Evaluation of qualitative and quantitative imaging features of hepatic hemangiomas with and without pseudo-washout sign on gadoxetic acid-enhanced MRI: a descriptive and comparative study.

BACKGROUND: Hepatic hemangiomas are the most common benign liver tumors. It is important to know the imaging features of hemangiomas on gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI). PURPOSE: To evaluate the qualitative and quantitative imaging features of hemangiomas on GA-enhanced MRI, and to compare imaging features of hemangiomas with and without pseudo-washout sign (PWS). MATERIAL AND METHODS: We retrospectively included 93 cases of hemangioma that underwent GA-enhanced MRI. The presence of an enhancement pattern in the arterial phase (AP) and PWSs in the transitional phase (TP) were evaluated. Signal-to-norm ratios (SINorm) of hemangiomas, liver parenchyma, and portal vein (PV) as well as contrast-to-norm ratio (CNorm) were assessed. Additionally, hemangiomas with and without PWSs were defined as two separate subgroups, and imaging features were compared. RESULTS: Of the 93 cases of hemangiomas, 49 (52.6%) had PWSs in the TP. The mean SINorms of hemangiomas showed the highest value in the AP (P < 0.05). The mean CNorms showed positive values in the AP, and gradually decreased (P < 0.05). Hemangiomas with PWSs were significantly rapidly enhanced and smaller in size (P < 0.05), and the mean SINorms was lower in the TP (P = 0.023). While the mean CNorms showed a significant difference in the AP between subgroups (P < 0.001), the enhancement pattern was equal to that of the PV. CONCLUSION: When evaluating GA-enhanced MRI, radiologists should utilize quantitative measures in addition to qualitative assessment and should be aware that SI matching with PV in all phases can be a distinguishing finding in the diagnosis of hemangioma.

Diagnostic accuracy and validity of the O-RADS MRI score based on a simplified MRI protocol: a single tertiary center retrospective study.

BACKGROUND: Adnexal masses (AM) are a common gynecological problem. It is important to use a reliable imaging method in the differentiation of benign and malignant AMs. PURPOSE: To assess the accuracy and validity of the O-RADS magnetic resonance imaging (MRI) score for characterizing AM using a simplified MRI protocol. MATERIAL AND METHODS: The study population comprised 332 women who underwent MRI due to the detection of indeterminate AM on ultrasonography between January 2018 and June 2020. An experienced radiologist calculated the O-RADS MRI score into five categories, using an MRI protocol with a simplified dynamic study. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >24 months of follow-up. RESULTS: Of 237 AMs, 28 (11.9%) were malignant. The malignancy rates of AMs with scores of 1, 2, 3, 4, and 5 were 0% (0/12), 0% (0/111), 1.2% (1/77), 50% (10/20), and 100% (17/17), respectively. The O-RADS MRI score showed 96.3% sensitivity, 95.2% specificity, and 95.3% accuracy in malignancy prediction. The AUC for the differentiation of benign and malignant masses were 0.983. False positivity rate was high in cases with an O-RADS MRI score of 4 (50%). CONCLUSION: The O-RADS MRI score, based on a simplified MRI protocol, has high accuracy and validity in distinguishing benign from malignant sonographically indeterminate AMs. Its use in clinical practice can classify the malignancy risks of masses and prevent unnecessary surgery in benign lesions.

Effects of acetylsalicylic acid and ultrasound elastography on testicular torsion in rats.

Background/aim: To investigate the effects of acetylsalicylic acid (ASA) and the use of ultrasound elastography on testicular torsion. Materials and methods: Herein, 6 equal groups of rats were formed (n: 48): control group, sham group, torsion/detorsion (T/D)-1 h group, T/D-1 h + ASA group, T/D-8 h group, and T/D-8 h + ASA group. Testicular torsion was created by rotating the left testis 720° clockwise. At 30 min before torsion, 100 mg/kg of ASA was injected intraperitoneally. Elastography was performed at 8 and 24 h. After orchiectomy, specimens were collected for histopathological evaluation. Results: When comparing the left testicular volume (LV) parameters obtained from the elastography applied at 8 h, significant differences were observed between the following group pairs: the sham and T/D-8 h groups, T/D-1 h and T/D-8 h groups, and T/D-1 h + ASA and T/D-8 h groups (p = 0.004, p = 0.023, and p = 0.026, respectively). The mean LVS (velocity) (stiffness assessment) of the groups was similar at 8 h. When comparing the LV parameters at 24 h, significant differences were found between the T/D-1 h and T/D-8 h groups and between the T/D-8 h and T/D-8 h + ASA groups (p = 0.008 and p = 0.004, respectively). For the LVS mean values at 24 h, significant differences were found between the control and sham groups, sham and T/D-1 h groups, sham and T/D-8 h groups, and sham and T/D-8 h + ASA groups (p = 0.009, p = 0.021, p = 0.027, and p = 0.009, respectively).Histopathological evaluation showed a decrease in the morphological grades and an increase in the mean testicular injury scores in the T/D-1 h + ASA group compared to the T/D-1 h group. The T/D-8 h + ASA group had a higher morphological grade than the T/D-8 h group, whereas their mean testicular injury scores were similar. Conclusion: ASA treatment for testicular torsion was shown to be ineffective. Elastography can be a complementary method to Doppler ultrasonography in the diagnosis of testicular torsion and can guide surgeons in their approach to surgery.

Gastrointestinal perforations and associated risk factors in children after liver transplantation.

In this study, possible risk factors of gastrointestinal perforations (GIP) that increase mortality after liver transplantation in children were investigated. One hundred and thirty-one pediatric patients who underwent 139 liver transplants between January 2016 and February 2020 were evaluated retrospectively based on preoperative and surgical data. Furthermore, cases with biliary atresia, which constitute 26.7% (35) of the patients, were compared within themselves and with other groups. It was found that the cases that developed perforations were younger, lower in weight, and had higher number of surgeries than those who did not, while the mortality and morbidity rates were higher in these patients. When cases with biliary atresia were analyzed within themselves, no significant difference was found between perforated biliary atresia and non-perforated cases in terms of age, weight, and previous surgery. When biliary atresia and other etiologies were compared, biliary atresia cases were found to be transplanted at a younger age, at a lower weight, and this group had a higher risk for perforation. Early laparotomy should be performed in order to reduce mortality in GIPs. Patients that are younger, underweight, previously operated, and using mesh must be closely monitored.

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

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

Extraction of the cardiac waveform from simultaneous multislice fMRI data using slice sorted averaging and a deep learning reconstruction filter.

Cardiac signal contamination has long confounded the analysis of blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging (fMRI). Cardiac pulsation results in significant BOLD signal changes, especially in and around blood vessels. Until the advent of simultaneous multislice echo-planar imaging (EPI) acquisition, the time resolution of whole brain EPI was insufficient to avoid cardiac aliasing (and acquisitions with repetition times (TRs) under 400-500 ms are still uncommon). As a result, direct detection and removal of the cardiac signal with spectral filters is generally not possible. Modelling methods have been developed to mitigate cardiac contamination, and recently developed techniques permit the visualization of cardiac signal propagation through the brain in undersampled data (e.g., TRs > 1s), which is useful in its own right for finding blood vessels. However, both of these techniques require data from which to estimate cardiac phase, which is generally not available for the data in many large databases of existing imaging data, and even now is not routinely recorded in many fMRI experiments. Here we present a method to estimate the cardiac waveform directly from a multislice fMRI dataset, without additional physiological measurements, such as plethysmograms. The pervasive spatial extent and temporal structure of the cardiac contamination signal across the brain offers an opportunity to exploit the nature of multislice imaging to extract this signal from the fMRI data itself. While any particular slice is recorded at the TR of the imaging experiment, slices are recorded much more quickly - typically from 10 to 20 Hz - sufficiently fast to fully sample the cardiac signal. Using the fairly permissive assumptions that the cardiac signal is a) pseudoperiodic b) somewhat coherent within any given slice, and c) is similarly shaped throughout the brain, we can extract a good estimate of the cardiac phase as a function of time from fMRI data alone. If we make further assumptions about the shape and consistency of cardiac waveforms, we can develop a deep learning filter to greatly improve our estimate of the cardiac waveform.

The role of ARFI elastography to evaluate microstructrual changes of patients with testicular microlithiasis.

BACKGROUND: Testicular microlithiasis (TML) is thought to cause microstructural changes in the parenchyma of the testis, but it is difficult to demonstrate this by ultrasonography. It may be possible to evaluate microstructural changes in the testis by Acoustic Radiation Force Impulse (ARFI) elastography, which measures tissue stiffness. PURPOSE: To assess the tissue stiffness of testicles of children with TML and to compare them with the healthy control group. MATERIAL AND METHODS: Between November 2015 and May 2016, 25 pediatric patients with TML and 24 healthy children were enrolled in the study (mean age for TML and control group 6.7 ± 3.17 and 7.9 ± 4.18 years, respectively). Testicular volumes and mean shear wave velocity (SWV) values were calculated and compared with each other in both groups. RESULTS: There was no significant difference in average testicular volumes between the TML group and the control group (1.14 cm3, 1.21 cm3, respectively; P = 0.986). Mean SWV of the testicles with TML and normal testicles with control group was 1.18 ± 0.22 cm/s and 0.88 ± 0.11 cm/s, respectively. The SWV of the testicles with TML was higher than the normal testicles and this was statistically significant ( P < 0.001). CONCLUSION: This study has shown that tissue stiffness in patients with TML is increased compared to the normal population. ARFI elastography helps the early detection of microstructural changes in TML and can be used for screening and follow-up.

Spontaneous thrombosis of a giant cerebral varix in a pediatric patient.

INTRODUCTION: Cerebral cortical venous aneurysm also known as cerebral varix is a rare entity that usually occurs in relation to high-flow draining veins of arteriovenous fistulas, arteriovenous malformations, and venous angioma. Isolated cerebral varix is an extremely rare entity. CASE REPORT: We present a 1-year-old male with isolated cerebral varix. During follow-up, the varix thrombosed spontaneously without causing any neurological deficits. CONCLUSION: To the best of our knowledge, spontaneous asymptomatic thrombosis of an isolated cerebral varix without any clinical finding was reported for the first time in the literature.

Liver transplantation from living donors with Gilbert's syndrome is a safe procedure for both donors and recipients.

Liver transplantation (LT) has become a favorable therapeutic option for patients with end-stage liver diseases. Gilbert's syndrome (GS) is a benign condition characterized by intermittent mild jaundice due to unconjugated hyperbilirubinemia. It is not obvious whether living-donor liver transplantation (LDLT) from a donor with GS could result in a normal outcome for both the recipient and the donor. We aimed to determine whether right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients. Between September 2011 and March 2015, 305 LDLT procedures using right lobe grafts were performed at Atasehir Memorial Hospital, Istanbul, Turkey. Nineteen of 305 LT candidates who had been diagnosed with GS were included in the current study. After a 12-h overnight fast, total and indirect bilirubin levels of donors and recipients were measured. The median follow-up after transplant was 16 months (range 3-36 months). The median age of donors was 25 (range 20-55 yr). Four donors (21%) were female, and 15 donors (89%) were male. The median age of donors was 51 (range 23-68 yr). Eleven recipients (57%) were female, and 8 (43%) were male. The median preoperative total bilirubin level of donors was 1.69 mg/dL (range 1.26-2.43 mg/dL) (normal range <1.2 mg/dL). The median total bilirubin level of donors on postoperative day 7 was 1.04 mg/dL (range 0.71-3.23 mg/dL). As our study has included a large number of donors with GS, it produced reliable evidence that right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients.

Acute Liver Ischemia Caused by Vasculitis Due to the Use of Synthetic Cannabinoids.

Teaching Point: Synthetic cannabinoids are drugs whose use has increased significantly in recent years and whose toxicological effects cannot be ignored. Chronic inflammatory processes such as vasculitis that may be caused by these substances pose serious health problems at all ages.

Detection of Coronary Artery Fistula between the LAD and the Great Cardiac Vein on Coronary CT Angiography.

Coronary artery fistulas (CAFs) are abnormal communications of coronary arteries whereby venous circuits bypass the normal capillaries within the myocardium. Coronary artery-to-cardiac vein fistula is the third most common type of CAF, accounting for 7% of cases. Electrocardiographic-gated cardiac computed tomographic (CT) angiography has emerged as a noninvasive alternative method of choice for diagnosis due to its high spatial and temporal resolution and short acquisition time. Herein, we aimed to present a left anterior descending coronary artery opened into the greater cardiac vein at the distal level, consistent with a coronary artery-to-cardiac vein fistula in a 77-year-old woman. Teaching point: Coronary artery CT angiography provides a detailed evaluation of the complex anatomy of coronary artery fistula without the need for invasive methods.

Prevalence of Bladder Cancers Incidentally Detected During Multiparametric MRI Scans of the Prostate Gland and the Clinical Significance of Scoring Them According to VI-RADS: A Pictorial Single-Centre Study.

Purpose: To determine the prevalence of incidentally detected bladder cancers (BCs) on multiparametric magnetic resonance imaging (mpMRI) of the prostate and to highlight the clinical importance of scoring them according to the Vesical Imaging-Reporting and Data System (VI-RADS). Materials and Methods: VI-RADS scores for incidental bladder lesions on mpMRI of the prostate were collected in 1693 patients with elevated prostate-specific antigen but no hematuria. The study included 19 patients with 28 incidental bladder lesions. Results: During this period, 39 incidental bladder lesions were found in 30 patients, representing 1.7% of cases. Of the 28 lesions, 11 were categorized by VI-RADS as VI-RADS 1, 14 as VI-RADS 2, 1 as VI-RADS 3, 1 as VI-RADS 4, and 1 as VI-RADS 5. Histopathological examination revealed 1 benign lesion, 24 non-muscle invasive BCs, and 3 muscle-invasive BCs in the 19 patients. Impressively, 97% of the incidental lesions detected by prostate mpMRI and categorized by VI-RADS were BCs without apparent prostate cancer invasion. Notably, 93% of these lesions were consistent with histopathological findings of muscle invasion and extravesical spread. Conclusion: Our study concludes the prevalence 1% incidental BC in prostate mpMRI. The research underscores a thorough bladder examination during prostate MRI scans. Utilizing mpMRI assists in distinguishing varying BC stages, aiding treatment decisions, and patient outcomes. VI-RADS categorization aligns with histopathological results, enhancing diagnosis, and healthcare communication. Early detection significantly influences patient care by enabling timely interventions and suitable treatment strategies, particularly for low-stage BCs linked to reduced progression and recurrence rates.

Comparison of the efficacy of the gadoxetic acid MRI-derived relative enhancement index (REI) and functional liver imaging score (FLIS) in predicting liver function: validation with Albumin-Bilirubin (ALBI) grade.

PURPOSE: This study compared the predictive performance of the relative enhancement index (REI) derived from gadoxetic acid (GA)-enhanced MRI with that of the functional liver imaging score (FLIS) in estimating liver function among patients with chronic liver disease (CLD) or liver cirrhosis (LC) by validating them with the albumin-bilirubin (ALBI) grade. MATERIALS AND METHODS: We retrospectively examined 166 patients (79 women, 87 men; 57.4 years) who were diagnosed with LC or CLD and underwent GA-enhanced MRI between August 2020 and September 2023. The enhancement ratio (ER) is calculated using the formula: ER = [hepatobiliary phase liver signal (SI HBP20)-precontrast liver signal (SI pre)]/SI pre. The REI is calculated using the formula: REI = Liver Volume (LV) × ER. FLIS was assigned from the sum of three HBP image features, each scored between 0 and 2: liver parenchymal enhancement, biliary contrast excretion, and portal vein sign. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff values of ER, REI, and FLIS in differentiating between ALBI grades. The area under the curve (AUC), accuracy, sensitivity, and specificity were calculated for REI and FLIS to distinguish the ALBI grades. Spearman's rank correlation was used to evaluate the ER, REI, and FLIS correlations between the ALBI grades. To evaluate inter-reader reliability for LV, ER, REI, and FLIS, intraclass correlation coefficient (ICC) was used. RESULTS: ROC curve analysis showed that the optimal cutoff value of REI for predicting ALBI Grade 1 was 899-905 for readers 1 and 2 and 461-477 for ALBI Grade 3, respectively. REI performed best in predicting ALBI Grade 1, achieving an accuracy range of 94%-92.2%, sensitivity of 94.9%-94.1%, and specificity of 91.7%-87.5% for readers 1 and 2, respectively. All parameters showed high accuracy in distinguishing ALBI Grade 3 from other grades. However, REI outperformed the others, showing an accuracy range of 98.8%-97.6%, sensitivity of 94.4%-94.4%, and specificity of 99.3%-98% for readers 1 and 2, respectively. REI showed the best and very strong correlation with ALBI for both readers. CONCLUSION: REI showed a very strong correlation with the ALBI grades for assessing liver function. It outperformed FLIS in predicting the ALBI grades, indicating its potential as a radiologic tool comparable to or better than FLIS in predicting liver function, especially given its dependence on liver volume.

The role of multiparametric magnetic resonance imaging in the diagnosis of granulomatous prostatitis mimicking prostate cancer.

PURPOSE: Aimed to investigate the role of multiparametric magnetic resonance imaging (mp-MRI) in the diagnosis of granulomatous prostatitis caused by intravesical Bacillus Calmette-Guérin (BCG). METHODS: In this prospective, single-center study, 10 male patients who were given intravesical BCG due to intermediate- and high-risk bladder cancer were included. Before transurethral resection of bladder tumors (TURB), all patients were evaluated by mp-MRI, serum prostate-specific antigen (PSA), and digital rectal examination (DRE). Serum PSA levels and DRE findings were evaluated before and after intravesical BCG treatment. Prostate mp-MRI was performed for patients with elevated levels of serum PSA and/or with abnormal DRE findings. Then, MRI fusion + systematic prostate biopsy was performed. Demographic data of the patients before and after intravesical BCG were compared. RESULTS: The average age of the patients was 66.9 years (55-87 years). While PSA was 1.7 ng/ml before intravesical BCG treatment, it was 4.3 ng/ml after intravesical BCG treatment (p = 0.005). PSA density (PSAD) was 0.04 and 0.10 before and after the treatment, respectively (p = 0.012). DRE findings of all patients were normal before the treatment. However, abnormal findings were detected in 80% of them after the treatment (p = 0.008). PI-RADS ≥ 3 lesions were found to be significantly higher in all patients after intravesical BCG (p = 0.004). CONCLUSION: Granulomatous prostatitis is a rare complication of intravesical BCG. High PSA, abnormal DRE, and PI-RADS ≥ 3 lesions detected after intravesical BCG should suggest granulomatous prostatitis and unnecessary biopsies may be avoided.

A Rare Cause of Obstructive Jaundice and Pancreatitis; Lemmel's Syndrome.

INTRODUCTION/BACKGROUND: Lemmel's syndrome is defined as obstructive jaundice due to a PDD in the absence of choledocholithiasis or a neoplasm. The most common cause is the presence of PDD which arise within 2-3 cm from the ampulla of Vater. Currently, there are very few case reports of this condition, which was first named in 1934 after Dr. Gerhard Lemmel. CASE PRESENTATION: A 74-year-old female patient presented to the emergency department with complaints of abdominal pain and jaundice, and also had signs of pancreatitis, with laboratory results showing elevated liver and pancreatic enzymes and hyperbilirubinemia. We present a case of a patient who was diagnosed with Lemmel's syndrome after abdominal CT, MRCP, and ERCP. CONCLUSION: Although rare, it is imperative for physicians to recognize this syndrome in order to deliver prompt care. Because making the correct diagnosis in these patients is very important for correct treatment and preventing the development of complications.

Comparison of the diagnostic performance of biparametric and multiparametric MRI in detecting muscle invasion of bladder cancer located at the ureteral orifice.

PURPOSE: To assess the diagnostic performance of biparametric magnetic resonance imaging (bp-MRI) in predicting detrusor muscle invasion for bladder cancer (BC) located at the ureteral orifice by comparing it with the Vesical Imaging Reporting and Data System (VI-RADS) system based on multiparametric MRI (mp-MRI). METHODS: Patients with histopathologically proven BC located at the ureteral orifice from December 2019 to November 2022 were analyzed retrospectively. Two sets, bp-MRI (set 1) and mp-MRI (set 2), were formed from the images. Both sets were evaluated independent of histopathology by three radiologists with different levels of experience in abdominal radiology. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of VI-RADS in the prediction of muscle invasion. The intraclass correlation coefficient (ICC) was used to evaluate inter-reader agreement. RESULTS: Of 68 patients with BCs located at the ureteral orifice, 50 (48 males, median age: 72 years) met the study criteria. Out of the 50 patients, 36 had non-muscle invasive BC (pTa-T1) and 14 had muscle invasive BC (MIBC) (pT2-T4). In the comparison of VI-RADS categories with histopathologic data for MIBC detection, the area under the curve of the ROC analysis for the bp- and mp-MRI protocol was 1.000-0.986 for reader 1, 0.893-0.901 for reader 2, and 0.808-0.865 for reader 3. There was no statistically significant difference in predicting detrusor muscle invasion with the bp- and mp-MRI-based on VI-RADS categories for all readers (p = 0.126, 0.203, and 0.322, respectively). The ICCs between all the readers showed excellent agreement and were similar for both protocols. CONCLUSION: The bp-MRI consisting of DWI and T2-WI can be used as an alternative to the mp-MRI in predicting detrusor muscle invasion for BCs located at the ureteral orifice; however, less experienced readers should exercise caution.

Intrascrotal Extratesticular Schwannoma: A Rare Cause of Scrotal Mass.

BACKGROUND: Schwannoma, also known as neurinoma, is the most common tumor of the peripheral nerves. Intrascrotal extratesticular schwannoma, which is not associated with schwannomatosis and neurofibromatosis-2, is a very rare entity, and few cases have been reported in the literature. In this paper, we have reported a case of extratesticular schwannoma, an extremely rare cause of scrotal mass, with ultrasound (US) and magnetic resonance imaging (MRI) findings. CASE REPORT: A 22-year-old male presented with painless left scrotal swelling. Scrotal US showed an extra-testicular heterogeneous hypoechoic mass with the lobulated contour in the inferior part of the scrotum. Scrotal MRI demonstrated well-defined extratesticular mass, which showed heterogeneous hypointense T2-weighted images compared to testis parenchyma. On contrast-enhanced images, the mass showed mild-to-moderate enhancement. The patient underwent surgery with the preliminary diagnosis of benign intrascrotal extratesticular mass. The lesion was removed with preservation of the testicles by urologists, and the final diagnosis was made as scrotal schwannoma by histological and immunohistochemical examination. CONCLUSION: Although there is no specific imaging finding of scrotal schwannoma, MRI can be used as a guide to surgery by helping to accurately determine whether the lesion is intra- or extratesticular. In addition, radiologists and urologists should keep schwannoma in mind in the differential diagnosis in the presence of an intrascrotal extratesticular mass.

Comparing the Outcomes of Pediatric Liver Transplantation.

BACKGROUND: Liver transplantation is a life-saving treatment for end-stage pediatric liver failure. We aimed to present the results of pediatric liver transplants performed in our center in the last 11 years (between 2012 and March 2022) in association with prognostic factors affecting survival. METHODS: Demographic characteristics, etiologic reasons, previous operations (Kasai procedure), morbidity, mortality, survival, and bilio-vascular complication rates were determined, and outcomes were evaluated. In the postoperative period, the duration of mechanical ventilation and intensive care unit stay and surgical and other complications were evaluated. Graft and patient survival rates were determined, and univariate and multivariate factors affecting these rates were evaluated. RESULTS: In the last 10 years, 229 pediatric liver transplantaion (Pe-LT)/1513 adult liver taransplantation (Ad-LT) (21.35%) were performed in our center. This ratio (Pe-LT/Ad-LT ratio) is 1741/15,886 (10.95%) for our country. A total of 229 liver transplants were performed in 214 pediatric patients. Retransplantation was performed in 15 patients (6.55%). Cadaveric liver transplantation was performed in 9 patients. Graft survival rates were 87%, 83%, 78%, 78%, 78%, and 78% at <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years, respectively. Patient survival rates for <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years were 91.5%, 85.7%, 82%, 81.5%, and 81.5%, respectively. Our 5-year survival rates in metabolic diseases and the acute fulminant failure group are 93.8% and 100%, respectively. CONCLUSIONS: The fact that the 1- and 5-year survival rates are the same shows that when patients overcome biliary vascular and infectious problems, their survival is prolonged.

Transperitoneal Laparoscopic Adrenalectomy for Metachronous Contralateral Adrenal Metastasis from Oligometastatic Renal Cell Cancer: Case Report and Review of the Literature.

BACKGROUND: The definition of oligometastasis is still controversial. Cytoreductive nephrectomy and metastasectomy are important approaches in selected patients with oligometastasis for improving survival. We aimed to present our laparoscopic metastasectomy experience in a rare case of contralateral adrenal metastasis in an oligometastatic kidney tumor. CASE REPORT: A 52-year-old male patient was admitted to our clinic with the diagnosis of an incidental right renal mass. On contrast-enhanced abdominal CT revealed a mass reaching approximately 8 cm in diameter in the right kidney located in the middle pole. On contrast-enhanced thorax, CT showed a metastatic lesion in the left main bronchus bifurcation. The patient underwent an open radical nephrectomy with the diagnosis of an oligometastatic right renal mass. His pathology was reported as clear cell renal cell carcinoma (ccRCC). The patient was referred to the medical oncology clinic for immunotherapy. The metastatic lesion in the lung completely regressed in the follow-up of the patient who was started on Chek point inhibitors. However, he was referred to our clinic after an incidental metachronous mass was detected in the contralateral left adrenal in FDG PET/CT (SUVmax: 6.7) in 1st year. Dynamic contrast-enhanced MRI was performed to reevaluate and for mass characterization, and a 4 cm mass was observed in the left contralateral adrenal. Laparoscopic metastasectomy was performed for the left adrenal mass. No recurrence or adrenal insufficiency developed in the 6-month follow-up after discharge. CONCLUSION: Transperitoneal adrenalectomy is a minimally invasive method that can be safely performed in metastatic adrenal masses. Although contralateral adrenal metastasis is rare in ccRCC, it should be kept in mind that adrenal metastasis may develop in the late period in patients with a history of renal cancer.

Comparing the Outcomes of Deceased-Donor and Living-Donor Liver Re-Transplantation In Adult Patients.

BACKGROUND: Patients with liver graft failures have an extremely low chance of finding a cadaveric graft in countries with a scarcity of deceased donors. We compared the outcomes of liver re-transplantation with living-donor liver grafts (re-LDLT) and deceased-donor liver grafts (re-DDLT) in adult patients (>18 years). METHODS: The medical records of 1513 (1417 [93.6%] LDLT and 96 [6.3%] DDLT) patients who underwent liver transplantation at Memorial Hospital between January 2011 and October 2022 were reviewed. Forty patients (24 adults and 16 pediatric) were re-transplanted (2.84%); 24 adult patients (2.72%: 25 re-LDLT, 1 patient with second re-LDLT) were divided into 2 groups: re-DDLT (n = 6) and re-LDLT (n = 18). The groups were compared in demographics, pre-, peri-, postoperative characteristics, and outcomes. RESULTS: The overall survival rates were 91.7%, 79.2%, 75.0%, and 75% for <30 days, 31 to 90 days, 1, and 3 years, respectively. The LDLT group was significantly younger (P = .022), had smaller graft weight (P = .03), shorter mechanical ventilation (P = .036) but longer operation time (P = .019), and hospitalization period (P = .003). The groups were otherwise comparable. There was no statistically significant difference in survival rates between the groups (P = .058), although the re-LDLT group had an evidently higher survival rate (88.9% and 83.3 % vs 50.0%). CONCLUSION: Re-LDLT has shown comparable outcomes to re-DDLT, if not better (even not far from significance P = .058). These results may encourage performing re-LDLTs in patients with indications for re-LT without worrying about low chances of survival, especially in countries with limited sources of deceased donors.