Superb Microvascular Imaging Doppler Technique In The Evaluation Of Ovarian Stromal Vascularity In Women With Polycystic Ovary Syndrome.

OBJECTIVE: To compare the assessment of intra-ovarian stromal vascularity through transabdominal ultrasonography with colour Doppler imaging, power Doppler imaging, colour superb microvascular imaging and monochrome superb microvascular imaging in polycystic ovary syndrome cases. METHODS: The retrospective cross-sectional study was conducted at the Obstetrics and Gynaecology outpatient department of the Usak Training and Research Hospital, Turkey, from April 11 to June 18, 2018, and comprised grayscale colour Doppler imaging, power Doppler imaging, colour superb microvascular imaging and monochrome superb microvascular imaging of women with polycystic ovary syndrome. The recorded video images were evaluated by three radiologists and rated through consensus decision. Mean values for age, body mass index, follicle stimulating hormone and luteinizing hormone levels, luteinizing hormone-follicle stimulating hormone ratio, Ferriman Gallwey score, and mean ovarian volume of the subjects were evaluated. Data was analysed using Number Cruncher Statistical System. RESULTS: Of the 54 women evaluated, data of 42(77.8%) was included. There were a total of 83 ovaries, as the left ovary of 1(1.2%) patient was not visible. The mean age and body mass index were 24.02±5.8 years and 25.08±4.5kg/m2. Mean follicle stimulating hormone and luteinizing hormone levels were 5.51±1.91 and 7.91±6.13m IU/mL. Luteinizing hormone/follicle stimulating hormone ratio and Ferriman Gallwey score were 1.4±0.8 and 8.67 ±6.94, respectively. The mean ovarian volume was 12.2±3.43 cm3. The detection of vascularity was colour Doppler imaging 0.72±0.97, power Doppler imaging 0.96±1.08, colour superb microvascular imaging 2.47±1.25, and monochrome superb microvascular imaging 2.75±1.31. The techniques were significant for superb microvascular imaging Doppler than conventional Doppler (p<0.001). Hyper- ovarian stromal vascularity, like a 'stellate' sign, was detected in 17(20.5%) of the total 83 ovaries analysed. CONCLUSIONS: Transabdominal ultrasonography-colour superb microvascular imaging was found to be more effective in detecting ovarian vascularity than conventional Doppler technique in women with polycystic ovary syndrome.

The role of positron emission tomography with 18F-fluorodeoxyglucose in nodal staging of clinical and radiological N0 head and neck cancers.

The objective of the study was to evaluate the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging on nodal staging for head and neck cancers. This was a retrospectively analyzed single institution study. The study population consisted of 36 patients with head and neck cancers who were evaluated with PET/CT and went on to neck dissection. All of them had clinically and radiographically negative neck (N0) and each patient underwent PET/CT imaging before undergoing selective neck dissection for N0 disease. Tissues were submitted for histopathologic examination and were oriented for the pathologist to permit correlation between the histopathologic findings and the imaging results. The sizes of the lymph nodes and the maximum standardized uptake values (SUVmax) measured from PET/CT images were compared with the histopathologic findings. All primary tumors were visualized with PET/CT. On histopathological examination, 19 patients had positive and 17 patients had negative lymph nodes. Receiver operating characteristic analyses were used to predict the optimal corrected SUVmax cutoffs; the optimal value was 2.95 for respective outcomes of lymph node involvement. This cutoff value yielded 84.2% sensitivity and 76.5% specificity for nodal-level staging. PET/CT proved to be accurate in 27 (75%) patients and inaccurate in 9 (25%) patients. PET/CT was a valuable tool to assess nodal stage of head and neck cancers, and should be considered before surgical treatment.

Evaluation of retrobulbar blood flow by color doppler ultrasonography after intravitreal ranibizumab injection in patients with neovascular age-related macular degeneration.

PURPOSE: This study aimed to evaluate the changes in retrobulbar blood flow by using color Doppler sonography in patients who had undergone intravitreal ranibizumab injection for neovascular age-related macular degeneration (AMD). METHODS: The study comprised 37 AMD patients who had undergone intravitreal 0.5 mg ranibizumab injection. The ophthalmic artery, central retinal artery, and short lateral posterior ciliary artery of both eyes of patients were evaluated by color Doppler sonography. Peak systolic velocity, end-diastolic velocity, and resistance index were calculated before injection, and after injection on day 7 and day 30. The pre- and postinjection values were compared using Wilcoxon signed rank test. RESULTS: In a comparison with the preinjection values of peak systolic velocity, end-diastolic velocity, and resistance index, the postinjection values at both day 7 and day 30 showed no statistically significant difference in ophthalmic artery, lateral posterior ciliary artery, and central retinal artery (p > 0.05). Similarly, for the same parameters, pre- and postinjection values in the uninjected fellow eye showed no statistically significant difference (P > 0.05). CONCLUSIONS: Intravitreal ranibizumab injection for neovascular AMD does not cause a significant change in the retrobulbar blood flow in either the injected eye or the fellow eye.

Facial vein aneurysm associated with sialadenitis.

A 20 year-old man presented with pain and swelling of the left submandibular area. Neck sonography revealed enlargement of the submandibular gland, coarsening of its echotexture with a few calculi and a multiloculated cystic lesion. Doppler sonography revealed venous flow within the cystic lesion and aneurysmal dilatation of the adjacent facial vein. CT angiography confirmed the facial vein aneurysm. We hypothesize that inflammation of the gland had weakened the wall of the adjacent facial vein, causing aneurysmal dilatation.

Multidetector CT imaging of arterial supply to sinuatrial and atrioventricular nodes.

PURPOSE: The aim of this study is to depict anatomic characteristics of sinuatrial nodal artery (SANA) and atrioventricular nodal artery (AVNA) of the heart with multidetector computed tomography. METHODS: In our study, 400 patients referred to radiology departments of two institutions for coronary CT angiography were retrospectively evaluated. 350 patients had been examined by dual-source 64-slice CT, and 50 patients by 64-section multidetector CT. Transverse sections with a thickness of 0.6 mm were used in dual-source 64-slice CT studies, and 0.8 mm were used in 64-section multidetector CT examinations for the evaluation of coronary arteries and conduction system branches. Anatomic origin, localization of the origin, diameter, number, course, and variants of the SANA and AVNA were examined with coronary multidetector CT angiography. RESULTS: SANA and AVNA could be imaged by multidetector CT in all patients. There was a single SANA in 383 (95.7%) patients, and two SANAs in 17 (4.2%) patients. Two hundred thirty-three (58.2%) patients had one SANA originating from right coronary artery (RCA), 149 (37.2%) patients had one SANA originating from left circumflex (LCX) artery, and one patient had a SANA originating from the aorta. AVNA originated from distal RCA in 351 patients (87.7% of all patients), and from distal LCX artery in 49 patients (12.3% of all patients). CONCLUSIONS: The arteries that supply the sinuatrial node and atrioventricular node can be imaged with multidetector CT. These arteries have variations in number, origin and course.

Patellofemoral Anatomical Measurements on MRI in Patient with Suprapatellar Fat Pad Edema and Mass Effect.

OBJECTIVE: To evaluate the impact of patellofemoral joint anatomical measurements of patients with anterior knee pain who were diagnosed with suprapatellar fat pad (SPFP) impingement syndrome (SP-FPIS) by magnetic resonance imaging (MRI). STUDY DESIGN: A prospective, descriptive study. PLACE AND DURATION OF STUDY: Goztepe Education and Research Hospital, between March 2015 and June 2019. METHODOLOGY: The study included 34 patients (Group 1) and 34 healthy volunteers (Group 2) who were referred to the radiology clinic with anterior knee pain; they underwent MRI and diagnosed with SP-FPIS. Twenty-three anatomical measurements such as SPFP cranio caudal length (CC), anteroposterior length (AP), oblique length (OBL), patellar length (PL), patellar tendon length (PTL), Insall Salvati Index (ISI), patellar cartilage distal-tibial tubercle (TT), patellar cartilage length (PCL), Modified Insall Salvati Index (MISI), patellotrochlear cartilage length (TCL), lateral trochlear inclination angle (LTI), etc. related to the morphological structure of SPFP and patellofemoral joint were evaluated and compared in both groups. RESULTS: The mean age of groups 1 and 2 was 45.62±10.87 and 41.47±11.98 years, respectively. There was a statistically significant difference in patients with SP-FPIS in PL, PT, TT, PC, MISI, TC, PTI, MF, PHY, PPI, MT, LTI, CC, AP, and OBL measurements compared with the control group (p<0.05). In the logistic regression analysis performed to evaluate the effect of statistically significant parameters on anterior knee pain, the probability of SP-FPIS increases 1.5 times as PTL increases among the groups, while the risk of SP-FPIS decreases 0.78 times as LTI decreases (p<0.05). CONCLUSION: There is a predisposing effect of PTL increase in SP-FPIS development, while LTI decrease has a protective effect. These results will guide future studies for the development and/or modification of treatment methods. KEY WORDS: Patellofemoral joint, Suprapatellar fat pad impingement syndrome, Anterior knee pain, Knee magnetic resonance imaging, Knee anatomy.

Ischemic colitis after capecitabine plus cisplatin treatment in advanced gastric cancer.

Systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. This report describes the case of a 45-year-old man with advanced gastric cancer who developed severe ischemic colitis after chemotherapy with cisplatin and capecitabine. The patient developed symptoms of gastrointestinal toxicity with abdominal pain and bloody diarrhea. He had a normal white blood cell count throughout his illness; the assay of stool specimens for Clostridium difficile toxins and the stool cultures were both negative. An endoscopy showed a mild, transient ischemic colitis. Although cisplatin is related to severe colonic cytotoxicity, it has not been previously reported that capecitabine induces arterial thrombosis and necrosis of the gastrointestinal mucosa and inhibits angiogenesis. Pseudomembranous colitis is the most frequent complication in patients with cancer who undergo capecitabine-based chemotherapy and develop gastrointestinal toxicity. Once Clostridium difficile infection has been excluded, a diagnosis of ischemic colitis should be considered, especially in patients with cancer who have normal white blood cell counts.

Blue rubber bleb nevus syndrome: imaging of small bowel lesions with peroral CT enterography.

Blue rubber bleb nevus syndrome (BRBNS) is a rare entity that consists of multiple venous malformations involving several organ systems, particularly the skin and the gastrointestinal tract. The diagnosis is based on clinical findings; however, imaging is required to investigate the extent of involvement and complications. A 17-year-old patient, with multiple blue skin nevus, was admitted to the emergency room of our hospital with severe gastrointestinal bleeding and melena. Upper endoscopy showed two wine-color vascular lesions in the duodenum, and colonoscopy revealed multiple lesions in the colon. Peroral CT enterography demonstrated multiple (more than 30) contrast-enhanced polypoid small bowel lesions, ranging in size from 5 to 16 mm. Some lesions contained millimetric calcifications representing phleboliths. The patient also had three pancreatic lesions which showed homogenous enhancement on the delayed images. Our findings show that peroral CT enterography is useful to demonstrate the extent of small bowel lesions of BRBNS. This is the first report of pancreatic involvement of BRBNS.

Nonoperative management of pancreatic injuries in pediatric patients.

PURPOSE: Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. METHODS: Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. RESULTS: The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extra-abdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. CONCLUSIONS: The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst.

Biliary Fasciola gigantica case report from Turkey.

We present a case of Fasciola gigantica-induced biliary obstruction and cholestasis diagnosed and treated via endoscopy and trichlorobendazole treatment. This is the first case of Fasciola gigantica treated via endoscopic biliary extraction during ERCP and drug treatment reported from Turkey.

A case of biliary Fascioliasis by Fasciola gigantica in Turkey.

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.

Hippocampus, glucocorticoids and neurocognitive functions in patients with first-episode major depressive disorders.

The aim of this study was to determine whether there was any relationship between hippocampal volume, and glucocorticoid regulation, and cognitive dysfunctions in drug-naïve major depressive disorder (MDD) patients during their first episode. Twenty drug-free female MDD patients in their first episode and 15 healthy females as control subjects were included in the study. All subjects underwent 3.0 Tesla (T) magnetic resonance imaging (MRI), comprehensive neuropsychological testing and dexamethasone suppression tests (DST). The volumes of the right and left hippocampus of the patients were found to be significantly smaller than those of the controls. Patients were found to have significantly lower scores on measures of attention, working memory, psychomotor speed, executive functions, and visual and verbal memory fields. The performance of the patients only in the recollection memory and memory of reward-associated rules were positively correlated with hippocampal volumes. The volumes of the left and right hippocampus did not correlate with basal or post-dexamethasone cortisol levels. Our findings indicate that depressed patients have smaller hippocampi even in the earlier phase of their illness. Further research efforts are needed to explain the mechanisms that are responsible for the small hippocampus in depressed patients.

MDCT findings of denim-sandblasting-induced silicosis: a cross-sectional study.

BACKGROUND: Denim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis. METHODS: Sixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT). The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP) on CT images. RESULTS: Silicosis was diagnosed radiologically in 73.3% of patients (44 of 60). The latency period (the time between initial exposure and radiological imaging) and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p < 0.05). Nodules were present in all cases with centrilobular type as the commonest (63.6%). All cases of silicosis were clinically classified as accelerated and 11.4% had progressive massive fibrosis (PMF). Mild NP lesions were the most prevalent in all six zones of the lung. The NP score was significantly correlated with the duration of silica exposure, the latency period, presence of PMF, and pleural thickening. Enlarged lymphadenopathy was present in 45.5% of patients. CONCLUSIONS: The duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.

Factor X deficiency presenting with bilateral chronic subdural hematoma.

Factor X deficiency is a rare coagulation defect that can result in several hemorrhagic manifestations including central nervous system hematomas in infants and children. In this case report, we present computed tomography (CT) and magnetic resonance (MR) imaging findings of bilateral chronic subdural hematomas due to factor X deficiency. Cranial CT and MR imaging in a hypoactive 7-month-old male infant with right hemiparesis revealed bilateral chronic subdural hematomas at different stages. Laboratory findings showed a severe factor X deficiency, with a level of 0.7%. After fresh frozen plasma replacement, the patient was operated and the large hematoma on the left side evacuated. The patient recovered uneventfully and remained asymptomatic during the 1-year follow-up.

Evaluation of interlobar and accessory pulmonary fissures on 64-row MDCT.

We aimed to describe the prevalence, morphology, and completeness of the oblique, horizontal, and accessory fissures on 64-row multidetector computed tomography (MDCT) scans. Three hundred and eighty-seven patients were included in this study. The lungs were scanned from apex to diaphragm using 1-mm collimation. Images were evaluated on a Philips workstation using the PACS system. Prevalence of the interlobar and accessory fissures and also incompleteness of the interlobar fissures was evaluated on axial, coronal, and sagittal planes. The frequencies of right oblique fissures, right horizontal fissures, and left oblique fissures were 99.7%, 94.8%, and 100%, and the percentage of incompleteness was 69.7%, 86.9%, and 48.3%, respectively. Accessory fissures were detected in 164 of the 387 patients (42.4%). Pulmonary fissures are well visualized on MDCT because of its capacity in evaluating the whole thorax with thin sections and at various planes. Fast-image acquisition in MDCT also accounts for less motion artifacts and high-image quality.

Multiple intracranial melanoma metastases: case report and review of the literature.

Although intracerebral metastases of malignant melanoma are common, those located in the sellar region and within the pontocerebellar area are extremely rare. Furthermore, to our knowledge, there is no report about melanoma metastasis to the epiphysis published so far. We report here a 46-year-old patient who had metastatic lesions in the sellar region, cerebellopontine area and epiphysial gland, preceded by a primary melanoma at her left shoulder. The diagnosis of sellar metastasis was confirmed histopathologically following a stereotactic biopsy. The patient received whole-brain irradiation therapy combined with chemotherapy. After 10 months, she died from a severe hemorrhage in the cerebellopontine angle. Autopsy findings confirmed melanoma metastases both in the cerebellopontine angle and additionally in the epiphysial gland. To our knowledge, this is the first case of multiple intracranial melanoma metastases including the suprasellar region, the pontocerebellar and epiphysial area.

The effect of clozapine on regional cerebral blood flow and brain metabolite ratios in schizophrenia: relationship with treatment response.

The purpose of this study was to investigate the effect of clozapine on regional cerebral blood flow (rCBF) and its relationship with response to treatment. In addition, we aimed to study the influence of clozapine on proton magnetic resonance spectroscopy ((1)H-MRS) findings in the dorsolateral prefrontal cortex (DLPFC) in a subgroup of patients. Psychopathology, neurocognitive functioning, and SPECT imaging of 22 patients were assessed at the baseline and 8 weeks after the initiation of clozapine treatment. In 10 of these patients intermediate-echo (TE: 135 ms) single-voxel (1)H-MRS was also performed at the baseline and after 8 weeks. Clozapine treatment increased the right frontal (superior and medial)/caudate perfusion ratio in the whole group, while it increased bilateral frontal (superior and medial)/caudate perfusion ratios in treatment responders. In addition, percentage changes in left and right frontal (superior and medial)/caudate perfusion ratios compared to the baseline were higher in treatment responders than in non-responders. The improvement in attention was related to the increase in percentage change in the right frontal (superior and medial)/caudate perfusion ratio, while the improvement in verbal fluency was related to the increase in percentage changes in both right and left frontal (superior and medial)/caudate perfusion ratios and to right frontal (superior and medial)/thalamus perfusion. Baseline frontal (superior and medial)/thalamus perfusion could explain 32% of the variability of percentage improvements in psychopathology. (1)H-MRS showed that the baseline PANSS general psychopathology score was inversely correlated with the baseline NAA/Cre ratio. An increased NAA/Cre ratio in DLPFC after 8 weeks of clozapine treatment was also revealed by (1)H-MRS. Our SPECT imaging results suggest the presence of an imbalance in fronto-striato-thalamic circuitry that changes with clozapine, especially in the responders, while (1)H-MRS results indicate a supportive effect of clozapine on neuronal integrity.

Antidepressant effect detected on proton magnetic resonance spectroscopy in drug-naïve female patients with first-episode major depression.

AIM: Recent neuroimaging studies support functional and structural alterations in the dorsolateral prefrontal cortex (DLPFC), particularly on the left side in patients with major depressive disorders (MDD). The aim of the present study was to examine the biochemical characteristics of left DLPFC as measured on proton ((1)H) magnetic resonance spectroscopy (MRS) in patients with drug-naïve first-episode MDD and a healthy control group. A second aim was to assess the effect of antidepressant treatment on the metabolites of DLPFC. METHODS: Short-echo single-voxel (1)H-MRS was done for the left DLPFC in 17 female drug-free MDD patients (mean age +/- SD, 30.9 +/- 6.9 years) and 13 matched control subjects (mean age +/- SD, 29.1 +/- 6.2 years) and was repeated at 8 weeks following antidepressant treatment. RESULTS: Comparison of baseline values indicated that there were no significant differences in any of the metabolite ratios (N-acetyl aspartate/creatine [NAA/Cr], myoinositol [Ino]/Cr, and choline [Cho]/Cr) between patients and controls. Significant differences were detected between pre- and post-treatment Ino/Cr ratios (0.67 +/- 0.13, 0.58 +/- 0.22, P = 0.032, respectively), although there was no difference in NAA/Cr and Cho/Cr ratios. CONCLUSION: Although no significant metabolic alterations exist in female patients with drug-naïve first-episode MDD as evaluated on (1)H-MRS, an increase in Ino/Cr was observed following 8-week antidepressant treatment. These findings give rise to the possibility that non-neuronal cells, particularly glial cells that are probably damaged, play a role in the action of antidepressant treatment.

Double outlet right ventricle with giant pulmonary artery aneurysm and severe aortic coarctation: diagnosis with multislice CT.

Complex cardiovascular pathologies in the pediatric population are usually evaluated with echocardiography and catheter angiography as initial and advanced imaging of choice, respectively. Echocardiography may pose some difficulties in the diagnosis of complex cardiovascular pathologies. Due to short acquisition times, detailed imaging by the use of post-processing techniques, reduced radiation exposure compared to catheter angiography, and additional information obtained on lung parenchyma, multi-slice computed tomography (CT) is the advanced imaging method of choice in selected cases. The present report describes a 14-year-old symptomatic case with complex cardiovascular pathology, whose vascular architecture could be properly demonstrated by multi-slice CT.

Diameters of normal thoracic vascular structures in pediatric patients.

PURPOSE: To determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference. METHODS: Contrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated. RESULTS: There was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent. CONCLUSIONS: Diameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.