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Preoperative Work-up (preoperative + work-up)
Selected AbstractsDiagnostic evaluation of cystic pancreatic lesionsHPB, Issue 1 2008B. C. VISSER Abstract Background. Cystic pancreatic neoplasms (CPNs) present a unique challenge in preoperative diagnosis. We investigated the accuracy of diagnostic methods for CPN. Material and methods. This retrospective cases series includes 70 patients who underwent surgery at a university hospital for presumed CPNs between 1997 and 2003, and for whom a definitive diagnosis was established. Variables examined included symptoms, preoperative work-up (including endoscopic retrograde cholangiopancreatography (ERCP) in 22 cases and endoscopic ultrasound (EUS) in 12), and operative and pathological findings. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans (n=50 patients; CT=48; MRI=13) were independently reviewed by two blinded GI radiologists. Results. The final histopathologic diagnoses were mucinous cystic neoplasm (n=13), mucinous cystadenocarcinoma (10), serous cystadenoma (11), IPMN (14), simple cyst (3), cystic neuroendocrine tumor (5), pseudocyst (4), and other (10). Overall, 25 of 70 were malignant (37%), 21 premalignant (30%), and 24 benign (34%). The attending surgeon's preoperative diagnosis was correct in 31% of cases, incorrect in 29%, non-specific "cystic tumor" in 27%, and "pseuodcyst vs. neoplasm" in 11%. Eight had been previously managed as pseudocysts, and 3 pseudocysts were excised as presumed CPN. In review of the CT and MRI, a multivariate analysis of the morphologic features did not identify predictors of specific pathologic diagnoses. Both radiologists were accurate with their preferred (no. 1) diagnosis in <50% of cases. MRI demonstrated no additional utility beyond CT. Conclusions. The diagnosis of CPN remains challenging. Cross-sectional imaging methods do not reliably give an accurate preoperative diagnosis. Surgeons should continue to err on the side of resection. [source] 3T versus 1.5T phased-array MRI in the presurgical work-up of patients with partial epilepsy of uncertain focusJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2009Maeike Zijlmans MD Abstract Purpose To study 3T compared to 1.5T phased array magnetic resonance imaging (MRI) in the presurgical work-up of patients with epilepsy with complex focus localization. Materials and Methods In all, 37 patients (>10 years) in preoperative work-up for epilepsy surgery were offered 3T in addition to 1.5T MRI if ambiguity existed about the epileptic focus. Scans were randomly reviewed by two observers, blinded for prior imaging, patient-identifying information, and each other's assessments, followed by a consensus meeting. The number of abnormal scans, detected lesions, and interobserver agreement were calculated and compared. The final consensus was compared to original scan reports. Results One observer identified 22 lesions in both 3 and 1.5T scans, while the second identified more lesions in 1.5T scans (28 vs. 20). 3T MRI had better interobserver agreement. 3T revealed more dysplasias, while 1.5T revealed more tissue loss and mesial temporal sclerosis (MTS). The final consensus yielded 29 lesions, whereas original reports identified only 17 lesions. Conclusion The 3T scans revealed different lesions compared to 1.5T. Patients can benefit most from 3T scans when a dysplasia is suspected. Reevaluation by another experienced neuroradiologist is advised in case of negative or equivocal MRIs. J. Magn. Reson. Imaging 2009;30:256,262. © 2009 Wiley-Liss, Inc. [source] Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resectionRESPIROLOGY, Issue 4 2007Ahmet Sami BAYRAM Background and objective: Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO2max) to predict cardiopulmonary complications following major pulmonary resection was evaluated. Methods: Following standard preoperative work-up and VO2max testing, 55 patients (49 male; mean age 59 years, range 20,74) underwent major pulmonary surgery: lobectomy (n = 31), bilobectomy (n = 6) and pneumonectomy (n = 18). An investigator blinded to the preoperative assessment prospectively collected data on postoperative cardiopulmonary complications. Patients were divided into two groups according to preoperative VO2max and also according to FEV1. The frequency of postoperative complications in the groups was compared. Results: Complications were observed in 19 (34.5%) patients, 11 of which were pulmonary (20%). There were two deaths (3.6%), both due to respiratory failure. Preoperative FEV1 failed to predict postoperative respiratory complications. Five of 36 patients with a preoperative FEV1 > 2 L suffered pulmonary complications, compared with six of 19 patients with FEV1 < 2 L. Cardiopulmonary complications were not observed in patients with VO2max > 15 mL/kg/min (n = 27); however, 11 patients with VO2max < 15 mL/kg/min (n = 28) suffered cardiopulmonary complications (P < 0.05). Conclusion: VO2max predicts postoperative pulmonary complications following major lung resection, and the risk of complications increases significantly when the preoperative VO2max is less than 15 mL/kg/min. [source] The role of 18F-FDOPA and 18F-FDG,PET in the management of malignant and multifocal phaeochromocytomasCLINICAL ENDOCRINOLOGY, Issue 4 2008D. Taïeb Summary Background,18F-DOPA has emerged as a promising tool in the localization of chromaffin-tissue-derived tumours. Interestingly, phaeochromocytomas (PHEO) are also FDG avid. Aim and methods,The aim of this study was to retrospectively evaluate the results of 18F-FDOPA and/or 18F-FDG,PET in patients with PHEO and paragangliomas (PGLs) and to compare the outcome of this approach with the traditional therapeutic work-up. Nine patients with non-MEN2 related PHEO or PGL were evaluated. At the time of the PET studies, the patients were classified into three groups based on their clinical history, conventional and SPECT imaging. The groups were malignant disease (n = 5, 1 VHL), apparently unique tumour site in patients with previous surgery (n = 1, SDHB) and multifocal tumours (n = 3, 1 VHL, 1 SDHD). 18F-FDOPA and 18F-FDG,PET PET/CT were then performed in all patients. Results, PET successfully identified additional tumour sites in five out of five patients with metastatic disease that had not been identified with SPECT + CI. Whilst tumour tracer uptake varied between patients it exhibited a consistently favourable residence time for delayed acquisitions. 18F-FDOPA uptake (SUVmax) was superior to 18F-FDG uptake in cases of neck PGL (three patients, four tumours). If only metastatic forms and abdominal PGLs were considered, 18F-FDG provided additional information in three cases (two metastatic forms, one multifocal disease with SDHD mutation) compared to 18F-FDOPA. Conclusions, Our results suggest that tumour staging can be improved by combining 18F-FDOPA and 18F-FDG in the preoperative work-up of patients with abdominal and malignant PHEOs. 18F-FDOPA is also an effective localization tool for neck PGLs. MIBG however, still has a role in these patients as MIBG and FDOPA images did not completely overlap. [source] | ||||||||||