Detecting Amyloid Goiter With 99mTc-PYP SPECT/CT in the Setting of Ankylosing Spondylitis: An Uncommon Involvement of AA Amyloidosis.

ABSTRACT: We present a case with systemic amyloidosis secondary to ankylosing spondylitis (AA amyloidosis), whose 99mTc PYP scintigraphy revealed amyloid deposition in the thyroid gland (amyloid goiter). Amyloidosis is characterized by extracellular accumulation of amyloid fibril proteins leading to organ malfunction. Even though AA amyloidosis can be observed in patients with systemic inflammatory diseases, it is a very rare complication in ankylosing spondylitis. SPECT/CT images showed diffuse tracer uptake in enlarged thyroid gland containing fat density areas.

Comparison of Fibroscan, Shear Wave Elastography, and Shear Wave Dispersion Measurements in Evaluating Fibrosis and Necroinflammation in Patients Who Underwent Liver Biopsy.

OBJECTIVE: Our aim was to predict these stages of hepatic fibrosis and necroinflammation using measurements from two-dimensional shear wave elastography (2D-SWE), transient elastography (Fibroscan, TE), and shear wave dispersion (SWD). MATERIALS AND METHODS: In this prospectively designed study, chronic liver patients with nonspecific etiology whose biopsy was performed for up to 1 week were included. Two-dimensional SWE, SWD, and TE measurements were performed. The METAVIR and F-ISHAK classification was used for histopathological evaluation. RESULTS: Two-dimensional SWE and TE were considered significant for detecting hepatic fibrosis. In distinguishing ≥F2, for 2D-SWE, area under the receiver operating characteristics (AUROC) was 0.86 (confidence interval [CI], 0.75-0.96) for the cutoff value of 8.05 kPa ( P = 0.003); for TE, AUROC was 0.79 (CI, 0.65-0.94) for the cutoff value of 10.4 kPa ( P < 0.001). No significance was found for TE in distinguishing ≥F3 ( P = 0.132). However, for 2D-SWE, a cutoff value of 10.45 kPa ( P < 0.001), with AUROC = 0.87 (CI, 0.78-0.97) was determined for ≥F3. Shear wave dispersion was able to determine the presence of necroinflammation ( P = 0.016) and a cutoff value of 15.25 (meter/second)/kiloHertz ([m/s]/kHz) ( P = 0.006) and AUROC of 0.71 (CI, 0.57-0.85) were calculated for distinguishing ≥A2. In addition, a cutoff value of 17.25 (m/s)/kHz ( P = 0.023) and AUROC = 0.72 (CI, 0.51-0.93) were found to detect severe necroinflammation. The cutoff value for SWD was 15.25 (m/s)/kHz ( P = 0.013) for detecting ≥A2 in the reversible stage of fibrosis (F0, F1, and F2), and AUROC = 0.72 (CI, 0.56-0.88). CONCLUSIONS: Two-dimensional SWE and TE measurements were significant in detecting the irreversible stage and the stage that should be treated in hepatic fibrosis noninvasively. Shear wave dispersion measurements were significant in detecting necroinflammation noninvasively.

ChatGPT-assisted deep learning model for thyroid nodule analysis: beyond artifical intelligence.

AIMS: To develop a deep learning model, with the aid of ChatGPT, for thyroid nodules, utilizing ultrasound images. The cytopathology of the fine needle aspiration biopsy (FNAB) serves as the baseline. MATERIAL AND METHODS: After securing IRB approval, a retrospective study was conducted, analyzing thyroid ultrasound images and FNAB results from 1,061 patients between January 2017 and January 2022. Detailed examinations of their demographic profiles, imaging characteristics, and cytological features were conducted. The images were used for training a deep learning model to identify various thyroid pathologies. ChatGPT assisted in developing this model by aiding in code writing, preprocessing, model optimization, and troubleshooting. RESULTS: The model demonstrated an accuracy of 0.81 on the testing set, within a 95% confidence interval of 0.76 to 0.87. It presented remarkable results across thyroid subgroups, particularly in the benign category, with high precision (0.78) and recall (0.96), yielding a balanced F1-score of 0.86. The malignant category also displayed high precision (0.82) and recall (0.92), with an F1-score of 0.87. CONCLUSIONS: The study demonstrates the potential of artificial intelligence, particularly ChatGPT, in aiding the creation of robust deep learning models for medical image analysis.

State-of-the-art Prostate Imaging.

Prostate cancer is one of the most common cancers in men. In addition to methods such as prostate-specific antigen test, digital rectal examination, and transrectal ultrasonography, magnetic resonance imaging has an important role for accurate and reproducible diagnosis. However, guidance in targeted biopsies and recent use in determining localization for treatment increase its importance. Due to technical difficulties, patient tolerance, and differences in interpretation, the prostate imaging reporting and data system recommends preparations for the patient and magnetic resonance imaging techniques. However, techniques continue to be developed to improve the diagnosis rate and image quality. In our article, patient preparation before imaging and techniques were tried to be discussed in detail. In addition, current approaches in biparametric magnetic resonance imaging and radiomics and new techniques such as T1 and T2 mapping will be mentioned.

The Evaluation of Adropin and Autotaxin as Potential Markers of Endothelial Dysfunction in Preeclampsia.

Endothelial dysfunction (ED) plays a prominent role in the pathogenesis of preeclampsia (PE). There is a need for non-invasive methods to assess endothelial function in preeclamptic patients. In the present study, adropin, autotaxin (ATX), and lysophosphatidic acid (LPA) were evaluated as indicators of ED. Patients diagnosed with PE and healthy pregnant women (n = 42 for each group) were compared. After measuring flow-mediated dilation (FMD), the participants were stratified as ED (+) or ED (-) based on a cut-off value of 6.5%. The PE patients were divided as early/late onset PE and severe/mild PE. Adropin, ATX, and LPA levels were measured, and their relevance to ED was evaluated. Student t, Mann-Whitney U, or ANOVA tests were used for statistics, as appropriate. Adropin levels were diminished in the ED (+) group, whereas ATX and LPA levels were increased. The decrease in adropin levels was more pronounced in severe PE, showing a positive correlation with the FMD. In the logistic regression model, adropin was the only parameter that was an independent variable for the FMD test (P < .001). Adropin measurements in serum may be of value for disease follow-up in patients with PE.

Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study.

BACKGROUND: Obesity and fatty-liver disease are increasingly common in children. Hepatic steatosis is becoming the most common cause of chronic liver disease during childhood. There is a need for noninvasive imaging methods that are easily accessible, safe and do not require sedation in the diagnosis and follow-up of the disease. OBJECTIVE: In this study, the diagnostic role of ultrasound attenuation imaging (ATI) in the detection and staging of fatty liver in the pediatric age group was investigated using the magnetic resonance imaging (MRI)-proton density fat fraction as the reference. MATERIALS AND METHODS: A total of 140 children with both ATI and MRI constituted the study group. Fatty liver was classified as mild (S1, defined as ≥ 5% steatosis), moderate (S2, defined as ≥ 10% steatosis), or severe (S3, defined as ≥ 20% steatosis) according to MRI-proton density fat fraction values. MRI studies were performed on the same 1.5-tesla (T) MR device without sedation and contrast agent. Ultrasound examinations were performed independently by two radiology residents blinded to the MRI data. RESULTS: While no steatosis was detected in half of the cases, S1 steatosis was found in 31 patients (22.1%), S2 in 29 patients (20.7%) and S3 in 10 patients (7.1%). A strong correlation was found between attenuation coefficient and MRI-proton density fat fraction values (r = 0.88, 95% CI 0.84-0.92; P < 0.001). The area under the receiver operating characteristic curve values of ATI were calculated as 0.944 for S > 0, 0.976 for S > 1 and 0.970 for S > 2, based on 0.65, 0.74 and 0.91 dB/cm/MHz cut-off values, respectively. The intraclass correlation coefficient values for the inter-observer agreement and test-retest reproducibility were calculated as 0.90 and 0.91, respectively. CONCLUSION: Ultrasound attenuation imaging is a promising noninvasive method for the quantitative evaluation of fatty liver disease.

Ultrasound phantom with solids mimicking cancerous tissue for needle breast biopsy.

This study aimed at synthesizing hydrogels to simulate opaque breast tissue (BT) and coloured cancerous tissues (CT) at different densities of the designed phantom to improve the biopsy-related skills along with ultrasonography. Both tissues are tear-resistant and therefore, the phantom can be trained multiple times in order to lower the price and improve the eye-hand coordination of users. For this purpose, self-healing (SH) polyacrylamide (PAAm) hydrogels (SH hydrogel) obtained by free-radical polymerization of AAm, in the presence of chemical cross-linker, BAAm, physical cross-linker stearyl methacrylate, C18, and ammonium persulfate APS as initiator were used in the design of phantoms. Psyllium was added to the BT to differentiate density and obtain human skin color and it could be distinguished from the CT which was also colored with methyl violet. BT and CTs were characterized with FTIR spectroscopy, mechanical, swelling, and refractive index measurements. Designing phantoms from BT and CT were characterized by ultrasonography, mechanical tests, observation of needle track after biopsy, and stabilization tests to follow the self-healing behaviours of tissues with time. As a result of this study, self-healing, low-cost, and suitable for multi-usage ultrasonographic phantom for needle breast biopsy was designed and cancerous tissue was successfully detected.

The risk of endothelial and erectile dysfunctions in Behçet's disease: a comparative analysis of mucocutaneous and systemic patient groups.

INTRODUCTION: Behçet's disease (BD) is a chronic inflammatory disease which can be limited to only mucocutaneous tissues or can affect different systems of the body. AIM: To investigate the association of endothelial and erectile dysfunctions with BD, on the basis of comparative analysis between mucocutaneous and systemic BD. MATERIAL AND METHODS: Thirty-eight men diagnosed with BD were included in the present study. The patients were stratified into two groups as mucocutaneous BD (n = 20, MBD group), and systemic BD (n = 18, SBD group). Erectile dysfunction (ED) was assessed using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. The coronary flow reserve (CFR) assessment was done for analysing endothelial dysfunction (EnD), and CFR < 2 was defined as EnD. Penile Doppler ultrasonography (PDU) was performed for ED. The demographic and clinical parameters, IIEF-EF score ED classification, CFR and PDU test findings were compared between two groups. RESULTS: The median age was 34 (22-52) years in the overall population, and there was no difference between two groups (p = 0.558). Time from diagnosis was significantly longer (24 vs. 102 months, p = 0.021) and the use of immunosuppressive therapies was higher (0 vs. 70.6%, p < 0.001) in the SBD group. In overall, median CFR was 1.92 (1.1-5.96), and there was no difference between two groups (1.88 vs. 1.97, p = 0.812). The percentage of patients with CFR < 2 was similar in two groups (52.6% vs. 52.9%, p = 0.985). The ED status according to IIEF-EF was similar in two groups (45% vs. 27.8%, p = 0.538) as well as according to PDU analyses (10% vs. 16.7%, p = 0.544). CONCLUSIONS: The increased risk of endothelial, and erectile dysfunctions should be considered in men who were diagnosed with mucocutaneous and systemic BD.

Complementary Roles of Cadaveric and Living Donor Liver Transplantation in Acute Liver Failure.

BACKGROUND: Living donor liver transplantation may complement cadaveric transplantation in acute liver failure (ALF) patients. METHODS: Between 2008 and 2017, 89 patients were treated for ALF; 15 patients (17%) recovered with intensive care treatment; 31 (35%) died without transplant. The records of the remaining 43 patients (median (range) age: 14 (1-62)) who underwent transplantation were evaluated. RESULTS: The etiologic factors were toxic agents (10; mushrooms: 8; herbs: 2), hepatitis viruses (7; A: 1; B: 6), Wilson's disease (7), autoimmune hepatitis (4), and Budd-Chiari syndrome (2); 13 cases were idiopathic. Cadaveric organs (whole, split, reduced) were transplanted to 32 patients; 11 patients underwent living donor transplantation. One patient (2%) died of septic shock on the second postoperative day. Bacterial infection was the most common early (< 3 months) complication in the remaining patients (31/42; 74%), followed by delirium (5/42; 12%) and acute rejection requiring steroid pulse (5/42; 12%). Seven other patients died during median (range) follow-up of 94 (14-142) months: various infections (5), leukemia (1), and acute myocardial infarction (1). The 1-, 5-, and 10-year survival rates were 100%, 96%, and 92% in children and 94%, 82%, and 65% in adults respectively. CONCLUSIONS: Cadaveric organ sharing and transplantation from living donors when appropriate yield a high survival rate, despite high early morbidity, in ALF patients whose conditions deteriorate despite intensive care treatment. Efforts to eliminate preventable causes of acute liver failure will lead to more efficient use of health care resources.

The role of multislice computerized tomography angiography in assessing postoperative vascular complications in liver transplant patients

Background/aim: Vascular complications can be detected in liver transplant patients. Digital subtraction angiography has served as the gold standard to make this diagnosis; however, due to its invasive nature, ultrasonography is used for the preliminary evaluation. The purpose of this study was to evaluate the role of multislice computerized tomography angiography (MSCTA) in the detection of vascular complications of symptomatic and asymptomatic liver transplant patients and to compare the results with Doppler ultrasound (Doppler US) findings. Materials and methods: Fifty-three liver transplant patients (6 symptomatic, 47 asymptomatic) underwent Doppler US examination followed by an MSCTA. The findings in each modality were interpreted in a blinded fashion and then compared. Results: MSCTA detected 15 abnormalities, none of which were detected by Doppler US. There were hepatic and splenic artery aneu-rysms (n = 4) and various stenoses (n = 4), infrarenal aortic anastomosis (n = 4), vena cava inferior thrombosis (n = 1), arteriovenous malformation (n = 1), and esophageal varices (n = 1). Conclusion: MSCTA detected more lesions and we believe that it should be considered as a road map for Doppler US follow-ups as well as a routine screening modality for early detection of vascular complications in symptomatic and asymptomatic liver transplantation patients that may be missed by Doppler US.

Evaluation of the natural course of thyroid nodules in patients with acromegaly.

PURPOSE: To investigate the nodular thyroid disease (NTD) and the natural course of thyroid nodules in patients with acromegaly. METHODS: 138 patients with acromegaly (73 F/65 M), whose initial thyroid ultrasonography performed in our university hospital, were included in this study. The frequencies of NTD, papillary thyroid cancer (PTC) and associated factors on nodule formation were investigated at initial assessment. Patients who had NTD continued to follow-up (n = 56) were re-evaluated with a ultrasonography performed after a mean 7-years follow-up period. The nodule size changes were compared with the initial data and the factors affecting nodule growth were investigated. RESULTS: The frequency of NTD was found 69%. Patients with NTD were older (p = 0.05), with higher baseline IGF-1%ULN (upper limit of normal) (p = 0.01). In patients with NTD, the majority had similar nodule size (45%), decreased nodule size in 30% and nodule growth in 25%. In patients with active acromegaly at last visit, nodule growth was more significant (p < 0.001). For one unit change in the IGF-1 levels, nodule growth increased by 1.01 folds and presence of active acromegaly disease was related with ninefolds increase in nodule growth. The frequency of PTC was 14% in patients with nodule growth and PTC was diagnosed 11% of all acromegalic patients. CONCLUSION: Both NTD and nodule growth is more frequent in active acromegalic patients. Thyroid nodules may show dynamic changes according to the disease activity and nodule growth should be closely monitored due to the risk of malignancy in patients with active acromegaly disease.

Utilidad de la resonancia magnética ponderada por difusión cervical en la detección del cáncer tiroideo / Diffusion-weighted magnetic resonance imaging for the detection of thyroid cancer

INTRODUCCIÓN: La enfermedad tiroidea nodular posee el potencial de desarrollar malignidad. El objetivo es evaluar la importancia de la resonancia magnética ponderada por difusión cervical (IRM-DP) para la detección de nódulos tiroideos malignos. MÉTODO: El grupo de estudio lo constituyen los pacientes intervenidos por enfermedad tiroidea, en los que preoperatoriamente se les realizó 3 métodos diagnósticos: biopsia guiada por PAAF, US e IRM-DP. El grupo de estudio total se dividió en 2 subgrupos, de acuerdo con la evaluación postoperatoria patológica final de los nódulos en 2 grupos: "grupo benigno" y "grupo de malignidad". Se evaluaron 65 nódulos tiroideos operados, en 58 pacientes. Los parámetros preoperatorios, (datos demográficos, los hallazgos ecográficos, los resultados de la biopsia por aspiración con aguja fina y los valores del coeficiente de difusión aparente (CDA) de los nódulos en IRM-DP), se compararon con los resultados de los exámenes patológicos postoperatorios. RESULTADOS: El "grupo benigno" lo constituyen 50 (76,9%) nódulos, mientras que 15 (23,1%) nódulos constituyeron el «grupo de malignidad». Los valores mínimos, máximos y medios de CDA de los nódulos fueron significativamente más bajos en el grupo con malignidad (p <0,05). El mejor valor de corte para el valor medio de CDA fue 1,33 × 10-3 mm2/s, con una sensibilidad del 66,67%, una especificidad del 89,13%, un valor predictivo positivo del 53,63% y un valor predictivo negativo del 89,13%. Un valor medio de CDA igual o inferior a 1,33 × 10-3 mm2/s se asoció a un riesgo 9 veces mayor de malignidad (p < 0,01, odds ratio: 9,111, intervalo de confianza del 95%: 2,49-33,21). CONCLUSIONES: El valor de CDA detectado en IRM-DP cervical puede considerarse como un parámetro predictivo para la detección de cáncer de tiroides

BACKGROUND: Nodular thyroid disease possesses the potential to harbor malignancy. Our aim was to evaluate the significance of cervical diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of malignant thyroid nodules. METHODS: Sixty-five thyroid nodules from 58 patients who had undergone surgery were evaluated. Preoperative parameters, demographic data, ultrasound findings, fine-needle aspiration biopsy results and apparent diffusion coefficient (ADC) values of the nodules at DW-MRI were compared with the results from postoperative pathology examinations. RESULTS: The "benign group" included 50 (76.9%) nodules, while 15 (23.1%) nodules constituted the "malignancy group". Minimum, maximum and mean ADC values of the nodules were significantly lower in the malignancy group (p < 0.05). The best cutoff value for the mean ADC value was 1.33 × 10-3 mm2/s, with a sensitivity of 66.67%, a specifity of 89.13%, a positive predictive value of 53.63% and a negative predictive value of 89.13%. A mean ADC value equal to or lower than 1.33 × 10-3 mm2/s was associated with 9 times higher risk of malignancy (odds ratio: 9.111, 95% confidence interval: 2.49-33.21). CONCLUSIONS: The ADC value detected by cervical DW-MRI can be considered a predictive parameter for the detection of thyroid cancer

Diffusion-weighted magnetic resonance imaging for the detection of thyroid cancer. / Utilidad de la resonancia magnética ponderada por difusión cervical en la detección del cáncer tiroideo.

BACKGROUND: Nodular thyroid disease possesses the potential to harbor malignancy. Our aim was to evaluate the significance of cervical diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of malignant thyroid nodules. METHODS: Sixty-five thyroid nodules from 58 patients who had undergone surgery were evaluated. Preoperative parameters, demographic data, ultrasound findings, fine-needle aspiration biopsy results and apparent diffusion coefficient (ADC) values of the nodules at DW-MRI were compared with the results from postoperative pathology examinations. RESULTS: The "benign group" included 50 (76.9%) nodules, while 15 (23.1%) nodules constituted the "malignancy group". Minimum, maximum and mean ADC values of the nodules were significantly lower in the malignancy group (p < 0.05). The best cutoff value for the mean ADC value was 1.33 × 10-3 mm2/s, with a sensitivity of 66.67%, a specifity of 89.13%, a positive predictive value of 53.63% and a negative predictive value of 89.13%. A mean ADC value equal to or lower than 1.33 × 10-3 mm2/s was associated with 9 times higher risk of malignancy (odds ratio: 9.111, 95% confidence interval: 2.49-33.21). CONCLUSIONS: The ADC value detected by cervical DW-MRI can be considered a predictive parameter for the detection of thyroid cancer.

The usefulness of agent emission imaging - high mechanical index ultrasound mode in the diagnosis of urolithiasis: a prospective preliminary study.

PURPOSE: We aimed to determine the feasibility and effectiveness of agent emission imaging - high mechanical index (AEI-High MI) mode ultrasonography (US) compared with gray-scale and color Doppler US, alone or in combination, for the diagnosis of urolithiasis with reference to unenhanced computed tomography (CT). METHODS: This prospective study included 72 consecutive patients (40 males, 32 females; mean age, 45.9±14.7 years) referred by the department of urology for acute or elective symptoms of urolithiasis and confirmed to have urinary calculi on unenhanced abdominal CT, between January 2015 and June 2015. Gray-scale, color Doppler, and AEI-High MI US were performed by two radiologists to determine the effectiveness of these methods in the diagnosis of urinary stones and to compare them with the reference modality. RESULTS: A total of 189 calculi were detected on CT examination. Gray-scale US had a sensitivity of 66.1% and positive predictive value (PPV) of 88.7% for detecting calculi, while twinkling artifact of color Doppler had a sensitivity of 70.4% and PPV of 94.3%. The scintillation artifact of AEI-High MI mode had a sensitivity of 75.1% and PPV of 95.9%. When all ultrasound-based modalities were combined, the sensitivity and PPV rose to 83.1% and 88.2%, respectively. When calculi were grouped according to their size ( < 5 mm, 5-10 mm, > 10 mm), AEI-High MI mode had a higher sensitivity (60%) compared with gray-scale (32.5%) and color Doppler (41.3%) for calculi < 5 mm. CONCLUSION: AEI-High MI mode had a higher sensitivity compared with gray-scale and color Doppler for the detection of calculi smaller than 5 mm, but it did not make a significant contribution to detection of larger calculi. The combined use of gray-scale US with AEI-High MI mode could increase the detection rate of calculi smaller than 5 mm and provide a method for verification of suspected calculi on gray-scale US.

Stromal fibrosis: imaging features with diagnostic contribution of diffusion-weighted MRI.

OBJECTIVE: To describe magnetic resonance imaging (MRI) and ultrasonography findings of breast stromal fibrosis (SF) and compare apparent diffusion coefficient (ADC) stromal fibrosis values with breast cancer and normal parenchyma. METHODS: 45 patients (ages 22‒74) with histopathologically proven SF who underwent MRI were included in this study. Their MRI and ultrasonography features were examined and categorized. The mean ADC values for SF, contralateral normal parenchyma, and breast malignancy of the control group values were calculated and compared among each other. RESULTS: The vast majority of SF on sonography showed features suggestive of malignancy: (1) irregular in shape 25/45 (55%); (2) indistinct in margin 27/45 (60%); and (3) hypoechoic 39/45 (87%) with posterior acoustic shadowing 11/45 (24%). An SF MRI showed a mass in 12/45 (26%) and non-mass enhancement in 33/45 (74%), mostly with irregular (8/12; 67%) shape. Non-mass lesions showed heterogeneous (12/33), clumped (9/33), and homogenous (9/33) enhancement. The initial SF contrast uptake rate varied between slow (57%), rapid (22%), and medium (21%). Delayed SF enhancement may be persistent (66%) or plateau (34%). Small cysts were located around/near 21 (47%) of lesions. Ductal ectasia was found in 14 (31%) of all patients. Mean ADCs of parenchyma, SF, and malignancy were 1.32 ± 0.32, 1.23 ± 0.25, and 0.99 ± 0.24 × 10-3 mm2 sec-1, respectively. CONCLUSION: SF often mimics breast carcinoma on imaging and leads the radiology‒pathology disagreement. In terms of distinguishing SF from malignancy, ADC could be a significant and promising value in diffusion-weighted MRI along with conventional sequences. Slow initial uptake with delayed persistent contrast enhancement in a non-mass lesion with relatively higher ADC values are very helpful for differentiating SF from malignancy. The presence of small cysts and ductal ectasia were common findings around/near the SF. Advances in knowledge: A quantitative analysis for measuring ADC values along with additional MRI features can be very helpful in distinguishing SF from malignant lesions.

MR Imaging Features of Tubular Carcinoma: Preliminary Experience in Twelve Masses.

OBJECTIVE: We retrospectively analyzed the magnetic resonance (MR) imaging features and diffusion-weighted imaging findings of the 12 masses of 10 patients with tubular carcinoma (TC), including mammography and sonography findings. MATERIALS AND METHODS: Mammographic, sonographic and magnetic resonance imaging features in 12 histopathologically confirmed masses diagnosed as TC of the breast within 10 patients were evaluated. Morphologic characteristics, enhancement features, apparent diffusion coefficient (ADC) values were reviewed. RESULTS: On mammography (n=5), TC appeared as high density masses with indistinct, spiculated or obscured margins. Sonographically, TC appeared as a hypoechoic appearance (n=12) with posterior acoustic shadowing in nine. On MR imaging, the margins of ten of twelve masses were irregular. Internal enhancement patterns were heterogeneous in 10 patients. Dynamic enhancement patterns illustrated plateau kinetics (n=8). On the T2-weighted images 4 masses were hypointense, and 8 were hyperintense; hypointense internal septation was found in seven of these. Tubular carcinoma appeared as hyperintense on diffusion-weighted imaging with ADC values of 0.85±0.16×10-3 mm2/s that was lower than the normal parenchyma of 1.25±0.25×10-3 mm2/s. CONCLUSION: According to our study with a limited number of cases, tubular carcinomas can be described as hyperintense breast carcinomas with or without dark internal septation like appearance on T2-weighted images. Low ADC values from DW imaging can be used to differentiate TC from hyperintense benign breast lesions.

The Value of Preoperative Volumetric Analysis by Computerised Tomography of Retrosternal Goiter to Predict the Need for an Extra-Cervical Approach.

BACKGROUND: A thyroidectomy can be performed via a cervical incision in most patients with retrosternal goiter. AIMS: To investigate the correlation between the volume of the mediastinal portion of the thyroid gland and the need for an extra-cervical approach for retrosternal goiter. STUDY DESIGN: Diagnostic accuracy study. METHODS: The measurement of craniocaudal length and the volume of the mediastinal component of the thyroid gland on computerised tomography images was performed in 47 patients with retrosternal goiter. Of these 47 patients, 8 (17%) required an extra-cervical approach and were classified as group 1, and 39 (83%) patients that required a cervical incision were classified as group 2. Receiver operating characteristic analysis was performed to determine the cut-off value for the craniocaudal length and the volume of the mediastinal thyroid mass, which significantly correlated with an extra-cervical approach for retrosternal goiter. RESULTS: Reoperative surgery was significantly more frequent in group 1 than in group 2 (50% vs 13%; p=0.03). The craniocaudal length of the mediastinal thyroid gland was significantly longer in group 1 than in group 2 (77±11 mm vs 31±21 mm, respectively; p=0.0001). The volume of the mediastinal component was significantly larger in group 1 compared to group 2 (264±106 cm3 vs 40±41 cm3, respectively; p=0.0001). The receiver operating characteristic curve of craniocaudal length and the volume of the mediastinal component identified ≥66 mm and ≥162 cm3 as the cut-off values with the maximum accuracy, respectively. The craniocaudal length of the thyroid mass below the thoracic inlet ≥66 mm or a volume of the mediastinal portion ≥162 cm3 were significantly associated with an extra-cervical approach (p=0.0001). For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off value for craniocaudal length was 87.5%, 64% and 97%, respectively. For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off values for the mediastinal volume were 100%, 89% and 100%, respectively. CONCLUSION: A thyroid volume of ≥162 cm3 extending below the thoracic inlet was a significant determining factor for an extra-cervical approach, with a negative predictive value for the extra-cervical approach of 100% for retrosternal goiter with smaller volumes. Further studies with an increased number of patients are needed to determine the value of volumetric analysis of retrosternal goiter to predict the need for an extra-cervical approach in retrosternal goiter.

Hypovitaminosis D is Associated with Endothelial Dysfunction in Patients with Metabolic Syndrome.

OBJECTIVES: Recent research has shown that hypovitaminosis D may increase the risk of hypertension, vascular disease, diabetes mellitus, obesity and Metabolic Syndrome (MetS). Endothelial Dysfunction (ED) is one of the key components of MetS which is associated with an imbalance between vasoactive substances such as Nitric Oxide (NO) and Endothelins (ET). In this study, we assessed the association of 25(OH) D3 level with endothelial dysfunction and subclinical atherosclerosis in MetS patients. DESIGN AND METHODS: 105 MetS patients and 48 controls were included. 25(OH) D3 levels were measured using Ultra-High Performance Liquid Chromatography (UHPLC). NOx (NO2 plus NO3) and Endothelin- 1(ET-1) concentrations were determined along with routine biochemical tests. Flow-Mediated Dilatation (FMD) and carotid Intima-Media Thickness (cIMT) were measured by ultrasonography. RESULTS: In MetS patients, vitamin D and NOx levels were significantly lower (p<0.001), while ET-1 levels were higher than controls (p<0.005). MetS patients with ED exhibited significantly lower vitamin D levels than their counterparts free of ED. Vitamin D levels were correlated positively with FMD and NOx, and negatively with systolic blood pressure and body mass index. Subclinical atherosclerosis as assessed by the cIMT did not associate with low vitamin D levels. CONCLUSION: Vitamin D deficiency seen in MetS patients is more prominent in the presence of ED. Hypovitaminosis D may affect endothelial cells, and participate in the development of hypertension.