Association between the most superior point of patella-entrance of femoral trochlea distance ratio (SP-ET index) and chondromalacia patella: an investigation via magnetic resonance imaging.

Purpose: In this study, the effect of the most superior point of patella-entrance of femoral trochlea distance ratio (SP-ET index) on chondromalacia patella (CP) was investigated with 2 reviewers. Material and methods: A total of 348 knees of 308 patients were analysed retrospectively with magnetic resonance imaging (MRI). Patients with or without CP constituted the study and the control groups in this cross-sectional investigation. Two reviewers interpreted the dataset regarding the SP-ET index. This ratio was calculated as the distance between the most superior point of patella and the entrance of femoral trochlea (ß) divided by the patellar articular surface length (α). The relationship between the SP-ET index and CP was presented using independent samples T-tests, and the intraclass correlation coefficient (ICC) was calculated to reveal the interobserver differences. Results: There was excellent agreement between the reviewers regarding α, ß, and SP-ET values (ICC was 0.971, 0.964, and 0.943, respectively). Higher SP-ET values were obtained for patients with CP, in comparison with patients without any chondral lesion (p < 0.001). A significant, positive, and moderate level of correlation was revealed between SP-ET measurements and CP grades for the total study population. Conclusions: SP-ET index showed high interobserver agreement and indicated a significant difference between patients with and without CP. Both reviewers' results indicated positive and significant correlation between the measured SP-ET values and different grades of CP for females, males, and the total study population.

Examination of ethmoidal roof regarding Keros and Yenigun classifications in a Turkish population: a computerized tomography study.

PURPOSE: Understanding ethmoid roof morphology is crucial to prevent complications in endoscopic sinus surgery. This study aimed to evaluate the morphological properties of the ethmoidal roof regarding gender and age differences using Keros and Yenigun classifications on high-resolution computed tomography images. METHODS: We retrospectively analyzed 891 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in coronal sections and the anterior-posterior length in axial planes. The study retrospectively examined CT images of paranasal sinuses of patients living in the eastern Anatolian region of Turkey. RESULTS: In both Keros and Yenigun Classifications, the most common class was type 2, and the least common class was type 3. According to Keros et al.'s method, no significant difference was observed between men and women (p = 0.698). However, according to Yenigun et al., the average values of women in terms of the anterior-posterior distance of the ethmoid roof were significantly higher than men (p = 0.001). When examined according to age, a very low, negative correlation was revealed regarding Keros and Yenigun classifications (p = 0.047 and p < 0.001 retrospectively). According to Keros and Yenigun's classification, there was no significant difference between the left and right sides (p = 0.488 and p = 0.919, respectively). CONCLUSION: The morphological properties of the ethmoidal roof have importance to be considered for preoperative planning. Studying larger patient groups and meta-analyses that gather various research results about this subject might help better understand the ethmoidal roof morphology among populations.

Correlation of Diffusion weighted MR Imaging and ADC values of hepatic metastasis of Gastrointestinal Stromal and Gastroenteropancreatic Neuroendocrine Tumors.

BACKGROUND: DWI and ADC-mapping was performed to analyze hepatic metastasis of GIST, GEP-NET. OBJECTIVE: The objective of this study is to present hepatic metastasis of GIST and GEP-NET with Diffusion weighted MR imaging(DWI) and the Apparent diffusion coefficients (ADC) values of masses. METHOD: 18 GIST patients and 8 GEP-NET patients were examined retrospectively. 11 males and 6 females were present in GIST group, 7 males to 5 females were involved in GEP-NET group. 18 primary GIST and 10 hepatic metastasis of GIST, 8 original GEP-NET and 19 hepatic metastasis of GEP-NET; total 55 GIST and GEP-NET masses were analysed by ADC mapping. MR images were acquired by 1,5 T MR units (32 mT/min gradient strength- Achieva; Philips Healthcare, Best, Netherlands and 32 channel GE Signa GE-Wisconsin-USA); by using a 4-8 channel standard phased-array torso XL coil, all images were evaluated by an Abdominal MRI experienced radiologist. DWI was performed in the transverse plane by using spin-echo-planar imaging sequence. RESULT: No statistical differences were observed between GIST and GEP-NET patients according to age and gender variations. No significant statistical differences were observed according to the diameters and ADC values of GIST and GEP-NET patients. A significant statistical difference was observed between GIST and GEP-NET groups in terms of size of liver metastasis which was significantly higher in GIST patients. All three groups (GIST_Hep. MET, GEP-NET_Liver_Met and normal) were statistically differed according to ADC values. With the ROC curve analysis: Hepatic metastasis of GIST(n=10) and normal liver (n:47) had cut-off value for ADC: 0.925 under AUC: 0.939 with regard to ADC values and regarded 89.4 % Sensitivity, 100% Specificity, 100% PPV and 66.7% PPV. ROC curve of GEP NET_ Hepatic metastasis (n=19) group and normal liver (n:47) group presented cut-off value for ADC: 0.860 under AUC: 0.967 correlated to ADC values with 93.6 % sensitivity, 89.5% specificity, 95.7% PPV and 85% PPV. CONCLUSION: High cellular tumors resulted from liver metastasis of GIST and GEP-NET's, and a positive correlation was observed between ADC values and cellularity/differentiation ratios of metastatic masses.

Association between the subcutaneous fat thickness of the knee and chondromalacia patella: a magnetic resonance imaging-based study.

OBJECTIVE: Subcutaneous fat tissue thickness (SFTT) is a representative marker of obesity. This study was performed to determine the relationship between SFTT and chondromalacia patella (CP) through routine 1.5-Tesla magnetic resonance imaging (MRI) of the knee. METHODS: In this retrospective cross-sectional study, 440 knee MRI scans were re-examined and divided into those with and without CP. A 1.5-Tesla MRI machine with a standard knee coil was used. Prepatellar SFTT (PSFTT) and medial SFTT (MSFTT) were measured on each MRI scan. PSFTT and MSFTT were compared between patients with and without CP. RESULTS: Both the PSFTT and MSFTT values were significantly higher in patients with than without CP. Women had significantly higher PSFTT and MSFTT values than men. A statistically significant correlation was found between the PSFTT and MSFTT values and the CP grades. CONCLUSIONS: The results of this study indicate an association between SFTT and CP. A positive correlation was also found between SFTT and CP severity.

Percutaneous management in hepatic alveolar echinococcosis: A sum of single center experiences and a brief overview of the literature.

BACKGROUND: Hepatic alveolar echinococcosis (HAE) is a serious zoonotic infection that affects humans. It may have a tumor-like appearance at times. Percutaneous treatment of HAE patients is extremely relaxing for them. HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae. It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period. The disease is endemic over central Europe, Asia, and North America. AIM: To characterize HAE patients who were treated percutaneously, their outcomes, and the major technical features of percutaneous treatment in HAE. METHODS: Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study. Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded. RESULTS: Thirty-two patients underwent percutaneous cyst drainage, two patients underwent percutaneous biliary drainage, and four patients underwent percutaneous biliary drainage alone. Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver, as well as diseased and clogged bile ducts. CONCLUSION: Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial. Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery, even when the mass resolves with long-term treatment.

Incidental findings on prostate MRI: a close look at the field of view in this anatomical region.

Magnetic resonance imaging (MRI) has been widely used as an advanced imaging modality to detect prostate cancer and indicate suspicious areas to guide biopsy procedures. The increasing number of prostate examinations with MRI has provided an opportunity to detect incidental lesions, and some might be very significant to elucidate patient symptoms or occult neoplastic process in the early stages. These incidental lesions might be located in the prostate gland, adjacent tissues, or organs around the prostate gland or out of the genitourinary system. The field of view of prostate MRI includes not only the prostate gland but also other critical pelvic organs in this specific anatomical region. Some of these incidental lesions might cause the same symptoms as prostate cancer and might explain the symptoms of the patient, and some might indicate early cancer stages located outside the prostate. Reporting these lesions might be life-saving by initiating early disease treatment. Awareness of the predicted locations of congenital anomalies would also be beneficial for the radiologists to mention these incidental findings.

The Role of Diffusion Weighted MR Imaging in the Diagnosis of Tendon Injuries of the Ankle and Foot.

Background and objectives: Our aim is to determine the diagnostic performance and utility of Diffusion Weighted MR Imaging (DWI) against the routine Magnetic Resonance Imaging (MRI) for the evaluation of patients with tendon injuries of the ankle and foot. Materials and Method: After institutional review board approval and informed consent taken from all the patients, ankle and foot MR imaging and DWI-Apparent Diffusion Coefficient (ADC) mapping were performed on the 81 injured tendons of 50 patients. All tendon injuries were named as Rupture (R), Partial tear (PT), and Tenosynovitis (T). Diagnostic interpretation was based on the MRI-DWI and ADC mapping, verified by either open surgery, diagnostic arthroscopy, or conservative procedures-splint application. Statistical analysis of this research was assessed by Fischer's exact test, variance analysis test between dependent groups, Receiver Operating Characteristics (ROC) curve, and Pearson chi square statistics. Results: MRI depicted all tendon injuries with 70% sensitivity and 100% specificity, and showed a significant statistical relationship to surgical and arthroscopic references with high agreement (p < 0.05, k: 0.609). DWI had 100% sensitivity and 83-90% specificity for the visualization of tendon injuries with certain agreement and a significant statistical relationship to the gold standard (p < 0.05, k: 0.890-0.899). For all those injured tendons, DWI had 100% sensitivity for the diagnosis of R, and 92-97% sensitivity corresponding to PT and T over routine ankle MR imaging. The specificity of DWI to MRI ranged from 75 to 44% for all the injured tendons. DWI had significant statistical superiority over MRI for the visualization of R, PT, and T of all tendons included in this research (p < 0.05). Conclusions: DWI is a good imaging modality for the visualization of ankles with tendon injuries, possibly further improving the sensitivity of the classical ankle and foot MRI, and supplying more beneficial and diagnostic information than routine MR imaging on the basis of R, PT, and T of tendons at the ankle and foot.

Relationship between Body Mass Index and Articular Injuries Accompanying Primary Anterior Cruciate Ligament Tear in Male Knees: A Retrospective Observational Study.

The objective of this study was to determine the effects of body mass index (BMI), as a modifiable risk factor, on meniscal, chondral, and ligamentous injuries, as well as on bone marrow edema accompanying anterior cruciate ligament (ACL) rupture. This retrospective observational study analyzed 84 male patients who underwent primary ACL reconstruction from 2015 to 2018. Magnetic resonance imaging was performed within 6 weeks of injury. Bone bruise, tendon, ligament, meniscal, and muscle injuries were evaluated. The surgery was performed within 3 months after the injury. Detailed arthroscopic findings (chondral, meniscal, and ligamentous injuries) were documented intraoperatively. The weight and height were used to quantify BMI (weight in kg/height in m2). Of the 84 male patients, 58 had associated articular injuries. The median age of the study population was 24 years (minimum: 17 years, maximum: 43 years) years. The mean BMI, height, and weight were 27.12 ± 0.78 kg/m2, 1.73 ± 0.01 m, and 81.17 ± 21.52 kg, respectively. The relationship between higher BMI and associated articular injuries (95% confidence interval [CI]) was statistically significant (p < 0.001). There was a statistically significant relationship between weight and associated articular injuries (p = 0.003). Height and age were not predictive factors. Higher BMI and weight were significant risk factors for associated articular injuries in the presence of ACL tear. Height was not found to be a predictive factor. Higher BMI was associated with increased risk of medial and/or lateral meniscus tears and bone bruising.

Analysis of the risk factors for anterior cruciate ligament injury: an investigation of structural tendencies.

OBJECTIVE: The aim of this study was to determine the most important anatomical risk factors for injury of the anterior cruciate ligament (ACL) of the knee. MATERIALS AND METHODS: After study approval by our institutional ethics committee, 3 radiologists reinterpreted the preoperative magnetic resonance (MR) images of 86 patients who had undergone surgery for ACL rupture. The measurements were compared with those for a control group comprising 109 patients with intact ACL who had undergone MR examinations for other reasons, such as meniscal injuries or Baker cyst ruptures. Interobserver differences were calculated after measurement of the notch width (NW), NW index (NWI), medial condyle width (MCW), lateral condyle width (LCW), MCW/LCW ratios, alpha (α) angle, NW angle, quadriceps angle (Q angle), posterior medial tibial slope (MTS), posterior lateral tibial slope, coronal tibial slope, and depth of medial tibial plateau for each group. The relationships between these parameters and ACL injury were studied by performing logistic regression and receiver operating characteristic curve analyses in comparison with those in the control group. RESULTS: We found that there were significant differences in the anatomical parameters of the NW, MCW, NWI, α angle, and MTS between the ACL injured and noninjured groups (p<0.05). There were also significant differences in the bicondylar width, α angle, Q angle, and MTS between the patients with ACL rupture because of noncontact injuries and the control group (p<0.05). The NWI and MTS had the highest predicted relative risk for both the male and female groups. CONCLUSION: We found that the NW, NWI, and MTS were the most important parameters in risk assessment of ACL injuries.

Diffusion weighted magnetic resonance imaging in the diagnosis of parotid masses. Preliminary results.

OBJECTIVE: To demonstrate the diagnostic potentials of MRI, diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) mapping in the detection of parotid masses correlated to the histopathological results. Methods: Study design was retrospective. Fifteen patients with parotid gland masses were included as the study group and contralateral normal parotis glands of same patients were taken as the control group. Patients with bilateral parotid gland tumors were excluded, 7 right-sided and 8 left-sided parotid masses were included in the research. The study took place at the Department of Radiology, Ankara, Turkey, between May 2012 and September 2014. Results: Apparent diffusion coefficient measurements of 15 parotis tumors in 1000 and 750 sec/mm2 b-values with comparison to the contralateral normal gland  parenchyma were demonstrated. Neurofibromas was predicted as the highest, and lipomas as the lowest ADC values. Pleomorphic adenomas, Warthin's tumor, and normal parotid parenchyma indicate significant statistical differences from each other on the basis of mean ADC values (p less than 0.05). Conclusion: The DWI and ADC mapping of parotis gland could aid in the differential diagnosis  of benign and malignant masses.

Overview of current multiparametric magnetic resonance imaging approach in the diagnosis and staging of prostate cancer.

This article is primarily based on the utility and validity of multiparametric magnetic resonance imaging in the diagnosis and staging of prostate gland tumors. Multiparametric magnetic resonance imaging is an emerging, useful approach for evaluating and detecting prostate cancers. It also aids in the management of a tumor and improve the care and follow-up of patients.

The role of proton MR spectroscopy and apparent diffusion coefficient values in the diagnosis of malignant thyroid nodules: preliminary results.

PURPOSE: Performance of proton magnetic resonance spectroscopy (H-MRS) and apparent diffusion coefficient (ADC) values in the diagnosis of malignant thyroid nodules. METHOD: In a retrospective study with malignant nodules of 14 patients, H-MRS and diffusion-weighted MR imaging (DWI) were performed. Choline (Cho) peak, Cho/creatine (Cr) ratio, and ADC values of malignant nodules were correlated with the five benign nodules and four normal-appearing thyroid lobe parenchymata. The gold standard reference was fine needle aspiration biopsy and histopathology. RESULTS: At echo time 40-144-ms acquisitions, average Cho/Cr ratio for the malignant nodules was 2.95±1.54-5.30±2.38, cutoff values were >0.805 and >1.225, and ADC values were 0.06±0.02. CONCLUSION: H-MRS acquisitions, DWI, and ADC mapping give diagnostic data about the nature of the nodules.

Detection of prostate cancer with magnetic resonance imaging: optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging apparent diffusion coefficient mapping sequences and MR spectroscopy, correlated with biopsy and histopathological findings.

PURPOSE: The aim of this study was to optimize and predict the most efficient magnetic resonance imaging (MRI) sequences; T1-weighted (T1W), T2-weighted (T2W), dynamic contrast-enhanced (DCE) T1W, diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) mapping sequences and proton MR spectroscopy (H-MRS) for the detection of prostate cancer. MATERIALS AND METHODS: After institutional review board approval and informed consent taken from all the patients, 40 patients with prostate cancer were included in this research. Two readers independently evaluated the results of T1W, T2W, DCE T1W, and DWI-ADC mapping sequences and proton H-MRS for the depiction of prostate cancer. Reference standard was the transrectal ultrasonography-guided biopsy and the surgical histopathological results. Statistical analysis was assessed by the Fisher exact t test, Wilcoxon signed rank test, variance analysis test with kappa (κ) values and receiver operating characteristics (ROC) curve for ADC values, choline (Cho)/citrate (Cit) and Cho+creatine (Cre)/Cit ratios for each observer. RESULTS: Based on both readers' results, sensitivity declined to 31% and specificity to 75% for the T1W sequence, sensitivity declined to 43% and specificity to 67% for the DCE T1W sequence, sensitivity declined to 46% and specificity to 68% for the T2W sequence, sensitivity declined to 29% and specificity to 82% for the DWI-ADC mapping; and specificity was 49% for the Cho/Cit and Cho+Cre/Cit ratios, sensitivity was 69% for the Cho/Cit ratio, and sensitivity was 70% for the Cho+Cre/Cit ratio for H-MRS. The T2W sequence and H-MRS presented significant statistical differences for the depiction of prostatic cancer (P < 0.05), the most efficient sequence to detect prostatic cancer was H-MRS: Cho+Cre/Cit and Cho/Cit ratios. CONCLUSION: Instead of using either sequences alone owing to low sensitivity and specificity rates, combined use of MRI techniques could easily improve the detection and staging of prostate cancer.