Mehmet Sait Menzilcioglu

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.

Importance of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of the Treatment Efficacy in Multiple Sclerosis Patients with Acute Attacks

Summary Background We planned to investigate contribution of DWMR to the treatment efficacy with ADC values which were measured in acute and chronic plaque before and after MS treatment. ADC changes in normal appearing white matter (NAWM) in patients with MS and healthy volunteers were also evaluated in this study. Material/Methods 25 patients with MS and 30 healthy subjects with normal brain MR findings were included to our study. Contrast enhancement in plaque was evaluated as an acute, and non-contrast enhancement in plaque was evaluated as a chronic. Also, ADC measurements were performed using the same parameters in NAWM in plaque neighborhood and volunteers. Results were compared with appropriate statistical methods. Results ADC values in acute and chronic plaques were decreased after the treatment, and these reductions were statistically significant for acute plaqus in b500 and for chronic plaques in b500 and b1000. The mean ADC values were measured as 1.53±0.49×10−3 and 1.43±0.58×10−3 in acute plaques and 1.40±0.35×10−3 and 1.34±0.36×10−3 mm2/sec in chronic plaques before and after the treatment. Conclusions We think that DWMR have important role due to quantitative measurement ability in the evaluation of the treatment efficacy of the MS patients with acute attack in addition to contrast-enhanced MR sequence.

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

Assessment of the Pancreas with Strain Elastography in Healthy Children: Correlates and Clinical Implications

Summary Background To determine strain index (SI) values at various locations in the pancreas and to investigate the relationship between age, gender, body weight, height, body mass index (BMI), and elasticity values of the pancreas in healthy children. Material/Methods This cross-sectional trial was performed in 147 healthy children who underwent transabdominal ultrasonography for strain elastography of the pancreas. A convex, 3.5–5-MHz probe was used to obtain the images. Baseline descriptive data including age (months), body weight (kg), height (cm), and BMI (kg/m2) were noted. Strain index values were calculated for the head, body, and tail of the pancreas, and a mean value was obtained. The relationship between demographic variables and SI values was assessed. Correlation between variables with normal distribution was evaluated with Pearson’s correlation coefficient and Spearman’s rho. Results The average SI values in girls and boys were 1.30±0.34 and 1.32±0.22, respectively. There was no significant difference between SI values measured in the head, trunk, and tail of the pancreas (p=0.594). The average SI value did not differ between girls and boys (p=0.751). Correlation analysis revealed that SI was positively associated with age (p=0.005), body weight (p=0.004), height (p=0.003), and BMI (p=0.005). Conclusions This study determined normal elasticity values of the pancreas in healthy children. SI values of pancreas change with age, body weight, height, and BMI in the pediatric population. Information obtained from healthy children can serve as a baseline against which pancreatic diseases can be examined.

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.

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.

A rare case of extramedullary myxopapillary ependymoma.

A 58-year-old man was admitted to neurosurgery outpatient clinic with the complaint of backache reflecting to the pelvic region in the prone position. There was no problem in erect position. In neurologic examination, there was mild motor weakness in the feet. Other findings were normal. Magnetic resonance imaging of the lumbar spine showed a posterolateral intradural extramedullary mass compressing the spinal cord at the levels L1–L2 (Figure). The mass showed low intensity according to the medullary tissue in T1-weighted images and slight hyperintensity in T2-weighted images. The mass was well and homogeneously enhanced on contrast enhanced T1-weighted images. We prediagnosed the lesion as schwannoma initially. The mass was totally resected in the operation performed by neurosurgery. Histologic examination revealed a low-