Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas

PURPOSE

Simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants.

METHODS

In total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher's exact test was used to compare independent groups, and Spearman's correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values.

RESULTS

The B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas).

CONCLUSION

As the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas.

Machine learning analysis of adrenal lesions: preliminary study evaluating texture analysis in the differentiation of adrenal lesions

PURPOSE

This study aimed to determine the accuracy of texture analysis in differentiating adrenal lesions on unenhanced computed tomography (CT) images.

METHODS

In this single-center retrospective study, 166 adrenal lesions in 140 patients (64 women, 76 men; mean age 56.58 ± 13.65 years) were evaluated between January 2015 and December 2019. The lesions consisted of 54 lipid-rich adrenal adenomas, 37 lipid-poor adrenal adenomas (LPAs), 56 adrenal metastases (ADM), and 19 adrenal pheochromocytomas (APhs). Each adrenal lesion was segmented by manually contouring the borders of the lesion on unenhanced CT images. A texture analysis of the CT images was performed using Local Image Feature Extraction software. First-order and second-order texture parameters were assessed, and 45 features were extracted from each lesion. One-Way analysis of variance with Bonferroni correction and the Mann-Whitney U test was performed to determine the relationships between the texture features and adrenal lesions. Receiver operating characteristic curves were performed for lesion discrimination based on the texture features. Logistic regression analysis was used to generate logistic models, including only the texture parameters with a high-class separation capacity (i.e., P < 0.050). SPSS software was used for all statistical analyses.

RESULTS

First-order and second-order texture parameters were identified as significant factors capable of differentiating among the four lesion types (P < 0.050). The logistic models were evaluated to ascertain the relationships between LPA and ADM, LPA and APh, and ADM and APh. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the first model (LPA vs. ADM) were 85.7%, 70.3%, 81.3%, 76.4%, and 79.5%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of the second model (LPA vs. APh) were all 100%. The sensitivity, specificity, PPV, NPV, and accuracy of the third model (ADM vs. APh) were 87.5%, 82%, 36.8%, 98.2%, and 82.7%, respectively.

CONCLUSION

Texture features may help in the characterization of adrenal lesions on unenhanced CT images.

[Evaluation of solid pulmonary nodules in patients with bladder cancer with computed tomography based texture analysis method: Is it possible to differentiate metastatic - non-metastatic nodules?]

Introduction

Solid Pulmonary Nodule (SPN) is defined as parenchymal radiopacity smaller than 3 cm in diameter. Evaluating the metastatic nature of the SPNs detected in the thorax computed tomography (TCT) examination for staging purposes in cancer patients becomes a fundamental problem for the physician. Invasive procedures, additional imaging or follow-up imaging, are often used to differentiate metastatic and non-metastatic nodules. In this study, we aimed to distinguish SPNs detected in patients diagnosed with bladder cancer (BC) as metastatic and non-metastatic nodules by texture analysis.

Materials and Methods

TCT images of patients diagnosed with BC in our hospital from January 2007 until December 2017 were retrospectively evaluated. A total of 46 patients with SPN, including metastatic (n= 19) and non-metastatic (n= 27), were included in the study. Short axis diameter, long-axis diameter, nodule volume and volume histogram values of the nodules were obtained. Chisquare test was used to evaluate dependent variables, and the Mann-Whitney U test was used to evaluate independent variables. ROC curves of the obtained data were plotted. Statistically, the significant p-value was determined as less than 0.05.

Result

A significant difference was found between SPN long axis, short axis and volume values. In the volumetric histogram analysis, the maximum density value and the mean density value were found to be statistically significant. When the average of the highest densities in the volume histogram data was evaluated, the area under the curve value was 0.702 (95% CI, 519-854). The metastatic nodule could be distinguished with a sensitivity of 88% and a specificity of 70% when the volume histogram has the maximum density threshold of 50 HU.

Conclusions

In this study, we concluded that SPN detected on CT images can be distinguished as metastatic and non-metastatic nodules using texture analysis method without invasive procedures.

Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery

BACKGROUND

Surgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE).

OBJECTIVE

The aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis.

MATERIAL AND METHODS

Data on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study.

RESULTS

The concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (^99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002).

CONCLUSION

IOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.

How to perform an excellent radiology board examination: a web-based checklist

BACKGROUND

Board exams are now considered as means of quality procedures that aim to keep the professional knowledge and skills of the physicians at the highest level. In addition, for an assessment to be scientifically valid, it has to be done within defined standards. Although there are different sources in this field, there is a need for a resource that details the steps required for the examinations to be performed perfectly, brings descriptions of the reasons for the procedure and associates the steps with assessment standards. Experts with national and international experience both in radiology and medical education contributed to the preparation of this checklist.

RESULTS

The guide includes 174 elements to consider before, after the exam order and examination. From the perspective of assessment standards, it has been observed that the steps to be considered before the exam have a greater impact on the validity and reliability of the exam. The standard in which the questions are most associated was validity with 117 (67.24%) questions.

CONCLUSIONS

We think that our guide, which will be accessible in the web environment, will be useful to the teams with a development goal or just start the exam, the candidates who will take the exam and the examiners.

Magnetic resonance spectroscopy to assess hepatic steatosis in patients with lipodystrophy

BACKGROUND/AIMS

Lipodystrophy is a rare metabolic disorder characterized by near total or partial lack of subcutaneous adipose tissue and associated with insulin resistance. We aimed to evaluate the efficacy of magnetic resonance spectroscopy imaging (MRS) to explore the fat content of the liver in patients with lipodystrophy and to determine the relationship between the liver fat accumulation and clinical presentations of lipodystrophy.

MATERIALS AND METHODS

Between July 2014 and February 2016, 34 patients with lipodystrophy were assessed by MRS for quantification of hepatic steatosis. All patients had metabolic abnormalities associated with insulin resistance. Metabolic parameters and the MRS findings were analyzed to identify potential correlations between the liver fat content and disease severity.

RESULTS

The MRS fat ratios (MRS-FR) were markedly higher, indicating severe hepatic steatosis in lipodystrophy. Patients with generalized and partial lipodystrophy had comparable levels of MRS-FRs, although patients with generalized lipodystrophy were significantly younger. Patients with genetically based lipodystrophy had elevated MRS-FR compared to those with acquired lipodystrophy (p=0.042). The MRS-FR was positively correlated with liver enzyme alanine aminotransferase (p=0.028) and serum adiponectin (p=0.043).

CONCLUSION

Our data suggest that MRS might be an effective, noninvasive imaging method to quantify hepatic fat content in patients with lipodystrophy. Further studies are needed to validate the technique and threshold values which would allow accurate comparison of data acquired by different machines and centers.

Statistical errors in articles published in radiology journals

PURPOSE

We aimed to evaluate articles in radiology journals indexed in the Science Citation Index or Science Citation Index Expanded in terms of statistical errors. By this means, we aim to contribute to the production of high quality scientific publications.

METHODS

In this study, a total of 157 articles published in 2016-2017 in 20 radiology journals were reviewed randomly. Selected articles were evaluated for statistical errors regarding P values and statistical tests, and for errors in terminology and other errors related to interpretation. In addition, in order to examine whether the error rates of the articles published in the radiology journals differed according to the impact factor, the statistical errors were compared according to the impact factors of the journals.

RESULTS

Of the 157 articles published in radiology journals, 10 had no statistical errors, while 147 had at least one statistical error. The most frequently encountered error was "errors in summarizing data" with a rate of 66%. This was followed by "incorrect representation of P values" with a rate of 42%. The least frequently encountered error was "statistical symbol errors" with a rate of 3%. There was no statistically significant difference according to impact factors.

CONCLUSION

In conclusion, radiology journals, as do journals in different fields, include articles containing statistical errors. Even when the quality of the journal increases, there is no difference in these statistical error rates. In order to prevent statistical errors in manuscripts, there are responsibilities for both the researchers who conduct scientific studies and the editors who publish these studies in their journals. Researchers should have a basic statistical knowledge, and the editor must submit all manuscripts for a statistical review.

Discrimination of oncocytoma and chromophobe renal cell carcinoma using MRI

PURPOSE

We aimed to evaluate magnetic resonance imaging (MRI) features, including signal intensities, enhancement patterns and T2 signal intensity ratios to differentiate oncocytoma from chromophobe renal cell carcinoma (RCC).

METHODS

This retrospective study included 17 patients with oncocytoma and 33 patients with chromophobe RCC who underwent dynamic MRI. Two radiologists independently reviewed images blinded to pathology. Morphologic characteristics, T1 and T2 signal intensities were reviewed. T2 signal intensities, wash-in, wash-out values, T2 signal intensity ratios were calculated. Sensitivity and specificity analyses were performed.

RESULTS

Mean ages of patients with oncocytoma and chromophobe RCC were 61.0±11.6 and 58.5±14.0 years, respectively. Mean tumor size was 60.6±47.3 mm for oncocytoma, 61.7±45.9 mm for chromophobe RCC. Qualitative imaging findings in conventional MRI have no distinctive feature in discrimination of two tumors. Regarding signal intensity ratios, oncocytomas were higher than chromophobe RCCs. Renal oncocytomas showed higher signal intensity ratios and wash-in values than chromophobe RCCs in all phases. Fast spin-echo T2 signal intensities were higher in oncocytomas than chromophobe RCCs.

CONCLUSION

Signal intensity ratios, fast spin-echo T2 signal intensities and wash-in values constitute diagnostic parameters for discriminating between oncoytomas and chromophobes. In the excretory phase of dynamic enhanced images, oncocytomas have higher signal intensity ratio than chromophobe RCC and high wash-in values strongly imply a diagnosis of renal oncocytoma.

Sonographically indeterminate scrotal masses: how MRI helps in characterization

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.

Determining residual adipose tissue characteristics with MRI in patients with various subtypes of lipodystrophy

PURPOSE

We aimed to investigate residual adipose tissue with whole-body magnetic resonance imaging to differentiate between subtypes of lipodystrophy.

METHODS

A total of 32 patients (12 with congenital generalized lipodystrophy [CGL], 1 with acquired generalized lipodystrophy [AGL], 12 with familial partial lipodystrophy [FPLD], and 7 with acquired partial lipodystrophy [APL]) were included.

RESULTS

Despite generalized loss of metabolically active adipose tissue, patients with CGL1 caused by AGPAT2 mutations had a significant amount of residual adipose tissue in the scalp, earlobes, retro-orbital region, and palms and soles. No residual adipose tissue was noted particularly in the head and neck, palms and soles in CGL2 caused by BSCL2 mutations. CGL4 caused by mutations in the PTRF gene was characterized with well-preserved retro-orbital and bone marrow fat in the absence of any visible residual adipose tissue in other areas. No residual adipose tissue was observed in AGL. Despite loss of subcutaneous fat, periarticular adipose tissue was preserved in the lower limbs of patients with FPLD. Retro-orbital adipose tissue was surprisingly preserved in APL, although they lacked head and neck fat.

CONCLUSION

Lipodystrophies are a heterogeneous group of disorders characterized by generalized or partial loss of adipose tissue, which can be congenital or acquired. Our results suggest that residual adipose tissue characteristics can help distinguish different subtypes of lipodystrophy.

Abdominal sarcoidosis: cross-sectional imaging findings

Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%-70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis.

Role of kisspeptin in polycystic ovary syndrome (PCOS)

OBJECTIVE

Due to the complex relationship between kisspeptin and the hypothalamic-pituitary-gonadal axis, the study was planned to measure the kisspeptin levels in polycystic ovary syndrome (PCOS) and to analyze the correlations between kisspeptin and PCOS-related reproductive, metabolic changes.

METHODS

The study was designed as a prospective study in Dokuz Eylul University between December 2011 and September 2013. A total of 285 PCOS cases and 162 controls were recruited. After the antropometric measeruments and physcial examination, blood samples were taken for biochemical analysis.

RESULTS

PCOS group's mean BMI was 24.32 ± 3.40 and for the control group, BMI value was 23.44 kg/m² ± 4.08 (p = 0.351). PCOS patients' FSH level was 5.10 ± 2.01 mIU/L, LH value was 7.75 ± 4.31 mIU/mL, LH/FSH ratio was 1.70 ± 1.28, DHEAS value was 221.84 ± 105.02 mg/dl, total testosterone value was 50.51 ± 27.93 ng/ml, free testosterone value was 2.52 ± 1.05 pg/ml, SHBG was 63.74 ± 45.62 nmol/L, LDL was 102.56 ± 23.45 mg/dL, HDL value was 51.36 ± 12.15 mg/dL, total cholesterol value was 214.85 ± 39.27 mg/dL, triglyceride value was 112.95 ± 46.88 mg/dL, Apo A1 value was 171.30 ± 35.35 mg/dL, Apo B value was 71.08 ± 19.07 mg/dL, Apo B/A1 ratio was 0.42 ± 0.14, free androgen index was 13.77 ± 14.15, fasting glucose value was 80.68 ± 13.80 mg/dL, fasting insulin levels was 14.13 ± 9.11 μiU/mL, HOMA-IR index was 2.76 ± 2.34, AMH value was 5.93 ± 3:33 in ng/ml, and found to be significantly higher (p < 0.001). Leptin value was 9.71 ± 5.54 pg/ml and kisspeptin value was 1.92 ± 1.29 ng/ml, respectively. Kisspeptin and leptin levels showed no statistically significant difference with control group and PCOS group. In all PCOS patients, kisspeptin showed positive correlations between LH and leptin levels.

CONCLUSION

In this study, kisspeptin had a positive correlation with LH and leptin levels in PCOS. In fact, the serum levels of kisspeptin and leptin does not differ statistically between PCOS and healthy women. There are limited data in the literature with regard to changes in kisspeptin levels and its relation with metabolic and hormonal disturbances.

Malignant epithelioid hemangioendothelioma of the adrenal gland treated by laparoscopic excision

Epithelioid hemangioendothelioma is a rare vascular tumor mostly seen in liver, lung, and bone. Involvement of the adrenal gland has not been reported previously. Here, we report the first case of adrenal malignant epithelioid hemangioendothelioma in an 81-year-old man who was successfully treated by laparoscopic excision.

Anatomic variations of the intrahepatic bile ducts: analysis of magnetic resonance cholangiopancreatography in 1011 consecutive patients

OBJECTIVES

The aim of the study was to evaluate the frequency of anatomic variations of the hepatic duct bifurcation using magnetic resonance cholangiopancreatography (MRCP).

METHODS

A total of 1,160 consecutive patients, referred to our department for MRCP due to suspected pancreatobiliary disease or before liver transplantation, were reviewed retrospectively. A total of 149 patients with less than optimal results due to imaging limitations or secondary differentiations of bile duct anatomy were excluded from the study. The final study population was composed of 1,011 cases.

RESULTS

Of the 1,160 patients, 149 were excluded from the analysis. Typical biliary anatomy was observed in 79.4% of cases, but female potential living liver donors more frequently presented an anatomic variation. Typical anatomy was present in 75.7% of the females and 85.3% of the males (p < 0.05). Out of the remaining 1,011 patients, 208 (20.57%) were diagnosed with different levels of various anatomic variations of the intra- and extrahepatic biliary ducts. Of the 208 cases with diagnosed variations, 204 (98.07%) and 4 (1.92%) turned out to have 1 and 2 different variations, respectively. The trifurcation variant was observed in 81 cases (8.01%), while 73 subjects (7.23%) had an aberrant right biliary duct draining into the common hepatic duct. A right dorsocaudal branch draining into the left hepatic duct was present in 42 cases (4.15%). Four cases (0.4%) had 2 different variations and 8 (0.8%) had uncommon anatomic variations.

CONCLUSIONS

Typical intrahepatic biliary anatomy is present in about 80% of the inhabitants of the Aegean region of Turkey, but anatomic variants seem to be more frequent in females as compared to males. Trifurcation was the most common anatomic variation in our study population. The presence of an aberrant right hepatic duct emptying into the common hepatic duct was the second most common observation amongst our findings.

Spontaneous asymptomatic gallbladder perforation

Gallstone disease is common. However, a proportion of patients are asymptomatic and remain undiagnosed until the occurrence of complications. Common complications include acute cholecystitis, biliary obstruction, acute pancreatitis and cholangitis. Severe complications include gallbladder perforation, Mirizzi syndrome and fistula formation are usually associated with significant morbidity and mortality. We report a case of asymptomatic spotaneous gallbladder perforation due to acute cholecystitis.

Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis

The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.

Fluid collections associated with acute pancreatitis: a pictorial essay

The terminology and classification scheme of acute pancreatitis proposed at the initial Atlanta Symposium was reviewed, and a new consensus statement was recently proposed. Major changes include subdividing acute fluid collections in the first 4 weeks into "acute peripancreatic fluid collection" and "acute necrotic collection" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled-off necrosis." Correct use of the new terms that describe these collections is important because they lead to different treatment decisions. The purpose of this article is to present an overview of fluid collections associated with acute pancreatitis, with an emphasis on their prognostic significance and impact on clinical management, and to illustrate the new terminology.

Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis

Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

Doppler US evaluation of renal biopsy complications in children

PURPOSE

Percutaneous renal biopsy plays an important role in the diagnosis and management of renal disease in children, but it does carry some complications. As most cases are vascular in origin, Doppler ultrasonography (US) has clear benefits in terms of detecting bleeding and assessing vascular damage. The aim of this study was to investigate the effectiveness of Doppler US in detecting possible complications after percutaneous renal biopsy in pediatric patients.

MATERIALS AND METHODS

This retrospective study was performed using the data obtained from all pediatric patients who underwent renal biopsy in our institution between 1999 and 2011.

RESULTS

A total of 175 biopsies were performed in 172 patients (48.3% male, 51.7% female) ranging in age from 1 to 17 years (mean, 8.7 years). Of 175 biopsies, 42 (24.0%) led to complications. Overall, 52 complications (25% major, 75% minor) occurred following 42 biopsies.

CONCLUSION

Doppler US examination is capable of and helpful in detecting possible vascular complications such as pseudoaneurysm and arteriovenous fistula and improves the management of these patients after biopsy. It is important to recognize the Doppler US appearance of complications associated with percutaneous renal biopsy and to perform close follow-up with Doppler US in the first 24 hours.

The effect of tumor volume on survival in patients with renal cell carcinoma

PURPOSE

The aim of this study was to investigate the effect of tumor volume on prognosis and the relation of tumor volume with other prognostic factors in patients with renal cell carcinoma (RCC).

MATERIALS AND METHODS

The study included 46 retrospectively assessed patients with RCC (32 males and 14 females; mean age, 58.13±10.47 years) who underwent surgery between January 2002 and January 2009. Patients were staged according to clinical, radiological, and pathological data. The basic radiological characteristics of tumors and tumor volumes were defined by two observers. The clinical information and the last health status of all patients were recorded. The life duration of the patients after surgery was determined, and cumulative survival rates were calculated.

RESULTS

The survival rates showed no difference between the male and female patients (P = 0.569); the five-year survival was 75.7% and 78.5%, respectively. The survival rates demonstrated differences between groups according to potential prognostic markers such as cell type, Fuhrman's grade, the diameter, invasion of perinephric fat, sinus, or adrenal gland, pathological stage, and presence of metastasis. The inter- and intra-observer reliability of radiological volume measurements were 93.6% and 100%, respectively (P < 0.001). Two groups of tumor volume (i.e., smaller and greater than 110 cm < sup > 3 < /sup > ) showed statistically significant difference in terms of survival (P < 0.032). In univariate analysis, only Fuhrman's grade and T stage were independent prognostic variables.

CONCLUSION

Tumor volume is predictive of survival in patients with RCC; however, it does not appear to be an independent prognostic factor. The prognostic factors for overall survival are Fuhrman's grade and T stage.

The role of dynamic subtraction MRI in detection of hepatocellular carcinoma

PURPOSE

The aim of this study was to investigate the role of dynamic subtraction magnetic resonance imaging (MRI) in detection of hepatocellular carcinoma (HCC) in patients with cirrhosis.

MATERIALS AND METHODS

MR images of 32 patients with cirrhosis were retrospectively investigated. The standard sequence images of the patients were evaluated for detection of HCC, and then the subtracted images of dynamic contrast-enhanced series were evaluated. The sensitivity, specificity, and accuracy of standard technique and additional use of subtracted images were investigated.

RESULTS

In detection of at least one HCC, standard protocol was useful in 14 of 17 (82.3%) patients; by additional use of subtraction imaging all 17 (100%) patients with HCC were detected. For detection of the correct number of HCC tumors, standard protocol was found to have 61.5% sensitivity, 78.9% specificity, and 71.8% accuracy. The use of subtracted images increased the sensitivity to 85.7%, specificity to 83.3%, and accuracy to 84.3%.

CONCLUSION

Subtraction is a simple automatic procedure that is commonly available in most MRI systems. The use of subtraction of dynamic contrast-enhanced series facilitates the detection of HCC in disorganized architecture of cirrhotic livers.

[The effect of levothyroxine suppression therapy for benign thyroid nodules on bone metabolism in premenopausal women]

OBJECTIVES

This prospective study was designed to investigate the effect of levothyroxine suppression therapy for benign thyroid nodules on markers of bone turnover in premenopausal women.

PATIENTS AND METHODS

The study included 28 premenopausal women who received levothyroxine suppression therapy for benign thyroid nodules for one year. The size of the thyroid gland and nodules, biochemical markers of bone turnover and urinary calcium excretion were measured before and after levothyroxine suppression therapy.

RESULTS

No significant adverse effects were seen during levothyroxine treatment. Decreases in total thyroid volume and the size of the nodules were not significant at the end of treatment. Although levothyroxine suppression therapy did not result in changes in serum levels of calcium and phosphor, and urinary calcium excretion, bone turnover markers, namely serum osteocalcin and urinary deoxypyridinoline levels, increased significantly. Serum intact parathyroid hormone levels showed a minimal decrease, which was not statistically significant.

CONCLUSION

Data from our study suggest that levothyroxine suppression therapy is associated with increased osteoblastic and osteoclastic activity in premenopausal women with benign thyroid nodules.

Kyphosis One Level Above the Cervical Disc Disease

If present, kyphotic angulation is generally at the level of the cervical disc disease (CDD) in the neck, but sometimes occurs at one level above the CDD. We name this situation as kyphosis one level above (KOLA). KOLA CDD has not been studied previously. In this study, we present 18 patients who had KOLA among 147 patients operated for CDD over a 5-year period. Seven of these 18 patients also received surgery for their KOLA. As new, surgical treatment of kyphotic level was performed with plating and without bony fusion in 5 patients. Clinical outcomes (according to Odom's criteria) and kyphotic corrections of KOLA patients receiving and not receiving surgery for their kyphosis during were compared. The 7 KOLA patients having surgery to correct the kyphosis had a mean 20.14+/-3.13 degrees correction in their kyphosis (from mean 12.85 to -7.28 degrees), whereas the 11 patients undergoing surgery only for CDD showed only a mean 3.00+/-2.52 degrees correction (from mean 7.45 to 4.45 degrees). When kyphotic corrections were compared, statistically significant difference was found between 2 groups (P<0.01). Clinical outcome scores showed a trend towards improvement in the patients operated upon for kyphosis correction. KOLA may be a factor in the development of cervical disc herniation and spondylosis, and should be treated if more than 11 degrees. In cervical region, upper adjacent level disease may be an extension of KOLA. Larger studies can further define the relationship between KOLA and CDD, and indications for surgical correction of KOLA.

Diffuse cavernous hemangioma of the rectosigmoid colon with extraintestinal involvement

Cavernous hemangioma of the colon is a rare cause of gastrointestinal bleeding. These lesions can be encountered as solitary, multiple, or part of a more complex syndrome with cutaneous manifestations. We herein describe a 26-year-old woman with cavernous hemangioma involving the rectosigmoid area. Additional hemangiomas were identified in the pelvic structures, spine, iliac bone and spleen. This multi-visceral involvement without cutaneous manifestations represents an intermediate variety between solitary hemangioma and well-defined syndromes with cutaneous and structural anomalies. The potential presence of extraintestinal hemangiomatosis should be considered and investigated in patients with cavernous hemangioma of the colon even without cutaneous manifestations or with a limited colonic involvement.

Hyperhomocysteinemia: a novel risk factor for erectile dysfunction

Nitric oxide (NO), the key mediator synthesized by different NO synthase isoenzymes, plays an important role in endothelial function. It was recently shown that hyperhomocysteinemia is an important regulator of NO synthase. We investigated the role of homocysteine (Hcys) in erectile dysfunction (ED), which is associated with the defect in NO generation. Thirty-one nondiabetic patients and 33 control cases were evaluated. Patients with diabetes, coronary artery disease, vitamin B(12), or folate deficiency were excluded in the study. The International Index of Erectile Function questionnaire was used to gauge identified erectile quality. Fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, vitamin B(12), folic acid, and Hcys levels of patients were measured. Penile color Dupplex ultrasound was used to detect vascular abnormalities in nondiabetic patients with ED. Patients with ED were older than the control subjects (55.6 +/- 8.4 vs 44.5 +/- 4.7 years, respectively; P < .001). Patients with ED had higher fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, and Hcys levels. There was a significant negative correlation between mean Hcys level and mean International Index of Erectile Function domain score (P < .001). The penile color Doppler ultrasound findings showed that there was a negative significant correlation between mean Hcys level and the 1st, 5th, and 10th minute's peak-systolic velocity. Logistic regression analysis revealed that age and Hcys levels were the main determinants in ED. Hyperhomocysteinemia, known to be an important risk factor in endothelial dysfunction, seems to be an important determinant in ED. These data suggest that slightly elevated Hcys levels are significantly related with arterial and probably endothelial dysfunction in patients with ED.

Cushing's syndrome due to ectopic CRH secretion by adrenal pheochromocytoma accompanied by renal infarction

Ectopic production of corticotropin-releasing hormone (CRH) by a pheochromocytoma is an infrequent cause of Cushing's syndrome. We report the case of a 43-year-old man with Cushing's syndrome due to a CRH-producing adrenal pheochromocytoma. The patient had clinical and biochemical evidence of hypercortisolism in conjunction with high ACTH levels and non-suppressible serum cortisol levels on low-dose and high-dose dexamethasone suppression testing. In addition to these clinical features of one month's duration, the patient developed symptoms of pheochromocytoma including headache, hypertension that was resistant to conventional therapy and excessive sweating. Biochemical testing confirmed elevated 24-hour urinary catecholamines and metabolites. Abdominal CT revealed a 4.5 x 4 x 3.5 cm mass in the left adrenal gland. He underwent elective left adrenalectomy. Light microscopic and immunochemical studies revealed a pheochromocytoma that contained immunoreactive CRH and was negative for ACTH. Plasma ACTH and dexamethasone supression tests normalized after surgery. This is an unusual case of a CRH-secreting pheochromocytoma. This was complicated by renal infarction, illustrating further the complexity of Cushing's syndrome in a patient with pheochromocytoma caused by CRH hypersecretion.

Laparoscopic excision of a giant ovarian cyst after ultrasound-guided drainage

The laparoscopic approach to giant ovarian cysts in pediatric population may be difficult regarding the risk of cyst rupture and limited working space. We herein report a 16-year-old adolescent girl that presented with a giant ovarian cyst. To reduce the limitations of the laparoscopy, we performed laparoscopy after draining the cyst under ultrasonographic guidance. Under local anesthesia, a nephrostomy catheter was placed into the cyst by the Seldinger technique. During laparoscopy, abdominal cavity was explored by the scope and then the nephrostomy catheter was removed. Laparoscopic procedure was completed easily. No pre- and postoperative complications were encountered and the patient was discharged on the second postoperative day. The pathologic examination of the cyst revealed as follicular cyst. Laparoscopic excision of giant ovarian cysts after ultrasound-guided drainage seems to be safe and applicable treatment modality in children.

Mesenterico left portal bypass for variceal bleeding owing to extrahepatic portal hypertension caused by portal vein thrombosis

BACKGROUND/PURPOSE

Portosystemic shunt operations are indicated in patients with extrahepatic portal hypertension owing to portal vein thrombosis (EPH-PVT) suffering from recurrent variceal bleeding despite endoscopic sclerotherapy. Mesenterico left portal bypass procedure (MLPB) is an alternative procedure to the portosystemic shunt operations in patients with EPH-PVT. MLPB operation reestablishes hepatopetal portal blood flow. We herein present our experience with MLPB in children with EPH-PVT.

METHODS

Six patients were treated for EPH-PVT with recurrent bleeding despite endoscopic sclerotherapy (2 boys and 4 girls) in our unit. All patients were evaluated preoperatively with complete blood count, portal duplex system Doppler ultrasonography, magnetic resonance angiography, and upper gastrointestinal (GI) endoscopy. MLPB operation was performed as described by de Ville de Goyet. During the postoperative period, patients were evaluated with complete blood count, portal duplex system Doppler ultrasonography, upper GI endoscopy, and magnetic resonance angiography.

RESULTS

Six patients were assessed to be candidates for MLPB procedure and were operated to perform the MLPB procedure. Left portal veins were found to be patent during the operation in 4 patients, and the MLPB procedure was performed. Internal jugular vein was used in 3 patients and enlarged inferior mesenteric vein in 1 patient. Left portal veins of the remaining 2 patients were found to be obliterated; therefore, mesocaval shunt was performed. The postoperative course of the patients was uneventful except for 1 patient. During the following period, the leukocyte and the platelet counts were significantly increased in 3 of the 4 patients after the MLPB procedure. Upper GI bleeding occurred in the early postoperative period in 1 patient with MLPB procedure because of prepyloric ulcer that was successfully treated by endoscopic sclerotherapy. Internal jugular vein graft thrombosis was detected on the 10th postoperative day. This patient underwent a second laparotomy, the distal half of the graft was found to be sclerosed and narrowed that the graft was revised with a synthetic allograft.

CONCLUSIONS

Based on a review of the literature, the MLPB functions well in patients with portal hypertension caused by portal vein thrombosis and appears to have a physiologic advance over shunts that decompress but do not return blood directly to the liver. Because intra-abdominal veins appear to function well as a conduit in this operation, it may be favored by eliminating additional incision and increased risk in such patients.

Efficiency of MR imaging in the detection of malignant liver lesions

PURPOSE

To evaluate the efficacy of preoperative magnetic resonance (MR) imaging in the detection of malignant liver neoplasms.

MATERIALS AND METHODS

MR images of 23 patients who had undergone hepatic resection or liver transplantation in the last two years were evaluated retrospectively. All MR imaging studies were performed with a 1.5 T magnet using a phased-array multi-coil. The MR imaging protocol was comprised of fat-suppressed T2-weighted TSE imaging, GRE with and without fat-suppressed T1-weighted imaging, and gadolinium-enhanced multiphasic dynamic GRE imaging. Images were reviewed on a PACS workstation by two independent abdominal radiologists. The image review was conducted on a lesion-by-lesion as well as segment-by-segment basis. MR imaging findings were compared with the results of pathology studies and intraoperative ultrasound examinations. Sensitivity, specificity, and positive predictive value (PPV) of MR imaging and interobserver variation were evaluated.

RESULTS

A total of 59 malignant liver lesions in 23 patients were identified by pathology studies and intraoperative sonographic examinations. Sensitivity and PPV of MR imaging on a lesion-by-lesion analysis were 68-86% and 85-89%, respectively; kappa=0.175 and agreement was 65.8% in these analyses. Sensitivity of MR images for small ( < 1cm) lesions was 13-67% and for large ( > 3 cm) lesions it was 100%. In segment-by-segment analysis, sensitivity and specificity of MR images were 87-95% and 97-98%, respectively; kappa=0.207 and agreement was 76.1%. Sensitivity and PPV of MR imaging in the detection of hepatocellular carcinoma were 46-85% and 55-73%, respectively.

CONCLUSION

Although MR imaging is generally a highly accurate method for the diagnosis of malignant liver tumors, it has some difficulty in detecting small lesions and hepatocellular carcinoma in cirrhotic livers.

Hepatocavopathy and isolated splenic vein thrombosis due to hypercoagulability state

We report a patient with protein C and protein S deficiency and factor V Leiden mutation presenting with splenic vein thrombosis and with a web between the hepatic venous confluence and vena cava inferior. These two findings were thought to be due to the hypercoagulable state of the patient. Interestingly, there was no need for invasive procedures as the inferior accessory hepatic vein was patent. Hepatic venous flow was being maintained by the inferior accessory hepatic vein or a dominant collateral vein.

Automated measurement of intima-media thickness of carotid arteries in ultrasonography by computer software

PURPOSE

Intima-media thickness (IMT) has been proposed to be a morphological criterion of atherosclerosis. The purpose of this study was to investigate the interobserver variability of manual and also of computer software measurements of IMT.

MATERIALS AND METHODS

High-resolution common carotid artery (CCA) images of 88 patients that have been obtained by a linear broadband L5-12 MHz transducer and archived in PACS were retrospectively evaluated. Two separate investigators, who were unaware of the former results, evaluated the same images by using computer software that had a dedicated tool for automatic measurement of IMT. The results of the investigators were compared.

RESULTS

According to the two investigators who have performed manual measurements, mean values of IMT of right CCA were 0.6396 mm and 0.6356 mm; of the left CCA were 0.6662 mm and 0.6575 mm, respectively. The interobserver variability of measurements revealed the mean IMT as 0.6071 mm and 0.6048 mm for the right, 0.6216 mm and 0.6227 mm for the left CCA. Manual measurements of both investigators were found to be higher than the automatic measurements and the differences were statistically significant. Interobserver correlation of manual measurements was between 0.80-0.88 and of the automated measurements was between 0.93-0.98.

CONCLUSION

Manual measurements reveal higher values than the automated measurements of IMT. The interobserver correlation of automated measurements is higher than manual measurements. The use of dedicated software may be proposed to reduce the measurement errors.

Publication rates of scientific presentations in Turkish national radiology congresses

PURPOSE

To investigate the publication rates of scientific presentations in Turkish radiology congresses.

MATERIALS AND METHODS

The abstracts of presentations at Turkish national radiology congresses between 1995-2002 were reviewed. According to the congress abstract booklets, types of the presentation (oral or poster presentation), as well as body system-based categorization were used. The presentations were searched for publication in Medline(R) indexed journals using the PubMed server. The rates of publication of the abstracts, the journals in which the presentations have been published and the time between the presentation and publication were investigated.

RESULTS

An overall number of 521 publications were found originating from 4,413 presentations (11.81%). The publication numbers of 2,116 scientific research, 1,995 case report and 302 educational exhibit type presentations were 261 (12.33%), 249 (12.49%) and 11 (3.64%), respectively. For oral presentations the publication ratio was found as 15.38% (116/754) and for posters it was 11.06% (405/3,659). The number of presentations and the number of publications were found to increase by years, however the ratio of publication to presentation remained the same. Mean time to publication was calculated as 24.4 months. In frequency of publication, Tanisal ve Girisimsel Radyoloji, European Radiology, European Journal of Radiology were the first three publication media of the presentations.

CONCLUSION

The publication rates of abstracts presented at Turkish national radiology congresses are lower than the previously reported publication rates in radiology and other specialties.

Megacalycosis: report of two cases

Congenital megacalycosis is a rare renal disorder consisting of caliceal dilatation without evidence of renal pelvic or ureteral obstruction. Since its first description in 1963, only a few cases have been reported. The defect is mostly unilateral, shows male predominance and does not disrupt the renal functions. We report on two male patients with bilateral megacalycosis and different clinical presentations. The first case was diagnosed in adolescence during examination for a urinary tract infection and was followed-up uneventfully for nearly ten years. The second case was found to have megacalycosis during the assessment of antenatal hydronephrosis. We aimed to emphasize the importance of considering megacalycosis in the differential diagnosis of both antenatal hydronephrosis and other causes of caliceal dilatation to prevent unnecessary diagnostic and therapeutic interventions.

Doppler sonographic indices in diagnosing the nutcracker phenomenon in a hematuric adolescent

Compression of the left renal vein between the aorta and the superior mesenteric artery, known as the nutcracker phenomenon, may cause gross or microscopic hematuria, pain in the flank, proteinuria, or a combination of these symptoms. We report the case of a hematuric adolescent diagnosed with a high index of suspicion by noninvasive Doppler sonography using the diagnostic indices of Doppler sonography established for adults with hematuria. Compression of the patient's left renal vein at the aortomesenteric portion and dilatation at the hilar portion were visualized by magnetic resonance angiography, which verified the diagnosis.

Calcium pyrophosphate dihydrate crystal deposition disease mimicking malignant soft tissue tumor

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease has multiple clinical features with variable courses creating several pitfalls in clinical diagnosis. There are number of reported cases mimicking malignant skeletal tumors such as chondrosarcoma. However, no case of CPPD disease with radiographic noncalcified soft tissue mass has been reported in the literature. Here we report a case of CPPD disease clinically mimicking soft tissue tumor with its magnetic resonance imaging appearance and histopathology.