Ulas Savas Yavas

Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism

Objective The objective of the study was to compare two scoring methods to predict the risk of pulmonary embolism (PE) as diagnosed with computed tomography angiography (CTA) and/or CT venography (CTV). Methods Prospectively over a 8-month period, emergency department patients and hospital inpatients with suspected PE were consecutively examined and their Wells and Revised Geneva scores calculated to stratify them into a risk group for PE probability. Then all patients were examined with CTA and CTV to determine the presence or absence of PE, as diagnosed by experienced radiology staff physicians. Results During the study period, 167 patients were suspected of having a PE and were interviewed for the calculation of their Wells and Revised Geneva scores. All patients underwent CTA or CTV, but the images of only 148 patients were adequate enough to make a certain diagnosis regarding PE. The data of these 148 patients were used for the study. The rates of PE in high, moderate, and low PE risk groups determined according to the Wells score and the Revised Geneva score were 89.6, 26.4, 7.8 and 83.3, 25.6, 0%, respectively. Among both inpatients and ED patients the area under the Wells score receiver operating characteristic curve was higher (P=0.04). When data from only ED patients were analyzed (104 patients) the scoring systems was not significantly different (P=0.07). Conclusion The Wells rule seems to be more accurate among both inpatients and emergency department patients. The Revised Geneva score can be used in emergency department patients with high reliability.

The Interobserver Agreement between Residents and Experienced Radiologists for Detecting Pulmonary Embolism and DVT with Using CT Pulmonary Angiography and Indirect CT Venography

Objective We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). Materials and Methods We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64×0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. Results Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). Conclusion It does not seem adequate to base the final long-term treatment of PE on only the residents reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.

A Sign of Arteriogenic Insufficiency on Penile Doppler Sonography Retrograde Flow in Penile Cavernosal-Spongiosal Communications

The purpose of this study was to evaluate the diagnostic usefulness of determining retrograde flow in the penile cavernosal‐spongiosal communications (CSCs) with Doppler sonography.

Mazabraud's Syndrome Coexisting with a Uterine Tumor Resembling an Ovarian Sex Cord Tumor (UTROSCT): a Case Report

The association of intramuscular myxoma and fibrous dysplasia is a rare disease known as Mazabrauds syndrome. We present a case of Mazabrauds syndrome coexisting with a uterine tumor and resembling an ovarian sex cord tumor (UTROSCT). This uterine tumor showed a high mitotic index and cytological atypia. To the best of our knowledge, the coexistence of the two different entities has not been reported in the literature.

Contribution of the amount of contrast media used in pulmonary CT angiography to assess the diagnostic value of CT venography; comparison of 100 and 150 ml of contrast media

AIM To prospectively compare the vascular attenuation achieved with 100ml iohexol (350mgI/ml) 75% with that achieved with 150ml iohexol (350mgI/ml) 75% for computed tomography (CT) venography, which was performed after CT pulmonary angiography. MATERIALS AND METHODS A total of 122 patients were included in the study. Group A, comprising 52 patients (mean age 64.8 years, mean body weight 70.8kg) received 150ml iohexol (350mgI/ml) contrast media. Group B, comprising 70 patients (mean age 61.2 years, mean body weight 71.4kg) received 100ml iohexol (350mgI/ml) contrast medium. RESULTS Venous opacification values measured at all levels were significantly higher in group A than those in group B (p<0.001). In group B the mean HU values were between 87 and 115 and only three of the patients had HU values less than 60 at the level of femoral vein. Assuming a venous enhancement of 80HU as the cut-off value for accurate diagnosis of deep venous thrombosis, 22.8% (16/70) in group B and 7.6% (4/52; p=0.028) in group A had non-diagnostic CT venography of left femoral vein. CONCLUSION One hundred millilitres of contrast medium with a concentration of 350mgI/ml may produce sufficient enhancement, but 150ml of contrast medium provides better accuracy for the diagnosis of deep venous thrombosis diagnosis. For better enhancement of lower extremity deep veins, the concentration of the contrast medium and the patients body weight may also have significance.

The Relationship between the Breast Arterial Calcification Detected by Mammography and the Hypertensive Retinopathy in Hypertensive Women

Objective The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. Materials and Methods Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. Results Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p < 0.01). The grade of HR was not significantly associated with BAC (p > 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were ≥ 60 years old. Conclusion The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.

Factors Affecting Swallowing During Thyroid Fine-Needle Aspiration Biopsy

Objective. This prospective study was conducted to examine the factors that affect swallowing during thyroid fine‐needle aspiration biopsy (FNAB). Methods. Consecutive patients who were to undergo FNAB were approached for inclusion in the study. The depth and size of the nodule were measured in all patients. In a random fashion, patients were told not to swallow during the procedure, or they were not given any instructions regarding swallowing. Results. Regarding the 143 participants in the study, no significant differences in age (P = .07), diameter and depth of the thyroid nodules (P = .14; P = .46, respectively), or cytologic diagnosis of thyroid aspirates (P > .20) were found between the swallowing (n = 50) and nonswallowing (n = 93) patient groups. Swallowing was observed in 29 patients who were instructed not to swallow (36%) and in 21 patients who were not given any instructions regarding swallowing (34%; P = .95). The mean duration of the procedure for swallowing patients was 19.8 seconds, and it was 15.7 seconds for nonswallowing patients. The duration of the procedure was significantly shorter in patients who did not swallow (P = .001). More male patients swallowed than female patients (P = .003). Conclusions. Giving specific instructions about not swallowing did not make a difference regarding swallowing by patients during the FNAB procedure. More male patients swallowed than female patients. A longer duration of the FNAB procedure meant that the operator was more likely to encounter swallowing (and thus displacement of the thyroid) while doing the procedure. Completing the procedure quickly is the surest method to avoid a moving thyroid while performing FNAB.