Beyond symptomatology: A comparative analysis of unilateral and bilateral macronodular mild autonomous cortisol secretion.

OBJECTIVE: To investigate the clinical, laboratory findings and signal intensity index (SII) on magnetic resonance imaging (MRI) of patients with bilateral and unilateral macronodular mild autonomous cortisol secretion (MACS). PATIENTS AND MEASUREMENTS: Clinical and laboratory findings of 81 patients with MACS were examined from retrospective records. SII of adenomas and internodular areas were evaluated by MRI. The unilateral group included patients with an adrenal macronodule (≥1 cm) in a single adrenal gland, while the bilateral group included patients with at least one macronodule in both adrenal glands. RESULTS: In total, 46 patients were in the unilateral (57%), while 35 (43%) patients were in the bilateral groups. The dehydroepiandrosterone sulphate (DHEA-S) level was lower in the unilateral than in the bilateral group (p < .001). The presence of type 2 diabetes mellitus (T2DM), glycosylated haemoglobin (HbA1c) and low-density lipoprotein (LDL) concentrations were higher in the bilateral group (p < .05). However, no significant difference was detected in terms of adrenocorticotropic hormone (ACTH) and overnight 1 mg dexamethasone suppression test (DST) between the two groups (p > .05). There was no difference in SII between adenomas within the same patient, as well as between the unilateral and bilateral groups (p > .05). Logistic regression analysis based on the differentiation between unilateral and bilateral macronodular MACS demonstrated that DHEA-S, HbA1c and LDL concentrations were associated factors. CONCLUSION: DHEA-S levels may not be as suppressed in patients with bilateral macronodular MACS as compared to those with unilateral adenoma. T2DM and hypercholesterolaemia have a higher frequency in bilateral patients. However, ACTH, overnight 1 mg DST and SII may not provide additional information for differentiation of bilaterality and unilaterality.

Clinical prediction model for primary aldosteronism subtyping and special focus on adrenal volumetric assessment.

PURPOSE: Our aim was to develop a prediction model based on a simple score with clinical, laboratory, and imaging findings for the subtype diagnosis of primary aldosteronism (PA). The contribution of adrenal volumetric assessment to PA subtyping was also investigated. METHODS: Thirty-five patients with adequate cannulation in adrenal venous sampling (AVS) were included. Laboratory data, the saline infusion test (SIT), and the AVS results of patients with PA were retrospectively evaluated. Volumetric assessment was performed using magnetic resonance imaging (MRI) and the ratio of adrenal volumes was calculated after adjusting for gender- and side-specific mean reference values of both adrenal glands. RESULTS: The AVS was consistent with unilateral PA in 49% and bilateral in 51% of the patients. Hypertension as a reason for work-up, the highest aldosterone/lowest potassium value higher than 12, the percentage of plasma aldosterone concentration (PAC) reduction after SIT by equal or less than 43.5%, the use of oral potassium replacement, unilateral disease at pre-AVS imaging, and a ratio of adjusted adrenal volumes equal to or below 1.7 were indicative of unilateral disease in univariate logistic regression analysis concerning the distinction of PA subtyping (p < 0.05). Multivariate logistic regression analysis also revealed that adrenal volumetric assessment has an impact on PA subtyping (p < 0.05). In the prediction model, when each of the six parameters that were significant in the univariate logistic regression analysis was assigned one point, < 4 predicted bilateral PA, whereas ≥ 4 predicted unilateral PA (AUC:0.92, p < 0.001). CONCLUSION: This prediction model before AVS may serve as a convenient and practical approach, while an adjusted adrenal volumetric assessment can make a positive contribution to PA subtyping.

Spontaneous improvement in syringomyelia in a patient with Chiari 1 malformation: illustrative case.

BACKGROUND: "Chiari malformation" refers to a spectrum of hindbrain abnormalities characterized by impaired cerebrospinal fluid circulation through the foramen magnum. Syringomyelia is frequently found in patients with Chiari malformation type 1. Although many theories have suggested how cerebrospinal fluid enters and makes the cystic cavity in the spinal cord, the pathogenesis of syringomyelia remains controversial. This report documents a case with spontaneous resolution of syringomyelia followed up by 3-year serial magnetic resonance imaging (MRI). These kinds of cases support a more conservative approach. OBSERVATIONS: A 59-year-old female presented to the authors' clinic in June 2019 with a history of Chiari malformation type 1. This symptomatic patient has been followed up with serial MRI. When the last MRI was performed in August 2022, compared with previous imaging, resolution of the syringomyelia was recognized. LESSONS: Because the natural evolution of mildly symptomatic/asymptomatic patients with syringes is unclear, these patients pose a treatment dilemma. Although surgical intervention is a widely accepted therapeutic method, a more conservative approach can be considered in cases with spontaneous resolution. Especially for patients without progressive symptoms, the surgical approach should not be considered as the first step. In view of relapses, follow-up with periodic neurological examinations and radiological imaging is preferrable.

Prediction of IDH Mutation Status in High-grade Gliomas Using DWI and High T1-weight DSC-MRI.

RATIONALE AND OBJECTIVES: We aimed to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic susceptibility contrast-enhanced (DSC) magnetic resonance imaging (MRI) parameters in the noninvasive prediction of the isocitrate dehydrogenase (IDH) mutation status in high-grade gliomas (HGGs). MATERIALS AND METHODS: A total of 58 patients with histopathologically proved HGGs were included in this retrospective study. All patients underwent multiparametric MRI on 3-T, including DSC-MRI and DWI before surgery. The mean apparent diffusion coefficient (ADC), relative maximum cerebral blood volume (rCBV), and percentage signal recovery (PSR) of the tumor core were measured and compared depending on the IDH mutation status and tumor grade. The Mann-Whitney U test was used to detect statistically significant differences in parameters between IDH-mutant-type (IDH-m-type) and IDH-wild-type (IDH-w-type) HGGs. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the diagnostic performance. RESULTS: The rCBV was significantly higher, and the PSR value was significantly lower in IDH-w-type tumors than in the IDH-m group (p = 0.002 and <0.001, respectively).The ADC value in IDH-w-type tumors was significantly lower compared with the one in IDH-m types (p = 0.023), but remarkable overlaps were found between the groups. The PSR showed the best diagnostic performance with an AUC of 0.938 and with an accuracy rate of 0.87 at the optimal cutoff value of 86.85. The combination of the PSR and the rCBV for the identification of the IDH mutation status increased the discrimination ability at the AUC level of 0.955. In terms of each tumor grade, the PSR and rCBV showed significant differences between the IDH-m and IDH-w groups (p ≤0.001). CONCLUSION: The rCBV and PSR from DSC-MRI may be feasible noninvasive imaging parameters for predicting the IDH mutation status in HGGs. The standardization of the imaging protocol is indispensable to the utility of DSC perfusion MRI in wider clinical usage.

Comparison of diagnostic performances in the evaluation of breast microcalcifications: synthetic mammography versus full-field digital mammography.

BACKGROUND: Although several studies proved that SM could substitute for FFDM, the efficacy of SM in microcalcification evaluation remains controversial. AIMS: To investigate the diagnostic performance of synthetic mammography (SM) in the evaluation of microcalcifications in comparison with full-field digital mammography (FFDM). METHODS: In this retrospective study, 76 mammograms of 76 patients who underwent FFDM and digital breast tomosynthesis (DBT) acquisitions concomitantly between 2018 and 2019 and whose final mammography interpretation revealed microcalcifications (28 malignant microcalcifications and 48 benign microcalcifications) were included. All mammograms were reviewed independently by three radiologists with different levels of breast imaging experience. Readers were blinded to patient outcomes and interpreted each case in two separate reading sessions (first FFDM, second SM + DBT), according to the BI-RADS lexicon. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated using ROC analysis in all cases for FFDM and SM + DBT sessions. The readers also assigned conspicuity scores to mammograms. The interobserver agreement was calculated using intraclass correlation coefficients (ICC). RESULTS: The overall AUCs for malignant microcalcifications were 0.80 (95% CI: 0.75-0.85) in FFDM and 0.85 (95% CI: 0.80-0.89) in SM, and no significant difference was found between the groups (p = 0.0603). The sensitivity of the readers increased slightly with experience. The ICC values of BI-RADS categorization between readers were 0.93 (95% CI: 0.90-0.95) and 0.94 (95% CI: 0.91-0.96) for FFDM and SM, respectively. CONCLUSIONS: SM had similar diagnostic performance in the evaluation of breast microcalcifications in comparison with FFDM, regardless of reader experience levels.

Do We Need Intraoperative Magnetic Resonance Imaging in All Endoscopic Endonasal Pituitary Adenoma Surgery Cases? A Retrospective Study.

There are previous reports investigating effectiveness of intraoperative magnetic resonance imaging (IO-MRI) in pituitary adenoma surgery but there is no clear data in the literature recommending when there is no need of intraoperative scan. This retrospective analysis was based on determining which patients does not need any IO-MRI scan following endoscopic endonasal pituitary adenoma surgery. Patients with functional or non-functional pituitary adenomas that were operated via endoscopic endonasal approach (EEA) between June 2017 and May 2019 were enrolled. Patients younger than 18 years old, patients who did not underwent IO-MRI procedure or not operated via EEA were excluded from the study. Hence, this study is designed to clarify if IO-MRI is useful in both functional and non-functional pituitary adenomas, functional adenomas did not split into subgroups. A total of 200 patients treated with pituitary adenoma were included. In Knosp Grade 0 - 2 group, primary surgeon's opinion and IO-MRI findings were compatible in 150 patients (98.6%). In Knosp Grade 3 - 4 correct prediction were performed in 32 (66.6%) patients. When incorrectly predicted Knosp Grade 3 - 4 patients (n = 16) was analyzed, in 13 patients there were still residual tumor in cavernous sinus and in 3 patients there were no residual tumor. Fisher's exact test showed there is a statistically significant difference of correct prediction between two different Knosp Grade groups (two-tailed P < 0.0001). Eighteen patients had a residual tumor extending to the suprasellar and parasellar regions which second most common site for residual tumor. Our findings demonstrate that there is no need of IO-MRI scan while operating adenomas limited in the sellae and not invading the cavernous sinus. However, we strongly recommend IO-MRI if there is any suprasellar and parasellar extension and/or cavernous sinus invasion.

Added Value of CT Pelvic Bone Unfolding Software to Radiologist Performance in Detecting Osteoblastic Pelvic Bone Lesions in Patients With Prostate Cancer.

PURPOSE: To evaluate the contribution of CT Bone Unfolding software to the diagnostic accuracy and efficiency for the detection of osteoblastic pelvic bone lesions in patients with prostate cancer. METHODS: A total of 102 consecutive (January 2016-September 2019) patients who underwent abdominopelvic CT with prostate cancer were retrospectively evaluated for osteoblastic pelvic bone lesions, using commercially available the post-processing-pelvic bone flattening-image software package "CT Bone Unfolding." Two radiologists with 3 and 15 years of experience in abdominal radiology evaluated CT image data sets independently in 2 separate reading sessions. At the first session, only MPR images and at the second session MPR images and additionally unfolded reconstructions were assessed. Reading time for each patient was noted. A radiologist with 25 years of experience, established the standard of reference. RESULTS: In the evaluations performed with the MPR-Unfold method, the diagnostic accuracy were found to be 2.067 times higher compared to the MPRs method (P < 0.001). The location of the lesions or the reader variabilities did not show any influence on accuracy (P > 0.05) For all readers the reading time for MPR was significantly longer than for MPR-Unfold (P < 0.05). For both methods substantial to almost-perfect inter-reader agreement was found (0.686-0.936). CONCLUSIONS: The use of unfolded pelvic bone reconstructions increases diagnostic accuracy while decreasing the reading times in the evaluation of pelvic bone lesions. Therefore, our findings suggest that utilizing unfolded reconstructions in addition to MPR images may be preferable in patients with prostate cancer for the screening of osteoblastic pelvic bone lesions.

Accuracy in tumor size measurements: Comparison of digital mammography, digital breast tomosynthesis and synthetic mammography.

PURPOSE: The aim of this study was to assess the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography (SM) in tumor size measurements compared with histological tumor sizes. MATERIALS AND METHODS: 71 breast cancer patients who underwent DM and DBT acquisitions simultaneously were included in this study. One radiologist with 8 years of experience in breast imaging measured tumor sizes independently in three separate sessions which include DM, DBT and SM images, respectively. The correlations between the measured tumor sizes on each imaging technique and histological sizes were analyzed using Spearman correlation test. The patients were categorized into two subgroups according to assigned breast density categories (dense and non-dense), and histological tumor sizes (≤2 cm and > 2 cm). To assess the agreement levels between the measured tumor sizes and histological sizes Bland-Altman analyses were performed for each imaging technique. RESULTS: The mean of histological size of tumors was 23.85 ±â€¯16.57 mm (median: 20). The means of measured tumor sizes were 21.21 ±â€¯13.59 mm (median: 19), 21.52 ±â€¯13.42 mm (median: 19) and 18.97 ±â€¯11.21 mm (median: 17) in DM, DBT and SM, respectively. The Spearman correlation values with histologic sizes were 0.814 (P < 0.001), 0.887 (P < 0.001), and 0.852 (P < 0.001) for DM, DBT and SM, respectively. In subgroup analyses, the correlation values showed decrement for tumors >2 cm in size compared to tumors ≤2 cm in size. CONCLUSION: DBT provides the most accurate tumor size measurements among mammographic imaging techniques and if mammography will be used in tumor size measurements, DBT should be preferred.

Validation of combined use of DWI and percentage signal recovery-optimized protocol of DSC-MRI in differentiation of high-grade glioma, metastasis, and lymphoma.

PURPOSE: With conventional MRI, it is often difficult to effectively differentiate between contrast-enhancing brain tumors, including primary central nervous system lymphoma (PCNSL), high-grade glioma (HGG), and metastasis. This study aimed to assess the discrimination ability of the parameters obtained from DWI and the percentage signal recovery- (PSR-) optimized protocol of DSC-MRI between these three tumor types at an initial step. METHODS: DSC-MRI using a PSR-optimized protocol (TR/TE = 1500/30 ms, flip angle = 90°, no preload) and DWI of 99 solitary enhancing tumors (60 HGGs, 24 metastases, 15 PCNSLs) were retrospectively assessed before treatment. rCBV, PSR, ADC in the tumor core and rCBV, and ADC in peritumoral edema were measured. The differences were evaluated using one-way ANOVA, and the diagnostic performance was evaluated using ROC curve analysis. RESULTS: PSR in the tumor core showed the best discriminating performance in differentiating these three tumor types with AUC values of 0.979 for PCNSL vs. others and 0.947 for HGG vs. metastasis. The ADC was only helpful in the tumor core and distinguishing PCNSLs from others (AUC = 0.897). CONCLUSION: Different from CBV-optimized protocols (preload, intermediate FA), PSR derived from the PSR-optimized protocol seems to be the most important parameter in the differentiation of HGGs, metastases, and PCNSLs at initial diagnosis. This property makes PSR remarkable and carries the need for comprehensive DSC-MRI protocols, which provides PSR sensitivity and CBV accuracy together, such as the preload use of the PSR-optimized protocol before the CBV-optimized protocol.

The Role of 18F-FDG PET/MRI in the Assessment of Primary Intrahepatic Neoplasms.

RATIONALE AND OBJECTIVES: To evaluate the results of 18F-FDG PET/MRI in relation to the histopathologic subtypes and histologic grades of mass-forming primary intrahepatic neoplasms. MATERIALS AND METHODS: We retrospectively evaluated 18F-FDG positron emission tomography/magnetic resonance imaging (PET/MRI) results for 39 patients with histopathologically confirmed primary hepatic neoplasms, 15 with mass-forming intrahepatic cholangiocarcinoma (ICC) and 24 with hepatocellular carcinoma (HCC). The apparent diffusion coefficient (ADC) and standardized uptake value (SUV) were analyzed in relation to the histopathologic diagnosis and histologic grade, including calculating the sensitivity and specificity of the imaging findings. RESULTS: The median SUV of ICC (6.0 [interquartile range, 5-10]) was significantly higher than that of HCC (4.0 [2.62-6.50]) (p = 0.002). An area under the curve (AUC) of 0.79 (95% confidence interval 0.649-0.932) had a sensitivity of 86.7% and a specificity of 67% at the best cut-off SUV of 4.41 to differentiate between ICC and HCC. ADC values did not differ significantly between HCCs and ICCs (p = 0.283). Both SUV and ADC values differed significantly between low-grade (well- and moderately differentiated) and high-grade (poorly differentiated) HCCs. Combining ADC and SUV further improved differentiation of low- from high-grade HCCs to a significant level (0.929). The SUV did not differ significantly between ICC histologic grades (p = 0.280), while the ADC differed significantly only between well and poorly differentiated ICCs (p = 0.004). CONCLUSION: Assessing primary hepatic neoplasms with 18F-Fluorodeoxyglucose PET/MRI may help to predict tumor grade and differentiate between types of intrahepatic neoplasms.

Intraoperative Magnetic Resonance Imaging Assisted Endoscopic Endonasal Resection of Clival Chordomas.

BACKGROUND: Cranial base chordomas are typically indolent and usually appear as encapsulated tumors. They slowly grow by infiltrating the bone, along with the lines of least resistance. Due to its relationship with important neurovascular structures, skull base chordoma surgery is challenging. OBJECTIVE: The usefulness of intraoperative magnetic resonance imaging (IO-MRI) in achieving the goal of surgery, is evaluated in this study. METHODS: Between March 2018 and March 2020, 42 patients were operated on for resection of skull base chordomas in our institution. All of them were operated on under IO-MRI. Patients were analyzed retrospectively for identifying common residue locations, complications and early post-operative outcomes. RESULTS: In 22 patients (52,4%) gross total resection was achieved according to the final IO-MRI. In 20 patients (47,6%) complete tumor removal was not possible because of extension to the petrous bone (8 patients), pontocerebellar angle (6 patients), prepontine cistern (4 patients), temporobasal (1 patient), cervical axis (1 patient). In 13 patients, the surgery was continued after the first IO-MRI control was performed, which showed a resectable residual tumor. 7 of these patients achieved total resection according to the second IO-MRI, in the other 6 patients all efforts were made to ensure maximal resection of the tumor as much as possible without morbidity. Repeated IO-MRI helped achieve gross total resection in 7 patients (53.8%). CONCLUSIONS: Our study proves that the use of IO-MRI is a safe method that provides the opportunity to show the degree of resection in skull base chordomas and to evaluate the volume and location of the residual tumor intraoperatively. Hence IO-MRI can improve the life expectancy of patients because it provides an opportunity for both gross total resection and maximal safe resection in cases where total resection is not possible.

The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection.

PURPOSE: The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. METHODS: Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. RESULTS: SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01). CONCLUSION: Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.

Comparison of Mass Size Measurements: Synthesized Mammography Versus Full-Field Digital Mammography.

OBJECTIVES: To compare mass size measurements between synthesized mammography (SM) and full-field digital mammography (FFDM), and to assess interobserver agreement for those measurements. MATERIALS AND METHODS: One hundred and forty-three patients who underwent FFDM and digital breast tomosynthesis acquisitions during the same compression session were included in the study. Two observers with four-and 1-year experience with digital breast tomosynthesis and SM images, respectively, measured mass sizes independently in two different sessions that were 2 weeks apart, and were blinded to each other. The first session included only FFDM images, and the second session included only SM images. Largest dimension of masses was measured in millimeters. Paired t test was used to compare differences in size measurements between FFDM and SM images. Intraclass correlation coefficient test was used to analyze interobserver agreement. Bland-Altman analyses were performed to evaluate agreements between the imaging techniques and between the observers. RESULTS: The mean mass sizes on FFDM and SM images were 20.27 ± 14.10 and 18.50 ± 13.05 mm, respectively, for the first observer and 21.56 ± 14.84 and 19.89 ± 13.68 mm, respectively, for the second observer. The mass size measurements were significantly different between FFDM and SM for both observers (p < 0.001). Range of measurement errors, defined as 95% limits of agreements between two imaging techniques for observers 1 and 2 were ±1.96*1.36 mm, and ±1.96*1.53 mm, respectively. Range of measurement errors, defined as 95% limits of agreements between two observers for SM and FFDM were ±1.96*3.68 mm, and ±1.96*3.35 mm, respectively. CONCLUSION: The measured mass sizes were significantly smaller on SM than FFDM images, and the interobserver differences for both of the imaging techniques were greater than the differences measured between FFDM and SM images.

Added Value of Contrast Medium in Whole-Body Hybrid Positron Emission Tomography/Magnetic Resonance Imaging: Comparison between Contrast-Enhanced and Non-Contrast-Enhanced Protocols.

OBJECTIVE: To compare the diagnostic ability and time efficiency of contrast-enhanced (CE) whole body fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) protocol and non-CE (NCE) protocol. SUBJECTS AND METHODS: Ninety-three patients with known primary tumors underwent whole-body hybrid FDG PET/MRI during the follow-up of their malignancies with the use of NCE and CE protocols. The NCE PET/MRI protocol consisted of diffusion-weighted (b = 0 and 800 s/mm2) and T1-weighted Turbo Flash in the axial plane and T2-weighted HASTE sequence in the coronal planes (Σ = 25 min). The CE PET/MRI protocol was performed by acquiring axial serial CE 3D FS VIBE images in the upper abdomen, completing the whole body in the late phase in the axial plane (Σ = 30 min). RESULTS: There was a statistically significant difference between the total number of lesions detected by the CE protocol (median 2, interquartile range (IQR) 0-14) and that detected by the NCE protocol (median 1, IQR 0-5; p < 0.001). More malignancies were detected in the abdomen (p < 0.001) and brain (p < 0.001) with the CE PET/MRI protocol, whereas no significant difference was present when comparing the 2 protocols in the detection of malignancies in the head and neck (p = 0.356), thorax (p = 0.09), lymph nodes (p = 0.196), and bone (p = 0.414). CONCLUSION: The CE FDG PET/MRI protocol enables fast and accurate detection of malignancies compared to the NCE FDG PET/MRI protocol, particularly in the upper abdomen and brain. Diagnostic ability and time efficiency can be increased with the proposed short CE protocol in place of the whole body PET/MRI protocol including both NCE and CE imaging sequences.

Usefulness of imaging findings in predicting tumor-infiltrating lymphocytes in patients with breast cancer.

OBJECTIVES: Tumor-infiltrating lymphocytes (TILs) have been determined as a new prognostic indicator of immunotherapy response in breast cancer (BC). The aim of this study is to investigate the effectiveness of imaging features in predicting the TIL levels in invasive BC patients. METHODS: A total of 158 patients with invasive BC were included in our study. All lesions were evaluated based on the BIRADS lexicon. US was performed for all the patients and 89 of them underwent MRI. The histologic stromal TIL (sTIL) levels were assessed and associations between the sTIL levels and imaging features were evaluated. RESULTS: Tumors with high sTIL levels had more circumscribed margins, round shape, heterogeneous echogenicity, and larger size on ultrasonography (p < 0.005). There was a statistically significant positive correlation between the sTIL levels and ADC value (p < 0.001). Tumors with high sTIL levels had significantly more homogeneous enhancement than the tumors with low sTIL levels (p = 0.001). Logistic regression analysis showed that the ADC was the most statistically significant parameter in predicting the sTIL levels (the odds ratio was 90.952; p = 0.002). The optimal cutoff value for ADC in predicting low and high sTIL levels was found to be 0.87 × 10-3 mm2 s-1 (AUC = 0.726, 73% specificity, and 60% sensitivity). CONCLUSIONS: Imaging findings, especially the ADC, may play an important role as an adjunct tool in cases of uncertain situations and may improve the accuracy of biopsy results. The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis. KEY POINTS: • Preoperative assessment of TILs is an important biomarker of prognosis and treatment efficacy. • ADC value can be a useful tool in distinguishing high and low sTIL levels as a non-invasive method. • The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis and an optimal treatment for the BC patients.

Evaluation of a two-image technique consisting of an axial and a coronal image generated by using the rib-flattening application: effect on reading time and diagnostic validity

Background/aim: When reading a chest CT, a radiologist needs to evaluate each rib one by one due to complex curvy shape, which makes reporting a tiresome and time-consuming task. A new curved planar reformat application that flattens ribs on a single plane may find a place in the radiology reporting room. This study aimed to evaluate the effect of a two-image set created by using the rib-flattening application on the performance of a radiologist in detecting sclerotic rib lesions in cancer patients. Materials and methods: The local Institutional Review Board approved this retrospective study. Two radiologists with different experience levels reviewed chest CT examinations of 106 patients (76 men, 30 women). We divided the patients into group A (n = 54), reviewed by a standard method, and group B (n = 52), reviewed by a standard method and the two-image set created on the rib- flattening application. Reading times, validity indices, and agreement levels with reference data were evaluated for both readers. Results: The median reading time of the junior examiner significantly decreased with the rib-flattening method (160.5 s vs. 70.0 s; P < 0.001). Diagnostic indices of the senior reader were improved significantly at per patient level (group A, AUC: 0.867; group B, AUC: 0.982; P = 0.046). The new method showed better agreement levels (kappa: 0.69 to 0.96) than the general method (kappa: 0.53 to 0.91). Conclusion: Based on improved agreement levels, reading times, and diagnostic validity indices we conclude that a two-image set consisting of an axial and a coronal flattened-rib image may be used in conjunction with an ordinary exam.

The Utility of Diffusion-Weighted Imaging and Perfusion Magnetic Resonance Imaging Parameters for Detecting Clinically Significant Prostate Cancer.

INTRODUCTION: To establish the diagnostic performance of the parameters obtained from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging at 3T in discriminating between non-clinically significant prostate cancers (ncsPCa, Gleason score [GS] < 7) and clinically significant prostate cancers (csPCa, GS ≥ 7) in the peripheral zone. MATERIALS AND METHODS: Twenty-six male patients with peripheral zone prostate cancer (PCa) who had undergone 3T multiparametric magnetic resonance imaging (MRI) scan prior to biopsy were included in the study and evaluated retrospectively. The GS was obtained by both standard 12-core transrectal ultrasound guided biopsy and targeted MRI-US fusion biopsy and then confirmed by prostatectomy, if available. For each confirmed tumour focus, DCE-derived quantitative perfusion metrics (Ktrans, Kep, Ve, initial area under the curve [AUC]), the apparent diffusion coefficient (ADC) value, and normalized versions of quantitative metrics were measured and correlated with the GS. RESULTS: Ktrans had the highest diagnostic accuracy value of 82% among the DCE-MRI parameters (AUC 0.90), and ADC had the strongest diagnostic accuracy value of 87% among the overall parameters (AUC 0.92). The combination of ADC and Ktrans have higher diagnostic performance with the area under the receiver operating characteristic curve being 0.98 (sensitivity 0.94; specificity 0.89; accuracy 0.92) compared to the individual evaluation of each parameter alone.The GS showed strong negative correlations with ADC (r = -0.72) and normalized ADC (r = -0.69) as well as a significant positive correlation with Ktrans (r = 0.69). CONCLUSION: The combination of Ktrans and ADC and their normalized versions may help differentiate between ncsPCa from csPCa in the peripheral zone.

Treatment-related alterations of imaging findings in osteoid osteoma after percutaneous radiofrequency ablation.

OBJECTIVES: We aimed to report the long-term outcomes of osteoid osteoma patients and to determine CT and dynamic contrast-enhanced MR imaging characteristics of radiofrequency ablation (RFA) treatment related changes of osteoid osteoma between follow-up periods. MATERIALS AND METHODS: Thirty patients (seven female, 23 male) who underwent CT-guided RFA of osteoid osteoma were included. Follow-up imaging examinations were divided into two subgroups; first (1-3 months) and second (> 6 months) periods. Nidus size, calcification, cortical thickening, maximum signal intensity (SImax), time of SImax (Tmax), slope of signal intensity-time (SIT) curves were noted. CT and dynamic MR imaging findings were compared between follow-up periods. RESULTS: Clinical success rate was 100%. The mean of OO nidi size was 5.85 ± 1.98 mm before treatment. There was a significant difference for OO nidi sizes between pretreatment and second follow-up period examinations (p = 0.002). SImax and slope of SIT curves of all patients (100%) showed decrease on follow-up MRIs. There was a significant decrease for SImax values between pretreatment and second follow-up period. There was a significant decrease for slope of SIT curves between pretreatment and both follow-up periods. CONCLUSIONS: RFA is an effective and safe treatment choice for osteoid osteomas. On follow-up imaging, slope of SIT curve and Tmax have the most important positive predictive value for long-term outcomes and single dynamic contrast-enhanced MRI within first 3 months after treatment may be sufficient for symptom-free patients.

Successful embolization in childhood hemoptysis due to abnormal systemic arterial bleeding of the lung and review of the literature.

BACKGROUND AND AIMS: Hemoptysis in children is a rare but potentially life-threatening symptom of an underlying respiratory tract abnormality. Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. With interventional radiological procedures and surgery, this rate has dropped to 7%-18%. The experience with bronchial arterial embolization in childhood is very limited; only a few case reports with short-term follow-up have been reported. METHODS: We report herein two patients with massive hemoptysis due to abnormal systemic arterial bleeding of the lung; neither patient had any lung or systemic disease. In both cases, the bleeding was controlled with endovascular embolization. The first case had bronchopulmonary arterial anastomosis and represents the first reported case with this anomaly. The second case had recurrent massive hemoptysis due to bronchial artery bleeding, and repeat embolization was performed. RESULTS: Both of these children had rare vascular anomalies without parenchymal lung disease and were treated successfully with bronchial arterial embolization. CONCLUSION: Massive hemoptysis due to abnormal systemic bleeding of the lung in the absence of parenchymal disease is an uncommon and severe symptom in childhood. Embolization can be a treatment option in children with abnormal vasculature bleeding and can be repeated safely when needed.