The use of radiomics and machine learning for the differentiation of chondrosarcoma from enchondroma.

PURPOSE: To construct and compare machine learning models for differentiating chondrosarcoma from enchondroma using radiomic features from T1 and fat suppressed Proton density (PD) magnetic resonance imaging (MRI). METHODS: Eighty-eight patients (57 with enchondroma, 31 with chondrosarcoma) were retrospectively included. Histogram matching and N4ITK MRI bias correction filters were applied. An experienced musculoskeletal radiologist and a senior resident in radiology performed manual segmentation. Voxel sizes were resampled. Laplacian of Gaussian filter and wavelet-based features were used. One thousand eight hundred eighty-eight features were obtained for each patient, with 944 from T1 and 944 from PD images. Sixty-four unstable features were removed. Seven machine learning models were used for classification. RESULTS: Classification with all features showed neural network was the best model for both readers' datasets with area under the curve (AUC), classification accuracy (CA), and F1 score of 0.979, 0.984; 0.920, 0.932; and 0.889, 0.903, respectively. Four features, including one common to both readers, were selected using fast correlation based filter. The best performing models with selected features were gradient boosting for Fatih Erdem's dataset and neural network for Gülen Demirpolat's dataset with AUC, CA, and F1 score of 0.990, 0.979; 0.943, 0.955; 0.921, 0.933, respectively. Neural Network was the second-best model for FE's dataset based on AUC (0.984). CONCLUSION: Using pathology as a gold standard, this study defined and compared seven well-performing models to distinguish enchondromas from chondrosarcomas and provided radiomic feature stability and reproducibility among the readers.

Clinical and radiological outcomes of longCOVID: Is the post-COVID fibrosis common?

Introduction: COVID-19 survivors may take longer to regain full well-being. This study aimed to investigate clinical and functional evaluation and radiologic changes in the third month after COVID-19. Materials and Methods: A total of 126 patients were assessed in the third month for symptoms, pulmonary function, exercise capacity, radiologic imaging, and quality of life after being discharged following COVID-19 treatment. Two radiologists evaluated the initial and follow-up images. Result: At the third month follow-up visit, the most common persisting symptoms were shortness of breath (32.5%), cough (12.7%), and muscle pain (12.7%). At the follow-up visit, oxygen saturations at rest and after a sixmin walking test were lower in patients with prior intensive care hospitalization compared to those without (p<0.001, p= 0.004). Computed tomography (CT) scans revealed persisting pulmonary pathologies in 64.6% of patients at the third month follow-up. The most common pathologies on follow-up thoracic CT were fibrotic-like changes in 44.2% and ground-glass opacities (GGO) in 33.3%. Regression analysis unveiled that age [95% confidence interval (CI), 1.01 to 1.15; p= 0.020], male sex (95% CI, 4.06 to 95.3, p<0.001), first CT severity score (95% CI, 1.02 to 1.41, p= 0.028), duration of hospitalization (95% CI, 1.02 to 1.18, p= 0.012), oxygen saturation (95% CI, 0.86 to 0.96, p<0.001) were independent predictors of fibrotic-like changes. Conclusions: In the third month following COVID-19, the most common symptom was dyspnea, and the most common radiological findings were fibrotic-like changes and GGO. Longer follow-up studies of COVID-19 survivors are needed to observe lasting changes.

Is there a Correlation between Hepatic Venous Indices and Main Pulmonary Artery Diameter?

OBJECTIVE: To search whether there is a correlation between middle hepatic venous indices (HVIs) obtained by pulsed waved doppler ultrasonography (PW-DUS) and the main pulmonary artery (mPA) diameter, calculated by computed tomography (CT). STUDY DESIGN: A descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Radiology, Balikesir University School of Medicine, Turkey, from February to December 2020. METHODOLOGY: After excluding the cases with suspected COVID-19 from the cases sent to the Radiology Department for chest CT exams with the mPA included in the cross-sections, the volunteers were evaluated with PW-DUS. The study group consisted of 66 cases. Two radiologists measured the velocity values of the A, S, and D waves in the recorded PW Doppler spectra. HVIs (A/S, A/S+D, A/A+S+D) were calculated. The mPA diameter was calculated in the axial plane from the pulmonary trunk, 1cm proximally to the bifurcation manually on the workstation. The correlation between the HIVs and mPA diameter was evaluated. Interoperator reliability was also analysed. RESULTS: Thirty-nine males (59%) and 27 (41%) females were included in the study group. The mean HVI values were 0.50 ±0.20, 0.28 ±0.12, and 0.21 ±0.07 for A/S, A/A+S, and A/A+S+D, respectively. The mean mPA diameter was 24.0 ±3.3 mm. Correlation analysis determined that the HVIs were positively correlated with mPA diameter (r=0.730-0.765-0.751, p<0.001). Inter-observer correlation coefficients were found to be compatible between two radiologists. CONCLUSION: A significant and strong correlation was found between HVIs and mPA diameter. The mPA diameter that reflects the pulmonary artery systolic pressure (PAP) increased as the HVIs increased. Therefore, PW-DUS may be helpful to evaluate PAP as a quantitative method that is cost-effective, easily accessible and radiation-free. KEY WORDS: Hepatic veins, Pulmonary artery, Multidetector computed tomography, Pulmonary hypertension, Pulsed doppler ultrasonography.

Spontaneous pneumomediastinum and subcutaneous emphysema secondary to pulmonary alveolar microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterized by intraalveolar accumulation of microliths. PAM is described as the formation and accumulation of calcium phosphate microliths in the alveoli after mutations in the SLC34A2 gene. The patients may be asymptomatic or present with heterogeneous signs such as dyspnea, cough, sputum, weakness, chest pain and hemoptysis. Recurrent pneumothoraces may occur over the course of the disease in advanced cases. Her, it was aimed to report a case of a 40-year-old female presenting with chest pain, sore throat, cough and green sputum for the past two months. Chest radiography and computed tomography showed pneumomediastinum and subcutaneous emphysema which have not been reported in previous studies due to PAM. Bronchoscopy with bronchoalveolar lavage (BAL) and mucosal biopsy were done after pneumomediastinum had cleared. BAL result was concordant with pulmonary alveolar microlithiasis. Diagnosis can be made with computed tomography but may necessitate histopathological verification for definitive diagnosis.

Arterial variations within the lateral cervical region: a multidetector CT angiography study / Variaciones arteriales en la región cervical lateral: estudio angiográfico por tomografía computarizada multidetector

It is important to know the arterial anatomy within the lateral cervical region before the flap-planning. We evaluated the arterial anatomy in this area using multidetector computed tomography (CT) angiography and our aim was to establish the arterial variations. Both sides of individuals in a total number of 155 carotid CT angiographies are reviewed by using 64-detector CT, retrospectively. The variations of suprascapular artery, superficial cervical artery, dorsal scapular artery that are inclusive of the lateral cervical region were assessed. Three arteries originated individually in 67 (23.8 %) sides. They arose by trunk formation in 214 (76.2 %) sides. The most common type of trunk formation was cervicodorsal trunk (107; 38 %). The others were cervicoscapular trunk, cervicodorsoscapular trunk, dorsoscapular trunk and detected in 66 (23.4 %), 40 (14.3 %), 1 (0.3 %) sides, respectively. The origins of arteries within the lateral cervical region may show variations and they may originate from subclavian artery or its branches individually or by trunk formations. It may be beneficial to know these variations before the reconstructive surgical procedures in head and neck. CT angiography is a non-invasive method that enables to evaluate the arterial anatomy and variations in this area.

Es importante conocer la anatomía arterial de la región cervical lateral antes de la planificación de un colgajo. Evaluamos la anatomía arterial en esta área mediante angiografía con tomografía computarizada (TC) multidetector con el objetivo de establecer las variaciones arteriales. Se revisaron retrospectivamente un total de 155 angiografías de ambos lados de la región cervical lateral por tomografía computarizada multidetector. Se evaluaron las variaciones anatómicas de las arterias supraescapular, cervical superficial y escapular dorsal. Las tres arterias se originaron individualmente en 67 casos (23,8 %). Surgieron por formación de un tronco en 214 casos (76,2 %). El tipo más común de formación del tronco fue el tronco cervicodorsal (107 casos; 38 %). Los otros troncos hallados fueron: el tronco cervicoescapular, el tronco cervicodorsoescapular, el tronco dorsoescapular, en 66 casos (23,4 %), 40 casos (14,3 %) y 1 caso (0,3 %), respectivamente. Los orígenes de las arterias en la región cervical lateral pueden mostrar variaciones y las arterias pueden originarse desde la arteria subclavia o sus ramas, individualmente o por formaciones de tronco. Puede ser beneficioso conocer estas variaciones antes de los procedimientos quirúrgicos reconstructivos en cabeza y cuello. La angiografía por TC es un método no invasivo que permite evaluar la anatomía arterial y las variaciones en esta área.

Detection of Dental Pathologies in Routine Paranasal CT Scans: A Retrospective Study.

INTRODUCTION: Multidetector Computed Tomography (MDCT) is a widespread method for evaluating paranasal sinuses and nasal cavity in daily practice. The maxillary teeth are in field of view in a paranasal sinus CT scan and it is possible to detect dental pathologies with CT. AIM: To determine the incidence of maxillary teeth pathologies in routine paranasal sinus CT scans. MATERIALS AND METHODS: A retrospective study was conducted. Consecutive 395 paranasal sinus CT scans were evaluated. All CT images were obtained with a 64 detector-CT. Patients with previous facial trauma, operation, invasive tumors and repeated exams were excluded. Detected findings were classified as "tooth loss, dental restorations or procedures and dental pathologies (carious lesions, dental developmental anomalies, periapical lesions and periodontal diseases). The proportion of findings was reported as simple percentiles. RESULTS: Three hundred and eighty-four CT scans were included in the study. Dental restorations or procedures were determined in 129 (33.5%) patients. A total of 34 (8.8%) patients had normal teeth count and morphology. A total of 264 (64.3%) patients had at least one tooth loss. A total of 195 (51%) patients had at least one or more dental pathology. Number of dental carious lesions, dental developmental anomalies, periapical lesions and periodontal disease were 104 (27.0%), 78 (14.3%), 46 (11.9%), 44 (11.4%), respectively. CONCLUSION: Dental pathologies were encountered in more than half of the patients. Detecting dental pathologies may prevent tooth loss and improve oral health. The radiologist should keep in mind dental pathologies while evaluating paranasal sinus CT in daily practice.

Which Is the Ideal Marker for Early Atherosclerosis in Obstructive Sleep Apnea (OSA) - Carotid Intima-Media Thickness or Mean Platelet Volume?

BACKGROUND Obstructive sleep apnea (OSA) is known to be closely associated with cardiovascular disease. Carotid intima-media thickness (IMT) is widely used for assessment of atherosclerosis. Mean platelet volume (MPV) is a new marker associated with atherothrombosis. In this study, we aimed to detect early atherosclerosis by measuring carotid intima-media thickness and to investigate the relationship between MPV and IMT and OSA severity. MATERIAL AND METHODS The study population consisted of 158 patients who underwent polysomnography and did not have any overt cardiac disease or risk factors. Carotid IMT was measured by ultrasonography. Blood samples were taken for MPV determination. Subjects were divided into 4 groups according to OSA severity: control, mild, moderate, and severe OSA. RESULTS CONCLUSIONS OSA patients appear to have increased carotid IMT suggestive of an atherosclerotic process. Carotid IMT could be a more useful indicator than MPV in these patients. Long-term prospective studies are needed to confirm these results.

Evaluation of Lacrimal Gland Dimensions and Volume in Turkish Population with Computed Tomography.

INTRODUCTION: Computed tomography (CT) is a widespread method for evaluating head and neck pathologies. The lacrimal glands (LGs) are usually visible in routine head and neck CT scans. LG pathologies usually manifests with changes in gland sizes, so it is important to know the normal values of the LG dimensions and volume. The LG sizes may change with age, gender and race. The normal values of LG dimensions and volume in Turkish population was not reported before. AIM: The aim of this study was to evaluate the dimensions and volumes of the LGs by CT in a Turkish population. MATERIALS AND METHODS: Two hundred seventeen consecutive paranasal CT scans of subjects evaluated retrospectively. Measurements of LG dimensions were performed in axial and coronal paranasal CT images. The LG volume was calculated with Aquarius software by outlining the gland in all consecutive axial images. RESULTS: Four hundred orbits of 200 subjects were included to the study. The mean axial LG length in right and left orbits were 16.2±2.0 mm and 16.0±2.0 mm and the mean axial width of the right and left orbits were 4.1±0.7 mm and 4.0±0.7 mm. The right and left LG mean values for coronal length and width were equal 18.3 ±2.2 mm and 4.1±0.7mm respectively. The mean LG volume was 0.617±0.210 cm(3) in right and 0.597±0.197 cm(3) in the left orbits. There were statistically significant differences in the axial width and volume of the LG according to sides, however there was no significant difference according to gender. Age and LG measurements were negatively correlated. CONCLUSION: Our study may serve as a guide to determine the average values of the LG measurements in Turkish population and find out the orbital pathologies that involves the LG.

Morphometric Evaluation of Bony Nasolacrimal Canal in a Caucasian Population with Primary Acquired Nasolacrimal Duct Obstruction: A Multidetector Computed Tomography Study.

OBJECTIVE: The bony nasolacrimal duct (BNLD) morphology as a contributory factor in primary acquired nasolacrimal duct obstruction (PANDO) is still controversial. The objectives of this study were to evaluate the morphometric differences of BNLDs in unilateral PANDO patients between PANDO and non-PANDO sides, as compared with the control group using multidetector computed tomography (CT). MATERIALS AND METHODS: Bilateral BNLDs in 39 unilateral PANDO patients and 36 control subjects were retrospectively reviewed. CT images with 0.5-mm thickness were obtained with a 64-slice scanner. The length, volume, coronal orientation type, sagittal orientation angle of BNLD, and relative lacrimal sac-BNLD angle were assessed. The entrance, minimum and distal end transverse diameters (TD) of BNLD was investigated. RESULTS: The mean minimum and distal end BNLD TDs measurements were significantly narrower in PANDO patients, both in PANDO and non-PANDO sides, as compared with the control group (p < 0.001 and p = 0.040, respectively); however, there were no significant differences between PANDO and non-PANDO sides within PANDO patients. The length, entrance TD, volume, coronal orientation type, sagittal orientation angle of BNLD, and relative lacrimal sac-BNLD angle were not significantly different between PANDO patients and control subjects, as well as between PANDO and non-PANDO sides within PANDO patients. CONCLUSION: The narrow mean minimum and distal end BNLD TD in PANDO patients, in both PANDO and non-PANDO sides, may be associated with PANDO development. The lack of difference between PANDO and non-PANDO sides within PANDO patients and some overlap between PANDO patients and control subjects suggest that narrow BNLD is not the sole factor.

Rare cause of bilateral groin swelling: Round ligament varicosities.

Round ligament varicosity (RLV) is rare and almost all cases are pregnant women. RLV appears as a unilateral or bilateral groin swelling. Pain and tenderness may present. Clinical evaluation is inadequate for exact diagnosis because inguinal hernia has similar findings. Ultrasonography (US) is essential when a groin swelling is detected in a pregnant woman. We present gray scale US and colour Doppler US findings of a 32-week pregnant woman with bilateral RLVs at the inguinal canal, parauterine area and in the myometrium.

Ultrasonography findings of vulvar liposarcoma. Case report.

Liposarcoma (LPS) of vulva is a rare entity. We present the ultrasonographic (US) and color Doppler ultrasonographic (CDUS) findings of a vulvar myxoid LPS. Although LPS cases have been reported in the extremities and trunk, the US or CDUS findings of LPS in vulva have not been described previously. On US the mass appeared as a well-defined, homogeneous hypoechoic structure and on CDUS it was quite hypervascular.

Giant colon lipoma.

Colon lipomas are rare, non-epithelial tumors. They are generally smaller than two centimeters and asymptomatic, they are incidentally diagnosed and do not require treatment. Large and symptomatic colon lipomas are rather rare. Its differential diagnosis is generally made by histopathological examination of the resected specimen. A fifty-year-old female patient presented with the symptoms of abdominal pain, swelling in the abdomen and loss of weight. During colonoscopy, there was a submucosal mass of 8×6 cm, which almost completely obstructed the lumen in the hepatic flexure and was covered by a mucosa that was sporadically ulcerated and necrotic in nature. In magnetic resonance imaging, an ovoid mass with a diameter of 8.5 cm at its widest dimension was detected, which had signal intensity similar to that of adipose tissue. Since the patient was symptomatic and differential diagnosis could not be made, she underwent laparoscopic right hemicolectomy. A submucosal lipoma was detected on histopathological examination of the specimen. The patient was discharged without any problems on post-operative day 7. Definite diagnosis of lipomas before surgery is challenging; they may be mistaken for malignancy, especially if the lesion is large and ulcerated. For large and symptomatic colon lipomas, surgery is required to both prevent complications and rule out malignancy.

Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography.

An extraordinary cerebral venous drainage pathway and dilated vein at the left posterior cervical region were detected with routine contrast-enhanced neck computed tomography exam. The left sigmoid sinus was drained by dilated mastoid emissary vein (MEV). The MEV continued as posterior auricular and posterior external jugular veins (PEJVs). The left PEJV directly drained into subclavian vein. Atretic right transverse sinus, left facial vein forming the external jugular vein, atresia and hypoplasia of upper internal jugular veins at the right and left sides, respectively, were the other uncommon findings in our case. Detecting venous variations may prevent complications during surgical and interventional procedures, so the radiologists should examine the superficial cervical veins closely.

Variations of the popliteal artery branching with multidetector CT angiography.

OBJECTIVE: To date the anatomy of the popliteal artery variations using multidetector-row computed tomography angiography (MD CTA) was not assessed. The objective of this study is to establish 3D CT anatomy of the popliteal artery variations. MATERIALS AND METHODS: A total of 126 lower limbs that underwent CTA using 64-detector MDCT were retrospectively reviewed. The anatomical variations of the distal popliteal artery branching were assessed. RESULTS: Ninety-seven lower limbs (83.6%) had the usual branching pattern (type 1 A) with tibialis anterior artery (TA) arising first followed by the tibial-peroneal trunk, which then gives rise to the tibialis posterior artery (TP) and peroneal artery. Variations in popliteal branching pattern were seen in 19 (16.4%) limbs. The commonest variation was first branch of the TP in 5 (4.4%) of the limbs (type 1 C) or high origin with anterior course of popliteus muscle of the TA in 5 (4.4%) limbs (type 2 A II). CONCLUSION: Many variations exist in the running patterns of the branching pattern of the popliteal artery. Knowledge of the branching pattern of the popliteal artery will be beneficial to radiologist for the evaluation of CT angiograms and interventional vascular procedures, and to vascular surgeons for various surgical approaches. MD CTA provides noninvasive means of assessing distal popliteal artery variations.

Acute suppurative thyroiditis accompanied by thyrotoxicosis after fine-needle aspiration: treatment with catheter drainage.

Fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of thyroid diseases. Serious complications are rare and this procedure is generally safe. Acute supurative thyroiditis (AST) after FNA has been seldomly reported. We report a case of a 57-year-old women with diabetes mellitus who developed AST with thyrotoxicosis after FNA. She was successfully treated by sonographically guided percutaneous drainage and antithyroid agent.

Evaluation of degenerative diseases of the lumbar spine with reformatted and 3-dimensional computed tomography images.

OBJECTIVE: To evaluate the identification of degenerative lesions of the lumbar spine with multiplanar reformatted images and 3-dimensional computed tomography (3DCT). METHODS: Fifty-three patients with degenerative spinal disease findings on lumbar CT scanning were reviewed in this retrospective study at the Department of Radiology, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey between January 2006 to January 2009. Two-dimensional multiplanar reformatted and 3DCT images were obtained. First, the axial CT images, and then 2-dimensional multiplanar reformatted images (2DMPR) were evaluated. The findings seen on reformatted CT images that were not visualized, or visualized only in retrospect on axial images were recorded. Finally, the 3D images were evaluated by the same team. The results were again recorded in the same manner. RESULTS: When 53 patients were taken into account, the 2DMPR provided better visualization of lateral neural foraminal stenosis in 62%, bulging of the disc in 32%, degenerative retrolisthesis in 15%, and spondylolysis in 15% as compared to axial images. The 3DCT images clearly revealed the presence of lateral neural foraminal stenosis in 41%, degenerative retrolisthesis in 13%, lateral spondylolisthesis in 15% as compared to axial and 2DMPR. CONCLUSION: The 2DMPR and 3DCT images provide significant anatomic and diagnostic information not readily derived from axial CT. It is useful in detecting degenerative conditions of the spine and associated complications.

Carotid CT angiography: comparison of image quality for left versus right arm injections.

PURPOSE: To evaluate the differences in image quality of carotid computed tomographic angiography (CTA) of patients injected with contrast material in their right arms versus patients injected with contrast material in their left arms. MATERIALS AND METHODS: Patients who had cerebrovascular accidents and subsequently underwent CTA were included in the study. Contrast material was injected into the right arms of 44 patients and into the left arms of 46 patients. Source images of a total of 90 CTAs were retrospectively evaluated for perivenous streak artifacts and contrast material reflux into the veins of the neck and upper thorax. After adjusting for differences in gender, the relationship between the injection site and the intensity of perivenous streak artifacts and venous reflux was determined. RESULTS: Perivenous streak artifacts and venous reflux were demonstrated in patients who underwent either right or left arm injections. However, the intensity of perivenous streak artifacts was stronger in patients who were injected with contrast material in the left arm. Venous reflux into the neck and upper thorax veins was also more severe and more frequent with left arm injections. A decreased retrosternal distance facilitated reversed flow into the veins when the left arm injection was used. CONCLUSION: Perivenous beam hardening streak artifacts and venous reflux could not be prevented with right or left arm injections. However, patients who were injected with contrast material in their right arms showed fewer artifacts, thus allowing for better quality images on CTA.

Splenic hydatic cyst as a cause of sinistral portal hypertension and isolated gastric variceal bleeding.

A 60-year-old male, living in a rural area, presented with recurrent upper gastrointestinal bleeding. Isolated fundal varices were seen on endoscopy. A lesion similar to cyst hydatid was seen in the spleen on abdominal ultrasonography and computerized tomography scanning. Also, sinistral (left-sided) portal hypertension and collaterals were seen due to the compression of the splenic vein by the cyst. Indirect hemagglutination antibody test for Echinococcus granulosus was positive. By screening, no other cyst was found in any other site of the body. The patient underwent open abdominal surgery, and the anterior wall of the cyst was resected partially; within it were multiple daughter cysts and hydatid fluid. After decontamination of the daughter cysts and hydatid fluid, germinative membrane omentoplasty was performed with a part of the omentum. However, the patient suffered from recurrent gastrointestinal bleeding postoperatively and he was re-evaluated. Later, splenectomy was performed in order to relieve left-sided portal hypertension. The patient did not experience further bleeding and gastric varices disappeared following splenectomy.

Mammographic features of the sternalis muscle.

PURPOSE: To evaluate the mammographic findings of the sternalis muscle and discuss appropriate diagnostic approaches. MATERIALS AND METHODS: Ten years of records from our mammography unit were retrospectively examined for the presence of the sternalis muscle. This variant was seen in 10 women out of the 52,930 examined, and the mammograms of these patients were reevaluated. The size, shape and contours of the muscle were reviewed on the craniocaudal (CC) and mediolateral oblique (MLO) views. Yearly mammograms were assessed to evaluate follow-up changes. Extra examinations were reviewed, including ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: The prevalence of the sternalis muscle was 0.018%. Its contours were well-defined, irregular or spiculated, and the diameter ranged from 3-4 mm to 15 mm. The shape of the muscle varied from slightly bulging to round or triangular. The muscle was detected on MLO projections in three patients as an inferior soft tissue density at the posterior edge of the breast, continuous with the pectoralis muscle. Distinct pulling of the breast led to variations in the appearance of the muscle on yearly mammograms. US examinations were normal in all patients. CT and MRI showed the muscle clearly. CONCLUSION: The appearance of the sternalis muscle may vary on CC views. It may also be detected on MLO projections. The ability to visualize the muscle depends on proper positioning. Knowledge of its detectability on mammograms will prevent the misdiagnosis of a mass and prevent further unnecessary investigations.