A comparison between the superb microvascular imaging technique and conventional Doppler ultrasound in evaluating chronic allograft damage in renal transplant recipients

PURPOSE: The present study comparatively evaluates the performance of conventional Doppler ultrasound and superb microvascular imaging (SMI) in delineating the cortical microvessels of the transplanted kidney and compares the chronic allograft damage index (CADI) based on the examination of biopsy specimens with Doppler ultrasound and SMI findings. METHODS: Sixty-eight renal transplant recipients underwent kidney biopsy with the pre-diagnosis of rejection before undergoing renal Doppler ultrasound examination between January 2020 and October 2020. The distance between the kidney capsule and the vascular structure closest to the kidney capsule was measured at the level of the lower pole in the transplanted kidney using color Doppler ultrasound (CDUS), power Doppler ultrasound (PDUS), and the SMI technique. The kidney size, resistive index at the level of the arcuate artery in the lower pole of the kidney, and renal artery flow rates were also measured. RESULTS: The mean distance between the kidney capsule and the vessel was 2.44 ± 2.0 mm on CDUS, 1.34 ± 1.2 mm on PDUS, 0.99 ± 1.8 mm using the color SMI (cSMI) technique, and 0.86 ± 1.8 mm using the monochrome SMI (mSMI) technique. The study found that the SMI technique was superior to CDUS and PDUS in delineating the cortical microvasculature of the kidney. Both Doppler ultrasound examinations and the SMI technique proved effective in predicting the CADI (P = 0.006 for CDUS, P = 0.002 for PDUS, P = 0.018 for cSMI, and P = 0.027 for mSMI). Among conventional Doppler ultrasound examinations and the SMI technique, PDUS had the highest sensitivity, and cSMI had the highest specificity in differentiating high and low CADI values. Both the cSMI and mSMI techniques had similar sensitivity values, whereas only cSMI exhibited high specificity. CDUS had the lowest specificity value (P = 0.003 for CDUS, P = 0.002 for PDUS, P = 0.005 for cSMI, and P = 0.004 for mSMI). CONCLUSION: The present study is the first in the literature to demonstrate the utility of the distance between the kidney capsule and the vessels in predicting the CADI score and to compare the Doppler ultrasound examinations and SMI technique in doing so.

The role of intraoperative ultrasonography in detection of hepatic vein variations in living donor liver transplantation.

BACKGROUND: With advances in surgical techniques and immunosuppression, liver transplantation has become the most effective treatment of acute and chronic liver failures. Evaluation of vascular anatomy and detection of hepatic vascular variations prior to surgery, especially transplantation surgery, can help reduce complications in both the donor and the recipient. Intraoperative ultrasonography (IOUS) is known to be beneficial during planning of the transplantation surgery, and can help direct the surgery itself. OBJECTIVES: To our knowledge, there are no existing studies that evaluate the number and diameter of segment 5 and 8 branches that need to be anastomosed with IOUS. PATIENTS AND METHODS: In this study, considering surgical anatomical evaluation as the gold standard, IOUS findings were compared to computed tomography angiography (CTA) findings. 40 patients were included in the study. RESULTS: The average diameters of segment 8 branches that were anastomosed and not anastomosed were significantly different when measured by IOUS (p = 0.016); however, no such statistically significant difference was found in measurements made with CTA (p = 0.89). CONCLUSION: CTA is superior to IOUS in detecting segment 5 and 8 veins draining into the middle hepatic vein. However, IOUS is more accurate in predicting which vessels are going to be anastomosed. For a complete and accurate assessment, both imaging modalities should be used to complement each other, and their respective advantages and disadvantages should be known.

Intrathyroidal ectopic thymus in children: a sonographic survey.

AIMS: Intrathyroidal ectopic thymus (IET) is being increasingly reported in the radiology literature. Most of the reports are of individual cases or small series and prevalence and natural course of the pathology is not well known. The purpose of this study is to establish the prevalence of IET in children and report long term follow-up results. MATERIAL AND METHODS: In 180 children who were examined by ultrasound (US) for other reasons, 7 patients were indentified with IET. Together with the other seven children who were already under follow-up for IET (diagnosed using US criteria), these 14 patients were followed up with US for 30 months. Size, shape, location, echotexture and internal echoes of the lesions were evaluated. RESULTS: There were 16 lesions in 14 children. The most common appearance was a fusiform hypoechoic lesion, with punctate and linear internal echoes and well-defined but slightly irregular borders located posteriorly in the lower thirds of the thyroid. In follow-up, there were no changes in echotexture, shape or border. In 3 patients, the lesion became slightly smaller, in a 10-year-old boy slightly larger, and in an 11-year old boy the lesion disappeared. In a patient with bilateral lesions, one lesion slightly decreased in size. CONCLUSIONS: IET in children may be more common than thought. Its growth reflects that of a normal thymus. Awareness of this entity is important in order not to misdiagnose them, especially as papillary cancer, and to prevent unnecessary interventions.

Bi-RADS category 3 nonpalpable breast masses on sonography: long-term results of a prospective cohort study.

PURPOSE: To determine the frequency of BI-RADS category 3 nonpalpable masses detected using only sonography (US) and the malignancy rate among these lesions. Second, to validate a proposed short-term follow-up regimen based on long-term observational results. METHODS: This prospective cohort study was conducted between September 2003 and April 2010. We conducted a 2-year short-term follow-up protocol composed of five US examinations at 3-month intervals for the first 6 months, and at 6-month intervals for the next 18 months, followed with age-appropriate screenings. Biopsy was recommended for the masses increasing in size and with changing imaging features. RESULTS: The frequency of category 3 nonpalpable masses detected only on US in 11,373 consecutive women was 5.3%. Of 562 lesions found in 451 women, 394 (70.1%) remained stable during the short-term and subsequent follow-up. Seventy-four (13.1%) masses showed interval regression and 79 (14.0%) showed interval progression. The malignancy rate was 0.3% (2 of 562), with about 85% of interval changes occurring within the first 2 years. The negative predictive value of US in the detection of cancer was 99.6% (95% CI, 98.7-99.9). The mean follow-up time was 65.5 ± 8.7 months. CONCLUSIONS: The frequency of BI-RADS 3 nonpalpable masses detected using sonography alone was 5.3%. During follow-up, the majority of interval changes occurred within the first 2 years. Because these masses have a very low malignancy rate, a 2-year follow-up instead of immediate biopsy is an appropriate option.

Follow-up versus tissue diagnosis in BI-RADS category 3 solid breast lesions at US: a cost-consequence analysis.

PURPOSE: The aim of this study was to compare the economic effect of a proposed follow-up strategy for managing category 3 breast masses. The strategy incorporated direct tissue diagnosis at the patient's discretion for masses that had been assessed only based on ultrasonography (US) and for which mammography made no diagnostic contribution. MATERIALS AND METHODS: This prospective cohort study was conducted between 2003 and 2006 and included 174 patients. We used a two-year short-term follow-up protocol composed of five steps. A biopsy was recommended for masses that were increasing in size and changing in nature. The long-term results were available at the end of 2010. The mean and total costs were calculated for the women who preferred our follow-up protocol and for those who preferred direct tissue diagnosis. The cost savings were calculated by comparing the costs of the current study protocol to the costs of two different scenarios. RESULTS: Two malignancies were found among the 18 women who underwent tissue diagnosis on the recommendation of the radiologist during follow-up. Thirteen of these women underwent biopsy at the request of the patient or surgeon, and these biopsies all revealed benign tumors. The overall negative predictive value was 99.2% (95% confidence interval, 98.46%-100%). There was a statistically significant difference between the mean costs for the women who chose our follow- up regimen (147.57±106.7 TL) and those who preferred direct tissue diagnosis (426.89±149.8 TL) (P = 0.0001). The use of our follow-up protocol decreased the cost of diagnosis by 60% compared with the cost of using direct tissue diagnosis as the initial procedure. CONCLUSION: Our long-term results indicate that following-up solid category 3 masses detected only by US for at least two years at short intervals is a cost-effective alternative to direct breast biopsy.

The effects of Kisspeptin antibodies on delayed estrus in rats.

In recent years, numerous studies have been conducted on the effects of Kisspeptin/GPR54 system on sexual cycle, which proved that this system regulated gonadotropin release through GnRH. This study aims to determine the effects of hyperimmune serum containing antibodies produced against Kisspeptin on the sexual cycle and GnRH receptors in rat pituitaries. To this end, five Wistar female rats were passively immunised using a hyperimmune serum obtained from two Wistar female rats against Kisspeptin 10. Another five rats were selected as the control group. Anti-Kisspeptin antibodies of the hyperimmunised rats in the serum were identified by ELISA. The sexual cycles of the rats were followed by the measurements of vaginal irrigations and the estradiol concentrations in their blood samples. The number of follicles and corpora lutea in their ovaries was determined through histopathological tests, and the GnRH receptors in their pituitaries were identified by immunohistochemistry. Consequently, strong seropositivity was detected in all passively immunised rats and the hyperimmune serum. However, no difference was found between the groups with regard to the number of estrous cycles observed, the interval between estrous periods, estradiol concentrations, the number of follicles and corpora lutea and immunohistochemical results.

Effect of joint motion on safety of portals in posterior ankle arthroscopy.

PURPOSE: The purpose of this study was to determine the anatomic relation of the neural structures posteriorly crossing the ankle by use of classical ankle arthroscopy posterior portals and hindfoot endoscopy portals. The effect of ankle and hindfoot motions on portal-nerve distance was also determined. METHODS: This study included 20 feet and ankles in 20 adult volunteers who had no complaints regarding their ankle joints. To obtain 6 fixed positions of the ankle and hindfoot (neutral-neutral, neutral-varus, neutral-valgus, dorsiflexion-neutral, dorsiflexion-varus, and dorsiflexion-valgus) during magnetic resonance imaging examination, feet were positioned in a polycaprolactone splint that was shaped before examination. Magnetic resonance imaging examinations were performed at all 6 positions, and the shortest distance between the sural and posterior tibial nerves to the portals was measured at 2 different levels. RESULTS: The mean distance between the posterior tibial nerve and the posteromedial portal was 16.5 +/- 5.6 mm and that between the sural nerve and the posterolateral portal was 13.1 +/- 3 mm at the hindfoot portal level. At the level of the posterior ankle arthroscopy portal, the mean distance from the posterior tibial nerve to the posteromedial portal line was 13.3 +/- 4.6 mm and that from the sural nerve to the posterolateral portal line was 9.7 +/- 2.9 mm. The differences in distances were statistically significant (P < .001) according to the paired t test. We determined that the sural nerve approached the posterolateral portal in the dorsiflexion-varus (P = .026), dorsiflexion-valgus (P = .014), dorsiflexion-neutral (P < .001), and neutral-varus (P = .035) positions, and all differences were statistically significant. CONCLUSIONS: We found that the posterior medial and lateral portals created at the level of the tip of the fibula as described by van Dijk et al. while the foot was in a neutral-neutral position provided the greatest margin of safety. We found no advantage of placing the ankle and hindfoot in different positions to avoid neurologic complications. CLINICAL RELEVANCE: These findings suggest that neurovascular structures draw away from the posterior portals of ankle arthroscopy distally; by lowering the level of portals toward the tip of the fibula and positioning the foot at neutral, arthroscopic surgeons will decrease the risk of iatrogenic lesions.

The effect of hemodialysis on accelerated atherosclerosis in diabetic patients: correlation of carotid artery intima-media thickness with oxidative stress.

OBJECTIVE: Both diabetes and hemodialysis (HD) are associated with increased oxidative stress. The aim of this study was to clarify the effect of maintenance HD on oxidative stress parameters in diabetic patients and to explore any relation between carotid artery intima-media thickness (CIMT) and oxidative stress markers. METHODS: Twenty Type 2 diabetic patients undergoing chronic maintenance HD, 20 type 2 diabetic patients with normal renal function, and 20 age- and sex-matched healthy subjects were included. Serum thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCO), and nitrite/nitrate levels were determined as oxidative stress markers. Serum vitamin E, plasma sulfhydryl (P-SH), erythrocyte glutathione (GSH) levels, and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were measured as antioxidants. CIMT was assessed by carotid artery ultrasonography. RESULTS: Both diabetic patient groups had enhanced oxidative stress indicated by higher levels of TBARS, PCO, and nitrate/nitrite and lower activities of SOD, CAT, and GPx compared to controls. Diabetic patients undergoing HD had significantly higher CIMT (P=.001) and higher levels of nitrite/nitrate (P=.05), PCO (P=.03), and GSH (P=.04) but significantly lower levels of P-SH (P<.001), serum vitamin E (P=.04), SOD (P=.02), CAT (P=.001), and GPx (P=.006) compared to diabetic patients with normal renal functions. There were significant negative correlations between CIMT and SOD (r=-0.50, P<.001), CAT (r=-0.41, P=.003), and P-SH levels (r=-0.51, P<.001) and significant positive correlation between CIMT and nitrite/nitrate levels (r=0.41, P=.003) and TBARS (r=0.35, P=.02). Linear regression analysis showed TBARS was significantly and positively correlated with CIMT (P=.04), while SOD and P-SH were significantly and negatively correlated with CIMT (P=.05 and P=.02, respectively). CONCLUSIONS: Hemodialysis exacerbates oxidative stress and disturbances in antioxidant enzymes in diabetic patients. Serum nitrite/nitrate and TBARS can be used as positive determinants, while erythrocyte SOD, CAT activities, and P-SH level can be used as negative determinants of atherosclerosis assessed by CIMT in diabetic patients.

Are uremia, diabetes, and atherosclerosis linked with impaired antioxidant mechanisms?

BACKGROUND: Oxidative stress is a new risk factor for atherosclerosis. Increased oxidative stress in hemodialysis (HD) patients may arise from uremia-associated metabolic/humoral abnormalities and bioincompatibility of dialysis. Patients with diabetes mellitus (DM) may be subject to an additional risk. Respective influences of uremia, diabetes, and HD duration in accelerated atherosclerosis and oxidative stress have not been clarified yet. METHODS: The study was performed on 24 nondiabetic HD patients, 23 diabetic HD patients, 20 stages 3 to 4 chronic kidney disease patients, and 21 diabetic patients without overt nephropathy. Carotid intima-media thickness, a surrogate of atherosclerosis, was measured by high-resolution B-mode ultrasonography. Oxidant status was determined by lipid peroxidation as expressed by malondialdehyde (MDA); antioxidant status was determined by superoxide dismutase, catalase, glutathione peroxidase, reduced intracellular glutathione, and plasma thiol. RESULTS: Intima-media thickness (IMT) was higher in patients undergoing HD but not different between nondiabetic HD patients and diabetic HD patients. No correlation was found between the duration of HD and intima-media thickness. Antioxidants were generally lower in HD patients. Intima-media thickness was positively correlated with MDA and negatively correlated with plasma thiol. Among other risk factors, only age was correlated with intima-media thickness. CONCLUSIONS: Increased carotid IMT in HD patients is independent of duration of HD or diabetes status. Age and MDA are the significant predictors of carotid IMT. Increased oxidative stress due to impaired antioxidant mechanisms, particularly reduced plasma thiol redox potential, may account for accelerated atherosclerosis in high-risk patients with chronic kidney failure and/or DM.

Carotid artery intima-media thickness correlates with oxidative stress in chronic haemodialysis patients with accelerated atherosclerosis.

BACKGROUND: Accelerated atherosclerosis is the major cause of mortality in patients on chronic haemodialysis (HD). Increased oxidative stress might be the major factor leading to high cardiovascular mortality rate in HD patients. The aim of our study was to clarify effects of uraemia and dialysis on oxidative stress parameters and explore the relation between oxidative stress markers and carotid artery intima-media thickness (CIMT) as an indicator of atherosclerosis. METHODS: Twenty chronic HD patients, 20 predialytic uraemic patients and 20 healthy subjects were included in the study. Serum thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCO) and nitrite/nitrate levels were determined as oxidative stress markers. Serum vitamin E, plasma sulfhydryl (P-SH), erythrocyte glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities were measured as antioxidants. CIMT was assessed by carotid artery ultrasonography. RESULTS: Both chronic HD and predialytic uraemic patients had enhanced oxidative stress indicated by higher levels of nitrite/nitrate, TBARS and PCO, and lower levels of P-SH, SOD, CAT and GPx compared to controls. HD patients had significantly higher CIMT and nitrite/nitrate while significantly lower P-SH,vitamin E, SOD, CAT and GPx compared to predialytic uraemic patients. There was a significant positive correlation between CIMT and TBARS (r = 0.38, P = 0.003) and nitrite/nitrate levels (r = 0.41, P = 0.001), while there was a significant negative correlation between CIMT and SOD (r = -0.35, P = 0.01), CAT (r = -0.65, P < 0.001) and P-SH levels (r = -0.50, P < 0.001). A linear regression analysis showed that TBARS were still significantly and positively correlated with CIMT (P = 0.001), while CAT and P-SH were significantly and negatively correlated with CIMT (P = 0.002 and P = 0.048, respectively). CONCLUSIONS: HD exacerbates oxidative stress and disturbances in antioxidant enzymes in uraemic patients. We propose that serum TBARS and nitrite/nitrate can be used as positive determinants, while erythrocyte SOD, CAT and P-SH may be used as negative determinants of atherosclerosis assessed by CIMT in uraemic and HD patients.

Hepatobiliary fascioliasis: sonographic and CT findings in 87 patients during the initial phase and long-term follow-up.

OBJECTIVE: The purpose of our study was to describe the initial and long-term imaging findings in hepatobiliary fascioliasis. CONCLUSION: Most patients with fascioliasis have typical hepatobiliary imaging findings. It is important to know that residual fibrotic or necrotic foci may remain for years after cure. Long-term complications are rare in fascioliasis, and malignancy or cirrhosis related to the disease has not been observed.

Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice?

AIM: To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. MATERIALS AND METHODS: Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. RESULTS: Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. CONCLUSION: Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts.

[MR imaging of meniscal tears at low-field (0.35 T) and high-field (1.5 T) MR units]. / Menisküs yirtiklarinin saptanmasinda düsük (0.35 T) ve yüksek (1.5 T) tesla MRG cihazlarinin tanisal degeri.

PURPOSE: To compare the effectivity of low (0.35 T) and high (1.5 T) field magnetic resonance imaging units in detecting meniscal tears. MATERIALS AND METHODS: Forty-eight knee MR imaging examinations performed in low field MR unit and 76 examinations performed in high field unit were retrospectively evaluated. MR results were compared with arthroscopy findings in all patients. RESULTS: For medial meniscus tears, sensitivity, specificity and accuracy values were 93.7%, 87.5% and 91.6%, respectively in the low field unit. For lateral meniscus tears, these values were 87.5%, 95.0% and 93.7%, respectively. In the high field unit (1.5 T), sensitivity, specificity and accuracy for the detection of medial meniscus tears were 96.6%, 88.2% and 94.7%, respectively. For lateral meniscus tears, these values were 71.4%, 98.5% and 96.0%, respectively. There was no statistically significant difference between high and low field units in the detection of medial and lateral meniscus tears. CONCLUSION: We think that low field MR units are as effective as high field units in the evaluation of meniscus tears.

[Mammography-related pain and anxiety]. / Mamografi çekimine bagli agri ve kaygi.

PURPOSE: To investigate whether informing patients about mammographic compression changed the anxiety and pain that they experience during mammography. MATERIALS AND METHODS: Five hundred and one patients were enrolled in the study. Two hundred and fifty seven (51.3%) were informed before the procedure by written forms explaining the necessity of compression. The remaining 244 (48.7%) didn't get any pre-procedural information. All participants completed demographic form and Spielberger's State Anxiety Inventory while they were waiting for mammography. They marked the level of pain due to compression on a 100-mm visual analog scale (VAS) after the procedure. Chi square, Pearson's correlation and Student's t tests were used for statistical analyses. RESULTS: We didn't find any significant difference between the anxiety scores of the informed (41.4+/-7.9) and uninformed (40.9+/-7.7) women, but the pain level was significantly lower in the informed group (16.5+/-22.4) than in the uninformed group (24.5+/-28.1). There was no statistically significant relationship between the anxiety and pain levels. Women who had recently felt tense and nervous or had a fear of breast cancer diagnosis had higher anxiety levels. CONCLUSION: Our data shows that informing patients about examination decreases the level of pain due to mammographic compression, but does not alter the anxiety level. The main cause of anxiety appears to be the fear of a malignant diagnosis. Any intervention to decrease this fear may increase the compliance rates for screening mammography.

Optic neuritis: evaluation with orbital Doppler sonography.

PURPOSE: To evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis. MATERIALS AND METHODS: Orbital Doppler sonography was performed in 20 patients with acute unilateral optic neuritis. Optic neuritis was diagnosed by a neurologist on the basis of clinical presentation, presence of decreased visual acuity, and assessment of visual evoked potentials. The peak systolic and end diastolic velocities and the resistive index were measured in the ophthalmic and central retinal arteries of both orbits. The values obtained from affected and unaffected orbits were compared by using the paired t test. RESULTS: The peak systolic and end diastolic velocities in the ophthalmic artery were significantly increased in the affected orbits (for peak systolic velocity P <.001, for end diastolic velocity P <.05). Resistive indexes in the ophthalmic arteries did not differ (P >.05). The difference between the peak systolic and end diastolic velocities and resistive indexes in the central retinal arteries of affected and normal eyes was not statistically significant (P >.05). CONCLUSION: Peak systolic and end diastolic velocities in the ophthalmic artery are increased in patients with acute optic neuritis.

Human fascioliasis: MR imaging findings of hepatic lesions.

Our objective was to describe MR imaging findings of liver lesions in human fascioliasis. The MR imaging of the liver was performed in 29 patients with fascioliasis. Seventeen patients were women and 12 were men, with a mean age of 47.5 years (age range 17-75 years). Hepatic lesions were grouped into five types based on their signal characteristics. Three patients had normal imaging findings. One or more lesions were observed in the other 26 patients. The lesion types and the frequency of appearances were as follows: hyperintensity of the liver capsule on T2-weighted images (n=16, 55.2%); ill-defined slightly hyperintense areas on T2-weighted images (n=18, 62.1%); lesions which were hypointense on T1-weighted and hyperintense on T2-weighted images (n=10, 34.5%); hypointense on T1-weighted images and centrally hypo- or hyperintense, surrounded by peripherally less hyperintense area on T2-weighted images (n=4, 13.8%); and hypointense foci or ill-defined hypointense areas on T1- and T2-weighted images (n=10, 34.5%). We describe the MR imaging features of the disease. Our findings may help the differential diagnosis in which fascioliasis should be added to the list.