmed the communication of the pseudoaneurysm with the superior mese...
Insulinomas are benign insulin-secreting neuroendocrine tumors originating in the pancreatic beta... more Insulinomas are benign insulin-secreting neuroendocrine tumors originating in the pancreatic beta cells. Symptoms are caused by hypoglycemia and clinical diagnosis is based on establishing their relationship to fasting, usually via a fasting test. The most conclusive imaging tests are endoscopic ultrasound (EUS) and CT. Surgery is the treatment of choice. A 33 year old male presented with a 2-year history of hunger which had intensified in the previous 6 months with added accompanying symptoms, culminating with an acute episode - loss of consciousness and seizures - which resolved after administering i.v. glucose. A fasting test was performed, with results suggestive for an insulinoma. Dual-phase CT showed a mass in the tail of the pancreas but no contrast enhancement. EUS was used for further assessment: B-mode showed a hypoechoic focal mass with a cystic component, on contrast enhancement the pattern was hypovascular, and elastography showed soft tissue. EUS fine needle aspiration...
Clinical evolution of the colorectal carcinoma occurs in up to 60% with colorectal liver metastas... more Clinical evolution of the colorectal carcinoma occurs in up to 60% with colorectal liver metastases (CRLM). Although hepatic resection is considered to be the golden standard in CRLM, novel less invasive techniques have emerged, of which radiofrequency ablation has received a high credibility. When tumors are not eligible for surgery, guided radiofrequency ablation is considered an alternative. This method is appropriate when there are no more than 5 lesions with a diameter of less than 3 cm. While open surgery guarantees a more precise tumor excision, the effectiveness of ablation must be evaluated either by contrast-enhanced computer tomography, magnetic resonance, or ultrasound. This paper aims to review the current standings in radiofrequency ablation for CRLM and to compare the technique with surgical resection in order to find which one is the best treatment option.
Video Journal and Encyclopedia of GI Endoscopy, 2013
Endoscopic ultrasound (EUS) elastography was designed to offer supplemental information about the... more Endoscopic ultrasound (EUS) elastography was designed to offer supplemental information about the examined area in order to obtain a better characterization of tissue elasticity. The principle of the method implies that malignant structures are harder than benign ones. Quantitative EUS elastography assessment can be done using post-processing computed analysis. New ultrasound systems incorporate advanced real-time analysis software in order to offer a real-time value of the elasticity, thus eliminating the inherent human bias induced by inter-and intraobserver perception errors. Other new EUS procedures are currently available in order to increase the accuracy of the examination. The gold standard method for certitude in cancer diagnosis remains EUS fine-needle aspiration biopsy and the cytological examination of the aspirate. This article is part of an expert video encyclopedia.
Stringent radiological follow-up is essential after renal tumor ablation. Drawbacks of postablati... more Stringent radiological follow-up is essential after renal tumor ablation. Drawbacks of postablation follow-up by contrast-enhanced computed tomography (CECT) are the associated ionizing radiation and nephrotoxic contrast agent. Contrast-enhanced ultrasound (CEUS) has shown potential to demonstrate microvasculature without using either ionizing radiation or toxic contrast agent. We assessed the concordance of enhancement patterns of CEUS and CECT/MRI in cryolesion assessment after laparoscopic renal cryoablation (LCA). From 01/2006 to 01/2009, a CEUS was performed before and after LCA (3 and 12 months) in addition to regular CECT/MRI. Using an enhancement score (0=no enhancement, 1=rim enhancement, 2=diffuse enhancement, 3=localized enhancement, 4=no enhancement defect), the cryolesion was assessed by both modalities, and concordance of enhancement score was assessed. In total, 45 tumors were included (29 biopsy proven renal cell carcinoma (RCC), mean size 2.66 cm). One cryoablation failed, resulting in a nonenhancing cryolesion apart from the persisting renal tumor. There were no postablation recurrences during the study period. Pre-LCA: Both modalities were available in 26 cases. In 20 out of 26, there was concordance of enhancement score (77%, all cases score 3 or 4). Three months: Both modalities were available in 32 cases. Enhancement score corresponded in 23 out of 32 cases (72%). Seven cases showed enhancement on CECT/MRI (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;1&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in six cases, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;4&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in one case) with enhancement score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;0&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on CEUS. Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 92%, negative predictive value [NPV] 77%). Except one case, all enhancement resolved on subsequent imaging. Twelve months: Both modalities were available in 21 tumors. Enhancement score corresponded in 19 out of 21 cases (91%). Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 90%, NPV 100%). This pilot study shows that CEUS is a safe imaging technique with high concordance of enhancement score between CEUS and CECT/MRI. While cross-sectional imaging seems sensible to demonstrate successful ablation at first follow-up, CEUS might be used to diminish the burden of contrast-enhanced cross-sectional imaging in the long-term follow-up.
Gastric cancer preoperative staging is of outmost importance to assure proper management of the d... more Gastric cancer preoperative staging is of outmost importance to assure proper management of the disease. Providing a relevant clinical stage relies on different imaging methods such as computed tomography (CT) or endoscopic ultrasound (EUS). We aimed to perform a network meta-analysis for gastric cancer clinical stage diagnostic tests, thus comparing the diagnostic accuracy of EUS vs. multidetector CT (MDCT) and EUS vs. EUS + MDCT. We plotted study estimates of pooled sensitivity and specificity on forest plots and summary receiver operating characteristic space to explore between-study variation in the performance of EUS, MDCT and EUS + MDCT for T1–T4, N0–N3, M0–M1 when data were available. Exploratory analyses were undertaken in RevMan 5. We included twelve studies with 2047 patients. Our results suggest that EUS was superior to MDCT in preoperative T1 and N staging. MDCT is more specific for the M stage but no significant difference in sensitivity was obtained. When comparing EUS...
Ultraschall in der Medizin (Stuttgart, Germany : 1980), Jan 6, 2018
The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ... more The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and st... more Contrast-enhanced endoscopic ultrasound (CE-EUS) allows characterization, differentiation, and staging of focal pancreatic masses. The method has a high sensitivity and specificity for the diagnosis of pancreatic adenocarcinoma which is visualized as hypo-enhanced as compared to the rest of the parenchyma while chronic pancreatitis and neuroendocrine tumors are generally either iso-enhanced or hyper-enhanced. The development of contrast-enhanced low mechanical index harmonic imaging techniques used in real time during endoscopic ultrasound (EUS) allowed perfusion imaging and the quantification of intensity of the contrast signal through time-intensity curve analysis. Thus, contrast harmonic imaging-EUS has been used to differentiate pancreatic adenocarcinoma based on lower values of the peak enhancement. Future applications of CE-EUS in pancreatic adenocarcinoma include not only use of targeted contrast agents for early detection, tridimensional and fusion techniques for enhanced st...
To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epitheli... more To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL). Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus. HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01). CEUS allows for chara...
Recently, the European Society of Gastrointestinal Endoscopy (ESGE) published recommendations on ... more Recently, the European Society of Gastrointestinal Endoscopy (ESGE) published recommendations on EUS-guided sampling made for various settings, including LNs. [13,14] Although the specificity of EUS-FNAB is close to 100%, [9,15-20] it potentially misses microinvasion of malignancy into LNs. [21] Also, it requires experience and it is associated with a risk
Ultraschall in der Medizin - European Journal of Ultrasound, 2005
Endoscopic ultrasound is considered the method of choice for evaluation of submucosal tumours. En... more Endoscopic ultrasound is considered the method of choice for evaluation of submucosal tumours. Endoscopic therapy of selected lesions represents a useful mini-invasive approach. The aim of this study was to assess the endoscopic management of submucosal tumours of the upper gastrointestinal tract (GIST), with emphasis on the use of colour and power Doppler endoscopic ultrasound. The study included 35 consecutive patients referred to endoscopic ultrasound with submucosal tumours of the upper gastrointestinal tract. Colour and power Doppler imaging were performed with radial or linear instruments in all patients and allowed a better characterisation of the submucosal lesions. Histology was obtained in 22 patients and permitted a correct diagnosis, as well as confirmation or exclusion of malignancy. In 18 patients (51.4%) there was discrepancy between the suspected endoscopic diagnosis and the diagnosis made by endoscopic ultrasound. Most of the malignant GISTs had significant intratumoural vessels detected by colour or power Doppler EUS (5 out of 6 patients, 83.3%), as compared with the benign GISTs (2 out of 7 patients, 28.6%). Colour Doppler EUS was essential, both to diagnose and to direct therapy in vascular submucosal lesions (two haemangiomas). The same technique was useful to better characterise lipomas or cysts. Endoscopic ultrasound management of submucosal tumours was enhanced by the use of colour and power Doppler imaging. A precise management plan, supported by colour and power Doppler findings improved the diagnostic options and increased the feasibility and safety of endoscopic ultrasound guided therapeutic interventions.
Journal of gastrointestinal and liver diseases : JGLD, 2013
Real time elastography has very good results in differentiating tumors of the breast, thyroid, pr... more Real time elastography has very good results in differentiating tumors of the breast, thyroid, prostate, pancreas and lymph nodes. Because liver biopsy is invasive and has complications, the method has been tried in diffuse or localized liver pathology in the hope of similar results. However, the published studies are isolated and performed on small groups of patients and the working methodology differs from author to author, without a consensus regarding the establishing of the area of interest, the recording and data analysis. The appearance of the elastography software on the convex probe with high penetration, the possibility for elastography to visualize the liver entirely and the development of elastography measurement information programs opened new perspectives in the noninvasive assessment of liver pathology.
Journal of gastrointestinal and liver diseases : JGLD, 2011
As therapeutic regimens for rectal cancer have seen considerable changes, an accurate staging is ... more As therapeutic regimens for rectal cancer have seen considerable changes, an accurate staging is mandatory for choosing the adequate strategy. Locoregional staging is the decisive factor in selecting patients for neoadjuvant chemoradiation therapy and for determining the extent of surgery. Endoscopic ultrasound (endorectal ultrasound--ERUS) is a very effective method for assessing the local extent of rectal cancer, especially regarding the depth of tumor infiltration. Although a significant limitation is represented by its lower accuracy for diagnosis of lymph node metastases, this is still a point of concern for other imaging tests as well. In this review we report the current data on ERUS, presenting both its advantages and limitations, and making a comparison to other staging methods. Recent developments of the technology that might enhance staging accuracy are also discussed.
Journal of gastrointestinal and liver diseases : JGLD, 2006
Endoscopic ultrasound (EUS) elastography is an imaging procedure used for the visualization of ti... more Endoscopic ultrasound (EUS) elastography is an imaging procedure used for the visualization of tissue elasticity during usual EUS examinations. EUS elastography can be accomplished real-time with state-of-the-art ultrasound systems, with the images being represented in transparent color superimposed on the conventional gray-scale B-mode scans. The aim of this review was to introduce the potential range of applications of EUS elastography. EUS elastography might be useful for the differentiation of benign and malignant lymph nodes, with a qualitative pattern analysis and a quantitative histogram analysis of the color images being used to adequately classify the lesions. Mapping of the tissue elasticity distribution might be useful for the differential diagnosis of focal pancreatic masses, especially in the setting of chronic pancreatitis where the accuracy of EUS-guided fine needle aspiration is also low. EUS elastography might also enhance the detection and differentiation of variou...
Journal of gastrointestinal and liver diseases : JGLD, 2012
Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) ha... more Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact. A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology. Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or non-diagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediasti...
Journal of gastrointestinal and liver diseases : JGLD, 2008
Imaging techniques, in particular ultrasonography, have led to great advances in clinical hepatol... more Imaging techniques, in particular ultrasonography, have led to great advances in clinical hepatology in the past few decades. The introduction of second-generation contrast agents and the development of contrast specific techniques have opened new prospects in the detection and characterization of liver lesions. New hybrid imaging techniques that combine in real-time transabdominal ultrasound with other cross-sectional imaging techniques (CT or MR) might add even more valuable information in the cases with focal lesions. The aim of this review is to describe the role of real-time contrast-enhanced and real-time virtual sonography in the assessment of benign liver lesions.
Video Journal and Encyclopedia of GI Endoscopy, 2013
Endoscopic ultrasonography (EUS) is the most efficient diagnostic method for local staging of gas... more Endoscopic ultrasonography (EUS) is the most efficient diagnostic method for local staging of gastric cancer, being able to differentiate between early and advanced primary gastric tumors with high performance rates. Although the accuracy of EUS for node (N) staging is lower than for the tumor (T) stage, ultrasound elastography could be used as a complementary method for the characterization and differentiation of benign and malignant lymph nodes in real time. EUS-guided fineneedle aspiration is indicated in gastric cancer if the positive result has a special impact on the clinical management of the patient. This article is part of an expert video encyclopedia.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary ... more Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary lung cancer staging. We describe a 66-year-old male who underwent EUS-FNA for the diagnosis of recurrent lung cancer. Two years after initial radiation therapy followed by complete remission, routine follow-up imaging study revealed a mass in the right hilum. Trans-esophageal EUS revealed a 1.3-cm mass and the result of EUS-FNA was consistent with non-small lung cancer. EUS-FNA can play an important role in diagnosis of recurrent lung cancer as well as primary staging avoiding the more invasive diagnostic technique.
Romania is an eastern European country that is undergoing rapid reform of its medical system. We ... more Romania is an eastern European country that is undergoing rapid reform of its medical system. We conducted an assessment of the potential for telemedicine in the country, through a literature review, personal visits to Romania and discussions with individuals from academia, the Ministry of Health and Family, and businesses. The results suggest that telemedicine has the potential to accelerate health-care reform. The main hospitals and universities could promote the wider distribution and development of telemedicine within Romania, which in turn would bring benefits to the Romanian people, 46% of whom live in rural areas.
Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe pro... more Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe prognosis and high mortality. Angiography is usually required for confirmation of the diagnosis, but transabdominal ultrasound and CT angiography are useful noninvasive diagnostic methods. We present the case of a 66-year-old patient with a large pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. Transabdominal ultrasound with color and power Doppler showed a large pancreatic head pseudoaneurysm that communicated directly to the superior mesenteric artery. Presence of a spinning blood flow inside the pseudoaneurysm was visualized by color Doppler, with evidence of bidirectional flow in the pseudoaneurysm neck that was showed by Doppler spectral analysis. The contrast-enhanced helical computer tomography with multiplanar sagittal and the 3D reconstruction of coronal images confirmed the communication of the pseudoaneurysm with the superior mese...
Insulinomas are benign insulin-secreting neuroendocrine tumors originating in the pancreatic beta... more Insulinomas are benign insulin-secreting neuroendocrine tumors originating in the pancreatic beta cells. Symptoms are caused by hypoglycemia and clinical diagnosis is based on establishing their relationship to fasting, usually via a fasting test. The most conclusive imaging tests are endoscopic ultrasound (EUS) and CT. Surgery is the treatment of choice. A 33 year old male presented with a 2-year history of hunger which had intensified in the previous 6 months with added accompanying symptoms, culminating with an acute episode - loss of consciousness and seizures - which resolved after administering i.v. glucose. A fasting test was performed, with results suggestive for an insulinoma. Dual-phase CT showed a mass in the tail of the pancreas but no contrast enhancement. EUS was used for further assessment: B-mode showed a hypoechoic focal mass with a cystic component, on contrast enhancement the pattern was hypovascular, and elastography showed soft tissue. EUS fine needle aspiration...
Clinical evolution of the colorectal carcinoma occurs in up to 60% with colorectal liver metastas... more Clinical evolution of the colorectal carcinoma occurs in up to 60% with colorectal liver metastases (CRLM). Although hepatic resection is considered to be the golden standard in CRLM, novel less invasive techniques have emerged, of which radiofrequency ablation has received a high credibility. When tumors are not eligible for surgery, guided radiofrequency ablation is considered an alternative. This method is appropriate when there are no more than 5 lesions with a diameter of less than 3 cm. While open surgery guarantees a more precise tumor excision, the effectiveness of ablation must be evaluated either by contrast-enhanced computer tomography, magnetic resonance, or ultrasound. This paper aims to review the current standings in radiofrequency ablation for CRLM and to compare the technique with surgical resection in order to find which one is the best treatment option.
Video Journal and Encyclopedia of GI Endoscopy, 2013
Endoscopic ultrasound (EUS) elastography was designed to offer supplemental information about the... more Endoscopic ultrasound (EUS) elastography was designed to offer supplemental information about the examined area in order to obtain a better characterization of tissue elasticity. The principle of the method implies that malignant structures are harder than benign ones. Quantitative EUS elastography assessment can be done using post-processing computed analysis. New ultrasound systems incorporate advanced real-time analysis software in order to offer a real-time value of the elasticity, thus eliminating the inherent human bias induced by inter-and intraobserver perception errors. Other new EUS procedures are currently available in order to increase the accuracy of the examination. The gold standard method for certitude in cancer diagnosis remains EUS fine-needle aspiration biopsy and the cytological examination of the aspirate. This article is part of an expert video encyclopedia.
Stringent radiological follow-up is essential after renal tumor ablation. Drawbacks of postablati... more Stringent radiological follow-up is essential after renal tumor ablation. Drawbacks of postablation follow-up by contrast-enhanced computed tomography (CECT) are the associated ionizing radiation and nephrotoxic contrast agent. Contrast-enhanced ultrasound (CEUS) has shown potential to demonstrate microvasculature without using either ionizing radiation or toxic contrast agent. We assessed the concordance of enhancement patterns of CEUS and CECT/MRI in cryolesion assessment after laparoscopic renal cryoablation (LCA). From 01/2006 to 01/2009, a CEUS was performed before and after LCA (3 and 12 months) in addition to regular CECT/MRI. Using an enhancement score (0=no enhancement, 1=rim enhancement, 2=diffuse enhancement, 3=localized enhancement, 4=no enhancement defect), the cryolesion was assessed by both modalities, and concordance of enhancement score was assessed. In total, 45 tumors were included (29 biopsy proven renal cell carcinoma (RCC), mean size 2.66 cm). One cryoablation failed, resulting in a nonenhancing cryolesion apart from the persisting renal tumor. There were no postablation recurrences during the study period. Pre-LCA: Both modalities were available in 26 cases. In 20 out of 26, there was concordance of enhancement score (77%, all cases score 3 or 4). Three months: Both modalities were available in 32 cases. Enhancement score corresponded in 23 out of 32 cases (72%). Seven cases showed enhancement on CECT/MRI (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;1&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in six cases, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;4&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in one case) with enhancement score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;0&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on CEUS. Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 92%, negative predictive value [NPV] 77%). Except one case, all enhancement resolved on subsequent imaging. Twelve months: Both modalities were available in 21 tumors. Enhancement score corresponded in 19 out of 21 cases (91%). Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 90%, NPV 100%). This pilot study shows that CEUS is a safe imaging technique with high concordance of enhancement score between CEUS and CECT/MRI. While cross-sectional imaging seems sensible to demonstrate successful ablation at first follow-up, CEUS might be used to diminish the burden of contrast-enhanced cross-sectional imaging in the long-term follow-up.
Uploads
Papers by Adrian Saftoiu