Varicocoele and saphenofemoral reflux: are they coincidentally related?

UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It has been proposed that there is a significant relation between varicocoele and saphenofemoral reflux. Our results show that there is no statistically significant relation between varicocoele and saphenofemoral reflux. OBJECTIVE: • To determine whether a relation between varicocoele and venous insufficiency at the level of the saphenofemoral junction (SFJ) is present. PATIENTS AND METHODS: • A total of 100 patients with varicocoele and 50 age-matched controls seen in the outpatient urology clinic were included in our prospectively designed survey. Patients with a history of scrotal, inguinal or vascular surgery were excluded from the study. • Following a physical examination by the same urologist, coloured Doppler ultrasonography of the pampiniform plexus and the SFJ were performed by the same radiologist. Patients who had spermatic veins greater than 3.0 mm in diameter and reversed blood flow in Doppler ultrasonography were included in the study group. • The competence of the SFJ was evaluated and retrograde venous flow for longer than 0.5 s was noted as positive for saphenofemoral incompetence. RESULTS: • The mean age of varicocoele patients and the control group was 22.9 and 23.7 years, respectively. There were 83 patients with left varicocoele, five patients with right varicocoele and 12 patients with bilateral varicocoele. • In the varicocoele group, 36 (36%) patients had saphenofemoral reflux while 64 (64%) had no reflux, whereas corresponding figures for the control group were 13 (26%) and 37 (74%) respectively (P= 0.32). • There were 39 (46.9%) patients with a maximal vein diameter less than 3.6 mm (median 3.1 ± 0.3 mm) while there were 44 (53.1%) patients with a maximal vein diameter over 3.6 mm (median 4.1 ± 0.37 mm) (P= 0.20). CONCLUSION: • There is no statistically significant relation between varicocoele and SFJ insufficiency. Varicocoele may not be attributable to a systemic vascular insufficiency; however, further comprehensive series with larger populations are required.

Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values.

The aim of this study was to retrospectively measure and compare pancreatic apparent diffusion coefficient (ADC) in patients with acute pancreatitis (AP) with aged matched controls who underwent diffusion weighted imaging (DWI). The institutional review board approved this retrospective Health Insurance Portability and Accountability Act compliant study with a waiver for informed consent. Pancreatic ADC values from 27 patients with a clinical diagnosis of AP and 38 normal age-matched controls evaluated with DWI (b = 0 and 800 mm(2)/s) were retrospectively and independently measured by two radiologists. The ADCs were compared between the groups and between each of the pancreatic segments in the normal group. Inter-observer reliability was calculated and receiver operating characteristic analysis was used to determine the sensitivity and specificity of DW imaging in the diagnosis of acute pancreatitis. P < 0.05 was considered statistically significant. The ICC for inter-observer reliability was 0.98 in the control and 0.97 in the AP group. The mean pancreatic ADC in the AP group (1.32 × 10(-3) mm(2)/s ± 0.13) was significantly lower than in the normal group (1.77 × 10(-3) mm(2)/s ± 0.32). There was no significant difference in mean ADCs between each of the pancreatic segments in the controls. A threshold ADC value of 1.62 × 10-3 mm(2)/s yielded a sensitivity of 93% and specificity of 87% for detecting acute pancreatitis for b values of 0 and 800 s/mm(2). Pancreatic ADCs are significantly lower in patients with AP than normal controls.

Active Crohn's disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging.

PURPOSE: To determine relative diagnostic value of MR diffusion and perfusion parameters in detection of active small bowel inflammation in patients with Crohn's disease (CD). MATERIALS AND METHODS: We reviewed 18 patients with active CD of terminal ileum (TI) who underwent MR enterography (MRE; including dynamic contrast enhanced MRI and diffusion-weighted MRI). Conventional MRI findings of TI were recorded. Regions of interest were drawn over TI and normal ileum to calculate apparent diffusion coefficient (ADC), the volume transfer constant (K(trans)) and the contrast media distribution volume (v(e)). Receiver operating characteristic analysis was used to determine their diagnostic performance. RESULTS: Among conventional MR findings, mural thickening and increased enhancement were present in all actively inflamed small bowel. K(trans), v(e), and ADC values differed significantly between actively inflamed TI and normal ileum (0.92 s(-1) versus 0.36 s(-1); 0.31 versus 0.15 ± 0.08; 0.00198 mm(2)/s versus 0.00311 mm(2)/s; P < 0.001). Area under the curve (AUC) for K(trans), v(e), and ADC values ranged from 0.88 to 0.92 for detection of active inflammation. Combining K(trans) and ADC data provided an AUC value of 0.95. CONCLUSION: Dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) provide quantitative measures of small bowel inflammation that can differentiate actively inflamed small bowel segments from normal small bowel in CD. DWI provides better sensitivity compared with DCE-MRI and combination of ADC and K(trans) parameters for analysis can potentially improve specificity.

A double abdominal aorta with a double inferior vena cava: a human congenital vascular patterning defect.

BACKGROUND: Developmental abnormalities of the abdominal aorta are exceedingly rare, and the molecular mechanisms underlying these defects are unknown. CASE: We present computed angiographic findings of a 64-year-old female with long-standing hypertension having an abdominal double aorta accompanied by a double inferior vena cava. The abdominal aorta bifurcated into two lumens just caudal to the diaphragm at the level of the 12th thoracic vertebra. The dorsal abdominal aortic trunk supplied several lumbar arteries, the inferior mesenteric artery, and both iliac arteries. The ventral abdominal aortic trunk supplied the celiac artery, both renal arteries, and the superior mesenteric artery. CONCLUSION: We propose that a defect in the development of the aortic vascular smooth muscle is a possible mechanism for this rare anomaly based on our current understanding of the formation of the aorta during early embryonic development.

Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis.

OBJECTIVE: The objective of our study was to investigate whether quantitative parameters derived from diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) correlate with Gleason score and angiogenesis of prostate cancer. MATERIALS AND METHODS: Seventy-three patients who underwent preoperative MRI and radical prostatectomy were included in our study. A radiologist and pathologist located the dominant tumor on the MR images based on histopathologic correlation. For each dominant tumor, the apparent diffusion coefficient (ADC) value and quantitative DCE-MRI parameters (i.e., contrast agent transfer rate between blood and tissue [K(trans)], extravascular extracellular fractional volume [v(e)], contrast agent backflux rate constant [k(ep)], and blood plasma fractional volume on a voxel-by-voxel basis [v(p)]) were calculated and the Gleason score was recorded. The mean blood vessel count, mean vessel area fraction, and vascular endothelial growth factor (VEGF) expression of the dominant tumor were determined using CD31, CD34, and VEGF antibody stains. Spearman correlation analysis between MR and histopathologic parameters was conducted. RESULTS: The mean tumor diameter was 15.2 mm (range, 5-28 mm). Of the 73 prostate cancer tumors, five (6.8%) had a Gleason score of 6, 46 (63%) had a Gleason score of 7, and 22 (30.1%) had a Gleason score of greater than 7. ADC values showed a moderate negative correlation with Gleason score (r = -0.376, p = 0.001) but did not correlate with tumor angiogenesis parameters. Quantitative DCE-MRI parameters did not show a significant correlation with Gleason score or VEGF expression (p > 0.05). Mean blood vessel count and mean vessel area fraction parameters estimated from prostate cancer positively correlated with k(ep) (r = 0.440 and 0.453, respectively; p = 0.001 for both). CONCLUSION: There is a moderate correlation between ADC values and Gleason score and between k(ep) and microvessel density of prostate cancer. Although the strength of the correlations is insufficient for immediate diagnostic utility, these results warrant further investigation on the potential of multiparametric MRI to facilitate noninvasive assessment of prostate cancer aggressiveness and angiogenesis.

Sonographically guided corticosteroid injection for treatment of plantar fasciosis.

OBJECTIVES: The purpose of this study was to prospectively investigate the effect of sonographically guided corticosteroid injection on the clinical and radiologic responses in patients with proximal plantar fasciosis. METHODS: Thirty-one consecutive patients with unilateral plantar fasciosis were enrolled. A 4-cm 21-gauge needle was positioned in a caudocranial oblique manner, and the needle was withdrawn to the near edge of the fascia so that the solution dispersed around the edge. Two milliliters (20 mg/mL) of lignocaine/prilocaine, 1%, and 0.5 mL (20 mg) of methylprednisolone acetate solutions were injected separately. The plantar fascia and fat pad thickness, fascial echogenicity, and perifascial edema were assessed with a 10-5 MHz linear array transducer. The American Orthopedic Foot and Ankle Society midfoot scale was used to assess function, alignment, and pain. The initial radiologic and clinical measurements were compared with data obtained not less than 6 weeks after the injections. RESULTS: A statistically significant decrease in the mean plantar fascia thickness was detected after treatment (P < .0001). There was no statistically significant difference in the plantar fascia echogenicity before and after treatment (P = .11). A statistically significant decrease was found for perifascial edema (P < .0001), and a statistically significant increase in American Orthopedic Foot and Ankle Society scores was detected (P = .0007). There was no decrease in fat pad thickness (P > .1). Plantar fascia rupture was detected in 1 patient. CONCLUSIONS: Sonographically guided corticosteroid injection enables real-time imaging of the plantar fascia during needle insertion. A caudocranial oblique injection beneath the fascia may have an incremental value in the treatment response in patients with plantar fasciosis.

Diffusion-weighted MR imaging of abdominopelvic abscesses.

This study was conducted to determine the incremental value of diffusion-weighted MR imaging (DW-MRI) over T2-weighted imaging diagnosing abdominopelvic abscesses and compare apparent diffusion coefficient (ADC) values of abscesses and non-infected ascites. In this IRB-approved, HIPAA-compliant study, two radiologists retrospectively compared T2-weighted, T2-weighted + DW-MRI and T2-weighted + contrast enhanced MR images of 58 patients (29 with abscess, 29 with ascites) who underwent abdominal MRI for abscess detection. Confidence and sensitivity was compared using McNemar's test. ADC of abscesses and ascites was compared by t test, and a receiver operating characteristic (ROC) curve was constructed. Detection of abscesses and confidence improved significantly when T2-weighted images were combined with DW-MRI (sensitivity: observer 1-100%, observer 2-96.6%) or contrast enhanced images (sensitivity: both observers-100%) compared to T2-weighted images alone (sensitivity: observer 1-65.5%, observer 2-72.4%). All abscesses showed restricted diffusion. Mean ADC of abscesses (observer 1-1.17 ± 0.42 × 10(-)³ mm²/s, observer 2-1.43 ± 0.48 × 10(-3) mm²/s) was lower than ascites (observer 1-3.57 ± 0.68 × 10(-3) mm²/s, observer 2-3.42 ± 0.67 × 10(-3) mm²/s) (p < 0.01). ROC analysis showed perfect discrimination of abscess from ascites with threshold ADC of 2.0 × 10(-3) mm²/s (Az value 1.0). DW-MRI is a valuable adjunct to T2-weighted images diagnosing abdominopelvic abscesses. ADC measurements may have the potential to differentiate abdominal abscesses from ascites.

Airway patency in children undergoing magnetic resonance imaging using neck collars: a single center, randomized, double-blind, prospective study.

BACKGROUND AND OBJECTIVES: Maneuvers precluding the downward shift of the mandibula and providing slight extension of the head have been shown to increase upper airway dimensions. This study aimed to investigate the role of Neck Collars (NC) in maintaining airway patency during Magnetic Resonance Imaging (MRI) examination in a pediatric population aged between 0 and 16 years. METHODS: One hundred twenty-five children were recruited in this prospective study. Subjects were randomly assigned to NC group (NC+) or standard imaging group (NC-). Measurements of anteroposterior and transverse dimensions and cross-sectional area were performed to determine the upper airway size at three distinct levels: soft palate, base of the tongue, and tip of the epiglottis. RESULTS: The anteroposterior diameter and cross-sectional area at the levels of base of the tongue and soft palate were significantly higher in NC+ patients compared to NC- patients. However, anteroposterior dimensions and cross-sectional areas at the epiglottis level were similar in the two groups. When patients were analyzed according to age groups of 0-2, 2-8, and 8-16 years, the anteroposterior diameter and cross-sectional area at the levels of base of the tongue and soft palate were significantly higher in NC+ patients compared to NC- patients in all age groups. CONCLUSIONS: This study clearly demonstrates that the application of a NC may improve retropalatal end and retroglossal airway dimensions in a pediatric population undergoing MRI examination and receiving sedation in supine position.

Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging.

PURPOSE: To analyze the diffusion and perfusion parameters of central gland (CG) prostate cancer, stromal hyperplasia (SH), and glandular hyperplasia (GH) and to determine the role of these parameters in the differentiation of CG cancer from benign CG hyperplasia. MATERIALS AND METHODS: In this institutional review board-approved (with waiver of informed consent), HIPAA-compliant study, 38 foci of carcinoma, 38 SH nodules, and 38 GH nodules in the CG were analyzed in 49 patients (26 with CG carcinoma) who underwent preoperative endorectal magnetic resonance (MR) imaging and radical prostatectomy. All carcinomas and hyperplastic foci on MR images were localized on the basis of histopathologic correlation. The apparent diffusion coefficient (ADC), the contrast agent transfer rate between blood and tissue (K(trans)), and extravascular extracellular fractional volume values for all carcinoma, SH, and GH foci were calculated. The mean, standard deviation, 95% confidence interval (CI), and range of each parameter were calculated. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed for differentiation of CG cancer from SH and GH foci. RESULTS: The average ADCs (× 10(-3) mm(2)/sec) were 1.05 (95% CI: 0.97, 1.11), 1.27 (95% CI: 1.20, 1.33), and 1.73 (95% CI: 1.64, 1.83), respectively, in CG carcinoma, SH foci, and GH foci and differed significantly, yielding areas under the ROC curve (AUCs) of 0.99 and 0.78, respectively, for differentiation of carcinoma from GH and SH. Perfusion parameters were similar in CG carcinomas and SH foci, with K(trans) yielding the greatest AUCs (0.75 and 0.58, respectively). Adding K(trans) to ADC in ROC analysis to differentiate CG carcinoma from SH increased sensitivity from 38% to 57% at 90% specificity without noticeably increasing the AUC (0.79). CONCLUSION: ADCs differ significantly between CG carcinoma, SH, and GH, and the use of them can improve the differentiation of CG cancer from SH and GH. Combining K(trans) with ADC can potentially improve the detection of CG cancer. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100021/-/DC1.

Multiple abdominal vascular anomalies in a patient with Alagille syndrome.

Alagille syndrome affects multiple organ systems. The most common vascular manifestation of Alagille syndrome is peripheral pulmonary artery stenosis. A few cases of abdominal vasculature involvement have been reported, particularly in the pediatric age group. Herein, the authors describe an adult patient with Alagille syndrome who presented with multiple visceral vascular abnormalities, including a high-grade stenosis of the celiac artery, superior mesenteric artery (SMA), aneurysms of the distal common hepatic artery, and distal SMA detected with computed tomographic angiography.

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçesehir (Istanbul) Breast Cancer Screening Project in Turkey.

PURPOSE: The Turkish Bahçesehir Breast Cancer Screening Project was a 10-year, organized, population-based screening program carried out in Bahçesehir county, Istanbul. Our aim was to examine the biologic features and outcome of screen-detected and interval breast cancers during the 10-year study period. METHODS: Between 2009 and 2019, 2-view mammograms were obtained at 2-year intervals for women aged 40 to 69 years. Clinicopathological characteristics including ER, PR, HER2-neu, and Ki-67 status were analyzed for those diagnosed with breast cancer. RESULTS: In 8,758 screened women, 131 breast cancers (1.5%) were detected. The majority of patients (82.3%) had prognostic stage 0-I disease. Contrarily, patients with interval cancers (n = 15; 11.4%) were more likely to have a worse prognostic stage (II-IV disease; odds ratio [OR], 3.59, 95% CI, 0.9 to 14.5) and high Ki-67 scores (OR, 3.14; 95% CI, 0.9 to 11.2). Interval cancers detected within 1 year were more likely to have a luminal B (57.1% v 31.9%) and triple-negative (14.3% v 1%) subtype and less likely to have a luminal A subtype (28.6% v 61.5%; P = .04). Patients with interval cancers had a poor outcome in 10-year disease-specific (DSS) and disease-free survival (DFS) compared with those with screen-detected cancers (DSS: 68.2% v 98.1%, P = .002; DFS: 78.6% v 96.5%, P = .011). CONCLUSION: Our findings suggest the majority of screen-detected breast cancers exhibited a luminal A subtype profile with an excellent prognosis. However, interval cancers were more likely to have aggressive subtypes such as luminal B subtype or triple-negative cancers associated with a poor prognosis requiring other preventive strategies.

Diffusion-weighted imaging of adnexal torsion.

We report the diffusion-weighted imaging findings (DWI) of a case with ovarian torsion. Magnetic resonance imaging revealed a large cyst within a non-enhancing ovary. DWI depicted restricted diffusion which in turn was found to be related with the infarction of the ovary in the laparoscopic salpingo-oophorectomy performed.

The nutcracker syndrome: The usefulness of different MRI sequences for diagnosis and follow-up.

OBJECTIVE: Nutcracker Syndrome (NCS) is the extrinsic compression of the left renal vein by neighboring arterial, ligamentous, muscular, or osseous structures. Diagnosis is made by Doppler ultrasonography (US), multidetector computerized tomography (MDCT), magnetic resonance imaging (MRI), phlebography. The aim of the current study is to assess the value of MRI and compare the efficiency of different sequences in diagnosis and follow up of children with NCS. MATERIAL AND METHODS: A total of 40 children (female/male ratio 3:1) with NCS were included in this prospective study. A standardized abdominal MRI protocol was used and T2-TRUFI (True Fast Imaging with Steady-State Free Precession), T2-HASTE (Half Fourier Acquisition with Single Shot Turbo Spin Echo), T1-VIBE (Volumetric Interpolated Breath Hold Examination), and out-of-phase (opposed-phase) T1 sequences were obtained. The sequences were compared according to anatomical depiction, measurability, and pulsation artifact. RESULTS: A four point-scale was used to assess subjective image quality and the results were listed as: 1 = poor, 2 = fair, 3 = good, and 4 = excellent. Both in total and for each individual criterion, the highest scores were obtained with T2-TRUFI (total mean 3.74 ±â€¯0.45, anatomical depiction 3.9 ±â€¯0.3, measurability 3.8 ±â€¯0.4, aortic pulsation artifact 3.52 ±â€¯0.55). CONCLUSION: Although Doppler US is the gold standard technique in the diagnosis of NCS, MR imaging may be used as an additional modality, as it is superior to Doppler US in terms of anatomic depiction and a lower rate of imaging artifacts. Non-contrast MR imaging, particularly TRUFI sequence, may have an incremental value in the accurate diagnosis and follow-up of these patients.

Improvement of early detection of breast cancer through collaborative multi-country efforts: Observational clinical study.

AIM: The aim of this paper is to present baseline imaging data and the improvement that was achieved by the participating centers after applying practice-specific interventions that were identified during the course of a multicentric multinational research coordinated project. INTRODUCTION: The incidence and mortality rates from breast cancer are rising worldwide and particularly rapidly across the countries with limited resources. Due to lack of awareness and screening options it is usually detected at a later stage. Breast cancer screening programs and even clinical services on breast cancer have been neglected in such countries particularly due to lack of available equipment, funds, organizational structure and quality criteria. MATERIALS AND METHODS: A harmonized form was designed in order to facilitate uniformity of data collection. Baseline data such as type of equipment, number of exams, type and number of biopsy procedures, stage of cancer at detection were collected from 10 centers (9 countries: Bosnia-Herzegovina, Costa Rica, Egypt, India, North Macedonia, Pakistan, Slovenia, Turkey, Uganda) were collected. Local practices were evaluated for good practice and specific interventions such as training of professionals and quality assurance programs were identified. The centers were asked to recapture the data after a 2-year period to identify the impact of the interventions. RESULTS: The data showed increase in the number of training of relevant professionals, positive changes in the mammography practice and image guided interventions. All the centers achieved higher levels of success in the implementation of the quality assurance procedures. CONCLUSION: The study has encountered different levels of breast imaging practice in terms of expertise, financial and human resources, infrastructure and awareness. The most common challenges were the lack of appropriate quality assurance programs and lack of trained skilled personnel and lack of high-quality equipment. The project was able to create higher levels of breast cancer awareness, collaboration amongst participating centers and professionals. It also improved quality, capability and expertise in breast imaging particularly in centers involved diagnostic imaging.

Sonographic and Magnetic Resonance Imaging Characteristics of Juvenile Papillomatosis: Three Cases With Different Manifestations.

Juvenile papillomatosis (JP) is an infrequently seen benign proliferative lesion in women younger than 30 years. Herein, we present different clinical manifestations of histopathologically proven JP of the breast, in addition to magnetic resonance and sonographic imaging features of these cases. Patient 1 exhibited nipple discharge and papillary carcinoma accompanied after the operation. Patient 2 presented with a giant mass with cystic and numerous solid nodular components that filled the entire right breast. Patient 3 exhibited cystic areas in a well-circumscribed hypoechoic solid mass besides ahypoechoic mass with indistinct borders, which was evaluated as multifocal JP.

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçesehir Mammography Screening Project.

OBJECTIVE: We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. MATERIALS AND METHODS: Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. RESULTS: A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. CONCLUSION: Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.

Iopromide- and gadopentetic acid-derived preparates used in MR arthrography may be harmful to chondrocytes.

BACKGROUND: Magnetic resonance arthrography, a procedure through which contrast agents containing gadolinium and/or iopromide are administered intra-articularly, has become a useful tool in musculoskeletal diagnosis. Nevertheless, despite being considered safe for systemic use, certain tissue toxicities have been identified for both drugs. In this study, the effects of short-term exposure of human primary chondrocyte cell cultures to gadolinium and/or iopromide contrast agents were examined by assaying for stage-specific embryonic antigen-1 (SSEA-1) protein expression (a chondrogenic differentiation marker), cell viability, toxicity, and proliferation. METHODS: Human articular chondrocytes were grown in monolayer culture and were exposed to iopromide and/or gadolinium diethylenetriamine-pentaacetate (Gd-DPT) for 2 and 6 h. Cell cultures with no drug exposure were used as the control group. Cell differentiation status was assessed according to SSEA-1 protein expression. Contrast agent effects on cell viability and proliferation were analyzed using MTT analysis. Further, changes in cell morphology in relation to the control group were evaluated using inverted light microscopy, environmental scanning electron microscopy (ESEM), and 3-tesla magnetic resonance imaging. The obtained data were statistically compared. RESULTS: When compared with the control group, both SSEA-1 protein expression and cell proliferation were lowest in the Gd-DPT group (P = 0.000). There was a statistically significant correlation between SSEA-1 expression and MTT results (rho = 0.351; P = 0.003). CONCLUSIONS: Nevertheless, the data obtained from in vitro experiments may not directly correspond to clinical applications. However, the mere fact that a drug used solely for diagnostic purposes may repress chondrocyte cell proliferation should be carefully considered by clinicians.

Subcutaneous Oleomas Following Sunflower Oil Injection: A Novel Case and Review of Literature.

Liquid foreign material injection has been used as an early medical intervention since the end of nineteenth century for the augmentation of body shape. Nowadays, these types of procedures have been abandoned by health professionals due to late onset of serious complications. However, it is still misused by some subcultures such as bodybuilders, passive homosexuals, transsexuals, and patients with mental illness. This article discusses a male patient who injected himself with a large amount of sunflower oil, which became complicated by an inflammatory response-abscess formation and sclerosing lipogranuloma of breasts. The radiologic and pathologic signs of this entity are discussed with a review of the relevant literature. Lack of suspicion of this entity may cause a great delay in establishment of definitive diagnosis, giving rise to prominent morbidity and mortality. It is necessary to know the diagnosis and treatment of this phenomenon because illegal substances that cause factitial panniculitis are widely available on websites and threaten thousands of people, which is anecdotally referred in medical literature. Chronic or recurrent lesions of a bizarre or atypical morphology should alert the physician to this artificial phenomenon. Radiologic findings are most important criteria for diagnosis because self-injection is denied by the patient.

Radiologic findings of screen-detected cancers in an organized population-based screening mammography program in Turkey.

PURPOSE: Bahçesehir Breast Cancer Screening Program is a population based organized screening program in Turkey, where asymptomatic women aged 40-69 years are screened biannually. In this prospective study, we aimed to determine the mammographic findings of screen-detected cancers and discuss the efficacy of breast cancer screening in a developing country. METHODS: A total of 6912 women were screened in three rounds. The radiologic findings were grouped as mass, focal asymmetry, calcification, and architectural distortion. Masses were classified according to shape, border, and density. Calcifications were grouped according to morphology and distribution. Cancers were grouped according to the clinical stage. RESULTS: Seventy cancers were detected with an incidence of 4.8/1000. Two cancers were detected in other centers and three were not visualized mammographically. Mammographic presentations of the remaining 65 cancers were mass (47.7%, n=31), calcification (30.8%, n=20), focal asymmetry (16.9%, n=11), architectural distortion (3.1%, n=2), and skin thickening (1.5%, n=1). The numbers of stage 0, 1, 2, 3, and 4 cancers were 13 (20.0%), 34 (52.3%), 14 (21.5%), 3 (4.6%), and 1 (1.5%), respectively. The numbers of interval and missed cancers were 5 (7.4%) and 7 (10.3%), respectively. CONCLUSION: A high incidence of early breast cancer has been detected. The incidence of missed and interval cancers did not show major differences from western screening trials. We believe that this study will pioneer implementation of efficient population-based mammographic screenings in developing countries.

Diffusion-weighted MR imaging and Doppler ultrasonography in the evaluation of renal parenchyma in acute ureteral obstruction.

OBJECTIVE: To compare the efficacy of diffusion-weighted (DW) magnetic resonance (MR) imaging and Doppler ultrasonography (US) by using quantitative markers in acute unilateral obstruction due to renal stones. METHODS: This prospective study included 28 patients with unilateral ureteral obstruction and 18 healthy control subjects. In Doppler US and DW MR imaging, resistive index (RI) and apparent diffusion coefficient (ADC) values were measured respectively. The results were compared in patients and in control subjects. Paired samples test, two-tailed unpaired Student's t test and Spearman analysis were performed for statistical analysis. RESULTS: The mean RI in the 28 obstructed kidneys was significantly higher than the mean RI in unobstructed kidneys and in control subjects (P < 0.05). The ADC of obstructed kidneys in the cortex was significantly lower than the ADC of the contralateral unobstructed kidneys (P < 0.05). The ADC of unobstructed kidneys was significantly higher than the ADC of control subjects in the cortex (P < 0.05). RI and ADC values yielded no significant correlation. CONCLUSION: Doppler US and DW MR imaging provide accurate and noninvasive diagnosis, Doppler US may be preferred as it is a more practical technique compared to DW MR imaging in the evaluation of acute ureteral obstruction due to renal stones.