Evaluation of facial artery course variations and depth by Doppler ultrasonography.

BACKGROUND: As deep nasolabial folds (NLF) are associated with facial aging, there is an increasing demand for esthetic correction with filler injections. Understanding the anatomy of the angular artery (AA) and facial artery (FA) around the NLF region is essential for ensuring the safety of dermal filler injections into the NLF. The purpose of this study was to provide detailed vascular anatomical information on the course and depth of AA and FA around NLF using Doppler ultrasound on live cases. METHODS: FA was observed from the origin level adjacent to the mandible corpus to the end of its terminal branch AA in 168 hemifaces of 84 cases with Doppler ultrasonography. RESULTS: We made a classification of the FA course based on the NLF. The minimum and maximum depths of the FA along its course were measured in 84 cases. The results showed that its course may be highly superficial (2.5 mm at the mandibular origin, 3.7 mm at the cheilion, 3.7 mm at the nasal ala) or it may follow a very deep course near the periosteum (15.0 mm at the mandibular origin, 18.7 mm at the cheilion, 23.5 mm at the nasal ala). FA depth was varied between 5.98 mm and 6.62 mm at the mandibular origin, between 8.36 mm and 9.20 mm at the cheilion, between 9.52 mm and 10.51 mm at the nasal ala at a 95% confidence interval. CONCLUSIONS: This study suggests that there is no absolutely safe depth or region for nasolabial fold filler injections.

Plasma Procalcitonin Is Useful for Predicting the Severity of Acute Cholecystitis.

BACKGROUND: Acute cholecystitis is a common complication of cholelithiasis. Delayed diagnosis may constitute morbidity and mortality; therefore, early diagnosis and determining the severity of acute cholecystitis are crucial. OBJECTIVES: This study aimed to determine the validity of blood procalcitonin (PCT) levels in assessing the severity of acute cholecystitis. METHODS: The Emergency Department (ED) patients diagnosed as acute cholecystitis were included in the study. Patients were allocated into three severity grades according to the Tokyo Guidelines 2013. PCT level was measured after the clinical and radiological diagnosis of acute cholecystitis in the ED. RESULTS: Ninety-five patients diagnosed with acute cholecystitis, among them 48 of were male. Forty patients (42.1%) were allocated to grade 1, 19 (20%) to grade 2, and 36 (37.9%) to grade 3. The median values of PCT were 0.104 ng/ml, 0.353 ng/ml, and 1.466 ng/ml for grade 1, 2, and 3 patients, respectively (p < 0.001). CONCLUSION: Blood procalcitonin levels can be used to determine the severity of acute cholecystitis effectively.

Duplex Doppler Sonographic Assessment of the Superior Mesenteric Artery in Patients With Mesenteric Panniculitis.

OBJECTIVES: We aimed to determine how the hemodynamic parameters of the superior mesenteric artery are affected in mesenteric panniculitis. METHODS: Twenty-one patients with a diagnosis of mesenteric panniculitis on computed tomography were evaluated with duplex Doppler sonography. The control group consisted 20 asymptomatic volunteers. The peak systolic velocity, end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), blood flow volume, and body mass index were measured in the group of patients with mesenteric panniculitis, and the findings were compared with those of the control group. RESULTS: The mean blood flow volume and EDV were significantly higher in the patient group: The mean superior mesenteric artery blood flow volume ± SD was 917.86 ± 228.97 mL/min in the patient group versus 389.73 ± 92.72 mL/min in the control group (P < .001). The mean EDV was 31.56 ± 8.44 m/s in the patient group versus 19.27 ± 4.19 m/s in the control group (P < .001). The mean RI and PI were significantly lower in the patient group: The mean RI was 0.81 ± 0.04 in the patient group versus 0.85 ± 0.03 in the control group (P = .001). The mean PI was 2.69 ± 0.68 in the patient group versus 3.81 ± 1.13 in the control group (P = .001). the mean superior mesenteric artery diameter was 7.30 ± 0.67 mm in the patient group versus and 6.46 ± 0.66 mm in the control group (P < .001). The mean BMI was 27.95 ± 3.80 kg/m2 in the patient group versus 23.16 ± 3.47 kg/m2 in the control group (P < .001). CONCLUSIONS: In patients with mesenteric panniculitis, the Doppler spectrum of the superior mesenteric artery shows detectable changes, which are characterized by decreased vascular resistance and increased blood flow.

Rare Endobronchial Inflammatory Myofibroblastic Tumor in Pediatric Patient Detected on PET/CT Imaging.

Inflammatory myofibroblastic tumor (IMT) can be seen in all age groups, although it is more common in children and adolescents. We report the FDG PET/CT findings in an 8-year-old boy with endobronchial IMT. Endobronchial IMT is more commonly seen in young adults.

Bilateral cleft foot: Radiographic and prenatal ultrasound features of two siblings with a review of literature.

Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is characterized by deformities like median deep clefts of distal extremities. Routine examination of feet during second-trimester ultrasound (US) may increase the detection rates of foot malformations. Many malformations can be diagnosed with 2-dimensional (2D) US, but 3-dimensional (3D) US also helps better understanding of the foot malformations. In the present study, we report the case of two brothers (a fetus and a 5-year-old) with cleft foot deformity. 2D and 3D second trimester US findings of one case and the foot radiography findings of the other are presented here.

Laparoscopic Approach to a Rare Cause of Ureteropelvic Junction Obstruction in a Child: Ureteral Polyp.

Fibroepithelial polyps are a rare underlying reason of ureteropelvic junction obstruction. In the past, open surgery was the only option. However, due to development of minimal invasive technics, treatment alternatives have been changed. Resection by laparoscopy or endoscopy, laser fulguration and/or percutaneous resection are recommended in children and adults. Here, we present a 10-year-old boy with severe left hydronephrosis due to fibroepithelial polyp close to the ureteropelvic junction and our laparoscopic approach.

Nonodontogenic mandibular lesions: differentiation based on CT attenuation.

Mandibular lesions are classified as odontogenic and nonodontogenic based on the cell of origin. Odontogenic lesions are frequently encountered at head and neck imaging. However, several nonodontogenic pathologies may also involve mandible and present further diagnostic dilemma. Awareness of the imaging features of nonodontogenic lesions is crucial in order to guide clinicians in proper patient management. Computed tomography (CT) may provide key information to narrow diagnostic considerations. Nonodontogenic mandibular lesions may have lytic, sclerotic, ground-glass, or mixed lytic and sclerotic appearances on CT. In this article, our aim is to present various nonodontogenic lesions of the mandible by categorizing them according to their attenuations on CT.

Abdominal nonparenchymatous cystic lesions and their mimics in children.

Abdominal cystic lesions in children may originate from parenchymatous organs or from nonparencyhmatous structures. Although these lesions have well-described imaging features, proper diagnosis usually depends on the accurate determination of the origin of the lesion. Because large lesions may resemble each other it is difficult to identify the site of origin, which results in a diagnostic dilemma. In this pictorial essay we describe abdominal nonparenchymatous cystic lesions and their mimics arising from parenchymatous organs in children.

Gray scale histogram analysis of solid breast lesions with ultrasonography: can lesion echogenicity ratio be used to differentiate the malignancy?

PURPOSE: The aim of this study was to investigate the diagnostic performance of lesion echogenicity ratios (LER) calculated by image histogram analysis for distinction of malignant and benign breast lesions. MATERIAL AND METHODS: A total of 55 patients (mean age, 44 years) with 59 lesions were included. Ultrasound images were analyzed retrospectively. RESULTS: Mean LER values in benign and malignant lesions were 1.63±0.41 and 3.1±0.87, respectively. The difference between LER values of benign and malignant breast lesions was statistically significant (P<.001). CONCLUSION: LER can be used as an adjunct ultrasound parameter to differentiate between benign and malignant breast lesions.

Radiologic findings of epiploic appendagitis.

The aim of this case report is to present typical US and CT features of epiploic appendagitis, characterized by the ischemia and inflammation of the epiploic appendices of the colon. A 44 year old man was admitted with a localized pain to umblical region. Physical examination revealed rebound tenderness. US examination showed a hyperechoic mass with a hypoechoic rim posterior to abdominal wall and CT features confirmed the diagnosis of epiploic appendagitis. The case was managed conservatively and had a self limited course.

Radiologic findings of thoracic scoliosis due to giant ganglioneuroma.

A 28-year-old male with scoliosis presented with complaints of dyspnea and vomiting. His medical history revealed a mediastinal ganglioneuroma resection at the age of 2. After the surgery, he had not been followed up until his admission to our hospital. Computed tomography and MRI showed severe scoliosis of the thoracic spine and a paravertebral mass extending from the upper thoracic level to the level of renal arteries. Based on its radiological findings and the patient's history, the tumor was considered to be a recurrent ganglioneuroma. Paravertebral ganglioneuromas may cause progressive scoliosis, and a careful examination for patients with progressive scoliosis is mandatory.

Ultrasonography of tubular ectasia of the rete testis with associated scrotal findings.

PURPOSE: Tubular ectasia of the rete testis (TERT) is a rare disorder that can be seen on ultrasonography (US) during a routine examination. In this study, we aim to discuss 15 cases of TERT and concomitant scrotal pathologies. METHODS: A total of 405 patients who were admitted to our department between March 2009 and December 2011 for scrotal US with different complaints such as scrotal pain, palpable mass, infertility, varicocele, or hydrocele were evaluated. Presence or absence of TERT and associated scrotal anomalies if TERT was present were considered on gray-scale US and color Doppler US. RESULTS: Tubular ectasia of the rete testis was detected in 15 patients (3.7 %). It was unilateral in eleven patients (73.3 %) and bilateral in four patients (26.7 %). The mean age of the patients with TERT in this study was 43.7 years (range 24-85 years). Five patients (33.3 %) with TERT presented with infertility, four of them (26.7 %) presented with palpable mass, and six of them (40%) were admitted with scrotal pain. In 14 patients (93.3 %), at least one of the following disorders associated with TERT was seen: epididymal cyst, spermatocele, hydrocele, and varicocele. CONCLUSION: Tubular ectasia of the rete testis shows characteristic appearances on gray-scale and Doppler US evaluation, and no other modality is necessary for diagnosis. TERT is usually associated with epididymal pathologies such as epididymal cyst or spermatocele located on the same side. Testicular neoplasms, intratesticular varicocele, and cystic dysplasia of the testis should be considered in the differential diagnosis of TERT.

Radiologic findings of a giant unilateral abdominoscrotal hydrocele associated with undescended testis.

Abdominoscrotal hydrocele (ASH) is an uncommon entity characterized by an hourglass-shaped hydrocele that extends from the scrotum into the abdominal cavity. In this case, ultrasonography and computed tomography findings of an 11-month-old patient with a right ASH and undescended testis are reported.

MRI in the diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome.

PURPOSE: The aim of this study was to establish the role of magnetic resonance imaging (MRI) in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS). MATERIALS AND METHODS: Sixteen female MRKHS patients (mean age, 19.4 years; range, 11-39 years) were studied using MRI. Two experienced radiologists evaluated all the images in consensus to assess the presence or absence of the ovaries, uterus, and vagina. Additional urogenital or vertebral pathologies were also noted. RESULTS: Of the 16 patients, complete aplasia of uterus was seen in five patients (31.3%). Uterine hypoplasia or remnant uterus was detected in 11 patients (68.8%). Ovaries were clearly seen in 10 patients (62.5%), and in two of the 10 patients, no descent of ovaries was detected. In five patients, ovaries could not be detected on MRI. In one patient, agenesis of right ovary was seen, and the left ovary was in normal shape. Of the 16 cases, 11 (68.8%) had no other extragenital abnormalities. Additional abnormalities were detected in six patients (37.5%). Two of the six had renal agenesis, and one patient had horseshoe kidney; renal ectopy was detected in two patients, and one patient had urachal remnant. Vertebral abnormalities were detected in two patients; one had L5 posterior fusion defect, bilateral hemisacralization, and rotoscoliosis, and the other had coccygeal vertebral fusion. CONCLUSION: MRI is a useful and noninvasive imaging method in the diagnosis and evaluation of patients with MRKHS.

Evaluation of testicular vein anatomy with multidetector computed tomography.

PURPOSE: We aimed to evaluate the normal anatomy and variations of testicular veins by multidetector CT (MDCT). MATERIALS AND METHODS: This prospective study included 101 male patients who underwent abdominal CT for various clinical indications. Mean age of patients was 53 years. Images were obtained by dual source 64-slice MDCT (n = 61) and 64-MDCT (n = 41). Images were analyzed using 1 mm thick slices on a dedicated workstation. The number of testicular veins, drainage site and diameter of proximal, mid and distal testicular veins were recorded. RESULTS: Testicular veins were visualized in all patients. There were single right testicular vein in 99 (98%) patients and 2 (2%) patients had duplicated right testicular veins (total 103 veins). Right testicular vein drained into inferior vena cava in 88 (87.1%) patients and right renal vein in 13 (12.9%) patients. One of duplicated right testicular veins drained into inferior vena cava and other paired drained into right renal vein and inferior vena cava separately. There were single left testicular vein in 88 (87.1%) patients and 13 (12.9%) patients had duplicated veins (total 14 veins). All left testicular veins drained into left renal vein. CONCLUSION: 64-MDCT enables evaluation of testicular veins in all patients. Right and left testicular veins are usually single, but can be duplicated more commonly.

FDG Uptake Pattern on PET/CT Imaging in Non-Infectious Graft of a Patient with Operated Abdominal Aortic Aneurysm.

UNLABELLED: Positron emission tomography using fluorodeoxyglucose is a well known diagnostic tool for routine assessment of the patients with carcinoma. Fluorodeoxyglucose uptake, as a marker of glucose metabolism, is increased in malignant conditions as well as infectious and inflammatory processes. In this case report, findings of postoperative changes in the graft on FDG PET/CT were presented in a patient on follow-up for operated renal cell carcinoma and aortic aneurysm graft surgery. The importance of the FDG uptake pattern has been pointed out for differential diagnosis of infectious and non-infectious conditions. CONFLICT OF INTEREST: None declared.

Multidetector-row computed tomography findings of sclerosing mesenteritis with associated diseases and its prevalence.

PURPOSE: Our aim was to report the multidetector-row computed tomography (MDCT) findings of sclerosing mesenteritis, which is a rare disease characterized by chronic nonspecific inflammation of mesenteric adipose tissue. It has associated diseases, and we explored its prevalence. MATERIALS AND METHODS: A total of 2100 patients were evaluated retrospectively for sclerosing mesenteritis between December 2007 and May 2009. Signs and symptoms, associated diseases, laboratory data, surgical histories, and related findings of a misty mesentery, which corresponds to sclerosing mesenteritis on MDCT, were recorded. RESULTS: Misty mesentery findings were seen in 51 (2.43%; 35 men) patients. Their ages ranged between 33 and 78 years (mean 56.2 years). The most frequent complaint of patients was abdominal pain (n = 19; 37.2%). The most prominent possible causative and/or associated factors in our study were malignancy (n = 9; 17.6%), previous surgery (n = 17; 33.3%), smoking (n = 20; 39.2%), coronary artery disease (n = 9; 17.6%), urolithiasis (n = 10; 19.6%), hypertension (n = 18; 35.2%), hyperlipidemia (n = 13; 25.5%), and diabetes mellitus (n = 11; 21.5%). On MDCT, density values in mesenteric fat (-62.8 ± 18.6 HU) were significantly higher than the values for subcutaneous (-103.9 ± 5.8 HU) and retroperitoneal (-105 ± 6 HU) fatty tissues (both P < 0.0001). A partially hyperdense stripe (n = 37; 72.6%), well-defined soft tissue nodules (100%), hypodense fatty halo enclosing vessels (n = 1; 1.9%), and nodules (n = 12; 23.5%) were demonstrated in most of the patients. CONCLUSION: The diagnosis of sclerosing mesenteritis has increased with the more frequent use of MDCT and the popularization of the DICOM viewer. Defined hallmarks on MDCT can be helpful for differentiating sclerosing mesenteritis from other pathologies.

Unusual presentation of an anterior sacral meningocele: magnetic resonance imaging, multidetector computed tomography, and fistulography findings of bacterial meningitis secondary to a rectothecal fistula.

An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44-year-old woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Nontraumatic pneumocephalus, tetraventricular hydrocephalus, fluid-fluid level at the lateral ventricles, and pial enhancement were observed on multidetector computed tomography. A ventricular drainage catheter was placed to decompress the hydrocephalus, and drainage was performed urgently. Escherichia coli was isolated from the drainage material. Whole-spine magnetic resonance imaging and fistulography were undertaken on the third day after admission to evaluate for anal and urinary incontinence and pareses of both upper and lower extremities. Spinal arachnoiditis, tethered cord, dysgenesis of the sacrum, and a rectothecal fistula were demonstrated. Specific antibiotic treatment and surgery for fistula tract excision were performed.

The value of dynamic contrast-enhanced MRI in the detection of recurrent prostate cancer after external beam radiotherapy: correlation with transrectal ultrasound and pathological findings.

PURPOSE: To assess the effectiveness of dynamic contrast-enhanced (DCE) T1- and T2-weighted magnetic resonance imaging (MRI) during the follow-up of patients with prostate cancer after undergoing external beam radiotherapy (EBRT) and to compare these imaging findings to pathological and transrectal ultrasound (TRUS) findings. MATERIALS AND METHODS: In this retrospective study, the MRI findings of 20 patients who had prostate cancer and were treated with EBRT were evaluated to detect tumor recurrence. The MRI findings were compared to those that had been obtained by TRUS and pathological analysis. RESULTS: The sensitivity and specificity of TRUS in the detection of tumor recurrence in patients who had undergone EBRT were 53.3% and 60%, respectively. In the same group of patients, the sensitivity and specificity of T2-weighted MRI were 86% and 100%, respectively. Strikingly, the sensitivity and specificity of DCE T1-weighted MRI in the diagnosis of recurrent prostate cancer were 93% and 100%, respectively. The accuracy of the DCE T1-weighted images in the detection of recurrence was significantly higher in comparison to that obtained using T2-weighted images. CONCLUSION: During the follow-up of these patients, TRUS without the use of any other imaging or biochemical modality is not a sufficient method for the detection of prostate cancer recurrence. DCE T1-weighted MRI increases the sensitivity of MRI alone for the detection of recurrence during the follow-up of prostate cancer patients who have been treated with EBRT. Thus, DCE T1-weighted MRI must be used as part of the routine MRI analysis to check for tumor recurrence in patients with prostate cancer.