Digital Mammography, Ultrasound and Magnetic Resonance Imaging Characteristics in Differential Diagnosis of Papillary Carcinoma Subtypes of the Breast and Diagnostic Challenges

Objective: We aimed to investigate mammography (MG), ultrasound (US), and magnetic resonance imaging (MRI) findings of papillary breast carcinoma subtypes and to compare the diagnostic features and performance of the imaging method in distinguishing subtypes. Materials and Methods: Forty-two patients presenting with pathological diagnosis of 45 papillary carcinoma lesions, between 2014 and 2019, were included. Cases were assigned to five subgroups according to the latest World Health Organization (WHO) classification. The clinical characteristics (n = 45) and imaging features of each pathological subgroup were retrospectively related to imaging findings from US (n = 45), MG (n = 37), and breast MRI (n = 23), and further compared. Results: The finding of a palpable mass in all subgroups was more common than nipple discharge on clinical breast evaluation, and no significant difference was found between the subgroups. Irregular shape on MG (10/12, 83.3%, p = 0.039) and US (11/12, 91.7%, p = 0.039) was found more frequently in invasive micropapillary carcinoma (IMPC) compared to other subgroups. Circumscribed margins (4/5, 80%, p = 0.002) occurred more frequently in papillary ductal carcinoma in situ (pDCIS) and encapsulated papillary carcinoma (EPC) than in other subgroups (6/8, 75%, p = 0.002). Lower apparent diffusion coefficient (ADC) values were found in solid papillary cancer (SPC) than in other subgroups (ADC = 0.35 x 10(-3), p = 0.017). Conclusion: Radiological findings of papillary carcinomas overlap with each other. US and MRI are complementary when revealing specific morphological characteristics

Aberrant Right Subclavian Artery Aneurysm: A Presentation of Two Cases

Aberrant right subclavian artery (ARSA) aneurysm can be an important cause of mortality or potential rupture of the esophagus or trachea. It is important to emphasize that diagnosis of ARSA aneurysm is crucial to avoid fatal complications. Contrast-enhanced computed tomography (CECT) is the best imaging modality to illustrate the necessary details of the anatomy and such complications. The aim of this report was to demonstrate the usefulness of CECT in 2 cases of ARSA aneurys

The Role Of Diffusion Weighted Magnetic Resonance Imaging in the Discrimination Of Malignant and Benign Thyroid Nodules

Amaç: Bu çalışmanın amacı, Difüzyon Ağırlıklı Manyetik Rezonans Görüntülemenin (DAMRG) tiroid nodüllerinde malign-benign ayrımındaki yerini araştırmak idi.Materyal ve Metot: Çalışmaya tiroid nodülü ve patolojik tanısı olan 39 hasta ve 40 nodül dahil edildi. İzlenen nodüller, DAMRG ile incelendi ve elde edilen Apparent Diffusion Coefficient (ADC) değerleri ve patolojik sonuçlar arasındaki ilişki istatistiksel olarak değerlendirildi.Bulgular: Nodüllerin 9’u malign, 31’i benign karakterdeydi. Malign ve benign nodüllerin ortalama ADC değerleri sırasıyla (1,60±0,29)x10?³ sn/mm²)ve (2,14±0,39)x10?³ sn/mm²) bulundu. Malign ve benign nodüllerin ADC değerleri arasında anlamlı istatistiksel farklılık izlendi (p<0,001). Receiver Operator Coefficient (ROC) analizi ile malign nodüllerde cut-off değer 1,67x10?³ sn/mm² olarak hesaplandı.Sonuç: ADC değerleri, benign ve malign tiroid nodüllerini ayırmak için non-invaziv bir tanı metodu olarak kullanılabilir.Aim: The aim of this study was to investigate the role of the Diffusion Weighted Imaging (DWI) sequences in diagnosis of malignant and benign nodules of thyroid nodules. Materials and Methods: Thirty nine patients and fourty nodules were enrolled to the study. The observed nodules were examined with DWI. Relationship between obtained Apparent Diffusion Coefficient (ADC) values and pathological results were statistically evaluated.. Results: There were 9 malignant and 31 benign nodules. Mean ADC values were evaluated (1.60±0.29)x10?³ sn/mm² for malignant, and (2.14±0.39)x10?³ sn/mm²) for benign nodules, respectively. There was a statistical difference between ADC values of malignant and benign nodules (p<0.001). The ADC cut-off value of malignant nodules was 1.67x10?³ sn/mm² with Receiver Operator Coefficient (ROC) analysis. Conclusion: ADC values might be used as a non-invasive diagnostic tool for discriminating the malignant and benign thyroid nodules

Morphological and Clinical Aspects of Aberrant Subclavian Artery: Single Center Multidedector Computed Tomography Based Study

Aim: Aberrant subclavian artery (ASA) anomalies are the most common aortic arch malformations. Incidence of these malformations increases with widespread use of computed tomography (CT). Our aim in this study was to investigate the relationship between ASA malformations, gender, age and reasons for admission, and arcus aorta (AA), ASA diameters and AA/ASA diameter ratios.Materials and Methods: A total 74 patients with ASA were evaluated by thorax CT retrospectively. Patients were divided into aberrant right (ARSA) and left (ALSA) subclavian artery groups. Age, gender, reasons for application, ASA and AA diameters and AA/ASA ratios were evaluated between the groups. Correlations of ASA and AA diameters with age were also evaluated.Results: 70 of the patients (94.5%) had ARSA, 4 of the patients (5.4%) had ALSA. There was no statistical relationship between gender (p=0.394), age (p=0.443) and reasons for application (p=0.322) between groups. There was no statistical relationship between ASA diameter (p=0.127), AA diameter (p=0.728) and AA/ASA ratio (p=0.339) between groups. There was weak positive correlation with ageand diameter of AA (r=0.379, p=0.001), but not with ASA diameter (p=0.059). Moderate positive correlation (r=0.573, p<0.001) was detected between diameters of AA and ASA.Conclusion: ASA malformations are the most common incidentally detected malformations with increased use of CT. These malformations are not related to age, gender and reasons for application.Amaç: Aberran subklavian arter(ASA) anomalileri en sık görülen aortik ark malformasyonlarıdır. Bilgisayarlı tomografi (BT) kullanımının artması ile bu malformasyonların görülme sıklığı artmaktadır. Bizim bu çalışmadaki amacımız ASA malformasyonlarının cinsiyet, yaş ve hastaneye başvuru nedenleri arasındaki ilişkiyi araştırmak; arkus aorta (AA), ASA çapları ve AA/ASA çap oranlarının arasındaki ilişkiyi değerlendirmekti. Materyal ve Metot: ASA’sı olan 74 hastanın toraks BT’leri retrospektif olarak incelendi. Hastalar, aberran sağ subklavian arteri (ARSA) olan ve aberran sol subklavian arteri (ALSA) olanlar şeklinde ikiye ayrıldı. İki grup; yaş, cinsiyet, başvuru nedenleri, ASA ve AA çapları ve AA/ASA oranları açısından karşılaştırıldı. Ayrıca ASA ve AA çaplarının yaş ile korelasyonu değerlendirildi. Bulgular: Hastaların 70’inde (%94.5) ARSA, 4’ünde (%5.4) ALSA mevcuttu. İki grup arasında cinsiyet (p=0.394), yaş (p=0.443) ve başvuru nedenleri (p=0.322) arasında istatistiksel ilişki bulunmadı. İki grup arasında ASA çapı (p=0.127), AA çapı (p=0.728) ve AA/ASA oranı (p=0.339) arasında istatistiksel ilişki saptanmadı. Yaş ile AA çapı arasında zayıf pozitif korelasyon (r=0.379, p=0.001) izlenirken; yaş ile ASA çapı arasında korelasyon saptanmadı (p=0.059). AA çapı ile ASA çapı arasında orta şiddette pozitif korelasyon (r=0.573, p<0.001) bulundu. Sonuç: ASA malformasyonları BT kullanımının artmasıyla birlikte daha sık görülen, genellikle insidental olarak saptanan malformasyonlardır. Bu malformasyonların yaş, cinsiyet ve başvuru nedenleri ile ilişkisi bulunmamaktadır

Cranial magnetic resonance imaging as a screening tool for evaluation of silent brain ischemia in severe coronary artery disease: A clinical based study

Aim: Silent brain ischemia (SBI), defined as ischemic changes and infarcts without neurologic signs, is an established marker of poor survival. Magnetic resonance imaging (MRI) is useful to define SBI and white matter hyperintensities that correspond to microangipathic ischemic disease. This study aimed to investigate the relationship among SBI, white matter lesions and the extent of coronary artery disease (CAD), and to determine possible predictors of SBI. Material and Methods: A total 10640 patients who underwent coronary angiography were retrospectively screened to reveal 312 patients who had been evaluated with a subsequent cranial MRI within 6 months. CAD severity was established with Gensini score and MRIs were evaluated to determine presence of SBI and white matter hyperintensities scored by Fazekas. Finally, 58 patients with SBI and 254 without SBI consisted SBI and non-SBI groups. Results: Patients with SBI were significantly older with higher prevalence of male gender than the non-SBI patients. Both Gensini and Fazekas scores were higher in SBI-group (p<0.001). Fazekas score was positively correlated with Gensini score (r=0.219, p<0.001) and age (r=0.465, p<0.001). In the logistic regression analysis; age, male gender and Gensini score were identified as the independent predictors of SBI. Conclusion: Although SBIs don’t present neurological symptoms they are associated with poor survival and future stroke. Our data suggest that cranial MRI may be a screening tool in risk stratification, particularly in elderly male patients with multivessel CAD. Our study also depicted that age, male gender and high Gensini scores are the independent predictors of SBI. © 2020, Duzce University Medical School. All rights reserved

Atypical CT Findings and Clinical Correlation Of COVID-19 Pneumonia

Aim: Our study aimed to evaluate the atypical CT findings and concomitant pathologies of COVID-19 pneumonia and clinical and laboratory findings and compare them with typical CT findings.Materials and Methods: A total of 69 patients were diagnosed with COVID-19, 14 of which were atypical (20.2%), and 55 of which were typical (79%) chest computed tomography (CT) findings. CT images and clinical and laboratory data of patients with atypical findings were retrospectively analyzed. Lesions of the typical and atypical group and CT severity scores were compared.Results: Atypical CT findings were centrilobular nodule, tree in bud, pleural effusion, lobar/segmental consolidation, bronchiectasis, pulmonary embolism, and mosaic attenuation by typical lesions with ground-glass opacity with/without consolidation. CT severity score was significantly higher in the atypical group (p <0.001). CRP, procalcitonin, the neutrophil rate increased, and the lymphocyte count decreased in patients with a high CT severity score. Comorbidity was common in the atypical group (50%).Conclusion: High CT severity score and widespread lung involvement of the patient group with atypical CT findings may be due to disease progression or other concomitant diseases. Atypical lesions accompanying typical lesions may cause false negativity in reporting. As radiologists' experience with COVID-19 pneumonia increases, it may improve that they categorize these images as typical or atypical

Soluble B7H3 level in breast cancer and its relationship with clinicopathological variables and T-cell infiltration

Aim of the study Although early diagnosis of breast cancer (BC) is often associated with a good prognosis, there is currently no biomarker with high sensitivity serving this purpose. B7H3, a recently identified member of the B7 family, appears to inhibit antitumor immunity. We investigated the soluble B7H3 (sB7H3) level in BC and its relationship with clinicopathological variables and stromal tumor-infiltrating lymphocytes (sTILs). Material and methods: The study which was designed as a cross-sectional trial between January 2020 and September 2021, included 93 BC patients, 20 patients with benign breast disease (BBD) and 14 healthy volunteers as the control group. Serum sB7H3 levels were measured using the ELISA (enzyme-linked immunosorbent assay) method and sTlLs were measured by immunohistochemistry using Tru-cut biopsy materials. Results: sB7H3 levels in BC patients were significantly higher than those in patients with BBD and healthy volunteers. Receiver operating characteristic curve analysis results showed that sB7H3 level may be a potential biomarker for distinguishing patients with BC from those with BBD (AUC: 0.807; sensitivity: 0.786; specificity: 0.706) and from healthy volunteers (AUC: 0.731; sensitivity: 0.700; spedicity: 0.692). Conclusions: To the best of our knowledge, the present study is the first to investigate the relationship between sB7H3 and disease parameters in BC. We found that sB7H3 may be a clinically practical and meaningful biomarker in differentiating BC from BBD. In order to evaluate the relationship of B7H3 with clinical variables in BC, and especially with sTILs, tissue-based studies with higher numbers of patients are needed

What Is the Important Point Related to Follow-Up Sonographic Evaluation for the Developmental Dysplasia of the Hip?

Developmental dysplasia of the hip (DDH) is an important cause of childhood disability. Subluxation or dislocation can be diagnosed through pediatric physical examination; nevertheless, the ultrasonographic examination is necessary in diagnosing certain borderline cases. It has been evaluated routine sonographic examination of 2,444 hips of 1,222 babies to determine differences in both, developmental dysplasia and types of hips, and evaluated their development on the 3-month follow-up. Evaluating the pathologic alpha angles under 59, there was no statistically significant differences between girls and boys in both right (55.57 +/- 3.73) (56.20 +/- 4.01), (p = 0.480), and left (55.79 +/- 3.96) (57.00 +/- 3.84), (p = 0.160) hips on the 45th day of life. Routine sonographic examinations on the 45th day of life revealed that 51 of (66.2%) 77 type 2a right hips were girls and 26 (33.8%) were boys. The number of the right hips that develop into type 1 was 38 (74.5%) for girls and 26 (100%) for boys on the 90th day of life (p = 0.005). A total of 87 type 2a left hips included 64 girls (73.6%) and 23 boys (26.4%). In the 90th day control, 49 right hip of girls (76.6%) and 21 right hip of boys (91.3%) developed into type 1 (p = 0.126). In the assessment of both left and right hips, girls showed a significantly higher frequency in latency and boys showed significantly higher development in the control sonography. A total of 31 girls (2.5%) and 11 boys (0.9%) accounted for a total of 42 (3.4%) cases who showed bilateral type 2a hips in 1,222 infants. On the 90th day control, 26 girls (83.9%) and all 11 boys (100%) developed into type 1 (p = 0.156). The study emphasizes the importance of the sonographic examination on the 90th day of life. Results of the investigation include the data of sonographic screening of DDH on the 45th day, and also stress the importance of the 90th-day control sonography after a close follow-up with physical examination between 45th and 90th days of life

Can Development of Diabetic Foot be Predicted Using Aortic, Iliac and Femoral Bifurcation Angles? A Computed Tomography Angiography Study

Objective: The aim of this study was to determine whether aortic, iliac, and femoral artery bifurcation angles were different in diabetic patients with and without diabetic foot, and whether angle differences assessed based on computed tomography angiography (CTA) imaging could predict the development of diabetic foot. Methods: A total of 111 patients with diabetes mellitus (DM) were included in the study: 61 with diabetic foot and 50 without diabetic foot. The aortic, right and left iliac, and right and left femoral bifurcation angles were measured using CTA images and evaluated retrospectively with the Sectra PACS system (Sectra Medical Systems GmbH, Koln, Germany). Results: When the values of the control and diabetic foot groups were compared, there was no statistically significant difference between the aortic bifurcation angle (p=0.438), right (p=0.223) and left (p=0.459) iliac bifurcation angles, or the right (p=0.080) and left (p=0.064) femur bifurcation angles. Conclusion: The results revealed no significant difference in the bifurcation angles of the aorta and lower extremity arteries in diabetic patients with and without diabetic foot, and suggested that the changes in vascular geometry caused by DM may not be a major factor in the development of diabetic foot

Contrast-Enhanced Computed Tomographic Findings of the Wandering Spleen: A Case Report

Wandering spleen is a rare entity that defines abnormal localization of spleen due to various causes. Wandering spleen is prone to rotate on its peduncular axis and finally torsion and infarction. Contrast-enhanced computed tomography can visualize the torsioned peduncle and non-enhanced parenchyma with contrast medium. A 60-year-old woman who had abdominal pain was admitted to ER. Contrast-enhanced computed tomography depicts the abnormal localization of spleen and absence of contrast medium in the parenchyma and peduncle. Diagnosis was torsioned wandering spleen. Contrast-enhanced computed tomography is very important useful modality for diagnosis of torsioned wandering spleen