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Zafar S, Elbanna KY, Todd AWM, Guimaraes L, O'Brien C, Goel A, Kim TK, Khalili K. Can absolute arterial phase hyperenhancement improve sensitivity of detection of hepatocellular carcinoma in indeterminate nodules on CT? Eur Radiol 2024; 34:2256-2268. [PMID: 37775590 DOI: 10.1007/s00330-023-10237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To determine if quantitative assessment of relative (R) and absolute (A) arterial phase hyperenhancement (APHE) and washout (WO) applied to indeterminate nodules on CT would improve the overall sensitivity of detection of hepatocellular carcinoma (HCC). METHODS One-hundred and fourteen patients (90 male; mean age, 65 years) with 210 treatment-naïve HCC nodules (190 HCCs, 20 benign) who underwent 4-phase CT were included in this retrospective study. Four radiologists independently assigned a qualitative LR (LI-RADS) category per nodule. LR-3/4 nodules were then quantitatively analyzed by the 4 readers, placing ROIs within nodules and adjacent liver parenchyma. A/R-APHE and WO were calculated, and per-reader sensitivity and specificity updated. Interobserver agreement and AUCs were calculated per reader. RESULTS Qualitative readers 1-4 categorized 57, 69, 57, and 63 nodules as LR-3/4 respectively with moderate to substantial agreement in LR category (kappa 0.56-0.69, p < 0.0001); their diagnostic performances in the detection of HCC were 80%, 73.2%, 77.4%, and 77.4% sensitivity, and 100%, 95%, 70%, and 100% specificity, respectively. A threshold of ≥ 20 HU for A-APHE increased overall sensitivity of HCC detection by 0.5-3.1% without changing specificity for the subset of nodules APHE - /WO + on qualitative read, with 2, 6, 6, and 1 additional HCC detected by readers 1-4. Relative and various A-WO formulae and thresholds all increased sensitivity, but with a drop in specificity for some/all readers. CONCLUSION Quantitatively assessed A-APHE showed potential to increase sensitivity and maintain specificity of HCC diagnosis when selectively applied to indeterminate nodules demonstrating WO without subjective APHE. Quantitatively assessed R and A-WO increased sensitivity, however reduced specificity. CLINICAL RELEVANCE STATEMENT A workflow using selective quantification of absolute arterial enhancement is routinely employed in the CT assessment of renal and adrenal nodules. Quantitatively assessed absolute arterial enhancement is a simple tool which may be used as an adjunct to help increase sensitivity and maintain specificity of HCC diagnosis in indeterminate nodules demonstrating WO without subjective APHE. KEY POINTS • In indeterminate nodules categorized as LI-RADS 3/4 due to absent subjective arterial phase hyperenhancement, a cut-off for absolute arterial phase hyperenhancement of ≥ 20 HU may increase the overall sensitivity of detection of HCC by 0.5-3.1% without affecting specificity. • Relative and various absolute washout formulae and cut-offs increased sensitivity of HCC detection, but with a drop in specificity for some/all readers.
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Affiliation(s)
- Sara Zafar
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Khaled Y Elbanna
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Andrew W M Todd
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Luis Guimaraes
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Ciara O'Brien
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Ankur Goel
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Tae Kyoung Kim
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Korosh Khalili
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada.
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Elbanna KY, Kowa JY, Mirajkar N, Khalili K, Kim TK. Radiology domain in the diagnosis of IgG4-RD according to the 2019 American College of Rheumatology and European League Against Rheumatism classification. Insights Imaging 2024; 15:94. [PMID: 38530483 DOI: 10.1186/s13244-024-01638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/21/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES To evaluate the performance of radiology-related inclusion criteria of the 2019 ACR-EULAR classification system in the diagnosis of IgG4-related disease (IgG4-RD). METHODS This retrospective single-institution study included patients who received a diagnosis of IgG4-RD between January 2010 and December 2020. Two abdominal radiologists independently reviewed baseline imaging studies and scored radiology findings according to the 2019 ACR-EULAR classification criteria. Additional scores were assigned based on serological, histopathological, and immunostaining features. RESULTS Seventy-four patients (58 males and 16 females) with a mean age of 59.3 ± 13.9 years diagnosed with IgG4-RD were included. 51/74 (68.9%) were classified as having IgG4-RD according to the 2019 ACR-EULAR classification criteria. To reach a score ≥ 20 in these 51 patients, the radiology domain was sufficient in 20/51 (39.2%) and adding the serology domain was required for another 20/51 (39.2%). The remaining 11/51 patients (21.6%) required the histopathology and immunostaining domains. Radiological involvement of two or more organs at presentation was significantly associated with a score of ≥ 20 and seen in 43/51 (84.3%) compared to 5/23 (21.7%) of the non-classified group (p < 0.001). The group classified as having IgG4-RD showed a significantly higher proportion of elevated IgG4 levels (39/51, 76.5%) than the non-classified group (8/23, 34.8%) (< 0.001). CONCLUSION The study findings support the effectiveness of the radiology-related inclusion criteria of the 2019 ACR-EULAR classification system in diagnosing IgG4-RD. Combining radiology and serology domains achieved the cut-off in 80% of IgG-RD patients, enabling non-invasive diagnosis. The classification of IgG4-RD was significantly associated with multi-organ involvement, particularly affecting the pancreas and biliary system. CRITICAL RELEVANCE STATEMENT This study is the first to evaluate the diagnostic performance of the radiology domain in the 2019 ACR-EULAR classification criteria. The study results confirm its utility and potential to enable non-invasive diagnosis when combined with serological testing in a significant proportion of patients. KEY POINTS • A significant proportion of patients can be diagnosed with IgG4-RD using the radiology and serology domains exclusively. • Multi-organ involvement is significantly associated with classifying patients as IgG4-RD, with the pancreas and biliary system most frequently affected. • A high level of inter-reader agreement in the scoring of the radiology domain supports its reliability.
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Affiliation(s)
- Khaled Y Elbanna
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada.
| | - Jie-Ying Kowa
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
| | - Nikhil Mirajkar
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
| | - Korosh Khalili
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
| | - Tae Kyoung Kim
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
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Elbanna KY, Krishna S, Finelli A, Atri M. Contrast-Enhanced Ultrasound of the Indeterminate Renal Mass, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024. [PMID: 38415576 DOI: 10.2214/ajr.24.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is distinguished from CT and MRI by the use of microbubble ultrasound contrast agents (UCAs) with intravascular blood pool distribution. When performing CEUS, low-intensity ultrasound allows real-time tissue subtraction imaging, whereas high-intensity ultrasound leads to microbubble destruction, enabling visualization of the contrast inflow pattern. CEUS has exceptional contrast resolution that enables the detection of even minimal blood flow, achieving very high NPV for ruling out vascular perfusion and providing high frame rates in the evaluation of tissue perfusion dynamics. UCAs undergo hepatic metabolism and pulmonary clearance, ensuring safety in patients with renal impairment. CEUS excels in distinguishing solid from cystic renal masses, with higher sensitivity than CT or MRI for detection of lesion enhancement. CEUS can aid the further characterization of both solid and cystic lesions and may have particular applications in the surveillance of cystic masses and surveillance after renal cell carcinoma ablation. This review describes the use of CEUS to help characterize indeterminate renal masses, based on the authors' institutional experience. The article highlights key differences between CEUS and CT or MRI, and provides practical insights for performing and interpreting CEUS of renal masses.
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Affiliation(s)
- Khaled Y Elbanna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Satheesh Krishna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
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Kowa JY, Kim TK, Khalili K, Elbanna KY. Patterns of Relapse and Complications of Immunoglobulin G4-Related Disease. J Clin Rheumatol 2023:00124743-990000000-00115. [PMID: 37157124 DOI: 10.1097/rhu.0000000000001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a multisystemic fibroinflammatory condition potentially resulting in organ dysfunction. We aimed to evaluate imaging characteristics of disease relapse and complications in this cohort of patients. METHODS This was a cohort study of IgG4-RD patients imaged between 2010 and 2020. Radiological manifestations of disease activity (remission/stability vs. relapse and complications) were correlated with clinical symptoms. Univariate analyses were performed with χ2, Fisher exact, and Mann-Whitney U tests. Times to relapse and organ atrophy were studied with Kaplan-Meier analyses. RESULTS A total of 69 patients had imaging surveillance over a median duration of 47 months. Radiological relapse occurred in 50.7% (35/69) with median time to relapse at 74 months (95% confidence interval, 45-122 months); 42.8% (15/35) of this cohort had different-site relapse with the following recognized primary-secondary patterns: pancreas-hepatobiliary (p = 0.005), hepatobiliary-pancreas (p = 0.013), and periaortitis-mesenteric (p = 0.006). Clinical symptoms were significantly associated with imaging characteristics (p < 0.001). Abdominal complications were detected in 52.2% (36/69) of patients, mostly solid organ atrophy (97.2% [35/36]). New-onset diabetes was more likely in pancreatic IgG4-RD (n = 51) when accompanied by gland atrophy (4/21 vs. 0/30 nonatrophy, p = 0.024). CONCLUSION Radiological relapse of IgG4-RD is common over prolonged imaging surveillance and is significantly associated with symptomatic relapse. A multisystem review to detect new/different sites of disease and abdominal complications may help predict future organ dysfunction.
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Affiliation(s)
- Jie-Ying Kowa
- From the University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada
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Elbanna KY, Jang HJ, Kim TK. Imaging for Screening/Surveillance of Pancreatic Cancer: A Glimpse of Hope. Korean J Radiol 2023; 24:271-273. [PMID: 36907596 PMCID: PMC10067696 DOI: 10.3348/kjr.2022.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- Khaled Y Elbanna
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Jhaveri KS, Babaei Jandaghi A, Bhayana R, Elbanna KY, Espin-Garcia O, Fischer SE, Ghanekar A, Sapisochin G. Prospective evaluation of Gadoxetate-enhanced magnetic resonance imaging and computed tomography for hepatocellular carcinoma detection and transplant eligibility assessment with explant histopathology correlation. Cancer Imaging 2023; 23:22. [PMID: 36841796 PMCID: PMC9960413 DOI: 10.1186/s40644-023-00532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/08/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND We aimed to prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed Tomography (CECT) for hepatocellular carcinoma (HCC) detection and liver transplant (LT) eligibility assessment in cirrhotic patients with explant histopathology correlation. METHODS In this prospective, single-institution ethics-approved study, 101 cirrhotic patients were enrolled consecutively from the pre-LT clinic with written informed consent. Patients underwent CECT and EOB-MRI alternately every 3 months until LT or study exclusion. Two blinded radiologists independently scored hepatic lesions on CECT and EOB-MRI utilizing the liver imaging reporting and data system (LI-RADS) version 2018. Liver explant histopathology was the reference standard. Pre-LT eligibility accuracies with EOB-MRI and CECT as per Milan criteria (MC) were assessed in reference to post-LT explant histopathology. Lesion-level and patient-level statistical analyses were performed. RESULTS Sixty patients (49 men; age 33-72 years) underwent LT successfully. One hundred four non-treated HCC and 42 viable HCC in previously treated HCC were identified at explant histopathology. For LR-4/5 category lesions, EOB-MRI had a higher pooled sensitivity (86.7% versus 75.3%, p < 0.001) but lower specificity (84.6% versus 100%, p < 0.001) compared to CECT. EOB-MRI had a sensitivity twice that of CECT (65.9% versus 32.2%, p < 0.001) when all HCC identified at explant histopathology were included in the analysis instead of imaging visible lesions only. Disregarding the hepatobiliary phase resulted in a significant drop in EOB-MRI performance (86.7 to 72.8%, p < 0.001). EOB-MRI had significantly lower pooled sensitivity and specificity versus CECT in the LR5 category with lesion size < 2 cm (50% versus 79%, p = 0.002 and 88.9% versus 100%, p = 0.002). EOB-MRI had higher sensitivity (84.8% versus 75%, p < 0.037) compared to CECT for detecting < 2 cm viable HCC in treated lesions. Accuracies of LT eligibility assessment were comparable between EOB-MRI (90-91.7%, p = 0.156) and CECT (90-95%, p = 0.158). CONCLUSION EOB-MRI had superior sensitivity for HCC detection; however, with lower specificity compared to CECT in LR4/5 category lesions while it was inferior to CECT in the LR5 category under 2 cm. The accuracy for LT eligibility assessment based on MC was not significantly different between EOB-MRI and CECT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03342677 , Registered: November 17, 2017.
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Affiliation(s)
- Kartik S. Jhaveri
- grid.17063.330000 0001 2157 2938Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G 2M9 Canada
| | - Ali Babaei Jandaghi
- grid.231844.80000 0004 0474 0428Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, Toronto, ON M5G 1X6 Canada
| | - Rajesh Bhayana
- grid.17063.330000 0001 2157 2938Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON M5G 2M9 Canada
| | - Khaled Y. Elbanna
- grid.17063.330000 0001 2157 2938Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON M5G 2M9 Canada
| | - Osvaldo Espin-Garcia
- grid.415224.40000 0001 2150 066XDepartment of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1 Canada ,grid.17063.330000 0001 2157 2938Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra E. Fischer
- grid.231844.80000 0004 0474 0428Department of Pathology, University Health Network and University of Toronto, Toronto, Ontario Canada
| | - Anand Ghanekar
- grid.17063.330000 0001 2157 2938University Health Network, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2N2 Canada
| | - Gonzalo Sapisochin
- grid.17063.330000 0001 2157 2938University Health Network, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2N2 Canada
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Odedra D, Jandaghi AB, Bhayana R, Elbanna KY, Espin-Garcia O, Fischer SE, Ghanekar A, Sapisochin G, Jhaveri KS. Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation. Cancer Imaging 2022; 22:55. [PMID: 36195953 PMCID: PMC9531508 DOI: 10.1186/s40644-022-00497-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To compare the diagnostic performance of international hepatocellular carcinoma (HCC) guidelines with gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed tomography (CECT) and their impact on liver transplant (LT) allocation in cirrhotic patients with explant histopathology correlation. METHODS In this prospective single-centre ethics-approved study, 101 cirrhotic patients were consecutively enrolled with informed consent from the pre-LT clinic. They underwent CECT and EOB-MRI alternately at three monthly intervals until LT or removal from LT list. Two abdominal radiologists, blinded to explant histopathology, independently recorded liver lesions visible on CECT and EOB-MRI. Imaging-based HCC scores were assigned to non-treated liver lesions utilizing Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian-Pacific Association for the Study of the Liver (APASL) and Korean Liver Cancer Association-National Cancer Center (KLCA) guidelines. Liver explant histopathology was the reference standard. Simulated LT eligibility was assessed as per Milan criteria (MC) in reference to explant histopathology. RESULTS One hundred and three non-treated HCC and 12 non-HCC malignancy were identified at explant histopathology in 34 patients (29 men, 5 women, age 55-73 years). Higher HCC sensitivities of statistical significance were observed with EOB-MRI for LI-RADS 4 + 5, APASL and KLCA compared to LI-RADS 5 and EASL with greatest sensitivity obtained for LIRADS 4 + 5 lesions. HCC sensitivities by all guidelines with both EOB-MRI and CECT were significantly lower if all histopathology-detected HCCs were included in the analysis, compared to imaging-visible lesions only. A significantly greater variation in HCC sensitivity was noted across the guidelines with EOB-MRI compared to CECT. No significant differences in simulated LT eligibility based on MC were observed across the HCC scoring guidelines with EOB-MRI or CECT. CONCLUSION HCC sensitivities are variable depending on scoring guideline, lesion size and imaging modality utilised. Prior studies that included only lesions visible on pre-operative imaging overestimate the diagnostic performance of HCC scoring guidelines. Per-lesion differences in HCC diagnosis across these guidelines did not impact patient-level LT eligibility based on MC.
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Affiliation(s)
- Devang Odedra
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada
| | - Ali Babaei Jandaghi
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada
| | - Rajesh Bhayana
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada
| | - Khaled Y Elbanna
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Sandra E Fischer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Anand Ghanekar
- Department of Surgery, University Health Network and Toronto General Hospital University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Department of Surgery, University Health Network and Toronto General Hospital University of Toronto, Toronto, ON, Canada
| | - Kartik S Jhaveri
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada.
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Elbanna KY, Jang HJ, Kim TK, Khalili K, Guimarães LS, Atri M. The added value of contrast-enhanced ultrasound in evaluation of indeterminate small solid renal masses and risk stratification of cystic renal lesions. Eur Radiol 2021; 31:8468-8477. [PMID: 33912992 DOI: 10.1007/s00330-021-07964-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/09/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate accuracy of contrast-enhanced ultrasound (CEUS) to characterize indeterminate small solid renal masses (sSRMs), excluding lipid-rich AMLs, and cystic renal masses (CRMs) according to the proposed Bosniak Classification 2019 MATERIALS AND METHODS: CEUS of pathology-proven CRMs and sSRMs (without definite enhancement or macroscopic fat on CT/MRI), and CRMs with ≥18 months follow-up were retrospectively reviewed. Two radiologists blindly categorized CRMs according to new Bosniak Classification on CT/MRI. On CEUS, two other radiologists evaluated arterial-phase enhancement of sSRMs relative to renal cortex and categorized CRMs following new Bosniak Classification. Fisher's exact/chi-squared test was used to compare categorical variables, and Cohen κ statistics for inter-observer agreement RESULTS: A total of 237 patients had 241 lesions: 161 pathology-proven sSRMs (122 malignant and 39 benign), 29 pathology-proven CRMs, 51 CRMs with adequate follow-up. Arterial-phase enhancement < renal cortex predicted malignancy with specificity of 97.4% (38/39) (CI 85.6-99.9%), and positive predictive value (PPV) of 98.2% (54/55) (CI 90.4-99.9%). Inter-observer kappa was 0.95. In pathology-proven CRMS, sensitivity of CEUS vs CT/MRI was 100% (15/15) (CI 79.6-100%) vs 60% (9/15) (CI 35.8-80.1%) (p value = .002) and negative predictive value (NPV) 100% (2/2) (CI 17.8-100%) vs 25% (2/8 ) (CI 4.4-59.1%) (p value < 0.0001), with similar specificity (50%) and PPV- 88.2% (15/17) (CI 65.7-97.9%) vs 81.8% (9/11) (CI 52.3-96.8%) ( p value = 0.586). Bosniak Classification inter-observer kappa was 0.92 for CEUS vs 0.68 for CT/MRI (p value = 0.009). CONCLUSION In our cohort, CEUS had high specificity and PPV to diagnose RCC in sSRMs excluding lipid-rich AML. CEUS had significantly higher sensitivity/NPV to diagnose malignancy in CRMs as compared to CT/MRI. KEY POINTS • Once lipid-rich AML is excluded by the other modalities, sSRM arterial phase hypo-enhancement relative to renal cortex on CEUS yielded high specificity (97.4%) and PPV (98.2%) to diagnose RCC. • When applying the proposed Bosniak Classification 2019, CEUS showed higher sensitivity compared to CT/MRI (100% vs 60%), p value=.0024, in the stratification of cystic renal masses to diagnose malignancy. • CEUS may reduce the number of CT/MRI Bosniak IIF lesions by assigning them to either II or III/IV categories.
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Affiliation(s)
- Khaled Y Elbanna
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Hyun-Jung Jang
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Korosh Khalili
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Luís S Guimarães
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Mostafa Atri
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada.
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Elbanna KY, Kielar AZ. Computed Tomography Versus Magnetic Resonance Imaging for Hepatic Lesion Characterization/Diagnosis. Clin Liver Dis (Hoboken) 2021; 17:159-164. [PMID: 33868658 PMCID: PMC8043714 DOI: 10.1002/cld.1089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/07/2020] [Accepted: 01/03/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Khaled Y. Elbanna
- Toronto Joint Department of Medical ImagingUniversity Health NetworkSinai Health System and Women’s College HospitalUniversity of TorontoTorontoONCanada
| | - Ania Z. Kielar
- Toronto Joint Department of Medical ImagingUniversity Health NetworkSinai Health System and Women’s College HospitalUniversity of TorontoTorontoONCanada,The University of OttawaOttawaCanada
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Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging 2020; 11:58. [PMID: 32335790 PMCID: PMC7183518 DOI: 10.1186/s13244-020-00861-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.
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Affiliation(s)
- Khaled Y Elbanna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Alharthy A, D’Mello M, Alabsi H, Murray N, Metwally O, Elbanna KY, Mohammed MF, Khosa F. Vascular Imaging: Utilization of Dual-Energy Computed Tomography. Curr Radiol Rep 2019. [DOI: 10.1007/s40134-019-0337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Elbanna KY, Mohammed MF, Huang SC, Mak D, Dawe JP, Joos E, Wong H, Khosa F, Nicolaou S. Correction to: Delayed manifestations of abdominal trauma: follow-up abdominopelvic CT in posttraumatic patients. Abdom Radiol (NY) 2018; 43:3204-3205. [PMID: 29383421 DOI: 10.1007/s00261-017-1439-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The original version of this article unfortunately contained few mistakes. Under the subheading "Data extraction and review process", in line 12 the word "prospective" is incorrectly given by the author. The correct word is "retrospective". In Fig. 2D, the label should read as RA instead of LA. In Table 6, the word "ischemic/gangrenous" should read as "ischemia/gangrene" in 9th row, column 6. The revised Fig 2 and Table 6 are available in the correction article.
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Affiliation(s)
- Khaled Y Elbanna
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
- , Toronto, ON, Canada.
| | - Mohammed F Mohammed
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Shih-Chieh Huang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Mak
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - J Philip Dawe
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Emilie Joos
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Heather Wong
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Faisal Khosa
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
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Mohammed MF, Elbanna KY, Mohammed AME, Murray N, Azzumea F, Almazied G, Nicolaou S. Practical Applications of Dual-Energy Computed Tomography in the Acute Abdomen. Radiol Clin North Am 2018; 56:549-563. [PMID: 29936947 DOI: 10.1016/j.rcl.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With new developments in workflow automation, as well as technological advances enabling faster imaging with improved image quality and dose profile, dual-energy computed tomography is being used more often in the imaging of the acutely ill and injured patient. Its ability to identify iodine, differentiate it from hematoma or calcification, and improve contrast resolution has proven invaluable in the assessment of organ perfusion, organ injury, and inflammation.
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Affiliation(s)
- Mohammed F Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia.
| | - Khaled Y Elbanna
- Department of Medical Imaging, Emergency and Trauma Radiology Division, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Abdelazim M E Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Nicolas Murray
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
| | - Fahad Azzumea
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Ghassan Almazied
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
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Elbanna KY, Mohammed MF, Huang SC, Mak D, Dawe JP, Joos E, Wong H, Khosa F, Nicolaou S. Delayed manifestations of abdominal trauma: follow-up abdominopelvic CT in posttraumatic patients. Abdom Radiol (NY) 2018; 43:1642-1655. [PMID: 29051983 DOI: 10.1007/s00261-017-1364-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Our study aims to investigate the frequency and patterns of delayed manifestations of abdominal and pelvic injuries which may not be identified or which fail to manifest on the initial abdominopelvic CT in posttraumatic patients. METHODS For our institutional review board (IRB)-approved retrospective study, our hospital trauma registry was queried for patients with blunt multitrauma and Injury Severity Score (ISS) ≥ 16 between January 2010 and August 2016, yielding 3735 patients. A total of 203 patients received a follow-up abdominopelvic CT within six months from the initial scan and those with new findings on follow-up CT were identified. A retrospective blinded review of the initial CT examinations was performed by two experienced radiologists. The retrospective readings and original reports were compared to categorize the new abnormalities detected on follow-up CT scans. The categories included missed injuries, late presentations and sequelae of trauma, and complications of surgery, hospital admission, and invasive procedures. The patients' notes were reviewed for the clinical indications, time interval for repeat CT examination, and subsequent clinical management. The software used for statistical analysis of the extracted data was Microsoft Excel for Mac (version 15.33). RESULTS Out of 3735 patients, 203 patients received 232 follow-up abdominopelvic CTs. The average elapsed time between the initial CT and the follow-up CT was 15 ± 27 days. Evaluation for an abdominal fluid collection was the most common clinical indication, accounting for 40% of the total number (n = 243) of indications. Delayed manifestations and complications of trauma were present in 41 patients due to 47 abnormalities, most commonly related to solid organ injury, followed by abdominal collections and hematoma. Twenty-nine CT findings (62%) were only detectable on follow-up CT, while nine injuries (19%) were missed on initial CT. The findings on repeated CT warranted eight surgical and 15 interventional procedures. CONCLUSION A small percentage of traumatic injuries may be unidentified or fail to manifest on the initial CT, resulting in delayed manifestations of abdominopelvic trauma, which may lead to subsequent readmission, delayed management, and more severe medical complications.
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Affiliation(s)
- Khaled Y Elbanna
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
- , Toronto, ON, Canada.
| | - Mohammed F Mohammed
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Shih-Chieh Huang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Mak
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - J Philip Dawe
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Emilie Joos
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Heather Wong
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Faisal Khosa
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
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Elbanna KY, Mohammed MF, Choi JI, Dawe JP, Joos E, Baawain S, Ali IT, Nicolaou S. What Are the Expected Findings on Follow-up Computed Tomography Angiogram in Post-traumatic Patients With Blunt Cerebrovascular Injury? Can Assoc Radiol J 2018; 69:266-276. [PMID: 29958832 DOI: 10.1016/j.carj.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/16/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating diagnosis. Our study establishes the temporal changes and findings on follow-up imaging. METHODS For this retrospective, institutional review board-approved study, the hospital trauma registry was queried for all severely injured polytrauma patients who underwent computed tomography angiogram (CTA) scans in the emergency department between January 1, 2010, and December 31, 2016, with injury severity score ≥16, yielding 3747 patients. A total of 128 patients had a follow-up CTA for BCVI. The grade, location, and outcomes of injuries on follow-up imaging were studied. RESULTS A vehicular collision was the most common mechanism of injury (75%). The majority of patients (61%) had a Glasgow Coma Scale of 10-15. Vertebral fractures were the most common associated injury (57%). The overall incidence of BCVI in our study population was 4.8%. On the initial CTA, 50% of injuries were grade 1, 25.4% were grade 2, 7% were grade 3, 17% were grade 4, and 0.6% were grade 5. For the different grades of injuries, improvement has been documented in 44% with complete healing in 34%, while 51% of injuries remained unchanged from the initial scan. Only 5% progressed to a higher-grade injury. Twelve patients developed strokes with an incidence of 9.4% in patients with a follow-up CTA. CONCLUSIONS This study can help increase the awareness of radiologists about the evolution patterns of different grades of BCVIs on follow-up CTA for severely injured posttraumatic patients.
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Affiliation(s)
- Khaled Y Elbanna
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Mohammed F Mohammed
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jung-In Choi
- Faculty of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
| | - J Philip Dawe
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saleh Baawain
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ismail Tawakol Ali
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Ali IT, Thomas C, Elbanna KY, Mohammed MF, Berger FH, Khosa F. Gastrointestinal Imaging: Emerging Role of Dual-Energy Computed Tomography. Curr Radiol Rep 2017. [DOI: 10.1007/s40134-017-0227-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Elbanna KY, Alzahrani HA, Azzumeea F, Alzamel HA. Neuroendocrine tumor of the appendix inside an incarcerated Amyand's hernia. Int J Surg Case Rep 2015; 14:152-5. [PMID: 26279257 PMCID: PMC4573861 DOI: 10.1016/j.ijscr.2015.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 12/08/2022] Open
Abstract
Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia is extremely rare. The diagnosis of Neuroendocrine tumor in a such emergency situation is a real challenge. Treatment of the hernia defect in a such condition is interesting.
Amyand’s hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand’s hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported. We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5 cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip. An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition.
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Affiliation(s)
- Khaled Y Elbanna
- Medical Imaging Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Riyadh 11426, Saudi Arabia
| | - Hassan A Alzahrani
- Department of Surgery, Faculty of Medicine, King Khalid University (KKU), Abha 61421, Saudi Arabia.
| | - Fahad Azzumeea
- Medical Imaging Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Riyadh 11426, Saudi Arabia
| | - Hyetham A Alzamel
- Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Riyadh 11426, Saudi Arabia
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