Comparative evaluation of shear wave elastography elasticity values in thyroid nodules with cytology results and TI-RADS scoring in differentiation of benign-malignant nodules.

PURPOSE: The aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). METHODS: This prospective study included 370 thyroid nodules in 308 patients aged 18-70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules. RESULTS: One hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001). CONCLUSION: This study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules.

Is condyle morphology a factor for anterior temporomandibular disc displacement?

BACKGROUND: To investigate morphological features of the mandibular condyle and its association with anterior temporomandibular disc displacement on sagittal oblique MRI plane. METHODS: One hundred and twenty patients with temporomandibular MRI examination were retrospectively involved in the study. Patients aged less than 18 years and those with severe osteoarthritis, posterior disk displacement, tumor, abscess, history of a rheumatic disease, facial trauma, and motion artifacts on images were excluded. Three radiologists evaluated all images in consensus. Temporomandibular disc locations were classified as normal, anteriorly displaced with reduction (ADr), and anteriorly displaced without reduction (ADwr) on sagittal oblique T1-weighted images. Condylar shapes were classified as flat, rounded, and angled, and condyle anteroposterior width (c-APW) was measured on these images in closed-mouth position. RESULTS: Ninety six discs were in normal position (40%), 70 discs were ADr (29%), and 74 discs were ADwr (31%). Eighty-four condyles were flat (35%), 100 condyles were rounded (42%), and 56 condyles were angled (23%). Mean c-APW was 7 mm in normal joints, 5.9 mm in ADr, and 5.8 mm in ADwr joints, and it was smaller in joints with anterior disc displacement (p < 0.001). In normal joints, flat and rounded type condylar shape was more common and almost equally prevalent (44% and 43%); however, rounded type was more common among ADr (%47) and angled type was more common among ADwr joints (36%) (p = 0.008). Patients with anterior disc displacement were significantly younger from normal cases and anterior disc displacement was more common among female sex. DISCUSSION: Mandibular condyle shape alterations and condyle size on sagittal oblique MRI plane are associated with anterior disc displacement. Angled shape was more common among ADwr joints. Joints with anterior disc displacement had smaller c-APW than normal joints.

MRI diagnosed cardiac lipoma in tuberous sclerosis: a case report with a very rare association.

Tuberous sclerosis is a genetic multisystem disorder characterised by hamartomas in several organs. Cardiac rhabdomyomas are the main features of the disease but lipomas can very rarely be associated. Herein, we present a very rare association of tuberous sclerosis and cardiac lipoma detected by echocardiography and diagnosed as a lipoma via MRI and fat suppression technic, aim to report this very rare association, and emphasise usefulness of MRI in cardiac mass lesions.

Does 3 Tesla Magnetic Resonance Imaging Have Adverse Effect on Cochlear Functions?

OBJECTIVE: The aim of this study was to investigate the effects of 3 Tesla (3T) magnetic resonance imaging (MRI) noise on cochlear functions. METHODS: The distortion product otoacoustic emission (DPOAE) test was applied to patients who were scheduled to have 3T MRI in the tertiary care center. Patients who revealed emission amplitudes at all frequencies (1, 1.5, 2, 3, 4, 6, and 8 kHz) in the DPOAE test before MRI were included in the study. After MRI, the DPOAE test was performed twice on 17 patients (33 ears) (immediately after MRI and 30 minutes after MRI). The changes in the results of the tests taken before MRI (pre-MRI), immediately after MRI (post-MRI 1), and at 30 minutes after MRI (post-MRI 2) in the DPOAE amplitudes at all frequencies were compared statistically. RESULTS: There was a significant difference between pre-MRI, post-MRI 1, and post-MRI 2 measurements at 3, 6, and 8 kHz. In pairwise comparisons; post-MRI 1 was statistically lower than post-MRI 2 at 3 kHz, and post-MRI 1 was statistically lower than pre-MRI and post-MRI 2 at 6 and 8 kHz. In addition, post-MRI 2 was significantly lower than pre-MRI at 8 kHz. CONCLUSION: According to these results, 3T MRI noise does not have any permanent negative impact on hearing functions. It can only cause DPOAE amplitude changes at high frequencies. This is a clinically negligible effect. Therefore, it can be considered that the 3T MRI examination with protective headphones does not cause any adverse side effects in terms of hearing functions.

Relationship between acute phase reactants and prognosis in patients with or without COVID-19 pneumonia.

In December 2019, several cases of pneumonia of unknown origin were reported in the city of Wuhan, province of Hubei, China. The pathogen was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was named coronavirus disease 2019 (COVID-19). Acute phase reactans (APRs) are critical in the early diagnosis, treatment, and for monitoring the progression of COVID-19. Seventy two patients were included in the study and infections confirmed by real-time reverse transcription polymerase chain reaction. Clinical parameters, the level of APFs and D-dimer were assessed and results were retrived from the patients' medical records. Chest computed tomography (CT) findings were described for each patient and they were divided into two groups, with or without COVID-19 pneumonia. The correlation between APRs and CT findings and the patients' prognosis were evaluated. Twenty eight (38.8%) of the 72 patients were female and 44 (61.2%) were male. The most common symptom was cough (43%) and the most common associated chronic disease was hypertension (12.5%). Thirty (41.6%) patients had completely normal chest CT, while 42 (58.4%) patients had typical findings in terms of COVID-19 pneumonia. C reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), ferritin, procalcitonin and D-Dimer levels were statistically significantly higher in patients with pneumonia than in those without pneumonia and these parameters were also statistically significantly higher in patients with severe illness. In conclusion, CRP, LDH, ESR, ferritin, and D-Dimer were associated with severe COVID-19 pneumonia. These biomarkers can be used to evaluate the prognosis to predict the clinical course of disease, allowing a proper management and treatment of the patients.

An adult patient presenting with right unilateral pulmonary agenesis: a case report and literature review.

Pulmonary agenesis is a rare developmental defect in which there is complete absence of one or both lungs. Although the diagnosis is often made during childhood, asymptomatic patients can be diagnosed later due to the absence of comorbid anomalies. Chest radiography with an elevation of the hemidiaphragm and heart shifted to the right should make physicians suspicious for right lung agenesis. Here, we present a case report of a 53-year-old male with unilateral pulmonary agenesis of right lung found incidentally. He had a complaint of dyspnea. The respiratory system examination revealed no breathing sounds on the right side with normal breathing sounds on the left side. A posterior anterior chest radiograph revealed homogenous opacity of the middle and lower radiological lung zone with elevation of the right hemidiaphragm. In addition, the trachea and heart were shifted to the right side. Contrast-enhanced multidetector computed tomography revealed the absence of the right lung parenchyma, right main bronchus, and right main pulmonary artery and vein. The left lung had normal pulmonary vasculature, was hyperinflated, and partially extended to the right hemithorax. A pulmonary conus was formed by only the left pulmonary artery. No congenital anomalies were detected.

Solitary fibrous tumor of the orbit: Computed tomography and histopathological findings.

A solitary fibrous tumor is a rare spindle cell neoplasm originating from the mesenchyme. This type of tumor of the orbit is very uncommon and can be misdiagnosed as a hemangiopericytoma, fibrous histiocytoma, meningioma, or neurofibroma. We report an orbital solitary fibrous tumor in an 18-year-old male, with slow-growing swelling in the right orbital region. An orbital contrast-enhanced computed tomography scan showed heterogeneously enhancing right extraconal inferomedial mass, with no evidence of calcification or bone destruction. The lesion was surgically excised without complications. Based on microscopic and immunohistochemical findings, the mass was finally diagnosed as a solitary fibrous tumor. These tumors should be preoperatively differentiated from other spindle cell tumors of the orbit, and radiological imaging methods are useful in the differential diagnosis but are nonspecific. Therefore, histopathological and immunohistochemical staining features are more useful for the diagnosis of solitary fibrous tumors, especially CD34 staining.

The diagnostic value of 4D MRI at 3T for the localization of parathyroid adenomas.

PURPOSE: The aim of this study was to assess the feasibility of four-dimensional magnetic resonance imaging (4D MRI) at 3 T for the localization of parathyroid adenomas. MATERIALS AND METHODS: Preoperative 4D MRI scans, encompassing dynamic contrast-enhanced (DCE) sequences and non-contrast enhanced (non-CE) sequences, including a T2-weighted multipoint Dixon (T2-mDixon) sequence, with in-phase, out-phase, and water-only images, were evaluated retrospectively in 41 patients with surgically proven parathyroid lesions. Two readers who were blinded to the surgical findings independently reviewed the images in two sessions (non-CE sequences alone and non-CE + DCE sequences). The MRI localization of the suspected adenoma in each session and the consensus interpretation of the MRI images, were compared with the surgical results and interobserver agreement was assessed. RESULTS: By interpreting the non-CE sequences alone, reader 1 correctly localized 34 parathyroid lesions (sensitivity 81.0%, positive predictive value (PPV) 87.2%), and reader 2 correctly localized 34 parathyroid lesions (sensitivity 81.0%, PPV 91.9%). With the addition of DCE sequences, reader 1 correctly identified 35 parathyroid lesions (sensitivity 83.3%, PPV 87.5%), while reader 2 correctly identified 36 parathyroid lesions (sensitivity 85.7%, PPV 92.3%). Overall, MRI detected 38 parathyroid lesions (sensitivity 90.5%, PPV 95.0%). Interobserver agreement was slightly superior in non-CE + DCE sequences compared to non-CE sequences alone (ĸ = 0.796 vs. ĸ = 0.738). CONCLUSION: 4D MRI with DCE sequencing is a reliable method for the localization of parathyroid adenomas.

Acoustic Radiation Force Impulse Quantification in the Evaluation of Thyroid Elasticity in Pediatric Patients With Hashimoto Thyroiditis.

OBJECTIVES: To evaluate the parenchymal elasticity of the thyroid gland with acoustic radiation force impulse imaging in pediatric patients with Hashimoto thyroiditis and to compare it with healthy volunteers. METHODS: Twenty-six patients with Hashimoto thyroiditis and 26 healthy volunteers between 6 and 17 years were included. The shear wave velocity (SWV) values of both thyroid lobes in both groups were evaluated. RESULTS: The age and sex characteristics of the controls and patients with Hashimoto thyroiditis were similar. The SWV of the thyroid gland in patients with Hashimoto thyroiditis (mean ± SD, 1.67 ± 0.63 m/s) was significantly higher than that in the control group (1.30 ± 0.13 m/s; P < .001). There was no significant difference between the thyroid lobes in both groups. A receiver operating characteristic curve analyses showed an optimal cutoff value of 1.41 m/s, with 73.1% sensitivity, 80.8% specificity, a 79.2 % positive predictive value, and a 75.0% negative predictive value (area under the curve, 0.806; P < .001). In patients with Hashimoto thyroiditis, there was a positive correlation between the SWV values versus anti-thyroperoxidase (Pearson r = 0.46; P = .038). There were no correlations between age, body mass index, thyroid function test results, and anti-thyroglobulin values and versus SWV values. Also, no significant differences were seen between the groups for gland size, gland vascularity, and l-thyroxine treatment. CONCLUSIONS: Acoustic radiation force impulse elastography showed a significant difference in the stiffness of the thyroid gland between children with Hashimoto thyroiditis and the healthy group. Using acoustic radiation force impulse elastography immediately after a standard ultrasound evaluation may predict chronic autoimmune thyroiditis.

The Role of Real-Time Sonoelastography in the Differentiation of Benign From Malignant Parotid Gland Tumors.

OBJECTIVE: The aims of this study are to evaluate the utility of sonoelastography for parotid gland masses and to determine which cutoff strain ratio (SR) would be best for the differentiation between benign and malignant lesions. METHODS: From August 2015 to December 2016, 39 parotid gland masses were examined prospectively by ultrasonography and strain sonoelastography. Elastographic scores were determined by a 4-point scoring method. Interventional procedures were performed on all patients after sonographic examinations. The lesions were divided into groups as benign or malignant according to histopathological findings. The difference in elastographic scores between benign and malignant masses was evaluated. RESULTS: Among the 39 parotid gland masses, 33 (84.6%) were benign and 6 (15.3%) were malignant tumors with 53.8% (n = 21) of the lesions being on the right side. Pleomorphic adenoma (41%) was the most common neoplasm followed by Warthin tumor (28.2%). The median elastographic score was 2 (range, 1-3) for benign tumors, and it was 3 (range, 2-4) (P = 0.003) for malignant tumors. Median SR was 1.11 (range, 0.26-2.15), and it was 2.75 (range, 1.03-3.54) (P = 0.01) for benign and malignant tumors. In the receiver operating characteristic analysis, the cutoff value of the SR was 2.1, sensitivity was 83.3%, specificity was 97%, positive predictive value was 83.3%, negative predictive value was 97%, and accuracy was 94%. CONCLUSIONS: There was a statistically significant difference between benign lesions and malignant lesions in both elastography score and SR. It is possible that elastography can improve the noninvasive diagnostic accuracy for certain pathological conditions.

Shear wave velocity of the healthy thyroid gland in children with acoustic radiation force impulse elastography.

PURPOSE: Acoustic radiation force impulse imaging is a kind of shear wave elastography that can be used in children for differentiating thyroid pathologies. Possible changes in the healthy thyroid gland in children may create difficulties in the use of shear wave velocities (SWV) in thyroid pathologies. The aim of this study was to define the normal values of SWV for the healthy thyroid gland in children, elucidate the correlation of the SWV values with potential influencing factors, and evaluate intra-operator reproducibility of the SWV. METHODS: Between January 2015 and December 2015, a total of 145 healthy children (81 girls, 64 boys; mean age, 10.5 ± 3.14 years; range 6-17 years) were enrolled in the study. The SWV and volume of the thyroid gland were determined. RESULTS: The mean shear wave velocity of the thyroid gland was 1.22 ± 0.20 m/s. There was no correlation between age and the mean SWV of the thyroid gland (Spearman Rho = 0.049, p = 0.556). There was also no correlation between the thyroid gland volume or BSA and the mean SWV. The only correlation detected was between BSA and total thyroid gland volume (p < 0.001). CONCLUSION: In the present study, the SWV of the healthy thyroid gland in children was determined. There was no correlation between the SWV of the thyroid gland and age, BSA, or thyroid gland volume.

A rare complication of metastatic lung disease treatment.

[No Abstract Available].

Radiological, clinical and audiological evaluation of jugular bulb-vestibular aqueduct dehiscence.

OBJECTIVE: The aim of this study is to determine the prevalence of jugular bulb-vestibular aqueduct dehiscence (JBVAD) in patients undergoing temporal bone multidetector computed tomography (MDCT) and assess the relationship between JBVAD and hearing loss with the findings of audiometry. METHODS: About 1503 temporal bone MDCT scans were evaluated for the prevalence of JBVAD. Correlation of the imaging findings and audiometric data was performed. Patients were divided into two groups, those with and those without hearing loss, and were statistically compared. RESULTS: Jugular bulb-vestibular aqueduct dehiscence was detected in 124 of the 1503 patients with a prevalence of 8.2%. MDCT images of 56 of the 124 patients were normal except for JBVAD (n = 38) and close proximity of the jugular bulb (JB) and vestibular aqueduct (VA) (n = 18). A total of 23 of 38 patients with JBVAD and 7 of 18 patients with close proximity of the JB and VA had hearing loss detected by audiometric evaluation. CONCLUSIONS: The most common hearing loss was detected as sensorineural hearing loss in patients with JBVAD. Also, median air and bone conduction and air bone gap values were found statistically higher in patients with hearing loss versus those without hearing loss.

Percutaneous closure of isolated ostium secundum-type atrial septal defect in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly characterized by complete or partial aplasia of the uterus and the upper part of the vagina. It is reported to be associated with cardiovascular disorders including atrial septal defect, anomalous pulmonary venous return, aortopulmonary window, pulmonary valve stenosis, mitral valve prolapse, tetralogy of Fallot, truncus arteriosus, and patent ductus arteriosus. Herein, for the first time in the medical literature, we present percutaneous closure of an isolated ostium secundum atrial septal defect in this syndrome.