Differential Diagnosis of Generalized Cystic Lymphangiomatosis: A Literature Review.

BACKGROUND: Generalized cystic lymphangiomatosis (GCL) is a rare disease characterized by the widespread proliferation of lymphatic vessels, often seen in the pediatric patient group. Imaging techniques are instrumental in revealing the extent and morphological features of the disease. OBJECTIVE: The objective of this study is to interpret the radiological findings of GCL and address the differential diagnosis between GCL and other lymphatic malformations in light of the relevant literature data. METHODS: The sample of this retrospective study consisted of six pediatric patients, four males and two females, diagnosed with GCL based on clinical, radiological, and histopathological findings between 2015 and 2022. The age of the patients at the time of diagnosis and their symptoms at admission were obtained from the hospital database. Radiological imaging findings were evaluated in detail based on the involved systems (thorax, abdomen, and musculoskeletal). RESULTS: The median age of the sample, 4/6 were male, was 9 years at admission (min. 3, max. 12). The most common symptom at admission was dyspnea, often accompanied by pleural effusion. Bone involvement was the most common extrathoracic finding. Abdominal involvement was primarily asymptomatic, and the spleen was the most frequently involved organ in the abdomen. CONCLUSION: The diagnosis of GCL is challenging because of its rarity and overlapping diseases. Whole-body magnetic resonance imaging is a valuable tool as it reveals the typical radiological features of GCL and how far it has spread throughout the body.

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.

Evaluation of the relationship between abdominal fat distribution and osteoporotic vertebral compression fracture with MRI.

OBJECTIVE: This study was carried out to investigate the effects of abdominal subcutaneous adiposity and visceral adiposity on osteoporotic compression fractures. MATERIAL AND METHODS: The study group consisted of a total of 152 individuals aged 50-80 years; 76 were included in the vertebral fracture group and 76 in the healthy control group, whose bone mineral density was calculated. In order to determine the distribution of abdominal fat in both groups, four different measurements, i.e., sagittal abdominal diameter (SAD), abdominal diameter (AD), ventral subcutaneous thickness (VST), and dorsal subcutaneous thickness (DST), were made using lumbar magnetic resonance imaging (MRI). The visceral fat ratio (VFR) was also calculated based on these measurements. RESULTS: There was a significant difference between the patient and control groups in VST and DST values, both when gender distribution was and was not taken into account (p < 0.006 for all cases). There was no significant difference between the patient and control groups in SAD and AS values, both when only female patients were considered, and gender distribution was not taken into account (p > 0.25 for all cases). On the other hand, in the analysis, when only male patients were considered, the SAD and AD values of the patient group were found to be significantly lower than those of the control group (p = 0.046 and p = 0.048, respectively). CONCLUSION: In conclusion, the study findings indicated that high SAD values in the male gender and high VST and DST values in both genders were associated with low lumbar vertebral fracture risk.

Evaluation of the Differences in the MRI Findings Related to Primary and Secondary Adhesive Capsulitis.

Purpose: The aim of this study is to describe the radiological findings of adhesive capsulitis due to different etiological factors and reveal that different clues due to different etiological causes should be considered in the diagnosis of adhesive capsulitis. Methods: The study group comprised 24 primary and 22 supraspinatus tendon rupture-related adhesive capsulitis patients with 24 individuals without adhesive capsulitis and with normal shoulder magnetic resonance imaging. Independent samples t-test and one-way analysis of variance tests were used to compare the measurements between the groups. Paired sample t-test and Cohen's kappa statistic were used to determine inter-observer reliability. The chi-squared test was used to determine the relationships between groups and categorical variables. Study participants were evaluated both qualitatively and quantitatively. Quantitative measurements included the thickness of the humeral and glenoid segment of the joint capsule and the thickness of the anterior joint capsule and the fluid depth within the biceps tendon sheath. The qualitative assessments included the detection of any signal abnormality at the rotator interval, the grading of the humeral and glenoid segment of the joint capsule, and the detection of any signal abnormality in respect of the anterior joint capsule. Results: A statistically significant difference was found between the groups of patients with primary adhesive capsulitis and with supraspinatus tear-related adhesive capsulitis in terms of the thickness of the humeral segment of the joint capsule at the axillary recess level (AUC = .729) (P: .006). Furthermore, setting the cutoff value for the thickness of the humeral segment of the capsule to 4.6 mm allowed the differentiation of primary adhesive capsulitis and supraspinatus tear-related adhesive capsulitis with a sensitivity of 70.8% and a specificity of 87.3%. Conclusion: In conclusion, the humeral segment of the joint capsule thickness at the axillary recess was found to be affected by different degrees depending on whether it is a primary or supraspinatus tear-related adhesive capsulitis.