The Kidney

Ultrasound and conventional radiographs still remain the first-line radiological tools for most of the kidney disorders. Ultrasonographic image quality has been astonishingly improved in recent years with the development of technology and software algorithms. In line with these developments, ultrasound is not only the primary imaging modality for kidney anatomy and lesions, but also sufficient for definitive diagnosis and follow up for some lesions. The aim of this chapter is to focus on the areas that ultrasound is used primarily about the kidney. These topics include kidney anatomy, anatomic variants that mimic lesions, congenital diseases, kidney stones, nephrocalcinosis, most of the cystic diseases, and some solid lesions, infection, and trauma

Ultrasound of the Pediatric Gastrointestinal Emergencies

With recent technologies, ultrasound has become an extremely useful imaging modality for evaluating children with acute abdominal symptoms. Higher frequency transducers can be used in children than in adults, owing to their small body size, the presence of less fat tissue in the abdominal wall and peritoneal cavity leading to higher resolution than computed tomography in many circumstances without exposure to ionizing radiation. Real-time ultrasound imaging provides information about motion such as peristalsis, and newly developed harmonic imaging enables improved resolution with decreased artifacts. Beyond gray-scale ultrasound, color Doppler ultrasound provides information on vascularity which increases in inflammatory processes. Point-of-care examination includes ability to focus on the symptomatic area of the patient while performing real-time ultrasound imaging. Ultrasound is sufficient for the diagnosis of several gastrointestinal diseases that cause acute abdominal pain in pediatric patients helping to an accurate patient management in the emergency settings. Common gastrointestinal indications for abdominal ultrasound in children are hypertrophic pyloric stenosis, acute appendicitis, intussusception, inflammatory bowel disease, malrotation, midgut volvulus, hernia, and necrotizing enterocolitis. In this chapter, typical sonographic findings of aforementioned diseases, and possible differential diagnoses were discussed

Unilateral primary adrenal B-cell lymphoma clinically mimicking chronic gastritis

Background: Primary adrenal lymphomas are a very rare type of extranodal lymphoma, and they usually are found bilaterally. Symptoms of the disease are variable and depend on the type of lymphoma and/or presence of adrenal insufficiency. Magnetic resonance imaging is the best radiologic modality for differentiating lymphomas from other adrenal malignancies; however, histopathology is considered as the gold standard method for diagnosing extranodal lymphomas. Case Report: We present a case of unilateral adrenal lymphoma that was initially diagnosed as an infectious disease and chronic gastritis, based on clinical and laboratory findings. Ultrasonography detected an adrenal mass, and magnetic resonance imaging excluded common lesions of the adrenal gland and showed lymphadenopathy around the major vessels of the abdomen. A percutaneous biopsy of the mass and bone marrow biopsy confirmed the diagnosis of primary adrenal lymphoma withoutbone marrow metastasis. Conclusions: Extranodal lymphomas can occur in almost every organ, and if nonspecific clinical findings are combined with the presence of a solid organ mass, lymphoma should be included in the differential diagnosi

Is Cranial Magnetic Resonance Imaging Necessary in Every Patient with Central Precocious Puberty?

INTRODUCTION: Central Precocious Puberty (CPP) is more common in girls and it is usually idiopathic. Although cranial magnetic resonance imaging (MRI) is recommended in patients with CPP that starts before the age of 6 to elucidate the underlying pathology, performing cranial magnetic resonance imaging in patients who are between the ages of 6 and 8 is controversial. In this study, we aimed to evaluate cranial MRI results and the frequency of intracranial lesions in girls who were diagnosed with CPP. METHODS: In the study, 121 female patients with CPP were included. In the review of the medical records of the patients, anthropometric measurements, laboratory findings and cranial MRI findings were evaluated. RESULTS: The mean age of the patients included in the study was found as 7.24 +- 1.04 years. In 7 (5.8%) of the 121 patients, lesions definitely associated with CPP were detected; in 5 (4.1%) patients, lesions possibly associated with CPP were detected and in 12 (9.9%) patients, lesions that did not induce CPP (incidentaloma) were detected. Neurological findings were not present in all of the patients with cranial pathology. All of the patients with intracranial lesions were between the ages of 6 and 8. DISCUSSION AND CONCLUSION: In our study, contrary to many previous studies, the frequency of cranial pathology was found to be high in patients with CPP that started after the age of 6. Therefore, we recommend performing cranial MRI in all girls who are diagnosed with CPP before the age of 8, regardless of the presence of neurological findings

The utility of ADC measurement techniques for differentiation of low- and high-grade clear cell RCC

Purpose: To evaluate the diffusion properties of clear cell renal cell carcinoma (ccRCC) on magnetic resonance imaging (MRI) concerning their Fuhrman nuclear grades and sizes, and to compare the diagnostic performance of two ROI placement techniques for apparent diffusion coefficient (ADC) measurement (entire mass vs. only the darkest region of the mass). Material and methods: Fifty-one ccRCC were enrolled in the study and grouped into low-grade ccRCC (Fuhrman grade 1 and 2, n = 37) and high-grade ccRCC (Fuhrman grade 3 and 4, n = 14). Selective ADC (Sel-ADC) measurement was performed by placing a circular ROI that included the darkest region of the tumour on ADC map images. Extensive ADC (Ext-ADC) measurement was performed by drawing an ROI that covered the entire tumour. Results: The Sel-ADC value was lower in high-grade ccRCC (p = 0.019), whereas the Ext-ADC value did not show a statistically significant difference (p = 0.42). Sel-ADC value of a ≤ 1.405 mm2/s has a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy value of 78.6, 72.2, 73.87, 77.13, and 75.4, respectively, to differentiate high-grade from low-grade ccRCC. The size and Fuhrman grade of the ccRCC were inversely correlated with the Sel-ADC value; however, the correlations were weak (r = -0.322, p = 0.021 and r = -0.376, p = 0.006, respectively). There was no difference between ADC values of small (≤ 4 cm) and large (> 4 cm) ccRCCs. Conclusions: The ADC value of the darkest region in solid part of the ccRCC may play a role in predicting the nuclear grade of ccRCC

Increased ocular wall thickness and decreased globe volume in children with mucopolysaccharidosis type VI

PURPOSElthough clinical ophthalmologic findings have been reported, no study documented magnetic resonance imaging (MRI) findings in mucopolysaccharidosis (MPS) type VI. The aim of this study was to determine the ophthalmologic imaging findings of MPS type VI in the pediatric age group retrospectively.METHODSBrain MRIs of 10 patients with MPS type VI and 49 healthy children were evaluated independently by two pediatric radiologists for the following characteristics: globe volume, ocular wall thickness, and optic nerve sheath diameter for each orbit. The means of the measurement of each group were compared by using an independent t-test. Agreement and bias between reviewers were assessed by intra-class correlation coefficients (ICC).RESULTSA total of 59 children [32 girls (54.23%), 27 boys (45.77%); age range, 4-16 years; mean age, 10.37 ± 3.73 years] were included in the study. Statistical analysis revealed smaller eyeballs and thicker ocular walls of patients with MPS type VI (P < .001 and P < .001, respectively). However, there was no statistically significant difference in terms of optic nerve sheath diameter between the two groups (P=.648).CONCLUSIONPatients with MPS type VI displayed reduced globe volumes and increased ocular wall thicknesses compared to the healthy children. Therefore, we recommend that ophthalmologic imaging findings might prove to be an auxiliary tool in the diagnosis of MPS patients

Endobiliary Radiofrequency Ablation And Percutaneous Biliary Stent Placement For Choledocal Invasion Of Renal Cell Carcinoma

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