Comparison of severity and complication rates of acute cholecystitis during pandemic and pre-pandemic periods?

BACKGROUND: Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications. PURPOSE: To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods. MATERIAL AND METHODS: We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated. RESULTS: A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group (P = 0.03). Murphy finding and diabetes status were similar between the two groups (P = 0.086 and P = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients (P = 0.045); with no significant difference in cases of complicated cholecystitis (P = 0.499). CONCLUSION: Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.

Ideal combination of MRI sequences for perianal fistula classification and the evaluation of additional findings for readers with varying levels of experience.

PURPOSE: The aim of our study was to assess the contribution of various magnetic resonance imaging (MRI) sequences in determining the type of perianal fistula and in obtaining critical information for surgical decisions, as well as to define the optimal combination of sequences for readers with varying levels of experience. MATERIALS AND METHODS: The study included 33 MRI examinations in 26 patients with suspected perianal fistula. The following sequences were obtained in both the coronal and axial planes: thin slice, high resolution T1-weighted (W) spin echo; T2-weighted turbo spin echo; short tau inversion recovery (STIR); and native and contrast enhanced T1-weighted gradient echo fast low-angle shot (FLASH) images with fat suppression (FS-CE-T1W-GRE). The examinations were interpreted by three radiologists with varying degrees of experience in two different sessions, and the inter-reader agreement was assessed. Seventeen of the patients underwent surgery. The agreement between the surgical findings and the MRI results were evaluated. RESULTS: A statistically significant concordance between the fistula classification and surgery was achieved with the FS-CE-T1W-GRE sequence for Reader 1 (Cramer's V=0.701, P = 0,022) and Reader 3 (Cramer's V=0.716, P = 0,043). For Reader 2, statistically significant concordance between fistula classification and surgery was achieved with the FS-CE-T1W-GRE (Cramer's V=0.703, P = 0,011) and the T2W images (Cramer's V=0.648, P = 0,027). For all sequences, there was statistically significant agreement between readers for fistula classification, internal opening location, and the presence of sinus tracts, abscess, a horseshoe component, and inflammation. CONCLUSION: For experienced readers, combining FS-CE-T1W-GRE images with either T2W or STIR images collected in both the coronal and axial planes was sufficient to make an assessment before deciding the surgical extent of the procedure.

The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts.

PURPOSE: The purpose of this study is to identify the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the classification of liver hydatid cysts (HCs) and their differentiation from simple cysts and liver abscesses. MATERIALS AND METHODS: Twenty-two patients that were sent to our department with preliminary diagnoses of HCs or abscess were included in the study. Thirty lesions were evaluated. MRI included T1-weighted fast gradient echo, T2-weighted half-Fourier acquisition single-shot turbo spin echo, and DW single-shot echo planar pulse sequencing (b, 0, 50, and 1000 s/mm²). The apparent diffusion coefficient (ADC) values (mm²/s) of the HCs, abscesses, and simple cysts were calculated. RESULTS: No statistically significant difference was found between the ADC values of type 1 and 3 (P > 0.05) HCs and of simple cysts and type 1 HCs (P > 0.05). The ADC values of abscesses were significantly lower than those of type 1 and type 3 HCs, and simple cysts. No statistically significant difference was found between the ADC values of abscesses and type 4 HCs (P > 0.05). Type 4 lesions exhibited significantly lower ADC values in comparison to type 1 and 3 HCs. CONCLUSION: DW-MRI helps differentiate type 4 lesions from other cysts and can distinguish abscesses from hydatid cysts other than type 4 as well as from simple cysts. Type 1 HCs cannot be differentiated from simple cysts using ADC values alone, and type 4 lesions are indistinguishable from abscesses.

The role of ultrasonography and computed tomography in determining the etiology of ascites.

OBJECTIVE: To determine the role of ultrasonography (US) and computed tomography (CT) in the evaluation of ascites etiology. METHODS: From 2000-2006, patients admitted to the Radiology Department, Uludag University Medical School Hospital, Bursa, Turkey, were studied to determine the etiology of ascites, or those in whom ascites was determined during the course of other investigations were evaluated using US and CT. Existence of septa-debris, accompanying organ pathology, omental involvement, intestinal wall thickening, peritoneal implant, lymph node, diameter of portal vein, thickening of gall bladder wall, pleural effusion, collateral vascular structure, and cavernous transformation were also investigated. RESULTS: A total of 30 cases were included. Causes were determined to be malignant in 15 (50%) cases and 15 (50%) benign. The US was significantly superior to CT in the evaluation of gall bladder thickening. Omental thickening, thickening of intestinal wall, and peritoneal implant development were seen significantly more frequently in malignant compared to benign cases, while thickening of the gall bladder wall was seen more frequently in benign cases. Ascites density of malignant cases detected in slices without contrast was higher than in benign cases. The probability of malignancy was 98% when omental thickening, thickening of intestinal wall, and peritoneal implant were present together in the same case. CONCLUSION: Although CT and US may help to evaluate ascites, however, the differential diagnosis of ascites etiology remains a challenge.

Value of chemical shift subtraction MRI in characterization of adrenal masses.

OBJECTIVE: The purpose of this study was to assess the advantages of the image subtraction technique in chemical shift MRI for the differentiation of adrenal adenomas from nonadenomas. SUBJECTS AND METHODS: Thirty-five patients with 42 adrenal masses (eight metastases and 34 nonfunctioning adenomas) underwent chemical shift MRI using a double-echo fast low-angle shot sequence. Subsequently, opposed-phase chemical shift MR images were subtracted from in-phase images. The subtraction images were assessed quantitatively and qualitatively. For quantitative assessment, the signal intensity values of the adrenal masses were measured by one investigator with manually defined regions of interest. Qualitative assessment of the subtraction images was performed independently by two investigators, who reported their confidence in diagnosing adenomas versus nonadenomas based on signal intensity of the adrenal masses on subtraction images. RESULTS: The mean signal intensities were significantly different between adenomas and metastases on subtraction images (213 vs 18; p < 0.0001). There was no overlap in signal intensities between adenomas and metastatic tumors. The accuracy in distinguishing adenomas from metastatic tumors was 100% if the cutoff value of the signal intensity selected was 36-106. Quantitative results corresponding to 100% specificity were also observed, with similar sensitivity. No difference in interpretation between the two investigators occurred. CONCLUSION: Chemical shift subtraction MRI provides a high confidence level in distinguishing adrenal adenomas from adrenal metastases. The image subtraction technique also facilitates quantitative and qualitative evaluation of adrenal masses in chemical shift MRI.

Ursodeoxycholic acid and atorvastatin in the treatment of nonalcoholic steatohepatitis.

BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is a serious disorder with the potential to gradually progress to cirrhosis. It is generally associated with obesity, diabetes and hyperlipidemia. Currently, there is no established therapy for NASH. The aim of the present study was to evaluate the effectiveness of atorvastatin and ursodeoxycholic acid (UDCA) in the treatment of NASH. METHODS: This prospective study included 44 adult patients (24 men, 20 women) with a mean age of 48.90+/-7.69 years and mean body mass index (BMI) of 29.40+/-3.82. Ten patients had a history of diabetes. Serological markers for viral hepatitis were negative in all patients and there was no history of alcohol or drug abuse. Patients who had autoimmune hepatitis were excluded from the study. Liver biopsy was performed before therapy to confirm the diagnosis. Among NASH patients, 17 normolipidemic cases received UDCA 13 to 15 mg/kg/day (group 1), while hyperlipidemic cases (n=27) received atorvastatin 10 mg/day (group 2) for six months. The BMI, serum lipids, liver function tests and liver density, assessed by computerized tomography, were evaluated before and after the treatment period. The BMI, serum aminotransferase levels, histological parameters (steatosis, inflammation, fibrosis scores) and liver densities were not statistically different between the groups at the beginning of therapy. RESULTS: The BMI, serum glucose, and triglyceride levels did not change in either group after the treatment period. In group 1, serum alanine aminotransferase (ALT) and gamma-glutamyl-transferase (GGT) levels reduced significantly, and in group 2, serum cholesterol, aspartate aminotransferase, ALT, alkaline phosphatase and GGT levels reduced significantly. Liver densities increased only in group 2, probably as a result of diminishing fat content of liver. The normalization of transaminases was also more prevalent in group 2. Liver steatosis was closely correlated with liver density, but inflammation and fibrosis were not. CONCLUSIONS: The use of atorvastatin in NASH patients with hyperlipidemia was found to be both effective and safe. The benefit of statin and UDCA therapy in normolipidemic patients with NASH requires confirmation with further placebo-controlled trials.

[Effect of different threshold levels and injection rates on hepatic enhancement by using bolus tracking technique in helical CT]. / Helikal BT'de bolus izleme yöntemi kullanilarak farkli esik deger ve farkli enjeksiyon hizlarinin karaciger boyanmasi üzerindeki etkileri.

PURPOSE: To evaluate the influence of different injection rates and different threshold levels on hepatic enhancement using the bolus tracking technique. MATERIALS AND METHODS: One hundred patients were included in this randomized and prospective study performed on a helical CT. Patients were assigned to one control and four study groups. Each group received 150 ml nonionic contrast medium. In the control group, used delay time and injection rate were 60 sec and 3 ml/sec, respectively. In the study groups, two different injection rates, 3 ml/sec (groups 1 and 2) and 5 mL/sec, respectively. In study groups, two different preselected thresholds, 40 HU (groups 1 and 3) and 50 HU (groups 2 and 4) were used. In these groups, delay times were determined individually by means of the bolus tracking technique. Peak enhancement time (PET), peak enhancement value (PEV), and mean hepatic enhancement (MHE) on CT scans was calculated for each group. RESULTS: PET was found to be significantly earlier in the study groups in which the injection rates were 5 mL/sec, compared to the other groups (p < 0.001). MHE was significantly higher in all study groups compared to the control group (p < 0.001). PEV was higher in study groups that the preselected threshold was 50 HU compared to only the control group (p < 0.01). CONCLUSION: Use of a bolus tracking program helps to achieve a greater level of hepatic enhancement. Increasing the injection rate shortens the time to peak hepatic enhancement. The threshold level of 50 HU achieves a great level of hepatic enhancement independent of injection rates in the bolus tracking technique. If the bolus tracking technique is not available, using an injection rate of 3 ml/sec and 70 sec delay time seems to be appropriate.