Fahrettin Kilic

Use of shear wave elastography to differentiate benign and malignant breast lesions

PURPOSE We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions. MATERIALS AND METHODS A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied. RESULTS Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%). CONCLUSION SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy.

Shear wave elastography of placenta: in vivo quantitation of placental elasticity in preeclampsia

PURPOSE We aimed to evaluate the utility of shear wave elastography (SWE) for assessing the placenta in preeclampsia disease. METHODS A total of 50 pregnant women in the second or third trimester (23 preeclampsia patients and 27 healthy control subjects) were enrolled in the study. Obstetrical grayscale and Doppler ultrasonography, SWE findings of placenta, and prenatal/postnatal clinical data were analyzed and the best SWE cutoff value which represents the diagnosis of preeclampsia was determined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of preeclampsia were calculated based on SWE measurements. RESULTS Mean stiffness values were much higher in preeclamptic placentas in all regions and layers than in normal controls. The most significant difference was observed in the central placental area facing the fetus where the umbilical cord inserts, with a median of 21 kPa (range, 3-71 kPa) for preeclampsia and 4 kPa (range, 1.5-14 kPa) for the control group (P < 0.01). The SWE data showed a moderate correlation with the uterine artery resistivity and pulsatility indices. The cutoff value maximizing the accuracy of diagnosis was 7.35 kPa (area under curve, 0.895; 95% confidence interval, 0.791-0.998); sensitivity, specificity, PPV, NPV, and accuracy were 90%, 86%, 82%, 92%, and 88%, respectively. CONCLUSION Stiffness of the placenta is significantly higher in patients with preeclampsia. SWE appears to be an assistive diagnostic technique for placenta evaluation in preeclampsia.

The management and the diagnosis of fever of unknown origin.

Prolonged fever presents a challenge for the patient and the physician. Fever with a temperature higher than 38.3°C on several occasions that lasts for at least 3 weeks and lacks a clear diagnosis after 1 week of study in the hospital is called a fever of unknown origin (FUO). More than 200 diseases can cause FUO, and the information gathered from history taking, physical examination, laboratory and imaging studies should be evaluated with care. History taking and physical examination may provide some localizing signs and symptoms pointing toward a diagnosis. Infection, cancers, noninfectious inflammatory diseases and some miscellaneous diseases are the main etiologies, and some patients remain undiagnosed despite investigations. Tuberculosis, lymphoma and adult-onset Still’s disease are the main diseases. Fluorodeoxyglucose PET is a promising imaging modality in FUO. Establishing a uniform algorithm for FUO management is difficult. Every patient should be carefully evaluated individually considering the previous FUO management experience.

Symptomatic Unilateral Submandibular Gland Aplasia Associated with Ipsilateral Sublingual Gland Hypertrophy

Aplasia or agenesis of the salivary gland is an uncommon disorder. Since Gruber first described a case of bilateral submandibular gland aplasia in 1885, about 30 cases have been reported in the world medical literature [1]. One or all of the glands may be absent. The absence of all major salivary glands was the most frequently encountered pattern in the reported cases [1, 2]. Other developmental anomalies could be found in association with aplasia of the salivary glands, such as atresia of the lacrimal puncta, mandibulofacial dysostosis (Treacher-Collins syndrome), or congenital malformations of the temporomandibular component [3, 4]. Unilateral aplasia of the submandibular gland is an extremely rare disorder and only 11 cases have been reported since Bruno described the first case encountered during a cadaver dissection in 1894. Most reported cases of unilateral submandibular aplasia were asymptomatic, probably because secretions from other salivary glands compensated for the aplasia [5]. Congenital unilateral absence of the submandibular gland is an isolated phenomenon and may result from other unique defects of early fetal development, unlike the cause of multiglandular agenesis associated with other facial anomalies [6]. In this study we report on a extremely rare case of isolated unilateral submandibular aplasia presenting with xerostomia and dysphagia which is associated with ipsilateral sublingual gland hypertrophy.

Ex Vivo Assessment of Sentinel Lymph Nodes in Breast Cancer Using Shear Wave Elastography.

Axillary lymph node status is one of the important prognostic factors in early‐stage breast cancer. Despite the combined use of sonography, fine‐needle aspiration, and sentinel lymph node (SLN) dissection, there is a gap between the potential effectiveness of those techniques and current success to determine the axillary lymph node status. The main aim of this study was to evaluate the baseline accuracy of shear wave elastography for differentiation of benign versus malignant SLNs in an ex vivo artifact‐free environment.

The impact of share wave elastography in differentiation of hepatic hemangioma from malignant liver tumors in pediatric population

OBJECTIVE In children it is crucial to differentiate malignant liver tumors from the most common benign tumor, hepatic hemangiomas since the treatment strategies are quite different. We aimed to evaluate the efficiency of shear wave elastography (SWE) technique in differentiation of malignant hepatic tumors and hepatic hemangiomas. METHODS Twenty patients with hepatic tumor were included in our study. Two radiologists performed SWE for 13 patients with malignant hepatic tumors including hepatoblastoma (n=7), hepatocellular carcinoma (n=3), metastasis (n=2), embryonal sarcoma (n=1) and 7 patients with hepatic hemangioma. All of our patients were between the age of 1 and 192 months (mean age: 56.88 months). Receiver operating characteristic analysis was achieved to evaluate the diagnostic accuracy of SWE and to determine the optimal cut-off value in differentiation hepatic hemangioma from malignant hepatic tumors. RESULTS The mean SWE values (in kPa) for the first observer were 46.94 (13.8-145) and 22.38 (6.6-49.6) and those for the second observer were 57.91 (11-237) and 23.87 (6.4-57.5), respectively for malignant hepatic tumors and hepatic hemangiomas. The SWE values of malignant hepatic tumors were significantly higher than those of hepatic hemangioma (p=0.02). The inter-observer agreement was almost perfect (0.81). The area under the receiver operating characteristic curve of SWE for differentiating the hepatic hemangioma from malignant hepatic tumors was 0.77 with a sensitivity of 72.7% and a specificity of 66.7% at a cutoff value of 23.62 with 95% confidence interval. CONCLUSION Shear wave elastography can be helpful in differentiation of malignant hepatic tumors and hepatic hemangioma.

Shear wave elastography of the placenta in patients with gestational diabetes mellitus

To evaluate placental elasticty in women with gestational diabetes mellitus (GDM) and non-diabetic controls. Thirty-three pregnant women with GDM according to the current criteria of the American Diabetes Association and 43 healthy pregnant women who were admitted to the antenatal clinic were recruited for this case–control study. Elasticity values of both the peripheral and the central parts of the placentas of the patients in both groups were determined by shear wave elastography (SWE) imaging. Mean elasticity values of both the central and the peripheral part of the placentas were significantly higher in GDM pregnancies (p < 0.001). No difference was observed in the mean elasticity values of the central and the peripheral part of the placentas in two groups (p > 0.05). SWE imaging technology might provide a quantitative assessment of the morphological pathologies of placentas in pregnant women with GDM.

Relative Proportions of Stromal to Cellular Components of Pleomorphic Adenomas Determination With Shear Wave Elastography

The purpose of this study was to evaluate whether the relative proportions of stromal to cellular components of pleomorphic adenomas have an effect on the shear elastic modulus determined by shear wave elastography (SWE).

Radio-guided localization of clinically occult breast lesions: current modalities and future directions

The extensive availability of breast cancer screening programs and improvement in diagnostic imaging have led to more frequent detection of suspicious and clinically occult breast lesions. Early detection of tumor is important for breast-conserving treatment. Incomplete excision is a major risk factor for local recurrence. Following precise localization and removing the entire lesion while achieving adequate clear margins is the key factor for successful management of non-palpable breast lesions. For this purpose, several techniques such as wire-guided localization, intra-operative ultrasound guided resection, radio-guided occult lesion localization and radioactive seed localization have been described and applied. In this article, we overview the two commonly used localization techniques, radio-guided occult lesion localization and wire-guided localization, particularly describing their advantages and drawbacks.

Radiological evaluation with Doppler sonography and multidetector CT angiography in congenital hepatic arteriovenous malformation in a newborn

Although hepatic arteriovenous malformations are rarely reported, they frequently have life-threatening complications such as cardiac failure and are associated with a high mortality rate. Consequently, accurate prenatal and early postnatal diagnosis is important and therapeutic procedures depend on the imaging features. We report the early postnatal sonographic, Doppler sonographic, multidetector CT and CT angiography findings of a congenital hepatic arteriovenous malformation in a newborn.