The Efficiency of Gray-Level Ultrasound Histogram Analysis in Patients with Supraspinatus Tendinopathy.

BACKGROUND: Musculoskeletal ultrasonography is a viable substitute for magnetic resonance imaging (MRI) that offers advantages in terms of time efficiency and cost-effectiveness. The gray-level histogram is a tool used to depict the distribution of pixel gray levels that provide quantitative data. AIM: The objective of our research was to establish a threshold value for ultrasonography-measured supraspinatus tendon gray-level values by comparing patients with tendinopathy to those without. MATERIALS AND METHODS: This study comprised a cohort of 271 individuals, consisting of 124 patients diagnosed with supraspinatus tendinopathy and 147 cases without the aforementioned condition who underwent shoulder MRI and ultrasound examinations. Two radiologists independently conducted the gray-level histogram analyses. The histogram parameters were determined, including the mean, minimum, median, maximum, fifth, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance. The interobserver agreement was evaluated using the interclass correlation coefficient. RESULTS: The supraspinatus tendinopathy group's all gray-level values were lower than those of the control group, and the difference was statistically significant (P < .05). The supraspinatus tendinopathy group exhibited greater values of skewness and kurtosis in comparison to the control group (P < .05). The area under the curve of the 95th percentile of the gray-level value was the highest (area under the curve = 0.960; cut-off value = 82.5; sensitivity = 96.7%; specificity = 88.2%). CONCLUSION: The analysis of the histogram of gray-level values has the potential to be a promising method for the monitoring of patients with supraspinatus tendinopathy. This approach could be considered a feasible alternative to MRI.

Assessment of Imaging Findings of Renal Carcinoma Subtypes with 3.0T MRI.

BACKGROUND: The prevalence of renal masses has escalated as a result of the augmented utilization of cross-sectional imaging techniques. The approach to managing renal masses may exhibit variability contingent upon the subtype of renal cell carcinoma (RCC). AIM: This research aimed to distinguish between clear cell and papillary RCCs, utilizing dynamic contrast magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI). MATERIALS AND METHODS: The study assessed the MR images of 112 patients with RCC. Two radiologists independently analyzed tumor size, vascular involvement, signal characteristics in T1- and T2-weighted sequences, the presence of hemosiderin, both microscopic and macroscopic fat content, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm². RESULTS: Seventy patients had clear cell RCC, and 42 had papillary. In the clear cell RCC, microscopic fat content was significantly higher than the papillary RCC (P < 0.001). However, in papillary RCC, hemosiderin content was substantially greater (P = 0.001). On T2-weighted MR images, clear cell RCCs were usually hyperintense, while papillary RCCs were hypointense (P < 0.001). Even though the rapid enhancement pattern was observed in clear cell RCCs, the progressive enhancement pattern was more prevalent in papillary RCCs (P < 0.001). CONCLUSION: Hyperintensity on T2-weighted images, microscopic fat content, and rapid enhancement pattern may be indicative of clear cell RCC, whereas hypointensity on T2-weighted images, hemosiderin content, and a progressive contrast pattern may be diagnostic for papillary RCC.

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations.

OBJECTIVE: To combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations. MATERIALS AND METHODS: Data of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. RESULTS: Stone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {-8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. CONCLUSION: We conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

Comparison of computed tomography and magnetic resonance imaging in the assessment of complex renal cysts by using the Bosniak classification. / Comparación entre tomografía computarizada y resonancia magnética en la evaluación de quistes renales complejos empleando la clasificación de Bosniak.

INTRODUCTION AND OBJECTIVES: The Bosniak classification of cystic renal lesions was first published in 1986 based on computed tomography (CT). In the present study, we aimed to investigate the effect of magnetic resonance imaging (MRI) on Bosniak category compared with CT, and to determine how this effect changed the treatment modality in the evaluation of complex renal cysts. MATERIAL AND METHODS: Data of 144 patients were collected retrospectively. After exclusion criteria, 102 cystic renal lesions with a Bosniak category of at least IIF on CT or MRI between 2013 and 2016 were evaluated by 2abdominal radiologists. The demographic data, Bosniak category, interobserver agreement, and pathologic data of patients who underwent surgery were recorded. RESULTS: The coherence between MRI and CT was 75.5%. The Bosniak classification of 17 patients was upgraded with MRI, and the treatment modality changed in 10 patients, and they underwent surgery. The Bosniak category was downgraded from III to IIF in 6 patients out of 8 whose Bosniak category was downgraded with MRI and the treatment modality changed. Surgery was performed in one patient out of these 6 patients, and the pathology was reported as benign. Progression was detected in the follow-up at month 18 of 1 patient out of 5, and surgery was performed. The pathology was reported as renal cell carcinoma. The pathology result was reported as RCC in 35 (68.6%) patients out of 51 who underwent surgery. Progression was detected in 7 patients out of 51 who were followed up (13.7%), and the pathology results were reported as RCC. The majority of the malignant tumors were low stage and grade. CONCLUSIONS: MRI may be successfully used in the evaluation of renal cystic lesions. In particular, the challenging Bosniak IIF and all Bosniak III lesions must be evaluated using MRI before making the decision for surgery. The upgrading of Bosniak category with MRI is more possible compared with CT due to its high-contrast resolution, therefore further studies are required to identify whether it was the cause of overtreatment of Bosniak III lesions.

Diagnostic values of diffusion tensor parameters in 3 T breast magnetic resonance imaging: Differentiation of breast tumors from bilateral healthy breast parenchyma.

PURPOSE: Our aim is to search diagnostic value of diffusion tensor parameters in the breast cancer. MATERIALS AND METHODS: We included 46 patients with contrast enhanced magnetic resonance imaging of the breast between the dates of July 2015 and December 2016. We measured fractional anisotropy (FA), apparent diffusion coefficient (ADC), relative anisotropy (RA) and volume ratio (VR) values of the malignant mass, ipsilateral and contralateral healthy breast parenchyma in each patient. RESULTS: ADC and VR values of the malignant lesions were significantly lower than normal parenchyma (P < 0.01). FA values were statistically higher in masses than normal breast parenchyma (P < 0.05). RA values were statistically higher in the mass than ipsilateral breast parenchyma (P < 0.01) but not significantly different from in contralateral breast parenchyma (P > 0.05). Only ADC values were statistically lower in contralateral side than ipsilateral breast parenchyma (P < 0.05) other parameters showed no statistical significance between parenchymas. CONCLUSION: DTI findings, such as FA, ADC, RA and VR, provide significant contribution in differentiating cancer from healthy breast tissue.

The Role of Diffusion-Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Simple and Hydatid Cysts of the Liver.

INTRODUCTION: The present study indicates that simple and hydatid cysts in liver are a common health problem in Turkey. The aim of the study is to differentiate different types of hydatid cysts from simple cysts by using diffusion-weighted images. MATERIALS AND METHODS: In total, 37 hydatid cysts and 36 simple cysts in the liver were diagnosed. We retrospectively reviewed the medical records of the patients who had both ultrasonography and magnetic resonance imaging. We measured apparent diffusion coefficient (ADC) values of all the cysts and then compared the findings. RESULTS: There was no statistically meaningful difference between the ADC values of simple cysts and type 1 hydatid cysts. However, for the other types of hydatid cysts, it is possible to differentiate hydatid cysts from simple cysts using the ADC values. CONCLUSION: Although in our study we cannot differentiate between type I hydatid cysts and simple cysts in the liver, diffusion-weighted images are very useful to differentiate different types of hydatid cysts from simple cysts using the ADC values.

Comparison of elasticity values of the right lobe of the liver of normal weight and morbidly obese Turkish patients.

INTRODUCTION: Shear wave elastography is a method for the measurement of tissue stiffness. The advantage of this method is that its outcome is not operator dependent. Our aim was to compare the elastiscity values of the right lobe of the liver of normal weighted and morbidly obese patients. MATERIALS AND METHODS: The mean elastiscity values of the right lobe of the liver were calculated for 38 normal weighted and 37 morbidly obese patients. All the patients had no history of liver disease. RESULTS: The mean elastiscity value was significantly higher in morbidly obese patients than (25,7 +3,30 kPascal) in normal weighted patients for the right lobe of liver (10,55 +2,20 kPascal). CONCLUSION: Morbidly obese patients have a potential risk for liver fibrosis even in the absence of hepatosteatosis.

Is hyperbaric oxygen therapy a salvage treatment option for sudden sensorineural hearing loss?

OBJECTIVE: To investigate of the efficacy of hyperbaric oxygen therapy as a salvage treatment after unsuccessful oral corticosteroid therapy. METHODS: Case notes of patients who were followed up because of idiopathic sudden sensorineural hearing loss between 2005 and 2011 in a tertiary care centre were examined retrospectively. Audiograms from before and after hyperbaric oxygen therapy were examined in terms of mean gains in pure tone average and at 0.25, 0.5, 1, 2, 4 and 8 kHz. In addition, recovery according to Siegel's criteria was noted. RESULTS: Mean gain in pure tone average was 10.55 ± 13.56 dB. Mean gains at 0.25, 0.5, 1, 2, 4 and 8 kHz were 16.66 ± 18.43 dB, 16.94 ± 19.93 dB, 12.63 ± 16.71 dB, 7.36 ± 15.28 dB, 5.27 ± 11.58 dB and 2.91 ± 12.44 dB, respectively. Three patients had complete recovery, 1 had partial recovery, 5 had slight recovery and 25 had no improvement. CONCLUSION: Hyperbaric oxygen utilised as a salvage therapy after failed corticosteroid therapy may be beneficial in some patients. Studies with more patients are needed.

The evaluation of the angles of Eustachian tubes in the patients with chronic otitis media on the temporal computerized tomography.

INTRODUCTION: Chronic otitis media (COM), affecting all over the world and in a wide range of age groups in Turkey, is an important cause of ear discharge and hearing loss. The main clinical manifestations are tympanic membrane perforation, ear, nose and throat problems. On the tympanic membrane perforation becomes persistent and cholesteatoma development, there are a lot of opinions today. Especially in the pathology associated with otitis media with effusion eustachian tube, it is known that COM and cholesteatoma develop. MATERIALS AND METHODS: In our study, we interpreted 210 patients' temporal computed tomography (CT). Seventy of these 210 patients had otitis media with cholesteatoma, 70 patients had only otitis media without cholesteatoma, and 70 patients had no otitis media. The eustachian tubes were evaluated using temporal CT multiplanar reconstruction method. Angles with the horizontal plane of the eustachian tube and Reid and tubotympanic angles were measured. RESULTS: The angles between eustachian tube and horizontally oriented Reid plane of the patients with cholesteatoma were found to be significantly lower than the patients with otitis media without cholesteatoma and the patients with no history of otitis media. For the tubotympanic angle, no statistically significant differences were observed between the groups. CONCLUSION: These results suggest that the decrease in the angle with the horizontal plane of Reid in the eustachian tube in adults may play a significant role in the etiology of cholesteatoma.

A case of sudden hearing loss associated with ANCA.

A 46-year-old female patient presented to our clinic with complaints of aural fullness and hearing loss for two days. On audiometric examination, she had sensorineural hearing loss in the left ear. Mean pure tone audiometry (PTA) was 53dB. Her medical history was significant for oral medication-controlled diabetes mellitus and chronic thyroiditis. Laboratory studies showed an erythrocyte sedimentation rate (ESR) of 40 mm/h and an anti-neutrophil cytoplasmic antibody directed against myeloperoxidase (MPO-ANCA) level of 33.1 EU/ml. ANCA-associated vasculitis was considered. The patient was started on immunosuppressive treatment. Seven months after the initial episode, the patient suffered a relapse. At 17 month follow-up after the initial event, the patient is healthy with normal hearing. Serum MPO-ANCA is within normal limits.

Value of apparent diffusion coefficient measurement for discrimination of focal benign and malignant hepatic masses.

The purpose of our study was to investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) to discriminate benign and malignant focal lesions of the liver using parallel imaging technique. A total of 77 patients and 65 healthy controls were enrolled in the study. DW-MRI was performed with b-factors of 0, 500 and 1000 s/mm(2), and the apparent diffusion coefficients (ADC) values of the normal liver and the lesions were calculated. The mean ADC value of the focal liver lesions were as follows: simple cysts (3.16 +/- 0.18 x 10(-3) mm(2)/s), hydatid cysts (2.58 +/- 0.53 x 10(-3) mm(2)/s), hemangiomas (1.97 +/- 0.49 x 10(-3) mm(2)/s), metastases (1.14 +/- 0.41 x 10(-3) mm(2)/s) and hepatocellular carcinomas (HCC) (1.15 +/- 0.36 x 10(-3) mm(2)/s). The mean ADC values of all the disease groups were statistically significant when compared with the mean ADC value of the normal liver (1.56 +/- 0.14 x 10(-3) mm(2)/s), (P < 0.01). There were also statistically significant differences among the ADC values of hemangiomas and HCC metastases (P < 0.01), and simple and hydatid cysts (P < 0.008). However, there was no statistically significant difference between HCC and metastases. The present study showed that ADC measurement has the potential to differentiate benign and malignant focal hepatic lesions. We propose to add DW sequence in the MR protocol for the detection and quantitative discrimination of hepatic pathologies.

Quantitative diffusion-weighted magnetic resonance imaging of normal and diseased uterine zones.

BACKGROUND: Magnetic resonance (MR) imaging has been established as the best imaging modality for the detection, localization, and staging of uterine cancers. Recently, the usefulness of diffusion-weighted imaging (DWI) in the diagnosis of cancers has been reported in several studies. PURPOSE: To calculate the apparent diffusion coefficient (ADC) values of normal uterine zones as well as benign and malignant uterine diseases, and to determine a cut-off ADC value for the quantitative detection of uterine malignancies with DWI. MATERIAL AND METHODS: Eighty-seven patients (mean age 53 years) with 107 benign and malignant uterine pathologies and 50 healthy controls (mean age 38 years) were enrolled in the study. DWI was performed with b factors of 0, 500, and 1000 s/mm(2). RESULTS: The ADC values of benign and malignant lesions were compared using Student's t test. The mean and the standard deviation of the ADC values of the control group were as follows: myometrium 1.76+/-0.19 x 10(-3) mm(2)/s, junctional zone 0.99+/-0.18 x 10(-3) mm(2)/s, endometrium 1.65+/-0.33 x 10(-3) mm(2)/s, and cervix 1.71+/-0.17 x 10(-3) mm(2)/s. There was a statistically significant difference among the ADC values of normal myometrium and leiomyomas (1.47+/-0.36 x 10(-3) mm(2)/s; P<0.009), endometrium and endometrial carcinomas (0.86+/-0.13 x 10(-3) mm(2)/s; P<0.001), myometrium-junctional zone and adenomyosis (1.24+/-0.20 x 10(-3) mm(2)/s; P<0.001), and cervix and cervical carcinomas (0.91+/-0.14 x 10(-3) mm(2)/s; P<0.001). The ADC values differed significantly between malignant (0.88+/-0.11) and benign lesions (1.55+/-0.33; P<0.01). A cut-off value for malignant lesions of 1.05 x 10(-3) mm(2)/s yielded a sensitivity, specificity, and accuracy of 95.83%, 94.55%, and 94.94%, respectively. CONCLUSION: The present study shows that ADC measurements have the potential to quantitatively differentiate between normal and cancerous tissues of the uterine zones. We propose adding DWI as an adjunct sequence in the MR protocol for the assessment of uterine lesions.

Etiologic agents of diarrhea in solid organ recipients.

After transplantation, diarrhea may be caused by infectious agents, drug-specific effects, metabolic conditions, or mechanical complications of surgery. Determining the cause helps to determine whether to initiate antimicrobial therapy and the duration of treatment. In this study we aimed to determine the causes of diarrhea in kidney or liver recipients. Fifty-two diarrhea episodes among 43 solid organ recipients were evaluated. The cause of diarrhea was detected in 43 patients (82.6%). Infectious etiologies accounted for 33 out of the 43 episodes (76.7%) in which a specific cause was determined: Giardia lamblia in 9, Cryptosporidium parvum in 7, cytomegalovirus (CMV) in 6, Clostridium difficile in 3, Campylobacter jejuni in 2, Shigella sonnei in 2, Salmonella enteritidis in 1, rotavirus in 1, Entamoeba histolytica in 1, and Blastocystis hominis in 1. Non-infectious etiologies were found for 10 episodes (23.3%): mycophenolate mofetil-associated diarrhea in 5, antibiotic-associated diarrhea in 2, colchicine-associated diarrhea in 2, and laxative drug-associated in 1. Non-infectious etiologies seem to be relatively common causes of diarrhea among transplant recipients. Therapy was adjusted in 5 patients because of mycophenolate mofetil-associated diarrhea. CMV and C. parvum, which are seldom seen in the normal population, were frequent causes of diarrhea in this group. Evaluating the transplant recipients for non-infectious causes of diarrhea is important in prompt diagnosis and treatment.

[Alveolar soft tissue sarcoma]. / Alveoläres Weichteilsarkom.

Alveolar soft part sarcoma is a malignant soft part tumor the etiology of which has not yet been clarified. Histopathological examinations show an alveolar or pseudoglandular pattern. PAS-positive, diastase resistant intraplasmic inclusion bodies are characteristic for this tumor which occurs in the head and neck region; mainly the tongue and the orbita. Primary therapy includes total resection which can later be combined with radiotherapy or chemotherapy. The present study involves a 17 year old patient. We totally removed the tumor and then used radiotherapy. The postoperative examinations over 3 years showed neither local recurrence nor distant metastases.

Fine-needle aspiration as a diagnostic tool for recurrent tonsillitis.

Acute tonsillitis is a common childhood disease, but repeated antibiotic treatment may fail, leading to tonsillectomy. Superficial swab cultures do not sufficiently represent the core bacteria present, but fine-needle aspiration may be a promising diagnostic method. We evaluated 58 patients undergoing tonsillectomy, and took superficial and core swabs, and fine-needle aspirations. Staphylococcus aureus was the most common bacterial pathogen identified, present in 26 out of 50 (52%) positive core cultures, followed by Haemophilus influenza in 13 positive core cultures (26%), and group A beta-haemolytic streptococci in 10 positive core cultures (20%). Fine-needle aspiration detected 33 out of 50 positive core cultures (66%), whereas superficial swab culture detected 18 of 50 (36%); the difference being statistically significant. All pathogens detected by superficial swabs and fine-needle aspiration were detected in core cultures. The sensitivity and specificity of fine-needle aspiration were 66% and 100%, respectively, compared with 36% and 100% for superficial swabs. Fine-needle aspiration is therefore a promising method for detecting core bacteria in patients with recurrent tonsillitis.

Evaluation of oxidative stress parameters in blood of patients with laryngeal carcinoma.

OBJECTIVES: In this study, plasma lipid peroxidation as assessed by thiobarbituric acid reactive substances and erythrocyte antioxidant status markers namely CuZn superoxide dismutase, glutathione peroxidase, glutathione and plasma levels of vitamin C and E were investigated in 20 patients with larygneal carcinoma and 15 healthy controls. DESIGN AND METHODS: Lipid peroxidation was observed to be significantly higher (0.01 > p > 0.001) in the larynx carcinoma group in comparison to the healthy controls. Both stage I + 11 and stage III carcinoma patients were observed to have significantly higher thiobarbituric acid reactive substances than the control group. A significant difference was found in plasma vitamin E level between the control group and stage I + 11 and stage III carcinoma patients (p < 0.01, 0.05 > p > 0.02, respectively). RESULTS: Our findings reveal the presence of increased lipooxidative damage in laryngeal carcinoma patients, but no change with respect to the endogenous antioxidant components-GSH, GSH Px, and CuZn SOD.