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The Clinical Spectrum of PTEN Hamartoma Tumor Syndrome: Exploring the Value of Thyroid Surveillance.

Horm Res Paediatr 2021 Apr 22:1-9. Epub 2021 Apr 22.

Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Introduction: Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) comprises a collection of clinical features characterized by constitutional variants in PTEN. Several guidelines recommend thyroid screening, beginning at the pediatric age at the time of PHTS diagnosis; however, the benefits of early surveillance has not been well defined.

Methods: We conducted a retrospective investigation of patients followed up at the Children's Hospital of Philadelphia with a diagnosis of PHTS between January 2003 and June 2019. Read More

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Outcomes of complex primary total knee arthroplasties performed with custom cutting guides.

Knee 2021 Apr 19;30:106-112. Epub 2021 Apr 19.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address:

Background: Total knee arthroplasty (TKA) is particularly challenging in patients with marked deformities or existing hardware due to the inability to use traditional instrumentation. One potential technique to mitigate this obstacle is the use of patient-specific cutting guides. The purpose of this study was to evaluate the use of custom cutting guides in complex primary TKAs. Read More

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Metrics of pN-staging in oral squamous cell carcinoma: An analysis of 1,905 patients.

Eur J Cancer 2021 Apr 19;150:33-41. Epub 2021 Apr 19.

Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.

Background: We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N), which classifies patients according to the number of positive lymph nodes and extranodal extension.

Methods: Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N. Overall survival probabilities were summarised with the Kaplan-Meier method. Read More

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Noninvasive Low-Grade Papillary Urothelial Carcinoma with Degenerative Nuclear Atypia: A Grading Pitfall.

Hum Pathol 2021 Apr 19. Epub 2021 Apr 19.

Departments of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231; Departments of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231; Departments of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21231; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, 21231. Electronic address:

Noninvasive low-grade papillary urothelial carcinoma is a papillary neoplasm with orderly appearance and mild nuclear pleomorphism. Some cases show significant nuclear pleomorphism with degenerative atypia leading to grading difficulties. Retrospective review of the pathology files identified 16 cases diagnosed as noninvasive low-grade papillary urothelial carcinoma with degenerative atypia. Read More

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Surgical Outcomes in Urogynecology-Assessment of Perioperative and Postoperative Complications Relative to Preoperative Hemoglobin A1c-A Fellow's Pelvic Research Network Study.

Female Pelvic Med Reconstr Surg 2021 Apr 21. Epub 2021 Apr 21.

From the Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC Division of Urogynecology, University of New Mexico HSC, Albuquerque, NM Complete Women Care, Long Beach, CA Female Pelvic Medicine and Reconstructive Surgery, Women and Infants Hospital of Rhode Island, Providence, RI Female Pelvic Medicine and Reconstructive Surgery, Mount Auburn Hospital, Cambridge, MA Beth Israel Deaconess Medical Center, Boston, MA Division of Urogynecology, Mayo Clinic, Rochester, MN Division of Urogynecology, Houston Methodist Hospital, Houston, TX Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN Female Pelvic Medicine and Reconstructive Surgery, Cooper University Hospital, Camden, NJ Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA Medstar Health Research Institute, Washington, DC.

Objectives: Poor control of diabetes mellitus is a known predictor of perioperative and postoperative complications. No literature to date has established a hemoglobin A1c (HbA1c) cutoff for risk stratification in the urogynecology population. We sought to identify an HbA1c threshold predictive of increased risk for perioperative and postoperative complications after pelvic reconstructive surgery. Read More

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Single-center experience with venetoclax combinations in patients with newly diagnosed and relapsed AML evolving from MPNs.

Blood Adv 2021 Apr;5(8):2156-2164

In patients with acute myeloid leukemia evolving from myeloproliferative neoplasms (post-MPN-AML), the clinical activity of the B-cell lymphoma 2 inhibitor venetoclax remains to be determined. We review our experience with venetoclax-based regimens in 14 newly diagnosed (frontline [FL]) and 17 relapsed/refractory (R/R) post-MPN-AML patients. Venetoclax was used in combination with hypomethylating agents in 58% of cases and in 19% with intensive chemotherapy (treatment including cytarabine ≥1 g/m2 or CPX-351); the remaining patients received cladribine and low-dose cytarabine or isocitrate dehydrogenase 1/2 inhibitors. Read More

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Clinical and volumetric predictors of local control after robotic stereotactic radiosurgery for cerebral metastases: active systemic disease may affect local control in the brain.

Radiol Oncol 2020 Nov 10;55(1):82-87. Epub 2020 Nov 10.

Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.

Background: The aim of the study was to assess the association between physical and biological dose normalized to volume of the metastatic tumor as well as clinical factors with local control in patients with brain metastases who underwent robotic stereotactic radiosurgery.

Patients And Methods: A cohort of 69 patients consecutively treated with robotic radiosurgery between 2011 and 2016 was analyzed. The patients were treated with either single fraction radiosurgery or hypofractionated regimens. Read More

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November 2020

Assessment of clinical factors affecting outcome of myasthenia gravis.

Muscle Nerve 2021 Apr 22. Epub 2021 Apr 22.

Department of Internal Medicine IV, Division of Neurology, Osaka Medical College, Osaka, Japan.

Introduction: In myasthenia gravis (MG) therapy, achieving Myeasthenia Gravis Foundation of America minimal manifestation (MM) or better status is proposed as a desirable target. However, this level of control often is not achieved and clinical factors affecting prognosis remain unclear.

Methods: Participants were 104 consecutive patients with MG who visited Osaka Medical College Hospital. Read More

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Method for safe Verres needle entry at the umbilicus, with modification for first trocar entry to reduce the complication rate of first entry.

J Minim Access Surg 2021 Apr 9. Epub 2021 Apr 9.

Department of Surgery, Grant Medical College and J. J. Hospital; Breach Candy Hospital and Medical Research Centre; Department of Surgery, B. D. Petit Parsee General Hospital; Department of Minimal Access Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India.

Background: Initial intraperitoneal access and first trocar entry are responsible for nearly half of all complications of laparoscopic surgery. The purpose of this article is to detail our method of initial intraperitoneal access with Veress needle and first trocar at the umbilicus used over the past 28 years.

Patients And Methods: Since 1990, a single surgeon performed laparoscopic surgery in 7600 patients. Read More

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Magnetic resonance imaging findings and clinical characteristics in mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy in a predominantly adult cohort.

Epilepsia 2021 Apr 22. Epub 2021 Apr 22.

Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil.

Objective: We aimed to better characterize the magnetic resonance imaging (MRI) findings of mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE), a rare clinicopathological entity associated with pharmacoresistance recently described in patients with frontal lobe epilepsy.

Methods: We studied 12 patients who underwent epilepsy surgery and whose surgical specimens showed histopathological findings of MOGHE, characterized by preserved cortical lamination, blurred gray-white matter interface due to increased number of oligodendrocytes, and heterotopic neurons in the white matter. The age at MRI evaluation ranged from 11 to 58 years, except for one 4. Read More

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A case of hereditary metachronous bilateral triple-negative breast cancer that was highly sensitive to carboplatin.

J Surg Case Rep 2021 Apr 14;2021(4):rjab018. Epub 2021 Apr 14.

Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan.

A 52-year-old woman with a strong family history of breast cancer was diagnosed as having triple-negative breast cancer (TNBC) in her right breast. Neoadjuvant chemotherapy (NAC; four cycles of epirubicin/cyclophosphamide/5-fluorouracil) was performed, followed by breast-conserving surgery and axillary lymph node dissection. Histopathological analysis of the surgical specimens demonstrated a few focal tumor cells remaining in the stroma, but not a pathological complete response (pCR). Read More

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Comparison of Outcomes in Patients with Obesity Between Two Administration Routes of Omeprazole After Laparoscopic Sleeve Gastrectomy: An Open-Label Randomized Clinical Trial.

Drug Des Devel Ther 2021 15;15:1569-1576. Epub 2021 Apr 15.

Department of Critical Care, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.

Background: The effect of different administration routes of omeprazole remains unclear on the recovery in patients with obesity after laparoscopic sleeve gastrectomy (LSG).

Methods: We designed a randomized clinical trial enrolling 120 patients with a BMI≥32.5 kg/m after LSG. Read More

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COVID-19 testing in a UK dental practice - results of a pilot study.

Br Dent J 2021 Apr 21. Epub 2021 Apr 21.

Clinical Research, DMG Dental-Material Gesellschaft mbH, Elbgaustrasse 248, 22547, Hamburg, Germany.

Objective In December 2019, a novel coronavirus (SARS-CoV-2) caused a disease outbreak that soon became a global pandemic. Dentists are potentially exposed to infectious microorganisms, including SARS-CoV-2, by virtue of the transmission routes and work environment. This study aims to determine the infection load in a dental healthcare setting during the onset of the pandemic in the UK, as well as to evaluate the effectiveness of recommended test regimens in order to estimate potential risks for caregivers and patients in a dynamically changing pandemic environment. Read More

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Risk factors for poor outcome in childhood tuberculous meningitis.

Sci Rep 2021 Apr 21;11(1):8654. Epub 2021 Apr 21.

Department of Pediatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107#, Wenhuaxi Road, Jinan, 250012, Shandong, China.

Tuberculous meningitis (TBM) remains a serious disease for children and its risk factors of poor outcome remain unclear. Therefore, a retrospective study was conducted aiming to investigate the risk factors associated with poor outcome of childhood TBM. Between January 2006 and December 2019, consecutive children patients (≤ 15 years old) who had a diagnosis of TBM were included for the analysis. Read More

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Development and validation of an early warning tool for sepsis and decompensation in children during emergency department triage.

Sci Rep 2021 Apr 21;11(1):8578. Epub 2021 Apr 21.

Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA.

This study was designed to develop and validate an early warning system for sepsis based on a predictive model of critical decompensation. Data from the electronic medical records for 537,837 visits to a pediatric Emergency Department (ED) from March 2013 to December 2019 were collected. A multiclass stochastic gradient boosting model was built to identify early warning signs associated with death, severe sepsis, non-severe sepsis, and bacteremia. Read More

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Gene Expression-Based Diagnosis of Infections in Critically Ill Patients-Prospective Validation of the SepsisMetaScore in a Longitudinal Severe Trauma Cohort.

Crit Care Med 2021 Apr 21. Epub 2021 Apr 21.

Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA. Department of Anesthesiology, University Medical Centre, Georg August University, Goettingen, Germany. Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Department of Anesthesiology and Intensive Care Medicine, Klinikum Region Hannover, Hannover, Germany. Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center, Georg August University, Goettingen, Germany. Division of Biomedical Informatics, Stanford Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA. Department of Anesthesiology, Asklepios Hospitals Schildautal, Seesen, Germany.

Objectives: Early diagnosis of infections is pivotal in critically ill patients. Innovative gene expression-based approaches promise to deliver precise, fast, and clinically practicable diagnostic tools to bedside. This study aimed to validate the SepsisMetaScore, an 11-gene signature previously reported by our study group, in a representative longitudinal cohort of trauma patients. Read More

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Challenging misconceptions about clinical ethics support during COVID-19 and beyond: a legal update and future considerations.

J Med Ethics 2021 Apr 21. Epub 2021 Apr 21.

Durham Law School, Durham University, Durham, UK.

The pace of change and, indeed, the sheer number of clinical ethics committees (not to be confused with research ethics committees) has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. Read More

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Human immunodeficiency virus-related renal cell carcinoma: a retrospective study of 19 cases.

Infect Agent Cancer 2021 Apr 21;16(1):26. Epub 2021 Apr 21.

Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Purpose: We aimed to investigate basic information, clinical findings, treatments for tumor, pathology, and outcomes of HIV-positive patients diagnosed with renal cell carcinoma (RCC).

Patients And Methods: We collected 19 patients from 2012 to 2020 who are diagnosed with RCC with HIV-positive. A retrospective analysis was performed on their hospitalization course and tumor-related parameters, including basic information, clinical findings, HIV-associated data, pathology, treatments for tumor, and outcomes. Read More

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Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis.

World J Surg Oncol 2021 Apr 21;19(1):129. Epub 2021 Apr 21.

Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska 213 Street, 50-556, Wroclaw, Poland.

Background: During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU. Read More

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Outcome measures for technique survival reported in peritoneal dialysis: A systematic review.

Perit Dial Int 2021 Apr 21:896860821989874. Epub 2021 Apr 21.

School of Medicine, 4212Keele University, Newcastle, UK.

Background: Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD.

Method: MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. Read More

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Fluid Responsiveness Predictability in Immediate Postoperative Pediatric Cardiac Surgery. Is the Old Slandered Central Venous Pressure Back Again?

Shock 2021 Apr 20. Epub 2021 Apr 20.

Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, 4920235 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 6997801.

Objective: Acute low cardiac output (CO) is a frequent scenario in pediatric cardiac intensive care units (PCICU). While fluid responsiveness has been studied extensively, literature is scarce for the immediate postoperative congenital heart surgery population admitted to PCICUs. This study analyzed the utility of hemodynamic, bedside ultrasound and Doppler parameters for prediction of fluid responsiveness in infants and neonates in the immediate postoperative cardiac surgery period. Read More

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18F-FDG PET-CT postoperative changes after maxillectomy: Findings and pitfalls in interpretation.

Dentomaxillofac Radiol 2021 Apr 21:20200574. Epub 2021 Apr 21.

Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.

Objective: We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre.

Methods: Fourteen patients (10 males), aged 22-84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up. Read More

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"Blepharophimosis-plus" syndromes: Frequency of systemic genetic disorders that also include blepharophimosis.

Clin Exp Ophthalmol 2021 Apr 21. Epub 2021 Apr 21.

Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Background: To determine the frequency of isolated blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) vs. systemic genetic disorders in patients presenting with blepharophimosis.

Methods: Retrospective clinical records review. Read More

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Update on establishing and managing an overnight emergency radiology division.

Emerg Radiol 2021 Apr 21. Epub 2021 Apr 21.

Department of Radiology, Division of Emergency Radiology, University Hospital, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB F508B, Newark, NJ, 07103, USA.

Emergency department (ED) radiology divisions that serve to provide overnight attending coverage have become an increasingly common feature of radiology departments. The purpose of this article is to review the common ED radiology coverage models, describe desirable traits of emergency radiologists, and discuss workflow in the ED radiology setting. ED radiologists may be trained as ED radiologists or may develop the necessary skills and adopt the subspecialty. Read More

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Long-Term Outcomes After Fenestration Closure in High-Risk Fontan Candidates.

Pediatr Cardiol 2021 Apr 21. Epub 2021 Apr 21.

Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.

The study aimed to assess the long-term outcomes after fenestration closure in patients at risk for Fontan failure. Of 119 patients who underwent Fontan operation between 1995 and 2004, fenestration was not created in 89 patients (NF group) and created in 30 patients with hypoplastic left heart syndrome, heterotaxy syndrome, high pulmonary arterial pressure, high systemic ventricular end-diastolic pressure, low ventricular ejection fraction, or atrioventricular valve regurgitation. All fenestrations were closed spontaneously or by catheter/surgical interventions, excepting two patients, and therefore, they were excluded. Read More

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Is the Use of Routine Echocardiogram Warranted in Large Pediatric Burns?

J Burn Care Res 2021 Apr 21. Epub 2021 Apr 21.

Shriners Hospitals for Children-Cincinnati, Cincinnati, OH.

Introduction: Cardiac dysfunction can develop in large pediatric burns during the acute and recovery phase. When occurring in this population, the cardiac abnormality appears as left ventricular dysfunction or dilated cardiomyopathy. Recent studies have demonstrated perioperative and long-term cardiac dysfunction resulting in longer hospital stays for patients over 40% total body surface area. Read More

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A phenomapping-derived tool to personalize the selection of anatomical vs. functional testing in evaluating chest pain (ASSIST).

Eur Heart J 2021 Apr 21. Epub 2021 Apr 21.

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA.

Aims: Coronary artery disease is frequently diagnosed following evaluation of stable chest pain with anatomical or functional testing. A more granular understanding of patient phenotypes that benefit from either strategy may enable personalized testing.

Methods And Results: Using participant-level data from 9572 patients undergoing anatomical (n = 4734) vs. Read More

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Supracondylar rotation osteotomy of the femur influences the coronal alignment of the ankle.

J Exp Orthop 2021 Apr 20;8(1):32. Epub 2021 Apr 20.

Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany.

Purpose: Osteotomies represent well-established treatment-options for the redistribution of loads and forces within and around the knee-joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal-femoral-rotation-osteotomy on the coronal alignment of the ankle. Read More

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Multiparameter Analysis Using F-FDG PET/CT in the Differential Diagnosis of Pancreatic Cystic Neoplasms.

Contrast Media Mol Imaging 2021 7;2021:6658644. Epub 2021 Apr 7.

Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Fuxing Road 28, Beijing 100853, China.

Purpose: To evaluate multiparametric analysis in differential diagnosis between pancreatic serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) as well as the differentiation of the benign and malignant MCNs with F-FDG (18-fluorodeoxyglucose) PET/CT (positron emission tomography).

Methods: Forty patients with total of 41 lesions (SCNs: 27/41; MCNs: 14/41), who were preoperatively examined with F-FDG PET/CT, were retrospectively analyzed. Multiple quantitative parameters using conventional and texture features were included. Read More

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