Diffusion-weighted Imaging in the Benign-malignant Differentiation of Endometrial Pathologies; Effectiveness of Visual Evaluation.

OBJECTIVE: To investigate the effectiveness of diffusion-weighted imaging (DWI) in the differentiation of benign and malignant endometrial pathologies by measuring the apparent diffusion coefficient (ADC) values and performing a visual evaluation. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey, from January 2017 to September 2019. METHODOLOGY: The inclusion criteria were women over 45 years of age with availability of the pelvic MRI in the PACS and the presence of pathological diagnosis by endometrial D and C or hysterectomy. Exclusion criteria were patients under 45 years of age, absence of histopathological results, hematoma or intrauterine device in the endometrial cavity, and endometrial thickness less than 5 mm. Quantitative ADC values were measured on ADC maps created automatically based on DWI data. DWI and ADC maps were also evaluated visually to differentiate between benign and malignant pathologies. RESULTS: Endometrial pathology was detected in a total of 88 patients, 36 of which were malignant and 52 benign lesions. The mean ADC values for both observers and the sensitivity and specificity in the differentiation of benign and malignant endometrial lesions were 81% - 75% and 88% - 90%, respectively (p<0.001 for both observers). The visual evaluation of b values and ADC map on DWI was also performed together, and the sensitivity and specificity in the differentiation of benign and malignant endometrial lesions were 81% - 86% and 69% - 56% for both observers, respectively (p <0.001 for both observers). CONCLUSION: ADC measurements are useful in differentiating benign and malignant endometrial pathologies, and visual evaluation of the ADC map and b values in DWI together also provides positive results. KEY WORDS: Diffusion-weighted imaging, Endometrial pathologies, ADC, Visual evaluation.

Radiological Recovery of Osteoid Osteoma after CT Guided Percutaneous Radiofrequency Ablation.

OBJECTIVE: To observe the necessity and usefulness of follow-up Magnetic Resonance Imaging (MRI) and Computed Tomography Imaging (CTI) after RFA of osteoid osteoma. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey, between May 2015 and January 2020. METHODOLOGY: Patients, who underwent CT-guided RFA for osteoid osteoma treatment, were followed-up both clinically and radiologically. MRI was recommended between the third and sixth months and CTI at 12th month or later for follow-up. All the pre and post-treatment radiological images were evaluated retrospectively. Radiological recovery was noted in three categories as complete/almost-complete, partial, and minimal-no recovery according to the healing of pre-treatment radiological findings. RESULTS: One-hundred and thirty-one patients with at least one follow-up CT or MRI were included. All had technically and clinically successful RFA treatments. Of 131 patients, 64.1% had CTI and 82.4% had MRI follow-up. In follow-up images, complete/almost-complete-recovery was observed in 70.2%, partial recovery in 26.7%, and minimal recovery in 3.1% of the cases. Re-ablation therapies were applied in 2 cases in this study due to pain recurrence after three months of successful treatments. CONCLUSION: Radiological follow-up is beneficial for the evaluation of outcome after RFA of osteoid-osteoma. At least one follow-up MRI may be helpful for the assessment of healing or recurrence. Follow-up CTI may not be needed unless planning a re-ablation. KEY WORDS: Osteoma osteoid, Radiofrequency ablation, Tomography, Magnetic resonance imaging.

Computed Tomography-guided Transthoracic Core Needle Biopsy of Lung Masses: Technique, Complications and Diagnostic Yield Rate.

OBJECTIVES: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses. METHODS: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients' post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively. RESULTS: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated. CONCLUSION: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses.

The safety and the efficacy of computed tomography guided percutaneous radiofrequency ablation of osteoid osteoma.

OBJECTIVE: The aim of this study was to investigate the efficacy and safety of Computed Tomography (CT) guided percutaneous Radiofrequency Ablation (RFA) in the treatment of osteoid osteoma (OO). METHODS: A total of 116 patients (82 male and 34 female patients; mean age of 17.7 years; age range 13-months-42 years) who had 118 CT guided RFA treatment between June 2015 and November 2018 (42 moths) with the diagnosis of OO were included in this study. All the patients had pre-procedural CT examinations. The clinical and technical success and the safety of the treatment were evaluated by assessing the clinical pain symptoms, complication rates and recovery of posture and gait. RESULTS: All the patients had a favorable immediate relief of the known pain caused by osteoid osteoma in 24 h after the procedure. Only in two patients (15-years-old boy with OO in right femoral neck and a 12 years old boy with OO in femur diaphysis) pain relapse was occurred in 3 months and 12 months after RFA and a second RFA was performed. During follow-up they had no pain. The technical success and efficacy-rates of the procedure were recorded as 100% and 98% respectively in this study. No significant complication was observed during treatment or recovery period. Seven minor complications were noted which were successfully treated. CONCLUSION: The rapid relief of pain symptoms, low relapse rate and low complication rates demonstrate the efficacy and safety of RFA therapy. RFA is an out-patient procedure that patients can be mobilized immediately after the procedure. RFA can be safely used as a first choice of treatment method in OO therapy. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Cervical spinal meningioma mimicking intramedullary spinal tumor.

STUDY DESIGN: Case report. OBJECTIVE: To report a very unusual spinal meningioma, mimicking an intramedullary spinal tumor. SUMMARY OF BACKGROUND DATA: Spinal meningiomas, usually associated with signs and symptoms of cord or nerve root compression, are generally encountered in women aged over 40. Radiologic diagnosis is often established by their intradural extramedullary location on magnetic resonance images. METHODS: A 60-year-old woman had a 6-month history of progressive weakness in her upper extremities, difficulty in walking, and cervical pain radiating through both arms. Neurologic examination revealed motor strength deficiency in all her extremities, with extensor reflexes, clonus, and bilateral hyper-reflexiveness. A sensory deficit was present all over her body. Magnetic resonance images revealed that the spinal cord appeared expanded with an ill-defined, homogeneously contrast-enhanced, lobulated, eccentric mass at the C1-C3 level. The patient was operated with a preliminary diagnosis of an intramedullary tumor. RESULTS: At surgery, the mass was found to be extramedullary, and gross total resection was performed. Histopathological examination revealed a meningioma characterized by the presence of fibrous and meningothelial components. The patient was able to ambulate with a cane, and extremity strength and sensation improved 2 months after surgery. CONCLUSION: Spinal meningiomas can mimic intramedullary tumors, and should be considered in differential diagnosis of intradural tumors with atypical appearance.