Acoustic Radiation Force Impulse (ARFI) Elastography in Evaluation of Supraspinatus Tendinopathy.

BACKGROUND: The most common etiology of shoulder pain in adults is rotator cuff tear. Elastography is an imaging method that can report the strain and elastic modulus of the biological tissue. We think acoustic radiation force impulse (ARFI) elastography can effectively assess rotator cuff tendinopathy. PURPOSE: This study aimed to investigate the usefulness of ARFI elastography in evaluating supraspinatus tendinopathy. MATERIALS AND METHODS: We included 44 patients (22 men, 22 women, median age, 47 years; range, 20-69 years) with unilateral supraspinatus tendinopathy diagnosed with magnetic resonance imaging (MRI) in this prospective study. The normal tendons and tendinopathies, including supraspinatus tendinosis, partial-thickness, and full-thickness supraspinatus tears, were evaluated with ultrasound and ARFI elastography. The ARFI elastography values were compared between healthy and tendinopathy groups, and the gender was compared between elastography values of the normal tendons and tendinopathies using the Mann-Whitney U test. RESULTS: The values of ARFI elastography correlated with tendinopathy. (P = 0.001). The gender differed between the elastography values of the normal tendons (P = 0.002) and tendinopathies (P = 0.001). CONCLUSION: ARFI elastography is a non-invasive and feasible method for quantitatively assessing supraspinatus tendinopathy. It can be an alternative method to MRI in diagnosing supraspinatus tendinopathy.

Idiopathic bilateral massive perirenal subcapsular effusion: The first case in the literature.

INTRODUCTION: Bilateral perirenal subcapsular effusion is a rare clinical condition and is associated with several underlying etiologies. We present a 33 years old male patient with idiopathic bilateral massive subcapsular effusion. CASE PRESENTATION: A 33-year-old male patient presented to our outpatient clinic with bilateral flank pain and fever for 2 weeks. Bilateral perirenal subcapsular effusion was detected in intravenous contrast-enhanced CT and dynamic MRI. TREATMENT: Bilateral ultrasound-guided percutaneous drainage was performed by an expert uroradiologist to reduce the parenchymal pressure, Control CT imaging after 6 weeks demonstrate that bilateral normal kidneys. DISCUSSION: It has been reported that subcapsular and perirenal effusion is a rare clinical condition that may develop secondary to causes such as Nephrotic syndrome, Eisenmenger Syndrome, Lymphangiomatosis, and Page Kidney Disease. In our case, the clinical symptoms of the patient regressed after the whole effusion fluid was drained. No underlying pathology was found in further examinations. Therefore, we present the first case of Idiopathic Bilateral Massive Perirenal Subcapsular Effusion in the literature.

Relationship between the degree and direction of nasal septum deviation and nasal bone morphology.

BACKGROUND: Nasal septal deviation may affect nasal bone growth and facial morphology. Knowledge of nasal morphologic parameters may plays an important role in planning successful rhinoplasty and septoplasty operation. The aim of our study was to evaluate the relationship between the direction and degree of nasal septal deviation with nasal bone morphology, along with factors such as age and gender. METHODS: Maxillofacial computed tomography (CT) of 250 patients with nasal septal deviation was analyzed retrospectively in this study. We excluded patients with factors that could affect their nasal bone morphology, and a total of 203 patients (111 males, 92 females; mean age, 36.23 years; age range, 18-79 years) were evaluated. The nasal deviation angle was measured on coronal CT images as the angle between the most deviated point of the septum, and the midline nasal morphology was determined by measuring nasal length, internasal angle and lateral and intermediate nasal thickness on both sides. RESULTS: The deviation of nasal septum has been detected as to the right in 107 patients (52.7%) and to the left in 96 patients (47.3%). Lateral and intermediate nasal bone thickness and nasal bone length were significantly greater on the ipsilateral deviation side (Table 3). No significant correlation was found between the variation of the nasal deviation angle and nasal bone morphology (Table 4). There were significant differences between the sexes for all investigated parameters except for the nasal deviation angle (p = 0.660). We found that the only internasal angle increases with aging (p = 0.002). CONCLUSION: The study shows that the direction of nasal septal deviation may be a factor that affects nasal bone morphology.

Evaluation of Eyeball and Orbit in Relation to Gender and Age.

The orbital aperture is the entrance to the orbit in which most important visual structures such as the eyeball and the optic nerve are found. It is vital not only for the visual system but also for the evaluation and recognition of the face. Eyeball volume is essential for diagnosing microphthalmos or buphthalmos in several eye disorders. Knowing the length of the optic nerve is necessary in selecting the right instruments for enucleation. Therefore, the aim of this study was to evaluate eyeball volume, orbital aperture, and optic nerve dimensions for a morphological description in a Turkish population sample according to gender and body side.Paranasal sinus computed tomography (CT) scans of 198 individuals (83 females, 115 males) aged between 5 and 74 years were evaluated retrospectively. The dimensions of orbital aperture, axial length and volume of eyeball, and diameter and length of the intraorbital part of the optic nerve were measured. Computed tomography examinations were performed on an Activion 16 CT Scanner (Toshiba Medical Systems, 2008 Japan). The CT measurements were calculated by using OsiriX software on a personal computer. All parameters were evaluated according to gender and right/left sides. A statistically significant difference between genders was found with respect to axial length of eyeball, optic nerve diameter, dimensions of orbital aperture on both sides, and right optic nerve length. Furthermore, certain statistically significant side differences were also found. There were statistically significant correlations between age and the axial length of the eyeball, optic nerve diameter, and the transverse length of the orbital aperture on both sides for the whole study group.In this study we determined certain morphometric parameters of the orbit. These outcomes may be helpful in developing a database to determine normal orbit values for the Turkish population so that quantitative assessment of orbital disease and orbital deformities will be evaluated both for preoperative planning and for assessing postoperative outcomes.

Sequential Evaluation of Pancreato-Biliary Findings in a Case with IgG4-Associated Cholangiopathy and Autoimmune Pancreatitis during Corticosteroid Treatment.

BACKGROUND: Immunoglobulin G4 (IgG4)-associated diseases mostly involve the pancreaticobiliary tree and pancreatic parenchyma. This disease complex is characterized by marked response to corticosteroid therapy and response to steroids is incorporated in the diagnostic algorithm of IgG4 associated diseases. However, there is much unknown about the sequences and duration of healing during the corticosteroid therapy in the literature. CASE REPORT: In this case report, we report a young male patient with IgG4 associated extrahepatic biliary stricture and autoimmune pancreatitis successfully treated with corticosteroids. Recovery in the laboratory and radiological findings seemed to correlate well with the decrease in serum IgG4 levels in this patient. We also discussed sequences and the duration of healing in the pancreaticobiliary tree and pancreatic parenchymal manifestations in this case report. CONCLUSION: There is a gap in our knowledge about the evaluation of response criteria after steroid trial with regard to the duration and sequences of healing in the pancreaticobiliary involvement in diagnosing IgG4-related biliary and pancreatic diseases.

The Adrenal Gland Volume Measurements in Manifestation of the Metabolic Status in Type-2 Diabetes Mellitus Patients.

Objectives. The aim of our study was to investigate the differences in adrenal gland volume between nondiabetic controls and Type-2 diabetic patients and to examine the influence of glycemic control in diabetes mellitus on adrenal gland volume. Methods. From March 2 to November 25, 2015, 62 consecutive patients with Type-2 DM along with 62 nondiabetics matched by age, gender, and BMI were enrolled in this prospective study. Our diabetes patients were categorized into two groups, well-controlled and poorly controlled diabetes groups. Adrenal volumetric measurements were performed by two radiologists, prospectively and independently, with semiautomatic software. Interobserver reliability was studied using the interobserver correlation coefficient (ICC). Results. The total adrenal volume (TAV) was significantly higher in Type-2 diabetic patients when compared with nondiabetic patients (p < 0.05). When we investigated diabetic patients according to glycemic controls, the TAVs in controlled diabetic patients were significantly higher than in those of the poorly controlled or uncontrolled diabetic patients (p < 0.05). Nondiabetic control patients have significantly smaller TAVs when compared to controlled and poorly or noncontrolled diabetic patients (p < 0.05). Conclusion. Our study suggests that adrenal gland volume measurement may be used as an indirect marker of glycemic control in patients with diabetes.

Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver.

AIMS: To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma. MATERIALS AND METHODS: The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the "cut-off" ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched. RESULTS: Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10(-3) mm(2)/s) and hemangiomas (2.705±0.63×10(-3) mm(2)/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the "cut-off" ADC value of 1.800×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the "cut-off" value of 1.858×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the "cut-off" value of 1.800×10(-3) mm(2)/s had a sensitivity of 96.1% and a specificity of 90.0%. CONCLUSION: DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure.

Cerebellar Infarction in Childhood: Delayed-Onset Complication of Mild Head Trauma.

Objective Cerebellar ischemic infarction is a rare complication of minor head trauma. Vertebral artery dissection, vasospasm or systemic hypo perfusion can cause infarct. However, underlying causes of the ischemic infarct cannot be explained in nearly half of cases. The accurate diagnosis is essential to ensure appropriate treatment. Here we report a five yr old boy patient of cerebellar infraction after minor head trauma, admitted to emergency serves of BulentEcevit University, Turkey in 2013. We aimed to remind minor head trauma that causes cerebellar infarction during childhood, and to review the important points of the diagnosis, which should be keep in mind.

Bilateral generalised synovial chondromatosis of the knee: Bone scintigraphic demonstration with radiologic correlation.

A 67-year-old woman with a history of bilateral progressive knee pain and swelling was referred for (99m)Tc-methyl diphosphonate bone scintigraphy. Flow and blood pool images showed bilateral heterogeneous increased uptake and delayed phase revealed mass-looking lobulated heterogeneous increased activity in both of knees extending distal part of the femoral shaft, but no other pathologic uptake was found in rest of the body. A diagnosis of synovial chondromatosis was made when correlated with X-ray and computed tomography.(CT) images. This is a rare presentation of generalized synovial chondromatosis involving both knees which demonstrated on bone scintigraphy with X-ray and CT correlation.

The Role of Computerized Tomography in the Assessment of Perivesical Invasion in Bladder Cancer.

BACKGROUND: The aim of the present study was to identify the contrast patterns of a tumor, and to evaluate the possibility of assessing the invasion of the perivesical fatty tissue in bladder cancer. MATERIAL/METHODS: In this study, 26 patients with bladder cancer were included. Multiphasic CT examination was performed to determine the stage of the disease before radical cystectomy. RESULTS: There were statistically significant differences in tumor and perivesical fatty tissue densities between pre- and post-contrast phases (p<0.05). CONCLUSIONS: Increases in focal density suspected of being invasion of the perivesical fatty tissue can show perivesical invasion with high specificity.

Congenital absence of internal carotid artery with intercavernous anastomosis: Case report and systematic review of the literature.

The absence of an internal carotid artery is a rare congenital anomaly. In the absence of the internal carotid artery, collateral circulations develop through the circle of Willis, persistent embryonic arteries or transcranial collaterals of the external carotid artery. Six pathways of collateral circulation have been described. Intercavernous anastomosis is between cavernous segments of the bilateral internal carotid arteries and is rarely seen. Patients with an absence of the internal carotid artery can be completely asymptomatic. However, these patients can present with subarachnoid hemorrhage or stroke accompanying cerebral aneurysm or abnormal collateral. We combined our case with 33 previous publications to form a retrospective series including 35 cases of unilateral internal carotid artery agenesis with intercavernous anastomosis.

Comparison of Drug-Eluting Balloon and Standard Balloon Angioplasty for Infrapopliteal Arterial Diseases in Diabetic Patients.

OBJECTIVE: To consider the clinical outcomes and restenosis rates of drug-eluting balloons (DEBs) and percutaneous transluminal angioplasty (PTA) in diabetic patients with infrapopliteal (IP) arterial disease. MATERIALS AND METHODS: This retrospective, single-center study included 51 patients (37 males; mean age: 63.43 ± 9.81 years) with diabetes mellitus having IP arterial disease, from October 2012 to September 2014. Twenty-two patients were treated with PTA, and 29 patients were treated with DEBs. After intervention, the patients were evaluated in the first week and every 3 months, clinically and radiologically. Univariate and multivariate analyses were used to evaluate the clinical outcomes of diabetic patients with IP arterial disease who were treated with either DEBs or PTA. RESULTS: There were no statistically significant differences between the groups in terms of age and gender, risk factors, characteristics of lesions, or the diameters or length of the balloons ( P > .05). Primary patency was higher in the DEB group than in the PTA group (97.8% vs 81.1%, P = .020) in the first 3 months. However, there was no statistically significant difference at 1-year follow-up (68.2% vs 48.5%, P = .131). At the 12-month follow-up, there was no difference in clinical improvement between the groups ( P = .193). CONCLUSION: The findings of this study reveal that DEB is a safe alternative treatment method for IP arterial disease in diabetic patients.

Is Mean Platelet Volume a Reliable Marker to Predict Ischemic Stroke in the Follow-Up of Patients with Carotid Stenosis?

BACKGROUND: The objective of the study is to evaluate the reliability of mean platelet volume (MPV) for predicting ischemic stroke (cerebrovascular event [CVE]) among patients with different degrees of carotid stenosis. METHODS: Fifty-two patients with CVEs, 136 patients with carotid artery disease (CAD), and 40 healthy volunteers were enrolled in this study. All participants were divided into the following groups according to CAD: absence of stenosis, less than 50% stenosis, 50%-69% stenosis, and 70% or more to total occlusion of the internal carotid artery. For each participant, the parameters of CAD were assessed using ultrasonography. To obtain the values of CRP and MPV and the leukocyte and platelet counts, all samples were processed within 30 minutes after blood collection. Univariate and multivariate analyses were used to evaluate the association between the values of serum C-reactive protein (CRP) and MPV and carotid stenosis. RESULTS: In terms of age and gender, there was no statistically significant difference between the groups (P = .094 and P = .428, respectively). However, CRP values in patients with CAD and CVEs were significantly higher than those in the controls (P < .001). There was no statistically significant difference between the CRP values in patients with CAD and CVEs (P = .249). Moreover, the MPV values did not show any significant difference between the groups (P = .053) and among the patients with CAD (P = .64). There was no positive correlation between serum CRP and MPV values in patients with CAD regarding the degree of carotid stenosis (r = .061, P = .477). CONCLUSION: The findings of this study claim that MPV has no predictive value during follow-up of the patients with CAD for CVEs.

Does the Degree of Septal Deviation Affect Cribriform Plate Dimensions and Middle Turbinate Length?

OBJECTIVE: To investigate the effect of septal deviation severity on the dimensions of the lateral lamina of the cribriform plate (LLCP), middle turbinate length (MTL), and the angle of the lateral lamella of the cribriform plate (ALLCP). METHODS: Paranasal computed tomography (CT) scans of 148 patients with septum deviation (102 males, 46 females; age range 18-63 years) were retrospectively evaluated. The patients were divided into 3 groups according to the measured angle of nasal septal deviation as mild (<9°), moderate (9-15°), or severe (>15°). Height and width of LLCP, MTL, and ALLCP on both sides were measured and these parameters were compared between the groups according to the septal deviation side. RESULTS: The nasal septum was deviated to the right in 73 patients (49.3%) and to the left in 75 patients (50.7%). The LLCP dimensions, MTL, and ALLCP between the groups at the contralateral side were not statistically different (P > 0.05). The LLCP height, ALLCP between the groups at the ipsilateral side were not statistically different (P > 0.05). There was a significant difference in the LLCP width at the ipsilateral side between the groups (P = 0.039). The MTL at the ipsilateral side was significantly different between the groups (P = 0.003). CONCLUSION: The severity of nasal septum deviation in patients with nasal septum deviation affects the ipsilateral LLCP width and the ipsilateral MTL. These findings suggest that the increase in the severity of septum deviation in patients undergoing endoscopic sinus surgery does not increase the risk of possible damages that may occur in LLCP.

Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality.

OBJECTIVE: The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. METHODS: This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. RESULTS: There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (p<0.001 and 0.002, respectively). Furthermore, there was a statistically significant difference in the RA/RV diameter ratio, but not in the RV/LV diameter ratio, between those with and without 30-day mortality (p=0.002 and 0.148, respectively). CONCLUSIONS: Measurement of the RA/RV diameter ratio may be an alternative and useful method for predicting 30-day mortality and adverse outcome in patients with APE.

Diffusion-weighted imaging in the head and neck region: usefulness of apparent diffusion coefficient values for characterization of lesions.

PURPOSE: We aimed to evaluate the role of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging for head and neck lesion characterization in daily routine, in comparison with histopathological results. METHODS: Ninety consecutive patients who underwent magnetic resonance imaging (MRI) at a university hospital for diagnosis of neck lesions were included in this prospective study. Diffusion-weighted echo-planar MRI was performed on a 1.5 T unit with b factor of 0 and 1000 s/mm2 and ADC maps were generated. ADC values were measured for benign and malignant whole lesions seen in daily practice. RESULTS: The median ADC value of the malignant tumors and benign lesions were 0.72×10-3 mm2/s, (range, 0.39-1.51×10-3 mm2/s) and 1.17×10-3 mm2/s, (range, 0.52-2.38×10-3 mm2/s), respectively, with a significant difference between them (P < 0.001). A cutoff ADC value of 0.98×10-3 mm2/s was used to distinguish between benign and malignant lesions, yielding 85.3% sensitivity and 78.6% specificity. The median ADC value of lymphomas (0.44×10-3 mm2/s; range, 0.39-0.58×10-3 mm2/s) was significantly smaller (P < 0.001) than that of squamous cell carcinomas (median ADC value 0.72×10-3 mm2/s; range, 0.65-1.06×10-3 mm2/s). There was no significant difference between median ADC values of inflammatory (1.13×10-3 mm2/s; range, 0.85-2.38×10-3 mm2/s) and noninflammatory benign lesions (1.26×10-3 mm2/s; range, 0.52-2.33×10-3 mm2/s). CONCLUSION: Diffusion-weighted imaging and the ADC values can be used to differentiate and characterize benign and malignant head and neck lesions.