Evaluation of meniscal elasticity using shear wave elastography in obese children and adolescents: a preliminary cross-sectional study.

BACKGROUND: Musculoskeletal problems such as pain, joint pathology, increased risk of fracture, and the development of structural deformities are common in childhood obesity. Increased mechanical stress on the knee joint leads to degenerative changes in the cartilage and meniscus. Meniscal elasticity values increase in meniscal degeneration. Shear wave elastography (SWE) is an ultrasound-based imaging technique based on the principle of measuring tissue elasticity. OBJECTIVE: We aimed to investigate the changes in meniscal stiffness and thickness that can be caused by obesity in children and adolescents using SWE. MATERIALS AND METHODS: In this prospective cross-sectional study, the menisci of obese (n=44) and age- and sex-matched healthy weight (n=44) children and adolescents were assessed by SWE. Meniscal elasticity was measured in kPa on the coronal plane. Independent samples t-test was used to compare meniscal elasticity values between groups. Additionally, Pearson's correlation test was used to examine the relationships between elasticity values and age, height, weight, and body mass index (BMI). RESULTS: Meniscal elasticity values were significantly higher in the obese group than in the control group (P<0.001). In both groups, there was no significant difference in meniscal stiffness between the boys and girls or between the right and left sides. In the obese group, there were weak and moderate positive correlations between meniscal elasticity values and age, weight, and BMI (P<0.05). There was no significant difference in meniscal thickness between the obese and control groups. CONCLUSION: Meniscal stiffness is increased in obese children and adolescents.

Importance of incidental coronary artery calcification in early diagnosis of obstructive coronary artery disease.

Purpose: The early diagnosis of coronary artery disease (CAD) enables early intervention for the modifiable risk factors of the disease. Coronary artery calcification (CAC) detected incidentally on standard noncontrast chest computed tomography (CT) provides an opportunity for the early diagnosis of CAD. The purpose of this study was to demonstrate that CAC should be routinely reported when evaluating thoracic CT examinations. Routine reporting of CAC will contribute to the early diagnosis of CAD. Material and methods: The present study included 279 patients who underwent conventional coronary angiography (CAG) and CT within one month before undergoing CAG. The CAG and CT images of the patients were evaluated retrospectively. The levels of coronary artery stenosis were determined in reference to the CAG images. The CAC scores of the patients were calculated using the Weston method based on their chest CT images. Results: The mean age of the patients was 63.2 ± 11.5 (range, 41-93) years, and 172 (61.6%) of them were men. The Weston score (WS) was 0 in 18.9% of the patients with obstructive CAD (OCAD), whereas it was ≥ 7 in 27.9% of patients. All patients with a WS of ≥ 7 had OCAD. All patients without luminal stenosis or < 50% stenosis had a WS of < 7. Conclusions: The CAC score is useful for the diagnosis of CAD and OCAD. If CAC is identified on standard noncontrast chest CT, it should be scored and reported accordingly. The WS can be used for CAC scoring.

The usefulness of quantitatively assessing temporomandibular joint disk stiffness with shear wave elastography in adolescents with bruxism.

OBJECTIVE: The objectives of this study were to quantitatively measure temporomandibular joint (TMJ) disk stiffness in adolescents with bruxism using shear wave elastography (SWE) and to examine the relationship between elastography values, patient age, and duration of bruxism. STUDY DESIGN: This prospective study evaluated 120 TMJ disks of 60 adolescents (30 patients with bruxism and 30 controls). The stiffness of the anterior, intermediate, and posterior parts of the disk was measured. The patient and control groups' respective quantitative SWE values of elasticity (kilopascals [kPa]) and velocity (meters/second [m/s]) were compared. RESULTS: The elasticity and velocity values of the anterior and intermediate parts were significantly higher in the patients than in the controls (P ≤ .013), with no significant difference in the size of the joint space (P = .886). A receiver operating characteristic analysis resulted in sensitivity for the anterior part of 0.80 for kPa and 0.83 for m/s, with specificity of 0.57 (kPa) and 0.60 (m/s). For the intermediate part, the sensitivity was 0.80 for kPa and 0.86 for m/s, with specificity of 0.64 (kPa) and 0.57 (m/s). No correlations were found between the SWE values and patient age (P ≥ .098) or duration of bruxism (P ≥ .134). CONCLUSIONS: SWE may be useful in the evaluation of TMJ disk stiffness in patients with bruxism.

Prediction of IDH Mutation Status in High-grade Gliomas Using DWI and High T1-weight DSC-MRI.

RATIONALE AND OBJECTIVES: We aimed to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic susceptibility contrast-enhanced (DSC) magnetic resonance imaging (MRI) parameters in the noninvasive prediction of the isocitrate dehydrogenase (IDH) mutation status in high-grade gliomas (HGGs). MATERIALS AND METHODS: A total of 58 patients with histopathologically proved HGGs were included in this retrospective study. All patients underwent multiparametric MRI on 3-T, including DSC-MRI and DWI before surgery. The mean apparent diffusion coefficient (ADC), relative maximum cerebral blood volume (rCBV), and percentage signal recovery (PSR) of the tumor core were measured and compared depending on the IDH mutation status and tumor grade. The Mann-Whitney U test was used to detect statistically significant differences in parameters between IDH-mutant-type (IDH-m-type) and IDH-wild-type (IDH-w-type) HGGs. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the diagnostic performance. RESULTS: The rCBV was significantly higher, and the PSR value was significantly lower in IDH-w-type tumors than in the IDH-m group (p = 0.002 and <0.001, respectively).The ADC value in IDH-w-type tumors was significantly lower compared with the one in IDH-m types (p = 0.023), but remarkable overlaps were found between the groups. The PSR showed the best diagnostic performance with an AUC of 0.938 and with an accuracy rate of 0.87 at the optimal cutoff value of 86.85. The combination of the PSR and the rCBV for the identification of the IDH mutation status increased the discrimination ability at the AUC level of 0.955. In terms of each tumor grade, the PSR and rCBV showed significant differences between the IDH-m and IDH-w groups (p ≤0.001). CONCLUSION: The rCBV and PSR from DSC-MRI may be feasible noninvasive imaging parameters for predicting the IDH mutation status in HGGs. The standardization of the imaging protocol is indispensable to the utility of DSC perfusion MRI in wider clinical usage.

Percutaneous radiological biliary interventions after failed endoscopic treatment in living liver donors: experience of a high-volume transplantation center.

This study aimed to evaluate the role of percutaneous radiological treatments for biliary complications (BCs) in donors after living donor liver transplantation (LDLT). We retrospectively evaluated BCs in donors involved in 1839 LDLTs between May 2009 and January 2019 at our centre. BCs were classified according to the modified Clavien-Dindo classification (MCDC). Patients treated with percutaneous transhepatic biliary intervention (PTBI) were identified. Complications requiring endoscopic, interventional or surgical treatment (MCDC grades III-IV) involved 123 (6.6%) donors. Complications comprised leakage, n = 73 (60%); stricture, n = 36 (29%); and both leakage and stricture, n = 14 (11%). Percutaneous drainage of biloma formations under ultrasound guidance was performed in 57 donors, endoscopic treatment in 83 and PTBI in 14. Of 83 patients who received endoscopic treatment, 13 were referred for PTBI due to failure or uncannulation. Eight of 14 patients were successfully treated with PTBI. Six patients were treated with a rendezvous procedure combining percutaneous and surgical treatments. In 13 patients, no BCs were developed after catheter or stent removal. In donors with BCs, the treatment should progress from the least invasive method to surgery. In some patients, percutaneous radiological treatments eliminate the need for surgery or can guide surgical treatment.

Evaluation of Early and Late Complications of Pediatric Liver Transplantation with Multi-slice Computed Tomography: A High-Volume Transplant Single-Center Study.

BACKGROUND: To present abdominal multi-slice computed tomography (MSCT) results following transplantation in pediatric patients with a liver transplantation (LT), and to create awareness of early (<3 months) and late (>3 months) complications that may occur. METHODS: This retrospective study included 119 children with an LT performed in our hospital from 2014 to 2017. The descriptive statistics relating to patients' age, gender, transplantation indications, transplantation technique, and MSCT findings were calculated, and are presented as numbers and percentages. The complications were divided into 4 groups: vascular, biliary, parenchymal, and extraparenchymal. RESULTS: The LT procedures were performed with organs from living donors for 83 patients, and from deceased donors for 36 patients. Hepatic artery and portal vein complications were mostly seen in the early period (n = 18), and hepatic vein complications were also observed in the late period (n = 6). The most commonly encountered biliary complications were stenosis/stricture (n = 13) and bile leak/ bilioma (n = 9). Stenosis/stricture frequently occurred in the late period. The most common parenchymal complications were ischemic infarct (n = 8) in the early period, and abscess (n = 4) and recurrent hepatoblastoma (n = 2) in the late period. Hematoma (n = 7), intestinal perforation (n = 3), and focal spleen infarct (n = 3) were among the most commonly observed extraparenchymal abdominal complications. CONCLUSION: The complications occurring after pediatric LT varied according to the time after surgery and the transplantation technique used. Using MSCT, different abdominal complications can be assessed simultaneously, greatly contributing to diagnosis and treatment.

Investigation of the prognostic value of psoas muscle area measurement in pediatric patients before liver transplantation: A single-center retrospective study.

BACKGROUND: In this study, our aim is to investigate the prognostic value of psoas muscle area (PMA) evaluation before liver transplantation (LT) in pediatric patients. METHODS: Two hundred seventy-six patients under 18 years of age who underwent LT between January 2012 and December 2019 were included in the study. The patients' demographic, laboratory, clinical, and imaging data were scanned retrospectively. PMA was measured at the L4/5 level using computed tomography images. To determine reproducibility, a different radiologist evaluated 30 randomly selected patients. RESULTS: In patients with end-stage liver disease (ESLD), PMA was significantly lower than in patients with acute liver failure (P < .001). In patients with ESLD, a weakly significant correlation was found between PMA and 1-year survival after LT (r: .251, P = .030), hospitalization period (r: -.275, P = .039), and pediatric ESLD score (r: -.338, P < .001). Interobserver correlation was excellent (ICC: .941, 95% CI: .925, .971). CONCLUSION: In children with ESLD, PMA evaluated before LT can be used as a negative prognostic factor.

Validation of combined use of DWI and percentage signal recovery-optimized protocol of DSC-MRI in differentiation of high-grade glioma, metastasis, and lymphoma.

PURPOSE: With conventional MRI, it is often difficult to effectively differentiate between contrast-enhancing brain tumors, including primary central nervous system lymphoma (PCNSL), high-grade glioma (HGG), and metastasis. This study aimed to assess the discrimination ability of the parameters obtained from DWI and the percentage signal recovery- (PSR-) optimized protocol of DSC-MRI between these three tumor types at an initial step. METHODS: DSC-MRI using a PSR-optimized protocol (TR/TE = 1500/30 ms, flip angle = 90°, no preload) and DWI of 99 solitary enhancing tumors (60 HGGs, 24 metastases, 15 PCNSLs) were retrospectively assessed before treatment. rCBV, PSR, ADC in the tumor core and rCBV, and ADC in peritumoral edema were measured. The differences were evaluated using one-way ANOVA, and the diagnostic performance was evaluated using ROC curve analysis. RESULTS: PSR in the tumor core showed the best discriminating performance in differentiating these three tumor types with AUC values of 0.979 for PCNSL vs. others and 0.947 for HGG vs. metastasis. The ADC was only helpful in the tumor core and distinguishing PCNSLs from others (AUC = 0.897). CONCLUSION: Different from CBV-optimized protocols (preload, intermediate FA), PSR derived from the PSR-optimized protocol seems to be the most important parameter in the differentiation of HGGs, metastases, and PCNSLs at initial diagnosis. This property makes PSR remarkable and carries the need for comprehensive DSC-MRI protocols, which provides PSR sensitivity and CBV accuracy together, such as the preload use of the PSR-optimized protocol before the CBV-optimized protocol.

The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection.

PURPOSE: The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. METHODS: Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. RESULTS: SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01). CONCLUSION: Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.

Analysis of magnetic resonance imaging findings of children with neurologic complications after liver transplantation.

OBJECTIVE: To analyze the magnetic resonance imaging findings in children diagnosed with neurologic complications after liver transplantation (LT). MATERIALS AND METHODS: A total of 39 patients diagnosed with neurologic complications following LT between 2010 and 2016. Neuroradiologic imaging was performed using cranial magnetic resonance imaging (MRI). Descriptive statistics regarding age, gender, type of complication, diagnostic and therapeutic modalities were calculated and presented as number and percentage. RESULTS: Our series consisted of 18 girls and 21 boys. Cryptogenic hepatitis (n = 13, 32%), metabolic diseases (Wilson's disease, tyrosinemia and glycogen storage disease) (n = 7, 18%) and fulminant toxic hepatitis (n = 4, 11%) constitute the most frequent indications for LT. The indications for neuroradiological imaging were convulsion and alteration of mental status. CONCLUSION: These central nervous system complications may present in a variable spectrum and convulsions and altered mental state were the most frequent clinical pictures. Imaging studies were normal in approximately one-third of cases; the most frequent pathologic findings were diffuse cerebral edema, atrophy, and PRES. Clinical history, careful examination and integrated analysis of radiologic data as well as close collaboration and multidisciplinary approach are of utmost importance for establishing the diagnosis rapidly and accurately.