Mehmet Sedat Durmaz

Evaluation of Parathyroid Lesions With Point Shear Wave Elastography

The aim of our study was to evaluate the shear wave velocity (SWV) of parathyroid lesions by point shear wave elastography (SWE) and to compare their stiffness with that of thyroid nodules and normal thyroid parenchyma quantitatively.

Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis

The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis.

Advantages of b-mode ultrasound combined with strain elastography in differentiation of idiopathic granulomatous mastitis from malignant breast lesions

Background/aim: To evaluate the diagnostic performance of strain elastography (SE) combined with B-mode ultrasound in distinguishing between idiopathic granulomatous mastitis (IGM) and malignant breast lesions. Materials and methods: Seventy-seven malignant breast lesions and 36 IGM were assessed using B-mode ultrasound and SE. Ultrasonographic findings for all the breast lesions were classified based on the 2013 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS-US), and the SE findings were evaluated based on the strain ratio and a five-point scale. The diagnostic performances of B-mode ultrasonography, SE, and the combination of both methods were compared. Results: Significant differences in strain ratio and elastography scores were found between IGM and malignant breast lesions. When the lesions were assessed with B-mode ultrasound alone, in order to distinguish between IGM and malignant breast lesions, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94.8%, 66.7%, 85.9%, 85.7%, and 85.8%, respectively. However, when assessed with a combination of B-mode ultrasonography and SE, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 96.1%, 100%, 100%, 92.3%, and 97.3%, respectively. Conclusion: The combination of SE and B-mode ultrasound has better diagnostic performance in the differentiation of IGM and malignant breast lesions than B-mode ultrasonography alone.

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

ObjectivenThe aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE).nnnMaterials and MethodsnBetween 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI).nnnResultsnPVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001).nnnConclusionnPVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination.

Molybdenum cofactor deficiency: Neuroimaging findings

Molybdenum cofactor deficiency is an extremely rare and fatal metabolic disorder that should be considered in the differential diagnosis of hypoxic-ischemic encephalopathy. Magnetic resonance imaging findings are useful in diagnosis. The short-echo-time magnetic resonance spectrum was characterized by a total loss of signal and lipid and lactate peaks. In this case, conventional magnetic resonance imaging and magnetic resonance spectroscopy findings of this extremely rare disease whose pathophysiology was not known were presented.

Left ventricular hydatid cyst mimicking acute coronary syndrome

Hydatid disease is caused by the larvae of Echinococcus granulosus. Domestic dogs and cats are the primary carriers of echinococcal organisms. In some particular regions of the world, this parasitic infection is still endemic. Despite the fact that hydatid disease is most frequently located in the liver (50%-70% of cases) and the lungs (20%-30% of cases), it can occur in any organ or tissue. However, intracardiac localization of hydatid cyst is very rare and it is found in less than 2% of the cases. Cardiac involvement can be caused by systemic or pulmonary circulation or direct spread from adjacent structures. After the cardiac hydatid cyst remained asymptomatic for many years, the cyst opens into the pericardium, causes cardiac tamponade, and mimics acute coronary syndrome, or it may get into the circulation and cause anaphylactic shock, which happens rarely. Because clinical signs and symptoms of cardiac hydatid cyst are not specific and varied, it may be difficult to diagnose this disease. It is critical to diagnose cardiac involvement early and perform prompt surgical intervention. Imaging findings of a patient who had a left ventricular wall cardiac hydatid disease are presented here.

Shear wave elastography evaluation of testes with non-communicating hydrocele in infants and toddlers: A preliminary study

INTRODUCTIONnShear wave elastography (SWE) is a new technology and non-invasive ultrasound device that can measure tissue rigidity and elasticity.nnnOBJECTIVEnThis controlled prospective study aimed to demonstrate using SWE whether there was a difference between the elasticity of testes with non-communicating (NC) hydrocele in infants and toddlers and elasticity of controls testes without hydrocele, and to reveal quantitative values of elasticity reflecting histological findings.nnnMATERIAL AND METHODSnTestes of 37 cases at an average age of 6.32 months and diagnosed with NC hydrocele between December 2016 and April 2017 were evaluated for hydrocele and testicular volumes, and testes elasticity through ultrasonography and SWE.nnnRESULTSnOf all cases, 15 had bilateral hydroceles, while 22 were diagnosed with unilateral hydrocele. Testes with NC hydrocele (nxa0=xa052) in infants and toddlers were compared with testes without hydrocele (nxa0=xa036) in controls. Median hydrocele volume of 52 testes with NC hydrocele was 5.0xa0cm3 (0.2-37). Median volume of testes with hydrocele was 0.6xa0cm3 (0.2-1.5) in the study group, and 0.5xa0cm3 (0.3-1) in controls (Pxa0=xa00.577). Although median elastography values were measured as 1.67xa0m/s (1.29-2.59) and 10.0xa0kPa (2.1-23) in patients, those of controls were found to be 1.61xa0m/s (1.27-2.34) and 8.25xa0kPa (5.1-18.9) (Pxa0=xa00.03, Pxa0=xa00.005, respectively). While there was no between-group difference in testes volumes, a statistically significant difference was observed in SWE-derived quantitative data (Summary Table).nnnDISCUSSIONnAs a novel elastographic method, SWE is used to track shear waves passing through tissues by quantifying the elasticity of structures and nodules, such as liver fibrosis, and to improve the characterization of breast and thyroid nodules. Shear wave elastography was assessed to be a beneficial ultrasonography tool to predict the histologic features of undescended testicles, which might replace testicular biopsy in the modern management of undescended testes. This study also quantitatively measured whether there was a change in testicular tissues with NC hydrocele through SWE, and found that SWE values of testes with NC hydrocele were significantly higher compared with those of controls, despite the absence of a significant difference in testes volumes.nnnCONCLUSIONSnThe present study confirmed that quantitative changes in testes elasticity can reliably be evaluated through SWE. Non-communicating hydrocele may be damaging to testicular tissues. More definitive results will be achieved with further comprehensive studies including larger patient populations. It is believed that the operation age of children with NC hydrocele can be re-evaluated in the future.

Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow

PurposeSuperb micro-vascular imaging (SMI) is a new blood flow (BF) technique recently developed to outface the limitations of conventional Doppler imaging techniques (CDIT). SMI can observe micro-vascular BF and low-velocity BF. SMI is available in two modes as color SMI (cSMI) and monochrome SMI (mSMI). To evaluate testicular BF, we have compared color Doppler (CD), power Doppler (PD), cSMI, and mSMI techniques.Patients and methodsA total of 156 patients (310 testes) were included in the study. We evaluated BF in the testes via CD, PD, cSMI, and mSMI techniques in a heterogenous patient group. Doppler examination was performed by observing the whole testis parenchyma within the examination area at the testicular hilus level at all examinations. Spot and linear flow color encoding determined in testis parenchyma were separately counted for every examination.ResultsSMI was found to be superior in all age groups and testis volumes for showing the BF. When we sequenced the examinations to show the BF in testis according to their priorities, it was found that mSMIxa0>xa0cSMIxa0>xa0PDxa0>xa0CD. As the testis volume decreases, a significant increase is observed in mSMI when compared to other examinations in showing vascularity in pediatric age groups, in cases diagnosed with undescended testis, and in cases that underwent surgery for undescended testis.ConclusionsSMI renders more detailed vascular information on BF in the testes than CDIT. In particular, as the testis volume decreases, the priority of SMI showing BF increases. SMI should be a part of vascular examination in pediatric patients with small testis volume.

Effectiveness of Shear Wave Elastography in the diagnosis of acute pancreatitis on admission

AIMnWe aimed to investigate the effectiveness of shear wave elastography (SWE) in the diagnosis of acute pancreatitisxa0(AP).nnnMATERIAL AND METHODSnThe pancreatic parenchyma of 50 patients whose clinical and laboratory findings were indicativexa0of AP and of 70 healthy, asymptomatic volunteer participants with normal laboratory values was examined using SWE.Computed tomography was performed in all patients with AP on admission. Elastographic measurements were performed byxa0manually drawing the contours of the pancreatic parenchyma using the free region of interest. The quantitative SWE valuesxa0(meters/second [m/s], kilopascal [kPa]) of the patients and asymptomatic volunteers group were compared.nnnRESULTSnThe meanxa0SWE value of the pancreatic parenchyma was 2.60 ± 1.63 m/s in the asymptomatic volunteers and 3.48 ± 0.52 m/s in patientsxa0with AP, with a statistically significant difference (p<0.001, t=-3.685). The mean SWE value of the pancreatic parenchyma wasxa023.77±6.72 kPa in the asymptomatic volunteers and 45.71 ± 10.72 kPa in patients with AP, indicating a significant differencexa0(p<0.001, t=-3.685). AP can be diagnosed with a sensitivity and specificity of 98.0% when 29.45 kPa was designated as cut-offxa0value and with a 96.0% sensitivity and 98.3% specificity when 2.77 m/s was designated as the cut-off value. The superiorityxa0of SWE was found over B-mode US and CECT in the diagnosis of AP on admission.xa0Conclusion: SWE can be used as an effective imaging method with high sensitivity and specificity for the diagnosis ofxa0AP. It may be used as an important imaging method to assist in the diagnosis of AP especially when B-mode US and CECTxa0findings are normal.

Effectiveness of Superb Microvascular Imaging for the differentiation of intraductal breast lesions

AIMSnThe aim of this study was to compare the diagnostic performance of superb microvascular imaging (SMI) andxa0power Doppler imaging (PDI) for the differentiation of intraductal breast lesions.nnnMATERIALS AND METHODSnA total of 54 intraductalxa0breast lesions (39 benign, 10 atypical, and 5 malignant) in 53 patients were examined using B-mode ultrasonography,xa0PDI, and SMI. Vascularity grading, distribution of microvessels, and penetrating vessels were evaluated using each Dopplerxa0technique. The diagnostic performances of both methods were compared.nnnRESULTSnSMI was more efficient in detecting flowxa0signals than PDI (p=0.004). The highest diagnostic accuracy rates were achieved with SMI using vascular grading. Whenxa0hypervascularity was used as a cut-off value to differentiate malignant and atypical lesions from benign lesions, the sensitivity,xa0specificity, positive predictive value, negative predictive value, and accuracy were 66.6%, 80.7%, 66.6%, 80.7%, and 75.6%for PDI, and 86.6%, 76.9%, 68.4%, 90.9%, and 80.4% for SMI, respectively.nnnCONCLUSIONSnSMI is more sensitive than PDI for detecting subtle blood flow in intraductal breast lesions with statistical significance. This novel and promising vascular imaging technique may be helpful in B-mode ultrasonography to distinguish intraductal breast lesions.