Contribution of 68 Ga-DOTA-FAPI-04 PET/CT to Prostate Cancer Imaging : Complementary Role in PSMA-Negative Cases.

PURPOSE: Prostate-specific membrane antigen (PSMA)-targeted PET/CT is a well-established imaging method in prostate cancer (PC) for both staging and restaging, and also for theranostic applications. An alternative imaging method is crucial for 15% PSMA-negative cases. We aimed to investigate the contribution of 68 Ga-DOTA-FAPI-04 PET/CT to PC imaging. PATIENTS AND METHODS: Thirty-six patients diagnosed with PC were included. Patients underwent both 68 Ga-PSMA PET/CT and 68 Ga-DOTA-FAPI-04 PET/CT imaging within 1 week. In staging group, primary tumor uptake values were compared, and also correlations were done with histopathological findings, MRI findings, and total PSA levels. In biochemical recurrence group, the uptake values in prostatic region and metastases were evaluated to define the local recurrence or metastatic disease. RESULTS: In staging group, PSMA PET showed increased uptake in the primary lesion area in 14/27 (52%) patients, whereas 20/27 (74%) patients were positive in FAPI-04 PET. FAPI-04 positivity was found to be quite high, such as 54%, in PSMA-negative patients. A significant difference was observed between ISUP grade 1-3 patients and ISUP grade 4-5 patients in FAPI-04 PET ( P = 0.03). Local recurrence was detected in 3 patients, pelvic lymph node metastasis in 1 patient, and sacrum metastasis in 1 patient in biochemical recurrence group, and all of the lesions had more intense uptake in PSMA PET than FAPI-04 PET. CONCLUSIONS: FAPI PET imaging seems to have a potential to contribute PSMA PET imaging with FAPI positivity in more than half of PSMA-negative cases. Also, FAPI-targeted radionuclide therapy may be a promising method in patients resistant to PSMA-targeted therapy.

Long-term effects of COVID-19 on lungs and the clinical relevance: a 6-month prospective cohort study.

Background: We aimed to explore the prevalence of prolonged symptoms, pulmonary impairments and residual disease on chest tomography (CT) in COVID-19 patients at 6 months after acute illness. Methods: In this prospective, single-center study, hospitalized patients with radiologically and laboratory-confirmed COVID-19 were included. Results: A high proportion of the 116 patients reported persistent symptoms (n = 54; 46.6%). On follow-up CT, 33 patients (28.4%) demonstrated residual disease. Multivariate analyses revealed that only neutrophil-to-lymphocyte ratio was an independent predictor for residual disease. Conclusion: Hospitalized patients with mild/moderate COVID-19 still had persistent symptoms and were prone to develop long-term pulmonary sequelae on chest CT. However, it did not have a significant effect on long-term pulmonary functions.

A Critical Analysis of the Magnetic Resonance Imaging Lesion Diameter Threshold for Adverse Pathology Features.

To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion > 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being > 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.

Utilizing shear wave elastography for the evaluation of optical nerve involvement in Behçet's disease.

In this study, we investigated the elasticity of the optic nerve using shear wave elastography (SWE) in patients with Behçet's Disease (BD) and compare findings with a healthy control group. Optic nerve measurements of 40 eyes in the BD group and 38 eyes in the control group were performed by SWE (SWE-right and SWE-left). The mean age of the individuals in the BD group was higher than controls (p = 0.022). The SWE measurement results in the right eye were significantly higher in the BD group (p = 0.005), while SWE-left values were similar in the two groups (p = 0.206). There was a moderate positive correlation between age and SWE-right (r = 0.347, p = 0.031), there was no correlation between SWE-left and age (p = 0.756). It was found that SWE-right had significant value in distinguishing between BD and healthy controls (sensitivity: 75%, specificity: 78.9%; p = 0.005); whereas, SWE-left did not (p = 0.206). In the multiple logistic regression analysis, after adjusting for age and sex, the performance of SWE-right to distinguish BD patients from controls was found to remain significant (OR: 15.045, 95% CI: 2.33-97.120, p = 0.004). Due to the fact that only SWE-right values appear to have significant discriminatory performance for BD, it is feasible to suggest that the frequency and severity of BD involvement are associated with SWE-related changes in the optic nerve. This finding indicates the need for more comprehensive studies evaluating optic nerve SWE values in this context.

The role of penile elastography in the evaluation of erectile dysfunction in patients with chronic obstructive pulmonary disease.

Introduction: In this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD). Material and methods: Seventy outpatient patients aged 50-80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-5 >17: Group A, IIEF-5 <17: Group B). The measurements were made in both transverse and longitudinal sections. Results: The mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p <0.001 and p <0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p <0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p <0.05 and p <0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p <0.05 and p <0.05, respectively). Conclusions: In our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.

Prepontine and Meckel's Cave Dermoid Cyst: MR and CT Findings with Literature Review.

Dermoid cysts (DCs) are benign, congenital tumors that comprise 0.04-0.6% of all intracranial tumors. DC rupture is a rare complication and usually occurs spontaneously. The most common localisations of intracranial DCs are the posterior fossa, and suprasellar and parasellar regions. The presentations of DCs are highly variable. They are often detected incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) scans while investigating the cause of seizure or headache. Prepontine cystern is a rare localisation for intracranial DCs. To the best of our knowledge, only four cases have been reported in the literature so far. We present MRI and CT findings of a patient with DC, which ruptured into the subarachnoid space extending from the right Meckel's cave to the prepontine cistern. Key Words: Dermoid cysts, Meckel's cave, Prepontine cistern, Rupture.

Report of Two Cases with Simultaneously Detected Tubular Carcinoma and Phyllodes Tumor of the Breast.

Tubular carcinoma (TC) is a subtype of invasive breast carcinoma with better prognosis, and phyllodes tumors (PT) are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows for correct surgical planning and avoidance of reoperation for these breast neoplasms. A database was created by analyzing the archives of Department of General Surgery of the Istanbul Faculty of Medicine between September 2006 and November 2017, and a total of 105 PTs and 55 TCs were collected. Two cases with concurrence of TC and PT were identified and examined in detail. The first patient was a 33-year-old woman with a 20×12 mm2 TC and a 65×32 mm2 malignant PT in the left breast. The second patient was a 28-year-old woman with two masses in the right breast. The first mass was 38×16 mm2 on the upper outer quadrant, and the second mass was 10×8 mm2 in size in the lower inner quadrant, accompanied by a 16×10 mm2 TC and a 33×26 mm2 borderline PT. Both cases were treated by mastectomies due to patient's decisions or insufficient margin control. This study extrapolated that if two tumors are detected simultaneously, margin control can become more difficult, and breast-conserving surgery should be thoroughly reviewed.

Cognitive Versus Magnetic Resonance-Ultrasound Fusion Prostate Biopsy: Which One Is Worthier to Perform?

The aim of our study is to compare 2 prostate fusion biopsy models in terms of accurate target sampling. One hundred patients who had Prostate Imaging-Reporting and Data System score 3, 4, or 5 lesions (lesion diameter, >5 mm in long axis) in multiparametric-magnetic resonance imaging and prostate-specific antigen levels between 3 and 10 ng/mL were enrolled in the study. All patients were biopsy naive. Two groups were composed with 50 patients each. Group 1 patients had cognitive fusion (CF) biopsy, and group 2 had magnetic resonance-ultrasound fusion platform biopsy. After fusion biopsy, standard biopsy was also performed. Outcomes of histopathologic and demographic data were evaluated statistically. There were no statistical differences between the 2 groups in terms of age, prostate-specific antigen levels, prostate volume, and lesion length (P > 0.05). There was no statistically significant difference in sampling targeted lesions (P > 0.05). Also, no difference was found between the 2 groups in terms of random biopsy cancer detection rates (P > 0.05). There was no statistically significant difference between CF and magnetic resonance-ultrasound fusion in terms of cancer detection rates. For the experienced operators, we recommend lesions that are longer than 5 mm can be sampled using CF, an inexpensive and faster technique.

Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy

ABSTRACT Objective: Minimally invasive techniques are used increasingly by virtue of advancements in technology. Surgery for prostate cancer, which has high morbidity, is performed with an increasing momentum based on the successful oncological and functional outcomes as well as cosmetic aspects. Materials and methods: Sixty two patients underwent robot-assisted perineal radical prostatectomy (R-PRP) surgery at our clinic between November 2016 and August 2017. Six pelvimetric dimensions were defined and measured by performing multiparametric magnetic resonance imaging (mpMRI) prior to operation in all patients. In light of these data, we aimed to investigate the effect of pelvimetric measurements on surgery duration and surgical margin positivity. Results: By using this technique in pelvic area, we observed that measurements only representing surgical site and excluding other pelvic organs had a significant effect on surgery duration, and pelvic dimensions had no significant effect on surgical margin positivity. Conclusion: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.

Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy.

OBJECTIVE: Minimally invasive techniques are used increasingly by virtue of advancements in technology. Surgery for prostate cancer, which has high morbidity, is performed with an increasing momentum based on the successful oncological and functional outcomes as well as cosmetic aspects. MATERIALS AND METHODS: 62 patients underwent robot-assisted perineal radical prostatectomy (R-PRP) surgery at our clinic between November 2016 and August 2017. Six pelvimetric dimensions were defined and measured by performing multiparametric magnetic resonance imaging (mpMRI) prior to operation in all patients. In light of these data, we aimed to investigate the effect of pelvimetric measurements on surgery duration and surgical margin positivity. RESULTS: By using this technique in pelvic area, we observed that measurements only representing surgical site and excluding other pelvic organs had a significant effect on surgery duration, and pelvic dimensions had no significant effect on surgical margin positivity. CONCLUSION: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.

The role of histopathologic testing on apocrine carcinoma of the breast.

BACKGROUND: Apocrine carcinoma is a rare primary breast tumor characterized by the apocrine morphology. The purpose of this article is to report a review of cases with apocrine carcinoma and draw physicians' attention to the benefits of immunphenotypic techniques in cases with suspected apocrine morphology in diagnosing this uncommon breast tumor. METHODS: In this study, authors report a case series of 15 cases with apocrine carcinoma from totally 4123 breast cancer cases. Data collected between years 2008 and 2016 from Istanbul School of Medicine department of surgery archive by analyzing surgical approach to cases and immunphenotypic features of tumors according to the date of examining in our pathology department. RESULTS: In this study, Androgen, "gross cystic disease fluid protein-15" (GCDFP-15), estrogen (ER), progesterone (PR) and Her-2 neu receptor status supported evidence of apocrine carcinoma has been reviewed. As a result, HER-2 neu, GCDFP-15, androgen receptor positivity in general are useful in the diagnosis of apocrine carcinoma. In addition of these data our study revealed that GCDFP-15 positive patients are more prone to have local recurrence and distant metastases. CONCLUSIONS: We briefly describe and discuss the molecular features and new diagnostic biomarkers for this rare mammary malignancy. The importance of comprehensive profiling is highlighted due to synergistic and potentially antagonistic molecular events in the individual patients.

Comparison of preoperative locoregional Ga-68 PSMA-11 PET-CT and mp-MRI results with postoperative histopathology of prostate cancer.

BACKGROUND: Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. MATERIALS AND METHODS: Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. CONCLUSION: Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.

Ultrasonic identification of internal jugular vein fenestration.

OBJECTIVE: Anatomic variations have curicial importance during neck surgery. We present a fenestrated internal jugular vein variation and the accessory nerve passing through it. Also, we discuss preoperative diagnosis of this variation using ultrasonography. METHOD: The possible recognition of this variation by ultrasonography is introduced. RESULTS: The accessory nerve in an internal jugular vein fenestration can be seen using ultrasonography. CONCLUSION: Preoperative identification of this rare variation may secure surgeon from potential complications.

Feasibility of Thyroid Imaging Reporting and Data System Classification in Predicting Thyroid Malignancy.

In this study, we aimed to evaluate the diagnostic value of thyroid imaging reporting and data system (TIRADS) in the estimation of malignancy and assess the concordance between TIRADS and the histopathology results of the postoperative specimens. Consecutive ultrasound imaging records of patients with multinodular goiter from January 2010 to December 2017 who underwent surgery were retrospectively reviewed. The risk of malignancy of each TIRADS category was determined, and correlation with pathology was assessed. The patients with malignant cytology findings (Bethesda 6) who were categorized TIRADS 6 were excluded from the study. The positive and negative predictive values, sensitivity, specificity, and accuracy of the TIRADS classification were calculated on a 2 × 2 table with their own formulas. A total of 1457 patients were evaluated, and 1122 of these were included in the study. The risk of malignancy for nodules evaluated as TIRADS 2 was 0.6 per cent, TIRADS 3 was 13.1 per cent, TIRADS 4a was 20 per cent, TIRADS 4b was 61.1 per cent, TIRADS 4c was 85.7 per cent, and TIRADS 5 was 93.3 per cent. The positive predictive value of TIRADS classification was found to be 43.4 per cent, negative predictive value was found to be 90.7 per cent, sensitivity was found to be 78 per cent, specificity was found to be 68.4 per cent, and accuracy was found to be 70.7 per cent for our institution. The TIRADS classification based on suspicious ultrasound findings is reliable in predicting thyroid malignancy and can be routinely used in daily practice.

Pinch-Off Syndrome, a Rare Complication of Totally Implantable Venous Access Device Implantation: A Case Series and Literature Review.

BACKGROUND: Pinch-off syndrome (POS) is a rare complication after totally implantable venous access device (TIVAD) implantation. In cancer patients, it is important to prevent this rare complication and to recognize it early if it does occur. We present a case series of POS after TIVAD implantation and the results of a literature search about this complication. METHODS: From July 2006 to December 2015, 924 permanent implantable central venous catheter implantation procedures were performed. The most common indication was vascular access for chemotherapy. RESULTS: POS occurred in 5 patients in our clinic. Two patients experienced POS within 2 weeks, and the other 3 patients were admitted to department of surgery, Istanbul Faculty of Medicine at 6 to 14 months following implantation. The catheters were found to be occluded during medication administration, and all patients complained of serious pain. The transected fragments of the catheters had migrated to the heart. They were successfully removed under angiography with a single-loop snare. CONCLUSION: POS is a serious complication after TIVAD implantation. It is important to be aware of this possibility and to make an early diagnosis in order to prevent complications such as drug extravasation and occlusion events.

Multi-ray medical ultrasound simulation without explicit speckle modelling.

PURPOSE: To develop a medical ultrasound (US) simulation method using T1-weighted magnetic resonance images (MRI) as the input that offers a compromise between low-cost ray-based and high-cost realistic wave-based simulations. METHODS: The proposed method uses a novel multi-ray image formation approach with a virtual phased array transducer probe. A domain model is built from input MR images. Multiple virtual acoustic rays are emerged from each element of the linear transducer array. Reflected and transmitted acoustic energy at discrete points along each ray is computed independently. Simulated US images are computed by fusion of the reflected energy along multiple rays from multiple transducers, while phase delays due to differences in distances to transducers are taken into account. A preliminary implementation using GPUs is presented. RESULTS: Preliminary results show that the multi-ray approach is capable of generating view point-dependent realistic US images with an inherent Rician distributed speckle pattern automatically. The proposed simulator can reproduce the shadowing artefacts and demonstrates frequency dependence apt for practical training purposes. We also have presented preliminary results towards the utilization of the method for real-time simulations. CONCLUSIONS: The proposed method offers a low-cost near-real-time wave-like simulation of realistic US images from input MR data. It can further be improved to cover the pathological findings using an improved domain model, without any algorithmic updates. Such a domain model would require lesion segmentation or manual embedding of virtual pathologies for training purposes.

Shear Wave Elastographic Alterations in the Kidney After Extracorporeal Shock Wave Lithotripsy.

OBJECTIVES: Extracorporeal shock wave lithotripsy (ESWL) is a method used frequently for the treatment of renal stone disease. Although its safety is proven, there are still concerns about its unwanted effects on kidneys. In this prospective study, we aimed to evaluate renal tissue alterations with shear wave elastography (SWE) after ESWL. We also studied the correlation between SWE and resistive index (RI) changes. METHODS: The study included 59 patients who underwent ESWL treatment for renal stone disease. We performed SWE and color Doppler ultrasonography to calculate SWE and RI values before, 1 hour after, and 1 week after lithotripsy treatment. A binary comparison was performed by the Bonferroni test. The correlation between SWE and RI values was evaluated by a Pearson correlation analysis. RESULTS: The patients included 26 women (44.1%) and 33 men (55.9%). Their ages ranged from 20 to 65 years (mean ± SD, 45.0 ± 1.1 years). Stone diameters ranged from 7 to 19 mm (mean, 13.0 ± 0.5 mm). There was a significant difference in SWE values before and 1 hour after lithotripsy treatment (P = .001; P < .01). In the follow-up measurement 1 week after treatment, this difference disappeared (P > .99; P > .05). Resistive index values increased significantly 1 hour after lithotripsy treatment and returned to prelithotripsy values 1 week after treatment. In the correlation analysis, SWE and RI values were not correlated. CONCLUSIONS: Measurements of alterations in SWE values after ESWL can provide useful information about renal tissue injury.

Retrospective comparison of three-dimensional imaging sequences in the visualization of posterior fossa cranial nerves.

PURPOSE: To compare efficancy of three-dimentional SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolutions) and CISS (constructive interference in steady state) sequences in the imaging of the cisternal segments of cranial nerves V-XII. METHODS: Temporal MRI scans from 50 patients (F:M ratio, 27:23; mean age, 44.5±15.9 years) admitted to our hospital with vertigo, tinnitus, and hearing loss were retrospectively analyzed. All patients had both CISS and SPACE sequences. Quantitative analysis of SPACE and CISS sequences was performed by measuring the ventricle-to-parenchyma contrast-to-noise ratio (CNR). Qualitative analysis of differences in visualization capability, image quality, and severity of artifacts was also conducted. A score ranging 'no artefact' to 'severe artefacts and unreadable' was used for the assessment of artifacts and from 'not visualized' to 'completely visualized' for the assesment of image quality, respectively. The distribution of variables was controlled by the Kolmogorov-Smirnov test. Samples t-test and McNemar's test were used to determine statistical significance. RESULTS: Rates of visualization of posterior fossa cranial nerves in cases of complete visualization were as follows: nerve V (100% for both sequences), nerve VI (94% in SPACE, 86% in CISS sequences), nerves VII-VIII (100% for both sequences), IX-XI nerve complex (96%, 88%); nerve XII (58%, 46%) (p<0.05). SPACE sequences showed fewer artifacts than CISS sequences (p<0.002).

Shear wave elastography findings of de Quervain tenosynovitis.

OBJECTIVE: Our aim was to evaluate the feasibility of using shear wave elastography (SWE) to assess first extensor compartment tendons rigidity and its alterations with tenosynovitis. MATERIALS AND METHODS: We performed B-mode ultrasound and SWE to total number of 80 participants. All participants were evaluated clinically to call the diagnosis of de Quervain tenosynovitis or to rule out the diagnosis. We composed 2 groups. Group 1 included 40 healthy volunteers (33 females and 7 male participants with ages ranging from 24 to 60 years, median age was 37.5 years) and group 2 had 40 de Quervain patients (32 females and 8 male patients with ages ranging from 25 to 51 years, median age was 34 years). SWE measurements were repeated 3 times and arithmetic average was used for the final SWE value. RESULTS: The median SWE value of healthy group (group 1) was 72kPa and the de Quervain patient group (group 2) was 29kPa. Two groups demonstrated statistically significant difference (p<0.001). The ROC curve analysis was performed and the SWE value of 40.5kPA was calculated as a cut-off value for the diagnosis of de Quervain tenosynovitis with 95% specificity and 85% sensitivity. CONCLUSION: SWE modality can provide useful data regarding de Quervain tenosynovitis.