Yasemin Kayadibi

Shear wave elastography of placenta: in vivo quantitation of placental elasticity in preeclampsia

PURPOSE We aimed to evaluate the utility of shear wave elastography (SWE) for assessing the placenta in preeclampsia disease. METHODS A total of 50 pregnant women in the second or third trimester (23 preeclampsia patients and 27 healthy control subjects) were enrolled in the study. Obstetrical grayscale and Doppler ultrasonography, SWE findings of placenta, and prenatal/postnatal clinical data were analyzed and the best SWE cutoff value which represents the diagnosis of preeclampsia was determined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of preeclampsia were calculated based on SWE measurements. RESULTS Mean stiffness values were much higher in preeclamptic placentas in all regions and layers than in normal controls. The most significant difference was observed in the central placental area facing the fetus where the umbilical cord inserts, with a median of 21 kPa (range, 3-71 kPa) for preeclampsia and 4 kPa (range, 1.5-14 kPa) for the control group (P < 0.01). The SWE data showed a moderate correlation with the uterine artery resistivity and pulsatility indices. The cutoff value maximizing the accuracy of diagnosis was 7.35 kPa (area under curve, 0.895; 95% confidence interval, 0.791-0.998); sensitivity, specificity, PPV, NPV, and accuracy were 90%, 86%, 82%, 92%, and 88%, respectively. CONCLUSION Stiffness of the placenta is significantly higher in patients with preeclampsia. SWE appears to be an assistive diagnostic technique for placenta evaluation in preeclampsia.

The impact of share wave elastography in differentiation of hepatic hemangioma from malignant liver tumors in pediatric population

OBJECTIVE In children it is crucial to differentiate malignant liver tumors from the most common benign tumor, hepatic hemangiomas since the treatment strategies are quite different. We aimed to evaluate the efficiency of shear wave elastography (SWE) technique in differentiation of malignant hepatic tumors and hepatic hemangiomas. METHODS Twenty patients with hepatic tumor were included in our study. Two radiologists performed SWE for 13 patients with malignant hepatic tumors including hepatoblastoma (n=7), hepatocellular carcinoma (n=3), metastasis (n=2), embryonal sarcoma (n=1) and 7 patients with hepatic hemangioma. All of our patients were between the age of 1 and 192 months (mean age: 56.88 months). Receiver operating characteristic analysis was achieved to evaluate the diagnostic accuracy of SWE and to determine the optimal cut-off value in differentiation hepatic hemangioma from malignant hepatic tumors. RESULTS The mean SWE values (in kPa) for the first observer were 46.94 (13.8-145) and 22.38 (6.6-49.6) and those for the second observer were 57.91 (11-237) and 23.87 (6.4-57.5), respectively for malignant hepatic tumors and hepatic hemangiomas. The SWE values of malignant hepatic tumors were significantly higher than those of hepatic hemangioma (p=0.02). The inter-observer agreement was almost perfect (0.81). The area under the receiver operating characteristic curve of SWE for differentiating the hepatic hemangioma from malignant hepatic tumors was 0.77 with a sensitivity of 72.7% and a specificity of 66.7% at a cutoff value of 23.62 with 95% confidence interval. CONCLUSION Shear wave elastography can be helpful in differentiation of malignant hepatic tumors and hepatic hemangioma.

Shear wave elastography of the placenta in patients with gestational diabetes mellitus

To evaluate placental elasticty in women with gestational diabetes mellitus (GDM) and non-diabetic controls. Thirty-three pregnant women with GDM according to the current criteria of the American Diabetes Association and 43 healthy pregnant women who were admitted to the antenatal clinic were recruited for this case–control study. Elasticity values of both the peripheral and the central parts of the placentas of the patients in both groups were determined by shear wave elastography (SWE) imaging. Mean elasticity values of both the central and the peripheral part of the placentas were significantly higher in GDM pregnancies (p < 0.001). No difference was observed in the mean elasticity values of the central and the peripheral part of the placentas in two groups (p > 0.05). SWE imaging technology might provide a quantitative assessment of the morphological pathologies of placentas in pregnant women with GDM.

Changes in the elasticity of fibroadenoma during the menstrual cycle determined by real-time sonoelastography

OBJECTIVE Shear-wave elastography (SWE) presents quantitative data that thought to represent intrinsic features of the target tissue. Factors affecting the metabolism of the breast parenchyma as well as age, menstrual cycle, hormone levels, pregnancy and lactation, pre-compression artifact during the examination could affect these elastic intrinsic features. Aim of our study is to determine variation of fibroadenoma elasticity during the menstrual cycle (MC) by means of real-time shear-wave elastography (SWE) and identify the optimal time for SWE evaluation. METHODS Thirty volunteers (aged 20-40 years) who had biopsy-proven fibroadenoma greater than 1cm in diameter, with regular menstrual cycle and without contraceptive medication underwent SWE (ShearWave on Aixplorer, France) once weekly during MC. Statistical data were processed by using the software Statistical Package for the Social Sciences (SPSS) 19.0. A repeated measures analysis of variance was used for each lesion where the repeated factor was the elastographic measurements (premenstrual, menstrual and postmenstrual). Pillais trace test was used. Pairwise correlation was calculated using Bonferroni correction. Values of p<0.05 were considered statistically significant. RESULTS The mean elasticity value of fibroadenomas in mid-cycle was 28.49 ± 12.92 kPa, with the highest value obtained in the third week corresponding to the premenstrual stage (32.98 ± 13.35 kPa) and the lowest value obtained in the first week corresponding to the postmenstrual stage (25.39 ± 10.21 kPa). Differences between the elasticity values of fibroadenomas in premenstrual and postmenstrual periods were statistically significant (p<0.001). There were no significant differences in lesion size between the different phases of the menstrual cycle (p>0.05). CONCLUSION In this study, we found that there is significant difference between the elasticity values of fibroadenomas on premenstrual and postmenstrual period. We propose that one week after menstruation would be appropriate time to perform breast SWE.

Primary Psammomatous Melanotic Schwannoma of the Spine

Schwannoma is an easily identifiable and frequently diagnosed lesion of the spinal column. However, if the schwannoma contains a melanin component, the diagnosis is challenging. Our purpose in this case report is to discuss the imaging and histopathologic findings of a rarely seen psammomatous type of melanotic schwannoma diagnosed in a 31-year-old woman.

Subserosal leiomyoma of uterus mimicking an ovarian tumor in adolescent patient

Abstract Uterine leiomyomas are the most common gynecological tumors in adult women. These benign tumors are rarely seen in the adolescent population: there are only a few cases that have been reported so far in this age group. In this case report, we present a giant uterine leiomyoma that mimicked an ovarian tumor in a 15-year-old girl.

Combined endovascular and surgical treatment of fusiform aneurysms of the basilar artery: technical note

BackgroundTo present the combined treatment of fusiform basilar artery aneurysms consisting of a surgical posterior fossa decompressive craniectomy and ventriculoperitoneal (VP) shunt operation at the same sitting, before the endovascular procedure with telescopic stenting of the aneurysmatic vessel segment in four cases.MethodsCombined treatment involving surgical procedure consisting of ventriculoperitoneal shunt placement for hydrocephalus and an occipital bone craniectomy and C1 vertebrae posterior laminectomy to decompress the posterior fossa in the same session. After surgery, the patients were loaded with acetylsalicylic acid and clopidogrel, and then the endovascular treatment was performed.ResultsAll of the procedures were performed successfully without technical difficulty. The patients tolerated the procedures well and all cases showed remodelling with the overlapping stent technique. The patients were discharged home with baseline neurological situation and computed tomography (CT) angiography was performed at the 3rd month.ConclusionThis technique is a safer endovascular approach to treating symptomatic fusiform basilar artery aneurysms by protecting patients from both the haemorrhagic complications of anticoagulant therapy and thrombotic complications due to the interruption of anticoagulant therapy, while treating the hydrocephalus and compression by surgical means.

Dysembryoplastic neuroepithelial tumours: clinical, radiological, pathological features and outcome

Abstract Object: To analyse the clinical, imaging and histopathological data of patients who were diagnosed to have Dysembrioplastic Neuroepithelial Tumour (DNET) and underwent surgery between 1995-2015. Materials and methods: Age at seizure onset, age at surgery, gender, disease duration, seizure outcome of 44 patients were analysed together with Magnetic Resonance Imaging (MRI) of 21 patients. MRI types were classified as type 1 (cystic/polycystic-like, well-delineated, strongly hypointense T1), type 2 (nodularlike,heterogeneous), type 3 (dysplastic-like, iso/hyposignal T1, poor delineation, gray–white matter blurring). Results: Histopathological classification revealed simple form in 19, complex in 14 and non-specific in 11 patients. Lobar distribution of the lesions was as follows: 21 Temporal (47.7%), 12 parietal (27.3%), 8 frontal (18.2%) and 3 occipital (6.8%). Type 1 MRI was observed in 10, type 2 was in 7, and type 3 in 4 patients on radiological evaluation. All cases with type 1 MRI corresponded to either simple or complex forms and all cases with type 3 MRI corresponded to nonspecific form. The histopathological distribution of cases with type 2 MRI was 4 as non-specific, 2 as simple, 1 as complex. There was no significant difference in the age of onset, age at operation and duration of epilepsy between the patients with different MRI subtypes. The majority of patients (N:36) had Engel I outcome (81,8%). In groups with Engel II and III outcome, duration of epilepsy was significantly higher (p:0,014) and simple form of DNET has significantly higher seizure freedom after surgery compared to complex and nonspecific forms of DNET (p:0,002). Conclusion: Patients with DNET constitute a group with favorable outcomes after epilepsy surgery especially with early referral to surgery. Longer duration of epilepsy was associated with worse seizure outcome for DNET patients. There was significant correlation between radiological and histopathological types of DNET especially in type 1 and 3.

Primary pericardial synovial sarcoma in an adolescent patient: magnetic resonance and diffusion-weighted imaging features.

Primary synovial sarcomas of the pericardium are extremely rare tumors, especially in pediatric population. As far as we know, only few cases have been reported in the literature. This uncommon location for synovial sarcomas could lead to misdiagnosis. Radiologists and clinicians should be aware of the imaging findings and differential diagnosis of pericardial synovial sarcoma. Herein we presented a 15-year-old boy who had primary pericardial synovial sarcoma with imaging features.