Diffusion-weighted Imaging in the Benign-malignant Differentiation of Endometrial Pathologies; Effectiveness of Visual Evaluation.

OBJECTIVE: To investigate the effectiveness of diffusion-weighted imaging (DWI) in the differentiation of benign and malignant endometrial pathologies by measuring the apparent diffusion coefficient (ADC) values and performing a visual evaluation. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey, from January 2017 to September 2019. METHODOLOGY: The inclusion criteria were women over 45 years of age with availability of the pelvic MRI in the PACS and the presence of pathological diagnosis by endometrial D and C or hysterectomy. Exclusion criteria were patients under 45 years of age, absence of histopathological results, hematoma or intrauterine device in the endometrial cavity, and endometrial thickness less than 5 mm. Quantitative ADC values were measured on ADC maps created automatically based on DWI data. DWI and ADC maps were also evaluated visually to differentiate between benign and malignant pathologies. RESULTS: Endometrial pathology was detected in a total of 88 patients, 36 of which were malignant and 52 benign lesions. The mean ADC values for both observers and the sensitivity and specificity in the differentiation of benign and malignant endometrial lesions were 81% - 75% and 88% - 90%, respectively (p<0.001 for both observers). The visual evaluation of b values and ADC map on DWI was also performed together, and the sensitivity and specificity in the differentiation of benign and malignant endometrial lesions were 81% - 86% and 69% - 56% for both observers, respectively (p <0.001 for both observers). CONCLUSION: ADC measurements are useful in differentiating benign and malignant endometrial pathologies, and visual evaluation of the ADC map and b values in DWI together also provides positive results. KEY WORDS: Diffusion-weighted imaging, Endometrial pathologies, ADC, Visual evaluation.

Radiological Recovery of Osteoid Osteoma after CT Guided Percutaneous Radiofrequency Ablation.

OBJECTIVE: To observe the necessity and usefulness of follow-up Magnetic Resonance Imaging (MRI) and Computed Tomography Imaging (CTI) after RFA of osteoid osteoma. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey, between May 2015 and January 2020. METHODOLOGY: Patients, who underwent CT-guided RFA for osteoid osteoma treatment, were followed-up both clinically and radiologically. MRI was recommended between the third and sixth months and CTI at 12th month or later for follow-up. All the pre and post-treatment radiological images were evaluated retrospectively. Radiological recovery was noted in three categories as complete/almost-complete, partial, and minimal-no recovery according to the healing of pre-treatment radiological findings. RESULTS: One-hundred and thirty-one patients with at least one follow-up CT or MRI were included. All had technically and clinically successful RFA treatments. Of 131 patients, 64.1% had CTI and 82.4% had MRI follow-up. In follow-up images, complete/almost-complete-recovery was observed in 70.2%, partial recovery in 26.7%, and minimal recovery in 3.1% of the cases. Re-ablation therapies were applied in 2 cases in this study due to pain recurrence after three months of successful treatments. CONCLUSION: Radiological follow-up is beneficial for the evaluation of outcome after RFA of osteoid-osteoma. At least one follow-up MRI may be helpful for the assessment of healing or recurrence. Follow-up CTI may not be needed unless planning a re-ablation. KEY WORDS: Osteoma osteoid, Radiofrequency ablation, Tomography, Magnetic resonance imaging.

Topographic evaluation of bithalamic infarcts: Are these due to occlusion of the artery of Percheron?

Occlusion of the artery of Percheron (AoP) causes bithalamic paramedian infarct (BTPI). Although it can be diagnosed easily in its pure form, it can be underdiagnosed in cases with concomitant extrathalamic acute infarcts (plus-BTPI) as it may be difficult to determine whether BTPI is due to occlusion of AoP or two different paramedian arteries even with conventional angiography. This study was performed to highlight plus-BTPI that could result from occlusion of AoP rather than of two distinct paramedian arteries using topographic evaluation of bithalamic infarcts. We retrospectively reviewed imaging and clinical databases for patients admitted to radiology department between 2013 and 2019. Two radiologists independently evaluated the results of imaging studies, and findings reached by consensus were used in the analysis. This retrospective review yielded 34 patients with bithalamic infarct. Each affected thalamic vascular region was investigated separately. Any patient could have more than 2 different vascular zone infarct. The affected thalamic vascular territories were paramedian (n = 24), inferolateral (n = 13), anterior (n = 10), and posterior (n = 7). When we evaluated bithalamic infarcts in terms of symmetrically affected territories, the distribution of symmetric affected territories was as: paramedian (n = 18), inferolateral (n = 2), anterior (n = 1), and posterior (n = 1). BTPI had a 4.5-fold higher frequency than the sum of symmetric involvement of other territories (p = 0.0552, OR = 4.5,95%CI 0.93-21.5). In addition, mesencephalic involvement was only observed in BTPI, and not in other patterns (p < 0.001). The fact that in bilateral thalamic infarcts the symmetric involvement of paramedic territory is significantly higher and mesencephalic involvement is seen only in BTPI can suggest that plus-BPTI may develop due to AoP occlusion rather than occlusion of two distinct paramedian arteries.

Computed Tomography-guided Transthoracic Core Needle Biopsy of Lung Masses: Technique, Complications and Diagnostic Yield Rate.

OBJECTIVES: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses. METHODS: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients' post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively. RESULTS: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated. CONCLUSION: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses.

Topographic evaluation of medullary infarcts from the radiologist's point of view.

PURPOSE: Despite considerable published information about the clinical-radiological correlation of medullary infarcts, no study has determined whether topographic evaluations are performed accurately among researchers. Our purpose in this study was twofold: to evaluate the topographic pattern of medullary infarcts on diffusion-weighted imaging by their radiological aspect, and to assess interobserver agreement on the topographic pattern. METHODS: We retrospectively reviewed our imaging and clinical database for patients admitted to our radiology department between January 2014 and September 2019. Two radiologists evaluated the imaging studies independently. Consensus data were used in the analysis. RESULTS: The retrospective review yielded 92 patients with medullary infarction. The affected vascular territories were lateral (n = 58), anteromedial (n = 28), posterior (n = 3), and anterolateral (n = 1). Two patients had hemimedullary infarction. The rostrocaudal levels of the medullary infarct were superior (n = 34), middle (n = 31), inferior (n = 4), superior-middle (n = 13), and middle-inferior (n = 10). The medullary infarcts were divided into two types: lateral (n = 62) and medial (n = 28). The affected vascular territories differed with rostrocaudal topography of medullary infarct (p = 0.003). Excellent interobserver agreement was found for type of medullary infarct, compared with moderate for vascular territory and fair for rostrocaudal topography. The anterolateral and posterior territories were the most often misdiagnosed, while the level with the most disagreements in rostrocaudal topography was middle. CONCLUSION: The accurate topographic evaluation of a medullary infarct can be an important basis for investigating stroke etiology. However, correct topographic evaluation may not always be available and smaller territories such as anterolateral and posterior should be assessed carefully.

The safety and the efficacy of computed tomography guided percutaneous radiofrequency ablation of osteoid osteoma.

OBJECTIVE: The aim of this study was to investigate the efficacy and safety of Computed Tomography (CT) guided percutaneous Radiofrequency Ablation (RFA) in the treatment of osteoid osteoma (OO). METHODS: A total of 116 patients (82 male and 34 female patients; mean age of 17.7 years; age range 13-months-42 years) who had 118 CT guided RFA treatment between June 2015 and November 2018 (42 moths) with the diagnosis of OO were included in this study. All the patients had pre-procedural CT examinations. The clinical and technical success and the safety of the treatment were evaluated by assessing the clinical pain symptoms, complication rates and recovery of posture and gait. RESULTS: All the patients had a favorable immediate relief of the known pain caused by osteoid osteoma in 24 h after the procedure. Only in two patients (15-years-old boy with OO in right femoral neck and a 12 years old boy with OO in femur diaphysis) pain relapse was occurred in 3 months and 12 months after RFA and a second RFA was performed. During follow-up they had no pain. The technical success and efficacy-rates of the procedure were recorded as 100% and 98% respectively in this study. No significant complication was observed during treatment or recovery period. Seven minor complications were noted which were successfully treated. CONCLUSION: The rapid relief of pain symptoms, low relapse rate and low complication rates demonstrate the efficacy and safety of RFA therapy. RFA is an out-patient procedure that patients can be mobilized immediately after the procedure. RFA can be safely used as a first choice of treatment method in OO therapy. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Sonographic assessment of fatty liver: intraobserver and interobserver variability.

Non-alcoholic fatty liver disease (NAFLD) is a common liver disease worldwide and ultrasonography is widely used in the diagnosis and the follow-up we purposed to assess intraobserver and interobserver variability in the sonographic evaluation of the existence and steatosis grades of NAFLD. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and AST to ALT (AST/ALT) ratio were compared between the grades of hepatosteatosis. Hepatic ultrasonography (US) examinations consisted of 5-10 static images of 113 successive adult patients, whose records were in the picture archiving and communication system (PACS) of our hospital were retrospectively evaluated by two experienced radiologists. Hepatic images were graded into 4 groups; as normal, mild, moderate or severe hepatic steatosis. Evaluation of hepatic steatosis of the same set of images was repeated after one month under the same conditions. Interobserver and intraobserver agreement was assessed by using kappa (κ) statistics. In each group, the percentage of individuals with high ALT and/or AST, or AST/ALT ratio over 1 was calculated. The intraobserver agreement was 51%, fair kappa (κ=0.356) for observer 1; and 68%, moderate (κ=0.591) for observer 2. The interobserver agreements in the initial and second readings were 39% and 40%, fair (κ=0.208) and (κ=0.225), respectively. Elevations of ALT and/or AST levels were similar between groups depending on the degree of hepatosteatosis among the patients. Visual assessment of NAFLD by ultrasonography has substantial interobserver variability, and reproducibility of results is limited. More objective imaging modalities are needed to evaluate the degree of hepatosteatosis.

The frequency of intracranial arterial fenestrations: a study with 64-detector CT-angiography.

Fenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations.

Factor X deficiency presenting with bilateral chronic subdural hematoma.

Factor X deficiency is a rare coagulation defect that can result in several hemorrhagic manifestations including central nervous system hematomas in infants and children. In this case report, we present computed tomography (CT) and magnetic resonance (MR) imaging findings of bilateral chronic subdural hematomas due to factor X deficiency. Cranial CT and MR imaging in a hypoactive 7-month-old male infant with right hemiparesis revealed bilateral chronic subdural hematomas at different stages. Laboratory findings showed a severe factor X deficiency, with a level of 0.7%. After fresh frozen plasma replacement, the patient was operated and the large hematoma on the left side evacuated. The patient recovered uneventfully and remained asymptomatic during the 1-year follow-up.

MDCT findings of denim-sandblasting-induced silicosis: a cross-sectional study.

BACKGROUND: Denim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis. METHODS: Sixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT). The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP) on CT images. RESULTS: Silicosis was diagnosed radiologically in 73.3% of patients (44 of 60). The latency period (the time between initial exposure and radiological imaging) and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p < 0.05). Nodules were present in all cases with centrilobular type as the commonest (63.6%). All cases of silicosis were clinically classified as accelerated and 11.4% had progressive massive fibrosis (PMF). Mild NP lesions were the most prevalent in all six zones of the lung. The NP score was significantly correlated with the duration of silica exposure, the latency period, presence of PMF, and pleural thickening. Enlarged lymphadenopathy was present in 45.5% of patients. CONCLUSIONS: The duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.

Evaluation of interlobar and accessory pulmonary fissures on 64-row MDCT.

We aimed to describe the prevalence, morphology, and completeness of the oblique, horizontal, and accessory fissures on 64-row multidetector computed tomography (MDCT) scans. Three hundred and eighty-seven patients were included in this study. The lungs were scanned from apex to diaphragm using 1-mm collimation. Images were evaluated on a Philips workstation using the PACS system. Prevalence of the interlobar and accessory fissures and also incompleteness of the interlobar fissures was evaluated on axial, coronal, and sagittal planes. The frequencies of right oblique fissures, right horizontal fissures, and left oblique fissures were 99.7%, 94.8%, and 100%, and the percentage of incompleteness was 69.7%, 86.9%, and 48.3%, respectively. Accessory fissures were detected in 164 of the 387 patients (42.4%). Pulmonary fissures are well visualized on MDCT because of its capacity in evaluating the whole thorax with thin sections and at various planes. Fast-image acquisition in MDCT also accounts for less motion artifacts and high-image quality.

Diameters of normal thoracic vascular structures in pediatric patients.

PURPOSE: To determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference. METHODS: Contrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated. RESULTS: There was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent. CONCLUSIONS: Diameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.

Cervical spinal meningioma mimicking intramedullary spinal tumor.

STUDY DESIGN: Case report. OBJECTIVE: To report a very unusual spinal meningioma, mimicking an intramedullary spinal tumor. SUMMARY OF BACKGROUND DATA: Spinal meningiomas, usually associated with signs and symptoms of cord or nerve root compression, are generally encountered in women aged over 40. Radiologic diagnosis is often established by their intradural extramedullary location on magnetic resonance images. METHODS: A 60-year-old woman had a 6-month history of progressive weakness in her upper extremities, difficulty in walking, and cervical pain radiating through both arms. Neurologic examination revealed motor strength deficiency in all her extremities, with extensor reflexes, clonus, and bilateral hyper-reflexiveness. A sensory deficit was present all over her body. Magnetic resonance images revealed that the spinal cord appeared expanded with an ill-defined, homogeneously contrast-enhanced, lobulated, eccentric mass at the C1-C3 level. The patient was operated with a preliminary diagnosis of an intramedullary tumor. RESULTS: At surgery, the mass was found to be extramedullary, and gross total resection was performed. Histopathological examination revealed a meningioma characterized by the presence of fibrous and meningothelial components. The patient was able to ambulate with a cane, and extremity strength and sensation improved 2 months after surgery. CONCLUSION: Spinal meningiomas can mimic intramedullary tumors, and should be considered in differential diagnosis of intradural tumors with atypical appearance.