The Relationship of Liver and Pancreas Density With Chest Computed Tomography Score Progression and Laboratory Findings in Patients With COVID-19.

OBJECTIVE: Abdominal involvement of COVID-19 is a current issue. We aimed to evaluate hepatic and pancreatic density alterations on computed tomography (CT) and to analyze whether these alterations had a relationship with chest CT score and laboratory findings. METHODS: Patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 from March 11, 2020, to February 6, 2021, were retrospectively analyzed. Patients were divided into nonprogressive and progressive groups according to their chest CT scores. Liver and pancreas density, and liver-to-spleen (L/S) ratio were calculated. Laboratory findings, medication, intensive care unit stay, and survival were noted. RESULTS: There were 51 patients in the nonprogressive group and 123 patients in the progressive group. The median (minimum to maximum) L/S value of the nonprogressive group was 1 (0.28-1.53) at admission and 1.06 (0.33-1.83) at follow-up ( P < 0.001). In the progressive group, the median L/S value was 1.08 (0.35-1.51) at admission and 0.92 (0.33-1.75) at follow-up ( P < 0.001). A significant difference was found between the 2 groups at admission and follow-up ( P = 0.010 and P < 0.001, respectively). Pancreatic density measured at follow-up was significantly lower in the progressive group ( P = 0.045). In the progressive group, aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values were higher; albumin and lymphocyte values were lower ( P < 0.05). CONCLUSIONS: Patients with COVID-19 with progressive CT scores may have a decrease in L/S values, and their pancreatic density is lower than nonprogressives. Aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values tend to be higher in patients with a high chest CT score.

The Effectiveness of Ischemia Modified Albumin in Determining Acute Cholecystitis and its Severity.

BACKGROUND: Acute cholecystitis (AC) is caused by chemical and bacterial inflammation of the gallbladder. The use of Tokyo guidelines is recommended in determining the diagnosis of AC and its clinical severity. In the early stages of AC, many cytokines are secreted due to the local inflammatory cell activation, leading to exacerbation of inflammation and organ failure. Ischemia modified albumin (IMA) is a type of albumin that occurs in ischemia and oxidation and is used as a marker of hypoperfusion and oxidative stress. This study aims to investigate the effectiveness of ischemia modified albumin, C-reactive protein (CRP), and some other inflammation parameters in predicting the severity of the AC on admittance. METHODS: Forty-two patients diagnosed with AC and 30 healthy individuals in the control group were included in the study. The severity assessment of the patients was performed based on the revised Tokyo guidelines (TG 13). The patients were divided into 3 groups according to severity of the disease. Blood samples were taken from the subjects on admittance. Serum IMA levels were studied using an ELISA kit. SPSS 22.00 package program was used for statistical analysis. RESULTS: Thirty (71.4%) of the participants were in the mild group, while 12 (28.6%) were in the moderate group. There were no patients in the severe group. Leukocyte, CRP, and IMA values in the patient group were higher than those of the control group (p > 0.05). According to the Tokyo classification, a significant difference was found between the groups with mild and moderate grades in terms of CRP and IMA values (p < 0.001 and p < 0.05, respectively). When the cutoff value of IMA was 84 ng/mL, the sensitivity was found to be 76% and specificity was determined to be 40% (AUC: 0.665, p = 0.017, 95% Confidence Interval). CONCLUSIONS: It is considered that IMA could be useful in predicting the clinical severity of TG13-based acute cholecystitis and, therefore, could be used in the management of treatment by the clinician such as medical treatment, early surgery, and interval surgery.

Assessment of Liver Fibrosis with Diffusion-Weighted Magnetic Resonance Imaging Using Different b-values in Chronic Viral Hepatitis.

OBJECTIVE: To examine the effectiveness of apparent diffusion coefficient (ADC) values and to compare the reliability of different b-values in detecting and identifying significant liver fibrosis. SUBJECTS AND METHODS: There were 44 patients with chronic viral hepatitis (CVH) in the study group and 30 healthy participants in the control group. Diffusion-weighted magnetic resonance imaging (DWI) was performed before the liver biopsy in patients with CVH. The values of ADC were measured with 3 different b-values (100, 600, 1,000 s/mm2). In addition, liver fibrosis was classified using the modified Ishak scoring system. Liver fibrosis stages and ADC values were compared using areas under the receiver-operating characteristic (ROC) curve. RESULTS: The study group's mean ADC value was not statistically significantly different from the control group's mean ADC value at b = 100 s/mm2 (3.69 ± 0.5 × 10-3 vs. 3.7 ± 0.3 × 10-3 mm2/s) and b = 600 s/mm2 (2.40 ± 0.3 × 10-3 vs. 2.5 ± 0.5 × 10-3 mm2/s). However, the study group's mean ADC value (0.99 ± 0.3 × 10-3 mm2/s) was significantly lower than that of the control group (1.2 ± 0.1 × 10-3 mm2/s) at b = 1,000 s/mm2. With b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s for the diagnosis of liver fibrosis, the mean area under the ROC curve was 0.702 ± 0.07 (p = 0.0015). For b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s to diagnose significant liver fibrosis (Ishak score = 3), the mean area under the ROC curve was 0.759 ± 0.07 (p = 0.0001). CONCLUSION: Measurement of ADC values by DWI was effective in detecting liver fibrosis and accurately identifying significant liver fibrosis when a b-value of 1,000 s/mm2 was used.

Diagnostic challenge in papillary thyroid carcinoma with cervical lymphadenopathy, metastasis, or tuberculous lymphadenitis.

Papillary thyroid carcinoma (PTC) is the most frequent histological subtype of thyroid cancer. Total thyroidectomy with neck dissection is recommended for treatment. Tuberculous adenitis is a common cause of lymphadenopathy in endemic areas. Therefore, tuberculous lymphadenitis should be considered in the etiology of enlarged lymph nodes when PTC patients with risk factors such as tuberculosis present with cervical lymph node enlargement. Detailed evaluation of the neck metastasis of patients with PTC is necessary to avoid postoperative complications due to neck dissection. We present a 55-year-old female patient with tuberculous lymphadenitis mimicking metastatic lymph nodes from PTC.

A Novel Deep Transfer Learning-Based Approach for Automated Pes Planus Diagnosis Using X-ray Image.

Pes planus, colloquially known as flatfoot, is a deformity defined as the collapse, flattening or loss of the medial longitudinal arch of the foot. The first standard radiographic examination for diagnosing pes planus involves lateral and dorsoplantar weight-bearing radiographs. Recently, many artificial intelligence-based computer-aided diagnosis (CAD) systems and models have been developed for the detection of various diseases from radiological images. However, to the best of our knowledge, no model and system has been proposed in the literature for automated pes planus diagnosis using X-ray images. This study presents a novel deep learning-based model for automated pes planus diagnosis using X-ray images, a first in the literature. To perform this study, a new pes planus dataset consisting of weight-bearing X-ray images was collected and labeled by specialist radiologists. In the preprocessing stage, the number of X-ray images was augmented and then divided into 4 and 16 patches, respectively in a pyramidal fashion. Thus, a total of 21 images are obtained for each image, including 20 patches and one original image. These 21 images were then fed to the pre-trained MobileNetV2 and 21,000 features were extracted from the Logits layer. Among the extracted deep features, the most important 1312 features were selected using the proposed iterative ReliefF algorithm, and then classified with support vector machine (SVM). The proposed deep learning-based framework achieved 95.14% accuracy using 10-fold cross validation. The results demonstrate that our transfer learning-based model can be used as an auxiliary tool for diagnosing pes planus in clinical practice.

Elabela levels in pregnancies with intrauterine growth retardation.

OBJECTIVES: The aim of our study is to examine maternal serum Elabela levels in pregnancy with intrauterine growth retardation (IUGR). IUGR is one of the most important causes of perinatal mortality and morbidity. IUGR is also related future comorobidities such as diabetes mellitus, hyperlipidemia, hypertension and coronary artery disease. MATERIAL AND METHODS: Fifty pregnancies diagnosed as IUGR (Group 1) and fifty healthy pregnancies (Group 2) enrolled into the study. Obstetric and demographic characteristics of the patients, serum elabela levels, ultrasound parameters, cord pH value and APGAR scores of the newborns were recorded. In the study, which was planned as a prospective case-control study, an independent t test was used for the evaluation of continuous data and the Mann Whitney U test was used for the statistical evaluation of ordinal data. p < 0.05 was considered significant. RESULTS: The mean gestational age of the cases at delivery was 36.35 ± 1.29 in Group 1 and 38.16 ± 0.94 weeks in Group 2 (p < 0.05). Mean serum Elabela levels were 15.05 ± 9.03 in Group 1 and 8.96 ± 4.33 ng/mL in Group 2 (p < 0.0001). Mean newborn weights were 2498.20 ± 465.92 in Group 1 and 3179.44 ± 387.99 gr. in Group 2 (p < 0.0001). Systolic and diastolic blood pressure measurements taken on the day of delivery were higher in Group 1, and diastolic blood pressure was 77.0 ± 9.53 in Group 1 and 72.60 ± 13.37 mmHg in Group 2 (p < 0.05). Bilateral uterine artery Pulsatile Index (PI) and umbilical artery PI value were significantly higher in Group 1 (p < 0.05), and middle cerebral artery PI and cerebroplacental ratio were significantly lower in Group 1 compared to Group 2 (p < 0.05). Although the cord pH value, 1st and 5th minute APGAR scores were lower in Group 1 compared to Group 2, no statistically significant difference was found (p > 0.05). CONLUSIONS: In our study, it was found that serum Elabela levels increased significantly in pregnancies complicated by IUGR compared to the control group.

The Diagnostic Role of Adiponectin in Pulmonary Embolism.

BACKGROUND AND AIMS: Pulmonary thromboembolism (PTE) is a frequent disease with difficult diagnosis and high mortality. Misdiagnosis occurs in 2/3 patients and mortality rates reach up to 30%. The aim of our study was to investigate the role of adiponectin used in emergency service in diagnosis of PTE. MATERIALS AND METHODS: 95 patients with suspected PTE included in the study. Plasma adiponectin and D-dimer levels were measured and chest X-ray and multidetector row computed tomography scan obtained. Diagnosis was supported by vascular filling defect on tomography. Control group consisted of patients with suspected PTE and normal chest computed tomography findings. RESULTS: Mean D-dimer level was 4241.66 ± 1082.98 ng/mL in patients and 2211.21 ± 1765.53 ng/mL in the control group (p ≤ 0.05). Mean adiponectin level was 5.46 ± 4.39 µg/mL in patients and 7.68 ± 4.67 µg/mL in the control group (p ≤ 0.05). Wells and Geneva scores were higher in patients compared to the control group. CONCLUSIONS: As a result, we conclude that lower adiponectin levels have an important role in the diagnosis of PTE.

The role of apparent diffusion coefficient values in differentiation between adrenal masses.

The aim of this study was to evaluate the utility of apparent diffusion coefficient (ADC) values in differentiation between solid adrenal masses. The ADC values of 73 adrenal lesions (54 benign, 19 malignant) in 69 patients were measured at b 100, 600 and 1000 gradients on diffusion-weighted magnetic resonance imaging (DW-MRI). No statistically significant difference was found between ADC values of benign and malignant adrenal masses, nonadenomatous benign adrenal masses and malignant adrenal masses, adrenal adenomas and nonadenomatous lesions, adenomas and metastases, adenomas and pheochromocytomas, metastases and pheochromocytomas. ADC values are not helpful in the differentiation between solid adrenal masses.

An unusual mesenteric tumor 'paraganglioma': a case report.

INTRODUCTION: Paragangliomas are mostly localized in the adrenal medulla and they are usually pheochromocytomas, derived from the neural crest, but otherwise mesenteric paragangliomas are extremely rare tumors. CASE PRESENTATION: In this article we represent a 59-year-old female with an abdominal mass and pain due to mesenteric paraganglioma. CONCLUSIONS: Paragangliomas can occur as mesenteric tumors; usually, preoperative accurate diagnosis is not possible with imaging methods and precise diagnosis is possible after histological evaluation.

Evaluation of liver hemangiomas using three different b values on diffusion MR.

PURPOSE: To determine which diffusion-weighted MR technique (i.e., b-100, b-600, b-1000 s/mm(2)) is most useful in depicting liver hemangiomas. We also aimed to assess the effect of lesion size on apparent diffusion coefficient (ADC) values. MATERIALS AND METHODS: Diffusion-weighed MR (DWMR) was performed for 61 hemangiomas in 32 patients. DWMR images were obtained before contrast administration using three different b values of 100, 600, and 1000 s/mm(2). ADCs were measured for each lesions and compared with normal liver parenchymal ADCs on different b values. Hemangiomas were subdivided according to lesion size (less than 3 cm and 3 cm or greater). Data were analyzed using SPSS software by analysis of variances (ANOVA) and post hoc values were tested using HSD Tukey test. RESULTS: There was no significant relation between lesion size and ADC values on different b values. Lower ADC values were obtained for higher b values in normal liver tissue and hemangiomas. Although there is significant difference between normal liver tissue and hemangiomas; this is more apparent on b-1000 images (p=0.022 on b-100, p=0.003 on b-600, and p=0.000 on b-1000 images). Variance analysis revealed hemangiomas had higher ADC values than normal liver tissue on b-1000 images. CONCLUSION: Mean values for ADCs of hemangiomas were lower than ADCs of the normal liver except for b-1000 value. Higher b values are useful for the differentiation between normal liver tissue and hemangiomas. Lesion size does not affect ADC measurement on different b values.