Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients.

PURPOSE: To investigate the safety and efficacy of thyroid artery embolization (TAE) in the treatment of nodular goiter (NG). METHODS: During a 5.5-year period, 56 consecutive patients with a NG underwent TAE. In Group A, there were 20 patients with a solitary/dominant 5-11-cm nodule, and in Group B, there were 36 patients with numerous nodules. Of the 56 patients, 47 (84%) had a retrosternal goiter and 25 had hyperthyroidism. In all patients, clinical and radiological evaluations were made at baseline and 6 months after TAE, and these parameters were statistically compared. RESULTS: In 56 patients, 145 of the 146 thyroid arteries were successfully embolized. The 30-day mortality rate was 1.8%. Minor and major complications occurred in 25 and 2 patients, respectively. Six months after the TAE, the mean nodule volume was reduced from 80.2 mL to 25.0 mL, the mean thyroid volume was reduced from 147.0 mL to 62.6 mL, and the mean intrathoracic extension was reduced from 31.7 mm to 15.9 mm (P < .001). Of the 22 patients with non-Graves hyperthyroidism, 19 (86%) became euthyroid. The mean thyroid-related patient-reported outcome scores improved from 155.4 to 70.4 (P < .001). Of the 51 patients, 50 (98%) declared that they would recommend TAE to other patients with NG. CONCLUSIONS: TAE is safe and effective for the treatment of NG, with a significant volume reduction of the nodule(s) and thyroid gland.

Quantitative analysis of distal femoral epiphysis blood supply in healthy infants with superb microvascular imaging: a pilot study

Background/aim: This study aimed to determine the blood supply of the distal femoral epiphysis (DFE) using superb microvascular imaging in newborns and infants, and to investigate the correlation with ossification center (OC) length, sex, and age. Materials and methods: A total of 140 cases were evaluated in this study. The cases were divided into 2 groups of less than 90 days and over 90 days. Cartilage blood supply was measured with vascularity index (%) (VI). Results: The mean OC length and median VI values were measured as 10.20 ± 3.72 mm and 0.80% (0.58­1.50) for boys and 10.03 ± 3.36 mm and 0.70% (0.30­1.40) for girls, respectively. There was no significant difference in OC length and VI between sexes. The mean OC length in Group II was significantly higher than in Group I (12.14 ± 3.14 vs 8.09 ± 2.64) (p < 0.001). The median VI in Group I was higher than in Group II (1.40% vs 0.40%) (p < 0.001). There were positive correlations between age and OC length (r = 0 .716), negative correlations between age and VI (r = ­0.822), and between VI and OC length (r = ­0.657). Conclusion: Quantitative reference values for DFE blood supply and OC length can guide the diagnosis and follow-up of many skeletal diseases.

Shear wave elastography of temporomandibular joint disc and masseter muscle stiffness in healthy children and adolescents: a preliminary study.

OBJECTIVES: Shear wave elastography (SWE) are promising techniques in diagnosing temporomandibular joint (TMJ) disc and masseter muscle disorders. To investigate normative stiffness values of the TMJ disc and masseter muscle by SWE in children and adolescents. METHODS: This prospective study evaluated 123 TMJ discs and masseter muscles in 123 subjects. The stiffnesses of anterior, middle, and posterior parts of the disc and the masseter muscle were measured. This study investigated differences in mean elasticity [kilopascal (kPa)] and velocity [metre/second (m/s)] values of the different disc parts and the masseter muscle in closed and open mouth positions, and the correlations of these SWE values with age, body mass index (BMI), height, and weight of the subjects. RESULTS: The median stiffness disc values of all participants were 28.7 kPa (elasticity) and 3.07 m/s (velocity) for the anterior, 29.10 kPa and 3.07 m/s for the middle, and 23.2 kPa and 2.77 m/s for the posterior parts. Posterior stiffness was significantly lower than other body regions in all subjects and across all age groups. The mean stiffness values of the muscle were 16.96 ± 9.01 kPa and 2.33 ± 1.2 m/s for the closed mouth, and 28.7 ± 10.2 kPa and 3.23 ± 1.32 m/s for the open mouth. CONCLUSION: The stiffness of the TMJ disc was significantly lower in the posterior part than in the anterior or middle parts. The mean stiffness was significantly higher in the open mouth than in the closed mouth position. Neither elasticity nor velocity were associated with age, height, weight, or BMI.

Diagnostic utility of arterial spin labeling in identifying changes in brain perfusion in patients with carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning is one of the most common poisonings worldwide. The affinity of hemoglobin for CO is significantly higher than that for oxygen, and the formation of carboxy-hemoglobin leads to a decrease in the capacity of blood to transport oxygen to tissues, tissue hypoxia, and early perfusion changes in the affected tissue. This study aimed to investigate the utility of arterial spin labeling perfusion imaging (ASL-PI) in revealing cerebral vascular hemodynamic changes in patients presenting to the emergency room with CO poisoning and to compare findings with those from diffusion-weighted imaging (DWI). METHOD: This study was conducted between November 2016 and May 2019 and was approved by the local ethics committee. DWI and ASL-PI examinations were performed in 83 patients who presented to the emergency room with CO poisoning. Four regions-the cerebral cortex, basal ganglia, cerebral white matter, and cerebellum-were evaluated for alterations in perfusion and diffusion, and findings from DWI and ASL-PI were compared. RESULTS: The study group included 39 (50.6%) females and 38 (49.4%) males, with a mean (±SD) age of 40.08 ± 20.41 years (range, 7-86 years). DWI revealed restricted diffusion in 10 regions in 6 (7.8%) patients, including the basal ganglia (n = 2), cerebral white matter (n = 2), cerebral cortex (n = 3), and the cerebellum (n = 3). ASL-PI revealed hypo-perfusion in 64 regions in 36 (46.8%) patients, including the basal ganglia (n = 21), cerebral white matter (n = 12), cerebral cortex (n = 23), and cerebellum (n = 7). CONCLUSION: ASL-PI provided additional information when used to identify perfusion changes in the brains of individuals who experienced CO poisoning and was superior to DWI as it revealed early changes in the brain. Considering its limitations, ASL-PI can be routinely used with DWI in cases of CO poisoning.

Utility of lung radiodensity ratios in diagnosis of radiolucent foreign body aspiration in children: a practical approach.

OBJECTIVE: To evaluate the utility of radiodensity ratio between lungs on chest X-ray for the diagnosis of radiolucent foreign body aspiration (FBA) in children. METHODS: X-rays of 33 patients with confirmed diagnosis of FBA by bronchoscopy were compared to 66 control patients. We divided the study group into three subgroups: symmetric (13-patients), right-oblique (RO;12-patients) and left-oblique (LO;8-patients). RESULTS: When we compared FBA-symmetric-subgroup to symmetric-control-group, FBA-RO-subgroup to RO-control-group and FBA-LO-subgroup to LO-control-group, radiodensity ratios were significantly higher in the FBA subgroups. CONCLUSION: The calculated radiodensity ratio between lungs on X-ray would be a useful and practical tool for the diagnosis of radiolucent FBA in children.

Bilateral Cystic Adrenal Neuroblastoma with Cystic Liver metastasis.

Bilateral congenital cystic adrenal neuroblastoma (NB) with cystic liver metastasis is a very rare condition and only few cases have been reported in the literature. Herein we report a case of a congenital bilateral cystic adrenal NB with cystic liver metastasis and briefly discuss characteristic imaging features of cystic NB.

Acoustic radiation force impulse (ARFI) elastography in the evaluation of renal parenchymal stiffness in patients with ureteropelvic junction obstruction.

PURPOSE: To investigate the role of acoustic radiation force impulse (ARFI) elastography in the detection of renal parenchymal damage in kidneys with and without ureteropelvic junction obstruction (UPJO). METHODS: Twenty-five pediatric patients with a diagnosis of UPJO who underwent surgery and 15 pediatric patients with conservatively managed UPJO were prospectively evaluated with ARFI elastography. Sixteen healthy volunteers constituted the control group. Shear wave velocity (SWV) measurements in the upper, mid, and lower poles of the affected kidney were performed. SWV values of kidneys based on presence of UPJO and hydronephrosis grade were compared. The correlation of SWV values with residual renal function obtained from diethylenetriaminepentaacetic acid or mercaptoacetyltriglycine-3 renal scan was evaluated. RESULTS: Significantly, higher SWV values were found in control kidneys compared to kidneys affected by UPJO. The median SWVs were 2.82 (2.51-3.07) m/s for the control kidneys and 2.36 (2.09-2.53) m/s for the kidneys in the UPJO group (p < 0.001). When UPJO patients were grouped according to the grade of hydronephrosis, grade 0 hydronephrotic kidneys [2.35 (2.11-2.50) m/s] and grade 3-4 hydronephrotic kidneys [1.86 (1.96-2.25) m/s] had significantly lower SWV values compared to grade 1-2 hydronephrotic kidneys [2.62 (2.37-2.90) m/s] (p < 0.05). CONCLUSIONS: ARFI as a noninvasive, radiation-free procedure for evaluating parenchymal stiffness may prove useful in the diagnostic work-up and follow-up of children with UPJO-induced renal disease.

A preliminary study of shear wave elastography for the evaluation of unilateral palpable undescended testes.

OBJECTIVES: We sought to compare unilateral palpable undescended testes and contralateral descended testes using shear wave elastography (SWE) to show potential quantitative differences in elasticity patterns, which might reflect the histologic features. METHODS: Approval for this prospective study was obtained from the local ethics committee. A total of 29 patients (mean age, 7.52 years; range, 1-18 years) with unilateral palpable undescended testes and contralateral descended testes were examined by greyscale ultrasonography and SWE between February 2015 and April 2016. The volume and the elasticity of each testicle were the main factors evaluated. RESULTS: There was no difference between undescended testes and contralateral descended testes in terms of volume. However, a significant difference was evident in SWE-derived quantitative data. CONCLUSIONS: SWE seems to be a useful sonographic technique to predict histologic features of the undescended testicle, which might replace testicular biopsy in modern management of the undescended testis.

A rare cause of vomiting: annular pancreas.

Annular pancreas is a rare congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the second part of the duodenum. It can affect anyone from neonates to adults, and is difficult to diagnose because it can present in a wide range of clinical conditions. Although cases have also been reported in adults, symptomatic cases are often referred in infancy or early childhood. A 17-year-old female patient who was diagnosed as having annular pancreas is reported. The patient had had non-bilious vomiting accompanied by abdominal pain, especially 5-10 minutes after meals, for seven years. Annular pancreas, which may be seen at any age, should be considered in the differential diagnosis of patients with non-bilious vomiting, particularly after meals, over a long period.