Volumetric apparent diffusion coefficient histogram analysis in term neonatal asphyxia treated with hypothermia.

OBJECTIVES: Our aim is to estimate the long-term neurological sequelae and prognosis in term neonatal asphyxia treated with hypothermia via volumetric apparent diffusion coefficient (ADC) map histogram analysis (HA). METHODS: Brain MRI studies of eighty-three term neonates with asphyxia who received whole-body hypothermia treatment and examined between postnatal (PN) 4 to 6th days were retrospectively re-evaluated by two radiologists. Volumetric HA was performed for the areas frequently affected in deep and superficial asphyxia (thalamus, lentiform nucleus, posterior limb of internal capsule, corpus callosum forceps major and perirolandic cortex-subcortical white matter) on ADC map. The quantitative ADC values were obtained separately for each region. Qualitative-visual (conventional) MRI findings were also re-evaluated. Neonates were examined neurodevelopmentally according to the Revised Brunet-Lezine scale. The distinguishability of long-term neurodevelopmental outcomes was statistically investigated. RESULTS: With HA, the adverse neurodevelopmental outcomes could only be distinguished from mild-moderated impairment and normal development at the thalamus with 10th percentile ADC (p = 0.02 and p = 0.03; respectively) and ADCmin (p = 0.03 and p = 0.04; respectively). Also with the conventional MRI findings, adverse outcome could be distinguished from mild-moderated impairment (p = 0.04) and normal development (p = 0.04) via cytotoxic edema of the thalamus, corpus striatum and diffuse cerebral cortical. CONCLUSION: The long-term adverse neurodevelopmental outcomes in newborns with asphyxia who received whole-body hypothermia treatment can be estimate similarly with volumetric ADC-HA and the conventional assessment of the ADC map. ADVANCES IN KNOWLEDGE: This study compare early MRI ADC-HA with neurological sequelae in term newborns with asphyxia who received whole-body hypothermia treatment. We couldn't find any significant difference in predicting adverse neurological sequelae between the visual-qualitative evaluation of the ADC map and HA.

The Relationship between Breast Cancer Subtypes, Prognostic Factors, and Apparent Diffusion Coefficient Histogram Analysis.

BACKGROUND: Diffusion Magnetic Resonance Imaging (MRI) is a useful method to evaluate tumor biology and tumor microstructure. The apparent diffusion coefficient (ADC) value correlates negatively with the cellular density of the tumor. OBJECTIVE: This study aimed to investigate the effectiveness of the ADC histogram analysis in showing the relationship between breast cancer prognostic factors and ADC parameters. METHODS: This study is a retrospective observational descriptive study. ADC histogram parameters were evaluated in all tumor volumes of 67 breast cancer patients. Minimum, 5, 10, 25, 50, 75, 90, 95 percentiles, maximum, mean, median ADC values, kurtosis, and skewness were calculated. Breast MRI examinations were performed on a 3T MR scanner. We evaluated the fibroglandular tissue density of bilateral breasts, background enhancement, localization of masses, multifocality-multicentricity, shape, rim, internal contrast enhancement, and kinetic curve on breast MRI. BIRADS scoring was performed according to breast MRI. Pathologically, histologic type, histologic grade, HER 2, Ki 67, ER-, and PR status were evaluated. RESULTS: A significant correlation was found between tumor volume and ADC scores. There is a significant correlation between min ADC values (p< 0.031), max ADC (p< 0.001), and skewness (p< 0.019). A significant correlation was found between tumor kurtosis and lymph nodes (p< 0.029). There was a significant difference in ADC values depending on ER-and PRstatus. (for ER p = 0.004, p = 0.018, p = 0.010, p = 0.008, p = 0.004, p = 0.004, p = 0.02, p = 0.02 and p = 0.038, for PR p < 0.001, p = 0.028, p = 0.011, p = 0.001, p < 0.001, p =<0.001, p < 0.001, and p < 0.001, respectively; p < 0.05). These values were lower in ER-and PR-positive status than in ER-and PR-negative receptor status. According to HER2 status, there was a statistically significant difference in ADC

Evaluation of cerebellum volume and trunk oscillation velocity in cases with adolescent idiopathic scoliosis: a preliminary report.

PURPOSE: It has been suggested that the cause of the balance disorder seen in adolescent idiopathic scoliosis (AIS) originates from the central nervous system. However, the extent of the balance problem and the dysfunction of which part of the central nervous system has not been investigated in detail. This study aimed to correlate the values obtained by balance analysis and cerebellum volume measurement in female individuals with AIS with healthy individuals. METHODS: Cerebellum volume was calculated via the cloud-based software " https://volbrain.upv.es " using brain magnetic resonance images of 27 healthy and 26 individuals with AIS. The duration of stay in the test positions, the movement strategy used during this time and the amount of postural sway were analyzed by using a computer-assisted force platform and compared statistically. RESULTS: Significant differences were found between the AIS and control groups in cerebellum total volume, vermis cerebelli volume (cm3), and trunk oscillation velocity (mm/s) parameters (p < 0.05). Cerebellum and vermis cerebelli volumes were found to be lower and trunk oscillation velocity was found to be greater in patients with AIS. CONCLUSION: Balance problems in patients with AIS are correlated with decreased cerebellum volume and increased trunk oscillation velocity.

Late-term cardiac magnetic resonance imaging in multisystem inflammatory syndrome in children.

BACKGROUND: Cardiac involvement in multisystem inflammatory syndrome in children may have a spectrum ranging from mild disease to severe heart failure due to fulminant myocarditis. Cardiac involvement usually resolves after clinical recovery. However, the adverse effects of myocarditis on cardiac function after recovery are not fully known. This study aims to investigate cardiac involvement by performing cardiac magnetic resonance imaging (MRI) after the acute and recovery periods. METHODS: 21 patients with clinical and laboratory signs of myocarditis, including left ventricular systolic dysfunction, mitral regurgitation, elevated troponin T, elevated N-terminal pro-B-type natriuretic peptide and electrocardiographic changes, who had given consent for cardiac MRI, underwent cardiac MRI after completion of the acute and recovery phases. RESULTS: When compared to 16 patients with normal cardiac MRI, five patients with cardiac fibrosis on MRI were older, had greater body mass indexes, lower leucocyte counts, lower neutrophil counts, higher blood urea nitrogen levels and higher creatinine levels. Cardiac fibrosis on MRI was located in the posterior right ventricle insertion point and in mid ventricular septum. CONCLUSIONS: Adolescence and obesity appear as risk factors for the development of fibrosis as a late-term sequela of myocarditis. Furthermore, future studies reporting the follow-up data of patients with fibrosis are necessary to predict and manage adverse outcomes.

The Effectiveness of Thyroid Elastography in Evaluating Thyroiditis in Children with Type 1 Diabetes.

OBJECTIVE: Shear wave elastography can detect inflammation and fibrosis in the thyroid tissue. It can be used to evaluate Hashimoto's thyroiditis or in the assessment of thyroid diseases accompanying type 1 diabetes mellitus. Our aim was to examine whether there is a difference between the shear wave elastography scores as kilopascals of individuals with type 1 diabetes mellitus and healthy children, and the relationship between diabetes-related parameters and shear wave elastography scores. MATERIALS AND METHODS: A total of 77 type 1 diabetes mellitus children and 53 healthy controls were compared. Serum thyroid-stimulating hormone, free thyroxine, free tri-iodothyronine, antibodies against thyroid peroxidase and thyroglobulin, average of the last 2 control plasma glycosylated hemoglobin A1c, duration of diabetes and daily insulin dose in diabetic individuals, thyroiditis staging by ultrasound, and shear wave elastography scores were also recorded. RESULTS: In terms of shear wave elastography scores, no significant difference was found between the healthy control group and the group with type 1 diabetes mellitus without Hashimoto's thyroiditis (7.9 ± 2.8 kPa vs. 8.4 ± 3.3 kPa, P = .772). The score of the group with type 1 diabetes mellitus accompanied by Hashimoto's thyroiditis (15.1 ± 6.6 kPa) was found to be higher than the group with type 1 diabetes mellitus without Hashimoto's thyroiditis and the healthy control group (P = .022 and P = .015, respectively). CONCLUSIONS: This is the first study to compare children with type 1 diabetes mellitus and healthy controls in terms of shear wave elastography scores. We found that there was no significant difference between the shear wave elastography scores of children with type 1 diabetes mellitus without Hashimoto's thyroiditis compared to healthy controls.

Can thyroid elastography with ultrasound be used to stage children with Hashimoto's thyroiditis?

OBJECTIVES: We aimed to evaluate the stiffness of the thyroid parenchyma with Shear wave elastography (SWE) in children with Hashimoto's thyroiditis (HT) and healthy controls. METHODS: A total of 130 children with HT and 46 healthy controls were included in this study. The clinical and laboratory characteristics of the groups, thyroiditis stages in thyroid ultrasonography, and SWE scores which was obtained as kilopascal (kPa), were analysed. RESULTS: We observed that SWE scores were significantly higher in children with HT compared to healthy controls, and SWE scores increased significantly in HT group, as the thyroiditis stage increased (p<0.001). Median, 1st (Q1) and 3rd (Q3) quartiles of SWE scores were as follows; healthy control: 7.4 kPa (6-10.6), stage 1 HT: 9.6 kPa (7.4-11.2), stage 2 HT: 15.2 kPa (10.8-19.9), stage 3 HT: 17.9 kPa (13.7-25.8), (p<0.001). Children with HT were divided into subgroups according to serum TSH and free T4 levels as euthyroid (103; 79.2% of children), euthyroid but subclinical TSH elevation (7; 5.4% of children), hypothyroidism (11; 8.5% of children) and hyperthyroidism (9; 6.9% of children). The SWE scores were significantly higher in children with hypothyroidism with HT compared to healthy controls 17.9 kPa (13.6-27.5) vs. 7.4 kPa (6-10.6), and in euthyroid children with HT compared to healthy controls 11.5 kPa (9.2-15.6) vs. 7.4 kPa (6-10.6), (p=0.006 and p<0.001, respectively). CONCLUSIONS: The SWE scores increase as the thyroiditis stage increases in children with HT. There was no significant difference in SWE scores between stage 2 and stage 3 thyroiditis.

Acute Pancreatitis and Acute Recurrent Pancreatitis in Children: Imaging Findings and Outcomes.

OBJECTIVE: The prevalence of acute pancreatitis and acute recurrent pancreatitis in children has increased over the years, and there are limited data about imaging findings. This study aimed to reveal the imaging findings of acute pancreatitis and acute recurrent pancreatitis in children at a tertiary care hospital. MATERIALS AND METHODS: The patients with acute pancreatitis and acute recurrent pancreatitis diagnosed between January 2007 and December 2018 were included. Demographic and clinical features, follow-up period, and interventions were noted. Imaging features were evaluated for pancreatic enlargement, peripancreatic fluid, and biliary ducts for initial examination and pancreas parenchymal necrosis, peripancreatic collection, walled-off necrosis, pseudocyst, parenchymal atrophy, and biliary ductal dilatation for follow-up. RESULTS: The study included 74 patients with a mean age of 9 ± 4.9 years. The most common causes of acute pancreatitis and acute recurrent pancreatitis were biliary tract anomalies (n = 21), biliary ductal stones (n = 9), and cystic fibrosis (n = 8). Findings consistent with acute pancreatitis were determined by ultrasound in 40.5% (n = 30/74), whereas by magnetic resonance imaging in 60% (n = 39/65). Forty-one percent of the patients (n = 16) with positive magnetic resonance imaging findings did not show any findings on ultrasound. Acute recurrent pancreatitis was seen in 32 patients (43.2%). Follow-up imaging was performed in 55 patients (74.3%) between 2 months and 11 years. At follow-up, 8 patients had peripancreatic collections (6 walled-off necrosis and 2 pseudocysts). CONCLUSION: Recognizing the imaging findings of acute pancreatitis and its complications is crucial. Magnetic resonance imaging should be preferred as a second option following ultrasound, with the advantages of biliary ductal system delineation and better characterization of complications.

Factors Affecting Thyroid Elastography in Healthy Children and Patients with Hashimoto's Thyroiditis

Objective: Hashimoto's thyroiditis (HT) is the most common form of thyroiditis in childhood. In addition to thyroid ultrasonography, shear-wave elastography (SWE) can evaluate thyroid parenchyma tissue stiffness, and more detailed findings can be obtained with this method. We aimed to evaluate the relationship between SWE values and clinical, biochemical and hormonal parameters of patients with HT and in healthy individuals. Methods: We compared 46 newly diagnosed HT cases with 46 healthy controls. We examined the effect of all metabolic parameters and thyroid-related markers on SWE values. Results: The mean SWE values in those patients with euthyroid HT were 12.5±5.1 kilopascal (kPa), whereas it was 8.2±2.82 kPa in healthy controls (p<0.001). Although the clinical [age, gender and body mass index (BMI)] and laboratory parameters (such as thyroid function tests, homeostasis model assessment of insulin resistance, insulin-like growth factor-1 values, which we think may affect SWE scores) of those children with HT and the healthy controls were statistically similar (p>0.05), except for their thyroid autoantibodies and thyroglobulin, SWE values and thyroid volume were significantly higher in those individuals with HT (p<0.001). Multiple linear regression analysis was performed to evaluate the direction and degree of the effect of the variables on thyroid elasticity scores. It was observed that age (p=0.002), BMI standard deviation score (SDS) (p=0.04) and anti-thyroid peroxidase (p=0.008) levels were effective on the thyroid elasticity score in the regression model. We detected a SWE cut-off value of 9.68 kPa with 68% sensitivity and 72% specificity, a 70% positive predictive value, and a 69% negative predictive value in thyroid elastography when differentiating between cases with HT and healthy controls. Conclusion: Our results show that no metabolic factor other than BMI SDS has any effect on SWE scores, especially in healthy children. There was a positive correlation between BMI SDS and SWE in healthy children (r=0.353; p=0.02), but not in those patients with HT (r=0.196; p=0.19). Likewise, age is another factor affecting SWE only in healthy children. We do not recommend routine evaluation of any laboratory parameters other than thyroid functions before thyroid elastography.

Is the Integration Problem in the Sensoriomotor System the Cause of Adolescent Idiopathic Scoliosis?

PURPOSE: The reason behind the balance control disorder seen in adolescent idiopathic scoliosis (AIS) has been suggested as a central nervous system dysfunction, yet it has not been investigated in detail whether this problem originates from sensory, motor, or from both systems. This study aimed to reveal the differences in the pathways that provide proprioceptive sense, motor control, and coordination between these 2 systems in female individuals with AIS. METHODS: Brain Diffusion Tensor Imaging was applied to 30 healthy individuals and 30 Lenke type 1 AIS patients. All of the individuals included in the study were predominantly right-handed and aged between 10 and 18. Diffusion tensor imaging of both groups were performed bilateral tractography on the corticospinal tract (CS tr), medial lemniscus (ML), superior longitudinal fasciculus (SLF), and inferior longitudinal fasciculus (ILF) tracts using DSI Studio software. RESULTS: Significant differences in the parameters of CS tr, ML, SLF, ILF pathways were found between the AIS and the control groups. In the AIS group, significant differences were found in the fiber count and fiber ratio of the ML that carries the proprioceptive sense and CS tr, which is responsible for the somatomotor system. There were also significant differences between the left and right CS tr, ML, SLF, and ILF pathways of the AIS group ( P <0.05). CONCLUSIONS: Differences in the CS tr, ML, SLF, and ILF pathways may trigger muscular asymmetry and cause postural instability and thus spinal deformity in AIS.

The role of pineal gland volume in the development of scoliosis.

PURPOSE: Adolescent idiopathic scoliosis (AIS) is believed to be caused by genetic, neurological, osseous growth anomalies, histological variables including muscle fiber percentage and core structure changes, metabolic and hormonal dysfunction, vestibular dysfunction, and platelet microarchitecture. The objective of this study was to contribute to the determination of the cause of AIS by analyzing the changes in pineal gland volume in AIS cases. METHODS: Study (AIS) and control group were each comprised of 26 patients who met the inclusion requirements. Scoliosis radiograph and MRI of the pineal glands were used for radiological examinations. The distribution of age, gender, Risser grading for skeletal radiological development, and sexual maturation according to Tanner categorization were uniform and statistically insignificant between groups. RESULTS: When the pineal gland volumes of the cases were evaluated according to age, the AIS group was found to have significantly reduced pineal gland volumes in all age groups. The pineal gland volume was found to be 38.1% lower in the AIS group compared to the control group (p˂0.001). In the AIS group, patients aged 13 years had the lowest pineal gland volume (77.2 ± 13.86 mm3), while patients aged 15 years had the highest volume (97.9 ± 16.47 mm3). CONCLUSION: Changes in pineal gland volume support the role of the pineal gland in the etiopathogenesis of AIS.

Is scoliosis related to mastication muscle asymmetry and temporomandibular disorders? A cross-sectional study.

OBJECTIVE: Patients with adolescent idiopathic scoliosis (AIS) may face motor control problems and health disability barriers during mandibular movements and chewing. However, studies investigating the extent of these disadvantages, and possible associated factors are quite limited in patients with AIS. This study was conducted to gain a deeper perspective on the effect of AIS on temporomandibular disorders (TMD) and to contribute to the small amount of data on this subject. METHODS: Twenty-nine patients with AIS and 29 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Cobb's method was used to measure scoliosis curves. In both groups, the volume of the masseter muscle was determined on magnetic resonance imaging, and Helkimo and Fonseca anamnestic indexes were used to evaluate temporomandibular joint (TMJ). RESULTS: It was observed that the TMD symptoms were higher in the AIS group (22.6- Helkimo and 1.2 - Fonseca) than the asymptomatic group (13.6 - Helkimo and 0.7 - Fonseca). There was no significant asymmetry in masseter volume in patients with AIS, however the volume of the masseter muscles was smaller in the AIS group (R = 14.6/L = 13.6) compared to the control group (R = 16.1/L = 16.2). CONCLUSIONS: The study results indicate that spinal curvatures affect the anatomical, biomechanical, and kinesiological features of the masticatory system, and individuals with AIS may experience more chewing problems than asymptomatic individuals. Examining musculoskeletal properties of masticatory system can provide information about the limitation of the TMJ in patients with AIS.

A truncating variant in the THOC6 gene with new findings in a patient with Beaulieu-Boycott-Innes syndrome.

Beaulieu-Boycott-Innes syndrome (BBIS; MIM#613680) is a rare, autosomal recessive neurodevelopmental genetic disorder associated with pathogenic variants in the THOC6 gene (*615403). Intellectual disability, dysmorphic facial features, developmental delay, structural cardiac and genitourinary anomalies, and dental caries are suggestive findings of the syndrome. Exome sequencing (ES) may facilitate the diagnosis of this syndrome, whose clinical features can be nonspecific. Here we report a BBIS patient with a homozygous truncating variant (NM_024339.5:c.299G>A; p.Trp100Ter) in the THOC6 gene, diagnosed by ES analysis. The patient's variant is novel and some features such as clivus dysplasia, occult spina bifida, tapered fingers, and upturned fleshy earlobes have not been reported in the literature before. This new case report will expand the knowledge of BBIS and provide more information about the genetic variants and phenotypic spectrum. Also, new cases with THOC6 variants will define the core clinical features and common phenotypes of the BBIS over time.

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma.

PURPOSE: Catheter-related complications are observed in infusion of chemotherapy, and these were encountered with targeted therapies. Our principle is to study non-mechanical effects of type and initiation time of chemotherapy among the other factors on patency of totally implantable vascular access devices (TIVAD) inserted in patients with colorectal carcinoma. METHODS: This is a one-center retrospective cohort study. We analyzed TIVAD related complications in 624 patients with colorectal carcinoma. The patients were categorized by chemotherapy type (non-target-directed chemotherapy agents (Group A), bevacizumab (Group B), and cetuximab (Group C)). Additionally, we divided the patients into groups by the time interval between TIVAD insertion and chemotherapy initiation. According to our study, a 3-day period was optimal. Therefore, we named the groups as within 3 days and beyond 3 days, and called this process 3 days cut-off. Age, gender, jugular-subclavian access, platelet count, INR, the types of chemotherapy, and the initiation time of chemotherapy were investigated by survival tests. We compared chemotherapy type groups both one-by-one and combined into one group. RESULTS: The TIVADs were removed due to the complications in 11 patients of Group A, 6 patients of Group B, and 3 patients of Group C. Only chemotherapy type was significant (p = 0.011) in Cox regression test. A clear difference (p = 0.010) was detected between the catheter patency of Group A and combination of Groups B and C, because of skin necrosis and thrombosis. Within 3 days of their first chemotherapy day, an important difference between Group A and Group C (p = 0.013) was observed in the TIVAD patency. The same observation was made between Group A and Group B (p = 0.007). Beyond this period, no major difference was detected (p = 0.341). CONCLUSION: A major effect on catheter patency was detected by using the target-directed chemotherapy agent within 3 days, which should be considered in target-directed chemotherapy.

Apparent diffusion coefficient echoplanar imaging maps of the optic nerves in childhood idiopathic intracranial hypertension.

BACKGROUND AND PURPOSE: Dueto motion artifacts, optic nerve (ON) findings of idiopathic intracranial hypertension (IIH) can easily be overlooked on T2-weighted (T2w) turbo spin-echo sequence. This study aimed to investigate the contribution of the apparent diffusion coefficient (ADC) map derived from the interleaved multi-shot (IMS) echoplanar imaging (EPI) to the ON findings of IIH in children. METHODS: MRIs of 42 pediatric patients aged 3-17 years diagnosed with definite IIH according to modified Dandy criteria were retrospectively re-evaluated, between April 2018 and January 2021. Forty-two age- and sex-matched subjects with no IIH symptoms and reported as normal were included as a control group. RESULTS: ON sheath distance (ONSD) on the ADC map (p = .005) and vertical tortuosity (p = .030) were significant single MRI parameters for predicting IIH. Other single parameters were not statistically significant. Flattening of the posterior sclera (FPS) and ON protrusion (ONP) were observed on ADC maps more frequently than T2w (42.8% vs. 19% and 19% vs. 4.7%, respectively). From combined MRI parameters, the presence of at least one of ONP, FPS, or ONSD on ADC maps (p = .001) showed greater significance than the presence of T2w (p = .048). The predictive values of other MRI findings evaluated together were not statistically significant (p > .05). CONCLUSIONS: This study's results show that due to the short readout time and less sensitivity to motion, the ADC map obtained from IMS-EPI can contribute to orbital findings of IIH, in addition to T2w.

Impact of the HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study

Objective: This study aimed to observe the preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Materials and Methods: This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017 and March 2019. Patients were followed for 1 year with 5 visits (baseline and 3th, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints, the Pettersson scoring system was used for radiological assessment, point-of-care (POC) ultrasonography was used for bilateral examinations of joints, and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score was used for evaluation of ultrasonography results. Results: Seventy-three PwH, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in the childhood group, the increment of scores was not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at baseline and at the 12th month. Conclusion: The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggest that POC ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.

A fern frond-like peripheral portal vein thrombosis in a neonate: A case report.

Although the ultrasonographic (US) features of portal vein thrombosis in premature newborns have been described, there are very few reports on thrombosis of the peripheral branches of the portal vein. Here, I describe a case of peripheral portal vein branch thrombosis in a neonate, appearing on US imaging with a fern frond pattern.

Hepatocyte-specific contrast-enhanced MRI findings of focal nodular hyperplasia-like nodules in the liver following chemotherapy in pediatric cancer patients.

PURPOSE: We aimed to assess the MRI findings and follow-up of multiple focal nodular hyperplasia (FNH)- like lesions in pediatric cancer patients diagnosed by imaging findings. METHODS: We retrospectively analyzed clinical data and MRI examinations of 16 pediatric patients, who had been scanned using gadoxetate disodium (n=13) and gadobenate dimeglumine (n=3). Hepatic nodules were reviewed according to their number, size, contour, T1- and T2-weighted signal intensities, arterial, portal, delayed and hepatobiliary phase enhancement patterns. Follow-up images were evaluated for nodule size, number, and appearance. RESULTS: All 16 patients received chemotherapy in due course. Time interval between the initial diagnosis of cancer and detection of the hepatic nodule was 2-14 years. Three patients had a single lesion, 13 patients had multiple nodules. The median size of the largest nodules was 19.5 mm (range, 8-41 mm). Among 16 patients that received hepatocyte-specific agents, FNH-like nodules appeared hyperintense in 11 and isointense in 5 on the hepatobiliary phase. During follow-up, increased number and size of the nodules were seen in 4 patients. The nodules showed growth between 6-15 mm. CONCLUSION: Liver MRI using hepatocyte-specific agents is a significant imaging method for the diagnosis of FNH-like lesions, which can occur in a variety of diseases. Lesions can increase in size and number in pediatric patients.

Diagnostic value of diffusion-weighted magnetic resonance imaging: differentiation of benign and malignant lymph nodes in different regions of the body.

INTRODUCTION: To evaluate the value of diffusion-weighted magnetic resonance imaging compared with conventional magnetic resonance imaging (C-MRI) for the differentiation of benign from malignant lymph nodes in different regions of the body. PATIENTS AND METHODS: A total of 31 patients ranging in age from 18 to 75 years (mean age: 53 years) were included in this study. The patients were examined using a 1.5-T magnetic resonance imaging system with coils chosen according to lymph node locations. Diffusion-weighted images were obtained using the single-shot echo planar sequence and had b values of 50, 500, and 1000 s/mm(2.) The apparent diffusion coefficient (ADC) values were measured from ADC maps. The correlation between the pathological diagnoses and mean ADC values in the benign and malignant lymph node groups were compared using the Mann-Whitney U-test with Bonferroni correction. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the method. RESULTS: The mean ADC value for benign lymph nodes was 0.97×10(-3) mm(2)/s (range: 0.6-1.2×10(-3) mm(2)/s), and the mean ADC value for malignant lymph nodes was 0.76×10(-3) mm(2)/s (range: 0.3-1.2×10(-3) mm(2)/s) (P<.001). In ROC analysis, the cut-off ADC value for malignant versus benign lymph node differentiation was 0.8×10(-3) mm(2)/s. Using an ADC value of 0.8×10(-3) mm(2)/s, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the method for differentiating between benign and malignant lymph nodes were 76.4%, 85.7%, 86.6%, 75%, and 80.6%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of C-MRI were 88.2%, 78.5%, 83.3, 84.6%, and 83.8%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of C-MRI findings suspicious for malignancy combined with the ADC values were 76.4%, 64.2%, 100%, 81.8%, and 91.6%, respectively. CONCLUSIONS: C-MRI alone remained superior to diffusion-weighted imaging (DWI) and combination C-MRI and DWI for differentiating malignant from benign lymph nodes; however, DWI and ADC calculation may play a role in lymph node characterization.

Comparison of subcutaneous central venous port via jugular and subclavian access in 347 patients at a single center.

The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method.