Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data.

BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID-19 infection and scrotal infection are associated. MATERIALS AND METHODS: Patients with a COVID-19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data. RESULTS: The median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo-orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group. CONCLUSIONS: Even if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID-19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.

Assessment of Psoas Muscle Index in Middle-Aged Type 2 Diabetes Patients: Impact of Insulin Therapy on Sarcopenia.

OBJECTIVE: Sarcopenia, characterized by progressive skeletal muscle loss, poses significant health risks, including physical impairment and mortality. The relationship between sarcopenia and insulin resistance suggests insulin therapy's potential in preserving muscle mass, particularly in Type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate the Psoas Muscle Index (PMI) via computed tomography (CT) in middle-aged T2DM patients on insulin therapy versus oral antidiabetic drugs (OAD) and controls. METHODS: This retrospective study included 107 middle-aged T2DM patients undergoing non-contrast CT scans and 58 age-matched controls. CT images were analyzed to calculate PMI. Statistical analysis included Chi-square tests, independent samples t-tests, Mann-Whitney U tests, and correlation analyses. RESULTS: Insulin-treated patients exhibited higher PMI than OAD users (p < 0.001), while OAD users had lower PMI than controls (p < 0.001). No significant difference was found between insulin-treated patients and controls (p = 0.616). Negative correlations were observed between T2DM duration/age and PMI across all groups, with a positive correlation between T2DM duration and BMI observed in the OAD group. CONCLUSIONS: Insulin therapy in T2DM patients, regardless of age or disease duration, positively impacts muscle mass, highlighting its potential in preserving muscular health and advocating for tailored treatment strategies in T2DM management.

Earthquakes from a radiological perspective: what is demanded from the radiologists, and what can we do? A pictorial review.

Earthquakes are among the most destructive and unpredictable natural disasters. Various diseases and ailments, such as bone fractures, organ and soft-tissue injuries, cardiovascular diseases, lung diseases, and infectious diseases, can develop in the aftermath of severe earthquakes. Digital radiography, ultrasound, computed tomography, and magnetic resonance imaging are significant imaging modalities utilized for the quick and reliable assessment of earthquake-related ailments to facilitate the planning of suitable therapy. This article examines the usual radiological imaging characteristics observed in individuals from quake-damaged regions and summarizes the strengths and functionality of imaging modalities. In such circumstances, where quick decision-making processes are life-saving and essential, we hope this review will be a practical reference for readers.

Exploring PGE2 and LXA4 Levels in Migraine Patients: The Potential of LXA4-Based Therapies.

Neurogenic inflammation plays a significant role in the pathogenesis of migraines. This study aimed to investigate the serum levels of prostaglandin E2 (PGE2), lipoxin A4 (LXA4), and other inflammatory biomarkers (C-reactive protein, fibrinogen) in migraine patients. In total, 53 migraine patients and 53 healthy controls were evaluated. Blood serum samples were collected during both attack and interictal periods and compared with the control group. In both the attack and interictal periods, PGE2 and LXA4 values were significantly lower in migraine patients compared to the control group (p < 0.001). Additionally, PGE2 values during the attack period were significantly higher than those during the interictal period (p = 0.016). Patients experiencing migraine attacks lasting ≥ 12 h had significantly lower serum PGE2 and LXA4 levels compared to those with attacks lasting < 12 h (p = 0.028 and p = 0.009, respectively). In ROC analysis, cut-off values of 332.7 pg/mL for PGE2 and 27.2 ng/mL for LXA4 were determined with 70-80% sensitivity and specificity. In conclusion, PGE2 and LXA4 levels are significantly lower in migraine patients during both interictal and attack periods. Additionally, the levels of LXA4 and PGE2 decrease more with the prolongation of migraine attack duration. Our findings provide a basis for future treatment planning.

Can Shear Wave Elastography Help Differentiate Acute Tonsillitis from Normal Tonsils in Pediatric Patients: A Prospective Preliminary Study.

Shear wave elastography (SWE) is a non-invasive imaging technique used to quantify the elasticity/stiffness of any tissue. There are normative SWE studies on tonsils in healthy children in the literature. The purpose of this study is to analyze the palatine tonsils in children with acute tonsillitis using ultrasound and SWE. In this prospective study, pediatric patients aged 4-18 years diagnosed with acute tonsillitis and healthy children were included. Those with antibiotic use, chronic tonsillitis, adenoid hypertrophy, and having chronic disease, immunodeficiency, and autoimmune disease, or any rheumatological disease were excluded. The volume and elasticity of palatine tonsil were measured via ultrasound and SWE. The study included 81 (46 female, 35 male) acute tonsillitis patients, and 63 (38 female, 25 male) healthy children between the ages of 4 and 18. Elasticity (kPa) values of tonsils were found significantly higher in the tonsillitis group (SWE-R: 25.39 ± 4.64, SWE-L: 25.01 ± 4.17) compared to the normal group (SWE-R: 9.71 ± 2.37, SWE-L: 9.39 ± 2.19) (p < 0.001). In the tonsillitis group, a significant positive correlation was found between tonsil volume and elasticity (r: 0.774, p: 0.002). In conclusion, in pediatric patients with acute tonsillitis, higher kPa values were obtained with SWE in the palatine tonsils.

Shear Wave Elastography-Correlated Dose Modifying: Can We Reduce Corticosteroid Doses in Idiopathic Granulomatous Mastitis Treatment? Preliminary Results.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease treated with local and systemic corticosteroids. This study aims to evaluate the efficacy of reducing corticosteroids doses in IGM cases based on shear wave elastography (SWE) tissue stiffness measurements. This prospective study included IGM patients who received systemic or local corticosteroids between January 2020 and September 2022. A 20% or more reduction in tissue elasticity values (kPa) was considered a positive response to treatment in the study group, and the corticosteroids dose was reduced. The control group was dosed routinely. All patients were followed for 2 years to compare treatment efficacy, duration, total corticosteroids dose, recurrence, and side effects. There were 12 patients (9 local/3 systemic corticosteroids) in the study group and 24 patients (17 local/7 systemic corticosteroids) in the control group. Ten (83.4%) out of 12 patients in the study group were successfully treated by reducing corticosteroid doses with follow-up, and 2 (16.6%) out of 12 patients were reverted to the initial treatment protocol due to an increase in elasticity values during the follow-up. Nevertheless, successful treatment results were obtained in these two patients without reducing the corticosteroid dose. When compared to the control group, the median corticosteroid dose in the study group was significantly lower in patients using both local (p < 0.01) and systemic (p < 0.01) corticosteroids. A significant negative correlation was found between the rate of decrease in elasticity values and the median dose of corticosteroids (r = -0.649, p < 0.05) and the median treatment time (r = -0.751, p < 0.01). Side effects due to corticosteroids were found to be significantly lower in the study group (p < 0.05). According to our first and preliminary results, the SWE-correlated dose-modifying technique may reduce corticosteroid doses and side effects without significantly compromising treatment efficacy.

Quantitative Analysis of Supraspinatus Tendon Pathologies via T2/T2* Mapping Techniques with 1.5 T MRI.

The aim of this study was to quantitatively assess supraspinatus tendon pathologies with T2/T2* mapping techniques, which are sensitive to biochemical changes. Conventional magnetic resonance imaging (MRI) and T2/T2* mapping techniques were applied to 41 patients with shoulder pathology, and there were also 20 asymptomatic cases included. The patients were divided into two groups: tendinosis and rupture. The supraspinatus tendon was divided into medial, middle, and lateral sub-regions, and the T2/T2* values were measured in both the coronal and sagittal planes for intergroup comparison. Intra-class and inter-class correlation coefficients (ICCs) were calculated to assess test reproducibility. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value in each group. A total of 61 patients (27 males and 34 females)-including 20 asymptomatic individuals, 20 with tendinosis, and 21 with rupture-were evaluated using T2/T2* mapping techniques. In the rupture group, there were significant differences in the values of the lateral region (p < 0.001), as well as in the middle and medial regions (p < 0.05) of the supraspinatus tendon compared to the tendinosis and asymptomatic groups. These were determined using both T2* and T2 mapping in both the coronal and sagittal plane measurements. In the tendinosis group, there were significant differences in the values of the lateral region with T2* mapping (p < 0.001) in both the coronal and sagittal planes, and also with the T2 mapping in the coronal plane (p < 0.05) compared to the asymptomatic groups. The cut-off values for identifying supraspinatus pathology ranged from 85% to 90% for T2 measurements and above 90% for T2* measurements in both planes of the lateral section. The ICC values showed excellent reliability (ICC > 0.75) for all groups. In conclusion, T2 and T2* mapping techniques with 1.5 T MRI can be used to assess tendon rupture and tendinosis pathologies in the supraspinatus tendon. For an accurate evaluation, measurements from the lateral region in both the coronal and sagittal planes are more decisive.

Imaging of fibroadenoma: Be careful with imaging follow-up.

The present letter to the editor is related to the study titled, "Preoperational diagnosis and management of breast ductal carcinoma in situ arising within fibroadenoma: Two case reports." Fibroadenoma is the most common benign mass lesion in young females. Based on this study showing that malignancy can develop on fibroadenomas, we want to emphasize that careful sonographic follow-up of fibroadenomas should be done and that each lesion should be followed carefully and separately in cases with multiple fibroadenomas. Additionally, we want to emphasize the critical role of sonographic examination in diagnosing fibroadenoma, the importance of correctly defining benign and malignant sonographic findings, and which lesions should be followed up sonographically and which lesions should be evaluated histopathologically.

Type 2 dynamic curves: A diagnostic dilemma.

BACKGROUND: Magnetic resonance imaging (MRI) with multiparametric dynamic contrast plays a critical role in the assessment of breast lesions. Dynamic curves are a critical parameter in determining the benign or malignant nature of lesions. Dynamic curves of type 1 are known to represent benign masses, while dynamic curves of type 3 are known to identify malignant masses. Type 2 dynamic curves have a sensitivity of 42.6% and specificity of 75% for malignancy detection. AIM: To investigate the pathological diagnosis of lesions with type 2 dynamic curves. METHODS: We evaluated breast MRI examinations performed between 2020 and 2021 retrospectively and included lesions with type 2 dynamic curves. We included 38 lesions from 33 patients. The lesions were evaluated for their pathological diagnosis and morphological characteristics. RESULTS: Twenty-six lesions were malignant, while twelve were benign. The most frequently encountered benign lesion (7/12, 58.3%) was sclerosing adenosis, while the most frequently encountered malignant diagnosis was invasive ductal cancer. The presence of a type 2 dynamic curve had a sensitivity of 40.2% and specificity of 73.4% for predicting malignancy. By combining type 2 curves and morphological features, the sensitivity and specificity were increased. CONCLUSION: The high rates of malignancy detected histopathologically among patients with type 2 dynamic curves in our study are remarkable. Type 2 dynamic curves can be detected in benign breast masses, especially in sclerosing adenosis cases. Considering morphological features can increase the diagnostic accuracy in cases with type 2 dynamic curves.

Antenatal imaging: A pictorial review.

Today, in parallel with the use of imaging modalities increases in all fields, the use of imaging methods in pregnant women is increasing. Imaging has become an integral component of routine pregnancy follow-up. Imaging provides parents with an early opportunity to learn about the current situation, including prenatal detection of anomalies or diseases, etiology, prognosis, and the availability of prenatal or postnatal treatments. Various imaging modalities, especially ultrasonography, are frequently used for imaging both maternal and fetal imaging. The goal of this review was to address imaging modalities in terms of usefulness and safety, as well as to provide demonstrative examples for disorders. And this review provides current information on selecting a safe imaging modality to evaluate the pregnant and the fetus, the safety of contrast medium use, and summarizes major pathological situations with demonstrative sonographic images to assist radiologists and obstetricians in everyday practice.

Are we aware of radiation: A study about necessity of diagnostic X-ray exposure.

BACKGROUND: Total exposure to ionizing radiation has nearly doubled in the last two decades. This increase is primarily due to increased computed tomography (CT) exposure. Concerns have been raised about the risks associated with patients' exposure to medical imaging radiation, which can increase a person's lifetime risk of developing cancer. Preventing unnecessary examinations becomes critical at this point. To avoid unnecessary examinations, it is necessary to understand the demanding process. AIM: To ascertain clinicians' awareness of and reasons for requesting a CT examination. METHODS: We developed an online questionnaire that included 20 questions about clinicians' awareness of radiation safety and their reasons for requesting a CT examination, as well as demographic information such as age, gender, and year of medical practice experience. Additionally, we asked participants the number of CT scans requested in a month, the patients' questions and approaches about the imaging method, the effect of the patient's previous imaging history on the current imaging request, whether they believed that they had sufficient information about radiation doses, and whether they requested CT without an indication. We administered the questionnaire to clinicians from a variety of different professions in four different cities. RESULTS: A total of 195 clinicians participated. Internal medicine specialists were the most crowded group (38/195, 19.5%). Mean age of the population was 33.66 ± 5.92 years. Mean year of experience was 9.01 ± 5.96. Mean number of requested CT scans in a month was 36.88 ± 5.86. Forty-five (23.1%) participants stated that they requested CT scans without clinical indication. The most common reasons for CT scan requests were work load, fear of malpractice, and patient demand/insistence. CONCLUSION: CT scan requests are influenced by a variety of factors, both internal and external to the doctors and patients. Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.

X-ray Use in Chest Imaging in Emergency Department on the Basis of Cost and Effectiveness.

RATIONALE AND OBJECTIVES: The increasing use of imaging in the emergency department (ED) services has become an important problem on the basis of cost and unnecessary exposure to radiation. Radiographic examination of the chest has been reported to be performed in 34.4% of ED visits, and chest computerized tomography (CCT) in 15.8%, whereas some patients receive both chest radiography and CCT in the same visit. In the current study, it was aimed to establish instances of medical waste and unnecessary radiation exposure and to show how the inclusion of radiologists in the ordering process would affect the amount of unnecessary imaging studies. MATERIALS AND METHODS: This retrospective study included 1012 ED patients who had both chest radiography and CCT during the same visit at Ankara Training and Research Hospital between April 2015 and January 2016. The patients were divided into subgroups of trauma and nontrauma. To detect unnecessary imaging examinations, data were analyzed according to the presence of additional findings on CCT images and the recommendation of a radiologist for CCT imaging. RESULTS: In the trauma group, 77.1% (461/598) and in the nontrauma group, 80.4% (334/414) of patients could be treated without any need for CCT. In the trauma group, the radiologist recommendation only, and in the nontrauma group, both the radiologist recommendation and the age were determined to be able to predict the risk of having additional findings on CCT. CONCLUSIONS: Considering only the age of the patient before ordering CCT could decrease the rate of unnecessary imaging. Including radiologists into both the evaluation and the ordering processes may help to save resources and decrease exposure to ionizing radiation.