Role of duplex power doppler ultrasound in differentiation between malignant and benign thyroid nodules

Objective: To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules. Materials and Methods: We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values. Results: A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05). Conclusion: Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules

The efficacy of the 3-dimensional vibe-caipirinha-dixon technique in the evaluation of pancreatic steatosis

Background/aim: CAIPIRINHA is a new technique in abdominal imaging. Pancreatic steatosis (PS) is a subject of increasing scientific interest. The aim of this study was to investigate the efficacy of the isotropic 3D-VIBE- CAIPIRINHA -DIXON technique on a new generation 3-tesla MR unit in the evaluation of PS. Materials and methods: In this retrospective study, the imaging findings of 49 patients with PS and 41 control subjects were examined. The pancreas-to-spleen ratio (PSR), pancreas-to-muscle ratio (PMR), and pancreatic signal intensity index (PSII) were defined as 3 new parameters and these indexes were calculated from the in-phase/out of phase 3D-VIBE- CAIPIRINHA-DIXON images. Results: The PSR, PMR, and PSII values were significantly different between the patient and control groups (P = 0.001, P = 0.009, P < 0.001, respectively). Statistically significant differences were observed between patient and control groups for ROI measurements of fatty areas on these sequences/images: subtraction (in-out) (P < 0.001), T2W HASTE (P < 0.001), DIXON-fat (P < 0.001), fat-suppressed T1W (P = 0.002), and subtraction (out-in) (P = 0.010). Conclusion: Evaluation of PS with the 3D-VIBE-CAIPIRINHA-DIXON technique can be made rapidly and effectively

Reduction of iodinated contrast load with the renal artery catheterization technique during endovascular aortic repair

PURPOSEWe aimed to present our clinical experience with the renal artery catheterization (RAC) technique, which reduces the volume of intra-arterial contrast media (ICM) used during endovascular aortic repair (EVAR), and describe the short-term results of this technique. MATERIALS AND METHODSWe retrospectively evaluated 16 patients (15 males and one female) who underwent EVAR between March 2011 and February 2012 using the RAC technique for an abdominal aortic aneurysm. A Simmons-1 catheter was preferred for renal artery cannulation. The mean age of the patients at the time of treatment was 70 years (range, 61–82 years). Fifteen cases were fusiform aneurysms, and one case was a saccular aneurysm. Creatinine and estimated glomerular filtration rate (eGFR) values were recorded before the procedure and during the first 72 hours postprocedure. RESULTSBifurcated stent grafts were implanted with 100% procedural success using the RAC technique. The inferiorly positioned renal artery was cannulated with a Simmons-1 catheter in the first five patients, and was maintained at the level of the renal artery orifice in the remaining patients. The mean volume of the ICM used was 47 mL (range, 23–83 mL). The creatinine and eGFR values were not significantly different between the pre- and postoperative periods (P > 0.05). CONCLUSIONReducing the volume of ICM used during EVAR is critical for protecting renal function. The RAC technique is a safe and effective method in appropriate patients when performed by experienced clinicians

Adhesive capsulitis: Contrast-enhanced shoulder MRI findings

Evaluation of contrast-enhanced magnetic resonance imaging (CE-MRI) findings in cases clinically diagnosed as adhesive capsulitis (AC). CE-MRI images of 12 cases diagnosed as AC (13 shoulder joints) and nine control cases were retrospectively evaluated. AC diagnosis was established based on the history and clinical symptoms. MR signal intensity changes in the axillary pouch, rotator interval, biceps anchor and anterior-posterior capsules were analysed with regard to the presence of abnormal soft tissue and contrast enhancement. Capsular and synovial thickening were measured in the axillary recess and rotator interval on coronal oblique CE T1-weighted images. Patient and control groups were compared by Fisher's exact and McNemar tests in terms of signal intensity changes and contrast enhancement in the described areas. Comparison of the group with AC and the control group regarding intensity changes showed a statistically significant difference in the axillary pouch (P 0.05). Comparison of AC and control groups in terms of contrast enhancement revealed statistically significant differences in the axillary pouch, rotator interval, biceps anchor and anterior-posterior capsules (P < 0.001). A significant difference was determined between the AC and control groups with regard to thickening in axillary pouch and rotator interval (P < 0.001). CE studies are useful for diagnosis of AC as it demonstrates thickening of specific soft-tissue areas like joint capsule and synovium

Evaluation of bone cortex and cartilage of spondyloarthropathic sacroiliac joint: Efficiency of different fat-saturated MRI sequences (T1-weighted, 3D-FLASH, and 3D-DESS)

Rationale and Objectives: Accurate assessment of the morphology of sacroiliac joint (SIJ) bone cortex and cartilage bears importance in terms of detecting sacroiliitis in its earliest period. The aim of this study was to evaluate the efficacies of fat-saturated T1-weighted (T1WFS) spin-echo, three-dimensional (3D)-fast low angle shot (3D-FLASH), and 3D-double excitation in the steady-state (3D-DESS) sequences for the detection of SIJ cartilage and bone cortex abnormalities in patients with clinically suspected active sacroiliitis. Materials and Methods: Magnetic resonance imaging (MRI) was performed in 9 controls and 30 patients with suspected active sacroilitis. T1WFS, short tau inversion recovery, 3D-DESS with FS, 3D-FLASH with FS, postcontrast (the same precontrast T1WFS sequence) T1WFS, and subtracted images were obtained in all the cases. The bone cortex and cartilaginous morphology were visually scored on the T1WFS, 3D-DESS, and 3D-FLASH images. MRI findings were statistically evaluated. Results: Active sacroiliitis was observed in 28 patients (49 SIJs) that were examined by postcontrast and subtracted images. T1WFS, 3D-DESS, and 3D-FLASH images revealed cartilage erosions in 26 (47 SIJs), 28 (55 SIJs), and 28 (55 SIJs) patients, respectively. Cartilage and bone cortex erosion scores in SIJs were significantly higher in 3D-DESS and 3D-FLASH images than in T1WFS images (P.05)

Neurochemical-structural changes evaluation of brain in patients with obstructive sleep apnea syndrome

Purpose: To evaluate neurochemical and structural changes in the patients with newly diagnosed obstructive sleep apnea syndrome (OSAS) by MR spectroscopy (MRS), T2 relaxometry, and diffusion weighted imaging (DWI). Material and methods: Following the acquisition of routine cranial MR, MRS, T2 relaxometry, and DWI images; spectroscopic metabolite ratios and DWI-T2 relaxometry findings of the thalami, hippocampi, frontal white matter (FWM) and frontal cortex of 24 OSAS patients and 9 controls were statistically compared. The relationship between two groups was evaluated with Mann-Whitney test. Results: Spectroscopic measurements in the frontal cortex and frontal white matter of the OSAS patients revealed significantly lower NAA/Cr ratios than those of the control group (P = 0.004 and P = 0.006, respectively). The measurements in the frontal white matter of the OSAS patients exhibited significantly lower NAA/Cho ratios compared with those of the control group (P = 0.005). Thalamic Cho/Cr ratios of the patient group were significantly higher than those of the control group (P = 0.002). In terms of the ADC-T2 relaxometry values, there was no significant relationship between the patient and the control groups (P > 0.05). Conclusion: MRS is a useful and non-invasive modality in showing neurochemical changes in various regions of the brain but our data does not show any change on diffusion weighting or T2 quantification in the OSAS group. DWI and T2 relaxometry appear to be not effective techniques to evaluate the brain structural changes of the patients with newly diagnosed OSAS