Evaluation of the relationship between shear wave elastography measurements with laboratory and Doppler US parameters in patients with adult Hashimoto's thyroiditis

Background/aim: Hashimoto thyroiditis (HT) is an autoimmune disease that leads to tissue stiffening secondary to lymphocyte infiltration of the thyroid gland. Gray-scale ultrasound (US) is widely used in its diagnosis. Numerous studies have been conducted comparing elastography findings of HT with tissue stiffness and immunoreactivity levels. This study aims to reveal the relationship between shear wave elastography (SWE) and Doppler parameters in patients with HT. Materials and methods: The study group consisted of 45 patients diagnosed with HT, and 20 control patients without thyroid pathology. Thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) values were examined in patients with HT. Thyroid gland volume and echo patterns were evaluated in the gray-scale US. Doppler measurements ­peak systolic velocity (Vmax), end-diastolic velocity (Vmin), pulsatility index (PI), resistivity index (RI)­ from the superior thyroidal artery and SWE measurements were taken from both thyroid lobes. Results: The mean age of men and women in the HT group was 44.8 and 43.4 years. The mean TSH value (normal value: 0.3­4.2 uIU/ mL) was 3.90 ± 6.6 uIU/mL, and the anti-TPO value (normal value: < 35 IU/mL) was 235.47 ± 271.12 IU/mL. The average thyroid gland volume was 10.12 ± 2.71 mL in the HT group and 6.62 ± 2.11 mL in the control group (P = 0.034). HT group mean Vmax, mean Vmin, mean PI and RI values were significantly lower compared to normal subjects (P = 0.022, P = 0.026, P = 0.042, P = 0.046, respectively). The average SWE value of the thyroid gland was 24.56 ± 18.04 kPa in the experimental group and 7.34 ± 3.54 (P < 0.05) in the control group. Conclusion: A positive correlation was found between PI and RI values and elastography values. An increase in SWE and decreases in Vmax and Vmin were found as high diagnostic value for HT.

Safety and efficacy of flow diverter stents in the treatment of middle cerebral artery aneurysms: a single-center experience and follow-up data

PURPOSE: This study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results. METHODS: The treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches. RESULTS: The mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents. CONCLUSION: MCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations.

Latent class analysis for exploring distribution patterns of primary superficial venous insufficiency.

BACKGROUND: This study aims to identify specific segmental distribution patterns of lower extremity chronic venous disease based on latent class analysis of Doppler mapping results. METHODS: A total of 1,871 lower extremities of 1,218 treatment-naïve patients (536 males, 682 females; mean age 45.4 years; range, 21 to 87 years) with chronic venous disease referred for Doppler examination between September 2009 and August 2018 were included. Refluxing superficial venous segments of the lower extremities were mapped and recorded in database in 10 distinct anatomic locations as follows: saphenofemoral junction and proximal greater saphenous vein, mid and distal thigh greater saphenous vein, anterior and posterior accessory saphenous veins, proximal and distal calf greater saphenous vein, saphenopopliteal junction and proximal lesser saphenous vein, distal lesser saphenous vein, and intersaphenous veins including Giacomini"s vein. Repeated examinations were excluded. The latent class analysis was applied to identify any possible anatomic distribution patterns of chronic venous disease. RESULTS: Bayesian information criteria revealed three latent class models fit for refluxing segment distribution as follows: 58.2% (n=1,089) were above-the-knee greater saphenous vein segments including saphenofemoral junction (pattern 1); 29.3% (n=548) were below-theknee greater saphenous vein segments (pattern 2); and 12.5% (n=234) were lesser saphenous vein segments and intersaphenous veins including Giacomini"s vein (pattern 3). There was no age- or sex-specific differences in the chronic venous disease distribution patterns. CONCLUSION: The latent class analysis, by identifying previously unseen subgroups within the sampled population, provides a new approach to classification of reflux patterns in chronic venous disease. Identification of latent classes may provide understanding of different pathophysiological bases of venous reflux and more optimal planning for interventions.