Ultrasonography-based Staging of Inflammatory Granulomatous Mastitis and Estimation of Steroid Response.

OBJECTIVE: The aim of this study is to present novel diagnostic ultrasonography-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. MATERIAL & METHODS: From January 2017 through March 2023 total of 230 biopsy-proven IGM patients were reclassified (Grade I, II, and III) according to ultrasonography-based morphological features.The injection applications were grouped in Group1 [40mg/mL between 2017-2019 years] vs. Group2 [80mg/mL between 2019-2023 years] and effectiveness analyzed for each grade in between groups. RESULTS: Total mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features 79 (34.3%) patients re-defined as Grade I, 64 (27.8%) as Grade II, and 87 (37.8%) as Grade III.All patients underwent loco-regional steroid injection only. The average treatment in the first group was 6 (±3 SD) with effective dose of 40mg/mL and 4 (±2 SD) with 80 mg/mL in the second group. Generalized linear mixed model investigated effects in between groups (p < 0.05). CONCLUSION: High dose steroid treatment was effective in burnout lesions (Grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. ADVANCE IN KNOWLEDGE: This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. And our study is the pioneer in comparing steroid dosage with no relapse on IGM patients.

Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study.

INTRODUCTION: Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS: This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS: Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS: Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.

Signal abnormalities of the bladder wall detected by native T1 mapping in patients with overactive bladder.

OBJECT: Native T1 mapping provides tissue-specific T1 relaxation times, which can be used to identify structural changes in the various organs. The object of this article was to evaluate the bladder wall of patients with overactive bladder using native T1 mapping and compare the relaxation times of patients and healthy controls. MATERIAL AND METHODS: Seventeen patients with a diagnosis of overactive bladder and 15 healthy controls were enrolled in this prospective study. All participants underwent pelvic MRI and T1 maps were acquired. Native T1 relaxation times were calculated via regions of interest acquired from the anterosuperior wall of the bladder in all participants. Mean T1 relaxation times of the overactive bladder patients were compared with those of controls. RESULTS: Overactive bladder patients had statistically significantly higher T1 relaxation times compared with controls (p = 0.004). In the subgroup analysis, there was no statistically significant difference between males (1113.42 ± 62.4) and females (1176.70 ± 100.9) regarding the T1 relaxation times (p = 0.165). There were no correlations between age and T1 relaxation times in patient or control groups (r = 0.057, p = 0.825, and r = 0.052, p = 0.932, respectively). CONCLUSION: Native T1 mapping can identify structural changes in the bladder wall of patients with overactive bladder. This technique has a promising role in the diagnosis of patients with suspected overactive bladder.

The distribution in joint recesses and adjacent synovial compartments of loose bodies determined on MR and CT arthrographies of ankle joint.

ADVANCES IN KNOWLEDGE: Loose bodies (LBs) are intraarticular free bodies and may cause synovial inflammation.Accurate and complete determination of the number and location of LBs before surgery are very important for effective treatment.The location, number and distribution of LBs in the ankle joint may be determined successfully by high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA).For this purpose, MRA and CTA may increase the diagnostic and therapeutic success of the arthroscopy.

Clinical, Histopathological, Imaging, and Treatment Perspectives of Inflammatory Granulomatous Mastitis: Review of the Literature.

Inflammatory granulomatous mastitis is a benign inflammatory disease of the breast mostly presenting in puerperal women. The disease is characterized by recurrent bouts of mastitis with clinical picture of hyperemia, breast mass, and swelling of the breast with or without purulent discharge depending on the severity of the underlying inflammatory process. Although no true prevalence and incidence have been reported in the literature, there are several reported studies setting forth a predilection in specific ethnic groups and/ or geographical areas. Due to the intricate nature of the disease, quite often inflammatory granulomatous mastitis may be mistaken for malignant processes of the breast and even so, there are no pathognomonic imaging appearances to differentiate one from another. The histopathological analysis is a definite way of diagnosis. In this article, we review the imaging manifestations and clinical and histopathological findings along with current trends of available treatment options in the literature and briefly discussed our institutional perspective regarding grading of inflammatory granulomatous mastitis based on ultrasonographic appearances.