Role of inflammatory markers in decreasing negative appendectomy rate: A study based on computed tomography findings

BACKGROUND: This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT). METHODS: Ninety-two patients who underwent CT examination with suspected AA were included. We investigated the relation between CT findings of AA and laboratory inflammatory markers and also performed receiver operating characteristic (ROC) analysis to calculate cut-off values of inflammatory markers and CT findings of AA. Appendectomy cases were re-evaluated considering cut-off values to make the operation decision and NAR was recalculated. Chi-squared test was used to compare the actual and recalculated NAR. RESULTS: Cut-off values of appendiceal diameter, appendiceal wall thickness, and caecal wall thickness were 7.9, 2, and 2.3 mm, respectively, for the diagnosis of AA. Cut-off values of WBC , NLR, and CRP on ROC analysis were 7.47, 4.06 and 13, respectively, for the diagnosis of AA. When the actual and recalculated NAR (21.9% versus 9.1%) were compared, the difference was found to be almost significant (p=0.058). CONCLUSION: Inflammatory markers are not sufficiently powerful on their own to accurately diagnose AA. However, particularly in equivocal cases, proposed cut-off values may be helpful for accurate diagnosis and a lower NAR can be achieved

Twinkling artifact on color Doppler ultrasound: an advantage or a pitfall?

The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered

Temporal bone posterior wall defect, a new clinic entity?

OBJECTIVE: To define clinical and audiological findings in patients with temporal bone posterior wall defects (TBPWD) and to investigate possible relationships between these findings and the characteristics of the defect. MATERIALS and METHODS: The computed tomography (CT) views of 1198 patients with vestibulocochlear symptoms between 2007 and 2012 were retrospectively evaluated, and TBPWD and associated anomalies were investigated. Patients who had TBPWD were called back, and clinical and audiological examinations (tympanometry, pure tone audiometry, acoustic reflexes, and otoacoustic emission) were performed. RESULTS: Twenty-eight (2.34%) patients had TBPWD. Twenty-three of them were eligible for the study. Size of the defect was significantly correlated with the presence of tinnitus and/or vertigo (p< 0.005). The cut-off values for the largest size of TBPWD were 1.65 mm [sensitivity: 0.67 and specificity: 0.77 (95% CI: 0.58-0.97); p= 0.04] in case of the presence of tinnitus and 1.85 for vertigo (sensitivity: 0.78 and specificity: 0.86 (95% CI: 0.67-0.99); p= 0.006). In pure tone audiometry tests, mixed-type hearing loss was present in four (17%) patients, sensorineural hearing loss was present in three (13%) patients, and conductive-type hearing loss was present only in one (4%) patient. Otoacoustic emission tests revealed significant differences in signal/noise ratios at frequencies of 500, 750, 1000, and 6000 Hz. CONCLUSION: For the first time in the literature, we defined clinical and audiological findings in patients with TBPWDs. These defects seem to cause more prevalent symptoms of vertigo and tinnitus and disturb the audiological characteristics of patients

Multi-regional Adaptive Image Compression (AIC) for hip fractures in pelvis radiography

High resolution digital medical images are stored in DICOM (Digital Imaging and Communications in Medicine) format that requires high storage space in database. Therefore reducing the image size while maintaining diagnostic quality can increase the memory usage efficiency in PACS. In this study, diagnostic regions of interest (ROI) of pelvis radiographs marked by the radiologist are segmented and adaptively compressed by using image processing algorithms. There are three ROIs marked by red, blue and green in every image. ROI contoured by red is defined as the most significant region in the image and compressed by lossless JPEG algorithm. Blue and green regions have less importance than the red region but still contain diagnostic data compared to the rest of the image. Therefore, these regions are compressed by lossy JPEG algorithm with higher quality factor than rest of the image. Non-contoured region is compressed by low quality factor which does not have any diagnostic information about the patient. Several compression ratios are used to determine sufficient quality and appropriate compression level. Compression ratio (CR), peak signal to noise ratio (PSNR), bits per pixel (BPP) and signal to noise ratio (SNR) values are calculated for objective evaluation of image quality. Experimental results show that original images can approximately be compressed six times without losing any diagnostic data. In pelvis radiographs marking multiple regions of interest and adaptive compression of more than one ROI is a new approach. It is believed that this method will improve database management efficiency of PACS while preserving diagnostic image content

Extraordinary presentation of elastofibroma dorsi after a thoracotomy procedure

Elastofibroma dorsi is a reactive pseudotumor of connective tissue, typically located in the infrascapular region. Awareness of this benign entity is crucial for radiologists, as well as clinicians, to avoid misdiagnosis and potential patient harm. In this report, we present clinical and imaging findings of an elastofibroma dorsi after a thoracotomy procedure

In-situ cranioplasty after microvascular decompression: A technical note

Cranioplasty is not only performed for cosmetic reasons but also for physiological requirements to balance the cerebral hemodynamics and to protect the brain from external traumas. Methyl methacrylate is one of the most preferred materials for cranioplasty. It is usually prepared out of the surgical site and therefore modelling of the cranioplasty material to fit the bone defect is sometimes difficult. In this technical note, we present our new technique of cranioplasty with methyl methacrylate in which the material is prepared on site of the bone defect and very easily shaped. Fixation materials are not needed. This technique is especially suitable for posterior fossa surgeries after craniectomy

Competency of residents and interns in pneumothorax diagnosis on chest radiography: an observer performance study

Aim: This study aimed to investigate the competency of residents and interns in diagnosing pneumothorax on chest radiography (CXR) as well as to identify potential areas requiring training on this subject. Materials and Methods: A case set including a total of 40 chest radiographies that were in the digital imaging and communications in medicine (DICOM) format were loaded to the DICOM-compatible software tool-Viewer for Digital Evaluation of X-ray images (ViewDEX). Fifty-three observers, including 25 residents and 28 interns, interpreted the images by answering all the questions determined for each case. Results: The overall accuracy rate to diagnose pneumothorax on CXR was 79% in the study cohort, with 79.5% and 78.6% for residents and interns, respectively. No significant difference was observed between residents and interns when compared in terms of accuracy rates (regardless of the residents' specialties; p=0.600). When the residents' specialties were considered, the diagnostic accuracy rate was found to be significantly different between the groups (p<0.05). Conclusion: The results of our study in terms of the overall accuracy rates of residents and interns in pneumothorax diagnosis on CXR are comparable to the previous studies in literature. However, comparison to another national study was not feasible due to the lack of published studies on this topic in Turkey. We believe that our study may serve as a starting point by raising the awareness on the subject and promote further studies in our country

Average glandular doses and national diagnostic reference levels in mammography examinations in Turkey

In order to establish national diagnostic reference levels for mammography examinations, entrance skin air kerma, entrance skin dose and average glandular doses (AGDs) were calculated for a total of 25 624 cranio-caudal (CC) and mediolateral oblique (MLO) projections of 6309 patients for 40-49 and 50-64 age groups. The average entrance skin air kerma and entrance skin dose values for both age groups were found to be higher in MLO projections compared with CC projections. The minimum and maximum values of AGDs were determined as 0.4 and 7.9 mGy for both projections. The maximum numbers of AGDs for CC and MLO projections were calculated in the range of 1.1-1.5 and 1.6-2.0 mGy, respectively. The third quartile values of AGDs were calculated for each compressed breast thickness between 20 and 99 mm. The first national diagnostic reference levels of the country were established for each 10-mm compressed breast thickness in mammography examinations.Turkish Atomic Energy AuthorityMinistry of Energy & Natural Resources - Turke

Bir orbital ensefaloselin tesadüfi tanısı-kapak miyokimisinin ötesi

A 38-years-old woman presented to our hospital for routine eye examination. She had no complaints but it was learnt that she has been followed up with the diagnosis of a left upper eyelid myokymia for more than 10 years in various ophthalmological centers. Since her eyelid movement was atypical for a myokymia, but in form of an orbital pulsation instead she has undergone an orbital magnetic resonance imaging (MRI) scan. She was coincidentally diagnosed to have a left frontoorbital encephalocele detected by MRI. She had no trauma or chronic illness in history, so the condition was diagnosed as a ‘congenital encephalocele’ which is lately detected since due to the absence of obvious proptosis or an active clinical complaint

Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD?

Objective: The aim of this study was to evaluate the D-dimer levels in patients with chronic obstructive pulmonary disease (COPD) exacerbation with and without pulmonary embolism (PE) and to attempt to define a new cut-off value for D-dimer to exclude the diagnosis of PE in patients with COPD exacerbation. Methods: This cross-sectional study was performed between the June 2012 and January 2013. The COPD patients who were admitted to the emergency department with acute exacerbation were consecutively included. D-dimer levels were measured upon admission. All patients underwent computed tomography angiography (CTA) and Doppler ultrasonography (US) of the lower extremities. Results: A total of 148 patients were enrolled. Fifty-three patients (36%) who did not have PE had higher than normal (>0.5 pg/mL) D-dimer levels. The D-dimer levels of the COPD patients with PE were significantly higher than those of the patients without PE (2.38±2.80 vs. 1.06±1.51 pg/mL) (P<0.001). The cut-off value for D-dimer in diagnosing PE in the COPD patients was 0.95 pg/mL. The area under the receiver operating characteristic (ROC) curve was 0.752±0.040 (95% CI: 0.672-0.831) (P<0.001). Conclusions: This study showed that the D-dimer concentrations of COPD patients who are in the exacerbation period may be higher than normal, even without PE. The cut-off level for D-dimer was 0.95 pg/mL (sensitivity 70%, spesificity 71%) for the exclusion of PE in the patients with COPD exacerbation. The D-dimer cut-off value that is used to exclude PE in patients with acute exacerbation of COPD should be reevaluated to prevent the excessive use of further diagnostic procedures