The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE.

Introduction: Despite advances in imaging techniques, the differentiation between pancreatic cancer and benign lesions remains difficult. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an effective method for providing tissue diagnosis, but problems occur when lesions are small or the cytological diagnosis is indeterminate. Aim: To prospectively evaluate the utility of EUS-FNA in patients with small solid pancreatic lesions and those with initial indeterminate or negative cytological diagnosis. Methods: During the study period we performed a total of 119 EUS-FNA procedures on 46 patients (mean age 56.3 years) for 47 small solid pancreatic lesions (range 7–30 mm, mean 17.2 mm in diameter). FNAs were performed in the presence of a cytopathologist. If cytological diagnoses were indeterminate, EUS-FNA was repeated within 3 weeks. Diagnoses were confirmed histologically or by follow-up (clinical and imaging: EUS +/– FNA and CT). Results: Localization of the lesions: head 28 (60%), uncinate process 4 (9%), body 11 (23%) and tail 4 (9%). On average, 3.7 passes were performed. We observed no complications. Initial cytological findings were: malignant 17 (36%), benign 21 (45%), and indeterminate 9 (19%). 8 (78%) of the indeterminate findings were confirmed to be malignant on repeated procedures. A diagnosis of pancreatic cancer was subsequently confirmed in 1 patient who had a benign cytological finding. 19 patients underwent surgery. Histology confirmed a neoplasm in all cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 68, 100, 100, 73 and 83%, respectively. After repeated EUS-FNAs of indeterminate findings sensitivity, negative predictive value and diagnostic accuracy rose to 92, 77 and 96%, respectively. Conclusion: EUS-FNA is a highly effective method for providing tissue diagnosis in patients with small solid pancreatic masses. Repeated procedures enhanced diagnostic accuracy in indeterminate findings, among which was high percentage of malignancies. EUS-FNA reduced the number of operations in patients with pancreatic solid masses.

The purpose of the study was to evaluate and compare opacification of the renal collecting system and ureters detected by computed tomographic urography (CTU) performed 20 min and 1 h after the ingestion of 1,000 ml of water. CTU was performed on 89 patients (55 men, 34 women; age 28-77 years) and 168 collecting systems and ureters were evaluated. A 16-detector-row scanner (Sensation 16, Siemens) was used; a two-phase protocol with a split bolus of contrast agent (total 120 ml) was applied. A combined nephrographic-excretory phase was obtained 100 s after the second injection. Three-dimensional reconstructions of the excretory phase were created and used to evaluate the degree of opacification of the collecting system and ureters. In 44 patients, water was administered 20 min before examination, and in 45 patients, 1 h before examination. CTU performed 1 h after water ingestion demonstrated complete opacification of calices in 87.5%, of renal pelvis in 97.5%, of upper ureter in 91.8% and of lower ureter in 87.5% of patients. CTU performed 20 min after water ingestion demonstrated complete opacification of calices in 79.5%, of renal pelvis in 85%, of upper ureter in 62.5% and of lower ureter in 54.5% of patients. Complete opacification of the proximal and distal ureter in the group with a 1-h delay was statistically higher (P<0.01). CTU performed on the distended bladder, 1 h after the oral ingestion of water, enables excellent opacification of collecting system, including distal ureters.

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