Doppler sonographic findings in testicular microlithiasis

OBJECTIVE: The aim of this prospective study was to compare the resistive index (RI) values, which is a parameter of testicular parenchymal perfusion, in testicular microlithiasis (TM) cases and normal cases. MATERIALS AND METHODS: 2179 volunteers, all healthy men (17-42 years of age) from the Annual Army Reserve Officer Training Corps training camp were included in the study. A screening scrotal ultrasound was performed and all men diagnosed with TM underwent a scrotal Doppler ultrasonography scan (US). US examinations were performed for subjects with TM and without TM as a control group and RI was determined. RESULTS: 53 men with TM were identified in the 2179 US. Spectral Doppler examination was applied to 50 randomly selected cases (100 testicles) without TM and 92 testicles with TM, 39 cases (78 testicles) with bilateral and 14 cases with unilateral involvement. However, 48 normal testicles (17 bilateral and 14 unilateral) and 47 testicles with TM (15 bilateral and 17 unilateral, 10 of which were cases with bilateral TM) where flow from the centripetal artery could be obtained and analyzed were included in the statistical analysis for resistive indices. There was no significant difference regarding the RI and spectral examinations between subjects with and without TM. An interesting finding was the twinkling artifact observed in three cases. CONCLUSION: Microliths did not alter the RI values and thus had no influence on testicular perfusion on Doppler US examination.

Assessment of mammographic density changes on plain film mammograms in postmenopausal women on hormone replacement therapy.

BACKGROUND & OBJECTIVES: Mammographic screening is an effective tool for the early detection of breast cancer. Hormone replacement therapy (HRT) has been shown to increase mammographic density and thus may hinder early detection of small tumours. We undertook this study to determine and compare the frequency and degree of change in mammographic density in postmenopausal women in HRT using two different methods: the classical Wolfe classification and a new semiquantitative method, which we named as the comparison wheel. METHODS: This study included 285 women, 206 under hormone treatment, and 79 control subjects. All women underwent baseline mammographic study before the beginning of treatment. Mean interval of the follow up mammograms was 16 months. The methods were compared in evaluating the effects of three types of hormone therapies on mammographic density. RESULTS: The frequency of change was only significant in the combined hormone replacement group when Wolfe classification was used. However, the frequency of increase in density (estrogen group 21%, combined therapy group 42%, tibolone group 28%) was markedly higher when the comparison wheel was used. The inter-rater Kappa value was calculated as 0.977 for the first and 0.957 for the second readings of the two radiologists for the comparison wheel, and 0.973 and 0.968 for the Wolfe classification. The intra-rater Kappa values were determined as 0.972 and 0.957 for the first and and 0.963 and 0.926 for the second radiologist for comparison wheel and Wolfe classification respectively. INTERPRETATION & CONCLUSION: Our findings indicate that the estimated increase of mammographic density depends on the selected hormone regimen, as well as the method of evaluation. The comparison wheel is a semiquantitative method of evaluating changes of mammographic density and is sensitive and reproducible with high inter- and intra-rater Kappa values. This method can be used as an alternative for comparison of digital mammographic applications in the future.