Evaluation of Facial Aging in Different Age and Gender Groups With Computed Tomography-Based Calvarium and Face Measurements.

BACKGROUND: The human face is a complex area formed by the combination of many different components and varies among individuals according to gender, age, and ethnicity. OBJECTIVE: The aim of this study was to evaluate age-related changes in the facial and calvarial bones in a large sample of both genders. METHODS: The retrospective study included nontraumatic brain computed tomography scans of 280 Turkish adults. Participants were divided into 7-decade groups with the age ranging from 20 to 89 years. Measurements of the face and calvaria were recorded, and calvarial volume was calculated. The relationship of these parameters with age and gender was examined. RESULTS: Statistically significant differences were observed in all the facial and calvarial measurements, except the transverse diameter of the head, with increasing age in both genders. Regardless of age, no significant differences were found in facial and calvarial measurements between genders. In addition, there was a significant decrease in the calvarial volume in both genders after the seventh decade of life. CONCLUSION: The structure of the face and calvarium continues to change and differentiate throughout life. Taking these changes into account during surgical and facial rejuvenation procedures can help predict outcomes and avoid the use of incorrect techniques.

Modified Glasgow Prognostic Score, Prognostic Nutritional Index and ECOG Performance Score Predicts Survival Better than Sarcopenia, Cachexia and Some Inflammatory Indices in Metastatic Gastric Cancer.

Background: Gastric carcinoma (GC) patients usually present with locally advanced or metastatic disease; therefore treatment aim is mainly palliation. In this study our purpose is to analyze the prognostic values of the sarcopenia index (SI), cachexia index (CIn) and other inflammatory indexes (advanced lung cancer inflammation index [ALI], modified Glasgow Prognostic Score [mGPS], prognostic index [PI], prognostic nutritional index [PNI] and neutrophil-to-lymphocyte ratio [NLR]) in metastatic GC patients.Methods: Data from the files of metastatic GC patients, who applied to Medical Oncology outpatient clinic in Marmara University Pendik Education and Research Hospital between January 2011 and June 2016, were retrospectively reviewed. Five hundred seventy patients with gastric cancer were detected. Exclusion criteria were the inability to reach the patient surveys for prognostic index calculations, the presence of additional comorbidities to affect the laboratory parameters, and the absence of metastatic disease. Finally, 87 of these patients were included in this study. For SI calculation L3 level muscle area was measured from patients' computed tomography (CT) by a radiologist. SI reference value was obtained from western-EGWSOP (The European Working Group on Sarcopenia in Older People) and eastern (Harada Y, et al.) sources separately, as Turkey doesn't have a reference value for SI. NLR cutoff value was accepted as the median value of patients' NLR measurements. Statistical analysis was conducted using SPSS. Kaplan-Meier and Cox regression models were used to assess independent prognostic factors. The area under the curve was used to compare the prognostic value of indexes.Results: The median length of follow-up of 87 patients was nine months (1-64 mo,/s), and 78 patients died during follow-up. Fifty-nine patients were male (63%), and the median age was 62 (range, 23-88). According to univariate analysis high mGPS and PI score, PNI level <45, NLR level ≥ 3.41, ALI level <18, CI level under 35, SI (Harada Y, et al) ≤44.5 for males and ≤36.5 for females, ECOG score ≥ 2, weight loss more than 10% during last 6 mo, BMI under 24 were poor prognostic factors. Age, gender, having multiple organ metastasis, history of gastric surgery, positivity C-erb-B2, SI (EGWSOP) ≤52.4 for males, and ≤38.4 for females did not have any impact on survival. According to multivariate analysis, high mGPS (score 2) (HR 2,494, 95% CI 1.25-4 .94, p = 0.02), PNI (score 1) (HR 4.2, 95% CI 1.73-10.1, p < 0.001) and ECOG score (≥2) (HR 1.541, 95% CI 1,089-4,214, p = 0.004) have been found to be independent prognostic factors which are determining the survival. mGPS was found to be more valuable than other indexes for predicting mortality by measuring the AUC with ROC analysis.Conclusions: In our study, mGPS, PNI and ECOG score were independent indicators for shorter survival in metastatic gastric cancer patients. mGPS and PNI, which can be done by using only serum CRP, albumin level and complete blood count, might be inexpensive, practical and beneficial to use in routine clinical practice to determine survival.

Educating the next generation of radiologists: a comparative report of ChatGPT and e-learning resources

Rapid technological advances have transformed medical education, particularly in radiology, which depends on advanced imaging and visual data. Traditional electronic learning (e-learning) platforms have long served as a cornerstone in radiology education, offering rich visual content, interactive sessions, and peer-reviewed materials. They excel in teaching intricate concepts and techniques that necessitate visual aids, such as image interpretation and procedural demonstrations. However, Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI)-powered language model, has made its mark in radiology education. It can generate learning assessments, create lesson plans, act as a round-the-clock virtual tutor, enhance critical thinking, translate materials for broader accessibility, summarize vast amounts of information, and provide real-time feedback for any subject, including radiology. Concerns have arisen regarding ChatGPT's data accuracy, currency, and potential biases, especially in specialized fields such as radiology. However, the quality, accessibility, and currency of e-learning content can also be imperfect. To enhance the educational journey for radiology residents, the integration of ChatGPT with expert-curated e-learning resources is imperative for ensuring accuracy and reliability and addressing ethical concerns. While AI is unlikely to entirely supplant traditional radiology study methods, the synergistic combination of AI with traditional e-learning can create a holistic educational experience.

Risk of Conversion from Laparoscopic Appendectomy to Open Surgery: The Role of Clinical and Radiological Factors in Prediction.

Introduction: Laparoscopic appendectomy is the most preferred surgical method in the treatment of acute appendicitis. In our study, we aim to determine the clinical and radiological factors affecting conversion from laparoscopic appendectomy to open surgery. Materials and Methods: All patients older than 18 years, who were operated on with the diagnosis of acute appendicitis in the General Surgery clinic of Prof. Dr. Ilhan Varank Training and Research hospital between January 2020 and January 2022, were included in the study. The data consisting of clinical, laboratory, and radiological (computed tomography) findings of the patients were evaluated retrospectively. The patients were divided into two groups as those whose surgery was completed laparoscopically (Group 1) and those converted from laparoscopic appendectomy to open surgery (Group 2). The risk of conversion to open surgery was analyzed by binary logistic regression analysis as univariate and multivariate models. Results: Appendectomy was performed in 831 patients within the specified period. The surgery of 31 (3.73%) patients started laparoscopically; however, they were completed by converting to open surgery. Multivariable analysis showed that the risk of conversion to open surgery increased with leukocyte count, Alvarado score and with the presence of periappendiceal fluid and lymphadenopathy on CT. Conclusion: Our study shows that patients with high risk of returning to open surgery can be identified preoperatively with the risk analysis method in which clinical, laboratory, and radiological findings are evaluated together. We conclude that, starting the operation of these patients with the open technique from the beginning will prevent unnecessary expenditures and reduce morbidities.

Accuracy and reliability of magnetic resonance imaging in the diagnosis of idiopathic intracranial hypertension.

PURPOSE: To determine the diagnostic utility of brain magnetic resonance imaging (MRI) findings in patients with idiopathic intracranial hypertension (IIH) and to investigate the significance of evaluating radiological findings together with neurological and ophthalmological data in the diagnosis of IIH. MATERIALS AND METHODS: All consecutive patients diagnosed with IIH in our tertiary neuro-ophthalmology center between January 1, 2018 and March 15, 2020, were included in the study. The clinical, radiological, and ophthalmological findings of IIH patients were compared with the control group with similar demographic characteristics. RESULTS: A total of 98 patients, 49 cases and 49 controls, were included in the study. Lateral ventricular index had the highest area under the curve (AUC) value (0.945) for prediction of disease group followed by sella height category (AUC = 0.915) and optic nerve tortuosity (AUC = 0.855) According to the multivariate model we developed, caudate index (OR = 0.572, 95% CI 0.329-0.996), lateral ventricle index (OR = 3.969, 95% CI 1.851-8.509) and bilateral optic nerve tortuosity (OR = 22,784, 95% CI 2.432-213.450) were significant predictors for disease group. CONCLUSION: Tortuosity in the optic nerve, lateral ventricular index and caudate index can be used as MRI parameters supporting the diagnosis of IIH in clinically suspicious cases. A holistic approach to the clinical and radiological findings of the cases in the diagnosis of IIH can prevent overdiagnosis and enable early correct diagnosis.

Differences between radiological findings of COVID-19 and non-COVID-19 infections in pediatric patients.

BACKGROUND: This study aimed to reveal the differences between coronavirus disease 2019 (COVID-19) infections and non-COVID-19 respiratory tract infections in pediatric patients. METHODS: Sixty pediatric patients admitted to the hospital between March 11, 2020 and April 15, 2020 with respiratory tract infections were evaluated retrospectively. Among them, 20 patients with reverse transcription-polymerase chain reaction (RT-PCR) tests and chest computed tomography (CT) examinations were included in the study. According to the RT-PCR test results, the patients were divided into the COVID-19 and non-COVID-19 groups. The clinical observations, laboratory results, and radiological features from the two groups were then compared. RESULTS: According to the RT-PCR test results, 12 patients were assigned to the COVID-19 group and 8 to the non-COVID-19 group. There were no significant differences between the two groups in terms of clinical or laboratory features. In terms of radiological features, the presence of bronchiectasis and peribronchial thickening was statistically significantly higher in the non-COVID-19 group (P = 0.010 and P = 0.010, respectively). CONCLUSIONS: In pediatric cases, diagnosing COVID-19 using radiological imaging methods plays an important role in determining the correct treatment approach by eliminating the possibility of other infections.

Analysis of intra-observer and inter-observer variability of pathologists for non-benign thyroid fine needle aspiration cytology according to Bethesda system categories.

AIM: To examine the intra- and inter-observer variability for non-benign thyroid cytological subcategories according to the Bethesda classification system after the second review. METHODS: Between November 2018 and May 2019, thyroid fine needle aspiration biopsies of 381 nodules were retrospectively evaluated. Among them, 74 non-benign (category III-VI) thyroid biopsies, analyzed according to the Bethesda system (pathologist 1:40 vs pathologist 2:34) by two independent pathologists, were reassessed by the same pathologists and by a cytopathologist. In this observer-blinded study, weighted Cohen's kappa was used to assess the intra-observer agreement, and Krippendorff's alpha was used to assess the inter-observer agreement. RESULTS: At the first and second evaluations of pathologists 1 and 2, the percentage agreement was 62.5% for pathologist 1 and 58.8% for pathologist 2. The intra-observer agreement was substantial (κ = 0.705) for pathologist 1, and moderate (κ = 0.447) for pathologist 2. In the second evaluation of pathologist 1 and 2, which was compared with the cytopathologist, the agreement percentage of pathologist 1 with the cytopathologist was 50.0%, and that of pathologist 2 was 56.8%. The inter-observer agreement was below the lowest acceptable limit for an overall agreement (α = 0.634) among the three raters. The inter-observer agreement was only acceptable between the cytopathologist and the second pathologist, while it was low between the other raters. In the evaluation of the non-benign nodules, the mean category score of the cytopathologist was 3.22 and lower than both pathologists (3.73 and 3.58, respectively). CONCLUSIONS: The intra-observer agreement of pathologists was moderate-to-substantial in the evaluation of non-benign thyroid biopsies according to the Bethesda reporting system. However, the inter-observer agreement was below the lowest acceptable limit when the cytopathologist was taken as a reference.

Clinical and radiologic characteristics of symptomatic pregnant women with COVID-19 pneumonia

Objective: To describe the radiological features, diagnostic accuracy and features of imaging studies and their relation with clinical course of Coronavirus disease-2019 (COVID-19) pneumonia in pregnant women. Material and Methods: The clinical, laboratory and radiological features of symptomatic pregnant women suspected of COVID-19 were retrospectively reviewed. Chest radiography (CXR) and chest computed tomography (CT) findings of COVID-19 in pregnant women were identified. Results: Fifty-five of eighty-one pregnant women were included in the final analysis. The most common admission symptoms were dry cough (45.4%), fever (29.1%) and dyspnea (34.5%). Radiological imaging studies were performed in 34 (61.8%) patients. Fourteen (66.7%) of the laboratory-confirmed COVID-19 patients had parenchymal abnormalities on CXR, and most common abnormalities were airspace opacities (61.9%) and prominent bronchovascular shadows (28.6%). Seventeen (85.0%) of the patients had parenchymal abnormalities consistent with COVID-19 on their chest CT. Chest CT most commonly showed bilateral (88.2%), multilobe (100%) involvement; peripheral and central distribution (70.6%); patchy-shape (94.1%) and ground-glass opacity (94.1%). The sensitivity of CXR and chest CT was calculated as 66.7% and 83.3%, respectively. Preterm birth rate was 41.2% (n=7/17). Five (9.1%) of the 55 pregnant women admitted to the intensive care unit, three of those developed acute respiratory distress syndrome and one died. Conclusion: This study describes the main radiological features of symptomatic pregnant women infected with COVID-19. The refusal rate among pregnant women for the imaging modalities involving ionizing radiation was high but these had high sensitivity for COVID-19 diagnosis. The preterm birth and cesarean section rates were observed as remarkably increased.

Relationship of the cycle threshold values of SARS-CoV-2 polymerase chain reaction and total severity score of computerized tomography in patients with COVID 19.

AIM: Studies analyzing viral load in COVID-19 patients and any data that compare viral load with chest computerized tomography (CT) severity are limited. This study aimed to evaluate the severity of chest CT in reverse transcriptase polymerase chain reaction (RT-PCR)-positive patients and factors associated with it. METHODOLOGY: SARS-CoV-2 RNA was extracted from nasopharyngeal swab samples by using Bio-speedy viral nucleic acid buffer. The RT-PCR tests were performed with primers and probes targeting the RdRp gene (Bioexen LTD, Turkey) and results were quantified as cycle threshold (Ct) values. Chest CT of SARS-CoV-2 RNA-positive patients (n = 730) in a period from 22 March to 20 May 2020 were evaluated. The total severity score (TSS) of chest CT ranged 0-20 and was calculated by summing up the degree of acute lung inflammation lesion involvement of each of the five lung lobes. RESULTS: Of the 284 patients who were hospitalized, 27 (9.5%) of them died. Of 236 (32.3%) patients, there were no findings on CT and 216 (91.5%) of them were outpatients (median age 35 years). TSS was significantly higher in hospitalized patients; 5.3% had severe changes. Ct values were lower among outpatients, indicating higher viral load. An inverse relation between viral load and TSS was detected in both groups. CT severity was related to age, and older patients had higher TSS (p < 0.01). CONCLUSION: Viral load was not a critical factor for hospitalization and mortality. Outpatients had considerable amounts of virus in their nasopharynx, which made them contagious to their contacts. Viral load is important in detecting early stages of COVID-19, to minimize potential spread, whereas chest CT can help identify cases requiring extensive medical care.

Spigelian Hernia Including the Urinary Bladder: A Rare Potential Cause of Surgical Complication.

Spigelian hernia is a rare type of anterior abdominal wall hernia. While it is itself very rare, seeing urinary bladder in this hernia is even rarer. Here, in this case, we specifically illustrate a rare case of Spigelian hernia including the urinary bladder, diagnosed with computerized tomography.