Did radiation exposure increase with chest computed tomography use among different ages during the COVID-19 pandemic? A multi-center study with 42028 chest computed tomography scans

PURPOSETo determine whether radiation exposure increased among different ages with chest computed tomography (CT) use during the coronavirus disease-2019 (COVID-19) pandemic.METHODSPatients with chest CT scans in an 8-month period of the pandemic between March 15, 2020, and November 15, 2020, and the same period of the preceding year were included in the study. Indications of chest CT scans were obtained from the clinical notes and categorized as infectious diseases, neoplastic disorders, trauma, and other diseases. Chest CT scans for infectious diseases during the pandemic were compared with those with the same indications in 2019. The dose-length product values were obtained from the protocol screen individually.RESULTSThe total number of chest CT scans with an indication of infectious disease was 21746 in 2020 and 4318 in 2019. Total radiation exposure increased by 573% with the use of chest CT for infectious indications but decreased by 19% for neoplasia, 12% for trauma, and 43% for other reasons. The mean age of the patients scanned in 2019 was significantly higher than those scanned during the pandemic (64.6 vs. 50.3 years). A striking increase was seen in the 10–59 age group during the pandemic (P < 0.001). The highest increase was seen in the 20–29 age group, being 18.6 fold. One death was recorded per 58 chest CT scans during the pandemic. Chest CT use was substantially higher at the beginning of the pandemic.CONCLUSIONChest CT was excessively used during the COVID-19 pandemic. Young and middle-aged people were exposed more than others. The impact of COVID-19-pandemic-related radiation exposure on public health should be followed carefully in future years

Yüksek risk grubu olgularda meme MR görüntülemenin mamografik bulgulara katkısı

Objective: We aimed to examine the contribution of breast magnetic resonance imaging (MRI) to mammography in high-risk patients with partial mastectomy, and/or with a family history. Material and Methods: 80 patients were scanned with mammography and MRI at our hospital. 30 of the patients had partial mastectomy due to the diagnosis of breast cancer. 52 patients had family history of breast cancer. Mammography scannings were performed under normal circumstances in standard craniocaudal (CC) and mediolateral (MLO) positions or in some special circumstances, scanings were performed using spot and magnification graphies. MRI scannings were performed using 1.5 Tesla MRI scanner with dual breast coil. Results: Fifty two of the patients enrolled in this study had a relative with breast cancer. 30 (37,5 %) out of 80 patients had history of breast cancer before. In 12 (15 %) out of 80 patients, the advantage of breast MRI to mammography could not be proven. In 54 (67,5 %) of the patients breast MRI had an advantage over mammography. In 5 (6,5 %) of the patients MRI had false negative results when compared with the pathology results. When compared with the pathology results in 9 (19 %) patients MRI scanning results were false positive. Conclusion: In this study, it was concluded that breast MRI scanning has reasonable advantage when compared to mammography for the patients who had breast cancer diagnosis or who has a first degree relative with breast cancer.Amaç: Meme kanseri nedeniyle parsiyel mastektomi veya aile öyküsü gibi, meme kanseri için yüksek risk grubu olgularda, meme manyetik rezonans görüntüleme (MRG)’nin mamografik görüntülemeye katkısını değerlendirmeyi amaçladık. Gereç ve Yöntem: Seksen olgu, bölümümüzde mamografi ve MRG ile değerlendirildi. 30 olgu, meme kanseri tanısı ile parsiyel mastektomi geçirmişti. 52 olgu, birinci derecede akrabada meme kanseri öyküsüne sahipti. Mamografik görüntüleme, standart kraniokaudal ve mediolateral pozisyonlarda elde olundu. Gerekli durumlarda spot ve magnifiye grafiler eklendi. MR görüntüleri, 1,5 Tesla MRG cihazında, dual meme koili ile elde edildi. Bulgular: Elli iki olguda aile öyküsü mevcuttu. 30(% 37,5) olguda daha önce geçirilmiş meme kanseri ve tedavi öyküsü vardı. 80 olgudan, 12'sinde (% 15), meme MRG görüntülemenin mamografi bulgularına herhangi katkısı veya ek bulgu saptanmadı. 54 (% 67,5) olguda, MRG, mamografi bulgularına ek bulgu ve tanıya katkı sağladı. Patoloji sonuç- larıyla kıyaslandığında, 5 (% 6,5) olguda MRG'de yanlış negatif, 9 olguda (% 19) yanlış pozitif bulgular saptandı. Sonuç: Bu çalışmada, birinci derece akrabalarında meme kanseri öyküsü veya geçirilmiş meme kanseri tanı ve tedavi öyküsü bilinen, yüksek riskli olgu grubunda, meme MRG görüntülemenin, mamografik bulgulara katkı sağladığını saptadı

Two Cases of Isolated Internuclear Presenting Ophthalmoplegia

Internuclear ophtalmoplegia (INO) is a gaze disorder caused by medial longitudinal fasciculus (MLF) injury and is characterized by impairment of adduction in the ipsilateral eye and dissociated nystagmus in the contralateral eye. INO usually develops due to lesions caused by multiple sclerosis or stroke, and rarely to head trauma. Disseciton of vertebral artery is an often overlooked cause of stroke, especially in young adults. Dissection of vertebral artery should be considered in differential diagnosis in patients with clinical findings of brain stem dysfunction and a history of head trauma. This paper discusses two cases of INO

Cerebral Hydatid Cyst: A Case Report

Hydatid cyst is a parasitic disease caused by larvae of Echinococcus. Central nervous system involvement is rare in patients with hydatid cyst. Cysts are asymptomatic until they reach large sizes. Clinical symptoms of central nervous system depends on the size and location of the lesion. The most common symptoms are headache and vomiting. Clinical diagnosis is confirmed by epidemiological evidence, medical history, clinical findings, serological tests and lesions determined with ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). Surgery is the primary treatment modality. The purpose is to remove the cyst without rupture in surgical approach. In this article, a rare case of an adult with multiple intracranial lesions presenting with obvious clinical symptoms has been reported with imaging findings

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

Background: Magnetic resonance imaging (MRI) has become a diagnostic and problem solving method for the breast examinations in addition to conventional breast examination methods. Diffusion-weighted imaging (DWI) adds valuable information to conventional MRI. Aims: Our aim was to show the impact of apparent diffusion coefficient (ADC) values acquired with DWI to differentiate benign and malignant breast lesions. Study Design: Diagnostic accuracy study. Methods: Forty-six women with 58 breast masses (35 malignant, 23 benign) were examined on a 1.5 T clinical MRI scanner. The morphologic characteristics of the lesions on conventional MRI sequences and contrast uptake pattern were assessed. ADC values of both lesions and normal breast parenchyma were measured. The ADC values obtained were statistically compared with the histopathologic results using Paired Samples t-Test. Results: Multiple lesions were detected in 12 (26%) of the patients, while only one lesion was detected in 34 (74%). Overall, 35 lesions out of 58 were histopathologically proven to be malignant. In the dynamic contrast-enhanced series, 5 of the malignant lesions were type 1, while 8 benign lesions revealed either type 2 or 3 time signal intensity curves (85% sensitivity, 56% spesifity). Mean ADC values were significantly different in malignant vs. benign lesions. (1.04±0.29x10-3 cm2/sec vs. 1.61±0.50x10-3 cm2/sec for the malignant and benign lesions, respectively, p=0.03). A cut-off value of 1.30x10-3 mm2/sec for ADC detected with receiver operating characteristic analysis yielded 89.1% sensitivity and 100% specificity for the differentiation between benign and malignant lesions. Conclusion: ADC values improve the diagnostic accuracy of solid breast lesions when evaluated with the conventional MRI sequences. Therefore, DWI should be incorporated to routine breast MRI protocol

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

Background: Magnetic resonance imaging (MRI) has become a diagnostic and problem solving method for the breast examinations in addition to conventional breast examination methods. Diffusion-weighted imaging (DWI) adds valuable information to conventional MRI. Aims: Our aim was to show the impact of apparent diffusion coefficient (ADC) values acquired with DWI to differentiate benign and malignant breast lesions. Study Design: Diagnostic accuracy study. Methods: Forty-six women with 58 breast masses (35 malignant, 23 benign) were examined on a 1.5 T clinical MRI scanner. The morphologic characteristics of the lesions on conventional MRI sequences and contrast uptake pattern were assessed. ADC values of both lesions and normal breast parenchyma were measured. The ADC values obtained were statistically compared with the histopathologic results using Paired Samples t-Test. Results: Multiple lesions were detected in 12 (26%) of the patients, while only one lesion was detected in 34 (74%). Overall, 35 lesions out of 58 were histopathologically proven to be malignant. In the dynamic contrast-enhanced series, 5 of the malignant lesions were type 1, while 8 benign lesions revealed either type 2 or 3 time signal intensity curves (85% sensitivity, 56% spesifity). Mean ADC values were significantly different in malignant vs. benign lesions. (1.04±0.29x10-3 cm2/sec vs. 1.61±0.50x10-3 cm2/sec for the malignant and benign lesions, respectively, p=0.03). A cut-off value of 1.30x10-3 mm2/sec for ADC detected with receiver operating characteristic analysis yielded 89.1% sensitivity and 100% specificity for the differentiation between benign and malignant lesions. Conclusion: ADC values improve the diagnostic accuracy of solid breast lesions when evaluated with the conventional MRI sequences. Therefore, DWI should be incorporated to routine breast MRI protocol

Yüksek risk grubu olgularda meme MR görüntülemenin mamografik bulgulara katkısı

Objective: We aimed to examine the contribution of breast magnetic resonance imaging (MRI) to mammography in high-risk patients with partial mastectomy, and/or with a family history. Material and Methods: 80 patients were scanned with mammography and MRI at our hospital. 30 of the patients had partial mastectomy due to the diagnosis of breast cancer. 52 patients had family history of breast cancer. Mammography scannings were performed under normal circumstances in standard craniocaudal (CC) and mediolateral (MLO) positions or in some special circumstances, scanings were performed using spot and magnification graphies. MRI scannings were performed using 1.5 Tesla MRI scanner with dual breast coil. Results: Fifty two of the patients enrolled in this study had a relative with breast cancer. 30 (37,5 %) out of 80 patients had history of breast cancer before. In 12 (15 %) out of 80 patients, the advantage of breast MRI to mammography could not be proven. In 54 (67,5 %) of the patients breast MRI had an advantage over mammography. In 5 (6,5 %) of the patients MRI had false negative results when compared with the pathology results. When compared with the pathology results in 9 (19 %) patients MRI scanning results were false positive. Conclusion: In this study, it was concluded that breast MRI scanning has reasonable advantage when compared to mammography for the patients who had breast cancer diagnosis or who has a first degree relative with breast cancer.Amaç: Meme kanseri nedeniyle parsiyel mastektomi veya aile öyküsü gibi, meme kanseri için yüksek risk grubu olgularda, meme manyetik rezonans görüntüleme (MRG)’nin mamografik görüntülemeye katkısını değerlendirmeyi amaçladık. Gereç ve Yöntem: Seksen olgu, bölümümüzde mamografi ve MRG ile değerlendirildi. 30 olgu, meme kanseri tanısı ile parsiyel mastektomi geçirmişti. 52 olgu, birinci derecede akrabada meme kanseri öyküsüne sahipti. Mamografik görüntüleme, standart kraniokaudal ve mediolateral pozisyonlarda elde olundu. Gerekli durumlarda spot ve magnifiye grafiler eklendi. MR görüntüleri, 1,5 Tesla MRG cihazında, dual meme koili ile elde edildi. Bulgular: Elli iki olguda aile öyküsü mevcuttu. 30(% 37,5) olguda daha önce geçirilmiş meme kanseri ve tedavi öyküsü vardı. 80 olgudan, 12'sinde (% 15), meme MRG görüntülemenin mamografi bulgularına herhangi katkısı veya ek bulgu saptanmadı. 54 (% 67,5) olguda, MRG, mamografi bulgularına ek bulgu ve tanıya katkı sağladı. Patoloji sonuç- larıyla kıyaslandığında, 5 (% 6,5) olguda MRG'de yanlış negatif, 9 olguda (% 19) yanlış pozitif bulgular saptandı. Sonuç: Bu çalışmada, birinci derece akrabalarında meme kanseri öyküsü veya geçirilmiş meme kanseri tanı ve tedavi öyküsü bilinen, yüksek riskli olgu grubunda, meme MRG görüntülemenin, mamografik bulgulara katkı sağladığını saptadı

Transverse Myelitis Associated with Toxocariasis and the Importance of Locally Produced Antibodies for Diagnosis

Toksokariyaz, dünyada yaygın olarak görülen, Toxocara canis veya daha az oranda T.catis tarafından oluşturulan bir parazit enfeksiyonudur. İnsanlarda klinik spektrum, alınan parazitin miktarına, larvanın göçtüğü bölgeye ve konağın infl amatuvar yanıtına bağlı olarak asemptomatik enfeksiyondan ciddi organ hasarına kadar değişebilir. Toksokariyaza bağlı transvers miyelit (TM) oldukça nadir görülen bir hastalık olup, literatürde çoğunlukla olgu sunumları şeklinde rapor edilmiştir. Bu raporda, transvers miyelit (TM) gelişen ve serolojik olarak nörotoksokariyaz tanısı konulan bir olgu sunulmuştur. Yaklaşık iki yıl önce sırt ağrısı yakınmasıyla başvurduğu bir merkezde TM tanısı konulan 44 yaşındaki erkek hasta, altı ay süreyle pregabalin ve steroid-dışı ilaç tedavisi almış, ancak lezyonlarda ilerleme olunca başka bir merkezde üç ay süreyle yüksek doz kortikosteroid tedavisi uygulanmıştır. Altı aylık takipte iyileşme saptanan olgu, bir yıl sonra yakınmaların tekrarlaması üzerine hastanemize başvurmuştur. Yapılan manyetik rezonans görüntüleme (MRG) tetkikinde, daha alt segmentte TM tanısı konmuştur. Sol alt ekstremitede güçsüzlük ve uyuşma yakınmaları olan olgunun anamnezinde kedi ve köpeklerle temas veya kırsal kesimde yaşama öyküsü yoktur. Fiziksel incelemede, kraniyal sinir muayeneleri, yüzeyel ve derin duyu muayenesi normal olarak saptanmış, motor defi sit ve patolojik refl eks izlenmemiş, derin tendon refl eksleri normoaktif olarak tespit edilmiştir. Laboratuvar tetkiklerinde hemogram ve biyokimyasal testler normal, PPD negatif olup, dışkıda parazit kist ve yumurtası görülmemiştir. Viral hepatit göstergeleri, anti-HIV, toksoplazma-IgM, CMV-IgM, rubella-IgM, EBV-VCA-IgM, VDRL, Brucella tüp aglütinasyonu, ekinokok antikorları, otoantikor testleri ve nöromyelitis optika testleri negatiftir. Alınan BOS örneğinin incelemesinde, lökosit sayısı 20/mm3 olarak belirlenmiş (mononükleer karakterde), protein 45 mg/dl, glukoz ve klor düzeyleri normal bulunmuştur. Hastanın hem serum hem de BOS örneğinde, Western blot (WB) yöntemiyle Toxocara-IgG antikor pozitifl iği saptanmıştır. Tekrarlanan WB testinde her iki örnekte de düşük molekül ağırlıklı (30-40 kDa) bantlar tespit edilmiş ve BOS'da lokal antikor üretimini düşündüren daha yoğun bantlar izlenmiştir. Bunun üzerine olguya nörotoksokariyaz tanısı konularak, kortikosteroid ile birlikte mebendazol tedavisi altı hafta süreyle uygulanmıştır. Klinik yanıt alınan olguda, iki ay sonra yapılan kontrol MRG'de miyelit bulgularında belirgin düzelme saptanmıştır. Sonuç olarak, santral sinir sistemi tutulumunun çok nadir görülmesine karşın, TM'nin ayırıcı tanısında toksokariyaz mutlaka akla gelmeli ve tanı için hem serum hem de BOS'da uygun serolojik testler yapılmalıdırToxocariasis caused by Toxocara canis or less frequently by T.catis is a common parasitic infection worldwide. Clinical spectrum in humans can vary from asymptomatic infection to serious organ disfunction depending on the load of parasite, migration target of the larva and the infl ammatory response of the host. Transverse myelitis (TM) due to toxocariasis is an uncommon illness identifi ed mainly as case reports in literature. In this report, a case of TM who was diagnosed as neurotoxocariasis by serological fi ndings has been presented. A 44-year-old male patient complained with backache was diagnosed as TM in a medical center in which he has admitted two years ago, and treated with pregabalin and nonsteroidal drugs for six months. Because of the progression of the lesions he readmitted to another center and treated with high dose steroid therapy for three months. After six months of follow up, improvement has been achieved, however, since his symptoms reccurred in the following year he was admitted to our hospital. Magnetic resonance imaging (MRI) examination revealed a TM in a lower segment of spinal cord. He was suffering with weakness and numbness in the left lower extremity. There was no history of rural life or contact with cats or dogs in his anamnesis. Physical examination revealed normal cranial nerve functions, sensory and motor functions. There has been no pathological refl exes, and deep tendon refl exes were also normal. Laboratory fi ndings yielded normal hemogram and biochemical tests, negative PPD and parasitological examination of stool were negative for cysts and ova. Viral hepatitis markers, anti-HIV, toxoplasma-IgM, CMV-IgM, rubella-IgM, EBV-VCA-IgM, VDRL, Brucella tube agglutination, echinococcus antibody, autoantibody tests and neuromyelitis optica test were negative. Examination of CSF showed 20 cells/mm3 (mononuclear cells), 45 mg/dl protein and normal levels of glucose and chlorine. In both serum and CSF samples of the patient Toxocara-IgG antibodies were detected by Western blot (WB) assay. Low molecular weight bands (30-40 kDa) were detected in both of the samples by repeated WB testing. CSF revealed more intense bands suggesting local antibody production. Therefore the patient was diagnosed as neurotoxocariasis, and treated with steroid and mebendazole for six weeks. Clinical improvement was detected in the case and thoracic MRI revealed signifi cant improvement in myelitis signs two months after treatment. In conclusion, toxocariasis should be considered in the differential diagnosis of TM although the involvement of central nervous system is rare and serological testing should be performed properly in the serum and CSF samples for the diagnosi