The role of superb micr ole of superb microvascular imaging in detecting low-gr ascular imaging in detecting low-grade inflammation among adults and those with chronic kidney disease: A preliminary study.

BACKGROUND: Pathophysiologic changes associated with chronic inflammation occur with aging and more prominently in patients with chronic kidney disease (CKD), and an association between chronic inflammation and muscle wasting has been identified. The microcirculation is extremely sensitive to the inflammatory process and actively participates in it. In a healthy adult, angiogenesis is a strictly controlled and rare occurrence. However, aberrant angiogenesis and the development of new tiny blood vessels are known in chronic inflammatory diseases. Superb microvascular imaging (SMI) is a noninvasive technique that can evaluate tiny vessels with low blood flow and provide quantitative data. Our goal was to detect increased blood flow secondary to low-grade chronic inflammation in micro-circulation in the rectus femoris (RF) muscle using SMI. METHODS: This cross-sectional study involved 30 patients with CKD, 30 adults without CKD or other chronic illnesses, and 32 young healthy volunteers. This study was conducted in our university hospital between March and December 2021. The RF cross-sectional area (CSA) was measured, and vascular index (VI) values were obtained using SMI. All three groups' RF-CSA and VI values were compared. RESULTS: Although there was no statistically significant difference in RF-CSAs between the groups, the VI values of all three groups were statistically different (p < 0.001). The median (min-max) VI values were 0.90 (0.60-1.30), 0.50 (0.20-1.0), and 0.30 (0.10-0.50) for the CKD, adult control, and young healthy groups, respectively. The VI significantly differentiated patients with CKD from all other patients and the adult control group. When a cutoff value of 6.5 was used for the VI in detecting increased blood supply in RF muscle in patients with CKD, the accuracy, positive predictive value, and negative predictive value were 93.5%, 85.3%, and 98.3%, respectively. DISCUSSION: SMI can detect increased blood supply caused by low-grade inflammation in the RF muscle.

Texture analysis of multiparametric magnetic resonance imaging for differentiating clinically significant prostate cancer in the peripheral zone.

BACKGROUND: Texture analysis (TA) provides additional tissue heterogeneity data that may assist in differentiating peripheral zone(PZ) lesions in multiparametric magnetic resonance imaging (mpMRI). This study investigates the role of magnetic resonance imaging texture analysis (MRTA) in detecting clinically significant prostate cancer (csPCa) in the PZ. METHODS: This retrospective study included 80 consecutive patients who had an mpMRI and a prostate biopsy for suspected prostate cancer. Two radiologists in consensus interpreted mpMRI and performed texture analysis based on their histopathology. The first-, second-, and higher-order texture parameters were extracted from mpMRI and were compared between groups. Univariate and multivariate logistic regression analyses were performed using the texture parameters to determine the independent predictors of csPCa. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of the texture parameters. RESULTS: : In the periferal zone, 39 men had csPCa, while 41 had benign lesions or clinically insignificant prostate cancer (cisPCa). Themajority of texture parameters showed statistically significant differences between the groups. Univariate ROC analysis showed that the ADC mean and ADC median were the best variables in differentiating csPCa (p < 0.001). The first-order logistic regression model (mean + entropy) based on the ADC maps had a higher AUC value (0.996; 95% CI: 0.989-1) than other texture-based logistic regression models (p < 0.001). DISCUSSION: MRTA is useful in differentiating csPCa from other lesions in the PZ. Consequently, the first-order multivariate regressionmodel based on ADC maps had the highest diagnostic performance in differentiating csPCa.

Cerebral developmental venous anomalies in children with mismatch repair deficiency.

BACKGROUND: Constitutional mismatch repair deficiency (CMMRD) is one of the rare cancer predisposition syndromes. The aim of this study was to evaluate the cerebral developmental venous anomalies in children with central nervous system tumors associated with CMMRD, an area in which there is extremely little experience. METHODS: Data from children diagnosed with medulloblastoma and high grade central nervous sytem tumor were retrospectively collected. According to the European CMMRD criteria, nine patients were diagnosed as CMMRD syndrome and the others consisted of the group without CMMRD. All radiological examinations of these children were retrospectively reviewed. Whole exome sequencing was performed to index cases` germline DNA. RESULTS: Nine children from four families, six females and three males, were studied. The median age at the first tumor diagnosis was 4.5 years (range, 9 months to 14 years). All CMMRD patients had café au lait spots, but none fulfilled the diagnostic criteria for neurofibromatosis. The patients developed high-grade glial tumor (n: 7) and medulloblastoma (n: 2). The affected genes in the three families were MSH6 [c.478C > T (p.Gln160Ter)], MSH6 [c.2871dupC (p.Phe958LeufsTer5)] and MLH1 [c.236G > A(p.Arg79Lys)], respectively. Seven patients had multiple developmental venous anomalies; six patients had leptomeningeal enhancement; and five patients had cavernomas. None of these findings were present in the group without CMMRD. CONCLUSIONS: Constitutional mismatch repair deficiency should be considered when multiple developmental venous anomalies, cavernomas, and leptomeningeal enhancement are detected, especially in patients with café au lait spots.

Can Dynamic Susceptibility Contrast Perfusion Imaging be Utilized to Detect Isocitrate Dehydrogenase Gene Mutation in Gliomas?

AIM: To explore the ability of dynamic susceptibility contrast perfusion imaging (DSC-PI) to detect isocitrate dehydrogenase (IDH) gene mutation in gliomas. MATERIAL AND METHODS: Preoperative DSC-PI data on histopathologically proven gliomas obtained between January 2015 and December 2019 were reviewed retrospectively. All magnetic resonance imaging (MRI) examinations were performed using a 1.5-T scanner. The maximum relative cerebral blood volume (rCBVmax), percentage signal recovery (PSR), and normalized PSR of tumor cores were calculated. Differences in these values between IDH-mutant and wild-type gliomas were compared, and receiver operating characteristic curves were generated. RESULTS: The patients (32 females, 47 males) were aged 21-76 years (mean 50.7 ± 15 years). The rCBVmax and all PSR values differed significantly between patients with IDH-mutant and those with wild-type tumors (p < 0.01 for all comparisons). CONCLUSION: The rCBVmax and PSR values obtained by DSC-PI may facilitate noninvasive detection of the IDH mutation status of gliomas. PSR provided more reliable values for differentiation of IDH-mutant gliomas from wild-type gliomas.

Anatomical Variations of the Celiac Trunk and Hepatic Arteries with a New Classification, Based on CT Angiography.

OBJECTIVES: To analyse the distribution of anatomical variations in both celiac trunk (CeT) and hepatic artery (HA) branching patterns on computed tomography (CT) angiography images; as well as to propose a new classification by unifying the already reported classifications of the CeT and HA vascular anatomy. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Faculty of Medicine, Selçuk University, Konya, Turkey, from February 2019 to March 2020. METHODOLOGY: CT angiography-based evaluation of the CeT and HA branching patterns was performed in patient undergoing routine contrast-enhauced CT of abdomen. Types of variation were determined and classified into five types (1-5) and ten subtypes. Distribution was also sorted by age and gender. RESULTS: Type 1 (classic CeT and HA branching pattern) was detected in 240 (70.6%) out of 340 cases (126 females, 214 males). Sixty-five (19.12%) had Type 2 subtypes, in which HA branching pattern coexists with normal CeT configuration; whereas, Type 3a and 3d, Type 4 and 5 having anomalous CeT variants, with typical HA pattern, were observed in 5.87% (20/340) of the cases. The frequency of the concurrent variations (Type 3b and 3c) was 4.41% (15/340). The least frequent subtypes, Type 4 and 5, were observed in one (0.29%) and three (0.88%) cases, respectively. There was no significant differences in branching types frequency by gender and age (p>0.05). CONCLUSION: Awareness of the range of anatomical variation in both the CeT and HA branching patterns, especially concurrent variations, is vital when planning surgical and radiological interventions to prevent possible iatrogenic injury and complications. Key Words: Branching pattern, Celiac trunk, Concurrent variations, CT angiography, Hepatic artery.

Comparison of Preoperative and Postoperative Testicular Elasticity and Vascularity in Pediatric Patients With Inguinal Hernia.

OBJECTIVES: Testicular complications after inguinal hernia (IH) operations can be overlooked because they are difficult to diagnose, but usually have a long-term effect. This study evaluates the effects of IH on preoperative and postoperative testicular elasticity and vascularity in children with unilateral hernias, examined using the superb microvascular imaging (SMI) and shear wave elastography (SWE) modalities. METHODS: Forty-four male children with unilateral indirect IHs were included. Quantitative SMI and SWE examinations of the testicles were performed on the herniated and intact sides, both preoperatively and at 1, 3, and 6 months postoperatively. The SMI and SWE values of the testicles were compared between the herniated and intact sides, as well as with the opposite testicle. RESULTS: Preoperative vascular index (VI) values were lower on the herniated side than on the intact side. Furthermore, preoperative kPa and m/s values were higher on the herniated side than on the intact side. In follow-up examinations performed at 6 months postoperatively, there was no equalization of kPa or m/s values, although VI values were equalized on both sides. CONCLUSIONS: Testicular vascularization secondary to mechanical compression in testicles on the herniated side increased significantly in the postoperative period, and reached a level similar to that of the contralateral side. Mean SWE values decreased in testicles on the herniated side, but were not equal with those of contralateral testicles. Preoperative and postoperative evaluation of testicles using SMI and SWE is important for detecting possible advanced testicular complications in children with IH.

Median Nerve's Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging.

BACKGROUND: The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging. METHODS: Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared. RESULTS: The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p < 0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p > 0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression. CONCLUSIONS: Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Nasopharyngeal carcinoma in a child with Kartagener`s syndrome.

BACKGROUND: Kartagener`s syndrome, a subgroup of primary ciliary dyskinesia, is characterized by situs inversus totalis, chronic sinusitis and bronchiectasis. To date, the association of malignant diseases and Kartagener`s syndrome has been reported and all cases except angioimmunoblastic T cell lymphoma in a child have been seen in adulthood. CASE: A 10-year-old boy who was followed with the diagnosis of Katagener`s syndrome, presented with a progressive mass in the cervical region for 6 months. Physical examination revealed mental retardation, multiple lymphadenopathies, the largest in the left cervical region (4x4 cm), and pectus carinatum. Also, on cardiovascular examination, apex beat was felt on the right fifth intercostal space along midclavicular line. Magnetic resonance imaging of nasopharynx showed narrowing of the nasopharyngeal airway with an increase in wall thickness up to 2.5 cm on the posterior wall of the nasopharynx. Also, bilateral multiple cervical lymphadenopathies were noted. The pathological examination of the biopsy from cervical lymphadenopathy revealed a diagnosis of undifferentiated nasopharyngeal carcinoma. Chemotherapy was started for nasopharyngeal carcinoma chemotherapy regimen including cisplatin, docetaxel, and 5-fluorouracil. After four cycles of chemotherapy there was a significant regression in nasopharyngeal mass and lymphadenopathies. The patient underwent radiotherapy to the nasopharynx and bilaterally cervical regions. The patient has been in follow-up for 6 years well and tumor free. However, he is still under the supervision of the pediatric immunology and allergy departments due to recurrent respiratory infections and sinusitis. CONCLUSION: We present a case of nasopharyngeal carcinoma which developed in a child with Kartagener`s syndrome. To our knowledge, this is the first report of nasopharyngeal carcinoma in a child with Kartagener`s Syndrome.

Surface anatomy and lumbar lordosis angle.

Awareness of the anatomical variations in abdominal surface anatomy with emphasis on relation to the abdominal planes may facilitate anatomical education and physical examination and inconvenience surgical intervention by giving surgeons more insight in surgical planning and training. This study was designed to verify whether the anatomical planes promote to the comprehension of surface anatomy and how the lumbar lordosis angle affects the vertebral level of the bifurcation of great vessels. This retrospective study was performed using computed tomography angiography images of 155 patients ranging from 18 up to 82 years. The vertebral levels of the celiac truncus, superior mesenteric artery, portal vein confluence, right and left renal arteries were within the transpyloric plane in 60%, 70%, 56.1% and 48.3-36.2% of patients, respectively. The inferior mesenteric artery was below the subcostal plane in 58% of patients. The aortic bifurcation (AB) was mostly corresponded to the level of L4 and was located within the umbilical plane in 73.1% of patients. The level of the inferior vena cava (IVC) confluence was within the supracristal plane in 54% of patients. We measured the mean value of the AB, IVC and lumbar lordosis angles as 39.54°, 58.05° and 54.26°, respectively. The AB and IVC levels showed a downward shift with decreasing lumbar lordosis angle. Precise knowledge of these relationships is crucial in clinical practice and surgical approaches to the anterior lumbosacral spine for safer and effective surgery.

Precise discrimination between meningiomas and schwannomas using time-to-signal intensity curves and percentage signal recoveries obtained from dynamic susceptibility perfusion imaging.

BACKGROUND AND PURPOSE: Meningiomas and schwannomas are common extra-axial brain tumors. Discrimination is challenging in some locations when characteristic imaging features are absent. This study investigated the accuracy of percentage signal recoveries obtained from dynamic susceptibility contrast perfusion imaging (DSC-PI) in discriminating meningiomas and schwannomas. MATERIAL AND METHODS: Retrospective database research was conducted. Sixty nine meningioma and 15 schwannoma having DSC-PI between January 2016 and February 2020 were included. Time to signal intensity curves (TSIC) were analyzed and grouped as T1-dominant leakage, T2*-dominant leakage and return to baseline. Relative cerebral blood volume (rCBV), relative mean transit time (rMTT), percentage signal recovery 1 (PSR 1) and PSR 2 values were calculated. The differences between the groups were investigated. Receiver operating characteristic curves were operated. RESULTS: rCBV, rMTT, PSR 1 and PSR 2 values were statistically different between meningiomas and schwannomas. PSR 2 provided the best discrimination. With the cut off value of 1.08 for PSR 2, meningiomas and schwannomas were differentiated with 95.7% sensitivity and 93.3% specificity. TSICs were also different between two groups. Most of meningiomas showed T2*-dominant leakage (78.2%), whereas most of shwannomas showed T1-dominant leakage (93.3%). CONCLUSION: DSC-PI is a useful imaging tool for non-invasive discrimination of meningiomas and schwannomas. Particularly, percentage signal recoveries discriminates meningiomas and schwannomas with high sensitivity and specificity.

Delayed Radiation Myelopathy in a Child With Hodgkin Lymphoma and ARTEMIS Mutation.

The authors present a case of delayed radiation myelopathy in a 12-year-old girl with Hodgkin lymphoma and Artemis mutation. This is the first of such a case presented in the literature.