Diffusion-weighted imaging in ectopic pregnancy: Ring of restriction sign

WOS: 000423547100010PubMed ID: 29023142Objective: To demonstrate the diffusion-weighted imaging (DWI) findings of ectopic pregnancy (EP) and introduce the "ring of restriction" sign by discussing possible causes. Methods: Between January 2014 and January 2017, patients with EP and examined by MRI on a 3T scanner were retrospectively evaluated. MRI and DWI findings were recorded. Results: A total of 40 patients were diagnosed with EP at our university hospital, 8 of whom (20%) were evaluated by MRI and DWI. All of them were haemodynamically and clinically stable and could be imaged adequately. Locations were ovary (n = 3, 37.5%), tuba (n = 2, 25%), Caesarean section scar (n = 2, 25%) and parauterine (n = 1, 12.5%). In all eight EPs, the gestational sac diameter was compatible with 7-9 weeks. With DWI, the gestational sac was seen as a thick-walled cyst-like structure. The thick wall showed diffusion restrictions in all patients (ring of restriction sign). Conclusions: DWI through its cellular and molecular evidence may contribute diagnosis of EP

Multisystem imaging findings of a case with relapsing polichondritis

Relapsing polychondritis is a rare immune-mediated systemic inflammatory disease. It is associated with inflammation in cartilaginous tissue and primarily affects cartilaginous structures of the ears, nose and tracheobronchial tree but also the joints, the inner ear, the eyes, and the cardiovascular system (1). With this report we share the multisystem imaging findings of a case with relapsing polychondritis

Importance of fat tissue and puborectal muscle thickness in pelvic floor prolapse and spastic pelvic floor syndrome evaluated by MR defecography

Manyetik rezonans (MR) defekografi ile değerlendirilen olgula- rın klinik ve radyolojik bulgularını sunmak; pelvik taban sarkması (PTS) ve spastik pelvik taban sendromu (SPTS) ile yağ dokusu ka- lınlıkları ve puborektal kas kalınlıkları arasındaki ilişkiyi değerlen- dirmek; PTS alt gruplarının ilişkisini değerlendirmek amaçlandı. Eylül 2015-Eylül 2017 tarihleri arasında MR defekografi ile değer- lendirilen hastalarda retrospektif olarak PTS, sarkmanın hangi kompartmanda olduğu, sarkmanın düzeyi (minimal, orta, ileri), rektosel, invajinasyon, enterosel ve SPTS bulguları değerlendi- rilerek suprapubik, presakral ve rektus abdominus kası anterio- rundaki yağ dokusu kalınlıkları, sağda ve solda puborektal kas kalınlıkları ölçüldü. PTS alt gruplarının (ön, orta, arka) birbirleri ile olan ilişkisi; PTS şiddeti ile suprapubik, presakral ve rektus ab- dominus kası anteriorundaki yağ dokusu kalınlığı arasındaki ilişki Spearman korelasyon testi ile analiz edildi. SPTS olan ve olmayan grupta suprapubik, presakral ve rektus abdominus kası anterio- rundaki yağ dokusu kalınlığı ve sağ-sol puborektal kas kalınlık- ları T testi ile karşılaştırıldı. Altmış üç olguda (ortalama yaş 45; 49 kadın, 14 erkek olgu), 62 arka, 35 orta ve 36 ön kompartman sarkması; 55 rektosel, 28 invajinasyon, 3 enterosel, 1 hipermo- bil üretra, 19 olguda SPTS izlendi. Orta kompartman ile ön kom- partman sarkması arasında kuvvetli bir korelasyon bulundu. Orta kompartman ile rektus abdominus kası anteriorundaki yağ doku- su kalınlığı arasında ve ön kompartman ile rektus abdominus kası anteriorundaki yağ dokusu kalınlığı arasında istatistiksel olarak anlamlı korelasyon saptandı. Ayrıca SPTS grubunda suprapubik yağ dokusu daha ince idi. Orta ve ön kompartman sarkması ara- sındaki güçlü korelasyon, problemin orta kompartmana geçince ön kompartmanı tutmasının kolay olduğunu gösteriyor olabilir. Yağ dokusu kalınlığının artışı orta ve ön kompartman sarkmasın- da etiyolojide obezitenin rol oynayabileceğini göstermekle bir- likte, arka kompartman sarkması ve SPTS’de obezitenin etkisinin belirgin olmadığı şeklinde yorumlanabilir.To present the clinical and radiological findings of cases evalua- ted by magnetic resonance (MR) defecography; to evaluate the relationship between pelvic floor prolapsus (PFP), spastic pelvic floor syndrome (SPFS) and thicknesses of fat tissue and puborec- tal muscles. MR defecograms of the patients evaluated between September 2015 and September 2017 were investigated retros- pectively. PFP, involved compartment, severity of PFP (minimal, moderate, advanced), rectocele, invagination, enterocele and spastic pelvic floor syndrome; thickness of suprapubic, presacral, and pre-rectus abdominus fat tissues, right and left puborectal muscle thicknesses were measured. The correlations among PFP subgroups (anterior, middle, posterior); the relationship between the severity of PFP, and thickness of suprapubic, presacral and pre-rectus abdominus fat tissue was analyzed by Spearman’s cor- relation test. In the groups with and without spastic pelvic floor syndrome, thickness of suprapubic, presacral, and pre-rectus ab- dominus fat tissue and thickness of right-left puborectal muscle were compared by T-test. Of the 63 cases (mean age 45, 49 fema- le, 14 male), 62 posterior, 35 middle, and 36 anterior compart- ment prolapses; 55 rectoceles, 28 invaginations, 3 enteroceles, 1 hypermobile urethra and 19 cases of SPFS were detected. There was a strong correlation between the middle and the anterior compartment prolapsus. There was a statistically significant cor- relation between middle compartment and rectus abdominalis anterior fat tissue thickness and between anterior compartment and rectus abdominus anterior fat tissue thickness. In addition, the suprapubic fat tissue in the SPFS group was thinner. The strong correlation between the middle and anterior compart- ment prolapses can indicate that the anterior compartment is ea- sily affected when middle compartment is involved. The increase in fat tissue thickness may indicate that obesity may play a role in the etiology of middle and anterior compartment prolapsus, but it can be interpreted that the effect of obesity on the posterior compartment prolapsus and SPFS is not so apparent

Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?

WOS: 000402802300017PubMed ID: 28339285Objective: To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions. Methods: Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. Results: A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (6 standard deviation) was 1.6160.51 in carcinomas, and it was 0.6560.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. Conclusion: The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field

Dynamic MR Urography in the Asssesment of Ureteropelvic Junction Obstruction in Pediatric Patients

The aim of this study was to determine morphologic and functional benefits of dynamic magnetic rezonans urography (MRU) at pediatric patients with ureteropelvic junction obstruction. Between 2009-2012, sixteen pediatric patients with known ureteropelvic junction obstruction were evaluated by ultrasound and dynamic MRU retrospectively. Eight of them also had diuretic renal scintigraphy. The findings of MRU were then compared with ultrasonography for morphological evaluation, diuretic renal scintigraphy for functional evaluation and against the results of final diagnosis established at surgery. MRU failed in one patient to find obstruction like ultrasound. MRU and ultrasound was successful to evaluate morphology of urinary system all of the other patients. Results were confirmed with surgery. MRU and diuretic renal scintigraphy were similar for functional evaluation. Dynamic MRU is reliable method for morphologic and functional evaliation of pediatric ureteropelvic junction obstruction. [Med-Science 2013; 2(4.000): 863-84

Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter

84th IEEE Vehicular Technology Conference, VTC Fall 2016 -- 18 September 2016 through 21 September 2016 -- 126901BACKGROUND: Central venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver. OBJECTIVE: Compare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique. DESIGN: Prospective clinical study. SETTING: University hospital. SUBJECTS AND METHODS: Healthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated. MAIN OUTCOME MEASURE(S): Hemodynamic measurements and RIJV dimensions. RESULTS: In 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P<.001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and <.001 for cross-sectional area and diameter, respectively). CONCLUSION: Channelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position. LIMITATIONS: No catheterization and study limited to healthy volunteers

A novel approach to contrast-induced nephrotoxicity: The melatonergic agent agomelatine

WOS: 000376488500007PubMed ID: 26886874Objective: To study the potential nephroprotective role of agomelatine in rat renal tissue in cases of contrast-induced nephrotoxicity (CIN). The drug's action on the antioxidant system and proinflammatory cytokines, superoxide dismutase (SOD) activity, levels of glutathione (GSH) and malondialdehyde (MDA) and the gene expression of interleukin-6 (IL-6), tumour necrosis factor (TNF)-alpha and nuclear factor kappa B (NF-kappa B) was measured. Tubular necrosis and hyaline and haemorrhagic casts were also histopathologically evaluated. Methods: The institutional ethics and local animal care committees approved the study. Eight groups of six rats were put on the following drug regimens: Group 1: healthy controls, Group 2: GLY (glycerol), Group 3: CM (contrast media-iohexol 10 ml kg(-1)), Group 4: GLY+CM, Group 5: CM+AGO20 (agomelatine 20 mg kg(-1)), Group 6: GLY+CM1AGO20, Group 7: CM1AGO40 (agomelatine 40 mg kg(-1)) and Group 8: GLY+CM+AGO40. The groups were evaluated by one-way analysis of variance and Duncan's multiple comparison test. Results: Agomelatine administration significantly improved the serum levels of blood urea nitrogen (BUN) and creatinine, SOD activity, GSH and MDA. The use of agomelatine had substantial downregulatory consequences on TNF-alpha, NF-kappa B and IL-6 messenger RNA levels. Mild-to-severe hyaline and haemorrhagic casts and tubular necrosis were observed in all groups, except in the healthy group. The histopathological scores were better in the agomelatine treatment groups. Conclusion: Agomelatine has nephroprotective effects against CIN in rats. This effect can be attributed to its properties of reducing oxidative stress and inhibiting the secretion of proinflammatory cytokines (NF-kappa B, TNF-alpha and IL-6). Advances in knowledge: CIN is one of the most important adverse effects of radiological procedures. Renal failure, diabetes, malignancy, old age and nonsteroidal anti-inflammatory drug use pose the risk of CIN in patients. Several clinical studies have investigated ways to avoid CIN. Theophylline/aminophylline, statins, ascorbic acid and iloprost have been suggested for this purpose. Agomelatine is one of the melatonin ligands and is used for affective disorders and has antioxidant features. In this study, we hypothesized that agomelatine could have nephroprotective, antioxidant and anti-inflammatory effects against CIN in rats