The challenge of this new technique is to distinguish different t

The challenge of this new technique is to distinguish different tissues on the basis of their specific consistency. Since malignant tumors tend to be harder than benign lesions and parenchyma, this new approach could result clinically relevant. Initial clinical experiences in US elastography have been promising in differentiating breast, thyroid and prostate nodules. Pancreatic applications see more of US elastography are relatively recent and under validation with several studies so far published in literature. (C) 2013 Elsevier

Ireland Ltd. All rights reserved.”
“Objective: In the long-term, malignancy-associated thoracic radiation leads to varying degrees of pulmonary fibrosis and radiation-associated cardiac disease, often requiring cardiothoracic surgery. We sought to determine whether pulmonary fibrosis affects mortality in patients with radiation-associated cardiac disease undergoing cardiothoracic surgery. Methods: We studied 117 patients (aged 63 +/- 15 years, 71% were women) with radiation-associated cardiac disease receiving multimodality imaging who underwent cardiothoracic surgery (21% redo) between 2000 and 2003. Some 50% of patients had breast cancer, 28% of patients had Hodgkin’s lymphoma, 9% of patients had lung cancer, and 13% of patients had other cancers. Time from radiation was 18

+/- 12 years. Clinical, pulmonary function, angiographic, and echocardiographic parameters were recorded. On multidetector chest computed tomography, ascending aortic calcification and degree of pulmonary fibrosis (in 5 lobes for a score of 15: 0 none, 1 linear streaks, 2 moderate fibrosis, and 3 severe fibrosis with traction bronchiectasis) were recorded. Results: Mean European System for Cardiac Operative Risk Evaluation was 7.9 +/- 3, and forced expiratory volume at 1 minute/forced vital capacity ratio was 0.75 +/- 0.2. Mean left ventricular ejection

fraction was 49% +/- 12%, and right systolic check details ventricular pressure was 42 +/- 5mm Hg. Some 27% of patients had severe aortic stenosis, and 46% of patients had II+ or greater mitral regurgitation. On multidetector chest computed tomography, mean pulmonary fibrosis score was 3.5 +/- 3, and 59% of patients had ascending aortic calcification. Isolated coronary artery bypass was performed in 17% of patients; the rest were combination surgeries. At 6.3 +/- 0.4 years, there were 59 deaths (50%) (3% died 1 month postoperatively). Forty-five patients (39%) had pulmonary complications in follow-up. Increasing pulmonary fibrosis score (hazard ratio, 1.11; 95% confidence interval, 1.02-1.20; P=.02), worse European System for Cardiac Operative Risk Evaluation (hazard ratio, 1.10; 95% confidence interval, 1.01-1.21; P=.04), and lack of beta-blocker (hazard ratio, 0.54; 95% confidence interval, 0.31-0.94, P=.008) and aspirin (hazard ratio, 0.54; 95% confidence interval, 0.31-0.94; P=.03) independently predicted mortality.

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