A novel measurement to evaluate supraspinatus tendinopathies with strain elastography.

BACKGROUND: In addition to the traditional strain ratio (STR), a novel measurement termed hard percent of the whole tendon, provided by the device's software and resembling shear-wave elastography, was included in the study. PURPOSE: To evaluate the correlation between magnetic resonance imaging (MRI) and strain elastography findings in cases with rotator cuff tendinopathy, including tears. MATERIAL AND METHODS: As a prospective study, cases suggestive of rotator cuff tendinopathy were included. After MRI evaluation by two observers, grading of the elastography examination was performed by a third radiologist. For the first measurement, the region of interest (ROI) was chosen from the gray-scale evaluation corresponding to the area showing a MRI pathological signal. Stiffness was assessed with the STR. For the second measurement, the whole visible tendon was measured as the ROI. The hard percent (unaffected areas as a percent) was measured. Correlation coefficients between MRI grade and the two strain value measurements were calculated. RESULTS: There were 93 cases (31 men, 62 women) with 112 involved tendons. The correlation coefficient between MRI grade and age was calculated as 0.56, between MRI grade and STR it was -0.51, and with the novel measurement the correlation coefficient was -0.53. CONCLUSION: This study showed a good association of findings of tendon stiffness with those of tendinopathy on MRI. Using the hard ratio as a novel measurement, its correlation with MRI grade was as reliable as the STR. We also experienced that the benefit of elastography is a challenging issue for defining small ruptures.

Evaluation of diagnostic value of conventional and color Doppler ultrasound with elastography strain ratios in differentiation between benign and malignant lymph nodes.

INTRODUCTION: The aim of this study was to evaluate the diagnostic value of conventional ultrasonography (USG) and color Doppler ultrasonography (CDU) with elastography strain ratios (ESR) in discrimination between benign and malignant lymphatic nodes. MATERIAL AND METHODS: Two hundred and forty-seven patients (252 lymph nodes) were included in this study. USG and CDU with ESR were performed. Materials were obtained by using fine-needle or vacuum-assisted aspiration methods depending on the site and condition of lymph nodes. The χ2 test and Student's t-test were used for comparisons. RESULTS: Ninety-two of 252 (36.5%) lymph nodes were malignant, and 160 (63.5%) were benign. Short axis, S/L ratio, presence or absence of the fatty hilum and extra-hilar vascularity were valuable, statistically significant indicators of malignancy. In contrast, long axis and ESR were not significant indicators of malignancy. The short axis cut-off value was calculated to be 12 mm and the S/L ratio cut-off value was calculated to be 1. CONCLUSIONS: Long axis of lymph nodes and strain ratios cannot be used as malignancy criteria, and their use is controversial despite the fact that some studies have found them valuable. On the other hand, our results support common knowledge that the short axis, S/L ratio, absence of the fatty hilum, and extrahilar vascularity are significant indicators.

Evaluating the role of strain ratio elastography in determining malignancy potential and calculating objective BIRADS US scores using ultrasonography and elastography features.

PURPOSE: The aims of this study were, firstly, to evaluate solid breast masses based on their malignancy potential and to determine whether the strain elastography ratio (SER) can contribute to classical grey-scale ultrasonography findings, and secondly, to define objective BIRADS US scores using ultrasound (US) and SER findings. MATERIAL AND METHODS: A total of 280 patients and 297 solid breast masses were evaluated using sonographic and elastographic data. The SER was measured for each lesion. RESULTS: The positive predictive values (PPV) for each criterion was calculated to be between 35% and 83.3%. The lowest PPV was obtained from hypoechogenicity (35%) and the highest PPV was obtained for anti-parallel features (83.3%). The difference between the mean SER of benign and malignant lesions was statistically significant. After ROC analysis, the SER cut-off value was calculated to be 3.1 for determining if the mass was benign or malignant. Mass scores were calculated for each solid breast mass based on positive predictive values, and BIRADS US score was defined as the sum of mass scores. CONCLUSIONS: SER findings can be used as malignancy criteria in evaluating solid breast masses. BIRADS US score can be objectively determined based on US and elastography features instead of doing subjective scoring. As an additional result, all solid breast masses have the possibility to be malignant, even though US and elastography findings indicate the opposite.

Evaluating Qualitative and Quantitative Computerized Tomography Indicators of Chronic Obstructive Pulmonary Disease and Their Correlation with Pulmonary Function Tests.

BACKGROUND: With increasingly aging populations, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death today. Emphysematous changes, an important component of the disease, must be determined on HRCT, either qualitatively or quantitatively. The purpose of this study was to evaluate features that help determine emphysematous changes and correlate them with respiratory function tests (RFTs). MATERIAL/METHODS: A total of thirty COPD patients and a control group of the same size, matched for age, were included in the study. The mean lung parenchyma density values on inspiration and expiration, visual HRCT scores, and pulmonary function tests were obtained. IBM SPSS statistical software (version 22) was used to perform correlation analysis (Pearson's coefficient) and the Mann-Whitney U test. RESULTS: The most valuable RFTs for determining emphysematous changes were DLCO, FEV1, and FEV1/FVC, in that order. Quantitative measures of the mean lung density had the highest correlation with coefficient on expiration. CONCLUSIONS: As regards the comparison between objective and subjective density values, the HRCT-based visual density values are satisfactory. On the other hand, the best assessment can be performed with the use of mean density values on expiration. DLCO, FEV1, and FEV1/FVC were found to be valuable parameters in determining parenchymal changes.

Effectiveness of Computed Tomography Guided Percutaneous Radiofrequency Ablation Therapy for Osteoid Osteoma: Initial Results and Review of the Literature.

BACKGROUND: The aim of this retrospective study is to determine our experience of technique success rate, complications and clinical results in long term follow up for computed tomography (CT)-guided radiofrequency ablation [RA] therapy for osteoid osteoma (OO). MATERIAL/METHODS: We performed RA therapy to 18 patients with OO referred to interventional radiology from other clinics primarily from orthopedics; between January 2011 to May 2014. Daytime and nighttime pain intensity of 18 patients was noted according to visual analog scale (VAS). After procedure pain intensity was compared with before one. We also discussed other factors can affect it. RESULTS: All procedures were completed technically successful for all patients [100%]. We did not experience any major complication or mortality. However we had 3 minor complications. Pain came back in 1 patient after 5 months from procedure and it was considered as recurrence. Dramatic pain intensity fall was seen in patients after procedure, both daytime and nighttime. However we did not find and statistically significant change in comparison of pain intensity reduce and time needed to return back to routine life when using patients demographic data and lesion size. CONCLUSIONS: CT guided RA therapy of OO is minimally invasive, effective and secure procedure.

Evalution of Renal Involvement in Patients with Behçet Disease: Need to be Aware About Potential Hypertension in Long Term Follow Up?

BACKROUND: The aim of this study was to evaluate frequency and severity of kidney involvement with some clinical, ultrasonography and color Doppler measurements in patients with Behçet disease. MATERIAL/METHODS: This study was including 32 patients with Behçet disease and 32 healthy sex and age-matched control subjects. Patients were divided into two groups as period of disease 0-6 years and 7 years and above to evaluate effect of duration of disease. We evaluated some biochemical tests in both blood and urine related to renal functions, blood pressure values. Gray scale and color Doppler findings were noted. RESULTS: Renal artery volume flow in patients with a duration of 7 years or above was significantly decreased compared to control group (p<0.05). However, gray scale ultrasound and color Doppler measurements reveal there was not statistically significant change compared to control group. There was no biochemical abnormalities in any patient. Four patients had elevated blood pressure but mean blood pressure values were not statistically different compared to volunteers. CONCLUSIONS: Renal involvement ratios varies in different studies but not common. End stage renal failure can be seen very rare. Furthermore, vasculitic changes can lead renal artery narrowness and can result to decrease in renal blood flow. It has a potential to activate renin angiotensin aldosterone cascade to elevate blood pressure. We must be aware about blood pressure of patients with Behçet disease, especially with long term follow up.

Potential causes for obtaining non-diagnostic results from fine needle aspiration biopsy of thyroid nodules.

PURPOSE: The aim of this prospective study was to evaluate factors that could affect the diagnostic result success ratio of fine needle aspiration biopsy of thyroid nodules. MATERIALS AND METHODS: 664 patients and 696 nodules were included in this study. Demographic features of age and gender and nodule features of macrocalcification (MC) and internal content (cystic or solid predominance) were evaluated. All biopsies were performed from 1 cm or larger nodules. Three different size needles were used for comparison (22, 23 and 25 G). The patients in each group had a similar number of nodules with MC, and cystic predominance to obtain comparable results. All procedures were performed by the same radiologist, who had 4 years of experience. Histologically adequate material criteria were identified. All pathological specimens were evaluated as diagnostic or non-diagnostic by the same pathology technician. Chi-square, student's t test and univariate analysis were used for statistical analysis. RESULTS: There were no statistically significant differences in demographic features and nodule properties from diagnostic results of fine needle aspiration biopsy of thyroid nodules. On the other hand, 23 G needles offered a better potential for obtaining adequate samples with a statistically significant difference. CONCLUSION: Obtaining adequate material in fine needle aspiration biopsy from thyroid nodules is a challenging issue and the results are controversial. Since we obtained the best ratio with 23 G needles, we recommend interventional radiologists to use 23 G needles as far as possible and not to consider needles thicker needles than 22 G or thinner than 25 G. Nodule features and demographic features did not have an effect on obtaining adequate cytological material.

Diffusion-weighted magnetic resonance imaging of femoral head osteonecrosis in two groups of patients: Legg-Perthes-Calve and Avascular necrosis.

INTRODUCTION: The aim of this prospective study was to evaluate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with osteonecrosis. Patients were divided into two subgroups as avascular necrosis (AVN) of femoral head for adult group and Legg-Calvé-Perthes (LCP) patients for children. PATIENTS AND METHODS: Seventeen patients with femoral head AVN (mean age 42.3 years) and 17 patients with LCP (mean age 8.2 years) were included in this study. Diagnosis confirmed with clinical and other imaging procedures among the patients complaining hip pain. DW images were obtained using the single-shot echo planar sequence and had b values of 0, 500, 1000 s/mm(2). The apparent diffusion coefficient (ADC) values were measured from ADC maps in epiphysis of patients with AVN, both from metaphysis and epiphysis in patients with LCP, respectively. Mann-Whitney U test was used to compare ADC values. RESULTS: The mean ADC value of femoral heads (1.285 ± 0.204 × 10(-3) mm(2)/s) was increased in patients with AVN when compared to normal bone tissue (0.209 ± 0.214 × 10(-3) mm(2)/s) (p < 0.01). The mean ADC values (×10(-3) mm(2)/s) of both metaphysis (0.852 ± 0.293) and epiphysis (0.843 ± 0.332) were also increased in patients with LCP and differences were statistically significant (p < 0.01). CONCLUSIONS: As a result, osteonecrosis shows increased ADC values. But it is a controversial concept that DWI offers a valuable data to conventional MRI or not. However, as there are report states, there is a correlation between the stage of the disease with ADC values in the LCP disease. DWI is a fast, without-contrast administration technique and provides quantitative values additional to conventional MR techniques; we believe DWI may play an additional assistance to the diagnosis and treatment for LCP patients. Multicentric larger group studies may provide additional data to this issue.

A prospective study on the utility of diffusion-weighted and quantitative chemical-shift magnetic resonance imaging in the distinction of adrenal adenomas and metastases.

OBJECTIVE: The purpose of this study was to assess the utility of diffusion-weighted and quantitative chemical-shift magnetic resonance imaging in the differentiation of adrenal adenomas and metastases. METHODS: One hundred eight patients (45 men and 63 women; mean age, 57 years) with 126 adrenal masses were prospectively evaluated by magnetic resonance imaging in this study. Signal intensity and apparent diffusion coefficient (ADC) measurements were performed on axial in- and opposed-phase T1-weighted gradient-echo images and on diffusion-weighted images, respectively. Adrenal signal intensity index (ASII), adrenal-to-spleen chemical-shift ratio (ASR), and ADC values were assessed separately. The threshold values of more than 16.5% for ASII and less than 0.71 for ASR were regarded as highly suggestive of adenoma diagnosis. We also investigated whether a cutoff value for ADC could be found in distinguishing adenomas from metastases. Final diagnoses of adrenal lesions were based on follow-up imaging, histopathologic proof, and adrenal washout study. Apparent diffusion coefficient values of adenomas and metastases were compared by using the Student t test, and ASII and ASR values of the lesions were compared by using the Mann-Whitney U test, and a P < 0.05 was accepted as statistically significant. Receiver operating characteristic curve analysis and sensitivity, specificity, positive and negative predictive values, and overall accuracies were calculated. RESULTS: Final analysis yielded 96 adenomas and 30 metastases. With the commonly used 16.5% threshold value for ASII, we obtained a 94.8% sensitivity, 93.3% specificity, 84.8% positive predictive value, and 97.8% negative predictive value. The overall accuracy was found as 94.4%. When we applied a 0.71 threshold value for ASR, it yielded a 91.7% sensitivity, 100% specificity, 78.9% positive predictive value, and a 100% negative predictive value. The overall accuracy was 93.6%. The mean ADC values were found to be 1.35 ± 0.19 × 10⁻³ mm²/s and 1.32 ± 0.34 × 10⁻³ mm²/s for adenomas and metastases, respectively. The difference between the groups with these ADC values was not statistically significant (P = 0.673). The receiver operating characteristic analysis could not determine a clear cutoff value for the differentiation of adenomas from metastases. CONCLUSIONS: We can advocate that a chemical-shift magnetic resonance imaging using quantitative parameters (ie, ASII and ASR formulas) has an important role in the distinction of adenomas from metastases. These 2 techniques seem to provide close sensitivity, specificity, and accuracy levels. But diffusion-weighted imaging using quantitative ADC measurements is not of value in this differential diagnosis because of the substantial overlapping of ADC values between adenomas and metastases.