Evaluation of Parotid Glands With Real-time Ultrasound Elastography in Children.

OBJECTIVES: The aim of this study was to determine the strain index for parotid glands in children by using ultrasound elastography. METHODS: In this prospective study, apparently healthy children were referred from the ear-nose-throat clinic to the radiology clinic for elastographic examinations. Conventional sonographic and elastographic examinations of the parotid glands were performed. A linear 5-12-MHz transducer was used to obtain the images. RESULTS: A total of 54 children were enrolled in this prospective study. The normal mean strain index value ± SD for the parotid glands was 1.24 ± 0.67 (range, 0.29-1.39) regardless of sex. The mean age of girls was 7.42 ± 2.94 years (range, 3-14 years), and the age of boys was 8.50 ± 3.46 years (range, 4-16 years). The strain index values for the parotid glands in boys was 1.25 ± 0.76, and in girls it was 1.22 ± 0.55. There was no statistically significant difference in the strain index values between girls and boys (P= .986). There was no correlation between the strain index and age (r = 0.026) or body mass index (r = 0.066). CONCLUSIONS: This study determined the mean strain index values for apparently healthy children. Such information can serve as a baseline from which pathologic parotid diseases can be diagnosed with ultrasound elastography in combination with other sonographic criteria.

The comparison of resistivity index and strain index values in the ultrasonographic evaluation of chronic kidney disease.

OBJECTIVES: Chronic kidney disease (CKD) is a disorder progressing to end-stage kidney failure. Early diagnosis and treatment are important for medical care. The aim of this prospective study was to define the strain index (SI) and resistivity index (RI) values in the same CKD group for each kidney separately at the same time, and also to compare the efficacy of SI and RI in the differentiation of normal population and CKD patients. MATERIALS AND METHODS: Toshiba Aplio 500 USG device and 3.5-5 MHz convex probe were used for USG, CDUSG, and USG elastography examinations. The patients were referred to radiology clinique from nephrology and endocrinology cliniques after GFR calculation. Patients with renal cyst, tumor, or obstructive renal disease were excluded. Healthy volunteers according to laboratory and clinical examinations were selected from non-kidney disease patients. RESULTS: A total of 121 CKD (68 men, 53 women) and 40 healthy volunteers (19 men, 21 women) were participated. The mean SI and RI values of CKD were significantly higher than the normal healthy volunteers (p < 0.05). The SI and RI values of right and left kidney did not show any difference in CKD patients (p values were 0.381 for SI and 0.821 for RI). The sensitivity and the specificity of the SI were higher than RI. CONCLUSION: The RI and SI values of kidneys in CKD patients were significantly higher than those of apparently normal kidneys. SI was more sensitive than RI in our study. Determining cut-off SI and RI values between normal and damaged renal parenchyma can help in the diagnosis and follow up of CKD patients. ADVANCES IN KNOWLEDGE: To the best of our knowledge, this is the first study comparing RI and SI in CKD patients, and SI is found to be more sensitive than RI for the evaluation of CKD.

Ultrasound Elastography in Pediatric Congenital Hypothyroid Patients.

OBJECTIVES: Congenital hypothyroidism (CH) is most frequently encountered in newborns as an endocrine disorder characterized by thyroid hormone deficiency, and is one of the most common reasons for preventable mental retardation. This prospective study was designed to detect the pediatric occurrences of CH followed as euthyroid, with no anomalies detected via US on the gray scale, in comparison with a pediatric group with normal levels. METHODS: A total of 42 apparently healthy children with no thyroid disorder (Group 1) and 54 euthyroid CH (Group 2) using thyroid hormone were included in this study. Both B-mode gray scale ultrasound (US) and elastography examinations were made using Toshiba Aplio 400 device (Toshiba Medical Systems Corporation, Otawara, Japan), with a 12 MHz linear probe. All the radiological examinations were made by a single radiologic physician with at least 5 years of experience in elastography. RESULTS: In total, 96 occurrences in the right and left lobes of 192 thyroid gland measurements were included in the research. There were 20 males and 22 females in the healthy group (n=42), and 28 males and 26 females in the CH group (n=54). Although, there were no significant differences in the average age or gender (p=0.563), there were significant differences in the strain index (SI) values in the CH group.The receiver operating characteristics (ROC) curve was done to calculate the cut-off value for diagnosing CH with strain index ratio (SIR); the value of the cut-off was 0.695, with 63.1% sensitivity and 50.9% specificity. CONCLUSIONS: This was the first study about CH in children. Our study found the SIR of CH to be higher than the normal thyroid parenchyma. It showed that in parenchymal related CH, SE should be used. This study should be a guide for new studies that should be done about the different etiological factors of CH.

Magnetic Resonance Imaging Perception of the Society in Kars: A Local Study.

BACKGROUND: The start point of this study was the sentence that a patient used: 'my pains had gone with MRI'. It is known that MRI has not a usage area in treatment, yet. Perhaps, the feeling of loss of pain was only a perception. But we want to search the demographic factors that make the perception of loss of pain. The purpose of this study was to determine the consciousness level of the society about MRI. MATERIAL/METHODS: This prospective survey study included 302 (107 men, 195 women; mean age 43.11±15.18 years) patients who were referred to the radiology clinic to undergo MRI. RESULTS: Almost half of the patients were illiterate and graduated from a primary school. Low level of education was more frequent in women than in men. Most of the patients declared that MRI would diagnose their disease. Among all the patients surveyed, 209 of 302 patients indicated no changes in the degree of pain before and after MRI, 30 indicated increased pain, 62 indicated decreased pain, and one patient did not answer the question. Most of the patients who declared decreasing pain had lumbar or cervical MRI. CONCLUSIONS: The function of MRI was known by the patients independently from their educational status. The degree of decrease in pain was higher in the 'treatment' answer. Perhaps the relatively higher percentage was a result of the expectations about treatment and was related with psychological motivation.

A Rare Case of Polyorchidism: Four Testes.

BACKGROUND: Polyorchidism or supernumerary testis means more than two testes. It is very rare and to the best of our knowledge, there have been only about 200 cases reported. CASE REPORT: In this case report we want to present radiological features and assessment of a patient with four testicles. CONCLUSIONS: If the vascularity and echogenicity of the scrotal mass is similar with the normal testis parenchyma, multitestis should be considered. The MRI might not provide us with additional information to USG or CDUSG, thus it is not necessary to perform it if there is no suspicion of malignancy.

Sonographic Elastography of the Thyroid Gland.

Thyroid gland disorders include benign and malignant thyroid nodules and diffuse thyroid disorders. The incidence of malignant thyroid nodules is low and the prognosis is good. The diagnosis of thyroid cancer and diffuse parenchymal disorders is generally based on clinical manifestations and histopathological evaluation. Ultrasonography has its place in the diagnostics and follow-up of thyroid disorders. Ultrasonographic elastography is a new, developing method that shows increase in clinical practice. In this study, we aimed to review the data on thyroid ultrasound elastography.

The Avaibility of Strain Elastography in a Hydatid Cyst - Interobserver Study.

BACKGROUND: To differentiate the hydatid cyst (HC) types by ultrasound elastography using two different sizes (4 mm and 8 mm) of the region of interest (ROI) and asking two different radiologists (interobserver) for their opinion. MATERIAL/METHODS: Patients with HC were evaluated by USG elastography. The statistical anayses were performed using Strain index (SI) which is the unit of strain elastography. RESULTS: A total of 26 out of 33 patients were female, and 7 were male. The mean age was 38.85±17.62 (range from 10 to 72 years). Type I: 6, Type 2: 6, Type III: 6, Type IV: 11, Type V: 4. There was no significant difference in HC SI (regardless of types) between O1 and O2, and 4-mm and 8-mm ROI (p>0.05). There was no statistically significant difference between SI of HC types of interobservers (O1-O2) and ROI sizes (4-8 mm) (p>0.05 for all parameters). The highest correlation between HC types and ROI sizes was in ROI size of 4 mm. CONCLUSIONS: The correlation between SI and types was reliable in standard-applied 4-mm ROI. There was no statistically significant difference between interobservers in SI values. Thus, elastography tecnhnique is objective for HC but not appropriate to differentiate the types.

Doppler Ultrasound and Magnetic Resonance Imaging Findings of Penile Mondor's Disease: Case Report and Literature Review.

BACKGROUND: Penile involvement is a rare, self-limiting, benign genital condition. In Mondor's disease the underlying pathology is thrombophlebitis of a superficial vein. CASE REPORT: In this case report, we want to present a rare Penile Mondor's disease with literature review. CONCLUSIONS: While the diagnosis can be based on history, physical examination and Doppler ultrasound, the necessity of both MRI, MR angiography and intracavernosal vasoactive agent administration can be questioned. Both MRI and intravenous vasoactive agent administration may be helpful in suspicious cases for differential diagnosis and to eliminate other etiologies like pelvic mass or thrombosis.

Pneumocephalus and Pneumorrhachis After Spinal Surgery.

BACKGROUND: Pneumocephalus and pneumorrhachis are rare complications of neurosurgery. When a closed system such as the head and spinal area get injuried, it becomes open and the air can come in through that opening. In this case, we present a case of pneumocephalus and pneumorrhachis after spinal fusion surgery. CASE REPORT: Herein we present a case of diagnosis and treatment of pneumocephalus and pneumorrhachis after spinal fusion surgery. CONCLUSIONS: Our patient developed postoperative pneumocephalus and pneumorrhachis as a late complication secondary to an infection. We wanted it to be considered as an important problem.

Comparison of Dynamic Contrast-Enhanced MRI and PET/CT in the Evaluation of Laryngeal Cancer After Inadequate CT Results.

BACKGROUND: To investigate the diagnostic value of dynamic magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for laryngeal cancers after inadequate CT results. MATERIAL/METHODS: The study comprised 45 patients investigated for primary laryngeal cancer or recurrence-residue in which CT was considered inadequate. A mass was found in 20 patients. Dynamic MRI and PET/CT were compared for diagnosis of mass, lymph node involvement, recurrence and residue. The dynamic curves formed in dynamic MRI were investigated for diagnostic contributions. RESULTS: The sensitivity and specificity of the dynamic MRI, for supraglottic, glottic and subglottic location, was 100%, 80%, and 92%; 100%, 85%, and 100%, respectively. In PET/CT the sensitivity and specificity were 100% for all of those localizations. For lymph node involvement, the sensitivity of dynamic MRI and PET/CT was 100%, the specificity was 100% and 93%, respectively. For recurrence-residue, the sensitivity and specificity of dynamic MRI were 86% and 67%, respectively, with 100% sensitivity and specificity in PET/CT. The sensitivity of type A curve for detection of malignancy was 40%, and specificity was 100%. When type A and B curves were included, the sensitivity was 100%. CONCLUSIONS: For patients investigated for laryngeal cancer in which CT is considered inadequate, dynamic MRI or PET/CT is useful.

Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and a reliable method for its calculation.

INTRODUCTION: The aim of this study was to investigate factors affecting median nerve cross-sectional area (CSA) and determine a dependable swelling ratio (SR) calculation method. METHODS: Using ultrasonography, median nerve CSAs were measured at the tunnel inlet, midtunnel, and outlet, and at 4 cm and 12 cm proximal to the wrist. We used CSAmax as the largest of the tunnel measurements and calculated swelling ratios (SRs) by using the CSAmax. Sonographic measurements were correlated with electrophysiologic findings. We evaluated the effects of gender, weight, and height on median nerve thickness. RESULTS: We studied 95 wrists of 55 CTS patients and 48 wrists of 27 volunteers. Gender, weight, and height had effects on certain median nerve CSA measurements. CSAmax, SRmax4, and SRmax12 had superior correlations with electrophysiologic findings. The correlation between 4-cm and 12-cm median nerve CSAs was statistically significant (r = 0.879 and P < 0,001). CONCLUSION: We have developed a reliable SR method considering factors affecting median nerve CSA.

Persistent left superior vena cava draining to the left atrium: A case report and review of the literature.

BACKGROUND: Persistent left superior vena cava is a rare but important congenital vascular anomaly. However, PLSVC with absent RSVC (isolated PLSVC) is a very rare venous malformation We report on a rare case of persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC). CASE REPORT: This venous malformation was identified incidentally in a 69-year-old woman during chest multi-detector computed tomography (MDCT). On chest MDCT, the SVC was noted on the left side. A bridging vein drained the right jugular and right subclavian veins and joined the left brachiocephalic vein in order to form the PLSVC, which descended on the left side of the mediastinum and drained into the left atrium (LA). The patient had no additional cardiac anomaly. CONCLUSIONS: Isolated PLSVC is usually asymptomatic but it can pose difficulties for establishing central venous access, pacemaker implantation and cardiothoracic surgery. This condition is also associated with an increased incidence of congenital heart disease, arrhythmias and conduction disturbances. A wide spectrum of clinicians should be aware of this anomaly, its variations and possible complications.

Idiopathic pulmonary artery aneurysm.

Pulmonary artery aneurysms are rare pathologic conditions of the thoracic cavity. The idiopathic form of the disease is reported very rarely. We report the case of a 16-year-old girl with idiopathic pulmonary artery aneurysm with surface rendered 3-dimensional images of 64-slice computed tomography. A right-sided aortic arch with normal aortic branching was seen. The main pulmonary artery was moderately dilated, and there was aneurysmal dilatation of the right pulmonary artery from its origin to the level of the right descending pulmonary artery. The maximal diameter of the main pulmonary artery was 38 mm; that of the right pulmonary artery was 31 to 34 mm. The left pulmonary artery was of normal diameter (18.5 mm). There was no other accompanying abnormality. Because the patient had no severe symptoms and there were no signs of aneurysmic compression or a shunt, she was scheduled for elective aneurysmectomy.

Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings.

The purpose of this study was to investigate ultrasound (US)- and US elastography-detected changes in the median nerve of patients with carpal tunnel syndrome (CTS). Seventy-four wrists of 41 female patients with CTS (mean age, 47.73 ± 11.45 y) and 45 wrists of 24 asymptomatic female controls (mean age, 42.83 ± 10.66 y) were examined with US and US elastography. Electromyography results confirmed the diagnosis of CTS in the patients. The mean median nerve perimeter (MN-P = 15.26 ± 2.18 mm) and median nerve cross-sectional area (MN-CSA = 11.81 ± 4.05 mm²) of patients with CTS were higher than those of controls (12.08 ± 1.54 mm and 7.76 ± 1.40 mm², respectively) (p < 0.05). Mean tissue strain was lower in the patients with CTS (0.094 ± 0.045 than in the controls (0.145 ± 0.068) (p < 0.05). The most sensitive cut-off value for tissue strain was 0.0635, and the most specific was 0.19. US and US elastography, in addition to electromyography, proved to be beneficial in the diagnosis of CTS. US elastography is a new technique that may well find a place in the diagnosis of nerve entrapment syndromes.