Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography.

INTRODUCTION: The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. MATERIALS AND METHODS: The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. RESULTS: The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. CONCLUSION: Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.

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

SUMMARY 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.

Determining the efficacy of functional liver imaging score (FLIS) obtained from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Albumin-Bilirubin (ALBI) grade and FLIS.

PURPOSE: (1) To evaluate the efficacy of functional liver imaging score (FLIS) in predicting liver function on gadoxetic acid-enhanced MRI in patients with chronic liver disease (CLD) or liver cirrhosis (LC) and its relationship with ALBI grade. (2) To assess the intra-reader reliability and interreader agreement of readers with different levels of experience in abdominal imaging of FLIS. METHODS: We retrospectively included 131 patients (70 men, 61 women; mean ± SD, 53.7 ± 14.6 years) with CLD and LC who underwent GA-enhanced MRI between November 2019 and March 2022. FLIS was assigned as a result of the sum of three hepatobiliary phase (HBP) images features, each scored 0-2: liver parenchymal enhancement, biliary contrast excretion, and portal vein sign. FLIS was calculated using HPB images independently by three radiologists with different experience. In addition, 50 randomly selected patients were reviewed a second time by a reader to assess intra-reader reliability. Patients were divided into the following three groups according to the albumin-bilirubin (ALBI) grade: ALBI grade 1, 2, and 3. We evaluated the correlation between ALBI grade and both FLIS and its parameters using Spearman's rank correlation for each reader. Receiver operating characteristic (ROC) curve analysis was performed to show the optimal cut-off value of FLIS to distinguish between ALBI grades. Intra-reader reliability and inter-reader agreement were evaluated by intraclass correlation coefficient (ICC). RESULTS: FLIS and three FLIS parameters showed very strong correlation with ALBI grade for each readers (r = - 0.843 to 0.976, - 0.831 to 0.962, and - 0.819 to 0.902, respectively). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of ALBI grade 1 for each readers (sensitivity, 83.7% to 95.4%; specificity, 82.6% to 87%; accuracy, 88.6% to 93.6% and area under the curve (AUC), 0.882 to 0.917), and FLIS ≤ 3 was the optimal cutoff for distinguish ALBI grade 3 from other grades for each readers (sensitivity, 100%; specificity, 95.2% to 96%; accuracy, 95.4% to 96.2% and AUC, 0.974 to 0.994). Intra-reader reliability (ICC = 0.95; 95% CI 0.93-0.96) and inter-reader agreement (ICC = 0.85 to 0.90; 95% CI 0.82-0.97) for FLIS were excellent. CONCLUSION: FLIS showed a very correlation with hepatic function level and can stratify the ALBI grades. This feature has demonstrated the potential of FLIS to be excellent radiological tools for predicting of liver function of CLD and LC patients in clinical practice. Also, the excellent agreement of FLIS among readers with different levels of experience indicates that it can be used with high accuracy and reproducibility regardless of experience.

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

SUMMARY 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 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.

Diagnostic efficacy of apparent diffusion coefficient measurements in differentiation of malignant intra-axial brain tumors

Background/aim: To evaluate diagnostic efficacy of the apparent diffusion coefficient measurements from tumor (ADCt) and tumor circumference hyperintensities (ADCtch) in different types of malignant intra-axial brain tumors. Materials and methods: Between April 2013 and June 2017, 125 patients (52 females (41.6%) and 73 males (58.4%); mean age: 53 years, age range: 14-81 years), who underwent diffusion-weighted imaging (DWI) with intracranial mass, were retrospectively evaluated. The mean ADCt and ADCtch values and ratios were measured. Results: Of the 125 patients, 22 (17.6%) had a low-grade glioma (LGG), 55 (44%) had a high-grade glioma (HGG), 32 (25.6%) had metastasis, and 16 (12.8%) had lymphoma diagnosis. There was a statistically significant difference in LGG and HGG in terms of mean ADCt and mean ADCtch values, and ratios. ADCtch values and ratios showed a statistically significant difference in the differentiation of HGG and metastasis and in the differentiation of HGG and lymphoma. According to ROC curve analysis, a cut-off value of 1.49 × 10−3 mm2/s for the mean ADCtch value generated the best combination of 70% sensitivity and 71% specificity for differentiation of HGGs and metastasis. The mean ADCtch value had the highest statistical predictive value for differentiation of HGGs and lymphoma with a sensitivity of 78% and a specificity of 76% for the optimal cut-off value of 0.82 × 10ˉ3 mm2/s. Conclusion: The mean ADCt ratio allowed reliable differentiation of LGG and high grade brain tumors, including HGGs, metastases, and lymphoma. The mean ADCtch might be a better imaging biomarker in the differentiation of HHG from metastasis and lymphoma.