Thyroid Image Reporting and Data System Categorization: Effectiveness in Pediatric Thyroid Nodule Assessment

Ultrasonography (US) is the main imaging method to assess thyroid nodules. In the pediatric population, thyroid nodules are less prevalently seen than those in adults. However, approximately 25% of the nodules can be malignant. Validation of Thyroid Image Reporting and Data System (TI-RADS) classification has been mostly tested in adults, and information on pediatric cases is limited. In the current study, we aim to define the diagnostic power of the TI-RADS risk stratification method in pediatric thyroid nodules.The study population consists of 68 nodules of 64 patients (20 malignant, 48 benign). We have included patients at least 18 years and with a pathological diagnosis. The researchers evaluated the US images of the patients, if available. If US images cannot be found, US reports of the patients were evaluated to define TI-RADS points and category.Mean age of the population is 15.15 ± 2.66 years. There were 10 (17.7%) male patients and 58 (85.3%) female patients. Median nodule size was 8 mm. Final diagnosis was benign in 48 nodules (70.6%) and malignant in 20 nodules (29.4%). There were 5 follicular carcinoma cases and 15 papillary carcinoma cases. The area under the curve estimate was 0.89 (95% confidence interval, 0.80-0.98), and the area under the curve value confirmed the diagnostic efficacy of TI-RADS categorization in pediatric thyroid nodules. A TI-RADS category of 4 or 5 seemed to be a good cutoff point to predict malignancy.To conclude, TI-RADS categorization can be effectively used to assess pediatric thyroid nodules. Nodules with TI-RADS categories of 4 and 5 have the greatest risk of malignancy, and they should be evaluated pathologically.

Lung perfusion changes in COVID-19 pneumonia: a dual energy computerized tomography study

OBJECTIVE

There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings.

METHODS

Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant.

RESULTS

Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation.

CONCLUSIONS

Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity.

ADVANCES IN KNOWLEDGE

Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.

Computed tomography at every step: Long coronavirus disease

BACKGROUND

Some patients continue to experience symptoms related to Coronavirus disease (COVID-19) after the acute phase of infection. Imaging studies, especially computed tomography (CT) of the chest, have gained importance since the beginning of the pandemic. CT can help diagnose COVID-19, assess the extent of pulmonary involvement, and predict the disease severity. We aimed to define the frequency of persistent symptoms and correlate their presence with the results of laboratory findings and the severity of the disease based on the findings of chest CT.

METHODS

We examined patients discharged from the hospital after treatment for COVID-19 and whose nasopharyngeal swab sample tested positive for severe acute respiratory syndrome coronavirus 2 after at least 4 weeks from the initial diagnosis. The patients were asked about the presence of persisting symptoms. In addition to the demographic data, laboratory results and severity levels seen on the chest CT were recorded.

RESULTS

In all, 116 patients were included in the study, of which 61 reported at least one persisting symptom (52.5%). The mean age of the study population was 48.90 ± 17.74 years. The persistent symptoms included shortness of breath, chest pain, cough, muscle weakness, dizziness, headache, fatigue, and palpitations. The mean CT severity score was 3.80 ± 0.38 and it was lower in patients without any persistent symptoms.

CONCLUSIONS

Levels of C-reactive protein and fibrinogen, anemia, and female sex were associated with some of the persistent symptoms., the severity of the disease seen on CT was a successful predictor for the disease severity/prognosis and was also correlated with prolonged COVID infection and more persistent symptoms.

Spontaneous Isolated Celiac Artery and Superior Mesenteric Artery Dissections: A Rare Case

BACKGROUND

Arterial dissection is defined as the cleavage of the arterial wall by an intramural hematoma. Reports of dissection of the celiac and/or superior mesenteric artery are rare; as far as we know, only 24 cases of spontaneous isolated celiac trunk dissection, and 71 cases of spontaneous isolated superior mesenteric artery dissection have been reported.

CASE REPORT

The case presents a 48-year-old male with a sudden-onset epigastric pain. A Computed Tomography Angiography of the thoracoabdominal aorta was applied and dissections of both the celiac artery and SMA were determined. A conservative therapeutic approach was preferred and the patient was discharged with anticoagulant and antihypertensive therapy.

CONCLUSIONS

Although rare, spontaneous isolated celiac artery and superior mesenteric artery dissections must be kept in mind in the differential diagnosis of the epigastric pain in the emergency room. Contrast-enhanced Computed Tomography Angiography examination is the method of choice in the diagnosis.

Intrathyroidal ectopic thymus tissue: a diagnostic challenge

OBJECTIVES

The prevalence of thyroid nodules in pediatric population is 0.2-2%, which is lower than adults. However, the probability of the nodule to be malignant is higher than adults (20-73%). Differential diagnosis of thyroid lesions in children includes intrathyroidal ectopic thymus tissue (ITT). ITT can present as a thyroid nodule, and be confused with malignancy with its hyperechoic pattern; this might cause unnecessary fine-needle aspiration biopsies and/or surgical interventions. In the current study, we mainly aim to define both US and color Doppler ultrasonography (CDUS) characteristics of ITT. We also aim to describe the most sensitive and most specific diagnostic parameters of ITT.

METHODS

We have evaluated US examination reports of 56 children for whom differential diagnosis included ITT between February 2015 and August 2018. We have recorded sonographic characteristics of the lesions, CDUS data, and thyroid hormone levels.

RESULTS

Study population consists of 56 patients (22 ITT, 34 other diagnoses). Median age of the population is 10 years. Age, sex, laboratory results, and follow-up change in lesion diameters do not show any significant difference between ITT and other diagnosis groups. Typical US appearance, fusiform lesion shape, and isovascular CDUS characteristics are higher in ITT group. The median value of the lesion's highest diameter is smaller in ITT group. The most valuable criteria to predict ITT presence were the fusiform shape and the longest diameter of the lesion.

CONCLUSIONS

Fusiform shape and a maximum diameter of ≤ 9 mm are the most selective criteria to predict ITT diagnosis.

Magnetic Resonance Imaging in Orbital Pathologies: A Pictorial Review

Orbital lesions form a wide range of pathologies, that create challenges in diagnosis, management, and treatment. The high-resolution soft tissue detail provided by magnetic resonance imaging (MRI) has allowed for better lesion characterization. Especially in cases where history and clinical evaluation are insufficient, MRI plays a crucial role. MRI is also important in the detection of the extent of orbital diseases. The aim of this study was to examine the MRI characteristics of common and/or rare diseases arising from or extending into the orbita to aid radiologists in the correct diagnosis of orbital lesions.

X-ray Use in Chest Imaging in Emergency Department on the Basis of Cost and Effectiveness

RATIONALE AND OBJECTIVES

The increasing use of imaging in the emergency department (ED) services has become an important problem on the basis of cost and unnecessary exposure to radiation. Radiographic examination of the chest has been reported to be performed in 34.4% of ED visits, and chest computerized tomography (CCT) in 15.8%, whereas some patients receive both chest radiography and CCT in the same visit. In the current study, it was aimed to establish instances of medical waste and unnecessary radiation exposure and to show how the inclusion of radiologists in the ordering process would affect the amount of unnecessary imaging studies.

MATERIALS AND METHODS

This retrospective study included 1012 ED patients who had both chest radiography and CCT during the same visit at Ankara Training and Research Hospital between April 2015 and January 2016. The patients were divided into subgroups of trauma and nontrauma. To detect unnecessary imaging examinations, data were analyzed according to the presence of additional findings on CCT images and the recommendation of a radiologist for CCT imaging.

RESULTS

In the trauma group, 77.1% (461/598) and in the nontrauma group, 80.4% (334/414) of patients could be treated without any need for CCT. In the trauma group, the radiologist recommendation only, and in the nontrauma group, both the radiologist recommendation and the age were determined to be able to predict the risk of having additional findings on CCT.

CONCLUSIONS

Considering only the age of the patient before ordering CCT could decrease the rate of unnecessary imaging. Including radiologists into both the evaluation and the ordering processes may help to save resources and decrease exposure to ionizing radiation.

Pediatric Emergency Care Applied Research Network head injuryprediction rules: on the basis of cost and effectiveness

Background/aim: Head injuries are commonly seen in the pediatric population. Noncontrast enhanced cranial CT is the method of choice to detect possible traumatic brain injury (TBI). Concerns about ionizing radiation exposure make the evaluation more challenging. The aim of this study was to evaluate the effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules in predicting clinically important TBI and to determine the amount of medical resource waste and unnecessary radiation exposure.Materials and methods: This retrospective study included 1041 pediatric patients presented to the emergency department. The patients were divided into subgroups of "appropriate for cranial CT", "not appropriate for cranial CT" and "cranial CT/observation of patient; both are appropriate". To determine the effectiveness of the PECARN rules, data were analyzed according to the presence of pathological findings Results: "Appropriate for cranial CT" results can predict pathology presence 118,056-fold compared to the "not appropriate for cranial CT" results. With "cranial CT/observation of patient; both are appropriate" results, pathology presence was predicted 11,457-fold compared to "not appropriate for cranial CT" results.Conclusion: PECARN rules can predict pathology presence successfully in pediatric TBI. Using PECARN can decrease resource waste and exposure to ionizing radiation.

Optimizing the Time for Developmental Dysplasia of the Hip Screening: Earlier or Later?

INTRODUCTION

Developmental dysplasia of the hip (DDH) is still a common and important disorder of childhood, with a prevalence of 0.1 to 2/1000 children. Using ultrasonography (US) in screening of DDH reduces the rates of open reductions and complications. In the current study, we aim to detect the optimal time for US examination for detecting DDH to prevent unnecessary repeating US examinations and treatments.

METHODS

Children referred to US examination for a healthy child screening program, according to the health policy of our country, are included in the current prospective study. Both hips of each child were sonographically examined by the same radiologist using Graf's method at 4th, 8th, 12th weeks of life.

RESULTS

A total of 2020 hips of 1010 children were examined. Fourth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 75.7%; left hip: sensitivity 100%, specificity 78.3%). Eighth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 87.5%; left hip: sensitivity 100%, specificity 83.9%). In predicting 12th-week US results, 8th-week results are found to be more successful than 4th-week results.

CONCLUSIONS

Late diagnosis of DDH might cause serious public health problems. On the other hand, early US examinations can result in false-positive diagnosis. Unfortunately, there is still confusion about the optimal time for DDH screening with US, especially among radiologists who are not specialized in DDH sonography. A US scan performed at eighth week of life can predict any pathology presence safely and correctly.

Fetal Epicardial Fat Thickness: Can It Serve as a Sonographic Screening Marker for Gestational Diabetes Mellitus?

BACKGROUND

Gestational diabetes mellitus (GDM) is defined as the new onset of impairment in carbohydrate tolerance during pregnancy. The aim of the current study was to define fetal epicardial fat thickness (fEFT) changes that developed before 24 weeks of gestation, to evaluate the diagnostic effectiveness of fEFT in predicting GDM diagnosis, and to correlate fEFT values with hemoglobin A1C (HbA1C) values.

METHODS

The study included a total of 60 GDM patients and 60 control subjects. A record consisted of fEFT measurements, maternal body mass index, maternal subcutaneous fat thickness, and fetal subcutaneous fat thickness during sonographic screening performed at 18-22 gestational weeks. Fetal abdominal circumference (AC) values, estimated fetal weight (EFW), and fetal gender were also recorded.

RESULTS

The median fEFT measurement of the whole study population was 0.9 ± 0.21 mm; 1.05 ± 0.21 mm in the GDM patients, and 0.8 ± 0.15 mm in the control group. The median fEFT values of the GDM patients were significantly higher than those of the control group (P < 0.01). According to the correlation analysis results, a strong positive correlation was determined between the fEFT and HbA1C values (r = 0.71, P < 0.01), gestational week of the fetus (r = 0.76, P = P < 0.01), AC (r = 0.81, P < 0.01), and EFW (r = 0.71, P < 0.01). According to the receiver operating characteristic analysis results, a fEFT value of > 0.95 can predict GDM diagnosis with sensitivity of 65% and specificity of 88% (odds ratio = 13).

CONCLUSION

fEFT values are increased in GDM cases, and the increase can be detected earlier than 24 weeks of gestation. fEFT values are positively correlated with HbA1C values and can serve as an early predictor for GDM diagnosis.

Role of natural products and intestinal flora on type 2 diabetes mellitus treatment

Diabetes mellitus (DM) is a complicated, globally expanding disease that is influenced by hereditary and environmental variables. Changes in modern society's food choices, physical inactivity, and obesity are significant factors in the development of type 2 DM (T2DM). The association between changes in intestinal flora and numerous disorders, including obesity, diabetes, and cardiovascular diseases, has been studied in recent years. The purpose of this review is to analyze the mechanisms underlying the alteration of the diabetic patients' intestinal flora, as well as their therapeutic choices. Also included is a summary of the anti-diabetic benefits of natural compounds demonstrated by studies. The short-chain fatty acids theory, the bile acid theory, and the endotoxin theory are all potential methods by which intestinal flora contributes to the establishment and progression of T2DM. Due to an intestinal flora imbalance, abnormalities in short-chain fatty acids and secondary bile acids have been found in diabetic patients. Additionally, metabolic endotoxemia with altering flora induces a systemic inflammatory response by stimulating the immune system via bacterial translocation. The agenda for diabetes treatment includes the use of short-chain fatty acids, probiotics, prebiotics in the diet, fecal bacteria transplantation, and antibiotics. Animal studies have proven the antidiabetic benefits of numerous bioactive substances, including Flavonoids, Alkaloids, Saponin, and Allicin. However, further research is required to contribute to the treatment of diabetes.

Perfusion and permeability MRI in glioma grading

Background

MRI is successful in showing the anatomy of probable pathologies of the central nervous system. Although it may not be sufficient to reveal physiological and metabolic changes, advanced MRI techniques, such as perfusion and permeability MRI, are the key to overcoming these limitations. The aim of this study was to detect the efficacy of permeability and perfusion MRI techniques.

Results

The study included 38 patients with a pathology result of primary brain glioma. The permeability MRI (Ktrans, Ve), perfusion MRI values (CBV, CBF), and pathology results were evaluated. The high-grade group included 22 patients, and the low-grade group, 16 patients. Mean CBV and CBF, median Ktrans, and Ve values were higher in the high-grade group. All parameters tended to elevate with grade and had a positive correlation. CBV > 2.25, with sensitivity and specificity of 100%, CBF > 2.02, with sensitivity and specificity of 100%, Ktrans > 0.043, with sensitivity of 81.82% and specificity of 100%, and Ve > 0.255, with sensitivity and specificity of 100%, can predict high grade.

Conclusion

Perfusion and permeability MRI can be used safely for the differentiation of high- and low-grade gliomas and for the prediction of glioma grades.

Diagnosing Small for Gestational Age during second trimester routine screening: Early sonographic clues

OBJECTIVE

Small for gestational age (SGA) is generally defined as birth weight being at or below the 10th percentile. Children with SGA have a higher risk for complications. There is a need for early predictors, as the accurate diagnosis rate is only 50%. In the current study, we aimed to evaluate diagnostic performance of ultrasound (US)/color Doppler ultrasound (CDUS) parameters (umbilical vein-UV, right portal vein-RPV diameter/flow rate, and portal sinus-PS diameter) examined at 20-22 gestational week as SGA diagnostic factors.

MATERIALS AND METHODS

93 pregnant included (32 SGA, 61 controls). All the US examinations were performed between 20 and 22 weeks of gestation. UV, RPV, and PS measurements were performed by using the same image acquired for abdominal circumference measurement. A fetus with as estimated fetal weight (EFW) below the 10th percentile was diagnosed as SGA and SGA at birth was defined as having a birth weight under the 10th percentile.

RESULTS

Pregnant women in the SGA group were significantly older (30 ± 4.8 vs. 26.6 ± 5.4 years, p < 0.01). Median UV diameter was significantly lower in SGA group (2.20 vs. 2.40 mm, p = 0.001). Median RPV diameter was significantly lower in SGA group (2 vs. 2.10 mm, p = 0.018). Median PS diameter was significantly lower in SGA group (2 vs. 20.10 mm, p = 0.008).

CONCLUSION

UV, RPV, and PS diameters can be earlier predictors for SGA diagnosis. Routinely evaluation of these parameters during second trimester screening can increase SGA diagnosis rates and serve for early diagnose.

Imaging Aspects of Hepatic Alveolar Echinococcosis: Retrospective Findings of a Surgical Center in Turkey

Radiologists should be aware of the findings of alveolar echinococcosis (AE) due to the diagnostic and management value of imaging. We are attempting to define the most common diagnostic imaging findings of liver AE, along with the prevalence and distribution of those findings. The patients' US, CT, and MRI images were reviewed retrospectively. CT images were acquired with and without the administration of contrast medium. The MRI protocol includes T2-weighted images (WI), diffusion (WI), apparent diffusion coefficient (ADC) maps, and pre- and post-contrast T1WIs. The current study included 61 patients. The mean age of the population was 58.2 ± 9.6 years According to Kratzer's categorization (US), 139 lesions (73.1%) were categorized as hailstorm. According to Graeter's classification (CT), 139 (73.1%) lesions were type 1-diffuse infiltrating. The most frequent types were Kodama type 2 and 3 lesions (MRI) (42.6% and 48.7%, accordingly). P2N0M0 was the most frequent subtype. The current study defines the major, characteristic imaging findings of liver AE using US, CT, and MRI. Since US, CT, and MRI have all been utilized to diagnose AE, we believe that a multi-modality classification system is needed. The study's findings may aid radiologists in accurately and timely diagnosing liver AE.

Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely?

PURPOSE

Lymphoid hyperplasia can be an important mimicker of acute appendicitis by creating a non-compressible appendix more than 6 mm in diameter. The aim of this study was to evaluate methods of distinguishing lymphoid hyperplasia and appendicitis on the basis of sonography, lamina propria thickness, and Alvarado scoring.

METHODS

This retrospective study included 259 patients (142 appendicitis, 117 lymphoid hyperplasia). The US (ultrasound) reports of the patients were reviewed and the maximum diameter of the appendix, the presence or absence of increased echogenicity of the surrounding pericaecal fat, local fluid collection, the presence of reactive lymph nodes in the periappendiceal area, and mural hyperemia within the appendix were recorded.

RESULTS

The use of additional sonographic criteria, lamina propria thickness (≤1 mm is indicative for appendicitis), or Alvarado scoring (>6 mm is indicative for appendicitis) provided a true-positive diagnosis for acute appendicitis.

CONCLUSION

The presence of local fluid collection in the periappendiceal area and a lamina propria thickness ≤ 1 mm are the most successful parameters for distinguishing appendicitis from lymphoid hyperplasia.

MRI in Evaluation of Solitary Pulmonary Nodules

OBJECTIVES

The aim of this study is to assess magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), T2-weighted image (T2WI), and apparent diffusion coefficient (ADC) maps' threshold values before computed tomography (CT)-guided transthorasic biopsy in solitary pulmonary nodules (SPN) by describing tumoral cell density.

MATERIALS AND METHODS

Patients who had SPN were prospectively evaluated with MRI (T1WI, T2WI) and DWI (b=0, b=500, b=1000).The ADC maps were created for each patient. Before the biopsy, lesion muscle ratios (LMR) at T2WI, ADC value, and lesion spinal cord ratio at each b values were noted. The measurements were correlated with the histopathological results.

RESULTS

A total of 53 patients were included in the study: 30.2% (n=16) were female, and 69.8% (n=37) were male. Among them, 17 lesions (32.1%) were benign, and 36 lesions (67.9%) were malignant. The age varied between 40 and 82 years, with a mean of 61.7±9.1 years. The SPN diameters were between 10 and 30 mm, and the median was 24 mm. The LSR0 and LMR values were not statistically significant in detecting malignancy. LSR500 >0.53 value can predict malignancy with 100% sensitivity and 70.6% specificity. LSR1000 >0.53 can predict malignancy with 88.9% sensitivity and 88.2% specificity. Setting the cut-off value at 0.9×10-3, the ADC values had a sensitivity of 72.2% and a specificity of 88.2% for predicting malignancy.

CONCLUSION

For SPN follow-up, a new following-up protocol can be safely established using DWI and ADC mapping. Using these MRI parameters might decrease unnecessary biopsy rates and complications of biopsies.

Normal palatine tonsil size in healthy children: a sonographic study

OBJECTIVES

Magnetic resonance imaging (MRI) and computerized tomography (CT) have been widely used to assess palatine tonsils. However, these imaging modalities have some limitations, such as high costs, need for sedation, and exposure to ionizing radiation. Ultrasound has been increasingly used to diagnose tonsillar pathologies. We aim to define normal tonsil size and volume of healthy children according to age.

METHODS

A total of 274 healthy children were included. Both right and left tonsil sizes were measured in anteroposterior (AP), transverse (Tr.), and longitudinal (Long.) planes. Patients were divided into six subgroups according to their age, and analysis was performed for these subgroups. Age, sex, height, weight, and body mass index were recorded to find possible correlations.

RESULTS

Median age of the whole population was 7 years (0-16 years). Mean tonsil volume is 1.5 ± 0.9 cm3 for right and left sides. We cannot detect any significant correlation between PT values and sex. We detected a significant positive correlation between PT values and height, weight and BMI.

CONCLUSION

US can be used as a diagnostic tool for PT pathologies. PT size correlates with age, height, weight, and BMI; however, no correlation is present for sex and side.

Normal pancreatic thickness values in healthy children: an MRI study

INTRODUCTION

Normal pancreatic thickness values on ultrasound (US) have been defined in literature. However, there is insufficient information about normal pancreatic measurements acquired from computed tomography (CT) or magnetic resonance imaging (MRI). To define normal pancreatic thickness measurements acquired from different localizations in order to provide reference values for more objectively identified parenchymal thickness changes.

MATERIALS AND METHODS

A retrospective evaluation was made of the abdominal MRI examinations of 162 pediatric patients. Patients with any pancreatic disease, or chronic gastrointestinal inflammatory disease were excluded from the study. Measurements were taken from T2-weighted images.

RESULTS

Evaluation was made of 162 children, comprising 82 (50.6%) males and 80 (49.3%) females with a mean age of 9.8 ± 2.4 years. Mean pancreatic thickness was 18.3 ± 3.1 mm, 10.2 ± 2.9 mm, 14.9 ± 3 mm, 14.9 ± 3.3 mm in head, neck, body and tail localizations, accordingly. A positive correlation was determined between age, height, weight, body mass index (BMI) and pancreatic thickness in all the anatomic localizations (r > 0.55, p < 0.05). No significant difference was determined with gender. Interobserver agreement between two researchers was moderate and strong according to the different anatomic localizations.

CONCLUSIONS

The defined normal ranges are mostly consistent with previously published US and CT based values. Pancreatic thickness values were positively correlated with age, height, weight and BMI for all four anatomical regions of the pancreas. Knowledge of normal pancreatic thickness values will increase the diagnostic accuracy of radiologists in the assessment of pancreatic diseases and may aid in interpreting atrophy in the setting of chronic pancreatitis.

Are we aware of radiation: A study about necessity of diagnostic X-ray exposure

BACKGROUND

Total exposure to ionizing radiation has nearly doubled in the last two decades. This increase is primarily due to increased computed tomography (CT) exposure. Concerns have been raised about the risks associated with patients' exposure to medical imaging radiation, which can increase a person's lifetime risk of developing cancer. Preventing unnecessary examinations becomes critical at this point. To avoid unnecessary examinations, it is necessary to understand the demanding process.

AIM

To ascertain clinicians' awareness of and reasons for requesting a CT examination.

METHODS

We developed an online questionnaire that included 20 questions about clinicians' awareness of radiation safety and their reasons for requesting a CT examination, as well as demographic information such as age, gender, and year of medical practice experience. Additionally, we asked participants the number of CT scans requested in a month, the patients' questions and approaches about the imaging method, the effect of the patient's previous imaging history on the current imaging request, whether they believed that they had sufficient information about radiation doses, and whether they requested CT without an indication. We administered the questionnaire to clinicians from a variety of different professions in four different cities.

RESULTS

A total of 195 clinicians participated. Internal medicine specialists were the most crowded group (38/195, 19.5%). Mean age of the population was 33.66 ± 5.92 years. Mean year of experience was 9.01 ± 5.96. Mean number of requested CT scans in a month was 36.88 ± 5.86. Forty-five (23.1%) participants stated that they requested CT scans without clinical indication. The most common reasons for CT scan requests were work load, fear of malpractice, and patient demand/insistence.

CONCLUSION

CT scan requests are influenced by a variety of factors, both internal and external to the doctors and patients. Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.

Detection of tracheal branching with computerized tomography: The relationship between the angles and age-gender

BACKGROUND

The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis, treatment and interventional interventions in areas such as anesthesia, thoracic surgery, pulmonary physiology.

AIM

To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography (CT) and minimum intensity projection (MinIP) technique, which is a non-invasive method.

METHODS

Our study was carried out retrospectively. Patients who underwent contrast and non-contrast CT examination, whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained, were included in the study. Measurements were made in the coronal plane of the lung parenchyma. In the coronal plane, right main bronchus-left main bronchus angle, right upper lobe bronchus-intermedius bronchus angle, right middle lobe bronchus-right lower lobe bronchus angle, left upper lobe bronchus-left lower lobe bronchus angle were measured.

RESULTS

The study population consisted of 1511 patients, 753 pediatric (mean age: 13.4 ± 4.3; range: 1-18 years) and 758 adults (mean age: 54.3 ± 17.3; range: 19-94 years). In our study, tracheal bifurcation angle was found to be 73.3° ± 13.7° (59.6°-87°) in the whole population. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls (74.6° ± 12.9° vs 71.2° ± 13.9°, P = 0.001). In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9° ± 12.9° vs 75.8° ± 14.7°, P < 0.001).

CONCLUSIONS

Our study, with the number of 1511 patients, is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data, measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique. Study data will not only be a guide during invasive procedures, but it can also guide studies to be done with imaging methods.

Pediatric acute appendicitis: Searching the diagnosis in portal vein

INTRODUCTION

Acute appendicitis is the most common reason for emergency abdominal surgery in the pediatric population. Ultrasound (US) is a widely used modality to diagnose acute appendicitis. The aim of this study was to evaluate the effectiveness of portal vein diameter and flow velocity in acute appendicitis diagnosis.

METHODS

Portal vein diameter and flow velocity were measured in children who were referred to radiology with a clinical diagnosis of acute appendicitis. The largest appendix diameter and leukocyte count of the patients were recorded. A control group was created which consisted of healthy children, and their portal vein diameter and flow velocities were also measured.

RESULTS

The median age of the population was 10 years (range, 3-17 years). Mean portal vein diameter was 7.53 ± 1.55 mm in the control group, 7.92 ± 1.88 mm in the other diagnosis group, and 8.76 ± 1.91 mm in the acute appendicitis group. Mean portal vein diameter was significantly higher in the acute appendicitis group (p = 0.001). Median portal vein flow velocity was 17 cm/s (10-29 cm/s) in the control group, 18.3 cm/s (8-27 cm/s) in the other diagnosis group, and 20.5 cm/s in the acute appendicitis group. Median portal vein flow velocity was significantly higher in the acute appendicitis group (p = 0.00).

CONCLUSION

Detecting an increase in portal vein diameter and/or flow velocity in equivocal cases may support other clinical signs associated with acute appendicitis. Portal vein diameter and flow velocity can serve as additional diagnostic markers in acute appendicitis cases.

The pneumatization of the sphenoid sinus, its variations and relations with surrounding neurovascular anatomic structures: A computerized tomography study

INTRODUCTION AND OBJECTIVES

The wide range of variability of SS pneumatization and relation with surrounding structures can result in serious complications; seeing that, the assessment of regional anatomy is essential for both surgeons and radiologists. We mainly aim to reveal the possible correlation between the SS pneumatization types and protrusion/dehiscence of the adjacent neurovascular structures in a larger population by using computerized tomography (CT) images.

METHODS

The type of SS pneumatization (I-IV), pneumatization of anterior clinoid process (ACP), greater wing of sphenoid (GWS), and pterygoid process (PP) was evaluated. Protrusion and dehiscence of ICA, ON, MN, and VN was noted.

RESULTS

1003 patients were included into the study. ICA, ON, and MN protrusions were not seen in patients with the type I or II SS on both sides. These protrusions were most frequently seen along with the type IV SS on both sides (p < 0.05). ICA, ON, MN, and VN dehiscence was not found in any patients with the type I SS. The rate of ICA protrusion increased with presence of GWS and PP; ICA dehiscence was found to be positively correlated with ACP, GWS, and PP pneumatization.

CONCLUSIONS

Variations, either amount or the extent, of the pneumatization of the SS are related with the presence of protrusion/dehiscence of ICA, ON, MN and VN. Knowing and reporting these relations can decrease the rate of complications during skull base surgery.

Are paraspinal muscle quantity, lumbar indentation value, and subcutaneous fat thickness related to disc degeneration? An MRI-based study

INTRODUCTION

The aim of the study was to investigate the relationship between lumbar disc herniation and Goutallier classification (GC), lumbar indentation value, and subcutaneous adipose tissue thickness.

METHODS

102 consecutive patients (59 female and 43 male) with lumbar back pain, numbness, tingling, or pain in the lower extremity indicating radiculopathy who had undergone lumbar magnetic resonance imaging (MRI) and had an intervertebral disc herniation in the L4-5 level, were included in the study. 102 patients who have undergone lumbar MRI in the same time period and have no disc herniation were chosen to be the control group and were selected so as to match the herniated group for sex and age. All these patients' scans were re-interpreted regarding paraspinal muscle atrophy (using the GC), lumbar indentation value, and subcutaneous adipose tissue thickness in the L4-5 level.

RESULTS

The Goutallier score was higher in the herniated group, compared with the non-herniated group (p < 0.001). There was no statistical difference between herniated and non-herniated groups regarding lumbar indentation value (LIV) and subcutaneous adipose tissue thickness (SATT). A Goutallier score of 1.5 provided the highest sensitivity x specificity value to indicate the disc herniation according to the statistical results. The individuals with a Goutallier score of 2, 3, and 4 have 2.87 times more likely to have disc herniation in their MRIs than the ones with a score of 0 and 1.

CONCLUSION

Paraspinal muscle atrophy seems to be related to the presence of disc herniations. The cut-off value of GC to indicate the disc herniation in this study might be useful to predict the risk for disc herniation regarding the Goutallier score. The LIV and SATT measured in magnetic resonance images were randomly distributed between individuals with herniated and non-herniated groups, and statistically, no relationship was observed between these groups regarding these parameters.

IMPLICATIONS FOR PRACTICE

The effect of the parameters studied in this research on disc herniations are expected to be an added value to the literature. The awareness of risk factors for intervertebral disc herniations might be used in preventive medicine to predict the risk and understand the tendency of an individual for disc herniations to occur in the future. Further investigations are needed to establish whether there is a causal relationship or correlation between these parameters and disc herniation.

COVID-19-related cardiomyopathy: Can dual-energy computed tomography be a diagnostic tool?

BACKGROUND

No study on dual energy computed tomography (DECT) has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019 (COVID-19) patients. Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion, and these deficits can be shown via DECT with a perfect interrater agreement.

AIM

To assess lung perfusion alterations in COVID-19 patients. To our knowledge, no study using DECT has been performed to evaluate possibly fatal cardiac/ myocardial problems in COVID-19 patients. The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases.

METHODS

Two blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association's classification of the segmentation of the left ventricular myocardium. Additionally, intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. Following segment-by-segment analysis, perfusion deficiencies identified on the iodine map pictures on DECT were identified.

RESULTS

The study enrolled a total of 87 patients. Forty-two of these individuals were classified as COVID-19 positive, and 45 were classified as controls. Perfusion deficits were identified in 66.6% (n = 30) of the cases. All control patients had a normal iodine distribution map. Perfusion deficits were found on DECT iodine map images with subepicardial (n = 12, 40%), intramyocardial (n = 8, 26.6%), or transmural (n = 10, 33.3%) anatomical locations within the left ventricular wall. There was no subendocardial involvement in any of the patients.

CONCLUSION

Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion. These deficits can be shown via DECT with a perfect interrater agreement. Additionally, the presence of perfusion deficit is positively correlated with D-dimer levels.