Pulmonary functions and life quality assessment results two years after COVID-19 comparison with the sixth month results.

INTRODUCTION: We aimed to investigate the effects of COVID-19 on patients 24 months after severe COVID-19 pneumonia. METHODOLOGY: Fifty-four patients with severe COVID-19 pneumonia were evaluated on the 24th month after discharge from the hospital. Spirometry and short form of health-related quality of life scale (SF-36) were used. Chest computed tomography (chest-CT) was performed and the findings were grouped according to lung involvement. RESULTS: Forced expiratory volume in 1 second (FEV1) % values of 19 patients (35.18%) and forced vital capacity (FVC) % values of 23 patients (42.54%) were found lower than expected on the 24th month. Physical function, energy-vitality, social functionality and general health parameters were found lower than normal on the SF-36 scale. 27 (50.00%) patients had a chest-CT abnormality. There was a correlation between FEV1% and FVC% values and group 3: medium-lower lobe dominant, reticulation + traction, 10-50% surface area. Chest-CT of 6 patients was fully recovered. No correlation was found between chest-CT findings on the 24th month and BMI, length of hospitalization, white blood cell (WBC), lymphocyte, C-reactive protein (CRP), ferritin and D-dimer values at the time of hospitalization. CONCLUSIONS: Functional and radiological abnormalities were detected in a significant number of patients on the 24th month. A systematic monitoring plan must be established to assess and properly manage the long-term problems that may arise.

Split Bolus Method in Computerized Tomography.

The split-bolus method in computed tomography (CT) is the method used in the evaluation of renal dynamic enhancement stages and in the detection of pathologies. When designing the CT urography technique, there are several important options such as single-bolus and split bolus techniques. The single-bolus method consists of three separate post-contrast phases: arterial, nephrographic, and excretory (pyelogram), as a result raising the total radiation dose imparted to patients. On the other hand, in the split-bolus technique, the contrast dose is divided into several separate administrations to obtain the nephrographic and excretory phases simultaneously. With the split-bolus technique, by reducing the radiation dose and the number of phases that the patient will be exposed to, urinary system evaluation and the whole abdomen pathological evaluations can be performed. The device to be used in imaging must be a tomography device with at least 16 Multidetector CT sections. The bolus tracking method is one of the most accurate contrast delivery methods for renal dynamics and the split-bolus technique. Automatic dose calibration is used.

Multidetector Computer Tomography Angiography Protocol in the Context of Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation is a procedure in the context of non-suitable for open surgery. Measurements of aortic root width, aortic valve surface area, and measurements of the aortic tree, coronary vessels, femoral, and subclavian arteries are of critical importance. In the TAVI procedure, the dimensions of the valve to be placed on the patient are determined by the computed tomography method. Appropriate protocols should be selected for coronary scoring and inclusion of coronary arteries in TAVI imaging and after the shooting, images of coronary arteries such as curved MPR and VRT should be processed, and these images should be prepared to guide the physician who will perform the procedure. The device to be used in imaging must be a tomography device with at least 64 MCDT sections. There are two methods for these shots using ECG triggering. These methods are as follows: Retrospective scan and prospective scan. Bolus tracking method for TAVI imaging is one of the most accurate contrast giving methods that can be used. Automatic dose calibration is used. With the success of the method day by day, the importance of "Computerized Tomography TAVI," which guides physicians during the method, has increase.

Frequency and Clinical Significance of Incidental Findings Detected in Internal Acoustic Canal Magnetic Resonance Imaging of Patients with Audiovestibular Symptoms.

Objectives: Retrocochlear pathology associated with audiovestibular symptoms is detected in very few of the patients, and most of the internal acoustic canal magnetic resonance imaging examinations (IAC-MRIs) are either completely normal or include accompanying incidental findings (IFs). The aim of our study is to reveal the presence and frequency of IFs in IAC-MRIs, together with retrocochlear lesions. In addition, we intend to emphasize the clinical importance of these IFs. Methods: A retrospective analysis of 374 serial IAC-MRI scans. Results: Gender distribution: 201 males and 173 females. Age range: 2-82 years. Seventy-two scans (19.25%) were totally normal. Fifteen scans (4.01%) demonstrated only pontocerebellar angle findings (PCAFs). The presence of PCAF and IF was together in 57 scans (15.24%). In 230 (61.50%) of the scans, only IFs were present. The incidence of IFs in all IAC-MRIs was 76.74% (287 of 374). Critical findings that may require clinical further evaluation and examination were present in 34 scans (9.09%). IFs that did not require further examination were observed in 253 scans (67.65%). Conclusion: Various IFs can be detected with IAC-MRI that may cause similar symptoms with PCAF. And unfortunately, some of these IFs may be of very high clinical importance. All referral clinicians should know well that these audiovestibular symptoms can appear as IFs anywhere in the auditory pathway, and how they should be followed in their clinical approach.

Comparison of chest computed tomography findings of RT-PCR negative and RT-PCR positive cases in COVID-19 patients.

OBJECTIVE: The purpose was to compare the results of the RT-PCR test, with the findings of Chest CT and to determine the features of CT for the diagnosis of COVID-19 and how to approach RT-PCR negative patients. MATERIAL METHOD: Chest CT findings of 569 COVID-19 diagnosed patients, followed up at the pandemic wards between March and June 2020 were retrospectively examined. Patients were grouped according to RT-PCR results, gender, and age. RESULTS: 284 (49%) were RT-PCR(+), 285 (50.8%) were RT-PCR(-) of total 569 patients. 11 (1.9%) of RT-PCR(+) had no involvement in Chest CT while all the RT-PCR(-) patients were CT(+). The distribution of lesions in CT were; 544 (95.6%) bilateral, 553 (97.2%) multilobar, 557(98%) peripherally 151 (26.5%) posteriorly localized. The most common findings were; 539 (94.7%) ground-glass opacity (GGO), 365 (64.1%) consolidation, 160 (28.1%) crazy paving interlobular septal thickening. CO-RADS mean value was 5.4 ± 0.7. GGO and reticulation in RT-PCR(-) patients were 280 (98.2%) and 24 (8.4%); while they were 259 (91.2%) and 12 (4.2%) in RT-PCR(+) patients, were significantly higher (p < 0.05). No significant difference was observed, in CT findings for gender. Only the findings of crazy paving interlobular septal thickening and reticulation in 18-64 age group were significantly higher than that in 65-94 age group, 105 (24.8%)-55 (37.9%), 19 (4.5%)-17 (11.7%) respectively (p < 0.05). CONCLUSION: The typical findings of COVID-19 pneumonia in Chest CT are: GGO, consolidation and crazy paving in bilateral, peripheral, posterior localization. CT plays an essential role for diagnosis, isolation and treatment in cases of COVID-19 and RT-PCR negative test should be verified by CT.

The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes.

PURPOSE: This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes. METHODS: Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value. RESULTS: The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%). CONCLUSIONS: US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.

Retrospective Evaluation of Ileocolic Artery and Vein Diameters according to Body Mass Index in the Diagnosis of Acute Appendicitis on Multislice Computerized Tomography.

OBJECTIVES: We aimed to investigate the diagnostic value of the increasement in the ileocolic artery and vein diameters considering the body mass index (BMIs) of the patients with acute appendicitis. METHODS: Between January 2016 and April 2019, 76 patients who were diagnosed with acute appendicitis by contrast-enhanced abdominal multislice computerized tomography (MSCT) and had histopathologically confirmed appendicitis after an appendectomy were included in this study. To evaluate the value of MSCT, we created a control group, which consisted of 81 patients who had contrast-enhanced MSCT for other reasons and had no clinical and radiological findings suspicious for acute appendicitis and also had no other abdominal pathology that might interfere with ileocolic artery and vein diameter. In both groups, ileocolic artery and vein diameters were measured in axial MSCT scan. The body mass index was calculated for each patient (kg/m2). Both groups were divided into three subgroups according to the BMI of patients (20-24.9; 25-29.9 and more than 30). Both groups and subgroups were compared individually. Statistical significance level was accepted as p <0.05. RESULTS: Ileocolic artery and vein diameters were higher in the patient group than control group, which was statistically significant (p<0.001), and a positive correlation was found between BMI and ileocolic artery and vein diameters (p < 0.001). CONCLUSION: Ileocolic artery and vein diameters with taking BMI into consideration can be used as alternative criteria in the suspicion of acute appendicitis in adults.

Evaluation of long-term radiological findings, pulmonary functions, and health-related quality of life in survivors of severe COVID-19.

OBJECTIVE: It was aimed to evaluate long-term radiological changes in severe coronavirus disease 2019 (COVID-19) patients, to investigate pulmonary function, exercise capacities, and health-related quality of life results. METHODS: Sixty-five patients with severe COVID-19 pneumonia were evaluated in the sixth month after discharge from the hospital. Spirometry, 6 min walking test (6MWT), and short form of health-related quality of life scale (SF-36) were applied in the sixth month. Chest computed tomography (CT) was performed and the findings were grouped according to lung involvement. RESULTS: Forty-nine male and 16 female patients were included in the study. Forced expiratory volume in 1 s (FEV1)% values of 18 patients (30.5%), forced vital capacity (FVC)% values of 27 patients (45.8%), and 6MWT of 13 patients (23.2%) were found lower than expected in the sixth month. On the SF-36 scale, physical function, energy-vitality, social functionality, pain, and general health parameters were found lower than normal. Minimal interstitial changes in chest CT were seen in 26 patients. Nine patients had lung area involvement between 10% and 50% of the surface, there was a correlation between FEV1% and FVC% values in this group. There was severe pulmonary fibrosis in four patients. There was a correlation between pulmonary function and physical function and general perception of health from SF-36 scale subparameters. CONCLUSION: Functional and radiological abnormalities were detected in a significant number of patients in the sixth month after severe COVID-19 pneumonia. A systematic monitoring plan must be established to assess and properly manage the long-term problems that may arise.

MRI as a Aiagnostic Tool for Paroxysmal Nocturnal Hemoglobinuria: A Case Report.

Paroxysmal nocturnal hemoglobinuria (PNH) is a type of hematopoietic stem cell disease and the clinical manifestation of the disease is mainly a combination of anemia and thrombosis. Intravascular hemolysis in PNH leads to hemosiderosis in renal cortex as a rare pattern of hemochromatosis. With this case presentation, we aim to show the radiological findings of this disease.

Comparison of the prognostic value of F-18 FDG PET/CT metabolic parameters of primary tumors and MRI findings in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy.

PURPOSE: To evaluate the effect of metabolic parameters of pretreatment primary tumor and regional lymph nodes with F-18-FDG PET/CT compared with MRI findings for the prognostic value and disease-free survival (DFS) in locally advanced cervical cancer. MATERIAL AND METHODS: From 2011 to 2016, 112 patients with a diagnosis of cervical cancer stages IB2-IVA treated with concomitant chemoradiation therapy with 3D intracavitary brachytherapy were analyzed. From this group, 50 patients who underwent pretreatment and posttreatment FDG PET/CT and MRI were enrolled. LRFFS, DFS, and overall survival were analyzed in comparison with FDG PET/CT and MRI data. Relationship between SUVmax data and DFS was also assessed. RESULTS: The median followup was 21 months, and median age was 54 years. The estimated 5-year locoregional failure-free survival, DFS, and overall survival rates were 87.4%, 70%, and 81%, respectively. DFS was 59.5% in patients with nodal metastases in FDG PET/CT and 100% in node negative patients (p:0,017). DFS was 50% and 79.4% in MRI node-positive and in node-negative patients, respectively (p:0,260). In addition, the nodal SUVmax (p: 0.005) and posttreatment response in FDG PET-CT (p < 0.001) were significant prognostic factors for DFS. Furthermore, primary tumor volume in MRI (p:0,982), node positivity in MRI (p:0,301), and response in posttreatment MRI (p:0,26) are not significant prognostic factors for DFS. CONCLUSION: As a result, FDG PET/CT has higher accuracy than MRI in detecting lymph node metastasis, and tumor volume reduction on FDG PET/CT images was greater than that on MRI images after CCRT.

The correlation between biological activity and diffusion-weighted MR imaging and ADC value in cases with prostate cancer.

PURPOSE: Firstly, we aimed to investigate the correlation among dynamic contrasted magnetic resonance (MR) images, diffusion-weighted MR images, and apparent diffusion coefficent (ADC) values in patients with prostate cancer. Secondly, we aimed to investigate the roles of these variables on clinical risk classification and the biological behavior of the prostate cancer. METHODS: A total of sixty with prostatic adenocarcinoma patients diagnosed between January 2011 and May 2013 were retrospectively included in the study. Risk classification of patients were evaluated as low-risk (Group 1) (n = 20) (Stage T1c-T2a, PSA < 10 ng/ml, Gleason Score < 7), moderate-risk (Group 2) (n = 18) (Stage T1b-T2c, PSA = 10-20 ng/ml, Gleason Score = 7) and high-risk (Group 3) (n = 22) (Stage > T3a, PSA > 20 ng/ml, Gleason Score > 7). Diffusion-weighted MR images, dynamic contrasted MR images, and ADC values of the prostates were correlated. RESULTS: ADC values of the cases in Group 3 were lower than those of the other groups (p < 0.001). ADC values of the areas without malignancy did not differ significantly between groups (p > 0.05). Biological activity of the tumor tissue was determined by GS, while a negative correlation was observed between GSs and ADC values of the patients, (p < 0.001). CONCLUSION: In tumors with higher Gleason scores, lower ADC values were obtained. These measured values can play a role in the noninvasive determination of the cellularity of the tumoral mass.

CT-angiography protocol with low dose radiation and low volume contrast medium for non-cardiac chest pain.

AIM: To evaluate the diagnostic quality of a new multiple detector-row computed tomography angiography (MDCT-A) protocol using low dose radiation and low volume contrast medium techniques for evaluation of non-cardiac chest pain. METHODS: Forty-five consecutive patients with clinically suspected noncardiac chest pain and requiring contrast-enhanced chest computed tomography (CT) were examined. The patients were assigned to the protocol, with 80 kilovolt (peak) (kV[p]) and 150 effective milliampere-second (eff mA-s). In our study group, 40 mL of low osmolar contrast material was administered at 3.0 mL/s. RESULTS: In the study group, four patients with pulmonary embolism, four with pleural effusion, two with ascending aortic aneurysm and eight patients with pneumonic consolidation were detected. The mean attenuation of the pulmonary truncus and ascendant aortic locations was considered 264±44 and 249±51 HU, respectively. The mean effective radiation dose was 0.83 mSv for MDCT-A. CONCLUSIONS: Pulmonary artery and the aorta scanning simultaneously was significantly reduced radiation exposure with the mentioned dose saving technique. Additionally, injection of low volume (40 cc) contrast material may reduce the risk of contrast induced nephropathy, therefore, facilitate the diagnostic approach. This technique can be applied to all cases and particularly patients at high risk of contrast induced nephropathy due to its similar diagnostic quality with a low dose and high levels of arteriovenous enhancement simultaneously.

Diffusion Weighted MRI for Hepatic Fibrosis: Impact of b-Value.

BACKGROUND: Hepatic fibrosis is a typical complication of chronic liver diseases resulting in cirrhosis that remains a major public health problem worldwide. Liver biopsy is currently the gold standard for diagnosing and staging hepatic fibrosis. Percutaneous liver biopsy; however, is an invasive procedure with risks of complications. Therefore, there is need for alternative non-invasive techniques to assess liver fibrosis and chronic liver diseases. In recent years, MRI techniques, including diffusion weighted imaging (DWI), have been developed for in vivo quantification of liver fibrosis. OBJECTIVES: The purpose of this study is to evaluate the utility of diffusion weighted MRI in the diagnosis and quantification of the degree of hepatic fibrosis and to investigate the influence of b-value. PATIENTS AND METHODS: Twenty-four patients (13 males, 11 females), with a mean age of 46 years (36-73 years) diagnosed as chronic hepatitis and histopathologically proven liver fibrosis and 22 other patients (8 males, 14 females) with no clinical or biochemical findings of liver disease, with a mean age of 51.2 years (32-75 years) were included in the study. All patients with chronic hepatitis underwent percutaneous liver biopsy by an experienced hepatologist without sonographic guidance. The Knodell histology activity index (HAI) for grading of necroinflammatory changes and Metavir scoring system for staging of the liver fibrosis were used to record the severity of the disease. All patients were examined with a 1.5 Tesla MRI system and the patients underwent diffusion weighted imaging (DWI) with a routine hepatic MRI protocol. Different b-values including 250, 500, 750, and 1000 sec/mm (2) were used to calculate apparent diffusion coefficients. RESULTS: We detected decreased apparent diffusion coefficient values in patients with hepatic fibrosis compared to patients without chronic hepatitis and there was a trend toward decrease in hepatic apparent diffusion coefficient values with an increasing degree of fibrosis. CONCLUSIONS: Our findings suggest that hepatic apparent diffusion coefficient measurement with a b-value of 750 sec/mm (2) or greater is useful in accurate quantification of liver fibrosis and necroinflammation.

Accuracy of ultrasonography in the diagnosis of sliding hiatal hernias.

RATIONALE AND OBJECTIVES: Diagnostic measures that can be used for sliding hiatal hernia are barium swallow radiography, endoscopy, manometry, and computed tomography. The aim of this study was to evaluate the diagnostic accuracy of transabdominal ultrasonography for sliding hiatal hernias. MATERIALS AND METHODS: This retrospective study was performed in the radiology department of a tertiary care center between May 2011 and May 2012. Twenty-one patients (10 females, 11 males) with sliding hiatal hernias and 41 controls (37 females, 4 males) were enrolled in this study. Esophageal hiatal diameters measured by ultrasonography and computerized tomography were compared. Correlation was tested via Pearson correlation analysis. RESULTS: The average age of patients and controls were 58.6 and 40.1, respectively. There was a statistically significant difference between esophageal hiatal diameters measured via ultrasonography in patients (31.7 mm) and controls (11.6 mm) (P < .001). Similarly, esophageal hiatal diameters measured via computed tomography in patients (31.4 mm) was statistically significantly higher than controls (11.5 mm) (P < .001). The average body mass index of patients (28.3) was higher than that of control group (P = .015). Ultrasonographic measurements were correlated well with tomographic results (P = .000, r = 0.995). CONCLUSION: Ultrasonography seems to be a valuable, safe, and practical alternative that avoids the side effects of contrast agents in the diagnosis of sliding hiatal hernias. Overall, we suggest that inclusion of ultrasound in the initial diagnostic steps for patients with sliding hiatal hernias may reduce the requirement for more expensive procedures.

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results.

PURPOSE: This study evaluated the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperative differentiation of T2 tumors from T3 tumors so the appropriate treatment can be applied. MATERIALS AND METHODS: Twenty-four patients with primary rectal cancer were examined preoperatively using 1.5 T MRI with a phased-array coil. Multiplanar T2-weighted images were obtained. Rectum anatomy, depth of tumor invasion, mesorectal involvement and lymph nodes were assessed. All patients underwent radical surgery. The histological sections were evaluated microscopically. The correlation of magnetic resonance imaging and histopathology was assessed using the kappa statistic. Overstaging with MRI was compared with Fischer's exact test. RESULTS: Histopathological examination of the tumors revealed adenocarcinoma. When the tumors were staged, there was one patient with a pT1 tumor, six patients with pT2 tumors, and 17 patients with pT3 tumors. Using MRI, four patients with pT2 were overstaged as T3, and one patient with pT3 was overstaged as T4. In the remaining cases (one pT1, two pT2, and 16 pT3), MRI correctly assessed the stage of transmural invasion. The accuracy of T staging and metastatic lymph node detection with MRI was calculated as 79.2% and 58.5%, respectively. CONCLUSION: Phased-array MRI is a valuable technique for the preoperative staging of rectal cancer, especially in the differentiation of T2 and T3 tumors.

Prevention of deep venous thrombosis and pulmonary embolism in patients with acute intracerebral hemorrhage.

OBJECTIVES: Although patients with intracerebral hemorrhage (ICH) are at risk for deep venous thrombosis (DVT), the data about preventive options for DVT prophylaxis in this population is insufficient. We investigated the safety of low dose low molecular weight heparin (LMWH) for DVT prophylaxis in patients with ICH and the effect of heparin on the enlargement of hemorrhage. METHODS: We prospectively randomized 75 primary ICH patients to subcutaneous LMWH (Enoxaparin sodium 40mg/d) or long compression stockings (CS) after the first 48 hours. All patients had cranial computed tomography (CT) scan at admittance, 24th and 72nd hours, seventh and 21st days, CT pulmonary angiography and bilateral lower extremity venous Doppler at 7th day. Hematoma volumes were calculated on the initial and follow-up CTs with ABC/2 method. RESULTS: Mean +/- SD age of the patients was 68.1 +/- 11.98 and 66.08 +/- 9.55 in LMWH and CS groups, respectively. Twenty-two of LMVH group and 8 of CS group were female. After randomization to LMWH or CS, we did not observe any hematoma enlargement at 72nd hours, 7 and 21st days in both groups. In addition, there was not any other systemic bleeding complication in LMWH group. We detected 4 asymptomatic DVT in our patients (3 in LMWH and 1 in CS group). Although asymptomatic DVT was more common in LMWH group, it was not statistically significant (P = 1). CONCLUSIONS: Low dose heparin treatment after 48 hours of stroke in ICH patients is not associated with an increased hematoma growth and should be used for DVT and PE prophylaxis.

Sixteen-slice multidetector computed tomographic virtual cystoscopy in the evaluation of a patient with suspected bladder tumor and history of bladder carcinoma operation.

PURPOSE: The purpose of this study was to evaluate the use of virtual cystoscopy performed with multidetector computed tomography (CT) in patients with suspected bladder tumors and histories of bladder carcinoma operation. MATERIAL AND METHODS: Thirty-six patients (29 men and 7 women) with a mean age of 66 years (range, 24-88 years) with suspected bladder tumors and histories of bladder carcinoma operation were included in this prospective study. Virtual cystoscopy was performed by 16-slice multidetector CT scanner. The bladder was filled with diluted contrast material solution through a Foley catheter. Then, all patients underwent conventional cystoscopy examination. RESULTS: Two reviewers found 18 lesions detected by virtual cystoscopy by consensus, whereas 19 lesions were depicted by conventional cystoscopy. At virtual and conventional cystoscopies, the conditions of 3 patients, 2 with chronic inflammations and 1 with foreign body reaction, were wrongly diagnosed as tumors. At conventional cystoscopy, one patient's result was wrongly interpreted as normal. In pathologic evaluation, all tumors were diagnosed as transitional cell carcinoma. CONCLUSIONS: Bladder tumor can be noninvasively diagnosed using virtual cystoscopy. Use of virtual cystoscopy should be considered inpatients who present with hematuria or have histories of bladder carcinoma operation and are for follow-up because of its lesser complication risk and its being a less invasive, easily applied procedure without need of anesthesia. In the future, owing to the development of the CT technology and image processing technique, virtual cystoscopy may have a part in the detection of bladder cancer.