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.

Volumetric apparent diffusion coefficient (ADC) histogram analysis of the brain in paediatric patients with hypoxic ischaemic encephalopathy.

Purpose: To evaluate the whole brain, hippocampus, thalamus, and lentiform nucleus by volumetric apparent diffusion coefficient (ADC) histogram analysis in paediatric patients with hypoxic-ischaemic encephalopathy (HIE). Material and methods: This retrospective study included 25 patients with HIE and 50 patients as the control group. Diffusion-weighted imaging was obtained at b-values of 1000 mm2/s. The histogram parameters of ADC values, including the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance were determined. The interclass correlation coefficient (ICC) was used to assess the inter-observer agreement. Results: ADCmin, ADCmean, and ADCmax, as well as the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values for the HIE group were all lower than those of the control group (p < 0.001) in the volumetric histogram analysis of the hippocampus, thalamus, and lentiform nucleus. In the whole-brain histogram analysis, ADC min, and the 50th and 75th percentiles of ADC values did not differ significantly, while other parameters were lower in the HIE group. The ROC curve revealed that the ADC histogram parameters of the hippocampus provided the most accurate results for the diagnosis of HIE. The area under the curve (AUC) of the 95th percentile of ADC values was the highest (AUC = 0.915; cut-off 1.262 × 10-3 mm2/s; sensitivity 88% and specificity 84%). Conclusions: Volumetric ADC histogram analysis of the whole brain, hippocampus, thalamus, and lentiform nucleus with b-values of 1000 mm2/s can serve as an imaging marker for determining HIE.

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.

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 Critical Analysis of the Magnetic Resonance Imaging Lesion Diameter Threshold for Adverse Pathology Features.

To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion > 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being > 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.

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.

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.

EFFECT OF MAMMOGRAPHY IMAGING PROCEDURE ON SERUM INFLAMMATORY AND/OR TUMOR MARKER LEVELS.

Mammography is one of the gold standard screening tests for breast cancer. The effects of mammography procedure on blood parameters are not known. This study aimed to investigate whether the procedure-associated breast compression affects the widely and simultaneously performed blood measurements of C-reactive protein (CRP), carcinoembryonic antigen (CEA), and cancer antigen (CA) 15-3. According to breast ultrasound examination results, participants were divided into 3 groups as follows: group 1 (participants with breast mass size ≥20.0 mm, n=48); group 2 (participants with breast mass size <20.0 mm, n=17); and group 3 (participants with no breast mass, n=23). In groups 1 and 2, on the day of the mammographic imaging study, serum CRP, CEA, and CA 15-3 levels were measured before and after the imaging study. Participants in group 3 had their blood parameters measured without mammography and/or any breast compression. Post-mammography blood measurements displayed a significant increase in serum CRP levels, and a significant decrease in serum CEA and CA 15-3 levels in group 1 (in comparison with the same day pre-mammography blood sampling levels; p<0.05 all). Although pre-mammography serum CEA levels in group 1 participants were significantly higher than those in group 2 and 3 participants, this significant elevation became nonsignificant at post-mammography measurements (p<0.05 and p>0.05, respectively). On the day of the mammographic imaging study, the optimal time of blood sampling for testing CRP, CEA and CA 15-3 levels in persons with a breast mass is before, but not after the mammographic imaging procedure. This issue requires additional detailed studies.

Sex estimation in a Turkish population using Purkait's triangle: a virtual approach by 3-dimensional computed tomography (3D-CT).

Sex estimation is considered one of the first steps in the forensic identification process. Morphological and morphometrical differences between males and females have been used as means for morphoscopic and metric methods on both cranial and postcranial skeletal elements. When dry skeletal elements are not available, virtual data can be used as a substitute. The present research explores 3-dimensional (3D) scans from a Turkish population to test a sex estimation method developed by Purkait (2005). Overall, 296 individuals were used in this study (158 males and 138 females). Purkait's triangle parameters were measured on computed tomography (CT) scans obtained from both right and left femora of each patient at the Bakirkoy Dr. Sadi Konuk Training Research Hospital (Istanbul, Turkey). Intra- and inter-observer errors were assessed for all variables through technical error of measurements analysis. Bilateral asymmetry and sex differences were evaluated using parametric and non-parametric statistical approaches. Univariate and multivariate discriminant function analyses were then conducted. Observer errors demonstrated an overall agreement within and between experts, as indicated by technical error of measurement (TEM) results. No bilateral asymmetries were reported, and all parameters demonstrated a statistically significant difference between males and females. Fourteen discriminant models were generated by applying single and combined parameters, producing a total correct sex classification ranging from 78.4% to 92.6%. In addition, over 67% of the total sample was accurately classified, with 95% or greater posterior probabilities. Our study demonstrates the feasibility of 3D sex estimation using Purkait's triangle on a Turkish population, with accuracy rates comparable to those reported in other populations. This is the first attempt to apply this method on virtual data and although further validation and standardisation are recommended for its application on dry bone, this research constitutes a significant contribution to the development of population-specific standards when only virtual data are available.Key pointsCT analysis using Purkait's triangle is a suitable tool for assessment of sex in unidentified individuals.The best overall estimation rate was achieved with the F11 model, with around 92% of accuracy.The results suggested 78.4% to 92.6% correct sex identification rates.More research is needed to expand the sample set and verify the results.

The performance of shear wave elastography on evaluating liver changes in obese and overweight children.

BACKGROUND: Real time shear-wave elastography (SWE) is a non-invasive imaging method which can quantitatively assess liver stiffness. Obesity and its complication are increasing with improving lifestyles in our century. We evaluated the performance of SWE for detecting liver changes (fatty liver, steatohepatitis) in obese and overweight children, in addition to this, we determined the diagnostic accuracy and clinical usefulness of SWE in non-alcoholic fatty liver disease (NAFLD). METHODS: Obese and overweight 41 children within the age range of 6-15 years were included in this singlecenter prospective study. Biochemical evaluation for aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglyceride (TG), total cholesterol (TC) levels, as well as conventional ultrasound and SWE of the liver were performed in the patient group. These values were compared with values of 25 normal weight and healthy children in the age range of 6-16 years. RESULTS: The mean SWE values was 13.7 ± 5.5 kiloPascal (kPa) and 2.03 ± 0.35 meter/second (m/s) in patient group and 7.99 ± 2.81 kPa and 1.62 ± 0.21 m/s in control group (p < 0.01). The receiver-operating characteristics (ROC) analysis was performed to determine the optimum cut-off value for elastography values (kPa) to evaluate liver changes; area under the curve was 87.5% (95% CI 79.3-95.8). When the cutoff value was set as 10.45 kPa, the sensitivity and the specificity was 69.2% and 100%, respectively. We could not observe a statistically significant difference when we compared the elastography values (kPa and m/s) according to presence of hepatosteatosis (p=0.581 and 0.172). There were no significant correlations between SWE and AST, ALT values. CONCLUSIONS: SWE may be a useful and accurate imaging method to evaluate liver changes and monitor NAFLD in obese and overweight children.

Imaging of Multisystem Inflammatory Disease in Children (MIS-C) Associated With COVID-19.

RATIONALE AND OBJECTIVES: To retrospectively evaluate imaging findings in multisystem inflammatory disease in children associated with COVID-19 (MIS-C). MATERIALS AND METHODS: The radiological imaging findings of 45 pediatric patients aged between 52 days and 16 years, who were diagnosed with MIS-C according to the World Health Organization (WHO) criteria, were evaluated. All the patients underwent chest X-ray and echocardiography. The findings obtained from 25 abdominal radiographs, 24 abdominal US, 7 abdominal CT, 16 thorax CT, 21 cranial MRI and one spinal MRI, MR cholangiography (MRCP) and cardiac MRI examinations were categorized and evaluated according to the affected systems. RESULTS: While the most common findings in chest X-ray were perihilar opacity and peribronchial thickening, pleural effusion was the most finding in thorax CT. Echocardiography findings of myocarditis were observed in 31% of the cases. The most common findings in abdominal radiological evaluation were hepatomegaly and splenomegaly, edema in the gallbladder wall and periportal area, mesenteric lymph nodes in the right lower quadrant, thickening of the intestinal walls, and free fluid. Reversible splenial lesion syndrome (RESLES) was the most common neurological finding. Acute disseminated encephalomyelitis (ADEM)-like lesions, acute hemorrhagic necrotizing encephalomyelitis, and radiological findings consistent with Guillain-Barré syndrome were found in one case each. CONCLUSION: Radiological findings seen in MIS-C in pediatric cases are correlated with the affected system. According to the system involved, there is no specific finding for this disease. Radiological findings are not the primary diagnostic tool but can assist in the evaluation of the affected systems and to guide treatment.

Evaluating the optic nerve stiffness and optic nerve sheath diameter in idiopathic intracranial hypertension patients after the resolution of papilledema.

PURPOSE: The objective of this study was to investigate the optic nerve's elastic properties and optic nerve sheath diameter (ONSD) using shear-wave elastography (SWE) in patients with idiopathic intracranial hypertension (IIH) compared to healthy individuals. METHODS: The study included 22 IIH patients and 15 healthy subjects. SWEs were performed on the optic nerve and ONSD, and optic nerve stiffness were measured. RESULTS: The patients with IIH demonstrated higher stiffness of the optic nerve compared with that of healthy volunteers (P < 0.001). The optic nerve sheath diameter of the optic nerve in the IIH group was significantly larger than that in the control group (P < 0.001). There was no correlation between the disease duration and SWE values in the Spearman correlation test. CONCLUSION: These findings suggest that ONSD can be used as a follow-up method in the treatment of IIH. However, there was not any correlation between the disease duration and SWE-based stiffness measurement of the optic nerve.

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.

Cognitive Versus Magnetic Resonance-Ultrasound Fusion Prostate Biopsy: Which One Is Worthier to Perform?

The aim of our study is to compare 2 prostate fusion biopsy models in terms of accurate target sampling. One hundred patients who had Prostate Imaging-Reporting and Data System score 3, 4, or 5 lesions (lesion diameter, >5 mm in long axis) in multiparametric-magnetic resonance imaging and prostate-specific antigen levels between 3 and 10 ng/mL were enrolled in the study. All patients were biopsy naive. Two groups were composed with 50 patients each. Group 1 patients had cognitive fusion (CF) biopsy, and group 2 had magnetic resonance-ultrasound fusion platform biopsy. After fusion biopsy, standard biopsy was also performed. Outcomes of histopathologic and demographic data were evaluated statistically. There were no statistical differences between the 2 groups in terms of age, prostate-specific antigen levels, prostate volume, and lesion length (P > 0.05). There was no statistically significant difference in sampling targeted lesions (P > 0.05). Also, no difference was found between the 2 groups in terms of random biopsy cancer detection rates (P > 0.05). There was no statistically significant difference between CF and magnetic resonance-ultrasound fusion in terms of cancer detection rates. For the experienced operators, we recommend lesions that are longer than 5 mm can be sampled using CF, an inexpensive and faster technique.

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.