Evaluation of treatment response by multiparametric MR imaging in locally advanced rectal tumors following neoadjuvant chemotherapy.

PURPOSE: To investigate the effectiveness of multiparametric MRI examination in determining tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal tumors. METHODS: 46 patients with locally advanced rectal adenocarcinoma were included and were divided into two groups as complete responders and nonresponders based on Mandard score. On MRI, relative T2w signal intensity and ADC values obtained before and after treatment and tumour volumes in dynamic contrast enhanced images (DCI) were used to determine complete response to treatment. RESULTS: There were no significant differences between mean ADC values obtained by single slice ADC and three circular ROI methods. There were significant differences between two groups in terms of Post-CRT ADC value, ΔADC and %ΔADC obtained by whole tumour volume ADC method (p < 0.05). There were significant differences between Pre-CRT and Post-CRT volume values. ΔV DCI and %ΔV DCI, ΔV ADC and T2w volume values were significantly lower in complete responders (p < 0.05). In multivariate analysis, sensitivity and specificity were calculated as 88.9% and 91.9% (AUC = 0.943) when Post-CRT mean ADC value and Post-CRT DCI volume values were used together, and sensitivity and specificity were calculated as 88.9% and 94.6% (AUC = 0.949) when ΔADC and Post-CRT DCI volume values were used together. CONCLUSION: Whole tumour volume mean ADC value is the most useful method to determine treatment response. Post-CRT DCI volume measurement stands out as the most useful method in assessing complete response alone. The highest diagnostic values are achieved when the post-CRT DCI volume is combined with the ADC change value of the whole tumor volume.

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Intraoperative Ultrasound Can Facilitate Laparoscopic Partial Nephrectomy in Adherent Perinephric Fat.

Background: Adherent perinephric fat (APF) is one of the challenging factors of laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the effect of intraoperative laparoscopic ultrasound (ILUS) on determining renal tumor localization and dissection in patients with APF who underwent LPN. Methods: Prospectively collected data from 517 patients who underwent LPN from October 2010 to September 2020 in tertiary university hospital were evaluated retrospectively. The cohort was divided into two main groups according to the Mayo Adhesive Probability (MAP) score: Group 1 (MAP score ≤3) and Group 2 (MAP score ≥4). After implementing propensity score-matched analysis including the complexity of tumor, age, and body mass index, Group 1 consisted of 202 patients with ≤3 MAP score and Group 2 included 46 patients. Then, both groups were allocated into two subgroups according to whether ILUS was used. Demographics, perioperative features such as perirenal fatty tissue dissection, tumor excision, operation time, and perioperative outcomes accepted as trifecta, considering warm ischemia time, negative surgical margin, and complications were compared. Results: In Group 1, ILUS use did not seem to affect perioperative outcomes in both subgroups. However, ILUS has a positive effect on perirenal fatty tissue dissection (10 versus 19 minutes, P = .011), tumor excision (4 versus 7 minutes, P = .005), and operation time (78 versus 90 minutes, P = .046) in Group 2. Trifecta outcomes were also better in higher MAP scores and ultrasound-used subgroups (P = .019). Conclusions: ILUS should be considered a helpful and effective instrument in overcoming APF in LPN. It might also have a positive effect on trifecta outcomes.

Laparoscopic resection of retroperitoneal bronchogenic cyst clinically presenting like adrenal cyst.

Bronchogenic cyst that is localized to retroperitoneum is a rare clinical entity. It is a congenital malformation generally occuring in the posterior mediastinum due to abnormal development of the foregut. We report the case of a retroperitoneal cyst presented like left adrenal cyst. A 38 years old female was presented with left upper abdominal pain. Endocrinologic evaluation was done and no adrenal hormonal secretion was detected. The cyst was removed laparoscopically. It was confirmed in pathologic examination as a bronchogenic cyst. Bronchogenic cysts should be considered in the differential diagnosis of retroperitonal cysts. Laparoscopic resection of retroperitoneal cysts results in better outcome.

Is condyle morphology a factor for anterior temporomandibular disc displacement?

BACKGROUND: To investigate morphological features of the mandibular condyle and its association with anterior temporomandibular disc displacement on sagittal oblique MRI plane. METHODS: One hundred and twenty patients with temporomandibular MRI examination were retrospectively involved in the study. Patients aged less than 18 years and those with severe osteoarthritis, posterior disk displacement, tumor, abscess, history of a rheumatic disease, facial trauma, and motion artifacts on images were excluded. Three radiologists evaluated all images in consensus. Temporomandibular disc locations were classified as normal, anteriorly displaced with reduction (ADr), and anteriorly displaced without reduction (ADwr) on sagittal oblique T1-weighted images. Condylar shapes were classified as flat, rounded, and angled, and condyle anteroposterior width (c-APW) was measured on these images in closed-mouth position. RESULTS: Ninety six discs were in normal position (40%), 70 discs were ADr (29%), and 74 discs were ADwr (31%). Eighty-four condyles were flat (35%), 100 condyles were rounded (42%), and 56 condyles were angled (23%). Mean c-APW was 7 mm in normal joints, 5.9 mm in ADr, and 5.8 mm in ADwr joints, and it was smaller in joints with anterior disc displacement (p < 0.001). In normal joints, flat and rounded type condylar shape was more common and almost equally prevalent (44% and 43%); however, rounded type was more common among ADr (%47) and angled type was more common among ADwr joints (36%) (p = 0.008). Patients with anterior disc displacement were significantly younger from normal cases and anterior disc displacement was more common among female sex. DISCUSSION: Mandibular condyle shape alterations and condyle size on sagittal oblique MRI plane are associated with anterior disc displacement. Angled shape was more common among ADwr joints. Joints with anterior disc displacement had smaller c-APW than normal joints.

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.

Compatibility of true and virtual unenhanced attenuation in rapid kV-switching dual energy CT.

PURPOSE: We aimed to evaluate whether virtual unenhanced images (VUI) generated from nephrographic phase on rapid kV-switching dual energy CT (rsDECT) can replace true unenhanced images (TUI) by comparing attenuation values of various intraabdominal structures. METHODS: In this retrospective study, 142 patients had unenhanced and nephrographic phase dual energy CT images. Attenuation values of the aorta, liver,spleen, pancreas, bilateral renal parenchyma, inferior vena cava, gallbladder and paraspinal muscle on TUI and VUI were recorded. Frequencies of organs who had more than 10 and 20 HU of attenuation difference were also calculated. RESULTS: A total of 1224 ROIs were sampled. No statistically significant differences were found between TUA and VUA of the aorta, spleen and pancreas. The other structures had significant differences (P < 0.001). Correlation between measurements were weak to moderate (r=0.17-0.72). 20% of organs had more than 10 HU difference and 5% had more than 20 HU difference between TUI and VUI. CONCLUSION: rsDECT based VUI does not seem to be an ideal surrogate for TUI.

Is gynecomastia related to the disease characteristics and prognosis in testicular germ cell tumor patients?

PURPOSE: We aimed to assess the relationship between gynecomastia and tumor markers, histologic subtypes, and prognosis in patients with testicular germ cell tumors. METHODS: This study included 73 testicular germ cell cancer patients with pretreatment chest, abdomen and pelvis computed tomography (CT) scans and tumor markers (ß-human chorionic gonadotropin [ß-hCG], lactate dehydrogenase [LDH], α-fetoprotein [AFP]). The volumetric analysis of the breast glandular tissue, the presence of gynecomastia and metastatic disease were determined using CT scans. Patients were classified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification. The association between gynecomastia, breast glandular tissue volume, tumor markers, metastatic disease, and disease prognosis were evaluated. RESULTS: Thirty-four of the patients (46.6%) had gynecomastia. A breast volume cutoff value of 0.78 cm3 to diagnose gynecomastia led to 85% sensitivity and 95% specificity. Serum ß-hCG level correlated with the breast glandular tissue volume weakly (r=0.242, P = 0.039). Gynecomastia was more common in patients with elevated ß-hCG levels (P = 0.047), and was not associated with pulmonary, nonpulmonary distant, or nodal metastases (P = 0.378, P = 0.884, P = 0.333, respectively). No significant association was found between the disease prognosis and gynecomastia (P = 0.556). CONCLUSION: Gynecomastia was common among testicular germ cell cancer patients with elevated ß-hCG. However, it was not associated with metastatic disease and prognosis.

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.

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.

Percutaneous Coronary Intervention for Coronary Arteries with Origin and Course Anomalies: Case Reports and Literature Review.

Coronary artery anomalies (CAAs) are defined as variants of normal epicardial coronary arteries. They are mostly detected incidentally during coronary angiography. Clinical studies have shown that abnormal origins and courses of coronary arteries make them more prone to atherosclerosis. Percutaneous treatment for atherosclerotic occlusions in anomalous coronary arteries has some difficulties, including inadequate guiding-catheter support and the need for an experienced operator. Here, we describe successful percutaneous coronary interventions for critical stenoses in 2 different CAAs and present a brief literature review.

Lower energy levels and iodine-based material decomposition images increase pancreatic ductal adenocarcinoma conspicuity on rapid kV-switching dual-energy CT.

PURPOSE: Multidetector computed tomography (MDCT) is used in the diagnosis of pancreatic ductal adenocarcinoma (PDAC), but it may be inadequate in some cases. Tumor detection can be improved using rapid kV-switching dual-energy CT (rsDECT) and iodine maps. Our aim this study is to evaluate tumor conspicuity in PDAC cases using rsDECT and iodine maps. METHODS: Ninety cases with PDAC were evaluated rsDECT. Tumor contrast (HU) differences, tumor size, CNR (contrast-noise ratio), and noise were measured at 70 keV, individual CNR-energy level, and 45 keV, respectively. Quantitative differences in contrast gain ∆70-CNR and ∆CNR-45 were compared. On iodine maps, the iodine concentration measured in the tumor and parenchyma was normalized to the aorta as normalized iodine concentration (NIC) and compared. RESULTS: The median optimized viewing energy level was 51 keV. The mean ± SD tumor contrast values were 62 ± 20, 115 ± 48, and 152 ± 48 HU (p < 0.001); the largest axial diameters were 36.6 ± 5.1, 37.9 ± 4.2, and 38.3 ± 3.7 mm (p = 0.015); the CNRs were 1.83 ± 0.72, 3.37 ± 0.93, and 2.36 ± 0.56; and the image noise levels were 23.7 ± 6.8, 39.3 ± 11.6, and 59.5 ± 17.2 (p < 0.001) (p < 0.001) for 70 keV, optimized energy level, and 45 keV, respectively. The mean ± SD contrast gain ∆70-CNR was 63 ± 12; and ∆CNR-45 was 31 ± 26 HU (p < 0.001). NICtumor and NICparenchyma values were 0.62 ± 0.03 and 1.36 ± 0.05 mg/mL, respectively (p = 0.004). CONCLUSION: The use of low energy levels on rsDECT and iodine maps improves tumor conspicuity. This situation may be help better detection of pancreatic tumors.

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.

Two-dimensional shear wave elastography of the perirenal fat: Can sticky fat be predicted?

PURPOSE: To evaluate whether two-dimensional (2D) shear wave elastography (SWE) can predict the presence of perirenal sticky fat (PSF) by showing increased perirenal fat stiffness. METHODS: We prospectively enrolled 28 patients with 31 renal tumors and 10 donor cases. Conventional renal ultrasound (US) and 2D-SWE examination of the perirenal fat were performed. Patient age, gender, body mass index (BMI), largest mass size, PF shear wave velocity (SWV) on both sides were recorded. During surgery, presence of PSF and perirenal fat dissection time (PFDT) were recorded. RESULTS: Twenty three renal masses were malignant and eight were benign. There were 13 clear cell carcinomas and 10 nonclear cell carcinomas. Eight patients had PSF. Mean PFDT was 13 minutes. PFDT and BMI were significantly increased in the PSF group (p < .05). No statistically significant differences were found in SWVs in patients with and without PSF. There were no significant differences with regard to SWVs between donor cases and patients, tumor side and nontumor side, benign masses and malignant masses, clear cell and nonclear cell tumors. No significant correlations were detected between SWVs and PFDT, mass size, Fuhrman grade and BMI (p > .05). CONCLUSION: 2D-SWE cannot detect PSF.

Laparoscopic resection of retroperitoneal bronchogenic cyst clinically presenting as adrenal cyst.

Bronchogenic cyst localized in the retroperitoneum is a rare clinical entity. It is a congenital malformation generally occurring in the posterior mediastinum due to the abnormal development of the foregut. We report the case of a retroperitoneal cyst presenting as left adrenal cyst. A 38-year-old female presented with left upper abdominal pain. Endocrinological evaluation was done, and no adrenal hormonal secretion was detected. The cyst was removed laparoscopically. Pathologic examination confirmed it as a bronchogenic cyst. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cysts. Laparoscopic resection of retroperitoneal cysts results in favorable outcome.

Acoustic Radiation Force Impulse Elastography in Determining the Effects of Type 1 Diabetes on Pancreas and Kidney Elasticity in Children.

OBJECTIVE: The aim of this study is to determine the effects of type 1 diabetes on pancreas and kidney elasticity in children, using acoustic radiation force impulse ultrasound elastography. SUBJECTS AND METHODS: Sixty autoantibody-positive patients with type 1 diabetes (45% girls; mean [± SD] age, 11.7 ± 4.4 years; range, 1.9-19.3 years) admitted to the pediatric endocrinology outpatient clinic and 32 healthy children (50% girls; mean age, 10.2 ± 3.8 years; range, 2.1-17.3 years) were included in the study. Acoustic radiation force impulse elastography measurements were performed of the kidneys and pancreas in both groups. Body mass index, duration of diabetes, HbA1c levels, and insulin dosage of patients with type 1 diabetes were recorded. RESULTS: The mean shear-wave velocities of the pancreas were 0.99 ± 0.25 m/s in patients with type 1 diabetes and 1.09 ± 0.22 m/s in healthy control subjects; the difference was not significant (p = 0.08). The median shear-wave velocities of the right and left kidneys in patients with type 1 diabetes were 2.43 ± 0.29 and 2.47 ± 0.25 m/s, respectively. There were no significant differences in the shear-wave velocities of the right and left kidneys between the patients with type 1 diabetes and the healthy control subjects (p = 0.91 and p = 0.73, respectively). Correlation analysis showed no correlation between the shear-wave velocities of the pancreas and kidney versus HbA1c level, duration of diabetes, insulin dosage, height, weight, and body mass index of the patients with type 1 diabetes. CONCLUSION: The current study showed no significant difference in the shear-wave velocity of kidneys in children with type 1 diabetes with normoalbuminuria compared with the healthy control subjects. We also observed that the shear-wave velocity of the pancreas in children with type 1 diabetes and healthy control subjects did not differ significantly.

Single center experience with intralesional bleomycin sclerotherapy for lymphatic malformations.

PURPOSE: The purpose of our study was to evaluate the efficacy of percutaneous sclerotherapy using bleomycin in treatment of lymphatic malformations. METHODS: Between January 2009 and January 2013, ten patients with lymphatic malformations who were admitted to the interventional radiology department were included in this retrospective study. Intralesional bleomycin was administered by percutaneous injection through 21-23 Gauge needles with a dose of 1 mg/kg body weight. Patients were clinically and radiologically assessed at baseline and followed at first and third months after treatment. Response to treatment was measured visually by using photographs and by radiological images. Symptomatic improvement was also evaluated either by patients or parents. RESULTS: Excellent resolution was obtained visually in 80% of patients with lymphatic malformation. Significant resolution was achieved in 20% of patients. The percentage of radiographic resolution in size and the improvement in symptoms evaluated by patients or parents were similar with visual outcomes. No side effects were recorded except for fever in one patient and transient erythema in another patient. CONCLUSION: Intralesional bleomycin is a safe and effective treatment for patients with lymphatic malformations.