Role of ultrasonography in upper airway assessment: A comparison with computerized tomography measurements.

INTRODUCTION: This study aimed to compare ultrasonography (US) measurements of the upper airway to computerized tomography (CT) measurements. Our study's primary outcome is to research the accuracy of US measurements in the evaluation of upper airway diameters when CT is taken as the gold standard; the secondary outcome is to determine the time required to obtain US measurements. METHODS: This prospective study included patients ≥18 years old that had undergone thoracic or neck CT due to current clinical necessity. The US measurement for each patient was performed by two researchers with different levels of experience, both of whom were blinded to each other and the CT measurements. Measurements were obtained from the vocal cords and subglottic region. The duration of the US performance was also recorded. RESULTS: The US and CT measurements were obtained from 94 patients. Concordance between US and CT measurements was found in the Bland-Altman analysis, with a mean -0.05 mm difference for vocal cord diameter and -1.2 mm for subglottic diameter. The intra-class correlation coefficients (ICC) between the CT and US measurements were 0.993, and 0.609 for vocal cord and subglottic diameter measurements, respectively. The ICC between US performers was 0.992 for vocal cord diameter and 0.959 for subglottic diameter. The US's mean time for vocal cord diameter measurement was 38 ± 23 s, and the mean time for subglottic diameter measurement was 49 ± 30 s. CONCLUSION: The concordance between US and CT measurements is high and the measurements of different practitioners with different experience levels are compatible with each other.

Lumbrical muscle enhancement on MRI and its association with rheumatoid arthritis.

OBJECTIVE: To investigate the significance of lumbrical muscle enhancement (LME) on magnetic resonance imaging (MRI) in rheumatoid arthritis (RA). MATERIALS AND METHODS: Blinded to the diagnoses, contrast-enhanced bilateral hand MRIs of patients with suspected early RA between 2014 and 2019 were reviewed by two observers for the presence and degree (weak/strong) of LME. The presence of other inflammatory findings was also noted. The patients were then stratified into RA (n = 41), control (n = 31), and other arthritides groups(n = 28) based on their final diagnoses in the hospital records within the following 12 months. Categorical variables were compared by chi-square test or Fisher's exact test. Differences among the groups were evaluated by one-way ANOVA or Kruskal-Wallis tests. When the p-value from the Kruskal-Wallis test was statistically significant, multiple comparison test was used to identify group differences. Correlations between LME and flexor tenosynovitis were evaluated by Spearman rank correlation test. The agreement between two observers was assessed by Cohen's Kappa (κ) statistic. P-value < 0.05 was considered as statistically significant. RESULTS: There were 100 patients (88 females) with mean age of 47.2 ± 11.2. There were no significant differences for age or sex between groups (p = 0.17, p = 0.84, respectively). RA patients showed significantly more frequent (p < 0.001) and stronger LME (p = 0.001). There were no correlations between LME and flexor tenosynovitis (p > 0.05). Interrater agreement for the degree of LME on right and left sides was substantial (κ = 0.74, κ = 0.67, respectively). CONCLUSION: RA patients demonstrated significantly more frequent and stronger LME with substantial interrater agreement. LME could constitute a subtle radiological clue for early RA.

Multifocal concomitant scapulothoracic and subgluteal-ischiofemoral elastofibromas.

PURPOSE: To evaluate the frequency, imaging findings, and patient demographics of synchronous elastofibroma dorsi (ED) and pelvic elastofibromas. METHODS: Image archives between 2011 and 2021 were retrospectively searched for CT and MRI reports including the keyword "elastofibroma". Patients with concomitant CT and/or MRI of the chest and pelvic regions were included. The greatest thickness and side of ED were noted. Subsequently, pelvic soft tissues were evaluated for a soft tissue mass with similar radiological features to ED. When detected, its location, greatest transverse diameter, and ischiofemoral space widths were noted. Wilcoxon matched-pairs signed-rank and Mann-Whitney U-tests were performed when appropriate. Pearson's correlations were used to assess the association of presence of subgluteal-ischiofemoral elastofibromas (SGIFE) and ED thickness. The model discrimination of ED thickness was evaluated by calculating the AUC of the ROC. RESULTS: Eighty-eight patients (Male:Female = 8:80) with a mean age of 70.6 (±10.3) years were included. 96.6 % of patients had bilateral ED. 18.2 % of patients (all females) had at least one concomitant SGIFE. Patients with SGIFE had significantly thicker ED (p < 0.001 right; p = 0.049 left). There was a significant positive correlation between the thickness of ED and presence of SGIFE (r = 0.43, p < 0.001 right; r = 0.25, p = 0.019 left). An AUC of 0.781 (p < 0.001, 95 %-CI:0.675-0.887) and 0.659 (p = 0.049, 95 %-CI:0.523-0.794) were revealed regarding the presence of ipsilateral right and left SGIFE, respectively. CONCLUSION: Concomitant SGIFE may accompany ED in up to 18.2% of cases, particularly in women with thick ED. Knowledge of this co-occurrence and the described SGIFE characteristics can facilitate correct diagnosis.

Endoscopic Anatomy and a Safe Surgical Corridor to the Anterior Skull Base.

OBJECTIVE: We describe the possibility to create precise preoperative planning for endonasal endoscopic approaches to the anterior skull base by overlapping endoscopic and radiologic anatomy. The important anatomic structures were marked. Morphometric measurements between these anatomic landmarks were performed endoscopically and compared with radiologic measurements of the same areas to ensure result compatibility. METHODS: Seven cadaver heads injected intravascularly with colored silicone were used for this study. Thin-section brain and paranasal sinus computed tomography scans were obtained on all cadavers. Using 0-degree rigid endoscopes and endonasal endoscopic surgical instruments, the anterior skull base was examined binostrally in all cadavers. Bilateral middle turbinates were identified and preserved. Next, an inferior uncinectomy and middle meatal antrostomy were performed. After performing a frontal antrostomy, bilateral anterior and posterior ethmoidal cells were opened and the skull base was identified and followed to the posterior wall of the frontal sinus. A transnasal transethmoidal sphenoidotomy was done with full exposure to the entire anterior skull base. RESULTS: The anatomic landmarks for endonasal endoscopic skull base approaches were distinguished and measurements were made. The anterior skull base was divided into 3 compartments: anterior (area between the posterior inferior border of the frontal sinus and the course of anterior ethmoidal artery), middle (area between the course of the anterior ethmoidal artery and that of the posterior ethmoidal artery [PEA]), and posterior (area between the course of the PEA and the attachment point of the anterior border of the sphenoid sinus to the skull base) compartments. The distances between important anatomic markers and endoscopic depth measurements of this area were measured. CONCLUSION: During endonasal endoscopic anterior skull base surgery, the area between the anterior border of the sphenoid sinus and PEA artery was safe as the first dissection zone. Preoperative radiologic width and depth measurements facilitate orientation to the endoscopic anatomy during surgery and help predict the endonasal surgical corridor anatomy preoperatively.

Is it possible to predict the side of hepatic metastases according to the primary location of colorectal cancer?

PURPOSE: The aim of this study was to investigate the impact of the primary location of colorectal adenocarcinoma on the lobar distribution of its hepatic metastases based on the streamline hypothesis. MATERIAL AND METHODS: The hospital database was utilised to identify the colorectal cancer patients. Eighty-six patients diagnosed with colorectal adenocarcinoma, who had hepatic metastases on the initial diagnostic stage or on the follow-up investigations, were enrolled the study. Computed tomography (CT) images of the study population were reviewed for the primary location of the colorectal tumour, and the side and number of hepatic metastases. RESULTS: A total of 481 metastases were counted on CT from 22 right-sided and 64 left-sided colon tumours. The ratio of right-to-left hemiliver involvement was 1.97 : 1 for whole study population. The right-to-left ratio was calculated as 1.55 : 1 for right colon tumours and 2.17 : 1 for left colon tumours (p = 0.106). In the subgroup analysis with unilobar metastatic patients, again there was no significant difference in terms of the colorectal tumours' primary location (p = 0.325). CONCLUSIONS: The lobar distribution of hepatic metastases from colorectal adenocarcinoma may not be associated with the primary tumour localisation.

Is it possible to discriminate pulmonary carcinoids from hamartomas based on CT features?

PURPOSE: The purpose of this study was to determine whether the computed tomography (CT) features might be used in distinguishing pulmonary carcinoids from hamartomas. MATERIALS AND METHODS: Ninety solid pulmonary nodules (43 carcinoids and 47 hamartomas) in 90 patients were evaluated. The following CT scan features were evaluated: size, location (peripheral/central), contour (lobulated/nodular), number of lobulation, attenuation, calcification, endobronchial status, bronchial extension and involvement, parenchymal abnormalities distal to the lesion e.g. hyperlucency, atelectasis, and nodularity. The final pathologic diagnosis of the lesions and bronchial extension were confirmed by review of histopathological specimens. RESULTS: Out of 43 carcinoids, 37 (86%) were typical. Twenty-three carcinoids and four hamartomas were central (p < 0.001). Ten carcinoids and one hamartoma were endobronchial. The majority of tumors had lobulated contours (65% of carcinoids, 44% of hamartomas) and carcinoids tended to have more lobulations (p = 0.052). Distal nodularity (p = 0.001), distal hyperlucency (p < 0.001), and atelectasis (p = 0.005) were significantly more common in carcinoids. Carcinoids had significantly more bronchial extension and involvement (p < 0.001; respectively). In addition, a new sign that we call "bronchial triangle sign" differentiated carcinoids with a sensitivity and specificity of 84.9% (95% CI: 69,1%-93.4%) and 91% (95% CI: 79.7%-96.6%). CONCLUSION: To the best of our knowledge this is the first study on discrimination of carcinoids and hamartomas. A new CT sign called "bronchial triangle sign" might be used to differentiate carcinoids from hamartomas. Distal parenchymal abnormalities are more common in carcinoids than in hamartomas.

Intrapericardial goiter.

Intrapericardial goiter cases are only a few in the literature. We present a 53-year-old woman who was operated for 8-cm anterior mediastinal mass located completely intrapericardial and histopathological examination revealed an ectopic goiter. It may be difficult to distinguish between mediastinal masses within or outside the pericardium. Thoracoscopy may be needed in such cases.

Is There a Correlation with Pre-donation Kidney Volume and Renal Function in the Renal Transplant Recipient?: A Volumetric Computed Tomography Study.

PURPOSE: The aim of this study is to determine the correlation between the predonation computed tomography (CT)-based calculated kidney volume and post-transplant renal function in recipients of renal transplants and to compare two different CT techniques. MATERIAL AND METHODS: The study group is comprised of 55 paired living kidney donor-recipients transplants. The total parenchymal renal volumes were calculated by using two CT-based techniques (3-dimensional renal volume [3DRV] and voxel-based volume calculation). Post-transplant creatinine and estimated glomerular filtration rate (eGFR) levels for the recipients at hospital discharge and sixth month were obtained. We tested the association with eGFR and creatinine by adjusting the renal volume to body weight and body mass index. For the creatinine levels above 1.5 mg/dL at discharge, a threshold value for renal volume-to-weight ratio on receiver operating characteristic curve (ROC) analysis and odds ratio (OR) were calculated. RESULTS: The renal volumes adjusted to weight were found to be moderately correlated with eGFR and creatinine levels at discharge (r = 0.51 and r = -0.54 for voxel-based calculation; r = 0.52 and r = -0.52 for 3DRV calculation, P < .001, respectively) and at sixth month (r = 0.55 and r = -0.58 for voxel-based calculation; r = 0.51 and r = -0.54 for 3DRV calculation, P < .001 respectively). A threshold value of 1.84 mL/kg was calculated for parenchymal volume-to-recipient weight ratio on ROC analysis (AUC±SE, 0.760 ± 0.078, P = .008). The likelihood of creatinine elevation above 1.5 mg/dL was found to be nine times greater for smaller renal volume-to-recipient weight ratios (OR = 9.6; 95% CI, 1.8-50.6) CONCLUSIONS: Predonation renal volume adjusted to recipient weight may estimate the renal function at discharge and 6 months after transplantation.