Recep Sade

The feasibility of dual-energy CT in differentiation of vertebral compression fractures

OBJECTIVE To prospectively evaluate the ability of dual-energy CT (DECT), compared with MRI, to identify vertebral compression fractures in acute trauma patients. METHODS This institutional review board-approved study included 23 consecutive patients with 32 vertebral fractures who underwent both DECT and MRI of the spine between February 2014 and September 2014. A total of 209 vertebrae were evaluated for the presence of abnormal bone marrow attenuation on DECT and signal on MRI by five experienced radiologists. The specificity, sensitivity, predictive values and intraobserver and interobserver agreements were calculated. RESULTS MRI revealed a total of 47 vertebrae (22.4% of all vertebrae) and DECT revealed 44 vertebrae (21.0% of all vertebrae) with oedema. Using MRI as the reference standard, DECT had sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of 89.3, 98.7, 95.4, 96.9 and 96.6%, respectively. With respect to establishing the presence of oedema, the interobserver agreement was almost perfect (k = 0.82), and the intraobserver agreement was substantial (k = 0.80). CONCLUSION Compared with MRI, DECT can provide an accurate demonstration of acute vertebral fractures and can be used as an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI. ADVANCES IN KNOWLEDGE Distinguishing of acute and chronic vertebral compression fracture is important for treatment choices. DECT is very fast compared with MRI and is an alternative imaging modality for the assessment of vertebral fractures in patients with contraindications for MRI.

How Can New Imaging Modalities Help in the Practice of Radiology

The purpose of this article was to provide an up-to-date review on the spectrum of new imaging applications in the practice of radiology. New imaging techniques have been developed with the objective of obtaining structural and functional analyses of different body systems. Recently, new imaging modalities have aroused the interest of many researchers who are studying the applicability of these modalities in the evaluation of different organs and diseases. In this review article, we present the efficiency and utilization of current imaging modalities in daily radiological practice.

Value of dynamic MRI using the Ktrans technique for assessment of native kidneys in pre-emptive renal transplantation.

Background Different non-invasive imaging techniques such as Doppler ultrasonography and renal scintigraphy are commonly employed to assess allograft function and associated complications. However, all such methods lack sufficient specificity to discriminate between residual renal function of native kidneys. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluates signal dynamics during the passage of contrast material through the renal cortex, medulla, and collecting system. Purpose To investigate the value of DCE 3T MRI using a quantitative pharmacokinetic parameter (Ktrans) for the assessment of native kidneys before and after pre-emptive renal transplantation. Material and Methods Twenty-five consecutive patients with end-stage renal disease underwent DCE MRI before and 6 months after kidney transplantation. MRI was performed using a 3T scanner. Regions of interests were drawn over each kidney, encompassing the cortex and medulla but excluding the collecting system and any coexisting cysts. Parametric Ktrans values were automatically generated. Results In the pre-transplantation group, mean Ktrans values for the right and left kidneys were 0.55 ± 0.09 min–1 and 0.44 ± 0.15 min–1, respectively. In the post-transplantation group, mean Ktrans values of the right and left kidneys were 0.27 ± 0.07 min–1 and 0.25 ± 0.10 min–1, respectively. There were statistically significant differences between right and left kidneys in terms of mean Ktrans values in the pre- and post-transplantation groups (P < 0.001). Conclusion Our preliminary results show that native kidneys were still functioning 6 months after transplantation. MR perfusion using Ktrans may constitute a non-invasive means of determination of the viability of native kidneys after renal transplantation.

Endometrial cancer metastasis mimicking spondylodiscitis and psoas abscess

A 51-year-old female patient was admitted to the hospital with lumbago for 3 weeks. Lumbar vertebral magnetic resonance imaging was performed. Magnetic resonance imaging showed heterogeneous lesion with peripheral enhancement in the right psoas muscle associated with bone involvement of the lumbar vertebrae (Figs. 1 and 2). It was interpreted as psoas abscess associated with spondylodiscitis. At this time the patient underwent endometrial biopsy for the vaginal discharge. Histopathologic diagnosis was endometrium cancer. Psoas abscess percutaneous drainage was

A sesamoid ossicle of the nuchal ligament mimicking spinous avulsion fracture.

A 25-year-old man who suffered a traffic accident was admitted to our emergency department. Computer tomography was performed. Computer tomography images showed an osseous structure mimicking avulsion fracture at the level of C5–C6 (Fig. 1). There was no bone defect corresponding to spinous process and so, the diagnosis was consistent with sesamoid ossicles of the nuchal ligament. Sesamoid ossicles of the nuchal ligament are an anatomical variant that are usually asymptomatic. Prominent differential diagnosis includes avulsion fractures of the spinal processes and myositis ossificans. Focal well-defined osseous masses, well-circumscribed with regular shape, are in favor of sesamoid ossicle of nuchal ligament, whereas triangular dense bony fragment with bony defect of the adjacent spinous process are in favor of spinous process fracture. Ihsan Yuce, MD Berhan Pirimoglu, MD Gokhan Polat, MD Recep Sade, MD Mucahit Emet, MD Mecit Kantarci, MD, PhD Department of Radiology, School of Medicine Ataturk University 25100 Erzurum, Turkey Department of Emergency Medicine, School of Medicine Ataturk University 25100 Erzurum, Turkey

Herniation of the Cerebral Gyrus Into the Giant Arachnoid Granulation in a Child With Intermittent Headache

Keywords: cerebral herniation; giant arachnoid granulation; advanced MR imaging; headache

Primary extraosseous Ewing sarcoma of the lumbar spine presenting with left leg weakness

A 7-year-old boy presented to the neurosurgery clinic with left leg weakness. Enhanced multidetector computed tomography and magnetic resonance imaging were performed. Multidetector computed tomography images revealed a mass with minimal contrast enhancement that extended into the left L3–L4 foramen and psoas muscle (Fig. 1). Magnetic resonance images revealed a mass that was isointense on T1-weighted images and hyperintense on T2-weighted images comparedwithmuscle (Figs. 2 and 3), with homogenous enhancement after contrast administration (Figs. 2 and 3), consistent with nerve sheath tumors. Pathologic specimens obtained at surgery showed Ewing sarcoma that has imaging features similar to nerve sheath tumors. Extraskeletal Ewing sarcoma is rare but has been reported [1,2].

Comparison of Ultrasonography and Low-Dose Computed Tomography for the Diagnosis of Pediatric Urolithiasis in the Emergency Department

OBJECTIVE This study aimed to compare ultrasonography (US) and low-dose computed tomography (LDCT) for diagnosing pediatric urolithiasis in the emergency department. MATERIALS AND METHODS This retrospective study was approved by our institutional ethics committee, and informed consent was waived. From March 2016 to March 2017, 100 consecutive patients met the selection criteria and were enrolled in the study. Patients were randomly selected in a 1:1 ratio and were allocated to one of the following two imaging groups: US or abdominal LDCT. LDCT examinations were performed using a 320-detector row CT. Radiation dose analysis was performed using Radimetrics. US examinations were performed using the Aplio 500 ultrasound system. The presence of urolithiasis, anatomical location of urolithiasis, and measurements of renal stones were evaluated and recorded. RESULTS There were statistically significant differences between US and standard-dose CT (SDCT) with respect to the diagnosis of urolithiasis, anatomical location of urolithiasis, and measurements of renal stones (p<0.001, p=0.005, and p=0.03, respectively). The mean effective radiation dose of LDCT was 1.44±0.34 mSv and that of SDCT was calculated to be 4.36±1.33 mSv. There was no statistically significant difference between LDCT and SDCT with regard to the diagnosis of urolithiasis, anatomical location of urolithiasis and measurements of renal stones (p=1 for all). The diagnostic accuracy of US and LDCT was 0.68 and 1.0, respectively. CONCLUSION Low-dose computed tomography had 1/3 SDCT radiation dose, and LDCT and SDCT accurately diagnosed pediatric urolithiasis in the emergency department. US had a lower accuracy than SDCT and LDCT for diagnosing pediatric urolithiasis in the emergency department. LDCT can be an alternative for SDCT for diagnosing pediatric urolithiasis.

The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury.

Purpose The purpose of this study was to evaluate the efficiency and feasibility of dual-energy computed tomography (DECT) used in the diagnosis of cardiac contusion with the mildest blunt cardiac injury. Material and Methods This study was performed between February 2014 and September 2015; a total of 17 consecutive patients (10 men and 7 women; median age, 51 years [range: 20–78]) were enrolled in the study. The DECT was performed within 48 hours of the trauma and a subsequent follow-up DECT was performed a little less than 1 year after the first examination. All examinations were analyzed on iodine map images by 2 experienced radiologists. Interobserver and intraobserver agreement was calculated. The correlation of initial troponin level, age, and sex with number of contusion areas in the left ventricle and complete recovery of contusion were measured. Results The contusion areas were amorphous, with considerable variation in their size, shape, and density. Contusions were primarily located in the left free wall of the ventricle, the ventricular septum, and the apex, respectively. In 10 patients, contusion areas disappeared on follow-up examination. In 4 patients, the contusion areas decreased but were still present in the follow-up examination. The interobserver agreements were almost perfect with respect to the presence of cardiac contusion, the anatomic location of contusions, and the contusion areas (kappa values of 1.0, 1.0, and 0.9 for intraobserver agreement and 1.0, 1.0, and 1.0 for intraobserver agreement, respectively). Correlations were found between age of patients and complete recovery of contusion (P = 0.01). Conclusions Dual-energy computed tomography can show cardiac contusion and could be useful and feasible for the diagnosis and follow-up of blunt cardiac injuries. Dual-energy computed tomography is a new, user-independent, and valuable imaging technique.

A very rare cause of abdominal pain.

It is evident from the family history that the condition is autosomal recessive. Silvery hair is a unique finding in three closely similar conditions known as Silvery hair syndromes: Chediak-Higashi syndrome, Griscelli syndrome and Elejalde disease. But the presence of giant granules points to Chediak Higashi syndrome which is a hallmark of this disease. Light microscopy of skin and hair shafts aids in further differentiation. Chediak-Higashi syndrome results from mutations in the lysosomal trafficking regulator (LYST) gene located on chromosome 1q42.1-42.2. The mutation leads to disturbances in lysosomal trafficking leading to aberrant fusion of diverse intracellular organelles, giving rise to the abnormally giant granules seen in several tissues. The main features are generalised hypopigmentation, silvery hair, immunodeficiency, progressive peripheral neuropathy and bleeding tendency. These patients usually die due to recurrent infections. They can also develop haemophagocytic lymphohistiocytosis, and bone marrow transplantation is the only curative treatment. Griscelli syndrome is also characterised by partial albinism, silvery hair, variable cellular and humoral immunodeficiency and neurological impairment. Elejalde disease is closely similar but with normal immunological function and early-onset severe neurological dysfunction. Images of the Month