Marek Stajgis

Sonoelastography – A Useful Adjunct for Parotid Gland Ultrasound Assessment in Patients Suffering from Chronic Inflammation

Background Shear wave elastography (SWE) is widely used in breast, liver, prostate and thyroid evaluations. Elastography provides additional information if used to assess parotid gland pathology. We assessed parotid glands by means of SWE to compare the parenchyma properties in different types of inflammation. Material/Methods Prospective analysis included 78 consecutive patients with parotid gland pathology: sialolithiasis (33), Stensen’s duct stenosis (15), chronic inflammation (10), and primary Sjögren syndrome (pSS) (20) treated at the Department of Otolaryngology, Head and Neck Surgery of PUMS. The primary predictor variable was type of parotid pathology, and secondary predictor variables were patient age and the duration and intensity of complaints. Ultrasound pictures were compared with elastography values of parotid parenchyma. Results Mean elasticity values for pSS (111 Kilopascals (kPa), Stensen’s duct stenosis (63 kPa), sialolithiasis (82 kPa), and chronic inflammation (77 kPa) were significantly higher than the mean value for healthy patients (24 kPa). Elasticity increased proportionally to the intensity of complaints: mild (51 kPa), moderate (78 kPa), and strong (90 kPa). Increased elasticity did not correspond with ultrasonographic pictures. In pSS the parenchyma was almost twice as stiff as in chronic inflammation (p=0.02), although subjective complaints were mostly mild or moderate, and the ultrasonographic picture did not present features of fibrosis. Conclusions Sonoelastography, by improving routine ultrasonographic assessment, might be a useful tool for parotid evaluations during the course of chronic inflammation. An extraordinarily high degree of stiffness was revealed in pSS despite lack of fibrosis by ultrasonography and moderate subjective complaints, suggesting that sonoelastography could be a valuable diagnostic tool.

Intestinal healing after anti-TNF induction therapy predicts long-term response to one-year treatment in patients with ileocolonic Crohn’s disease naive to anti-TNF agents

Introduction Objective assessment of Crohn’s disease (CD) activity in patients treated with anti-tumour necrosis factor (anti-TNF) antibodies is crucial for the prediction of its long-term results. Mucosal healing estimated endoscopically has a strong predictive value; however, only combined assessment together with transmural healing in magnetic resonance enterography (MRE) gives full information about the whole spectrum of inflammatory lesions in CD. Aim To assess the usefulness of intestinal healing phenomenon in CD, defined as improvement both in endoscopy and MRE, after anti-TNF induction therapy, in predicting long-term results of 1-year treatment. Material and methods Twenty-six patients with ileocolonic CD were enrolled into the study. In this group a parallel assessment of disease activity was estimated before and after induction doses of anti-TNF antibodies with ileocolonoscopy and MRE by using appropriate scores. Subsequently the patients were treated until 12 months and then followed-up. The associations between intestinal healing (assessed in MRE and endoscopy), and mucosal and transmural healing with long-term results of 1-year anti-TNF therapy were analysed statistically. Results The median time of follow-up was 29 months (interquartile range – IQR: 14–46). Intestinal healing was significantly associated with favourable therapeutic outcomes (p = 0.02) and had 75% (IQR: 35–97%) sensitivity and 72% (IQR: 46–90%) specificity in predicting long-term remission. Other parameters were not useful (transmural healing) or their usefulness was of borderline significance (mucosal healing). Conclusions Dynamic assessment of intestinal healing is an accurate method in predicting long-term outcomes in CD patients responding to 1-year anti-TNF therapy.

Usefulness of magnetic resonance imaging in diagnosis and monitoring of treatment of perianal fistulas.

A fistula-in-ano (also referred to as anal fistula, rectal fistula, perianal fistula or anorectal fistula) is an abnormal tract or cavity communicating with the rectum or the anal canal by an identifiable internal opening (1). The problem is still up-to-date and remains a difficultone to handle, with an overall incidence of 8.6:100,000 annually, affecting patients with a mean age of 38.3 years. The problem is much more common in men, with a female to male ratio of 2:15. There is a wide spectrum of potential causes of fistulas, but it appears that the majority of fistulas result from infection (abscess) in the anal glands extending from the intersphincteric plane to various anorectal spaces (2). The fistula-in-ano significantly decreases the quality of life, most patients experience recurrent perianal drainage, fever, perianal pain, itching and/or recurrent abscesses (3). Although anal fistulas were known to Hippocrates and have been described throughout the centuries, they began to receive special attention in the 19th century. In 1835, Frederick Salmon founded the Benevolent Dispensary for the Relief of the Poor Afflicted with Fistula, Piles, and Other Diseases of the Rectum and Lower Intestines, he now world famous St Mark’s Hospital in London. Much of our understanding of perianal fistulas comes from the work of surgeons at St Mark’s Hospital: Salmon, who operated on Charles Dickens; Goodsall, who described the course of fistulous tracks from the skin to the anus (4); and Parks, whose classification of fistulas in relation to anal anatomy is widely used in surgical practice (5). In this article we will discuss the anatomy of the perirectal area, the causes of anal fistulas and MRI protocols useful to assess the position of the fistula duct. Also, we will present classification types (gradation) of fistulas in surgery based on MR imaging.

Peripheral vascular malformations – modern imaging

Currently the major aim in peripheral vascular malformation diagnosis, crucial for subsequent management and treatment, is to identify its haemodynamic characteristics. Other significant features that should be specified by a radiologist are the exact location of the anomaly, its size, and its morphology. Until recently the diagnostic methods available for comprehensive evaluation of malformations have been rather limited. Moreover, they were often associated with the necessity of exposing the patient to X-ray radiation and with invasive procedures, as for example in angiography. The development of imaging techniques used in the diagnosis of vascular abnormalities in recent years, especially magnetic resonance imaging, has contributed to improved diagnostic value of the tests. In this article we review the currently available imaging modalities with particular consideration of magnetic resonance imaging and its capability to distinguish between high- and low-flow malformations.

Arterial stiffness, body fat compartments, central hemodynamics, renal function and left atrial size

Abstract Background. Left atrial (LA) size is an important predictor of stroke, death, and atrial fibrillation. It was demonstrated recently that body fat, arterial stiffness and renal functions are associated with LA diameter. However, data are lacking for comprehensive assessments of all these risk factors in a single population. Therefore, the aim of the present study was to investigate the association between LA size and different fat descriptors, central hemodynamics, arterial stiffness, and renal function in healthy subjects. Methods. To this end, body fat percentage, abdominal, subcutaneous fat, and general descriptors of body fat were estimated in 162 healthy subjects (mean age 51 years). Echocardiography was performed to assess LA diameter. Arterial stiffness and peripheral and central hemodynamics were estimated by digital volume pulse analysis and pulse wave analysis. Glomerular filtration rate was estimated by MDRD formula. Results. There were significant (p < 0.05) bivariate correlations between LA diameter and all descriptors of body fat (except subcutaneous fat). Arterial stiffness and estimated glomerular filtration rate (eGFR) were also significantly correlated with LA size. Multiple regression analysis including all significant confounders, such as sex, mean arterial pressure, arterial stiffness, eGFR and body fat descriptors, explained 35% of variance in LA diameter. Conclusions. In conclusion, the present study reveals significant, independent relationships between body fat, arterial stiffness, and LA size.

Renal morphology assessed by ultrasound in relation to central haemodynamics and body fat

There is a correlation between renal function and the morphological characteristics of the kidney. However, little is known about the association between renal morphology and other important predictors of the risk of cardiovascular diseases, such as central haemodynamics or body fat. Thus, in the present study we investigated correlations between renal morphology, body fat and central haemodynamics. Renal morphology and intra‐abdominal and subcutaneous fat were assessed by ultrasound, whereas central haemodynamics were evaluated by pulse wave analysis, in 93 healthy, non‐obese subjects (mean (±SEM) age 52 ± 1 years; 43 men, 50 women). Significant correlations were found for indices of body fat (waist : hip ratio, body mass index and intra‐abdominal fat) and renal morphology (kidney length, width and volume). Significant inverse correlations were found between central augmentation pressure (cAP) and kidney length (r = −0.33; P = 0.0009), width (r = −0.24; P = 0.01) and volume (r = −0.27; P = 0.007). In addition, significant negative correlations were found between the central augmentation index (cAIx) and kidney length (r = −0.36; P = 0.0003), width (r = −0.29; P = 0.003) and volume (r = −0.33; P = 0.0008). Multiple linear regression analysis revealed independent associations between kidney length and both cAP and cAIx. In conclusion, common morphometric characteristics of the kidney, as assessed by ultrasound, are associated with measures of body fat and descriptors of central haemodynamics. The relationships demonstrated in the present study indicate that these associations may be a biologically plausible phenomenon.