فهرست مطالب

  • Volume:16 Issue:3, 2019
  • تاریخ انتشار: 1398/04/10
  • تعداد عناوین: 20
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  • Selen Bayraktaroglu *, Pınar Karakan Öztürk, Naim Ceylan Özer Makay, Gökhan İçöz, Yeşim Ertan Page 1
    Background
    High field strength magnets have the potential to provide good quality diffusion weighted imaging (DWI) sequence images and apparent diffusion coefficient (ADC) maps can give important data for differential diagnosis of thyroid nodules.
    Objectives
    To determine the sensitivity and specificity of ADC values of malignant and benign thyroid nodules at 3 Tesla (T) magnetic resonance imaging (MRI) and to correlate imaging findings with histopathologic results.
    Patients and
    Methods
    Thirty two patients and 20 healthy volunteers were enrolled in the study. DWI was acquired with b values of 500 and 1000. Mean apparent diffusion coefficient values (ADCMEAN) of the nodules and thyroid parenchyma were measured. Nodule ADCMEAN/thyroid parenchymal ADCMEAN ratio were calculated for each nodule in 25 patients.
    Results
    Thirteen malignant and 63 benign nodules were analysed. The ADCMEAN values of malignant nodules were significantly lower than benign nodules in each b value (P < 0.0001). Nodular ADCMEAN/thyroid parenchymal ADCMEAN ratio was significantly lower in the malignant group at b:500 and b:1000 (P < 0.0001). Considering the selected cut off values (0.98 for b:500 and 0.95 for b:1000) this ratio showed the best performance in differentiation of malignant and benign nodules with a sensitivity of 100% and specificity of 92% - 100%.
    Conclusion
    DWI with quantitative ADC measurements is useful in the differentiation of benign and malignant thyroid nodules. The nodule ADCMEAN/thyroid parenchyma ADCMEAN ratio can be used as an adjunctive parameter in differentiation.
    Keywords: Thyroid, Nodular Disease, DiffusionWeighted Imaging, ADC Ratio
  • Shu, Yu Chang, Chia, Hsin Lu, I, Chan Chiang, Wei, Shiuan Chung, Tsyh, Jyi Hsieh * Page 2
    Background
    Computed tomography (CT) with rapid injection of contrast medium is important for the diagnosis of many diseases. To obtain good diagnostic accuracy, a power injector is recommended and routinely used to achieve a consistent injection rate of contrast medium. Although rapid contrast injection improves diagnostic accuracy, it increases the risk of extravasation of contrast medium.
    Objectives
    The aim of this study was to evaluate the extravasation rate of contrast medium using a power injector and determine if using a saline test injection mode can reduce the rate.
    Patients and
    Methods
    The records of 10,310 computed tomography (CT) examinations with contrast administration by a dual-syringe power injector were retrospectively reviewed. Before contrast administration, the same volume of saline was injected with a higher injection rate than that for contrast medium and the protocol was defined as “saline test injection mode”. The incident reports of patients with extravasations were reviewed and the extravasation rate and prevention rate were calculated.
    Results
    Extravasations occurred in 12 (0.12%) of 10310 patients, and follow-up information was available for all patients. Five (41.67%) of 12 extravasations occurred during the saline test injection period, and the CT examinations were completed after creation of a new venous access. Contrast medium extravasation occurred in only six (0.06%) patients. One of the patients with contrast medium extravasation developed compartment syndrome and required decompression surgery. Other cases with extravasation had only mild symptoms and improved within 5 days.
    Conclusion
    The saline test injection mode may reduce the risk of contrast medium extravasation and improve the safety of using a power injector.
    Keywords: Multidetector Computed Tomography, Contrast Media, Extravasation of Contrast, Media, Patient Safety, Power Injector
  • Sinan Erdogan, Sibel Caglar Okur, Aysegul Atici, Huseyin Bahadir Gokcen, Barış Polat *, Yunus Atici Page 3
     
    Background
    Facet joint blockage is a type of regional anesthesia which is performed selectively on the medial branch of the ramus dorsalis of the spinal nerve and is a current approach for the treatment of pain originating from facet arthropathy. This current approach to chronic low back pain caused by facet joint pathology is usually performed with ultrasound guidance.
    Objectives
    The accuracy of anatomical placement of the facet joint with ultrasonography guidance is determined by C-arm fluoroscopy image taken as reference.
    Patients and
    Methods
    A total of 22 patients who were diagnosed with facet joint syndrome were involved in the study. After detecting the superolateral corner of the facet joint, which is the target point with ultrasound, the control was provided with C-arm fluoroscopy by giving radiopaque fluid. In order to verify the localization, a mixture of 40 mg triamcinolone and 1 cc 2% lidocaine was injected.
    Results
    Nerve blockage was applied to 67 facet joints at L3 - L4, L4 - L5 and L5 - S1 level in a total of 22 patients (15 female and seven male) diagnosed with facet joint syndrome. The patients’ mean age was 63 (range, 48 - 80), the mean body mass index was 28.4 (range, 18.9 - 38.1) and the mean time to determine facet localization with ultrasonography (USG) was 240 seconds (range, 140 - 320). Patients’ mean visual analog scale (VAS) decreased from 7 (range, 6 - 9) to 2.5 (range, 1 - 6). In the C-arm fluoroscopy control after the injection of radio-opaque material, the needle was found to be located in the lamina in four segments and it was relocated. In addition to this, two facet joints were not localized in ultrasound. This study concluded that the location of the facet joint with USG guidance is possible with 91% sensitivity and 100% positive predictive value when C-arm fluoroscopy was regarded as a gold standard in determining facet joint localization. No complications were observed.
    Conclusion
    The results showed that ultrasonography guided facet joint block can be considered as a minimally invasive procedure that could be easily applied without radiation exposure.
    Keywords: Facet Joint Blockage, Ultrasonography, Fluoroscopy, Low Back Pain
  • Azad Hekimoglu *, Aynur Turan, Begum Demirler Simsir, Hasan Ali Durmaz, Mehmet Deniz Ayli, Baki Hekimoglu Page 4
    Background
    Changes in tendon structure are expected in chronic renal failure (CRF) due to metabolic alterations. Shear-wave elastography (SWE) is a new elastography technique that determines soft tissue elasticity noninvasively. SWE may determine early tendon degeneration due to CRF.
    Objectives
    We aim to determine Achilles tendon thickness and elasticity in CRF patients undergoing hemodialysis with B-mode and SWE ultrasonography (US).
    Patients and
    Methods
    Thirty-four (23 male, 11 female) patients with CRF and 32 healthy individuals (24 male, eight female) were included in the study. Initially both Achilles tendons of patients were evaluated for structural abnormalities or focal lesions then tendon thickness was measured with B-mode US. Tendon stiffness was measured by SWE in kilopascal (kPa) units.
    Results
    Mean Achilles tendon thickness in the patient group was significantly lower than the control group (4.16 ± 0.59 mm vs. 4.78 ± 0.61 mm, P < 0.001). The mean elasticity scores in the patient group was 26.00 ± 9.74 kPa and 24.64 ± 6.64 kPa in the control group which was not statistically significant.
    Conclusion
    Achilles tendon is thinner in chronic renal failure patients compared to the control group. However, there was no significant difference between the groups in stiffness values of tendons measured by SWE.
    Keywords: Achilles Tendon, Chronic Kidney Failure, Elastography, Hemodialysis
  • Ji Eun Kim, Hyun Ok Kim, *, Kyungsoo Bae, Jae Min Cho, Ho Cheol Choi, Dae Seob Choi, Jaebeom Na Page 5
     
    Background
    Low-energy advanced virtual monochromatic images (VMIs) from dual source dual-energy CT (DSCT) could be applied to reduce contrast medium dose due to superior iodine contrast-to-noise ratios (CNRs).
    Objectives
    To investigate feasibility of advanced VMIs from DSCT to reduce contrast medium dose in multiphase liver CT without impairing image quality and conspicuity of focal hepatic lesions (FHLs).
    Patients and
    Methods
    Ninety-four patients with 110 FHLs underwent follow-up CT twice prospectively with different protocols: protocol A, conventional 100 kVp and 555 mgI/kg; protocol B, dual-energy mode and 389 mgI/kg. The signal-to-noise ratio (SNR) and lesion-to-liver CNR were compared between the VMIs (40 - 120 keV, 10-keV interval) reconstructed using advanced image-based algorithm and conventional images. Two radiologists qualitatively evaluated VMIs, compared with the 100 kVp images, using a six-point scale.
    Results
    The SNRs of pancreas, aorta, portal and hepatic vein were similar to those at 100 kVp images (P > 0.05) at 40-50 keV images during late arterial phase (LAP) and at 40-60 keV images during portal venous phase (PVP) except for the SNRs of aorta and veins at 40 keV images which were significantly higher (P < 0.0109) during both phases and PVP, respectively. The CNR of 56 hypervascular FHLs was significantly higher at 40 - 50 keV images (P < 0.0002) and was similar at 60 keV images (P > 0.05) during LAP. The CNR of 58 hypovascular FHLs was similar at 40 - 120 keV images (P > 0.05) during PVP. Among the VMIs, 50 keV and 50 - 60 keV images received the highest scores (P < 0.0315 and P < 0.0041) by both reviewers during LAP and PVP, respectively.
    Conclusion
    Advanced 50 - 60 keV images from DSCT allowed contrast dose reduction by 30% in multiphase liver CT without impairing image quality and conspicuity of FHLs, compared with the conventional 100 kVp images with 555 mgI/kg.
    Keywords: Contrast Medium, Computed Tomography, Dual-Energy, Virtual Monochromatic Image
  • Seyed Alireza Mousavi * Page 6
    Background
    To prevent any tissue from absorbing the excess dose during radiotherapy, dosimetry and irradiation time calculation must be carried out as accurately as possible. Water phantoms and the medical internal radiation dose (MIRD) methods are appropriate for dosimetry. At present, measurement of the required irradiation time in clinical settings is done only based on estimation.
    Objectives
    Our primary objective was to determine the accurate dosimetry of liver tissue for the course of X-ray radiotherapy and the secondary objective was to calculate the required irradiation time for this course.
    Materials and Methods
    First, the Hounsfield unit (HU) of every existing tissue in the abdominal region was defined. Then, their constituent materials were determined and fed into MATLAB and MCNPX codes, in sequence. The abdominal region was completely filled up with the related components to obtain its own radiodensity. Afterward, the liver tissue was contoured and separated in the middle of the abdominal region. The exact information of the separated liver tissue was extracted as data, and these data were converted to MCNPX nuclear code. The accurate irradiation time was then obtained by keeping up a proper proportion between absorbed dose and X-ray activity.
    Results
    The accurate duration of X-ray treatment was calculated via a highly developed software application (Delphi 7 programming language) by making an equivalence between the absorbed dose and X-ray activity. This calculation was performed based on the energy of X-ray photons and interpolating the value of the required treatment dose according to the values of absorbed doses obtained by the software package.
    Conclusion
    This technique can be used for every patient based on his/her own digital imaging and communications in medicine (DICOM) images. The required time for irradiation of liver tissues is determined to reach the desired absorbed dose during X-ray therapy for analogous liver tissues. This method might also be applicable to other types of radiation therapy including proton therapy and neutron therapy and for various soft tissues with different shapes and sizes.
    Keywords: DICOM Image, Dosimetry, Liver, Required Irradiation Time, X-Ray Therapy
  • Ali Mohammadzadeh*, Vahid Shahkarami, Madjid Shakiba, Parto Sabetrasekh, Maryam Mohammadzadeh Page 7
    Background
    Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease (6% - 35%) and is associated with cardiovascular risk factors and metabolic syndromes (age, diabetes, hyperlipidemia, hypertension and smoking). Hereby, we evaluated the association of increased carotid intima-media thickness (IMT) with NAFLD considering other cardiovascular risk factors to see if NAFLD is independently associated with increased carotid IMT.
    Patients and
    Methods
    Totally 300 patients [150 NAFLD and 150 normal] who were referred to four academic referral hospitals were enrolled. Patients with a history of alcohol use, hepatitis, HIV, chemotherapy and other organ failures were excluded. A single radiologist performed abdominal sonographies [3 - 5 MHz probe] and carotid sonography [7.5 MHz probe] (measured the posterior wall of both common carotids and calculated the mean value). NAFLD was diagnosed based on sonographic findings in the absence of acute or chronic liver and kidney diseases and malignancies.
    Results
    The mean age was 51.2 ± 14.8 [20 - 97] and 184 [61.3%] were male. Mean IMT was greater in patients with diabetes, hypertension, hyperlipidemia and NAFLD [all Ps < 0.001] and these variables with age were statistically significant in univariate models for estimating IMT. Among NAFLD patients, 38 [25.3%] had increased IMT [unilateral or bilateral; considering 0.8 as cutoff point] while this frequency was 8 [%5.3] among normal subjects [P < 0.001, odds ratio = 6, 95% confidence interval (CI) = 2.7 - 13.4]. In multivariate regression models [IMT as dependent variable], NAFLD, age and hyperlipoproteinemia (HLP) were independent significant variables in linear model [R2 = 0.41] and NAFLD showed highest odds ratio [16.4] among significant variables [age, body mass index (BMI), NAFLD and HLP] in the logistic model.
    Conclusion
    Increase carotid IMT is highly associated with NAFLD independent of other cardiovascular risk factors and should be considered in these patients.
    Keywords: Sonography, Non-Alcoholic Fatty Liver Disease, Carotid Artery, Intima-Media Thickness
  • Amin Abolhasani, Mahdi Saeedi, Banafsheh Zeinali *, Masoume Nazeri Page 8
    Background
    Multiple sclerosis (MS) is a demyelinating disease, involving almost 2.5 million people around the world. There are different MR pulse sequences, which are used to detect MS plaques.
    Objectives
    This study aimed to compare, T2 weighted, short-tau inversion recovery (STIR) and phase-sensitive inversion recovery (PSIR) pulse sequences, for detecting cervical spinal cord lesions in MS patients.
    Patients and
    Methods
    Sixty patients with definite MS diagnoses, participated in this study from June to December 2016. 1.5 T Siemens (Avanto, Erlangen, Germany) MR scanner and three pulse sequences (T2 weighted, STIR and PSIR sequences) were used for cervical cord MR imaging. To assess the effectiveness of these pulse sequences, the lesion to cord ratio (LCR) and lesion to noise ratio (LNR) were calculated.
    Results
    The LCR and LNR of the T2 and PSIR were the same (LCR of 0.04, -0.03 and LNR of 2.74, -2.09 respectively), just the intensities were reverse. STIR had a significantly different LCR and LNR [0.23 (P < 0.001) and 22.7(P < 0.001) respectively], hence it was better in diagnosing cervical cord MS plaques.
    Conclusion
    According to the results, using 1.5 T MRI machine, it implies that the STIR pulse sequence was the best pulse sequence in comparison to T2 and PSIR in detecting cervical cord MS plaques.
    Keywords: MRI, Pulse Sequence, STIR, PSIR, LCR, LNR
  • Yasemin Kayadibi *, Fahrettin Kılıç, Omer Faruk Karatas, Sennur Ilvan, Emel Ure Esmerer, Turgut Kayadibi, Mehmet Halit Yılmaz Page 9
    Background
    Shear wave elastography (SWE) is a non-invasive and easily applicable imaging modality, which can provide quantitative information of tissue stiffness. Peritumoral high SWE elasticity values (stiff rim sign) has been reported in many studies. Lysyl oxidase (LOX) enzyme is implicated in the formation of peri-tumoral stiffness.
    Objectives
    The aim of the study was to investigate the correlation between SWE measures with LOX gene expression levels in breast cancer patients.
    Patients and
    Methods
    Forty seven women were included in the study. The lesions evaluated by SWE and ultrasound guided tru-cut biopsies were performed from both of the central and peripheral parts. SWE values, LOX family gene expression levels, histopathological features of the lesions, as well as axillary and distant metastasis statuses were evaluated statistically.
    Results
    Thirty of the patients had breast cancer (BC) (the patient group) and 17 of them had fibroadenoma (the control group). Lysyl oxidase like1 (LOXL1) expression level in BC samples (central parts) were found to be significantly higher than the control group (P = 0.022). Stiff rim sign was present in all BC lesions and none of the control group. The elastography values of the patient group were significantly higher than the control group statistically (P < 0.05). There was no statistically significant relationship between LOX, LOXL1, LOXL2 expressions and SWE parameters (P > 0.05) both for patient and control groups.
    Conclusion
    Although there were no significant correlations between LOX expressions and SWE parameters in our study, axillary and distant metastasis were found to be correlated with SWE features, which emphasized the prognostic potential of SWE.
    Keywords: Breast Cancer, Lysyl Oxidase, ShearWave Elastography, Genetics
  • Sahar Rabani Khorasgani *, Farhad Niaghi, Pooneh Dehghan Page 10
    Background
    The high prevalence of colorectal cancer (CRC) and its increasing incidence can be a major problem in cancer management. Preoperative staging plays a significant role in the therapeutic process, especially in CRC which has high risk for lung metastases.
    Objectives
    This study aimed to evaluate accuracy of chest X-ray (CXR) in comparison with chest CT (CCT) for diagnosing lung metastases in patients with CRC.
    Patients and
    Methods
    A cross sectional study was conducted of 377 patients with newly diagnosed CRC which were evaluated with CXR and CCT.
    Results
    CCT revealed normal/benign findings in 285 (75.6%), indeterminate nodules in 28 (17%) and suspicious nodules in 64 (17%) patients. Although CXR did not reveal any pulmonary metastatic lesions in of the 23 (7%) patients, the measure of agreement between CXR and CCT was good (0.64, P < 0.01) and CCT changed TNM staging in only eight (2%) patients. On logistic regression analysis, liver metastasis could increase the risk of pulmonary metastasis (P < 0.01).
    Conclusion
    The study suggested CCT for preoperative staging in CRC patients, especially at stages 3 and 4 in TNM staging and for liver metastases.
    Keywords: Colorectal Cancer (CRC), Chest CT (CCT), Chest X-Ray (CXR), Lung Metastases, Indeterminate Lung Lesions
  • Go Eun Yang, Eun, Kyung Kim, Min Jung Kim, Hee Jung Moon, Vivian Youngjean Park, Jung Hyun Yoo* Page 11
     
    Background
    Currently, there are no strict post-biopsy guidelines for managing stereotactic biopsy-proven benign lesions manifesting as microcalcifications on mammography without an accompanying mass.
    Objectives
    To evaluate whether short-term follow-up mammography contributes to the detection of early cancer for patients with microcalcification-only lesions that were diagnosed as benign stereotactic biopsy.
    Patients and
    Methods
    Two-hundred sixty-two microcalcification-only lesions in 259 women (mean age: 47.7 years) who were diagnosed as benign on stereotactic biopsy and been followed with mammography for at least 2 years were included. Serial mammograms were reviewed from the initial pre-biopsy mammograms to the most recent examination. Mammographic findings were designated as stable, decreased, or newly developed microcalcifications. Medical records of each patient were reviewed for clinical information and pathology results of additional biopsy or surgical procedures.
    Results
    Of the 262 microcalcifications diagnosed as benign on stereotactic biopsy, 258 (98.5%) were finally diagnosed as benign, one (0.4%) as high-risk lesion, and three (1.1%) as malignant. The three cancers were all diagnosed as ductal carcinoma in situ (DCIS) at 31, 36 and 6 months after initial biopsy. The DCIS diagnosed at 6 months post-biopsy had no mammographic changes, and was detected on breast ultrasonography, while the remaining two cases had no detectable findings on the short-term follow-up mammography.
    Conclusion
    Short-term follow-up mammography did not contribute in detecting additional breast cancers, and may have a limited role in patients diagnosed with benign-concordant microcalcifications on large-bore stereotactic biopsy.
    Keywords: Breast, Biopsy, Stereotactic Biopsy, Mammography, Microcalcifications
  • Sanaz Sharifi, Mahshid Razavi, Parisa Boostani Fard *, Ali Rohani, Shadi Hamidiaval, Naghme Niroomand Page 12
    Background
    New cone beam computed tomography (CBCT) devices have the ability to take images with different fields of views (FOVs) and resolutions. The larger the FOV and the higher resolution of the image, the higher the patient’s dose would be.
    Objectives
    This research aims to analyze the diagnostic accuracy of FOV’s different dimensions and the various resolutions in the diagnosis of mandibular condyle erosions.
    Methods
    CBCT images using NewTom VGi (Verona, Italy) system in five different FOVs and resolutions (voxel size) were taken from eight human dried mandibles in which the erosion-like lesions were created on both condyles. Imaging was performed before and after the formation of erosion; afterwards, the images were evaluated by two maxillofacial radiologists to analyze the absence or presence of the lesions. Resultant data was evaluated by SPSS V. 22.0, McNemar and Kappa statistical methods.
    Results
    The highest sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were attributed to 8 × 8 FOV and the lowest was attributed to 12 × 8 FOV. In analyzing different resolutions, the highest sensitivity, specificity, PPV, and NPV were attributed to high resolution (0.125 and 0.15 mm voxel size). There was no statistically significant difference between sensitivity, specificity, PPV, and NPV of different FOVs and different resolutions. Inter-observer and intra-observer cofficiency were at excellent range.
    Conclusion
    Considering there was no significant difference between the results, it is possible to use voxels in larger size to reduce patient’s dose in order to detect mandibular condyle erosions. In addition, FOV with lower patient’s dose is the method of choice.
    Keywords: Mandibular Condyle Erosions, CBCT NewTom VGi System, Voxel Size, FOV
  • Parinaz Mehnati, Reza Malekzadeh *, Mohammad Yousefi Sooteh Page 13
    Background
    The main problem with coronary computed tomography angiography (CCTA) scan is the extreme exposure of patients during imaging. Bismuth belt shield is a new design to minimize the received dose in CCTA.
    Objectives
    The purpose of this study was to design and construct new bismuth-silicon composite shields to reduce the risk of ionizing radiation during CCTA, along with an examination of the diagnostic capability of the image for the physician.
    Materials and Methods
    Dose reduction was calculated by placing thermoluminescent dosimeters (TLDs) in skin and glandular position for breast dose measuring in the multi detector CT. CCTA scans were performed with new 10% and 15% bismuth composite shields with 1 mm and 1.5 mm thicknesses. Image quality was assessed by CT numbers and noise evaluation.
    Results
    The breasts recorded dose without using shield were 7 - 8.90 mGy related to large or normal breasts and skin or glandular dose. The results of using 10% and 15% bismuth composite shields induced to dose reduction 9% - 31% depending on breast size, shield thickness and skin or gland position. There was a significant relationship between the reduction of breast doses and the thickness of the shields, bismuth weight percentage, the size of the breast and the dosimetry in the skin or gland. The mean noise increased from 8% to 33% in the breast position and from 4% to 25% in regions of Interest (ROIs) in locations of coronary arteries.
    Conclusion
    The new belt bismuth-silicon shields have the potential to reduce breast dose by conserving image quality for acceptable diagnosis in CCTA.
    Keywords: Belt Bismuth-Silicon Shield, Coronary CT Angiography, Breast Dose Reduction, Image Quality
  • Niloofar Yousefi, Ali Yaghobi Joybari, *, Ahmad Mostaar Page 14
    Background
    Nowadays, medical imaging has an important role in radiotherapy and treatment planning process. Despite the increasing usage of the magnetic resonance imaging (MRI) in the external radiotherapy (RT) design process, computer tomography (CT) remains a basic imaging modality in radiotherapy because of its relation with electron density value. In conventional external radiotherapy, MRI is used in functional tissue structures with registration on the CT image, which causes systematic errors during the registration of MRI and CT images.
    Objectives
    The main purpose of this paper was to investigate the possibility of removing the CT simulator and replacing it with pseudo-CT for the electron density calculation in radiotherapy treatment planning.
    Materials and Methods
    The pseudo-CT images were generated for 10 randomly chosen patients with brain disease. The data consisted of image voxels chosen within the segmented area of the brain in both MRI and CT images. The relationship between electron density information in CT images and MRI intensity value was derived from simple polynomial models.
    Results
    It was found that the MRI intensity value is related to the Hounsfield unit (HU) value within different parts including the skull bone, sinus, and brain in CT images. The mean errors of the conversion model were 0.7479, 0.334 and -0.043 HU in the brain, skull, and air regions respectively, with the simple polynomial model in the upper slice.
    Conclusion
    The proposed method generated pseudo-CT images from different segmented parts of the brain of MRI series. The application requires segmentation of the cortical bones in MR images. The result indicated that finding a complex model does not necessarily lead to achieving a better result.
    Keywords: Magnetic Resonance Imaging, Computed Tomography, Pseudo-CT, Radiotherapy Treatment Planning
  • Ozlem Gungor ORCID *, Nazan Ciledag Page 15
    Objectives
    Rapid and accurate risk assessment is critical in selecting the appropriate treatment strategy in the management of pulmonary embolism. This study was designed to assess the relationship between multidetector computed tomographic (MDCT) imaging and the pulmonary obstruction index, right ventricular dysfunction, and serum D-dimer levels in normotensive patients with pulmonary embolism.
    Patients and
    Methods
    In 74 patients with suspected pulmonary embolism (38 men, 36 women), two readers in consensus assessed the central clot score and the signs of right ventricular dysfunction using MDCT by quantifying right ventricular diameter (RVD), left ventricular diameter (LVD), the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV), and septal deviation.
    Results
    The patients were divided into three groups. Thirty five patients had negative CT pulmonary angiography (CTPA) and deep vein thrombosis (DVT) findings (group 1), 29 had positive CTPA and negative DVT findings of pulmonary embolism (PE) (group 2), and 10 patients had positive DVT and CTPA findings (group 3).Serum D-dimer levels were statistically higher in group 3 than in the other groups. It was found as 329.2 ± 46.9, 461.3 ± 70.5, and 1726.6 ± 543.5 in groups 1, 2, and 3 (P = 0.0001), respectively. We found a significant positive correlation between the lower extremity clot load score and the pulmonary artery obstruction index, and pulmonary artery clot volumes. The right ventricle (RV)/left ventricle (LV) short-axis ratio, azygos vein diameter, the RV wall thickness (RVW), reflux of contrast medium into the inferior vena cava (IVC), leftward septal bowing, and interventricular septal thickness were statistically different in group 1 compared to groups 2 and 3.
    Conclusion
    Evaluation of the total pulmonary artery clot load and morphologic findings of the right heart obtained using CTPA are extremely important in order to follow up patients with suspected venous thrombosis. Keywords: clot load; pulmonary embolism; right heart failure; severity.
    Keywords: Clot Load, Pulmonary Embolism, Right Heart Failure, Severity
  • Furkan Ufuk O *, Furkan Kaya, Duygu Herek, Ergin Sagtas, Pinar Cakmak, Ahmet Baki Yagci Page 16
    Background
    Increased right ventricle-to-left ventricle (RV/LV) ratio on computed tomography pulmonary angiography (CTPA) has been reported as a poor prognostic indicator in patients with acute pulmonary embolism (PE). It has also been reported that pulmonary vein sign (PVS) on CTPA is a rare finding of PE.
    Objectives
    To evaluate PVS on CTPA and unenhanced magnetic resonance imaging (MRI) in patients with PE suspicion. We also aimed to investigate the relationship between the severity of PE and presence of PVS, RV/LV ratio and combination of these two on unenhanced MRI.
    Patients and
    Methods
    One-hundred-twelve patients with PE suspicion who underwent CTPA and unenhanced-MRI [steady state free precession (SSFP)] within the first 48-hours constituted the study group. All CTPA images were evaluated for the presence, location and severity of PE by observer-1. Two observers (observer-2 and 3), independently evaluated unenhanced-MR images for the presence of PVS without knowing the results of CTPA. Then, these 2 observers reviewed the CTPA and MRI images together with observer-4 to reach the final consensus for the presence of PVS and measurement of RV/LV ratio. Cohen’s Kappa analysis was used to assess the agreement between observers. Relationship between the mean PE index and imaging findings (PVS, RV/LV) were calculated.
    Results
    Presence of PVS on CT or MRI is significantly correlated with PE index and patients with PVS had more severe PE than those without. Presence of both PVS and RV/LV ratio > 1 on MRI indicates more severe pulmonary embolism than absence of PVS or RV/LV ratio > 1. There was a very good agreement for the detection of PVS between two observers on unenhanced MRI.
    Conclusion
    PVS on CTPA or unenhanced MRI can be used as a sign of severe PE and it may also be an indicator of right heart dysfunction.
    Keywords: Pulmonary Thromboembolism, CT Angiography, Magnetic Resonance Imaging, Pulmonary Vein, Severity of Illness Index
  • Wenting Fan , Jiaan Zhu *, Zheng Chen, Wenxue Li Page 17
    Background
    Gout is the most common form of inflammatory arthritis. Unfortunately, the burden of gout is increasing and treatment is still suboptimal. Nowadays, ultrasound is increasingly used to evaluate gout, especially in the early stage. However, little is known about the prevalence of the ultrasound signs in the first gout attack.
    Objectives
    The aim of this study was to evaluate the prevalence of ultrasound features in the first gout attack and to correlate those features with the duration of hyperuricemia.
    Patients and
    Methods
    We analyzed the ultrasound features of the knees, ankles and the first metatarsal-phalangeal joints (1st MTP) of patients with first gout attack compared to individuals with asymptomatic hyperuricemia (AHU). The findings were also compared with clinical, laboratory parameters and hyperuricemia duration.
    Results
    Forty-eight patients with first gout attack gout were studied. The first attack affected the first MTP in 61%, the ankle in 33%, and the knee in 6% of the instances. The prevalence of snow-storm sign, double contour (DC) sign, tophi, bone erosion and abnormal blood flow was 92%, 29%, 6%, 13% and 83%, respectively. The prevalence of snow-storm sign and abnormal blood flow was significantly higher in the first attack of gout compared to AHU (P < 0.001). The hyperuricemia duration of patients with tophi and bone erosion was significantly longer than those with snow-storm sign and DC sign (7.5y and 6.5y vs 4.0y and 2y) (P = 0.004).
    Conclusion
    Ultrasound features are associated with hyperuricemia duration. Furthermore, tophi and bone erosion can be detected in first gout attack. These data suggest that low-grade inflammation induced by uric acid may also occur in individuals with AHU.
    Keywords: Ultrasound, Gout, First Attack, Hyperuricemia, Duration
  • Elif Gündoğdu *, Mahmut Kebapçı Page 18
     
    Background
    Sex determination from skeletal bones is very important, especially for forensic science and anthropology. Radiological techniques are commonly used for this purpose.
    Objectives
    This study aimed to evaluate the accuracy rate of the subpubic angle and width-length ratio of foramen obturatum (FO) in sex determination and determine the cut-off values for differentiation between genders.
    Patients and
    Methods
    Three-dimensional (3D) volume-rendered images were obtained from the pelvic CT scans of 100 patients (50 female, 50 male). The subpubic angle was automatically measured on these images using image analysis software. The maximum width and height of FO were recorded and their ratio were calculated.
    Results
    The subpubic angle was between 75.9 and 101.2 in females (mean: 82.92 ± 15.06) and, 47.4 and 91.5 in males (mean: 67.91 ± 9.15). The accuracy rate of the subpubic angle in determining sex was 96%. For the best cut-off value of 79.45 on the subpubic angle, the parameters for sex determination were as follows: sensitivity 84%, specificity 74%, positive predictive value (PPV) 76%, and negative predictive value (NPV) 82%. The aspect ratio of FO was 0.48 - 0.74 (mean: 0.60 ± 0.039) for the right side and 0.48 - 0.72 (mean: 0.60 ± 0.054) for the left side in females, and 0.45 - 0.68 (mean: 0.55 ± 0.058) for the right side and 0.45 - 0.69 (mean: 0.54 ± 0.052) for the left side in males. For the best cut-off value of 0.615 on the right side, the parameters for sex determination were as follows: sensitivity 84%, specificity 74%, PPV 76%, and NPV 82%. The accuracy rate of the right-side FO in sex determination was 79%. For the best cut-off value of 0.635 on the left side, the parameters for sex determination were as follows: sensitivity 98%, specificity 32%, PPV 59%, and NPV 94%. The accuracy rate of the left-side FO in sex determination was 65%.
    Conclusions
    The subpubic angle and aspect ratio of foramen obturatum parameters have high accuracy in determining sex.
    Keywords: Subpubic Angle, Foramen Obturatum, Multidetector Computed Tomography, Sex Determination, Anthropometry, Accuracy Rate
  • Woo Jin Yang, Jung Im Kim *, Eun, Sun Jin, Han Na Lee, So Youn Shin Page 19
    Noncompaction of ventricular myocardium, once thought to represent a rare cardiomyopathy, is being diagnosed with increased frequency. It is often accompanied by various congenital heart diseases. Coexisting valvular anomalies are an emerging issue that requires further investigation in patients with noncompaction cardiomyopathy, because they can increase the potential for adverse clinical events. This article describes the case of a 45-year-old male diagnosed with left ventricular noncompaction (LVNC) with a bicuspid aortic valve. Progressive deterioration of cardiac function in this patient could be explained by myocardial fibrosis and accompanying valvular anomalies on cardiac magnetic resonance imaging (MRI). The clinical implications of cardiac MRI in noncompaction cardiomyopathy are discussed based on its ability to depict both morphological and functional features. Considering the potential for coexisting congenital heart disease to declines in cardiac function, patients with LVNC should be comprehensively evaluated for concurrent cardiac anomalies and myocardial fibrosis.
    Keywords: Noncompaction, Bicuspid Aortic Valve, Magnetic Resonance Imaging, Echocardiography, Transesophageal
  • Seung Min Kang, Shin Young Kim *, Sun Huh, Si Hyong Jang Jong Eun Lee Page 20
    A malignant phyllodes tumor is a rare disease of the breast that usually differentiates into fibrosarcoma, with liposarcomatous differentiation rarely being reported. In general, malignant phyllodes tumors appear as hypoechoic lesions on ultrasonography examination, and have rarely been reported as hyperechoic tumors. Here, we present an extremely rare case of a 62-year-old woman with a palpable mass that was diagnosed as a malignant phyllodes tumor with liposarcomatous differentiation, seen as an unusual hyperechoic mass on ultrasonography. She underwent resection and biopsy, and there was no evidence of tumor recurrence on follow-up examinations. Radiological explanations of this case are presented in detail, and the possible associations between hyperechoic appearance and liposarcomatous differentiation are described. Through our case report, we can identify several potential rare features of various and unpredictable phyllodes tumors.
    Keywords: Breast, Phyllodes Tumor, Malignant Phyllodes Tumor, Mammography, Ultrasonography