Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging.

BACKGROUND: Central nervous system (CNS) lymphomas, either primary or secondary in origin, are rare malignant tumors affecting the brain, spinal cord, or leptomeninges. Diagnosis of CNS lymphomas is complicated by their diverse clinical presentations, radiological features, and histopathological characteristics. Although frozen section (FS) analysis is commonly employed for various CNS tumors, its role and accuracy in CNS lymphoma diagnosis are less explored. In this study, we conducted a comparative analysis to assess the impact of knowledge of preoperative imaging on enhancing the accuracy of FS diagnosis in CNS lymphomas. METHODS: Data collection involved a retrospective review of CNS lymphoma patients from January 2009 to August 2021. Patients who underwent intraoperative consultation were included, excluding those with prior cortisone treatment. The dataset incorporated patient demographics, classification as primary or secondary lymphoma, radiological preliminary diagnoses, FS diagnosis, and permanent section diagnosis. We employed various archived materials, including FSs, touch imprint slides, crush cytology slides, H&E-stained sections, and immunohistochemical stains, and re-evaluated all slides for diagnostic validation. RESULTS: Our study included 25 patients, of whom 60 % were female and had a mean age of 56.5 years. Preoperative radiology data were available for 80 % of cases, with preliminary diagnoses commonly including lymphoma and/or metastasis. Intraoperative consultation results indicated lymphoma in 18 (72 %) patients, with discordance observed in 28 % of cases when compared to permanent section diagnoses. Most permanent section diagnoses were diffuse large B-cell lymphomas (92 %), with the remainder being T-cell non-Hodgkin lymphoma (4 %) and follicular lymphoma (4 %). Intraoperative misdiagnoses were significantly associated with the absence of knowledge of preoperative imaging. CONCLUSION: Our study demonstrates the reliability of FS diagnosis for CNS lymphomas during surgery, with a favorable complete concordance rate of 72 % when compared to permanent diagnoses. Importantly, lack of knowledge of preoperative imaging significantly impaired diagnostic accuracy in FS, emphasizing the need for close collaboration between pathologists and radiologists.

Did radiation exposure increase with chest computed tomography use among different ages during the COVID-19 pandemic? A multi-center study with 42028 chest computed tomography scans

PURPOSE: To determine whether radiation exposure increased among different ages with chest computed tomography (CT) use during the coronavirus disease-2019 (COVID-19) pandemic. METHODS: Patients with chest CT scans in an 8-month period of the pandemic between March 15, 2020, and November 15, 2020, and the same period of the preceding year were included in the study. Indications of chest CT scans were obtained from the clinical notes and categorized as infectious diseases, neoplastic disorders, trauma, and other diseases. Chest CT scans for infectious diseases during the pandemic were compared with those with the same indications in 2019. The dose-length product values were obtained from the protocol screen individually. RESULTS: The total number of chest CT scans with an indication of infectious disease was 21746 in 2020 and 4318 in 2019. Total radiation exposure increased by 573% with the use of chest CT for infectious indications but decreased by 19% for neoplasia, 12% for trauma, and 43% for other reasons. The mean age of the patients scanned in 2019 was significantly higher than those scanned during the pandemic (64.6 vs. 50.3 years). A striking increase was seen in the 10-59 age group during the pandemic (P < 0.001). The highest increase was seen in the 20-29 age group, being 18.6 fold. One death was recorded per 58 chest CT scans during the pandemic. Chest CT use was substantially higher at the beginning of the pandemic. CONCLUSION: Chest CT was excessively used during the COVID-19 pandemic. Young and middle-aged people were exposed more than others. The impact of COVID-19-pandemic-related radiation exposure on public health should be followed carefully in future years.

The coexistence of os trigonum, accessory navicular bone and os peroneum and associated tendon and bone pathologies.

PURPOSE: To determine how often os trigonum is accompanied by accessory navicular and os peroneum. A secondary aim of the study was to investigate the bone and related tendon pathologies that may develop in these three accessory bones. MATERIALS AND METHODS: A total of 110 patients who were evaluated by ankle MRI and were determined with os trigonum between 2009-2015 were included in the study. The frequency was determined of os trigonum together with accessory navicular bone and os peroneum. MR images were also evaluated in respect of bone pathologies and related tendon pathologies of these 3 accessory bones. RESULTS: Of 110 patients determined with os trigonum on MRI, 21 (19%) were also determined with accessory navicular bone and 5 (4.5%) with os peroneum.When bone pathologies were examined, the most frequently seen pathology was bone marrow edema.The most common pathology in the tendons related to the accessory bones was increased amount of synovial fluid within the tendon sheath. In cases with os trigonum, bone changes were observed more frequently than pathologies of the adjacent tendons, in the accessory navicular bone cases, tendon pathologies were observed more than bone changes and in the cases with os peroneum, bone and tendon pathologies were determined at equal rates.There was no significant difference in terms of FHL tendon pathology between patients with and without edema in os trigonum. However, TP tendon was significantly more pathological in patients with edema in accessory navicular bone. CONCLUSION: More than one accessory bone was determined in approximately one in four cases.The most common pathologies determined in these accessory bones was bone marrow edema and increased amount of synovial fluid within the tendon sheath.It is necessary to investigate and report all these findings on MRI as they play an important role in the explanation of clinical findings and treatment planning.

Carotid angle in young stroke.

PURPOSE: To investigate whether the carotid bifurcation angle as assessed by computed tomographic angiography (CTA) is associated with anterior circulation ischemic stroke (ACIS) in young patients. MATERIAL AND METHODS: Thirty patients (mean age 41.5 ± 6 years) with known acute ACIS (group 1) were compared to 30 control patients (mean age/ 41.2 ± 6 years) (group 2) with similar demographic variables in this retrospective study. Geometrical characteristics of bilateral carotid bifurcation were obtained by CTA. The ICA bifurcation (ICAB) angle, the carotid central bifurcation (CCB), and the carotid bifurcation wall (CBW) angle among the ICA, CCA, and ECA were measured. Carotid artery angle measurements were compared between group 1 and group 2. The comparison of pathological (ACIS) and non-pathological (non-ACIS) carotid sides in group 1 was performed as well. RESULTS: All the measured angles (AMA) of group 1 were higher than group 2 (p˂0.05). In patients with left-sided ACIS, AMA on the left side were higher than the right side (p˂0.05), this was more prominent in males (p˂0.05). All angles measured were found to be higher in ipsilateral ACIS (p˂0.05). The left CCB angle values had a significant effect on ischemic stroke (p˂0.05). Male patients had more left-sided ACIS (p˂0.05). Plaque development in ICA was found statistically significant in group 1 compared to group 2 (p˂0.05). CONCLUSION: Carotid artery geometry may play an important role in the development of ischemic events in young patients, especially in men and, also in patients with left-sided stroke. The left CCB angle had a significant effect on ACIS.

Interacting Factors of Strain Ratio Values in Fibroadenomas and the Contribution of Color Scale.

BACKGROUND: The purpose of this retrospective study is to investigate the association of qualitative and semiquantitative strain elastography (SE) features with factors such as lesion size, skin-to-lesion distance, and patient's age in fibroadenomas and to discuss false-positive results. METHODS: A total of 120 lesions that were performed SE with histopathologically confirmed fibroadenoma were included in the study. All images were reviewed from the archiving system with a consensus of two radiologists. Tsukuba elasticity score was used for color scoring (from 1 to 5). Lesions with strain ratio (SR) ≥2.27 and color scale score of 4 or 5 were considered as false positive. The patients were divided into two groups according to the age: <50 and ≥50 years old. Regard of the size, lesions were divided into two groups: <15 mm and ≥15 mm. The distances of the lesions to the skin were also divided into two groups: <5 mm and ≥5 mm. Statistical analysis to identify associations between these groups and SR was carried out with Pearson Chi-square test and Fisher's exact test. The false-positive rates were calculated. RESULTS: There was no statistically significant difference between patients' age, lesion size, skin-to-lesion distance, and SR values. The false-positive rate was 21.66% for SR, while it was 3.33% for color scale. CONCLUSION: SR values of the fibroadenomas were not affected by factors such as age, lesion size, and depth. In addition, false-positive rates significantly decrease when color scale scores are evaluated for fibroadenomas.