Delayed Aortic Dissection after Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) offers functional improvement for high-risk patients with aortic stenosis. Vascular complications after TAVI are known to occur frequently. Among them, aortic dissection is a rare but life-threatening vascular complication. We present a case of delayed aortic dissection following a successful TAVI.

Relationship between androgenic alopecia and white matter hyperintensities in apparently healthy subjects.

A healthy brain is essential for living a longer and fuller life. Detecting asymptomatic white matter hyperintensities (WMHs) may be clinically important in terms of treatment and prognostic evaluation. WMHs in brain may reflect brain aging. Androgenic alopecia (AGA) is associated with significant cardiovascular risk factors that also have a negative impact on brain aging. The main purpose of present study was to know whether alopecia might provide predictive information of WMHs that may be considered as a surrogate marker of cerebral small vessel disease which is related to arteriolosclerosis and vascular risk factors. From January 2017 to March 2018, 256 cases were enrolled consecutively. Patients under 18 years old, older than 90 years old, known to be affected by neurodegenerative diseases, demyelinating disorders or stroke and/or a brain tumor, were excluded from the study. A 4-point cerebral white matter Magnetic Resonance Imaging (MRI) hyperintensities scoring system, the Fazekas scale, was used to evaluate brain aging. Presence of AGA was evaluated with inspection according to Hamilton-Norwood classification system (grade I to VII). Two hundred eleven (82%) of individuals had mild alopecia (grade I, II, III), 28 (11%) had moderate alopecia (grade IV, V) and 17 (7%) had severe alopecia (grade VI, VII). Frequency of abnormal WMHs was significantly higher in patients with AGA compared to the without AGA. Hypertension (HT) (95% confidence interval [CI]: 1.873-9.487, p < 0.001) and the AGA (95% CI: 2.989-12.916, p < 0.0001) were independent determinants of abnormal WMHs. AGA may be regarded as a surrogate marker of asymptomatic WMHs which is related to arteriolosclerosis and vascular risk factors that has a significant impact on people's life.

Relationship between the earlobe crease and brain white matter abnormalities in apparently healthy subjects

Background/aim: In the present study we aimed to investigate whether the earlobe crease (ELC) might provide predictive information about white matter intensities (WMIs) in the brain that reflect brain aging. Materials and methods: A total of 350 individuals examined from January 2016 to July 2016 were screened. Patients with known demyelinating white matter disease, neurodegenerative disorders, cerebrovascular event history, or brain tumors were excluded from the study. Finally, 285 cases were included in the study. The four-point cerebral intensity classification system of Fazekas was used in the evaluation of the brain. The ELC was evaluated by inspection. Results: A total of 285 patients were enrolled consecutively. The incidence of WMI was significantly higher in patients with ELC than the others. Age (95% CI: 1.105­1.213, P < 0.001) and ELC (95% CI: 0.098­0.783, P = 0.015) were found as an independent determinants of abnormal WMI. ELC predicted abnormal WMIs with 89% specificity and 62% sensitivity. Conclusion: The presence of an ELC may provide predictive information in terms of detecting abnormal WMIs with prognostic impact in apparently healthy subjects.

Efficacy of chemical shift MRI for differentiating diffuse red bone marrow reconversion and hematological malignancies

Background/aim: The main purpose of our study was to determine the efficacy of chemical shift imaging (CSI) for differentiating diffuse red bone marrow reconversion (RBMR) and hematological malignancies. We also aimed to calculate the cut-off value for these entities with similar imaging features in routine magnetic resonance (MR) sequences. Materials and methods: A total of 54 patients were included: 17 patients (31.4%) with hematological malignancies (group 1), 16 patients (29.6%) with RBMR (group 2), and 21 patients (38.0%) with no clinical and hematological malignancies (control group). Patients with no pathological data or completed two-year follow-up and children were excluded from the study. An experienced radiologist on MRI evaluated the images blindly for final diagnosis. Pathologic results were determined as gold standard. Regions of interests (ROI) were placed on the vertebrae in CSI and signal intensity ratios (SIR) were calculated. The cut-off value was calculated using receiver operating characteristic (ROC) analysis. Results: SIR values were 0.97 ± 0.16, 0.69 ± 0.31 and 0.28 ± 0.35 (P < 0.001) for GI, G2, and G3, respectively. The cut-off value was 0.82 (P < 0.001). The sensitivity rate was 83.3% (AUC: 58%­96%), specificity was 87% (AUC: 58­98). Conclusion: CSI may be a valuable diagnostic tool for differentiating diffuse RBMR and hematological malignancies.

A very rare renal venous anomaly: Accessory polar left renal vein.

A 49-year-old female patient with hypertension was admitted with an intraabdominal murmur and referred for multidetector computed tomography angiography for suspected renal artery stenosis. Her medical history, clinical examination, serum biochemistry, and ultrasound examination findings showed no pathological findings of diabetes mellitus or any other disease. Axial and coronal reformatted multidetector computed tomography angiography revealed a dilated accessory polar renal vein which drained the venous circulation of the left lower pole into the inferior vena cava at midline. In conclusion, multidetector computed tomography angiography plays a progressively substantial role in the assessment of renal vascularity. Vascular surgeons and urologists should be a thorough knowledge of renal vascular variations.

Value of tomography in detecting breast masses and discriminating malign and benign lesions.

OBJECTIVES: The main purpose of the present study was to determine the effectivity of computerized tomography (CT) in detecting breast masses and discriminating masses as malignant or benign. MATERIAL AND METHODS: After having received the institutional local ethics committee approval, an experienced radiologist who did not participate in the study created a patient pool by searching our health center's Pathology department database between 2010 and 2018. The group created consisted of dense and non-dense breast types equally and included approximately similar percentages of benign and malignant breast mass sizes. Finally, 70 subjects were included: 30 females with definite malign, 20 with definite benign breast masses, and 20 without any breast pathology based on mammography and ultrasonography results, who were considered as the control group. Three experienced Radiologists (R1, R2, R3) who were not aware of the final diagnosis evaluated all images independently. Radiologist performance was assessed by calculating the area under the receiver operating characteristic curve (AUC) and interobserver reliability values were estimated by intraclass correlation coefficient (ICC) analysis. RESULTS: The diagnostic accuracy suitability of CT according to BI-RADS scores for R1, R2 and R3 were found as p <0.001, p <0.001 and p <0.001, respectively. There were significant interobserver reliability rates between all investigators (p= 0.0001). CONCLUSION: CT may be used as a valuable diagnostic tool in discriminating breast masses with further training in widely varying appearances of normal breast tissues leading to false positive findings.