Pancreatic injury due to blunt trauma on CT: does retropancreatic fat tissue reduce the severity of pancreatic injury?

BACKGROUND: Pancreatic injuries from blunt abdominal trauma have a high mortality rate, often accompanied by injuries to adjacent organs. This study aims to investigate the relationship between the size of retropancreatic adipose tissue and the severity of pancreatic and adjacent organ injuries in patients with pancreatic trauma. METHODS: We retrospectively screened computed tomography (CT) images of 34 patients (25 males, nine females, aged 13-69 years) and 34 controls (28 males, six females, aged 15-66 years) who suffered blunt abdominal trauma. The area of adipose tissue located posterior to the pancreatic body was measured in the axial plane for all subjects. The severity of pancreatic injury was assessed in terms of the injury site, the retropancreatic adipose tissue area, and the degree of other organ injuries. RESULTS: Pancreatic injuries were located in the head for 16 patients (23.5%), in the body for four patients (5.9%), and in the tail for 14 patients (20.6%). The retropancreatic fat area was found to be significantly smaller in patients with pancreatic trauma compared to controls (p<0.0001). Furthermore, the ratio of the retropancreatic fat area to the vertebral corpus area differed significantly between patients with and without pancreatic injuries (p=0.014). CONCLUSION: Retropancreatic adipose tissue protects the pancreatic body from the impacts of blunt abdominal trauma. An increased amount of retropancreatic adipose tissue is associated with a reduced rate of pancreatic injury.

The value of multimodal ultrasonography in the evaluation of late presenting testicular torsion in a rat experimental model.

OBJECTIVE: To evaluate the value of multimodal ultrasonography (US) in a rat experimental torsion model after 6 h of torsion with different degrees. METHODS: Twenty-one male rats were divided into three groups. Left testes of the rats were twisted around their vascular pedicle 360 degrees in group 1, 720 degrees in group 2, and 1080 degrees in group 3 and intact right testes of the rats were accepted as control group. Grey-scale US, superb microvascular imaging (SMI), colour Doppler ultrasonography (CDUS), strain elastography (SE), and two-dimensional (2-D) shear wave elastography (SWE) examinations were applied 6 h after torsion procedure and testes were removed for pathological evaluation. RESULTS: Short-axis dimensions and volumes of the torsion side were higher than control testes. Lengths of the testes in the 3rd torsion group were smaller than the testes in groups 1 and 2 (P < 0.002). SMI was better than CDUS in recognizing blood flow in testicular tissue. Strain ratios were higher in group 1 and decreased with the increasing torsion degree. Emean and standard deviation (SD) measurements increased in the torsion side. Pathologically the mean testicular damage scores were statistically significant between torsion and control testes in all groups. CONCLUSION: Our results showed that short-axis and volume measurements, SMI, 2D-SWE, and SE are effective in the evaluation and diagnosis of testicular torsion (TT). ADVANCES IN KNOWLEDGE: Evaluation of affected testis and intact testis with multiparametric US in late presenting TT cases is more reliable than being dependent on a single sonographic modality.

Emergency ultrasound of respiratory muscles: a promising tool for determining the outcomes of COPD exacerbations.

BACKGROUND: The respiratory muscles of patients with chronic obstructive pulmonary disease (COPD) exhibit structural and functional changes that can be evaluated and monitored by ultrasonography. METHODS: This single-center, prospective study was conducted in the emergency department (ED) of a tertiary care hospital over an eight-month period (September 2020-May 2021). Diaphragmatic excursions, end-expiratory thickness, and thickening fractions, as well as right and left intercostal muscle thicknesses, of all adult subjects manifesting COPD exacerbation, were assessed. The data were analyzed regarding ward/intensive care unit (ICU) hospitalization or discharge from the ED, mortality, and readmission within 15 days. RESULTS: Sixty-three subjects were recruited for the study. Diaphragmatic excursion, end-expiratory diaphragmatic thickness, and intercostal muscle thickness measurements were significantly different between the ward, ICU, and discharge groups (p < 0.001) but lower in the deceased subjects (all p < 0.05). The diaphragmatic excursion value of 3.25 cm was the threshold value measured for distinguishing discharge from ED, and 1.82 cm was measured for admission to the ICU, both with 100% sensitivity and selectivity (AUC = 1). DISCUSSION: Diaphragmatic excursion, diaphragmatic end-expiratory thickness, and right and left intercostal muscle thicknesses vary in the prognosis of subjects presenting with COPD exacerbation.

Diagnostic Performance of Radiology Residents in Thoracic CT Imaging in Emergency Radiology During The COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, the workload of all radiologists and radiology residents, as well as other clinical physicians, has increased. INTRODUCTION: This study aims to determine the diagnostic performance of radiology residents, who effectively contribute to the diagnosis of COVID-19. METHODS: The thoracic Computed Tomography (CT) images of 135 patients aged 20-83 diagnosed with COVID-19 were evaluated retrospectively by five radiology residents and a radiologist with 10 years of experience. The diagnostic performance of the radiology residents in evaluating COVID-19 was assessed according to their year of residency and the patients' age and gender. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of radiology residents. RESULTS: The radiology residents' performance in determining COVID-19 using CT findings was evaluated as follows: sensitivity 97.22%, specificity 88.89%, positive predictive value 90.91%, negative predictive value 96.55%, and accuracy 93.33%. According to the year of residency, the sensitivity and specificity of the radiology residents in determining COVID-19 using CT images were between 92.3% and 100%, and 71.43% and 100%, respectively. CONCLUSION: The high sensitivity and specificity of radiology residents in evaluating thoracic CT images for COVID-19 diagnosis indicate that radiologists are as important as clinical physicians in the diagnosis of COVID-19.

Evaluation of the chest computed tomography and hemogram data in patients with COVID-19: the importance of thymus

Background/aim: To investigate the relationship between imaging findings and peripheral blood cell counts of COVID-19 patients and the degree of thymus fat involution of these patients. Materials and methods: Computed tomography (CT) images of 87 patients with COVID-19 positive through RT-PCR testing were evaluated retrospectively by two radiologists. Ground glass densities and other signs of viral pneumonia were recorded, lung involvement was scored quantitatively. The patients thymus fat involution was graded on CT. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratios (PLR), lymphocyte and platelet counts were calculated. Imaging findings and degrees of thymus fat involution were compared with laboratory data. Results: Quantitative scoring of lung involvement was calculated at mean 6.63 ± 4.70 (1­23) for observer 1 and mean 6.55 ± 4.65 (1­23) for observer 2 (K = 0.824­1.000). Statistical significance was determined between the increase in age and the increase in scores of lung findings (p = 0.003). Lymphocyte count (p = 0.0001) and PLR (p = 0.001) were significantly lower in patients with severe CT involvement. A statistically significantcorrelation was found between increased thymus fat component and presence of COVID-19 lung involvement in CT (r = 0.461). Conclusion: The severity of imaging findings for COVID-19 patients significantly correlates with the degree of fat involution in patients' thymus tissue.

Does otosclerosis affect the dimensions of the facial canal and cochlear aquaduct?

PURPOSE: Our aim was to evaluate the relationship of the dimensions of the facial canal (FC) and cochlear aqueduct (CA) in otosclerosis (OS) with the type and severity of OS. METHODS: Two radiologists retrospectively evaluated temporal bone high-resolution computed tomography (HRCT) images obtained from 48 healthy individuals and 94 OS patients between January 2015 and July 2020. In the study group, the CA width, funnel base width, and funnel length, in addition to the FC transverse length, were measured in the axial plane. The CA length was measured in the coronal plane on HRCT images. The FC craniocaudal length was measured in the same plane as the fissula ante fenestram (FAF) in coronal reformatted HRCT images. Grading of OS was based on otosclerotic plaque density and new bone formation extending toward the tympanic cavity at the FAF level. RESULTS: In the OS patients, the CA width and FC craniocaudal and FC transverse diameters were significantly decreased on both sides compared to those in the control group (p < 0.001). In fenestral OS, the FC craniocaudal and transverse widths on both sides were statistically significantly lower than the FC widths in the control group (p < 0.0001). A statistically negative correlation was found in the FC craniocaudal (r = - 0.831/- 0.818) and transverse (r = - 0.742/- 0.750) measurements on both sides in accordance with an increase in the otosclerotic plaque density (p < 0.0001). CONCLUSION: The presence of narrowing in the FC and CA adjacent to the FAF supports the role of autoimmunity theory in the etiology of OS.

Association between laboratory parameters and CT severity in patients infected with Covid-19: A retrospective, observational study.

INTRODUCTION: Patients diagnosed with COVID-19 have presented to emergency departments (EDs) worldwide with a wide range of symptoms. In this study we reported the clinical, laboratory and radiological features of the cases diagnosed with COVID-19. METHODS: This is a single-center, retrospective, descriptive, and observational study. The patients who have admitted to ED between March 11 and May 31, 2020 and diagnosed COVID-19 infection. RESULTS: 130 (73 male and 57 female) patients with COVID-19 polymerase chain reaction (PCR) positive test were included in the study. The average age of the study group was calculated as 52.63 ± 17.95 year. While 15.4% of the patients were asymptomatic, the most common symptom was identified as cough (46.2%), followed by dyspnea (23.1%), fever (17.7%). The computed tomography (CT) severity scores proved significantly higher in the patients with hypertension and coronary artery disease (CAD) than in those without these diseases (p = 0.010 and p = 0.042, respectively). The moderate positive correlation between serum ferritin level and CT severity score is another finding worth noting (rho = 0.530 and p = 0.0001). In a similar vein, the high level of D-dimer in the CT-positive group and its positive moderate correlation with CT severity (rho = 0.375 and p = 0.0001). CONCLUSION: In our study, serum ferritin and D-dimer levels were observed to be high in the CT-positive group and have moderate positive correlation with CT severity. We thus argue that D-dimer and ferritin levels measured at the time of admission to the ED can be taken into consideration to predict radiological severity.

Efficiency of Fat Suppression in T1-Weighted Inner Ear Magnetic Resonance Imaging: Multipoint Dixon Method Versus Hybrid Techniques.

BACKGROUND: Temporal bone is a region where fat suppression is difficult due to the inhomogeneity of various structures with different molecular properties. INTRODUCTION: We aimed to determine the most effective fat suppression sequence in order to increase the visibility of the inner ear region. MATERIALS AND METHODS: The hybrid techniques and T1-Weighted mDIXON images of 40 patients with Magnetic Resonance (MR) imaging of the inner ear were prospectively compared by two experienced radiologists in terms of fat suppression efficacy. In all fat-suppressed sequences, the Signal to Noise Ratio (SNR), the spinal cord signal intensity / mean fat signal intensity ratio and spinal cord signal to noise ratio were calculated. The suppression efficacy of MR techniques for fat areas in the inner ear was visually graded. RESULTS: Qualitative assessment of image quality due to fat suppression in the inner ear was made; the Dixon technique performed significantly better than SPAIR and SPIR techniques (p<0.0001). The mean signal intensity of the inner ear fat and SNR for the Dixon technique were significantly lower than that for SPIR and SPAIR techniques (p<0.0001). Inter-observer agreement regarding the assessment of the inner ear fat, mean signal intensity values and mean SNR values for fat suppression techniques was significant. CONCLUSION: The Dixon technique exhibited higher image quality and fat suppression efficiency than the hybrid techniques in the MR imaging of the inner ear.

D-Dimer as a potential biomarker for disease severity in COVID-19.

INTRODUCTION: This study seeks to determine the utility of D-dimer levels as a biomarker in determining disease severity and prognosis in COVID-19. METHODS: Clinical, imaging and laboratory data of 120 patients whose COVID-19 diagnosis based on RT-PCR were evaluated retrospectively. Clinically, the severity of COVID-19 was classified as noncomplicated or mild or severe pneumonia. Radiologically, the area of affected lungs compatible with viral pneumonia in each patient's computed tomography was classified as either 0-30% or ≥ 31% of the total lung area. The D-dimer values and laboratory data of patients with COVID-19 were compared with inpatient status, duration of hospitalization, and lung involvement during treatment and follow-up. To assess the predictive value of D-dimer, receiver operating characteristic (ROC) analysis was conducted. RESULTS: D-dimer elevation (> 243 ng/ml) was detected in 63.3% (76/120) of the patients. The mean D-dimer value was calculated as 3144.50 ± 1709.4 ng/ml (1643-8548) for inpatients with severe pneumonia in the intensive care unit. D-Dimer values showed positive correlations with age, duration of stay, lung involvement, fibrinogen, neutrophil count, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR). When the threshold D-dimer value was 370 ng/ml in the ROC analysis, this value was calculated to have 77% specificity and 74% sensitivity for lung involvement in patients with COVID-19. CONCLUSION: D-Dimer levels in patients with COVID-19 correlate with outcome, but further studies are needed to see how useful they are in determining prognosis.

Prevelance of the costal cartilage fracture on the computerised tomography in chest trauma.

INTRODUCTION: Radiography remains limited in costal cartilage injuries, and sonography, CT and MR imaging turns out to be more sensitive in the detection of cartilage injuries. This study aims to determine the frequency of costal cartilage fractures detected in the CT images of the patients with high energy chest trauma and to evaluate the association of costal cartilage fracture with the complications of trauma. METHODS: The CT images of 93 patients aged 18-91 years with a trauma admitted to the Emergency Department of the State Hospital between February 2019 and June 2019 were studied retrospectively. Thorax CT images of 93 patients who presented to the emergency department with blunt chest trauma with AIS > 2 were retrospectively investigated by a radiologist with a board certificate who had 15 years of experience in the field. RESULTS: Costal cartilage fracture was identified in 39 of 93 patients with severe chest trauma. Among the 93 chest trauma patients admitted to the emergency department between February and June 2019, the prevalence of costal cartilage was calculated as 41.93%. Note that the most common costal cartilage fractures in the study group were identified in the 6th, 7th, 8th and 1st costal cartilages. Another significant relationship (p = 0.007) was found between costal cartilage calcification and cartilage fracture. CONCLUSION: Costal cartilage fractures frequently occur in blunt thoracic trauma with multiple rib fractures and are of clinical importance as they lead to the instability of chest wall. The incidence of cartilage fractures increases in elderly patients with costal cartilage calcification.

Diffusion-weighted MRI of pulmonary lesions: Comparison of apparent diffusion coefficient and lesion-to-spinal cord signal intensity ratio in lesion characterization.

PURPOSE: To evaluate the diagnostic performance of minimum apparent diffusion coefficient (ADCmin ) and lesion-to-spinal cord signal intensity ratio (LSR) in the differentiation of benign and malignant pulmonary lesions. MATERIALS AND METHODS: Forty-seven patients (36 men, 11 women; range, 17-81 years) with 62 pulmonary lesions underwent magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) performed using a 1.5T scanner during free-breathing using b 600 s/mm2 . The ADCmin values and LSR were calculated. A receiver operating characteristic (ROC) curve analysis was performed to detect the threshold value of the ADCmin and LSR values for discrimination between benign and malignant pulmonary lesions. RESULTS: There were 42 malignant (33 primary tumors, 9 metastases) and 20 benign lesions. The mean ADCmin ± standard deviations (×10-3 mm2 /s) were 1.45 ± 0.33 for malignant tumors, and 2.4 ± 0.69 for benign lesions (P < 0.001). The mean LSR ± standard deviations for lung cancer was 1.24 ± 0.78, and for benign lesions was 0.55 ± 0.57 (P < 0.001). The area under the ROC curve for ADCmin (0.931; 95% confidence interval [CI]: 0.868-0.993) was greater than that for LSR (0.801; 95% CI: 0.675-0.926) (P = 0.029). For benign/malignant discrimination, the ROC curve showed threshold value of ADCmin to be 1.78 × 10-3 mm2 /s and that of LSR to be 0.86. Using these cutoff values, accuracy of ADCmin and LSR were 89%, 74%, respectively (P = 0.383). CONCLUSION: Being a contrast-free and radiation-free technique, DWI allows discrimination of benign and malignant lung lesions. The ADCmin value performed marginally better than LSR values in distinction of benign and malignant lesions. LEVEL OF EVIDENCE: 1 J. Magn. Reson. Imaging 2017;45:845-854.

Confident diagnosis of bronchobiliary fistula using contrast-enhanced magnetic resonance cholangiography.

We report the utility of contrast-enhanced magnetic resonance cholangiography (MRC) using gadoxetic acid (Gd-EOB-DTPA) in the diagnosis of bronchobiliary fistula associated with liver hydatid cyst. Contrast-enhanced MRC clearly delineated the leakage of contrast agent from the biliary duct and its communication with the bronchial tree. Providing functional information about physiologic or pathologic biliary flow in addition to the display of biliary anatomy, contrast-enhanced MRC stands as a robust technique in confidently detecting bronchobiliary fistula and bile leaks.