Sonoelastographic evaluation for benign neck lymph nodes and parathyroid lesions.

Aim: The aim of the study was to evaluate the performance of real-time strain sonoelastography for comparison of perithyroidal lymph nodes of Hashimoto thyroiditis patients, jugular lymph nodes of healthy individuals and parathyroid lesions. Material and methods: Fifty parathyroid lesions (Group 1), 52 lymph nodes in Hashimoto thyroiditis patients (Group 2) and 51 reactive jugular lymph nodes (Group 3) were examined by ultrasound, and elastography was performed for a total of 95 patients. Real-time strain sonoelastography using elasticity score (E-index) was performed. The differences in E-index between the three groups were evaluated. Results: The mean E-index and size of parathyroid lesions were 2.30 ± 0.91 and 13.46 ± 5.69 mm, respectively. Parathyroid hyperplasia was detected by parathyroidectomy in two patients (2/37; 5%) with a total of four lesions (4/50; 8%). The remaining lesions were considered as adenomas. The mean E-index and size in Group 2 were 2.70 ± 0.93 and 7.83 ± 3.35 mm, respectively. The mean E-index and size in Group 3 were 1.88 ± 0.59 and 11.60 ± 4.96 mm, respectively. There were statistically significant differences between the groups in terms of E-index (p <0.01). Conclusions: When reactive jugular lymph nodes, perithyroidal lymph nodes of Hashimoto thyroiditis patients and parathyroid lesions are compared, it seems that strain sonoelastography indices add a benefit to routine practice in the differential diagnosis of parathyroid lesions and benign neck lymph nodes.Aim: The aim of the study was to evaluate the performance of real-time strain sonoelastography for comparison of perithyroidal lymph nodes of Hashimoto thyroiditis patients, jugular lymph nodes of healthy individuals and parathyroid lesions. Material and methods: Fifty parathyroid lesions (Group 1), 52 lymph nodes in Hashimoto thyroiditis patients (Group 2) and 51 reactive jugular lymph nodes (Group 3) were examined by ultrasound, and elastography was performed for a total of 95 patients. Real-time strain sonoelastography using elasticity score (E-index) was performed. The differences in E-index between the three groups were evaluated. Results: The mean E-index and size of parathyroid lesions were 2.30 ± 0.91 and 13.46 ± 5.69 mm, respectively. Parathyroid hyperplasia was detected by parathyroidectomy in two patients (2/37; 5%) with a total of four lesions (4/50; 8%). The remaining lesions were considered as adenomas. The mean E-index and size in Group 2 were 2.70 ± 0.93 and 7.83 ± 3.35 mm, respectively. The mean E-index and size in Group 3 were 1.88 ± 0.59 and 11.60 ± 4.96 mm, respectively. There were statistically significant differences between the groups in terms of E-index (p <0.01). Conclusions: When reactive jugular lymph nodes, perithyroidal lymph nodes of Hashimoto thyroiditis patients and parathyroid lesions are compared, it seems that strain sonoelastography indices add a benefit to routine practice in the differential diagnosis of parathyroid lesions and benign neck lymph nodes.

Real-Time Sonoelastography of Parotid Gland Tumors.

OBJECTIVES: We sought to determine the performance of real-time sonoelastography in the differential diagnosis of parotid gland tumors. METHODS: Between April, 2014, and June, 2015, 54 parotid gland masses were examined by ultrasound and strain sonoelastography in 46 patients. Real-time sonoelastography using the elasticity score (E-index), which gives an absolute value between 0 (softest) and 6 (hardest), was performed. Demographic characteristics, histopathologic examination, and difference in elasticity scores between benign and malignant masses were evaluated. RESULTS: The mean age of the patients was 60.01 ± 2.97 years, and 56.52% of the patients were male (n = 26). Among the 54 parotid gland masses, 44 (81.5%) were benign and 10 (18.5%) were malignant tumors, 63% (n = 34) of the lesions being on the right side. The diagnoses as benign tumors consisted of Warthin tumor (n = 18, 33.3%), pleomorphic adenoma (n = 8, 14.8%) and other benign tumors (n = 18, 33.3%). The mean elasticity score and the size of all tumors were 2.87 ± 0.96 and 23.68 ± 12.38 mm, respectively. The mean elasticity score for benign tumors was 2.75 ± 0.95, and for malignant tumors it was 3.44 ± 0.85 (P = .034). CONCLUSIONS: According to our results, real-time strain sonoelastography seems to have additional value over routine sonographic evaluation of parotid gland tumors in the differential diagnosis of benign and malignant parotid masses. However, with a small sample of malignant cases and appreciable overlap of the stiffness of benign and malignant masses, caution must be applied because the findings may not be representative of all patients with a parotid gland tumor.

Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview.

BACKGROUND: Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts. CASE REPORT: We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson's disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features. CONCLUSIONS: Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.

The Role of Computerized Tomography in the Assessment of Perivesical Invasion in Bladder Cancer.

BACKGROUND: The aim of the present study was to identify the contrast patterns of a tumor, and to evaluate the possibility of assessing the invasion of the perivesical fatty tissue in bladder cancer. MATERIAL/METHODS: In this study, 26 patients with bladder cancer were included. Multiphasic CT examination was performed to determine the stage of the disease before radical cystectomy. RESULTS: There were statistically significant differences in tumor and perivesical fatty tissue densities between pre- and post-contrast phases (p<0.05). CONCLUSIONS: Increases in focal density suspected of being invasion of the perivesical fatty tissue can show perivesical invasion with high specificity.

The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer.

BACKGROUND: In this study we aimed to determine the need for 18F-flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the preoperative staging of rectal carcinoma in our large patient group according to level and location of tumor. METHOD: Totally, 97 patients diagnosed with primary rectal adenocarcinoma between May 2009 and July 2011 were included in the study. Preoperative staging was performed by evaluating contrast-enhanced thoracic, abdominal, and pelvic computed tomographies. After staging by conventional methods, all patients underwent an 18F-FDG PET/CT. In all cases, the relationship between 18F-FDG uptake and gender, tumor height at the anal canal, localization in the rectal wall, plasma carcinoembryonic antigen levels, histopathological tumor type, and tumor stage were examined. RESULTS: While the ceCT was normal in 4 (4%) patients, it was positive for the rectum in 93 (95%), pelvic lymph nodes in 22 (22%), and distant metastases in 14 (14%) (liver (8), lung (8), bone (2), distant lymph nodes (6), and uterus (1)). Using computed tomography, disease stages were determined as stage 0, 1, 2, 3, and 4 in 4, 8, 48, 23, and 14 patients, respectively; 18F-FDG PET/CT was normal in two (2%) patients. The mean SUVmax of FDG-positive rectal tumors was calculated as 17.31 ± 9.37. Additionally, 18F-FDG uptake was seen in pelvic lymph nodes in 15 (15%) patients and in distant organs in 24 (24%) patients (liver (9), lung (12), bone (5), distant lymph nodes (11), uterus (1), and sigmoid colon (1)). According to an 18F-FDG PET/CT, 2, 7, 47, 20, and 21 patients were staged as stage 0, 1, 2, 3, and 4, respectively. In 14 patients (14.4%), the stage of the disease was either changed, and there was a need to make adjustments to the patient's treatment strategy (n = 10), or the type of operation was changed (n = 4). In seven patients (0.7%), findings from 18F-FDG PET/CT images did not require any changes of the treatment plan. CONCLUSION: F-FDG PET/CT provides new findings in addition to conventional techniques in the staging of primary rectal cancer. These findings could change the patients' treatment strategies.

Diuretic agent and normal saline infusion technique for ultrasound-guided percutaneous nephrostomies in nondilated pelvicaliceal systems.

PURPOSE: Percutaneous nephrostomy (PCN) in a nondilated pelvicaliceal system is technically challenging. We describe an effective method to achieve transient dilatation of the pelvicaliceal system via induction of diuresis using infusion of a diuretic agent in normal saline, therefore allowing easier access to the pelvicaliceal system. METHODS: Under real-time ultrasound guidance, the technique had been tested in 22 nephrostomies with nondilated system (a total of 20 patients with 2 patients having bilateral nephrostomies) during a 5-year period. Patients were given 40 mg of furosemide in 250 ml of normal saline solution intravenously by rapid infusion. As soon as maximum calyceal dilatation of more than 5 mm was observed, which is usually 15 min later after the end of rapid infusion, patients were positioned obliquely, and PCN procedure under ultrasound guidance was performed. RESULTS: The procedure was successful in 19 of the nephrostomies in 17 patients with a success rate of 86.36 % per procedure and 85 % per patient in nondilated pelvicaliceal systems. No major nephrostomy-, drug-, or technique-related complications were encountered. The technique failed to work in three patients due to the presence of double J catheters and preexisting calyceal perforation which avoided transient dilation of the pelvicaliceal system with diuresis. CONCLUSIONS: Diuretic infusion in saline is a feasible and effective method for PCN in nondilated pelvicaliceal systems.

US and MDCT findings in a caudal blind ending bifid ureter with calculi.

Herein we present a rare ureteric duplication anomaly; blind ending bifid ureter with calculi which is asymptomatic unless complicated by infection, reflux, calculi or malignancy. The diagnosis is often missed at intravenous urography (IVU) and US because the ipsilateral ureter and kidney are grossly normal. In this case the diagnosis was established with ultrasound (US) and mainly with multidetector computerized tomography (MDCT) imaging using multiplanar reformats and 3-D reconstructions which were unique to this case. MDCT scans not only revealed the exact diagnosis and anatomic relationships but also ruled out other pathologies included in the differential diagnosis as well, such as ureter and bladder diverticula.

A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility.

OBJECTIVES/HYPOTHESIS: To evaluate airway sufficiency and airflow dynamics in a group of patients who underwent a posterior transverse laser cordotomy (PTLC) procedure. STUDY DESIGN: Mixed methods research, university hospital setting. METHODS: Sixteen patients who underwent a PTLC procedure volunteered to be involved in this study. Dyspnea levels, voice, and glottic opening in indirect laryngoscopy were evaluated subjectively. The airway was evaluated objectively by pulmonary function tests, and glottic areas were measured from axial computed tomography (CT) images. The control group consisted of 63 subjects from the tomography archive. For computational fluid dynamics (CFD) analyses, two subjects from the study group were chosen on the basis of obstruction level, and a normal female subject was selected from the control group. Cartesian coordinates for airway boundaries were determined from axial CT images, and a three-dimensional computational model of the larynx was constructed. Flow simulations were performed with two different flow conditions during inspiration. Comparison of velocity, static pressure, turbulence intensity, and wall shear stress distribution values were made between selected cases and control. RESULTS: Pulmonary data varied widely and did not correlate with the size of the glottic area or dyspnea level. CFD analyses revealed that in addition to obstruction at the glottic level, aerodynamic properties of the larynx are altered due to loss in muscular tonus. Also, the contour of the glottic opening was found to be very important in determining the character of airflow as laminar or turbulent. CONCLUSIONS: Patients have considerable differences in their flow patterns and force distributions during respiration. Patient-specific models may help in evaluation and treatment planning.

Computerized tomography for detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma.

OBJECTIVES: Computerized tomography (CT) is used in the preoperative staging of invasive bladder carcinoma. We evaluated the role of CT for detecting perivesical invasion and lymph node metastases in patients who had undergone radical cystectomy and pelvic lymphadenectomy for invasive bladder carcinoma. PATIENTS AND METHODS: We retrospectively analyzed the clinical and pathological data of 100 patients with invasive bladder carcinoma who had undergone radical cystectomy. The preoperative CT images were reevaluated and interpreted by one uroradiologist blinded to the final pathological results for evidence of extravesical tumor extension or lymph node metastases. RESULTS: Of the 100 patients, CT showed extravesical tumor involvement in 57. Of these 57 cases, 22 displayed no evidence of extravesical tumor involvement in the final pathological analysis. In 6 cases, although perivesical invasion was identified in the final pathological analysis, preoperative CT showed no evidence of extravesical tumor involvement. Regarding extravesical tumor spread, the differences between CT and pathological stages were statistically significant (p < 0.001). CT was highly suggestive of lymph node metastases in 9 cases, but only 4 were pathologically confirmed. On the other hand, in 9 patients pelvic lymph node metastasis were pathologically diagnosed, but there was no evidence of lymphadenopathy on CT. Regarding lymph node involvement, there was moderate concordance between CT and pathological findings (p = 0.003, kappa = 0.29 +/- 0.14). CONCLUSION: CT has limited accuracy in detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. The information provided by CT is insufficient and we urgently need more reliable staging techniques.

Ruptured iliac aneurysm presenting as lumbosacral plexopathy.

Isolated internal iliac aneurysms are rare. Unless rupture occurs, they usually remain asymptomatic. In this paper, a patient with a ruptured internal iliac aneurysm that resulted in chronic stage hematoma causing lumbosacral plexopathy and erosion of the pelvic bony structures is presented, along with magnetic resonance imaging (MRI) and computed tomography (CT) findings. To expedite the diagnosis of extraspinal radicular pain, one should pay attention to the extraspinal structures involved in lumbar CT or MRI examinations. If necessary, further investigation can be made with pelvic CT or MRI.

3-Dimensional computerized tomography in follow-up of patients with urinary diversion.

INTRODUCTION: The aim of our study was to evaluate the usefulness of 3-dimensional computerized tomography (3D-CT) in routine follow-up of patients who had undergone radical cystectomy and different kinds of urinary diversions and compare it with conventional CT. PATIENTS AND METHODS: Nineteen patients (18 men, 1 woman) who had undergone radical cystectomy and different kinds of urinary diversions with diagnosis of invasive bladder cancer were enrolled into the study. The mean age of the patients was 55.5 (46-69) years. For all patients, conventional CT was performed, followed by 3D reconstruction of these images. RESULTS: Orthotopic ileal neobladder (Abol-Enein and Ghoneim procedure) was performed in 12, rectosigmoid pouch (Mainz pouch II) in 2 and ileal conduit in 5 patients. There were no pathological findings visible either on conventional CT or on 3D-CT, but the shape, configuration, and the relationships of the pouch with ureters, urethra and other adjacent organs were much better visualized on 3D-CT. CONCLUSION: 3D-CT did not have any advantages over conventional CT for showing pathological findings that were oncological origin, but as the anatomy of the lower urinary tract can be perfectly demonstrated, we think that it may be used for planning of a re-operation after urinary diversion and may help the urologist who has less experience with radiological studies to evaluate pouch configuration and indentations to the adjacent organs better.

Is fluid ingestion really necessary during ultrasonography for detecting ureteral stones? A prospective randomized study.

OBJECTIVE: Ultrasonographic evaluation of ureteral stones is usually performed after fluid ingestion for filling the bladder to visualize the ureterovesical junction better. We hypothesized that water ingestion may decrease the imaging quality of ultrasonography for detecting ureter stones. In our prospective randomized study, the accuracy of ultrasonography for detecting ureteral stones performed with or without fluid intake were evaluated. METHODS: The study population comprised 150 consecutive patients thought to have ureteral stones who underwent ultrasonography. Patients were divided into 2 groups. Group A patients ingested 500 mL of water to distend the bladder before ultrasonographic examination. Group B patients were restricted from drinking any water at least 4 hours before the procedure. RESULTS: Ultrasonography showed 35 (67.30%) of 52 stones in group A and 68 (93.15%) of 73 stones in group B. The difference of detection rates between the 2 groups was statistically significant (P < .001). The greatest improvement in detection rates was noted in the middle ureter stones. The evaluated sensitivity and specificity rates for group A were 67% and 82%, respectively, and those for group B were 93% and 94%. When the 2 methods were compared, total accuracy of ultrasonography increased from 71% in group A to 93% in group B. CONCLUSIONS: This prospective randomized study showed that the diagnostic accuracy of ultrasonography for detection of middle ureteral stones increased significantly when performed without any water ingestion before the procedure. We recommend that patients thought to have ureteral stones should be first examined without any fluid ingestion.

[Late presentation of an extrarenal pseudoaneurysm in a renal transplant patient: CT and color Doppler US findings (case report)]. / Renal transplantasyon sonrasi gelisen ekstrarenal psödoanevrizma: BT ve renkli Doppler US bulgulari.

Vascular complications associated with renal transplants are a significant cause of graft dysfunction or failure. The most common complications are arterial and venous stenoses/thromboses, intrarenal and extrarenal arteriovenous fistulas, and pseudoaneurysms. In this case report, an extremely rare complication following renal transplantation, an extrarenal pseudoaneurysm, is presented with CT, gray scale, and color Doppler US findings.

The value of transrectal ultrasound guided needle aspiration in treatment of prostatic abscess.

INTRODUCTION: Prostatic abscess (PA) is a very uncommon disorder. The value of transrectal ultrasound (TRUS) guided aspiration in the treatment of PA has not been clearly defined. We present our experience with six such patients. MATERIALS AND METHODS: Between July 1997 and December 2002, six patients with PA were diagnosed by TRUS and treated by TRUS guided needle aspiration in our department. PA was defined as hypoechoic, inhomogeneous, thick walled fluid collection. TRUS guided needle aspiration of the abscess was performed transrectally in all patients with a 20-cm long 18 gauge Chiba needle. Successful treatment criteria were defined as clinical improvement in symptoms and decrease of more than half of the estimated abscess volume on follow up TRUS control. Patients with continuing clinical symptoms were defined as treatment failures. RESULTS: The most common TRUS finding was detection of a hypoechoic area with inhomogeneous structures, which was determined in all patients (100%). In some patients irregular contour and heterogeneous areas were additionally described. TRUS guided needle aspiration treatment of PA was successful in five of six patients (83.3%). In one patient treatment failed and the abscess recurred 3 weeks after the procedure. As this patient had additionally a bladder outflow obstruction, transurethral resection of the prostate was performed instead of a repeat procedure. There were no complications associated with the procedure. CONCLUSIONS: In conclusion, TRUS has an important value in diagnosis and treatment of PA. TRUS guided aspiration is an effective and minimally invasive treatment modality for PA which causes no serious complications.

Efficacy of transrectal ultrasonography in the evaluation of hematospermia.

OBJECTIVE: To assess the efficacy of transrectal ultrasonography (TRUS) in the evaluation of hematospermia. MATERIAL AND METHODS: This study included 54 patients with hematospermia. Patients age range was between 25 and 75 years (mean=49.7 years). All patients were evaluated by TRUS using a biplane transducer and a Toshiba SSA-270A device. RESULTS: TRUS revealed one or more abnormalities in 51 patients (94.5%). Prostatic calcifications were found in 23 patients, ejaculatory duct calculi in 21, dilated ejaculatory ducts in 18, benign prostatic hyperplasia in 18, dilated seminal vesicles in 12, calcifications in seminal vesicles in 11, ejaculatory duct cyst in 6, prostatitis in 6, and periurethral Cowper gland mass in 1. CONCLUSION: TRUS is a noninvasive, safe method for the investigation of causes of hematospermia. We believe that it should be the first radiological investigation to be performed in patients presenting with hematospermia.

[Omental infarction: CT findings (case report)]. / Omental infarkt: BT bulgulari.

Omental infarction, the end result of impaired perfusion of the greater omentum, is an uncommon cause of acute abdominal pain. Because its clinical symptoms are nonspecific, it is usually confused with more common conditions such as appendicitis or cholecystitis. Consequently, the diagnosis is generally made intraoperatively. However, computed tomography shows characteristic findings and allows a reliable preoperative diagnosis, preventing unnecessary laparotomy. We report two cases of omental infarction, and describe typical CT findings of this rare entitiy.

Virtual cystoscopy in the evaluation of bladder tumors.

OBJECTIVE: The objective of this study was to investigate the value of contrast material-filled virtual cystoscopy in the detection of bladder tumors. MATERIALS AND METHODS: Thirty-nine patients who had recent diagnosis or were followed up due to priory history of bladder tumor underwent virtual cystoscopy. After the intravenous injection of contrast medium, the bladder was examined with helical computed tomography (CT) scan. The data were transferred to a workstation for interactive navigation using surface rendering. Two radiologists independently interpreted the axial and virtual images, and discrepancies were resolved by consensus. The results of virtual cystoscopy were compared with the findings of conventional cystoscopy. RESULTS: Forty-nine of 54 bladder lesions detected with conventional cystoscopy in 33 patients were also shown on virtual images. On virtual cystoscopy, three of the seven lesions 5 mm or smaller in diameter could be identified. There were no false-positive findings. The sensitivity of the technique was 96.2% for polypoid tumors and 88.9% for sessile lesions. When axial and virtual images were evaluated together, the sensitivity rate increased to 94.4%. CONCLUSION: Bladder tumors can be diagnosed noninvasively using contrast medium-filled virtual cystoscopy. Evaluation of both the axial and virtual images increases the sensitivity of the technique.

Clitoral metastasis from transitional cell carcinoma of the renal pelvis: CT and MRI findings.

Metastatic tumors of the clitoris are extremely rare. We report a case of clitoral metastasis in a 75-year-old woman who was treated for transitional cell carcinoma of renal pelvis 2 years ago. The computed tomography and magnetic resonance imaging findings are presented with a short review of the literature. To the best of our knowledge, clitoral metastasis originating from transitional cell carcinoma of the renal pelvis has not been reported in the English language literature.

[Cross-sectional imaging findings in intradiverticular bladder tumors: Case report]. / Mesane divertikülünden kaynaklanan tümörlerde kesitsel görüntüleme bulgulari.

Neoplasms originating in bladder diverticula are characterized by early transmural invasion and a tendency for higher histopathological grades, which make prompt diagnosis and treatment crucial in these tumors. Filling defects caused by intradiverticular tumors cannot always be visualized in intravenous urography and/or cystography. Cross-sectional imaging methods including ultrasonography, computed tomography and magnetic resonance imaging have been used singly or in combination in neoplasms of the lower urinary tract. We herein present radiological findings in four patients with intradiverticular bladder neoplasms. Although diverticula were readily visualized in all patients, intravenous urography did not detect the neoplasm in two patients. Accurate diagnosis and staging were possible in all patients with both ultrasonography and computed tomography. In one patient magnetic resonance imaging clearly showed the intradiverticular tumor and peridiverticular extension. Cross-sectional imaging methods should be used in the evaluation of bladder diverticula as an adjunct to intravenous urography.