Evaluation of Arachnoid Granulations in Cranial Dural Sinuses with Contrast-Enhanced 3-Dimensional T1-Weighted Magnetic Resonance Imaging.

OBJECTIVE: Several studies in the literature have used contrast-enhanced magnetic resonance imaging to investigate arachnoid granulations protruding into the cranial dural sinuses. The current study aimed to investigate the protrusion of arachnoid granulations into the superior sagittal sinus, transverse sinus, straight sinus, and confluence of sinuses and determine the frequency of brain herniation into giant arachnoid granulations using contrast-enhanced 3-dimensional T1-weighted magnetic resonance imaging. MATERIALS AND METHODS: Images of 550 patients with intra-sinus arachnoid granulations who underwent contrast-enhanced 3-dimensional T1-weighted thin-slice magnetic resonance imaging were retrospectively re-evaluated. Only 300 patients with at least 1 intra-sinus arachnoid granulation were included in the study. The protrusion of arachnoid granulations into superior sagittal sinus, transverse sinus, straight sinus, and confluence of sinuses was investigated. In addition, large arachnoid granulations and brain herniations into arachnoid granulations were also noted. RESULTS: A total of 889 focal filling defects of arachnoid granulations, at least 1 in the dural sinus, were detected. Of the filling defects of arachnoid granulations, 183 were in the right transverse sinus, 222 in the left transverse sinus, 265 in superior sagittal sinus, 185 in straight sinus, and 34 in confluence of sinuses. Brain herniation into arachnoid granulations was detected in 8 (2.7%) of the patients included in the study. All the filling defects detected in the dural sinuses on post-contrast 3-dimensional T1-weighted images were isointense with cerebrospinal fluid and had round, oval, or lobulated contours. A positive weak correla- tion was found between patient age and the size and number of arachnoid granulations (r = 0.181, P < .01 and r=0.207, P < .001, respectively). It was observed that the size and number of arachnoid granulations increased as the age of the patients increased. CONCLUSIONS: The distribution, shape, number, and size of intra-sinus arachnoid granulations can vary considerably. Brain herniation into arachnoid granulation can also be seen. Three-dimensional cranial magnetic resonance imaging sequences can be safely used in the evaluation of arachnoid granulations.

Transrectal shear wave elastography for detection of prostate cancer.

AIM: To evaluate the value of transrectal shear-wave-elastography(SWE) to differentiate benign and malignant tissues in patients with suspected prostate cancer. MATERIALS AND METHODS: Between January and May 2019, the study was designed as a prospective clinical study. The SWE value of 504 cores measured before biopsy and the pathology result of each core were used in the statistical analysis. The SWE values of benign and malignant cores were compared according to pathology results. ROC analysis was used to calculate the best cut-off SWE value for differentiating malignancy from benign tissues. Specificity, sensitivity, negative, and positive predictive values (NPV, PPV) were also calculated for cut-off value. RESULTS: Prostate cancer was detected in 74 (14.7%) of 504 core biopsies. The mean SWE values were found significantly higher in malignant cores (71.1 kPa) than benign cores (42.3 kPa) (p < 0.001). Cores with gleason score 7 had a significantly higher SWE value than Gleason score 6 (p = 0.009). The cut-off value to differentiate malignancy and area-under-curve were calculated 35.85 kPa, 0.733, respectively. The sensitivity, specificity, NPV, and PPV were 83%, 49%, 78%, and 95%, respectively for 35.85 kPa value. CONCLUSIONS: The malignant tissues have significantly higher SWE values. Also high gleason score was shown to be associated with high SWE values. To predict the prostate cancer, the difference of SWE values of between benign and malignant tissues has high sensitivity. In the near future, to prevent unnecessary prostate biopsies, SWE will be part of the standard protocol for prostate imaging.

Frequency of Hypoplasia of the Vertebral Body at L5, and Its Relationship with Degeneration in Patients with Low Back Pain.

AIM: To explain the association between vertebral body hypoplasia and degenerative changes in the discovertebral complex and facet joints, and to assess the incidence of hypoplasia of the vertebral body at the L5 level. MATERIAL AND METHODS: A retrospective analysis was made of 3,100 patients aged 20?50 years who underwent lumbar MRI with a complaint of back pain, of which 55 were identified with vertebral body hypoplasia. Intervertebral disc degeneration was evaluated in the study using the Pfirrmann and Modified Pfirrmann classification systems, while degenerative changes in the vertebrae endplate were assessed using the Modic classification system. Osteoarthritis of the facet joint was graded at the L4-5 level, and spondylolysis and spondylolisthesis rates were compared between the control group and the hypoplasic group. RESULTS: The incidence of hypoplasia of the vertebral body at the L5 level was found to be 1.8% in the population with back pain in the 20?50-year age group. In the hypoplasia group, disc degeneration was detected at a higher rate than in the control group (p < 0.001). The distribution of Modic signal changes in the superior and inferior endplates of the vertebrae differed significantly between the hypoplasia and control groups (p < 0.001).The rate of spondylolysis was 7.7% in the control group and 65.5% in the hypoplasia group (p < 0.001), and spondylolisthesis was significantly more common in the hypoplasia group (18.4%, p < 0.001). In addition, facet joint degeneration was identified more frequently in the hypoplasia group. Degenerative findings were detected in 74.5% of the right posterior intervertebral joints, and in 70.9% of the left posterior intervertebral joints in the hypoplasia group. CONCLUSION: Vertebral body hypoplasia is a predisposing factor for disc degeneration, facet osteoarthritis and degeneration in the vertebral endplates, and has also been associated with spondylolysis and spondylolisthesis.

Normative Measurements and Apparent Diffusion Coefficient Values of Parotid Lymph Nodes on Magnetic Resonance Imaging.

OBJECTIVE: To determine the morphological features and apparent diffusion coefficient (ADC) values of normal intraparotid lymph nodes (IPLNs) obtained from the MRI examination. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Radiology, Ankara, Turkey, from January 2018 to December 2021. METHODOLOGY: The study included 232 patients who underwent neck MRI examination. The long axis diameter (LAD) was measured as the largest diameter of the IPLN, and the short axis diameter (SAD) was measured perpendicular to the LAD. ADC measurements were undertaken by placing the largest region of interest suitable for the size of the IPLNs. RESULTS: A total of 394 lymph nodes were evaluated. The median LAD and SAD of the lymph nodes were 5.50 (2.50) mm and 3.50 (2.00) mm, respectively. The LAD was 9 mm or lower in 95.7% of the lymph nodes; the SAD was 6 mm or lower in 94.7%. The ADC map was evaluated in 275 IPLNs, with the median ADC value being calculated as 0.77(0.18)x10-3 mm2/s. The ADC value was 1.05x10-3 mm2/s or lower in 96.3% of the lymph nodes. CONCLUSION: A SAD of 6 mm; and a LAD of 9 mm could be used as normalcy criteria in IPLNs. Normal IPLNs may have an ADC of 1.05x10-3 mm2/s or lower. Considering that benign IPLNs may have low ADC values, those can prevent false-positive results in terms of malignancy. KEY WORDS: Parotid glands, Lymph nodes, Magnetic resonance imaging, Apparent diffusion coefficient.

Frequency of Ipsilateral Axillary Lymphadenopathy After the Inactivated COVID-19 Vaccine.

OBJECTIVE: During COVID-19 vaccine development studies, vaccines' efficacy and safety profiles should be carefully investigated. Only a few studies have shown that the COVID-19 vaccine can cause axillary lymphadenopathy on the injection arm. This study aimed to investigate the incidence of axillary lymphadenopathy and imaging findings using B-mode and Doppler ultrasonography (US) examinations in volunteers who had recently been vaccinated against COVID-19. METHODS: The ipsilateral and contralateral axillae of 101 volunteers who received the COVID-19 vaccine were evaluated using B-mode and Doppler US examinations. The volunteers were asked when and to which arm the vaccine had been applied, and the type and dose of the vaccine were recorded. It was also questioned whether the individual experienced any side effects after vaccination, such as pain, tenderness, fever, and redness at the injection site. In addition, the demographic data of the participants, such as age and gender, were recorded. RESULTS: The B-mode US examinations revealed that the long- and short-axis diameters, size, cortical thickness, and asymmetric cortical thickening of the left axillary lymph nodes were significantly higher compared to the right side in individuals having received the CoronaVac vaccine (p<0.05). When the individuals were evaluated separately according to gender, the frequency of cortical thickness and asymmetric cortical thickening in the left axillary lymph nodes was higher than on the right side in both males and females (p=0.011). CONCLUSION: It should be kept in mind that ipsilateral reactive lymphadenopathy may develop after the COVID-19 vaccine. This knowledge can prevent unnecessary axillary lymph node biopsies.

Fetal posterior cerebral artery duplication, true fetal posterior cerebral artery variation and trifurcation anterior cerebral artery association.

We would like to present a case with fetal posterior cerebral artery duplication and anterior cerebral artery trifurcation, which we detected using magnetic resonance angiography. We believe this is the first case defined in the literature. Embryological explanation of posterior cerebral artery variations is discussed in light of the literature.

Relationship between Abdominal Aortic Calcification, Abdominal Adiposity, and Liver Density.

OBJECTIVE: To identify any relationship among visceral adipose tissue area (visceral FA), liver density (liver HU), psoas muscle area (psoas MA), waist circumference (WC) and the presence and severity of abdominal aortic calcific atherosclerosis (AAC). STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Ankara Kecioren Training and Research Hospital, Ankara, Turkey, from January to February 2019. METHODOLOGY: This study included 316 patients, who had CT performed for urolithiasis investigation. For all patients, the presence and grade of AAC was recorded. Then, liver HU, spleen density (spleen HU), psoas MA, visceral FA, total abdominal fat area (total FA), subcutaneous fat area (subcutaneous FA), WC and hip circumference (HC) were measured on a workstation. RESULTS: AAC was present in 127 patients (40.2%). The age, visceral FA, total FA, visceral FA/total FA ratio, WC and WC/HC ratio of patients with AAC were significantly higher than for patients without AAC (p <0.05). Psoas MA was significantly lower in patients with AAC (p <0.05).  The cut-off value of visceral FA for the prediction of AAC was 131 cm2. The risk for AAC was 4.5 times higher in the group with visceral FA >131 cm2 (p <0.001). There were significant correlations between AAC grade and liver HU and spleen HU (p = 0.002 and p = 0.001, respectively). However, there was no significant correlation between AAC grade and liver HU/spleen HU ratio (p = 0.741). CONCLUSION: Psoas muscle area, visceral adiposity and waist circumference can be used to predict abdominal aortic calcification. Key Words: Visceral adipose tissue, Subcutaneous adipose tissue, Fatty liver.

An assessment of the relationship between thyroid nodule characteristics, insulin resistance and arterial stiffness in euthyroid nodular goiter.

OBJECTIVES: Publications suggesting that thyroid nodule might be associated with insulin resistance and metabolic syndrome are quite interesting. There is a need for studies assessing the relationship between nodule presence and cardiovascular risk in individuals with non-functioning nodular goiter. The purpose of the present study is to reveal whether or not insulin resistance, nodule presence, and nodule stiffness affect arterial stiffness, which is a reliable and valid cardiovascular risk indicator, in individuals with euthyroid nodular goiter using the pulse wave analysis (PWA). MATERIALS AND METHODS: 50 patients with euthyroid nodular goiter and 50 healthy volunteers were included in the study. All participants were examined by B-mode thyroid ultrasound, and the participants in the nodular goiter group were also examined by strain elastography (SE). The strain index of nodules was calculated according to the Rago scoring. Also, fasting plasma glucose (FPG) and insulin levels were measured, and HOMA-IR. Arterial stiffness measurements of the participants were performed using a PWA device which employs a cuff-based oscillometric method from the brachial artery. RESULTS: PWV was found to be significantly higher in the euthyroid nodular goiter group (p < 0.001). PWV was found to be positively correlated with FPG and waist circumference. Fasting plasma glucose was found to be higher in the group with nodular goiter (p = 0.03). However, no difference was found between the groups in terms of HOMA-IR and insulin level. HOMA-IR was not correlated with thyroid volume, nodule volume, and nodule count. Also, HOMA-IR was not correlated with strain index value and PWA data. CONCLUSION: We found that PWV was significantly higher in patients with euthyroid nodular goiter. This result suggests that these patients may be at risk for cardiovascular disease.

Aneurysmal bone cyst of the calcaneus.

Aneurysmal bone cysts (ABCs) are benign, non-neoplastic, expansile, vascular, locally destructive lesions. The lesion may arise de novo (65%) or secondarily (35%) in pre-existing benign or malignant lesions (giant cell tumor, osteoblastoma, chondroblastoma, angioma, and others). The calcaneus is a rare localization for ABC, comprising only 1.6% of the cases. In this paper, we present a case of a female patient with a 3-month history of heel pain that got worse and was accompanied by swelling and difficulty in walking. The magnetic resonance images of the postero-lateral calcaneus showed a contrast-enhanced cystic lesion located in the medullary cavity; exophytic portion of the tumor extended into the soft tissue causing distinctive cortical thinning. Heterogeneous hyperintense septae formations and blood level components were also detected. After correlation with pathology results, the lesion was diagnosed as an ABC. Since an ABC of the calcaneus is a rarely seen phenomenon, we present the radiologic findings in this case and a review of the literature.

Ewing's Sarcoma of the Finger.

Ewing's sarcoma is a mesenchymal cell tumor usually seen in long bones but very rarely seen in the bones of a finger. Swelling and pain are the most common complaints of the affected finger. In radiological imaging, it may be seen as permeative bone destruction accompanied by a soft tissue component or an expansile bone lesion. A 27-year-old right-hand dominant female patient presented with a swelling on the proximal phalanx of her right 3(rd) finger that had existed for 3 years. However, the mass started to gradually increase in size and the pain worsened over a period of 5 weeks. The mass was excised under regional intravenous anesthesia and Ewing's sarcoma was confirmed following a histopathological evaluation. No local recurrence or metastasis was detected 1 year after surgery. Since Ewing's sarcoma is rarely seen in the finger, we present this case with its radiological and clinical findings.

A rare cystic lesion of the neck: parathyroid cyst.

Parathyroid cysts are rarely observed neck masses. Their physical examination is not specific and preoperative diagnosis is usually difficult. Imaging findings and ultrasound-guided fine-needle aspiration with hormone analysis evaluation are important diagnostic criteria. A 48-year-old female patient admitted to our hospital with a symptom of swelling on the left side of the neck was diagnosed with parathyroid cyst by imaging methods (ultrasonography, MRI, parathyroid scintigraphy) and laboratory findings. Fine-needle aspiration biopsy was performed and because of relapse on the follow-up sclerotherapy was planned. Our aim in this study was to present the radiological findings of this case of parathyroid cyst.

Giant intrascrotal lipoma.

Intrascrotal lipomas are rarely seen. Scrotal lipomas originate from the spermatic cord. We present a 64-year-old male patient, in the light of the literature, with painless swelling on the left half of the scrotum, histopathologically diagnosed with scrotal lipoma.

Surgical Measurement of the Sphenoid Sinus on Sagittal Reformatted CT in the Turkish Population.

OBJECTIVE: The objectives of this study were to determine sinus measurements specific for the Turkish population using CT sagittal thin-slice reconstruction images and to clarify the three-dimensional anatomical features of the sphenoid sinus, along with its surrounding structures, that are relevant to performing an endoscopic sphenoidotomy. MATERIALS AND METHODS: Images of 300 patients (165 female, 135 male) were studied. The research was conducted on the axial plane with a 1 mm slice thickness and a 0.6 mm slice interval, and sagittal reconstruction was performed with a 0.4 mm slice interval. Measurements of the sinus were obtained, and the presence of Onodi cells was researched. RESULTS: Line 1 was found to be significantly shorter in the Turkish patients of this study compared to studies of other populations. Lines 4 and 6 were found to be longer on the left side (Line 4 right: 18.8±3.6 mm, left: 19.3±3.4 mm, p=0.027; Line 6 right: 24.1±6.8 mm, left: 24.3±6.8 mm, p=0.008). Lines 2, 3, 4 and 6 were longer in men than in women (p<0.05). CONCLUSION: In the Turkish population, Line 1 is shorter, so the risk of skull base perforation is greater. Lines 4 and 6 are longer on the left side; thus, choosing the left ostium in sinus dilation is safer. Because of sex differences regarding Lines 2, 3, 4 and 6, sex should be considered in sphenoid sinus procedures.

An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography.

OBJECTIVE: To determine the Keros classification and asymmetrical distribution rates of the ethmoid roof and the frequency of anatomic variations of the paranasal sinuses. MATERIALS AND METHODS: Paranasal sinus scans of 500 patients obtained using computed tomography were evaluated retrospectively. Measurements were performed using a coronal plan with right-left comparison and with distance measurement techniques. The depth of the lateral lamella was calculated by subtracting the depth of the cribriform plate from the depth of the medial ethmoid roof. The results were classified according to their Keros classification. Any asymmetries in the ethmoid roof depth and fovea ethmoidalis configuration were examined. The anatomic variations frequently encountered in paranasal sinuses (pneumatized middle concha, paradoxical middle concha, agger nasi cells, Haller cells, Onodi cells, etc.) were defined. RESULTS: The mean height of the lateral lamella cribriform plate (LLCP) was 4.92±1.70 mm. The cases were classified as 13.4% Keros Type I, 76.1% Keros Type II, and 10.5% Keros Type III. There was asymmetry in the LLCP depths of 80% of the cases, and a configuration asymmetry in the fovea in 35% of the cases. In 32% of the cases with fovea configuration asymmetry, there was also asymmetry in the height of the right and left LLCP. The most frequent variations were nasal septum deviation (81.8%), agger nasi cells (63.8%), intralamellar air cells (45%), and concha bullosa (30%). CONCLUSION: Using the Keros classification for LLCP height, higher rates of Keros Type I were found in other studies than in our study. The most frequent classification was Keros Type II. The paranasal sinus variations in each patient should be carefully evaluated. The data obtained from these evaluations can prevent probable complications by informing rhinologists performing endoscopic sinus surgery about preoperative and intraoperative processes.

A case of swyer-james-macleod syndrome associated with middle lobe hypoplasia and arteriovenous malformation.

A 58-year-old female patient presented to the hospital with hearing loss. In the chest radiography obtained before her ear surgery, volume decrease in the right hemithorax, elevation of the right diaphragm, and increase of ventilation in the right lung were detected. At the thorax CT-CT angiography, hypoplasia of the main pulmonary artery and its branches and arteriovenous malformation localized in the middle lobe of the right lung were detected. Thus, diagnosis of Swyer-James-Macleod syndrome associated with right lung middle lobe hypoplasia and arteriovenous malformation was made. This kind of association has not been reported earlier, so we are presenting it in the light of the literature knowledge.