Comparative evaluation of shear wave elastography elasticity values in thyroid nodules with cytology results and TI-RADS scoring in differentiation of benign-malignant nodules.

PURPOSE: The aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). METHODS: This prospective study included 370 thyroid nodules in 308 patients aged 18-70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules. RESULTS: One hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001). CONCLUSION: This study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules.

Comparison of 5 Thyroid Ultrasound Stratification Systems for Differentiation of Benign and Malignant Nodules and to Avoid Biopsy Using Histology as Reference Standard.

OBJECTIVE: We aimed to compare the thyroid ultrasound risk stratification systems (RSSs) of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), European TI-RADS, Korean TI-RADS, and American Thyroid Association (ATA), American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi guidelines to differentiate benign from malignant thyroid nodules and to avoid unnecessary fine needle aspiration (FNA). METHODS: The records of 1143 nodules ≥1 cm that underwent FNA biopsy and thyroidectomy between 2012 and 2020 at our institution were reviewed. Ultrasound categories and FNA recommendation indications of 5 international RSSs were compared with histopathological findings as benign or malignant. The ultrasound categories and recommended FNA indications, the proportion of the avoidable FNA procedures, and false negative rates (FNRs) by different systems were compared with each other. RESULTS: Of the 1143 nodules, 45% had thyroid malignancy. FNA recommendation and ultrasound risk classification of ATA guidelines had the highest area under curves of 0.619, and 0.715, respectively. ACR TI-RADS, American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, European TI-RADS, ATA guidelines, and Korean TI-RADS would have avoided FNA for 34.7%, 31%, 25.7%, 20%, and 6% of nodules with an FNR of 24%, 28.5%, 22%, 7.2%, and 1.9%, respectively. CONCLUSION: Our findings showed that all RSSs classified the nodules appropriately for malignancy. ATA guidelines had the highest area under curves and a low FNR, whereas ACR TI-RADS would have spared more patients from FNA with a high FNR.

Comparison of intrahepatic vein-to-liver parenchyma and intercostal muscle-to-liver parenchyma strain ratios in the assessment of liver fibrosis: which one should we use?

PURPOSE: The aims of this study were to investigate whether there is a difference in diagnostic value between vein to parenchyma strain ratio (VPSR) and muscle to parenchyma strain ratio (MPSR). METHODS: VPSR and MPSR were calculated via sonoelastography, and were recorded for comparison with histopathology. ROC analysis, the Mann-Whitney U test, the Kruskal-Wallis test, and Spearman's rank correlation test were used for statistical analysis. RESULTS: The study included 59 cases of individuals who underwent biopsy (29 women, 30 men). When the threshold value for VPSR was set at 3.23, the sensitivity was 96.2% and the specificity was 83.3% (p < 0.001, F ≥ 1). When the threshold value was set at 3.01 for MPR, the sensitivity was 88.7% and the specificity was 83.3% (p < 0.001, F ≥ 1). The areas under the curve values were VPSR 0.95 and MPSR 0.92 for F ≥ 1, VPSR 0.94 and MPSR 0.92 for F ≥ 2, and VPSR 1.00 and MPSR 0.76 for F = 3 (p < 0.001). The Spearman's correlation coefficient was 0.75, and a high positive concordance was found between VPSR and MPSR (p < 0.001). CONCLUSIONS: In this study, a high positive correlation was observed between two strain ratios, and VPSR was found to be more reliable than MPSR in determining liver fibrosis.

Can a b value of 500 be substituted for a b value of 1000 in the characterization of focal liver lesions?

PURPOSE: Comparison of two different b values in diffusion-weighted magnetic resonance imaging (DWI) for characterization of focal liver lesions. METHODS: A total of 174 focal liver lesions from 100 patients were analyzed using two different b values (500 and 1000 s/mm(2)). The DWI with b values of 500 s/mm(2) (DWI500) and 1000 s/mm(2) (DWI1000) were analyzed using the Mann-Whitney test, kappa statistic, and paired t test with respect to image quality. The statistically significant differences between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values were evaluated via χ (2) test. RESULTS: DWI500 had the highest mean score in the qualitative evaluation of image quality (p < 0.0001) and the highest signal-to-noise ratio (8.7 ± 2.1; p < 0.0001). The sensitivity, specificity, and AUC for discriminating malignant from benign focal lesions on DWI500 and DWI1000 using cutoff ADC values of 1.54 × 10(-3) and 1.38 × 10(-3) s/mm(2) were 95.8%, 92.3%, 0.98, and 93.8%, 92.3%, 0.97, respectively. There was no statistically significant difference in sensitivity, specificity, and AUC values between DWI500 and DWI1000 with respect to the cutoff ADC values (p > 0.05). CONCLUSIONS: The image quality of DWI500 was better than that of DWI1000, and there was no significant difference between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values. The b value of 500 s/mm(2) can be substituted for the b value of 1000 s/mm(2) in the characterization of focal liver lesions.

Ultrasonography in the evaluation of midpalatal suture in surgically assisted rapid maxillary expansion.

Surgically assisted rapid maxillary expansion (SARME), which combines orthodontics and surgery, is a well-established therapy for transverse maxillary hypoplasia in adults after sutural closure or completion of skeletal maturation. X-rays are usually the preferred monitoring technique for this treatment. Recently, ultrasound scanning has been used successfully in the follow-up of patients undergoing distraction osteogenesis. In this study, ultrasonography (US) was used in the evaluation of bone callus formation in the midpalatal suture in 3 patients undergoing SARME. For each patient, US was performed immediately after active expansion, at 2 and 4 months of the expansion period, at the removal of the expander 6 months later, and at 2 months after expander removal. The results indicated that US might be a useful and accurate method to assess bone fill in the midpalatal suture in patients undergoing SARME. However, further studies are necessary to clarify the US scores in a larger patient group undergoing SARME.

Diffusion-weighted MRI at 3T in Endometrial Cancer: Correlation of Apparent Diffusion Coefficient with Histopathological Prognostic Parameters.

OBJECTIVE: To evaluate the value of apparent diffusion coefficient (ADC) for the differentiation of histological subtypes in endometrial cancer, and to assess if ADC values correlate with histopathological parameters. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Radiology, Faculty of Medicine, Ondokuz Mayis University between January 2016 and December 2019. METHODOLOGY: Eighty-three patients (mean age: 60.28 ± 9.07) with endometrial cancer underwent diffusion-weighted imaging (DWI) at 3T before surgery. The mean ADC (ADCmean) and minimum ADC (ADCmin) values of the tumours were assessed to predict histological subtype of endometrial cancer, grade of tumour, presence of myometrial invasion, lower uterine segment involvement, cervical involvement, lymphovascular invasion, and lymph node metastasis. RESULTS: Sixty patients (72.3%) were diagnosed with endometrioid carcinoma, and 23 patients (27.7%) were diagnosed with non-endometrioid carcinoma. The median ADCmean/ADCmin of endometrioid and non-endometrioid tumours were 0.72/0.58 ×10-3 mm2/s and 0.82/0.63 ×10-3 mm2/s, respectively. ADCmean and ADCmin were significantly different between endometrioid and non-endometrioid tumours (p=0.016 and p=0.048). For the endometrioid carcinomas, ADCmean and ADCmin were significantly different between low-grade (G1 and G2) and high-grade (G3) tumours (ADCmean/ADCmin = 0.75/0.65 vs. 0.59/0.49 x10-3 mm2/s, p=0.010 and p=0.013). Myometrial invasion, lymphovascular invasion, cervical involvement, lower uterine involvement, serosal involvement and lymph node metastasis were not significantly associated with ADC values. CONCLUSION: ADC measurements were useful for differentiating endometrioid and non-endometrioid carcinomas. High-grade endometrioid carcinomas had significantly lower ADC values compared to low-grade ones. Key Words: Endometrial cancer, Diffusion-weighted MRI, Apparent diffusion coefficient, Prognostic factors, Histological grade.

A rare cause of recurrent hematuria in children: Nutcracker syndrome.

Nutcracker syndrome (NCS), the left renal vein hypertension due to compression between aorta and superior mesenteric artery, may present with hematuria, flank pain and proteinuria. We report a 6-year-old girl with episodic macroscopic hematuria who was diagnosed as NCS with Doppler ultrasound and 3D computerized tomography angiography. She was managed conservatively with spontaneous resolution of macroscopic hematuria. With this case we would like to emphasize that in children with hematuria and orthostatic proteinuria without an apparent cause, a great index of suspicion and appropriate imaging is necessary for the diagnosis of NCS.

Discrimination of papillary renal cell carcinoma from benign proteinaceous cyst based on iodine and water content on rapid kV-switching dual-energy CT.

PURPOSE: We aimed to evaluate whether rapid kV-switching dual energy CT (rsDECT) can discriminate between papillary renal cell carcinoma (RCC) and benign proteinaceous cysts (BPCs) based on iodine and water content. METHODS: Twenty-four patients with histopathologically proven papillary RCC and 38 patients with 41 BPCs were retrospectively included. Patients with BPCs were eligible for inclusion when the cysts were stable in size and appearance for at least 2 years or proved to be a cyst on ultrasound or MRI. All patients underwent delayed phase (70-90 s) rsDECT. Iodine and water content of each lesion was measured on the workstation. RESULTS: Of papillary RCC patients, 4 (16%) were female and 20 (84%) were male. Mean tumor size was 39±20 mm. Mean iodine and water content was 2.08±0.7 mg/mL and 1021±14 mg/mL, respectively. Of BPC patients, 9 were female and 29 were male. Mean cyst size was 20±7 mm. Mean iodine and water content was 0.82±0.4 mg/mL and 1012±14 mg/mL, respectively. There were significant differences between iodine and water contents of papillary RCCs and BPCs (P < 0.001). The best cutoff of iodine content for differentiating papillary RCC from BPC was 1.21 mg/mL (area under the curve [AUC]=0.97, P < 0.001, sensitivity 96%, specificity 88%, positive predictive value [PPV] 82%, negative predictive value [NPV] 97%, accuracy 91%,); the best cutoff of water content was 1015.5 mg/mL (AUC=0.68, P = 0.016, sensitivity 83%, specificity 56%, PPV 52%, NPV 85%, accuracy 66%). CONCLUSION: An iodine content threshold of 1.21 mg/mL accurately differentiates papillary RCC from BPCs on a single postcontrast rsDECT. Despite having a high sensitivity, water content has inferior diagnostic accuracy.

Three-dimensional multislice spiral computed tomographic angiography: a potentially useful tool for safer free tissue transfer to complicated regions.

Three-dimensional multislice spiral computed tomographic angiography (3D-MSCTA) is a minimally invasive method of vascular mapping. The aim of this study was to evaluate the clinical usefulness of this imaging technique in delineating the recipient vessels for safer free tissue transfer to complicated regions. 3D-MSCTA was performed preoperatively in 26 patients scheduled for free tissue transfer, in whom the availability of the recipient vessels were considered to be uncertain, and 23 of these were operated on. Radiographic and operative findings regarding the availability of the recipient vessels for anastomosis were correlated in 21 of these 23 patients. 3D-MSCTA yielded two false-positive results; anastomosis was not possible because of widespread atherosclerotic plaques and poor flow observed in the recipient arteries despite the good caliber observed in 3D-MSCTA images. 3D-MSCTA provides a noninvasive means of preoperatively assessing recipient site vessels for anatomic variations and suitability before free tissue transfer and enables the surgeon to establish an appropriate treatment plan. But it is not 100% reliable yet and the possibility of false-positive results should be kept in mind, especially inthe patients with peripheral vascular disease. 3D-MSCTA has the potential to replace digital subtraction angiography for planning of microvascular reconstructions and newer devices with higher resolutions will probably increase the reliability of this technique. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.

Efficacy of perfusion CT in differentiating of pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis and characterization of isoattenuating pancreatic lesions.

PURPOSE: Multidetector computed tomography (MDCT) is routinely used in the diagnosis of pancreatic ductal adenocarcinoma (PDAC), but it may be inadequate in some cases, especially mass-forming chronic pancreatitis (MFCP) and isoattenuating pancreatic lesions. Perfusion CT (pCT) may help resolve this problem. The aim of this study was to evaluate whether pCT could help differentiating PDAC from MFCP and in characterization of isoattenuating pancreatic lesions. MATERIALS AND METHODS: This prospective study included 89 cases of pancreatic lesions detected by MDCT and further analyzed with pCT. Sixty-one cases with final pathological diagnosis PDAC and 12 cases with MFCP were included from the study. Blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface area product (PS) maps were obtained. Perfusion values obtained from the lesions and normal parenchyma were compared. RESULTS: Compared with normal parenchyma, BV, BF, PS were lower and MTT was longer in PDAC and MFCP (p < 0.05). Compared with MFCP, BV, BF, PS were lower and MTT was longer in PDAC (p < 0.001). Compared with normal parenchyma, BV, BF, PS were lower and MTT was longer in isoattenuating lesions, (p < 0.001). Cutoff values of 7.60 mL/100 mL, 64.43 mL/100 mL/min, 28.08 mL/100 mL/min for BV, BF, PS, respectively, provided 100% sensitivity and specificity and 7.47 s for MTT provided 98.3% sensitivity, 80% specificity for distinguishing PDAC from MFCP. CONCLUSION: pCT is a useful technology that can be helpful in overcoming the limitations of routine MDCT in diagnosing PDAC and characterization of isoattenuating lesions.

Usefulness of rapid kV-switching dual energy CT in renal tumor characterization.

PURPOSE: To investigate whether iodine content can discriminate between benign or malignant renal tumors, malign tumor subtypes, low-grade and high-grade tumors on rapid kv-switching dual-energy CT (rsDECT). METHODS: This prospective study enrolled 95 patients with renal tumors who underwent rsDECT for tumor characterization between 2016 and 2018. Attenuation on true and virtual unenhanced images, absolute enhancement and enhancement ratio and iodine content of each lesion on nephrographic phase iodine density images were measured. Histopathological diagnosis was obtained following either surgery or core biopsy. RESULTS: Eighty-five tumors were renal cell carcinoma (RCC) (56 clear cell, 20 papillary, 9 chromophobe) and 10 were benign (6 angiomyolipoma,4 oncocytoma). 46 tumors were low-grade and 23 high-grade. There was significant difference between iodine content of clear cell and non-clear cell (papillary + chromophobe) RCC (p < 0.001). However, no significant iodine content differences were found between papillary and chromophobe RCC, benign and malignant tumors, low-grade and high-grade tumors. The best cut-off iodine content for differentiating clear cell from non-clear cell RCC was 3.2 mg/ml and clear cell from papillary RCC was 2.9 mg/ml with a high sensitivity and specificity. Also, significant difference was found between attenuation values of true and virtual unenhanced images (p = 0.007). Mean iodine content, absolute enhancement and enhancement ratio were highly correlated. CONCLUSION: rsDECT contributes to renal tumor characterization by showing higher iodine content in clear cell RCCs compared with non-clear cell RCCs.

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.

Evaluation of artifacts generated by titanium, zirconium, and titanium-zirconium alloy dental implants on MRI, CT, and CBCT images: A phantom study.

OBJECTIVE: The aim of this study was to assess artifacts generated by zirconium, titanium, and titanium-zirconium alloy implants on magnetic resonance imaging(MRI), computed tomography(CT), and cone beam computed tomography(CBCT) and to correlate the findings to the dose-area product and exposure factors on CT and CBCT. STUDY DESIGN: Three phantoms were built by embedding zirconium, titanium, and titanium-zirconium implants in ultrasound gel. MRI, CT, and CBCT images were acquired by using multiple sequences and settings. For MRI, "artifact" was described as the length of signal void beyond the limits of the implant. For CT and CBCT, "artifact" was calculated by subtracting the gray level of the darkest pixel from the level of the lightest pixel. RESULTS: On MRI, zirconium implants had minor distortion artifacts, whereas titanium and titanium-zirconium implants created extensive artifacts (P < .05). On CT and CBCT, artifacts were less prominent with titanium and titanium-zirconium implants compared with zirconium (P < .05). Titanium grade 5 implants with 0.3 and 0.4 mm3 voxels produced the least severe artifacts. CONCLUSIONS: MRI images were less affected by artifacts from zirconium implants, whereas CT and CBCT images showed less severe artifacts from titanium and titanium-zirconium alloy implants. CT generated greater artifacts compared with CBCT. Larger CBCT voxel sizes reduced the dose-area product and the severity of artifacts.

Focal liver lesions: whether a standard dose (0.05 mmol/kg) gadobenate dimeglumine can provide the same diagnostic data as the 0.1 mmol/kg dose.

OBJECTIVE: Gadobenate dimeglumine (Gd-BOPTA) is a liver-specific contrast agent also showing a distribution in the extracellular compartment which is recommended to be used at standard dose (0.05 mmol/kg) in magnetic resonance imaging (MRI) of liver lesions. However, its use at 0. 1mmol/kg is gradually increasing in recent clinical practice. Which dose should we use in routine MRI of liver lesions from now on? This study investigated the efficacy of Gd-BOPTA at a standard dose versus 0.1 mmol/kg dose in demonstrating diagnostic data in MRI of focal liver lesions. MATERIALS AND METHODS: The study included 47 patients with focal liver lesions. Twenty-two patients received standard dose and 25 patients received 0.1 mmol/kg dose Gd-BOPTA intravenously. MRI of both groups was carried out with T1-A FLASH-2D and T2-A TURBO spin echo before contrast injection and T1-A FLASH-2D sequences in dynamic and late phase (90th minute) after the contrast injection. The lesion conspicuity for each image was evaluated qualitatively. Liver signal to noise ratio (SNR), absolute lesion-liver contrast to noise ratio (CNR), mean lesion-liver CNR and contrast enhancement rate of the liver obtained from both groups were compared quantitatively. RESULTS: While liver contrast enhancement rate in the group receiving standard dose Gd-BOPTA were 41%+/-42 in the arterial phase, 66%+/-58 in the portal phase, 45%+/-45 in the venous phase and 42%+/-88 in the late phase, these values were 43%+/-59, 86%+/-73, 63%+/-75 and 61%+/-105, respectively, in the group receiving the dose of 0.1 mmol/kg. There were no statistically significant differences between the means of both groups. While the absolute lesion-liver CNR values were 18+/-15 precontrast, 22+/-18 in the arterial phase, 19+/-17 in the portal phase, 15+/-10 in the venous phase and 24+/-26 in the late phase in the group receiving the standard dose Gd-BOPTA, these values were 13+/-11, 18+/-15, 15+/-15, 13+/-13 and 19+/-21, respectively, in the group receiving the 0.1 mmol/kg dose. There were no statistically significant differences between the means of both groups (p>0.05). However, when the mean lesion-liver CNR values were compared, there was statistically significant difference between each arterial and portal phases of metastases in both groups (p<0.05). There was no statistical difference found in other lesions. When lesion conspicuity scores were compared, there were no significant differences between the two groups. CONCLUSION: In liver lesions, similar diagnostic data are obtained in dynamic and late phase MRI with either standard dose Gd-BOPTA or with a dose of 0.1 mmol/kg. Because there was a difference in only metastases in both groups, in oncological patients who are being investigated for liver metastasis, it is expedient to use a dose of 0.1 mmol/kg.

A comparison of low-dose and normal-dose gadobutrol in MR renography and renal angiography.

OBJECTIVE: It has been advocated that a reduced injection volume with highly concentrated (1 M) contrast material can produce a sharper bolus peak and an increased intravascular first-pass gadolinium concentration when compared with the use of a lower concentration (0.5 M). A higher concentration would also cause a reduction in dose. The purpose of our study was to test the use of a low dose (0.05 mmol/kg) of gadobutrol in magnetic resonance renography and angiography and compare the findings with a dose of 0.1 mmol/kg. MATERIALS AND METHODS: One-hundred-thirty-four patients referred for magnetic resonance angiography for suspected renovascular disease participated in the study. Contrast enhanced MR renography and angiography were performed after administration of a bolus of 0.1 mmol/kg or 0.05 mmol/kg gadobutrol in randomized patients. The relative signal intensity-time curves of the aorta, peripheral cortex and parenchyma, were obtained. Two radiologists evaluated the angiographic images and evaluated the quality of angiography. RESULTS: The signal intensity with a low dose of gadobutrol was significantly lower in early phases, in the peripheral cortex (for 36, 54, 72 and 90 seconds), the parenchyma (for 36, 54, 72 seconds) and the aorta (for 18, 36, 54, 72 seconds). The decreases in the early phase obtained with a low dose of gadobutrol caused blunter time intensity curves. The difference in the quality scores of the readers for the angiographic images for the use of the two different doses was not statistically significant (p > 0.05). CONCLUSION: A lower dose of gadobutrol can be used for MR renal angiography, but for MR renography the normal dose should be used.

Leiomyosarcoma of the inferior vena cava.

Primary vascular leiomyosarcoma is a rare tumor, which arises mainly from the inferior vena cava. Clinical signs are non-specific. Systemic metastasis occurs in the late stage. Imaging with color Doppler ultrasonography, contrast-enhanced computed tomography, or magnetic resonance imaging can significantly contribute to the diagnosis. We present a case of leiomyosarcoma of the inferior vena cava that extended into the right renal vein and the right iliac vein, as it is a rare case and emphasize the significance of the imaging methods in its diagnosis.

A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma.

Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented.

Caesarean Scar Choriocarcinoma: Ultrasound and Magnetic Resonance Imaging Findings.

Primary gestational choriocarcinoma in a uterine caesarean section scar (CSS) is an extremely rare entity, and its timely diagnosis and treatment is crucial in order to prevent related complications and metastatic disease. Herein, we report on a 33-year-old female who was referred to our department with an initial diagnosis of ectopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) demonstrated a nodular mass on CSS. The final histopathological diagnosis was CSS choriocarcinoma.

Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries.

INTRODUCTION: The aim of this study was to evaluate the role of diffusion-weighted magnetic resonance imaging (MRI) in the diagnosis of ovarian torsion. METHODS: We retrospectively identified 84 patients with surgically confirmed ovarian torsion. Seventeen patients with unclear ultrasound findings underwent MRI examination with two different magnetic resonance (MR) systems. RESULTS: In ovarian torsion, the mean apparent diffusion coefficient (ADC) value of the torsed ovary was significantly lower than that of the nonaffected ovary in both MR systems (n=17; 0.898±0.539 vs. 1.615±0.469×10(-3)mm(2)/s; P<.001). CONCLUSIONS: ADC comparisons were useful for detecting ovarian torsion.