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PurposeTo investigate the role of non-echo planar diffusion weighted imaging (DWI) using \"periodically rotated overlapping parallel lines with enhanced reconstruction\" (PROPELLER) sequence for the diagnosis of cholesteatoma compared to surgical and histopathological results in an attempt to determine the factors causing false negative and false positive diagnoses.MethodsPatients who had PROPELLER DWI before ear surgery were retrospectively reviewed. The presence of a lesion with diffusion restriction on PROPELLER DWI was accepted as positive for cholesteatoma, and the results were compared to the intraoperative and histopathological findings.ResultsA total of 112 ears in 109 patients were reviewed. On PROPELLER DWI, a lesion with diffusion restriction was found in 101 (90.2%) ears, while in 11 (9.8%) of the patients, no diffusion restriction was found. Surgery and histopathological analysis revealed a cholesteatoma in 100 (89.3%) ears, while in 12 (10.7%) ears, no cholesteatoma was found surgically. There were 96 (85.7%) true positives, 7 (6.2%) true negatives, 5 (4.5%) false positives and 4 (3.6%) false negatives. The accuracy, sensitivity, specificity, positive predictive and negative predictive values of non-echo planar DWI were calculated to be 91.96%, 96%, 58.33%, 95.05%, and 63.64%, respectively.ConclusionNon-echo planar DWI using PROPELLER sequence has high accuracy, sensitivity and positive predictive value and can be used for the detection of cholesteatoma. The external auditory canal, postoperative ears and small lesions should be evaluated with caution to avoid false results.

BACKGROUND Accumulation of macrocyclic gadolinium agents in children's brains remain to be determined. PURPOSE To demonstrate whether there is an intracranial macrocyclic gadolinium deposition after multiple contrast-enhanced MRI with gadoterate meglumine in a pediatric population. STUDY TYPE Retrospective case-control. POPULATION In all, 45 children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the study group and 45 healthy children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the control group. FIELD STRENGTH/SEQUENCE T1 - and T2 -weighted axial images on a 1.5T scanner. ASSESSMENT Children with at least three enhanced brain MRIs and an age- and sex-matched control group with an unenhanced brain MRIs were compared in terms of T1 signal intensity (SI). All patients in the study group received gadoterate meglumine intravenously (0.1 mmol/kg). SI measurements were made by drawing six regions of interest (ROIs): dentate nuclei (DN), pons, globus pallidi (GP), frontal white matter (FWM), thalamus (T), clivus, and cerebrospinal fluid (CSF) for both groups on unenhanced T1 -weighted images. STATISTICAL TESTS Student's t-test was used for comparison of SI. The Pearson correlation was calculated for the correlation between the SI and the number of gadolinium administrations. RESULTS A significant difference was detected between two groups for DN/CSF, pons/CSF, GP/CSF, thalamus/CSF, and FWM/CSF (P

Background Magnetic resonance myelography (MRM) with three-dimensional (3D) T2-weighted (T2W) turbo spin echo (TSE) sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) may be a guide to the etiology of low back pain. Purpose To research the efficiency of a 3D T2W TSE SPACE MRM sequence for visualization of anatomic details of spinal nerve root at the spinal canal and lateral recess levels in the patients with low back pain. Material and Methods Lumbar spinal MRM 3D T2W TSE SPACE was performed in a total of 70 patients (median age 46 years). Patients were imaged while lying in a supine position with straightened legs. According to the degree of facet arthropathy findings, patients were divided into four separate subgroups in our retrospective cross-sectional study. Spinal nerve root angle was measured within the spinal canal and at lateral recess level, and facet joint angle and lumbar lordosis measurements were measured by two radiologists, independently. Results Lumbar level was strongly negatively correlated with facet joint angle (r = −0.95) as well as nerve root angle within the spinal canal (NRASC) (r = –0.857) and at the lateral recess level (NRALR) (r = −0.947). Intracanal decline of the spinal root angle caused by spinal stenosis findings was also observed ( P SC and NRALR, inter-observer correlation was 0.85 and 0.82 for the spinal canal and at lateral recess level, respectively. Conclusion 3D T2W SPACE in NRASC and NRALR provided high resolution images for evaluation. Therefore, this method may be a qualitative guide for the clinician and the surgeon in terms of root anatomy before any intervention.

Aim:To investigate the role of non-contrast magnetic resonance imaging (MRI) and findings of quantitative MRI in the evaluation of pancreatic lipomatosis in patients undergoing bariatric surgery.Methods:Pre-operative and post-operative MRI findings and laboratory test results of 44 obese patients, who underwent sleeve gastrectomy, were reviewed retrospectively. Liver craniocaudal length, hepatic and pancreatic region of interest (ROI) ratios at in-phase and out-of phase sequences (in-phase/out-of phase), pancreas/spleen ROI ratio on T2-weighted sequence (T2 ratio) and thickness of subcutaneous fat were estimated. The relationship between pre-operative and postoperative findings was analyzed.Results:A total of 44 (41 female, three male) patients with a mean age of 42 were included in the study. Liver length, hepatic and pancreatic in-phase/out-of phase ratios, pancreas/spleen T2 ratio and thickness of subcutaneous fat in the post-operative period were found to be lower than those in the pre-operative period (p

The purpose of this research was to compare the sonographic features of papillary thyroid microcarcinomas (micro-PTCs) to those of macro-PTCs. Patients with known PTC were retrospectively reviewed and divided into micro- or macro-PTC groups, according to the largest nodule diameter, ≤10 mm or >10 mm, respectively. Eighty-nine nodules (62 macro-PTCs and 27 micro-PTCs) were evaluated. Contour irregularity was more common in micro-PTCs than macro-PTCs ( P < .05). No significant difference was found in the presence of hypoechogenicity, heterogeneity, microcalcifications, cystic component, and absence of peripheral halo between groups ( P > .05). Internal vascularity was detected in none of the micro-PTCs while being present in 13% of macro-PTCs ( P < .05). Micro-PTCs demonstrated similar sonographic findings as larger PTCs. In micro-PTCs, the presence of irregular contours, in a micro-nodule, should increase suspicion and consideration for biopsy, when clinically indicated. Internal nodular vascularity may not be present in micro-PTCs and therefore not decrease the suspicion of malignancy in the presence of other suspicious sonographic features.

To investigate the effectiveness of gadoxetic acid-enhanced magnetic resonance cholangiopancreatography (CE-MRCP) and T2-weighted half-Fourier acquisition single-shot turbo spin-echo (T2W HASTE) sequences for diagnosis of cysto-biliary communication in hydatid cysts compared to surgical results. Preoperative abdominal magnetic resonance imaging examinations of patients who underwent surgery for hepatic hydatid cysts were reviewed by two radiologists retrospectively. A total of 45 patients with hydatid cysts were included. Of 45, 27 also had CE-MRCPs. T2W HASTE sequences and CE-MRCPs were investigated separately for cysto-biliary communication. The relationship between radiological and surgical results was analyzed. The interobserver agreement was evaluated. Of 45 hydatid cysts, there were surgically proven 21 cysts without biliary communications and 24 cysts with biliary communications. All cysts with biliary communications were shown on T2W HASTE sequences. There was no leakage of gadoxetic acid into these cysts (n = 24). Sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy of diagnosis of cyst with biliary communication on T2W HASTE sequences was 100%, 63.64%, 100%, 66.67%, and 78.95%, respectively. Specificity (77.78%), PPV (87.50%), and accuracy (91.30%) were increased in ≥ 10 cm cysts. There was almost perfect interobserver agreement (K = 0.81–1.00). Leakage of gadoxetic acid inside the cyst indicates biliary communication. However, the lack of leakage does not rule out cysto-biliary communication. When biliary communication is clearly shown on T2W HASTE sequences, it should be reported as cysto-biliary communication even if there is no leakage of gadoxetic acid into the cyst on CE-MRCP.

Objective The objective of the study was to describe the findings of pediatric patients diagnosed with COVID-19 in computed tomography (CT) and chest X-ray (CXR) images. Therefore, the aim of this study is to show protecting the children from radiation as much as possible while guiding the diagnosis. Methods Between March and June 2020, 148 pediatric patients examined who underwent CT due to suspicion of COVID-19. Fifty patients of 148 with normal thorax CT and negative reverse transcription polymerase chain reaction (RT-PCR) were excluded from the study. Of the remaining 98 patients were evaluated retrospectively by two pediatric radiologists with 15 years of experience. Results The demographic, clinical, and laboratory data were evaluated for 52 RT-PCR-positive patients. CT finding of 23 RT-PCR positive and 12 negative patients was classified. According to our study, unilateral (61-67%), multifocal (50-52%), and peripheral (83-91%) involvement were higher in all groups. Lower lobe involvement was frequently detected (58-65%). The most frequently detected parenchymal lesion was ground-glass opacity followed by consolidated areas accompanying ground-grass opacities. Halo sign and vascular enlargement signs were the common signs of lung lesions (35%). In addition, some rare findings not previously described in this disease in children were mentioned in this study. The clinical course of all our patients was mild and control radiological imaging checked by CXR. Conclusion Most pediatric patients have a mild course. Hence, a balance between the risk of radiation and necessity for chest CT is very important. Low-dose CT scan is more suitable for pediatric patients but still it should be used cautiously.

Amaç: Amacımız, bilgisayarlı tomografi (BT) tetkiklerinde, 65 yaş ve üstü hastalarda insidental saptanan adrenal lezyonların prevalansını araştırmaktır.Gereç-Yöntem: Hastanemizde, Ocak 2013 ve Nisan 2014 tarihleri arasında, üst batın BT tetkikleri yapılmış ardışık 903 hasta tekrar değerlendirildi. Bilinen kanser öyküsü olan, adrenal patolojilere yönelik tetkik yapılan ve 65 yaş altı hastalar çalışma dışı bırakıldı. Çalışma grubunu, 178 hasta oluşturdu. Çalışma grubunda yer alan hastaların, BT tetkikleri incelendi. Adrenal lezyon varlığı, varsa lezyon en uzun çapı ve görüntüleme özellikleri bir radyolog tarafından kaydedildi. Lezyonların radyolojik bulgularına göre ön tanıları yapıldı. Malignite özellikleri olanlar, çalışma dışı bırakıldı. BT’ de, adrenal insidentaloma saptanma oranı hesaplandı. Bulgular: BT tetkikleri incelenen, 93’ü kadın, 85’i erkek olan, 65 yaş ve üzeri 178 hasta çalışma grubunu oluşturdu. Bu hastaların, 86’sında adrenal lezyon saptanırken 92’sinde adrenal glandlar doğaldı. Olguların ikisinde malignite ile uyumlu görünüm saptandığı için insidentaloma grubundan çıkarıldı. İnsidental adrenal lezyon saptanan 84 olgunun, 20’sinde diffüz adrenal hiperplazi, 53’ünde adenom, 11’inde myelolipom ile uyumlu radyolojik özellikler izlendi. Adrenal insidentaloma prevalansı %47,2 olarak saptandı. Sonuç: Çalışmamızda, BT’de geriatrik hastalarda adrenal insidentaloma prevalansı %47,2 bulunmuş olup küçümsenmeyecek derecededir. Günümüzde görüntüleme yöntemlerinin daha çok kullanılması ile sık saptanan adrenal insidentalomaların malignite ekartasyonu yapıldıktan sonra fonksiyonel açıdan değerlendirilmesi gereklidir.

The purpose of this study was to describe the magnetic resonance imaging (MRI) findings including diffusion-weighted MRI of nonfunctional pancreatic neuroendocrine tumors (PanNETs) and their hepatic metastases, and investigate the relationships between MRI features and histopathological findings for each grade of PanNETs.A total of 30 patients were included. There were 14 men and 16 women with a mean age of 61.60±11 (SD) years (range: 31-81years). PanNET lesions were analyzed qualitatively (signal intensities, contrast enhancement, lesion margins, presence of metastasis and characteristics of metastases) and quantitatively (signal intensity ratios, contrast enhancement indices and normalized apparent diffusion coefficient [ADC]). The relationships between MRI findings and histopathological findings were evaluated.Among 30 nonfunctional PanNETs, 11 were high-grade tumors, 10 were intermediate and 9 were low-grade tumors. All high grade PanNETs showed low to intermediate signal on T2-weighted images and ill-defined borders. All intermediate grade PanNETs had intermediate and 6 low grade PanNETs have high signal on T2-weighted images. Patients with hepatic metastases from high grade PanNETs had cystic component in 8/10 (80%) and wash-out in 7/10 (70%) whereas intermediate grade PanNETs had none (P0.05). The normalized ADC values of high grade PanNETs was lower than those of intermediate and low grade PanNETs (P0.05).The presence of cystic component or contrast wash-out in hepatic metastases correlates with high grade PanNETs. The pre-operative MRI combined with DWI has an important role in grading and surgical planning of PanNETs.

Small intestine tumors are extremely rare. They account for approximately 1-5% of all gastrointestinal tumors. However, the risk of development of small intestine tumor increases in patients with celiac disease. Celiac disease is also known as gluten-sensitive enteropathy. Lymphoma is the most common small intestine tumor in patients with Celiac disease. Adenocarcinoma and adenoma of the small intestine are less common. Adenocarcinoma is frequently seen in the proximal segments of the small intestine. The prognosis of adenocarcinoma is worse than lymphoma. In the literature, there are few reported cases of duodenal adenocarcinoma in patients with Celiac disease and the imaging findings were not emphasized enough. For this reason, in this study, computed tomography and magnetic resonance imaging findings in a patient with duodenal adenocarcinoma associated with Celiac disease are presented.

WOS:000576583500003 Objective: We aimed to evaluate the diagnostic value and comparison of sonoelastography and diffusion-weighted magnetic resonance imaging in differentiation of benign and malignant breast masses. Method: Forty-five patients who were referred to our Radiology Department for the biopsy of a known breast mass following a breast MRI were evaluated by sonoelastography using a 5-scaled Tsukuba scoring system and measurements of ADC values on diffusion weighted MRIs. Contribution of the Tsukuba scores and ADC values of the masses to the conventional methods were evaluated. Results: Histopathological results of all masses with Tsukuba scores 1 and 2 were evaluated as benign. Histopathological results of 37.5% of patients with a Tsukuba score of 3 were found to be benign and 62.5% of the patients were found to be malignant. Histopathologically 80% of the patients with a Tsukuba score of 4 were evaluated to have malignant, while all (100 %) of the patients with a Tsukuba score of 5 were considered to have malignant disease. Statistically significant correlation was found between the histopathological results and Tsukuba scoring system (p

Seminomas are the most common testicular tumors But frequency of bilateral testicular seminomas is about Seminomas can spread and metastasize in a very short time because of short doubling time For this reason early diagnosis and management is essential The tendency of multicentricity and bilateral location in lymphoma is higher than seminoma The first line treatment of testicular lymphoma is chemotherapy So management is different in lymphoma and seminoma The accurate preoperative diagnosis is important We report a case of a year old man with bilateral multicentric testicular lesions who had not yet fathered a child and had malignant findings on magnetic resonance imaging MRI and diffusion weighted imaging DWI After surgery histological examination revealed bilateral multicentric testicular seminomas This case underlines the role of MRI and DWI in the management of patient nbsp

The relationship of patellofemoral congruency with chondromalacia patellae (CP) was retrospectively evaluated. Lateral patellar tilt angle (LPTA), sulcus angle (SA), trochlear depth (TD), and patella angle (PA) were measured at 301 knee magnetic resonance images and compared between groups with and without CP. In the CP group, LPTA and TD were significantly low (P.01), SA was high (P.01), while PA showed no difference (P.05). The parameters were also compared between groups with mild and severe CP, and no significant difference was found (P.05). Our results demonstrate that patellar tilt and trochlear dysplasia are related to the presence but not the degree of CP.

Ovotesticular disorder of sex development (DSD) is a very rare chromosomal anomaly characterized by the presence of both ovarian and testicular tissues. We reported a case of delayed diagnosis in a 18-year-old man presenting with nonpalpable testes. Pre-operative magnetic resonance imaging (MRI) demonstrated associated anomalies (agenesis of seminal vesicle, configuration of urethra) and Mullerian duct remnants. The presence and location of both ovary and testis, and restricted diffusions of gonads were detected on MRI. On histopathology, malignancies were found in both gonads. Pre-operative MRI findings were helpful for surgical approach. We emphasized the importance of pre-operative MRI on treatment planning.

Objectives: In this study it was aimed to investigate the safety and technical success of percutaneous radiological gastrostomy and gastrojejunostomy. Materials and Methods: Results of 35 patients with a percutaneous gastrostomy or gastrojejunostomy are retrospectively evaluated. The indications for the procedure were dysphagia due to central nervous system disorders in 22, feeding disturbance due to oropharyngeal problems in 8 and excessive weight loss secondary to gastrointestinal system dysfunction in 5. The indications for percutaneous gastrojejunostomy were a history of aspiration, gastroesophageal reflux and diaphragmatic hernia. Results: Percutaneous radiological gastrostomy was performed in 22 and percutaneous gastrojejunostomy in 11 patients. In one patient, the procedure was not performed because of colonic superposition on the entire stomach, which precluded a safe access route. In another patient intervention was not successful. Minor complications, consisting of tube dislocation (n=2) and access site drainage (n=1) were seen in 3 (9%) patients. Major complications and 30 day mortality occurred in one (3%) patient. Conclusions: Percutaneous radiological gastrostomy and gastrojejunostomy are safe and effective methods with high technical success and low complication rates. Percutaneous radiological gastrostomy may be the method of choice for long term enteric feeding in patients, in whom endoscopy cannot be performed., Amaç: Bu çalışmada perkütan radyolojik gastrostomi ve gastrojejunostominin güvenlik ve teknik başarısının araştırılması amaçlanmıştır. Gereç ve Yöntem: Perkütan gastrostomi ya da gastrojejunostomi uygulanmış olan 35 hastanın sonuçları retrospektif olarak incelendi. İşlem için endikasyonlar, 22 olguda santral sinir sistemi patolojisine bağlı yutma bozukluğu, 8 olguda orofaringeal problemler nedeniyle beslenememe ve 5 olguda gastrointestinal sistem disfonksiyonu nedeniyle aşırı kilo kaybı idi. Aspirasyon, diyafragma hernisi ya da gastroözofagial reflü öyküsü olan olgulara perkütan gastrojejunostomi uygulandı. Bulgular: Perkütan radyolojik gastrostomi 22 olguda, gastrojenunostomi ise 11 olguda uygulandı. Bir olguda kolonun mide üzerine süperpoze olması nedeniyle emniyetli giriş penceresi bulunamadığından işlem gerçekleştirilmedi. Bir olguda ise girişim yapılmasına karşın işlem başarılı olmadı. İşlem sonrasında 2 olguda tüp dislokasyonu ve 1 olguda giriş yeri akıntısı olmak üzere toplam 3 olguda (% 9) minör komplikasyon görüldü. İşlem sonrasında majör komplikasyon ve 30 günlük mortalite bir olguda (% 3) görüldü. Sonuç: Perkütan radyolojik gastrostomi ve gastrojejunostomi, yüksek teknik başarı ve düşük komplikasyon oranları ile etkin ve güvenli yöntemlerdir. Özellikle çeşitli nedenlerle endoskopi yapılamayan olgularda uzun dönemli enterik beslenme için perkütan radyolojik gastrostomi yöntemi tercih edilebilir.

A case of aberrant left pulmonary artery originating from the right pulmonary artery resembling pulmonary artery sling malformation, but without true sling formation, is presented. Anomalous left pulmonary artery was accompanied with long-segment proximal tracheal stenosis and other congenital malformations typically associated with PAS complex. The anomalous pulmonary artery passed anterior to the trachea; therefore, no true sling was formed. Because no airway compression by the aberrant left pulmonary artery was detected, the proximal tracheal stenosis was thought to be primary.

We aimed to describe the clinical and multidetector computed tomography (MDCT) angiography findings of celiac, mesenteric, and renal artery entrapment by the median arcuate ligament.Patients (n = 453) who underwent MDCT abdominal aorta angiography in a period of 3 years were retrospectively reviewed for vascular compression by median arcuate ligament known as median arcuate ligament syndrome. The MDCT examinations were performed with 16-slice (n = 292) and 64-slice scanners (n = 161). The median arcuate ligament itself and adjacent vascular branches of abdominal aorta were assessed for compression by 2 different radiologists who are experienced on MDCT angiography more than 3 years. Both axial, multiplanar reformatted images and 3-dimensional angiographies were used for interpretation.Twelve patients were found to have clinically significant vessel entrapments by median arcuate ligament; 6 of them with celiac artery, 4 of them with renal artery, and 2 of them with both celiac and mesenteric artery involvement. Patients with celiac and mesenteric vessel entrapments presented with epigastric pain. All patients with renal artery entrapment had resistant hypertension. The MDCT showed the proximal narrowing caused by compression of median arcuate ligament. The proximal portions of renal arteries pulled down and in toward the aorta, with mild to moderate narrowing.The MDCT exanimation with multiplanar images and 3-dimensional angiography is a noninvasive imaging technique that can be used with high accuracy in the diagnosis of median arcuate ligament syndrome.

Giant-cell reparative granuloma (GCRG) occurs in the jaw, temporal bone, and short tubular bones of the hands and feet. Although GCRG can affect long bones, only small numbers of such cases have been sporadically reported. This report describes a giant-cell reparative granuloma in the proximal tibia in a 60-year-old woman, describes features of GCRG in long bones and reviews the literature. A 60-year-old female patient was referred to us with complaints of moderately tender swelling of the right leg. Whole-body scintigraphic scanning was performed, which incidentally also disclosed a distal femoral lesion. The patient was admitted for surgery and incisional biopsies were performed on both lesions. Pathology analysis of the specimen from the tibia showed new bone lamellae encircled by osteoblasts and multinucleated giant cells which were more numerous in the haemorrhagic regions of the stroma; the latter displayed fibroblasts, histiocytes and inflammatory cells. The specimen from the femoral lesion showed typical features of a benign enchondroma. The patient was readmitted for surgery. The femoral enchondroma was curetted and the cavity was packed with bone graft. The tibial GCRG was treated with marginal resection, autogenous and allogenous bone grafting and intramedullary nailing. Follow-up examination after two years showed no clinical or radiological evidence of a recurrence. Although GCRG is uncommon, it should be considered whenever a lucent, expansile, and possibly destructive lesion of a long bone is encountered. It should be distinguished from true giant cell tumours occurring in the same locations because they have different biologic behaviours.