Shear wave elastography in the characterization of renal cell carcinoma and angiomyolipoma.

BACKGROUND: Detection and characterization of renal lesions are common in daily clinical practice. PURPOSE: To investigate the effectiveness of shear wave elastography (SWE), a novel radiological examination technique, in the characterization of renal masses. MATERIAL AND METHODS: The study included a total of 68 patients (33 men, 35 women; mean age = 57.71 ± 12.08 years; age range = 19-83 years) who underwent SWE. SWE measurements were obtained at depths of 2-8 cm from the probe surface in two different positions from an analysis window of approximately 0.5 × 1.0 cm on ultrasound. The cutoff SWE was calculated for the differentiation of renal cell carcinoma (RCC) and angiomyolipoma (AML) by receiver operating characteristic (ROC) analysis. When the result was statistically significant, the sensitivity, specificity, accuracy, and positive and negative predictive values of the test were calculated. RESULTS: Mass-to-parenchyma SWE ratios of RCCs were significantly higher than those of AMLs (P = 0.003). In ROC curve analysis, the SWE cutoff was 1.215 m/s to differentiate RCCs from AMLs. The area under the ROC curve was calculated as 0.74 (95% CI = 0.610-0.871, sensitivity = 70.7%, specificity = 70.6%, positive predictive value = 87.8%, negative predictive value = 44.4%). CONCLUSION: The SWE technique is increasingly used and may be useful in distinguishing RCC and AML lesions, and especially clear cell and non-clear cell RCCs.

An investigation of the efficacy of shear wave elastography in the characterization of benign and malignant liver lesions.

Purpose: To investigate whether shear wave elastography (SWE) examination, which has recently been proposed as an accessory radiological examination technique, is effective in characterizing focal liver lesions (FLLs). Material and methods: A total of 105 patients, comprising 48 males and 57 females, underwent SWE examination. The mean age of the patients was 53.31 ± 1.59 (age range 5-87) years. The SWE measurements were obtained from FLLs that were approximately 2 to 8 cm in depth in a box that was approximately 0.5 × 1 cm wide on an ultrasonography (USG) screen from approximately 2 different locations. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic SWE values in the differentiation of benign and malignant lesions. Sensitivity, specificity, and positive predictive and negative predictive values were calculated in the presence of significant limit values. Results: The SWE values, in kPa and m/s, in the malignant lesions were significantly higher than those in the benign lesions (p = 0.006, p = 0.011). In the ROC curve analysis, the cut-off value was calculated as 9.005 kPa in the differentiation of malignant lesions from benign lesions. The area under the ROC curve was calculated as 0.656 in the range of 0.551-0.761 with 95% reliability. Sensitivity was calculated as 64.2%, specificity as 61.5%, positive predictive value as 63%, and negative predictive value as 62.7%. Conclusions: In addition to providing little contribution to the differentiation of benign and malignant lesions, the SWE technique is thought to contribute to a certain extent, especially in suspected cases, during the diagnosis with cross-sectional methods.

Comparison of the Effect of Platelet-Rich Plasma and Simvastatin on Healing of Critical-Size Calvarial Bone Defects.

OBJECTIVE: In previous studies, it has been shown that both simvastatin (chlolesterollowering drug) and platelet-rich plasma (PRP) were capable of promoting bone formation. The aim of this study was to compare the effects of PRP and simvastatin on healing of critical-size bone defects. METHODS: A total of 33 rats (3 for PRP preparation) were used in the experiment. Critical-size defect 8-mm diameter was created in 30 rats' calvarium. Rats were divided into 3 groups. Each group contained 10 animals. In Group A the defect was filled with phosphate-buffered saline only, in Group B with 0.5 mL PRP, and in Group C with 0.1 mg simvastatin. The defects were evaluated by radiographic analysis at 8th and 16th weeks. The animals were sacrificed 16 weeks after the surgery. Histological examination was performed to assess the new bone-forming area. Vessels, fibroblasts, osteoblasts, and osteoclasts were marked in 524749.1-µm area and counted with using Clemex Vision Lite 3.5 Image Analysis program. The results were statistically analyzed.

The value of magnetic resonance imaging in the diagnosis of penile fracture.

PURPOSE: We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. MATERIALS AND METHODS: Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5 T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectile disfunction. RESULTS: In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. CONCLUSIONS: Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process.

[Computed tomography findings in pulmonary involvement of Wegener's granulomatosis: pictorial review]. / Wegener granülomatozis akciger tutulumunda bilgisayarli tomografi bulgulari: resimlerle bir konu.

Wegener's granulomatosis is a necrotising granulomatous vasculitis which has a variable manifestations in the chest that are best described on computed tomography. Imaging findings may include masses or nodules, which may cavitate; consolidations and ground-glass opacities. Wegener's granulomatosis can mimic pneumonia, malignancy, and noninfectious inflammatory diseases. The purpose of this pictorial essay is to demonstrate the characteristic computed tomography findings of pulmonary Wegener's granulomatosis.

Prognostic value of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, and multiphasic renal tomography findings in histological subtypes of renal cell carcinoma.

BACKGROUND: To determine the relationship between renal cell carcinoma subtypes and the associated mortality and biochemical parameters. An additional aim was to analyze multiphasic multidetector computed tomography findings. METHODS: This study is a hospital-based retrospective investigation, using 211 patients with a diagnosis of renal cell carcinoma upon computed tomography examination. The histological subtypes included clear cell in 119 patients, chromophobe cell in 30 patients, papillary cell in 25 patients, mixed cell in 32 patients, and sarcomatoid cell in 4 patients. RESULTS: The mean age of the patients participating in this study was 61.18 ± 11.81 years, and the mortality rate was 10.4% (n = 22) through the 2-year follow-up. The ratios of both the neutrophil-to-lymphocyte upon admission to the hospital and platelet-to-lymphocyte of the non-surviving group were significantly higher than those of the surviving group (p < 0.05). When the analysis of the 2-year survival of the patients was examined according to the median platelet-to-lymphocyte ratio values, the Kaplan-Meier survival curves were significantly different between the surviving and non-surviving groups (p = 0.01). In two-way analysis of variance test, statistically significant results which were influenced by mortality (p = 0.028) and were found between renal cell carcinoma subtypes in the computed tomography density of corticomedullary phase (p = 0.001). CONCLUSIONS: The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio may represent widely available biomarkers in renal cell carcinoma, and the logistic regression model indicated that neutrophil-to-lymphocyte ratio was a significant predictor for mortality. According to the median platelet-to-lymphocyte ratio values, the Kaplan-Meier survival curves were significantly different between the surviving and non-surviving groups.

Evaluation of effects of bronchiectasis on bronchial artery diameter with multidetector computed tomography.

BACKGROUND: Among patients with increased bronchial artery diameter there is a significant association between hemoptysis and bronchiectasis score. The higher score of bronchiectasis, the higher risk of hemoptysis development. PURPOSE: To investigate the association of stages of bronchiectasis based on a computed tomography (CT) grading system, with bronchial artery diameter and hemoptysis in patients with bronchiectasis. MATERIAL AND METHODS: Patients with lung pathologies other than bronchiectasis, which may cause hemoptysis, were excluded from the study. One hundred and forty-five patients who underwent contrast-enhanced thorax CT by a 64-detector CT for various indications, and who were diagnosed with bronchiectasis, were evaluated retrospectively. CT examinations were carried out by two radiologists with 9 and 4 years of experience with chest radiology, respectively. The diameters of the right and left bronchial arteries were measured 1 cm from the aortic origin and perpendicular to the vessel axis. Cases were assessed based on the Bhalla CT scoring system. The hemoptysis history of every patient was taken. RESULTS: The diameters of the right and left bronchial arteries were significantly greater in patients with scores of 2 and 3 bronchiectasis than in patients with a score of 1. This was significantly greater in patients with a score of 3 than in patients with a score of 2 (P < 0.05). In patients with a score of 1, the right bronchial artery diameter was significantly greater than that of the left bronchial artery (P < 0.05). Right bronchial artery diameters were significantly greater than left bronchial artery diameters in score 3 patients (P < 0.05). A significant association was observed between hemoptysis and bronchiectasis in patients with increased bronchial artery diameter (P < 0.05). CONCLUSION: In patients with bronchiectasis, as the stage of bronchiectasis increases, the bronchial artery diameters and the risk of hemoptysis increase. We think that in patients who are diagnosed with bronchiectasis via multidetector CT (MDCT), based on scoring with bronchial artery diameters, the risk of hemoptysis can be estimated, and early management plans can be implemented.

Is neutrophil/lymphocyte ratio predict to short-term mortality in acute cerebral infarct independently from infarct volume?

BACKGROUND: Neutrophil/lymphocyte ratio (NLR) is related with increased mortality in both myocardial infarction and acute ischemic stroke. It remains unclear whether NLR is a simple marker of ischemic infarct volume or an independent marker of stroke mortality. The aim of this study is to investigate the relationship of NLR with infarct volume and short-term mortality in acute ischemic stroke (AIS). METHODS: This retrospective study included 151 patients with first AIS that occurred within 24 hours of symptom onset. Patients were screened from the hospital's electronic record system by using International Classification of Diseases code (G 46.8). NLR was calculated as the ratio of neutrophils to lymphocytes. Short-term mortality was defined as 30-day mortality. RESULTS: A total 20 of 151 patients died during follow-up. Both NLR and infarct volume of nonsurvived group were significantly higher than survived group (P < .05). Infarct volume, NLR, and National Institutes of Health Stroke Scale (NIHSS) were independent predictors of the mortality in Cox regression analysis. The optimal cutoff value for NLR as a predictor for short-term mortality was determined as 4.81. NLR displayed a moderate correlation with both NIHSS and Glasgow Coma Scale (P < .01). NLR values were significantly higher in the highest infarct volume tertile than both in the lowest volume tertile and midtertile of infarct volume (P = .001). CONCLUSIONS: NLR at the time of hospital admission maybe a predictor of short-term mortality independent from infarct volume in AIS patients. NLR should be investigated in future prospective trials investigating AIS.

Two vascular variations in one patient of the hepatogastric trunk and retro-aortic left renal vein.

This study reports the case of a 61-year-old man with right upper quadrant pain who underwent abdominal computed tomography examination. A solid lesion originating from the biliary tract was detected on the images. While evaluating the vascular structures, the splenic artery was seen to directly originate from the abdominal aorta. Retro-aortic left renal vein was also seen on computerised tomography. Splenic artery originating from the abdominal aorta is a rare variation. The retro-aortic left renal vein is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Such anatomical variations are important for surgeons to be aware of.

The role of decoy receptor 3 in inflammation and atherosclerosis in patients with chronic kidney disease and renal transplant patients.

INTRODUCTION: The cardiovascular risk has been increased in chronic kidney disease associated with chronic inflammation and atherosclerosis. Decoy receptor 3, is a member of the TNF receptor superfamily and associated with inflammation and atherosclerosis. The aim of our study is to determine the relationship, between serum DcR3 levels and inflammatory markers in patients with renal transplantation, those receiving dialysis treatment and cases with chronic renal failure that did not receive replacement therapy, and to evaluate their correlation with USG findings. MATERIAL AND METHODS: A total of 150 patients aged between 22-86 years, consisting of 4 groups, namely renal transplantation, dialysis, predialysis chronic kidney disease and control groups, were included in the study. Serum decoy receptor 3, VCAM-1, ICAM-1 and IL-8 measured with ELISA method. Carotid intima-media thickness and presence of carotis arter plaque performed by ultrasound probe, non-invasively. RESULTS: All serum markers were higher in dialysis and pre-dialysis chronic kidney disease groups compared to renal transplant and control groups (p<0.05). Serum decoy receptor 3 level (median(min-max)) of renal transplant group (0.49ng/mL (0.19-1.65)) was higher than control group (0.35ng/mL (0.19-2.22)). There was no difference between patients receiving dialysis (0.89ng/mL (0.41-4.98)) and patients with pre-dialysis chronic kidney disease (0.71ng/mL (0.29-1.68)). There was no difference between patient groups in terms of the presence of plaque. CONCLUSION: Although renal transplantation provides a significant improvement in the inflammatory process, not return completely. Inflammatory process associated with uremic milieu may predispose to atherosclerosis in patients with pre-dialysis chronic kidney disease and hemodialysis patients.

Evaluation of fetal nasofrontal angle in the second trimester in normal pregnancies.

PURPOSE: The nasal bone is one of the important fetal structures to be radiologically evaluated in the first and second trimesters. In this study, we aimed to evaluate the nasal root and to determine the normal range of the naso-frontal angle, which may potentially be used as a predictive or diagnostic parameter in the diagnosis of the above-mentioned syndromes or other congenital abnormalities with associated nasal features using obstetric ultrasonography in normal fetuses. METHODS: We evaluated the naso-frontal angle using transabdominal ultrasonography in 195 healthy fetuses between the 18(th) and 21(st) weeks of gestation. The measurements were performed with the fetal neck in mild flexion and three echogenic lines (nasal end, skin on the nasal bone, nasal bone) visualized. RESULTS: The minimum, maximum and mean naso-frontal angle values were 110°, 143° and 128°, respectively, between the 18(th) and 21(st) weeks of gestation. Linear regression analysis showed no association between NFA and gestational week (Beta = 0.020 p = 0.786). CONCLUSIONS: The normal range of NFA between the 18(th) and 21(st) weeks of gestation was determined in this study. The association between NFA measurements and various congenital anomalies or fetal outcomes remains to be investigated.

CT findings of a thoracic vertebral hemangioma presenting with acute neurological symptoms.

Vertebral body hemangiomas are benign lesions and account for 4% of all spinal tumors. The most common histological type is cavernous hemangioma. These tumors generally locate in the vertebral body as a solitary lesion. Multiple lesions are seen in approximately 25-30% of vertebral hemangiomas. Mostly they are asymptomatic and incidentally found with radiological studies. Symptomatic vertebral hemangiomas are rare and represent < 1% of all hemangiomas; however, if untreated, they may cause local or radicular pain and neurological deficits ranging from myeloradiculopathy to paralysis. In this case we aim to present preoperative and postoperative Computed Tomography findings of a cavernous hemangioma that caused sudden motor deficit and was localised to the thoracic vertebra corpus and posterior elements.

Comparison of Superb Microvascular Imaging With Other Doppler Methods in Assessment of Testicular Vascularity in Cryptorchidism.

Superb microvascular imaging (SMI) is a new Doppler technique. Superb microvascular imaging can observe microvascular and low-velocity blood flow. Superb microvascular imaging is available in 2 modes: color SMI (cSMI) and monochrome SMI (mSMI). To evaluate testicular flow, we have compared color Doppler ultrasound (CDUS), power Doppler ultrasound (PDUS), Advanced Dynamic Flow (ADF), cSMI, and mSMI techniques.Fifty-six participants less than 36 months of age were included in the study (mean age, 18.21 ± 1.5 months). One of the testes examined was in the scrotal sac, and the other was undescended testis (UT), and its location was at the level of the lower/middle inguinal canal. Testicular vascularization was evaluated with the CDUS, PDUS, ADF, and SMI techniques. Spot and linear signal encoding detected in the parenchyma were recorded between 0 and III for each technique. At the level of the testicle hilus, the outer boundary of the testicle was drawn manually along the long axis of each testis, and the vascularity index (VI) was automatically calculated from this area on the cSMI method.There was no significant relationship between normal and undescended testicles in terms of age, weight, height, testicle volume, and VI. Superb microvascular imaging was found to be superior in showing testicular vascularity, especially UT. The power of detecting Doppler signal in mSMI is significantly higher than in other methods (P < 0.001). The most valuable method according to the power of detecting testicular vascularity was mSMI. Next were cSMI, ADF, PDUS, and CDUS.In conclusion, the SMI technique should be included in vascular examination in pediatric patients with UT. The SMI technique can play an important role in assessing vascularization of UT.

Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis.

BACKGROUND: Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer. OBJECTIVES: The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings. PATIENTS AND METHODS: A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology. RESULTS: MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%). CONCLUSION: Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience.

PURPOSE: We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts. METHODS: Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates. RESULTS: Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374). CONCLUSION: This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.

Gangrenous Appendicitis in a Boy with Mobile Caecum.

A mobile caecum and ascending colon is an uncommon congenital disorder, and it is even rarer as the cause of an acute abdomen during childhood. This report presents the case of a 6-year-old boy with acute gangrenous appendicitis with a mobile caecum and ascending colon. Data from the surgical course, as well as laboratory and imaging studies, were acquired and carefully examined. Emergency ultrasound (US) was performed and revealed no signs of appendicitis in the right lower quadrant. Serial imaging study, including non-enhanced computed tomography (CT), was performed. An imaging study identified epigastric appendicitis with mobile caecum. Surgery was executed under general anesthesia with a median incision extending from the epigastrium to the suprapubic region. The caecum was mobile and placed in the right epigastric area, next to the left lobe of the liver and gallbladder. The gangrenous appendix was discovered posterior to the caecum and transverse colon, enlarging to the left upper quadrant. Appendectomy was executed, the gangrenous appendix was confirmed pathologically, and the patient was released 4 days later. In the US, if there are unusual clinical findings or no findings in patients with abdominal pain, CT is beneficial in determining the location of the caecum and appendix and preventing misdiagnosis in children.

Incidental Breast Lesions Detected on Computed Thorax Tomography.

OBJECTIVE: Although mammography is the primary imaging method of the breast, incidental benign and malignant breast lesions are increasingly being detected on computed tomographies (CTs) performed to detect different pathologies. Therefore, the detection and accurate identification of these lesions is important. In this study, we aimed to evaluate the frequency, morphological features, and results of incidental breast lesions on CTs performed for the detection of extramammarian pathologies. MATERIALS AND METHODS: Incidental breast lesions on CTs performed in our department between 2011 and 2013 were evaluated. Patients who had previously diagnosed breast lesions were excluded from the study. The inclusion criteria were histopathologic diagnose and being followed-up for at least 2 years. RESULTS: The study population consisted of 33 women whose mean age was 55±1.38 (37-78) years. Of the 33 women, 12 (36%) had malignant and 21 (64%) had benign or normal findings. The most common malignant lesion was invasive ductal carcinoma, and the most common benign lesion was fibroadenoma. Ill-defined contour and lymphadenopathy in malignant lesions and well-defined contour in benign lesions were the most important CT findings. CONCLUSION: Breast must be carefully evaluated if it is included in the scans. An accurate report of breast lesions gives an opportunity for early diagnosis and treatment.

Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy.

INTRODUCTION: To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment. MATERIAL AND METHODS: Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL. RESULTS: Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05). CONCLUSIONS: ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible.

Endovascular treatment of complex intracranial aneurysms by pipeline flow-diverter embolization device: a single-center experience.

OBJECTIVE: Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant aneurysms, fusiform shaped aneurysms, wide necked aneurysm, or small aneurysm that are unsuitable for coil embolization are still deterrent to be treated. Flow diversion is a novel concept that is applied in the treatment of these complex intracranial aneurysms. METHOD: We review the results and important features of 25 aneurysms in 24 patients who underwent endovascular treatment by using the pipeline flow-diverter embolization device. RESULT: At 6 month follow-up, all aneurysms (100%) showed total occlusion in our series. Only one patient who had giant vertebrobasilar aneurysm experienced major complication related to endovascular treatment. DISCUSSION: We suggest that parent artery reconstruction via flow diversion with the PED is a valid and safe treatment modality.

Strain elastography in the characterization of renal cell carcinoma and angiomyolipoma.

INTRODUCTION: We evaluate the diagnostic performance of strain elastography to differentiate renal cell carcinoma (RCC) from angiomyolipoma (AML). METHODS: Strain elastography was performed in 65 patients (mean age 55.5 years; range: 32-81) who had renal lesions (24 AMLs and 41 RCCs) prospectively. Lesions were classified according to lesion size and histological subtypes. The strain ratios of the RCCs and AMLs were evaluated by a radiologist. The area under the curve and the cut-off point were used to assess diagnostic performance. Sensitivity, specificity, and positive and negative predictive values were obtained. RESULTS: In assessing the mean strain ratio, we divided the groups in 3 according to size: (1) <20-mm lesions; (2) 20- to 40-mm lesions; and (3) >40-mm lesions; the respective mean strain ratios were: 1.5 ± 0.5 (range: 0.06-5.92), 2.8 ± 0.4 (range: 0.17-9.92), 2.7 ± 0.3 (range: 0.08-6.15). When RCCs and AMLs were compared, there was a statistically significant difference in the strain ratio among the 3 groups divided per lesion size (p < 0.01). For the strain ratio, the mean ± standard deviation was 1.1 ± 0.1 for AMLs and 3.4 ± 0.3 for RCCs (p < 0.01). When lesion subtypes were compared, there was a statistically significant difference in the strain ratio between the AML and clear cell RCC (p < 0.01). CONCLUSIONS: For assessing renal lesions, strain elastography and strain ratio values may be useful in differentiating RCCs from AMLs.