Cuneyt Calisir

Value of Power Doppler and Gray-Scale US in the Diagnosis of Carpal Tunnel Syndrome: Contribution of Cross-Sectional Area just before the Tunnel Inlet as Compared with the Cross-Sectional Area at the Tunnel

Objective To determine the value of gray-scale and power Doppler ultrasonography in the evaluation of carpal tunnel syndrome (CTS). Materials and Methods Median nerves at the carpal tunnel were evaluated by using gray-scale and power Doppler ultrasonography and by using accepted and new criteria in 42 patients with CTS (62 wrists) confirmed by electromyogram and 33 control subjects. We evaluated the cross-sectional area of the nerve just proximal to the tunnel inlet (CSAa), and at mid level (CSAb). We then calculated the percentage area increase of CSAb, and area difference (CSAb-CSAa). We measured two dimensions of the nerve at the distal level to calculate the flattening ratio. The power Doppler ultrasonography was used to assess the number of vessels, which proceeded to give a score according to the vessel number, and lastly evaluated the statistical significance by comparing the means of patients with control subjects by the Student t test for independent samples. Sensitivities and specificities were determined for sonographic characteristics mentioned above. We obtained the receiver operating characteristic (ROC) curve to assess the optimal cut-off values for the diagnosis of CTS. Results A statistically significant difference was found between patients and the control group for mean CSAb, area difference, percentage area increase, and flattening ratio (p < 0.001, p < 0.001, p < 0.001, p < 0.05, respectively). From the ROC curve we obtained optimal cut-off values of 11 mm2 for CSAb, 3.65 for area difference, 50% for the percentage of area increase, and 2.6 for the flattening ratio. The mean number of vessels obtained by power Doppler ultrasonography from the median nerve was 1.2. We could not detect vessels from healthy volunteers. Mean CSAbs related to vascularity intensity scores were as follows: score 0: 12.3 ± 2.8 mm2, score 1: 12.3 ± 3.1 mm2, score 2: 14.95 ± 3.5 mm2, score 3: 19.3 ± 3.8 mm2. The mean PI value in vessels of the median nerve was 4.1 ± 1. Conclusion Gray-scale and power Doppler ultrasonography are useful in the evaluation of CTS.

Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism

Objective The objective of the study was to compare two scoring methods to predict the risk of pulmonary embolism (PE) as diagnosed with computed tomography angiography (CTA) and/or CT venography (CTV). Methods Prospectively over a 8-month period, emergency department patients and hospital inpatients with suspected PE were consecutively examined and their Wells and Revised Geneva scores calculated to stratify them into a risk group for PE probability. Then all patients were examined with CTA and CTV to determine the presence or absence of PE, as diagnosed by experienced radiology staff physicians. Results During the study period, 167 patients were suspected of having a PE and were interviewed for the calculation of their Wells and Revised Geneva scores. All patients underwent CTA or CTV, but the images of only 148 patients were adequate enough to make a certain diagnosis regarding PE. The data of these 148 patients were used for the study. The rates of PE in high, moderate, and low PE risk groups determined according to the Wells score and the Revised Geneva score were 89.6, 26.4, 7.8 and 83.3, 25.6, 0%, respectively. Among both inpatients and ED patients the area under the Wells score receiver operating characteristic curve was higher (P=0.04). When data from only ED patients were analyzed (104 patients) the scoring systems was not significantly different (P=0.07). Conclusion The Wells rule seems to be more accurate among both inpatients and emergency department patients. The Revised Geneva score can be used in emergency department patients with high reliability.

The Interobserver Agreement between Residents and Experienced Radiologists for Detecting Pulmonary Embolism and DVT with Using CT Pulmonary Angiography and Indirect CT Venography

Objective We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). Materials and Methods We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64×0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. Results Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). Conclusion It does not seem adequate to base the final long-term treatment of PE on only the residents reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.

Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography.

Summary Background To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. Material/Methods Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. Results While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p<0.05). The same values for acetabular cartilage assessment were 89/56, 40/60, 71/71 (p>0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa) Conclusions Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.

Irreversiblity of Remodeled Features on High-Resolution Computerized Tomography Scans of Asthmatic Patients on Conventional Therapy: A 6-Year Longitudinal Study

Airway remodeling can be assessed using high-resolution computerized tomography (HRCT) scanning of both parenchymal-and airway abnormalities in patients with asthma. The aim of this study was to examine structural changes in large and small airways of asthmatic patients using HRCT to determine if remodeling changes had occurred after prolonged use of conventional anti-asthma therapy. HRCT scans were evaluated prospectively for evidence of the following abnormalities: bronchial wall thickening (BWT), bronchiectasis, mucoid impactions, small centrilobular opacities, thick linear opacities, focal hyperlucency, and emphysema. Fifty mild and moderate asthmatics were enrolled in the study group. These abnormalities were re-evaluated in the patients after the passage of 6 years of regular anti-asthma medication. Forty-six of the patients completed the study. The probability of finding at least one abnormality by HRCT investigation was statistically higher in the second scan than in the first (26 patients [56.5%] versus 18 patients [39.1%], p = 0.02]. Irreversibility ratios of abnormalities were 80%, 100%, 75%, 87.7%, 77.8%, and 100% for BWT, bronchiectasis, small centrilobular opacities, focal hyperlucency, thick linear opacity, and emphysema, respectively. The ratios for newly detected structural abnormalities were 25%, 2.5%, 0%, 7.9%, 8.1%, and 0% for BWT, bronchiectasis, small centrilobular opacities, focal hyperlucency, thick linear opacity, and emphysema, respectively. New occurrences and progression in BWT are associated with the duration of asthma affliction (p = 0.03). The results of our study indicate that HRCT remodeling features, once occurring, are irreversible in most of the patients, and new remodeling features also occur despite administering the standard asthma treatment.

Bilateral narrow duplicated internal auditory canal.

Internal auditory canal (IAC) anomalies are rare malformations that may include alterations of shape, size or orientation of the IAC. Bilateral duplication of IAC is a very rare malformation and only one case has been described in literature. We report a case of bilateral duplicated IAC together with other inner ear anomalies.

A Sign of Arteriogenic Insufficiency on Penile Doppler Sonography Retrograde Flow in Penile Cavernosal-Spongiosal Communications

The purpose of this study was to evaluate the diagnostic usefulness of determining retrograde flow in the penile cavernosal‐spongiosal communications (CSCs) with Doppler sonography.

Mazabraud's Syndrome Coexisting with a Uterine Tumor Resembling an Ovarian Sex Cord Tumor (UTROSCT): a Case Report

The association of intramuscular myxoma and fibrous dysplasia is a rare disease known as Mazabrauds syndrome. We present a case of Mazabrauds syndrome coexisting with a uterine tumor and resembling an ovarian sex cord tumor (UTROSCT). This uterine tumor showed a high mitotic index and cytological atypia. To the best of our knowledge, the coexistence of the two different entities has not been reported in the literature.

Inhalation Therapy of Calcitonin Relieves Osteoarthritis of the Knee

This study was conducted to determine if nasal salmon calcitonin has additional beneficial effects on clinical symptoms, serum NO, IL-1β, matrix metalloproteinase 3, urinary C-terminal telopeptide type II collagen (CTX-II) levels and MRI findings in knee osteoarthritis (OA) when used concomitantly with exercise therapy. Fifty female patients with knee OA were randomized into two groups. The first group (n = 30) received 200 IU/day nasal salmon calcitonin and a home exercise program; the second group (n = 20) received a home exercise program for 6 months. Compared with baseline,while significant improvements were observed in visual analogue scale (VAS), WOMAC pain, physical function scores, 20-m walking time (P < 0.001) and WOMAC stiffness score (P = 0.041) in the first group, walking and resting VAS, and WOMAC physical function scores were improved (P = 0.029) in the second group after treatment. Significantly increased levels of serum NO and urinary CTX-II (P < 0.001) and significant improvements in the area of medial femoral condyle (P < 0.05) were noted only in the first group. There were significant differences in VAS activation values (P = 0.032) and NO levels (P < 0.001) in the favor of the first group. In conclusion, nasal salmon calcitonin may have possible chondroprotective effects besides its known effects on symptoms in patients with knee OA.

Contribution of the amount of contrast media used in pulmonary CT angiography to assess the diagnostic value of CT venography; comparison of 100 and 150 ml of contrast media

AIM To prospectively compare the vascular attenuation achieved with 100ml iohexol (350mgI/ml) 75% with that achieved with 150ml iohexol (350mgI/ml) 75% for computed tomography (CT) venography, which was performed after CT pulmonary angiography. MATERIALS AND METHODS A total of 122 patients were included in the study. Group A, comprising 52 patients (mean age 64.8 years, mean body weight 70.8kg) received 150ml iohexol (350mgI/ml) contrast media. Group B, comprising 70 patients (mean age 61.2 years, mean body weight 71.4kg) received 100ml iohexol (350mgI/ml) contrast medium. RESULTS Venous opacification values measured at all levels were significantly higher in group A than those in group B (p<0.001). In group B the mean HU values were between 87 and 115 and only three of the patients had HU values less than 60 at the level of femoral vein. Assuming a venous enhancement of 80HU as the cut-off value for accurate diagnosis of deep venous thrombosis, 22.8% (16/70) in group B and 7.6% (4/52; p=0.028) in group A had non-diagnostic CT venography of left femoral vein. CONCLUSION One hundred millilitres of contrast medium with a concentration of 350mgI/ml may produce sufficient enhancement, but 150ml of contrast medium provides better accuracy for the diagnosis of deep venous thrombosis diagnosis. For better enhancement of lower extremity deep veins, the concentration of the contrast medium and the patients body weight may also have significance.