Deniz Alis

A preliminary study of shear wave elastography for the evaluation of unilateral palpable undescended testes

OBJECTIVES We sought to compare unilateral palpable undescended testes and contralateral descended testes using shear wave elastography (SWE) to show potential quantitative differences in elasticity patterns, which might reflect the histologic features. METHODS Approval for this prospective study was obtained from the local ethics committee. A total of 29 patients (mean age, 7.52 years; range, 1-18 years) with unilateral palpable undescended testes and contralateral descended testes were examined by greyscale ultrasonography and SWE between February 2015 and April 2016. The volume and the elasticity of each testicle were the main factors evaluated. RESULTS There was no difference between undescended testes and contralateral descended testes in terms of volume. However, a significant difference was evident in SWE-derived quantitative data. CONCLUSIONS SWE seems to be a useful sonographic technique to predict histologic features of the undescended testicle, which might replace testicular biopsy in modern management of the undescended testis.

Is There Any Difference Between Seminomas and Nonseminomatous Germ Cell Tumors on Shear Wave Elastography? A Preliminary Study

OBJECTIVES The purpose of this study was to evaluate the ability of shear wave elastography (SWE) to differentiate seminomas from nonseminomatous germ cell tumors. METHODS Approval for this retrospective study was obtained from the local Ethics Committee of Istanbul University Cerrahpasa Medical School. Fifteen patients with malignant testicular lesions were examined by grayscale sonography, color or power Doppler sonography, and SWE between February 2011 and October 2015. The size of each lesion, Doppler signal parameters, echogenicity, presence of microlithiasis, unifocality or multifocality, and histopathologic findings were the main factors evaluated. RESULTS The mean age of the patients was 33 years (range, 25-55 years). There were no differences between seminomas and nonseminomatous germ cell tumors in terms of Doppler signals, echogenicity, microlithiasis, or focality. Only the homogeneous and heterogeneous echogenicity patterns differed significantly. However, a significant difference was evident in SWE-derived quantitative data. CONCLUSIONS Seminomas and nonseminomatous germ cell tumors do not differ significantly on grayscale or Doppler sonography, except in terms of homogeneity. However, SWE seems to differentiate seminomas from nonseminomatous germ cell tumors.The purpose of this study was to evaluate the ability of shear wave elastography (SWE) to differentiate seminomas from nonseminomatous germ cell tumors.

Evaluation of median nerve by shear wave elastography and diffusion tensor imaging in carpal tunnel syndrome

PURPOSE The aim of the current study is to investigate the diagnostic role of shear-wave elastography and diffusion tensor imaging in patients with carpal tunnel syndrome. MATERIAL AND METHODS The study included a total of 77 wrists; 18 normal, 35 wrists with mild, 9 wrists with moderate and 15 wrists with severe carpal tunnel syndrome. Elastography of the median nerve was performed by defining the boundaries of a segment of the nerve at sagittal plane at the level of proximal carpal row. Additionally, the cross-sectional area of the median nerve was evaluated. Fractional anisotropy and apparent diffusion coefficient measurements were carried out by placing region-of-interest at three levels: at pisiform bone (carpal tunnel inlet), mid carpal tunnel, and hook of hamate (carpal tunnel outlet). RESULTS Patients with carpal tunnel syndrome had higher elasticity values of median nerve (53.0 kPa; IQR 40.8-77.0 kPa) compared to control subjects. (36.8 kPa; IQR 31.0-39.9 kPa) Patients with moderate-severe carpal tunnel syndrome had higher elasticity values (82 kPa; IQR 64.0-95.5 kPa) compared to patients with mild carpal tunnel syndrome. (44 kPa; IQR 32.5-59.5 kPa) Patients with carpal tunnel syndrome had lower fractional anisotropy at mid-carpal level (0.382; IQR 0.330-0.495) compared to the control group. (0.494; IQR 0.434-0.537) Patients with moderate-severe carpal tunnel syndrome had lower fractional anisotropy values (0.366; IQR 0.331-0.407) and higher apparent diffusion coefficient values (1.509 mm2/s; IQR 1.374-1.733 mm2/s) compared to patients with mild carpal tunnel syndrome. (0,423; IQR 0.324-0.526 and 1.293 mm2/s; IQR 0.967-1.514 mm2/s) CONCLUSION: Shear-wave elastography and diffusion tensor imaging are helpful imaging modalities in diagnosing carpal tunnel syndrome and assessing its severity.

Flat-detector CT angiography in the evaluation of neuro-Behçet disease

In patients with unknown Behçet disease (BD), the diagnosis of neuro-Behçet disease (NBD) is challenging, since various diseases may mimic NBD [1]. Flat detector-computed tomography (FDCT) allows obtaining rotational datasets and images with ultra-high spatial resolution [2]. The combination of FDCT with digital subtraction angiography (DSA) allows tracking the entire course of iodinated contrast material bolus from its initial injection through the arterial or venous vasculature [2]. We report two patients with NBD without a prior history of BD, who were diagnosed as having NBD based on clinical investigations and FDCT angiography. The first patient was a 34-year-old man who was referred to our neurology department with a 1-month history of headache, blurred speech and difficulty in walking. Magnetic

Elastography in Distinguishing Benign from Malignant Thyroid Nodules.

Aim: The aim of this study is to test the diagnostic success of strain elastography in distinguishing benign from malignant thyroid nodules. Materials and Methods: The size, echogenicity, and halo integrity of 293 thyroid nodules and the presence of microcalcification in these nodules were evaluated on gray-scale examination. Doppler characteristics and elastography patterns were also evaluated and recorded. Nodules were classified in four categories (patterns 1-4) based on elastographic examination. Results: According to the cytopathological findings, 222 nodules were benign, and 71 nodules were malignant. The risk of a nodule to be malignant was 3.8 times increased by hypoechogenicity, 7.7 times increased by the presence of microcalcification, and 11.5 times increased by the absence of halo. On Doppler patterns, the presence of central vascularity increased the malignancy risk of a nodule by 5.8 times. According to the receiver operating characteristic analysis, patterns 3 and 4 were malignant, and patterns 1 and 2 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of elastography were 100%, 80.2%, 61.7%, 100%, and 85%, respectively. Conclusion: Strain elastography can be used as a noninvasive method in distinguishing benign from malignant thyroid nodules and in identifying the patients who would undergo surgery.

Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux: Shear Wave Elastography in the Evaluation of Unilateral Vesicoureteral Reflux

To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux.

Clinical and radiological findings of a rare case: reversible Parkinsonism in cerebral venous sinus thrombosis

A 46-year-old woman admitted to our emergency department with a 3 days history of a persistent headache, slurred speech, urinary and fecal incontinence. General physical examination and laboratory tests were normal. On neurologic examination, the patient had a masked face, bradykinesia, and resting tremors. Romberg test was positive. Magnetic resonance (MR) examination, including diffusionweighted imaging (DWI), dynamic susceptibility contrast MR perfusion, contrast-enhanced angiography, 2D time of flight (TOF) MR venography sequences, was performed to exclude potential intracranial pathologies. MR venography examination revealed lack of flow in the left transverse sinus, sinus rectus, Galen vein and inferior sagittal sinus (Fig. 1). We detected hyper-intensity in both of the lentiform nuclei, caudate nuclei (more prominent on the right) and thalami on T2-weighted FLAIR sequences. Furthermore, diffusion restriction on DWI (Fig. 2) and decreased relative cerebral blood volume (rCBV) (Fig. 3) on MR perfusion imaging were also accompanied aforementioned signal abnormalities. The MR imaging findings were suggestive of cerebral venous sinus thrombosis (CVST), and intravenous heparin was started. The Parkinsonism symptoms and headache were resolved within a week.

Apparent Diffusion Coefficient Measurement in Mediastinal Lymphadenopathies: Differentiation between Benign and Malignant Lesions

Objectives: We aimed to prospectively assess the diagnostic value of apparent diffusion coefficient (ADC) measurement in the differentiation of benign and malignant mediastinal lymphadenopathies. Materials and Methods: The study included 63 consecutive patients (28 women, 35 men; mean age 59.3 years) with 125 mediastinal lymphadenopathies. Echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum was performed with b-factors of 0 and 600 mm2/s before mediastinoscopy and mediastinotomy, and ADC values were measured. The ADC values were compared with the histological results, and statistical analysis was done. P < 0.05 was considered statistically significant. Results: The mean ADC value of malignant mediastinal lymphadenopathy (1.030 ± 0.245 × 10−3 mm2/s) was significantly lower (P < 0.05) when compared to benign lymphadenopathies (1.571 ± 0.559 × 10−3 mm2/s). For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.334 × 10−3 mm2/s was used as a threshold value; area under the curve 0.848, accuracy 78.4%, sensitivity 66%, specificity of 86%, positive predictive value 76.7%, and negative predictive value of 79.2%. Interobserver agreement was excellent for ADC measurements. Conclusions: ADC measurements could be considered an important supportive method in differentiating benign from malignant mediastinal lymphadenopathies.

Comment on “Adding Shear Wave Elastography to Conventional Sonography Did Not Improve Diagnostic Performance: Was There a Problem With the Cutoff Value?”

and inhibits accurate measurement of diaphragmatic displacement. This result can be avoided by the use of angle-independent M-mode. We found Dr Gautman and his colleagues’ use of speckle tracking to assess diaphragm caudal displacement to be intriguing. We had attempted to use this technique to assess diaphragm function by interrogation of diaphragm thickening. The use of speckle tracking to assess diaphragm displacement, as well as diaphragm strain, may become a suitable single technique for assessing diaphragmatic function in the near future. One of the limitations of speckle tracking is the additional time needed for analysis. Until further improvement in software processing is made, angleindependent M-mode seems to be the most accurate and clinically efficient method to assess diaphragm displacement, since many ultrasound machines are already equipped with this feature. Further studies in this area, particularly in critically ill patients who often present with diaphragm dysfunction, are warranted.

Evaluation of parenchymal thyroid diseases with multiparametric ultrasonography

Aim: Differential diagnosis of parenchymal thyroid diseases by gray-scale ultrasound is quite difficult for a radiologist as the findings are very similar to each other. In this study we aimed to assess some quantitative spectral Doppler parameters, resistivity index (RI), acceleration time (AT), and quantitative elastography [shear wave velocity (SWV)] together to show their reliability for differential diagnosis of parenchymal thyroid diseases. Materials and Methods: We retrospectively reviewed findings of 227 patients (179 females, 48 males) that underwent spectral Doppler ultrasound and acoustic radiation force impulse between October 2013 and March 2016. Ages of the patients were between 18 and 74 years (39.52 ± 12.67). Based on clinical and laboratory findings, patients were divided into five groups (N: Normal, EH: Early Hashimoto, H: Late Hashimoto, M: Nodular Thyroid Disease, HM: Hashimoto + Nodular Thyroid Disease). Detailed statistical analyses were done on parameters such as age, gender, volume information, and RI, AT (ms), SWV (m/s). Results: No significant effect of gender or volume on the differentiation of disease pattern (Chi-square test: P = 0.306, Kruskal-Wallis test: P = 0.290) was found in this study. RI (0.41 ± 0.06) and SWV values (1.19 ± 0.18 m/s) were the lowest. AT values (>55 ms) were the highest in EH group (area under the curve: 0.913). Existence of H decreased RI and SWV values, while it extended AT in a different thyroid disease. Conclusion: Thyroid parenchymal diseases could be classified and differentiated from each other by measuring RI, AT, and SWV values quantitatively. So, in suspicious cases, these parameters could be a reliable asset for differential diagnosis.