Preferred music lowers anxiety levels and pain perception while promoting patient satisfaction in women undergoing ultrasound-guided breast biopsy: randomized controlled study.

BACKGROUND: Image-guided breast biopsies are well accepted, yet stressful procedures for patients in radiology clinics. PURPOSE: To investigate the effect of music on anxiety, pain, and patient satisfaction related to a breast biopsy session. MATERIAL AND METHODS: After approval of institutional review board and giving informed consent, 93 women scheduled for ultrasound-guided breast biopsy or stereotactic wire localization were prospectively enrolled in this randomized controlled study. Patients were referred into two groups either listening to music of their own choice from three options of genre list during the procedure or not. Immediately before and after the biopsy session, participants were asked to complete questionnaires for measuring anxiety (State-Trait Anxiety Inventory, Beck Anxiety Inventory), pain, and patient satisfaction (visual analog scale). Sociodemographic data were described, and the duration was noted at the end. Statistical analysis was made using paired samples t-test, chi-square test, independent samples t-test, and Mann-Whitney U test. RESULTS: Except for the duration, demographic characteristics were statistically similar between the two groups. Trait and preprocedural state anxiety scores did not have significant difference between the groups. Both groups showed lowered state anxiety values after the biopsy (P < 0.05) and there was statistically significant reduction in state anxiety levels of music group (10.35 ± 7.5 music vs. 7 ± 7.98 control; P = 0.024). Pain perception was fewer (P < 0.05) and patient satisfaction was greater (P < 0.05) through the implementation of music. CONCLUSION: Music intervention reduces anxiety and pain and thereby increases patient satisfaction during ultrasound-guided breast biopsies.

The effect of the use of the Gail model on breast cancer diagnosis in BIRADs 4a cases.

Objectives: The BI-RADS classification system and the Gail Model are the scoring systems that contribute to the diagnosis of breast cancer. The aim of the study was to determine the contribution of Gail Model to the diagnosis of breast lesions that were radiologically categorized as BI-RADS 4A. Material and Methods: We retrospectively examined the medical records of 320 patients between January 2011 and December 2020 whose lesions had been categorized as BI-RADS 4A. Radiological parameters of breast lesions and clinical parameters according to the Gail Model were collected. The relationship between malignant BI-RADS 4A lesions and radiological and clinical parameters was evaluated. In addition, the effect of the Gail Model on diagnosis in malignant BI-RADS 4A lesions was evaluated. Results: Among radiological features, there were significant differences between lesion size, contour, microcalcification content, echogenicity, and presence of ectasia with respect to the pathological diagnosis (p <0.05). No significant difference was found between the lesions' pathological diagnosis and the patients' Gail score (p> 0.05). An analysis of the features of the Gail model revealed that there was no significant difference between the age of menarche, age at first live birth, presence of a first-degree relative with breast cancer, and a history of breast biopsy and the pathological diagnosis (p> 0.05). Conclusion: As a conclusion Gail Model does not contribute to the diagnosis of BC, especially in patients with BI-RADS 4A lesions.

Acoustic Radiation Force Impulse Elastography Findings of Achilles Tendons in Patients on Chronic Hemodialysis and in Renal Transplant Patients.

OBJECTIVES: The Achilles tendon, which is composed of tendinous parts of gastrocnemius and soleus muscles, is the strongest and the largest tendon in the human body. Chronic renal disease can lead to reduced physical activity and exercise capacity. Spontaneous rupture of the Achilles tendon can occur in patients with chronic renal failure, with recurrent microtraumas, hypoxia, and chronic acidosis as predisposing factors. Here, we assessed and compared the elastographic findings in the Achilles tendon using acoustic radiation force impulse elastography in patients on chronic hemodialysis, in renal transplant patients, and in healthy volunteers. MATERIALS AND METHODS: Our study included 25 patients on chronic hemodialysis, 25 renal transplant patients, and 25 healthy individuals (control group). The thickness and shear wave velocity of the Achilles tendons were measured bilaterally by ultrasonography and acoustic radiation force impulse elastography. RESULTS: The mean shear wave velocity was 3.67 m/s in the right and 3.64 m/s in the left Achilles tendon in the hemodialysis group. In the renal transplant group, the mean shear wave velocity was 4.29 and 4.25 m/s for the right and left Achilles tendon, respectively. In the control group, the mean shear wave velocity was 6.68 and 6.59 m/s, respectively for the right and left Achilles tendon. A statistically significant difference in shear wave velocities was shown among the groups (P < .05). CONCLUSIONS: Achilles tendons in patients with chronic renal failure and on hemodialysis were softer than in renal transplant patients and softer than in the control group. Chronic tendinopathy causes softening of the tendon. In the renal transplant group, stiffness of the Achilles tendon was increased versus the hemodialysis group but still softer than the control group, which could be explained as a positive clinical effect of renal transplant. Acoustic radiation force impulse elastography is an objective, easy, and noninvasive method to assess Achilles tendinopathy.

Use of Computed Tomography Volumetry to Assess Liver Weight in Patients With Cirrhosis During Evaluation Before Living-Donor Liver Transplant.

OBJECTIVES: Computed tomography liver volumetry has been widely used to detect total and segmental liver volume in living-donor liver transplantation. However, use of this technique to evaluate the cirrhotic liver remains unclear. In this study, we evaluated the accuracy of freehand computed tomography volumetry to assess total liver volume by comparing weights of total hepatectomy specimens in patients with cirrhosis. For our analyses, we considered the density of a cirrhotic liver to be 1.1 kg/L. MATERIALS AND METHODS: Liver volume was measured using a freehand computed tomography technique in 52 patients with cirrhosis from different causes and who had no solid lesions before transplant. Measurements were made with a 16-slice multidetector computed tomography scanner (Siemens Somatom Sensation 16, Erlangen, Germany). For volumetric measurements, 10-mm-thick slices with 10-mm reconstruction intervals were preferred. Total hepatectomy weights of explant livers and computed tomography volumetry data were compared. RESULTS: We excluded 3 cirrhotic patients with Budd-Chiari syndrome due to wide variations in scatterplot results. In the 49 patients included in the final analyses, average estimated liver volume by computed tomography was 721 ± 398 mL and actual cirrhotic liver weight was 727.8 ± 415 g. No significant differences were shown between these measurements. A simple regression analysis used to analyze correlations between estimated liver volume by computed tomography and real cirrhotic liver weight showed correlation of 0.957 (P < .001). When computed tomography liver volumetry as the independent variable and cirrhotic liver weight as dependent variable were considered, regression analyses showed R2 = 0.915. CONCLUSIONS: Freehand computed tomography liver volumetry can be confidently used to evaluate liver volume in cirrhotic liver patients similar to use of this technique to estimate actual weights in normal livers. This technique can also be valuable during pretransplant and liver resection evaluations to ensure a more successful outcome.

Liver Stiffness Measurements Using Acoustic Radiation Force Impulse in Recipients of Living-Donor and Deceased-Donor Orthotopic Liver Transplant.

OBJECTIVES: The aim of this study was to evaluate the diagnostic efficiency of the acoustic radiation force impulse (Siemens Medical Solutions, Erlangen, Germany) elastography in assessment of fibrosis in orthotopic liver transplant patients. MATERIALS AND METHODS: We enrolled 28 orthotopic liver transplant patients (deceased and living donors), whose biopsy decision had been prospectively given clinically. Ten acoustic radiation force impulse elastographic measurements were applied before the biopsy or within 3 days after the biopsy by 2 radiologists. After the core tissue needle biopsy, specimens of all patients were analyzed according to the modified Ishak scoring system. Measurements of acoustic radiation force impulse elastography and pathology specimen results were compared. RESULTS: From 28 biopsies, fibrosis scores of 4 biopsies were evaluated as F0 (14.3%), 16 as F1 (57.1%), 4 as F2 (14.3%), and 4 as F3 (14.3%). Mean results of acoustic radiation force impulse measurements were calculated as 1.4 ± 0.07 in F0, 1.74 ± 0.57 in F1, 2.19 ± 0.7 in F2, and 2.18 ± 0.35 in F3. There were no significant correlations of mean acoustic radiation force impulse values between the F0 versus F1 (P = .956) and F0 versus F2 stages (P = .234). A statistically significant correlation of mean acoustic radiation force impulse values was found between the F0 and F3 fibrosis stages (P = .046). CONCLUSIONS: Acoustic radiation force impulse imaging is a promising screening test for detecting significant liver fibrosis (≥ F3 in modified Ishak) in living-donor or deceased-donor orthotopic liver transplant recipients.

Acoustic Radiation Force Impulse Elastography and Ultrasonographic Findings of Achilles Tendon in Patients With and Without Diabetic Peripheral Neuropathy: A Cross-Sectional Study.

AIMS: We aimed to evaluate the elastographic features of Achilles tendon with Acoustic Radiation Force Impulse in patients with and without diabetic neuropathy. METHODS: According to the presence of peripheral neuropathy, 45 patients with type 2 diabetes were divided into 2 subgroups. Those with peripheral neuropathy were defined as group I (22 patients) and those without peripheral neuropathy were defined as group II (23 patients). A total of thirty age-, gender-, and body mass index-matched healthy individuals were selected as controls. All participants underwent both ultrasonographic and Acoustic Radiation Force Impulse elastographic examination in order to evaluate Achilles Tendon thickness and stiffness. RESULTS: Achilles tendon thicknesses were similar between groups (p=0.991). Achilles tendon thicknesses of both patient groups were significantly higher than the control group (group I vs control p=0.01; group II vs control p=0.006). Stiffness values of Achilles tendons were similar between the control group and group II (p=0.993). Shear Wave Velocity was significantly lower in group I than group IIand control group (p<0.001). CONCLUSION: Diabetic patients with neuropathy have thicker and softer Achilles tendon while the elasticity of Achilles tendon in diabetic patients without neuropathy is similar to the healthy controls. Softening of the Achilles tendon may be an early sign of diabetic foot and reveal the patients with a risk of diabetic foot.

Interobserver and intermethod variability in data interpretation of breast strain elastography in suspicious breast lesions

Background/aim: Strain elastography has the disadvantage of being operator-dependent. Interobserver variability is observed during image acquisition and interpretation. This study aimed to analyze the interobserver and intermethod variability of strain elastography in image interpretation and evaluate the diagnostic performance combining elasticity score and strain ratio with ultrasonography. Materials and methods: A retrospective study was conducted on 70 breast lesions evaluated with B-mode ultrasonography and strain elastography. B-mode ultrasonography findings, elasticity scores, and strain ratio values were evaluated using static images by two radiologists. BI-RADS assessment of the lesions and the decision of both observers as to whether the biopsy was required using B-mode ultrasonography, and the combined ultrasonography+elasticity score, and the combined ultrasonography+elasticity score+strain ratio were compared with the histopathological results. Also, the interobserver agreement was analyzed for all the combinations. Results: There was very good agreement (weighted κ = 0.865) between the observers for the elasticity scores. Very good agreement was observed between the observers for BI-RADS assessments using the combined ultrasonography+elasticity score and the combined ultrasonography+elasticity score+strain ratio (weighted κ = 0.848, and 0.902, respectively). Area under the curve of B-mode ultrasonography, the combined B-mode ultrasonography+elasticity score, and the combined B-mode ultrasonography+elasticity score+strain ratio, were calculated as 0.859, 0.866, and 0.916 for observer 1, and 0.851, 0.829, and 0.916 for observer 2, respectively. There were no statistically significant differences between the observers' diagnostic performances in any of the combinations (P = 0.703, 0.067, and 0.972, respectively). Conclusion: In the evaluation and further assessment of breast lesions, semiquantitative strain ratio calculation may help improve diagnostic accuracy by reducing interpretational variety, when used together with B-mode ultrasonography and elasticity scoring, especially for inexperienced individuals.

The Effects of Adipose Derived Stromal Vascular Fraction and Platelet-Rich Plasma on Bone Healing of a Rat Model With Chronic Kidney Disease.

BACKGROUND: Chronic kidney disease (CKD) impairs osteoblast/osteoclast balance and damages bone structure with diminished mineralization and results in bone restoration disorders. In this study, we investigate the effects of adipose-derived stromal vascular fraction and platelet-rich plasma (PRP) on bone healing model in rats with CKD. METHODS: Sprague-Dawley rats were separated into 4 groups. All groups except group I (healthy control) had CKD surgery using 5/6 nephrectomy model. All groups had intramedullary pin fixation after receiving bone fracture using drilling tools. Group II rats were used as control group for CKD. Group III rats received PRP treatment on fracture site. Group IV rats received PRP and stromal vascular fraction treatment on fracture site.Weight loss and blood samples were followed at the time of kidney surgery, third, sixth, and 12th weeks. Bone healing and callus formations were compared, biomechanically, radiologically, histopathologically, and immunohistochemically. Osteoblastic transformation of stem cells was assessed with DiI staining. RESULTS: Negative effects of CKD on bone healing were reduced by increasing mechanical, histological, radiological, and biochemical properties of the bone with stromal vascular fraction and PRP treatments. Although thickness of callus tissue delayed bone healing process, it also enhanced biomechanical features and bone tissue organization. CONCLUSIONS: Platelet-rich plasma and adipose-derived stromal vascular fraction treatments were effective for bone healing in animal model, which can be promising for clinical trials.

Evaluation of Neuroimaging Findings of Central Nervous System Complications in Heart Transplant Recipients.

OBJECTIVES: In this study, we presented neuroradiologic findings and diagnoses of neurologic complications in a series of heart transplant recipients. MATERIALS AND METHODS: A retrospective review was conducted at Baskent University Hospital. We searched the hospital and radiology databases and identified 109 heart transplant recipients. Thirty-one of these recipients had neuroradiologic evaluations secondary to presentation of neurologic symptoms after heart transplant, with 18 patients evaluated with computed tomography and 22 patients evaluated with magnetic resonance imaging (overlap of imaging-defined groups occurred in 9 recipients). Computed tomography and magnetic resonance imaging studies were retrieved from the Picture Archiving and Communication System, with each type of imaging retrospectively evaluated on consensus by 2 radiologists. RESULTS: Radiopathologic findings related to symptoms were detected in 12 of the 31 study patients. The most common abnormality was posterior reversible leukoencephalopathy syndrome (5 patients, 4.6%). The other abnormalities were ischemic stroke (3 patients, 2.8%), hemorrhagic stroke (1 patient, 0.9%), intracranial abscess (2 patients, 1.8%), and intracranial dissemination of sinusoidal fungal infection and related hemorrhagic infarct (1 patient, 0.9%). The other 19 heart transplant recipients who underwent computed tomography and/or magnetic resonance imaging for neurologic complaints showed no neuroradiologic findings related to neurologic symptoms. CONCLUSIONS: Posterior reversible leukoencephalopathy syndrome and ischemic stroke were the most common neurologic complications in our heart transplant recipients. The other complications were hemorrhagic stroke, intracranial abscess, and intracranial dissemination of sinusoidal fungal infection. Neurologic complications are common in heart transplant recipients and should be identified promptly for early treatment. For the recognition of these complications, computed tomography should be performed for initial evaluation to rule out edema or hemorrhage. However, in the presence of serious neurologic symptoms that cannot be explained by computed tomography, magnetic resonance imaging should be indicated.

Is Unenhanced Computed Tomography Reliable in the Assessment of Macrovesicular Steatosis in Living Liver Donors?

OBJECTIVES: In this retrospective study, we aimed to determine the diagnostic value of unenhanced computed tomography in the assessment of macrovesicular steatosis in potential living liver transplant donors by using biopsy as a reference standard. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board, and all included patients provided written informed consent. Our study group included 181 donor candidates (mean age of 35.9 ± 9.3 y) who underwent unenhanced computed tomography and subsequent needle biopsy (mean period after scan of 12.74 d) in the right hepatic lobe (at least 2 samples per patient). Histologic degree of macrovesicular steatosis was determined. A radiologist with 10 years of experience assessed steatosis ofthe right hepatic lobe by using 2 methods: (1) a 4-point visual grading system that used attenuation comparison between the liver and hepatic vessels and (2) the liver attenuation index, which was calculated with region of interest measurements of hepatic attenuation. We used statistical analyses to compare accuracy in the diagnosis of macrovesicular steatosis. RESULTS: Our study population was divided into 3 groups according to histologic steatosis grade. Group 1 consisted of 157 candidates with 0% to 5% steatosis, group 2 consisted of 11 candidates with 6% to 15% steatosis, and group 3 consisted of 13 candidates with 16% to 100% steatosis. Mean liver attenuation (in Hounsfield units ± standard deviation) was 58.93 ± 5.07 for group 1, 47.8 ± 4.17 for group 2, and 39.11 ± 6.5 for group 3. Significant differences in liver attenuation were observed between groups using one-way analyses of variance (F = 107307; P < .01). For visual grading, correlation coefficient for computed tomography was 0.959. CONCLUSIONS: Unenhanced computed tomography to assess liver attenuation represents an objective and noninvasive means for detection of hepatic steatosis. This method can prevent unnecessary biopsies.

Can unenhanced brain magnetic resonance imaging be used in routine follow up of meningiomas to avoid gadolinium deposition in brain?

PURPOSE: We hypothesized that unenhanced brain MRI can be used in follow up of patients with intracranial meningioma to avoid gadolinium deposition in the brain and allow measurement of meningioma dimensions from pre-contrast T2-weighted images. METHODS: Dimensions of meningiomas were measured on pre-contrast T2, post-contrast T1 weighted images. RESULTS: The sizes of meningiomas in post-contrast axial T1-weighted images were similar with that in pre-contrast axial T2-weighted images. Signal intensity increase was detected in dentate nucleus and globus pallidus (P < 0.05). CONCLUSION: Gadolinium deposition could be avoided in patients with meningioma by using unenhanced brain MRI for follow up scans.

Assessment of Parotid and Submandibular Glands With Shear Wave Elastography Following Radioactive Iodine Therapy for Papillary Thyroid Carcinoma.

OBJECTIVES: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Radioactive iodine (RAI) therapy is used for remnant ablation following thyroidectomy. Side effects such as dysphagia, xerostomia, and sialoadenitis may occur. We aimed to determine the differences in the parotid and submandibulary glands between healthy patients and patients with PTC who had undergone RAI therapy and have dry mouth symptoms using both shear wave elastography and ultrasonography. METHODS: We enrolled 30 patients with PTC who had undergone RAI therapy following surgery and 30 healthy controls. Ultrasonography and shear wave elastography of submandibular and parotid glands were performed. The volume of the submandibular glands and the thickness of parotid glands were determined. Ten independent measurements were obtained from each gland, with the region of interest placed at different points on the glands. The mean shear wave velocities (SWVs) were calculated and compared between the patients and controls. RESULTS: In the PTC group, there was a significant reduction in the volume of the submandibular glands (P < .05) and in the thickness of the parotid glands (P < .05) compared with the control group. The mean SWVs of the parotid glands and submandibular glands were significantly higher in the PTC group compared with the control group (P < .0001). The SWVs of the parotid glands were higher than the SWVs of the submandibular glands (P < .0001). CONCLUSIONS: Shear wave elastography could be a noninvasive and easy assessment method of parotid and submandibular glands in patients who had undergone RAI therapy and experience dry mouth.

Value of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology

Background/aim: This study was performed to assess the diagnostic accuracy of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology and to differentiate Graves' disease from Hashimoto's thyroiditis. Materials and methods: Thirty patients with Hashimoto's thyroiditis and 22 patients with Graves' disease were evaluated with conventional ultrasonography and shear wave elastography by virtual touch tissue imaging quantification. Thirty healthy participants formed the control group. Ten elastographic measurements of each thyroid lobe were performed in all three study groups. The mean shear wave velocity was calculated and compared between the patients and controls. Results: The mean shear wave velocity of the controls (1.92 ± 0.14 m/s) was significantly lower than that of the patients with Graves' disease (2.71 ± 0.22 m/s) and Hashimoto's thyroiditis (2.50 ± 0.20 m/s). Patients with Graves' disease had significantly higher shear wave velocities than those with Hashimoto's thyroiditis (P < 0.001). Conclusion: Shear wave elastography by virtual touch tissue imaging quantification can be used to discriminate a normal thyroid gland from diffuse thyroid gland pathology after conventional sonography and may assist in the diagnosis of Graves' disease and Hashimoto's thyroiditis.

Diagnostic value of acustic radiation force impulse imaging in the assessment of salivary gland involvement in primary Sjögren's sydrome.

AIMS: The aim of this study is to investigate the diagnostic value of Acoustic Radiation Force Impulse (ARFI) imaging in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS). MATERIAL AND METHODS: Twenty five patients with pSS and 25 healthy volunteers were included. First, echostructures and the thickness of the submandibular and parotid glands were evaluated by B-mode ultrasonography. Then, ARFI imaging with Virtual Touch Quantification® was performed. Ten independent shear wave velocity measurements were taken from each gland. Finally, the mean shear wavevelocity (SWV) values were calculated, and used for further analysis. RESULTS: The mean SWV values of parotid and submandibular glands were significantly higher in the pSS patients than in the healthy control group (p<0.001). The cut-off of SWV values were calculated to be 1.98 m/s for submandibular glands, and 1.93 m/s for parotid glands. In pSS patients, the mean SWV values of parotid glands were higher than those of the submandibular glands (p<0.001) and no statistically significant relationships between symptom duration or the degree of xerostomia and mean SWV values of parotid and submandibularglands were found (all p>0.005). CONCLUSIONS: Our findings indicate that ARFI imaging may provide a non-invasive, simple and fast means of assessment of glandular impairment as an alternative test when other salivary gland tests are inconclusive or cannot be performed. ARFI may be a valuable adjunct for the clinical diagnosis of pSS.

Does renal function affect gadolinium deposition in the brain?

OBJECTIVE: Was to compare T1 signal intensity ratios of dentate nucleus to cerebellar white matter (DN/cerebellum), dentate nucleus to pons (DN/pons) and globus pallidus to thalamus (GP/thalamus) in patients with normal renal function and in patients on chronic hemodialysis. To find out if renal function affects the deposition of gadolinium in brain after administration of linear gadolinium based contrast agents (GBCA). METHODS: Seventy eight contrast enhanced brain MRIs (Magnetic Resonance Imaging) with linear GBCA of 13 patients on chronic hemodialysis and 13 patients with normal renal function retrospectively evaluated. The DN/pons, DN/cerebellum and GP/thalamus signal intensity ratios were measured from each brain MRI on unenhanced axial T1 weighted images. RESULTS: In hemodialysis group statistically significant increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus were found between the first and the last brain MRIs (p = .001). The increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus between the first and the last brain MRIs in control group were not significant (p > 0.05). The signal intensity increase in DN and globus pallidus were significantly higher in hemodialysis group than control group (p < 0.05). CONCLUSIONS: Patients on hemodialysis had significantly higher DN and GP signal intensity increase compared to the patients with normal renal function. Renal function affects the rate of gadolinium deposition in the brain after administration of linear GBCA.