Evaluation of iron overload in visceral organs in thalassemia patients by point shear-wave elastography.

INTRODUCTION: The aim of this study was to investigate the value of point shear-wave elastography (pSWE) in the measurement of iron overload in the liver and other visceral organs in patients with beta thalassemia major (BTM). MATERIALS AND METHODS: The study included 103 patients diagnosed with BTM who were referred to our clinic for cardiac and liver T2* measurement and a control group of 120 age- and gender-matched healthy volunteers. Cardiac and hepatic T2* measurements were performed in the patient group. Hepatic, pancreatic, splenic, and renal pSWE values were measured in both groups. The pSWE values were compared between the two groups. In the patient group, correlations between pSWE values, cardiac-hepatic T2* values and hepatic size, patient age, and serum ferritin levels were analyzed. RESULTS: Hepatic, pancreatic, splenic, and renal pSWE values were significantly higher in the patient group compared to the control group (p ≤ 0.001, < 0.001, 0.014, 0.026, respectively). In the patient group, hepatic pSWE values established a significant correlation with cardiac T2* values, liver size-T2*, pancreatic pSWE values, serum ferritin levels, and age (p = 0.006, < 0.001, 0.001, 0.042, 0.001, 0.032, respectively). In the ROC analysis, the area under the ROC curve was 0.807 for hepatic pSWE in the discrimination of thalassemia patients and healthy controls, and the cut-off value was 1.42, which gave a sensitivity and specificity of 75.7% and 75%, respectively. CONCLUSiON: Point shear-wave elastography can be a useful technique in the clinical measurement of iron overload in the liver, pancreas, spleen, and kidney.

Morphological investigation of deep femoral artery variations using multidetector computed tomography angiography.

PURPOSE: The deep femoral artery (DFA) is the largest and thickest branch of the femoral artery (FA), separated from the posterior lateral surface of the FA. This study aimed to analyze the anatomy of DFA using multidetector computed tomography (MDCT) angiography images to improve its clinical applications. MATERIALS AND METHODS: Eight hundred right and left DFA MDCT angiography images from 400 individuals, 302 males (75.5%) and 98 females (24.5%), were included. RESULTS: It was determined that the DFA originates from six different aspects of the FA. The DFA was found to most commonly originate from the posterolateral aspect of the FA, with an incidence of 53%. The DFA originated from the posterior, lateral, medial, anterolateral, and posteromedial aspects at an incidence of 35.3%, 9.8%, 1%, %0.5, and 0.37%, respectively. The average distance between the DFA's origin and the midpoint of the inguinal ligament (IL) was 43.07 mm across both genders. The average distance between the DFA's origin and the midpoint of the IL was 43.07 mm. The average diameters of the DFA, medial circumflex femoral artery (MCFA), and lateral circumflex femoral artery (LCFA) were 5.62 mm, 3.01 mm, and 3.44 mm, respectively. The average distance between the DFA and MCFA was 14.64 mm, while between the DFA and LCFA, it was 19.05 mm. CONCLUSION: Knowledge regarding the anatomical variants and morphology of the DFA will enhance the accuracy of decision-making during interventional procedures and operations in the femoral region, as well as aid in the prevention of iatrogenic injuries.

Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?

BACKGROUND: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. OBJECTIVES: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. METHODS: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gynecology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. RESULTS: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. CONCLUSION: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in consideration of the invasive nature and the higher complication rate of laparoscopy.

A comprehensive study of right and left inferior phrenic artery variations in 1000 patients with multidetector computed tomography angiography: an important study for HCC.

PURPOSE: To investigate the anatomic variations in the origins of the right and left inferior phrenic arteries (IPAs) using multidetector computed tomography and to classify their combined variations. METHODS: This retrospective study included patients undergoing abdominal aorta angiography between January 2015 and October 2019. The RIPA and LIPA origins were evaluated both separately and combined on three-dimensional images. The variant patterns of the IPAs were determined and classified. The numerical evaluation of the data was performed with SPSS 21. RESULTS: In total, 1000 patients (478 women, 522 men) were evaluated. The IPAs originated from a common trunk or a common root in 360 (36.00%) patients, while the IPAs originated independently without a common trunk in 609 (60.90%) patients. The most common combined variant detected in the present study was IPAs originating as a common trunk from the coeliac trunk in 197 (19.70%) patients; 14 (1.40%) patients had no inferior phrenic artery (IPA), and 17 (1.70%) patients had only one IPA. CONCLUSION: Fifty-two different types of variations in the combined origin of the inferior phrenic arteries were described in this study for the first time in the literature. Awareness of the anatomic variations in the IPAs, which is critical for hepatocellular carcinoma origins, may benefit various clinical procedures, such as transcatheter arterial chemoembolization, organ transplantations, laparoscopic surgical procedures, and radiological procedures.

Relationship Between Pituitary Siderosis and Endocrinological Disorders in Pediatric Patients with Beta-Thalassemia.

Introduction Excess iron accumulation occurs mainly in organs such as reticuloendothelial cells, the pituitary gland, and the pancreas in beta-thalassemia because of blood transfusions. In the present study, it was aimed to investigate the relationship between T2* values on magnetic resonance imaging (MRI) and clinically diagnosed pituitary endocrinological disorders in children with thalassemia major. Methods This study enrolled patients diagnosed with beta-thalassemia at pediatric hematology outpatient clinics. In the study, in addition to the medical history of the patients, routinely performed tests, including hemoglobin electrophoresis, routine biochemical tests, and tests for pubertal development (follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, etc.), as well as iron deposition measured by hepatic MRI T2* (STAR) sequence, were retrospectively assessed. A total of 29 patients were enrolled. Results Hypothyroidism was detected in 34.6% (9/26) of patients, short stature in 37% (10/27), and pubertal retardation in 50% (14/28) of the patients. There was no significant correlation between hypothyroidism and pituitary MRI T2* values. No significant correlation was found between laboratory parameters and pituitary MRI examination. Although the sensitivity of T2* levels could rise above 80%, their specificity remained low. This is one of the major limitations of the pituitary MR T2* study for the prediction of short stature. The best lower cut-off level of MR T2* to predict short stature was found 14.6 ms. Conclusion The diagnostic specificity pituitary MR examination levels for short stature were detected as low. Thus, the clinical standardization and validation of pituitary MR T2* values examination are needed before clinical follow-up and multifaceted studies are needed.

Evaluation of the relationship between splenic iron overload and liver, heart and muscle features evident on T2*-weighted magnetic resonance imaging.

BACKGROUND: Splenic iron overload is the most common clinical condition in patients with thalassemia. However, few studies of the effects of splenectomy have been published. OBJECTIVES: To evaluate the relationship between splenic iron overload and liver, heart and muscle features visible in T2*-weighted magnetic resonance imaging, and to investigate the effects of splenectomy on these tissues in patients with beta-thalassemia major (TM). MATERIAL AND METHODS: We retrospectively included 131 patients (76 male and 55 female) diagnosed with TM. All radiological assessments were performed with the aid of a Philips Achieva 1.5T scanner running a multiecho gradient-echo sequence. Hepatic and splenic T2* values were assessed in the same gradient multiecho series. Muscle T2* values were assessed in the shoulder girdle muscles adjacent to the heart area. The relationships among splenic T2*, hepatic T2*, cardiac T2* and muscle T2* parameters, serum ferritin levels, age and other parameters were evaluated. RESULTS: The splenic T2* value correlated with serum ferritin level and the hepatic T2* value (p < 0.001 and p < 0.001, respectively). The splenic T2* value did not correlate with age, cardiac or muscle T2* values, or with spleen size (p = 0.27, 0.21, 0.99, and 0.39, respectively). The muscle T2* value correlated weakly with the serum ferritin level (p = 0.022). The cardiac T2* value was lower and the liver size greater in patients who had undergone splenectomy compared with those who had not (p < 0.001 and 0.001, respectively). CONCLUSIONS: Splenic iron overload correlated with hepatic overload and the serum ferritin level. Splenectomy increased cardiac iron overload and triggered liver enlargement. However, the muscle iron overload was low and the muscles were therefore unaffected by splenectomy.

Accessory liver within the thoracic cavity.

Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.

Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients.

The aim of this study is to show the frequency of incidentally found (pulmonary thromboembolism) PTE in oncological patients and evaluate dispersion of incidents in terms of underlying primary tumor and seek risk factors associated with incidental PTE. Among one thousand oncology patients, 46 (4.6%) individuals found to have incidental PTE. Of positive patients, the highest proportion (24%) was belong to breast cancer group (n=11). The most common location for pulmonary emboli was the lower lobe branch of right pulmonary artery (n=33, 71.7%). Evident PTE had not been reported in final radiology reports of 21 cases.

MRI-based evaluation of the factors leading to pituitary iron overload in patients with thalassemia major.

AIM: Given the lack of studies evaluating pituitary iron overload in patients with thalassemia major, we used magnetic resonance imaging (MRI) to evaluate these patients and the factors affecting the disease process. MATERIALS AND METHODS: The 84 patients with ß-thalassemia major who were included in this study were referred to our clinic for cardiac and hepatic T2(*) MRI. T2(*)-weighted images of the pituitary gland, heart, and liver were obtained using a 1.5-tesla MRI unit and a multi-echo gradient-echo sequence. Associations between pituitary T2(*), cardiac T2(*), hepatic T2(*), pituitary height, serum ferritin (SF) level, patient age, and other demographic findings were assessed. RESULTS: Pituitary T2(*) values correlated with hepatic T2(*) values, cardiac T2(*) values, SF level, and patient age (P≤0.001, 0.001, 0.001, 0.01, respectively) but not with pituitary height (P=0.76). Pituitary and cardiac T2(*) values were lower in the subset of patients who underwent splenectomy (P=0.046 and P=0.002, respectively). CONCLUSION: Pituitary iron overload rapidly increases during puberty and in this study correlated with cardiac and hepatic T2(*) values, patient age, SF level, and liver size, but not with the height of the pituitary. Pituitary iron overload also increases following splenectomy. Together, these findings indicate that numerous factors contribute to pituitary iron overload.

Quantitative volumetric assessment of pulmonary involvement in patients with systemic sclerosis.

BACKGROUND: Computed tomography (CT) is the gold standard for assessing interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). In this study, we performed a quantitative calculation of ILD severity by examining the lung volume of SSc patients. METHODS: The present study was performed retrospectively on 38 patients with SSc who were referred to our clinic. Patients were divided into two groups based on high-resolution computed tomography (HRCT): patients with ILD and patients without ILD.The percentage of lower lobe volume (PLLV) was calculated using HRCT. In addition, we evaluated the PLLV in all patients according to age, diffusing capacity of the lung for carbon monoxide (DLCO) and spirometric findings, and assessed the relationships among these factors. RESULTS: PLLV of the right lung in patients with ILD was reduced when compared with patients without ILD (P=0.041). The PLLV of the right lung in patients with ILD was negatively correlated with age and forced vital capacity (FVC; P=0.01 and P=0.012, respectively). CONCLUSIONS: The PLLV of the right lung may decrease in SSc patients with ILD. In these patients, the PLLV may be a quantitative parameter indicating damage in the lung.

Evaluation of the glucocorticoid, mineralocorticoid, and adrenal androgen secretion dynamics in a large cohort of patients aged 6-18 years with transfusion-dependent ß-thalassemia major, with an emphasis on the impact of cardiac iron load.

The variable presence of adrenal insufficiency (AI) due to hypocortisolemia (HC) in patients with thalassemia is well established; however, the prevalence of adrenocortical hypofunction (ACH) in the zona glomerulosa and zona reticularis of the adrenal cortex is unknown. To establish the prevalence of ACH, we examined the cortisol response to 1-µg and 250-µg ACTH tests, plasma aldosterone (A)/plasma renin activity (PRA) ratio, and serum dehydroepiandrosterone sulfate (DHEAS) levels in a large cohort of patients with thalassemia, and to investigate the impact of total body iron load (TBIL) on adrenocortical function. The setting used was University hospital and government-based tertiary care center. One hundred twenty-one (52 females) patients with ß-thalassemia major (ß-TM) and 72 healthy peers (38 females) were enrolled. The patients underwent a 250-µg cosyntropin test if their peak cortisol was <500 nmol/L in a 1-µg cosyntropin test. Magnetic resonance imaging (MRI) was performed to assess the MRI-based liver iron content and cardiac MRI T2* iron. The associations between ACH and TBIL were investigated. The patients with thalassemia had lower ACTH, cortisol, DHEAS, and A/PRA values compared with the controls (p < 0.001). Thirty-nine patients (32.2 %) had HC [primary (n = 1), central (n = 36), combined (n = 2)], and 47 (38.8 %) patients had reduced DHEAS levels; 29 (24.0 %) patients had reduced A/PRA ratios. Forty-six (38.0 %) patients had hypofunction in one of the adrenal zones, 26 (21.5 %) had hypofunction in two adrenal zones, and 9 (7.4 %) had hypofunction in all three zones. Patient age and TBIL surrogates were significant independent parameters associated with ACH. Cardiac MRI T2* iron was the only significant parameter that predicted the severity of ACH at a cut-off of 20.6 ms, with 81 % sensitivity and 78 % specificity. Patients with thalassemia have a high prevalence of AI due to HC and zona glomerulosa and zona reticularis hypofunction. TBIL surrogates can predict ACH, but cardiac iron was the only surrogate that was adequately sensitive to predict the severity of ACH.

Effect of airway dynamics on the development of larynx cancer.

OBJECTIVES/HYPOTHESIS: This study aimed to investigate and measure airway dynamics in anatomical regions where laryngeal cancer was most common in comparison to other regions of the larynx, thereby determining the effect of airway dynamics on the development of laryngeal cancer. STUDY DESIGN AND METHODS: Pulmonary function test airflow data and larynx anatomy measurement data obtained by three-dimensional computed tomography. A healthy male adult was modeled by simulation using the ANSYS program. Analysis of air flow rates, pressure, and force were also made. RESULTS: The supraglottic region average pressure was higher when compared to the subglottic region and clearly lower when compared to the glottic region. The subglottic had the lowest pressure and force levels. The glottic region was the first ranked location for laryngeal cancer; the supraglottic region was the second; and the frequency of laryngeal cancer was much lower in the subglottic region. Our data suggests that the high pressure and force contribute to an increased amount of contact and interaction between toxic particles and mucosa and to increased diffusion of the particles, leading to an increased carcinogenic effect and frequency of cancer. CONCLUSION: Laryngeal cancer was found more frequently in regions with an increased pressure and force stress and reduced air velocity, with a subsequent increase in penetration of the inhaled toxic agents. These findings demonstrate the importance of basic physical fluid mechanics in cancer pathogenesis. LEVEL OF EVIDENCE: NA. Laryngoscope, 126:1136-1142, 2016.

Which type of reaction in retained surgical sponge is more dangerous?

BACKGROUND: Retained surgical sponge is a term to define forgotten surgical sponges during operation. RSS causes two kinds of reactions in the body. The first one is to develop an abscess through exudative inflammatory reaction in early phases and second one is to form a mass through aseptic inflammatory reaction which can stay asymptomatic for months, even for years. In this study we aimed to investigate the time of hospital admission, type of reaction and effect of need for bowel resection on prognosis in patients with retained surgical sponge. METHODS: In the study, we scanned the files of 18 patients with retained surgical sponge who had been operated at Dicle University Medical Faculty General Surgery Clinic between January 1994 and July 2012, retrospectively. RESULTS: Need for intestine resection was higher in patients who were operated in the early phase (p:0.034). Morbidity and duration of hospital stay were significantly higher (respectively P:0.02, P:0.007) in patients who had underwent intestine resection. CONCLUSION: In patients with retained surgical sponge, need for intestine resection is increased due to exudative reaction in the early phase. This increase is giving rise to morbidity rates and prolonged hospital stay. KEY WORDS: Morbidity, Retained surgical sponge.

Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions.

OBJECTIVES: Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions. METHODS: We prospectively examined 141 breast lesions in 122 patients. All lesions were classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography, BI-RADS for sonography, and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) pattern. Internal and marginal shear wave velocity (SWV) values for the lesions were noted. The sensitivity, specificity, accuracy, and positive and negative predictive values for VTI and Virtual Touch tissue quantification (VTQ; Siemens Medical Solutions) were calculated. RESULTS: The marginal SWV values were statistically higher in malignant lesions (mean ± SD, 5.41 ± 1.37 m/s) than benign lesions (2.91 ± 0.88 m/s; P < .001). When the SWV cutoff level was set at 4.07 m/s, and the higher of the internal and marginal values was adopted, the combination of VTI and VTQ showed 95.1% sensitivity, 99.0% specificity, and 97.8% accuracy. CONCLUSIONS: Breast Imaging Reporting and Data System category 4 lesions are the main focus of research for early detection of breast cancer. Unfortunately, BI-RADS category 4 assessment covers a wide range of likelihood of malignancy (2%-95%). This wide range reflects the necessity for a more specific imaging modality. The combination of VTI and VTQ could increase the diagnostic performance of conventional sonography.

Acoustic radiation force impulse imaging for evaluation of renal parenchyma elasticity in diabetic nephropathy.

OBJECTIVE. The goal of this study is to evaluate the changes in the elasticity of the renal parenchyma in diabetic nephropathy using acoustic radiation force impulse imaging. SUBJECTS AND METHODS. The study included 281 healthy volunteers and 114 patients with diabetic nephropathy. In healthy volunteers, the kidney elasticity was assessed quantitatively by measuring the shear-wave velocity using acoustic radiation force impulse imaging based on age, body mass index, and sex. The changes in the renal elasticity were compared between the different stages of diabetic nephropathy and the healthy control group. RESULTS. In healthy volunteers, there was a statistically significant correlation between the shear-wave velocity values and age and sex. The shear-wave velocity values for the kidneys were 2.87, 3.14, 2.95, 2.68, and 2.55 m/s in patients with stage 1, 2, 3, 4, and 5 diabetic nephropathy, respectively, compared with 2.35 m/s for healthy control subjects. Acoustic radiation force impulse imaging was able to distinguish between the different diabetic nephropathy stages (except for stage 5) in the kidneys. The threshold value for predicting diabetic nephropathy was 2.43 m/s (sensitivity, 84.1%; specificity, 67.3%; positive predictive value, 93.1%; negative predictive value 50.8%; accuracy, 72.1%; positive likelihood ratio, 2.5; and negative likelihood ratio, 0.23). CONCLUSION. Acoustic radiation force impulse imaging could be used for the evaluation of the renal elasticity changes that are due to secondary structural and functional changes in diabetic nephropathy.

The Role of Acoustic Radiation Force Impulse Elastography in the Differentiation of Infectious and Neoplastic Liver Lesions.

We aimed to evaluate the effectiveness of acoustic radiation force impulse (ARFI) elastography in differentiating between hepatic lesions. The prospective study included 117 patients with liver masses. Shear wave velocity (SWV) values for lesions were determined by ARFI imaging and compared statistically. The difference between SWV values for benign and malignant hepatic masses was significant (p < 0.01). The threshold SWV value for malignant hepatic lesions was established at 2.52 m/s, and the sensitivity and specificity of this cut-off value were 97% and 66%, respectively. We concluded that ARFI elastography provides supplementary data that aid in the differential diagnosis of liver masses.

The role of quantitative measurement by acoustic radiation force impulse imaging in differentiating benign renal lesions from malignant renal tumours.

PURPOSE: The purpose of this preliminary study was to prospectively evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) imaging for differentiating benign lesions from malignant renal tumours. MATERIALS AND METHODS: Sixty patients with renal lesions were enrolled in the study; mean patient age was 49.52 ± 20.46 years (range 1-83 years) and patients included 30 men and 30 women. Lesions were categorised as benign (n = 19), malignant (n = 36) and infectious (n = 5) in origin. The shear wave velocities (SWVs) of the tumours and the intact parenchyma were determined by ARFI quantification, and the differences in the SWVs were compared among groups. The final diagnoses were determined via pathologic (n = 33), clinical (n = 13) and imaging findings (n = 14). The SWV values of the renal tumours were analysed according to the final diagnoses. RESULTS: The mean SWV value of the normal renal parenchyma was significantly different from that of all other lesions (p < 0.01). There was a significant difference between the SWV values of benign renal lesions including haematomas and the malignant renal lesions (p = 0.033). However, the SWV values of the infectious lesions and leiomyoma corresponded well with the malignant lesions. A Receiver operating characteristic (ROC) analysis demonstrated a cut-off value of 2.34 m/s between benign and malignant lesions, while sensitivity and specificity were determined to be 88 and 54 %, respectively. CONCLUSION: ARFI elastography with ARFI quantification may be useful for differentiating benign renal lesions from malignant renal tumours.

Imaging features of cerebral and spinal cystic echinococcosis.

PURPOSE: The main objective of this study was to describe the characteristic imaging features of cerebral and spinal hydatid disease (HD) in magnetic resonance imaging (MRI) and computed tomography (CT) in order to provide more effective differential diagnoses in endemic regions. We also aimed to use MRI and CT to evaluate whether the World Health Organization's (WHO) new classification of hepatic cystic echinococcosis (CE) could be used in the classification of cerebral HD. MATERIALS AND METHODS: We retrospectively reviewed the CT and MR images of 30 patients who were diagnosed with cerebral and spinal HD between 1990 and 2014. The imaging findings were noted. All hydatid cysts were classified according to the WHO classification of hepatic CE, consisting of six types. RESULTS: The study group consisted of 49 CEs in 27 patients with cerebral HD and 12 CEs in three patients with spinal HD. Of the cysts, 14 were type CL (cystic lesion), 29 were type CE1, 11 were type CE2 and seven were type CE3. In other words, 54 cysts were in the active group and seven were in the transition group. Most of the cysts were type CL and CE1. CONCLUSIONS: Even though characteristic imaging features could be used in the differential diagnosis of HD, sometimes the differentiation of HD from other cystic lesions may be difficult. The use of WHO classification will provide standardisation of uniform treatment modality, as the treatment of HD, according to the stage of the disease, may be surgical or medical.

Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children.

BACKGROUND: Acoustic radiation force impulse (ARFI) imaging is a promising method for noninvasive evaluation of the renal parenchyma. OBJECTIVE: To investigate the contribution of ARFI quantitative US elastography for the detection of renal damage in kidneys with and without vesicoureteral reflux (VUR). MATERIALS AND METHODS: One hundred seventy-six kidneys of 88 children (46 male, 42 female) who had been referred for voiding cystourethrography and 20 healthy controls were prospectively investigated. Patients were assessed according to severity of renal damage on dimercaptosuccinic acid (DMSA) scintigraphy. Ninety-eight age- and gender-matched healthy children constituted the control group. Quantitative shear wave velocity (SWV) measurements were performed in the upper and lower poles and in the interpolar region of each kidney. DMSA scintigraphy was performed in 62 children (124 kidneys). Comparisons of SWV values of kidneys with and without renal damage and/or VUR were done. RESULTS: Significantly higher SWV values were found in non-damaged kidneys. Severely damaged kidneys had the lowest SWV values (P < 0.001). High-grade (grade V-IV) refluxing kidneys had the lowest SWV values, while non-refluxing kidneys had the highest values (P < 0.05). Significant negative correlations were found between the mean quantitative US elastography values and DMSA scarring score (r = -0.788, P < 0.001) and VUR grade (r = -0.634, P < 0.001). SWV values of the control kidneys were significantly higher than those of damaged kidneys (P < 0.05). CONCLUSION: Our findings suggest decreasing SWV of renal units with increasing grades of vesicoureteric reflux, increasing DMSA-assessed renal damage and decreasing DMSA-assessed differential function.

Primary and Metastatic Liver Malignancy: Utility Low and High B Value (1600-2000) in 3 Tesla MRI.

BACKGROUND/AIMS: To determine the utility of the quantitative apparent diffusion coefficient (ADC) values at various b values, in the differentiation of malignant hepatic masses on 3.0 Tesla (T) MRI. METHODOLOGY: We evaluated 81 consecutive patients presenting with 529 malignant masses in the liver. Of those patients 27 had a primary hepatic malignancy while the other 54 patients had metastases in the liver. Quantitative ADC values of malignant hepatic masses was measured at four b values (b 400, b 800, b 1600, b 2000 mm2/s) on MR-DWI. We compared the primary and metastatic tumors within their groups and also with each other in terms of their ADC values. RESULTS: In 4 various b value measurements, the mean ADC values of the primary and metastatic hepatic masses were 1. x 10(-3), 1.06 x 10(-3), 0.87 x 10(-3), and 0.736 x 10(-3)mm2/ seconds, 1.30 x 10(-3), 1.10 x 10(-3), 0.84 x 10(-3), and 0.715 x 10(-3) mm2/seconds respectively. There was no significant difference between mean ADC values of HCCs and metastases at b 400, 800, 1600 and 2000 gradients (P > 0.05). CONCLUSIONS: The ADC values obtained at intermediate (400, 800) and high (b 1600, 2000) diffusion gradients are not helpful in differentiation between HCCs and liver metastases.