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.

Visceral to subcutaneous fat ratio predicts short-term mortality in patients with Covid 19. A multicenter study.

OBJECTIVE: To evaluate the association of body composition parameters with outcomes in Covid-19. METHODS: 173 patients hospitalized for Covid-19 infection in 6 European centers were included in this retrospective study. Measurements were performed at L3-level and comprised skeletal muscle index (SMI), muscle density (MD), and adipose tissue measurements [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), visceral-to-subcutaneous-adipose-tissue-area-ratio (VSR)]. The association with mortality, the need for intubation (MV), and the need for admission to ICU within 30 days were evaluated. RESULTS: Higher SAT density was associated with a greater risk of MV (OR = 1.071, 95%CI=(1.034;1.110), p < 0.001). Higher VAT density was associated with admission to ICU (OR = 1.068, 95%CI=(1.029;1.109), p < 0.001). Higher MD was a protective factor for MV and ICU admission (OR = 0.914, 95%CI=(0.870;0.960), p < 0.001; OR = 0.882, 95%CI=(0.832;0.934), p = 0.028). Higher VSR was associated with mortality (OR = 2.147, 95%CI=(1.022;4.512), p = 0.044). Male sex showed the strongest influence on the risk of ICU admission and MV. SMI was not associated with either parameter. CONCLUSION: In patients hospitalized for Covid-19 infection, higher VSR seems to be a strong prognostic factor of short-term mortality. Weak associations with clinical course were found for MD and adipose tissue measurements. Male sex was the strongest prognostic factor of adverse clinical course. ADVANCES IN KNOWLEDGE: VSR is a prognostic biomarker for 30-day mortality in patients hospitalized for Covid-19 disease.

A 3-DoF robotic platform for the rehabilitation and assessment of reaction time and balance skills of MS patients.

The central nervous system (CNS) exploits anticipatory (APAs) and compensatory (CPAs) postural adjustments to maintain the balance. The postural adjustments comprising stability of the center of mass (CoM) and the pressure distribution of the body influence each other if there is a lack of performance in either of them. Any predictable or sudden perturbation may pave the way for the divergence of CoM from equilibrium and inhomogeneous pressure distribution of the body. Such a situation is often observed in the daily lives of Multiple Sclerosis (MS) patients due to their poor APAs and CPAs and induces their falls. The way of minimizing the risk of falls in neurological patients is by utilizing perturbation-based rehabilitation, as it is efficient in the recovery of the balance disorder. In light of the findings, we present the design, implementation, and experimental evaluation of a novel 3 DoF parallel manipulator to treat the balance disorder of MS. The robotic platform allows angular motion of the ankle based on its anthropomorphic freedom. Moreover, the end-effector endowed with upper and lower platforms is designed to evaluate both the pressure distribution of each foot and the CoM of the body, respectively. Data gathered from the platforms are utilized to both evaluate the performance of the patients and used in high-level control of the robotic platform to regulate the difficulty level of tasks. In this study, kinematic and dynamic analyses of the robot are derived and validated in the simulation environment. Low-level control of the first prototype is also successfully implemented through the PID controller. The capacity of each platform is evaluated with a set of experiments considering the assessment of pressure distribution and CoM of the foot-like objects on the end-effector. The experimental results indicate that such a system well-address the need for balance skill training and assessment through the APAs and CPAs.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study.

RATIONALE AND OBJECTIVES: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.

Design, Implementation, and Evaluation of a Variable Stiffness Transradial Hand Prosthesis.

We present the design, implementation, and experimental evaluation of a low-cost, customizable, easy-to-use transradial hand prosthesis capable of adapting its compliance. Variable stiffness actuation (VSA) of the prosthesis is based on antagonistically arranged tendons coupled to nonlinear springs driven through a Bowden cable based power transmission. Bowden cable based antagonistic VSA can, not only regulate the stiffness and the position of the prosthetic hand but also enables a light-weight and low-cost design, by the opportunistic placement of motors, batteries, and controllers on any convenient location on the human body, while nonlinear springs are conveniently integrated inside the forearm. The transradial hand prosthesis also features tendon driven underactuated compliant fingers that allow natural adaption of the hand shape to wrap around a wide variety of object geometries, while the modulation of the stiffness of their drive tendons enables the prosthesis to perform various tasks with high dexterity. The compliant fingers of the prosthesis add inherent robustness and flexibility, even under impacts. The control of the variable stiffness transradial hand prosthesis is achieved by an sEMG based natural human-machine interface.

sEMG-Based Natural Control Interface for a Variable Stiffness Transradial Hand Prosthesis.

We propose, implement, and evaluate a natural human-machine control interface for a variable stiffness transradial hand prosthesis that achieves tele-impedance control through surface electromyography (sEMG) signals. This interface, together with variable stiffness actuation (VSA), enables an amputee to modulate the impedance of the prosthetic limb to properly match the requirements of a task while performing activities of daily living (ADL). Both the desired position and stiffness references are estimated through sEMG signals and used to control the VSA hand prosthesis. In particular, regulation of hand impedance is managed through the impedance measurements of the intact upper arm; this control takes place naturally and automatically as the amputee interacts with the environment, while the position of the hand prosthesis is regulated intentionally by the amputee through the estimated position of the shoulder. The proposed approach is advantageous since the impedance regulation takes place naturally without requiring amputees' attention and diminishing their functional capability. Consequently, the proposed interface is easy to use, does not require long training periods or interferes with the control of intact body segments. This control approach is evaluated through human subject experiments conducted over able volunteers where adequate estimation of references and independent control of position and stiffness are demonstrated.

Virtual morphometric method using seven cervical vertebrae for sex estimation on the Turkish population.

Sex estimation from skeletal remains is crucial for the estimation of the biological profile of an individual. Although the most commonly used bones for means of sex estimation are the pelvis and the skull, research has shown that acceptable accuracy rates might be achieved by using other skeletal elements such as vertebrae. This study aims to contribute to the development of sex estimation standards from a Turkish population through the examination of CT scans from the seven cervical vertebrae. A total of 294 individuals were included in this study. The CT scans were obtained from patients attending the Bakirkoy Training and Research Hospital (Turkey) and the data was collected retrospectively by virtually taking measurements from each cervical vertebrae. The full database was divided into a training set (N = 210) and a validation set (N = 84) to test the fit of the models. Observer error was assessed through technical error of measurement and sex differences were explored using parametric and non-parametric approaches. Logistic regression was applied in order to explore different combinations of vertebral parameters. The results showed low intra- and inter-observer errors. All parameters presented statistically significant differences between the sexes and a total of 15 univariate and multivariate models were generated producing accuracies ranging from a minimum of 83.30% to a maximum of 91.40% for a model including three parameters collected from four vertebrae. This study presents a virtual method using cervical vertebrae for sex estimation on the Turkish population providing error rates comparable to other metric studies conducted on the postcranial skeleton. The presented results contribute not only to the development of population-specific standards but also to the generation of virtual methods that can be tested, validated, and further examined in future forensic cases.

Could Computed Tomography Hounsfield Unit Values of Lumbar Vertebrae Detect Osteoporosis?

BACKGROUND: Dual-energy X-ray absorptiometry (DEXA) scanning has several disadvantages determining osteoporosis, especially for the degenerative spine. INTRODUCTION: This study aims to determine spinal osteoporosis in patients suffering from lumbar degenerative disease using computed tomography (CT). METHODS: A total of 547 subjects that underwent DEXA and abdominal CT within a period of three months were examined retrospectively and separated into groups based on lumbar degenerative alteration on the CT scan. The subjects that showed degenerative severity at L1-L4, in at least two levels, were graded and placed in the degenerative group (Group D, n=350). In contrast, the other subjects constituted the control group (Group C, n=197). The Hounsfield unit (HU) of the vertebral body trabecular bone, the T-score, and bone mineral density (BMD) of L1-L4 and hips were determined from the CT images. CT-HU parameters for osteoporosis acquired from the control group were used to ascertain undiagnosed osteoporosis. RESULTS: The CT-HU was positively correlated with T-score and lumbar BMD for both groups (P<0.001), while the L1-L4 correlation was higher in Group C than in Group D. Based on linear regression, the T-score and CT-HU for L1-L4 osteoporosis were 129, 136, 129 and 120 HU, respectively in Group C. Undiagnosed spinal osteoporosis was greater in Group D compared to the controls (44.2% vs. 9.6%, respectively) based on the CT-HU thresholds. CONCLUSION: Lumbar spine degeneration can augment BMD and T-score, resulting in the underestimation of lumbar osteoporosis. The osteoporosis threshold determined by CT-HU may be a valuable technique to determine undiagnosed spinal osteoporosis.

Correlation of Pectoralis Muscle Volume and Density with Severity of COVID-19 Pneumonia in Adults.

RATIONALE AND OBJECTIVES: The aim of our study was to evaluate whether there is any correlation between a histogram analysis of the pectoralis muscle derived from chest computed tomography (CT) and the mortality rate for COVID-19 pneumonia in the adult population. METHOD: Chest CT derived measurements were evaluated retrospectively for 217 patients with a diagnosis of COVID-19 pneumonia. Using a CT histogram analysis, we measured pectoralis muscle volume (PV) and pectoralis muscle density (PD). Patients were divided into groups first according to gender and then subgroups, which are age and outcome. RESULTS: The COVID-19 diagnoses were confirmed by RT-PCR testing, chest CT and clinical findings in 217 patients (108 men, 109 women), aged 21-92 years (mean 61 years). PD measurements were lower in the exitus group (p = 0.001) and in patients aged ≥65 than in those aged <65 years (p < 0.05). There was a significant difference between PD measurements of outpatient and inpatient under 65 years age (p < 0.05). Additionally, there was a statistically significant difference between fatty volume measurements according to the exitus status of cases (p < 0.05). CONCLUSION: CT-derived measurements of the pectoralis muscle can be useful in predicting disease severity and mortality rate of COVID-19 pneumonia in adult patients.

Comparison of breast density assessments according to BI-RADS 4th and 5th editions and experience level.

BACKGROUND: Breast density is an important variable that can change the sensitivity of mammography. It can be analyzed with using the 4th and 5th editions of the Breast Imaging and Reporting Data System (BI-RADS) recommendations from the American College of Radiology (ACR). PURPOSE: To define the intra- and inter-reader agreement levels of breast density assignments performed by readers with different experience levels using two versions of BI-RADS. MATERIAL AND METHODS: The breast density assessments of 330 women were conducted by two readers with different levels of experience (one breast radiologist and one resident). Each reader independently defined the breast density four times-twice using the 4th edition and twice using the 5th edition. Assessments were analyzed on four- and two-category scales. RESULTS: The intra-reader agreement of the breast radiologist for the 4th and 5th editions of BI-RADS was almost perfect (k = 0.90 and k = 0.87, respectively.) The resident had similar results (k = 0.88 and k = 0.87, respectively). The agreement between the breast radiologist and resident for the 4th and 5th edition of BI-RADS was substantial (k = 0.70 and k = 0.63, respectively). There was a statistically significant difference with the two-category scale analysis between the dense and non-dense for both readers and versions of BI-RADS (McNemar's test, P < 0.001). CONCLUSION: Although there were high intra- and inter-reader agreement levels when using both versions, the percentage of women having dense breasts increased when using the 5th edition, and the difference was statistically significant. There were no differences found with regard to the readers' level of experience in all analyses.

Age estimation in the living: cervical ring apophysis development in a Turkish sample using CT.

With increases in migration across borders, age estimation in living individuals of not (reliably) documented identity becomes all the more important. Unfortunately, there are not many age indicators that can be used for this purpose, and human variation requires specific methodical approaches. In this paper, a recently proposed age marker to assess the age around the critical age limit of 18 completed years is tested. The method uses apophyseal development of cervical vertebrae 2, 3 and 4. Here CT scans of a large sample of Turkish individuals (n = 1276) were assessed, and likelihoods of being 18 years at a given stage were calculated. The likelihood of being at least 18 years for stages 0, 1 and 2 were zero or close to zero in both males and females. By the time that stage 4 was reached, the likelihood to be 18 years were between 65 and 70% (depending on the vertebra) in females and 81 and 90% in males. In comparison to South Africans, the Turkish individuals developed earlier, but the likelihoods of being 18 years were lower at stage 4 as some individuals were still judged to be in stage 3 well into their twenties. Although fairly variable, this method is a valuable new addition to the modalities that can be used for age assessment in the living. CT scans seemed to provide good visualization of the structures in question, although in actual forensic cases the high radiation dose may be problematic.

Shear wave elastography of the uterine cervix under different conditions with inter-operator agreement analysis.

PURPOSE: Shear wave elastography (SWE) is a relatively new technique for measuring tissue elasticity. Its implementation for assessing the tissue of the cervix is evolving, and SWE analyses of healthy, nonpregnant cervixes is the first step in understanding other SWE changes related to cervical pathologies; nevertheless, some challenges in the use of the technique still require investigation. We aimed to target the consistency of healthy cervix shear wave elastography measurements and examine the changes induced by patient-related factors. MATERIAL AND METHODS: Elastograms were obtained at the internal and external os in the anterior (IA, EA) and posterior (IP, EP) portions of the cervix using a transvaginal approach in eight postmenopausal and 25 premenopausal women. Measurements with a standard deviation of over 20% and patients who presented with colour loss or heterogeneity were excluded from the study. Shear wave elastography assessments were performed using a Toshiba Aplio 500 version 6. Statistical significance was defined as a p value less than 0.10, due to the small number of patients. RESULTS: The mean speeds obtained at the external os on the anterior and posterior aspects was 3.17 ± 0.85 m/s and 3.18 ± 0.84 m/s, respectively, and at the internal os, the results on the anterior and posterior aspects were 3.38 ± 0.73 m/s and 3.53 ± 0.81 m/s, respectively. The difference in speed among all regions was statistically significant (p < 0.05). Fifteen patients were also analysed by a second radiologist with a similar experience level as that of the first. Nine measurements for IP, 13 measurements for IA, 11 measurements for EP, and 15 measurements for EA were performed. The correlation coefficients between the two sets of measurements were 0.46, 0.30, 0.67, and 0.51, respectively. There was no difference in the SWE values with respect to age, parity, and gravidity for any of the regions. The SWE values at the IA, IP, and EA regions between the postmenopausal and premenopausal women were significantly different (p = 0.038, p = 0.059, p = 0.065). CONCLUSIONS: The posterior portion of the internal os is most likely to undergo inaccurate SWE measurement among the different anatomical positions. The correlation between radiologists was found to be different for different locations in the cervix. More studies are needed to determine the SWE values of the healthy cervix and the agreement levels between radiologists.

Relationship Between Shear Wave Elastography Findings and Histologic Prognostic Factors of Invasive Breast Cancer.

OBJECTIVE: Shear wave elastography (SWE) is an adjunct to grayscale ultrasound examinations for evaluating breast masses. This study aimed to determine the SWE features that correlated with prognostic parameters for breast cancer. METHODS: Between January 2018 and May 2018, 80 patients who were confirmed to have invasive cancers by core-needle biopsy and who were scheduled for surgery were imaged using B-mode ultrasound and SWE. Measurements were taken from a region of interest positioned over the stiffest part of the peripheral zone and mass. Three measurements were taken, and the average of the mean stiffness value was used for analysis. RESULTS: The mean tumor size, elasticity value of tumors, and elasticity of the peripheral zone were 2.9 ± 1.48 cm (range, 0.6-8 cm), 154.8 ± 8.55 kPa (range, 116.25-179 kPa), and 171.34 ± 5.22 kPa (range, 150.95-182.43 kPa), respectively. The types of breast cancer included were invasive ductal carcinoma (n = 71 [88.75%]; 69 invasive ductal carcinoma not otherwise specified, 1 solid papillary carcinoma, and 1 invasive micropapillary carcinoma), invasive lobular carcinoma (n = 2 [2.5%]), mixed invasive ductal and lobular carcinoma (n = 4 [5%]), mucinous carcinoma (n = 2 [2.5%]), and metaplastic cancer (n = 1 [1.25%]). A strong correlation was found between mean elasticity values and tumor grade (P = 0.018) and between mean elasticity values and lymphovascular invasion (LVI) positivity (P = 0.008). There were no significant differences between SWE values and tumor diameter or between histological tumor characteristics and SWE. CONCLUSIONS: We found that some clinicohistopathologic features of poor prognosis had higher elasticity values than those of favorable prognosis.

Forensic age diagnostics by magnetic resonance imaging of the proximal humeral epiphysis.

The most commonly used radiological method for age estimation of living individuals is X-ray. Computed tomography is not commonly used due to high radiation exposure, which raises ethical concerns. This problem can be solved with the use of magnetic resonance imaging (MRI), which avoids the use of ionizing radiation. The purpose of the present study was to evaluate the utility of MRI analysis of the proximal humeral epiphyses for forensic age estimations of living individuals. In this study, 395 left proximal humeral epiphyses (patient age 12-30 years) were evaluated with fast-spin-echo proton density-weighted image (FSE PD) sequences in a coronal oblique orientation on shoulder MRI images. A five-stage scoring system was used following the method of Dedouit et al. The intra- and interobserver reliabilities assessed using Cohen's kappa statistic were κ = 0.818 and κ = 0.798, respectively. According to this study, stage five first appeared at 20 and 21 years of age in males and females, respectively. These results are not directly comparable to any other published study due to the lack of MRI data on proximal humeral head development. These findings may provide valuable information for legally important age thresholds using shoulder MRI. The current study demonstrates that MRI of the proximal humerus can support forensic age estimation. Further research is needed to establish a standardized protocol that can be applied worldwide.

Evaluation of Normal Thyroid Tissue and Autoimmune Thyroiditis in Children Using Shear Wave Elastography

Objective: Shear wave elastography (SWE) is a user-independent ultrasonographic technique that evaluates tissue elasticity. It is used especially in the evaluation of thyroiditis and thyroid nodules when it is capable of distinguishing malignant from benign thyroiditis in adults. To date, no studies have evaluated SWE in pediatric thyroid patients. The aim of this study was to measure the elasticity of normal thyroid tissue in children and adolescents using SWE and to investigate its role in the diagnosis of pediatric autoimmune thyroiditis. Methods: In total, 113 healthy children of whom 66 (58.4%) were girls and 57 children with autoimmune thyroiditis of whom 45 (78.9%) were girls were evaluated by SWE after B-mode ultrasound. The quantitative evaluation of normal thyroid tissue in healthy children and those with autoimmune thyroiditis was performed using shear wave velocity (SWV) values (m/s). Thyroid antibodies were consistent with autoimmune thyroiditis. Data were compared using descriptive and analytical statistics and receiver-operating characteristic curves. Results: The mean ± standard deviation (range) of SWV value in thyroid parenchyma of the healthy children was 1.82±0.3 m/s (1.32-2.37) m/s. There was a significant positive correlation between age and SWV values which increased with age. The average SWV value of thyroid parenchyma in children with autoimmune thyroiditis was 3.7±1.2 (2.59-6.25) m/s which was statistically significantly greater than in healthy children (p=0.00). The cut-off value for elasticity with the highest diagnostic accuracy was 2.39 m/s; sensitivity and specificity were 97.4% and 100% respectively. There was no correlation between elasticity, thyroid function tests and autoantibody concentrations (p>0.05). Conclusion: SWE is a useful imaging method that can be used with routine ultrasonography in evaluation of the thyroid in children.

Assessment of the Efficacy of Extracorporeal Shockwave Therapy for Plantar Fasciitis with Magnetic Resonance Imaging Findings.

BACKGROUND: Extracorporeal shockwave therapy (ESWT) has recently been used as a new treatment modality for plantar fasciitis. We aimed to determine the efficacy of ESWT by magnetic resonance imaging (MRI) findings. METHODS: Thirty patients with plantar fasciitis who had received no treatment for 6 months were included. Extracorporeal shockwave therapy was applied once a week for a total of three sessions (frequency of 12-15 Hz, 2-3 bars, and 2,500 pulses). All of the patients were assessed with the visual analog scale, a 6-point evaluation scale, the Foot and Ankle Outcome Score (FAOS), and MRI findings before and 3 months after ESWT. Visual analog scale scores were used in determining the pain level of patients in the morning, during activity, and at rest. Foot and ankle-related problems were evaluated with the FAOS. RESULTS: The duration of painless walking according to the 6-point rating scale, the FAOS, and pain showed significant improvements after ESWT ( P < .05). Significant decreases in MRI findings, including thickening of the plantar fascia, soft-tissue edema, and bone marrow edema, were observed after treatment ( P < .05). CONCLUSIONS: Extracorporeal shockwave therapy is a safe and effective treatment that yields favorable results in improvement of pain and function for plantar fasciitis. An MRI is useful for determining response to ESWT for these patients.

Retrospective comparison of three-dimensional imaging sequences in the visualization of posterior fossa cranial nerves.

PURPOSE: To compare efficancy of three-dimentional SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolutions) and CISS (constructive interference in steady state) sequences in the imaging of the cisternal segments of cranial nerves V-XII. METHODS: Temporal MRI scans from 50 patients (F:M ratio, 27:23; mean age, 44.5±15.9 years) admitted to our hospital with vertigo, tinnitus, and hearing loss were retrospectively analyzed. All patients had both CISS and SPACE sequences. Quantitative analysis of SPACE and CISS sequences was performed by measuring the ventricle-to-parenchyma contrast-to-noise ratio (CNR). Qualitative analysis of differences in visualization capability, image quality, and severity of artifacts was also conducted. A score ranging 'no artefact' to 'severe artefacts and unreadable' was used for the assessment of artifacts and from 'not visualized' to 'completely visualized' for the assesment of image quality, respectively. The distribution of variables was controlled by the Kolmogorov-Smirnov test. Samples t-test and McNemar's test were used to determine statistical significance. RESULTS: Rates of visualization of posterior fossa cranial nerves in cases of complete visualization were as follows: nerve V (100% for both sequences), nerve VI (94% in SPACE, 86% in CISS sequences), nerves VII-VIII (100% for both sequences), IX-XI nerve complex (96%, 88%); nerve XII (58%, 46%) (p<0.05). SPACE sequences showed fewer artifacts than CISS sequences (p<0.002).

Can Ultrasound Imaging Predict the Success of an Experimental Steatofibrosis Model?

Our goal was to evaluate the role of ultrasound (US) imaging in an experimental 2-hit steatofibrosis rat model. Nineteen female Sprague-Dawley rats were divided into 2 groups: control group (n = 6) and high-fat diet carbontetrachloride (HFD-CCl4) group (n = 13) that was fed with HFD for 14 weeks. Ultrasound was performed to evaluate liver steatosis. The HFD-CCl4 group rats were divided further into 2 subgroups: HFD rats with liver steatosis [US (+) group; n = 6] and without steatosis [US (-) group; n = 7]. All rats in the subgroups were administered with CCl4. In both US (+) and US (-) subgroups, steatosis score, fibrosis score, triglyceride, and hydroxyproline contents were markedly higher compared with the control group. When compared with the US (-) group, triglyceride and hydroxyproline contents were significantly higher in the US (+) group, whereas steatosis and fibrosis scores were not different. Ultrasound imaging may be useful to assess the success of a 2-hit experimental steatofibrosis model.

Assessment of sex in a modern Turkish population using cranial anthropometric parameters.

The utilization of radiological imaging methods in anthropometric studies is being expanded by the application of modern imaging methods, leading to a decrease in costs, a decrease in the time required for analysis and the ability to create three-dimensional images. This retrospective study investigated 400 patients within the 18-45-years age group (mean age: 30.7±11.2years) using cranial computed tomography images. We measured 14 anthropometric parameters (basion-bregma height, basion-prosthion length, maximum cranial length and cranial base lengths, maximum cranial breadth, bizygomatic diameter, upper facial breadth, bimastoid diameter, orbital breadth, orbital length, biorbital breadth, interorbital breadth, foramen magnum breadth and foramen magnum length) of cranial measurements. The intra- and inter-observer repeatability and consistency were good. From the results of logistic regression analysis using morphometric measurements, the most conspicuous measurements in terms of dimorphism were maximum cranial length, bizygomatic diameter, basion-bregma height, and cranial base length. The most dimorphic structure was the bizygomatic diameter with an accuracy rate of 83% in females and 77% in males. In this study, 87.5% of females and 87.0% of males were classified accurately by this model including four parameters with a sensitivity of 91.5% and specificity of 85.0%. In conclusion, CT cranial morphometric analysis may be reliable for the assessment of sex in the Turkish population and is recommended for comparison of data of modern populations with those of former populations. Additionally, cranial morphometric data that we obtained from modern Turkish population may reveal population specific data, which may help current criminal investigations and identification of disaster victims.

Computed tomography evaluation of the iliac crest apophysis: age estimation in living individuals.

Determination of the ossification properties of the iliac apophysis is important not only in the clinical evaluation of patients undergoing orthopedic surgery but also in age estimation studies for forensic purposes. The literature includes both anthropological and radiological (conventional radiography, ultrasonography, and magnetic resonance imaging modalities) investigations of the different staging systems used for these purposes. In this study, we assessed the utility of computed tomography (CT) of the iliac crest apophysis in estimating forensic age. CT scans of the iliac crest apophysis of 380 patients (187 females, 193 males, and 10-29 years of age) were evaluated according to the four-stage system. Further subclassification did not give data properly due to the reference length measurement of the iliac wing with CT. Thus, in our series, stage 2 was first seen in 12 years of age and stage 3 in those 14 years of age in both sexes and on both sides of the pelvis. Stage 4 was first seen in 17 years of both sexes but only on the right side; on the left side, it appeared in females 18 years of age and in males 17 years of age. Present data was found consistent with previous pelvic radiographic findings. First seen ages for stage 2 and 3 are 12 and 14 years respectively which presented valuable information for legally important age thresholds. However, disadvantages of CT, including high-dose radiation exposure to gonads, the difficulty of evaluating the iliac crest, and the age boundary of 17 years, could make this method infeasible, as compared with hand wrist and pelvic radiographic methods. CT of the iliac crest has probably a greater utility where preexisting CT scans of the pelvic region are available, and it may be considered as a supportive method for age-estimation purposes.