Browsing by Author "Djuric-Stefanovic, A. (16021199600)"

Purpose To analyze value of the computed tomography (CT) perfusion imaging in response evaluation of the esophageal carcinoma to neoadjuvant chemoradiotherapy (nCRT) using the histopathology as reference standard. Methods Forty patients with the squamous cell esophageal carcinoma were re-evaluated after the nCRT by CT examination, which included low-dose CT perfusion study that was analyzed using the deconvolution-based CT perfusion software (Perfusion 3.0, GE). Histopathologic assessment of tumor regression grade (TRG) according to Mandard's criteria served as reference standard of response evaluation. Statistical analysis was performed using Spearman's rank correlation coefficient (rS) and Kruskal-Wallis's test. Results The perfusion CT parameter values, measured after the nCRT in the segment of the esophagus that had been affected by neoplasm prior to therapy, significantly correlated with the TRG: blood flow (BF) (rS = 0.851; p < 0.001), blood volume (BV) (rS = 0.732; p < 0.001) and mean transit time (MTT) (rS = -0.386; p = 0.014). Median values of BF and BV significantly differed among TRG 1-4 groups (p < 0.001), while maximal esophageal wall thickness did not (p = 0.102). Median BF and BV were gradually rose and MTT decreased as TRG increased, from 21.4 ml/min/100 g (BF), 1.6 ml/100 g (BV) and 8.6 s (MTT) in TRG 1 group, to 37.3 ml/min/100 g, 3.5 ml/100 g and 7.5 s in TRG 2 group, 81.4 ml/min/100 g, 4.1 ml/100 g and 3.8 s in TRG 3 group, and 121.1 ml/min/100 g, 4.9 ml/100 g and 3.7 s in TRG 4 group. In all 15 patients who achieved complete histopathologic regression (TRG 1), BF was <30.0 ml/min/100 g. Conclusions CT perfusion could improve the accuracy in response evaluation of the esophageal carcinoma to nCRT. © 2015 Elsevier Ireland Ltd. All rights reserved.

Purpose: To estimate if CT perfusion parameter values of the esophageal cancer, which were obtained with the deconvolution-based software and maximum slope algorithm are in agreement, or at least interchangeable. Methods: 278 esophageal tumor ROIs, derived from 35 CT perfusion studies that were performed with a 64-MDCT, were analyzed. "Slice-by-slice" and average "whole-covered-tumor-volume" analysis was performed. Tumor blood flow and blood volume were manually calculated from the arterial tumortime- density graphs, according to the maximum slope methodology (BFms and BV ms), and compared with the corresponding perfusion values, which were automatically computed by commercial deconvolutionbased software (BF deconvolution and BVdeconvolution), for the same tumor ROIs. Statistical analysis was performed using Wilcoxon matched-pairs test, paired-samples t-test, Spearman and Pearson correlation coefficients, and Bland-Altman agreement plots. Results: BFdeconvolution (median: 74.75 ml/min/100 g, range, 18.00-230.5) significantly exceeded the BF ms(25.39 ml/min/100 g, range, 7.13-96.41) (Z = -14.390, p < 0.001), while BVdeconvolution (median: 5.70 ml/100 g, range: 2.10-15.90) descended the BVms(9.37 ml/100 g, range: 3.44-19.40) (Z = -13.868, p < 0.001). Both pairs of perfusion measurements significantly correlated with each other: BFdeconvolution, versus BFms (rS = 0.585, p < 0.001), and BVdeconvolution, versus BV ms (rS = 0.602, p < 0.001). Geometric mean BF deconvolution/BFms ratio was 2.8 (range, 1.1-6.8), while geometric mean BVdeconvolution/BVms ratio was 0.6 (range, 0.3-1.1), within 95% limits of agreement. Conclusions: Significantly different CT perfusion values of the esophageal cancer blood flow and blood volume were obtained by deconvolution-based and maximum slope-based algorithms, although they correlated significantly with each other. Two perfusion-measuring algorithms are not interchangeable because too wide ranges of the conversion factors were found. © 2013 Elsevier Ireland Ltd.

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Graphical Abstract: [Figure not available: see fulltext.]. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Graphical Abstract: [Figure not available: see fulltext.]. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Purpose: Only a few series of patients with a spigelian hernia managed on an outpatient basis have been reported in the literature. The aim of this prospective study was to evaluate the results of the elective spigelian hernia repair as an ambulatory procedure. Methods: From June 2007 to June 2010, 8 patients with 9 spigelian hernias were electively operated on under local anesthesia as a day case. Four patients had unilateral spigelian hernia, 1 had spigelian and inguinal on the same side, 1 had spigelian and epigastric, 1 had spigelian and umbilical, and 1 patient had bilateral spigelian and umbilical hernia. Spigelian hernia was managed by the "open preperitoneal flat mesh technique." In patients with several ventral hernias at different sites, "the open preperitoneal flat mesh technique" was performed using one separate flat mesh for each of the hernias; for the patient with inguinal hernia, the Lichtenstein procedure was performed in addition. Results: No complications and recurrences were recorded during a mean follow-up of 23.5 months (range: 11-35). Conclusion: The elective spigelian hernia can be successfully repaired under local anesthesia as a day-case procedure. The "open preperitoneal flat mesh technique" provides excellent results under these conditions. © 2012 Springer-Verlag France.

Purpose Standardized perfusion value (SPV) is a universal indicator of tissue perfusion, normalized to the whole-body perfusion, which was proposed to simplify, unify and allow the interchangeability among the perfusion measurements and comparison between the tumor perfusion and metabolism. The aims of our study were to assess the standardized perfusion value (SPV) of the esophageal carcinoma, and its correlation with quantitative CT perfusion measurements: blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) of the same tumor volume samples, which were obtained by deconvolution-based CT perfusion analysis. Methods Forty CT perfusion studies of the esophageal cancer were analyzed, using the commercial deconvolution-based CT perfusion software (Perfusion 3.0, GE Healthcare). The SPV of the esophageal tumor and neighboring skeletal muscle were correlated with the corresponding mean tumor and muscle quantitative CT perfusion parameter values, using Spearman's rank correlation coefficient (rS). Results Median SPV of the esophageal carcinoma (7.1; range: 2.8-13.4) significantly differed from the SPV of the skeletal muscle (median: 1.0; range: 0.4-2.4), (Z = -5.511, p < 0.001). The cut-off value of the SPV of 2.5 enabled discrimination of esophageal cancer from the skeletal muscle with sensitivity and specificity of 100%. SPV of the esophageal carcinoma significantly correlated with corresponding tumor BF (rS = 0.484, p = 0.002), BV (rS = 0.637, p < 0.001) and PS (rS = 0.432, p = 0.005), and SPV of the skeletal muscle significantly correlated with corresponding muscle BF (rS = 0.573, p < 0.001), BV (rS = 0.849, p < 0.001) and PS (rS = 0.761, p < 0.001). Conclusions We presented a database of the SPV for the esophageal cancer and proved that SPV of the esophageal neoplasm significantly differs from the SPV of the skeletal muscle, which represented a sample of healthy tissue. The SPV was validated against quantitative CT perfusion measurements and statistically significant correlation was proved. © 2015 Elsevier Ireland Ltd. All rights reserved.

Background: The modern concept of type-related individualized groin hernia surgery imposes a demand for precise and accurate preoperative determination of the type of groin hernia. The aim of this prospective study was to evaluate the accuracy of ultrasonography in classification of groin hernias, according to the criteria of the unified classification system. Unified classification divides groin hernias into nine types (grades): type I (indirect, small), II (indirect, medium), III (indirect, large), IV (direct, small), V (direct, medium), VI (direct, large), VII (combined-pantaloon), VIII (femoral), and O (other). Patients and methods: One hundred and twenty-five adult patients with clinically diagnosed or suspected groin hernias were examined. Ultrasonography of both groins was performed with a 5 to 10-MHz linear-array transducer. Preoperative ultrasonographic findings of type of groin hernia were compared with the intraoperative findings, which were considered the gold standard. Results: Total accuracy of ultrasonography in determination of type of groin hernia was 96% (119 of 124 correct predictions of type of groin hernia compared with surgical explorations). All hernias of types I, IV, V, VII, and VIII were correctly identified with ultrasonography (sensitivity and specificity 100%). In the remaining five cases of the 124 (4%), hernia was incorrectly classified with ultrasonography: type VI (direct, large) was misdiagnosed as type III (indirect, large) in three cases, type III as type VI in one case, and type III as type II (indirect, medium) in one case. The sensitivity and the specificity of ultrasonography in classifying type II were 100 and 99%, respectively, for type III, 85 and 97%, and for type VI, 90 and 99%. Conclusion: Ultrasonography of the groin regions could be used with great accuracy for precise classification of groin hernias in adults. Each type of groin hernia, according to the unified classification system that we used for classification, has a characteristic ultrasonographic presentation, which is demonstrated in this study. © Springer-Verlag 2008.

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The aim of this prospective study was to investigate the accuracy and inter-observer reliability of MRI in detection of local recurrence (LR) of pancreatic adenocarcinoma (PAC) after surgery, which was proved by PET-CT and access correlation between functional MRI and PET parameters. Forty-five patients who underwent PET-CT and MRI for follow-up purposes after radical operation of PAC were included. Twenty-three were PET positive (study group) and 22 negative for LR (control group). MR examination was performed within one month after PET-CT and three readers who were blind for PET-CT findings searched LR in T2W, 3D-dynamic post-contrast T1W-FS and DWI sequences, respectively. Sensitivity and specificity were calculated while inter-reader agreement was estimated by Cronbach’s Alpha reliability coefficient (CARC). Apparent diffusion coefficient (ADC) of LR was correlated with the size (maximal diameter) and functional PET-CT parameters: mean and maximum standardized uptake values (SUVmean, SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), using Spearman’s correlation coefficient (rS). Sensitivity and specificity among three readers in detecting the LR were 70% and 77–84% in T2W (CARC 0.806), 91–100% and 100% in 3D post-contrast T1W-FS (CARC 0.980), and both 100% in DWI sequences (CARC 1.000). Moderate inverse correlation was found between the ADC and SUVmean (r S = − 0.484), MTV (r S = − 0.494), TLG (r S = − 0.519) and lesion size (r S = − 0.567). MRI with DWI shows high diagnostic accuracy in detecting the LR of PAC in comparison to PET-CT as reference standard. ADC significantly inversely correlates with standard and advanced PET parameters and size of LR. © 2024, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

The aim of this prospective study was to investigate the accuracy and inter-observer reliability of MRI in detection of local recurrence (LR) of pancreatic adenocarcinoma (PAC) after surgery, which was proved by PET-CT and access correlation between functional MRI and PET parameters. Forty-five patients who underwent PET-CT and MRI for follow-up purposes after radical operation of PAC were included. Twenty-three were PET positive (study group) and 22 negative for LR (control group). MR examination was performed within one month after PET-CT and three readers who were blind for PET-CT findings searched LR in T2W, 3D-dynamic post-contrast T1W-FS and DWI sequences, respectively. Sensitivity and specificity were calculated while inter-reader agreement was estimated by Cronbach’s Alpha reliability coefficient (CARC). Apparent diffusion coefficient (ADC) of LR was correlated with the size (maximal diameter) and functional PET-CT parameters: mean and maximum standardized uptake values (SUVmean, SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), using Spearman’s correlation coefficient (rS). Sensitivity and specificity among three readers in detecting the LR were 70% and 77–84% in T2W (CARC 0.806), 91–100% and 100% in 3D post-contrast T1W-FS (CARC 0.980), and both 100% in DWI sequences (CARC 1.000). Moderate inverse correlation was found between the ADC and SUVmean (r S = − 0.484), MTV (r S = − 0.494), TLG (r S = − 0.519) and lesion size (r S = − 0.567). MRI with DWI shows high diagnostic accuracy in detecting the LR of PAC in comparison to PET-CT as reference standard. ADC significantly inversely correlates with standard and advanced PET parameters and size of LR. © 2024, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Purpose: To explore individual variations in visibility of the fat planes between the pancreatic parenchyma and adjacent organs and blood vessels using the multi-detector-computed tomography (MDCT). Methods: Abdominal contrast-enhanced MDCT examinations of 520 consecutive adult individuals were retrospectively analysed by exploring the presence of visible fat planes between the healthy pancreas and the following surrounding structures: stomach, descending duodenum (D2), splenic, portal, superior mesenteric vein (SV, PV, SMV), inferior vena cava (IVC), and coeliac trunk, common hepatic and superior mesenteric artery (CT, HA and SMA). Spearman’s rank correlation coefficient (rS) was used to assess the correlation of individual gender, age, body mass and BMI, and visible fat planes towards particular surrounding structures. Results: Fat planes between the pancreatic parenchyma and surrounding structures was visible as follows: stomach in 76%, D2 11.7%, SV 51.5%, PV 0%, SMV 28.8%, IVC 80.8%, CT 99.4%, HA 90.4% and SMA in 100% participants. The presence of visible fat planes significantly correlated (p < 0.001) with body mass for stomach (rS = 0.367), D2 (rS = 0.247), SV (rS = 0.355), SMV (rS = 0.384) and IVC (rS = 0.259); BMI for stomach (rS = 0.292), SV (rS = 0.248), SMV (rS = 0.290) and IVC (rS = 0.216); age for D2 (rS = 0.363), SV (rS = 0.276) and SMV (rS = 0.409); and male gender for stomach (rS = 0.160) and SV (rS = 0.198). Conclusion: Fat planes around the pancreatic parenchyma in the MDCT scan was almost always visible towards the adjacent magistral visceral arteries and IVC, always invisible towards the PV, and variably visible towards the SV, SMV, stomach and duodenum depending on the individual body mass, BMI, age and gender. © 2019, Springer-Verlag France SAS, part of Springer Nature.