Mahmut Duymus

Sonographic Elastography of the Thyroid Gland.

Summary Thyroid gland disorders include benign and malignant thyroid nodules and diffuse thyroid disorders. The incidence of malignant thyroid nodules is low and the prognosis is good. The diagnosis of thyroid cancer and diffuse parenchymal disorders is generally based on clinical manifestations and histopathological evaluation. Ultrasonography has its place in the diagnostics and follow-up of thyroid disorders. Ultrasonographic elastography is a new, developing method that shows increase in clinical practice. In this study, we aimed to review the data on thyroid ultrasound elastography.

Acoustic radiation force impulse elastography for evaluating renal parenchymal stiffness in children

Sir, We read the article “Acoustic radiation force impulse elastography for detection of renal damage in children” by Goya et al. [1], with great interest. A precise identification of sampled renal segments and their orientation according to the US beam is obligatory when performing renal ultrasound elastography [2], because Gennisson et al. [3] showed the effects of anisotropy in vivo in pig kidneys with high mean variation due to complex intrarenal architecture [3]. Later Bruno et al. [4] in evaluating the kidneys in children with vesicoureteric reflux stressed the importance of orienting the region of interest with its main axis lying as parallel as possible to the main axis of the pyramids to reduce the effect of anisotropy. However, Goya et al. [1] did not discuss this technical aspect in their article [1]. In addition, Bruno et al. [4] emphasised the importance of constant compression exerted on the transducer when making shear wave velocity measurements. This followed from the findings of Syversveen et al. [5], who reported that acoustic radiation force impulse elasticity estimates may, in general, vary with applied transducer force. This technique detail also was not mentioned by Goya et al. [1]. Studies have shown that variability of measurements in the renal parenchyma is a real issue, whichever elastography technique is used [2]. Therefore meticulous attention to quality control in image acquisition and measurements is essential for implementation of this technique, especially in children. We also think it is essential to calculate shear wave velocity cut-off values with receiver operator characteristics curve analyses, using dimercaptosuccinic acid scintigraphy severity score and vesicoureteral reflux grade as reference standards, before clinical implementation.

Pneumocephalus and Pneumorrhachis After Spinal Surgery.

Summary Background Pneumocephalus and pneumorrhachis are rare complications of neurosurgery. When a closed system such as the head and spinal area get injuried, it becomes open and the air can come in through that opening. In this case, we present a case of pneumocephalus and pneumorrhachis after spinal fusion surgery. Case Report Herein we present a case of diagnosis and treatment of pneumocephalus and pneumorrhachis after spinal fusion surgery. Conclusions Our patient developed postoperative pneumocephalus and pneumorrhachis as a late complication secondary to an infection. We wanted it to be considered as an important problem.

Evaluation of Parotid Glands With Real-time Ultrasound Elastography in Children

The aim of this study was to determine the strain index for parotid glands in children by using ultrasound elastography.

Comparison of Dynamic Contrast-Enhanced MRI and PET/CT in the Evaluation of Laryngeal Cancer After Inadequate CT Results.

Summary Background To investigate the diagnostic value of dynamic magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for laryngeal cancers after inadequate CT results. Material/Methods The study comprised 45 patients investigated for primary laryngeal cancer or recurrence-residue in which CT was considered inadequate. A mass was found in 20 patients. Dynamic MRI and PET/CT were compared for diagnosis of mass, lymph node involvement, recurrence and residue. The dynamic curves formed in dynamic MRI were investigated for diagnostic contributions. Results The sensitivity and specificity of the dynamic MRI, for supraglottic, glottic and subglottic location, was 100%, 80%, and 92%; 100%, 85%, and 100%, respectively. In PET/CT the sensitivity and specificity were 100% for all of those localizations. For lymph node involvement, the sensitivity of dynamic MRI and PET/CT was 100%, the specificity was 100% and 93%, respectively. For recurrence-residue, the sensitivity and specificity of dynamic MRI were 86% and 67%, respectively, with 100% sensitivity and specificity in PET/CT. The sensitivity of type A curve for detection of malignancy was 40%, and specificity was 100%. When type A and B curves were included, the sensitivity was 100%. Conclusions For patients investigated for laryngeal cancer in which CT is considered inadequate, dynamic MRI or PET/CT is useful.

Association between any histologic features and wall striations.

AJR 2014; 203:W550 0361–803X/14/2035–W550

Multiple neurofibromas occupying all the neural foramens

Fig. 1. Axial T2-weighted magnetic resonance images at the level of thoracal and lumbar regions and similar findings were seen at all other levels in that region of the spine. The white arrowhead indicates the iso-heterogenous intensity neurofibromas passing through bilateral neural foramens. Fig. 2. Axial T2-weighted magnetic resonance images at the level of thoracal and lumbar regions and similar findings were seen at all other levels in that region of the spine. The white arrowhead indicates the iso-heterogenous intensity neurofibromas passing through bilateral neural foramens.

The Avaibility of Strain Elastography in a Hydatid Cyst - Interobserver Study.

Summary Background To differentiate the hydatid cyst (HC) types by ultrasound elastography using two different sizes (4 mm and 8 mm) of the region of interest (ROI) and asking two different radiologists (interobserver) for their opinion. Material/Methods Patients with HC were evaluated by USG elastography. The statistical anayses were performed using Strain index (SI) which is the unit of strain elastography. Results A total of 26 out of 33 patients were female, and 7 were male. The mean age was 38.85±17.62 (range from 10 to 72 years). Type I: 6, Type 2: 6, Type III: 6, Type IV: 11, Type V: 4. There was no significant difference in HC SI (regardless of types) between O1 and O2, and 4-mm and 8-mm ROI (p>0.05). There was no statistically significant difference between SI of HC types of interobservers (O1–O2) and ROI sizes (4–8 mm) (p>0.05 for all parameters). The highest correlation between HC types and ROI sizes was in ROI size of 4 mm. Conclusions The correlation between SI and types was reliable in standard-applied 4-mm ROI. There was no statistically significant difference between interobservers in SI values. Thus, elastography tecnhnique is objective for HC but not appropriate to differentiate the types.

Magnetic Resonance Imaging Perception of the Society in Kars: A Local Study.

Summary Background The start point of this study was the sentence that a patient used: ‘my pains had gone with MRI’. It is known that MRI has not a usage area in treatment, yet. Perhaps, the feeling of loss of pain was only a perception. But we want to search the demographic factors that make the perception of loss of pain. The purpose of this study was to determine the consciousness level of the society about MRI. Material/Methods This prospective survey study included 302 (107 men, 195 women; mean age 43.11±15.18 years) patients who were referred to the radiology clinic to undergo MRI. Results Almost half of the patients were illiterate and graduated from a primary school. Low level of education was more frequent in women than in men. Most of the patients declared that MRI would diagnose their disease. Among all the patients surveyed, 209 of 302 patients indicated no changes in the degree of pain before and after MRI, 30 indicated increased pain, 62 indicated decreased pain, and one patient did not answer the question. Most of the patients who declared decreasing pain had lumbar or cervical MRI. Conclusions The function of MRI was known by the patients independently from their educational status. The degree of decrease in pain was higher in the ‘treatment’ answer. Perhaps the relatively higher percentage was a result of the expectations about treatment and was related with psychological motivation.

A Rare Case of Polyorchidism: Four Testes

Summary Background Polyorchidism or supernumerary testis means more than two testes. It is very rare and to the best of our knowledge, there have been only about 200 cases reported. Case Report In this case report we want to present radiological features and assessment of a patient with four testicles. Conclusions If the vascularity and echogenicity of the scrotal mass is similar with the normal testis parenchyma, multitestis should be considered. The MRI might not provide us with additional information to USG or CDUSG, thus it is not necessary to perform it if there is no suspicion of malignancy.