D-dimer levels and acute pulmonary embolism development in COVID-19 patients

Objective. To identify those who develop pulmonary embolism with Ddimer levels by evaluating pulmonary CT angiographies of patients who are followed up with suspicion of coronavirus disease 2019 (COVID-19). Methods. Patients who were followed up in a community hospital with suspicion of COVID-19 and underwent Pulmonary CT angiography examination were evaluated. Clinical and demographic parameters and DDimer values for patients with and without pulmonary embolism were evaluated in the pulmonary CT angiogram. Results. During the COVID-19 pandemic, Thorax CT examination was performed in our center for suspicion or follow-up of COVID-19 infection in 3396 patients. Pulmonary CT angiography was applied to 312 (9.2%) of these cases. Of these 312 patients, 141 were identified as COVID-19 patients. Acute pulmonary embolism was detected in 33 (23.4%) of 141 patients with COVID-19 and pulmonary CT angiogram. D-dimer levels (5964.97±4036.8 μg/L) of patients with COVID-19 infection and pulmonary embolism were significantly higher than D-dimer levels (972.4±1766.8 μg/L) of patients without pulmonary embolism. In patients with COVID-19 infection, a Ddimer value higher than 1013 μg/L was determined as a cut-off value with 100% sensitivity for the presence of pulmonary embolism. Conclusions. For those struggling with the COVID-19 pandemic, pulmonary embolism should be kept in mind if D-dimer values increase more than expected in the presence of respiratory distress that Thorax CT findings cannot explain

Evaluation of the coronal malposition of the volar locking plate in the treatment of distal radius fractures

Background and objectives: Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We aimed to investigate the functional and laboratory results of the coronal malposition of the volar locking plate in patients with distal radius fracture treated with internal fixation. Methods: In this retrospective study, we included patients who had volar plate fixation, were aged between 18 and 80, had no pathological fracture, had a minimum of six months of follow-up, and had the same rehabilitation protocol. We consider the angle subtended on the coronal axis between the distal radius long axis and the distal radius locking plate as coronal malposition. We named the coronal malposition angle the "AYE Angle." Patients with an AYE angle of over 1 degree were evaluated under group 1. Patients with an AYE angle of 0-1 degrees were evaluated under group 2. Radiological parameters were taken from AP-Lateral X-ray views. Superficial University System of Georgia (USG) examinations were applied to detect tendon problems. The DASH and QUICK-DASH scoring systems were used for clinical evaluation. Grip strength was measured with a dynamometer in all patients. All results were compared between the two groups. Results: Thirteen patients were female and 27 patients were male. Nineteen patients who had coronal malposition were added to group 1, while 21 patients who had no coronal malposition were added to group 2. Fifteen patients had normal USG results in group 2, while 18 patients had edema around the flexor pollicis longus (FPL) tendon as a result of USG in group 1. Statistically, a significant difference was detected between the two groups in terms of the amount of tenosynovitis around FPL (p=0.01). A statistically significant relationship was found between USG grading and malposition grading. The study revealed that a higher rate of USG grade 2 was found in patients with malposition grade 2 (90.9%), while a higher rate of USG grade 1 (50%) was observed in patients with malposition grade 1 (p=0.01). A statistically significant difference was not found between Soong grading and USG in terms of the level of tenosynovitis around the FPL tendon. The amount of tenosynovitis detected around the FPL tendon was 62.5% for Soong and grade 0 level, 60.7% for grade 1 level, and 50% for grade 2 level. There was no statistically significant difference between the two groups in the DASH and QUICK-DASH scoring systems (p=0.96). There was no statistically significant difference between the two groups in the grip strength (p=0.52). Conclusion: Coronal plate position in the treatment of the distal radius fracture is important to avoid potential flexor tendon problems. The volar plate position should be adjusted properly both in the coronal and sagittal axes

Valor añadido de la secuencia coronal-T1W agregada al protocolo de imágenes de RM lumbar para el dolor lumbar

Introduction: Magnetic resonance imaging is the most appropriate imaging method to investigate low back pain. Low back pain is very common and therefore a large number of MRI scans are performed. Objective: The aim of this study was to evaluate the extraspinal findings and clinical effect of T1 weighted spin echo (T1W SE) coronal sequence added to the lumbar MR imaging protocol for low back pain. Materials and methods: In 2015, we have added a T1 weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images demanded for low back pain performed with this protocol. The extraspinal MRI findings obtained from these images were then grouped as “associated with low back pain (Category 1)” and “not associated with low back pain (Category 2)”. We also evaluated whether the recorded incidental extraspinal findings can be detected on conventional sagittal and axial images. Results: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1), and 56 (37%) were Category 2 which is not associated with low back pain.  Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. Conclusion: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.Introducción. La resonancia magnética (RM) es el método de imagen más apropiado para investigar el dolor lumbar. El dolor lumbar es muy común y, por lo tanto, se realiza una gran cantidad de resonancias magnéticas. Objetivo. El objetivo de este estudio es investigar los hallazgos extraespinales que se pueden detectar con la secuencia coronal T1W agregada al protocolo de imágenes de RM lumbar para el dolor lumbar y evaluar el efecto clínico de los hallazgos. Materiales y métodos. En 2015, agregamos una secuencia coronal ponderada en T1W a nuestro protocolo de resonancia magnética lumbar de rutina. Evaluamos retrospectivamente 969 imágenes de resonancia magnética lumbar solicitadas para el dolor lumbar realizadas con este protocolo. Los hallazgos de la resonancia magnética extraespinal obtenidos a partir de estas imágenes se agruparon luego como "asociados con el dolor lumbar (Categoría 1)" y "no asociados con el dolor lumbar (Categoría 2)". También evaluamos si los hallazgos extraespinales incidentales registrados pueden detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63%) de los hallazgos extraespinales se asociaron con lumbalgia (Categoría 1) y 56 (37%) fueron de Categoría 2 que no se asociaron con lumbalgia. El setenta y ocho por ciento de los hallazgos extraespinales se detectaron solo en imágenes coronales-T1W y no en imágenes convencionales. Conclusión. Agregar la secuencia coronal-T1W al protocolo de rutina de la resonancia magnética lumbar puede ayudar a identificar hallazgos extraespinales y guiar el tratamiento clínico

Magnetic resonance imaging/ultrasound fusion-guided sacroiliac joint corticosteroid injection in patients with axial spondyloarthritis

Local glucocorticoid injections are used in the treatment of isolated sacroiliitis in patients with spondyloarthritis. Sacroiliac joint injections can be performed intraarticularly or periarticularly. Since the accuracy of blind injections is low, fluoroscopy, magnetic resonance imaging, computed tomography, or ultrasonography guidance are used to increase the accuracy of sacroiliac joint injections. Currently, imaging fusion software is successfully used in sacroiliac joint interventions with three-dimensional anatomic information added to ultrasonography. Herein, we present two cases of sacroiliac joint corticosteroid injections under ultrasonography-magnetic resonance imaging fusion guidance

Supplemental Material - Stent plus balloon-assisted coiling with low-profile braided stents in the treatment of complex wide-necked intracranial bifurcation aneurysms

Supplemental Material for Stent plus balloon-assisted coiling with low-profile braided stents in the treatment of complex wide-necked intracranial bifurcation aneurysms by Ahmet Gunkan, Yilmaz Onal, Leyla Ramazanoglu, Mohamed EM Fouad, Ahmet Nedim Kahraman, Esin Derin Cicek, Hakan Demirhindi, and Murat Velioglu in The Neuroradiology Journal</p

Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases

Abstract Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood–brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10–14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8–22.2). The median overall survival (OS) was 29 months (95% CI, 25.2–33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities

Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases

Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood-brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10-14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8-22.2). The median overall survival (OS) was 29 months (95% CI, 25.2-33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities