Relationship between DXA measured systemic bone mineral density and subchondral bone cysts in postmenopausal female patients with knee osteoarthritis: a cross-sectional study : Osteoarthritis cysts and bone mineral density.

BACKGROUND: Individuals with high systemic bone mineral density (BMD) may have an increased risk of incident knee osteoarthritis (OA). Besides that, radiographic osteophytes are strongly associated with BMD. Because of these reasons, the aim of the study was to investigate the possible association between radiological subchondral bone cyst (SBC) grade and systemic BMD and vitamin D status in the postmenopausal female patients with knee OA in a crosss-sectional study. METHODS: This study included of 48 osteoporosis treatment-free postmenopausal patients diagnosed with symptomatic medial compartment knee OA. BMD analysis was performed using dual-energy X-ray absorptiometry (DXA) and serum vitamin D levels were measured after recording patients' findings. Each knee was scanned using computed tomography (CT), and categorical SBC scores were graded for the medial and lateral tibiofemoral (TF) and patellofemoral (PF) compartments and further calculated as compartmental total, total TF and grand total of both TF compartments. SBC scores were analysed with correlation analysis. RESULTS: The patient population was characterized by radiographic joint space narrowing, obesity and low vitamin D status. Median medial total and grand total TF SBC scores were significantly different between the patient groups according to the Kellgren-Lawrence (KL) radiographic grading (p = 0.006 and p = 0.007, respectively). There were no correlations between femoral BMD values and SBC scores. However, positive correlations were detected significantly between L1 - 4 DXA values and TF SBC scores, but not with PF SBC scores (p = 0.005 for the correlation between L1 - 4 BMD and medial compartments total TF SBC score, p = 0.021 for the correlation between L1 - 4 BMD and grand total TF SBC score). No significant correlations were found with Vitamin D levels. CONCLUSIONS: Development of TF OA high-grade SBCs may be linked to systemic bone mass as represented by trabecular bone-rich lumbar vertebrae. The relationship might point to the importance of bone stiffness as an acting factor in knee OA possibly with mechanical energy transfer to the joint.

Comparison of autogenous cartilage, acellular dermis, and solvent-dehydrated pericardium for the prevention and correction of dorsal nasal irregularities: an experimental study.

BACKGROUND: Numerous materials have been used for the correction and prevention of dorsal nasal irregularities. Experimental and clinical studies have been useful but have provided insufficient results for several reasons, including the impossibility of obtaining pathologic specimens from aesthetic patients and imprecise experimental models. In this study, an experimental model for rhinoplasty is used for the comparative evaluation of solvent-dehydrated pericardium, acellular dermal matrix, and autogenous ear cartilage as onlay grafts for the prevention and correction of nasal dorsal irregularities. We used an experimental rabbit rhinoplasty model that has a human nose-like osteocartilaginous junction. Thus, our goal is to get a more realistic idea about the features of these three materials. METHODS: Thirty New Zealand rabbits weighing 2,100-2,550 g were used. The noses of the rabbits were evaluated with computerized tomographic measurements, "pinch" tests were performed for skin properties, and all were photographed before the surgical procedures. They were divided into three groups: Autogenous cartilage grafts were applied after the rhinoplasty operation in group 1, acellular dermal matrixes were used after the rhinoplasty in group 2, and pericardium allografts were used after the rhinoplasty in group 3. The rabbits were followed up for 4 months before they were evaluated by photography, computerized tomography, and "pinch" tests for the skin properties of the nose. Then they were killed for histopathologic evaluation. Adhesion and resorption rates of the onlay grafts were observed and subdermal thickness measurements were made to determine the fate of the grafts as well as their effects on the overlying skin. RESULTS: The major advantages of the allografts used in groups 2 and 3 are the ease of obtaining them without any donor site morbidity, shorter operative procedures, and lower distortion rates due to lack of cartilage memory. The results of this study conform to those of previous reports and demonstrate that the used allografts had no adverse effects such as ulceration or extrusion. The evaluation of the internal nasal valve angles before and after the surgical interventions showed that cartilage grafts created a spreader effect as expected, but acellular dermis and solvent-dehydrated pericardium did not. Despite a moderate graft reaction, pericardium or acellular dermis remained intact. None of the materials caused adhesion to the overlying skin. CONCLUSION: The results of this experimental study showed that acellular dermis (AlloDerm®) or solvent-dehydrated pericardium (Tutogen) may be used successfully as an "onlay" graft for dorsal nasal problems compared to autogenous cartilage, which is commonly used for this purpose. There has been more cartilage resorption than thought. This should be considered when overcorrection is performed. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Optimisation of contrast medium volume and injection-related factors in CT pulmonary angiography: 64-slice CT study.

OBJECTIVE: To compare the image quality of computed tomography pulmonary angiography (CTPA) obtained with the injection of various low doses of contrast medium (CM) with different injection-related factors. METHODS: A total of 90 patients (42 females, 48 males; 54.3 +/- 18.6 years) undergoing CTPA were included. Three CM protocols, each containing 30 patients, were created. Protocols 1, 2 and 3 consisted of a CM of 60 ml, 55 ml and 50 ml, and a bolus trigger level of 120 HU, 90 HU and 75 HU, respectively. Injection was uniphasic for protocols 1 and 2 (flow rate 5 ml/s), and biphasic for protocol 3 (flow rates 5 and 4 ml/s); with saline flushing afterwards. Enhancement was measured in three central and six peripheral pulmonary arteries. RESULTS: The mean attenuation value for pulmonary arteries was over 250 HU for all protocols. There was no difference between the attenuation levels with the protocols (p > 0.05). The percentage of pulmonary arteries exceeding optimal attenuation (> or =250 HU) showed that protocols 2 and 3 were 90-100% successful (p < 0.05). CONCLUSION: The use of proper injection-related factors during CTPA, such as a low trigger level and a high flow rate with saline injection following a decreased CM volume (55 ml or 50 ml), will enable adequate pulmonary artery contrast enhancement.

Relationship between Abdominal Aortic Calcification, Abdominal Adiposity, and Liver Density.

OBJECTIVE: To identify any relationship among visceral adipose tissue area (visceral FA), liver density (liver HU), psoas muscle area (psoas MA), waist circumference (WC) and the presence and severity of abdominal aortic calcific atherosclerosis (AAC). STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Ankara Kecioren Training and Research Hospital, Ankara, Turkey, from January to February 2019. METHODOLOGY: This study included 316 patients, who had CT performed for urolithiasis investigation. For all patients, the presence and grade of AAC was recorded. Then, liver HU, spleen density (spleen HU), psoas MA, visceral FA, total abdominal fat area (total FA), subcutaneous fat area (subcutaneous FA), WC and hip circumference (HC) were measured on a workstation. RESULTS: AAC was present in 127 patients (40.2%). The age, visceral FA, total FA, visceral FA/total FA ratio, WC and WC/HC ratio of patients with AAC were significantly higher than for patients without AAC (p <0.05). Psoas MA was significantly lower in patients with AAC (p <0.05).  The cut-off value of visceral FA for the prediction of AAC was 131 cm2. The risk for AAC was 4.5 times higher in the group with visceral FA >131 cm2 (p <0.001). There were significant correlations between AAC grade and liver HU and spleen HU (p = 0.002 and p = 0.001, respectively). However, there was no significant correlation between AAC grade and liver HU/spleen HU ratio (p = 0.741). CONCLUSION: Psoas muscle area, visceral adiposity and waist circumference can be used to predict abdominal aortic calcification. Key Words: Visceral adipose tissue, Subcutaneous adipose tissue, Fatty liver.

Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia?

PURPOSE: Modern treatment of inguinal hernias includes prosthetic mesh repairs. However, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. The aim of this prospective study was to evaluate the effect of mesh implantation/perimesh fibrosis on testicular flow after repair of indirect inguinal hernias (IIHs). METHOD: Forty-eight male patients with unilateral IIH were included. Both testicular parenchyma were assessed using gray-scale sonography, and color/spectral Doppler sonography was performed to evaluate testicular arterial impedance, perfusion, and venous flow. Measurements were made bilaterally at the level of the inguinal canal 1 day before and at the end of the 2nd month after the operation. RESULTS: There was no difference in testicular and echotexture perfusion between the hernia and the control sides pre- and postoperatively. No venous thrombosis was found. In all groups, resistance index and pulsatility index, measured at 4 levels, were highest in the proximal inguinal canal and lowest at the extratesticular-intrascrotal level (p < 0.05). For all Doppler parameters there was no significant difference between the pre- and postoperative measurements on both the hernia and the control sides. CONCLUSION: Mesh implantation/perimesh fibrosis does not adversely affect ipsilateral testicular flow. Mesh application is still a safe procedure in male patients in whom testicular function is important.

Ultrasonographic evaluation of hand and foot tendons in Behçet's disease.

BACKGROUND: There have been few studies in the literature evaluating the effect of Behçet's disease (BD) on tendons. Thus, we planned to search for the involvement of hand and foot tendons in BD by using ultrasonography and to determine the relation of tendon involvement with clinical measurements. METHODS: The study consisted of 33 randomly selected BD patients and 36 voluntary healthy controls matched by age and body mass index. Sonographic evaluations were performed from hands (flexor digitorum süperficialis (2-5), flexor digitorum profundus (2-5), flexor carpi radialis) and Achilles tendons of the nondominant extremities using an 8-10 MHz linear array probe. Grip strength and crepitation were also measured on the nondominant side. RESULTS: Mean hand and foot tendon thickness values of BD patients were significantly higher than in control group (p=0.00). Disease duration, age, and presence of crepitation were not correlated with tendon thickness in the BD group (all p values>0.05). Grip strength values were lower in the BD group than in control group but the difference was not statistically significant (p=0.344). Grip strength values were not correlated with hand tendon thicknesses in BD groups (all p values>0.05). CONCLUSION: Because tendons tears and thicknesses are associated with inflammation, awareness of tendon pathologies is very important in rheumatic diseases. It would be of value to investigate this relationship in future studies in order to determine if this increment in tendon thickness is an indicator of disease activity and affects prognosis. The physician should be on alert about tendon involvement even if the patient has no complaints.

An assessment of the relationship between thyroid nodule characteristics, insulin resistance and arterial stiffness in euthyroid nodular goiter.

OBJECTIVES: Publications suggesting that thyroid nodule might be associated with insulin resistance and metabolic syndrome are quite interesting. There is a need for studies assessing the relationship between nodule presence and cardiovascular risk in individuals with non-functioning nodular goiter. The purpose of the present study is to reveal whether or not insulin resistance, nodule presence, and nodule stiffness affect arterial stiffness, which is a reliable and valid cardiovascular risk indicator, in individuals with euthyroid nodular goiter using the pulse wave analysis (PWA). MATERIALS AND METHODS: 50 patients with euthyroid nodular goiter and 50 healthy volunteers were included in the study. All participants were examined by B-mode thyroid ultrasound, and the participants in the nodular goiter group were also examined by strain elastography (SE). The strain index of nodules was calculated according to the Rago scoring. Also, fasting plasma glucose (FPG) and insulin levels were measured, and HOMA-IR. Arterial stiffness measurements of the participants were performed using a PWA device which employs a cuff-based oscillometric method from the brachial artery. RESULTS: PWV was found to be significantly higher in the euthyroid nodular goiter group (p < 0.001). PWV was found to be positively correlated with FPG and waist circumference. Fasting plasma glucose was found to be higher in the group with nodular goiter (p = 0.03). However, no difference was found between the groups in terms of HOMA-IR and insulin level. HOMA-IR was not correlated with thyroid volume, nodule volume, and nodule count. Also, HOMA-IR was not correlated with strain index value and PWA data. CONCLUSION: We found that PWV was significantly higher in patients with euthyroid nodular goiter. This result suggests that these patients may be at risk for cardiovascular disease.

Diffuse stylohyoid chain ossification.

Clinical symptoms of stylohyoid chain ossification vary from ear pain to dysphagia. It is usually diagnosed coincidentally. Localized ossification of the chain is common, whereas diffuse ossification is rare. Herein, a case with bilateral diffuse stylohyoid chain ossification diagnosed with computed tomography, which was performed in order to evaluate the patient's temporomandibular joint pain, a rare onset of this condition, is discussed.

Low 25-hydroxyvitamin D level is not an independent risk factor for hepatosteatosis in obese children.

BACKGROUND: Obesity is an important risk factor for non-alcoholic fatty liver disease. Few studies have evaluated the association between vitamin D and non-alcoholic fatty liver disease in obese children. Therefore, we conducted a study to examine the relationship of vitamin D levels and hepatosteatosis in obese children. METHODS: One hundred and eleven children with obesity participated in this study. Hepatosteatosis was diagnosed and graded using ultrasonography in all patients. Study participants were divided based on the presence of hepatosteatosis into two subgroups (hepatosteatosis and non-hepatosteatosis). Serum levels of 25-hydroxyvitamin D, calcium, phosphate, alkaline phosphatase, parathormone, and lipids were measured and compared. RESULTS: Hepatosteatosis existed in 52% of obese children without chronic diseases. There was no statistically significant difference in the vitamin D level between the hepatosteatosis and non-hepatosteatosis groups. Alanine aminotransferase levels and the triglycerides-to-high density lipoprotein ratio were significantly higher, and the high density lipoprotein levels were significantly lower in the hepatosteatosis group compared to the non-hepatosteatosis group. CONCLUSIONS: Vitamin D deficiency is not directly related with hepatosteatosis. A high ALT level and a high triglycerides-to-HDL ratio and low HDL levels are more significant in hepatic steatosis in obese children.

Evaluation of the mastoid triangle for determining sexual dimorphism: A Saudi population based study.

Demographic assessment of skeletal remains in forensic investigations includes identification of sex. The present study aimed to develop population-specific, sex-discriminating anthropometric standards for the mastoid triangle of a documented Saudi population using computed tomographic (CT) images of the lateral aspect of the skull. The present study was performed on 206 CT images of a documented Saudi population of known sex and age. The clinical CT images of subjects visiting the Department of Radiology, Dammam Medical Complex, Dammam, Saudi Arabia (KSA) were evaluated to know the validity of the metric assessment of the mastoid triangle for identification of sex in a Saudi population. The distance between asterion to porion (AP), asterion to mastoidale (AM), porion to mastoidale (PM) were measured and the area of the mastoid triangle (AMT) was calculated using these measurements. Discriminant function procedure was used to analyze the data for sexual dimorphism. In conclusion, the results of the present study indicate that all the 3 sides of the mastoid triangle and AMT were sexually dimorphic in the sampled Saudi population with PM being the best individual parameter in discriminating sex with an accuracy of 69.4%. Whereas, all the parameters combined showed the highest accuracy (71.4%).

Can renal dimensions and the main renal artery diameter indicate the presence of an accessory renal artery? A 64-slice CT study.

PURPOSE: To evaluate whether renal dimensions and the main renal artery (mRA) diameter can provide indirect evidence of the presence or absence of accessory renal arteries (aRA). MATERIALS AND METHODS: The study group consisted of 167 patients (83 women, 84 men; mean age, 52.4±13.1 years) who presented to our radiology department for abdominal CT examinations with various indications. CT examination was performed on a 64-slice CT scanner in the arterial phase. The kidney diameters were recorded. The number of renal arteries supplying each kidney was evaluated, and their diameters were measured. We attempted to determine a formula that could be used to predict the presence or absence of aRAs. RESULTS: One or multiple aRAs were found in 76 (22.8%) of the 334 kidneys. The mRA diameter was 5.51±0.96 mm. The mRA diameter was smaller in kidneys with aRAs than in those without (P < 0.001). A cut-off value of 4.15 mm for the diameter of mRA to predict the presence of aRAs led to negative and positive predictive values of 80% and 90%, respectively. A formula that can predict that an aRA is absent with 97% accuracy given the values of the mRA diameter and the kidney length was determined using logistic regression. CONCLUSION: The mRA diameter (4.15 mm) alone and the results of the formula developed herein employing the mRA diameter and kidney length can respectively predict the presence or absence of an aRA with high accuracy.

The stylohyoid chain: CT imaging.

We aimed in this report to discuss the embryology, anatomy, theories of ossification and symptoms, clinical presentation, and diagnosis of the stylohyoid chain (SHC) variations, together with the role of radiographs, computed tomography (CT) and three-dimensional (3D)-CT in showing these variations. Because CT/3D-CT additionally facilitates visualization of the entire SHC with different axes, it is the most valuable method for establishing the relationship between the SHC and the surrounding tissue. SHC variation can be discovered during CT performed for indications other than ossified SHC. It is important to diagnose whether or not the SHC is ossified, since one of the treatment procedures in ossified SHC is total excision. If the clinician and radiologist are aware of these variations observed in the SHC, patients with vague symptoms may be spared unnecessary investigations and may be properly diagnosed earlier.

Assessment of vascularity with color Doppler ultrasound in gynecomastia.

PURPOSE: The aim of this study was to analyze the presence and type of vascularity with color Doppler ultrasound (CDUS) in gynecomastia, to describe gray-scale ultrasound (US) and CDUS features in different stages of gynecomastia, and to compare these findings with the characteristic US appearances of Tanner stages. MATERIALS AND METHODS: A total of 108 breasts of 54 males aged 11-27 years with complaint of gynecomastia and US verification of gynecomastia were evaluated. Each breast was then classified according to Tanner stages. The retroareolar thickness was measured. The breast was divided into three regions (medial, lateral, and retroareolar) and the arterial flow was scored according to the number of regions in which arterial flow was observed. Venous blood flow was scored according to the number of vessels in each breast. RESULTS: Gynecomastia was present in 78 breasts with a retroareolar thickness of 5-31 mm and symptom duration of 1-300 weeks. Fifteen breasts with gynecomastia had no arterial or venous flow. Tanner stages were found to be strongly associated with arterial and venous flow scores, duration of symptoms, and retroareolar thickness (P < 0.001). CONCLUSION: This study shows that vascular structures should be accepted as a component of gynecomastia. Vascularity in gynecomastia corresponds to progression of breast development, and as the process advances vascularity becomes more prominent.

Diagnosis and follow-up in constipated children: should we use ultrasound?

PURPOSE: We investigated the efficacy of ultrasound in determining megarectum and fecal load and the response to treatment in constipation and tried to specify objective criteria in this study. METHODS: A total of 66 cases were queried and divided into 2 groups as constipated (n = 35; mean age, 6.8 ± 2.9 years) and control (n = 31; mean age, 8.4 ± 3.8 years) according to Rome III criteria. After the clinical evaluation, pelvic ultrasonography (US) was performed by 2 separate radiologists. The bladder capacity and the transverse rectal diameter were measured with a full bladder. Then the rectal diameter and rectal anterior wall thickness were measured, and the presence of fecal load in the rectum and sigmoid colon was recorded with an empty bladder. The examination and ultrasound were repeated after treatment for a month in these patients. RESULTS: Comparison of the US measurements of the 2 radiologists performing the US tests did not show any interobserver difference (r = 0.981; P < .001). We therefore believe our results are objective and reproducible. We found a positive correlation between the rectal diameters and the age, height, weight, and bladder capacity. The posturination mean rectal diameter was thicker in the constipated group (3.02 ± 1.04 cm) than in the control group (1.98 ± 0.64 cm) (P < .001). The cutoff point of rectal diameter for a diagnosis of constipation was determined as 2.44 cm (71% sensitive; 76% specific; area under curve, 0.825; P < .001). The rectal anterior wall thickness and fecal load were higher in the constipated patients (P < .001). There was a significant decrease in the constipation score and fecal load after treatment for a month (P < .001), but the rectal diameter had not reached normal limits yet despite the decrease (2.71 ± 0.77 cm) (P > .05). CONCLUSION: The use of US helps in making a correct diagnosis and in the follow-up with objective criteria and also convinces the patient and the family that the treatment needs to be continued.

Sex determination from measurements of the sternum and fourth rib using multislice computed tomography of the chest.

INTRODUCTION: One of the most important data that can be obtained from bones is sex determination for which the recommended method is taking metric measurements. Metric measurements can be performed directly on dried bones obtained from the cadaver or indirectly from their radiographs. AIM: We assessed the accuracy of sex determination and the applicability of previously defined rules using the sternum and 4th rib measurement data from chest multislice computed tomography (MSCT) imaging of 340 patients and developed a model/formula that would provide the best way to determine sex. METHODS: We analyzed the chest MSCT of 340 patients (143 females, 197 males; mean age: 57.6+/-15.2 years) and created a coronal image parallel to the sternal long axis and a coronal image at the level of sternal ending of the 4th rib. The 5 sternal measurements [length of the manubrium and sternal body, combined length of the manubrium and sternal body (CL), manubrium width and corpus sterni width] and 4th rib width (FRW) described in the literature were obtained. Sternal index (SI) and sternal area (SA) were calculated from these measurements. RESULTS: The left FRW values were used for sex determination as the left FRW was found to be more significant than the right FRW. An accuracy of over 80% was achieved for sex determination when the "142 rule" was used for CL only, a cut-off value of 5600 mm(2) for SA only and a cut-off value of 16 mm for FRW only. We found that Hyrtl's law and SI did not provide adequate accuracy for sex determination in our patients. The model with the highest accuracy (88.2%) for sex determination used SA and FRW together. We also believe that the best predictors for sex determination using the sternum and 4th rib are SA and FRW, similar to the Torwalt and Hoppa report. CONCLUSION: Radiological methods such as MSCT are useful in making reliable measurements to be used in various anthropological and forensic investigations and determining their accuracy.

Assessment of the stylohoid chain by 3D-CT.

BACKGROUND: To assess the variations of stylohyoid chain (SHC) using 3D-CT. METHODS: We evaluated a total of 200 SHC on the head/neck CT scans of 100 patients (44 females, 56 males, age range 18-73 years). All of the patients had been scanned for neck lesions other than those concerning the region of the SHC. The morphology of both SHCs was examined in the 3D-CT images and the following aspects were evaluated; 1. length, 2. thickness, 3. mediolateral angling (MLA), 4. anteroposterior angling (APA), and 5. bending of the SHC. RESULTS: Absence of the styloid process (n: 5), double proximal origin (n: 2), segmentation (n: 49), and complete ossification (n: 2) were found. The length of the SHC was 27.9 +/- 11.3 mm, and 26.2 +/- 11.1 mm on the right and left, respectively. The mean thickness of the SHC was 5 mm, and it showed positive correlation with length (P < 0.05). MLA was 73.2 +/- 6.7 and 70.7 degrees +/- 8.0 degrees for the right and left, respectively. APA was 64.6 degrees +/- 10.1 degrees and 62.7 degrees +/- 10.2 degrees for the right and left, respectively. There was a negative correlation between the right and left MLA (P = 0.001), and a positive correlation between the right and left APA (P = 0.001). Nine SHCs had bending of the lower end. CONCLUSION: Three-dimensional CT gives detailed and reliable information about the SHC. We propose that the bending and thickness, which are new parameters, should be taken into consideration in the CT evaluation and classification of SHC variations.