Patellar height: an important parameter in knee MRI associated with tendinopathy, quadriceps fat pad edema (QFPE), anterior cruciate ligament mucoid degeneration (ACL-MD), and lateral cartilage damage.

BACKGROUND: Some pathologies associated with abnormal patellar height have been reported in the literature. However, its relationship with some pathologies, such as anterior cruciate ligament mucoid degeneration (ACL-MD) and focal cartilage defect, has not been investigated. PURPOSE: To investigate the relationship between patellar height with patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. MATERIAL AND METHODS: Magnetic resonance imaging of the knees of 261 patients were classified into three groups as normal, patella alta, and patella baja, and evaluated in terms of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. RESULTS: There were 261 patients (140 men, 121 women; age range = 18-60 years; mean age = 30 ± 4.7 years). Of the 261 patients, 181 (69.3%) were normal, 56 (21.4%) were patella alta, and 24 were patella baja (9.1%). Patellar-quadriceps tendinopathy, quadriceps fat pad edema, and ACL-MD rates were significantly higher compared to the normal group (P <0.05). While a moderate positive correlation was found between patellar height shift and patellar-quadriceps tendinopathy and ACL-MD, there was a small correlation between patellar height shift and quadriceps fat pad edema. The rate of focal cartilage defect was significantly higher in the middle part of the lateral femoral condyle and lateral knee joint only in patella alta. CONCLUSION: The risk of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and lateral focal cartilage defect is higher in patients with alta-baja. The radiologist should evaluate these pathologies more carefully, especially subtle ones, in patients with abnormal patellar height.

Advanced cerebrospinal fluid flow MRI findings of aqueductal stenosis caused by web.

BACKGROUND: The aqueductal web (AW) is one of the causes of aqueductus stenosis (AS). Recent advances in Magnetic resonance (MR) imaging have enabled us to better reveal the cerebrospinal fluid (CSF) flow dynamics and aqueductal anatomy. PURPOSE: The aim of this study is to evaluate the CSF flow dynamics of patients with AW with phase contrast Magnetic resonance imaging (MRI) and compare them with the imaging findings. MATERIALS AND METHODS: We evaluated 23 patients under 65-year-old age. On constructive interference in steady-state (T2 CISS) images, the width of prepontine cistern (PPC) and the width of Sylvian aqueduct (SA) were measured. Localization and number of webs were evaluated. The existence of flow at the aqueduct and the presence of spontaneous third ventriculostomy (STV) were evaluated on sagittal Sampling Perfection with Application optimized Contrast (SPACE) sequences. RESULTS: Of the 23 patients included in the study, 11 were male and 12 were female. The mean age was 34.02 (0.5-64). A total of 31 AWs were detected in 23 patients. Six of 23 patients (26.1%) had STV and 17 of those not. Four of 23 patients (17.4%) had aqueductal flow on SPACE sequences. The PPC distance was significantly wider in patients with STV (median: 6.7-4.5, interquartile range (IQR): 1.35, p = 0.004). In the cases where artifact secondary to flow is observed in SPACE sequences in aqueduct, the Evan index (EI) was significantly lower (median: 0.2955-0.3900, IQR: 0.03-0.14, p < 0.001). CONCLUSION: In patients with a low EI, there may be flow in the SA even if there is a web. In patients with a wide PPC distance, it is necessary to consider the presence of STV and evaluate the presence of flow with the SPACE sequences.

Differentiation of lung and breast cancer brain metastases: Comparison of texture analysis and deep convolutional neural networks.

PURPOSE: Metastases are the most common neoplasm in the adult brain. In order to initiate the treatment, an extensive diagnostic workup is usually required. Radiomics is a discipline aimed at transforming visual data in radiological images into reliable diagnostic information. We aimed to examine the capability of deep learning methods to classify the origin of metastatic lesions in brain MRIs and compare the deep Convolutional Neural Network (CNN) methods with image texture based features. METHODS: One hundred forty three patients with 157 metastatic brain tumors were included in the study. The statistical and texture based image features were extracted from metastatic tumors after manual segmentation process. Three powerful pre-trained CNN architectures and the texture-based features on both 2D and 3D tumor images were used to differentiate lung and breast metastases. Ten-fold cross-validation was used for evaluation. Accuracy, precision, recall, and area under curve (AUC) metrics were calculated to analyze the diagnostic performance. RESULTS: The texture-based image features on 3D volumes achieved better discrimination results than 2D image features. The overall performance of CNN architectures with 3D inputs was higher than the texture-based features. Xception architecture, with 3D volumes as input, yielded the highest accuracy (0.85) while the AUC value was 0.84. The AUC values of VGG19 and the InceptionV3 architectures were 0.82 and 0.81, respectively. CONCLUSION: CNNs achieved superior diagnostic performance in differentiating brain metastases from lung and breast malignancies than texture-based image features. Differentiation using 3D volumes as input exhibited a higher success rate than 2D sagittal images.

Radiological evaluation of maxillary artery and descending palatine artery in the pterygopalatine fossa by 3D rotational angiography.

PURPOSE: The aim of this study is to evaluate the branching patterns and topographical features of the third part of the maxillary artery (t-MA) and descending palatine artery (DPA) by 3-Dimensional Rotational Angiography (3DRA) images and to define the radiological classification of their variations, based upon the previous cadaveric studies and a review of the literature. METHOD: This study was conducted from May 2020 through June 2021. All consecutive adult patients who were examined with 3D-RA were enrolled in the study. The morphological evaluations and measurements of t-MA, DPA and their branches were made on maximum intensity projection images with 10-20 mm slice thickness. RESULTS: Eighty-five hemifaces, including 58 females and 45 right sides, were evaluated. The diameter of the t-MA was measured as 1.73 ± 0.30 mm. The most common pattern of the t-MA according to its course was loop type (63/85, 74.1%) and according to branching pattern was Type Ib (29/85, 34.1%). The mean diameter of DPA was 1.19 ± 0.20 mm. The DPA presented as a single trunk in 11/85 cases. Type II, which was defined as one lesser palatine artery originating from distal-DPA, was the most common morphological variation (51.8%). CONCLUSIONS: 3DRA imaging provides valuable information for vascular anatomical studies. The most common morphological variation related to t-MA, DPA is the distal branching pattern.

Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension.

PURPOSE: To search for CSF dynamics of idiopathic intracranial hypertension (IIH) and communicating hydrocephalus and any correlation between MRI findings, CSF metrics and CSF opening pressure in IIH. MATERIALS AND METHODS: Healthy subjects (30) and subjects with IIH (29) and high-pressure communicating hydrocephalus (43) were enrolled. Nonparametric Kruskal-Wallis test (p = 0.05) was used to compare three groups, Mann-Whitney U test with Bonferroni correction to compare two groups (p = 0.016). Correlation of MRI findings of IIH with CSF metrics and CSF opening pressure was analyzed by Spearman's Rank correlation coefficient (p = 0.05). RESULTS: In IIH, no correlation between MRI findings and aqueductal stroke volume (ASV) but statistically significantly CSF opening pressure in the presence of transverse sinus compression was noted. Comparing with healthy subjects, ASV was nonsignificantly lower and standardized diastolic and sum and difference of systolic and diastolic flow durations were statistically significantly lower. Comparing with hydrocephalus, the width of prepontine cistern (PPC)/the width of aqueductus sylvii (AS) was significantly higher and other CSF metrics with standardized systolic and sum of systolic and diastolic flow durations were significantly lower. In hydrocephalus, ASV and peak velocities were significantly higher. Compared with normal group, PPC/AS and reverse/forward flow duration were significantly lower and other CSF metrics were significantly higher. CONCLUSION: In hydrocephalus, significant increase in ASV and peak velocities were noted. In IIH, CSF opening pressure was statistically significantly high in the presence of transverse sinus compression and standardized diastolic flow durations were statistically significantly short that are probably effects of increased impedance of CSF flow against increased intracranial pressure and unchanged or even decreased intraventricular CSF volume.

Genomic rearrangements and signatures of breeding in the allo-octoploid strawberry as revealed through an allele dose based SSR linkage map.

BACKGROUND: Breeders in the allo-octoploid strawberry currently make little use of molecular marker tools. As a first step of a QTL discovery project on fruit quality traits and resistance to soil-borne pathogens such as Phytophthora cactorum and Verticillium we built a genome-wide SSR linkage map for the cross Holiday x Korona. We used the previously published MADCE method to obtain full haplotype information for both of the parental cultivars, facilitating in-depth studies on their genomic organisation. RESULTS: The linkage map incorporates 508 segregating loci and represents each of the 28 chromosome pairs of octoploid strawberry, spanning an estimated length of 2050 cM. The sub-genomes are denoted according to their sequence divergence from F. vesca as revealed by marker performance. The map revealed high overall synteny between the sub-genomes, but also revealed two large inversions on LG2C and LG2D, of which the latter was confirmed using a separate mapping population. We discovered interesting breeding features within the parental cultivars by in-depth analysis of our haplotype data. The linkage map-derived homozygosity level of Holiday was similar to the pedigree-derived inbreeding level (33% and 29%, respectively). For Korona we found that the observed homozygosity level was over three times higher than expected from the pedigree (13% versus 3.6%). This could indicate selection pressure on genes that have favourable effects in homozygous states. The level of kinship between Holiday and Korona derived from our linkage map was 2.5 times higher than the pedigree-derived value. This large difference could be evidence of selection pressure enacted by strawberry breeders towards specific haplotypes. CONCLUSION: The obtained SSR linkage map provides a good base for QTL discovery. It also provides the first biologically relevant basis for the discernment and notation of sub-genomes. For the first time, we revealed genomic rearrangements that were verified in a separate mapping population. We believe that haplotype information will become increasingly important in identifying marker-trait relationships and regions that are under selection pressure within breeding material. Our attempt at providing a biological basis for the discernment of sub-genomes warrants follow-up studies to streamline the naming of the sub-genomes among different octoploid strawberry maps.

MRI findings in crural compartment syndrome: a case series.

Compartment syndrome occurs when the pressure inside a closed fascial compartment increases to a level that compromises the blood supply to the structures. Untreated compartment syndrome commonly leads to muscle necrosis, limb amputation, and, if it is severe, which is seen in large compartments, renal failure and death may occur. We discussed MRI findings of crural compartment syndrome based on the case series.

The significance of finerenone as a novel therapeutic option in diabetic kidney disease: a scoping review with emphasis on cardiorenal outcomes of the finerenone phase 3 trials.

This scoping review prepared by endocrinology and nephrology experts aimed to address the significance of finerenone, as a novel therapeutic option, in diabetic kidney disease (DKD), based on the biological prospect of cardiorenal benefit due to non-steroidal mineralocorticoid receptor antagonist (MRA) properties, and the recent evidence from the finerenone phase 3 program clinical trials. The importance of finerenone in slowing DKD progression was critically reviewed in relation to the role of MR overactivation in the pathogenesis of cardiorenal disease and unmet needs in the current practice patterns. The efficacy and safety outcomes of finerenone phase III study program including FIDELIO-DKD, FIGARO-DKD and FIDELITY were presented. Specifically, perspectives on inclusion of patients with preserved estimated glomerular filtration rate (eGFR) or high albuminuria, concomitant use of sodium-glucose co-transporter-2 inhibitor (SGLT2i) or glucagon-like peptide 1 receptor agonist (GLP-1 RA), baseline glycated hemoglobin (HbA1c) level and insulin treatment, clinically meaningful heart failure outcomes and treatment-induced hyperkalemia were addressed. Finerenone has emerged as a new therapeutic agent that slows DKD progression, reduces albuminuria and risk of cardiovascular complications, regardless of the baseline HbA1c levels and concomitant treatments (SGLT2i, GLP-1 RA, or insulin) and with a favorable benefit-risk profile. The evolving data on the benefit of SGLT2is and non-steroidal MRAs in slowing or reducing cardiorenal risk seem to provide the opportunity to use these pillars of therapy in the management of DKD, after a long-period of treatment scarcity in this field. Along with recognition of the albuminuria as a powerful marker to detect those patients at high risk of cardiorenal disease, these important developments would likely to impact standard-of-care options in the setting of DKD.

Presence of Auditory Pathway Abnormalities in Children With Neurofibromatosis Type 1 With Brainstem Focal Areas of Abnormal Signal Intensity: Diffusion Tensor Imaging Features.

Background: To investigate whether there is a difference in mean diffusivity (MD) and fractional anisotropy (FA) values in the auditory pathways of neurofibromatosis type 1 patients with and without focal areas of abnormal signal intensity (FASI) compared to healthy controls by using diffusion tensor imaging (DTI). Methods: Patients were classified as group 1 with focal areas of abnormal signal intensity in the brainstem, group 2 without focal areas of abnormal signal intensity, and healthy control group 3 according to the MRI findings. Mean diffusivity and fractional anisotropy values of lateral lemniscus, inferior colliculus, corpus geniculatum mediale, Heschl gyrus, and brainstem were compared between groups. The correlation between mean diffusivity and fractional anisotropy values of auditory pathways and age was investigated. Results: There was a significant difference between group 1 and group 2 in terms of mean diffusivity and fractional anisotropy values at lateral lemniscus, inferior colliculus, corpus geniculatum mediale, and Heschl gyrus. Increased mean diffusivity and decreased fractional anisotropy values at brainstem were found in group 1. There was a significant difference between group 1 and group 3 in terms of mean diffusivity values at all auditory pathways. Fractional anisotropy values obtained from lateral lemniscus, inferior colliculus, and Heschl gyrus decreased in group 1 compared with group 3. There was a negative correlation between mean diffusivity values and positive correlation between fractional anisotropy values at lateral lemniscus, inferior colliculus, Heschl gyrus, and age. Conclusions: Our diffusion tensor imaging findings show that the neuronal integrity of the auditory pathways is affected in neurofibromatosis type 1 patients with brainstem focal areas of abnormal signal intensity. We think that the disappearance of brainstem focal areas of abnormal signal intensity associated with myelin repair and the regression of diffusion tensor imaging changes in the auditory pathways occur simultaneously with advancing age in patients with neurofibromatosis type 1.

Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults.

There is concern about an emerging diabetes epidemic in Turkey. We aimed to determine the prevalence of diagnosed and undiagnosed diabetes, prediabetes and their 12-year trends and to identify risk factors for diabetes in the adult Turkish population. A cross-sectional, population-based survey, 'TURDEP-II' included 26,499 randomly sampled adults aged ≥ 20 years (response rate: 87 %). Fasting glucose and biochemical parameters were measured in all; then a OGTT was performed to identify diabetes and prediabetes in eligible participants. The prevalence of diabetes was 16.5 % (new 7.5 %), translating to 6.5 million adults with diabetes in Turkey. It was higher in women than men (p = 0.008). The age-standardized prevalence to the TURDEP-I population (performed in 1997-98) was 13.7 % (if same diagnostic definition was applied diabetes prevalence is calculated 11.4 %). The prevalence of isolated-IFG and impaired glucose tolerance (IGT), and combined prediabetes was 14.7, 7.9, and 8.2 %, respectively; and that of obesity 36 % and hypertension 31.4 %. Compared to TURDEP-I; the rate of increase for diabetes: 90 %, IGT: 106 %, obesity: 40 % and central obesity: 35 %, but hypertension decreased by 11 % during the last 12 years. In women age, waist, body mass index (BMI), hypertension, low education, and living environment; in men age, BMI, and hypertension were independently associated with an increased prevalence of diabetes. In women current smoking, and in men being single were associated with a reduced risk. These results from one of the largest nationally representative surveys carried out so far show that diabetes has rapidly become a major public health challenge in Turkey. The figures are alarming and underscore the urgent need for national programs to prevent diabetes, to manage the illness and thus prevent complications.

Radiological evaluation of middle meningeal artery by 3D rotational angiography.

PURPOSE: This study aimed to evaluate the topographic features and branches of the middle meningeal artery (MMA) by three-dimensional rotational angiography (3DRA) and describe its variations' radiological classification based on previous clinical examples of cadaver studies and literature. METHODS: We consecutively evaluated 87 cerebral hemispheres, including 32 females and 49 right sides between May 2020 and December 2021 who had undergone unilateral or bilateral cerebral and carotid artery 3D rotational angiography imaging by CCA injection and between 18 and 76-years-old. Maximum intensity projection images with 10-30 mm slice thickness were used for the morphological evaluations and measurements of MMA and its foramen, canal, and branches. RESULTS: The diameters of the common carotid artery, internal carotid artery, and external carotid artery were significantly smaller in females than in men (p = 0.021, 0.021, and <0.001, respectively). According to the branching pattern, the most common pattern of the MMA was Type Ia (49.4%). The ophthalmic artery completely originated from MMA in the 1 (1.1%) cerebral hemisphere. The MMA arises from the ophthalmic artery in 2 cerebral hemispheres (2.3%), and the ophthalmic artery and maxillary artery in 2 cerebral hemispheres (2.3%). CONCLUSION: It was observed that the branching pattern may show differences when compared to the cadaver studies with a radiologic evaluation with 3D-RA.

Evaluation of toxic effects of chemotherapy in lung malignancies on cerebral white matter using diffusion tensor imaging.

BACKGROUND: Non-small cell lung cancer (NSCLC) is a leading cause of morbidity and mortality. Carboplatin and cisplatin based regimens are used in the treatment of NSCLC. The aim of the study was to find out whether there is a difference in white matter (WM) changes between two platinum-based chemotherapy agents using diffusion tensor imaging (DTI). PATIENTS AND METHODS: 25 patients who received chemotherapy for NSCLC and 27 age-matched healthy controls were enrolled in the study. Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD) values of the study population were measured from 11 regions of interest in pre-chemotherapy and post-chemotherapy MRI data. RESULTS: Cisplatin group showed a significant decrease in the FA of the inferior longitudinal fasciculus (P = 0.028). Carboplatin group showed a significant FA decrease and RD increase in the forceps minor (P = 0.022 and P = 0.011, respectively), and a significant reduction in AD and increase in MD in frontal white matter (WM) (P = 0.008 and P = 0.029, respectively). In comparison of post chemotherapy DTI values of the two groups, carboplatin group showed lower FA, and higher MD and RD values than cisplatin group in parieto-occipital WM (P = 0.034, P = 0.034, P = 0.029, respectively). CONCLUSIONS: The findings of the study suggest that subtle effects of chemotherapy detectable with DTI may emerge after the treatment. In addition, carboplatin regimen may have more impact on WM than cisplatin regimen.

Papillary Lesions of the Breast: Addition of DWI and TIRM Sequences to Routine Breast MRI Could Help in Differentiation Benign from Malignant.

AIM: We aimed to investigate the magnetic resonance imaging (MRI) features of benign, atypical, or malignant papillary breast lesions and to assess the additional value of diffusion-weighted imaging (DWI) and turbo inversion recovery magnitude (TIRM) sequences to routine breast MRI. BACKGROUND: Differentiation between benign and malignant papillary breast lesions is essential for patient management. However, morphologic features and enhancement patterns of malignant papillary lesions may overlap with those of benign papilloma. METHODS: Seventy-two papillary breast lesions (50 benign, 22 atypical or malignant) were included in the current study, retrospectively. We divided the patients into two groups: benign papillary breast lesions and atypical or malignant papillary breast lesions. Morphologic, dynamic, turbo inversion recovery magnitude (TIRM) values and diffusion features of the papillary lesions were compared between two groups. RESULTS: Benign papillary lesions were smaller in size (p=0.006 and p=0.005, for radiologists 1 and 2 respectively), closer to the areola (p=0.045 and 0.049 for radiologist 1 and 2 respectively), and had higher ADC values (p=0.001 for two radiologists) than the atypical or malignant group. ROC curves showed diagnostic accuracy for ADC (AUC=0.770 and 0.762, p = 0.0001 for two radiologists), and showed a cut-off value of ≤ 957 x 10-6 mm2/s (radiologist 1) and ≤ 910 x 10-6 mm2/s (radiologist 2). CONCLUSION: MRI is a useful method for differentiation between benign and malignant papillary breast lesions. Centrally located, lesser in size, and higher ADC values should be considered benign, whereas peripherally located, larger in size, and lower ADC values should be considered malignant.

Diffusion Tensor Imaging Can Discriminate the Primary Cell Type of Intracranial Metastases for Patients with Lung Cancer.

PURPOSE: Histopathological differentiation of primary lung cancer is clinically important. We aimed to investigate whether diffusion tensor imaging (DTI) parameters of metastatic brain lesions could predict the histopathological types of the primary lung cancer. METHODS: In total, 53 patients with 98 solid metastatic brain lesions of lung cancer were included. Lung tumors were subgrouped as non-small cell carcinoma (NSCLC) (n = 34) and small cell carcinoma (SCLC) (n = 19). Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) values were calculated from solid enhanced part of the brain metastases. The association between FA and ADC values and histopathological subtype of the primary tumor was investigated. RESULTS: The mean ADC and FA values obtained from the solid part of the brain metastases of SCLC were significantly lower than the NSCLC metastases (P < 0.001 and P = 0.003, respectively). ROC curve analysis showed diagnostic performance for mean ADC values (AUC=0.889, P = < 0.001) and FA values (AUC = 0.677, P = 0.002). Cut-off value of > 0.909 × 10-3 mm2/s for mean ADC (Sensitivity = 80.3, Specificity = 83.8, PPV = 89.1, NPV = 72.1) and > 0.139 for FA values (Sensitivity = 80.3, Specificity = 54.1, PPV = 74.2, NPV= 62.5) revealed in differentiating NSCLC from NSCLC. CONCLUSION: DTI parameters of brain metastasis can discriminate SCLC and NSCLC. ADC and FA values of metastatic brain lesions due to the lung cancer may be an important tool to differentiate histopathological subgroups. DTI may guide clinicians for the management of intracranial metastatic lesions of lung cancer.

A Rare Complication of Microwave Ablation for Renal Cell Carcinoma; Nephrocolic Fistula.

INTRODUCTION: Nephrocolic fistula is a pathological connection between the kidney and colon. Percutaneous tumour ablation therapy is a rare cause of iatrogenic nephrocolic fistulain in the literature. CASE PRESENTATION: Interventional radiologist should be careful especially in patients with repeated ablation. Granulation tissue may lead to unexpected results secondary to tissue fragility and impedance changes. CONCLUSION: In addition, we should keep in mind that there is decreasing hydrodissection benefit in cases with previous ablation. As far as we know, this is the first case report of an iatrogenic ephrocolic fistula after microwave ablation for recurrence renal cell carcinoma.

Expert Panel Recommendations for Use of Standardized Glucose Reporting System Based on Standardized Glucometrics Plus Visual Ambulatory Glucose Profile (AGP) Data in Clinical Practice.

This expert panel of diabetes specialists aimed to provide guidance to healthcare providers on the best practice in the use of innovative continuous glucose monitoring (CGM) techniques through a practical and implementable document that specifically addresses the rationale for and also analysis and interpretation of the new standardized glucose reporting system based on standardized CGM metrics and visual ambulatory glucose profile (AGP) data. This guidance document presents recommendations and a useful algorithm for the use of a standardized glucose reporting system in the routine diabetes care setting.

Avascular Necrosis of Humeral Trochlea: A Case Report of the Rare Condition.

INTRODUCTION: Avascular necrosis of humeral trochlea is a very rare condition and was described by Hegemann in 1957. We reported two cases of avascular necrosis of humeral trochlea and also performed a literature review of the reported cases. We expect that this case report will assist clinicians in making a timely diagnosis when encountering similar clinical scenarios. MATERIALS AND METHODS: We presented cases of an 11-year-old and a 14-year-old with avascular necrosis of the humeral trochlea. The common etiology was idiopathic because there were no recent trauma history and sports activity. Also, there was no history of drug use. We discussed the clinical and radiological findings of these cases. RESULTS: These cases, two teenage boys, were diagnosed withHegemann's disease with clinical and radiological outcomes. We found that the etiology of both thecases is idiopathic;. The number of previously reported cases in the literature is limited to 64. In our study, there was a lateral crest in one of our two cases and a posteromedial involvement in another. The radiograph of trochleae of these two cases showed irregularity and granular appearance. In our case, heterogeneous signal changed and irregularities were accompanied by hypointensive changes on T1-weighted images. Also, hyperintensive changes on proton density sequences were detected. CONCLUSION: Radiological evaluation plays an important role in the diagnosis and evaluation of response to treatment in avascular necrosis of the humeral trochlea. Avascular necrosis should be one of the differential lesions involving the trochlea. Recognition of avascular necrosis in the trochlea may prevent the unnecessary biopsy.

Diagnostic performance of apparent diffusion coefficient values for the differentiation of intrahepatic cholangiocarcinoma from gastrointestinal adenocarcinoma liver metastases.

BACKGROUND: We aimed to investigate whether there is a difference between intrahepatic cholangiocarcinoma (IHCC) and liver metastases of gastrointestinal system (GIS) adenocarcinoma in terms of apparent diffusion coefficient (ADC) values. PATIENTS AND METHODS: From January 2018 to January 2020, we retrospectively examined 64 consecutive patients with liver metastases due to gastrointestinal system adenocarcinomas and 13 consecutive IHCC in our hospital's medical records. After exclusions, fifty-three patients with 53 liver metastases and 10 IHCC were included in our study. We divided the patients into two groups as IHCC and liver metastases of GIS adenocarcinoma. For mean apparent diffusion coefficient (ADCmean) values, the region of interests (ROI) was placed in solid portions of the lesions. ADCmean values of groups were compared. RESULTS: The mean age of IHCC group was 62.50 ± 13.49 and mean age of metastases group was 61.15 ± 9.18. ADCmean values were significantly higher in the IHCC group compared to the metastatic group (p < 0.001). ROC curves method showed high diagnostic accuracy (AUC = 0.879) with cut-off value of < 1178 x 10-6 mm2/s for ADCmean (Sensitivity = 90.57, Specificity = 70.0, positive predictive value [PPV] = 94.1, negative predictive value [NPV] = 58.3) in differentiating adenocarcinoma metastases from IHCC. CONCLUSIONS: The present study results suggest that ADC values have a potential role for differentiation between IHCC and GIS adenocarcinoma liver metastases which may be valuable for patient management.

Relationship with Programmed Cell Death Ligand 1 (PD-L1) and DTI Features in Brain Metastases of Non-small Cell Lung Cancer: A Preliminary Study.

OBJECTIVE: The purpose of the study was to determine DTI properties of brain metastases in subjects with Non-Small Cell Lung Carcinoma (NSCLC) to evaluate whether there was a correlation between DTI findings and Programmed Cell Death Ligand-1 (PD-L1). METHODS: The study population (n:22) was assigned to PD-L1 negative (Group 1: PD-L1 expression<% 50) (n=11) or positive (Group 2: PD-L1 expression ≥%50) (n=11). We compared ADC and FA values measured from the enhanced solid metastases and peritumoral edema area with PD-L1 protein status. RESULTS: The mean ADC values were lower in group 2 compared to group 1. The peritumoral ADC values were higher in group 2 compared to group 1. Mean peritumoral edema FA values were lower in group 2 compared to group 1. The peritumoral edema nADC values were higher in group 2 compared to group 1. As PD-L1 expression frequency increased, ADC values in the peritumoral edema area increased and FA values decreased. CONCLUSION: We thought that the existence of PD-L1 protein does not affect ADC and FA values of brain metastasis (BM) originating from NSCLC. DTI characteristics of the peritumoral edema area could be a guide in determining the PD-L1 protein status of brain metastases of NSCLC. The relationship between PD-L1 expression status and DTI features in BM from NSCLC could help us to have an idea regarding the response to immunotherapy.