Effect of sex-specific abdominal fat tissue composition on WHO/ISUP nuclear grade of clear cell renal cell carcinoma.

Background/aim: To investigate the relationship between sex-related visceral obesity and WHO/ISUP nuclear grade in clear cell renal cell carcinoma (ccRCC). Materials and methods: Between January 2018 and June 2022, 95 patients (56 men and 39 women) with pathologically proven ccRCC who underwent abdominal computed tomography examination were retrospectively examined. The patients were classified into two groups: low- and high-WHO/ISUP nuclear grade ccRCC (n = 58 and n = 37), respectively. Patient height, weight, body mass index (BMI), sex, age, subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), and percentage of visceral fat (VF%) were recorded for the two groups. Results: No significant differences were found in age, BMI, SFA, or TFA, but VFA and VF% were significantly higher in the high-grade patient group. In males, maximal tumor diameter (MTD) (67.8% sensitivity and 76.9% specificity) had the highest area under the curve (AUC), while in females, VF% (70.0% sensitivity and 73.7% specificity) had the highest AUC. VF% revealed an odds ratio (OR) of 1.09 in females with high-grade ccRCC, and in males, MTD was an independent predictor of ccRCC with an OR of 1.03. Conclusions: Sex-related body fat tissue, including VFA and VF%, could be used for estimating WHO/ISUP nuclear grade in patients with ccRCC, especially in females.

Evaluation of cardiovascular changes in patients with gastric wall fat halo sign.

BACKGROUND: This study aims to investigate the relationship between gastric wall fat halo sign and potentially associated cardiovascular disease (CVD) in thoracic computed tomography (CT). METHODS: Between October 2020 and January 2021, 62 patients with gastric wall fat halo sign and 62 controls were evaluated with thorax CT. Patient's height, weight, body mass index (BMI), sex, age, comorbidities, laboratory parameters, diameters of cardiac axes, aorta and pulmonary artery; aorta and coronary artery calcium scores were recorded for the two groups. RESULTS: No significant differences were found in sex, age, height, body weight or BMI between the two groups (p > 0.124). Patients with gastric wall fat halo sign had significantly larger diameters of the ascending aorta, the descending aorta, the main pulmonary artery, the right and left pulmonary arteries, and the short and long cardiac axes and a higher cardiothoracic ratio (CTR) than the control group (p < 0.001). Additionally, the calcium scores of the ascending, arcus, and descending aortas and the coronary arteries were significantly higher detected in patients group (p < 0.001). Patient group had significantly higher lipid profile, frequencies of diabetes mellitus (DM) and hypertension (HT) than control group (p<0.026). DISCUSSION: Patients with a gastric wall fat halo may show higher cardiovascular risk because of increased visceral fat tissue, vascular diameters, CTR, heart sizes, presence of DM, HT, increased lipid profile and calcium scores.

Evaluation of Intracranial Vascular and Non-Vascular Pathologies in Patients Hospitalized due to COVID-19 Infection.

OBJECTIVE: Although Coronavirus disease 2019 (COVID-19) is a respiratory virus different clinical presentations may appear by affecting other organs and systems. Along with vascular diseases in COVID-19 disease, other conditions involving the central nervous system (CNS) such as meningocephalitis, cerebral edema, and lesions on corpus callosum. Neuroimaging has an extremely important place in the diagnosis when central nervus system involvement is clinically suspected in people infected with COVID-19. METHODS: The study was monocentric, retrospectively designed between March 2020 and May 2021 in a tertiary healthcare facility. Among the patients who underwent neurological evaluation, patients with anomaly in brain MRI and CT were included in the study. RESULTS: Among 5,430 patients who have been admitted due to COVID-19 between the dates mentioned above, 51 patients including 27 (52.9%) females and 24 (47.1%) males presented abnormal findings in cerebral radiological tests. Vascular abnormality was detected in 45 patients whereas 6 patients presented non-vascular abnormality. General demographic data and concomitant diseases of the patients were presented in Table 1and Table 2. CONCLUSION: In line with the literature, this study which reviewed abnormalities of CNS involvement reflected on brain MRI and CT among neurological complications due to COVID-19 infection revealed that vascular abnormalities. Presence of concomitant diseases including advanced age and hypertension was detected as risk factors for development of vascular abnormality. It was documented that non-vascular brain anomalies which are less common and treated differently and these are at earlier ages when compared to patients with vascular anomalies with fewer co-morbidities and shorter duration of infection.

The relationship between vertebral deformities and thoracic arthropathy with back pain in Chronic Obstructive Pulmonary Disease.

OBJECTIVES: The aim of the study was to investigate the relationship between back pain and thoracic vertebral deformities and arthropathy in patients with COPD who underwent thorax CT scans to screen for lung nodules and cancer. MATERIALS AND METHODS: The data of patients who underwent thoracic CT and pulmonary function tests (PFTs) between July 2019 and February 2020 were retrospectively reviewed. The patients were divided into two groups: the COPD (n = 64) and control groups (n = 101), according to the PFT results. The CT images were evaluated for vertebral deformities, osteoporosis and thoracic vertebral joint arthropathy, and the Spinal Deformity Index (SDI) was calculated. RESULTS: Back pain was detected in 43.7% of the COPD patients and 20.9% of the controls. The patients with COPD had significantly higher rates of costotransverse, intervertebral, facet joint arthropathy, and osteoporosis than did the control group (P < .001). The OR analyses showed that the presence of a vertebral deformity (OR 4.42, 95% CI 2.26 - 8.63, P < .001), of facet joint arthropathy (OR 3.6, 95% CI 2.83-4.58, P < .001), and of costotransverse arthropathy (OR 2.20, 95% CI 1.47-2.77, P < .001) were associated with the presence of back pain. Although a strong positive correlation was found between the SDI and pain score, a moderate negative correlation was found between the FEV1% values and pain score. CONCLUSIONS: Back pain was present in patients with COPD and was related to vertebral deformities and facet and costotransverse joint arthropathy. Additional studies are required to clarify the relationships of back pain with musculoskeletal system diseases, including cervical and lumbar spine arthropathy and vertebral deformities.

Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue.

Aim    High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness.Material and methods    Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI ≥11.6 ng / l) and without myocardial damage (hs-TnI<11.6 ng / dl).Results    A total of 46 patients were women (63.0 %). The mean age was 66.4±12.3 yrs in the myocardial injury group and 55.9±9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9 %) in the injury group, while there were 12 hypertensive patients (27.3 %) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil / lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6±1.6 mm in the injury group, whereas it was 4.8±1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65 % sensitivity and 39 % specificity (AUC=0.65, 95 % CI: 0.52-078, p=0.031).Conclusion    In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients.

The efficiency of susceptibility-weighted MRI in the differentiation of endometriomas from haemorrhagic ovarian cysts.

OBJECTIVES: The aim of the study was to investigate the efficiency of susceptibility-weighted magnetic resonance (MR) imaging (SWIs) in differentiating endometriomas from haemorrhagic ovarian cysts. MATERIALS AND METHODS: Between July 2017 and January 2019, 89 ovarian cystic lesions (57 endometriomas and 32 haemorrhagic cysts) that were identified as complicated cystic lesions on ultrasonography (US) and underwent lower abdominal MRI with susceptibility weighting were retrospectively evaluated. Final diagnoses were obtained with surgical pathological correlation and radiological-clinical follow-up. Two radiologists blinded to the final diagnoses retrospectively reviewed the images in consensus. The signal intensity on T1- and T2-weighted images and curved linear or punctate signal void areas on SWI were noted for the presence of lesions. RESULTS: Forty of the 57 endometriomas demonstrated the defined MRI criteria, including a cystic hyperintensity on T1-weighted images and hypointensity on T2-weighted images. The remaining 17 lesions did not demonstrate these criteria on conventional MR images. SWI showed punctate or curved linear signal void areas in 53 of 57 endometriomas (92.9%) and none of the haemorrhagic cysts. The sensitivity, specificity and accuracy of SWI in differentiating endometrioma from haemorrhagic cyst were 92.9%, 100.0%, and 95.5%, respectively. CONCLUSIONS: The addition of the SWI sequence to conventional MRI can help distinguish endometriomas from haemorrhagic ovarian cysts.

Can diffusion weighted imaging be used as an alternative to contrast-enhanced imaging on magnetic resonance enterography for the assessment of active inflammation in Crohn disease?

The present study aimed to investigate the potential use of T2-weighted sequences with diffusion weighted imaging (DWI) in magnetic resonance (MR) enterography instead of conventional contrast-enhanced MR imaging (MRI) sequences for the evaluation of active inflammation in Crohn disease.Two-hundred thirteen intestinal segments of 43 patients, who underwent colonoscopy within 2 weeks before or after MR enterography were evaluated in this retrospective study. DWI sequences, T2-weighted sequences, and contrast-enhanced T1-weighted sequences were acquired in the MR enterography scan after cleaning of the bowel and using an oral contrast agent. First, the intestinal segments that had active inflammation in MR enterography were qualitatively evaluated in T2-weighted and contrast-enhanced T1-weighted sequences and then MR activity index (MRAI 1) and MRAI 2 were formed with and without contrast-enhanced sequences in 2 separate sessions.The correlation coefficient between contrast enhanced and DWI MR enterography scores (MRAI 1 and MRAI 2) of intestinal inflammation was 0.97 for all segments. In addition, separate correlation coefficients were calculated for terminal ileum, right colon, transverse colon, left colon, and rectum, and there was a strong correlation between the MRAI 1 and MRAI 2 scores of each segment (r = 0.86-0.97, P < .001). On the other hand, MR enterography had 88.7% sensitivity, 97.9% specificity, 95.5% positive predictive value, 94.6% negative predictive value, and 94.8% accuracy for detection of active inflammation in all intestinal segments in Crohn disease.DWI and T2-weighted sequences acquired with cleaning of the bowel can be used instead of contrast-enhanced MRI sequences for the evaluation of active inflammation in Crohn disease.

Pipeline Flex Embolization Device (PED Flex) for the treatment of intracranial aneurysms: Periprocedural outcomes and first-year angiographic results

Background/aim: The Pipeline Flex Embolization Device (PED Flex) is a new updated version of the PED classic that incorporates a new delivery system to allow facilitation of stent deployment, resheathing, and removal of the capture coil. This study evaluated the PED Flex in terms of the technical aspects of the procedure and first-year follow-up results. Materials and methods: This retrospective study involved prospectively collected data from May 2015 to August 2017. The primary endpoint was technical aspects of the procedure, and the secondary endpoint was first-year follow-up results. Results: Forty-nine patients with 59 target intracranial aneurysms were enrolled. Patients' mean age was 52 years (range 21−71 years), and 31 (63.0%) were female. All aneurysms except for three were unruptured. The mean aneurysm diameter was 8 mm. Forty-seven patients with 56 aneurysms were successfully treated. Due to advancement, repositioning, and migration problems, 8 (13.1%) stents were not deployed and discharged. The total aneurysm occlusion rate was 77.0%. The mortality rate was 4.3%. Conclusion: Our experience shows that the applicability and safety of the renewed delivery system provided by PED Flex for improving device apposition and opening has been proven with one-year angiographic and clinical follow-up results.

Diagnostic Efficacy of T2 Dark Spot, T2 Dark Rim Signs, and T2 Shading on Magnetic Resonance Imaging in Differentiating Endometriomas From Hemorrhagic Cysts.

OBJECTIVE: This study aimed to evaluate the diagnostic efficacy of T2 dark spot, T2 dark rim, and T2 shading signs on magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts. METHODS: Seventy-two hemorrhagic lesions were included in this retrospective study. The presence of T2 dark spot, T2 dark rim, and T2 shading signs in the lesions and the presence of complete or incomplete rim in lesions exhibiting T2 dark rim signs were evaluated. RESULTS: Of 72 lesions, 50 were diagnosed with endometrioma and 22 were diagnosed with hemorrhagic cyst. Twenty-six of 50 endometriomas and none of the hemorrhagic cysts showed T2 dark spot sign. T2 shading was observed in 90% of endometriomas and 18% of hemorrhagic cysts. Incomplete T2 dark rim was detected in 67% of endometriomas and 21% of hemorrhagic cysts. CONCLUSIONS: T2 dark spot and T2 dark rim signs could be useful for distinguishing endometriomas from hemorrhagic cysts.

Contribution of DECT in detecting serosal invasion of gastric cancer

Background/aim: This study aimed to investigate the relationship between the iodine concentration (IC) of perigastric fat tissue as assessed by dual-energy computed tomography (DECT) and serosal invasion of gastric cancer. Materials and methods: A total of 41 patients underwent preoperative staging evaluation for gastric cancer using DECT between July 2015 and March 2018. Patients were divided into 2 groups based on pathology results: serosal invasion (stage T4a) and intact serosa (stages T1­T3). Cutoff values, the diagnostic efficacy of IC in the perigastric fat tissue, and the perigastric fat tissue/tumor (P/T) ratio were determined. Results: Among the 41 patients, 22 had stage T4a gastric cancer and 19 patients had gastric cancer with a stage lower than T4a. The mean IC of perigastric fat tissue and the P/T ratio were significantly higher in patients with serosal invasion than in those with intact serosa (P < 0.001). During the arterial phase, the area under the curve (AUC) was 0.915 and 0.854 for the IC of perigastric fat tissue and the P/T ratio, respectively. During the venous phase, the AUC was 0.890 and 0.876 for the IC of perigastric fat tissue and the P/T ratio, respectively. Conclusion: The IC in the perigastric fat tissue seems to be a reliable indicator for serosal invasion of gastric cancer.

Value of tomography in detecting breast masses and discriminating malign and benign lesions.

OBJECTIVES: The main purpose of the present study was to determine the effectivity of computerized tomography (CT) in detecting breast masses and discriminating masses as malignant or benign. MATERIAL AND METHODS: After having received the institutional local ethics committee approval, an experienced radiologist who did not participate in the study created a patient pool by searching our health center's Pathology department database between 2010 and 2018. The group created consisted of dense and non-dense breast types equally and included approximately similar percentages of benign and malignant breast mass sizes. Finally, 70 subjects were included: 30 females with definite malign, 20 with definite benign breast masses, and 20 without any breast pathology based on mammography and ultrasonography results, who were considered as the control group. Three experienced Radiologists (R1, R2, R3) who were not aware of the final diagnosis evaluated all images independently. Radiologist performance was assessed by calculating the area under the receiver operating characteristic curve (AUC) and interobserver reliability values were estimated by intraclass correlation coefficient (ICC) analysis. RESULTS: The diagnostic accuracy suitability of CT according to BI-RADS scores for R1, R2 and R3 were found as p <0.001, p <0.001 and p <0.001, respectively. There were significant interobserver reliability rates between all investigators (p= 0.0001). CONCLUSION: CT may be used as a valuable diagnostic tool in discriminating breast masses with further training in widely varying appearances of normal breast tissues leading to false positive findings.

Gastric wall fat halo sign in patients without intestinal disease.

PURPOSE: To investigate the relationship between gastric wall fat halo sign and visceral obesity with potentially associated diseases. MATERIALS AND METHODS: Between September 2015 and April 2017, 90 patients with gastric wall fat halo signs and 130 controls were prospectively evaluated. Patient height, weight, body mass index (BMI), sex, age, subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), percentage of visceral fat (VF%) and the presence of colic or ileal fat halo signs, hepatic steatosis and aortic calcified plaques were recorded for the two groups. Cut-off values for the VFA, TFA, and VF% were determined and the diagnostic efficacy was calculated using receiver operating characteristic (ROC) curve analysis. RESULTS: No significant differences were found in age, BMI and SFA, but the VFA, VF%, TFA and frequencies of colic or ileal fat halo signs, hepatic steatosis and aortic calcified plaques were significantly higher in the patient group. The areas under the ROC curve (AUCs) were 0.803, 0.770 and 0.596 for VFA, VF% and TFA, respectively. The diagnostic efficacies of VFA and VF% were significantly higher than those of the TFA. CONCLUSION: Gastric wall fat halo signs may be observed in overweight people, especially those with increased VFA and VF%. Additionally, these signs are usually observed along with fat halo signs of the colon or terminal ileum. However, extensive studies are needed to clarify the relationship between gastric wall fat halo signs and type 2 diabetes, cardiovascular diseases and metabolic syndrome.

A Novel Treatment of Very Rare Anomaly; Breast Pseudoaneurysm Developed During Pregnancy.

Pseudoaneurysms (PA) in the arterial supply of the breast are quite rare and mostly iatrogenic secondary to biopsies. Breast PAs after blunt trauma is even rarer. In this paper, a case of breast PAs secondary to blunt trauma and its percutaneous treatment using human thrombin injection and after N-butyl cyanoacrylate is presented.