Prognostic and Clinical Role of Contrast Enhancement on Magnetic Resonance Imaging in Patients with Bell's Palsy.

Objective: To investigate the prognostic value of the magnetic resonance imaging in Bell's palsy patients. Methods: Patients who were diagnosed and treated with Bell's palsy between October 2013 and March 2016 retrospectively selected. House-Brackmann grades, pre- and post-treatment pure tone audiograms, stapedial reflexes were analyzed and magnetic resonance imaging (MRI) scans with gadolinium-based contrast agents were evaluated. Contrast-enhanced segments of the facial nerve were determined. MRI findings were compared statistically with pre- and post-treatment grade, recurrence rate of Bell's palsy, MRI scanning timing, presence of stapes reflexes and posttreatment recovery data. Results: No significant correlation was observed between pretreatment House-Brackmann grades and enhancement (p>0.05). Similarly, there was no significant correlation between clinical recovery and enhancement (p>0.05). Also, no significant correlation was observed between MRI scanning time, the recurrence rate of Bell's palsy and MRI findings (p>0.05). None of the MRIs showed neoplastic contrast enhancement. Conclusion: The routine use of the contrast-enhanced temporal MRI is not recommended in the diagnosis and monitoring of Bell's palsy patients, because the contrast enhancement pattern of the facial nerve has no effect on the prognosis of Bell's palsy. MRI should be used in cases that do not heal despite treatment, for the differential diagnosis of facial nerve tumors and in patients who are candidates for surgical decompression.

Anti-fibrotic Treatment for Pulmonary Fibrosis Induced by COVID-19: A Case Presentation.

Coronavirus disease 19 infection clinical presentation varies from asymptomatic cases to acute respiratory distress syndromes. In some cases, pulmonary fibrosis is observed after or during the disease. Pirfenidone is an agent approved for the treatment of idiopathic pulmonary fibrosis. Here we report a patient treated with pirfenidone for pulmonary fibrosis related to coronavirus disease 19.

The Effects of the Fat Distribution of Body, Skeletal Muscle Mass and Muscle Quality on Acute Pancreatitis Severity: A Retrospective Cross-Sectional Study.

OBJECTIVE: We aim to investigate a possible relationship between acute pancreatitis (AP) and body fat and muscle parameters in computed tomography (CT). METHODS: Computed tomography images of 107 patients with AP were scored in terms of AP severity using the modified CT severity index. Muscle mass, muscle mass index, visceral and subcutaneous adipose tissue area, multifidus muscle/fat attenuation ratio, total psoas index (TPI) and Hounsfield units average calculation (HUAC) values were performed. RESULTS: Total psoas index and HUAC of mild AP cases were significantly higher than those with moderate and severe AP. The TPI of patients with severe pancreatic necrosis were found to be significantly lower than those without necrosis. Hounsfield units average calculation of cases without necrosis were significantly higher than those with severe necrosis in the pancreas. CONCLUSIONS: Our study indicated that lower volume and density of psoas muscle associated with worse CT severity score and larger pancreatic necrosis in patients with AP.

The impact of TI-RADS in detecting thyroid malignancies: a prospective study.

INTRODUCTION: Thyroid ultrasonography (US) is the first-step noninvasive and easily accessible diagnostic method widely used in the detection and characterization of nodular thyroid disease. We aimed to develop a TI-RADS, which is easy to apply and only relies on the counting of suspicious criteria. In order to measure the reliability of the system, we investigated its correlation with fine needle aspiration biopsy (FNAB) and post-surgery histological results. MATERIALS AND METHODS: In this prospective study, 242 patients who had undergone FNAB with simultaneous cytopathologist in the radiology department between April and August 2016 were analyzed. Before FNAB, the thyroid gland was re-evaluated with US, and TI-RADS classification was made. Demographic characteristics, family thyroid cancer history and radiotherapy history to the neck region were noted. RESULTS: Of the 242 patients, 17.3% were male (42 males/200 females). US-guided FNAB was applied to all patients. Mean age was 50 ± 13 years (min: 19, max: 82). Both FNAB and final post-surgery histology results showed that sex and age were not statistically significantly associated with malignancy (p = 0.193) TI-RADS criteria and FNAB results revealed a statistically significant association between irregular contours, the state of anteroposterior diameter being longer than transverse diameter, microcalcifications, marked hypoechogenicity, and malignancy (p < 0,05). Thirty patients were TI-RADS ≥ 4, 206 patients were TI-RADS ≤ 3 and there was a significant correlation between TI-RADS and Bethesda classification (p = 0.001). In addition, statistically significant associations were found between malignancy and family history of thyroid cancer (p = 0.035) and radiotherapy history to the neck region (p = 0.01). CONCLUSION: TI-RADS system after nodule identification is based only on the counting of suspicious criteria. It will be safe and effective to recommend follow-up with low score TI-RADS, benign characters and insufficient FNAB results, and thus, unnecessary thyroidectomy operations will be prevented. It will be easier for surgeons to recommend surgery and persuade the patients for it when patients have high TI-RADS scores. TI-RADS has high power in detecting malignancy by recommending biopsy of suspicious nodules.

The neuroimaging features of Rathke's cleft cysts in children with endocrine-related diseases.

PURPOSE We aimed to evaluate the frequency and neuroimaging features of Rathke's cleft cysts (RCCs) in children examined for endocrine-related diseases and to determine changes in the neuroimaging features of RCCs during the follow-up of children. We hypothesize that RCCs are being more commonly diagnosed in children with endocrine-related diseases and most of the RCCs show neither fluid intensity nor intensity due to high protein content on magnetic resonance imaging (MRI). METHODS After approval by the local ethics committee, the medical records and contrast-enhanced pituitary MRI of 833 children (boys/girls, 338/495; mean age±SD, 9.4±3.7 years) were retrospectively reviewed between January 2016 and January 2019. The size, location, signal intensities, and postcontrast enhancement pattern of RCCs were assessed by a pediatric radiologist. Same imaging features were also independently reviewed by another radiologist to determine the interobserver agreement by using the kappa statistics (κ) and intraclass correlation coefficient (ICC). RESULTS RCC was evident on MRI in 13.5% of the patients (boys/girls, 39/74; mean age±SD, 9.8±3.9 years). The mean size of RCCs was 5.5 mm (range, 3.1-8.5 mm). An RCC frequency higher than expected was found in patients with central precocious puberty, diabetes insipidus, and hypersecretion of prolactin (P = 0.007). The mean size of RCCs did not show significant differences among the clinical indications for MRI (P ≥ 0.461). All RCCs showed abnormal signal on T2-weighted image and most (89%) showed neither fluid intensity nor intensity due to high protein content (i.e., isointense on T1-weighted imaging and hypointense on T2-weighted imaging compared with the normal anterior pituitary gland). Eighty-four patients with RCCs (74%) had follow-up MRI and the mean follow-up was 1.5 years. In follow-ups, five RCCs disappeared; the mean size of 10 RCCs increased and that of 6 RCCs decreased. These size changes were not statistically significant (P = 0.376). No signal intensity changes of RCCs were seen during the follow-up, except for 4 RCCs, whose protein content increased over time and T1 signals increased on imaging. Interobserver agreements were almost perfect for the MRI findings of RCCs (κ and ICC range, 0.81-1, P < 0.001). CONCLUSION RCCs were not uncommon in patients examined for endocrine-related diseases, and nearly 1 in 10 patients had an RCC. The size and signal intensities of RCCs may change over time and the evolution of RCCs is unpredictable. Most RCCs showed neither fluid intensity nor intensity due to high protein content on MRI, and all RCCs had an abnormal signal on T2-weighted imaging, thus eliminating the need to administer a contrast agent at follow-up imaging of the patients.

Measurements in cervical vertebrae CT of pediatric cases: normal values.

PURPOSE: This study aims to determine the normal limits of atlanto-dental interval (ADI), basion-dens interval (BDI), basion-cartilaginous dens interval (BCDI), and prevertebral soft tissue thickness (PVSTT) according to age groups for normal pediatric cases. MATERIALS AND METHODS: CT images of 256 pediatric patients aged between 1 and 15 years were retrospectively evaluated. ADI, BDI, BCDI and PVSTT measurements were performed. RESULTS: Upper normal limit (UNL) values for ADI were 2.65-4.8 mm. UNL values for PVSTT were found to be 6.9 mm at C1 level, 6.7 mm at C2 level, 9.3 mm at C3 level, 14.2 mm at C4 level, 14.1 mm at C5 level, 13.8 mm at C6 level and 12.8 mm at C7 level. The maximum value of BDI in the group with non-ossified os terminale was 12 mm, and in the group with ossified os terminale it was 10 mm. The UNL of BCDI determined for females was 5.1 mm, while the UNL for males was 5.6 mm. CONCLUSION: We propose the obtained values as the UNL values for ADI, BDI, BCDI and PVSTT on CT images in the pediatric population from 1 to 15 years.

Evaluation of pterygoid plate fractures unrelated to Le Fort fractures using maxillofacial computed tomography.

BACKGROUND: This study aims to describe the major pterygoid plate fractures (PPFs) patterns unrelated to Le Fort fractures (LFFs) using maxillofacial computed tomography (CT). METHODS: After obtaining our hospital ethics committee approval (37-05), data for PPF were acquired from the medical records of all the trauma patients who were diagnosed using CT at our hospital from April 2014 to April 2017. RESULTS: Of the 178 patients, 135 (male/female = 86/49; mean age = 37.2 years) had LFF and 43 (male/female = 35/8; mean age = 38.6 years) had PPF without associated LFF. PPF patterns unrelated to LFF included temporal bone (11.6%), sphenotemporal buttress (25.5%), zygomaticomaxillary complex (30.2%), displaced mandible (23.3%), nasal (4.7%), and isolated fractures (4.7%). The etiologies of facial fractures were not significantly different between both sexes (p=0.576). No significant difference between Le Fort and non-Le Fort groups was found for age (p=0.603) and the causes of trauma (p=0.183). CONCLUSION: PPF is most commonly seen with LFF, but it may also be seen alone or with other non-LFF indicating that all PPF are not related to LFF. Axial reformatted CT images can easily display PPF and the degree of displacement of the fragments, and they can be used to guide surgical reduction of the fractures.

Normal abdominal aorta diameter in infants, children and adolescents.

BACKGROUND: The normal limits of arterial diameters must be known to diagnose pathologies such as dilatation, stenosis and hypoplasia. Thoracic aorta diameter in childhood has been measured in previous studies, but the number of studies in which normal aortic diameter is determined is very small. The aim of this study was therefore to determine the normal standard diameter of the aorta and iliac arteries in children according to gender and level. METHODS: Pediatric abdominal computed tomography carried out for various reasons was retrospectively re-evaluated between January 2016 and February 2017. Patients were classified according to age into six groups. Vessel diameter, age, gender and vertebra diameter were evaluated. RESULTS: Mean proximal aorta diameter was 8.84 mm for 12-36 months, 10.02 mm for 37-84 months, 12.32 mm for 85-132 months, 14.45 mm for 133-180 months, and 16.51 mm for 181-204 months. Mean distal aorta diameter was 6.67 mm for 12-36 months, 8.07 mm for 37-84 months, 10.79 mm for 85-132 months, 12.14 mm for 133-180 months, and 14.01 mm for 181-204 months. The lumen diameter of the abdominal aorta, both proximally and distally, correlated linearly with age as an independent predictor. Similarly, the lumen diameter of the right and left common iliac artery correlated linearly with age as an independent predictor. There was no statistically significant difference in vascular diameter according to gender in any age groups. CONCLUSIONS: Optimal evaluation of aortic diameter is possible on computed tomography. Measurement outside the normal range is a sign of aneurysm or hypoplasia.

A rare cause of abdominal pain: Catheter in the middle hepatic vein.

Hemodialysis catheters are vital for chronic renal failure patients. Permanent tunneled dialysis catheters may be inserted through the jugular, subclavian, and femoral veins. In this paper, we aimed to present the computed tomography findings of a chronic renal failure patient who had referred our clinic with abdominal pain and dyspnea symptoms. This patient had a formerly inserted hemodialysis catheter for chronic renal failure and her catheter was found to be extending towards the middle hepatic vein with the tip leaning onto the parenchyma. Hemodialysis catheters can provide instant vascular access and can also be used for the consecutive procedures. Permanent hemodialysis catheters are ideal for long-term use when placing an arteriovenous fistula is contraindicated or is no longer possible under conditions like advanced heart failure, peripheral artery disease or short life expectancy. The internal jugular, subclavian, the femoral veins, and the inferior vena cava can be used for catheter insertion. The tip of the catheters inserted in the neck or the thorax must extend to the vena cava superior. Catheter malposition may both lead to fatal outcomes and ineffective dialysis. It is important to obtain chest X-rays after the procedure, particularly to detect catheter malposition.