Efficacy of Ultrasound and Shear Wave Elastography for the Diagnosis of Breast Cancer-Related Lymphedema.

OBJECTIVES: To assess the feasibility of ultrasound and shear wave elastography (SWE) in the diagnosis of breast cancer-related lymphedema. METHODS: Forty-one patients with a history of unilateral breast surgery and axillary dissection or sentinel lymph node excision were included in this prospective study. The patients were classified as having normal findings, latent lymphedema, and clinical lymphedema on the basis of a physical examination, lymphedema index scores, and limb circumference measurements. The thickness and stiffness of the cutaneous and subcutaneous tissue of the forearm and arm were measured by ultrasound and SWE. The thickness and stiffness of the cutaneous and subcutaneous tissue of the affected limb and contralateral limbs of the normal, latent lymphedema, and clinical lymphedema groups were compared. RESULTS: The mean age ± SD of the 41 patients was 55.42 ± 10.12 years. There were 15 patients with normal findings, 10 with latent lymphedema, and 16 with clinical lymphedema. In the latent lymphedema group, the thickness measurements of the cutaneous tissue of the affected forearm and the cutaneous and subcutaneous tissue of the affected arm were significantly greater than those of the contralateral forearm and arm (P = .034; P = .022; and P = .002, respectively), and the stiffness measurements of the cutaneous and subcutaneous tissue of the affected forearm were significantly greater than those of the contralateral forearm (P = .011; and P = .002). In the clinical lymphedema group, the thickness and stiffness measurements of the cutaneous and subcutaneous tissue of the affected forearm and arm were significantly greater than those of the contralateral limb (P < .001-P = .032). CONCLUSIONS: Ultrasound and SWE are effective for diagnosing breast cancer-related lymphedema even at a latent stage.

Acoustic Radiation Force Impulse Quantification in the Evaluation of Renal Parenchyma Elasticity in Pediatric Patients With Chronic Kidney Disease: Preliminary Results.

OBJECTIVES: To evaluate renal parenchymal elasticity with acoustic radiation force impulse imaging in pediatric patients with chronic kidney disease (CKD) and compare with healthy volunteers. METHODS: Thirty-eight healthy volunteers and 30 pediatric CKD patients were enrolled in this prospective study. The shear wave velocity (SW) values of both kidneys in CKD patients and healthy volunteers were evaluated. RESULTS: The mean SW in healthy volunteers was 2.21 ± 0.34 m/s, whereas the same value was 1.81 ± 0.49, 1.72 ± 0.63, 1.66 ± 0.29, 1.48 ± 0.37, and 1.23 ± 0.27 for stages 1, 2, 3, 4, and 5 in CKD patients, respectively. The SW was significantly lower for each stage in the CKD patients compared with healthy volunteers. Acoustic radiation force impulse could not predict the different stages of CKD, with the exception of stage 5. The cut-off value for predicting CKD was 1.81 m/s; at this threshold, sensitivity was 76.5% and specificity was 92.1% (area under the curve = 0.870 [95% confidence interval: 0.750-0.990]; P < .001). Interobserver agreement expressed as intraclass coefficient correlation was 0.65 (95% confidence interval: 0.34 to 0.83; P < .001). CONCLUSIONS: Acoustic radiation force impulse may be a potentially useful tool in detecting CKD in pediatric patients.

Evaluation of Renal Parenchyma Elasticity With Acoustic Radiation Force Impulse Quantification in Nutcracker Syndrome and Comparisons With Grayscale Doppler Sonography and Laboratory Findings.

OBJECTIVES: We sought to evaluate renal parenchymal elasticity with Virtual Touch quantification of acoustic radiation force impulse imaging in nutcracker syndrome and to compare shear-wave velocity (SWV) values with grayscale Doppler sonography and laboratory findings. METHODS: Thirty-eight healthy volunteers and forty-three nutcracker syndrome patients were enrolled in this prospective study. SWV values for both kidneys in nutcracker syndrome patients and healthy volunteers were evaluated. Grayscale Doppler ultrasound and laboratory findings were obtained and compared with SWV values in both nutcracker syndrome patients and healthy volunteers. RESULTS: In nutcracker syndrome patients, SWV values for the left kidney were significantly lower than those for the right kidney (n = 43; 1.93 ± 0.43 m/s vs 2.53 ± 0.45 m/s [P < .001]). Healthy volunteers' SWV values for both kidneys had no statistically significant differences. There was a statistically significant difference between nutcracker syndrome patients and healthy volunteers for the SWV values and body mass index values. There was no statistically significant correlation between SWV values of nutcracker syndrome patients and age, gender, glomerular filtration rate, body mass index, vein diameter ratio, peak velocity ratio, or resistive indices. CONCLUSIONS: Acoustic radiation force impulse imaging offers new, additional information on the affected left kidney parenchymal changes in nutcracker syndrome patients.

Autosomal recessive osteopetrosis with a unique imaging finding: multiple encephaloceles.

Osteopetrosis is a hereditary form of sclerosing bone dysplasia with various radiological and clinical presentations. The autosomal recessive type, also known as malignant osteopetrosis, is the most severe type, with the early onset of manifestations. A 5-month-old infant was admitted to our hospital with recurrent respiratory tract infections. Chest X-ray and skeletal survey revealed the classic findings of osteopetrosis, including diffuse osteosclerosis and bone within a bone appearance. At follow-up, the patient presented with, thickened calvarium, multiple prominent encephaloceles, and dural calcifications leading to the intracranial clinical manifestations with bilateral hearing and sight loss. Autosomal recessive osteopetrosis is one of the causes of encephaloceles and this finding may become dramatic if untreated.

The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease.

Objectives Platelet-to-lymphocyte ratio is a novel biomarker, recently shown to be correlated with atherosclerotic inflammation. This study investigated the role of platelet-to-lymphocyte ratio in patients with carotid artery stenosis and stroke. Methods Patients, who underwent carotid angiography with Multiple Detector Computed Tomography Angiography at our hospital, were retrospectively screened. Patients enrolled were divided into three groups based on the platelet-to-lymphocyte ratio. Patients with a platelet-to-lymphocyte ratio value between 55.0 and 106.71 were assigned to Group I, patients with a platelet-to-lymphocyte ratio value between 106.79 and 160.61 were assigned to Group II and patients with a platelet-to-lymphocyte ratio value between 162.96 and 619.61 were assigned to Group III. The carotid arterial stenosis calculated was classified as per the criteria of North American Symptomatic Carotid Endarterectomy Trial. Results One hundred fifty patients were included in our trial (mean age 61.9 ± 13.1 with 104 males). The rate of carotid arterial stenosis was detected to be higher in patients with a high platelet-to-lymphocyte ratio value (p = 0.010). Additionally, the platelet-to-lymphocyte ratio was positively correlated with the carotid arterial stenosis percentage (r = 0.250, p = 0.002). In the multi-variate regression analysis, platelet-to-lymphocyte ratio was detected to be an independent variable with respect to stroke (odd's ratio = 1.012, confidence interval = 1.001-1.024, p = 0.031). Conclusions Increased platelet-to-lymphocyte ratio could be a simple and practical marker of the clinical course in patients with carotid arterial stenosis.

Osteoskeletal manifestations of scurvy: MRI and ultrasound findings.

Scurvy has become very rare in the modern world. The incidence of scurvy in the pediatric population is extremely low. In the pediatric population, musculoskeletal manifestations are more common and multiple subperiosteal hematomas are an important indicator for the diagnosis of scurvy. Although magnetic resonance imaging findings of scurvy are well described in the literature, to our knowledge, ultrasound findings have not yet been described. In this article, we report a case of scurvy with associated magnetic resonance imaging and ultrasound findings.

Vaccine-induced myositis with intramuscular sterile abscess formation: MRI and ultrasound findings.

Although limb swelling is a well-known complication of vaccination, its rarity and wide band of differential diagnosis of limb swelling make it a diagnostic challenge. In this case report, we describe three cases of vaccine-induced myositis with intramuscular sterile abscess formation in patients with limb swelling and their magnetic resonance imaging and ultrasonography findings. Both radiologists and clinicians should be familiar with this rare entity, its clinical and imaging spectrum, and follow-up strategies.

Giant Congenital Pelvic AVM Causing Cardiac Failure, Diplegia, and Neurogenic Bladder.

BACKGROUND: Pelvic arteriovenous malformations (AVMs) are uncommon lesions and only a rare number of male cases have been reported. Their clinical presentations are variable and imaging modalities have an important place in diagnosis and treatment planning. CASE REPORT: We present the imaging findings of a giant congenital pelvic AVM that was diagnosed in a 30-year-old male patient eight years ago and which progressed despite follow-up and treatment, causing cardiac failure, diplegia, and neurogenic bladder. CONCLUSIONS: Pelvic AVMs are uncommon lesions and they can present with various symptoms based on their locations and sizes. Delays in the diagnosis and treatment can cause local and systemic complications. Imaging is very important in the diagnosis of pelvic AVM.

Primary malignant mucosal melanoma of the nasopharynx: an unusual cause of unilateral hearing loss.

There are many causes of unilateral hearing loss, and making the correct differential diagnosis, especially in elderly patients, is difficult. A primary malignant mucosal melanoma of the nasopharynx is extremely rare and can cause a variety of symptoms. Hearing loss, as a presenting symptom of mucosal malignant melanoma of the nasopharynx, has not yet been defined in the literature. Herein, we report a case of primary mucosal malignant melanoma of the nasopharynx presented with unilateral hearing loss in a 70-year-old man.

Sonographic diagnosis of ascariasis causing small bowel obstruction.

Acute right lower quadrant pain is a common, but nonspecific presenting symptom of a wide variety of diseases in children. Sonography (US) can play a significant role in the accurate and early diagnosis of right lower quadrant pain. In this article, we report a case of small bowel obstruction due to intestinal ascariasis diagnosed at bedside US and confirmed by MRI and describe a new US sign of intestinal ascariasis.

Prevalence of Bladder Cancers Incidentally Detected During Multiparametric MRI Scans of the Prostate Gland and the Clinical Significance of Scoring Them According to VI-RADS: A Pictorial Single-Centre Study.

Purpose: To determine the prevalence of incidentally detected bladder cancers (BCs) on multiparametric magnetic resonance imaging (mpMRI) of the prostate and to highlight the clinical importance of scoring them according to the Vesical Imaging-Reporting and Data System (VI-RADS). Materials and Methods: VI-RADS scores for incidental bladder lesions on mpMRI of the prostate were collected in 1693 patients with elevated prostate-specific antigen but no hematuria. The study included 19 patients with 28 incidental bladder lesions. Results: During this period, 39 incidental bladder lesions were found in 30 patients, representing 1.7% of cases. Of the 28 lesions, 11 were categorized by VI-RADS as VI-RADS 1, 14 as VI-RADS 2, 1 as VI-RADS 3, 1 as VI-RADS 4, and 1 as VI-RADS 5. Histopathological examination revealed 1 benign lesion, 24 non-muscle invasive BCs, and 3 muscle-invasive BCs in the 19 patients. Impressively, 97% of the incidental lesions detected by prostate mpMRI and categorized by VI-RADS were BCs without apparent prostate cancer invasion. Notably, 93% of these lesions were consistent with histopathological findings of muscle invasion and extravesical spread. Conclusion: Our study concludes the prevalence 1% incidental BC in prostate mpMRI. The research underscores a thorough bladder examination during prostate MRI scans. Utilizing mpMRI assists in distinguishing varying BC stages, aiding treatment decisions, and patient outcomes. VI-RADS categorization aligns with histopathological results, enhancing diagnosis, and healthcare communication. Early detection significantly influences patient care by enabling timely interventions and suitable treatment strategies, particularly for low-stage BCs linked to reduced progression and recurrence rates.

Pulmonary Histoplasmosis Mimicking Lung Cancer.

Teaching point: Due to the mass-like appearance of pulmonary histoplasmosis in the lung, radiological misdiagnosis may occur. Fungal infections should be considered in the differential diagnosis, especially in immune-compromised patients.

A unique presentation of renal cell carcinoma: both upper and lower gastrointestinal bleeding.

Renal cell carcinoma (RCC) constitutes 3% of all adult malignancies and may present with various symptoms due to local growth, metastasis, and paraneoplastic syndrome. Gastrointestinal hemorrhage because of RCC is a very rare event and more commonly seen as a recurrence of RCC many years after nephrectomy. Both upper and lower gastrointestinal bleeding due to direct invasion of RCC has not been reported yet in the literature. Herein, we report a case of 78-year-old man with both massive upper and lower gastrointestinal bleeding as a presenting symptom of RCC.

Isolated Intracranial Extramedullary Hematopoiesis in an Adult Patient.

This article describes the case of a 56-year-old male patient who presented with a headache and swelling on the left side of his head. Medical examinations, including non-contrast computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI), revealed the presence of an expansile soft tissue lesion in the frontoparietal bone structures, causing compression of the brain tissue. Further immunohistochemical analysis confirmed the diagnosis of extramedullary hematopoiesis (EMH) in the bone lesion, with predominant involvement of the myeloid series. EMH is a compensatory mechanism of the body to meet the demand for erythropoiesis. While EMH is commonly associated with thalassemia in children and myelofibrosis in adults, it can occur in various tissues throughout the body, including the intracranial region, although it is rare. The imaging findings of EMH on MRI typically show iso-hypointense signals on T1-weighted images and hypointense signals on T2-weighted images due to the presence of hemosiderin. However, in this case, the lesions appeared hyperintense on T2-weighted images, which posed a challenge in the differential diagnosis. The article highlights the importance of clinical evaluation and imaging findings in diagnosing EMH, as these lesions can resemble other conditions such as metastases, angiomatous meningioma, chloroma, or epidural hematoma. Teaching Point: Isolated cases of intracranial EMH should be considered as a differential diagnosis in adult patients as they may be radiologically confused with malignant conditions such as metastases, angiomatous meningioma, chloroma or epidural hematoma.

Intrascrotal Extratesticular Schwannoma: A Rare Cause of Scrotal Mass.

BACKGROUND: Schwannoma, also known as neurinoma, is the most common tumor of the peripheral nerves. Intrascrotal extratesticular schwannoma, which is not associated with schwannomatosis and neurofibromatosis-2, is a very rare entity, and few cases have been reported in the literature. In this paper, we have reported a case of extratesticular schwannoma, an extremely rare cause of scrotal mass, with ultrasound (US) and magnetic resonance imaging (MRI) findings. CASE REPORT: A 22-year-old male presented with painless left scrotal swelling. Scrotal US showed an extra-testicular heterogeneous hypoechoic mass with the lobulated contour in the inferior part of the scrotum. Scrotal MRI demonstrated well-defined extratesticular mass, which showed heterogeneous hypointense T2-weighted images compared to testis parenchyma. On contrast-enhanced images, the mass showed mild-to-moderate enhancement. The patient underwent surgery with the preliminary diagnosis of benign intrascrotal extratesticular mass. The lesion was removed with preservation of the testicles by urologists, and the final diagnosis was made as scrotal schwannoma by histological and immunohistochemical examination. CONCLUSION: Although there is no specific imaging finding of scrotal schwannoma, MRI can be used as a guide to surgery by helping to accurately determine whether the lesion is intra- or extratesticular. In addition, radiologists and urologists should keep schwannoma in mind in the differential diagnosis in the presence of an intrascrotal extratesticular mass.

A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part II.

OBJECTIVE: This study aimed to determine the computed tomography findings associated with very recent catastrophic 2023 Turkey-Syria earthquake-related injuries and their anatomotopographic distribution in the adult population. METHODS: The incorporated computed tomography scans of 768 adult cases who had been admitted to the hospital and had undergone computed tomography imaging after these tragic disasters had been examined on the Teleradiology Reporting System of the Turkish Ministry of Health. To this end, the injuries were classified into six categories: head, thoracic, spinal, pelvic, extremity, and abdominal injury, with three age groups (18-34, 35-64, and ³65 years) and four different imaging intervals (<24, 24-48, 49-72, and >72 h). RESULTS: This study incorporated 316 (41.1%) cases on the first day, 57 (7.5%) on the second day, 219 (28.5%) on the third day, and 176 (22.9%) on the fourth day after the earthquake or later. Of the 768 cases, 109 (14.2%) had a head injury, 100 (13.0%) had a thoracic injury, 99 (12.9%) had a spinal injury, 51 (6.6%) had a pelvic injury, 41 (5.4%) had an extremity injury, and 11 (1.4%) had an abdominal injury. CONCLUSION: In these regrettable earthquake disasters, we determined a high ratio of head injuries, which was closely followed by thoracic and spinal injuries, in our preliminary outcomes for the pediatric population, Part I. The frequency of abdominal injuries was low among individuals who experienced the earthquake. Last but not least, we have noticed a higher likelihood of spinal injury in individuals older than 65 years in the studied population.

A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part I.

OBJECTIVE: This study was carried out to evaluate the injuries in pediatric earthquake victims due to the 2023 Turkey-Syria earthquakes with computed tomography and determine the anatomotopographic distribution of injuries. METHODS: The material of this retrospective study consisted of the computed tomography findings of 257 pediatric cases injured in the 2023 Turkey-Syria earthquakes, and those were divided into subgroups based on their age group, i.e., 0-4, 5-9, 10-14, and 15-18 years, and the type of injury, i.e., head, maxillofacial, thoracic, abdominal, pelvic, and spinal injuries. RESULTS: Earthquake-related injuries had been detected in 102 (39.6%) patients. Of the 29 patients with multiple injuries, 17, 10, and 2 had injuries in two, three, and four topographic regions, respectively. The most common injury was a head injury, which was detected in 48 (18.7%) cases, followed by thoracic injury, spinal injury, pelvic fracture, abdominal injury, and maxillofacial fracture, which were detected in 40 (15.6%), 22 (8.5%), 19 (7.4%), 10 (3.9%), and 6 (2.3%) patients, respectively. The cranial bone fractures and intracranial injuries were significantly more frequent in the 0-4 years age group compared with other age groups (p=0.028 and p=0.024, respectively). The rib fractures with spinal and pleural injuries were significantly more common in the 15-18 years age group compared with others (p=0.016, p=0.004, and p=0.002, respectively). CONCLUSION: The head injury was the most common earthquake-related injury in pediatric cases. Herein, it was more common in younger children compared with other age groups, whereas rib, spine, and pleural injuries were more common in older children.

Differentiation of affected and nonaffected ovaries in ovarian torsion with magnetic resonance imaging texture analysis.

OBJECTIVE: This study aimed to evaluate the feasibility of texture analysis on T2-weighted axial images in differentiating affected and nonaffected ovaries in ovarian torsion. METHODS: We included 22 torsioned ovaries and 19 healthy ovaries. All patients were surgically proven ovarian torsion cases. On T2-weighted axial images, ovarian borders were delineated by the consensus of two radiologists for magnetic resonance imaging-based texture analysis. Statistical differences between texture features of affected and nonaffected ovaries were assessed. RESULTS: A total of 44 texture features were extracted from each ovary using LIFEx software. Of these, 17 features were significantly different between affected and nonaffected ovaries in ovarian torsion. NGLDM_Coarseness and NGLDM_Contrast, which are the neighborhood gray-level difference matrix parameters, had the largest area under the curve: 0.923. The best cutoff values for the NGLDM_Contrast and NGLDM_Coarseness were 0.45 and 0.01, respectively. With these cutoff levels, NGLDM_Contrast had the best accuracy (85.37%). CONCLUSION: Magnetic resonance imaging-based texture analysis on axial T2-weighted images may help differentiate affected and nonaffected ovaries in ovarian torsion.

Comparison of Doppler Ultrasound and Clinical Features of Patients With and Without Femoral Hernia in Lower Extremity Venous Insufficiency Patients.

ABSTRACT: In this study, we aim to evaluate Doppler ultrasound (US) and clinical features of patients with and without femoral hernia (FH) in lower extremity chronic venous insufficiency (CVI) patients.We retrospectively analyzed prospectively collected data of 1364 limbs with the CVI suspected. Femoral hernia was detected in 32 of the limbs, and the control group was formed with 32 limbs without FH. All limbs were evaluated with Valsalva maneuver and augmentation method to detect venous reflux in FH group. Venous reflux rates in the Doppler US, venous clinical severity scores (VCSSs), and clinical classes of Clinical-Etiology-Anatomy-Pathophysiology classification were compared statistically in both groups.The mean VCSS was 3.87 ± 0.74 in the FH group and 2.68 ± 0.65 in the control group, which was statistically significant ( P = 0.04). In the more severe clinical classes of Clinical-Etiology-Anatomy-Pathophysiology (C4-6), the number of limbs in the FH group was higher than in the control group (8 and 4, respectively). Doppler US examinations showed venous reflux in 22 of 32 limbs in the FH group and 19 of 32 patients in the control group, and there was a statistically significant difference ( P = 0.029). In the FH group, reflux could be shown only by augmentation method in the vast majority of limbs (16 of 22, 73%).In conclusion, VCSS and reflux rates are higher in limbs with CVI accompanied by FH. In addition, FH may cause false negative results in the evaluation of CVI. The use of augmentation method in limbs with FH can help avoid false negatives.

Comparison of the diagnostic accuracy and validity of biparametric MRI and multiparametric MRI-based VI-RADS scoring in bladder cancer; is contrast material really necessary in detecting muscle invasion?

PURPOSE: (1) To evaluate the accuracy and validity of the biparametric MRI (bp-MRI), including T2-weigthed image (WI) and DWI sequences, and the availability of an alternative to the multiparametric MRI (mp-MRI), for the muscle-invasiveness assessment of bladder cancer (BC). (2) To evaluate the diagnostic performance and agreement of readers with different experiences in the abdominal imaging of using both protocols. METHODS: Preoperative bladder mp-MRI was performed on 128 patients with a initial diagnosis of BC. Two sets of images, set 1 (bp-MRI) and set 2 (mp-MRI), were independently evaluated by both readers. Descriptive statistics, including sensitivity, specificity, accuracy, and area under the curve (AUC), for VI-RADS scores were calculated using ≥ 4 as the cutoff for muscle invasion for each reader and image sets. Inter-reader agreement was evaluated using the Cohen's kappa coefficient. RESULTS: The sensitivity ranged between 90.3-93.5% and 87.1-90.3%, specificity ranged between 96.6-99.1% and 91.6-96.6%, accuracy ranged between 96-97.3% and 91.3-94.6%, and AUC ranged between 0.947-0.951 and 0.919-0.921, for bp-MRI and mp-MRI, and reader 1 and reader 2, respectively. No significant differences were shown in diagnostic performance for either reader between both the protocols (p = 0.238 and 0.318). There was excellent agreement among the readers in the VI-RADS scores, using both protocols. CONCLUSION: A bp-MRI protocol has a diagnostic accuracy comparable to an mp-MRI protocol for the detection of muscle-invasive BC using the VI-RADS criteria. Also, in both MRI protocols, the reader's experience does not appear to significantly affect diagnostic performance when using the VI-RADS criteria.