A Rare Tumor Causing Optic and Oculomotor Nerve Compression: Clivus Plasmacytoma Case Report.

Plasmacytomas rarely affect the skull base and may be found as an isolated lesion or as a part of multiple myeloma. The typical feature of plasmacytomas is aggressive bone destruction in the skull. It is often confused with the chordoma of the clivus. The most common location for skull-base plasmacytomas is the nasopharynx. The most commonly affected cranial nerve in clivus tumors is the abducens nerve. In our 64-year-old male case, a plasmacytoma was detected in the clivus. There was ptosis and decreased vision due to optic nerve and oculomotor nerve involvement due to the plasmacytoma. Radiotherapy was applied for the treatment.

Superb Microvascular Imaging at Evaluation of Nonvisible Buried De-epitelized Flap Vascularization in Breast Reconstruction.

OBJECTIVE: Superb microvascular imaging is a Doppler technique that increases the visibility of small vessels and gives quantitative information about tissue blood supply by measuring the vascular index. In this study, it is aimed to evaluate the long-term and postradiotherapy changes in blood flow of buried de-epitelized flaps in breast reconstruction by using the quantitative values obtained through superb microvascular imaging. MATERIALS AND METHODS: Retrospective review of the 14 patients who underwent nipple-sparing breastconserving surgery and immediately breast reconstruction with a de-epitelized extended latissimus dorsi flap was done. In order to demonstrate the effect of radiotherapy on flaps microvascular circulation, patients were evaluated using superb microvascular imaging postoperative first week, first month, and postradiotherapy first week and sixth month. The normal distribution of the data was evaluated with the Shapiro-Wilk test. Paired samples t-test was used for comparisons. RESULTS: According to the paired samples t-tests, postoperative first week mean vascular index was higher than postoperative first month and postradiotherapy first week (P < .05). Besides, postradiotherapy first week mean vascular index was higher than postoperative first month and also than postradiotherapy sixth month (P < .05). CONCLUSION: Radiotherapy can affect the results of breast reconstruction by endothelial and fibrotic injury. In this study, the changes in the microvascular circulation of the latissimus dorsi flap were discussed and found to increase at postoperative and postradiotherapy early period related to inflammation and not decreased significantly at long-term follow-up after radiotherapy.

Evaluation of nipple vascularity using superb microvascular imaging in patients with reduction mammoplasty.

We aimed to investigate the effect of the chosen pedicle on nipple vascularity by evaluating changes in the microvascular circulation of the nipples in patients undergoing reduction mammoplasty through superb microvascular imaging study (SMI). 70 nipples were included in this retrospective study. There were 15 patients (30 nipples) in Group A using the inferior pedicle and 20 patients (40 nipples) in Group B using the superomedial pedicle. The vascular index (VI) of each nipple were evaluated preoperatively and at the third postoperative month using SMI. The mean VI in Group A was 1.25 (0.5-3.6) preoperatively and 1.3 (0.4-3.2) at the third postoperative month (P > .05). The mean VI in Group B was 1.65 (0.7/2.9) preoperatively and 1.15 (0.2/1.9) at the third postoperative month (P < .05). While the VI increased by 11.3% in Group A, it decreased by 30.6% in Group B (P < .001). The changing of the VI was analyzed between comparable groups, and decreasing microvascular circulation of the nipple with use of the superomedial pedicle was detected by quantitative values, which can be useful in at-risk patient groups, the planning of surgical procedures, and early revisions at postoperative month 3.

Differences in the anatomical structure of the uterus between fertile and infertile individuals.

Infertility affects a significant portion of the reproductive population and is caused by structural and hormonal factors. The prevalence of congenital uterine anomalies is 3%-4%, with the most common anomaly being septate uterus. However, further research is needed to determine whether these anomalies can cause infertility. In this study, we compared the morphometric parameters of the uterus of fertile and infertile individuals. Based on the data obtained, we aimed to determine the parameters to be evaluated for fertility prediction and to investigate the effect of uterine septum on fertility. The uteruses of 55 infertile and 80 fertile individuals between the age range of 20-45 years were analyzed retrospectively using magnetic resonance images. Infertile individuals were categorized into two groups according to the reasons for infertility: Group I, which included women with congenital uterine anomalies (septate uterus), and Group II, which included women with tubal and male factors. Group III comprised fertile individuals. Uterine length (UL), uterine body length (UbL), cervical length (CxL), uterine cavity length (UcL), anteroposterior diameter (APD), transverse diameter (TD), fundal thickness (FT), and ostial distance (OD) were measured. The uterine positions were examined. The data of uterine variables were evaluated statistically according to age and groups. The mean ages of individuals in Groups I, II, and III were 29.88 ± 6.69, 29.21 ± 4.59, and 27.45 ± 5.43 years, respectively. Significant differences were observed between the groups in terms of UL, UbL, CxL, UcL, APD, FT, and OD variables (p < 0.05), except for TD (p > 0.05). We observed that UL, UcL, length/width ratio, and APD parameters are important factors that influence fertility. Evaluating these parameters before septum resection would be useful in predicting the contribution of this surgical operation to fertility.

Can magnetic resonance imaging texture analysis change the breast imaging reporting and data system category of breast lesions?

PURPOSE: This study aimed to reveal magnetic resonance imaging (MRI) texture analysis (TA)'s contribution to categorizing breast lesions according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. METHOD: Two hundred and seventeen women with BI-RADS category 3, 4, and 5 lesions on breast MRI were included in the study. For TA, the region of interest was drawn manually to encompass the entire lesion on the fat-suppressed T2W and the first post-contrast T1W images. To identify the independent predictors of breast cancer, multivariate logistic regression analyses were performed using texture parameters. Estimated benign and malignant groups were formed according to the TA regression model. RESULTS: Texture parameters extracted from T2WI, including median, gray-level co-occurrence matrix (GLCM) contrast, GLCM correlation, GLCM joint entropy, GLCM sum entropy, and GLCM sum of squares, and parameters extracted from T1WI, including maximum, GLCM contrast, GLCM joint entropy, GLCM sum entropy, were independent predictors of breast cancer. In the estimated new groups according to the TA regression model, 19 (91%) of the benign 4a lesions were downgraded to BI-RADS category 3. CONCLUSIONS: The addition of quantitative parameters obtained by MRI TA to BI-RADS criteria significantly increased the accuracy rate in differentiating benign and malignant breast lesions. When categorizing BI-RADS 4a lesions, the use of MRI TA in addition to conventional imaging findings may reduce unnecessary biopsy rates.

Diagnostic compatibility of V/Q SPECT and CTPA, which are non-invasive diagnostic methods, for the detection of CTEPH, which is a treatable cause of pulmonary hypertension.

OBJECTIVE: To evaluate the compatibility between ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) scintigraphy and computed tomography pulmonary angiography (CTPA) in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). SUBJECT AND METHODS: Twenty cases of CTEPH, out of 98 patients with pre-diagnosis of pulmonary hypertension (PH), who was diagnosed with CTEPH with a multidisciplinary approach and a council decision, were included in the study retrospectively. The diagnostic performances of V/Q SPECT and CTPA, which are used as noninvasive methods in diagnosing CTEPH, and the compatibility between them were calculated statistically. RESULTS: Of 20 patients diagnosed with CTEPH, 12 were female, and 8 were male; the mean age was 59.1 (range: 36-79). The sensitivity of V/Q SPECT scintigraphy of imaging methods used to diagnose CTEPH was 90%, CTPA was 80%, specificities were 88% and 92%, respectively, and accuracy was 88% in both cases methods. According to the reference standard, the kappa value for V/Q scintigraphy was calculated as 0.765 and 0.678 for CTPA. These values were statistically significant (P<0.01), and there was a substantial concordance between them. CONCLUSION: There is significant compatibility between V/Q SPECT scintigraphy and CTPA in diagnosing CTEPH, whose differential diagnosis is essential because of its high cure potential due to PH causes.

Can Dynamic Susceptibility Contrast Perfusion Imaging be Utilized to Detect Isocitrate Dehydrogenase Gene Mutation in Gliomas?

AIM: To explore the ability of dynamic susceptibility contrast perfusion imaging (DSC-PI) to detect isocitrate dehydrogenase (IDH) gene mutation in gliomas. MATERIAL AND METHODS: Preoperative DSC-PI data on histopathologically proven gliomas obtained between January 2015 and December 2019 were reviewed retrospectively. All magnetic resonance imaging (MRI) examinations were performed using a 1.5-T scanner. The maximum relative cerebral blood volume (rCBVmax), percentage signal recovery (PSR), and normalized PSR of tumor cores were calculated. Differences in these values between IDH-mutant and wild-type gliomas were compared, and receiver operating characteristic curves were generated. RESULTS: The patients (32 females, 47 males) were aged 21-76 years (mean 50.7 ± 15 years). The rCBVmax and all PSR values differed significantly between patients with IDH-mutant and those with wild-type tumors (p < 0.01 for all comparisons). CONCLUSION: The rCBVmax and PSR values obtained by DSC-PI may facilitate noninvasive detection of the IDH mutation status of gliomas. PSR provided more reliable values for differentiation of IDH-mutant gliomas from wild-type gliomas.

Can shear wave elastography determine remnant thyroid tissue in the early postoperative period in patients with differentiated thyroid carcinoma?

PURPOSE: This study aims to investigate the usability of ultrasonography (US) and shear wave elastography (SWE) in detecting remnant thyroid tissue (RTT) within the first three postoperative months in patients who underwent total thyroidectomy (TT) for differentiated thyroid cancer (DTC) and who were scheduled for radioiodine (RAI) ablation therapy. METHODS: Sixty-nine patients who underwent a TT operation due to DTC were included in the study. The participant's thyroid surgical bed was first evaluated by thyroid scintigraphy and then by greyscale US and SWE to investigate RTT. The participants were divided into two groups, those with and those without RTT. SWE quantitative data were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values for stiffness and velocity in distinguishing RTT. RESULTS: A total of 149 regions were analysed in 69 participants (43 females, 26 males). The average time elapsed after the operation was 65.2 ± 24.1 days. RTT was determined by scintigraphy and US-SWE in 38 (55%) patients. The stiffness and velocity values were significantly higher in the group with RTT than in the group without RTT. To distinguish RTT from the thyroid bed, the best cut-off values for stiffness and velocity were 15.7 kPa and 2.12 m/s, respectively. CONCLUSIONS: US with SWE can detect RTT in the early postoperative period in patients who have undergone TT due to DTC and who are scheduled for RAI treatment. The use of US and SWE will be particularly beneficial in patients with RTT but who have false-negative Tg levels and RTT that is not I-131 avid.

The Coexistence of Two Different Epithelial Ovarian Tumors: A Rare Case.

BACKGROUND: Epithelial tumors are the most common subgroup and are seen in 60-70% of all ovarian tumors. Serous cystadenoma and mucinous cystadenoma are the most common benign epithelial tumors. Serous cystadenomas are ovarian tumors with the highest bilateral incidence. The coexistence of tumors with different histopathology in the ovaries is extremely rare and has only been reported in a few cases in the literature. We present a case of bilateral ovarian tumor that was diagnosed as serous and mucinous cystadenoma after laparoscopic surgery. CASE REPORT: A 45-year-old female patient was admitted to our center with swelling in the pelvic region and pain in the left lumbar region. US imaging showed a cystic lesion in the right adnexal area, 4x2 cm in size, well-circumscribed, containing a few thin septa, and a low echo fluid content. A cystic lesion with 6x4cm sized multilocular, well-circumscribed, slightly high echo fluid content was observed in the left adnexal area. On CT, a complex cystic lesion measuring 6x4cm was observed in the left adnexal area, pushing the left ureter laterally and causing the hydroureter. In addition, a 4x2 cm cystic lesion was observed in the right adnexal area and hydroureter was observed on the right side proximal to this lesion. Both lesions were removed by surgery. On histopathologic examination, the left-sided cystic lesion was diagnosed as mucinous cystadenoma, and the right-sided cystic lesion was diagnosed as serous cystadenoma. CONCLUSION: The coexistence of different ovarian tumor subtypes is rare. In this article, we presented a case in which serous and mucinous cystadenoma lesions were seen together for the fourth time in the literature, according to our knowledge.

Anatomical variations of the aortic arch branching pattern using CT angiography: a proposal for a different morphological classification with clinical relevance.

The aortic arch (AA) branching pattern variations are usually asymptomatic, but they may lead to complications during cardiovascular procedures. In this retrospective study, we aimed to analyze the frequency of anatomical variations of the AA and to develop a different approach of morphological classification based on radiological criteria. 1026 computed tomography angiography scans of adults were evaluated and the presence of left-sided (LAA) and right-sided (RAA) AA were determined in 1023 (99.71%) and 3 (0.29%) of patients, respectively. According to the number of branches, LAA branching pattern of each patient was subclassifed in five morphological types. Based on the order and type-specific reference points, an anomalous LAA variants were classified into 20 subtypes. Type 1 (Typical branching pattern) LAA was identifed in 781 (76.12%) of the patients. Among 242 aberrant LAA variants (four types, 23.58%), the most common subtypes; Type 2A with brachiocephalico-carotid trunk (BCT), Type 4A1 with an aberrant left vertebral artery (ALVA), and Type 3A1, in which BCT coexisted with ALVA, were observed in 17.6%, 3.6%, and 0.88% of the cases, respectively. The frequency of remaining LAA variants ranged from 0.39% to 0.097%. In addition, Type 3B2 and Type 4C were first identified in our study. We observed Type I and II RAA in one female (0.097%) and two cases (male and female, 0.19%), respectively. Knowledge of AA branching variations is of great interest in neck and thoracic surgery and the new morphological types in clinically applicable form recommended in this study can be used in endovascular interventions.

Measurement of the subglottic diameter of the trachea and its distance from the skin by ultrasonography in children.

OBJECTIVE: To investigate the relationship between age, sex, height, weight and body mass index (BMI) by measuring the subglottic diameter of the trachea (SDT) and its distance to the skin by ultrasonography (US) in children. METHODS: This prospective study included a total of 234 children, 104 girls and 134 boys, with ages ranging from 3 to 17 years. Demographic data including sex, age, height, weight and BMI were recorded. The SDT and its distance to the skin was measured with a 14L5 high-frequency surface transducer. The correlation of SDT and its distance to the skin with basic descriptive data was investigated. Statistical analyses used were Mann-Whitney U, Kruskal-Wallis and Spearman correlation tests. RESULTS: No significant difference was found among the median SDT and distance of the trachea from the skin values for boys (10.85 mm) and girls (11.15 mm) (p = 0.58). The distance of the trachea from the skin was greater in girls (5.5 mm) than in boys (4.75 mm) (p = 0.009). Median SDT values were 9.4 mm, 11.2 mm, and 13.35 mm in age groups 1, 2, and 3, respectively. There were highly significant strong positive correlations between SDT with age (p = 0.001, r = 0.78), height (p = 0.001, r = 0.76), and weight (p = 0.001, r = 0.70), and a highly significant moderate positive correlation between SDT with BMI (p = 0.001, r = 0.43). Median distance values of the trachea from the skin were 4.6 mm, 5.2 mm, and 6.2 mm in age groups 1, 2, and 3, respectively. There were moderate positive correlations between distance of the trachea from the skin with age (p = 0.001, r = 0.41), height (p = 0.001, r = 0.42), weight (p = 0.001, r = 0.53), and BMI (p = 0.001, r = 0.54). CONCLUSION: US is an accurate, safe, inexpensive, non-invasive and accessible method for objective evaluation of SDT and its distance to the skin. There is a positive correlation between age, height, weight, and BMI with SDT and its distance to the skin in healthy children.

Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19.

PURPOSE: To evaluate the diagnostic performance of the RSNA structured reporting language for chest CT findings in patients with COVID-19. MATERIAL AND METHODS: Patients with suspected COVID-19 who underwent chest CT and RT-PCR tests were enrolled consecutively in this retrospective study, regardless of symptoms. Imaging findings were categorized as "typical", "indeterminate", "atypical", or "negative" according to RSNA reporting language and compared to RT-PCR. "Single, round GGO" and "single, peripheral GGO," do not fit the reporting language, were also analyzed as "indeterminate" patterns. RESULTS: Of the 1186 patients included in the analysis, the diagnosis of COVID-19 was confirmed in 388 patients. Of the 388 patients, CT findings were categorized as "typical" in 248, "indeterminate" in 77, and "negative" in 63. The sensitivity, specificity, and accuracy of "typical" findings were 63.9, 99.0, and 87.5% for COVID-19, respectively. In addition to the "typical" findings, the highest diagnostic accuracy of 92.2% was achieved when the "single, peripheral GGO" and "single, round GGO" were considered to be CT-positive. CONCLUSION: The RSNA reporting language has significant diagnostic performance for identifying COVID-19 pneumonia. CT findings that do not exactly fit the RSNA reporting language, such as "single, round GGO" and "single, peripheral GGO" improve diagnostic performance.

Comparison of the Effectiveness of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Breast Masses.

ABSTRACT: This study aims to determine the diagnostic performance of superb microvascular imaging (SMI) and shear wave elastography methods in evaluating breast lesions. We will also compare the effectiveness of the stiffness, velocity, and vascular index (VI) parameters in distinguishing malignancy.From January to June 2019, 121 patients with 121 solid breast masses (category 4 and 5 lesions according to the Breast Imaging-Reporting and Data System) detected during the routine grayscale sonographic examination were included in the study. Stiffness and velocity values were obtained using shear wave elastography for all lesions, and VI was obtained using SMI. The receiver operating characteristic curves were obtained to set the best cutoff values for the stiffness, velocity, and VI to differentiate patients with malignant breast lesions.All 121 lesions were pathologically verified by US-guided core needle biopsy. Forty-seven (38.9%) of the lesions were malignant, and 74 (61.1%) were benign. Median stiffness, velocity, and VI values were significantly lower in benign masses compared with malignant masses (P < 0.001). The optimum cutoff values for the stiffness, velocity, and VI were determined to be 58.3 kPa, 4.5 m/s, and 1.1%, respectively. The areas under the curves were 0.897 for stiffness, 0.884 for velocity, and 0.687 for VI.Shear wave elastography and SMI are noninvasive methods that may be used to evaluate breast masses. Although both methods' quantitative data are beneficial in differentiating malignant from benign masses, stiffness is the best parameter to be used.

Chest CT findings in RT-PCR positive asymptomatic COVID-19 patients.

PURPOSE: To investigate chest computed tomography (CT) findings in asymptomatic patients tested positive for coronavirus disease (COVID-19) by reverse transcription-polymerase chain reaction (RT-PCR). MATERIAL AND METHODS: The chest CT images of 64 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who were RT-PCR test-positive but asymptomatic were retrospectively evaluated for the appearance and distribution of abnormal parenchymal findings. RESULTS: Of the 64 patients (mean age 59.4 ± 12; range 23-85), 42 (65%) were female, and 22 (35%) were male, and 16 (25%) of the patients had no abnormal findings on chest CT. Of the remaining 48 patients, lung involvement was bilateral in 32 (67%). Right upper lobe in 26 (54%), right middle lobe in 20 (42%), right lower lobe in 38 (79%), left upper lobe in 27 (56%), and left lower lobe were affected in 34 (71%) patients. The mean number of opacities detected in patients was 7.5 ± 5.7. The opacities were located only peripherally/subpleural in 22 (46%), only centrally/peribronchovascular in 5 (10%), and mixed in 21 (44%) patients. The frequency of pure ground glass opacities (GGO) was 63% GGO with a crazy-paving pattern or consolidation was 33%. Pure consolidation was detected in only two (4%) patients. Parenchymal opacities were only round in 27 (56%), only geographic demarcated in 3 (6%), only patchy in 2 (4%), and mixed in 16 (33%) patients. CONCLUSION: Chest CT was normal in only one-quarter of the asymptomatic patients. CT findings in asymptomatic COVID-19 patients were often peripherally located, mostly round-shaped GGO.

Evaluating nail thickness and stiffness with shear-wave elastography in nail psoriasis: A preliminary study.

INTRODUCTION: Psoriasis is a chronic, relapsing skin disease affecting millions of people worldwide. Nail changes have been reported to occur in up to 40% of patients with mild psoriasis and 50%-70% with severe disease. Shear-wave elastography (SWE) is a new non-invasive ultrasonic technique that evaluates thickness and stiffness of tissues. AIMS: To evaluate nail plate thickness and stiffness of patients with psoriasis and determine whether there are differences among psoriatic patients with and without nail involvement, and to investigate the feasibility of using SWE in assessing this disease. MATERIALS AND METHODS: Nail plate thickness and stiffness were investigated in 54 patients with psoriasis and 58 healthy controls. SWE was performed with an Aplio 500 ultrasound system. RESULTS: Increased nail plate thickness was observed more often in the affected nails of psoriatic patients compared to non-affected nails of patients and controls. Stiffness was similar in both groups. CONCLUSIONS: Our study is the first report to evaluate the SWE scores in nail psoriasis. While it may not provide reliable information for diagnosis, it can be used for follow-up treatment.

A preliminary study on ultrasound techniques applied to cicatricial alopecia.

BACKGROUND: Cicatricial alopecia (CA) is a group of disorder characterized by permanent destruction of the hair follicle. Shear wave elastography (SWE) and superb microvascular imaging (SMI) are noninvasive ultrasonic techniques which evaluate thickness, stiffness, and vascular index of tissues. OBJECTIVES: This study explored the ranges of cicatricial alopecia area and normal scalp with a combined modality of SMI and SWE and investigated the feasibility of their use in assessing these diseases. METHODS: Seventeen patients diagnosed with CA and twenty healthy controls were included in the study. SWE and SMI were performed with an Aplio 500 ultrasound system. RESULTS: The mean age of patient group was 37.00 ± 13.16, and the mean age of the healthy controls were 36.00 ± 11.79. SWE results as m/s in cicatricial plaques ( x ¯  = 5191) were higher than non-alopecic scalp areas ( x ¯  = 4460) in patient group (t (16) = 2260; P = 0.038 < 0.05). SMI values in patient group (cicatricial plaques) ( x ¯  = 1200) were significantly higher than control group SMI values ( x ¯  = 0.005) (t (35) = 3.075; P = 0.012 < 0.05). CONCLUSIONS: To the best of our knowledge, this is the first study to evaluate SWE and SMI scores in cicatricial alopecia. We found higher stiffness and vascularity in patient group. We conclude that SWE and SMI can show fibrosis and inflammation like previous studies. Especially, SWE as m/s is more sensitive than as kPa for cicatricial alopecia.