Iron overload in hemodialysis patients: Comparison of serum iron parameters with T2* MRI sequence.

PURPOSE: To evaluate correlation between serum iron parameters and liver T2* value in hemodialysis patients with iron overload due to parenteral iron therapy. MATERIALS AND METHODS: We evaluated 30 hemodialysis patients using a multiecho T2*-weighted MRI sequence. Age, sex, duration of dialysis, iron and erythropoietin doses taken in the past year, and serum iron parameters were recorded. Liver T2* values were averaged from three distinct liver regions. A T2* value of 33 ± 7 ms is considered normal. Declines below 24, 21, and 14 ms signify iron overload grades 1, 2, and 3, respectively. RESULTS: There was no statistically significant difference comparing the measurements of 3 different ROIs (p > 0.05). A total of 23 patients (76.6%) had iron overload. Serum ferritin levels of patients with iron overload were significantly higher than those without iron overload (687.25 [186.5-1489] ng/mL vs. 371.25 [127.5-542.5] ng/mL, p = 0.008). No linear correlation was observed between age, dialysis duration, serum iron metrics, medication doses, and T2* values. Likewise, no significant differences were found among patients based on iron overload status or its grades concerning these parameters. CONCLUSION: While standard serum markers might overlook iron overload, elevated ferritin levels are promising. MRI reliably detects iron overload in patients receiving parenteral iron.

Elevating healthcare through artificial intelligence: analyzing the abdominal emergencies data set (TR_ABDOMEN_RAD_EMERGENCY) at TEKNOFEST-2022.

OBJECTIVES: The artificial intelligence competition in healthcare at TEKNOFEST-2022 provided a platform to address the complex multi-class classification challenge of abdominal emergencies using computer vision techniques. This manuscript aimed to comprehensively present the methodologies for data preparation, annotation procedures, and rigorous evaluation metrics. Moreover, it was conducted to introduce a meticulously curated abdominal emergencies data set to the researchers. METHODS: The data set underwent a comprehensive central screening procedure employing diverse algorithms extracted from the e-Nabiz (Pulse) and National Teleradiology System of the Republic of Türkiye, Ministry of Health. Full anonymization of the data set was conducted. Subsequently, the data set was annotated by a group of ten experienced radiologists. The evaluation process was executed by calculating F1 scores, which were derived from the intersection over union values between the predicted bounding boxes and the corresponding ground truth (GT) bounding boxes. The establishment of baseline performance metrics involved computing the average of the highest five F1 scores. RESULTS: Observations indicated a progressive decline in F1 scores as the threshold value increased. Furthermore, it could be deduced that class 6 (abdominal aortic aneurysm/dissection) was relatively straightforward to detect compared to other classes, with class 5 (acute diverticulitis) presenting the most formidable challenge. It is noteworthy, however, that if all achieved outcomes for all classes were considered with a threshold of 0.5, the data set's complexity and associated challenges became pronounced. CONCLUSION: This data set's significance lies in its pioneering provision of labels and GT-boxes for six classes, fostering opportunities for researchers. CLINICAL RELEVANCE STATEMENT: The prompt identification and timely intervention in cases of emergent medical conditions hold paramount significance. The handling of patients' care can be augmented, while the potential for errors is minimized, particularly amidst high caseload scenarios, through the application of AI. KEY POINTS: • The data set used in artificial intelligence competition in healthcare (TEKNOFEST-2022) provides a 6-class data set of abdominal CT images consisting of a great variety of abdominal emergencies. • This data set is compiled from the National Teleradiology System data repository of emergency radiology departments of 459 hospitals. • Radiological data on abdominal emergencies is scarce in literature and this annotated competition data set can be a valuable resource for further studies and new AI models.

Prognostic value of computed tomography associated body composition measurement changes in metastatic colorectal cancer patients.

BACKGROUND: Sarcopenia is associated with poor prognosis in metastatic colorectal cancer (mCRC) patients. PURPOSE: To investigate the prognostic value of body composition measurement changes measured by computed tomography (CT) in mCRC patients. MATERIAL AND METHODS: The abdominal skeletal muscle density (SMD) and skeletal muscle (SMI) indices, as well as the visceral (VATI) and subcutaneous fat tissue (SATI) indices, were calculated by automatic segmentation method on the abdominal CT images obtained before (n = 71) and after chemotherapy (n = 52). Skeletal muscle gauge (SMG = SMD × SMI) was calculated. We calculated the percentage change of body composition measurements with respect to the first measurements. The cutoff value for the change in SMG was calculated by receiver operating characteristic analysis. Kaplan-Meier and Cox regression analyses were performed to calculate the prognostic value of age, gender, tumor location, metastasis site and carcinoembriogenic antigen (CEA) elevation, hypoalbuminemia, body mass index classification, presence of sarcopenia and SMG changes in terms of overall survival. RESULTS: There was a significant association between SMG change and mortality (P = 0.037). According to survival analyses, highly decreased SMG, hypoalbuminemia and CEA variables of the patients were the significant factors (P < 0.001, P = 0.015 and P = 0.019, respectively). According to multivariate regression analysis, hypoalbuminemia (P = 0.004, hazard ratio = 3.60) and highly decreased SMG (P < 0.001, hazard ratio = 14.98) were found to be significant prognostic factors together. CONCLUSION: In mCRC patients, hypoalbuminemia and highly decreased SMG are significant prognostic factors for overall survival. Therefore, we suggest that the change in SMG calculated in follow-up images should also be evaluated in the prognosis estimation of this patient group.

Evaluation of Cribriform Plate Dimensions and Middle Turbinate Length in Patients With Vomeral Agenesis: A Computed Tomography Study.

The cribriform plate and attachment area of the middle turbinate are anatomical structures that may potentially be injured during septoplasty and/or endoscopic sinus surgery. The purpose of this study is to compare the cribriform plate and middle turbinate length dimensions between patients with vomer agenesis (VA) and the control group using paranasal sinus computed tomography (CT). Paranasal sinus CTs performed in our hospital between January 2011 and January 2021 were evaluated and patients with VA were identified. A control group was created from patients who underwent paranasal sinus CT for various reasons during the same date interval. The cribriform plate and middle turbinate lengths were statistically compared between the groups. A total of 10,095 paranasal sinus CTs were evaluated and 54 patients with VA were identified. Seven patients with VA were excluded from the study because their measurements could not be made accurately. Forty-seven VA patients were included in the study group, while 94 patients were included in the control group. There was no statistical difference in cribriform plate dimensions (medial ethmoid roof plate height, cribriform plate height, cribriform plate lateral lamella height and width) between the groups (for all dimensions P >0.05). The middle turbinate length was significantly higher in the VA group (for right and left P =0.020 and 0.011, respectively). These findings theoretically suggest that the risk of cribriform plate injury during septoplasty and/or endoscopic sinus surgery is similar in patients with or without VA.

The diagnostic value of magnetic resonance imaging-based texture analysis in differentiating enchondroma and chondrosarcoma.

OBJECTIVE: To assess the diagnostic performance of MRI-based texture analysis for differentiating enchondromas and chondrosarcomas, especially on fat-suppressed proton density (FS-PD) images. MATERIALS AND METHODS: The whole tumor volumes of 23 chondrosarcomas and 24 enchondromas were manually segmented on both FS-PD and T1-weighted images. A total of 861 radiomic features were extracted. SelectKBest was used to select the features. The data were randomly split into training (n = 36) and test (n = 10) for T1-weighted and training (n = 37) and test (n = 10) for FS-PD datasets. Fivefold cross-validation was performed. Fifteen machine learning models were created using the training set. The best models for T1-weighted, FS-PD, and T1-weighted + FS-PD images were selected in terms of accuracy and area under the curve (AUC). RESULTS: There were 7 men and 16 women in the chondrosarcoma group (mean ± standard deviation age, 45.65 ± 11.24) and 7 men and 17 women in the enchondroma group (mean ± standard deviation age, 46.17 ± 11.79). Naive Bayes was the best model for accuracy and AUC for T1-weighted images (AUC = 0.76, accuracy = 80%, recall = 80%, precision = 80%, F1 score = 80%). The best model for FS-PD images was the K neighbors classifier for accuracy and AUC (AUC = 1.00, accuracy = 80%, recall = 80%, precision = 100%, F1 score = 89%). The best model for T1-weighted + FS-PD images was logistic regression for accuracy and AUC (AUC = 0.84, accuracy = 80%, recall = 60%, precision = 100%, F1 score = 75%). CONCLUSION: MRI-based machine learning models have promising results in the discrimination of enchondroma and chondrosarcoma based on radiomic features obtained from both FS-PD and T1-weighted images.

Bladder Urothelial Carcinoma: Machine Learning-based Computed Tomography Radiomics for Prediction of Histological Variant.

RATIONALE AND OBJECTIVES: Histological variant (HV) of bladder urothelial carcinoma (UC) is a significant factor for therapy management. We aim to assess the predictive performance of machine learning (ML)-based Computed Tomography radiomics of UC for HV. MATERIALS AND METHODS: Volume of interest of 37 bladder UC tumors, of which 21 were pure and 16 were HV, were manually segmented. The extracted first- and second-order texture features (n = 117) using 3-D Slicer radiomics were compared to the radical cystectomy histopathological results. ML algorithms were performed to determine the significant models using Python 2.3, Pycaret library. The sample size was increased to 74 by synthetic data generation, and three outliers from the training set were removed (training dataset; n = 52, test dataset; n = 19). The predictive performances of 15 ML algorithms were compared. Then, the best two models were evaluated on the test set and ensembled by Voting Classifier. RESULTS: The ML algorithms demonstrated area under curve (AUC) and accuracy ranging 0.79-0.97 and 50%-90%, respectively on the train set. The best models were Gradient Boosting Classifier (AUC: 0.95, accuracy: 90%) and CatBoost Classifier (AUC: 0.97, accuracy: 85%). On the test set; the Voting Classifier of these two models demonstrated AUC, accuracy, recall, precision, and F1 scores as follows; 0.93, 79%, 86%, 67%, and 75%, respectively. CONCLUSION: ML-based Computed Tomography radiomics of UC can predict HV, a prognostic factor that is indeterminable by qualitative radiological evaluation and can be missed in the preoperative histopathological specimens.

The comparison of the prognostic value of scored patient generated subjective global assessment and Computed Tomography measured sarcopenia in patients with gynecological cancer.

BACKGROUND: Screening of the nutrition status is recommended for the early detection and treatment of cancer-associated malnutrition to improve the prognosis. We aimed to compare the prognostic value of Patient Generated-Subjective Global Assessment (PG-SGA) and CT measured sarcopenia in patients with gynecological cancer. METHODS: A total of 107 patients of which were 57 endometrial, 37 ovarian, and 13 cervical cancer who underwent surgery and evaluated by PG-SGA were enrolled. Skeletal muscle index (SMI) was calculated by automatic segmentation of the muscle area at the L3 level on abdominal CT scan and defined by the cut-off value of 38.9 cm2/m2. Karnofsky and Eastern Cooperative Oncology Group (ECOG) Performance Status scorings were performed. Hospitalization length (HL), overall- (OS), and progression-free- survival (PFS) were analyzed. Body muscle index (BMI) (kg/m2) was calculated. Serum CA-125 and albumin levels were obtained. RESULTS: The prevalence of malnutrition and sarcopenia were 67% and 26.2%, respectively. BMI was significantly associated with PG-SGA (p = 0.02) and SMI (p = 0.01). PG-SGA significantly correlated with CA-125 (r = 0.33, p = 0.002), ECOG (r = 0.29, p = 0.002), Karnofsky (r = -0.34, p < 0.001), and HL (r = 0.27, p = 0.004). PG-SGA showed a significant association with PFS (p = 0.007) and OS (p = 0.001). PG-SGA≥9 showed a significant relationship with prolonged HL, mortality, and progression (OR = 1.08; p = 0.03, OR = 23.09; p = 0.003, and OR = 5.39; p = 0.001, respectively). CONCLUSION: PG-SGA can identify patients at nutritional risk earlier than SMI. PG-SGA shows a higher correlation with HL and clinical performance scores than SMI. PG-SGA is a better prognostic factor for prolonged HL, OS, and PFS.

Endometrial cancer: the role of MRI quantitative assessment in preoperative staging and risk stratification.

BACKGROUND: New methods to reduce subjectivity in preoperative magnetic resonance imaging (MRI) staging of endometrial cancer are needed. PURPOSE: To investigate the role of MRI quantitative assessment in staging and risk stratification of endometrial cancer. MATERIAL AND METHODS: Preoperative T2-weighted (T2W) images and diffusion-weighted imaging of 42 patients were analyzed retrospectively by two radiologists. Tumor area ratio (TAR) and tumor volume ratio (TVRseg) were calculated by semi-automatic segmentation of the tumor and uterus on T2W imaging and apparent diffusion coefficient (ADC). TVR was also calculated by the 3D metric method (TVRmetric). Mean ADCtumor was calculated. The patients were allocated to risk groups regarding the stage, grade, and lymphovascular invasion (LVI) status. RESULTS: TAR, TVRmetric, T2W TVRseg, and ADC TVRseg showed a significant difference between the superficial and deep myometrial invasion groups (P < 0.001). All of these parameters showed a good diagnostic performance for detecting deep myometrial invasion (AUC>0.82), the highest accuracy rate (85%) was found with T2W TVRseg. LVI was significantly associated with TAR (P = 0.002) and T2W TVRseg (P = 0.014), while the cervical invasion was associated with TAR (P = 0.03). ADCtumor was significantly lower in high-grade tumors (P = 0.002). There was a significant difference in ADCtumor (P = 0.002), TAR (P = 0.004), and T2W TVRseg (P = 0.038) between the low- and high-risk groups. AUC of TAR and T2W TVRseg for detecting high-risk groups were 0.80 and 0.77, respectively, while AUC of ADCtumor for the low-risk group was 0.75. CONCLUSION: MRI quantitative assessments such as TAR, TVR, and ADCtumor may improve the accuracy of preoperative staging and can help in risk stratification of endometrial cancer.

Magnetic resonance imaging-derived fat fraction predicts risk of malignancy in intraductal papillary mucinous neoplasm.

PURPOSE: Assess the relationship between MRI-derived pancreatic fat fraction and risk of malignancy in intraductal papillary mucinous neoplasm (IPMN). METHODS: MRIs of patients with IPMN who underwent pancreaticoduodenectomy were analyzed. IPMN with low-grade dysplasia (n = 29) were categorized as low-risk while IPMN at high risk of malignancy consisted of those with high-grade dysplasia/invasive carcinoma (n = 33). Pancreatic fat-fraction (FFmean) was measured using the 2-point Dixon-method. Images were evaluated for the high-risk stigmata and worrisome features according to the revised 2017 Fukuoka consensus criteria. Data on serum CA19-9, Diabetes Mellitus (DM) status, body mass index (BMI), and histological chronic pancreatitis were obtained. RESULTS: A significant difference in FFmean was found between the high-risk IPMN (11.45%) and low-risk IPMN (9.95%) groups (p = 0.027). Serum CA19-9 level (p = 0.021), presence of cyst wall enhancement (p = 0.029), and solid mass (p = 0.008) were significantly associated with high-risk IPMN. There was a significant correlation between FFmean and mural nodule size (r = 0.36, p Ë‚ 0.01), type 2 DM (r = 0.34, p Ë‚ 0.01), age (r = 0.31, p Ë‚ 0.05), serum CA 19-9 (r = 0.30, p Ë‚ 0.05), cyst diameter (r = 0.30, p Ë‚ 0.05), and main pancreatic duct diameter (r = 0.26, p Ë‚ 0.05). Regression analysis revealed FFmean (OR 1.103, p = 0.035) as an independent predictive variable of high-risk IPMN. CONCLUSION: FFmean is significantly associated with high-risk IPMN and an independent predictor of IPMN malignant risk. FFmean may have clinical utility as a biomarker to complement the current IPMN treatment algorithm and improve clinical decision making regarding the need for surgical resection or surveillance.

The prognostic value of fat necrosis deposits on CT imaging in acute pancreatitis

Background/aim: Investigate the prognostic value of the fat necrosis deposit (FND) pattern in acute pancreatitis. Materials and methods: The contrast-enhanced computed tomography (CT) images of 35 necrotizing pancreatitis (NP) and 51 edematous pancreatitis (EP) cases were included in our retrospective study. Computed tomography severity index (CTSI) and Ranson scores were calculated. Images were evaluated for FND, complications (infection/ hemorrhage), walled-off necrosis (WON), and venous thrombosis (VT). We developed a new grading system called fat necrosis deposit-CTSI (FND-CTSI), which was the sum of FND and CTSI scores. The relationship between grading systems and mortality, length of hospital-intensive care unit stay, surgical and percutaneous interventions were evaluated. Results: FND-CTSI scores were significantly higher in NP than EP (P < 0.001). FND-CTSI demonstrated a significant correlation with CTSI (r:0.91, P < 0.001) and Ranson score (r:0.24, P = 0.025). CTSI was significantly higher in only mass form amongst the FND groups (P < 0.001). There was a significant difference in WON, complications, and mortality between FND groups (P < 0.05). CTSI and FND-CTSI scores were both significantly associated with WON, VT, surgical intervention, mortality (P < 0.001), and the presence of complications (P = 0.013 and P = 0.007, respectively). FND-CTSI was also significantly associated with percutaneous intervention (P = 0.019), while CTSI was not (P > 0.05). According to ROC analysis, AUC values of FND-CTSI were higher than CTSI for the detection of WON, complications, mortality, and percutaneous intervention (P < 0.05). FND-CTSI showed a highly significant correlation with the length of hospital and intensive care unit stays (P < 0.001). Conclusion: FND-CTSI can be used in acute pancreatitis grading and considered as a prognostic factor.

Quantitative assessment of disease severity of primary sclerosing cholangitis with T1 mapping and extracellular volume imaging.

PURPOSE: Assess the relationship between liver T1 relaxation time and extracellular volume (ECV) fraction and the disease severity of primary sclerosing cholangitis (PSC). METHODS: This retrospective study included 93 patients with PSC and 66 healthy patients in the control group. T1 relaxation times were measured in the right and left lobe, as well as in the area of stricture. T1PSC and ECVPSC were calculated by averaging T1 and ECV of both lobes and stricture site. T1 and ECV were compared between the two groups and according to PSC phenotypes and severity based on Mayo Risk Score (MRS). We also examined the relationship between T1 and ECV with non-invasive measures of fibrosis such as Fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by transient elastography. RESULTS: Mean liver T1 (774 ± 111 ms, p < 0.001) and liver ECV (0.40 ± 0.14, p < 0.05) were significantly higher with both large-duct and small-duct-type PSC which may lack classic imaging findings on MRCP compared to the control group (p < 0.001). T1PSC and ECVPSC showed weak-moderate correlation with LSM, FIB-4, and MRS (p < 0.05). Cut-off values of liver T1 to detect patients in low-risk and high-risk MRS groups were 677 ms (AUC: 0.68, sensitivity: 76%, specificity: 53%, p = 0.03) and 743 ms (AUC: 0.83, sensitivity: 79%, specificity: 76%, p < 0.001), respectively. CONCLUSION: T1 relaxation time and ECV fraction can be used for quantitative assessment of disease severity in patients with PSC.

Wirsungocele: evaluation by MRCP and clinical significance.

PURPOSE: Wirsungocele is a rare cystic dilatation of the main pancreatic duct seen at the terminal portion of the duct of Wirsung. The purpose of our study is to evaluate the diagnostic value of MRCP in detection of Wirsungocele and the association between the MRCP-determined size of Wirsungocele and the MRCP-clinical findings of pancreatitis. METHODS: Thirty-four patients with reported 'Wirsungocele' were analyzed in the study. Two radiologists reviewed MRCP/S-MRCP images for the presence and diameter of Wirsungocele (WD), main pancreatic duct dilatation (MPDD), side branch ectasia (SBE), acinarization, and duodenal filling grade. Electronic medical record review included symptoms (abdominal pain), signs (recurrent acute/chronic pancreatitis), and select laboratory testing (serum amylase and lipase). Inter-reader agreement values were calculated by ICC. Pearson correlation analysis was performed to evaluate the association of WD with radiological and clinical findings. The comparison of WD on MRCP versus S-MRCP was calculated by Wilcoxon test. Mann-Whitney U test was used for two independent variable comparisons. RESULTS: The sensitivity of MRCP for the detection of Wirsungocele calculated using the S-MRCP and ERCP as the reference method was 76.9% and 100%, respectively. There was a significant difference in the diameter of Wirsungocele measured by MRCP vs S-MRCP (p < 0.001). There was good inter-reader agreement for the detection of Wirsungocele on MRCP and measurement of WD on MRCP and S-MRCP (ICC: 0.79, 0.89, and 0.80, respectively, p < 0.001). There was a significant difference in WD between the patients with and without MPDD (p < 0.05). There was a significant positive correlation between WD and MPDD (r = 0.66, p < 0.05). WD was significantly associated with recurrent acute pancreatitis (p < 0.05). CONCLUSION: MRCP is a highly sensitive and non-invasive imaging tool for detection of Wirsungocele. Greater Wirsungocele diameter is associated with MPDD and recurrent acute pancreatitis.

Serum biomarkers in patients with stable and exacerbated COPD-bronchiectasis overlap syndrome.

INTRODUCTION: Bronchiectasis (B), commonly seen in patients with chronic obstructive pulmonary disease (COPD), is associated with exacerbations and predicts mortality. OBJECTIVES: To differentiate patient groups with COPD-(B+) or COPD-(B-) and their exacerbations by using inflammatory markers. METHODS: Consecutive COPD patients were divided into two groups according to findings on high resolution thorax CT (HRCT) images using Smith and modified Reiff scores. Patients were prospectively followed for possible future exacerbations. Serum fibrinogen, C-reactive protein (CRP), soluble urokinase-type plasminogen activator receptor (suPAR) and Plasminogen activator inhibitor-1 (PAI-1) levels were studied during exacerbation and stable periods. RESULTS: Eighty-seven patients were included and (85 M, 2 F), mean aged was 68.1 ± 9 (46-87). HRCT confirmed bronchiectasis in 38 (43.7%) patients, most commonly in tubular form (89.4%) and in lower lobes. COPD-B(+) group had lower body mass index (P = 0.036), more advanced stage of disease (P = 0.004) and more frequent exacerbation (P = 0.01). The HRCT scores were correlated with exacerbation rate (r = 0.356, P < 0.05). Fibrinogen and CRP values were higher in exacerbation (P = 0.01, P = 0.013, respectively) especially in COPD-B(+) patients. suPAR and PAI-1 levels were also higher in COPD-B(+) patients although it was not statistically significant. CONCLUSION: Bronchiectasis is common and causes frequent exacerbations in COPD. Identifying of COPD-B(+) phenotype by HRCT scoring systems has considerable importance for both therapeutic options and clinical outcome of the disease. In addition to fibrinogen and CRP, high serum levels of suPAR and PAI-1 suggest us their significant roles in increased systemic inflammation associated with coexisting of COPD and bronchiectasis.

Prognostic value of metabolic tumor volume and total lesion glycolysis assessed by 18F-FDG PET/CT in endometrial cancer.

OBJECTIVE: Surgical staging is the most confidential method for prognosis prediction. However, in which stage the surgery is needed and the treatment management of these patients is controversial. Presentation of new determinant factors with imaging methods for prediction of poor prognosis can provide better disease management. The aim of our study was to demonstrate the ability of metabolic tumor volume and total lesion glycolysis as a prognostic factor to predict the disease-free survival time, necessity of adjuvant radiotherapy-chemotherapy, and the association of these parameters with the clinicopathological features. METHODS: Forty-four endometrial cancer diagnosed patients whose PET/CT scans were performed for treatment planning were included in our study. Metabolic parameters (SUVmax, metabolic tumor volume, total lesion glycolysis) of the primary tumor were calculated. Abdominal hysterectomy was performed for all patients. Histopathologic findings were noted. Patients were followed for 31.4 ± 14.8 months. RESULTS: Metabolic tumor volume and total lesion glycolysis were significant prognostic factors for disease-free survival, whereas SUVmax did not effect disease-free survival. According to regression analysis, only metabolic tumor volume was found significant for radiotherapy planning (cutoff metabolic tumor volume; 26.30 ml). There was significant association between metabolic tumor volume, total lesion glycolysis and early-stage, myometrial invasion, and lymph node positivity. We observed only weak association between SUVmax and myometrial invasion. ROC curve calculated metabolic tumor volume and total lesion glycolysis cutoff values as 19.6 ml and 90 g for early-stage, 14.3 ml and 173.4 g for myometrial invasion, and 29.7 ml and 283.1 g for lymph node positivity, respectively. CONCLUSION: Metabolic tumor volume and total lesion glycolysis may be used as prognostic factors for endometrial cancer. The association between SUVmax and clinical findings, disease-free survival, histopathological features are weak. Further studies are needed for demonstrating the prognostic value of metabolic volumetric parameters.

Solitary Pulmonary Nodule: Morphological Effects on Metabolic Activity Assessment

Objectives: We aimed to evaluate the effects of morphological characteristics of the solitary pulmonary nodules (SPN) on metabolic activity assessment. To the best of our knowledge, this is the first study to compare the volumetric metabolic activity parameters according to the morphologic parameters of the nodules. Methods: In this retrospective study, 18F-FDG positron emission tomography and computed tomography scans performed between 2011 and 2018 were evaluated by a nuclear and diagnostic radiologist. One hundred thirteen patients with SPNs with biopsy-proven diagnosis were included. SPNs were classified as solid, partially solid (PS), and ground glass opacity (GGO). Results: SPN diameter, SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and density were significantly higher in the malignant group. SUVmax, MTV, TLG increased in direct proportion to the diameter. There was no a significant difference between GGO, PS, and solid nodules in terms of SUVmax values. MTV and TLG values increased in parallel with the density of the nodules, but this increase was only significant in the malignant group. There was a significant difference between SPNs <2 cm and SPNs ≥2 cm in terms of MTV, while there was no difference in terms of SUVmax. The cut-off value determined by the ROC curve was found to be 4.39 for SUVmax, 7.33 mL for MTV and 31.88 g for TLG. The cut-off values for SUVmax of solid and subsolid nodules were close to each other, but cut-off values for MTV and TLG were higher in solid nodules. Conclusion: SUVmax, MTV, and TLG are affected by diameter and attenuation. We suggest using different MTV and TLG cut-off values for solid and subsolid nodules, but we suggest using same SUVmax values. MTV can be a more reliable parameter than SUVmax in prediction of malignancy in smaller nodules.

The efficacy of new oral contrast mixture for computed tomography enterography.

PURPOSE: To show the reliabilities of the new mixture (composed of water, methylcellulose, lactulose, locust bean gum, and sorbitol) and to compare the luminal distension and radiological confidence scores of this solution with water-lactulose mixture. MATERIAL AND METHODS: Computed tomography enterography (CTE) images in a three-year period were included randomly in our institutional review board-approved and retrospective study. Ninety-one patients drank a lactulose and water mixture (Group 1), and 54 patients drank the new mixture (Group 2). Patients who drank the oral contrast agent were taken to a 64-detector row multiple detector computed tomography machine. Coronal and sagittal reformatted images were also formed. The gastrointestinal tract was divided into 11 segments for scoring. Each segment was graded for distensional and radiological confidence. CTE images were evaluated by two radiologists. RESULTS: Inter- and intra-reader reliabilities were good or excellent for all gastrointestinal segments in both groups (p < 0.001). The best κ values were obtained in sigmoid colon assessments. Lower agreement values were detected in duodenum and jejunum scores. The new mixture group (Group 2) showed better results than Group 1 for ileum and colonic segments according to distension and confidence scorings. CONCLUSIONS: Inter- and intra-reader reliabilities of the new mixture were good or excellent for CTE. The new mixture seems to be more efficient and reliable for ileum and colon. The new mixture can increase bowel distention, radiological confidence, and quality in CTE evaluations.

Delayed Small Bowel Perforation with Findings of Severe Ischemia Following Blunt Abdominal Trauma.

BACKGROUND: Isolated small bowel perforation following blunt abdominal trauma (BAT) is an uncommon situation with high morbidity and mortality rates, and delayed small bowel perforation is even rarer. The pathophysiology of this condition is not clear in all cases. To the best of our knowledge, this is the first case report of delayed small bowel perforation following BAT with extensive portomesenteric vein gas. CASE REPORT: A 33-year-old male patient was admitted to the emergency department after a car accident. His initial abdominal CT showed no signs of posstraumatic injury. However, follow-up CT, performed after deterioration in his general condition, showed jejunal dilatation, intestinal intramural gas, portomesenteric vein gas, extensive intraperitoneal gas and intraabdominal free fluid. CT findings and emergent laparotomy findings were both compatible with small bowel ischemia-necrosis and perforation. CONCLUSIONS: Delayed small bowel perforation following BAT is thought to occur secondary to mesenteric hematoma formation or mesenteric tear complications. Our patient did not have any mesenteric injury or hematoma on initial abdominal CT. We are not aware of any other case report of delayed small bowel perforation following BAT without signs of intraabdominal injury on initial imaging and extensive portomesenteric vein gas on follow-up imaging. Ischemic bowel necrosis was the main cause of portomesenteric vein gas in our case. Posttraumatic patients should be kept under medical observation and abdominal CT should be preferred for imaging in case of a deterioration in the general condition and laboratory findings or appearance of new abdominal complaints.

The Impact of Gd-Eob-Dtpa-Enhanced MR Cholangiography in Biliary Diseases: Comparison with T2-Weighted MR Cholangiopancreatography.

BACKGROUND: Contrast enhanced magnetic resonance cholangiography is a novel technique and promising method in demonstrating biliary tree anatomy and evaluating biliary disorders. However, to date, there are a limited number of studies that have focused on the impact of this technique. AIMS: We aimed to evaluate the additional role of contrast enhanced MR cholangiography (MRC) and compare contrast enhanced MRC with T2-weighted (w) magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary disorders. STUDY DESIGN: Diagnostic accuracy study. METHODS: The T2w-MRCP and contrast enhanced MRC sequences of 31 patients whose gold standard test results were available were scored visually for the existence of pathological findings with regard to any of the biliary diseases. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) was used as the contrast agent. The correlation values were determined according to the statistical analysis made from those scores and the sensitivity, specificity and accuracy values of each sequence were detected as well. RESULTS: We detected that the correlation values with gold standard methods of contrast enhanced MRC sequences were significantly higher than the ones of T2w-MRCP sequences. The correlation ratios of T2w-MRCP sequences were between 26 and 34%, while those for contrast enhanced MRC sequences were between 81 and 83% for the first reader and the correlation ratios of T2w-MRCP sequences were between 10 and 61%, whereas those of contrast enhanced MRC were between 79 and 81% for the second reader The mean sensitivity, specificity and accuracy values of T2w-MRCP sequences were 14.3-42.5%, 85-89.2% and 59.3-72.5%, respectively, while the mean sensitivity, specificity and accuracy values of contrast enhanced MRC sequences were 100%, 86.7% and 93.2-93.3%, respectively. CONCLUSION: We suggest that obtaining of contrast enhanced MRC sequences in addition to the T2w-MRCP can be useful in the diagnosis of many diseases in relation with biliary tree.

MR enterography with oral contrast agent composed of methylcellulose, low-dose barium sulfate, sorbitol, and lactulose: assessment of diagnostic performance, reliability, image quality, and patient tolerance.

OBJECTIVE: The objective was to show efficiency of magnetic resonance enterography (MRE) with our previously assessed new oral contrast agent. MATERIALS AND METHODS: Each bowel segments was evaluated for luminal distension, wall conspicuity, wall thickening, and hyperintensity on fat-saturated (FS) T2-weighted and contrast enhancement on postcontrast FS T1-weighted images. Also, consensus scoring results of MRE exams were compared with the gold standard tests in terms of active inflammatory bowel disease detection. RESULTS: Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRE for active inflammatory bowel disease detection were 62%, 98%, 80%, 96%, and 71.4%, respectively. CONCLUSION: MRE obtained with the new mixture has a high reliability and shows good correlation with endoscopic examination±biopsy.

Computed Tomography (CT) Findings of a Diagnostic Dilemma: Atypically Located Acute Appendicitis.

BACKGROUND: Acute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis. CASE REPORT: We presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised. CONCLUSIONS: Atypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates.