In the last few years, notable technical progress has taken place in ultrasound elastography. Qualitative methods have been replaced by quantitative ones, such as: transient elastography, acoustic radiation force impulse and shear wave elastography. Owing to the fact that the spleen is superficially located, it is possible to obtain reliable measuring accuracy of its hardness using sonoelastography. Lately, many researchers have been investigating how spleen elasticity changes in patients infected with hepatitis B virus or hepatitis C virus and in patients suffering from liver fibrosis, portal hypertension, esophageal varices or myelofibrosis. In this article, we review the role and current status of accessible qualitative ultrasound elastography methods, including recent advances in the evaluation of spleen stiffness and its clinical utility. As study results demonstrate, spleen stiffness correlates with liver fibrosis and is helpful in determining the level of fibrosis in the METAVIR scoring system. In patients infected with hepatitis B virus or hepatitis C virus, spleen stiffness increases even when liver elasticity remains unaltered. Furthermore, it is useful in diagnosing portal hypertension or predicting existence of esophageal varices. Moreover, in patients suffering from biliary atresia after Kasai portoenterostomy, spleen sonoelastography may be helpful in selecting patients for liver transplantation as well as for choosing the best strategy for portal vein reconstruction before liver transplantation. In myelofibrosis, spleen stiffness correlates with bone marrow fibrosis and may be used to assess the response to treatment. Spleen sonoelastography is also useful in the monitoring of transjugular intrahepatic portosystemic shunt function.

Patient: Female, 65-year-old Final Diagnosis: Carcinoid tumor Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Radiology Objective: Unknown ethiology Background: Carcinoid tumor is the most frequent neuroendocrine tumor (NET) that causes liver metastases. One of the best methods to assess this type of pathology is magnetic resonance imaging with hepatocyte-specific contrast media with low molecular weight gadolinium chelate Gd-BOPTA. As these lesions do not contain hepatocytes, they present as hypointense on MRI in comparison with liver tissue which enhances this type of contrast. Case Report: In this article, we present a case of a 65-year-old female patient who was admitted to the Emergency Department with abdominal pain. Computed tomography revealed a single focal lesion in her liver. The patient underwent further evaluation using magnetic resonance imaging (MRI). The hepatobiliary phase MRI showed an unspecific homogenous enhancement of the hepatobiliary agent Gd-BOPTA. Since the lesion was interpreted as a non-characteristic lesion, the patient was discharged from the hospital with a recommendation for early follow-up. The follow-up MRI 6 months after discharge disclosed multiple liver metastases. Conclusions: Liver metastases generally demonstrate enhancement of hepatobiliary contrast agents in the T1-weighted hepatocellular phase. Metastasis from a carcinoid tumor may also demonstrate this enhancement.

Background. The esophageal cancer treatment strategy depends on the tumor stage according to the tumor, node and metastasis (TNM) classification. One of the methods recommended for esophageal cancer assessment is computed tomography (CT). The CT imaging is especially important for patients with contraindications for gastroscopy, which is the primary method used for assessing esophageal diseases.Objectives. The aim of this retrospective study was to evaluate the inter-rater reliability of low-dose hydro-CT with a sinogram-affirmed iterative reconstruction algorithm (SAFIRE) used for the staging of esophageal cancer by 2 independent radiologists. We also evaluated the application of this method for the diagnosis of esophageal cancer. Materials and methods.Low-dose hydro-CT was performed in 65 patients, and the raw data were reconstructed with SAFIRE. Obtained images were retrospectively interpreted by 2 independent and experienced radiologists. Histopathological results were used as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in the diagnosis of esophageal cancer were calculated for hydro-CT. The examination of the inter-rater reliability level in the assessment of the esophageal cancer stage in the TNM classification was performed by calculating Cohen's kappa coefficient (κ) with square weights and standard errors (SEs) for kappa. Independence tests were also performed (Fisher's exact test -two-tailed, and Pearson's χ 2 test).Results. For the diagnosis of esophageal cancer with hydro-CT, a sensitivity of 93%, a specificity of 100%, a PPV of 100%, and a NPV of 88% were observed. In the statistical analyses for the T, N and M stages, κ values greater than 0.90 and significance levels of p < 0.001 were obtained.Conclusions. Hydro-CT using low-dose techniques may be a valuable diagnostic method for staging and diagnosis of esophageal cancer, especially in patients with contraindications for invasive procedures.

Objective: The aim of this retrospective study was to evaluate the application of hydro-CT using sinogram-affirmed iterative reconstruction (SAFIRE) in the diagnosis of gastric cancer. Material/Methods: Low-dose hydro-CT was performed on 30 patients with suspicion of gastric cancer in gastroscopy. The raw data were reconstructed with SAFIRE. Images were retrospectively analyzed by two experienced radiologists in tandem who were blinded to the gastroscopy results. The results of the gastric biopsy were treated as a standard of reference. We compared the diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric cancer using the chi-square test with Yates’ correction. A P value of less than 0.05 was considered statistically significant. Results: The diagnosis of gastric cancer was confirmed in a histopathological examination in 25 (83.3%) patients, while in the remaining 5 cases (16.7%) benign gastric ulceration or gastritis was diagnosed. In 23 cases (92%) a correct diagnosis of gastric cancer was made in hydro-CT. The accuracy of endoscopy was at the level of 83.3%. There was no significant difference in the correctness of the diagnosis of gastric cancer in endoscopy and hydro-CT (p>0.05). For the diagnosis of gastric cancer with hydro-CT, sensitivity of 100%, specificity of 80%, a positive predictive value of 95.8%, and a negative predictive value of 100% were calculated. Conclusions: Low-dose hydro-CT using SAFIRE may be considered as a valuable diagnostic method for the diagnosis of gastric cancer, especially for patients who have contraindications to endoscopy or gastric biopsy.