Differentiating renal cell carcinoma and oncocytoma with volumetric MRI histogram analysis.

OBJECTIVE: In this study, the utility of histogram parameters derived from diffusion-weighted imaging for differentiate renal cell carcinoma (RCC) from oncocytoma was investigated. METHODS: This research tracked 126 individuals who were diagnosed with RCC and oncocytoma through histopathological analysis, using magnetic resonance imaging (MRI) assessments from 2015 to 2023. We observed various attributes of these patients, including demographic details, surgical records, pre-surgery MRI results, MRI apparent diffusion coefficient (ADC) histogram analysis, and post-surgery histopathological outcomes. Calculations of ADC measurements such as mean, minimum, and maximum in conjunction with the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantile points were made. In addition, we also noted the skewness, kurtosis, and variance of these data points. RESULTS: The focus group for this investigation consisted of 75 male and 51 female patients. Out of these, 82 were diagnosed with RCC and 44 with oncocytoma. All ADC parameters including ADCmin, ADCmedian, ADCmean, and ADCmax, including the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantile divisions among the oncocytoma cohort were observed to be higher than the corresponding ones in the RCC group. A statistically meaningful difference was discovered between the minimum ADC value along with the 5th ranking of ADC measurements (p<0.001), in addition to mean of ADC (p=0.050), and the 10th (p=0.002) and 25th (p=0.015) quantiles of ADC data. When considering the region below the curve (AUC) in ROC analysis, the value of ADCmin was recorded as 0.739, with a sensitivity of 75.0%, and specificity of 68.2%. CONCLUSION: To distinguish oncocytoma from RCC, it may be useful to conduct a whole-tumor histogram and textural analysis of ADC values.

Computed Tomography Findings Affecting the Decision of Sternotomy in Substernal Goiter.

Objectives: Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery. Methods: Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded. Results: The total thyroid volume of the sternotomy group (280.75±127.01 mm3) was significantly greater than that of the cervical group (155.38±74.18 mm3) (p=0.015). The retrosternal thyroid volume (mm3), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001). Conclusion: The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.

Predictive value of sphericity index and other multidetector computed tomography findings in perforated acute appendicitis.

BACKGROUND: Early radiological prediction and diagnosis of perforated acute appendicitis remain controversial. In the current study, it was aimed to examine the predictive value of multidetector computed tomography (MDCT) findings in perforated acute appendicitis. METHODS: The patients (n=542) who underwent appendectomy between January 2019 and December 2021 were retrospectively evaluated. The patients were divided into two groups as non-perforated appendicitis and perforated appendicitis. Preoperative abdom-inal MDCT findings, appendix sphericity index (ASI) scores, and laboratory findings were evaluated. RESULTS: The sample consisted of 427 cases in the non-perforated group and 115 cases in the perforated group, with a mean age of 33.88±12.84 years. The mean time until admission was 2.06±1.43 days. Appendicolith, free fluid, wall defect, abscess, free air, and retroperitoneal space (RPS) involvement were all found to be significantly higher in the perforated group (P<0.001). The mean long axis, short axis, and ASI values were found to be higher in the perforated group (P<0.001; P=0.004; and P<0.001, respectively). C-reac-tive protein (CRP) was found to be significantly higher in the perforated group (P=0.008), but the mean white blood count was found to be similar between the groups (P=0.613). Among MDCT findings, free fluid, wall defect, abscess, high CRP, long axis, and ASI were observed to be predictive values for perforation. According to receiver operating characteristic analysis, ASI had a cut-off value of 1.30, a sensitivity of 80.87%, and a specificity of 93.21%. CONCLUSION: MDCT findings, namely, appendicolith, free fluid, wall defect, abscess, free air, and RPS involvement are significant findings for perforated appendicitis. With a high sensitivity and specificity, the ASI appears to be a key predictive parameter for perfo-rated acute appendicitis.

Analysis of Pancreatobiliary and Intestinal Type Periampullary Carcinomas Using Volumetric Apparent Diffusion Coefficient Histograms.

RATIONALE AND OBJECTIVES: Magnetic resonance imaging plays an important role in the evaluation of patients with known or suspected periampullary masses. The utilization of volumetric apparent diffusion coefficient (ADC) histogram evaluation for the entire lesion eradicates the potential for subjectivity in the region of interest placement, thus guaranteeing the accuracy of computation and repeatability. PURPOSE: To investigate the value of volumetric ADC histogram analysis in the differentiation of intestinal-type (IPAC) and pancreatobiliary-type periampullary adenocarcinomas (PPAC). MATERIALS AND METHODS: This retrospective study included 69 patients with histopathologically confirmed periampullary adenocarcinoma (54 PPAC and 15 IPAC). Diffusion-weighted imaging was obtained at b values of 1000 mm²/s. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated independently by two radiologists. Using the interclass correlation coefficient, the interobserver agreement was evaluated. RESULTS: The ADC parameters for the PPAC group were all lower than those of the IPAC group. The PPAC group had higher variance, skewness, and kurtosis than the IPAC group. However, the difference between the kurtosis (P = .003), the 5th (P = .032), 10th (P = .043), and 25th (P = .037) percentiles of ADC values was statistically significant. The area under the curve (AUC) of the kurtosis was the highest (AUC=0.752; cut-off value=-0.235; sensitivity=61.1%; specificity=80.0%). CONCLUSION: Volumetric ADC histogram analysis with b values of 1000 mm²/s can discriminate subtypes noninvasively before surgery.

The Effectiveness of Volumetric MRI Histogram Analysis in Renal Cell Carcinoma.

RATIONALE AND OBJECTIVES: This study investigated the utility of histogram parameters derived from diffusion-weighted imaging (DWI) for evaluating renal cell carcinoma (RCC) grading prior to surgery. MATERIALS AND METHODS: This retrospective study included 88 patients who were histopathologically diagnosed with RCC and underwent magnetic resonance imaging (MRI) examinations. The patients were divided into two groups as well-differentiated (Group 1) and poorly differentiated (Group 2). Demographic data, preoperative MRI findings, MRI apparent diffusion coefficient (ADC) histogram analyzes, operation types, postoperative histopathological data and cancer stages of the patients were recorded. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated. RESULTS: The study included 59 males and 29 women with an average age of 56.21 ± 1.33 years. There were 52 patients in Group 1 and 36 patients in Group 2. The ADCmin, ADCmean, ADCmax, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values of the poorly differentiated group were all lower than those of the well-differentiated group. ADCmin and the 5th percentile of ADC values, as well as ADCmean and the 10th, 25th, 50th, and 75th percentiles of ADC values, showed a statistically significant difference (p < 0.05). The AUC, sensitivity, and specificity of the ADCmin value were 0.703, 56.3%, and 75.7%, respectively. CONCLUSION: The present study indicated that histogram parameters generated from DWI were capable of differentiating between high-grade and low-grade RCC.

Evaluation of Imaging Findings of Pancreatobiliary and Intestinal Type Periampullary Carcinomas with 3.0T MRI.

RATIONALE AND OBJECTIVES: The aim of this study was to differentiate pancreatobiliary and intestinal type periampullary carcinomas using dynamic contrast MRI and MRCP (Magnetic Resonance Cholangiopancreatography) with diffusion-weighted imaging (DWI) MATERIALS AND METHODS: MRI and MRCP images of 70 patients with pathologically proven periampullary adenocarcinoma were included. MRCP image features, extra-ampullary features, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm² were evaluated by two radiologists independently. The interclass correlation coefficient (ICC) or Cohen's kappa statistic was used to evaluate the interobserver agreement. RESULTS: 51 patients were diagnosed with pancreatobiliary type carcinomas, and 19 with intestinal type. In the pancreatobiliary subtype, the distal wall of the common bile duct was usually irregular (p = 0.047). Although the progressive enhancement pattern was evident in the pancreatobiliary type, an oval filling defect in the distal common bile duct was found to be more common in the intestinal type (p<0.001). The pancreatic duct cut-off sign (p<0.001), gastroduodenal artery involvement (p <0,001), and lymphadenopathy (p<0.05) were mostly observed in pancreatobiliary carcinomas. The ADCmin, ADCmean, and ADCmax values of the pancreatobiliary type carcinomas were all lower compared to the intestinal type carcinomas (p <0.05). CONCLUSION: The oval filling defect seen in MRI and MRCP examinations suggests intestinal type, whereas the progressive contrasting pattern of the masses with irregular narrowing in the distal margin of the common bile duct, the pancreatic duct cut-off sign, gastroduodenal artery involvement, lymphadenopathy, and low ADC values indicate pancreatobiliary type carcinomas.

Gastric perforation: An unusual complication after esophageal intubation.

Gastric perforation secondary to accidental esophageal intubation is a very rare mortal complication with only a few cases reported in the literature. In the management of this fatal complication, the early diagnosis and rapid surgical intervention are critical. In this case report, we present our experience with an unusual case, who required intubation in the intensive care unit due to acute hypoxemia and subsequently developed gastric perforation.

A Comparative Olfactory MRI, DTI and fMRI Study of COVID-19 Related Anosmia and Post Viral Olfactory Dysfunction.

RATIONALE AND OBJECTIVE: To evaluate how COVID-19 anosmia imaging findings resembled and differed from postinfectious olfactory dysfunction (OD). MATERIAL AND METHODS: A total of 31 patients presenting with persistent COVID-19 related OD and 97 patients with post-infectious OD were included. Olfactory bulb MRI, DTI and olfactory fMRI findings in both groups were retrospectively assessed. RESULTS: All COVID-19 related OD cases were anosmic, 18.6% of post-infectious OD patients were hyposmic and remaining 81.4% were anosmic. Mean interval between onset of OD and imaging was 1.5 months for COVID-19 related OD and 6 months for post-infectious OD. Olfactory bulb volumes were significantly higher in COVID-19 related OD than post-infectious OD. Deformed bulb morphology and increased olfactory bulb signal intensity was seen in 58.1% and 51.6% with COVID-19 related OD; and 63.9% - 46.4% with post-infectious OD; without significant difference. Significantly higher rate of olfactory nerve clumping and higher QA values at orbitofrontal and entorhinal regions were observed in COVID-19 related OD than post-infectious OD. Absence of orbitofrontal and entorhinal activity showed no statistically significant difference between COVID-19 related OD and post-infectious OD, however trigeminosensory activity was more robust in COVID-19 related OD cases. CONCLUSION: Olfactory bulb damage may play a central role in persistent COVID-19 related anosmia. Though there is decreased olfactory bulb volume and decreased white matter tract integrity of olfactory regions in COVID-19 related anosmia, this is not as pronounced as in other post-infectious OD. Trigeminosensory activity was more robust in COVID-19 related OD. These findings may reflect better preserved central olfactory system in COVID-19 related OD compared to COVID-19 related OD.

Neutrophil oxidative metabolism in Down syndrome patients with congenital heart defects.

Down syndrome (DS) occurs when an individual has three, rather than two, copies of the 21st chromosome. Cytosolic superoxide dismutase (SOD-1) is encoded by a gene on chromosome 21 and thus, SOD-1 activity is elevated in patients with DS. Forty percent of all cases with DS are associated with congenital heart defects (CHD). Although the contribution of SOD1 to disease phenotype is unknown, it is considered to be a "molecular marker" of the disease. It was hypothesized herein that the presence of CHD may alter the expression of SOD1 and oxidative metabolism in patients with DS. This hypothesis was tested via four experimental groups as follows: patients with DS without CHD, DS patients with CHD, CHD patients without DS and controls. Expression and activity of superoxide dismutase (SOD), glutathione peroxidase (GPx), myeloperoxidase (MPO), and catalase (CAT) were determined in neutrophils from all experimental groups. Intracellular hydrogen peroxide concentration and superoxide release were also evaluated in neutrophils. A significant increase was observed in SOD and GPx amount and activity in patients with DS with and without CHD. No significant difference was found in the amount and activity of MPO and CAT among the different experimental groups. Intracellular hydrogen peroxide concentration was similar in all groups, whereas a prominent decrease was seen in superoxide release in cases with DS. Patients with DS with and without CHD showed no significant differences in any of the measured parameters. The data suggest that CHD observed in patients with DS does not result from altered redox metabolism associated with the disease.