Serhat Avcu

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.

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.

The efficiency of apparent diffusion coefficient quantification in diagnosis of acute cholecystitis and in differentiation of cholecystitis from extrinsic benign gallbladder wall thickening

PurposeThe aim of the current study was to assess the efficiency of the apparent diffusion coefficient (ADC) measurement in diagnosis of acute cholecystitis and in differentiation of cholecystitis from extrinsic benign gallbladder wall thickening.MethodsForty patients who were diagnosed to have acute cholecystitis by ultrasonographic examination were included in this study. The control group consisted of 18 patients without symptoms of gallstones and cholecystitis whose gallbladder walls were thickened due to cirrhotic ascites. Both groups were examined using diffusion weighted imaging, and the mean ADC values were compared using Student’s t-test.ResultsThe diagnoses of the 40 patients were proven by histopathological examination. The mean ADC values of patients diagnosed with cholecystitis (1.68xa0±xa00.36xa0×xa010−3 mm2/s) were significantly lower than the mean ADC values of the control group (2.35xa0±xa00.24xa0×xa010−3 mm2/s) (pxa0<xa00.05). Receiver operating characteristics curve analysis based on ADC revealed a cut-off value of 2.04xa0×xa010−3 mm2/s for the diagnosis of cholecystitis, with a sensitivity of 94xa0% and a specificity of 89.7xa0%.ConclusionADC value quantification may be an efficient method for making a diagnosis of cholecystitis and in differential diagnosis of cholecystitis from the extrinsic benign gallbladder wall thickening that can be seen during the course of cirrhotic ascites.

The Efficacy of One Molar Contrast Material in the Evaluation of Breast Lesions with MR Imaging

Summary Background To investigate the efficacy of 1 molar (containing 1 mol/mL gadobutrol) contrast material in the differentiation of malignant and benign breast lesions with MRI. Material/Methods Thirty-seven women (age range: 22–77 years, mean: 43.7 years) with 76 breast lesions were included in this study. Dynamic post-contrast images with 0.2 mL/kg gadobutrol (Gadovist) injection were obtained in all patients. Contrast-to-noise-ratio (CNR) of the lesions, as well as their contrast enhancement patterns (ring, heterogeneous, homogenous), and perilesional increased vascularity were studied. Results Fifty-six benign and 20 malignant lesions were examined histopathologically. In malignant cases, heterogeneous and peripheral enhancements were most commonly determined, whereas homogeneous enhancement was most commonly determined in benign cases. CNR was 450% in malignant lesions, and 60% in benign lesions. Conclusions Type II/III contrast-time curves, ring/heterogeneous enhancement, prominent increase in CNR, and perilesional vascularity increase are important findings determining malignancy, whereas Type I curves, homogenous enhancement, a slight increase in CNR, and absence of perilesional vascularity increase support findings of benign breast lesions. By increasing CNR and providing increased perilesional vascularity, Gadovist can help in the determination of malignant breast lesions.

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.

RE: Diffusion-Weighted MRI in Intrahepatic Bile Duct Adenoma Arising from the Cirrhotic Liver

We have read with great interest the recent case report of An et al. (1) revealing an intrahepatic bile duct adenoma (BDA) arising from a cirrhotic liver that was studied using both diffusion-weighted imaging (DWI) and gadoliniumethoxybenzyl-diethylene triamine pentaacetic acidenhanced magnetic resonance imaging. They stated that the BDA showed an apparent diffusion coefficient (ADC) twofold greater than that of the background liver parenchyma on DWI. In our opinion, some points about the report are not sufficiently clear. They declared that the ADC values of the BDA may have been higher than the background liver parenchyma due to its histological features. Nevertheless, they report a patient with alcoholic liver cirrhosis, and ADC values of patients with cirrhosis are lower than those of patients with a