Does ARFI elastography complement B-mode ultrasonography in the radiological diagnosis of idiopathic granulomatous mastitis and invasive ductal carcinoma?

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a chronic, unpleasant autoimmune inflammatory condition and is clinically and radiologically often confused with breast malignancy. PURPOSE: To investigate the contributions of qualitative and quantitative aspects of acoustic radiation force impulse (ARFI) elastography to the differential diagnosis between IGM and invasive ductal carcinoma (IDC) in the breast. MATERIAL AND METHODS: Ninety-four women with IDC and 39 with IGM were included in the study. Shear wave velocity (SWV) was calculated for all lesions using quantitative elastography. Next, each lesion's correspondence on qualitative elastographic images to those on the B-mode images was evaluated: pattern 1, no findings on elastography images; pattern 2, lesions that were bright inside; pattern 3, lesions that contained both bright and dark areas; and pattern 4, lesions that were dark inside. Pattern 4 was subdivided into 4a (dark area same size as lesion) and 4b (dark area larger than lesion size). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. RESULTS: The mean SWV based on ARFI elastography was 3.78 ± 1.26 m/s for IGM and 5.34 ± 1.43 m/s for IDC lesions (P < 0.05). Based on qualitative ARFI elastography, IDC lesions were mostly classified as pattern 4b, while IGM lesions were mostly classified as pattern 1 or 2 (P = 0.01). Evaluation of both the qualitative and quantitative aspects of ARFI elastography yielded a sensitivity of 89% and specificity of 84%. CONCLUSION: ARFI elastography may facilitate the differential diagnosis between IGM and IDC.

Evaluation of distal femoral cartilage by B-mode ultrasonography and shear wave elastography in patients with knee osteoarthritis: a preliminary study.

BACKGROUND: Degenerative change in articular cartilage is one of the most important factors in the development of osteoarthritis. Shear wave elastography can be used to identify pathologic cartilage. PURPOSE: To evaluate distal femoral cartilage by shear wave elastography in patients with symptomatic knee osteoarthritis. MATERIAL AND METHODS: Twenty patients with bilateral knee osteoarthritis (study group) and 20 volunteers with the same demographic characteristics but without symptomatic knee pain (control group) were included in the study. A total of 80 knee joints of 40 individuals were evaluated. At the medial, intercondylar, and lateral condylar levels distal femoral cartilage thickness was measured by B-mode ultrasonography and stiffness was measured by shear wave elastography. RESULTS: The medial, intercondylar, and lateral cartilage thickness measurements were similar between the two groups and no statistically significant difference was observed (P = 0.711, P = 0.766, and P = 0.575, respectively). The shear wave velocity values in the medial and intercondylar cartilage were significantly higher in the study group (P = 0.002). Shear wave velocity values measured from lateral cartilage were higher in the study group and the difference between the groups had a borderline statistical significance (P = 0.053). CONCLUSION: Shear wave elastography seems to be a reliable, non-invasive, and acceptable method for the assessment of pathologic cartilage.

The effect of computed tomography on oxidative stress level and some antioxidant parameters.

BACKGROUND: X-rays are defined as ionizing radiation and hydrolyze the water, causing free radical formation. Oxidative stress is the damage that occurs in cells due to the lack of antioxidants, which detoxifies them, with the increased production of free radicals that occur during normal cellular metabolism. PURPOSE: To examine the acute effects of computed tomography (CT), i.e. ionizing radiation, on oxidative stress and antioxidant defense mechanisms. MATERIAL AND METHODS: The study included a total of 53 patients that were selected among the patients that underwent non-contrast full-body CT. Malondialdehyde (MDA) and reduced glutathione (GSH) levels and superoxide dismutase (SOD) and catalase (CAT) activities were investigated in blood samples taken from patients. RESULTS: The post-scan levels of MDA increased significantly while the post-scan levels of GSH, SOD, and CAT decreased significantly compared to their pre-scan levels. CONCLUSION: CT, which is a widely used X-ray imaging technique and has numerous known side effects, was found to increase the levels of MDA, which is an indicator of oxidative stress, and to decrease the levels of some antioxidants including GSH, SOD, and CAT.

Histopathology and elastography discordance in evaluation of breast lesions with acoustic radiation force impulse elastography.

PURPOSE: It is known that, besides its benefits, ultrasound (US) elastography may show discordance findings, leading to biopsy, so this technique has some limitations. The purpose of the present study was to compare histopathological results and shear wave velocity (SWV) values in patients, to reveal discordance findings, and to investigate its statistical significance in making the decision for biopsy with SWV values. MATERIAL AND METHODS: A total of 190 patients presenting with breast lesions were included in the study. The mean age of the patients was 39.87 ± 13.56 years. All morphological features of lesions were evaluated by B-mode US. The mean SWV values were measured using the region of interest (ROI) through all lesions with ARFI elastography. An ultrasound-guided Tru-Cut needle biopsy was performed, and histopathologic data were obtained. RESULTS: The SWV values of false positive benign lesions, such as: granulomatous mastitis, sclerosing adenosis, chronic inflammation, fat necrosis, fibrotic breast tissue, and scar tissue, were as high as the SWV values of malignant lesions. Sensitivity was found as 91.6% and specificity as 40.9% for SWV values in ARFI US. CONCLUSIONS: Our results showed that breast lesions showed false positivity (59.1%) and false negativity (8.3%) in ARFI US. Elastography is useful and sensitive in the evaluation of breast lesions, but some benign lesions may mimic malignant lesions; thus, this information should not be underestimated in biopsy decision-making for elastography users.

Efficacy of Strain Elastography in Diagnosis and Staging of Acute Appendicitis in Pediatric Patients.

BACKGROUND In the present study, the role and efficiency of strain elastography (SE) were evaluated in diagnosis and staging of acute appendicitis in pediatric patients. MATERIAL AND METHODS We enrolled 225 pediatric patients with suspected clinical and laboratory findings of acute appendicitis. Gray-scale sonographic findings were recorded and staging was made by the colorization method of SE imaging. Appendectomy was performed in all patients and the results of the surgical pathology were compared with the imaging findings. The sensitivity, specificity, and accuracy of SE imaging were determined in terms of evaluating the "acute appendicitis". RESULTS Sonographic evaluation revealed acute appendicitis in 100 patients. Regarding the SE analysis, cases with appendicitis were classified into 3 groups as: mild (n=17), moderate (n=39), and severe (n=44). The pathological evaluation revealed 95 different stages of appendicitis and normal appendix in 5 cases: acute focal (n=10), acute suppurative (n=46), phlegmonous (n=27), and perforated (n=12), regarding the results of surgical pathology. Five patients with pathologically proven "normal" appendix were noted as "mild stage appendicitis" based on gray scale and SE analysis. In total, when gray-scale and SE results were compared with pathology results regardless of the stage of appendicitis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96%, 96%, 95%, 96.8%, and 96%, respectively. No statistically significant difference was detected between other groups (P<0.05). CONCLUSIONS In acute appendicitis, the use of SE imaging as a supportive method for the clinical approach can be useful in diagnosis, and its results are closely correlated with the histopathologic stage of appendix inflammation.

Second-Line Modified FOLFOX6 Regimen in The Patients with Metastatic Esophagus Cancer.

BACKGROUND/AIMS: We aimed to investigate the efficacy of second line treatment with modified FOLFOX6 (mFOLFOX6) following cisplatin- plus 5-fluorourasil (CF) chemotherapy in patients with metastatic esophagus cancer (mEC). METHODOLOGY: In our oncology clinic, between March 2011 and September 2014, we reviewed patients admitted with progressive mEC following first line CF chemotherapy and those with >60 kanofsky performance status performed second line mFOLFOX6 regimen. RESULTS: A total of 242 patients with mEC were evaluated. 94 of 242 patients (38.8%) had received second-line chemotherapy treatment. All of these patients had received mFOLFOX6 regime. Median age was 53 years (range: 28-71). The received median number of chemotherapy cycles was 6 (2-12). Objective response rate (ORR) was obtained in 39 of 94 (41.4%) patients, 6 (6.3%) of these had complete response (CR) and 33 (35.1%) had partial response (PR). Stable disease (SD) was obtained in 20 (21.3%) patients and progression was observed in 35 (37.3%) patients. Grade ¾ toxicity was observed in 67 (71.2%) patients. The hematologic toxicity was found as the most common toxicity (69.1%). CONCLUSIONS: mFOLFOX6 regimen as a second line treatment can be applied to the mEC patients with progressive disease following CF chemotherapy.

Cerebral perfusion in type 2 diabetes mellitus: A preliminary study with MR perfusion.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with altered cerebral vasoreactivity, cognitive impairment, and functional decline. Magnetic Resonance (MR) perfusion can be used to assess cerebral blood flow (CBF). The aim of this study is to analyze the association between diabetes mellitus and cerebral perfusion. METHODS: The study included 52 patients diagnosed with T2DM and 39 healthy individuals. The diabetic patients were classified into three groups (PRP: proliferative retinopathy, NPRP: non-proliferative retinopathy, Non-RP: non-retinopathy DM). The rCBF measurements of cortical gray matter and thalami were carried out using the region of interest. Reference quantitative measurements were performed from ipsilateral white matter. RESULTS: The comparison between the T2DM group and the control group revealed that rCBF values of bilateral frontal lobes, cingulate gyrus, medial temporal lobe, thalami and right occipital lobe were measured to be significantly lower in the T2DM group (p < 0.05). No significant difference was detected between the two groups in terms of rCBF values of the left occipital lobe and anterior aspect of the left temporal lobe (p > 0.05). The rCBF values were lower in the anterior aspect of the right temporal lobe and the difference showed borderline statistical significance (p = 0.058). No significant difference was detected regarding mean rCBF values measured in the regions of cerebral hemispheres among the three patient groups with T2DM (p˃0.05). CONCLUSION: Regional hypoperfusion was encountered in most of the lobes in the T2DM group when compared with the healthy group. However, in terms of rCBF values, there was no significant difference among the three groups with T2DM.

Is the Prevalence of Estimated Pelvic Congestion Higher than Examined? A Retrospective Study of Consecutive Abdominopelvic Computed Tomography Analyses.

BACKGROUND: Chronic Pelvic Pain (CPP) is a common complaint in women, and is the key factor in the diagnosis of Pelvic Congestion Syndrome (PCS). INTRODUCTION: Consecutive abdominal and pelvic Computed Tomography (CT) scans in adult female patients not diagnosed with PCS and collected over a period of 3 years were evaluated retrospectively to determine the prevalence of underestimated Pelvic Congestion (PC). METHODS: 500 consecutive abdominal and pelvic CT scans collected from female patients aged 18-80 years were retrospectively analyzed for the presence of PC. RESULTS: 90 of the CT scans examined showed the presence of PC (18%). These patients were divided into two groups: Group I had 52 scans with unilateral PC, while Group II had 38 scans with the bilateral enlarged Ovarian Vein (OV). Left and right OV diameters were measured as 7.14±2.15 and 5.56±1.87 mm, respectively. Co-occurrence of additional vascular anomalies, such as nutcracker- type compression of the left renal vein, and May Thurner, was significantly higher in Group I than Group II (p<0.001). The diameter of the OV remained wide irrespective of age in Group I, but showed a decrease with increasing age in Group II. The most common complaint was abdominal pain; these patients required an average of six referrals to two different clinics (primarily general surgery and internal medicine) before being diagnosed with PC. CONCLUSION: The diagnosis of PCS remains to be an important problem for patients because of insufficient perception of physicians. PCS should be considered in female patients with complaints of chronic abdominal and pelvic pain and CT may be a valuable examination tool for diagnosis.

The course of cervical spinal cord atrophy rate and its relationship with NEDA in relapsing remitting multiple sclerosis.

This study aimed to compare the annualized segmental cervical spinal cord atrophy rate (ASCAR) in the early and late stages of relapsing remitting multiple sclerosis (RRMS), and to investigate the relationship between ASCAR and no evidence of disease activity (NEDA) in RRMS. Participants in this study included early stage MS (EMSg) patients, late stage MS (LMSg) patients, and healthy controls. All of the included participants (n = 175 subjects) were followed up for 14 months, and an MRI was performed on each participant at the beginning and at the end of the study. Cervical spinal cord average segmental area (CSCA) was measured by a semi-automated method, and ASCAR (mm2/year) was calculated. Data from the EMSg (n = 81 subjects) and LMSg (n = 94 subjects) patient groups were compared with each other and with the control group (n = 43 subjects). Examination of the initial CSCA values revealed that the baseline CSCA of the control group was larger than that of the EMSg (p < 0.001), and the baseline CSCA of the EMSg was larger than that of the LMSg (p < 0.001). The ASCAR of the control group, LMSg, and EMSg were 0.48, 0.93, and 1.81 mm2 (p < 0.001), respectively. Regression analysis revealed that disability increase was associated with ASCAR, while MRI activity and relapse presence were unrelated to ASCAR. In both patient groups, ASCAR was slower in those who fulfilled NEDA but this relationship was not significant. Cervical spinal cord atrophy progression over time occurs at a greater rate in the early stages of RRMS disease compared to the late stages. ASCAR was unrelated to MRI activity and relapse, which are clinical markers of acute inflammation.

Pediatric infrafossal fracture of the humerus: A case series.

OBJECTIVES: In this case series, we aimed to evaluate the clinical and radiographic outcomes of the patients with infrafossal fracture of the humerus and to evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. PATIENTS AND METHODS: Between January 2005 and July 2020, the clinical data and radiographs of 2,443 children who were treated due to distal humerus fracture were retrospectively analyzed. A total of six patients (5 males, 1 female; mean age: 6.7±2.6 years, range, 3 to 11 years) treated due to an infrafossal fracture of the humerus were included. Radiographic measurements, such as Baumann's angle, lateral capitellohumeral angle, and carrying angle of the elbow, were performed. At the final follow-up, elbow joint range of motion (ROM) was measured, functional scores of the elbow and upper extremity were assessed. Complications were also recorded. RESULTS: The mean follow-up was 62.8±47.4 (range, 20 to 140) months. Two patients underwent open and three underwent closed reduction and internal fixation by different surgeons. One of the patients was treated with a long-arm cast. There was no major elbow ROM limitation. There was no significant deterioration in the lateral capitellohumeral and elbow carrying angles of the patients. Baumann's angle was normal for all the patients; however, it could not be measured in two patients, as their epiphyses were closed. Four patients had an excellent MEPS and two patients a good MEPS. The QuickDASH scores were low in all patients. There were two patients with cubitus varus who were treated surgically using lateral closing-wedge corrective osteotomy. CONCLUSION: Infrafossal fracture of the humerus is a fracture type which is different from supracondylar and transcondylar fractures and has not been previously reported in the literature. Despite the cubitus varus developed in two of our patients, functionally satisfactory results were achieved in all patients at the end of the treatment. Due to the risk of developing cubitus varus, patients with infrafossal fracture of the humerus should be followed closely until the end of adolescence. Although the current study is very limited in terms of being a guide for the treatment, it may contribute to the literature in terms of defining a new fracture subtype.

Ponseti management of clubfoot after walking age.

BACKGROUND: With an incidence of 1-2 per 1000 live births, clubfoot is one of the commonest congenital deformities. Deformity has four components: equinus, hindfoot varus, forefoot adductus, and cavus. The Ponseti method for the treatment of clubfoot has been shown to be effective in children up to one year of age. Even with this effective method, late-presenting cases are still challenging. The aim of this study is to evaluate the corrective effect of the Ponseti method on different components of clubfoot after walking age and to find how the patient's age relates to this correction. METHODS: From 2003 to 2005 we treated 31 feet of 27 patients with clubfoot with a mean age of 21 months (12-72 months) with the Ponseti method. Average follow up was 42 months. All of the patients were evaluated before and after treatment for Dimeglio scores. Patients in the first group, aged less than 20 months, were compared with those in the second group, who were older than 20 months. The corrections for each component of the deformity were analyzed separately. RESULTS: All deformities showed significant correction. Improvements for each separate component were found to be statistically significant. Patients older than 20 months improved less for the components of varus, medial rotation of calcaneopedal block and adductus compared to younger patients. CONCLUSIONS: The Ponseti method is effective in correcting deformities of clubfoot, even after walking age, but affectivity may decrease with age.

Prevelance of Fabella: An MRI Study in The Eastern Anatolia Region of Turkey.

BACKGROUND: The fabella, which is generally located in the lateral head of the gastrocnemius muscle, is a sesamoid bone that articulates with the posterior face of the lateral femoral condyle. As traditional information, the prevalence of fabella is between 10-30% in the population and is usually present in both knees. INTRODUCTION: The objective of this study was to investigate the knee MRIs in the Eastern Anatolia Region of Turkey subjects in order to assess the prevalence of the fabella and analyse the differences between gender, age and laterality and its symmetry pattern. METHODS: This study was a retrospective study in patients older than 18 years whose knee MRIs were taken between February 2014 and February 2016. In this study, a total of 531 patients (290 females and 241 males) were included. The radiographs were examined by two orthopedic surgeons and the fabella was located. Later, an expert radiologist made the final decision and confirmed the results. RESULTS: The number of patients included in the study was 531. We detected os fabella in 59 (11.1%) patients. Of the 59 os fabella, 33 were in the right knee and 26 were in the left knee, 38 were female and 21 were male. CONCLUSION: In this study, we investigated the age and gender differences besides the prevalence and the symmetry pattern of the fabella in the Eastern Anatolia Region of Turkey's population. Prevalence of the fabella was found to be 11.1% which is different than previously published studies.

A new custom-made plate preparation method for bony mallet finger treatment and a comparison with extension block technique.

OBJECTIVES: In this study, we aimed to describe a new hook plate technique (HPT) and to compare our results with the conventional extension block technique (EBT) with a Kirschner wire (K-wire) for bony mallet finger treatment. PATIENTS AND METHODS: Between April 2015 and January 2018, a total of 19 patients including 10 who were treated with EBT (7 males, 3 females; mean age: 30.1±7.3 years; range, 17 to 48 years) and nine who were treated with HPT (6 males, 3 females; mean age: 31.7±11.3 years; range, 19 to 42 years) for bony mallet finger with distal interphalangeal (DIP) joint subluxation and/or fracture fragment larger than one-third of distal phalanx (Wehbe-Schneider type 1/b, 2/a, 2/b, 3/a) joint were retrospectively analyzed. The DIP range of motion (ROM), Warren and Crawford scores, time to return to work/daily activity, operation time, the number of fluoroscopy shots, cost and complications were compared. RESULTS: No significant difference was found in the DIP ROM (p=0.708) and the Warren/Norris and Crawford scores (p=0.217 and p=0.175, respectively) between the two groups. Operation time and material cost were higher with HPT (p=0.006, p=0.001). There was no significant difference in the number of fluoroscopy shots (p=0.344). Although DIP joint motion was started at two weeks in the HPT group and at eight weeks in the EBT group, no significant difference was observed in the time of return to work and normal daily life in both groups (p=0.859). Complications were observed in two patients in the EBT group and in three patients in the HPT group. No significant difference in total complications was observed between the two groups (p=0.666). CONCLUSION: Bony mallet finger treatment with a custom-made hook plate prepared from 1.3-mm AO plates appeared to be clinically and radiologically similar to EBT. Additionally, HPT had the advantages of allowing early ROM to DIP joint and eliminating the need for a secondary surgery such as K-wire removal. On the other hand, hardware cost with HPT was higher than EBT.

Anterior Cerebral Artery and Anterior Communicating Artery Variations: Assessment with Magnetic Resonance Angiography.

BACKGROUND: Although anterior cerebral artery (ACA) and anterior communicating artery (AcomA) variations have been frequently investigated by contrast-enhanced angiography, the number of studies performed with magnetic resonance angiography is quite low. Our aim in this study is to investigate ACA and AcomA variations with time of flight magnetic resonance angiography (TOF MRA). METHODS: Source and maximum intensity projection images of 581 adult patients (273 males, 308 females) who were scanned for intracranial arteries with the TOF MRA method were retrospectively analyzed. RESULTS: We found the typical configuration rate of the ACA and AcomA complex to be 40.6%. The most common structural anatomic variations out of typical configuration were AcomA aplasia (18.9%) and AcomA hypoplasia (17.9%), respectively. The least frequent variation that we found was duplicated AcomA (0.9%). When we examined gender comparatively, unilateral A1 segment aplasia was found to be higher in males and azygos ACA was found to be higher in females (P = 0.001 and P = 0.029, respectively). CONCLUSIONS: In this study, in which we used the TOF MRA technique, we detected high rates of anatomic variations of ACA and AcomA. This method, which is noninvasive, does not require contrast material and does not contain ionizing radiation, can be preferred especially in the evaluation of patients with kidney disease and contrast allergy.

Goldston syndrome in a fetus: case report and literature review.

We present a case of the Goldston syndrome which is the association of polycystic kidneys with Dandy-Walker malformation. The diagnosis was made by ultrasound in twenty second week of gestation. Obstetric ultrasound and fetal MRI studies showed hydrocephalus, agenesis of the cerebellar hemispheres, vermian hypoplasia, cystic dilatation of the 4(th) ventricle, enlargement of the posterior fossa, abdominal distension, and oligohydramnios.. The kidneys were symmetrically enlarged and multicystic. To our knowledge this is the third reported case of Goldston syndrome which was diagnosed during intrauterine life.

A case of primary vertebral osteosarcoma metastasizing to pancreas.

CONTEXT: Osteosarcoma is the most common malignant bone tumor in children and adolescents and possesses a high potential for metastasis. The most common sites of osteosarcomatous metastases are the lungs, pleurae, and bone; the pancreas being extremely rare. CASE REPORT: We report the computed tomography findings of a rare case of pancreatic metastasis in a 14-year-old boy with primary vertebral osteosarcoma being followed-up for 6 years. On abdominal CT, a huge mass containing necrotic and calcified areas and causing bone destruction was seen between thoracic vertebra 7 and sacral vertebra 1 involving both the vertebrae and paravertebral soft-tissue. A large metastatic mass with an irregular contour was also visualized in the pancreatic head and peripancreatic region having tomographic findings similar to the vertebral mass. Tru-cut biopsy of the pancreatic mass confirmed the diagnosis of osteosarcoma metastasis. CONCLUSIONS: Although extremely rare, osteosarcoma metastasis should be included in the differential diagnosis of pancreatic mass lesions, particularly in patients with a primary tumor.

A new enema for treatment of intussusception with hydrostatic reduction: Olive oil.

OBJECTIVES: Intussusception is routinely treated using ultrasound-guided hydrostatic reduction (USGHR) with normal saline in our paediatric surgery department. With this study, olive oil was added to normal saline in ultrasound-guided reduction of intussusception. MATERIALS AND METHODS: Forty patients who were diagnosed and treated for intussusception in Van Yuzuncu Yil University Faculty of Medicine Pediatric Surgery Department from March 2017 to May 2017 were included in the study. During this retrospective study, randomly chosen 20 patients that treated with USGHR using normal saline were marked as Group 1. Moreover, 20 patients that treated with USGHR using a mixture of olive oil and saline (10% olive oil 90% normal saline) were marked as Group 2. Patients' age, gender, symptoms, treatment techniques, complications and hospitalisation periods were retrospectively noted. RESULTS: Forty patients were included in the study. In Group 1, 14 patients were treated in the first session, 4 patients were treated in the second session and 2 patients required laparotomy. Mean reduction time in this group was 15 min mean fluid volume used in each reduction was 80 ml/kg and mean hospitalisation period was 38 h. In Group 2, 19 patients were treated in the first session, and only 1 patient required a second session. Mean reduction time was 12 min, used fluid volume was 58 ml/kg for each reduction and hospitalisation period was 24 h. CONCLUSION: The average volume of fluid used for reduction, average reduction time, numbers of recurrent reductions and hospitalisation were less when a mixture of olive oil and normal saline were used in comparison with when normal saline was used alone to reduction the intussusception under ultrasound guidance. Using olive oil mixed with normal saline as a new enema fluid is likely to increase the success rate of ultrasound-guided reduction of intussusception.

The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome.

OBJECTIVES: The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS). METHODS: Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n = 21), (II) mild (n = 39), (III) moderate (n = 38), and (IV) severe (n = 19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups. RESULTS: Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic "idiopathic CTS" patients (48 women, 2 men; mean age 45.9 years, range 23-73 years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P < 0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P < 0.001). A 3.250 m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively. CONCLUSION: The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.

A Case of Metastatic Esophageal Carcinoma in a Pregnant Woman with Radiologic Findings.

The incidence of all malignant tumours during pregnancy is extremely rare and esophageal carcinoma ranges from 0.07 to 0.1% of all malignant neoplasms. The physiological changes during pregnancy frequently mask the complaints and symptoms related to the disease. The physical and physiological clinical conditions limit the diagnostic approaches. Therefore, the stage of cancer at the time of diagnosis is usually advanced. The management with cancer surgery and chemotherapy regimens must be modified in pregnant women in order to minimize fetal and maternal risks. Here, we report a very rare case of metastatic esophagus cancer in a 39-year-old woman with 28 weeks of pregnancy and aim to show the ultrasound (USG) and magnetic resonance imaging (MRI) findings with treatment and follow up management.

Giant thyroid abscess related to postpartum Brucella infection.

Thyroid gland infection, although rare, may be a life threatening disease. Thyroid abscess, arising from acute suppurative thyroiditis (AST), is a rare clinic condition depending on widespread use of antibiotics. Infection may involve one or both lobes and abscess formation may not be apparent until late stage of the progress of illness. Thyroid left lobe is more often affected than the right one. Brucellosis, especially obvious in endemic areas, is a widely seen zoonosis around the world. Although brucella infection can affect many organs through various complications, thyroid gland infection is rare. We aimed to present ultrasonography (USG) and magnetic resonance images (MRI) of a case with an acute thyroiditis which rapidly developed and grew fast on the left half of the neck during the first postpartum month. As far as we know from literature reviewing, our case is the first case report of a thyroid abscess arising from brucella infection which is developed in first postpartum period with images of ultrasonography and MRI.