Shear wave elastography evaluation of brachial plexus in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a chronic neuroinflammatory disease characterized by inflammation involving the peripheral nerves. Shear wave elastography (SWE) is potentially a method of choice for detecting peripheral nerve involvement. PURPOSE: To compare the degree of thickening and nerve elasticity of brachial plexus (BP) nerve roots and evaluate the usefulness of sonoelastography in patients with clinically diagnosed MS without brachial plexopathy. MATERIAL AND METHODS: Thirty-two patients with MS and 32 controls were included in the study. Bilateral C5, C6, and C7 mean nerve root diameters, and mean elasticity values in kiloPascal (kPa) were measured in the patient and control groups. The relationship between the age, height, and weight values and nerve diameter-elasticity values of the patient and control groups was compared. RESULTS: The elasticity values of the C5 and C6 nerve roots were increased, and the nerve root thickness was decreased in the MS group compared to that in the control (P < 0.05). There was no difference between the C7 mean nerve root elasticity (kPa) and diameter measurements in the patient and control groups (P > 0.05). CONCLUSION: Our study showed an increase in the BP nerve root elasticity values (kPa) in patients with MS compared to that of the control group and a decrease in diameter values thought to be related to the possible chronic atrophic process. The results are consistent with the demyelinating process of the peripheral nervous system (PNS) due to MS.

Diagnostic performance of 2D shear wave elastography in predicting liver fibrosis in patients with chronic hepatitis B and C: a histopathological correlation study.

PURPOSE: In this study, we investigated the diagnostic efficacy of 2D-Shear Wave Elastography (2D-SWE) in detecting stages of liver fibrosis and determining the disease-specific cut-off values in patients with chronic hepatitis B and C infection, using histopathological analysis as the reference method. METHOD: Our study included 103 consecutive adult patients with chronic hepatitis B and C infection (CHB and CHC) who had liver biopsy within three months of elastography examination. A real-time 2D-SWE was performed using the LOGIQ E9 system (GE Medical Systems, Wisconsin, USA). The correlation between the liver stiffness measurements and the METAVIR scores was evaluated. The diagnostic performance of 2D-SWE was assessed, and cut-off values were set. RESULTS: We found a statistically significant positive correlation between elastography values and the degree of liver fibrosis (Spearman's correlation coefficient = 0.76 and 0.83 for CHB and CHC; respectively) (p = 0.0001). The stiffness cut-off values were F ≥ 1: 5.92 kPa, F ≥ 2: 7.69 kPa, F ≥ 3: 8.97 kPa, F ≥ 4: 12.15 kPa in CHB; and F ≥ 1: 6.09 kPa, F ≥ 2: 7.81 kPa, F ≥ 3: 9.0 kPa, F ≥ 4: 12.47 kPa in CHC patients. CONCLUSION: 2D-SWE is reliable and accurate for the diagnosis of liver fibrosis. In selected patients, 2D-SWE may be useful in reducing the need for liver biopsy when staging fibrosis. Further studies in larger prospective series are needed to confirm these results and determine the most appropriate cut-off values for each stage of liver fibrosis.

Diaphragmatic muscle thickness in older people with and without sarcopenia.

BACKGROUND: Studies in mice have suggested that sarcopenic animals may have atrophic diaphragmatic muscles; however, to date, no clinical studies are available. AIMS: To investigate whether the diaphragmatic thickness is affected in older patients with sarcopenia and if this is associated with impaired respiratory functions. METHODS: Thirty sarcopenic and 30 non-sarcopenic elderly patients aged over 65 were included. All patients underwent comprehensive geriatric assessment. The diagnosis of sarcopenia was made according to the criteria of the European Working Group on Sarcopenia in Older People. Ultrasonographic evaluations of the patients were carried out by an experienced radiologist. Diaphragmatic thickness was measured in three positions: end of deep inspiration, quiet breathing, end of forced expiration. Peak expiratory flow (PEF) rate was evaluated by a peak flow meter. RESULTS: The mean age of the patients was 77 ± 6 years, and 58% were females. Diaphragmatic thickness in three different positions (deep inspiration [2.3 mm (min-max: 1.3-4.1) vs. 2.5 mm (min-max: 1.9-4.9)], quiet breathing [1.8 mm (min-max: 1.0-2.8) vs. 2.00 mm (min-max: 1.3-3.9)] and end of forced expiration [1.1 mm (min-max: 0.7-2.5) vs. 1.5 mm (min-max: 0.5-3.4)]) were found to be thinner in sarcopenic patients compared to non-sarcopenics (p = 0.02, p = 0.02, p < 0.01, respectively). Also, PEF rate results were lower in patients with sarcopenia (245 L/min [min-max: 150-500] vs. 310 L/min [min-max: 220-610], p < 0.01). Diaphragmatic muscle thicknesses in all three positions were independently associated with sarcopenia status of the participants. CONCLUSIONS: Our results suggest that sarcopenia in older people may be associated with reduced diaphragmatic muscle thickness and respiratory functions. Findings are needed to be confirmed in further multicenter studies with big sample sizes.

The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection.

PURPOSE: The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. METHODS: Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. RESULTS: SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5 kPa, post-BoNT-A: 25.0 ± 5.7 kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9 kPa, post: 28.4 ± 5.2 kPa) decreased significantly (P < 0.01). CONCLUSION: Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.

Evaluation of effects of aging on skeletal muscle elasticity using shear wave elastography.

PURPOSE: To evaluate the effects of aging on skeletal muscle stiffness in relaxed and contracted status using shear wave elastography (SWE). MATERIALS AND METHODS: A total of 57 participants were enrolled to this institutional review board approved prospective study. Medial head of the gastrocnemius muscle (GM) of all participants were examined bilaterally by a single radiologist in prone position. Muscle thickness, stiffness values in both relaxed and contracted status were measured. Stiffness increase rate (SIR) was calculated for all muscles. The Spearman's correlation test was used for correlation analyses. Mann-Whitney U test was used to compare subgroups. RESULTS: The mean age of the participants was 41.15 ±â€¯16.19 (range, 18-74). The means of stiffness values of medial head of GM were 12.51 ±â€¯2.56 kPa and 81.74 ±â€¯15.77 kPa in relaxed and contracted status, respectively. The mean of SIR values was 5.62 ±â€¯1.05 (range, 3.18-8.66). The stiffness values of relaxed and contracted medial head of GM had moderate to strong inverse correlations with age for both dominant and non-dominant extremities (r range: -0.703 to -0.590). Age subgroup analyses revealed significant differences in muscle thickness and stiffness values, whereas no significant difference was found in SIR values. CONCLUSION: In conclusion, despite the decrease in stiffness of skeletal muscle with advancing age, SIR remained similar. Any improvement in stiffness values of skeletal muscle in relaxed status may play pivotal role in the management of sarcopenia.

Quantification of liver fat content with ultrasonographic attenuation measurement function: Correlation with unenhanced multidimensional computerized tomography.

PURPOSE: To evaluate the efficacy of attenuation measurement function (ATT), a newly developed quantitative ultrasonography(US) method based on measurement of the attenuation coefficient, using unenhanced computerized tomography(CT) attenuation values as a reference standard, for the detection and measurement of hepatosteatosis. MATERIAL AND METHODS: A total of 98 patients were analyzed. The diagnostic ability of ATT was evaluated using receiver operating characteristic (ROC) curve analysis, and the correlation between liver attenuation index (LAI), the liver-to-spleen attenuation ratio (CTL/S), liver attenuation value (CTL), and ATT was determined. RESULTS: ATT is negatively correlated with LAI (r = -0.571, p < 0.001), CTL/S (r = -0.532, p < 0.001), and mean CTL (r = -0.50, p < 0.001). A significant difference was found between ATT values of patients with different grades of hepatosteatosis (p < 0.001). A significant difference was found between ATT values of patients with LAI < -10 and LAI > -10, CTL < 40 and CTL > 40, and CTL/S < 1 and CTL/S > 1 (p < 0.001). An ATT ≥ 0.665 showed a sensitivity of 100% and a specificity of 90% in diagnosing moderate-severe steatosis. The corresponding area under the ROC curve(AUROC) was 0.935. The intraclass correlation coefficient for the interobserver variability of ATT was 0.907 (95% CI, 0.85-0.95). CONCLUSION: In conclusion, ATT values for evaluation of hepatosteatosis was closely correlated with the degree of hepatosteatosis and liver fat content. It can be used as a noninvasive method in the diagnosis and follow-up.

Interobserver variability and stiffness measurements of normal common extensor tendon in healthy volunteers using shear wave elastography.

OBJECTIVES: The purposes of our study are to determine the quantitative elasticity values of normal common extensor tendon (CET) and to assess the interobserver variability of stiffness measurements using shear wave elastography (SWE). MATERIALS AND METHODS: A total of 60 CETs of 30 (15 female, 15 male, mean age 30.2 years) healthy volunteers without any symptoms of lateral epicondylitis were examined by two radiologists. Age, sex, height, weight, body mass index (BMI), and dominant hand of all participants were noted. The first observer performed B-mode and SWE imaging, and the second observer performed only SWE imaging. Tendon thickness and stiffness values in kPa were measured. RESULTS: The mean thickness of CETs was 3.57 ± 0.36 mm. The mean stiffness values of CETs for two observers were 45.28 ± 9.82 kPa and 45.80 ± 9.72 kPa respectively. Tendon thickness had a weak correlation with weight (r = 0.281, p = 0.03), and moderate correlation with stiffness values (r = 0.429, p < 0.001). The mean interobserver difference of CET stiffness measurements was -0.5% of the mean CET stiffness values. Range of measurement error, defined as 95% limits of agreement, was ±23.5%. There was no significant difference between absolute values of interobserver measurements (p = 0.741). CONCLUSION: Shear wave elastography is a reproducible imaging technique for the evaluation of CET elasticity and the standard stiffness values of normal CET can be used as reference data to differentiate normal from pathological tissues.

High incidence of co-existing factors significantly modifying the phenotype in patients with Fabry disease.

Fabry disease results from deficiency of the lysosomal enzyme alpha-galactosidase A. The families of 11 index cases were screened by enzyme and molecular assays. Further clinical and laboratory investigations were carried out in all cases. Including 33 new patients, a total of 28 females (Age 25,82 ±â€¯12,1 Range 8-46) and 16 males (Age 24,56 ±â€¯15,04 Range 2-48) were investigated. Ten different disease-causing variants were found two of them being novel. One patient had co-existing familial mediteranian fever, one had celiac disease and three had rheumatological disorders. Lipoprotein (a) levels were elevated in 17,6%, homocysteine in 22,2%, total and low density cholesterol in 12% and antithrombin 3 levels were elevated in 13,3%. One patient was found to be heterozygous for prothrombin p.G20210A disease-causing variant (5,8%) and two for factor V Leiden disease-causing variant (11,7%). Anticardiolipin IgM antibody was found to be positive in 11,7%. The patients with abnormal cranial imaging were also noticed to have additional risk factors for thrombosis. This study provides the largest data about Fabry patients from Turkey and implies that co-existing risk factors unrelated to Fabry Disease have significant association with the presence of clinical symptoms in females and might cause an early and severe clinical course in males.

Ultrasound elastography in assessment of salivary glands involvement in primary Sjögren's syndrome.

OBJECTIVE: Our study aimed to assess the pathological sonoelastographic changes in the major salivary glands and to demonstrate the diagnostic effectiveness of Sonoelastography as an additional method to US in Sjögren's syndrome. METHODS: Fifty eight patients with primary Sjögren's syndrome (pSS) were selected according to the American-European Consensus Group Classification criteria. Twenty five healthy volunteers involved in this study. All patients were evaluated with B-mode and elastography by using Hitachi EUB 7500 digital ultrasound equipment. All subjects were female. The sonoelastography examination, which allowed us to assess the elasticity of the parenchyma, was performed and strain ratios were measured by comparing with the adjacent tissues. RESULTS: Statistically significant differences were found between the pSS and control groups for the elastographic scores and strain ratios (p < 0.001). The highest sensitivity and specificity levels were obtained when the strain ratio cut-off value was taken as 1.55 for the submandibular gland and 2.45 for the parotid gland (sensitivity and specificity were 83% and 88% respectively for the submandibular gland and 83% and 92% respectively for the parotid gland). However, no statistically significant differences were found between the disease duration and the elasticity scores or strain ratios in pSS group (p > 0.05). CONCLUSION: US examination is an efficient method to assess major salivary gland involvement in the diagnosis of pSS. Sonoelastography is a modality which can contribute to the diagnosis by improving specificity in the differential diagnosis of pSS. Strain ratio measurement, which is a semi-quantitative method, increases the diagnostic effectiveness by providing high sensitivity, specificity, and negative predictive values.

Assessment of Endothelial Dysfunction With Flow-Mediated Dilatation in Myeloproliferative Disorders.

BACKGROUND: Thrombosis is the most important cardiovascular complication of classical myeloproliferative disorders (MPDs). Endothelial dysfunction (ED) is known to play a major role in the mechanism of thrombophilia in MPDs. METHODS: Endothelial dysfunction and its associations with other parameters were investigated. A total of 18 patients with polycythemia vera (PV), 24 with essential thrombocytosis (ET), 7 with primary myelofibrosis (PMF), and 30 healthy patients as a control group were included in the study. To assess the ED, flow-mediated dilatation (FMD) measurements were used. RESULTS: The FMD (%) result showing ED was determined as 9.9 (0.0-21.6) in the patients with PV, 7.3 (0.0-30.5) in patients with ET, 7.5 (0.0-18.0) in patients with PMF, and 13.9 (6.2-26.7) in the control group. The FMD (%) was markedly impaired in all patients with MPD compared to the control patients (7.8 [0.0-30.5] vs 13.9 [6.15-26.8], P = .02). According to the disease subtypes, FMD (%) was significantly lower in the ET group than in the control group ( P = .01). CONCLUSION: Endothelial function was assessed in patients with MPD having FMD and was determined to demonstrate ED. Lower FMD was associated with older age, leukocytosis, thrombocytosis, and thrombosis history.

Value of Ultrasound Elastography in the Differential Diagnosis of Cervical Lymph Nodes: A Comparative Study With B-mode and Color Doppler Sonography.

OBJECTIVES: The purpose of this study was to determine the usefulness of ultrasound elastography in the evaluation of enlarged cervical lymph nodes in comparison with B-mode and color Doppler sonography. METHODS: A total of 220 lymph nodes in 168 consecutive patients who were referred for sonography of the neck were included in this study. B-mode sonograms were evaluated according to short-axis diameter, long-to-short-axis ratio, hilum, echogenicity, and microcalcification. For color Doppler sonography, 5 different patterns were defined according to vascularity. Elastographic patterns of the lesions were categorized to 5 main types. The mean strain index values were calculated for all lymph nodes. Histopathologic findings, clinical and laboratory data, and imaging findings were used as reference standards for the diagnosis of benign and malignant lymph nodes. RESULTS: Of the 220 lymph nodes, 69.5% were diagnosed as benign, and 30.5% were diagnosed as malignant. The sensitivity, specificity, and accuracy of B-mode sonography were 97.0%, 31.4%, and 51.3%, respectively; the values were 76.1%, 82.4%, and 80.5% for color Doppler sonography and 82.1%, 56.2%, and 64.1% for elastography. The strain index cutoff value for the differentiation of benign and malignant lymph nodes was accepted as 1.7. The sensitivity, specificity, and accuracy of the strain index were 71.6%, 76.5%, and 75.0%. CONCLUSIONS: Ultrasound elastography adds no additional value to combined B-mode and color Doppler sonography for differentiation of benign and malignant cervical lymph nodes.

A very feasible alternative in patients with feeding difficulties from gastrostomy: Jejunal tube advanced through the gastrostomy.

BACKGROUND: Our aim is to share our experiences regarding patients who cannot be fed effectively through the gastrostomy tube, but were inserted feeding jejunostomy through the gastrostomy orifice using scopic fluoroscopic techniques utilised by the interventional radiology. PATIENTS AND METHODS: Between January 2010 and May 2013 the patients that were inserted jejunostomy tube through the gastrostomy orifice using fluoroscopic techniques were retrospectively analysed. Data including primary indication for gastrostomy, sex, concomitant disease and the requirement for gastroesophageal reflux disease (GERD) were all recorded. RESULTS: There were five patients with these criteria. They all received either medical or surgical GERD therapy; nevertheless enteral feeding failed to reach an effective level, they all had vomiting and did not gain any weight. Following conversion, all the patients gained minimum 2 kg in 2-5 months; all the patients tolerated enteral feeding and were discharged in the early period. There were neither procedure related complications such as perforation, bleeding nor sedation related complications. Procedure took no more than 30 min as a whole. There was no need for surgical intervention. However in one patient re-intervention was required due to accidental removal of the catheter. CONCLUSIONS: In case of feeding difficulties following the gastrostomy; instead of an invasive surgical intervention; physicians should consider jejunal feeding that is advanced through the gastrostomy, which does not require any anaesthesia.

Intraocular pressure lowering effect of orbital decompression is related to increased venous outflow in Graves orbitopathy.

PURPOSE: To investigate the effects of combined orbital bone and fat decompression on intraocular pressure (IOP) and superior ophthalmic vein blood flow velocity (SOV-BFV), and their association with the clinical features of Graves orbitopathy (GO). METHODS: During the 2002-2008 period, 72 eyes of 36 GO cases demonstrating moderate to severe orbitopathy were evaluated according to their clinical features as: cases with or without dysthyroid optic neuropathy (DON), and underwent orbital decompression. A control group comprised 40 eyes of 20 healthy subjects. In both groups, a full ophthalmic examination including IOP and Hertel measurements was performed, and SOV-BFV was analyzed with color Doppler imaging. Examinations were repeated after orbital decompression in GO patients. RESULTS: All the cases demonstrated clinical features of inactive disease. Among the patients 24 of 72 eyes (33.3%) showed clinical features of DON. After surgery, the mean decrease in Hertel values was 6.2 ± 1.8 mm (p = 0.001). The mean decrease in IOP was 3.0 ± 1.7 mmHg (from 17.3 ± 2.7 to 14.3 ± 2.0 mmHg) after orbital decompression where the post-operative values were comparable with the control group (12.9 ± 1.4 mmHg, p = 0.36). The mean increase in SOV-BFV achieved with decompression was 1.2 ± 0.6 cm/s (from 4.8 ± 1.7 to 6.0 ± 1.8 cm/s) and post-operative SOV-BFV values were also comparable with the control group (6.6 ± 1.3 cm/s, p = 0.26). The increase in SOV-BFV in cases with DON did not differ from cases without DON (p = 0.32), however, post-operative SOV-BFV of cases with DON was stil lower than cases without DON (p = 0.035). CONCLUSIONS: Combined orbital bone and fat decompression significantly reduced the IOP levels and increased the SOV-BFV in GO. This could be the confirmative finding of prediction that elevated IOP in GO is associated with increased episcleral venous pressure. The post-operative changes in IOP and SOV-BFV show differences regarding the clinical features of disease.

Oxidized low-density lipoprotein levels and carotid intima-media thickness as markers of early atherosclerosis in prepubertal obese children.

OBJECTIVES: Children with obesity have a high cardiovascular risk and an impaired oxidant-antioxidant status, which may lead to endothelial dysfunction and increased carotid intima media thickness (IMT) even in childhood. The aim of this study was to investigate the circulating oxidized low-density lipoprotein (LDL) concentrations and the IMT of carotid arteries in prepubertal obese children, and also to search for its possible association with carotid atherosclerosis. METHODS: Twenty-seven prepubertal obese children (age, 7.48±2.05 years; boys, 59%) and 30 healthy children (age, 7.80±2.19 years; boys, 55%) were included in the study. Serum concentrations of oxidized LDL, total cholesterol, triglyceride, high-density lipoprotein, LDL, and glucose were measured, and carotid IMT was determined by ultrasound. RESULTS: Serum oxidized LDL levels were significantly higher in prepubertal obese children than in healthy children (p<0.01). No significant correlation was observed between oxidized LDL levels and carotid IMT measurements. However, a significant positive correlation was found between oxidized LDL levels and body mass index, total cholesterol, and LDL-cholesterol. CONCLUSION: Our findings revealed that the oxidation of LDL starts early in obese children but the carotid IMT is not significantly affected. Also, oxidized LDL levels are more strongly associated with obesity and dyslipidemia than the carotid IMT in prepubertal children.

Correlation between vessel diameters of superficial and deep inferior epigastric systems: Doppler ultrasound assessment.

BACKGROUND: The deep inferior epigastric artery perforator (DIEAP) flap is a technically demanding procedure and the dissection is directly influenced by the size of the perforator vessels. There is a common belief that the size of the superficial inferior epigastric vein (SIEV) is inversely proportional to the perforators from the deep inferior epigastric system. To investigate the validity of this hypothesis, we evaluated and compared the diameters of the SIEV and deep inferior epigastric perforator vessels (DIEP-A and DIEP-V). METHODS: Between 2004 and 2006, 50 patients scheduled for breast reconstruction with autologous tissue were evaluated with colour Doppler ultrasound to determine the diameters of SIEV and DIE perforator vessels. The correlation between SIEV and ipsilateral DIEP-V, the correlation between DIE perforator vessels on each side and the impact of body mass index were assessed. Results were analysed statistically to compare the diameter of the SIEV with the largest perforator on the same side and the largest perforators on the contralateral side. Additionally, partial correlation coefficients were calculated to assess if there is an inverse correlation between SIEV and DIE perforators. RESULTS: Diameters of SIEV ranged from 0.50 to 4.06 mm. DIEP-A ranged from 1.00 to 3.49 mm, while DIEP-V ranged from 0.50 to 4.32 mm. There was a slightly inverse correlation between the size of SIEV and DIEP-V, but this was not statistically significant. However, the correlation between SIEVs on both sides was statistically significant. There was also a strong correlation between the size of DIEP-A and DIEP-V on the same side as well as the size of those on the contralateral side. However, the largest artery and vein matched only in 50% of perforator bundles on the right and 62% on the left side. In addition, the vessel diameters increased as the body mass index increased; however, this finding was significant only for perforator veins. CONCLUSION: The inverse correlation between the size of SIEV and DIEP-V was not significant. If SIEV and DIE perforator vessels are large on one side, they are also large on the other side. In addition, the larger the artery, the larger is the vein on the same perforator. However, the largest arteries and veins are not necessarily on the same perforator bundle.

Uric acid level and its association with carotid intima-media thickness in patients with hypertension.

OBJECTIVE: Carotid intima-media thickness (C-IMT) measured noninvasively by ultrasonography is now widely used as a surrogate marker for atherosclerotic disease and directly associated with increased risk of cardiovascular disease. Hyperuricemia (HU) is a well recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. But the possible contributory effect of HU to carotid intima-media thickness (C-IMT) produced by hypertension (HT) has not been clarified yet. The study was designed to assess the C-IMT in patients with hypertension (HT) with or without HU. METHODS: The study participants consisted of 30 patients (men 60%, mean age+/-S.D.: 49+/-11 years) with HT without HU, and 25 patients with HT and HU (men 52%, mean age+/-S.D.: 52+/-12 years), and 25 age-matched healthy control subjects (men 56%, mean age+/-S.D.: 50+/-13 years). All study groups were examined by B-mode ultrasound to measure the C-IMT at the far wall of the common carotid artery. RESULTS: C-IMT were significantly higher in the patient groups (HT without HU and HT with HU) compared to the control cases (0.70+/-0.14, 0.83+/-0.16 versus 0.57+/-0.16, mm, respectively, p<0.001). In the patients groups, patients with HU had significantly higher carotid IMT compared to the patients without HU. In stepwise linear regression analysis, we found that serum uric acid (SUA) levels independently but modestly associated with C-IMT (beta=0.42, p=0.002). CONCLUSION: We have shown that higher SUA levels are associated with atherogenesis independent from hypertension. Prospective studies will be necessary to confirm and extend these findings including early screening for hyperuricemia and lowering of SUA level looking at potential benefits in slowing progression of C-IMT in hypertensive patients.

Evaluation of renal function in Turkish children receiving BFM-95 therapy for acute lymphoblastic leukemia.

This study examined renal function in 42 children with acute lymphoblastic leukemia (ALL) treated according to BFM-95 protocol. Fifteen (group 1) were investigated longitudinally at 3 time points: before (T1), 4 weeks after (T2), and 2-6 months after (T3) consolidation therapy with high-dose methotrexate (HDMTX). The frequency of abnormalities in glomerular and tubular tests were nil at T1 and ranged from 13 to 40% at T2 and 7 to 33% at T3 in group 1. Twenty percent of the patients (n = 10) in group 2, who were examined at a single time point 7-36 months after consolidation, had glomerular and tubular abnormalities. There was only mild tubular abnormality in 5.8% of patients (n = 17) in group 3, who were examined at a single time point a mean of 56.1 +/- 12.5 months after completion chemotherapy. These data show that consolidation therapy with HDMTX is frequently associated with acute renal toxicity in children with ALL but does not leave clinically significant late sequelae.

Closed perforation of the small bowel secondary to a phytobezoar: imaging findings.

Small bowel perforation secondary to phytobezoars is a rare clinical entity, which is not well-documented in the radiological literature. Sonographic and computed tomography (CT) findings of a case of closed small bowel perforation secondary to phytobezoars in a patient with previous gastric surgery are presented. Both abdominal ultrasound and CT examinations revealed a collection containing air at the left lower quadrant as well as neighboring intraluminal masses suggestive of bezoars. We propose that appropriate CT examination is a very useful imaging modality for evaluating this kind of bowel perforation.

The role of late-phase pulse inversion harmonic imaging in the detection of occult hepatic metastases.

OBJECTIVE: The purpose of this study was to investigate the efficacy of late-phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal. METHODS: Thirty-two patients (21 women and 11 men; age range, 20-87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir-enhanced magnetic resonance imaging was performed as part of the clinical workup. RESULTS: After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow-up and CT. Conclusions. Late-phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.

Portomesenteric venous gas: imaging findings with an emphasis on sonography.

OBJECTIVE: Portomesenteric venous gas is a rare condition with an unclear pathogenesis. Most studies in the medical literature mention computed tomography (CT) as the primary imaging tool for this entity. The objective of this study was to outline the advantages and disadvantages of sonography in the evaluation of patients with portomesenteric venous gas. METHODS: We describe 7 patients (3 female and 4 male; age range, 47-83 years) with portomesenteric venous gas. Both CT and sonographic examinations were performed in each patient. Our patient population consisted of 2 patients with superior mesenteric artery occlusion, 3 with ischemia of the colon, small bowel, or both, 1 with gastric ulcer perforation, and 1 with ischemic bowel disease presumably secondary to complications of continuous ambulatory peritoneal dialysis. RESULTS: Portal venous gas was observed in all 7 patients with sonography and in 6 patients with CT. Computed tomography was unable to show gas in the portal venous system in 1 patient. Sonography showed patchy hepatic gas accumulation (likely within small peripheral portal vein branches) with no correlative findings on CT. Computed tomography showed important associated findings, including pneumatosis intestinalis. CONCLUSIONS: In cases with portomesenteric gas, CT is the preferred modality for showing the underlying etiology. However, with its real-time imaging capability, sonography may also be a very valuable imaging modality in the evaluation of this entity.