Calcific tendinitis: intramuscular and intraosseous migration.

Calcific tendinitis is a well-documented and extensively studied disease in the literature. Intramuscular and intraosseous migration are rare complications, which may present diagnostic challenges. This pictorial essay illustrates the imaging findings of these complications. Considering that neoplastic processes and infectious diseases are included in the differential diagnosis, recognizing the imaging findings of these complications is of critical importance.

Role of apparent diffusion coefficient values and diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant thyroid nodules.

OBJECTIVE: The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). MATERIALS AND METHODS: Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. RESULTS: The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. CONCLUSION: We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.

Determination of the frequency of dyssynergic defecation and patient characteristics in patients with functional constipation.

BACKGROUND/AIMS: Dyssynergic defecation, a subgroup of functional constipation, is a relatively new definition, diagnostic criteria of which have recently been described. Distribution of subgroups of functional constipation in our population is scarcely known. We aimed to evaluate the demographic characteristics and defecation features of patients as we determined the frequency of dyssynergic defecation in patients with functional constipation in our community. METHODS: Eighty-two patients, 52 women and 30 men, with functional constipation were included in the study by using a questionnaire after secondary causes were excluded. Colonic transit time and balloon expulsion tests were performed to determine sub-groups of functional constipation. Colonoscopy and/or sigmoidoscopy in all patients and double contrast colonography in some patients were obtained at the beginning of the study to exclude anatomic and organic causes and patients with constipation predominant irritable bowel syndrome were also excluded from the study. RESULTS: The results of the study revealed that functional constipation in our community occurs more frequently in women and at relatively older (middle to old) age. Patients with normal transit constipation pattern are the largest portion (52.4%) of patients with functional constipation, whereas dyssynergic defecation is the second most frequent (25.6%) reason among this population. CONCLUSION: The frequency of dyssynergic constipation is lower in our population compared to western communities, but the symptoms are similar. We believe that the questionnaire we used is helpful in revealing defecation characteristics and when combined with balloon expulsion test and colonic transit time measurements it can be a valuable tool in the diagnosis of dyssynergic defecation.

Power Doppler sonography: anything to add to BI-RADS US in solid breast masses?

OBJECTIVE: To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses. MATERIALS AND METHODS: Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria. RESULTS: Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p<0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p<0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively. CONCLUSION: PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.

Sonographic appearances of the normal ulnar nerve in the cubital tunnel.

PURPOSE: To investigate the sonographic characteristics of the normal ulnar nerve in the cubital tunnel, as well as any differences related to age, sex, and dominant arm. METHOD: Two hundred twelve elbows in healthy volunteers were evaluated sonographically. The cross-sectional area (CSA) of the ulnar nerve within the cubital tunnel was measured with the elbow in extension and in flexion. The presence and number of fascicles was determined. The displacement of the ulnar nerve out of the cubital tunnel in full elbow flexion was also investigated. RESULTS: The mean +/- SD CSA of the ulnar nerve was 6.6 +/- 1.7 mm(2) (6.7 +/- 1.8 mm(2) in men and 6.5 +/- 1.7 mm(2) in women). The mean CSA of the ulnar nerve was highest for subjects aged 50-59 years, and lowest for subjects aged 30-39 years. Forty-two of 212 (19.8%) ulnar nerves had 2 fascicles, and 5 (2.4%) had 3 fascicles. The remaining 165 (77.8%) nerves had 1 fascicle. During elbow flexion, 49 of 212 (23.1%) ulnar nerves showed subluxation, and 18 (8.5%) were dislocated. CONCLUSION: There were differences in the CSA of the ulnar nerve between some age groups, but there was no variation with sex or handedness. Sonography can evaluate the morphologic changes of the nerve during flexion of the elbow.

MRI findings of intracranial tuberculomas.

PURPOSE: Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis. METHODS: We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients. RESULTS: A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient. CONCLUSION: MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

A variant of Poland syndrome associated with dextroposition.

Poland syndrome is characterized by partial or complete absence of pectoralis muscles, ipsilateral syndactyly, and occasionally other malformations of the anterior chest wall and breast. Other associated anomalies, including dextrocardia, renal malformations, and vertebral anomalies, have been reported in rare cases. The condition is more frequent among males, and usually occurs on the right hemithorax in the unilateral form. The syndrome is believed to be caused by a genetic disorder that reduces the embryonal circulation in the subclavian and vertebral arteries. We report a 20-year-old man with Poland syndrome on the left hemithorax, which is rarely associated with dextroposition.

Multicentric malignant peripheral nerve sheath tumor.

We present a case of malignant peripheral nerve sheath tumor of multicentric origin, an extremely rare condition. A 25-year-old man was admitted to hospital with presenting symptoms of cough, dyspnea and left lateral back pain. Computed tomography and magnetic resonance imaging revealed extrapleural masses in the left hemithorax in addition to synchronous left inguinal mass. After surgical resection of the masses from the thoracic and inguinal regions, histological examination confirmed the preoperative diagnosis of malignant peripheral nerve sheath tumor.

The effect of pharyngeal soft tissue components on snoring.

OBJECTIVE: To determine the effect of oropharyngeal air column area, parapharyngeal fat pad thickness, pterygoid muscle thickness, and parapharyngeal wall thickness on snoring. MATERIALS AND METHODS: Fifty-six individuals (35 men, 21 women) complaining of snoring in a questionnaire administered to patients attending the MR unit for cervical MR imaging were enrolled as the study group, and 39 (23 men, 16 women) individuals with no complaint of snoring were enrolled as the control group. Firstly, patients' body mass index (BMI) was determined. Then turbo spin echo T2-weighted MR imaging in the axial plane was performed, from the nasopharynx to the hyoid bone level, in both groups. From the MR images, oropharyngeal air column area, parapharyngeal fat pad thickness, pterygoid muscle thickness and parapharyngeal wall thickness measurements were made. Finally, the results were statistically analysed using SPSS (Statistical Package for Social Sciences) for Windows 10.0. Student's t-test was used as a complementary method in the analysis of the study data. The correlations between BMI and parapharyngeal wall thickness, and BMI and oropharyngeal air column area were determined by Pearson's correlation analysis. RESULTS: No statistically significant difference was found between study and control groups in terms of mean age, pterygoid muscle thickness, or pharyngeal fat pad thickness (P>.05). Snorers' BMI levels (P<.01) and average parapharyngeal wall thicknesses (P<.05) were statistically significantly higher than those of the control subjects. Snorers' oropharyngeal air column area was significantly narrower than that of the control subjects, statistically (P<.01). CONCLUSION: As a result of the study, it was concluded that only oropharyngeal air column area and parapharyngeal muscle thickness had an effect on snoring.

Diagnostic value of CTE in patients with Crohn's disease.

OBJECTIVE: The goal of our study was to compare the accuracy of computed tomography enteroclysis (CTE) to that of biopsy in detecting bowel wall alterations of the terminal ileum in Crohn's disease (CD). SUBJECTS AND METHODS: A total of 43 patients with either diagnosed or suspected CD (16 females, 28 males) underwent CTE and ileoscopy. Ileoscopy diagnosed 35 patients with CD of the ileum, while 8 patients served as the control group. RESULTS: Computed tomography enteroclysis detected CD in 31 patients (88%) and in none of the control group. According to the criteria used for evaluation of small bowel loop distension, 31 cases were (72%) with optimal distension, nine cases (%21) with good distension, and three cases (7%) with poor distension. Computed tomography enteroclysis showed that mean ileal wall thickness in patients with CD was 6.8 mm (range, 9.5-4.1 mm) and 1.79 mm in patients in the control group (range, 2.20-1.38 mm). Mean postcontrast wall density in patients with CD was 81.9 HU (range, 111.6-52.2 HU) and 41.1 HU (range, 49.8-22.4 HU) in the control group. Mean postcontrast wall density in 17 patients with active CD was 97 HU (range, 67-123 HU) and 62 HU (range, 46-87 HU) in 18 CD patients in remission. We calculated that the overall sensitivity and specificity of CTE in detecting the severity of CD were 89% and 100%, respectively. Positive predictive value was 100%; negative predictive value was 89%. CONCLUSION: Our results indicate that CTE can reveal CD involvement of small bowel accurately and allow assessment of the degree of disease activity.

Effects of altitude on spleen volume: sonographic assessment.

PURPOSE: To use sonography to determine changes that may arise in splenic volume in humans from regions of lower altitude who begin to live in regions of higher altitude. MATERIALS AND METHODS: The study was conducted in the Turkish province of Agri, at an altitude of 1750 m and included 108 healthy, nonsmoking, disease-free volunteers who had moved from regions at an altitude lower than 500 m. Length, width, and thickness of the spleen were measured using sonography. Splenic volume was calculated using the following standard ellipsoid formula: length x width x thickness x 0.523. Sonographic assessments were repeated at 3 and 6 months along with other blood tests, including hemoglobin, hematocrit, and platelet levels. RESULTS: The mean +/- SD splenic volume was 299 +/- 97 cm(3) (range, 116-574 cm(3)). At 3 and 6 months, the splenic volumes decreased significantly compared to their initial values (p < 0.05). An increase in hemoglobin, hematocrit, and platelet count was observed in all subjects. CONCLUSION: Our data show that splenic volume in healthy individuals who begins to live at high altitudes decreases gradually.

Imaging of pulsatile tinnitus: a review of 74 patients.

OBJECTIVE: Our aim was to assess the effectiveness of imaging modalities in detecting the underlying pathologies in patients with pulsatile tinnitus. MATERIALS AND METHODS: Seventy-four patients with pulsatile tinnitus were radiologically evaluated. All patients except two are evaluated on a thin-section bone algorithm computed tomography scan covering the temporal bone and skull base, 14 patients with or without contrast-enhanced brain computed tomography, 7 patients with magnetic resonance imaging and magnetic resonance angiography, 5 patients with digital subtraction angiography, and 12 patients with Doppler ultrasonography. RESULTS: The underlying pathology of tinnitus was detected in 50 patients (67.6%), and 24 patients were normal with radiologic studies. The most common cause was high jugular bulbus (21%) followed by atherosclerosis, dehiscent jugular bulbus, aneurysm of internal carotid artery, dural arteriovenous fistula, aberrant internal carotid artery, jugular diverticulum, and glomus tumor. CONCLUSION: It was concluded that radiologic imaging methods are effective in detecting the underlying pathology of pulsatile tinnitus.

Gadolinium-enhanced 3D MR angiography of pulmonary hypoplasia and aplasia.

OBJECTIVE: The goal of this study was to determine the role of gadolinium-enhanced 3D MR angiography (MRA) in patients with suspected pulmonary hypoplasia and aplasia in a retrospective analysis of MRA and digital subtraction angiography in 11 patients with clinical and/or radiologic suspicion of pulmonary hypoplasia and aplasia. CONCLUSION: Gadolinium-enhanced 3D MRA is capable of diagnosing pulmonary hypoplasia and aplasia rapidly and accurately. Both pulmonary hypoplasia and aplasia can be shown morphologically in a noninvasive manner, obviating digital subtraction angiography.

Asymmetry of the height of the ethmoid roof in relationship to handedness.

The aim of this work was to study the handedness differences in the height of the right and left ethmoid roofs. Hand preference was assessed using the Edinburgh Handedness Inventory. The height of the right and left ethmoid roofs was measured with computerised tomography (CT). The incidence of persons who had a lower ethmoid roof on the right side was significantly greater among right-handers than among left-handers; the incidence of persons who had a lower ethmoid roof on the left side was significantly greater among left-handers than among right-handers; and right and left ethmoid roofs were equal in all ambidextrous subjects. The relationship between the asymmetric ethmoid roofs and handedness may result from the right or left embryonic craniofacial region being smaller in the right- or left-handed subjects. This is particularly important in the light of the high degree of variability in the ethmoid roof, and even between the right and left sides in a given individual. Preoperative awareness of a patient's unique sinus anatomy may help prevent iatrogenic injury to the surrounding vital structures during ethmoid sinus surgery (ESS).