Achilles Tendon Stiffness in the Etiology of Sever Disease: A Shear Wave Elastography Study.

BACKGROUND: Sever disease is one of the most common causes of heel pain in growing children and adolescents. There is no consensus about etiology of Sever disease. METHODS: The study comprised 41 participants aged 8 to 13 years who visited the orthopedic outpatient clinic: 17 patients with Sever disease and 24 asymptomatic children. The middle third segment of the body of the Achilles tendon and the calcaneal insertion zone were separately assessed. Five measuring points for the quantitative value of each point were randomly selected. The color scale used in the Young's modulus shows the lowest values in blue and the highest values in red. The mean values were used for the statistical analysis. RESULTS: Less elasticity was detected at the insertional site for the control group (4.02 kPa versus 3.65 kPa), the situation was reversed in the body of the Achilles tendon and the elasticity of the study group was less than that of the control group (241.0 kPa versus 260.5 kPa). However, no statistically significant difference was found between the groups. CONCLUSIONS: In conclusion, no difference was found in Achilles tendon elasticity between patients with Sever disease and healthy individuals in both the tendon body and the calcaneal insertionof the tendon. Achilles tendon elasticity has not been found to play a role in the etiology of Sever disease.

Patellofemoral Anatomical Measurements on MRI in Patient with Suprapatellar Fat Pad Edema and Mass Effect.

OBJECTIVE: To evaluate the impact of patellofemoral joint anatomical measurements of patients with anterior knee pain who were diagnosed with suprapatellar fat pad (SPFP) impingement syndrome (SP-FPIS) by magnetic resonance imaging (MRI). STUDY DESIGN: A prospective, descriptive study. PLACE AND DURATION OF STUDY: Goztepe Education and Research Hospital, between March 2015 and June 2019. METHODOLOGY: The study included 34 patients (Group 1) and 34 healthy volunteers (Group 2) who were referred to the radiology clinic with anterior knee pain; they underwent MRI and diagnosed with SP-FPIS. Twenty-three anatomical measurements such as SPFP cranio caudal length (CC), anteroposterior length (AP), oblique length (OBL), patellar length (PL), patellar tendon length (PTL), Insall Salvati Index (ISI), patellar cartilage distal-tibial tubercle (TT), patellar cartilage length (PCL), Modified Insall Salvati Index (MISI), patellotrochlear cartilage length (TCL), lateral trochlear inclination angle (LTI), etc. related to the morphological structure of SPFP and patellofemoral joint were evaluated and compared in both groups. RESULTS: The mean age of groups 1 and 2 was 45.62±10.87 and 41.47±11.98 years, respectively. There was a statistically significant difference in patients with SP-FPIS in PL, PT, TT, PC, MISI, TC, PTI, MF, PHY, PPI, MT, LTI, CC, AP, and OBL measurements compared with the control group (p<0.05). In the logistic regression analysis performed to evaluate the effect of statistically significant parameters on anterior knee pain, the probability of SP-FPIS increases 1.5 times as PTL increases among the groups, while the risk of SP-FPIS decreases 0.78 times as LTI decreases (p<0.05). CONCLUSION: There is a predisposing effect of PTL increase in SP-FPIS development, while LTI decrease has a protective effect. These results will guide future studies for the development and/or modification of treatment methods. KEY WORDS: Patellofemoral joint, Suprapatellar fat pad impingement syndrome, Anterior knee pain, Knee magnetic resonance imaging, Knee anatomy.

The Relationship between PI-RADS Categories and Incidental Findings in Multiparametric Prostate MRI.

OBJECTIVE: To find the frequency and significance of extraprostatic incidental findings (ep-IFs) during multiparametric-magnetic prostate resonance imaging (mp-MRI), and compare them with prostate imaging reporting and data system (PI-RADS) outcomes. STUDY DESIGN: Analytical study. Place & Duration of Study: Goztepe Education and Research Hospital, Istanbul, Turkey, from June 2019 to January 2020. METHODOLOGY: Images of 185 men, who underwent mp-MRI, were reviewed and ep-IFs were also classified as urologic or non-urologic and benign or malign. The PI-RADS score was also recorded in biopsy-naïve subjects or in whom a sufficient time (which would not impair imaging) was elapsed after the biopsy. The cases were also divided into two groups, according to the PI-RADS score (Group 1: PI-RADS 1 or 2, Group 2: PI-RADS 3 or more) and the incidental findings (IFs) were compared between the groups. RESULTS: Overall, 139 ep-IFs were detected in 88 (47.6%) patients. The remaining 97 (52.4%) cases were free of ep-IFs. The ep-IFs were benign in 85 (96.6%) and malignant in 3 (3.4%) cases. The frequency of total ep-IFs did not differ between groups 1 and 2 (47.8% vs. 47.6%, respectively, p>0.05). CONCLUSION: Extra prostatic incitental findings are frequently encountered during mp-MRI, benign ep-IFs are quite frequent; although rare malignant ep-IFs may be subject to being missed due to focused analysis and interpretation of prostate. PI-RADS scoring system does not contribute to the diagnosis of incidental mp-MRI. Key Words: Incidental findings, Multiparametric prostate MRI, Prostate cancer, MP-MRI.

Apparent Diffusion Coefficient in Predicting the Preoperative Grade of Meningiomas.

OBJECTIVE: To investigate the relationship between the apparent diffusion coefficients (ADC) value obtained from magnetic resonance imaging (MRI) and histopathologic grade of meningiomas. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Radiology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey between January 2015 and June 2019. METHODOLOGY: Data of 45 patients with meningiomas, who underwent surgery at the University Hospital, were retrospectively reviewed; 28 patients were enrolled in the study. The pathology preparations of the patients were re-evaluated according to the World Health Organisation (WHO) 2016 classification updated by a neuropathologist. ADC values were measured in a standard region of interest range from the three consecutive sections where the mass had the largest width and from the opposite white matter. RESULTS: Fourteen patients (50%) were diagnosed with WHO grade I tumor, 11 with grade II (39.3%), and three with grade III (10.7%). The ADCmin value was found statistically significant for the differentiation of tumor grades (p = 0.018). The cut-off point of the ADCmin value was 0.634x10-3mm2s for the differential diagnosis of grade I and grade II/III meningiomas. The sensitivity of the cut-off value was found as 86% and its specificity as 57%. The patients with increased cellularity and Ki67 proliferation index had statistically significantly lower ADCmin values (p = 0.025). CONCLUSION: The data of this study show a significant difference in the ADCmin values on MRI between low- and high-grade meningiomas. A negative correlation was found between histopathologic grade and ADCmin. Key Words: Meningioma, Apparent diffusion coefficient, Magnetic resonance imaging, Histopathological grade, Quantitative.

MRI and MRS findings in fucosidosis; a rare lysosomal storage disease.

Fucosidosis is a rare lysosomal storage disorder caused by deficient activity of the enzyme l-fucosidase in all tissues. We presented magnetic resonance imaging [MRI] and MR spectroscopy [MRS] findings of a 4-year-old boy with genetically proven fucosidosis. He had a history and clinical findings of recurrent sinopulmonary infections, hypertonicity on lower extremities, gingival hypertrophy, bilateral ptosis, angiokeratoma corporis diffusum, and dysostosis multiplex. He had no organomegaly and urine glycosaminoglycan analysis were normal. MRI revealed abnormalities within the globus pallidus and periventricular and subcortical white matter. MRS showed a peak at the 3.8-3.9 ppm as a result of accumulating carbohydrate containing macromolecules and another peak at 1.2 which was doublet and inverted on TE 135, suggesting fructose peak. A final diagnosis of fucosidosis was proved by mutational analysis of FUCA1 gene which is responsible for the Fucosidosis phenotype. Two recent reports of MRS of two patients demonstrated that MRS is specific for fucosidosis. In this case, we aim to discuss fucosidosis with MRI and MRS findings accompanied by the literature.