Can unenhanced breast MRI be used to decrease negative biopsy rates?

PURPOSEWe aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates.METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging characteristics, masses were classified as either malignant or benign. Unenhanced MRI results were compared with final diagnoses obtained by histopathology or imaging surveillance, and diagnostic values were calculated.RESULTSOf 156 masses, 112 underwent biopsy. Four malignancies were diagnosed, three of which having ADC values lower than the cutoff. In women who rejected the biopsy, masses were stable during a follow-up of at least two years (n=44). MRI revealed 91% specificity and 99% negative predictive value (NPV) for detection of breast cancer.CONCLUSIONCombination of T2-weighted imaging with DWI is a feasible method to further characterize breast masses with a low probability of malignancy. With the use of unenhanced MRI instead of immediate biopsy, it might be possible to decrease negative biopsy rates of low-risk breast masses

Cerebral blood flow during single lung ventilation

Aim: Our aim was to show the effect of one-lung ventilation (OLV) on cerebral blood flow (CBF) by measuring carotid blood flow. This technique has been the subject of experimental and clinical studies. Materials and methods: Carotid doppler flows were measured at 4 different times. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured and pulsatility index (PI) and resistive index (RI) calculated. Results: There were no significant changes in PSV, PI, RI, or flow volume in the normal or diseased sides at repeated measures (P > 0.05).There was no significant difference between the flow velocities, PIs, RIs, or flow volumes measured in the supine and decubitus positions during OLV. In addition, there was no significant difference between the flow parameters of the upper and lower carotids measured in the lateral decubitus position before and after OLV. There was no correlation between any of the flow parameters and duration of OLV. Conclusion: OLV poses no additional risk in terms of CBF. However, further studies, supported by biochemical parameters and involving wider patient groups, are now needed

High-resolution diffusion-weighted imaging compared with conventional diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging with regard to image quality and assessment of breast cancer morphology

PURPOSETo evaluate the image quality and tumor morphology depiction ability of high resolution (HR) diffusion- weighted imaging (f-DWI) in comparison to conventional DWI (c-DWI) and dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) in the primary breast cancer setting.METHODSThe f-DWI, c-DWI, and DCE-MRIs of 160 malignant breast masses were evaluated retrospectively by two independent radiologists. Data on image quality [sharpness, distortion, and perceived signalto- noise ratio (SNR)], apparent diffusion coefficient (ADC) value, lesion size, and tumor morphology (shape, margin, and internal pattern) obtained on f-DWI, c-DWI, and DCE-MRI were compared. Consistency between the readers and imaging methods for morphological parameters was analyzed.RESULTSThe ADC values measured on f-DWI were significantly lower than those measured on c-DWI for both readers (P < 0.001 for each), whereas mean lesion size was significantly larger in c-DWI than in f-DWI and DCE-MRI for both readers (P < 0.001 for each). Higher consistency values were obtained for f-DWI compared with c-DWI when correlated with DCE-MRI for each morphological parameter. The least distorted images were obtained using DCE-MRI compared with c-DWI and f-DWI for both readers, whereas the highest distortion scores were obtained using c-DWI. Sharpness and perceived SNR scores were rated as significantly higher for f-DWI and DCE-MRI images compared with c-DWI by both readers (P < 0.001 for all). The concordance between c-DWI and DCE-MRI was fair to slight (κ = 0.15 to 0.41), whereas concordance between f-DWI and DCE-MRI was significantly better (κ = 0.68 to 0.87) for each reader and for all morphological parameters (P < 0.001). The highest concordance between the readers was achieved in margin assessment (κ = 0.87 to 0.89) regardless of the MRI method, followed by shape and internal pattern parameters (κ = 0.63 to 0.79).CONCLUSIONThe results demonstrated that f-DWI produces higher-quality images than c-DWI, enabling the morphological features to be identified in similar detail to that offered by HR DCE-MRI. Accordingly, f-DWI, as a method that highly correlates with DCE in determining the morphological characteristics of breast cancers, seems to have potential in the evaluation of breast tumors in patients for whom the use of contrast media is contraindicated

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients

he COVID-19-related death rate varies between countries and is affected by various risk factors. This multi center registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corre sponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ?65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored

The association of anti-CCP antibodies with disease activity in rheumatoid arthritis

Antibodies to citrullinated proteins have been described in patients with rheumatoid arthritis (RA) and these appear to be the most specific markers of the disease. Our objective was to determine the frequency of antibodies to cyclic citrullinated peptides (CCPs) in patients with RA and the association of anti-CCP antibodies with disease activity, radiological erosions and HLA DR genotype. Forty patients with RA and 38 patients with fibromyalgia were included in this study. Serum samples were collected from both patient groups with RA and fibromyalgia. Anti-CCP was measured by the corresponding enzyme-linked immunosorbent assay. Additionally, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), disease activity score (DAS), visual analog scala (VAS), HLA genotype and radiographic information were determined in patients with RA. The rate of sensitivity and specificity of anti-CCP reactivity for the diagnosis RA were measured (sensitivity 50%, specificity100%). There is no significant difference between anti-CCP (+) and anti-CCP (−) RA patients for DAS28, VAS, ESR, CRP, disease duration, HLA genotype, and radiological assessment of hand. However, there was a significant difference between anti-CCP (+) and anti-CCP (−) RA patients for RF and the radiological assessment of left and right wrists (respectively, P < 0.05, P = 0.04, P = 0.01). There was no significant correlation between anti-CCP antibody and ESR, CRP, VAS, DAS 28 or radiological assessment. A small but significant correlation was found between RF and anti-CCP antibody (P = 0.02, r = 0.35)

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe 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.METHODSThis 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.RESULTSThe 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.CONCLUSIONADH 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

A comparison of screening tests for the prediction of airway difficulties in obstetric patients

Obstetrik olgularda başarısız entübasyon oranı normal popülasyona oranla 8 kat fazladır. Bu nedenle, gebelerde havayolu zorluğunun girişim öncesi saptanması önemlidir. Çalışmamızda gebelerde modifiye Mallampati testi (MMT), tiromental mesafe (TMM) ölçümü, boy/tiromental mesafe (boy/TMM) oranı, sternomental mesafe (SMM) ölçümü, üst dudak ısırma testi (ÜDIT), boyun çevresi kalınlığı (BÇK) ölçümü ve Wilson risk skoru (WRS) testlerinin önemini, tek başına veya kombine kullanıldıklarında duyarlılık, seçicilik, pozitif ve negatif öngörü değerlerini saptamayı amaçladık.Genel anestezi altında sezaryen uygulanacak ASA I-II, 18-45 yaş 118 gebe çalışmaya alındı. MMT sınıf 3-4, TMM25, SMM?13,5cm, ÜDIT sınıf 3, BÇK>43cm, WRS?2 olması zor havayolu olasılığı kabul edildi. Cormack-Lehane (C&L) klasifikasyonu grade 3-4 zor laringoskopi olarak kabul edilirken; entübasyon zorluk skalası (EZS)>5 zor entübasyon olarak kabul edildi. Komplikasyonlar kaydedildi. İstatistiksel analiz amacıyla Mann Whitney ve ki-kare testi kullanıldı. P5 olan olgular ile MMT sınıf 3-4, BÇK>43cm, WRS?2 olanlar arasındaki ilişki anlamlı bulundu (p25, SMD?13.5cm, ULBT grade 3, NC>43cm, or WRS ?2 were considered as difficult airway, those with Cormack-Lehane (C&L) grade 3-4 were considered as difficult laryngoscopy and those with intubation difficulty scale (IDS)>5 were considered as difficult intubation. Complications were recorded. Mann Whitney and chi-square tests were used for statistical analysis. A value of p5 and MMT grade 3-4, NC>43cm, WRS?2 was found to be statistically significant (p<0.05). For the MMT, NC and WRS tests sensitivity was found to be 85%, 43% and 71% respectively, specifity 81%, 95% and 81% and positive predictive value 23%, 38% and 19%, respectively. When two of the three tests were combined, sensitivity decreased but the positive predictive value was significantly higher when compared to single test use. When the three tests were used together, sensitivity, specificity and positive predictive value were found to be 43%, 100% and 100% respectively.In conclusion, in the evaluation of airway difficulty of pregnant patients, the results of this study have shown that the combined use of the MMT, NC and WRS tests has the highest positive predictive value

Gossypiboma of the Breast: Imaging Findings

We report a case of retained surgical sponge in the breast with its sonographic and magnetic resonance (MR) imaging findings. Striped and spotted low signal intensity structures seen within the lesion on T2 weighted MR imaging was characteristic. Sonographic examination also was helpful with the appearance of strong posterior acoustic shadowing at the lesion. It is extremely rare, to see a gossypiboma in the breast. A high degree of suspicion and imaging findings are very important for the diagnosis

Analysis of inter-rater reliability of the mammography assessment after image processing

3rd International Work-Conference on Bioinformatics and Biomedical Engineering (IWBBIO) -- APR 15-17, 2015 -- Grenada, SPAINKurt, Burcin/0000-0001-5781-2382WOS: 000410784400008The aim of this study is to assess whether image processing causes information lost on mammography images. in the study, 50 mammogram from MIAS database (open database of mammograms) are selected: 20 images include mass, 20 images include calcification and 10 normal images. Selected images are read and marked by radiologists. the same radiologists read the enhanced version of images after three months later. in order to assess the consistency, inter-rater reliability statistics are used. Results indicate that image processing on mammography images especially images without calcification does not affect radiologists' evaluation consistency. Also, it is indicated that images including calcifications reduce evaluation consistency of the radiologists and it is decided to use other image processing methods for images with calcifications.Univ Granada, CITIC, BioMed Cent, E Hlth Business Dev BULL S A, Univ Granada, Fac Sci, Dept Comp Architecture & Comp TechnolRepublic of Turkey Science, Technology and Industry Ministry; AKGUN Computer Programs and Services Industry Tic. Ltd. StiThe study is a part of a computer-aided breast cancer diagnosis system which is supported as a SANTEZ project by Republic of Turkey Science, Technology and Industry Ministry and AKGUN Computer Programs and Services Industry Tic. Ltd. Sti