Effective diameter of the abdominal aorta in children

PURPOSE

Measure out of the standard interval in the aorta diameter is a clue for aortic aneurysm or hypoplasia. Pediatric studies focusing specifically on the normal diameter of the abdominal aorta (AA) were limited in the literature. Therefore, the main goal of this work was to determine changes in the effective diameter of AA in healthy children aged 1-18 years for diagnosis of vascular diseases.

METHODS

This retrospective work focused on abdominopelvic computed tomography views of 180 children (sex: 90 males / 90 females, average age: 9.50 ± 5.20 years) without any abdominopelvic disease to measure diameters of AA, common iliac artery (CIA), external iliac artery (EIA), and first lumbar vertebra (L1).

RESULTS

Vessel and vertebra diameters increased in pediatric subjects between 1 and 18 years (p < 0.001). Considering pediatric age periods, vessel diameters increased steadily, but L1 diameter showed an irregular growth pattern between age periods. All parameters were greater in males than females (p < 0.05), except from effective diameters of AA over the coeliac trunk (p = 0.084) and over the renal artery (p = 0.051). The ratios of diameters of vessels to L1 increased depending on ages between 1 and 18 years. Considering pediatric age periods, the ratios increased from infancy period to postpubescent period in irregular pattern; however, the ratios for right and left CIA, and AA over the aortic bifurcation did not alter after late childhood period. All ratios for males were similar to females (p > 0.05).

CONCLUSION

Our age-specific ratios may be beneficial for surgeons and radiologists for the diagnosis of vascular disorders such as aortic aneurysm.

The place of B-mode ultrasonography, shear-wave elastography, and superb microvascular imaging in the diagnosis of De Quervain tenosynovitis

PURPOSE

Superb microvascular imaging (SMI) and Shear wave elastography (SWE) are newly developed ultrasonographic diagnostic tools used to support the diagnosis of De Quervain tenosynovitis (DQT). The aim of this study was to examine the capacity to differentiate between the wrist with DQT and the healthy wrist, as well as the potential for predicting the disease's severity using B-mode ultrasonography, SWE, and SMI.

METHODS

A total of 19 cases with unilateral clinical DQT were included in the prospective study. The wrists of these cases without DQT clinic constituted the control group.

RESULTS

The SWE parameters of m/s and kPa cutoff values were ≤5.225 and ≤ 77.65, respectively, in the wrists with DQT compared to the wrists not diagnosed with DQT (p < 0.001). Regarding SMI findings no microvascularity was determined in the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon sheaths of the wrists without DQT, and a significant increase was observed in the degree of microvascularity as the clinical severity of DQT increased.

CONCLUSION

SWE results can differentiate between the presence and absence of DQT. SMI grading of the APL and EPB tendon sheaths may be helpful to the clinician in deciding the clinical severity of DQT.

Evaluation of supratrochlear artery depth and course variations by Doppler ultrasonography along the glabellar frown lines for safer filler injections

PURPOSE

Hyaluronic acid (HA) injection is a popular nonsurgical, rejuvenating procedure to treat glabellar frown lines, which has devastating complications such as blindness and skin necrosis due to the arterial occlusion of supratrochlear artery (STA). Therefore, when injecting into the frown lines, knowledge of the STA's depth and plane is necessary to prevent possible adverse events. The aim of this study was to identify the depths of STA in the area of the frown lines in order to maximize safety during filler injections.

METHODS

Supratrochlear artery depth measurements were performed at the level of eyebrow and at the level of 1.5 cm above the eyebrow. Superficial duplex Doppler ultrasonography was performed of 71 cases.

RESULTS

In the eyebrow level, the epidermis-artery distance (EAD) is between 1,8 and 5.9 mm, and the artery-periost distance (APD) is between 0.7 and 3.7 mm. In the 1.5 cm superior level of the eyebrow, the EAD is between 1.8 and 5.1 mm and the APD is between 0.6 and 3.8 mm. There was no significant difference between the depth measurements of the right and left STA. At the eyebrow level, APD is greater in men than in women. As the body mass index increases, the EAD and APD depth increases. EAD depth increases with increasing age.

CONCLUSIONS

Based on the findings of this study, safe filler injections to correct the glabellar frown lines can be possible with intradermal injections just below the ryhtide. In the glabellar region, subcutaneous and supraperiosteal injections seems to be risky.

Ischiofemoral space dimensions for ischiofemoral impingement: is it different in children?

OBJECTIVE

This study intended to analyze alterations in ischiofemoral space (IFS) dimensions in normal children between the ages of 1 and 18 years for the ischiofemoral impingement.

MATERIALS AND METHODS

This study retrospectively focused on computed tomography images of 360 hips of 180 (90 boys and 90 girls) pediatric subjects (mean age: 9.50 ± 5.20 years, range: 1-18 years) without any hip disorders to measure IFS, femoral neck angle (FNA), and ischial angle (IA).

RESULTS

Mean IFS, FNA, and IA were measured as 14.64 ± 7.24 mm, 34.61 ± 11.47°, and 131.52 ± 4.22°, respectively. IFS increased in children aged between 1 and 18 years, whereas FNA and IA decreased. IFS was similar in infancy and early childhood periods but then increased up to postpubescent period. FNA decreased proportionally from birth, whereas IA decreased in an irregular pattern. Linear functions were detected as y = 3.451 + 1.178 × years for IFS, as y = 48.555 - 1.468 × years for FNA, and as y = 132.535 - 0.107 × years for IA.

CONCLUSION

Our findings indicate that IFS tends to increase in size with age during childhood but decreases with further aging. Therefore, age-specific values for IFS, FNA, and IA may be beneficial for clinicians and radiologists for the diagnosis of ischiofemoral impingement.

Pterygospinous and pterygoalar bars in children

PURPOSE

The formation of pterygoalar (Pa) and pterygospinous (Ps) bars are controversial whether they are secondary ossifications with aging or phylogenetic remnant. Therefore we aimed to evaluate the presence of Pa and Ps bars in children on routine cranial computed tomography images.

METHODS

We retrospectively analyzed the cranial computed tomography images of 500 children under the age of 18. Besides the 0.5 mm axial images, maximum intensity projection and 3D reconstructions were also used. The existence of incomplete or complete Pa and Ps bars were investigated.

RESULTS

Incomplete and complete Pa bar was detected in 4.6% and 2.2% of the cases, respectively. Incomplete Ps bar was seen in 13.6% of the cases and complete was in 6%. In total, per 1000 sides, 12 (2.4%) complete and 27 (5.4%) incomplete Pa bars were detected. In the same way, 35 (7%) complete and 88 (17.6%) incomplete Ps bars were seen. The smallest age ossification detected was 5 months old. Additionally, the prevalence of Pa and Ps bars between the under and over 10 years old age groups were statistically significant. Aging increased the prevalence.

CONCLUSION

Considering our results, it seems that the ossification of Pa and Ps ligaments may not be solely related with aging.

The place of B-mode ultrasonography, shear-wave elastography, and superb microvascular imaging in the pre-diagnosis of androgenetic alopecia

PURPOSE

Androgenetic alopecia (AGA) is the most common cause of hair loss in males. Physical examination and history are the most important examinations in diagnosis of the disease. As yet, there is no diagnostic method to be able to determine which individuals will develop AGA. Shear-wave elastography (SWE) is a novel diagnostic tool, which can evaluate tissue stiffness. Superb microvascular imaging (SMI) can determine low flow in microvessels. The aim of the current study was to determine whether or not AGA would develop in individuals with normal hair and a family history of AGA using B-mode US, SMI, and SWE.

METHODS

The study included 26 patients clinically diagnosed with AGA and a control group of 26 volunteers.

RESULTS

Thickness with the distance from the epidermis to the calvarium (ECD) on the hairline and cranial subcutaneous tissue thickness (CSTD) were determined to be statistically significantly thinner in the AGA group than in the control group (p < 0.0001). For the differentiation of the AGA patients, the cutoff value was determined to be 5.5 mm for ECD and 4.05 mm for CSTD. The cranial epidermis-dermis (CED) stiffness values both as meter/second (m/s) and kilopascals (kPa) were statistically significantly lower in the AGA patients than in the control group (p < 0.0001). The cutoff values were 6.075 as m/s and 104.4 as kPa.

CONCLUSIONS

The results of this study demonstrated that differentiation could be made of individuals before the development of AGA from normal healthy individuals with CSTD measurement on B-mode US and CED stiffness measurement on SWE.

Evaluation of facial artery course variations and depth by Doppler ultrasonography

BACKGROUND

As deep nasolabial folds (NLF) are associated with facial aging, there is an increasing demand for esthetic correction with filler injections. Understanding the anatomy of the angular artery (AA) and facial artery (FA) around the NLF region is essential for ensuring the safety of dermal filler injections into the NLF. The purpose of this study was to provide detailed vascular anatomical information on the course and depth of AA and FA around NLF using Doppler ultrasound on live cases.

METHODS

FA was observed from the origin level adjacent to the mandible corpus to the end of its terminal branch AA in 168 hemifaces of 84 cases with Doppler ultrasonography.

RESULTS

We made a classification of the FA course based on the NLF. The minimum and maximum depths of the FA along its course were measured in 84 cases. The results showed that its course may be highly superficial (2.5 mm at the mandibular origin, 3.7 mm at the cheilion, 3.7 mm at the nasal ala) or it may follow a very deep course near the periosteum (15.0 mm at the mandibular origin, 18.7 mm at the cheilion, 23.5 mm at the nasal ala). FA depth was varied between 5.98 mm and 6.62 mm at the mandibular origin, between 8.36 mm and 9.20 mm at the cheilion, between 9.52 mm and 10.51 mm at the nasal ala at a 95% confidence interval.

CONCLUSIONS

This study suggests that there is no absolutely safe depth or region for nasolabial fold filler injections.

A Computed Tomography Study of the Prechiasmatic Sulcus Anatomy in Children

PURPOSE

To investigate the characteristics of the prechiasmatic sulcus in children aged between 1-20 years.

METHODS

Patient files of 200 children admitted to the university hospital on 2019 were analyzed, retrospectively. The computed tomography images of patients were used to obtain anatomical knowledge containing prechiasmatic sulcus types and dimensions.

RESULTS

The measurements related to the sulcal length (6.94 ± 1.25 mm) and sulcal angle (31.01 ± 18.13°) showed that the sulcal length did not alter in children between 1 and 20 years, whereas the sulcal angle did not vary from infancy to prepubescent period, but it was decreasing in postpubescent period. In 29 patients, the sulcal length was observed to divide into 2 parts with an evident angle. The interoptic distance and planum length were found as follows: 14.70 ± 2.85 mm and 14.84 ± 4.12 mm, respectively. The order of PS types was observed as type 4 (26.5%, 53 cases) > type 2 (26%, 52 cases) > type 1 (24%, 48 cases) > type 3 (23.5%, 47 cases).

CONCLUSIONS

The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.