Paediatric liver biopsies: A single-centre experience in Erzincan Binali Yildirim University.

Introduction: Liver biopsies are the main method in the diagnosis and treatment of paediatric liver pathologies. Major complication rates of paediatric liver biopsies range from 0% to 6.6% in the literature and minor complication rates range from 0% to 25%. In this study, we aimed to review the complications, indications and results of percutaneous core liver biopsies with paediatric sonography in a tertiary care centre by an interventional radiologist. Methods: We retrospectively evaluated the results, indications and complications of paediatric liver biopsies performed in our tertiary health centre between January 2017 and December 2020. Biopsies were performed with a 16G semi-automatic needle in 17 patients (29.8%) and with an 18G semi-automatic needle in 40 patients (70.2%). Biopsies were performed only with local anaesthesia in patients older than 12 years; in younger patients, it was performed under general anaesthesia. Results: Fifty-eight liver biopsies were obtained from 57 children (34 males, 23 females). The most common indications were elevated liver enzymes (33 patients), cholestasis (14 patients), and adiposity and metabolic problems (6 patents). The most common pathological diagnoses were chronic hepatitis (33 patients) and steatosis (10 patients). Major complication in the form of symptomatic subcapsular haematoma developed after liver biopsy performed with 18G needle in only one patient (1.8%). Conclusions: As previously stated in the literature, percutaneous biopsies performed by interventional radiologists in paediatric patients under the guidance of sonography can be used in diagnosis and treatment; the complication rate is low and it is a safe method.

Earthquakes from a radiological perspective: what is demanded from the radiologists, and what can we do? A pictorial review.

Earthquakes are among the most destructive and unpredictable natural disasters. Various diseases and ailments, such as bone fractures, organ and soft-tissue injuries, cardiovascular diseases, lung diseases, and infectious diseases, can develop in the aftermath of severe earthquakes. Digital radiography, ultrasound, computed tomography, and magnetic resonance imaging are significant imaging modalities utilized for the quick and reliable assessment of earthquake-related ailments to facilitate the planning of suitable therapy. This article examines the usual radiological imaging characteristics observed in individuals from quake-damaged regions and summarizes the strengths and functionality of imaging modalities. In such circumstances, where quick decision-making processes are life-saving and essential, we hope this review will be a practical reference for readers.

Diabetic neuropathy results in vasomotor dysfunction of medium sized peripheral arteries.

BACKGROUND: The effect of the sympathetic nervous system on peripheral arteries causes vasoconstriction when smooth muscle cells in the walls of blood vessels contract, which leads to narrowing of arteries and reduction of the blood flow. AIM: To compare sympathetic vasomotor activation of the brachial arteries in healthy subjects and patients with painful diabetic neuropathy; and therefore, to assess whether there is significant vasomotor dysfunction of medium sized arteries in diabetic neuropathy. METHODS: The study included 41 diabetic neuropathy patients and 41 healthy controls. Baseline diameter and flow rate of the brachial arteries were measured. Then, using a bipolar stimulus electrode, a 10 mA, 1 Hz electrical stimulus was administered to the median nerve at the wrist level for 5 s. The brachial artery diameter and blood flow rate were re-measured after stimulation. RESULTS: In the control group, the median flow rate was 70.0 mL/min prior to stimulation and 35.0 mL/min after stimulation, with a statistically significant decrease (P < 0.001), which is consistent with sympathetic nervous system functioning (vasoconstriction). In the diabetic neuropathy group, median flow rate before the stimulation was 35.0 mL/min. After stimulation, the median flow rate was 77.0 mL/min; thus, no significant decrease in the flow rate was detected. In the control group, the median brachial artery diameter, which was 3.6 mm prior to stimulation, decreased to 3.4 mm after stimulation, and this decrease was also statistically significant (P = 0.046). In the diabetic neuropathy group, the median brachial artery diameter increased from 3.4 mm to 3.6 mm following nerve stimulation. Once again, no narrowing was observed. CONCLUSION: Our research suggests that diabetic neuropathy results in significant vasomotor dysfunction of medium sized peripheral arteries. Physiological vasoconstriction in response to sympathetic activation is impaired in diabetic neuropathy.

Can the change of vasomotor activity in irritable bowel syndrome patients be detected via color Doppler ultrasound?

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most frequently referred conditions to the gastrointestinal outpatient clinic. The pathophysiology of IBS has not been determined with certainty. Visceral hypersensitivity is indicated as one of the pathophysiologies. The sympathetic nervous system is primarily in charge of controlling the arteries, and its effect is vasospasm in the medium and large arteries, resulting in decreased blood flow. AIM: To demonstrate, using Doppler evaluation of the brachial artery, that sympathetic activity impairs vasomotor performance due to autonomic neuropathy, which we believe is associated with IBS. METHODS: There were 58 participants in the study. The control group consisted of 29 healthy patients, while the remaining 29 patients had been diagnosed with IBS. Patients who met the Rome IV criteria and had IBS were included in the study. People with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial, as were those with essential hypertension, diabetes mellitus, cardiovascular disease, or peripheral arterial disease, and patients diagnosed with anxiety or depression. Those with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial. A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa. The Doppler probe remained stationary throughout the experiment, allowing for continuous measurements. Then, to activate the sympathetic fibers, an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level via the bipolar stimulus electrode. The artery diameter and flow rates were measured again immediately following the fifth stimulus. RESULTS: In healthy persons with no history of chronic illness, there was a statistically significant decrease in flow rate after stimulation (P < 0.001). In addition, stimulation resulted in a statistically significant reduction in the diameter of the brachial artery (P < 0.001). Patients diagnosed with IBS had statistically significant vasodilation and an increase in flow rate. CONCLUSION: Sympathetic stimulation causes a reduction in vascular diameter and blood flow, whereas it has the reverse effect on IBS patients. In investigating the involvement of autonomic neuropathy in the development of IBS, significant changes in brachial artery Doppler parameters were observed before and after stimulation of the median nerve with low-current sensory stimulation. This method is thought to be more user-friendly and comfortable than other methods described in the literature.

Normal umbilical artery doppler values in 18-22 week old fetuses with single umbilical artery.

Umbilical cord with a single umbilical artery (SUA) can carry twice the blood volume of a three-vessel cord (TVC). So, the normal hemodynamics of the fetuses with SUA was different from those with TVC. Furthermore, structural abnormalities, fetal aneuploidy, and intrinsic growth retardation may be associated with the presence of a SUA. In order to evaluate these patients, intermittent doppler measurements have been suggested. From this point, we aimed to determine the CDUS flow parameters in SUA cases and to demonstrate that these flow parameters are different from the TVC parameters. Ultrasound (US) examinations were performed in the 18-22 weeks of gestation during routine fetal anatomy screening. Resistance index (RI), Pulsatility index (PI), and S/D: systole to diastole ratio values were measured. The samples were taken from the proximal, mid-portion, and distal of the umbilical cord. In addition to Doppler Ultrasound values, AC and estimated fetal weight (EFW) values were also recorded. The study included 167 pregnant women, 86 of whom were study group with SUA and 81 were control group with TVC. The measurements of RI, PI, and S/D at all three levels were significantly lower in the SUA group compared to the TVC group. The resistance in the UA of fetuses with SUA is lower than in fetuses with TVC. The resistance in the UA of fetuses with SUA decreases from the fetal end to the placental end. Knowing the normal values for fetuses with SUA might provide a better and more reliable Doppler Ultrasoundassessment.

Evaluation of Sympathetic Vasomotor Activity of the Brachial Arteries Using Doppler Ultrasound.

BACKGROUND The sympathetic nervous system is principally accountable for peripheral artery regulation, and its effect is that vasospasm occurs in the medium and large arteries of the extremities, resulting in decreased flow of blood. Because of this information of how the body works, our goal is to create a noninvasive and repeatable self-test model that uses Doppler ultrasound examination. MATERIAL AND METHODS The study was conducted on 31 healthy and active participants who volunteered for the study. Written informed consent was obtained from all participants. The baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa were determined using a Doppler probe, which remained stationary throughout the experiment, allowing for continuous measurements. Then, to activate the sympathetic fibers, an electrical stimulus was applied for 5 s with an intensity of 10 mA and frequency of 1 Hz at the level of the median nerve at the wrist via the bipolar stimulation electrode. Immediately following the sixth stimulation, the artery diameter and flow rates were assessed again. RESULTS Following the stimulation, a statistically significant decrease in flow rate was observed (P<0.001). Moreover, stimulation resulted in a statistically significant reduction in the diameter of the brachial artery (P<0.001). CONCLUSIONS Our research suggests that Doppler ultrasonography can be routinely used to detect the normal and abnormal functioning of the peripheral sympathetic nervous system.

Median Nerves' Electrical Activation Reduces Ipsilateral Brachial Arteries' Blood Flow and Diameter.

Purpose: Our main objective in this study was to determine whether there is a difference between ipsilateral and contralateral brachial arteries' flow parameters in response to median nerves' electrical activation. Material and Methods: The study was conducted in healthy and active subjects. The arterial diameter and flow were measured using the probe from the brachial artery. Then, the median nerve was stimulated for 5 seconds via the bipolar stimulus electrode. Arterial diameter and flow were measured once more with the Doppler transducer, which kept going to monitor continuously just after the fifth stimulus. After a week, the same subjects are invited for the purpose of measuring the contralateral brachial arteries' vasomotor response to the same stimulus. Results: Before electrical stimulation, the median flow rate was 72.15 ml/min; after stimulation, the median flow rate was 39.20 ml/min. The drop in flow after stimulation was statistically significant (P < 0.001). While the median value of brachial artery vessel diameter before median nerve stimulation in the entire study group was 3.50 mm, the median value of vessel diameter after stimulation was 2.90 mm. After stimulation, the median nerve diameter narrowed statistically significantly (P < 0.001). As for the contralateral brachial in response to the right median nerves' activation, no significant flow or diameter change was found (P = 0.600, P = 0.495, respectively). Conclusion: We discovered that electrical stimulation of the median nerve caused significant changes in ipsilateral brachial artery blood flow and diameter in healthy volunteers. The same stimulation does not result in flow parameter changes in the contralateral brachial artery.

Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data.

BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID-19 infection and scrotal infection are associated. MATERIALS AND METHODS: Patients with a COVID-19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data. RESULTS: The median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo-orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group. CONCLUSIONS: Even if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID-19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.

T2 MRI Mapping of Knee Cartilage in Professional Ballet Dancers.

AIMS: Professional ballet dancers are at risk for degenerative knee cartilage changes. In the current study, we evaluated the knee cartilage with T2 mapping methods in professional ballet dancers and healthy controls and investigated possible differences of T2 values between these groups. METHODS: We included healthy dancers with 5-20 years of professional ballet dancing experience and sex-matched healthy controls without knee pathology. T2 values of the knee cartilage were measured from axial, coronal, and sagittal images. The values were measured by free hand region of interest (ROI). RESULTS: The study population consisted of 44 people (22 dancers, 22 controls), with mean age of 25.57 ± 5.53 yrs. We found no significant relationship between sex and T2 values. We detected a significant positive correlation between age and T2 values for patellofemoral joint cartilage. T2 values of patellofemoral and tibiofemoral joints of dancers were significantly higher. Mean T2 values of patellofemoral joint were around 32 in all planes in dancers and around 12 in controls (p<0.05). Mean tibiofemoral joint values in dancers were around 39 and around 32 in controls (p<0.05). CONCLUSIONS: T2 values of knee cartilage were higher in professional ballet dancers. T2 mapping method can reveal knee cartilage changes successfully in professional ballet dancers. All anatomical planes (axial, coronal, and sagittal) can be used in order to obtain T2 values.

Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely?

PURPOSE: Lymphoid hyperplasia can be an important mimicker of acute appendicitis by creating a non-compressible appendix more than 6 mm in diameter. The aim of this study was to evaluate methods of distinguishing lymphoid hyperplasia and appendicitis on the basis of sonography, lamina propria thickness, and Alvarado scoring. METHODS: This retrospective study included 259 patients (142 appendicitis, 117 lymphoid hyperplasia). The US (ultrasound) reports of the patients were reviewed and the maximum diameter of the appendix, the presence or absence of increased echogenicity of the surrounding pericaecal fat, local fluid collection, the presence of reactive lymph nodes in the periappendiceal area, and mural hyperemia within the appendix were recorded. RESULTS: The use of additional sonographic criteria, lamina propria thickness (≤1 mm is indicative for appendicitis), or Alvarado scoring (>6 mm is indicative for appendicitis) provided a true-positive diagnosis for acute appendicitis. CONCLUSION: The presence of local fluid collection in the periappendiceal area and a lamina propria thickness ≤ 1 mm are the most successful parameters for distinguishing appendicitis from lymphoid hyperplasia.

Classification of Carotid Artery Intima Media Thickness Ultrasound Images with Deep Learning.

Cerebrovascular accident due to carotid artery disease is the most common cause of death in developed countries following heart disease and cancer. For a reliable early detection of atherosclerosis, Intima Media Thickness (IMT) measurement and classification are important. A new method for decision support purpose for the classification of IMT was proposed in this study. Ultrasound images are used for IMT measurements. Images are classified and evaluated by experts. This is a manual procedure, so it causes subjectivity and variability in the IMT classification. Instead, this article proposes a methodology based on artificial intelligence methods for IMT classification. For this purpose, a deep learning strategy with multiple hidden layers has been developed. In order to create the proposed model, convolutional neural network algorithm, which is frequently used in image classification problems, is used. 501 ultrasound images from 153 patients were used to test the model. The images are classified by two specialists, then the model is trained and tested on the images, and the results are explained. The deep learning model in the study achieved an accuracy of 89.1% in the IMT classification with 89% sensitivity and 88% specificity. Thus, the assessments in this paper have shown that this methodology performs reasonable results for IMT classification.

Correction to: Classification of Carotid Artery Intima Media Thickness Ultrasound Images with Deep Learning.

The original article unfortunately contained a mistake. Figure 2b was removed in the article.