Evaluation of lung densitometric and volumetric changes in silicosis patients using three-dimensional software for multidetector CT and the relationship with profusion scores

AIM

To evaluate the density and volume changes in the lungs of silicosis patients and their relationship with the disease severity classification of the International Labor Organization (ILO).

MATERIALS AND METHODS

The multidetector computed tomography (CT) images of 44 patients diagnosed with silicosis and 32 controls that underwent thoracic CT due to trauma were evaluated. Patients with silicosis were divided into three categories according to the ILO classification. Data related to the total lung volume, total lung mean density, lung opacity score, percentage of lung high opacity, and mean density in the lower and upper lobes were obtained using three-dimensional (3D) software.

RESULTS

There was no significant difference between the total lung mean densities of the silicosis and control groups (p=0.213); however, a significant difference was observed between the two groups in terms of the total lung volume (p<0.0001). According to the ILO classification, there was a significant difference between the disease severity categories in relation to the percentage of lung high opacity (p=0.000005). A strong correlation was detected between disease severity and high opacity percentage (p<0.0001, r=0.804). According to the ILO classification, there was also a significant difference between disease severity categories in terms of the lung opacity score (p=0.000144), as well as a moderate correlation between disease severity and opacity score (p<0.0001, r=0.580).

CONCLUSION

Total lung volume is a CT finding that shows variation in exposure to crystalline silica. The percentage of high opacity determined using multidetector CT is an effective parameter in evaluating disease severity.

Analysis of posterior circulation diameters depending on age, sex and side by computed tomography angiography

BACKGROUND

Posterior circulation of brain is important because of vital organs' blood supply provided by them. In this study, we evaluate the relationship of posterior circulation measurements with age, gender and side by using computed tomography angiography (CTA) images.

MATERIALS AND METHODS

A total 199 brain CTA examinations were retrospectively analysed for all posterior circulation arteries (vertebral artery, basilar artery, posterior cerebral artery [PCA], superior cerebellar artery [SCA], anterior inferior cerebellar artery, and posterior inferior cerebellar artery [PICA]) to compare the difference based on age, gender and side.

RESULTS

There is no correlation between age and the mean diameters of all vessels (p > 0.05). The mean diameter of left vertebral artery was higher than right vertebral artery in all genders (p = 0.004 for males and p < 0.001 for females). The mean diameter of left SCA and PICA were higher than right SCA and PICA in females (p = 0.032 and p = 0.027, respectively). The mean diameters of basilar, left PCA, left SCA, left vertebral, right PCA, right SCA, right PICA and right vertebral artery were higher in males and that differences were statistically significant (p < 0.001, p = 0.002, p = 0.006, p = 0.004, p = 0.001, p = 0.003, p = 0.002, and p = 0.006, respectively).

CONCLUSIONS

The posterior circulation vessel diameter is not affected by aging. The mean diameters of basilar artery, both PCAs, both SCAs, right PICA, both vertebral arteries were higher in males. The mean diameter of left vertebral artery is higher than that of right vertebral artery in all genders.

Relationship of vascular variations with liver remnant volume in living liver transplant donors

BACKGROUND

In this study, we investigated the relationship between the portal vein and hepatic artery variations and the remaining liver volume in living donors in liver transplantation.

MATERIALS AND METHODS

In the study, triphasic abdominal computed tomography images of 180 live liver donor candidates were analysed retrospectively. Portal veins were divided into four groups according to the Nakamura classification and seven groups according to the Michels classification. The relationship between vascular variations and remnant liver volume was compared statistically.

RESULTS

According to the Nakamura classification, there were 143 (79.4%) type A, 23 (12.7%) type B, 7 (3.9%) type C and 7 (3.9%) type D cases. Using the Michels classification, 129 (71%) type 1, 12 (6.7%) type 2, 24 (13%) type 3, 2 (2.2%) type 4, 10 (5.6%) type 5, 1 (0.6%) type 6, and 2 (1.1%) type 7 cases were detected. There was no significant difference in the percentage of the remaining volume of the left liver lobe between the groups (p = 0.055, p = 0.207, respectively).

CONCLUSIONS

Variations in the hepatic artery and portal vein do not affect the remaining liver volume in liver transplantation donors.

Differentiation between hepatic alveolar echinococcosis and primary hepatic malignancy with diffusion-weighted magnetic resonance imaging

PURPOSE

To determine the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in discriminating between hepatic alveolar echinococcosis (AE) and hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

METHODS

We included 49 patients (27 men, 22 women; mean age: 52.02±9.76 [SD] years; range: 25-72years) with 57 histopathologically confirmed hepatic AE lesions. Fifty patients (18 men, 32 women; mean age: 58.93±8.42 [SD] years; range: 42-71years) with 61 histopathologically confirmed hepatocellular carcinoma and 50 patients (24 men, 26 women; mean age: 50.11±7.70 [SD] years; range: 38-69years) with 54 histopathologically confirmed intrahepatic cholangiocarcinoma lesions were used as control groups. All patients had MRI examination of the liver that included conventional MRI sequences and DW-MRI using b values of 50, 400 and 800s/mm². Two radiologists evaluated conventional MRI and DW-MRI images and calculated ADC values of hepatic lesions.

RESULTS

The mean ADC value of solid components of hepatic AE lesions was 1.34±0.41×10^-3 mm²/s (range: 0.9-1.59×10^-3 mm²/s) and was significantly higher than that of the solid components of hepatocellular carcinoma lesions (mean ADC value, 0.99±0.29×10^-3 mm²/s; range: 0.7-1.15×10^-3 mm²/s) and of intrahepatic cholangiocarcinoma lesions (mean ADC value, 1.05±0.22×10^-3 mm²/s; range: 0.86-1.18×10^-3 mm²/s) (P<0.001).

CONCLUSION

In general ADC values can help discriminate between AE and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, the use of ADC values cannot help differentiating Type 4 AE from hepatocellular carcinoma or intrahepatic cholangiocarcinoma.

Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children's testicular blood flow

OBJECTIVE

We have compared conventional Color Doppler (CD) and Power Doppler (PD) techniques, which are used for evaluating the testicular blood flow in small children, and the Superb Microvascular Imaging (SMI), which is a new technique. We have also investigated their contributions to testicular evaluations.

PATIENTS AND METHODS

We evaluated blood flow in testicles using a grading system with CD, PD and SMI techniques. We determined the average duration of the three techniques.

RESULTS

There was a statistically significant difference between the SMI and CD techniques for all patients (p < 0.001, p = 0.001). When we compared the PD and SMI, either as much or more vascular information was obtained (p = 0.106). There was a statistically significant difference between the application durations of the tests (p < 0.05).

CONCLUSIONS

Superb Microvascular Imaging yields more detailed vascular information in blood flow in testicles in small children, than either CD or PD. Furthermore, this technique decreases the duration of the examination at a significant level. Superb Microvascular Imaging may represent an alternative method that can be used safely for evaluating blood flow in the testicles of small children. Additional studies may increase the reliability of SMI.

Aortoesophageal fistula and double aortic arch: two important points in management

Two children with double aortic arch and aortoesophageal fistula (AEF) are reported to warn of this lethal complication of double aortic arch and to stress important points in the diagnosis and management. A review of the records of 30 children with double aortic arch disclosed two patients who had AEF. The first patient had respiratory distress and repair of a vascular ring (double aortic arch) at 5 weeks of age. At 9 weeks of age, because of difficulty with tracheal extubation, aortopexy was performed. Ten days later, profuse upper gastrointestinal bleeding required control by a Sengstaken-Blakemore (SB) tube. Thoracotomy and repair AEF was accomplished successfully under cardiopulmonary bypass. The second patient had hepatomegaly and Pseudomonas sepsis. Endotracheal and nasogastric intubation was necessary, and subsequently the double aortic arch was demonstrated by magnetic resonance imaging (MRI). On the 48th day of hospitalization, life-threatening upper gastrointestinal hemorrhage required insertion of an SB tube. Cardiopulmonary bypass allowed successful repair of the AEF. Both children are alive, after 3 and 2 years (respectively). These patients demonstrate that AEF must be diagnosed clinically (no imaging technique is effective); its history and physical presentation are typical. The SB tube is effective for controlling the hemorrhage until cardiopulmonary bypass can be performed to allow repair.

Transesophageal echocardiographic evaluation of cor triatriatum in children

Four children with cor triatriatum underwent intraoperative transesophageal echocardiography. Two patients had cor triatriatum alone and two had associated complex congenital heart disease. Transesophageal echocardiography provided optimal imaging of these defects and provided unique information that facilitated surgical management in these children.

Ultrastructural autoradiographic studies of the early vasoproliferative response in tumor angiogenesis

The early local vasoproliferative response induced by live tumor cells and an extract derived from such cells was studied in rat subcutaneous tissue by means of electron microscopy and ultrastructural autoradiography after local injections of tritium-labeled thymidine. DNA synthesis was localized in endothelial cells, pericytes, and perivascular cells 6 to 8 hours after exposure to 10(6) live Walker ascites tumor cells. At this time, DNA-synthesizing endothelial cells in parent vessels exhibited a continuous basement membrane and could not be readily differentiated, ultrastructurally, from control endothelium. At 48 to 50 hours, the number of labeled cells increased and there was ultrastructural evidence of regenerating endothelium: marked increase in ribosomes and endoplasmic reticulum, scarce or absent pinocytotic vesicles, attenuated or discontinuous basement membrane and marked irregularities in cytoplasmic surfaces. Labeled endothelial cells were present in parent vessels, as well as along newly formed sprouts. Autoradiographic and ultrastructural findings after tumor extract or live tumor cells at 48 hours were similar. Evidence was also presented that cells which were recognizable as pericytes, by ultrastructural criteria and by their localization within the basement membrane, were capable of DNA synthesis and mitosis.

Tumor angiogenesis. Rapid induction of endothelial mitoses demonstrated by autoradiography

Walker ascites tumor cells and an extract derived from such cells (tumor angiogenesis factor, TAF) were injected into the subcutaneous tissue of rats by using a dorsal air sac technique. At intervals thereafter, thymidine-(3)H was injected into the air sac and the tissues were examined by autoradiography and electron microscopy. Autoradiographs of 1micro thick Epon sections showed thymidine-(3)H labeling in endothelial cells of small vessels 1-3 mm from the site of implantation, as early as 6-8 hr after exposure to live tumor cells At this time interval endothelial cells appeared histologically normal. DNA synthesis by endothelium subsequently increased and within 48 hr new blood vessel formation was detected. The presence of thymidine-(3)H-labeled endothelial nuclei, endothelial mitoses, and regenerating-type endothelium was confirmed by electron microscopy. TAF also induced neovascularization and endothelial cell DNA synthesis after 48 hr. A similar response was not evoked in saline controls. Formic acid, which elicited a more intense inflammatory response, was associated with less endothelial labeling and neovascularization at the times studied. Pericytes and other connective tissue cells were also stimulated by live tumor cells and TAF. The mechanism of new blood vessel formation induced by tumors is still unknown but our findings argue against cytoplasmic contact or nonspecific inflammation as prerequisites for tumor angiogenesis.