How did radiologists' diagnostic performance has changed in COVID-19 pneumonia: A single-centre retrospective study.

AIMS: Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for the management of patients with COVID-19-suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have affected the diagnostic performance of on-call radiologists. The aim of this study was to reveal the interpretation errors (IEs) in chest CT reports of COVID-19-suspected patients admitted to the Emergency Room (ER). METHODS: Chest CT scans between March and June 2020 were re-evaluated and compared with the former reports and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments' workload, COVID-19-related educational activities have been examined. RESULTS: Out of 5721 Chest CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included in this study. PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in "normal" and "typical for covid" groups whereas lowest in "atypical for covid" and "not covid" groups. 5%-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding the number of chest CT scans performed, radiologists' workload has found to be increased six-folds. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in the "not covid" class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of the pandemic have seemed to be related to the decline of IEs within time. CONCLUSION: COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest CT reporting. This workload and concomitant factors have effects on diagnostic challenges in COVID-19 pneumonia.

Medially displaced common and internal carotid arteries presenting as a pulsatile mass: Clinicoradiologic analysis of 62 cases.

We conducted a prospective study to analyze the medially displaced courses of the common carotid artery (CCA) and the cervical segment of the internal carotid artery (ICA) in patients who were diagnosed with a pulsatile mass on nasopharyngolaryngoscopy and by clinicoradiologic findings. Our study group was made up of 62 patients-40 women and 22 men, aged 30 to 88 years (mean: 63.7)-who presented with a submucosal pseudomass or a bulging mass on the pharyngeal wall with obvious pulsation. For comparison purposes, we recruited a control group of 62 consecutively presenting patients who had been admitted to our Neurology Department with acute severe headache and who had undergone CT angiography based on a suspicion of an aneurysm or a vertebral or carotid artery dissection. A medially displaced carotid artery was identified in all patients in the study group. Two main course abnormalities were observed: (1) a pharyngeal superficial placement (PSP), consisting of a bulging or placement immediately adjacent to the naso-orohypopharyngeal lumen, and (2) a retropharyngeal midline placement (RMP), which entailed medialization of the carotid arteries to the midline. A PSP was observed in 11 patients, an RMP was found in 17 patients, and both were seen in 34 patients. The distance from the aberrant carotid artery to the pharyngeal wall and to the retropharyngeal midline of the retropharynx was measured at four levels: nasopharyngeal, retropalatal, retroglossal, and retroepiglottic in both groups. The mean distance was significantly shorter in the study group than in the control group at all four levels (p < 0.002). We conclude that the most likely diagnosis of a pulsatile mass detected on nasopharyngolaryngoscopy is an aberrant CCA or cervical ICA.

Hepatic Artery Pseudoaneurysm: A Life-Threatening Complication of Liver Transplantation.

Hepatic artery pseudoaneurysm is a rare but serious complication following liver transplantation. A 50-year-old male patient with ulcerative colitis, sclerosing cholangitis, and end-stage liver disease underwent right lobe transplantation from a living donor. The patient was hospitalized because of impairment in liver function tests and massive pretibial edema three months after surgery. In color Doppler ultrasound and multidetector computed tomography, a pseudoaneurysm with peripheral large thrombus was detected at the anastomosis site extending anterior to the hepatic artery. The patient died as a result of unstable hemodynamic conditions.

Lipomatosis of terminal ileum and ileocecal valve: multidetector computed tomography findings.

Intestinal lipomatosis also known as lipohyperplasia is a rare disease. Diffuse infiltration of the fatty tissue mainly in the submucosal layer is characteristic. It is usually asymptomatic and found incidentally. We report a case of lipomatosis in the terminal ileum and ileocecal valve. Multidetector computed tomography (MDCT) with contrast enhancement showed fatty infiltration of the terminal ileum and ileocecal valve.

Common extensor tendon thickness measurements at the radiocapitellar region in diagnosis of lateral elbow tendinopathy.

PURPOSE: The aim of this study was to determine the value of measuring common extensor tendon (CET) thickness at the radiocapitellar and capitellar regions with qualitative ultrasonographic findings in the diagnosis of lateral elbow tendinopathy. MATERIALS AND METHODS: The study included 164 lateral elbow tendinopathy patients (84 bilateral, 80 unilateral) matched by age, gender, and body mass index with 80 normal subjects. CET was examined using gray-scale and Doppler ultrasonography for tendinopathy, and tendon thickness was measured at two landmark locations: capitellar and radiocapitellar. RESULTS: In tendinopathy, tendon thickness including the dominant capitellar region, increased in every measured location. In the capitellar region of the dominant elbow, the cut-off thickness was 5.15 mm, and in the radiocapitellar region, this value was 4.05 mm. For the non-dominant elbow, the cut-off thickness was 4.61 mm, whereas in the radiocapitellar region, this value was 3.51 mm. The greatest risk of tendinopathy was at the radiocapitellar region on the dominant side. The overall sensitivity and specificity of gray-scale findings were 54% and 88%, respectively, and the addition of Doppler readings did not alter these values. When capitellar measurements were added, the values increased to 79% and 80% for sensitivity and specificity, respectively. These values further increased to 93% and 91%, respectively, when radiocapitellar measurements were included. CONCLUSION: A second tendon thickness measurement at the radiocapitellar region of CET in addition to the capitellar region is recommended on the grounds that combined qualitative and quantitative evaluation of CET increases the diagnostic per- formance of ultrasonography in lateral elbow tendinopathy.

The importance of vertebral artery proximity to the odontoid process during anterior odontoid approaches.

The proximity of the vertebral artery (VA) to the odontoid process makes it vulnerable to injury during surgery. Knowledge of the quantitative anatomy of the VA groove is therefore necessary. In this study we assessed the spatial relationship between the VA and the odontoid process on cadavers by direct measurement and in patients by CT angiography. Our goal was to measure the distances from the VA and vertebrobasilar junction to the odontoid tip. The VA and odontoid process of 10 craniocervical cadavers ("cadavers") and of 20 patients were evaluated and average measurements obtained. The measured parameters were: (i) distance from the right VA to the odontoid tip (right VA-odontoid tip); (ii) distance from the left VA to the odontoid tip (left VA-odontoid tip), and (iii) distance from the vertebrobasilar junction to the odontoid tip (vertebrobasilar-odontoid tip). On the cadavers, the right VA-odontoid tip distance was 11.55mm, the left VA-odontoid tip was 11.02mm, and the vertebrobasilar junction-odontoid tip distance was 24.55mm. In patients, using CT angiography, the right VA-odontoid tip distance was 11.47mm and the left VA-odontoid tip distance was 11.50mm. The VA-odontoid tip distance is important in anterior odontoid approaches. Since the odontoid process may be in close contact with the VA, the relationship between them should be evaluated preoperatively in all candidates for odontoid surgery using three-dimensional CT angiography.

Age-related changes in the incidence of pineal gland calcification in Turkey: A prospective multicenter CT study.

The goal of this cross-sectional observational study was to determine the incidence of pineal gland calcification (PGC), to investigate the interaction of PGC and aging, and to compare the incidence of PGC among the populations living in Turkey. In a prospective study the rate of PGC on CT scans of 1376 individuals in six referral centers from different regions of Turkey was investigated, with emphasis on effects of climatological parameters and aging on PGC. It was found that the incidence of PGC increased rapidly after first decade and the increase remains gradual thereafter, higher in males than in females for all age groups. There was a significant difference for incidence and degree of PGC between different clinics and between both sexes (p<0.001). In addition, there was a significant difference for the degree of PGC between the clinics in low altitude group and those in high altitude group (p<0.001 for each). Logistic regression analysis revealed that age, sex, altitude and intensity of sunlight exposure significantly affected the risk of PGC (odds ratios (OR) 1.335, 95% confidence intervals (CI) 1.261-1.414, p<0.001; OR 1.900, 95% CI 1.486-2.428, p<0.001; OR 0.715, 95% CI 0.517-0.990, p<0.05; OR 0.997, 95% CI 0.994-0.999, p<0.01, respectively). Furthermore, by multiple linear regression analysis, high altitude and increased intensity of sunlight exposure were found to affect the degree of PGC (beta=0.003, p<0.001). It is concluded that there is a close relationship between PGC and the aforementioned parameters, supporting a link between the development of PGC and these. This study provides some reference data for new clinical studies on the putative role of pineal gland in future.

Unusual imaging characteristics of complicated hydatid disease.

Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although the liver and the lungs are the most frequently involved organs in the body, hydatid cysts of other organs are unusual. Radiologically, they usually demonstrate typical imaging findings, but unusual imaging characteristics of complicated cyst of hydatid disease, associated with high morbidity and mortality, are rarely described in the literature. The purpose of this study is to review the general features of hydatidosis and to discuss atypical imaging characteristics of the complicated hydatid disease in the human, with an emphasis on structure and rupture of the cystic lesion as well as ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) features of the disease. In our study, the available literature and images of the cases with complicated hydatidosis involving liver, lung, brain, spine and orbit were reviewed retrospectively. In hydatid disease, there are many potential local and systemic complications due to secondary involvement in almost any anatomic location in humans. Radiologically, in addition to the presence of atypical findings such as perifocal edema, non-homogenous contrast enhancement, multiplicity or septations and calcification, various unusual manifestations due to rupture or infection of the cyst have been observed in our cases with complicated hydatid disease. To prevent subsequent acute catastrophic results and the development of recurrences in various organs, it should be kept in mind that complicated hydatid cysts can cause unusual USG, CT, and MRI findings, in addition to typical ones, in endemic areas. Therefore, familiarity with atypical radiological appearances of complicated hydatid disease may be valuable in making a correct diagnosis and treatment.

Transethmoidal approach to the optic canal: surgical and radiological microanatomy.

BACKGROUND: The purpose of the study is to describe anatomic topographic landmarks for transethmoidal approach to optic canal for optic nerve decompression. The study focuses on microsurgical/radiologic anatomies and their relationships in the region of the optic canal and orbit. METHODS: Human optic canal and related anatomic structures were studied in orbits of 6 formalin preserved adult human cadavers. In addition, anatomic measurements were made with digital vernier caliper on the orbits of 25 adult human skulls. The relation between ethmoidal and sinus was assessed with computed tomography (CT) scan in 25 living human heads needing cranial CT scan for any reason. RESULTS: The suture on the conjunction of frontal, maxilla, and lacrimal bones with a location in medial side of the orbit was accepted as a landmark. When the measurements were taken from this landmark, the distances to supraorbital margin were: right(R): 16.76 +/- 2.62 mm, left (L): 17.10 +/- 1.97 mm, and to infraorbital margin were R: 20.18 +/- 3.24 mm, L: 18.94 +/- 2.19 mm. The distances to the anterior ethmoidal foramen were R: 19.66 +/- 3.96 mm, L: 19.11 +/- 2.84 mm, and to the posterior ethmoidal foramen were R: 32.01 +/- 2.90 mm, L: 32.62 +/- 3.33 mm. Mean distance between the anterior and posterior ethmoidal foramen were R: 12.55 +/- 3.4 mm, L: 13.51 +/- 4.2 mm. The posterior ethmoidal foramen and optic ring were separated only by the mean distances of R: 5.34 +/- 2.81 mm, L: 4.9 +/- 3.35 mm. The distance from the suture to the distal (orbital) opening of the optic canal was R: 37.35 +/- 2.73 mm, L: 37.52 +/- 3.47 mm and to proximal (intracranial) opening of the canal were R: 49.52 +/- 2.62 mm, L: 50.94 +/- 3.35 mm. The average widths of proximal (intracranial) canal measured were R: 7.43 +/- 1.95 mm, L: 7.38 +/- 2.01 mm and those of distal canal (orbital) were R: 5.12 +/- 1.1 mm, L: 4.95 +/- 1.32 mm. The mean lengths of the optic canal were R: 11.19 +/- 2.68 mm, L: 12.42 +/- 3.38 mm. In radiologic examinations, the mean numbers of anterior group ethmoidal cells were R: 7, L: 6 and those of posterior group ethmoidal cells were R: 4, L: 3. The results of CT demonstrated 7 (14%) Onodi or sphenoethmoidal cells in 50 orbits of living humans. CONCLUSION: The examination of radiologic anatomy in addition to microanatomy can significantly contribute to preoperative and postoperative evaluation of the patients.

Relation of coronary artery calcium to left ventricular mass and geometry in patients with essential hypertension.

BACKGROUND: There is a close relationship between left ventricular hypertrophy and cardiovascular diseases that are observed in hypertension. In this study, the amount of coronary artery calcium, which is an indicator of atherosclerosis, has been measured and its relationship with left ventricular hypertrophy and geometry and other traditional risk factors has been investigated. DESIGN: A total of 249 (104 females, 145 males) hypertensive asymptomatic patients, without diabetes with an average age of 55.09 +/- 11.32 years were included in the study. Left ventricular mass of the patients was measured with M-mode echocardiography and coronary artery calcium with electron beam tomography. The average age of the patients who had calcium in their coronary arteries (CAC+) was 59.99 +/- 9.85 years, and the average age of the ones without calcium (CAC-) was 49.29 +/- 10.19 years. RESULTS: Mean left ventricular mass index (LVMI) was measured as 130.18 +/- 43.24 g/m2 in CAC+ patients and as 108.47 +/- 29.09 g/m2 in CAC- patients. These two groups did not differ in terms of the parameters such as total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride and uric acid levels, the presence of early coronary disease in the family and smoking. Patients who had calcium in their coronary arteries (CAC+) were more obese (P < 0.004). In the logistic regression analysis, we demonstrated that body mass index and age were the factors affecting the presence and amount of calcification seen in coronary arteries in left ventricular hypertrophy. In the analysis performed by taking left ventricular hypertrophy into consideration, mean calcium scores of the patients with normal remodeling, concentric remodeling, eccentric hypertrophy and concentric hypertrophy were 50.9 +/- 187.4, 68.6 +/- 159.3, 92.2 +/- 160.2 and 315.4 +/- 760.6, respectively. In the patients with concentric left ventricular hypertrophy (LVH), the mean calcium scores of the coronary arteries and the rate of being CAC+ were significantly high, although these patients were also older. After linear regression, the relationship between concentric LVH and coronary artery calcium (CAC) was still significant. CONCLUSION: In conclusion, left ventricular hypertrophy that is observed in hypertension is an important risk factor for sub-clinical atherosclerosis. Concentric left ventricular hypertrophy is a more important risk factor than other geometric patterns.

[Relationship of coronary artery calcification identified by electron beam tomography with age and gender]. / Elektron demeti tomografisi ile saptanan koroner arter kalsifikasyonunun yas ve cinsiyet ile iliskisi.

PURPOSE: To investigate the relationship of coronary artery calcification identified by electron beam tomography with age and gender. MATERIALS AND METHODS: Electron beam tomography was performed in 654 patients to detect coronary artery calcification. Examinations were done with electron beam tomography (Imatron C-150 XP), using prospective electrocardiography triggering to prevent cardiac motion artifacts. Total calcification scores were calculated based on the number, area and computed tomographic number of the calcifications. The influence of age and gender on the presence and amount of coronary artery calcification were evaluated. RESULTS: There were significant differences (p < 0.001) in mean total calcification scores between men and women. Men always had more coronary artery calcification than women at all age groups. The youngest patient with coronary artery calcification was below 40 years of age in men and above 40 years of age in women. The difference in the prevalence of coronary artery calcification between men and women was great at younger ages, and decreased after age 60. The difference in prevalence of coronary artery calcification for men and women was starting to be decreased after age 60. CONCLUSION: We observed that coronary artery calcification, a marker of arteriosclerosis, is strongly associated with age and gender.