Percutaneous treatment of giant hydatid cysts: a single-center experience of 58 cysts.

PURPOSE: The aim of this study is to evaluate the efficacy of percutaneous treatment in hydatid cysts (HCs) with at least one diameter larger than 10 cm. MATERIALS AND METHODS: 58 CE1 or CE3a HCs with at least one diameter larger than 10 cm which were treated with catheterization between September 2016 and December 2021 were retrospectively analyzed. RESULTS: Mean age was 40 ± 17.7 (18-80). Majority of HCs were in the liver (89.6%). Median follow-up was 28 months. Technical success rate was 100%; however, a second procedure was needed in 13 cysts due to recollection (n = 4), infection (n = 6), and recurrence (n = 3). CONCLUSIONS: Giant HCs can be effectively treated with catheterization with low complication rates.

Evaluation of femoral head bone quality by Hounsfield units: a comparison with dual-energy X-ray absorptiometry.

BACKGROUND: Osteoporosis is associated with decreases in bone mineral density (BMD) and is diagnosed using dual-energy X-ray absorptiometry (DXA). Computed tomography (CT), performed in routine practice, can also be used to evaluate bone quality without additional cost. PURPOSE: To determine whether Hounsfield units (HU), a standardized CT attenuation coefficient, measured from the femoral head correlated with DXA-measured BMD. MATERIAL AND METHODS: We evaluated 82 patients (14 men, 68 women; mean age, 67 years) undergoing femoral DXA and CT (non-enhanced abdominopelvic and hip scans) with 130 kV to determine whether HU correlated with T-scores. HU were measured by two radiologists using the largest spherical region of interest including the medullary bone of the femoral head from the junction point of the most caudal section of the femoral head with the femoral neck in 5-mm axial sections. The correlations of both sides' HU values with their ages and DXA femur T-score were evaluated. RESULTS: HU values obtained from both femoral heads showed significant variation between the osteoporotic and non-osteoporotic groups (both P = 0.000) and strongly correlated with each other and DXA femur T-scores (left r = 0.75, right r = 0.73, respectively). In ROC curve analysis, predictive power of left HU values in identifying patients with osteoporotic femur DXA T-score was 0.905, and for right HU values it was 0.924. Osteoporosis cutoff values were 198 HU and 204 HU for the left and right hips, respectively. CONCLUSIONS: HU obtained from CT performed in routine practice correlated with the DXA scores, thus providing an alternative method to determine regional bone quality without additional cost. This may be useful when choosing a fixation method, especially in trauma cases with already-performed abdominopelvic or pelvic CT in emergency services.

The Prognostic Effects of Clinicopathological Features on Rectal Cancer Patients undergoing Neoadjuvant Chemoradiotherapy.

OBJECTIVE: To investigate the effects of clinicopathological features on disease-free survival (DFS) and overall survival (OS) in in-patients with local advanced rectal cancer (LARC) who received neoadjuvant chemoradiotherapy (nCRT). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Clinic of Radiation Oncology, Kayseri Training and Research Hospital and Kayseri City Hospital, Turkey, between January 2014 and June 2019. METHODOLOGY: The pre-nCRT, post-nCRT, and postoperative imaging methods of 51 patients, who were operated upon, were examined. Radiological images (CT and MRI) of the patients were reviewed using the hospital's PACS system. Pathology reports and preparations were re-evaluated, and TNM staging and the pathological tumour regression grade (pTRG) were graded according to the American Joint Committee on Cancer's (AJCC) 2018 version. For the descriptive statistics of the data, the mean, standard deviation, lowest-highest median, frequency, and ratio values were used. Cox regression (univariate-multivariate analysis) and Kaplan-Meier curves were used for survival analysis. RESULTS: In the univariate model, the postoperative pathological T and N stages (ypT and ypN), pathological stage, positive lymph node count (pLN+, pathological sampling) and lymphovascular invasion (LVI) positivity had a significant effect (p <0.05) on DFS. In the multivariate reduced model, a significant independent (p <0.05) effect of the ypT and pLN+ number was observed on DFS. In the univariate model, the pathological tumour diameter after nCRT, the ypT, perineural invasion (PNI) positivity, and relapse presence had a significant effect (p <0.05) on OS. In the multivariate reduced model, a significant independent (p <0.05) effect of recurrence was observed on OS. CONCLUSION: LVI, the ypTN stage, and the pLN+ number affected the disease-free survival, while the residual tumour diameter after nCRT, ypT stage, and PNI affected the overall survival. The predicted DFS time decreased as the ypT stage increased and the predicted OS time decreased as the recurrence increased. Key Words: Rectal cancer, Neoadjuvant chemoradiotherapy, Disease-free survival, Overall survival.

On the identification of thyroid nodules using semi-supervised deep learning.

Detecting malign cases from thyroid nodule examinations is crucial in healthcare particularly to improve the early detection of such cases. However, malign thyroid nodules can be extremely rare and is hard to find using the traditional rule based or expert-based methods. For this reason, the solutions backed by Machine Learning (ML) algorithms are key to improve the detection rates of such rare cases. In this paper, we investigate the application of ML in the healthcare domain for the detection of rare thyroid nodules. The utilized dataset is collected from 636 distinct patients in 99 unique days in Turkey. In addition to the texture feature data of the Ultrasound (US), we have also included the scores of different assessment methods created by different health institutions (e.g., Korean, American and European thyroid societies) as additional features. For detection of extremely rare malign cases, we use auto-encoder based neural network model. Through numerical results, it is shown that the auto-encoder based model can result in an average Recall score of 0.98 and a Sensitivity score of 1.00 for detecting malign and non-malign cases from the healthcare dataset outperforming the traditional classification algorithms that are trained after Synthetic Minority Oversampling Technique (SMOTE) oversampling.

Is biopsy necessary? Role of DCE-MRI in BIRADS-3 lesions.

PURPOSE: We aimed to evaluate BIRADS-3 breast lesions with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and compare with histopathology, and to investigate the effectiveness of breast MRI for follow-up and management. METHODS: A total of 84 BIRADS-3 lesions reported by US or mammography and evaluated by DCE-MRI between September 2014 and October 2015 were included in this study. All patients underwent percutaneous or surgical biopsy for histopathologic diagnosis. Morphologic and kinematic features on MRI were compared with histopathologic results. RESULTS: Of the 84 BIRADS-3 breast lesions, 9 (10.7%) had malignant features on DCE-MRI and all were verified with histopathologic results. DCE-MRI had 96.7% sensitivity, 72% specificity, 92% positive predictive value, and 82.5% negative predictive value. MRI and histopathology results were correlated for the diagnosis of malignant lesions. The sensitivity and negative predictive value of MRI for diagnosis of malignant lesions were both 100%. CONCLUSION: Differentiation of benign versus malignant lesions was accomplished with 100% accuracy with DCE-MRI. We suggest that DCE-MRI should be an additional diagnostic tool and problem-solving modality for BIRADS-3 lesions, particularly in patients with relative risk factors.

Post-traumatic pneumolabyrinth: a rare cause of hearing loss.

Pneumolabyrinth (PL) is the presence of air within the vestibule, semicircular canals, or cochlea. It represents an abnormal connection between the inner ear and middle ear spaces. PL most commonly occurs after blunt head trauma, followed by penetrating injuries. Temporal fractures may or may not accompany. Prognosis of hearing loss is poor, while prognosis of vestibular symptoms is good. Herein we present a 45-year-old female with unilateral pneumolabyrinth, who presented with significant dizziness and unilateral total hearing loss after a car accident.

Impact of anatomical features of the left atrial appendage on outcomes after cryoablation for atrial fibrillation.

AIMS: Pulmonary vein isolation (PVI) using cryoballoon has been accepted as a safe and effective method for treatment of atrial fibrillation (AF). Despite advances in catheter-based technologies, some patients still experience AF recurrence. In this study, we aimed to compare left atrial appendage (LAA) morphology in AF patients and subjects with sinus rhythm and also investigate the association between LAA morphology and success of PVI using cryoballoon in subjects with AF. METHODS: In this prospective study, 359 AF patients who underwent pre-ablation computed tomographic angiography (CTA) scan between January 2013-March 2016 were included as the patient group. 100 age and gender-matched subjects in sinus rhythm who had no AF episodes in 24-h Holter monitoring that underwent CTA were included as the control group. RESULTS: Non-chicken wing LAA morphology was more common in AF patients (p < 0.001). LAA was significantly deeper (p < 0.001) and short-axis diameter of LAA orifice and LAA orifice area were significantly larger (p < 0.001) in AF patients. Low take-off type morphology of LAA was more common in controls compared to AF patients (p = 0.006). At a median follow-up of 37 months, only longitudinal-axis left atrial diameter on CT (p = 0.003) and cauliflower-type LAA morphology (p = 0.004) were independent predictors of AF recurrence. CONCLUSION: This is the first study in the literature that investigates the relationship between anatomical variations of LAA and AF recurrence following cryoablation. Our findings demonstrate that cauliflower-type LAA morphology is associated with two-fold increased risk of AF recurrence.

Outcomes of Radioembolization in Patients with Chemorefractory Colorectal Cancer Liver Metastasis: a Single-Center Experience.

PURPOSE: We aimed to evaluate the efficacy and outcomes of radioembolization with Yttrium-90 (Y-90) microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastasis (CRCLM). METHODS: This single-center study included 43 patients (34 male, 9 female) who underwent radioembolization with Y-90 for unresectable, chemorefractory CRCLM between September 2008 and July 2014. Overall survival (OS), liver progression-free survival (LPFS), overall response rate (ORR), local disease control rate (LDCR), and relations of these parameters with patient disease characteristics were evaluated. OS and LPFS rates were compared according to microspheres. Survival rates were calculated with Kaplan-Meier method, and potential prognostic variables were evaluated on univariate analyses. RESULTS: Post-procedural median OS was 12.8 months. LPFS was 5.6 months. ORR was 33%, LDCR was 67% on 3rd month follow-up. Low tumor burden (< 25%) was associated with higher median OS after radioembolization (< 25 vs > 25-50% p < 0.0001 and < 25 vs > 50% p = 0.005). Patients with left colon tumors exhibited significantly longer median OS after metastasis than right colon tumors (p = 0.046). Extrahepatic disease and synchronicity showed poorer survival parameters; however, the difference was not significant (p = 0.1 and p = 0.3, respectively). In subgroup analyses, the distribution of patient number and characteristics showed heterogeneity as number of patients with low tumor burden was higher in resin Y-90 group. Resin Y-90 group exhibited significantly higher median OS and LPFS compared to glass Y-90 group (16.5 vs. 7 months, p = 0.001; 6.73 vs. 3.38 months, p = 0.023, respectively). CONCLUSION: Radioembolization is a safe local-regional treatment option in chemorefractory, inoperable CRCLM. Radioembolization at earlier stages may lead to more favorable results especially with lower tumor burden patients.

Evaluation of anterior intermeniscal ligament in discoid lateral meniscus cases and presenting the accompanying meniscal pathologies with MRI.

BACKGROUND: Although several studies were conducted to put forth the biomechanical function of anterior intermeniscal ligament (AIML) on the stability of meniscal structures, there are few data on the etiology of the early degeneration of discoid type compared to the normal shaped ones. PURPOSE: To determine the AIML subtypes and accompanying meniscal pathologies in discoid lateral menisci (DLM) on knee MRI exams. MATERIAL AND METHODS: Knee MRI exams of 171 individuals with DLM were reviewed. DLMs and AIMLs were typed according to Watanabe's classification and Nelson-Laprade classification, respectively. Medial and lateral menisci were evaluated for tear and menisco-capsular pathology. Pearson's correlation test was used for statistical analysis. RESULTS: DLM was type I in 83 (48.5%) individuals and type II in 88 (51.5%) individuals. AIML was absent in 90 (52.6%) participants; type I AIML was seen in 38 out 81 (22.2%), type II in 31 out of 81(18.1%), and type III in 12 out of 81 (7%). Meniscal pathology was observed in 56 (32.7%) individuals as follows: menisco-capsular strain/separation in 25 (14.6%); medial meniscal tear in 22 (12.8%); and lateral meniscal tear in nine (5.2%); Of these 56 cases, 26 (46%) had no AIML, 15 cases (27%) had type I, nine cases (16%) had type II, and six cases (11%) had type III AIML. CONCLUSION: No statistically significant correlation was found between the type of DLM and type of AIML ( P = 0.855), between the type of DLM and meniscal pathology ( P = 0.791), or between the type of AIML and meniscal pathology ( P = 0.282).

Pulmonary vein orientation is independently associated with outcomes following cryoballoon-based atrial fibrillation ablation.

AIMS: Several studies have investigated the influence of pulmonary vein (PV) anatomy on outcomes of atrial fibrillation (AF) ablation. We aimed to evaluate the relationship between PV orientation and AF-free survival following cryoablation. METHODS: 160 patients scheduled for cryoablation between September 2012-March 2014 were included. Patients underwent a pre-procedural cardiac CT scan with retrospective ECG gating. PV orientation was assessed according to the position of the PV orifice relative to the sagittal plane with reference to coronal and horizontal planes. RESULTS: 160 patients (57 ±â€¯9 years, 54% male, 33% persistent AF) were included and followed for a median of 17 (12-36) months. Excluding a blanking period of 3 months, freedom from AF after a single ablation procedure was 76%. Ventral-caudal left upper PV (p = 0.044) and ventral-caudal left lower PV orientation (p = 0.001) were more common in patients with AF recurrence. In multivariate Cox regression analysis, only left lower PV orientation [particularly dorsal-caudal (HR: 3.447, 95% CI: 1.180-10.070, p = 0.024) and ventral-caudal (HR: 3.391, 95% CI: 1.088-10.571, p = 0.035) orientations compared to dorsal-cranial orientation] as well as LA diameter (HR: 3.420, 95% CI: 1.809-6.465, p < 0.001) were significantly associated with AF recurrence. CONCLUSION: This is the first study to demonstrate the impact of PV orientation on prediction of AF recurrence following cryoablation. Preprocedural assessment of PV orientation may modify operator preferences on treatment strategies in AF.

Pulmonary vein anatomy and its variations in a Turkish atrial fibrillation cohort undergoing cryoballoon-based catheter ablation.

OBJECTIVE: Pulmonary vein (PV) anatomy has drawn attention since assumption that atrial fibrillation (AF) may originate from PVs and that electrical isolation of PVs may be beneficial in eliminating these triggers. The present study aims to investigate PV anatomy and its variations in a sample of Turkish patients undergoing PV isolation (PVI) for AF. METHODS: 250 patients underwent multidetector computed tomography before cryoballoon-based PVI for AF. PV and left atrial (LA) anatomy were evaluated in 3-dimensional epicardial reconstructions. RESULTS: 980 PVs were observed. All PVs drained into the LA. Mean superoinferior (SI) dimension for each vein was significantly larger than mean anteroposterior (AP) dimension. Accessory PVs were only seen on right side. Accessory veins were significantly smaller in both AP and SI diameter than other veins. Right-sided PV ostia were more round. Expected anatomy of 2 atrial ostia for right upper and lower lobe veins on each side was seen in 94.8% of patients. Remainder had other variant anatomy in right PVs. Conjoined ostium in the LA was seen in 35.6% of patients. CONCLUSION: PV variations were common in Turkish AF cohort undergoing PVI, which may be important to know about prior to ablation therapy for procedural success.

Periatrial epicardial adipose tissue thickness is an independent predictor of atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation.

BACKGROUND: Epicardial adipose tissue (EAT) is a metabolically active fat depot. Studies have investigated the effect of EAT thickness on outcomes of radiofrequency catheter ablation of atrial fibrillation (AF). However, data on the relationship between EAT thickness and outcome of cryoballoon-based pulmonary vein isolation (PVI) are lacking. OBJECTIVE: In this study, we investigate the association between EAT thickness and AF recurrence after cryoballoon-based PVI. METHODS: Patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug(s) were scheduled for cryoballoon-based PVI for AF per the recent recommendations. Periatrial, periventricular, and total EAT thickness measurements were obtained from preprocedural multidetector CT scans. RESULTS: A total of 249 patients (55.6 ± 10.7 years; 48.2% male; 18.5% persistent AF) were involved in the study. Patients were followed-up for 29 months (8-48 months). When blanking period was considered, freedom from AF after the ablation procedure was 75.9% at a median follow-up of 29 months. Total periatrial EAT thickness (18.1 ± 6.2 vs. 14.7 ± 4.7 mm; P < .001) was greater in patients with late AF recurrence when compared to those without. On the other hand, periventricular or total EAT thickness measurements did not differ between both groups (P > .05). Multivariate Cox proportional hazard regression analysis showed that periatrial EAT thickness (hazard ratio, 1.086; P = .001) and left atrial volume index (hazard ratio, 1.144; P < .001) were independent predictors for late AF recurrence. CONCLUSION: Quantification of EAT thickness from preprocedural multidetector CT scans may serve as a beneficial parameter for prediction of AF recurrence after cryoballoon-based PVI.

Fracture of the Atlas through a Synchondrosis of Anterior Arch.

Cervical fractures are rare in paediatric population. In younger children, cervical fractures usually occur above the level of C4; whereas in older population, fractures or dislocations more commonly involve the lower cervical spine. Greater elasticity of intervertebral ligaments and also the spinal vertebrae explains why cervical fractures in paediatric ages are rare. The injury usually results from a symmetric or asymmetric axial loading. In paediatric cases, most fractures occur through the synchondroses which are the weakest links of the atlas. The prognosis depends on the severity of the spinal cord injury. In this case, we presented an anterior fracture in synchondrosis of atlas after falling on head treated with cervical collar. There was no neurologic deficit for the following 2 years.