Nazan Ciledag

Quantitative Assessment of Normal Soft-Tissue Elasticity Using Shear-Wave Ultrasound Elastography

OBJECTIVE The aim of this study was to measure the elasticity of various tissues and report it in kilopascals. SUBJECTS AND METHODS The thyroid, submandibular, and parotid glands, masseter and gastrocnemius muscles, supraspinatus and Achilles tendons, renal cortex and pelvis, pancreas, and spleen of 127 healthy volunteers (89 women, 38 men; mean age, 37.72 ± 9.11 years; range, 17-63 years) were evaluated with shear-wave ultrasound elastography. RESULTS The mean elasticity values were determined to be 10.97 ± 3.1 kPa for the thyroid, 10.92 ± 3.1 kPa for the submandibular glands, 10.38 ± 3.5 kPa for the parotid glands, 10.4 ± 3.7 kPa for the masseter muscle, 11.1 ± 4.1 kPa for the gastrocnemius muscle, 31.2 ± 13 kPa for the supraspinatus muscle, 51.5 ± 25.1 kPa for the Achilles tendons, 5.0 ± 2.9 kPa for the renal cortex, 23.6 ± 5.4 kPa for the renal pelvis, 4.8 ± 3 kPa for the pancreas, and 2.9 ± 1.8 kPa for the spleen. CONCLUSION Elasticity values were determined for different tissues with shear-wave ultrasound elastography. Further studies comparing the elasticity values of normal and pathologic tissues are necessary to determine the diagnostic role of this technique.

The Utility of Ultrasound Elastography and MicroPure Imaging in the Differentiation of Benign and Malignant Thyroid Nodules

OBJECTIVE The aim of this study was to evaluate the utility of ultrasound elastography and MicroPure imaging in the differential diagnosis of benign and malignant thyroid nodules. SUBJECTS AND METHODS A total of 74 consecutive patients (65 women and nine men; age range, 21-80 years; mean [± SD] age, 51 ± 12.7 years) with thyroid nodules, who were referred for fine-needle aspiration biopsy by endocrinology or general surgery clinics, were prospectively examined using B-mode ultrasound, ultrasound elastography, and MicroPure imaging. The strain value ratio (strain index) of thyroid nodules was calculated. Patients with malignant or intermediate fine-needle aspiration biopsy results underwent thyroid surgery. RESULTS Using MicroPure imaging, 17 of 65 benign thyroid nodules (26.6%) and three of nine malignant thyroid nodules (33.3%) were found to contain microcalcifications. The sensitivity, specificity, negative predictive value, positive predictive value, and the accuracy rate of MicroPure imaging were 42.9%, 80.6%, 93.1%, 18.8%, and 77%, respectively. By using receiver operating characteristic analysis, the best cutoff point (2.31) was computed (area under the curve, 0.87; p < 0.001). The sensitivity, specificity, negative predictive value, positive predictive value and accuracy rate of the strain index values were 85.7%, 82.1%, 98.2%, 33.3%, and 82.4%, respectively, when the best cutoff point of 2.31 was used (p = 0.001). The p value (x = malign) was 0.96 for a strain index value higher than 2.31. CONCLUSION This preliminary study indicated that ultrasound elastography and MicroPure imaging can be used for the differentiation of benign and malignant thyroid nodules.

Pancreatic schwannoma: A case report and review of the literature

Schwannoma or neurilemmoma is a well-defined, benign tumor, which arises from neural crest cells and surrounds the nerve sheath. It is rare neoplasm that is typically found in the extremities, such as the thorax, head, neck, pelvis and rectum. Schwannoma localized to the pancreas is particularly rare and only a limited number of cases have been reported in the literature to date. The present study reports the case of a 30-year-old male with pancreatic schwannoma presenting with weight loss and abdominal pain. Pancreatic schwannoma was diagnosed using magnetic resonance imaging and ultrasonography-guided biopsy, which was followed by a duodenopancreatectomy. Although pancreatic schwannomas are rare, they must be considered during the differential diagnoses of cystic pancreatic masses.

Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast

BACKGROUND AND OBJECTIVES The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. METHODS In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. RESULTS Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. CONCLUSION Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.

The Advantages and Limitations of Ultrasound Elastography in Diagnosis of Thyroid Carcinoma

Thyroid nodules have high prevalence in the general population. Only minorities of thyroid nodules are malignant; nevertheless, still biopsies are performed in differen‐ tial diagnosis of malignant and benign thyroid nodules. Conventional ultrasound is widely used in diagnosis and characterization of thyroid nodules. There are several suspicious ultrasound features that predict thyroid cancer, such as solid consistence, marked hypoechogenicity, taller-than-wide shape, irregular or microlobulated or spiculated margins, no peripheral hypoechoic halo, and microor macrocalcifications. However, none of these signs have high sensitivity or specificity nor high degree of confidence for diagnosis or exclusion of thyroid carcinoma. Ultrasound elastography, recently developed, promising, noninvasive technique that evaluates tissue stiffness, has become one of the main focuses in thyroid imaging. There are two ultrasound elastography methods: strain ultrasound elastography (also known as real-time elastography or qualitative elastography) and shear wave elastography (quantitative elastography and acoustic radiation force impulse imaging). The purpose of this chapter is to present the principles of thyroid application, advantages, and limitations of both ultrasound elastography techniques.

Magnetic Resonance Imaging Findings in Childhood Period Nasopharynx Cancer

Summary Background Nasopharyngeal carcinoma is a rarely seen tumor in childhood. It is mostly detected late as the clinical features are similar to other childhood tumors which affect the nasopharynx and adenoidal hypertrophy. Therefore, the radiological features of childhood tumors of the nasopharynx must be well known. The aim of this study was to investigate the contribution of MR imaging features of childhood nasopharynx cancer. Material/Methods The study included 10 nasopharyngeal carcinoma patients under the age of 18 years who presented at hospital between February 2008 and March 2014 and who had tissue diagnosis and MRI of the nasopharynx region. The MRI scans were evaluated by two radiologists. Loco-regional spread, asymmetry, signal intensity of the tumors, and lymph nodes were evaluated. Results In all the patients there was a mass which narrowed the nasopharynx. In all cases, unilateral mastoid opacification was observed. In 9 cases (90%), parapharyngeal extension was found. In 8 cases (80%), the mass showed an extension into the nasal cavity or oropharynx. In 5 cases (50%), there was an involvement of the skull base. In 3 patients (30%), an extension to the masticator space and pterygopalatine fossa was found. There were enlarged cervical lymph nodes bilaterally in 10 cases (100%). In 4 cases (40%), a lateral retropharyngeal lymph node was detected. Conclusions Childhood nasopharyngeal cancers are often diagnosed at an advanced stage. MR imaging can be helpful in diagnosis and differential diagnosis of childhood nasopharynx cancer from other diseases of the nasopharynx.

Peritoneal mezotelyoma: Bilgisayarlı tomografi ve magnetik rezonans görüntüleme bulguları ve ayırıcı tanıya katkısı

Objective: In this article, we review radiologic findings of malignant peritoneal mesothelioma with our patient archives. We also want to determine importance of radiologic findings about differential diagnosis of malignant peritoneal mesothelioma. Materials and methods: We scanned our patient archive of mesothelioma between 2008 and 2012 years. We included 15 patients with peritoneal mesothelioma who underwent computerized tomography (CT) or magnetic resonance imaging (MRI) at their initial diagnosis. Results: We found peritoneal irregularity and nodular thickening in 11 patients (73.3%), diffuse peritoneal thickening (omental cake) in 5 patients (33.3%), ascites in 9 patients (60%), extension of adjunct tissue and hepatic metastases in only one patient (6.6%). Conclusion: The diagnosis of peritoenal malignant mesothelioma may be difficult with only clinical findings. CT and MRI are helpful to diagnose and show spread of disease, but tissue biopsy is required for the definitive diag nosis.

Radiologic Evaluation of Malignant Pleural and Peritoneal Mesothelioma

Mesothelioma usually presents in the fifth to seventh decades, and 70-80 % of cases occur in men (Moore et al., 2008). Malignant pleural mesothelioma (MPM) is the most widely form of mesothelioma. Patients frequently present with dyspnea, chest pain, cough, and weight loss (Moore et al., 2008, Wang et al., 2004). Although most of the mesotheliomas cover the pleural surface, approximately 35% arise only from peritoneum. Patients with malignant peritoneal mesothelioma may present with abdominal pain, distention, anorexia, and weight loss (Park et al., 2008).