Predictors for the risk and severity of post-thrombotic syndrome in vascular Behçet's disease.

OBJECTIVE: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behçet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment. METHODS: Patients with BD (n = 205; 166 men, 39 women; age 39 ± 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated. RESULTS: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-α use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010). CONCLUSIONS: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-α also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS.

Chemical shift MRI: is there any contribution to morphologic evaluation of solid breast masses?

RATIONALE AND OBJECTIVES: To investigate the contribution of chemical shift magnetic resonance imaging for assessment of the margins of solid breast masses by benefiting from India ink artifact. METHODS AND MATERIALS: Eighty-eight masses in 64 patients were evaluated in T1- and T2-weighted images, dynamic contrast and chemical shift studies according to Breast Imaging Reporting and Data System magnetic resonance lexicon. Subtraction images were automatically obtained by chemical shift imaging and dynamic studies. Each sequence was scored using a scale of 1 to 5 according to its ability to demonstrate margins separate from surrounding parenchyma. Breast parenchyma was evaluated as fatty and dense. The results were compared with the histopathologic results. RESULTS: Twenty-eight (31.8%) of the lesions were localized in fatty breast, and the remaining 60 (68.2%) lesions were localized in dense breast. There were 34 (38.6%) benign and 54 (61.4%) malignant masses. In fatty breast, chemical shift subtraction and T1-weighted images were valuable both for the demonstration and differentiation of benign lesions (P < .05). None of the sequence was valuable for both the demonstration and differentiation of malignant lesions in fatty breasts (P > .05). In dense breasts, chemical shift subtraction and dynamic contrast subtraction images were valuable for both the demonstration and differentiation of benign and malignant lesions. Additional to these sequences, T2-weighted images was also valuable for benign lesions (P < .05). CONCLUSION: Chemical shift subtraction can contribute to routine dynamic contrast subtraction in morphologic analysis particularly for the evaluation of margins of benign lesions in fatty breasts. It can also help in morphologic analysis of masses in dense breast.

Clinical value of the malnutrition-inflammation-atherosclerosis syndrome for long-term prediction of cardiovascular mortality in patients with end-stage renal disease: a 5-year prospective study.

BACKGROUND/AIM: Mortality resulting from cardiovascular disease in patients with end-stage renal disease (ESRD) is high. In this study we sought to investigate the clinical value of the malnutrition-inflammation-atherosclerosis (MIA) syndrome for long-term prediction of cardiovascular mortality in patients treated with ESRD. METHODS: A total of 42 ESRD patients on hemodialysis were enrolled. Inflammatory markers and nutritional parameters were determined. Carotid atherosclerosis was investigated by ultrasonographically evaluated carotid intima-media thickness (cIMT). Mortality was evaluated at a 5-year follow-up. RESULTS: No correlation was evident between nutritional markers and inflammatory indexes. cIMT was inversely correlated with predialysis serum albumin. In the overall population of 42 patients, 11 (26.2%) died of cardiovascular causes during follow-up. Kaplan-Meier survival curves indicate that cIMT (> or =0.9 mm), C-reactive protein (CRP) (>1 mg/dl), and serum albumin (<3.5 g/dl) predict cardiovascular death in patients with ESRD. CONCLUSIONS: We have demonstrated that cIMT, CRP and serum albumin predict long-term mortality in ERSD patients. Our study suggests that further investigation of the MIA syndrome will provide insights into the susceptibility to CVD in this patient group.

Miliary osteoma cutis of the face: treatment with the needle microincision-extirpation method.

Multiple miliary osteoma cutis of the face represents primary extra-skeletal bone formation that arises within the skin of the face. Multiple miliary osteoma cutis of the face is a rare complication of chronic inflammatory acne vulgaris and has invasive and non-invasive treatment alternatives different from acne vulgaris. Invasive techniques should be simple, easy, and inexpensive, with minimal risk of scarring and pigmentation. We used a needle microincision-extirpation technique in a patient with multiple miliary osteoma cutis unresponsive to non-invasive treatment modalities. Skin overlying the papules was incised with a needle and then the calcificated papules were extirpated by using a small curettage device. Lesions were left to secondary healing. Results were quite good and cosmetically acceptable.

Evaluation of different cerebral mass lesions by perfusion-weighted MR imaging.

PURPOSE: To investigate the contribution of perfusion-weighted MR imaging (PWI) by using the relative cerebral blood volume (rCBV) ratio in the differential diagnosis of various intracranial space-occupying lesions. MATERIALS AND METHODS: This study involved 105 patients with lesions (high-grade glioma (N=26), low-grade glioma (N=11), meningioma (N=23), metastasis (N=25), hemangioblastoma (N=6), pyogenic abscess (N=4), schwannoma (N=5), and lymphoma (N=5)). The patients were examined with a T2*-weighted (T2*W) gradient-echo single-shot EPI sequence. The rCBV ratios of the lesions were obtained by dividing the values obtained from the normal white matter. Statistical analysis was performed with the Mann-Whitney U-test. A P-value less than 0.05 was considered statistically significant. RESULTS: The rCBV ratio was 5.76+/-3.35 in high-grade gliomas, 1.69+/-0.51 in low-grade gliomas, 8.02+/-3.89 in meningiomas, 5.27+/-3.22 in metastases, 11.36+/-4.41 in hemangioblastomas, 0.76+/-0.12 in abscesses, 1.10+/-0.32 in lymphomas, and 3.23+/-0.81 in schwannomas. The rCBV ratios were used to discriminate between 1) high- and low-grade gliomas (P<0.001), 2) hemangioblastomas and metastases (P<0.05), 3) abscesses from high-grade gliomas and metastases (P<0.001), 4) schwannomas and meningiomas (P<0.001), 5) lymphomas from high-grade gliomas and metastases (P<0.001), and 6) typical meningiomas and atypical meningiomas (P<0.01). CONCLUSION: rCBV ratios can help discriminate intracranial space-occupying lesions by demonstrating lesion vascularity. It is possible to discriminate between 1) high- and low-grade gliomas, 2) hemangioblastomas and other intracranial posterior fossa masses, 3) abscesses from high-grade gliomas and metastases, 4) schwannomas and meningiomas, 5) lymphomas and high-grade gliomas and metastases, and 6) typical and atypical meningiomas.

Bronchopulmonary sequestration: radiologic findings.

Bronchopulmonary sequestration (BPS) is a nonfunctioning bronchopulmonary tissue that is separate from the tracheobronchial tree and receives arterial blood from the systemic circulation. BPS has a wide spectrum of imaging findings. Surgery is generally indicated for the treatment of BPS. It is important to demonstrate the arterial supply and venous drainage of the sequestered segment preoperatively. Today, with the help of noninvasive imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), preoperative diagnosis of BPS can be made easily, so, invasive techniques such as angiography are not required frequently. In this report, radiological findings of BPS were retrospectively reviewed.