Can lung semi-quantitative measurements and mediastinal adipose tissue volume predict prognosis in patients with idiopathic pulmonary fibrosis (IPF)? A CT-based preliminary study.

Introduction: The aim of this study was to assess the potential of subcutaneous adipose tissue volume, mediastinal adipose tissue volume, lung density, and lung volume (as measured on high-resolution computed tomography) to predict disease progression in patients with idiopathic pulmonary fibrosis (IPF). Additionally, the study aimed to evaluate the changes in these semiquantitative measures over time. Materials and Methods: The HRCT images of 57 patients diagnosed with IPF were retrospectively screened. Subcutaneous adipose tissue volume, mediastinal adipose tissue volume, and mean lung density and volume were measured at the time of diagnosis and at the 12th month. The ability of these parameters to predict progression was evaluated using the univariate and multivariate Cox regression analyses. Results: Low mediastinal adipose tissue volume at diagnosis had a 0.991-fold effect [odds ratio (OR)= 0.991, 95% confidence interval (CI)= 0.984-0.997, p< 0.001] on progression. Low mediastinal adipose tissue volume at diagnosis had a 0.993-fold effect [odds ratio (OR)= 0.993, 95% confidence interval (CI)= 0.975-1.011, p< 0.001] and progression development at the 12th month had a 6.5-fold effect [odds ratio (OR)= 6.516, 95% confidence interval (CI)= 1.594-26.639, p< 0.009] on mortality. Conclusion: This study indicate that the prognosis was better in those with a large mediastinal adipose tissue volume among the patients with IPF.

Can the Gleason score be predicted in patients with prostate cancer? A dynamic contrast-enhanced MRI, (68)Ga-PSMA PET/CT, PSA, and PSA-density comparison study.

PURPOSE: The present study aims to evaluate whether perfusion parameters in prostate magnetic resonance imaging (MRI), (68)Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT), prostate-specific antigen (PSA), and PSA density can be used to predict the lesion grade in patients with prostate cancer (PCa). METHODS: The study included a total of 137 PCa cases in which 12-quadrant transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed, the Gleason score (GS) was determined, and pre-biopsy multiparametric prostate MRI and (68)Ga-PSMA PET/CT examinations were undertaken. The patient population was evaluated in three groups according to the GS: (1) low risk; (2) intermediate risk; (3) high risk. The PSA, PSA density, pre-TRUSBx (68)Ga-PSMA PET/CT maximum standardized uptake value (SUVmax), perfusion MRI parameters [maximum enhancement, maximum relative enhancement, T0 (s), time to peak (s), wash-in rate (s-1), and wash-out rate (s-1)] were retrospectively evaluated. RESULTS: There was no significant difference between the three groups in relation to the PSA, PSA density, and (68)Ga-PSMA PET/CT SUVmax (P > 0.05). However, the values of maximum enhancement, maximum relative enhancement (%), T0 (s), time to peak (s), wash-in rate (s-1), and wash-out rate (s-1) significantly differed among the groups. A moderate positive correlation was found among the prostate volume, PSA (r = 0.490), and (68)Ga-PSMA SUVmax (r = 0.322) in the patients. The wash-out rate (s-1) and wash-in rate (s-1) had the best diagnostic test performance (area under the curve: 89.1% and 78.4%, respectively). CONCLUSION: No significant correlation was found between the (68)Ga-PSMA PET/CT SUVmax and the GS. The wash-out rate was more successful in estimating the pretreatment GS than the (68)Ga-PSMA PET/CT SUVmax.

Evaluation of the performance of and interobserver agreement on postoperative baseline CT findings in the identification of locoregional recurrence in patients with pancreatic ductal adenocarcinoma.

PURPOSE: To evaluate interobserver agreement on the findings of baseline contrast-enhanced multidetector computed tomography (CE-MDCT) performed at the postoperative third month in patients who underwent surgery due to ductal adenocarcinoma of the pancreatic head and investigate the value of these findings in predicting locoregional recurrence. MATERIAL AND METHODS: The baseline CE-MDCT images of 198 patients who underwent the Whipple procedure due to pancreatic head tumors were evaluated independently by three radiologists at the postoperative third month. The radiologists were asked to note suspicious findings in terms of locoregional recurrence, including postoperative fat stranding, the presence of perivascular contrast-enhanced solid tissue, short diameter of solid tissue if present, the shape of solid tissue (convex/concave), presence of peritoneal implants, diameter (mm) of pancreatic duct dilatation if present, the presence of lymph nodes larger than 5 mm, portal vein stenosis (≥50 and <50%), the presence of ascites, and the presence of distant metastases, as specified by the Society of Abdominal Radiology in October 2022. The agreement between the radiologists and the value of these parameters in predicting locoregional recurrence were investigated. RESULTS: Among the CE-MDCT findings evaluated, the radiologists had a moderate-to-high level of agreement concerning the presence of perivascular contrast-enhanced solid tissue. However, there was a poor interobserver agreement on the shape of solid tissue. A very high level of agreement was found among the radiologists in the evaluation of pancreatic duct dilatation, peritoneal implants, ascites, and the presence of distant metastases. According to the univariate analysis, the rates of portal vein stenosis had a 1.419 -fold effect [odds ratio (OR)=1.419, [95% confidence interval (CI)= 0.548-3.679, p=0.041], lymph node presence had a 2.337 -fold effect [odds ratio (OR)=2.337, [95% confidence interval (CI)= 1.165-4.686, p=0.015], perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.241, [95% confidence interval (CI)= 1.072-4.684, p=0.005]. In the multivariate analysis, perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.519, [95% confidence interval (CI)= 1.132-5.605, p=0.024]. CONCLUSION: In the postoperative baseline CE-MDCT examination, the presence of solid tissue, lymph node presence, and portal vein stenosis in the surgical bed are among the findings that may indicate early locoregional recurrence in patients with pancreatic ductal adenocarcinoma.

Different chest CT scoring systems in patients with COVID-19: could baseline CT be a helpful tool in predicting survival in patients with matched ages and co-morbid conditions?

BACKGROUND: Computed tomography (CT) gives an idea about the prognosis in patients with COVID-19 lung infiltration. PURPOSE: To evaluate the success rates of various scoring methods utilized in order to predict survival periods, on the basis of the imaging findings of COVID-19. Another purpose, on the other hand, was to evaluate the agreements among the evaluating radiologists. MATERIAL AND METHODS: A total of 100 cases of known COVID-19 pneumonia, of which 50 were deceased and 50 were living, were included in the study. Pre-existing scoring systems, which were the Total Severity Score (TSS), Chest Computed Tomography Severity Score (CT-SS), and Total CT Score, were utilized, together with the Early Decision Severity Score (ED-SS), which was developed by our team, to evaluate the initial lung CT scans of the patients obtained at their initial admission to the hospital. The scans were evaluated retrospectively by two radiologists. Area under the curve (AUC) values were acquired for each scoring system, according to their performances in predicting survival times. RESULTS: The mean age of the patients was 61 ± 14.85 years (age range = 18-87 years). There was no difference in co-morbidities between the living and deceased patients. The survival predicted AUC values of ED-SS, CT-SS, TSS, and Total CT Score systems were 0.876, 0.823, 0.753, and 0.744, respectively. CONCLUSION: Algorithms based on lung infiltration patterns of COVID-19 may be utilized for both survival prediction and therapy planning.

A rare lesion of breast: Hydatid cyst.

Hydatid cyst (HC) is a lesion most commonly seen in the liver but can occur in many parts of the body. Breast involvement with HC is extremely rare. It can be isolated or accompanied by other organ involvements. In this report, we present a 46-year-old female with isolated HC located in the right breast. In the ultrasonography and MR images of the patient, the lesion was compatible with the HC, and homogenous dens lesion was shown on mammography. Diagnosis of HC was confirmed pathological. With this study, it was aimed to emphasize the radiological findings of isolated breast HC.

Evaluation of magnetic resonance imaging findings in adhesive capsulitis: which quantitative findings are most valuable?

OBJECTIVE: This study aims to investigate magnetic resonance imaging (MRI) findings in adhesive capsulitis (AC) and determine the most valuable MRI finding in diagnosis using easily applied quantitative methods. METHODS: Shoulder MRI was performed on 193 patients who were diagnosed with AC by clinical examination and 116 controls. Axillary pouch thickness (APT), superior and inferior glenohumeral ligament (SGHL and IGHL) thickness, coracohumeral ligament (CHL) thickness, fluid increase and soft-tissue thickness in the rotator interval (RI), and increases in the fluid and signal in the localization of biceps tendon attachment were evaluated. MRI examinations were assessed by three radiologists blinded to the clinical findings of the patients, and the results were obtained based on consensus and records. RESULTS: There were 119 women and 74 men in the AC group and 80 women and 36 men in the control group. IGHL, SGHL, RI, and CHL thicknesses were measured thicker in AC patients than in the control group. When IGHL=4, RI=3.6, SGHL=2.0, CHL=4.6-mm cutoff, the area under the receiver operating characteristic (ROC) curve (AUC) values were 0.700, 0.922, 0.972, and 0.783, respectively. CONCLUSIONS: According to the results obtained in this study, IGHL=4 mm, RI=3.6 mm, SGHL=2.0 mm, and CHL=4.6 mm can support the diagnosis of AC. Using the quantitative values in diagnosis can provide objective criteria and prevent variability among interpreters.

Magnetic resonance imaging evaluation of incidentally detected hyperechoic liver lesions: comparison of two modalities in terms of detection, diagnosis, and morphological features.

OBJECTIVE: This study aimed to investigate and compare the ultrasonography and contrast-enhanced magnetic resonance imaging characteristics of incidentally detected hyperechoic focal liver lesions. METHODS: Seventy-four patients (29 males and 45 females) who had undergone a B-mode ultrasonography and contrast-enhanced magnetic resonance imaging examination were included in this study. A total of 91 hyperechoic lesions detected on ultrasonography were evaluated. The ultrasonography features of these hyperechoic lesions were recorded, and the results were compared with those acquired from contrast-enhanced magnetic resonance imaging. The results were compared statistically using the Shapiro-Wilk, McNemar, and Wilcoxon signed-rank tests. RESULTS: A corresponding lesion was found on contrast-enhanced magnetic resonance imaging in 72 of the 91 (79.1%) hyperechoic lesions detected on ultrasonography. Forty-one (56.9%) of the magnetic resonance imaging-defined lesions were typical hemangiomas, while 10 (13.9%) were focal steatosis areas and 4 (5.6%) were diagnosed with hepatocellular carcinoma. In contrast, 6 lesions (8.3%) were diagnosed as simple hepatic cysts, 4 (5.6%) as sclerosing hemangioma, 2 (2.8%) as thrombosed hemangioma, 1 (1.4%) as focal nodular hyperplasia, 1 (1.4%) as hamartoma, 2 (2.8%) as hydatid cysts, and 1 (1.4%) as hepatic lipoma. No statistically significant differences were found between ultrasonography and magnetic resonance imaging in terms of the segmental classification of the true positive lesions based on contour structures and lesion area measurements (p=0.558, p=0.375, and p=0.636, respectively). CONCLUSIONS: Incidentally detected hyperechoic zones may not necessarily be detected on magnetic resonance imaging. This may be secondary to focal hepatic steatosis or false interpretation of the radiologist. Lesions requiring therapy must be considered in the differential diagnosis.

Evaluation of the olfactory bulb volume and morphology in patients with coronavirus disease 2019: can differences create predisposition to anosmia?

SUMMARY OBJECTIVE: This study aimed to investigate whether the volume and morphology of the olfactory bulb are effective in the occurrence of anosmia in patients after COVID-19 infection. METHODS: The olfactory bulbus volume was calculated by examining the brain magnetic resonance imaging of cases with positive (+) COVID-19 polymerase chain reaction test with and without anosmia. Evaluated magnetic resonance imaging images were the scans of patients before they were infected with COVID-19. The olfactory bulbus and olfactory nerve morphology of these patients were examined. The brain magnetic resonance imaging of 59 patients with anosmia and 64 controls without anosmia was evaluated. The olfactory bulb volumes of both groups were calculated. The olfactory bulb morphology and olfactory nerve types were examined and compared between the two groups. RESULTS: The left and right olfactory bulb volumes were calculated for the anosmia group and control group as 47.8±15/49.3±14.3 and 50.5±9.9/50.9±9.6, respectively. There was no statistically significant difference between the two groups. When the olfactory bulb morphology was compared between the two groups, it was observed that types D and R were dominant in the anosmia group (p<0.05). Concerning olfactory nerve morphology, type N was significantly more common in the control group (p<0.05). CONCLUSIONS: According to our results, the olfactory bulb volume does not affect the development of anosmia after COVID-19. However, it is striking that the bulb morphology significantly differs between the patients with and without anosmia. It is clear that the evaluation of COVID-19-associated smell disorders requires studies with a larger number of patients and a clinicoradiological approach.

Diagnostic performance and interobserver agreement of CO-RADS: evaluation of classification in radiology practice.

PURPOSE: We aimed to evaluate the use of the COVID-19 reporting and data system (CO-RADS) among radiologists and the diagnostic performance of this system. METHODS: Four radiologists retrospectively evaluated the chest CT examinations of 178 patients. The study included 143 patients with positive reverse transcriptase-polymerase chain reaction (RT-PCR) test results and 35 patients whose RT-PCR tests were negative but whose clinical and/or radiological findings were consistent with COVID-19. Fleiss' kappa (κ) values were calculated, and individual observers' scores were compared. To investigate diagnostic efficiency, receiver operating characteristic (ROC) curves were calculated for each interpreter. RESULTS: The interpreters were in full agreement on 574 of 712 (80.6%) evaluations. The common Fleiss' κ value of all the radiologists combined was 0.712 (95% confidence interval [CI] 0.692-0.769). A reliable prediction on the basis of RT-PCR and clinical findings indicated the mean area under the curve (AUC) of Fleiss' κ value as 0.89 (95% CI 0.708-0.990). General interpreter agreement was found to range from moderate to good. CONCLUSION: The interpreter agreement for CO-RADS categories 1 and 5 was reasonably good. We conclude that this scoring system will make a valuable contribution to efforts in COVID-19 diagnosis. CO-RADS can also be of significant value for the diagnosis and treatment of the disease in cases with false-negative PCR results.

Evaluation of the contour of the pancreas: types and frequencies.

PURPOSE: Pancreas contour variations can sometimes be misdiagnosed as mass lesions. This study aimed to evaluate normal pancreatic contour morphology, variations, frequency and the development of the uncinate process. METHODS: Out of 1183 consecutive computed tomography images taken in our hospital for various reasons (e.g. malignity, donor), 899 suitable images were included in the study. The following variations were identified: globular, elongated or globular-elongated contours of the pancreas head, protrusions of the body-tail surfaces and globular, lobular, globular-lobular, tapered and bifid contours of the tail. Hypoplasia and aplasia of the uncinate process were identified. All images were evaluated retrospectively by two radiologists. RESULTS: Of the 899 patients, 504 (56.1%) were males. The mean age of the patients was 53.9 ± 14.7 (range 18-89). Hypoplasia of the uncinate process was found in 72 (8%) patients; aplasia was seen in 11 (1.2%) patients. Thirty-one (3.5%) of the pancreatic head variations were globular, 49 (5.4%) elongated and three (0.3%) elongated-globular. In patients with pancreatic uncinate process developmental anomaly, contour variations were also detected in the head of the pancreas. The pancreatic body-tail showed protrusions anteriorly in 76 (8%) patients and posteriorly in 11 (1.2%) patients. Seventy-two (8%) of the pancreatic tail variations were globular, 39 (4.4%) were globular-lobular, 18 (2%) were tapered and 17 (1.8%) were bifid. CONCLUSION: Patients with pancreatic uncinate process developmental anomaly also have contour variations in the head of the pancreas. Pancreatic uncinate process developmental anomaly was seen in 9.2%. Pancreatic tail contour variation was 16.2%. The pancreatic body-tail showed protrusion in 9.2% of patients.

Can the mesorectal fat tissue volume be used as a predictive factor in foreseeing the response to neoadjuvant chemoradiotherapy in rectum cancer? A CT-based preliminary study.

PURPOSE: This study was to investigate the effect of mesorectal fat tissue volume (MRV) on the pathological response to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer. METHODS: 88 patients who had been diagnosed with locally advanced rectal cancer between January 2017 and June 2020 were reviewed retrospectively. The total abdominal, subcutaneous, visceral, and mesorectal fatty tissue components were measured semiquantitatively by two radiologists using computed tomography (CT)-based findings. The patients were divided into two groups as those with and without a pathological response to nCRT. The relationship of MRV with the other fat tissue components of the body was also evaluated. RESULTS: We performed a retrospective analysis of 88 patients (mean age 62.7 years [range, 33-90 years]; 31 males and 57 females). A positive response to nCRT was present in 47 patients. There were 59 patients with stage 3 disease. 46 patients demonstrated lymph node involvement. The mean MRV was 69.6 ± 31.0 ml in no-response group and 105.8 ± 47.5 ml in response-positive patients (p < 0.05). MRV showed the highest correlation with visceral fat volume (VFV). There was a negative correlation between the MRV and the N stage. A cut-off value of ≥ 69.4 for MRV predicted the repsonse to nCRT, with 82.9% sensitivity and 58.5% specificity [AUC: 0.757 (0.653-0.842), p < 0.001] in receiver operating characteristic (ROC) curve analysis CONCLUSIONS: MRV can be used as a novel parameter in predicting of pathological response to nCRT in locally advanced rectal cancer patients.

Evaluation of the olfactory bulb volume and morphology in patients with coronavirus disease 2019: can differences create predisposition to anosmia?

OBJECTIVE: This study aimed to investigate whether the volume and morphology of the olfactory bulb are effective in the occurrence of anosmia in patients after COVID-19 infection. METHODS: The olfactory bulbus volume was calculated by examining the brain magnetic resonance imaging of cases with positive (+) COVID-19 polymerase chain reaction test with and without anosmia. Evaluated magnetic resonance imaging images were the scans of patients before they were infected with COVID-19. The olfactory bulbus and olfactory nerve morphology of these patients were examined. The brain magnetic resonance imaging of 59 patients with anosmia and 64 controls without anosmia was evaluated. The olfactory bulb volumes of both groups were calculated. The olfactory bulb morphology and olfactory nerve types were examined and compared between the two groups. RESULTS: The left and right olfactory bulb volumes were calculated for the anosmia group and control group as 47.8±15/49.3±14.3 and 50.5±9.9/50.9±9.6, respectively. There was no statistically significant difference between the two groups. When the olfactory bulb morphology was compared between the two groups, it was observed that types D and R were dominant in the anosmia group (p<0.05). Concerning olfactory nerve morphology, type N was significantly more common in the control group (p<0.05). CONCLUSIONS: According to our results, the olfactory bulb volume does not affect the development of anosmia after COVID-19. However, it is striking that the bulb morphology significantly differs between the patients with and without anosmia. It is clear that the evaluation of COVID-19-associated smell disorders requires studies with a larger number of patients and a clinicoradiological approach.

Reconstruction of traumatic lower extremity soft tissue defects with the combination of ipsilateral and contralateral perforator flaps.

Many flaps have been used to repair complex soft tissue defects of the leg. When the affected areas are relatively small and the local flaps are not suitable, microsurgical operation seems to be an excessive treatment and thus perforator flaps can be used. The authors present the combination of ipsilateral and contralateral perforator flaps for coverage of the traumatic lower extremity.

Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg.

BACKGROUND: Soft-tissue defects in the knee region are usually complex and require adequate reconstruction with flaps. The aim of this article is to present the authors' experience using the reverse-flow anterolateral thigh perforator flap for the reconstruction of a variety of soft-tissue defects around the knee including the upper third of the leg. METHODS: A total of 17 reverse-flow anterolateral thigh perforator flaps were used for reconstruction of soft-tissue defects around the knee and the upper third of the leg between December 2006 and December 2010. The ages of patients ranged from 26 to 82 years (mean, 64.3). Defect sizes ranged from 6×8 to 10×14 cm. The application of the reverse-flow anterolateral thigh perforator flaps in relation to the variable arterial anatomy was described. RESULTS: The dimensions of the largest flap used for reconstruction were 10×16 cm. The perforators were musculocutaneous in 14 patients and septocutaneous in three patients. The maximal pedicle length was 28 cm. All of the flaps survived. Only two flaps developed partial skin necrosis at the distal end. Good aesthetic and functional results with adequate range of motion were achieved in all cases. CONCLUSION: Despite a variable vascular anatomy that can be challenging for the surgeon, reverse-flow anterolateral thigh perforator flap is a safe and reliable method for reconstruction of the defects around the knee and even the upper third of the leg.