Shear wave elastography in early diabetic kidney disease

OBJECTIVE:

This study aimed to analyze the kidneys among the subjects with early stages of type 2 diabetic kidney disease by shear wave elastography quantitatively.

METHODS:

A total of 108 patients with type 2 diabetic kidney disease and 17 control subjects were enrolled. According to the estimated glomerular filtration rate and urinary albumin-to-urinary creatinine ratio, patients were classified into stages 1 to 3 diabetic kidney disease. Grayscale ultrasound andshear wave elastography were performed. The sizes, depths, and shear wave elastography values were recorded. These parameters were compared between the diabetic kidney disease and the control subjects.

RESULTS:

The mean shear wave elastography values were significantly higher in the diabetic kidney disease group (10.156±1.75 kPa vs. 8.241±1.4 kPa; p<0.001). We obtained statistically significantly higher shear wave elastography values in stages 2 and 3 diabetic kidney disease subjects than control subjects and in patients with stage 3 diabetic kidney disease compared to those with stage 1 diabetic kidney disease (p<0.05 for all). We obtained a cutoff value of 9.23 kPa for predicting diabetic kidney disease in early stages, with a sensitivity of 67% and a specificity of 82%.

CONCLUSION:

Shear wave elastography may be used as a noninvasive, simple, and quantitative method to provide diagnostic information as a part of routine management of patients with type 2 diabetes mellitus, especially in the early stages of diabetic kidney disease.

Color Doppler Ultrasound Assessment of Clinical Activity in Inflammatory Bowel Disease

BACKGROUND

Ulcerative colitis (UC) and Crohn's disease (CD) are two varieties of inflammatory bowel disease (IBD). Clinicians need a monitoring technique in the IBD. The disease activity can be assessed with endoscopy, activity indexes, and imaging techniques. Color Doppler US (CDUS) is also a non-invasive, radiation, and contrast material free examination which shows the intramural blood flow.

OBJECTIVE

To evaluate the usefulness of B-mode, CDUS, and a newly developed software Color Quantification (CQ) to determine the activity of the IBD.

METHODS

The disease activity was assessed by clinical activity indexes. Caecum, terminal ileum, ascending colon, transverse colon, and descending colon were evaluated by B-mode, CDUS, and the CQ. Bowel wall thickness (BWT), loss of bowel stratification, loss of haustration, and the presence of enlarged lymph nodes, mesenteric masses, abscesses, fistula, visual vascular signal patterns of the bowel as "hypo and hyper-flow" and the CQ values were investigated. BWT was compared with laboratory results and clinical activities. Vascular signal patterns and the CQ values were compared with BWT and clinical activity. The diagnostic performances of the CQ were investigated.

RESULTS

Fifty-two patients with IBD were evaluated. Patients with increased BWT at the transverse colon had an increased frequency of "hyper-flow" pattern. Clinically active patients had an increased incidence of "hyper-flow" pattern at the terminal ileum, ascending colon, and whole segments. They had increased CQ values at the terminal ileum, ascending colon, and descending colon, and whole segments. A cut-off value for the CQ (24.7%) was obtained at the terminal ileum. In the diagnostic performances of CQ, we observed utilities significantly at the ascending colon, descending colon, terminal ileum, and whole segments. There was a positive correlation between the CQ values and BWT at the caecum, ascending colon, transverse colon, and descending colon.

CONCLUSION

Increased visual vascular signal scores and CQ values might be useful for monitoring the disease activity in patients with IBD.

Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves' Disease

BACKGROUND

Graves' Disease is an autoimmune disorder characterized by increased levels of thyroid hormones correlated with increased thyroid blood flow. Thyroid scintigraphy is an important and conventional method. However, it has limited accessibility, has ionizing radiation, and is expensive.

OBJECTIVES

To investigate the thyroid blood flow in patients with Graves' Disease by color Doppler Ultrasonography and a newly developed software Color Quantification.

METHODS

Forty-one consecutive subjects with GD and 41 healthy controls were enrolled. Color Doppler ultrasonography parameters of the thyroid arteries and Color Quantification values of the gland were measured by a radiologist. The correlations between thyroid blood flow parameters, levels of 99mTechnetium pertechnetate uptake, thyrotropin, and free thyroxine were evaluated. The diagnostic performances of these parameters were investigated.

RESULTS

The peak systolic-end diastolic velocities of thyroid arteries and Color Quantification values were increased in the study group (p < 0.05 for all). We observed negative correlations between thyrotropin levels and peak-systolic and end-diastolic velocities of superior thyroid arteries and Color Quantification values. There were positive correlations between 99mTechnetium uptake levels and thyroid blood flow parameters (p < 0.05 for all). In the diagnostic performance of thyroid blood flow parameters, we observed utilities significantly in peak-systolic and end-diastolic velocities of thyroid arteries and Color Quantification values (p < 0.05 for all).

CONCLUSION

The increased peak-systolic and end-diastolic velocities of thyroid arteries, and increased Color Quantification values might be helpful in the diagnosis of Graves' Disease.

Locations of lesser tuberosity cysts and their association with subscapularis, supraspinatus, and long head of the biceps tendon disorders

BACKGROUND

Humeral head cysts are not uncommon in individuals with rotator cuff disorders. The cysts are usually considered an indicator of rotator cuff pathologies; however, they may have different meanings in different regions.

PURPOSE

To determine the frequency of cysts within and adjacent to the lesser tuberosity and the relationship between these cysts and subscapularis, supraspinatus, and long head of the biceps tendon (LHBT) disorders.

MATERIAL AND METHODS

We retrospectively reviewed 760 consecutive shoulder magnetic resonance imaging (MRI) examinations. Among these MRIs, we selected a group of patients with cysts located around the lesser tuberosity. The study population was also divided into two subgroups, patients with cysts within the lesser tuberosity and those with cysts adjacent to the lesser tuberosity. In addition to the number and size of cysts, the MRI appearance of the tendons was evaluated.

RESULTS

Eighty-one (10.7%) patients had cysts within and/or adjacent to the lesser tuberosity, 34 (42%) patients had cysts within the lesser tuberosity, and 47 (58%) patients had cysts adjacent to it. LHBT and subscapularis tendon disorders were significantly related to more than one cyst. In a univariate analysis, cysts within the lesser tuberosity were significantly associated with LHBT and subscapularis tendon disorders; however, multivariate analyses showed that only LHBT disorders were significantly associated with cysts within the lesser tuberosity.

CONCLUSION

Cysts within the lesser tuberosity were less common than cysts adjacent to it. LHBT and subscapularis tendon disorders were more frequently found in patients with more than one cyst within and/or adjacent to the lesser tuberosity. In addition, cysts within the lesser tuberosity were associated with LHBT disorders.

Pulmonary involvement in ankylosing spondylitis assessed by multidetector computed tomography

Background

Ankylosing spondylitis (AS) may present with extra-articular involvement in the lungs. We aimed to evaluate the abnormal pulmonary multidetector computed tomography findings of patients with AS and compare them with the clinical symptoms, duration of illness, laboratory results and pulmonary function tests (PFT).

Material/Methods

We evaluated the chest multidetector computed tomography (MDCT) findings of 41 patients with ankylosing spondylitis (AS) and compared them with pulmonary function test (PFT) results, demographic characteristics, duration of illness and laboratory findings that we were able to obtain.

Results

The most common abnormalities were nodules, peribronchial thickening, pleural thickening and bronchiectasis. Abnormalities occurred in 96.87% of patients in the early AS group and 77.8% of patients in the late AS group. Patients with early AS included asymptomatic individuals with normal PFT results and abnormal MDCT findings.

Conclusions

The use of MDCT in AS patients may be beneficial for the evaluation of pulmonary disease, even in asymptomatic patients without any PFT abnormalities and those in the early stages of the disease.

Tenosynovitis of the peroneal tendons associated with a hypertrophic peroneal tubercle: radiography and MRI findings

An enlarged peroneal tubercle can cause a peroneal tendon tear and/or tenosynovitis due to chronic friction. We present the case of a 45-year-old man with tenosynovitis in the peroneus longus and brevis tendons associated with a hypertrophic peroneal tubercle. On admission to our facility, the patient presented with pain while walking and had a fixed mass on the lateral aspect of his right foot. In addition, an osseous prominence corresponding to a hypertrophic peroneal tubercle was seen on the lateral side of the right calcaneus on radiography. MRI confirmed the hypertrophic peroneal tubercle and revealed high-signal intensity within the peroneus longus and brevis tendons along with fluid in their sheaths.

Assessment of color Doppler ultrasonography findings in gynecomastia

AIM

To evaluate the color Doppler ultrasound (US) findings of gynecomastia and compare them with sonographic Tanner staging to determine an additional diagnostic tool.

PATIENTS AND METHODS

Eighteen male (mean age 13.87 ± 1.72) patients (36 breasts) with breast enlargement were examined with gray-scale and color Doppler ultrasound (US), and these were used to determine the Tanner stages. In addition, the arterial and venous flow scores were assessed. The resistivity index (RI) values were also measured at the medial, lateral, and retroareolar regions of the breasts, and the mean RI values for each breast were then calculated.

RESULTS

Gynecomastia was detected in 30 breasts, and the mean retroareolar thickness was 8.03 mm. Furthermore, arterial and venous flows were detected in 73.3% and 56.7% of the breasts, respectively. However, there was no correlation between the arterial and venous flows and the retroareolar glandular tissue thickness. The average of the mean RI values of the three regions of the breast was 0.62, and there was a statistically significantly positive correlation between the mean RI values of the breasts and the Tanner stages as established by US. Furthermore, there was a strongly significant positive correlation between the arterial and venous flow scores and the Tanner stages.

CONCLUSIONS

Our research indicates that vascularity is correlated with breast development in patients with gynecomastia. Additionally, we determined that RI values might be as important as Tanner stages on US.

Pulmonary involvement in rheumatoid arthritis: multidetector computed tomography findings

BACKGROUND

Pulmonary involvement in rheumatoid arthritis (RA) is common and encompasses a large spectrum of disease with different treatment options and prognoses. Therefore, assessment of these patients with multidetector computed tomography (MDCT) is vital.

PURPOSE

To evaluate the MDCT pulmonary findings of patients with RA and to compare these findings with the clinical status.

MATERIAL AND METHODS

Chest MDCT scans of 85 patients with RA between 2006-2012 were assessed. One patient with a pulmonary infection was excluded from the study. MDCT findings and distribution of the CT findings were examined, and patients were classified according to the predominant CT pattern. The pulmonary function test (PFT) results and categories, demographic characteristics, and clinical status of some of the patients for whom the results were obtained were evaluated, and the CT findings, PFT results, demographic characteristics, and clinical status were compared.

RESULTS

The study group consisted of 20 men (mean age, 58.1 years ± 13.1; range, 15-77 years) and 64 women (mean age, 55.3 years ± 11.5; range, 30-84 years). The most frequent findings were nodules (78.6%) and pleural thickening (48.8%). The most common CT patterns were follicular bronchiolitis (FB) in 28 (33.3%) patients and nodular disease (ND) in 12 (14.3%) others. There was no statistically significant difference between the CT findings and PFT results, and no statistically significant difference was noted in the CT findings between symptomatic and asymptomatic patients. In addition, there were some patients who exhibited no symptoms and/or had abnormal PFT results but had abnormal CT findings.

CONCLUSION

Rheumatoid arthritis is associated with a high frequency of CT findings and CT patterns, with nodules and pleural thickening being the most common CT findings and FB and ND being the most common CT patterns. MDCT identification of patients with RA may be helpful in the evaluation of pulmonary disease, even in patients without symptoms and PFT abnormalities.

Multidetector computed tomography findings of the sternoclavicular joint in patients with rheumatoid arthritis

We evaluated the multidetector computed tomography (MDCT) findings of the sternoclavicular joint in patients with rheumatoid arthritis (RA) and compare them with general population. Chest MDCT scans of RA patients were reviewed. The control group was formed from age and sex-matched individuals. The most common CT findings were cortical irregularity, joint space narrowing, and osteophytes in study group. There were no statistically significant differences in the MDCT findings between the two groups except that osteophytes were observed more often in the control group. It is difficult to distinguish between the involvement of RA and age-related degenerative changes at the sternoclavicular joint.

Multidetector computed tomography findings of central bronchopleural fistulas as sequelae of tuberculosis, chemo radiation and trauma: A report of three cases

A bronchopleural fistula (BPF) is defined as a direct pathway between the bronchial tree or lung parenchyma and the pleural space. Herein, we describe the clinical findings and imaging results of BPFs in three cases. The patients' medical histories revealed that the first had recurrent pulmonary tuberculosis, the second had small-cell lung cancer (SCLC) and had previously undergone chemoradiotherapy, and the third had trauma. Multidetector computed tomography (MDCT) showed clear communication between the airways and pleural spaces which was sufficient for a proper diagnosis without performing a bronchoscopy.