Can pelvic diameter measurement have an effect on surgical outcomes in radical cystectomy?

OBJECTIVE

To determine the effectiveness of pelvis diameters in determining postoperative outcomes in men who underwent open radical cystectomy + urinary diversion, it is aimed to predict the factors that may affect the operative difficulty and possible surgical outcomes before the operation.

METHODS

A total of 79 radical cystectomy patients operated in our institution with preoperative computed tomography (CT) were included the study. Pelvic dimensions; symphysis angle (SA), upper conjugate, lower conjugate, pelvic depth, apical depth (AD), interspinous distance (ISD), bone femoral width and soft tissue width were measured by preoperative CT. ISD index were defined as ISD/AD. Postoperative outcomes and indicators of operative difficulty were recorded. Regression analyses were used to predict perioperative and postoperative outcomes.

RESULTS

Total of 96 complications were observed in 52 of the 79 patients in ninety days (65,8%) with a mean age of 68.25 years. There were significant correlations between SA and body mass index (BMI) with operative time (p = 0.006, p < 0.001; respectively). For estimated blood loss, there were significant correlations between preoperative hematocrit (p = 0,031). Analysis of multivariate logistic regression revealed that higher Charlson comorbidity index (CCI) and BMI were found to be significant predictors for major complications while CCI, pathological T stage and ISD index are prominent predictors for surgical margin positivity.

CONCLUSIONS

Pelvic dimensions are not significant with minor or major complications. However, operative time may be associated with SA. Also, narrow and deep pelvis may increase the risk of positive surgical margins.

Bilateral Conjugating Carotid Body Tumor and Associated Jugular Vein Aneurysm

Carotid body tumors (CBTs) originate from the paraganglionic tissue in the bifurcation of the common carotid artery. Magnetic resonance (MR) imaging is a commonly used diagnostic method in the preoperative diagnosis of these tumors. In this study, we demonstrated an isthmus between the right and left carotid body tumors in a patient with bilateral CBT. The left CBT also was associated with a saccular aneurysm of left external jugular vein.

Modified lyse and wait technique for the treatment of dialysis fistula thrombosis: Percutaneous thrombolytic therapy with a 27-G dental needle

BACKGROUND

The lyse and wait technique is a percutaneous endovascular technique in the treatment of thrombosed dialysis fistulas. In this study, our aim was to introduce a more easily applicable modification of the lyse and wait technique and present our results.

METHODS

A total of 84 patients (56 male; 66.6%), with a mean age of 61 years, were included in the study. The treatment was performed in patients presenting with dialysis fistula thrombosis no more than 1 week before the procedure, whose thrombosed segment length was less than 10 cm. A 27-G dental needle was inserted into the thrombosed segment under ultrasonography guidance, and 5 mg of alteplase was injected in a controlled manner. After about 6 to 12 h, the patients were taken to the angiography unit, and balloon angioplasty was performed.

RESULTS

The technical and clinical success of the procedure was 98.8%. Technical and clinical failure occurred in only one patient. The median primary patency duration was 13.5 months. None of the patients had major complications. At the end of 12 months, the primary patency rate was 66.6%, and the secondary patency rate was 80%.

CONCLUSIONS

Our technique has shown to have high technical and clinical success and patency.

Contribution of advanced MRI to the diagnosis of giant tumefactive perivascular spaces

BACKGROUND

Giant tumefactive perivascular spaces (PVSs) are uncommon benign cystic lesions. They can imitate cystic neoplasms.

PURPOSE

To evaluate the contribution of advanced neuro magnetic resonance imaging (MRI) techniques in the diagnosis of giant tumefactive PVSs and to further characterize these unusual cerebral lesions.

MATERIAL AND METHODS

The MRI scans of patients with tumefactive PVS diagnosed between 2010 and 2019 were retrospectively reviewed. All imaging studies included three plane conventional cerebral MRI sequences as well as precontrast 3D T1 MPRAGE, post-gadolinium 3D T1 acquisitions, sagittal plane 3D T2 SPACE, diffusion-weighted imaging, and time-of-flight (TOF) angiography. Some patients received perfusion MR, MR spectroscopy, diffusion tensor imaging (DTI), and contrast-enhanced TOF MR angiography.

RESULTS

A perforating vessel was demonstrated in 16 patients (66.7%) by TOF imaging. In four patients, there were intracystic vascular collaterals on contrast-enhanced TOF MR angiography. Septal blooming was observed in four patients in susceptibility-weighted imaging. On perfusion MR, central hyperperfusion was observed in four patients, and peripheral hyperperfusion was observed in one patient. On MR spectroscopy, choline increase was observed in two patients, and there was a lactate peak in three patients, and both a choline increase and lactate peak in one patient. On DTI, there was fiber distortion in five patients and fiber deformation in one patient.

CONCLUSION

Advanced MRI techniques and 3D volumetric high-resolution MRI sequences can provide a valuable contribution to the diagnosis and can be successfully used in the management of these lesions.

Native T1 mapping of the breast in MRI to differentiate fibroadenomas from benign phyllodes tumors: a preliminary study

OBJECTIVE

Both fibroadenomas (FAs) and phyllodes tumors (PTs) are classified as fibroepithelial lesions. PTs are rare fibroepithelial neoplasms that have a morphologic spectrum ranging from benign to malignant. The differentiation of these entities is important as PTs are to be enucleated surgically. The purpose of this study was to calculate the T1 relaxation times of fibroadenomas and phyllodes tumors and assess the potency of native T1 mapping for the differentiation of these tumors.

MATERIALS AND METHODS

This prospective study included 11 patients with a proven diagnosis of benign PT and 14 patients with a proven diagnosis of FA. All the patients underwent T1 mapping prior to conventional dynamic contrast-enhanced MRI (DCE-MRI). Two radiologists, in consensus, selected lesion locations using freehand regions of interest from the DCE images and copied them onto T1 maps to acquire T1 relaxation times. The T1 relaxation times of the FA and PT groups were compared statistically.

RESULTS

The mean T1 relaxation times were higher in the PT group compared to the FA group (p ≤ 0.001). The receiver operating characteristic analysis showed that the T1 relaxation time being longer than 1,478 ms differentiated PTs from FAs with a sensitivity of 0.89, specificity of 1, and area under the curve value of 0.93.

CONCLUSION

We found that benign PTs had longer relaxation times in T1 mapping compared to FAs. Native T1 mapping can be used to differentiate PTs from FAs and adding T1 mapping in breast MRI in cases with fast-growing fibroepithelial lesions or multiple fibroepithelial lesions can facilitate the decision-making process.

Ultrasound-Guided Subgluteal Sciatic Nerve Block for Pain Management during Endovascular Treatment for Below-the-Knee Arterial Occlusions

PURPOSE

To evaluate the ability of subgluteal sciatic nerve block (SSNB) to provide pain control during endovascular treatment of below-the-knee (BTK) occlusions.

MATERIALS AND METHODS

This randomized prospective controlled study evaluated 60 consecutive adult patients who underwent endovascular treatment for BTK occlusions. The patients were randomized into 2 equal groups; the SSNB group underwent SSNB in the subgluteal space under ultrasound guidance, while the control group received fentanyl as an analgesic. The visual analog scale (VAS) and Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were recorded.

RESULTS

Compared with the control group, the SSNB group showed significantly lower median VAS (0 [range, 0-30] vs 70 [range, 20-100], P < .001) and median FLACC scale (0 [range, 0-2] vs 6 [range, 3-10], P < .001) scores. There was no statistically significant difference between the 2 groups regarding the remaining parameters. There was a very strong correlation between the VAS and FLACC scale scores in both the SSNB (r = 0.805, P < .001) and control (r = 0.950, P < .001) groups. The procedure time and total balloon inflation time correlated with the VAS (r = 0.411, P = .024, and r = 0.402, P = .031, respectively) and FLACC scale (r = 0.431, P = .017, and r = 0.414, P = .022, respectively) scores in the control group but not in the SSNB group (r = 0.364, P = .056, and r = 0.300, P =.085, respectively, for correlation with VAS score and r = 0.730, P = .068, and r = 0.704, P = .075, respectively, for correlation with the FLACC scale score).

CONCLUSIONS

SSNB is a highly effective and safe pain management modality for the endovascular treatment of BTK occlusions.

Is common carotid artery intima-media thickness (cIMT) a risk assessment marker in children with attention deficit/hyperactivity disorder?

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is associated with impairment in social, academic and job-related functioning in both children and adults. The purpose of this study is to investigate the susceptibility to cardiovascular risk factors in children with ADHD diagnosis through common carotid artery intima-media thickness (cIMT) measurement, to compare cIMT in ADHD and control groups and to evaluate the association between cIMT and ADHD symptom severity.

METHODS

The mean cIMT of 42 children with ADHD, ADHD symptom scales and a semi-structured psychiatric interview, and 42 age and sex matched healthy controls were measured with B-mode Doppler neck ultrasonography.

RESULTS

The median cIMT was significantly higher for the ADHD group compared to the healthy controls. There was a statistically significant, negative, moderate correlation between cIMT and Conners ADHD index score, hyperactivity score, oppositional score and the presence of ODD comorbidity.

CONCLUSIONS

In this study, we found significantly higher cIMT in children with ADHD when compared to healthy controls. Considering that increased cIMT is a sign of atherosclerosis and it can be used as a marker of cardiovascular risk factors, our finding may indicate that children with ADHD are at increased risk for cardiovascular diseases.KeypointscIMT was significantly higher in children with ADHD when compared to healthy controls.Higher cIMT in children with ADHD may indicate that children with ADHD are at increased risk for cardiovascular diseases.cIMT measurement may be studied as a potential tool for risk assessment before a child with ADHD is started on psychostimulant medications.

An analysis of lesions associated with developmental venous anomalies

OBJECTIVE

The aim of this study was to describe different lesions and features associated with developmental venous anomalies (DVAs).

METHODS

The records and magnetic resonance imaging (MRI) images of 1,722 patients who underwent cranial MRI between 2010 and 2017 were retrospectively reviewed. It was found that 124 (7.2%) patients had DVAs, and 48 of these patients (38.7%) had additional anomalies accompanying DVAs. Of the patients with DVAs, 25 were female and 23 were male, with a mean age of 39.3 years (range, 3-77 years). MRI was performed in all the patients.

RESULTS

In addition to DVAs, cavernomas were present in 30 patients (62.5%), haematomas in 7 (14.5%), gliosis in 6 (12.5%), demyelinating plaques in 4 (8.3%) and a glioblastoma in 1 (2.2%). The mean diameter of the DVAs was 1.1mm and the mean diameter of the lesions was 17.4mm. The susceptibility weighted imaging (SWI) sequence was also applied to 12 patients with cavernomas. The relevant sequence in all of these patients contributed to the diagnosis.

CONCLUSION

Our study shows that DVAs can accompany a wide spectrum of lesions, especially cavernomas. Although their pathophysiology has not yet been clearly established, these lesions may have a common aetiology.

Posterior shoulder labrocapsular structures in all aspects; 3D volumetric MR arthrography study

Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies have been associated with traumatic posterior dislocation. A smaller portion of the lesions include posterior extension of superior labral anteroposterior lesions, posterior superior internal impingement, and damage to the posterior band of the inferior glenohumeral ligament. Labrocapsular anatomic variations of the posterior shoulder joint can mimic labral pathology on conventional MR and occasionally on MR arthrographic images. Knowledge of this variant anatomy is key to interpreting MR images and studying MR arthrography of the posterior labrocapsular structure to avoid misdiagnosis and unnecessary surgical procedures. In this article, we review normal and variant anatomy of the posterior labrocapsular structure of the shoulder joint based on MR arthrography and discuss how to discriminate normal anatomic variants from labrocapsular damage.

Evaluation of craniocervical pseudomeningoceles with three-dimensional T2-SPACE sequence at 3T

BACKGROUND

Pseudomingocele is a postoperative fluid collection adjacent to the dural membrane. The distinction of pseudomeningocele from other postoperative collections is very important.

PURPOSE

To show the efficacy of three-dimensional (3D) T2-weighted sampling perfection with application-optimized contrasts using a different flip-angle evolution (SPACE) magnetic resonance imaging (MRI) sequence in the diagnosis of pseudomeningocele in which conventional MRI sequences may be insufficient.

MATERIAL AND METHODS

A total of 10 patients were included in the study. All of these patients also had 3D T2-SPACE high-resolution volumetric MR image in addition to conventional cervical and cerebral MR sequences. All MR examinations were reviewed by two neuroradiologists.

RESULTS

Pseudomeningocele neck was shown in six patients by both conventional sequences and SPACE sequence. In two patients, the neck was only shown in the SPACE sequence. Four pseudomeningocele necks were shown to have flow void with both conventional sequences and SPACE sequence. Flow void could only be demonstrated by SPACE sequence in two patients.

CONCLUSION

A T2-SPACE sequence can show the presence of pseudomeningocele neck and flow void even in cases where conventional MRI cannot show, thus contributing to the diagnosis of pseudomeningocele. Therefore, especially in postoperative imaging, the T2-SPACE sequence may be included in routine sequences to make the differential diagnosis correctly.

Evaluation of Hepatic Steatosis with CT and Correlation with Anthropometric Measurements

OBJECTIVE

The aim of the study was to evaluate hepatic steatosis in an asymptomatic group of patients with unenhanced abdominal computed tomography (CT) and to compare the results with anthropometric measurements.

METHODS

The study included 617 patients aged 18-93 years, who underwent unenhanced abdominopelvic CT between January 2016 and December 2017. Three imaging criteria were used in the assessment of hepatic steatosis on CT: mean region of interest (ROI) value of measured liver lobe (40 HU ≥), mean ROI value of measured liver lobe / measured spleen mean ROI value (1 ≥), mean ROI value of measured liver lobe - mean ROI value of spleen (10 HU≥). The liver fat was quantitatively assessed both visually and using multidetector CT grading. The anthropometric measurements used were the size of the liver and spleen, abdominal anterior-posterior diameter, abdominal transverse diameter, abdominal circumference, subcutaneous adipose tissue area, and anterior, posterior, and posterolateral subcutaneous adipose tissue thickness.

RESULTS

The prevalence of hepatic steatosis was 29.3% according to the visual evaluation, 29.8% according to the quantitative evaluation, 67.1% according to at least one criterion and 23.3% according to at least two criteria. A positive correlation was determined between hepatic steatosis and anthropometric measurements. Differences between the genders were observed in both hepatic steatosis and anthropometric measurements.

CONCLUSION

By setting more objective criteria for evaluation, with the possibility of quantitative analysis in particular, non-contrast CT will have a more important role in assessing liver fat in the future.

Isolated pineal gland metastasis of acute lymphocytic leukemia: case report

Metastasis in the pineal region is a rare condition. To best of our knowledge, there is no case report of isolated pineal metastasis secondary to acute lymphocytic leukemia (ALL). The aim of this study is to show the pineal gland involvement of ALL in a case for the first time in the literature. A 25-year-old male patient diagnosed with ALL 2 years ago presented with headache and visual impairment. Brain magnetic resonance imaging (MRI) revealed a well-defined solid lesion which was revealed intensive enhancement after contrast. On diffusion-weighted images, the lesion showed significant diffusion restriction. Three months after therapy, control MRI demonstrated a completely resorbed pineal lesion. The pineal region may be a possible site of metastasis and involvement due to the absence of a blood-brain barrier, and should not be overlooked in patients with not only solid cancers but also ALL.

Tumefactive perivascular space demonstrated with post-contrast time-of-flight MR angiography

The cerebral perivascular spaces are interstitial fluid-filled anatomic structures surrounding the perforating arteries. They appear as small, round or curvilinear structures on magnetic resonance (MR) imaging. Occasionally, these structures may become very large and cause mass effect. In this case, they may imitate malignant processes and are referred to as tumefactive perivascular spaces. In this study, we present a case of tumefactive perivascular space demonstrated with post-contrast time-of-flight (TOF) MR angiography. To our knowledge, there have been no previous clear demonstrations of the perforating artery in tumefactive perivascular space with contrast-enhanced TOF MR angiography. The purpose of this study was to describe advanced imaging findings in this unusual condition.

Tunica albuginea cyst presenting with milk of calcium

Tunica albuginea cysts are rarely seen but are important and can be diagnosed easily with ultrasonography. Calcium milk is defined as the precipitation of calcium in a cyst or other fluid-containing structure and can be seen in many organs. In this case report, calcium milk seen in a tunica albuginea cyst is discussed.

A rare cause of congenital portosystemic shunt: type 2 Abernethy malformation

The Abernethy malformation is characterised by congenital extrahepatic portosystemic shunts and is divided into two groups according to the type of anastomosis. In type 1, all portal venous blood is discharged into the inferior vena cava and there is no intrahepatic portal vein. In type 2, the portal vein is partially discharged to the inferior vena cava via side-by-side anastomoses. Imaging has an important role in the diagnosis and follow-up of this malformation. Magnetic resonance imaging should be preferred to demonstrate both vessel anatomy and associated anomalies. The aim of this study was to present a 17-year-old male patient and to discuss the imaging findings of Abernethy malformation.

MR arthrographic evaluation of the association between anterolateral soft tissue impingement and osteochondral lesion of the tibiotalar joint

PURPOSE

To retrospectively evaluate on magnetic resonance (MR) arthrography the relationship between joint capsule thickness and the stage of osteochondral lesions of the tibiotalar joint, as well as to evaluate the ankle joint capacity in patients with osteochondritis dissecans (OCD). Also, we demonstrate the unusual locations of osteochondral lesions of the ankle joint.

METHODS

MR arthrography images were analyzed by two staff radiologists in consensus. The normality of the data was analyzed by the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare the relationship between joint capsule thickness and patient groups with OCD.

RESULTS

The anterolateral joint capsule thickness was significantly higher than the anteromedial and posterior joint capsule thickness in the OCD with loose bodies group (p = 0.049). Osteochondral defects were most commonly detected at the medial talar dome: in 29 of 37 patients (78.3%) in the OCD without loose bodies group and in 16 of 29 (55.2%) patients in the OCD with loose bodies group. The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients].

CONCLUSIONS

Clinical and radiological evidence of anterolateral impingement syndrome often accompanies stage 4 OCDs. OCDs of the distal tibial plafond are not rare in the ankle joint and are often associated with loose bodies.

Supradiaphragmatic origin of the renal artery; frequency on contrast-enhanced MR imaging

PURPOSE

The purpose of this study was to evaluate extremely rare cases of supradiaphragmatic origin of the renal artery, with magnetic resonance (MR) imaging findings.

METHODS

The study included 9 patients diagnosed with supra-diaphragmatic originating renal artery between 2010 and 2017. The patients were 7 females and 2 males with a mean age of 58.25 years (range, 41-71 years). MR imaging was applied to all patients.

RESULTS

In 2 patients, lumen loss was of a moderate degree, and mild in 3 patients. Renal artery stenosis was not observed in the remaining 4 patients. None of the patients had advanced luminal stenosis. The distance of the renal arteries to the diaphragmatic crus was 24 mm at the longest and 8 mm at the shortest. Congenital anomaly was found in 6 patients. Of the 9 patients, 7 had concomitant hypertension, and 2 had no history of hypertension.

CONCLUSIONS

The anomaly of supradiaphragmatic origin of the renal artery is rare but may be associated with renal artery stenosis, which may then result in hypertension. The clinician should investigate renal artery origin anomalies and renal artery compression syndrome in hypertensive cases where the cause cannot be explained.