Browsing by Author "Dugalić, Vladimir (9433624700)"

Background: Pancreatic adenocarcinoma is a highly lethal disease even in initially resectable patients. Functional imaging procedures such as diffusion-weighted imaging (DWI) and computed tomography (CT)-perfusion might facilitate preoperative prediction of factors influencing prognosis in patients with pancreatic adenocarcinoma. Purpose: To evaluate CT-perfusion and DWI quantitative parameters of pancreatic adenocarcinoma and to assess their correlation with clinicopathological features. Material and Methods: Forty-four patients with histopathologically proven pancreatic adenocarcinoma underwent CT-perfusion and DWI for estimating blood volume (BV), blood perfusion (BF), mean transit time (MTT), time to peak (TTP), and apparent diffusion coefficient (ADC) values. The statistical analysis was performed using Wilcoxon matched-pairs test, t-test for independent samples, Spearman’s rank correlation coefficient (rs), and receiver operating characteristic analysis. Results: The mean CT-perfusion parameters and ADCs were significantly different in pancreatic adenocarcinoma versus healthy parenchyma. BV (2.66 ± 0.98 mL/100g), BF (17.45 ± 4.06 mL/min/100g), and ADCs (0.91 ± 0.15 × 10−3mm/s2) in high-grade tumors were significantly lower in comparison to low-grade tumors (BV = 5.35 ± 1.36 mL/100g, BF = 28.51 ± 7.73 mL/min/100g, ADC = 1.07 ± 0.21 × 10−3mm/s2). For prediction of high-grade tumors, the sensitivity and specificity were 79.2% and 82.4% for BF and 87.5% and 88.2% for BV, respectively. A significant negative correlation was found between BV and tumor size (rs = −0.445, P = 0.029), MTT and tumor size (rs = −0.330, P = 0.043), BV and M-stage (rs = −0.286, P = 0.049), and ADC and M-stage (rs = −0.274, P = 0.038). Moreover, BF and BV values were significantly associated with ADCs. Conclusion: CT-perfusion parameters and ADC values could improve preoperative assessment of pancreatic adenocarcinoma with possibility of tumor grade prediction. © The Foundation Acta Radiologica 2018.

Background: Pancreatic adenocarcinoma is a highly lethal disease even in initially resectable patients. Functional imaging procedures such as diffusion-weighted imaging (DWI) and computed tomography (CT)-perfusion might facilitate preoperative prediction of factors influencing prognosis in patients with pancreatic adenocarcinoma. Purpose: To evaluate CT-perfusion and DWI quantitative parameters of pancreatic adenocarcinoma and to assess their correlation with clinicopathological features. Material and Methods: Forty-four patients with histopathologically proven pancreatic adenocarcinoma underwent CT-perfusion and DWI for estimating blood volume (BV), blood perfusion (BF), mean transit time (MTT), time to peak (TTP), and apparent diffusion coefficient (ADC) values. The statistical analysis was performed using Wilcoxon matched-pairs test, t-test for independent samples, Spearman’s rank correlation coefficient (rs), and receiver operating characteristic analysis. Results: The mean CT-perfusion parameters and ADCs were significantly different in pancreatic adenocarcinoma versus healthy parenchyma. BV (2.66 ± 0.98 mL/100g), BF (17.45 ± 4.06 mL/min/100g), and ADCs (0.91 ± 0.15 × 10−3mm/s2) in high-grade tumors were significantly lower in comparison to low-grade tumors (BV = 5.35 ± 1.36 mL/100g, BF = 28.51 ± 7.73 mL/min/100g, ADC = 1.07 ± 0.21 × 10−3mm/s2). For prediction of high-grade tumors, the sensitivity and specificity were 79.2% and 82.4% for BF and 87.5% and 88.2% for BV, respectively. A significant negative correlation was found between BV and tumor size (rs = −0.445, P = 0.029), MTT and tumor size (rs = −0.330, P = 0.043), BV and M-stage (rs = −0.286, P = 0.049), and ADC and M-stage (rs = −0.274, P = 0.038). Moreover, BF and BV values were significantly associated with ADCs. Conclusion: CT-perfusion parameters and ADC values could improve preoperative assessment of pancreatic adenocarcinoma with possibility of tumor grade prediction. © The Foundation Acta Radiologica 2018.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy, with mass-forming growth pattern being the most common. The typical imaging appearance of mass-forming ICC (mICC) consists of irregular ring enhancement in the arterial phase followed by the progressive central enhancement on portal venous and delayed phases. However, atypical imaging presentation in the form of hypervascular mICC might also be seen, which can be attributed to distinct pathological characteristics. Ancillary imaging features such as lobular shape, capsular retraction, segmental biliary dilatation, and vascular encasement favor the diagnosis of mICC. Nevertheless, these radiological findings may also be present in certain benign conditions such as focal confluent fibrosis, sclerosing hemangioma, organizing hepatic abscess, or the pseudosolid form of hydatid disease. In addition, a few malignant lesions including primary liver lymphoma, hemangioendothelioma, solitary hypovascular liver metastases, and atypical forms of hepatocellular carcinoma (HCC), such as scirrhous HCC, infiltrative HCC, and poorly differentiated HCC, may also pose a diagnostic dilemma by simulating mICC in imaging studies. Diffusion-weighted imaging and the use of hepatobiliary contrast agents might be helpful for differential diagnosis in certain cases. The aim of this manuscript is to provide a comprehensive overview of mICC imaging features and to describe useful tips for differential diagnosis with its potential mimickers. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Introduction Accessory spleens can be found in up to 10% of the population, and their intrapancreatic occurrence is considered uncommon. When present, the intrapancreatic accessory spleen is usually found in the tail of the pancreas in about 1.7% of adult individuals. The infrequent presence of the accessory spleen in the pancreatic tissue could lead to inappropriate diagnosis and hence therapeutic approach, as they are commonly presented as a hypervascular node in the tail of the pancreas on abdominal CT and MRI, mimicking a well differentiated tumor of the pancreas or non-functioning pancreatic neuroendocrine tumor. Case Outline We present a 70-year-old female in whom a preoperative evaluation finding was highly suggestive of a non-functioning neuroendocrine tumor of the pancreatic tail. We performed spleen preserving laparoscopic distal pancreatectomy, and histopathological examination revealed the intrapancreatic accessory spleen. Conclusion Although infrequent, the presence of the intrapancreatic accessory spleen must be considered in the differential diagnosis of pancreatic tail tumors. © 2015, Serbia Medical Society. All rights reserved.

Introduction The radical antegrade modular pancreatosplenectomy (RAMPS) procedure was introduced as a modification of standard retrograde pancreatosplenectomy (SRPS). It was designed to establish a new surgical approach, with intension to increase possibility of achieving negative posterior (retroperitoneal) resection margin, as well as to provide complete N1 lymph node clearance. Outline of cases We present two cases with diagnosed left-sided pancreatic tumors, who were surgi-cally treated in our hepato-pancreato-biliary department. Both patients underwent posterior RAMPS procedure. Postoperative course was uneventful in both patients. Conclusion RAMPS is a safe procedure because it provides complete vascular and bleeding control. It is a superior procedure in oncologic terms compared to SRPS, as it increases the rate of R0 resection, and provides larger number of lymph nodes harvested. Furthermore, RAMPS is associated with better overall survival. © 2021, Serbia Medical Society. All rights reserved.