Ibrahim Inan

Localized Breast Amyloidosis

Localized amyloidosis in the breast is a very rare disease and may mimic malignant lesions. A 60-year-old woman who had a history of breast-conserving surgery presents with a new a well-defined oval opacity accompanied by many round tight clustered micro- and macrocalcifications on mammograms. It could not be visualized sonographically due to the intense posterior acoustic shadowing of the fat necrosis areas and contrast enhancement was not detected in this area on the dynamic contrast enhanced magnetic resonance images. At pathological examination breast amyloidosis was detected. Amyloidosis of the breast is a rare disease, but it can mimic malignancy and should be included in the differential diagnosis.

Diffusion-Weighted Imaging for the Discrimination of Benign and Malignant Breast Masses; Utility of ADC and Relative ADC

Purpose: To determine the contribution of apparent diffusion coefficient (ADC), and relative ADC (rADC) values to differentiate between benign and malignant breast masses. Materials and Methods: Magnetic resonance imaging (MRI) of the breast with diffusion-weighted imaging (DWI) of patients with benign or malignant breast masses diagnosed either by histopathological findings or by follow-up imaging were evaluated retrospectively. Histopathological analyses were performed for 71 lesions (80.7%) while the remaining were followed up every six months for one year. DWI was performed using b-values of 0 and 1000 sec/mm2, and ADC and rADC were calculated and compared. A receiver operating characteristic (ROC) curve and Youden index were used to evaluate the parameter’s optimal threshold and diagnostic value. Statistical significance was set as p < 0.05. Results: Eighty-eight lesions from a total of 81 patients, aged between 16 and 73 (mean age 42 ± 11.3) years were obtained and evaluated. Pathological results of 34 (38.6%) out of 71 lesions were malignant and 37 lesions (42%) were benign. Seventeen (19.3%) lesions remained stable at one-year follow-up and were accepted as benign breast masses. Mean ADC values of benign and malignant lesions were 1.584 × 10–3mm2/sec and 0.884 × 10–3mm2/sec (p < 0.05), respectively. Sensitivity and specificity of ADC were 88% and 87%, respectively at a cut-off value of 1.04 × 10–3mm2/sec. Mean rADC was 0.931 for benign lesions and 0.557 for malignant lesions (p < 0.05). Sensitivity and specificity were 82% and 83% at a cut-off value of 0.639. No prominent superiority of rADC over ADC is identified in the differentiation of breast masses. Conclusion: ADC and rADC values derived from DWI can be equally useful in clinical setting to differentiate benign from malignant breast masses.

Is real-time elastography helpful to differentiate acute from subacute deep venous thrombosis? A preliminary study

To detect and characterize changes in stiffness of thrombus in patients with acute and subacute deep venous thrombosis (DVT) by using real‐time elastography (RTE).

Sclerosing encapsulated peritonitis: typical imaging findings for easy diagnosis

Sclerosing encapsulated peritonitis (SEP) is a rare disease characterized by intestinal encasement within a fibrocollagenous membrane. Diagnosis of SEP may be challenging due to a lack of specific symptoms. Demonstration of clustered intestinal segments surrounded by a membranous sac by various imaging modalities is crucial to reveal the presence of SEP. Radiologic examinations play an important role in the management of the disease. This case is not unusual. Our intention is to emphasize the role of the imaging findings of a patient with primary SEP that presented with recurrent intestinal obstruction.

Comparison of likert and PI-RADS v2 scoring in the diagnosis of prostate cancer

Aim: We aimed to compare the inter- and intra-observer variability and diagnostic performance of PI-RADS v2 and Likert scoring in the evaluation of prostate cancer on multiparametric prostate MR imaging. Material and Methods: MRI findings of 53 patients who had histopathologic diagnosis of prostate cancer and 51 patients who had one or more negative transrectal ultrasound guided prostate biopsy were evaluated retrospectively. The images were assessed by three independent observers blinded to histopathologic results of the patients. Intra-observer and inter-observer variability were evaluated by CohenÂ’s Kappa coefficient for all possible pairs of observers. ROC curve analysis was used to determine AUC to evaluate diagnostic performance of Likert and PI-RADS v2 scoring with a 1.5T MR in the diagnosis of prostate cancer. Results: Kappa values for 4 or higher PI-RADS v2 scores were calculated and κ=0.59-0.71 for intra-observer and κ=0.48-0.67 for inter-observer variability were obtained. κ=0.54-0.69 for intra-observer and κ=0.42-0.75 for inter-observer reliability were obtained for 4 or higher Likert scoring. AUC was 72% for PI-RADS v2 scores and was 75.9% for Likert scores for determining Gleason 6 or higher prostate cancers. There was not a statistically significant difference in the comparison of Likert and PI-RADS v2 ROC curves. Conclusion: PI-RADS v2 has no significant superiority compared to Likert scoring in intra-observer and inter-observer reliability. Likert and PI-RADS v2 scoring has no difference in the terms of diagnostic capability of prostate cancers.

Isolated hepatic actinomycosis mimicking hepatocellular carcinoma: Case report and review

Actinomyces are a rare cause of the intra‐abdominal infection that results in chronic suppurative and infectious granulomatous disease. The liver is involved in 15% of cases with abdominal infection and comprises 5% of all cases. Major risk factors include previous surgery, abdominal trauma, gastrointestinal foreign body, gut lesions, and immunosuppression. Due to the insidious course of the disease, symptoms arise several months after onset of the disease. The diagnosis of liver actinomycosis relies on clinical manifestations and imaging findings. Thus, it is often misdiagnosed as a primary liver cancer or metastatic tumor. Here we describe a case of isolated hepatic actinomycosis that mimicked a hepatocellular carcinoma with pretreatment and posttreatment magnetic resonance imaging findings. The patient was cured with long‐term antibiotherapy.

A Severely Encrusted Forgotten Double J Ureteral Catheter

Double J (DJ) stents provide efficient upper urinary system drainage in patients with ureteral obstruction [1]. Long-term indwelling DJ stents may be complicated by encrustation and stone formation. Patients should have their DJ stents replaced every three months [2]. Plain abdominal radiography and computed tomography are the imaging methods of choice in these patients for making a diagnosis and guiding the therapy.

Real-time elastography for differentiation of breast lesions

Summary Backroung To investigate the diagnostic performance of the elastography-based strain index ratio in the differential diagnosis of malignant and benign breast lesions. Material/Methods Seventy-nine breast masses that were classified as BI-RADS category 3, 4, and 5 on B-mode ultrasonography (US) were further prospectively evaluated by real-time sonoelastography (RTE). To obtain an optimal cut-off value of the strain ratio for differentiating between malignant and benign breast lesions, RTE findings were compared with histopathology of core needle biopsy samples or with ultrasound follow-up data of the analyzed masses. Results Seventy-nine breast lesions [BI-RADS category 3 (n=15), BI-RADS category 4 (n=34), and BI-RADS category 5 (n=30)] were classified as malignant (n=36) or benign (n=43). The mean strain index value was 6.59±3.44 (range 0.6–14) for malignant lesions and 2.79±2.16 (range 0.6–8.7) for benign lesions, respectively (p<0.05). As regards the detection of malignant lesions, US was characterized by sensitivity and specificity of 100% (CI 95%; 88–100) and 90% (CI 95%; 76–97), respectively. When an optimal value of the strain ratio (4.25) was obtained by ROC curve analysis, the sensitivity and specificity for diagnosing malignant lesions were 86% (CI 95%; 70–95) and 76% (CI 95%; 60–87), respectively. Conclusions RTE can play an important role in the differentiation between malignant and benign breast masses, but it should be used in conjunction with ultrasonography.

Utility of diffusion-weighted magnetic resonance imaging in diagnosing hepatocellular carcinoma in cirrhotic liver

received: 18.06.2016 Accepted: 08.08.2016 1Department of Radiology, Ümraniye Training and Research Hospital, Istanbul, Turkey 2Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul 3Department of Radiology, King Hamad University Hospital. Bahrain Yazışma adresi: Ahmet Aslan, Department of Radiology, Ümraniye Training and Research Hospital, Istanbul e-mail: aslahmet@gmail.com INtrodUctIoN