Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSE

The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.

METHODS

This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses.

RESULTS

The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.

CONCLUSION

ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Quantitative T2 mapping of the sacroiliac joint cartilage at 3T in patients with axial spondyloarthropathies

OBJECTIVE

To evaluate the diagnostic value of T2 mapping of sacroiliac joint cartilage in patients with axial spondyloarthropathies (SpA).

METHODS

Thirty-seven SpA patients and 43 controls (mean age: 36.5 ± 8.2; 20 men) prospectively underwent conventional MRI and T2 mapping of the sacroiliac joints at 3 T. SpA patients and their sacroiliac joints were categorized into active and inactive based on the presence of bone marrow edema on the conventional MRI. T2-relaxation times were measured by drawing six manual ROIs on the cartilaginous part of the joints. T2 values of the bilateral iliac and sacral joint cartilages for each patient (T2_subject), iliac and sacral cartilages for each sacroiliac joint (T2_joint), iliac cartilage (T2_iliac), and sacral cartilage (T2_sacral) were calculated and compared between SpA patients and controls, and active and inactive joints.

RESULTS

The T2_subject of SpA patients (50.48 ± 5.32 ms) was significantly higher than the T2_subject of the controls (46.33 ± 3.30 ms, p < 0.001). Selecting an optimal T2_subject cut-off value of 48.77 to differentiate SpA patients from controls revealed a sensitivity and a specificity of 62.2% and 81.4% respectively (AUC = 0.739). In SpA patients, T2_joint, T2_iliac, and T2_sacral values of the inactive joints were not significantly different from those of the active joints (p = 0.088, p = 0.179, and p = 0.069). T2_joint, T2_iliac, and T2_sacral values of the inactive joints of SpA patients were significantly higher than those of the controls (p = 0.012, p = 0.029, and p = 0.016).

CONCLUSIONS

T2 values of both active and inactive sacroiliac joint cartilages of SpA patients were increased. Thus, T2 mapping may be used in the diagnosis of SpA.

KEY POINTS

• Sacroiliac cartilage T2 values of SpA patients increase compared to those of the non-SpA controls. • Sacroiliac cartilage T2 values of active and inactive joints of SpA patients increase compared to those of the non-SpA controls. • Sacroiliac cartilage T2 values of active and inactive joints of SpA patients do not show statistically significant difference.

The Effect of Breast Size and Density in Turkish Women on Radiation Dose in Full-Field Digital Mammography

Objective

The purpose of this study was to look into the relationship between breast size and mammographic breast density in women and breast radiation dose on full-field digital mammography (FFDM), as well as the factors that influence radiation dose.

Materials and Methods

The study included a total of 2,060 FFDM images from 515 consecutive participants. The participants were divided into two groups: those exposed to high doses (>3 mGy) and those exposed to low doses (<3 mGy). Moreover, the researchers analyzed the relationship between mean glandular dose (MGD) of the breast and patient age, compressed breast thickness, compression force, mammographic breast composition, and mammographic breast size.

Results

The mean mammographic breast volume was 936.2 ± 425.2 (114.5-3,018) mL, and the mean compressed breast tissue thickness was 56.75 ± 10.44 mm. Moreover, the mean MGD in the high-dose group was 3.51 ± 0.48 mGy and 1.92 ± 0.56 mGy in the low-dose group. The high-dose group had greater breast thickness, diameters, volume, compression pressure, and surgical rate. However, the high-dose group was younger and had less dense breasts. In multivariate logistic regression analysis, the most important predictors of dose determination were breast thickness [odds ratio (OR): 1.178, 95% confidence interval (CI): 1.156-1.200, p<0.001], history of previous surgery (OR: 2.210, 95% CI: 1.417-3.447, p<0.001), compression force (OR: 1.008, 95% CI: 1.004-1.013, p<0.001), and breast density (OR: 1.873, 95% CI: 1.359-2.580, p<0.001).

Conclusion

Women with larger breast volumes are subjected to higher doses of radiation. Therefore, breast-screening programs can be individualized to young women with larger breast volumes and women who have had breast-conserving surgery.

Whole-lesion ADC histogram analysis versus single-slice ADC measurement for the differentiation of benign and malignant soft tissue tumors

PURPOSE

To evaluate and compare the diagnostic performances of whole-lesion apparent diffusion coefficient (ADC) histogram analysis and single-slice ADC measurement in the differentiation of benign and malignant soft tissue tumors.

METHODS

Fifty-three patients (mean age: 48.5 ± 21.4) with soft tissue tumors (27 benign and 26 malignant) were evaluated with diffusion-weighted MRI. Whole-lesion ADC histogram parameters (mean, median, 10^th percentile, 90^th percentile, minimum, maximum, range, mean absolute deviation, interquartile range, kurtosis, skewness, root mean squared, variance and inhomogeneity) of the lesions were measured using the whole solid tumor volume region of interest (ROI). In other sessions, five ROIs were manually drawn on the tumor slices, and mean ADC and minimum ADC of the measurements were calculated. Diagnostic accuracies of the two methods were assessed and compared.

RESULTS

Mean, median, minimum, 10^th percentile, 90^th percentile, range, root mean squared and inhomogeneity of ADC histogram analysis, and mean ADC and minimum ADC of single-slice ADC measurement were significantly different between malignant and benign lesions (p < 0.001 - p = 0.002). Among the ADC histogram parameters, 10^th percentile had the highest diagnostic performance (AUC = 0.825) followed by mean (AUC = 0.792) and median (AUC = 0.789). For the single-slice ADC measurement, the AUC of mean ADC and minimum ADC were 0.842 and 0.786, respectively. Mean ADC of single-slice measurement had a similar diagnostic performance with the 10^th percentile, mean, and median of ADC histogram analysis (p = 0.070-1.000).

CONCLUSIONS

Both whole-lesion ADC histogram analysis and single-slice ADC measurement can differentiate benign and malignant soft tissue tumors with similar diagnostic performances.

The diagnostic value of ultrasound and shear wave elastography in the differentiation of benign and malignant soft tissue tumors

AIM

To evaluate the diagnostic value of ultrasound (US) and shear wave elastography (SWE) in the differentiation of benign and malignant soft tissue tumors.

MATERIALS AND METHODS

A hundred and nine patients (mean age 43.3 ± 20.5, range 0-85; 64 men and 45 women) diagnosed with soft tissue tumors between August 2016 and January 2020 were evaluated with US and SWE. The stiffness of the lesions was measured as mean and maximum shear wave velocity (SWV_mean and SWV_max) in meters/second (m/s). Two radiologists evaluated the US images independently and then reached a final consensus. Final diagnosis was obtained either by histopathological examination (core needle biopsy or surgery) or by follow-up. The diagnostic value of US and SWE in the differentiation of malignant and benign lesions was assessed.

RESULTS

Pathology results revealed 37 malignant and 43 benign lesions. Twenty-nine lesions were benign based on follow-up criteria. Consensus US reading revealed 91.9% sensitivity and 72.2% specificity with almost perfect inter-observer agreement (κ = 0.802). Larger lesion size, male gender, advanced patient age, deep location, hypoechoic and hypervascular appearance, ill-defined margins, and presence of cystic area were associated with malignant diagnosis (p < 0.001, p = 0.010, p = 0.001, p = 0.001, p = 0.003, p < 0.001, p = 0.001, and p = 0.011, respectively). Median SWV_mean and median SWV_max of malignant lesions (2.87 and 2.68) were not significantly different than those of the benign lesions (3.30 and 3.05; p = 0.271 and p = 0.402, respectively).

CONCLUSION

US features can differentiate malignant and benign soft tissue tumors, whereas SWE did not contribute to the differentiation of soft tissue tumors.

Efficacy of Ultrasound and Shear Wave Elastography for the Diagnosis of Breast Cancer-Related Lymphedema

OBJECTIVES

To assess the feasibility of ultrasound and shear wave elastography (SWE) in the diagnosis of breast cancer-related lymphedema.

METHODS

Forty-one patients with a history of unilateral breast surgery and axillary dissection or sentinel lymph node excision were included in this prospective study. The patients were classified as having normal findings, latent lymphedema, and clinical lymphedema on the basis of a physical examination, lymphedema index scores, and limb circumference measurements. The thickness and stiffness of the cutaneous and subcutaneous tissue of the forearm and arm were measured by ultrasound and SWE. The thickness and stiffness of the cutaneous and subcutaneous tissue of the affected limb and contralateral limbs of the normal, latent lymphedema, and clinical lymphedema groups were compared.

RESULTS

The mean age ± SD of the 41 patients was 55.42 ± 10.12 years. There were 15 patients with normal findings, 10 with latent lymphedema, and 16 with clinical lymphedema. In the latent lymphedema group, the thickness measurements of the cutaneous tissue of the affected forearm and the cutaneous and subcutaneous tissue of the affected arm were significantly greater than those of the contralateral forearm and arm (P = .034; P = .022; and P = .002, respectively), and the stiffness measurements of the cutaneous and subcutaneous tissue of the affected forearm were significantly greater than those of the contralateral forearm (P = .011; and P = .002). In the clinical lymphedema group, the thickness and stiffness measurements of the cutaneous and subcutaneous tissue of the affected forearm and arm were significantly greater than those of the contralateral limb (P < .001-P = .032).

CONCLUSIONS

Ultrasound and SWE are effective for diagnosing breast cancer-related lymphedema even at a latent stage.

Shear wave versus strain elastography in the differentiation of benign and malignant breast lesions

Background/aim

To evaluate and compare the diagnostic performances of shear wave elastography (SWE) and strain elastography (SE) in the differentiation of benign and malignant breast lesions.

Materials and methods

The current study included 87 breast lesions in 84 patients. The Breast Imaging Reporting and Data System (BIRADS) categories were determined with ultrasound features. The maximum shear wave velocity (SWV), mean SWV, maximum SWV to fat SWV ratio, and mean SWV to fat SWV ratio were measured using SWE. The strain ratio (SR) was calculated as the ratio of lesion strain to the adjacent fat strain using SE. Receiver operating characteristic (ROC) curves were constructed to assess and compare the diagnostic performances of each parameter.

Results

Forty-five benign and 42 malignant lesions were diagnosed. The sensitivity and specificity of the BIRADS classification was 100% and 35.6%, respectively. Selecting a cutoff SR value of 3.22 led to an 88.1% sensitivity and an 88.4% specificity (AUC: 0.913 [95% CI: 0.854–0.971], P < 0.001). Selecting cutoff maximum SWV value of 3.41 m/s led to an 88.1% sensitivity and an 86.7% specificity (AUC: 0.918 [95% CI: 0.858–0.978], P < 0.001). The diagnostic performance of the maximum SWV, mean SWV, and maximum SWV to fat SWV ratio were similar to the diagnostic performance of the SR (P = 1.00, P = 1.00, P = 0.629, respectively).

Conclusion

SE and SWE are both feasible imaging modalities in the differentiation of malignant and benign breast lesions with similar diagnostic performances.

Assessment of the association between pre-treatment and post-treatment left atrium size and severity of disease in patients with acute pulmonary embolism by using computed tomography pulmonary angiography

Introduction

As far as we know, left atrium (LA) imaging findings of pre-treatment and post-treatment nonmassive, submassive and massive acute pulmonary embolism (APE) have not been reported in literature. The aim of this study is to assess LA sizes of nonmassive, submassive and massive APE before and after treatment with computed tomography pulmonary angiography (CTPA) and to research whether there are differences between groups.

Materials and Methods

Sixty two adult APE patients (21 nonmassive, 31 submassive and 10 massive) who were diagnosed with CTPA and who had post-treatment follow-up images and recorded clinical information were included in the study. Pre-treatment and post-treatment LA sizes of all groups were measured by two radiologists independently.

Result

The lowest pre-treatment LA size was found in massive APE and this difference was found to be statistically significant when compared with submassive (p= 0.001) and nonmassive (p< 0.001) groups. In addition, submassive APE patients were found to have lower LA size when compared with nonmassive APE patients (p= 0.006). In massive and submassive APE, post-treatment LA sizes were found to be statistically significantly higher when compared with pre-treatment (p< 0.001 for both groups). However, in nonmassive APE patients, pre-treatment and post-treatment LA size difference was not found to be statistically significant (p= 0.082).

Conclusions

As the severity of APE increases, LA size decreases. Thus, a decrease LA size during APE can show increased APE severity. This study reported that LA size increased statistically in post-treatment massive and submassive APE patients when compared with pre-treatment. These results suggest that in APE patients, as a response to treatment, LA size can be an additional parameter reflecting the changes in cardiac morphology.

Is gynecomastia related to the disease characteristics and prognosis in testicular germ cell tumor patients?

PURPOSE

We aimed to assess the relationship between gynecomastia and tumor markers, histologic subtypes, and prognosis in patients with testicular germ cell tumors.

METHODS

This study included 73 testicular germ cell cancer patients with pretreatment chest, abdomen and pelvis computed tomography (CT) scans and tumor markers (β-human chorionic gonadotropin [β-hCG], lactate dehydrogenase [LDH], α-fetoprotein [AFP]). The volumetric analysis of the breast glandular tissue, the presence of gynecomastia and metastatic disease were determined using CT scans. Patients were classified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification. The association between gynecomastia, breast glandular tissue volume, tumor markers, metastatic disease, and disease prognosis were evaluated.

RESULTS

Thirty-four of the patients (46.6%) had gynecomastia. A breast volume cutoff value of 0.78 cm3 to diagnose gynecomastia led to 85% sensitivity and 95% specificity. Serum β-hCG level correlated with the breast glandular tissue volume weakly (r=0.242, P = 0.039). Gynecomastia was more common in patients with elevated β-hCG levels (P = 0.047), and was not associated with pulmonary, nonpulmonary distant, or nodal metastases (P = 0.378, P = 0.884, P = 0.333, respectively). No significant association was found between the disease prognosis and gynecomastia (P = 0.556).

CONCLUSION

Gynecomastia was common among testicular germ cell cancer patients with elevated β-hCG. However, it was not associated with metastatic disease and prognosis.

The diagnostic value of 4D MRI at 3T for the localization of parathyroid adenomas

PURPOSE

The aim of this study was to assess the feasibility of four-dimensional magnetic resonance imaging (4D MRI) at 3 T for the localization of parathyroid adenomas.

MATERIALS AND METHODS

Preoperative 4D MRI scans, encompassing dynamic contrast-enhanced (DCE) sequences and non-contrast enhanced (non-CE) sequences, including a T2-weighted multipoint Dixon (T2-mDixon) sequence, with in-phase, out-phase, and water-only images, were evaluated retrospectively in 41 patients with surgically proven parathyroid lesions. Two readers who were blinded to the surgical findings independently reviewed the images in two sessions (non-CE sequences alone and non-CE + DCE sequences). The MRI localization of the suspected adenoma in each session and the consensus interpretation of the MRI images, were compared with the surgical results and interobserver agreement was assessed.

RESULTS

By interpreting the non-CE sequences alone, reader 1 correctly localized 34 parathyroid lesions (sensitivity 81.0%, positive predictive value (PPV) 87.2%), and reader 2 correctly localized 34 parathyroid lesions (sensitivity 81.0%, PPV 91.9%). With the addition of DCE sequences, reader 1 correctly identified 35 parathyroid lesions (sensitivity 83.3%, PPV 87.5%), while reader 2 correctly identified 36 parathyroid lesions (sensitivity 85.7%, PPV 92.3%). Overall, MRI detected 38 parathyroid lesions (sensitivity 90.5%, PPV 95.0%). Interobserver agreement was slightly superior in non-CE + DCE sequences compared to non-CE sequences alone (ĸ = 0.796 vs. ĸ = 0.738).

CONCLUSION

4D MRI with DCE sequencing is a reliable method for the localization of parathyroid adenomas.

Beneficial Therapeutic Effects of Sildenafil on Bone Healing in Animals Treated with Bisphosphonate

Objectives

The purpose of the present study was to evaluate the effects of sildenafil on mandibular fracture healing in animals treated with zoledronic acid by using histologic, histomorphometric, immunohistochemical, and radiodensitometric methods.

Materials and Methods

A total of 36 Sprague-Dawley rats (3 months old) were used. All animals were treated intraperitoneally with 0.1 mg/kg zoledronate three times per week, for a total of 8 weeks. Postoperatively, the animals were divided into two groups: zoledronate group (Z), which had no treatment applied (n = 18), and zoledronate + sildenafil (ZS), which were treated daily with 10 mg/kg sildenafil (n = 18). Each group was divided into two subgroups and the animals were sacrificed at the end of week 1 (Z1 and ZS1, n = 9) and week 4 (Z4 and ZS4, n = 9) after the operation. Histologic, histomorphometric, immunohistochemical analysis, and radiodensitometry were performed on the test subjects.

Results

Sildenafil-treated groups showed a significant increase in fracture healing scores. This result was supported by the densitometric, histologic, histomorphometric, and immunohistochemical findings.

Conclusions

Sildenafil may have positive effects on accelerating and improving fracture healing, and it may be used as a supporting factor in bone healing in patients treated with bisphosphonate (BP) to prevent negative effects of BP's.

Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery?

Background

Hip-knee arthroplasty and knee arthroscopy (KA) is frequently applied in the orthopaedic surgery. The approach does not exist related with the preoperative asymptomatic deep venous thrombosis (DVT). In this study, the patients who would undergo surgery lower extremity were screened for asymptomatic DVT, using the venous Doppler ultrasonography (USG).

Patients and Methods

DVT was screened by venous Doppler USG in the patients who would undergo hip-knee arthroplasty and KA between the dates of November 2013 and September 2015. The patients were investigated regarding the age, gender, and the planned operation. The cases were separated to the following three groups: group I (<49 years), Group II (49-69 years), and Group III (≥70 years).

Results

The study included 222 patients; of these, 174 were female and 48 were male. Group I, Group II, and Group III included 45, 115, and 62 patients, respectively. Of the six patients determined to exist with DVT, 2 (1.73%) were in Group II, and 4 (6.45%) were in Group III.

Conclusion

Although the differences were not found to be statistically significant, it may be useful to screen asymptomatic DVT by Doppler USG in the preoperative period in the 70-year-old male patients, and in those over 70.

The diagnostic value of shear wave elastography for parathyroid lesions and comparison with cervical lymph nodes

AIMS

The aim of this study was to prospectively assess the feasibility of the Virtual Touch tissue imaging quantification (VTIQ) method of shear wave elastography (SWE) for the discrimination of parathyroid lesions and to compare the lesions' stiffness with that of cervical lymph nodes.

MATERIALS AND METHODS

SWE using VTIQ was performed on 66 patients with 87 histopathologically proven parathyroid lesions (54 parathyroid adenomas and 33 parathyroid hyperplasia) and 29 patients with 31 inflammatory cervical lymph nodes. The mean SWVs of the lesions were compared and receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance.

RESULTS

The mean SWV of parathyroid adenomas (2.16±0.33 m/s) differed significantly from those of parathyroid hyperplasia and lymph nodes (1.75±0.28 m/s and 1.86±0.37 m/s respectively, p<0.001). Selecting a cutoff value of 1.92 m/s for diagnosing adenoma led to 80% sensitivity and 82% specificity (area under the curve [AUC]: 0.832 [95% confidence interval (CI): 0.742-0.921], p< 0.001).

CONCLUSIONS

The VTIQ method of SWE can contribute to the differentiation of parathyroid adenoma from parathyroid hyperplasia and cervical lymphnodes.

Thiopental versus ketofol in paediatric sedation for magnetic resonance imaging: A randomized trial

OBJECTIVE

To compare the efficiency of intravenous thiopental against intravenous ketamine-propofol combination in paediatric sedation for magnetic resonance imaging.

METHODS

This prospective study was conducted at Ondokuz Mayis University Hospital, Samsun, Turkey, from July 1, 2014, to January 1, 2015, and comprised children aged 1 month to 12 years undergoing elective magnetic resonance imaging who were randomly assigned to two equal groups. Group I received thiopental 3 mg/kg intravenously followed by an additional dose of thiopental 1 mg/kg to achieve a Ramsay sedation score of 4. Group II received ketofol, a 1:1 mixture of ketamine 10 mg/mL and propofol 10 mg/mL, in a single syringe intravenously at a dose of 0.5 mg/kg at 1 minute intervals and titrated to reach a Ramsay sedation score of 4. The groups were compared for total drug dose, time to sedation, recovery time, total sedation time, and adverse effects. Data was analysed using SPSS 22.

RESULTS

There were 120 children in the study; 60(50%) in each group. The time to sedation was significantly longer with ketofol than thiopental (p<0.01). The mean recovery time was significantly shorter with thiopental than with ketofol (p<0.01). Total sedation time was significantly longer with ketofol than thiopental (p<0.01). Overall, 17(28.3%) ketofol patients had adverse events, whereas no thiopental patients had adverse events (p<0.0001).

CONCLUSIONS

Thiopental had a comparable effectiveness with shorter anaesthesia inductions and recovery times than ketofol. Intravenous thiopental can be an effective and safe alternative drug in sedating children undergoing magnetic resonance imaging.

Evaluation of Renal Parenchyma Elasticity With Acoustic Radiation Force Impulse Quantification in Nutcracker Syndrome and Comparisons With Grayscale Doppler Sonography and Laboratory Findings

OBJECTIVES

We sought to evaluate renal parenchymal elasticity with Virtual Touch quantification of acoustic radiation force impulse imaging in nutcracker syndrome and to compare shear-wave velocity (SWV) values with grayscale Doppler sonography and laboratory findings.

METHODS

Thirty-eight healthy volunteers and forty-three nutcracker syndrome patients were enrolled in this prospective study. SWV values for both kidneys in nutcracker syndrome patients and healthy volunteers were evaluated. Grayscale Doppler ultrasound and laboratory findings were obtained and compared with SWV values in both nutcracker syndrome patients and healthy volunteers.

RESULTS

In nutcracker syndrome patients, SWV values for the left kidney were significantly lower than those for the right kidney (n = 43; 1.93 ± 0.43 m/s vs 2.53 ± 0.45 m/s [P < .001]). Healthy volunteers' SWV values for both kidneys had no statistically significant differences. There was a statistically significant difference between nutcracker syndrome patients and healthy volunteers for the SWV values and body mass index values. There was no statistically significant correlation between SWV values of nutcracker syndrome patients and age, gender, glomerular filtration rate, body mass index, vein diameter ratio, peak velocity ratio, or resistive indices.

CONCLUSIONS

Acoustic radiation force impulse imaging offers new, additional information on the affected left kidney parenchymal changes in nutcracker syndrome patients.

Background Parenchymal Enhancement and Fibroglandular Tissue Proportion on Breast MRI: Correlation with Hormone Receptor Expression and Molecular Subtypes of Breast Cancer

OBJECTIVE

To assess the relationship between background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) proportion on breast magnetic resonance imaging (MRI) and hormone receptor expression and molecular subtypes in invasive breast cancer.

MATERIALS AND METHODS

This retrospective study enrolled 75 breast cancer patients who underwent breast MRI before treatment. T1-weighted images were reviewed to determine the FGT proportion, and contrast-enhanced fat-suppressed T1-weighted images were reviewed to determine BPE. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2-neu (HER2) status, and molecular subtypes of the tumors were compared with the BPE and FGT proportions.

RESULTS

Women with high BPE tended to have increased rate of ER and PR positive tumors (p=0.018 and p=0.013). FGT proportion was associated with ER positivity (p=0.009), but no significant differences between FGT proportion and PR positivity were found (p=0.256). There was no significant difference between HER2 status and any of the imaging features (p=0.453 and p=0.922). For premenopausal women, both FGT proportion and BPE were associated with molecular subtypes (p=0.025 and p=0.042). FGT proportion was also associated with BPE (p<0.001).

CONCLUSION

In women with invasive breast cancer, both high FGT containing breasts and high BPE breasts tended to have ER positive tumors.

Does Bedside Sonography Effectively Identify Nasogastric Tube Placements in Pediatric Critical Care Patients?

BACKGROUND

A nasogastric tube (NGT) insertion is a common procedure in intensive care units, with some serious complications that result from the malposition of the NGT tip. This pilot study was designed to investigate the efficiency of ultrasound in verifying correct NGT placement and to compare these results with radiographic findings.

MATERIALS AND METHODS

This was a single-center, double-blind prospective study of patients who had received an NGT in the pediatric critical care unit. Twenty-one patients aged 1 month to 18 years were included in this study. All NGTs were inserted by the same critical care physician. After insertion, the physician first confirmed NGT placement by the auscultation of the epigastrium following the insufflation of air. Confirmation was supplemented with an abdominal radiograph. A radiologist who was unaware of the radiographic findings performed bedside sonography on all patients and verified the location of the NGTs. The findings from these 2 physicians were then compared.

RESULTS

NGTs were inserted without any complications, and none of the NGTs were positioned in the respiratory tract in any of the patients. All NGT tips were visualized by radiography and sonography with a sensitivity of 100%.

CONCLUSION

Bedside sonography performed by a radiologist is an effective and sensitive diagnostic procedure for confirming the correct NGT position in patients in the pediatric critical care unit.

Efficacy of Sonoelastography in Distinguishing Benign from Malignant Breast Masses

OBJECTIVE

The study aimed to evaluate the influence of sonoelastographic strain ratio in distinguishing benign from malignant breast masses.

MATERIALS AND METHODS

Patients who were referred for diagnostic biopsy of a breast mass were examined by ultrasound and sonoelastography prior to percutaneous biopsy. Sonoelastography was performed twice by the same observer in the same session. The strain ratios (SR) were calculated for both measurements as well as the mean strain ratio. Results were compared with histopathologic findings. For each strain ratio, a threshold value was determined using a ROC analysis for the differentiation of benign and malignant masses.

RESULTS

After histopathological examination of 135 mass lesions in 132 female patients (mean age 48±12 years), 65 masses were diagnosed as benign and 70 as malignant. According to the Tsukuba classification with 5 scores; 44 of 65 benign masses had scores of either 1 or 2 while 56 of 70 malignant lesions had scores of either 4 or 5. No benign lesion was classified as score 5, and no malignant lesion as score 1. The mean cut-off in the two ROC measurements in distinguishing benign from malignant lesions was calculated as 4.52. When a threshold value of 4.52 was used for the mean strain ratio: the sensitivity, specificity, PPV, NPV, and accuracy rates were determined as 85.5%, 84.8%, 85.5%, 84.8% and 85.2%, respectively.

CONCLUSION

The threshold value for strain ratio in the differentiation of benign and malignant masses was detected as 4.52, and a significant intra-observer difference was not observed in this study. The diagnostic value of sonoelastograghy in distinguishing benign from malignant breast masses was higher in comparison to conventional ultrasound.

Vaccine-induced myositis with intramuscular sterile abscess formation: MRI and ultrasound findings

Although limb swelling is a well-known complication of vaccination, its rarity and wide band of differential diagnosis of limb swelling make it a diagnostic challenge. In this case report, we describe three cases of vaccine-induced myositis with intramuscular sterile abscess formation in patients with limb swelling and their magnetic resonance imaging and ultrasonography findings. Both radiologists and clinicians should be familiar with this rare entity, its clinical and imaging spectrum, and follow-up strategies.

Osteoskeletal manifestations of scurvy: MRI and ultrasound findings

Scurvy has become very rare in the modern world. The incidence of scurvy in the pediatric population is extremely low. In the pediatric population, musculoskeletal manifestations are more common and multiple subperiosteal hematomas are an important indicator for the diagnosis of scurvy. Although magnetic resonance imaging findings of scurvy are well described in the literature, to our knowledge, ultrasound findings have not yet been described. In this article, we report a case of scurvy with associated magnetic resonance imaging and ultrasound findings.

Can a b value of 500 be substituted for a b value of 1000 in the characterization of focal liver lesions?

PURPOSE

Comparison of two different b values in diffusion-weighted magnetic resonance imaging (DWI) for characterization of focal liver lesions.

METHODS

A total of 174 focal liver lesions from 100 patients were analyzed using two different b values (500 and 1000 s/mm(2)). The DWI with b values of 500 s/mm(2) (DWI500) and 1000 s/mm(2) (DWI1000) were analyzed using the Mann-Whitney test, kappa statistic, and paired t test with respect to image quality. The statistically significant differences between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values were evaluated via χ (2) test.

RESULTS

DWI500 had the highest mean score in the qualitative evaluation of image quality (p < 0.0001) and the highest signal-to-noise ratio (8.7 ± 2.1; p < 0.0001). The sensitivity, specificity, and AUC for discriminating malignant from benign focal lesions on DWI500 and DWI1000 using cutoff ADC values of 1.54 × 10(-3) and 1.38 × 10(-3) s/mm(2) were 95.8%, 92.3%, 0.98, and 93.8%, 92.3%, 0.97, respectively. There was no statistically significant difference in sensitivity, specificity, and AUC values between DWI500 and DWI1000 with respect to the cutoff ADC values (p > 0.05).

CONCLUSIONS

The image quality of DWI500 was better than that of DWI1000, and there was no significant difference between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values. The b value of 500 s/mm(2) can be substituted for the b value of 1000 s/mm(2) in the characterization of focal liver lesions.

Normal pressure hydrocephalus versus atrophic dilatation to distinguish and predict the benefits of surgical intervention with a phase-contrast MRI technique

AIM

To compare mean cerebrospinal fluid (CSF) volume in the aqueduct by using phase-contrast magnetic resonance imaging for the patients with idiopathic normal pressure hydrocephalus (INPH) and atrophic dilation (AD) to investigate the efficacy of this technique in predicting surgery.

MATERIAL AND METHODS

The MR images of a total of 80 individuals, consisting of 30 patients considered to have INPH, 20 patients with AD not proportional with cerebral sulci, and 30 control cases without a hydrocephalus clinical picture, were evaluated retrospectively. The minute mean aqueductal CSF flow rates of the three groups were compared using the Kruskall-Wallis analysis of variance, and the inter-group statistical comparisons were made using the Mann-Whitney U test.

RESULTS

The mean aqueductal flow rates were 46.56 ± 25.06 ml/min for the INPH group, 9.28 ± 4.68 ml/min for the AD group, and 8.68 ± 3.40 ml/min for the control group. The mean flow rate of the INPH group was significantly higher than those of the control and ADH groups (p < 0.001).

CONCLUSION

The mean CSF flow rate may be useful in the diagnosis and differential diagnosis, and the prediction of the potential benefits of surgical intervention for patients considered to have INPH.

Detection of duct ectasia of mammary gland by ultrasonography in a neonate with bloody nipple discharge

Bloody nipple discharge, a rare finding in infants, is associated most often with benign mammary duct ectasia and commonly resolves spontaneously. Ultrasonography is a useful diagnostic imaging method to detect the cause of discharge. The rarity of this symptom in infants and its association with breast carcinoma in adults can lead to unnecessary investigation and treatment. Here, we describe ultrasonographic and color Doppler ultrasonographic findings of a 20-day-old boy with bilateral bloody nipple discharge that resolved spontaneously without treatment after 15 days. We conclude that bloody nipple discharge is usually a benign and self-limited process in infancy, and that it is advisable to avoid unnecessary invasive investigations initially.

Intravascular virtual MR endoscopy evaluation of cerebral aneurysms

AIM

The aim of this study was to evaluate the role of intravascular virtual MR endoscopy in the planning of correct surgical clipping of the aneurysm neck.

MATERIAL AND METHODS

A total of 36 aneurysms were detected by using magnetic resonance angiography (MRA) in thirty patients. Intravascular virtual MR endoscopy is a realistic 3-dimensional simulation of intravascular structures that is generated by postprocessing of MRA maximum-intensity projection images. The images were evaluated by two neuroradiologists, in terms of image quality via qualitative analysis of MRA and intravascular virtual MR endoscopy of the orifice of the aneurysm neck, as well as the relationship of the main and bifurcating arteries with the orifice of the aneurysm. The readers were fully blinded. Mann-Whitney U test was used to compare the differences in mean scores for each reader between these two groups.

RESULTS

Based on the scoring system, evaluating image quality using qualitative analysis, both readers found the mean scores to be 3.82 ± 0.52 and 3.91 ± 0.72 for intravascular virtual MR endoscopy, and 2.97 ± 0.71 and 2.89 ± 0.83 for MRA, which was statistically different (p < 0.001).

CONCLUSION

Intravascular virtual MR endoscopy may provide useful knowledge in the proper the surgical clipping of the aneurysm neck.

Sonographic diagnosis of ascariasis causing small bowel obstruction

Acute right lower quadrant pain is a common, but nonspecific presenting symptom of a wide variety of diseases in children. Sonography (US) can play a significant role in the accurate and early diagnosis of right lower quadrant pain. In this article, we report a case of small bowel obstruction due to intestinal ascariasis diagnosed at bedside US and confirmed by MRI and describe a new US sign of intestinal ascariasis.

Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center

We aimed to study the factors affecting cosmetic outcome (CO) in breast conserving surgery (BCS) without oncoplastic techniques in our center with a BCS rate higher than 60% in more than 1000 breast cancer surgeries a year. In this study 284 patients who underwent BCS without oncoplastic techniques were included. Surgeries were performed by two experienced breast surgeons with more than 25 years of experience. These patients were followed in our established Wellness Clinic postoperatively. The CO is evaluated according to the "Harvard Breast Cosmesis Grading Scale" by a breast surgeon who did not participate in the patient's surgery. The correlation among patient factors (age, breast volume, menopausal status), tumor factors (size, location, distance to areola) and treatment factors (excision volume, breast skin excision, axillary surgery, adjuvant therapy) and CO were evaluated. The mean age was 57.6 [33-98] years in the successful CO group and 58.1 [34-85] years in the unsuccessful CO group (p > 0.05). The mean follow-up time was 37.9 [24-84] months. The CO was successful in 88.7% (n:252) of the patients. Tumor size, retroareolar location of the tumor, adjuvant chemotherapy administration and whole breast radiation therapy (WBRT) were correlated with a poorer CO (p < 0.05). We were able to attain a successful CO in approximately 90% of our patients. Adding oncoplastic techniques to the surgical management of larger tumors and retroareolar tumors, may increase the percentage of good CO. In selected patients choosing balloon brachytherapy instead of WBRT, may also have positive effects on CO.

Isolated torsion of the fallopian tube with hydrosalpinx mimicking a multiloculated ovarian cyst: whirlpool sign on preoperative sonography and MRI

Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage. However, diagnosis is rarely made before surgery due to nonspecific clinical and imaging features. We report a case of isolated tubal torsion with specific imaging findings on preoperative ultrasonography, color Doppler ultrasonography, and magnetic resonance imaging that was misdiagnosed as a multiloculated ovarian cyst at a local hospital.

Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation of benign and malignant thyroid nodules: which one should we use?

OBJECTIVE

The aim of this study is to investigate the diagnostic accuracy of muscle-to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid nodules and to see if there was a difference between MNSR and parenchyma-to-nodule strain ratios (PNSR) in diagnosis.

METHODS

A total of 106 consecutive patients (88 women and 18 men; age range 19-79 years) with thyroid nodules were prospectively examined using ultrasound and sonoelastography before the fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for each nodule and the elasticity score was determined according to four-point scoring system.

RESULTS

According to the four-point scoring system, 44 of the 83 benign nodules had a score of one or two while 22 of the 23 malignant nodules had a score of three or four (p<0.001). Using ROC analysis, the best cutoff point for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%, respectively, when the best cutoff points were used (p<0.001). The κ value for the PNSR and MNSR methods was 0.87, which indicated an almost perfect agreement (p<0.001).

CONCLUSIONS

Sonoelastography has a high diagnostic accuracy in the differentiation of benign and malignant thyroid nodules. There was no significant difference between MNSR and PNSR in the differentiation of benign and malignant thyroid nodules. Therefore, we think that MNSR could safely be used in situations where PNSR could not be used.

Sonographic appearance of a retained surgical sponge after thyroidectomy: report of three cases

Although a number of cases of retained surgical sponge (RSS) after thoracic and abdominal surgery have been reported in the literature, the occurrence of RSS after thyroidectomy is very rare. We report the imaging findings of three cases of RSS after thyroidectomy. Sonography of the three patients revealed a hyperechoic mass with marked acoustic shadow. Computed tomography showed a well-defined, circumscribed heterogeneous mass that had gas bubbles inside in two patients, whereas the mass in the third patient was hyperdense and homogenous with smooth margins. All three RSSs were surgically removed.

The importance of pre-operative needle core breast biopsy results on resected tissue volume, margin status, and cosmesis

PURPOSE

This study aimed to evaluate the relationship between pre-operative image-guided large needle core biopsy (LNCB) histopathology results and surgical resection volumes in breast conserving surgery (BCS), with attention to both margin status and cosmetic outcome.

METHODS

Breast volumes (BV) were calculated using the elliptical cone based formula on mammography images for each patient. Initial resected volume (IRV), final resected volume (FRV), and resected volume ratio (RVR) were calculated and compared according to histopathological diagnosis and cosmetic outcomes. Final pathology results were classified as benign, high risk lesion (HRL), ductal carcinoma in situ (DCIS), or invasive cancer. The cosmetic results were graded based on the Harvard breast cosmesis grading scale.

RESULTS

A total of 217 women underwent BCS by the same experienced breast surgeon. The resected volumes (mean, cm3) were higher among patients who underwent LNCB than those who did not (54.3 vs 26.5 ;p=0.005). The LNCB diagnoses were 16% benign, 19% HRLs, 16% DCIS, and 49% invasive cancers. Reexcision rates were 15.6% and 25.8% for DCIS and invasive cancer, respectively. Cosmesis was excellent in 79.8%. Age, pathological tumor size, IRV and FRV were different among the benign, HRLs and carcinoma groups (p= 0.001).

CONCLUSION

The diagnosis of carcinoma by LNCB leads to the planning of a wider resection, but the need for reexcision is no different than less resection. HRLs are best approached with diagnostic excision, as there is no strong evidence that larger resections reduce the incidence of involved resection margins.

Anterior sacral meningocele mimicking ovarian cyst: a case report

Anterior sacral meningocele (ASM) is a rare congenital anomaly, characterized by herniation through a defect in the anterior aspect of the sacrum. We reported a case of ASM associated with neurofibromatosis, which was mimicking a complex ovarian cyst in ultrasonography. ASM can easily be misdiagnosed as an ovarian cyst and needle aspiration can cause intracranial hypotension syndrome or even death.

An accidentally ingested mandibular prosthesis was exempt from surgery

Removable dentures are commonly used in routine dental practice at older ages. Accidental swallowing of various numbers of teeth has been reported in the literature before. However, total swallowing of removable mandibular prostheses in this size is a very rare emergency. In this study, we reported a case of accidental ingestion of a partially removable mandibular prosthesis and its final passing through the gastrointestinal (GI) tract without complication without need for surgical intervention. With this case we also aimed to increase the awareness of health professionals of the potential risk and management of swallowing dentures.