Efficacy of diffusion-weighted MRI in the differentiation of all liver hydatid cyst types.

INTRODUCTION: The aim of this study was to evaluate the efficacy of diffusion-weighted images (DWIs) in the differentiation of hydatid cysts (HCs) of the liver. METHODS: In this prospective study, 54 patients with 92 HC lesions were evaluated. The mean apparent diffusion coefficient (ADC) values of each lesion were calculated using the ADC maps derived from the DWIs at b-values of 50, 500 and 1000 s/mm(2). We compared the mean ADC values of the different HC types, which had already been classified using the sonographic criteria. A receiver operator curve (ROC) analysis was used for determining the diagnostic performance of the ADC values of the HC types. RESULTS: When the mean ADC values of each type of HC were compared using each of the b-values, no statistically significant differences were obtained between (cystic echinococcosis) CE1 and CE2 or CE3, CE2 and CE3, CE3 and CE4, or CE4 and CE5. In addition, the mean ADC values of CE1 and CE2 were significantly higher than those of CE4 and CE5. For discrimination between types CE1, CE2 and CE3, and types CE4 and CE5, the sensitivity and specificity values were, respectively, 75.9 and 89.5 for the b50 DWI, 87.0 and 86.8 for the b500 DWI, and 75.9 and 89.5 for the b1000 DWI in the ROC analysis. CONCLUSION: Diffusion-weighted imaging may be useful for providing additional data to determine the type of HC, and for differentiating types CE1, CE2 and CE3 from types CE4 and CE5.

Diffusion Weighted Magnetic Resonance Imaging for the Characterization of Solitary Pulmonary Lesions.

BACKGROUND: We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging. AIMS: To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pulmonary lesions. STUDY DESIGN: Randomized prospective study. METHODS: This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 malignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm(2)). Apparent diffusion coefficients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the lesions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups. RESULTS: On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm(2). In contrast, on T2 weighted images, it was seen that the distinction of malignant lesions from benign lesions was not statistically significant. The ADCs of the malignant lesions were significantly lower than those of benign lesions (mean ADC was 2.02×10(-3) mm(2)/s for malignant lesions, and 1.195×10(-3)±0.3 mm(2)/s for benign lesions). Setting the cut-off value at 1.5×10(-3), ADC had a sensitivity of 86.7% and a specificity of 88.9% for the differentiation of benign lesions from malignant lesions. CONCLUSION: DWI may aid in the differential diagnosis of solitary pulmonary lesions. (ClinicalTrials.gov Identifier: NCT02482181).

Myocardial infarction as a rare cause of otalgia.

Aim. To present a case referred to our clinic with severe right ear pain but without any abnormal finding during otological examination and diagnosed as myocardial infarction and also to draw attention to otalgia which can occur secondary to myocardial infarction. Case Report. An 87-year-old female admitted with right ear pain lasting for nearly 12 hours and sweating on the head and neck region. On otolaryngologic examination, any pathological finding was not encountered. Her electrocardiogram revealed findings consistent with myocardial infarction. Her troponin values were 0.175 ng/L at 1 hour, and 0.574 ng/L at 3 hours. The patient was diagnosed as non-ST MI, and her required initial therapies were performed. On cardiac angiography, very severe coronary artery stenosis was detected, and surgical treatment was recommended for the patient. The patient who rejected surgical treatment was discharged with prescription of medical treatment. Conclusion. Especially in elderly patients with complaints of ear pain but without any abnormal finding on otoscopic examination, cardiac pathologies should be conceived.