Determining the Incidence of Gynecoid Pelvis Using Three-Dimensional Computed Tomography in Nonpregnant Multiparous Women.

OBJECTIVES: To determine the incidence of gynecoid pelvis by using classical criteria and measured parameters obtained from three-dimensional computed tomography (3D CT) pelvimetry in nonpregnant multiparous women who delivered vaginally. SUBJECTS AND METHODS: Our hospital's picture archiving and communication system was reviewed retrospectively. All adult women who had undergone CT examination with routine abdominal protocols were identified. In the pelvic inlet, midpelvis, and pelvic outlet, classical criteria and measured parameters, both alone and in combination, were used to determine the presence of gynecoid pelvis. RESULTS: 3D CT pelvimetry was performed on 226 women aged 23-65 years without any history of cephalopelvic disproportion and who had at least one delivery of an average fetal size (>2,500 g). The median parity was 4, and the mean (±SD) birth weight was 3,700 ± 498 g. Compared to the classical criteria, measured parameters and their combined use with the classical criteria significantly reduced the frequency of gynecoid pelvis (51.3 and 47.8%, respectively, vs. 71.6%; p = 0.001); however, there was no significant difference between the measured parameters and their combined use with classical criteria with regard to the frequencies of gynecoid pelvis (p > 0.05). CONCLUSIONS: With the use of measured parameters of 3D CT pelvimetry, the incidence of gynecoid pelvis reduces to a more acceptable level (51.3%) in accordance with obstetric knowledge. Since there is no considerable decrease with the addition of classical criteria, 3D CT pelvimetry alone has merit for determining a woman's pelvic capacity for obstetric needs after the improvement and standardization of measured parameters.

A Rare Case of Vesicourachal Diverticulum with Calculus in a 24-Year-Old Man.

BACKGROUND: During embryonal period, complete obliteration of the urachus at the umbilicus and incomplete closure at the bladder level are the cause of vesicourachal diverticulum. This abnormality is a rare finding that is usually discovered incidentally during radiological evaluation. Occasionally, stones have been detected within the diverticulum. CASE REPORT: We present a case of a vesicourachal diverticulum with calculus diagnosed by multidetector computed tomography and confirmed surgically and histopathologically in a 24-year-old man. CONCLUSIONS: During the radiological differential diagnosis of abnormalities of abdominal wall and urinary system, consideration of urachal abnormalities is important especially in symptomatic patients.

Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally.

BACKGROUND: We assessed retrospectively the reference values of pelvic dimensions by 3D CT performed for non-obstetrical indications in non-pregnant multiparous women with a successful vaginal delivery. We further aimed to evaluate the impact of maternal short stature on these parameters. MATERIAL/METHODS: The 3D CT pelvimetry was performed retrospectively in 203 non-pregnant women selected consecutively if they had at least one singleton term delivery with head presentation and if there was no history of maternal or fetal birth trauma or cerebral palsy after childbirth. With standard sagittal and reformatted axial-oblique views, anteroposterior including three conjugates of pelvic inlet, transverse, posterior sagittal diameters of pelvic inlet, the plane of greatest diameter, the plane of least diameter, and pelvic outlet were measured. Selected obstetric parameters were collected. RESULTS: Overall, the pelvises had transverse oval appearance in inlet and size of the female pelvis. The diagonal conjugate was at least 15 mm longer than the obstetric conjugate. Women with short stature had lower maximal birth weight, and this was in accordance with their somewhat lower pelvic diameters. CONCLUSIONS: The findings of this study present the reference values of the main planes of the true pelvis by 3D CT pelvimetry in a relatively large group of multiparous women who passed a trial of labor successfully. Overall, the pelvises had features of female pelvic bony structure although pelvic diameters were somewhat lower in multiparous women with short stature. The 3D pelvimetry with CT applications may be used as an adjunct to clinical and ultrasonographic examinations to rule out cephalopelvic dystocia in selected cases.

Role of thalamic diffusion for disease differentiation between multiple sclerosis and ischemic cerebral small vessel disease.

INTRODUCTION: Cerebral small vessel disease (CSVD) and multiple sclerosis (MS) both harbor multiple, T2-hyperintense white matter lesions on conventional magnetic resonance imaging (MRI).We aimed to determine the microstructural changes via diffusion-weighted imaging (DWI) in normal appearing thalami. We hypothesized that the apparent diffusion coefficient (ADC) values would be different in CSVD and MS, since the extent of arterial involvement is different in these two diseases. METHODS: DWI was performed for 50 patients with CSVD and 35 patients with MS along with gender- and age-matched controls whose conventional MRI revealed normal findings. DWI was done with 1.5 Tesla MR devices using echo planar imaging (EPI) for b = 0, 1000 s/mm(2). ADC values were obtained from the thalami which appeared normal on T2-weighted and FLAIR images. Standard oval regions of interest (ROIs) of 0.5 cm(2) which were oriented parallel to the long axis of the thalamus were used for this purpose. RESULTS: The mean ADC value of the thalamus was (0.99 ± 0.16) × 10(-3) mm(2)/s in patients with CSVD, whereas the mean ADC value was (0.78 ± 0.06) × 10(-3) mm(2)/s in the control group. The mean ADC value was significantly higher in patients with CSVD compared to the controls (p < 0.001). The mean ADC values of the thalamus were (0.78 ± 0.08) × 10(-3) mm(2)/s in MS patients, and (0.75 ± 0.08) × 10(-3) mm(2)/s in the control group, which are not significantly different (p > 0.05). CONCLUSION: Our study revealed a difference in the diffusion of the thalami between CSVD and MS. DWI may aid in the radiological disease differentiation.

Diagnosis of High Bifurcation of the Abdominal Aorta with Associated Vascular Variations: Case Report with Multidedector Computed Tomography.

BACKGROUND: Variations of the branches and bifurcation of the abdominal aorta and their relations with other abdominal structures and organs are important concerning abdominal and spinal surgery. CASE REPORT: In this report, authors present a high -positioned bifurcation of the abdominal aorta at the level of the L3 vertebral body and its associations with multiple variations of other abdominal arteries during contrast-enhanced multi-detector computed tomography (MDCT) examination of the abdomen. CONCLUSIONS: We reported on a unique clinically and surgically significant case of variations of the abdominal aorta as related to the location and type of bifurcation. The awareness of the variations of the abdominal aorta is of great importance for surgeons in order to reduce complications during abdominal and spinal interventions, as well as for radiologists for precise interpretation of angiograms.

CT and MR Imaging in a Large Series of Patients with Craniofacial Fibrous Dysplasia.

BACKGROUND: In this retrospective review of patients with craniofacial fibrous dysplasia (FD), the clinical and radiological findings of CT and MR scan were analyzed. MATERIAL/METHODS: The study material included 32 patients, at 9 to 68 years of age that were directed for differential diagnostics of several disorders in the head. We recorded CT and MRI data related to the lesion number, location, sidedness, appearance, and sex of the cases with craniofacial FD. RESULTS: Of 32 patients involved in this study, 17 had monostotic and 15 had polyostotic involvement pattern. Bones most commonly involved by monostotic involvement in females were, in descending order, mandibular, maxillary, and sphenoid bones, while the sphenoid bone was involved the most in males. Leontiasis ossea was observed in 2 patients. Sclerotic and mixed lesion types were more common in both females and males. In T1- and T2-weighted MRI sequences, hypointensity was more common compared to hyperintensity or heterogeneous intensity. The type of enhancement of lesions was found similar after contrast medium administration. CONCLUSIONS: In the presence of craniofacial FD during CT or MRI imaging of the head, a detailed description of FD lesions may provide an important clinical benefit by increasing radiological experience during the diagnostics of this rare disorder.

Carotid artery Doppler ultrasonography in patients with chronic kidney disease.

BACKGROUND: We investigated the changes in the values of carotid intima-media thickness (IMT) and Doppler index measurements in the autosomal dominant polycystic kidney disease (ADPKD), peritoneal dialysis (PD), and hemodialysis (HD) patients. MATERIAL AND METHODS: Twenty outpatients on HD (mean age 46.1 ± 16.4), 27 outpatients on PD (mean age 45 ± 12.4), and 26 normotensive outpatients with ADPKD (mean age 52.4 ± 16.7) as the case groups and 21 healthy subjects (mean age 48.4 ± 7.2), as the control group, were included. The participants underwent ultrasonography of the common, right, and left carotid arteries for the IMT and Doppler flow measurements. RESULTS: Overall, compared to the normal group, in the study groups, the IMT and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) were significantly higher in common carotid arteries; however, their differences were not meaningful in internal carotid arteries (p<0.05). CONCLUSIONS: Overall, ADPKD, PD, and HD increase the IMT, PSV, EDV, RI, and PI values of CCA; however, their effect considerable less on the study parameters of ICA. There is no considerable difference among the effects of ADPKD, HD, and PD on the study parameters. Of CKD patients during the first diagnostic and follow-up workups, the measurements of carotid IMT and Doppler indices may provide valuable data for improving success of the clinical management.

Classical signs and appearances in pediatric neuroradiology: a pictorial review.

Radiological practice includes classification of illnesses with similar characteristics through recognizable signs. In this report, twenty-eight important and frequently seen neuroradiological signs in childhood are presented and described using X-rays, computed tomography (CT), magnetic resonance (MR) images, illustrations and photographs.

A giant juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibromas are locally growing and highly vascular tumors. They are primarily treated through surgical excision ranging from an open approach to an endoscopic approach. We presented a 20-year-old man with a giant juvenile nasopharyngeal angiofibroma that bilaterally obliterated the pterygopalatine fossa, invaded the sphenoid bone, and extended to the left nasal passage. His complaints were epistaxis and nasal obstruction. After embolization, the patient was treated surgically using the endoscopic approach and declared cured and discharged without any complications.

Magnetic resonance imaging mesencephalic tectum dimensions according to age and gender.

OBJECTIVE: To analyze and classify normal MRI tectum length and colliculus dimensions according to age and gender. METHODS: Tectum length and colliculus diameters were measured on the T1 midsagittal and axial cranial MR images in the radiology archive of 532 (344 women, 188 men) patients aged 37.36+/-21.49 (range: 4-91) years old on average, and with no disorders affecting the mesencephalic tectum. All 532 patients underwent clinical MR imaging of the cranium at the MRI Unit of Sivas Numune Hospital and Sivas Cumhuriyet University Hospital, Sivas, Turkey between February and December 2011. RESULTS: Although there was a positive linear correlation between tectum length and age, there was a negative correlation between the anteroposterior diameter of the colliculus superior and colliculus inferior and age (p<0.01). While tectum length (M3) increases with age, the anteroposterior diameter of the colliculus superior and inferior (M1 and M2) decreased (p<0.01). The colliculi were larger, and the tectum was longer in men. Although there was no difference in size between right and left superior colliculi, the left colliculus inferior was larger than the right one. CONCLUSION: In addition to the fact that normal mesencephalic tectum dimensions provide information on the brain development of individuals, they may also be beneficial for the detection and treatment of related pathologies.

Analysis of ethmoid roof and skull base with coronal section paranasal sinus computed tomography.

Chronic paranasal sinus disease is one of the most common causes of application to physicians in pediatric and adult patients. In the surgical treatment of these diseases, endoscopic sinus surgery is an application that is often done to increase the quality of the patient's life. On account of this, the anatomic variations in skull basement must be well known to avoid possible major complications that may occur during the operation. Recent developments in paranasal sinus surgery also enhanced the need for examining exhaustively the anatomy of this region and existing pathology. Superiority of computed tomography (CT) has an unquestionable importance for the evaluation of anatomic structure and pathology compared with conventional radiographs. A likely anatomic knowledge is needed for a safe surgery. Before the surgery, determining the anatomic variations makes the operation safer and increases the prospects, so we can prevent complications that may occur during the surgery. In this study, CT coronal sections of 300 patients who were admitted to the Department of Ear Nose Throat of Medical Faculty of Cumhuriyet University Research and Training Hospital between the dates December 2008 and January 2011 with complaints of nasal flow and postnasal drip were studied. According to coronal section CT examinations, the patients were divided into 2 groups. Group 1, with 156 cases (64%), showed mucosal changes, and in 144 cases (36%), no mucosal changes were established (group 2). In comparison between the sexes, in groups 1 and 2 females, significant difference was determined for other parameters except the average height of the ethmoid roof. In the comparison between the sexes, in groups 1 and 2 males, significant difference was determined for all parameters. The difference between these 2 rates was statistically significant. Keros types 1 and 2 cases were compared with the control group, and there was no statistically significant difference. Notwithstanding, at the comparison of the Keros type 3 with the control group, there was a statistically significant difference for all the parameters (maximum orbital height, the length of the middle concha, and the nasal wall). It seems to be important for us to know the average length of the peripheral anatomic structures to avoid serious complications that may occur during the operation. Careful preoperative review of paranasal sinus CT scans in patients undergoing sinus surgery seems to be the most important to prevent severe intraoperative complications.

The Relationship between the SUVmax Value Obtained in Ga-68 PSMA PET/CT and Lactate Dehydrogenase and Alkaline Phosphatase in Prostate Cancer.

OBJECTIVES: ALP and LDH are serum markers of prognostic importance in prostate cancer patients. PET/CT imaging with Ga-68 PSMA has played an important role in prostate cancer imaging in recent years. Our aim in this study was to evaluate the relationship and prognostic significance between SUVmax values obtained with Ga-68 PSMA PET/CT and LDH and ALP levels in prostate cancer patients. METHODS: We retrospectively evaluated 61 prostate cancer patients who had Ga-68 PSMA PET/CT imaging and who did not have a prostatectomy between 2019 and 2020. PSA, ALP and LDH levels were measured in all patients before or after imaging within a maximum of 28 days. RESULTS: The median age of the patients included in this study was 73 (range: 57-89) and all 61 patients were prostatic adenocarcinoma. 50 (82%) of the patients had distant metastasis in Ga-68 PSMA PET/CT. There was a significant positive correlation between serum LDH and PSA levels. There was a positive correlation between serum ALP and PSA levels. A negative correlation was found between ALP levels and prostate SUVmax. CONCLUSIONS: While negative correlation was found between SUVmax and ALP levels, no correlation was found between LDH levels and SUVmax. High ALP levels were found to be related to metastasis rates and severity and high serum PSA levels.

Kimura disease in the parotid gland.

Kimura disease (KD) is a rare entity that occurs primarily in Asian people characterized histopathologically by a lymph-folliculoid granuloma with infiltration of the mass and the surrounding tissues by eosinophils, often with concomitant peripheral blood eosinophilia and elevated serum immunoglobulin E, generally seen in the head and neck region, especially preauricular area. In this article, we present the case of a 14-year-old male patient with KD on his left parotid area. The clinical, radiologic, surgical, and pathologic findings of KD are discussed in this article.

Evaluation of respiratory findings in Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease with a high mortality rate causing viral hemorrhagic fever. We studies the respiratory system findings, demographics, clinical and laboratory findings of patients with CCHF admitted to our hospital. In this retrospective study we evaluated 108 patients with CCHF confirmed by laboratory findings. The charts of all hospitalized patients were reviewed, and the age, sex, occupation, city of residence, history of tick bite or of removing a tick, smoking history, chest X-ray results, outcome and clinical and laboratory findings were recorded for each patient. Sixty of the chest radiographs were read as normal, 33 were read as showing unilateral pathology and 15 showed bilateral pathology. Seven of the 108 patients died due to severe pulmonary infection and hemorrhage. The frequency of pathological chest radiographs was higher among the CCHF patients who died than among the survivors, but the difference was not significant. Pulmonary parenchyma hemorrhage can occur in CCHF patients with hemoptysis, dyspnea, chest pain and infiltration on chest radiographs and may lead to morality.

Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese patients.

OBJECTIVE: We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur. METHODS: In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL. RESULTS: Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was 45.9 ± 8.3 years; BMI was 31.6 ± 4.4 kg/m2; and symptom duration was 2.3 ± 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 ± 1.0 vs. 4.4 ± 0.9, p = 0.001; VAS score before vs. after: 8.3 ± 1.4 vs. 4.6 ± 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03). CONCLUSIONS: In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration.

Biomass exposure and the high resolution computed tomographic and spirometric findings.

BACKGROUND: The adverse health effects of biomass fuel exposure (BFE) is complex and widespread. According to our knowledge, the interstitial lung disease due to BFE is not clear in literature. OBJECTIVE: In this descriptive crossectional study, the main objective was to assess the effects of BFE on the respiratory system. METHODS: Patient group was included non-smoker 21 woman and the control group was included non-smoker 22 woman. High resolution computed tomographic (HRCT) examinations were made with supin and prone positions in two groups. The spirometric measurements, including the diffusion capacity at rest for carbon monoxide, single breath (DLCO), were also made. RESULTS: It was found that BFE caused obstructive and restrictive spirometric impairments. The prevalence of the fibrotic bands, peribronchovascular thickenings, nodular radio opacities, and curvilinear densities in the high resolution computed tomographic examinations were 7, 5, 7, and 16 times higher in the exposure group than the control group, respectively. There was a significant positive correlation between the forced vital capacity (FVC), forced expiratory volume first second (FEV(1)), FEV(1)/FVC, forced expiratory flow during middle half of forced vital capacity (FEF25-75), DLCO and the volumetric densities of the HRCT slices with deep expiration in prone position. CONCLUSIONS: We think that, the findings due to BFE, pose a special situation and it can be named "biomass lung".

Potential impact of atelectasis and primary tumor glycolysis on F-18 FDG PET/CT on survival in lung cancer patients.

BACKGROUND: Atelectasis is an important prognostic factor that can cause pleuritic chest pain, coughing or dyspnea, and even may be a cause of death. In this study, we aimed to investigate the potential impact of atelectasis and PET parameters on survival and the relation between atelectasis and PET parameters. MATERIALS AND METHODS: The study consisted of patients with lung cancer with or without atelectasis who underwent (18)F-FDG PET/CT examination before receiving any treatment. (18)F-FDG PET/CT derived parameters including tumor size, SUVmax, SUVmean, MTV, total lesion glycosis (TLG), SUV mean of atelectasis area, atelectasis volume, and histological and TNM stage were considered as potential prognostic factors for overall survival. RESULTS: Fifty consecutive lung cancer patients (22 patients with atelectasis and 28 patients without atelectasis, median age of 65 years) were evaluated in the present study. There was no relationship between tumor size and presence or absence of atelectasis, nor between presence/absence of atelectasis and TLG of primary tumors. The overall one-year survival rate was 83% and median survival was 20 months (n=22) in the presence of atelectasis; the overall one-year survival rate was 65.7% (n=28) and median survival was 16 months (p=0.138) in the absence of atelectasis. With respect to PFS; the one-year survival rate of AT+ patients was 81.8% and median survival was 19 months; the one-year survival rate of AT- patients was 64.3% and median survival was 16 months (p=0.159). According to univariate analysis, MTV, TLG and tumor size were significant risk factors for PFS and OS (p<0.05). However, SUVmax was not a significant factor for PFS and OS (p>0.05). CONCLUSIONS: The present study suggested that total lesion glycolysis and metabolic tumor volume were important predictors of survival in lung cancer patients, in contrast to SUVmax. In addition, having a segmental lung atelectasis seems not to be a significant factor on survival.

An MRI study of age-related changes in the dimensions related temporal lobe.

The aim of this study was to determine the effect age-related changes on the MRI-based parameters related to several measurement of temporal lobe in the lifespan of adult persons. MRI scans of head (n=236) were reviewed retrospectively to identify abnormalities of temporal lobe, third ventricle, and temporal horn of lateral ventricle. Patients were divided into 3 study groups according to their age. Using axial and coronal views of the cerebral hemispheres, interuncal distance, thickness of temporal lobe, Evans' ratio, and the width of third ventricle, height of hippocampus, width of choroid fissure, and width of the temporal horn were measured. The mean age of study group was 44.2±17.7 (18 to 86). The gender ratio (F/M) of study group was 129/107. There is mild-moderate significant correlation between age and Evans' ratio (r=0.35, p<0.05). There is mild significant correlation between age and interuncal distances (r=0.24, p<0.05). There was no correlation between age and third ventricle widths, temporal lobe widths, and temporal horn widths of left and right sides of brain (p>0.05). A mild and significant correlation was present between these variables (r=0.14 and r=0.17, respectively; p<0.05). There was a mild and significant correlation between these variables. (r=-0.14 and r=-0.19, respectively; p<0.05). Although several parameters including our measurements were developed for the assessment of size and structure of temporal lobe. It is not ease to determine MRI-based markers for the prediction, diagnosis, and follow-up of mild cognitive impairment and Alzheimer's disease in the elderly.

Evaluation of clinical and laboratory findings of pediatric and adult patients with oropharyngeal tularemia in Turkey: a combination of surgical drainage and antibiotic therapy increases treatment success.

We analyzed the clinical and laboratory findings of both pediatric and adult patients with oropharyngeal tularemia. We also compared the therapeutic outcomes of patients who underwent surgical drainage of lymph nodes early or late during antibiotic therapy. A total of 68 patients with oropharyngeal tularemia, including 26 children and 42 adults, were enrolled in this study. The average duration between symptom onset and hospital admission was 20.8 days (4-60 days) in the pediatric group and 32.6 days (4-90 days) in the adult group (P = 0.009). The most frequently observed clinical symptoms were sore throat (100% and 100%), fever (96.2% and 90.5%), tonsillitis (69.2% and 78.6%), and rash (15.4% and 11.9%) in the pediatric and adult groups, respectively. However, the frequencies of erythema, tenderness, and fluctuant of enlarged lymph nodes were significantly higher in the adult group than in the pediatric group (P = 0.005, P = 0.029, and P = 0.041, respectively). Treatment failure was observed in 2 (7.7%) pediatric patients and 4 (9.5%) adult patients, for a total of 6 (8.8%) treatment failures in the study group. Similar clinical findings and treatment outcomes were observed in both groups. We concluded that a combination of surgical drainage and antibiotic therapy increases treatment success for patients diagnosed with oropharyngeal tularemia.