Sacroiliac pain and CT-guided steroid injection treatment: high-grade arthritis has an adverse effect on outcomes in long-term follow-up.

OBJECTIVE: The sacroiliac joint (SIJ) is one of the major sources of low back pain that can lead to severe morbidity. Possible SIJ pain requires a thorough evaluation and treatment option. The purpose of this study was to analyze the possible relationships between computed tomography (CT) grading of SIJ arthritis and the effectiveness of intraarticular steroid injection treatment under CT guidance. PATIENTS AND METHODS: A total of 61 patients with SIJ pain who were treated with CT guided intraarticular steroid injection were retrospectively reviewed. Visual analog scale (VAS) scores for pain control were recorded for short-term (day after injection, first week, third week) and long-term (sixth months and final control) follow-up times. SIJ arthritis was graded using CT images according to the New York criteria. Patients were assigned into low-grade (0, 1 and 2) and high-grade (3 and 4) groups. The relationship between arthritis grades and VAS scores in short and long-term follow-ups were statistically analyzed. RESULTS: Mean age and follow-up was 54.8 years (range: 41-68 years) and 27.8 months (range: 24-36 months), respectively. In 40 patients there was low-grade arthritis, while 21 patients were characterized on having high-grade sacroiliac arthritis detected during the radiological evaluation. There was no statistically significant difference between low and high-grade arthritis in regard to short-term VAS scores. On contrary, for long-term VAS scores, there was significant difference between low- and high-grade arthritis. CONCLUSIONS: Steroid injection treatment for SIJ pain is not effective on a long-term basis for patients with high-grade arthritis, and although they have had decreased VAS scores in the short-term, after 2 years of follow-up, their VAS scores significantly increased leading to symptomatic sacroiliac joint pain.

Accuracy and safety of percutaneous US-guided needle biopsies in specific focal liver lesions: comparison of large and small needles in 1300 patients.

AIM: The aim of this study was to compare small size aspiration needles with large size cutting needles in focal liver lesions for using small needles instead of large ones without on-site cytopathologist. METHODS: Percutaneous ultrasonography-guided liver biopsy was evaluated retrospectively in a biopsy cohort study of 1300 patients. In this series, 690 patients were biopsied with large size (<19G) cutting needles and 610 with small size (20G) aspiration needles. On-site cytopathologist was not present in the biopsy-room at any intervention. Needles were compared for diagnostic accuracy and safety for various focal liver diseases. RESULTS: We had diagnostic accuracy rate of 85.0% in small needle group vs. 96.9% in large needle group with metastasis (P<0.001). This rate was 85.5% in small needle group vs. 97.9% in large needle group with hepatocellular carcinoma (P=0.039). Accuracy rates of them were not different in hemangioma (P=0.277) and infection-inflammation (P=0.470). This rate was 75.0% in small needle group vs. 98.9% in large needle group with regenerative nodules (P=0.018). These rates were not different in focal steatosis (P=1.000). Sensitivity, specificity, and accuracy were 85.1%, 100%, and 89.2%, respectively. Only 2 (0.15%) major complications were found with small needles in uncooperative patients. Any major complication was not seen in hemangioma. CONCLUSION: In uncertain diagnosis with modern imaging, we propose that large size cutting needles should be used in suspected liver metastasis, hepatocellular carcinoma, and regenerative nodules if cytopathologist was not present. Small needles can be successfully used as well as large ones in focal steatosis, infection-inflammation, and hemangioma of liver in unclear diagnosis.

Imaging findings and clinical features of patients with multiple myeloma with the prognostic effect of bone marrow focal and diffuse infiltration patterns on spine MRI.

AIM: Aim of this study was to evaluate the prognostic effect of the magnetic resonance imaging (MRI) infiltration type as diffuse or focal patterns on spine magnetic resonance imaging (MRI), as well as other imaging and clinical features of patients with multiple myeloma. METHODS: A retrospective analysis of 35 patients with multiple myeloma was performed in this study. Patients were mean of 56.5 ± 12.4 year old, male/female ratio=1.3. Patients were at stage 2 and one at stage 3. Skeletal surveys were obtained in all patients, additionally bone scintigraphy (N.=25), CT (N.=22), and spine MRI (N.=16) were conducted. On imaging, lesion number, size and distribution and characteristics were assessed. On MRI, bone marrow involvements were assessed as focal and diffuse patterns (mild, moderate, and severe). All patients were followed-up with MRI for a median of 8.5 months (range, 1-105). Statistical analysis for bone marrow infiltration on MRI was performed using Kaplan-Meier survival test. RESULTS: Patients with diffuse infiltration pattern on MRI survived as median 13.0 months (range, 1-105), whereas cases with only focal pattern survived as median 3.5 months (range, 1-27). There was no difference between these groups (P=0.071). The disease-free survivals were not different, either (P=0.118). Scintigraphy, CT, and MRI detected more lesions in flat bones except for cranium where craniography was successful. CONCLUSION: It was not possible to find any further effect of the diffuse MRI infiltration type beyond focal infiltration on overall and disease-free survivals. Among typical findings of the radiography, spherical, punched-out lesions were seen, but lesion uniformity was not seen.

Percutaneous US-guided needle biopsies of solid renal masses.

Our objective was to examine the variables affecting diagnostic yield and complications in percutaneous ultrasonography-guided needle biopsies of solid renal masses. Percutaneous ultrasonography-guided needle biopsy of solid renal masses was performed in 172 patients with either large size (18G) cutting needles or small size (20G) aspiration needles. Retrospectively, 120 patients with diagnosis by percutaneous biopsy and follow-up data were included in this series. Age, gender, side, locations in kidneys, necrosis, calcification, maximum size, needle groups due to needle size and type (either 18G cutting needles or 20G aspiration needles), and needle pass were selected as variables. Their role was investigated in diagnostic yield. Two needle groups were divided and compared for diagnostic yield and safety. Also, change in treatment was evaluated. The mean maximum size of the masses was 8.8±4.9 cm. The only predictor affecting accuracy was side of kidney (p=0.002). Among patients, 15 (12.5%) and 105 (87.5%) had benign and malignant solid masses, respectively. Small and large needle groups did not differ in accuracy, 80.3% vs. 87.1% (p=1.000). Technical success was detected as 100%. No major complications neither tumor seeding was seen. Percutaneous ultrasonography-guided needle biopsy of solid renal masses is effective and safe method with large size cutting needles and small aspiration needles. Change in clinical management was significant at 63.3% rate. Diagnostic yield was low in left kidney relating to right kidney, 69.4 vs. 93.1, while upper lobe location did not lead to significant false result. Repeat biopsies can be taken under CT guidance after nondiagnostic diagnosis in solid tumors of left kidney. All the needles including large cutting type were found safe.

Fine-needle aspiration biopsy of cervical lymph nodes: factors in predicting malignant diagnosis.

The objective of the study was to determine the predicting factors in malignant diagnosis in ultrasonography guided fine-needle aspiration biopsy of cervical lymph nodes. Design is retrospective follow-up study. Ultrasonography guided fine-needle aspiration biopsies of cervical lymph nodes were performed in 290 patients. The mean age was 45.5 ± 14.4 years (range; 15-85). 207 (71.4%) and 83 (28.6%) were women and men, respectively. Cytopathologist was not present in any biopsy procedure. Factors in predicting malignancy were age, gender, presence of primary malignancy, localization (Level 1-6), hypoechogenicity with loss of echogenic hilum, microcalcification, cystic feature, minimum and maximum sizes, and index value (minimum size/maximum size). Factors were analyzed by univariate and multivariable tests. The mean minimum size and index value of the lymph nodes were 10.4 ± 5.5 mm and 0.58 ± 0.18, respectively. Age, gender, microcalcification, cystic feature, minimum size, and index value were poor predictors in malignancy. Predictors were presence of primary malignancy (p-< 0.001), the level of localization (p=0.001), and hypoechogenicity (p-< 0.001)- in malignancy. Microcalcification and cystic parts were specific US findings of metastasis of thyroid carcinoma; nevertheless cystic parts were seen more specific finding in the other malignancies. Malignant lymph nodes were often found in the presence of primary malignancy, mid neck and lower neck localizations as Level 3-6, and markedly hypoechoic lymph nodes. In 131 patients with a primary thyroid carcinoma, the predictors for malignancy were localization where the most often regions were Level 3, 4, and 6 and hypoechogenicity. Malignancy rate was relatively low in patients with thyroid malignancy than those with non thyroid malignancies in Level 5. Level 6 was the most difficult area for biopsy due to postoperative changes. Microcalcification was specific only in thyroid carcinoma, whereas cystic parts were more specific in the other malignancies

Single-session percutaneous sclerotherapy in symptomatic simple renal cysts: long-term results.

AIM: To evaluate the efficacy of single-session percutaneous sclerotherapy with needle aspiration or catheter drainage, under ultrasound (US) or computed tomography (CT) guidance, based on cyst size and depth in 22 symptomatic simple renal cysts. METHODS: Sclerotherapy with 95% alcohol for 20 min was performed in 22 symptomatic simple renal cysts in 15 patients. The method (aspiration or drainage) was chosen according to cyst size and depth: catheter drainage was done for larger (>6 cm) and shallow (<7.5 cm) cysts (N=12) and needle aspiration was done for smaller (<6 cm) or deeper (>7.5 cm) cysts (N=10). The median follow-up period was 6.0 months (range 1-62). RESULTS: Volume reduction of cysts (mean and median, respectively) was 94.1% and 97.0%. Average cyst volume reduction (mean and median, respectively) was 94.7% and 96.0% with US-guided methods and 93.3% and 99.0% with CT-guided methods (P=0.382). Median volume loss was 97.5% with needle aspiration and 96.5% with catheter drainage (P=0.839). No correlation between the groups and volume reduction was found. All procedures were successful. No major complications or recurrences were noted. CONCLUSIONS: Single-session percutaneous alcohol sclerotherapy with needle aspiration or catheter drainage, under US or CT guidance, is an effective and safe method for treating symptomatic simple renal cysts. CT-guided needle aspiration may be more suitable for treating deeper and/or smaller (<6 cm) cysts, while US-guided catheter drainage may be preferable in cases of shallow and/or larger (>6 cm) cysts.