What is the role of breast MRI in the management of women with pathologic nipple discharge and normal conventional imaging?

BACKGROUND/AIMS

To investigate the diagnostic performance of breast MRI in revealing mammographically and sonographically occult lesions requiring excision in patients with pathologic nipple discharge.

MATERIALS AND METHODS

In this retrospective study, 57 women with pathologic nipple discharge who had normal or inconclusive mammography and ultrasonography results and underwent breast MRI were determined. Patients who had histopathological diagnosis or ≥ 1-year imaging follow-up were included. MRIs were classified as positive and negative according to final BI-RADS assessment categories. Diagnostic performance of MRI, including sensitivity, specificity, negative predictive value, and positive predictive value, was calculated for detecting both malignancy and lesions requiring surgery.

RESULTS

Abnormal contrast enhancement on the pathologic nipple discharge side was detected in 29 MRIs (50.8%), categorized as BI-RADS 4. Abnormal findings were solid masses in 17 cases (58.6%) and non-mass enhancement in 12 cases (41.3%). Despite normal conventional imaging results, 4 malignant lesions and 16 lesions requiring surgery were detected with MRI. The sensitivity and specificity of MRI for detecting lesions requiring surgery were 100% and 68.2%, respectively. The positive predictive value (PPV) and negative predictive value were 55.1% and 100%, respectively.

CONCLUSION

In conclusion, this study confirmed that MRI is a reliable tool to detect lesions requiring surgery in patients with pathologic nipple discharge. MRI should be used in routine workup in patients with normal conventional imaging and imaging follow-up can be safely applied in patients with negative MRI.

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.

The Utility of Quantitative Parameters of Shear-Wave Elastography to Predict Prognostic Histologic Features of Breast Cancer

ABSTRACT

In this study, we aimed to investigate the correlation of stiffness values of shear-wave elastography (SWE) and histopathological prognostic factors in patients with breast cancer. Between January 2021 and June 2022, SWE images of 138 core-biopsy proven breast cancer lesions from 132 patients were retrospectively reviewed. Histopathogic prognostic factors, including tumor size, histologic grade, histologic type, hormone receptor positivity, human epidermal growth factor receptor (HER2) status, immunohistochemical subtype and Ki-67 index were documented. Elasticity values including mean and maximum elasticity ( Emean and Emax ) and lesion-to-fat ratio ( Eratio ) were recorded. The association between histopathological prognostic factors and elasticity values were assessed using Mann-Whitney U and Kruskal-Wallis test, and multiple linear regression analysis. Tumor size, histological grade, and Ki-67 index were significantly associated with the Eratio ( P < 0.05). Larger tumor size and higher Ki-67 index also showed significantly higher Emean and Emax values ( P < 0.05). However, hormone receptor positivity, HER2 status, and immunohistochemical subtype were not significantly associated with elasticity values ( P > 0.05). Multivariate logistic regression analysis revealed that tumor size was significantly associated with Emean , Emax , and Eratio values ( P < 0.05). A high Ki-67 index was also significantly associated with high Eratio values. Larger tumor size and higher Ki-67 index are independently associated with high Eratio values. Preoperative SWE may improve the performance of conventional ultrasound in predicting prognosis and treatment planning.

Diagnostic performance of Kaiser score in patients with newly diagnosed breast cancer: Factors associated with false-negative results

PURPOSE

To investigate the factors associated with false-negative results in the diagnosis of breast cancer via breast magnetic resonance imaging (MRI) using the Kaiser score (KS).

METHODS

This institutional review board (IRB)-approved, single-center, retrospective study enrolled 219 consecutive histopathologically proven breast cancer lesions in 205 women who underwent preoperative breast MRI. Two breast radiologists evaluated each lesion according to the KS. The clinicopathological characteristics and imaging findings were also analyzed. Interobserver variability was assessed using the intraclass correlation coefficient (ICC). Multivariate regression analysis was used to investigate factors associated with false-negative KS results for breast cancer diagnosis.

RESULTS

Of 219 breast cancers, KS yielded 200 (91.3%) true-positive and 19 (8.7%) false-negative results. The interobserver ICC for the KS between the two readers was good, with a value of 0.804 (95% CI 0.751-0.846). Multivariate regression analysis revealed that small lesion size (≤1 cm) (adjusted OR 6.86, 95% CI 2.14-21.94, p = 0.001) and personal breast cancer history (adjusted OR 7.59, 95% CI, 1.55-37.23, p = 0.012) were significantly associated with false-negative KS results.

CONCLUSION

Small lesion size (≤1 cm) and presence of personal breast cancer history are factors significantly associated with false-negative KS results. Our results suggest that radiologists should consider these factors in clinical practice as potential pitfalls of KS, which may be compensated for by a multimodal approach combined with clinical evaluation.

Impact of Menopausal Status on Imaging Findings of Patients With Triple-Negative Breast Cancer

OBJECTIVE

To investigate whether there are differences in multimodality imaging characteristics of patients with triple-negative breast cancer (TNBC) based on menopausal status.

METHODS

This IRB-approved retrospective study reviewed clinicopathologic features and radiological imaging findings of 81 patients with TNBC, of whom 38.2% (31/81) were pre- and perimenopausal and 61.7% (50/81) postmenopausal. Data analysis was performed using the chi-square test or Fisher's exact test, and a P-value of <0.05 was considered significant. Subgroup analysis excluding non-basal TNBCs was also conducted.

RESULTS

Fifty-eight percent (18/31) of TNBCs in the premenopausal group were round or oval in shape, whereas irregularly shaped tumors accounted for 82.0% (41/50) in postmenopausal group (P < 0.001). Associated calcifications were more common in the postmenopausal group (59.5% (25/42) versus 16.6% (3/18)) (P = 0.07). The subgroup analyses that included only basal-type TNBCs were also consistent with these results. Sixty percent (15/25) of basal-like TNBCs in the premenopausal group had a round or oval shape, whereas 82.3% (28/34) of tumors in the postmenopausal group had an irregular shape (P = 0.001). Moreover, 36.0% (9/25) of basal-like TNBCs in the premenopausal group had microlobulated margins, while 73.5% (25/34) of the postmenopausal group had spiculated margins (P = 0.001). On MRI, most common finding was a T2 hyperintense mass with rim enhancement.

CONCLUSION

Menopausal status should be taken into consideration when considering breast cancer phenotype. Although imaging findings alone are not sufficient for determining the phenotype, such information can aid better understanding of the biological behavior of TNBCs.

Is There Any Association Between Mammographic Features of Microcalcifications and Breast Cancer Subtypes in Ductal Carcinoma In Situ?

RATIONALE AND OBJECTIVES

To analyze the association between mammographic features of microcalcifications and histopathological prognostic factors based on estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2/neu) in ductal carcinoma in situ (DCIS).

MATERIALS AND METHODS

We retrospectively determined 66 patients with microcalcification-associated pure DCIS. Distribution and morphological features of the microcalcifications were described using Breast Imaging Reporting and Data System lexicon. All patients were divided into three subgroups: ER-positive, HER-2 positive, and triple-negative according to the immunohistochemical findings.

RESULTS

The morphological features of microcalcifications and receptor subtypes were significantly correlated (p = 0.026). Fine pleomorphic and fine linear branching microcalcifications were observed in 85.2% of HER-2 positive cases, whereas this ratio was 71.4 % in ER-positive and 25% in the triple-negative group. Fine linear branching microcalcifications with linear or segmental distribution were more frequently found with comedo necrosis (p < 0.05). Larger tumour sizes were also associated with microcalcification distribution (p < 0.001). Segmental microcalcifications more likely associated with larger tumour sizes.

CONCLUSION

Mammographic features in DCIS correlated with immunohistochemical and histopathological prognostic factors.

Self-compassion, optimism and shame in childhood trauma among 18-25 years old individuals

Introduction

Childhood trauma has a negative impact on mental health of individuals. Self-compassion involves being open to painful and troubling feelings, approaching them in a caring and loving way, accepting negative experiences as a part of human life. Optimism is an individual’s belief that everything will be better in the future despite the difficulties and obstacles of life. Shame is the feeling that occurs when an inadequacy or inappropriate behavior is noticed.

Objectives

The aim of this study was to investigate the effects of childhood trauma on self-compassion, optimism, and shame.

Methods

Childhood Trauma Scale, Self-Compassion Scale, Life Orientation Test and Shame Scale were administered to 384 individuals (304 Female and 80 Male). Their age range was between 18 and 25, with the mean of 21.26.

Results

The findings of MANOVA indicated that a significant main effect of gender on emotional abuse and sexual abuse however there was no main effect of gender on physical abuse, physical neglect, emotional neglect, and excessive protection. Women were exposed to emotional and sexual abuse more than men. MANOVA that was applied to the scores of CTQ revealed a significant overall main effect of self-compassion and optimism whereas there was no main effect of shame.

Conclusions

While self-compassion and optimism are the protective factors for the traumatized individuals, shame is the risk factor.

Disclosure

No significant relationships.

Accuracy in tumor size measurements: Comparison of digital mammography, digital breast tomosynthesis and synthetic mammography

PURPOSE

The aim of this study was to assess the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography (SM) in tumor size measurements compared with histological tumor sizes.

MATERIALS AND METHODS

71 breast cancer patients who underwent DM and DBT acquisitions simultaneously were included in this study. One radiologist with 8 years of experience in breast imaging measured tumor sizes independently in three separate sessions which include DM, DBT and SM images, respectively. The correlations between the measured tumor sizes on each imaging technique and histological sizes were analyzed using Spearman correlation test. The patients were categorized into two subgroups according to assigned breast density categories (dense and non-dense), and histological tumor sizes (≤2 cm and > 2 cm). To assess the agreement levels between the measured tumor sizes and histological sizes Bland-Altman analyses were performed for each imaging technique.

RESULTS

The mean of histological size of tumors was 23.85 ± 16.57 mm (median: 20). The means of measured tumor sizes were 21.21 ± 13.59 mm (median: 19), 21.52 ± 13.42 mm (median: 19) and 18.97 ± 11.21 mm (median: 17) in DM, DBT and SM, respectively. The Spearman correlation values with histologic sizes were 0.814 (P < 0.001), 0.887 (P < 0.001), and 0.852 (P < 0.001) for DM, DBT and SM, respectively. In subgroup analyses, the correlation values showed decrement for tumors >2 cm in size compared to tumors ≤2 cm in size.

CONCLUSION

DBT provides the most accurate tumor size measurements among mammographic imaging techniques and if mammography will be used in tumor size measurements, DBT should be preferred.

Comparison of Mass Size Measurements: Synthesized Mammography Versus Full-Field Digital Mammography

OBJECTIVES

To compare mass size measurements between synthesized mammography (SM) and full-field digital mammography (FFDM), and to assess interobserver agreement for those measurements.

MATERIALS AND METHODS

One hundred and forty-three patients who underwent FFDM and digital breast tomosynthesis acquisitions during the same compression session were included in the study. Two observers with four-and 1-year experience with digital breast tomosynthesis and SM images, respectively, measured mass sizes independently in two different sessions that were 2 weeks apart, and were blinded to each other. The first session included only FFDM images, and the second session included only SM images. Largest dimension of masses was measured in millimeters. Paired t test was used to compare differences in size measurements between FFDM and SM images. Intraclass correlation coefficient test was used to analyze interobserver agreement. Bland-Altman analyses were performed to evaluate agreements between the imaging techniques and between the observers.

RESULTS

The mean mass sizes on FFDM and SM images were 20.27 ± 14.10 and 18.50 ± 13.05 mm, respectively, for the first observer and 21.56 ± 14.84 and 19.89 ± 13.68 mm, respectively, for the second observer. The mass size measurements were significantly different between FFDM and SM for both observers (p < 0.001). Range of measurement errors, defined as 95% limits of agreements between two imaging techniques for observers 1 and 2 were ±1.96*1.36 mm, and ±1.96*1.53 mm, respectively. Range of measurement errors, defined as 95% limits of agreements between two observers for SM and FFDM were ±1.96*3.68 mm, and ±1.96*3.35 mm, respectively.

CONCLUSION

The measured mass sizes were significantly smaller on SM than FFDM images, and the interobserver differences for both of the imaging techniques were greater than the differences measured between FFDM and SM images.

Determination of Normal Breast and Areolar Skin Elasticity Using Shear Wave Elastography

OBJECTIVES

In this study, we aimed to determine reference values for normal breast and areolar skin elasticity using shear wave elastography.

METHODS

The right breasts of 200 female participants were evaluated. The age, weight, body mass index, menopausal status, and parity number of all participants were noted. The elasticity values and thickness of the areolar skin and 4 quadrants of the breast skin of all participants were measured. To assess the reproducibility of shear wave elastography, a randomly selected subgroup of 35 participants was reevaluated by a second observer.

RESULTS

The mean age of the participants ± SD was 48.79 ± 10.74 years (range, 18-79 years). The mean elasticity measurements for the superior, inferior, lateral, and medial regions of the breast and areolar skin were 33.54, 29.84, 30.16, 29.20, and 31.35 kPa, respectively. The mean of the 4-quadrant measurements of breast skin elasticity was 30.68 ± 9.11 kPa. Age had a moderate negative correlation with breast skin elasticity (r = -0.353; P < .001) and a weak negative correlation with areolar skin elasticity (r = -0.237; P = .001). The parity number had weak negative correlations with breast (r = -0.150; P = .034) and areolar (r = -0.207; P < .001) skin elasticity. The interobserver agreement varied from good to excellent (intraclass correlation coefficients, 0.67-0.91) for the breast and areolar skin elasticity measurements.

CONCLUSIONS

Shear wave elastography is a reproducible imaging modality for evaluations of breast and areolar skin elasticity, and our results may provide important pilot data for evaluations of clinical entities that affect the breast and areolar skin structures.

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients

AIM

Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures.

PATIENTS AND METHODS

We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9+/-5.57 years (age range: 59-81 years). The mean follow-up period was 78.8+/-26.6 months (range: 48-118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system.

RESULTS

We found good-to-excellent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59+/-17.95 (25-94), 121.30+/-42.99 degrees (range: 30-170 degrees ) and 30 degrees (range: 0-80 degrees ), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p<0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r=0.872, p<0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r=-0.853, p<0.001).

CONCLUSION

In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction.

[Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation]

OBJECTIVES

We compared open reduction-internal fixation (ORIF) and closed reduction-internal fixation (CRIF) with respect to operation and radiation exposure times in the treatment of displaced supracondylar humeral fractures in children.

METHODS

This retrospective study included 124 children (76 boys, 48 girls) who underwent surgical treatment for displaced supracondylar humeral fractures (Gartland type 3). Of these, 52 patients (mean age 7.5 + or - 2.8 years) underwent ORIF, and 72 patients (mean age 6.1 + or - 2.5 years) underwent CRIF. Operation and fluoroscopy times were recorded in both groups. Final assessments included range of motion, varus- valgus angulation, neurovascular findings, and cosmetic appearance. Functional and cosmetic results were assessed using the criteria of Flynn et al. after a mean follow-up period of 49.3 + or - 18.6 months and 50.4 + or - 17.9 months in the ORIF and CRIF groups, respectively.

RESULTS

Radiographical union was obtained in all the patients within six weeks postoperatively. The two groups did not differ with respect to functional and cosmetic results (p>0.05), with excellent-good results accounting for 90.3% in the CRIF group, and 86.6% in the ORIF group. The mean operation times were 44.2 + or - 12.6 and 28.3 + or - 8.2 minutes, and the mean fluoroscopy times were 36.0 + or - 15.3 and 11.7 + or - 4.5 seconds, in the CRIF and ORIF groups, respectively, both being significantly longer in the former (p=0.000).

CONCLUSION

As extended fluoroscopy use increases radiation exposure, ORIF sems to be more convenient for the treatment of displaced supracondylar humeral fractures.

Clinical outcome assessment in mammography: an audit of 7,506 screening and diagnostic mammography examinations

PURPOSE

To perform an audit of our routine mammographic practice and to compare our results to performance benchmarks.

MATERIALS AND METHODS

We analyzed the outcomes of 7,506 consecutive examinations performed in 1 year. Screening and diagnostic cases were evaluated separately and mammographic assessments were based on the Breast Imaging Reporting and Data System (BI-RADS) classification.

RESULTS

In 6,858 (91%) screening and 648 (9%) diagnostic cases, outcomes varied substantially. The recall rate was 10.9%. Estimated sensitivity and specificity were similar (100% vs. 98% and 88% vs. 94%) in the screening and diagnostic groups. Positive predictive values (PPV1, PPV2, and PPV3) were higher in the diagnostic group compared to the screening group (64%, 65%, and 68% vs. 4.9%, 33%, and 39%, respectively). Cancer outcomes in the screening and diagnostic groups were, respectively, as follows: cancer detection rate, 6.1 per thousand vs. 86.4 per thousand; mean invasive cancer size, 15.7 mm vs. 24.5 mm; minimal cancers, 38% vs. 19%; stage 0-1 cancers, 50% vs. 21%; and lymph node negativity, 76% vs. 29%.

CONCLUSION

The measures of our screening outcomes were concordant with the literature and the performance benchmarks for screening mammography; however, in our diagnostic group, the reasons for the higher PPV, higher cancer detection rate, and the diagnosis of cancer in a more advanced stage compared to the performance benchmarks should be investigated with more detailed periodic audits.

Mammography device use in Turkey, and quantity and quality analysis of mammography education

PURPOSE

To evaluate in detail the ways and methods of mammography education, to survey currently used mammography devices, and to determine the quality of mammography examinations in Turkey in order to increase the quality of said examinations and to offer guidance to standardization studies in Turkey.

MATERIALS AND METHODS

This study depended on the analysis of a questionnaire that was completed by volunteering medical centers. The questionnaire was mailed to all institutions in Turkey with a mammography device and which were registered with the Turkish Atomic Energy Commission and individual city health administration databases (n = 456).

RESULTS

It was not possible to determine the exact number of mammography devices in Turkey. In all, 270 questionnaires were completed and returned from the registered centers. Among the mammography devices declared (n = 291), automatic exposure control (AEC), spot view, and magnification view were not used at 21%, 34%, and 43% of the centers, respectively. Preoperative wire localization was not practiced at 180 centers (62%) despite the ability to do so. At 16% of the centers, mammograms were not labeled and at 57% of the centers labeling was handwritten. At 23% of the centers only small cassettes were used, and at 58% the heat and at 94% the humidity of film storage areas were inappropriate or unknown. At 25% of the centers light and at 15% radiation exposure of the film was present. Mammography quality control tests were performed at 40%, and in 70% control records were not well kept. There were no thermometers in 49% of the centers, no phantom breast at 80%, no sensitometer at 93%, and no densitometer at 81%. At 50% of the centers, regular periodic maintenance was not performed. Second look was performed consistently at 12% of the centers and BI-RADS (Breast Imaging Reporting and Data System) categorization was used at 40%.

CONCLUSION

The exact number of mammography devices is not officially known in Turkey, and it is apparent that registration of some devices was not made by the Turkish Atomic Energy Commission. Questionnaire responses about mammography education and procedures revealed that there was a serious lack of quality across regions. Education, accreditation, inspection, and sanctions are needed immediately to institute standardization and improve quality. This is a critical situation that should be addressed by the Turkish Society of Radiology.

The role of late-phase pulse inversion harmonic imaging in the detection of occult hepatic metastases

OBJECTIVE

The purpose of this study was to investigate the efficacy of late-phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal.

METHODS

Thirty-two patients (21 women and 11 men; age range, 20-87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir-enhanced magnetic resonance imaging was performed as part of the clinical workup.

RESULTS

After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow-up and CT. Conclusions. Late-phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.

Spinal infections

Spinal infections have an increasing prevalence among the general population. Definitive diagnosis based solely on clinical grounds is usually not possible and radiological imaging is used in almost all patients. The primary aim of the authors is to present an overview of spinal infections located in epidural, intradural and intramedullary compartments and to provide diagnostic clues regarding different imaging modalities, particularly MRI, to the practicing physicians and radiologists.

[Assessment of mandibular vascular canals by dental CT]

PURPOSE

Sublingual artery and its branches run in the floor of the mouth and prone to substantial bleeding when injured during an implantation procedure. These branches enter the mandible from the lingual side and run through bony canals in the mandible. The purpose of this investigation is to evaluate the frequency, diameter, direction and position of lingual canals by dental CT.

MATERIALS AND METHODS

26 patients who underwent dental CT of the mandible before implantation were included in this study. Tomographic examination was performed in a transverse plane parallel to the mandibular base by bone algorithm. Multiplanar reconstructions were obtained in the sagittal and coronal oblique planes.

RESULTS

All patients demonstrated at least one canal, and 8 patients had two or more canals. Two of the patients presented with four canals. The typical lingual canal locations were the middle of the mandible and the premolar regions. The mean diameter of the lingual canals was 0.8 mm +/- 0.2 mm in the middle, 0.6 mm +/- 0.1 mm in the premolar regions. The direction of median canal was anterior and slightly caudal. Lateral canals were directed in a medial manner.

CONCLUSION

Before the dental implantation procedure, beside the relationships of implant with the important anatomic structures, lingual vascular canals should also be evaluated. Dental CT examination easily demonstrates the presence, position, direction and size of the lingual canals. By ensuring that radiologists and dentists are aware of these canals and their importance, bleeding complications during the placement of implants could be avoided.

Repairing great duodenal defects in rabbits by ePTFE patch

The aim of this experimental study was to evaluate the results of repairing large duodenal defects in rabbits by an ePTFE (Gore-Tex) soft tissue patch graft. A defect as large as 50% of the total circumference of the duodenum (i.e. Grade 3 injury) on anterior surface of the second part in 14 white New Zealand rabbits was done and repaired by 1 mm ePTFE graft. The stomach and duodenum were inspected for evidence of either leak or obstruction, and completeness of the mucosa covering the defect. Neither leak nor obstruction were observed and the whole grafted area was covered by the mucosa at the end of the sixth month. The main conclusion is that the method we used, is easy and reliable. Further experience will appropriate animal models is needed before this technique can be considered for application (in human duodenal injuries).

The effect of different anaesthetic agents in hearing loss following spinal anaesthesia

The cause of hearing loss after spinal anaesthesia is unknown. Up until now, the only factor studied has been the effect of the diameter of the spinal needle on post-operative sensorineural hearing loss. The aim of this study was to describe this hearing loss and to investigate other factors influencing the degree of hearing loss. Two groups of 22 similar patients were studied: one group received 6 mL prilocaine 2%; and the other received 3 mL bupivacaine 0.5%. Patients given prilocaine were more likely to develop hearing loss (10 out of 22) than those given bupivacaine (4 out of 22) (P < 0.05). The average hearing loss for speech frequencies was about 10 dB after prilocaine and 15 dB after bupivacaine. None of the patients complained of subjective hearing loss. Long-term follow-up of the patients was not possible.