Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study.

BACKGROUND: Obesity and fatty-liver disease are increasingly common in children. Hepatic steatosis is becoming the most common cause of chronic liver disease during childhood. There is a need for noninvasive imaging methods that are easily accessible, safe and do not require sedation in the diagnosis and follow-up of the disease. OBJECTIVE: In this study, the diagnostic role of ultrasound attenuation imaging (ATI) in the detection and staging of fatty liver in the pediatric age group was investigated using the magnetic resonance imaging (MRI)-proton density fat fraction as the reference. MATERIALS AND METHODS: A total of 140 children with both ATI and MRI constituted the study group. Fatty liver was classified as mild (S1, defined as ≥ 5% steatosis), moderate (S2, defined as ≥ 10% steatosis), or severe (S3, defined as ≥ 20% steatosis) according to MRI-proton density fat fraction values. MRI studies were performed on the same 1.5-tesla (T) MR device without sedation and contrast agent. Ultrasound examinations were performed independently by two radiology residents blinded to the MRI data. RESULTS: While no steatosis was detected in half of the cases, S1 steatosis was found in 31 patients (22.1%), S2 in 29 patients (20.7%) and S3 in 10 patients (7.1%). A strong correlation was found between attenuation coefficient and MRI-proton density fat fraction values (r = 0.88, 95% CI 0.84-0.92; P < 0.001). The area under the receiver operating characteristic curve values of ATI were calculated as 0.944 for S > 0, 0.976 for S > 1 and 0.970 for S > 2, based on 0.65, 0.74 and 0.91 dB/cm/MHz cut-off values, respectively. The intraclass correlation coefficient values for the inter-observer agreement and test-retest reproducibility were calculated as 0.90 and 0.91, respectively. CONCLUSION: Ultrasound attenuation imaging is a promising noninvasive method for the quantitative evaluation of fatty liver disease.

What is the clinical impact of occult HBV infections and anti-HBc positivity in patients with chronic hepatitis C?

Occult hepatitis B infection (OBI) is defined by the persistence of the hepatitis B virus (HBV) genome in the liver of individuals testing negative for hepatitis B surface antigen (HBsAg). Hepatitis B core antibody (anti-HBc) is the serological marker that indicates HBV exposure. The impact of anti-HBc and OBI on patients with chronic hepatitis C remains unclear. The aim of the present study was to determine the prevalence of anti-HBc and OBI and to evaluate their impact on the clinical and pathological outcomes of patients with chronic hepatitis C. The study included 59 HBsAg-negative chronic hepatitis C patients who underwent a liver parenchymal biopsy. The presence of HBV DNA was investigated using an in-house nested PCR method. OBI was detected in 16 (27.1%) of the 59 cases and also in 10 (62.5%) of 22 (37.3%) anti-HBc-positive patients. None of the patients had positive serum HBV DNA. OBI was associated with the presence of anti-HBV antibodies (P < 0.05). There was also an association between anti-HBc positivity and the activity grades and fibrosis stages of the liver and also a prevalence of liver steatosis (P < 0.05). Positive anti-HBc results may predict OBI and may also be associated with the progression of liver injury in HBsAg-negative patients with chronic hepatitis C. Therefore, it is suggested that patients with chronic hepatitis C should be screened for anti-HBc positivity, and anti-HBc-positive patients should be carefully evaluated for disease progression.

Magnetic Probe-Guided Excision of Nonpalpable Neck Lesions.

BACKGROUND: Reoperative neck surgery is technically more demanding because of the presence of scar tissue and distorted anatomy. We aimed to investigate the magnetic probe-guided excision of nonpalpable neck lesions in patients with previously operated neck compartments. METHODS: This study included 9 patients with recurrent/persistent thyroid carcinoma, recurrent/persistent hyperparathyroidism with previously operated neck compartments. The pathologic lesions were localized by ultrasonography, and magnetic tracer (0.2 mL, iron oxide) was injected directly into the pathologic lesions. Careful dissection was carried out following the area of maximum magnetic activity until the nonpalpable lesions were identified and excised. RESULT: All neck lesions were removed in 9 patients. The median count from lesion was significantly higher than values from lesion bed (background activity; (9900/5 seconds vs 250/5 seconds, P < .001). During follow-up, all patients had negative ultrasonography. CONCLUSION: Magnetic probe-guided technique could provide access to nonpalpable lesion localization in centers without readily available access to nuclear medicine facilities.

Imaging Appearances of Paratesticular Fibrous Pseudotumor.

BACKGROUND: In this paper the clinical and radiological features of three cases with paratesticular fibrous pseudotumor were presented after a retrospective analysis of medical archives of our hospital. CASE REPORT: Each of the three cases had unilateral, multiple nodular lesions with smooth borders accompanied by a hydrocele. On sonographic examination, the lesions showed echogenicity similar to, or slightly lower than, the testis, and the two large lesions had posterior acoustic shadowing. Color Doppler ultrasound examination of two cases showed intralesional vascularity of mild-to-moderate degree. All lesions appeared hypointense compared to testicular tissue on T1W and T2W magnetic resonance images. Moderate-to-high enhancement was observed in the diffuse pattern after intravenous injection of contrast material. An intraoperative pathological examination was performed and local excision carried out in all three cases. CONCLUSIONS: Fibrous pseudotumor is a rare benign paratesticular lesion, which can be confused with malignant masses. Imaging procedures play an important role in correct diagnosis. Unfamiliarity with imaging findings of paratesticular fibrous pseudotumor may eventuate in an unnecessary orchiectomy.

The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study.

PURPOSE: This study investigated the sonographic properties of drug packets containing narcotic drugs and the diagnostic role of ultrasonography in detecting body packing in comparison with CT. METHODS: Forty-five suspects admitted to our hospital for diagnosis and management were routinely evaluated by non-contrast CT for the presence of drug packets. A single radiologist blind to CT data independently performed the abdominal ultrasonographic scans. RESULTS: Thirty-five of 45 suspects were carrying packets. In positive cases, two types of packets with different properties were noted. Twenty-eight cases had type 1 packets (solid form drug) and 7 had type 2 packets (liquid form cocaine). The sensitivity, specificity, positive, and negative predictive values of ultrasonography for detecting drug packets were 91%, 70%, 91%, and 70%, respectively. Ultrasonography accurately determined the presence or absence of packs in 39 of 45 suspects. CONCLUSION: Ultrasonography was found to have a high sensitivity but a low specificity in suspected cases. A negative ultrasonography cannot rule out the diagnosis of body packing. However, it may be preferred as the initial imaging method or for follow-up of suspected cases as a radiation-free, easy-to-use, and inexpensive technique.

Fibroadenomatosis involving bilateral breasts and axillary accessory breast tissues in a renal transplant recipient given cyclosporin A.

We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention.

Comparison of Fibroscan, Shear Wave Elastography, and Shear Wave Dispersion Measurements in Evaluating Fibrosis and Necroinflammation in Patients Who Underwent Liver Biopsy.

OBJECTIVE: Our aim was to predict these stages of hepatic fibrosis and necroinflammation using measurements from two-dimensional shear wave elastography (2D-SWE), transient elastography (Fibroscan, TE), and shear wave dispersion (SWD). MATERIALS AND METHODS: In this prospectively designed study, chronic liver patients with nonspecific etiology whose biopsy was performed for up to 1 week were included. Two-dimensional SWE, SWD, and TE measurements were performed. The METAVIR and F-ISHAK classification was used for histopathological evaluation. RESULTS: Two-dimensional SWE and TE were considered significant for detecting hepatic fibrosis. In distinguishing ≥F2, for 2D-SWE, area under the receiver operating characteristics (AUROC) was 0.86 (confidence interval [CI], 0.75-0.96) for the cutoff value of 8.05 kPa ( P = 0.003); for TE, AUROC was 0.79 (CI, 0.65-0.94) for the cutoff value of 10.4 kPa ( P < 0.001). No significance was found for TE in distinguishing ≥F3 ( P = 0.132). However, for 2D-SWE, a cutoff value of 10.45 kPa ( P < 0.001), with AUROC = 0.87 (CI, 0.78-0.97) was determined for ≥F3. Shear wave dispersion was able to determine the presence of necroinflammation ( P = 0.016) and a cutoff value of 15.25 (meter/second)/kiloHertz ([m/s]/kHz) ( P = 0.006) and AUROC of 0.71 (CI, 0.57-0.85) were calculated for distinguishing ≥A2. In addition, a cutoff value of 17.25 (m/s)/kHz ( P = 0.023) and AUROC = 0.72 (CI, 0.51-0.93) were found to detect severe necroinflammation. The cutoff value for SWD was 15.25 (m/s)/kHz ( P = 0.013) for detecting ≥A2 in the reversible stage of fibrosis (F0, F1, and F2), and AUROC = 0.72 (CI, 0.56-0.88). CONCLUSIONS: Two-dimensional SWE and TE measurements were significant in detecting the irreversible stage and the stage that should be treated in hepatic fibrosis noninvasively. Shear wave dispersion measurements were significant in detecting necroinflammation noninvasively.

Detection of body packing by magnetic resonance imaging: a new diagnostic tool?

PURPOSE: In this study, we aimed to describe non-contrast abdominal MRI findings in body packers and emphasize the role of this imaging technique in diagnosis of body packing. MATERIALS AND METHODS: Non-contrast abdominopelvic MRI was performed at the radiology department in 16 suspected body packers that were brought to our hospital, and 13 of them were diagnosed with body packing. We evaluated the presence, location, and shapes of packets as well as signal characteristics on T1- and T2-weighted images. RESULTS: We came across two types of packets: those containing solid substances (10 cases) and those filled with liquid cocaine (3 cases). Both types were accurately diagnosed with the help of MRI. Only 1 suspected body packer received a false positive diagnosis. CONCLUSION: Abdominopelvic MRI is a reliable and valuable method of diagnosing body packing.

Superparamagnetic iron oxide-enhanced magnetic resonance imaging in a case of spleen hamartoma.

OBJECTIVE: To emphasize the contribution of superparamagnetic iron oxide (SPIO) contrast agent in the diagnosis of the splenic hamartoma. CLINICAL PRESENTATION AND INTERVENTION: A 63-year-old female was admitted to our hospital with diffuse abdominal pain. An ultrasound examination revealed a 5 × 4 cm solid lesion in the spleen. Dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of the abdominal findings was consistent with a splenic hamartoma. SPIO-enhanced MRI was then performed and it confirmed the diagnosis. The lesion showed a decrease of signal intensity on T2-weighted images. CONCLUSION: This case showed that SPIO-enhanced MRI was useful for establishing a noninvasive diagnosis of the splenic hamartomas.

Intraperitoneal Ultrasound-Guided Safe Laparoscopic Fenestration of Lymphocele After Kidney Transplantation.

Background: Lymphocele is a common complication after kidney transplantation, which does not require treatment unless it is symptomatic. In this study, we aimed to evaluate the incidence, clinical symptoms, treatment choices, and success of different treatment methods of symptomatic lymphocele. Materials and Methods: We evaluated 168 patients who had kidney transplantation between January 2012 and January 2020. Patients with decreased kidney functions due to lymphocele formation during the clinical follow-up were included in the study. External drainage catheter was placed in all patients, except one. In case of treatment failure with external drainage, laparoscopic fenestration guided by intraperitoneal ultrasonography was performed. Clinical symptoms and success rates of treatments were evaluated. Results: Symptomatic lymphocele requiring interventional treatment was detected in 15 (8.9%) of 168 renal transplant patients. All of the symptomatic lymphocele cases had increased serum creatinine levels, whereas 10 had decreased urine volume, 4 had abdominal discomfort, and 2 had ipsilateral lower extremity edema. External drainage catheter was placed as the first-line treatment in 13 patients. In 6 cases, due to treatment failure with external drainage and in 2 patients as a first-choice treatment, laparoscopic fenestration was performed. No lymphocele recurrence was observed during follow-up. Conclusion: Among various methods defined in the treatment of lymphocele, use of laparoscopic fenestration is increasing because of its high success rate and advantages over other methods. Intraperitoneal ultrasound-guided laparoscopic fenestration is a useful and safe method that can be performed as a first-choice treatment since it eliminates the risk of organ injury or bleeding.

Comparison of S gene mutations in patients with occult and chronic hepatitis B virus infection.

BACKGROUND AND AIM: This study aimed to detect mutations in the HBV S gene and evaluate their relationship to occult hepatitis B virus (HBV) infection (OBI). METHODS: The study included 32 patients with negative serum HBsAg and HBV DNA who underwent liver biopsy due to different clinical indications defined as the OBI group and 32 patients who underwent liver biopsy due to chronic hepatitis B (CHB) as the comparison group. The HBV S gene region was amplified by Nested PCR, and Sanger sequencing was performed. RESULTS: At least one amino acid (aa) mutation was detected in the major hydrophilic region (MHR) of the HBV S gene in 14/32 (43.75%) of the patients with OBI and 8/32 (25.0%) with CHB. The genotype of all patients with OBI and CHB was HBV/D. Although 9 (28.1%) of the cases with OBI had sub-genotype HBV/D3, none of the patients with CHB had sub-genotype HBV/D3. Unlike patients with CHB, L15*, D33N, Q51P, V63F, L91I, P108S, T115I, P120L, T125M, Q129H, T189I, L216F, P217L mutations were detected in the HBV S gene in OBI cases. Also, P127T aa polymorphism was frequently detected. Mutation frequency in the HBV S gene in the major hydrophilic region (MHR) was higher in patients with OBI with sub-genotypes HBV/D3 and D2 than those with HBV/D1 and those with serotype HBV/ayw3 compared to those with HBV/ayw2 (p < 0.05). CONCLUSIONS: Sub-genotypic-specific mutation patterns were seen in the "a" determinant region and T helper cell epitopes of HBsAg, especially in the C-terminus domain; this may be associated with OBI.

The effects of IL28B rs12979860 and rs8099917 polymorphism on hepatitis B infection.

OBJECTIVE: The purpose of this study was to evaluate the relationship of IL28B rs12979860 and rs8099917 polymorphisms with the clinical, histological, and virological outcomes of patients with chronic hepatitis B (CHB) also the treatment responses of patients who received Nucleos(t)ide analogs (NAs) therapy. METHODS: This study included 152 CHB patients who were underwent liver parenchymal biopsy. The IL28B rs12979860 and rs8099917 polymorphism were genotyped using the TaqMan assay. RESULTS: The IL28B rs12979860 CC and IL28B rs8099917 TT were identified as the genotypes with the highest frequency in all patients. On the other hand, IL28B rs12979860 TT and IL28B rs8099917 GG were the genotypes with the lowest frequency. The frequency of IL28B rs8099917 TG genotype was significantly different between patients with hepatitis B, who has histologically defined liver cirrhosis and no-fibrosis (p=0.02). In addition, a statistically significant correlation was found between the presence of IL28B rs8099917 G allele and virological unresponsiveness to NAs treatments in CHB patients (p=0.028). CONCLUSION: The presence of the IL28B rs8099917 G allele in CHB patients might be associated with the risk of developing cirrhosis and virological unresponsiveness to NAs treatments.

Impact of the HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study

Objective: This study aimed to observe the preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Materials and Methods: This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017 and March 2019. Patients were followed for 1 year with 5 visits (baseline and 3th, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints, the Pettersson scoring system was used for radiological assessment, point-of-care (POC) ultrasonography was used for bilateral examinations of joints, and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score was used for evaluation of ultrasonography results. Results: Seventy-three PwH, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in the childhood group, the increment of scores was not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at baseline and at the 12th month. Conclusion: The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggest that POC ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.

The usefulness of agent emission imaging - high mechanical index ultrasound mode in the diagnosis of urolithiasis: a prospective preliminary study.

PURPOSE: We aimed to determine the feasibility and effectiveness of agent emission imaging - high mechanical index (AEI-High MI) mode ultrasonography (US) compared with gray-scale and color Doppler US, alone or in combination, for the diagnosis of urolithiasis with reference to unenhanced computed tomography (CT). METHODS: This prospective study included 72 consecutive patients (40 males, 32 females; mean age, 45.9±14.7 years) referred by the department of urology for acute or elective symptoms of urolithiasis and confirmed to have urinary calculi on unenhanced abdominal CT, between January 2015 and June 2015. Gray-scale, color Doppler, and AEI-High MI US were performed by two radiologists to determine the effectiveness of these methods in the diagnosis of urinary stones and to compare them with the reference modality. RESULTS: A total of 189 calculi were detected on CT examination. Gray-scale US had a sensitivity of 66.1% and positive predictive value (PPV) of 88.7% for detecting calculi, while twinkling artifact of color Doppler had a sensitivity of 70.4% and PPV of 94.3%. The scintillation artifact of AEI-High MI mode had a sensitivity of 75.1% and PPV of 95.9%. When all ultrasound-based modalities were combined, the sensitivity and PPV rose to 83.1% and 88.2%, respectively. When calculi were grouped according to their size ( < 5 mm, 5-10 mm, > 10 mm), AEI-High MI mode had a higher sensitivity (60%) compared with gray-scale (32.5%) and color Doppler (41.3%) for calculi < 5 mm. CONCLUSION: AEI-High MI mode had a higher sensitivity compared with gray-scale and color Doppler for the detection of calculi smaller than 5 mm, but it did not make a significant contribution to detection of larger calculi. The combined use of gray-scale US with AEI-High MI mode could increase the detection rate of calculi smaller than 5 mm and provide a method for verification of suspected calculi on gray-scale US.

The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools.

Emergency physicians and radiologists have been increasingly encountering internal concealment of illegal drugs. The packages commonly contain powdered solid drugs such as cocaine, heroin, methamphetamine and hashish, but they may also contain cocaine in the liquid form. The second type of package has recently been more commonly encountered, and poses a greater diagnostic challenge. As clinical evaluation and laboratory tests frequently fail to make the correct diagnosis, imaging examination is typically required. Imaging methods assume a vital role in the diagnosis, follow-up and management. Abdominal X-ray, ultrasonography, CT and MRI are used for the imaging purposes. Among the aforementioned methods, low-dose CT is state-of-the-art in these cases. It is of paramount importance that radiologists have a full knowledge of the imaging characteristics of these packages and accurately guide physicians and security officials.

Multimodality Imaging Findings of a Renal Aspergilloma.

BACKGROUND: Renal aspergillosis is a rare infection that usually occurs in persons with a predisposition for this condition. Its differential diagnosis includes primary and metastatic renal malignancies, pyelonephritis and secondary abscess formation, granulomatous disorders, and renal infarction. We aim to stress the role of multimodality imaging and percutaneous biopsy in the diagnosis of this condition. CASE REPORT: We present diffusion weighted imaging (DWI) and positron emission tomography-computed tomography (PET-CT) findings in addition to conventional imaging modalities in a 55-year-old man with secondary renal aspergilloma. CONCLUSION: Radiological imaging methods are an integral part of diagnostic workup for renal aspergillosis. A definitive diagnosis is made by histopathological and/or microbiological examination of the material obtained via percutaneous biopsy under guidance of imaging methods.

Treatment of atypically-localized cavernous hemangioma in abdomen with atypical pain.

INTRODUCTION: Hemangiomas are the most common benign lesions of the liver. They usually remain asymptomatic and it is sufficient to follow up with intermittent imaging methods. The case presented herein featured with localization and atypical symptoms. PRESENTATION OF CASE: A man aged 59 years was admitted with a three-month history of continuous and recently increased abdominal pain, and also early satiety. Computed Tomography (CT) showed a 9×6-cm mass that compressed the spleen on the left sub-diaphragmatic area, attached to the inferior part of the diaphragm. The mass was removed laparoscopically and pathology was cavernous hemangioma. DISCUSSION: Although surgical treatment of cavernous hemangioma of the liver (CHL) remains in the background, for symptomatic patients who have no clear diagnosis, when complications emerge, surgery can be preferable. Here in minimally invasive surgery was performed in this case suffering from atypical abdominal pain. CONCLUSION: Cavernous hemangiomas of the liver rarely require treatment. Surgery is one of the options in selected cases and abdominal pain is one of the indications. In patients complaining from persistent abdominal pain, if intraabdominal atypical-localized mass was seen in examinations, hemangioma should be remembered in differential diagnosis.

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality.

BACKGROUND: Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. AIMS: In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts- 4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. RESULTS: Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. CONCLUSION: CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates.