The orthogonal measurements approach in estimating spleen size on CT images.

PURPOSE: To find out which single measurement and/or linear regression model correlates well with splenic volume using the orthogonal measurements approach. METHODS: The study relied on retrospective analysis of 205 contrast-enhanced abdominal CT examinations carried out in adult patients using a 320-detector CT system. CT volumetry was conducted by a semi-automated, model and threshold based segmentation algorithm that enables voxel-based volume calculation of abdominal organs. The orthogonal measurements were carried out in axial sections by measuring the maximum diameters of spleen projected in sagittal, coronal and transverse planes. In addition, we calculated the diagonal diameter of spleen, which is a derivative of orthogonal measurements. Statistical analysis included calculation of interobserver agreement on orthogonal measurements, followed by model building using linear regression analysis of the measurements. RESULTS: The interobserver agreement between two radiologists was very strong for all orthogonal measurements (r ≥ 0.971). The highest model performance was detected with the diagonal diameter (r2 = 0.956), followed by the superoinferior diameter (r2 = 0.857). Agreement statistics revealed that the regression formula derived from the diagonal diameter outperformed that of superoinferior diameter. CONCLUSION: The diagonal diameter appears to be the best parameter which correlates with splenic volume, whereas the superoinferior diameter can be an alternative in daily CT reporting practice. The orthogonal measurements approach not only provides a high interobserver agreement, but also the diagonal diameter can be translated into ultrasound studies.

What are the requirements for patient-centered breast imaging? Communication preferences of mammography patients in Turkey.

We have investigated communication preferences of mammography results in 90 patients through a structured interview approach. About 81% of patients expressed that they wanted to get the results, and 18% expressed that getting the results does not help if they are incomprehensible. In patients who want to get the results, 80% preferred face-to-face interaction with physicians, whereas the others preferred other modes of communication to prevent loss of time. Majority of patients infavor of face-to-face interaction (57%) preferred both the referring physician and the radiologist. Comprehensibility and fast delivery of reports, plus direct communication with radiologists are the requirements in mammography patients while implementing patient-centered radiology.

Autosomal dominant polycystic kidney disease: new role for ultrasound.

OBJECTIVES: To evaluate the accuracy of US in calculating renal volumes and renal resistive index (RRI) that was obtained using a new method in patients with autosomal dominant polycystic kidney disease (ADPKD). METHODS: In this prospective study, US and MRI were performed in 57 patients with ADPKD (31 female and 26 male; age range, 19-79 years) between August 2017 and May 2018. The volumes determined using US and MRI were compared. The ellipsoid formula was re-evaluated using different multipliers. RRI was obtained 1.5-2 cm distal to the outlet of main renal arteries. The relationship between mean RRI, renal function tests, and kidney volumes and difference between mean RRI of ADPKD patients with and without renal failure were investigated using a two-sided independent samples t test and Pearson correlation test. Interobserver agreements for volume assessments and RRI measurements were determined. RESULTS: By changing the ellipsoid formula, a very good agreement was found (ICC 0.970 for the right kidney and ICC 0.973 for the left kidney). The mean RRI in the right renal artery was 0.61 ± 0.07 and in the left renal artery 0.63 ± 0.06. The mean RRI of ADPKD patients with renal failure was significantly higher than that of patients without renal failure (p = 0.005). There was a significant correlation between mean RRI and renal function tests. CONCLUSION: The accuracy of the US in calculating renal volumes increases by adapting the ellipsoid formula. RRI may be used for the management of ADPKD independently of volumes. KEY POINTS: •The accuracy of ultrasonography for renal volume measurement increases by changing the classical ellipsoid formula. •Renal resistive index measured by color Doppler ultrasonography is helpful for the management of autosomal dominant polycystic kidney disease. •The role of Doppler US in autosomal dominant polycystic kidney disease should increase as a result of our findings.

Referring Physicians' Tendency to Collaborate With Radiologists in Managing Contrast Media-Related Risk Factors.

PURPOSE: The aim of this study was to investigate the tendency of referring physicians to collaborate with radiologists in managing contrast media (CM)-related risk factors. METHODS: The study was conducted at a single academic hospital. Among 150 referring physicians from various specialties, 51 referring physicians (34%) responded to the invitation letter asking for an interview with a radiologist. During the interview, a modified form of the Control Preferences Scale was administered, in which there were five preferences (each displayed on a separate card) that ranged from the fully active to fully passive involvement of referring physicians in managing CM-related risk factors. A descriptive analysis was performed through categorization of the results depending on the respondents' two most preferred roles. RESULTS: Thirty-six referring physicians (70.5%) preferred a collaborative role, and 15 (29.4%) preferred a noncollaborative role (i.e., remained on either the fully active or fully passive side). Among the referring physicians who preferred a collaborative role, the most common response (n = 15 [29.4%]) was collaborative-active. CONCLUSIONS: Referring physicians at the authors' institution have basic cognitive and motivational-affective tone toward collaboration in future teamwork aimed at the management of CM-related risk factors. A modified form of the Control Preferences Scale, as in this study, can be used to investigate the tendency of referring physicians to collaborate with radiologists. The results are discussed from ethical and legal perspectives.

Importance of Clinical Decision Making by Experienced Pediatric Surgeons When Children Are Suspected of Having Acute Appendicitis: The Reality in a High-Volume Pediatric Emergency Department.

OBJECTIVE: The aim of the present study was to compare the pediatric appendicitis score (PAS), the Alvarado score (AS), white blood cell count (WBC), absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin level, and ultrasound (US) data, with the appendectomy decisions of pediatric surgeons diagnosing acute appendicitis (AA) in a real-life setting; this was a top-level, high-volume pediatric emergency department (PED) in a developing country. METHODS: The study was conducted prospectively between January 2012 and June 2013 in the PED of the Tepecik Teaching and Research Hospital in Izmir, Turkey. The study was observational in nature; no attempt was made to influence indications for exploration or the timing thereof. Children aged 4 to 18 years presenting to the PED on suspicion of AA were included. The WBC, ANC, CRP level, and procalcitonin level were measured, and US was performed on all patients on admission. The PAS and AS were calculated. An operative decision was made by each pediatric surgeon who had the results of laboratory and radiological tests. The criterion standard for AA was histopathological assessment. RESULTS: Upon receiver operating curve (ROC) analysis, the areas under the ROCs (AUROCs) of the WBC, ANC, CRP level, procalcitonin level, US positivity, PAS, AS, and decisions of pediatric surgeons supported by laboratory and US data were 0.734, 0.741, 0.671, 0.675, 0.670, 0.831, 0.794, and 0.910, respectively. When US data were employed only in cases with PASs 4 to 7, the sensitivity increased but specificity decreased. The sensitivity and specificity of pediatric surgical decisions were 100% and 82.50%, respectively. The difference between the PAS AUROC and the pediatric surgeon decision-making AUROC was significant (P = 0.0393; 95% confidence interval, 0.0470-0.226). CONCLUSIONS: Good pediatric surgical decision making supported by laboratory and US data for those suspected of AA may be the most effective diagnostic tool in a high-volume PED in a developing country.

Preferences of referring physicians regarding the role of radiologists as direct communicators of test results.

PURPOSE: Currently, there is a growing need for patient-centered radiology in which radiologists communicate with patients directly. The aim of this study is to investigate the preferences of referring physicians (RPs) regarding direct communication between radiologists and patients. METHODS: This study was conducted in a single academic hospital using a survey form. The survey items investigated the preferences of RPs regarding: 1. who should be the communicator of test results when a patient with abnormal findings requests information (the options were the radiologist; another health professional with communication skills training (CST); and the RP with CST); and 2. how the communication activity should be conducted if the radiologist is obliged (or chooses) to communicate with the patient directly (the options were that the disclosure should be limited to the findings in the radiology report; the radiologist should emphasize that the RP is the primary physician; and the communication activity should be conducted in accordance with guidelines established by consensus). The respondents were 101 RPs from various fields of specialty; they were asked to rate the items using a 5-point Likert scale. The effects of age, sex, field of specialty (surgical vs. nonsurgical), and total years of experience as a medical specialist on the ratings were statistically compared. RESULTS: Most RPs preferred that the radiologist transmit the information to the RP without communicating directly with the patient (89.1%). Although 69.3% of the RPs declared that health professionals with CST have priority in communication, 86.1% declared that the RP should be the person who received CST. If the radiologist communicates with patients directly, the RPs favored that 1. the disclosure should be limited to the findings in the radiology report (95%); 2. the communication activity should include an emphasis on the RP as the patient's primary agent (84.1%); and 3. communication should be conducted in accordance with guidelines established by consensus (73.2%). The percentage of strong opinions did not change significantly with regard to age, sex, field of specialty, or total years of experience, except that surgeons expressed strong disagreement with delegating the communication activity to another health professional who received CST (χ² = 9.9; P = 0.042). CONCLUSION: These findings may serve as a basis to implement institutional and national policies for patient-centered radiology.

In vivo nephroprotective efficacy of propolis against contrast-induced nephropathy.

PURPOSE: Contrast agents administered in diagnostic imaging or interventional procedures of clinical radiology may cause contrast-induced nephropathy (CIN). Preventive measures against CIN involve pharmaceutical pretreatments, such as N-acetylcystein (NAC) or calpain, but alternative medicines can also be helpful. This study aims to assess the prospects of a natural compound, propolis, as a potential nephroprotector against a specific contrast agent, diatrizoate. METHODS: In vivo experiments were performed on 35 male rats in five groups: control, diatrizoate alone, and pretreatments with propolis, NAC, or calpain one hour before diatrizoate administration. Three days later, blood and renal tissue samples were collected and quantitatively processed for determining induced changes in critical biomarkers malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT), as well as serum creatinine and plasma urea. RESULTS: Diatrizoate increased creatinine (113%), urea (400%), and MDA (162%) levels and decreased GSH (-71%), SOD (-69%), GSH-Px (-77%), and CAT (-73%) levels. Evaluating the response of each pretreatment provided sufficient evidence that propolis was as effective as either NAC or calpain, but consistently more prominent in restoring the MDA, GSH, SOD, and GSH-Px levels close to their normal range. This outcome demonstrated the nephroprotective effect of propolis against CIN. CONCLUSION: Propolis protects renal tissue against toxicity, free radicals, and other adverse effects induced by diatrizoate. This function is most likely exerted through the antioxidant and antitoxic activities of propolis.

Risk factors of germinal matrix intraventricular hemorrhage in premature infants.

OBJECTIVE: To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear. METHODS: A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher's exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors. FINDINGS: Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear. CONCLUSION: Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does not seem to be linear.

Stereologic orbital volume measurements in zygomatic fractures.

PURPOSE: To evaluate the efficacy of stereologic methods to measure the orbital volume using computed tomography images of patients with zygomatic fractures. MATERIALS AND METHODS: The present study was retrospectively conducted using hard-copy computed tomography images acquired during the postoperative period of 22 patients with unilateral zygomatic fractures. Orbital volume measurements were performed on the surgically treated and contralateral normal orbits using stereologic methods. The estimates obtained from both sides were compared statistically using the paired samples t test. The measurements were repeated by 2 different observers to estimate the interobserver variability. RESULTS: When both observers were taken into account, the mean volume in the normal and surgically treated orbits was 23.6 +/- 3.2 and 24.4 +/- 3.1 cm(3), respectively. A statistically significant difference was noted between the surgically treated and normal orbits (P < .05). The volumes of 16 treated orbits were enlarged by 5.8% +/- 3.8% and 6 were diminished by 2.7% +/- 1.4%. A very high statistical correlation was noted between the 2 observers (R > .95). The total time consumed for calculation in each patient (2 orbits) was 9 to 12 minutes. CONCLUSIONS: Stereologic estimation of the orbital volume is an easy, practical, and time-saving procedure that can be performed on readily available, hard-copy computed tomography images. The high interobserver agreement observed in our study shows that it can be safely used in the quantitative detection of preoperative and postoperative volume changes.

Denoising of arterial and venous Doppler signals using discrete wavelet transform: effect on clinical parameters.

In this paper, the effects of a wavelet transform based denoising strategy on clinical Doppler parameters are analyzed. The study scheme included: (a) Acquisition of arterial and venous Doppler signals by sampling the audio output of an ultrasound scanner from 20 healthy volunteers, (b) Noise reduction via decomposition of the signals through discrete wavelet transform, (c) Spectral analysis of noisy and noise-free signals with short time Fourier transform, (d) Curve fitting to spectrograms, (e) Calculation of clinical Doppler parameters, (f) Statistical comparison of parameters obtained from noisy and noise-free signals. The decomposition level was selected as the highest level at which the maximum power spectral density and its corresponding frequency were preserved. In all subjects, noise-free spectrograms had smoother trace with less ripples. In both arterial and venous spectrograms, denoising resulted in a significant decrease in the maximum (systolic) and mean frequency, with no statistical difference in the minimum (diastolic) frequency. In arterial signals, this leads to a significant decrease in the calculated parameters such as Systolic/Diastolic Velocity Ratio, Resistivity Index, Pulsatility Index and Acceleration Time. Acceleration Index did not change significantly. Despite a successful denoising, the effects of wavelet decomposition on high frequency components in the Doppler signal should be challenged by comparison with reference data, or, through clinical investigations.

Investigation of the arterial stiffness on renal artery Doppler sonograms.

This study aims to identify the effect of stiffness on renal artery Doppler sonograms by using a curve fitting approach. The study includes 20 patients with suspected renovascular hypertension. Each patient underwent recordings during renal artery examinations before and after administration of Captopril 25 mg (Kapril tablet, MN Pharmaceuticals, Istanbul, Turkey). Doppler signals were analyzed with short time Fourier transformation, followed by curve fitting to sonograms using Savitzky-Golay method. Doppler parameters obtained from pre- and post-Captopril curve-fitted sonograms were statistically compared with "Paired-Samples t-Test". Captopril administration resulted in a significant decrease in the mean frequency and a significant increase in Pulsatility Index of the periods. No significant difference was detected between maximum systolic and minimum diastolic frequencies, Resistivity Index, and the Acceleration Index. The computational approach in this study appears to be promising.

Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS).

BACKGROUND: Sleep-related disorders are among the important risk factors for neurovascular diseases. Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, excessive daytime sleepiness, and insomnia. Our aim was to investigate the presence of glaucoma in patients with OSAS and to reveal vascular pathology related to the pathogenesis of glaucoma in those patients. PATIENTS AND METHODS: The study included 31 patients with OSAS and 25 control subjects. Orbital Doppler ultrasonography was used to determine the resistivity index (RI) in the ophthalmic artery and central retinal artery. All patients and controls underwent perimetric examination. RESULTS: The prevalence of glaucoma in the group of patients with OSAS was 12.9% (4/31); all of these 4 patients with glaucoma were in the "severe" OSAS group. No statistically significant difference was found between ophthalmic artery resistivity index (OARI), central retinal artery resistivity index (CRARI), and intraocular pressure (IOP) between patients and controls (p > 0.05). There was a positive correlation between OARI and mean defect (MD), CRARI and MD, and CRARI and loss variance (LV) values (p < 0.05). There was also a positive correlation between IOP and the apnea-hypopnea index (AHI) (p = 0.001). CONCLUSIONS: In patients with OSAS, a high prevalence was found and it is interesting to note that all of the four glaucoma patients were in the severe OSAS group. The positive correlation observed between IOP and AHI suggests that increased IOP values may reflect the severity of OSAS. The positive correlation between OARI and MD and also between CRARI and MD as well as LV suggests that visual field defects may be due to optic nerve perfusion defects and these field defects also increase as the RI increases.

Inferior vena cava obstruction due to cecum adenocarcinoma.

In this paper, we report the radiologic findings of cecal adenocarcinoma with caval invasion in a 60-year-old man. Caval invasion was confirmed by ultrasonographically guided fine-needle aspiration biopsy and by surgery. To our knowledge, this is the first case report demonstrating malignant caval thrombus due to colon cancer. In addition, we suggest that fine-needle aspiration biopsy may be helpful for prompt diagnosis and treatment in such a case.

Primary hydatid cyst of the thigh: a case report of an unusual localization.

The sartorius muscle is a rare location of primary hydatid cyst. In this report, the clinical, pathologic, and radiologic features are discussed, with special emphasis on the pathologic and radiographic features. We report a case of hydatid cyst of the proximal thigh in an eight-year-old girl. Magnetic resonance (MR) images revealed muscular hydatid cyst in the sartorius muscle, with a striking appearance of daughter cysts. We did not find any visceral organ involvement. Wide excision was performed without destroying the cyst wall. Primary muscular hydatidosis should be kept in mind in the differential diagnosis of a cystic mass of a skeletal muscle.

Color Doppler imaging of ocular hemodynamic changes in Behçet disease and uveitis patients with different etiologies.

PURPOSE: To investigate blood flow velocity changes and resistivity index values of orbital vessels in Behçet disease with or without ocular involvement, in uveitis patients with different etiologies, and in healthy volunteers. METHODS: Subjects were divided into four groups: those with ocular involvement in Behçet disease (group I), those without ocular involvement in Behçet disease (group II), uveitis patients with different etiologies (group III), and a control group (group IV). Twenty-seven eyes in group I, 14 eyes in group II, 25 eyes in group III, and 27 eyes in group IV were investigated. The blood flow in the central retinal artery (CRA), ophthalmic artery (OA), nasal posterior ciliary artery (NPCA), and the temporal posterior ciliary artery (TPCA) was measured using color Doppler ultrasonography (CDU) to determine the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). RESULTS: The PSV and EDV value of CRA in groups I, II, and III were found to be significantly lower than those in the control group (p < 0.05 for each). The PSV and EDV values of TPCA and NPCA in groups I, II, and III were significantly lower than those in the control group (p < 0.05 for each). Resistivity indexes of all arteries were higher in groups I, II, and III than the control group. The PSV and EDV in CRA, TPCA, and NPCA in Behçet disease patients with ocular involvement were significantly lower than all other groups (p < 0.05). CONCLUSIONS: There are significant reductions in the blood flow values of the orbital arteries in patients with Behçet disease and uveitis patients with different etiologies when compared with healthy volunteers. The decrease in blood flow values in Behçet disease is more evident in patients with ocular involvement than the patients without ocular involvement. This might be the result of occlusive vasculitis, which is frequently seen in the retinal vessels of patients with Behçet disease.

Comparison of fast Fourier transformation and autoregressive modelling as a diagnostic tool in analysis of lower extremity venous signals.

In this study, we have compared the efficacy of autoregressive modelling (ARM) and fast Fourier transformation (FFT) of Doppler signals from lower extremity veins of healthy volunteers in various physiologic situations. Compared to FFT, ARM produced smooth spectra and less spectral broadening both in sonograms and power spectra. However, faulty positioning of the peaks along the time axis in FFT-derived power spectral density curves show that FFT is not a suitable method if these graphs are to be used as a diagnostic tool. Analysis of ARM-based venous sonograms and power spectral density graphs revealed that FFT should not be used in signals with high power spectral density levels and low-frequency bandwidth within limited segments of time.

Discontinuous doppler signals simulating respiratory misregistration: effect on autoregressive frequency spectra.

In this study, we have produced discontinuous Doppler signals of carotid artery and internal jugular vein, simulating respiratory misregistration. The aim of the study is to observe the effect of signal discontinuity and its duration on power spectral density vs. frequency graphs obtained by Autoregressive Modeling. The signals were recorded from ten male volunteers. Signal interruption was performed by moving the sampling volume in and out of the vessel bidirectionally. To estimate the effect of on-line recording time and signal discontinuity on frequency spectra, we have worked on a control data of 30s with continuous signal, and three sets of data with artificially interrupted signals of 30, 60 and 90s duration. Maximum power spectral density, area under the power spectral density, and frequency level corresponding to maximum power spectral density were calculated on frequency spectra. The frequency level corresponding to maximum power spectral density provides the most statistically stable finding in our preliminary data. The signal duration of the signal had no significant effect on the statistical stability of the frequency level.

A novel index to estimate the corpus callosum morphometry in adults: callosal/supratentorial-supracallosal area ratio.

PURPOSE: To prospectively investigate the feasibility of a new index (callosal/supratentorial-supracallosal area ratio) in morphometric analysis of the corpus callosum in adults. MATERIALS AND METHODS: The callosal and supratentorial-supracallosal areas of 50 healthy volunteers were measured on T1 weighted midsagittal magnetic resonance images. Mean value and variation coefficient for the index was calculated. In a limited subset of subjects (n=25), an interobserver agreement study was conducted to estimate the reproducibility of the index. RESULTS: There was a statistically significant difference between the area for corpus callosum and supratentorial-supracallosal regions in males and females, although the calculated ratio (index) had no sex-difference. When compared to the literature, the variation coefficient was relatively lower (12.0%), with good interobserver agreement (Pearson correlation analysis, r=0.83). CONCLUSION: Callosal/supratentorial-supracallosal area ratio might serve as a reliable index in morphometric analysis of the corpus callosum in adults.

Comparison of the autoregressive modeling and fast Fourier transformation in demonstrating Doppler spectral waveform changes in the early phase of atherosclerosis.

In this study, we have performed fast Fourier transformation (FFT) and autoregressive (AR) signal processing of the Doppler signals at a nonstenotic arterial site in patients with atherosclerosis and healthy volunteers. We have not only utilized Doppler sonograms, but also facilitated the power spectral density distribution graphs using AR modeling and FFT. Our preliminary analysis show that AR modeling has a higher efficacy in demonstrating Doppler spectral waveform changes in the preclinic or silent phase of atherosclerosis. AR has especially revealed an outstanding difference in the calculation for frequency level of maximum power spectral density.