Cyst Type Differentiates Rathke Cleft Cysts From Cystic Pituitary Adenomas

PurposeA classification system for cystic sellar lesions does not exist. We propose a novel classification scheme for these lesions based on the heterogeneity of the cyst wall/contents and the presence of a solid component on imaging.MethodsWe retrospectively reviewed 205 patients’ medical records (2008–2020) who underwent primary surgery for a cystic sellar lesion. Cysts were classified a priori into 1 of 4 cyst types based on the heterogeneity of the cyst wall/contents and the presence of a solid component imaging. There was high interrater reliability. Univariable and multivariable models were used to estimate the ability of cyst type to predict the two most common diagnoses: Rathke cleft cyst (RCC) and cystic pituitary adenoma.ResultsThe frequencies of RCC and cystic pituitary adenoma in our cohort were 45.4% and 36.4%, respectively. Non-neoplastic lesions (e.g., arachnoid cysts and RCC) were more likely to be Type 1 or 2, whereas cystic neoplasms (e.g., pituitary adenomas and craniopharyngiomas) were more likely to be Type 3 or 4 (p<0.0001). Higher cyst types, compared to Type 1, had higher odds of being cystic pituitary adenomas compared to RCCs (OR: 23.7, p=0.033, and 342.6, p <0.0001, for Types 2 and 4, respectively). Lesions with a fluid-fluid level on preoperative MRI also had higher odds of being pituitary adenomas (OR: 12.7; p=0.023). Cystic pituitary adenomas were more common in patients with obesity (OR: 5.0, p=0.003) or symptomatic hyperprolactinemia (OR: 11.5; p<0.001, respectively). The multivariable model had a positive predictive value of 82.2% and negative predictive value of 86.4%.ConclusionWhen applied to the diagnosis of RCC versus cystic pituitary adenoma, higher cystic lesion types (Type 2 & 4), presence of fluid-fluid level, symptomatic hyperprolactinemia, and obesity were predictors of cystic pituitary adenoma. Further validation is needed, but this classification scheme may prove to be a useful tool for the management of patients with common sellar pathology.

Adenocarcinoma in situ and minimally invasive adenocarcinoma in lungs of smokers: image feature differences from those in lungs of non-smokers

Purpose We aimed to examine the characteristics of imaging findings of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) in the lungs of smokers compared with those of non-smokers. Materials and methods We included seven cases of AIS and 20 cases of MIA in lungs of smokers (pack-years ≥ 20) and the same number of cases of AIS and MIA in lungs of non-smokers (pack-years = 0). We compared the diameter of the entire lesion and solid component measured on computed tomography (CT) images, pathological size and invasive component diameter measured from pathological specimens, and CT values of the entire lesion and ground-glass opacity (GGO) portions between the smoker and non-smoker groups. Results The diameters of AIS and MIA on CT images and pathological specimens of the smoker group were significantly larger than those of the non-smoker group (p = 0.036 and 0.008, respectively), whereas there was no significant difference in the diameter of the solid component on CT images or invasive component of pathological specimens between the two groups. Additionally, mean CT values of the entire lesion and GGO component of the lesions in the smoker group were significantly lower than those in the non-smoker group (p = 0.036 and 0.040, respectively). Conclusion AIS and MIA in smoker’s lung tended to have larger lesion diameter and lower internal CT values compared with lesions in non-smoker’s lung. This study calls an attention on smoking status in CT-based diagnosis for early stage adenocarcinoma.

Precise Measurements of the Temperature Influence on the Complex Permittivity of Power Transformers Moistened Paper-Oil Insulation

The reference characteristics of complex permittivity of the transformers insulation solid component were determined for use in the precise diagnostics of the power transformers insulation state. The solid component is a composite of cellulose, insulating oil and water nanoparticles. Measurements were made in the frequency range from 10−4 Hz to 5000 Hz at temperatures from 293.15 to 333.15 K. Uncertainty of temperature measurements was less than ±0.01 K. Pressboard impregnated with insulating oil with a water content of (5.0 ± 0.2) by weight moistened in a manner maximally similar to the moistening process in power transformers was investigated. It was found that there are two stages of changes in permittivity and imaginary permittivity components, occurring for low and high frequency. As the temperature increases, the frequency dependencies of the permittivity and imaginary permittivity component shifts to the higher frequency region. This phenomenon is related to the change of relaxation time with the increase in temperature. The values of relaxation time activation energies of the permittivity ΔWτε′ ≈ (0.827 ± 0.0094) eV and the imaginary permittivity component ΔWτε″ = 0.883 eV were determined. It was found that Cole-Cole charts for the first stage are asymmetric and similar to those described by the Dawidson–Cole relaxation. For stage two, the charts are arc-shaped, corresponding to the Cole-Cole relaxation. It has been established that in the moistened pressboard impregnated with insulating oil, there is an additional polarization mechanism associated with the occurrence of water in the form of nanodrops and the tunneling of electrons between them.

ENDOSCOPIC ULTRASOUND FEATURES OF PANCREATIC FLUID COLLECTIONS AND THEIR IMPACT ON THERAPEUTIC DECISIONS: AN INTEROBSERVER AGREEMENT STUDY

Background and study aims: A validated classification of endoscopic ultrasound (EUS) morphological characteristics and consequent therapeutic intervention(s) in pancreatic and peripancreatic fluid collections (PFCs) is lacking. We performed an interobserver agreement study among expert endosonographers assessing EUS related PFCs features and therapeutic approaches utilized. Patients and methods: Fifty EUS videos of PFCs were independently reviewed by 12 experts and evaluated for PFC type, percentage of solid component, presence of infection, recognition and communication of the main pancreatic duct (MPD), stent choice for drainage, and direct endoscopic necrosectomy (DEN) performance and timing. The Gwet’s AC1 coefficient was used to assess interobserver agreement. Results: A moderate agreement was found for lesion type (AC1, 0.59), presence of infection (AC1, 0.41), and need for DEN (AC1, 0.50), while fair or poor agreements were stated for percentage of solid component (AC1, 0.15) and MPD recognition (AC1, 0.31). Substantial agreement was rated for ability to assess PFC-MPD communication (AC1, 0.69), decision between placing a plastic versus lumen-apposing metal stent (AC1, 0.62), and timing of DEN (AC1, 0.75). Conclusions: Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted.

Clinical and Imaging Features of The Ovarian Cystadenofibroma or Adenofibroma and Their Correlation With Pathological Findings

Purpose To improve the accuracy of the preoperative diagnosis of ovarian cystadenofibroma (CAF) or adenofibroma (AF). Methods Clinical symptoms, laboratory results, imaging features, and pathological results of 11 patients with 11 histologically proven ovarian CAF/AF were reviewed retrospectively. The computed tomography (CT) and magnetic resonance imaging (MRI) features of the tumor including location, number, size, internal characteristics, CT density or MRI signal intensity, enhancement performance, lymphadenopathy, and amount of ascites were comprehensively evaluated. Results With regard to the clinical findings, results of serum cancer antigen 125 (CA125), cancer antigen 199 (CA199), and other laboratory tests were normal in most cases (81.8%, 9/11). The imaging features of the 11 lesions were as follows: unilateral occurrence, well-defined boundary, round or roundish, unilocular (63.6%, 7/11), cystic mass (81.8%, 9/11), multilocular (27.3%, 3/11), black sponge sign (18.2%, 2/11), carpet sign (81.8%, 9/11), residual ovary sign (45.5%, 5/11), papillary nodule clusters (45.5%, 5/11), and small vesicle with an acute angle to the inner cyst wall (18.2%, 2/11). The signal intensity of the solid component was isointense or hypointense on T2-weighted imaging and hypo intense on diffusion-weighted imaging. The CT value of the lesions ranged from 21 Hounsfield units (Hu) to 45 Hu. A slight to moderate enhancement degree occurred in more than half of the lesions (54.5%, 6/11). No or a small amount of ascites was present in these cases. Histologic examination revealed SCAF (45.5%, 5/11), SAF (27.3%, 3/11), and borderline CAF/AF (27.3%, 3/11). No necrosis, hemorrhage, or calcification was observed in any of these masses. Conclusion Ovarian CAF/AF usually mimics malignancy, demonstrating a cystic mass combined with solid component on CT or MR images. The integrity of case data including laboratory results and imaging features can help radiologists make an accurate preoperative diagnosis. No or a small amount of ascites may narrow the differential diagnosis.

A Case of Torsion in an Otherwise-Normal Ovary with a Giant Hematosalpinx Larger than Enlarged Ovary: Utilization of Diagnostic Laparoscopy for the Accurate Diagnosis

We report a case of torsion in an otherwise-normal ovary with a giant hematosalpinx. A 23-year-old woman presented with complaints of abdominal pain and nausea. At initial visit, there was few abnormal findings of imaging tests, and we made a diagnosis of ovarian hemorrhage. Three days later, she came back with increased symptoms, and we detected the mass of a complex solid cystic structure with a unilocular cyst much larger than solid component. A diagnostic laparoscopy was performed immediately, and we could make a diagnosis of torsion in an otherwise-normal ovary with a giant hematosalpinx. We performed a salpingectomy and could preserve her ovary. This is the first case of torsion in an otherwise-normal ovary with a giant hematosalpinx which enlarged to a greater extent than the ovary.

Role of Transabdominal Ultrasound in Characterization of the Ovarian Mass

The use of grey-scale ultrasound morphology to characterize a pelvic mass may also be called ‘pattern recognition’. The grey-scale ultrasound image provides as much information as that obtained by the surgeon or pathologist when they cut a surgical specimen to see what it looks like inside. Aim of our study is to characterize the ovarian mass by ultrasound. The study was conducted in Department of Radiology and Imaging, College of Medical Sciences, Bharatpur. Patients with suspected ovarian mass in Gynecology OPD were included in our study. A prospective cross-sectional study was conducted on 60 patients in college of medical science, Bharatpur, over the period of one year (from November 2019 to October 2020). Present study showed benign ovarian (90.0%) pathology are the most commonly encountered ovarian mass. Ovarian mass is most common in adult female of age 15-30 years and malignant ovarian mass was most common among the age group of 30-60 years. Among benign pathology of ovary simple follicular cysts are most common (39.0%), followed by hemorrhagic cyst (31.0%), dermoid cyst (17.0%), chocolate cyst (9.0%) and ectopic pregnancy (4.0%). Among the malignant ovarian mass serous cystadenocarcinoma and mucinous cystadenocarcinoma showed similar frequency (33.0% each) and followed by immature teratoma and krukenberg tumor (17.0% each). Ultrasound parameters like size, septal thickness, solid component and spectral doppler (RI ans PI) are very helpful for determination of malignant pathology. In this study the sensitivity and specificity of size parameter is least (40.3% and 60.2%) and highest in solid component and spectral Doppler parameter (PI) being (82.0% and 92.0%). Combined study of grey scaleand spectral Doppler study plays crucial role in characterization of ovarian mass to differentiate between benign and malignant pathology.

Aluminum-free glass ionomer cements containing 45S5 Bioglass® and its bioglass-ceramic

Although the incorporation of bioactive glasses into glass ionomer cements (GICs) has led to promising results, using a bioactive glass as the only solid component of GICs has never been investigated. In this study, we developed an Al-free GIC with standard compressive strength using various combinations of 45S5 Bioglass® and its glass-ceramic as the solid component. The glass-ceramic particles with 74% crystallinity were used for this purpose as they can best act as both remineralizing and reinforcing agents. Strengthening mechanisms including crack deflection and crack-tip shielding were activated for the GICs containing 50–50 wt% bioglass and bioglass-ceramic as the optimum ratio. The progression of the GIC setting reaction at its early stages was also monitored and verified. We also discussed that our bimodal particle size distribution containing both micron- and nanosized particles may enhance the packing density and integrity of the structure of the cements after setting. In such GICs produced in this study, the toxic effects of Al are avoided while chemical bonds are expected to form between the cement and the surrounding hard tissue(s) through interfacial biomineralization and adhesion.