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Background: Following the increased use of biological agents, a subset of patients experiences hypersensitivity reaction (HSR). We reported our experience with rapid drug desensitization (RDD) to nine biologics (rituximab, infliximab, cetuximab, trastuzumab, pertuzumab, nivolumab, brentuximab, tocilizumab and filgrastim) and identified risk factors for breakthrough reactions (BTRs)., Method: This was a retrospective review (2013-2022) of patients with immediate HSRs to biological agents. Initial HSRs were classified as grade 1, 2, or 3 in their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed using implicated agents. The phenotypes of HSRs were defined as Type I, cytokine-release syndrome (CRS), mixed reactions (cytokine-release + type I) based on history, clinical presentations and skin tests with implicated biologicals. A 12-step RDD protocol was used., Results: The study comprised 45 patients (F/M: 31/14, median age: 55 (range: 20-69)). Majority of the patients reacted at the first infusion (n: 29/45, 64.4%). The majority of initial HSRs were grade 3 (n: 24/45, 53.3%) and grade 2 (n: 21/45, 46.6%); none were grade 1. Initial reactions were presented as type I (n: 20/45, 44.4%), CRS (n: 12/45, 26.6%) and mixed (n: 13/45, 28.8%). A total of 258 RDDs were performed and 98.4% of them were completed successfully. BTRs occurred in 36/258 (13.9%) infusions of RDDs. There was no significant association between the BTRs and age, drug cycle, SPT and IDT positivity, gender, comorbidities, or atopy., Conclusion: In our experience, 98.4% of 258 RDDs to biologics were successfully completed; RDD was safe and effective for our population., (© 2024 The Author(s). Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Background: Methotrexate (MTX) and leflunomide (LEF) play fundamental roles in rheumatoid arthritis (RA) treatment and require proper monitoring of side effects. Concerns about MTX/LEF-related liver fibrosis (LF) in patients with RA remain unclear. This study investigated liver stiffness using two-dimensional shear wave elastography (2D-SWE) in RA patients undergoing disease-modifying antirheumatic drug (DMARD) therapy. Moreover, 2D-SWE was employed to evaluate the correlations between liver stiffness, cumulative MTX and LEF doses and risk factors for substantial LF., Methods: We recruited 222 participants from the Department of Rheumatology. The participants were divided into healthy controls (n = 78) and patients with RA (n = 144). Pearson's correlation analysis was performed to assess the correlations between liver stiffness and the cumulative dose of MTX/LEF and other clinical and laboratory variables., Results: The mean elasticity modulus was 4.79 ± 0.92 kPa, excluding the presence of significant fibrosis. Mean 2D-SWE values were significantly lower in healthy controls than in RA treated with MTX and LEF. The cut-off ≥3.8 kPa 2D-SWE values with the sensitivity of 86.1%, specifity of 83.3%. 2D-SWE values were not significantly different across the strata of the cumulative MTX subgroups., Conclusions: MTX and LEF increase liver stiffness but may be considered low risk for the development of LF., (© 2024 Wiley Periodicals LLC.)

Purpose: We aimed to investigate maternal thyroid parenchymal vascularity with 2-dimensional color superb microvascular imaging vascularization index (2D-cSMIVI) levels and thyroid gland volume in the first, second and third trimesters., Methods: This longitudinal prospective study was carried out with participants selected from 30 healthy asymptomatic pregnant women. Ultrasonography (US) for the thyroid gland was performed in each trimester. The vascularization index (VI) values obtained by manually drawing the contours of the thyroid parenchyma in the longutidinal plane, using the free region of interest (ROI) with 2DcSMIVI mode. VI values obtained in each trimester, thyroid hormone levels (TSH, T3, T4) and thyroid volumes were compared., Results: We have detected that thyroid gland vascularity increased significantly as pregnancy progresses. The mean VI values of thyroid gland in third trimester were significantly higher than first and second trimester (p < 0.001), and the mean VI values of the thyroid gland in the second trimester were significantly higher than first trimester (p < 0.001). During pregnancy, we detected the increase in VI values, TSH levels and thyroid gland volumes., Conclusion: Maternal thyroid gland gray scale findings, parenchymal vascularization, thyroid volumes should be evaluated routinely for the healthy fetal development. 2D-cSMIVI method allows us to evaluate vascularization with quantitative numerical values objectively. We have detected that the VI values and volume of the thyroid gland increases as pregnancy progresses. In the complex situation of pregnancy process, the thyroid gland can be evaluated quantitatively with SMI method effectively., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients., Aims: The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not., Methods: To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated., Results: Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001)., Conclusions: We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Purpose: Taxanes can cause hypersensitivity reactions (HSRs), which pose a significant challenge in the treatment of malignancies. Patients who are eligible for rapid drug desensitization (RDD) can continue treatment; however, some patients experience breakthrough reactions (BTRs). Data about risk factors for BTRs during RDDs in patients with HSRs to taxanes are limited., Methods: This was a multicenter, retrospective study of patients with immediate-HSRs to taxanes. Initial HSRs were classified as grade 1, 2, or 3 based on severity. Prick/intradermal skin tests were performed with implicated taxanes. A 12-step protocol was used during RDD., Results: The study comprised 75 patients (F/M: 63/12, mean age 49.92 ± 11.72 years, 43 HSRs to paclitaxel, 32 HSRs to docetaxel). The majority of reactions (86.7%) occurred during the first or second exposure. The prevalence of drug allergy history was higher in patients with paclitaxel HSR than in those with docetaxel HSR, although it was not statistically significant (23.3% vs. 6.3%). The initial HSRs were mostly grade 2 (n = 50, 66.7%) or grade 3 (n = 22, 29.3%). Skin tests with implicated taxanes were done on 48 patients, and the rate of positive response in patients with grade 1, 2, and 3 initial HSRs were 50%, 17.6%, and 16.7%, respectively. . A total of 255 RDDs were completely performed, although BTRs occurred in 27 (grade 1, 55.6%; grade 2, 40.7%; grade 3, 3.7%). There were no statistically significant correlations between the risk of BTR and age, drug cycle, gender, positivity of skin test or atopy. The step reduction was successfully done on 9 eligible patients with mild or moderate HSRs during the 12-step RDDs., Conclusions: Our experience demonstrates a 100% success rate in completing the 255 RDDs for taxanes, affirming the safety and efficacy of the RDD within the study population., Competing Interests: There are no financial or other issues that might lead to conflict of interest., (Copyright © 2024 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease.)

Introduction: Inborn errors of immunity (IEI) increase morbidity and mortality risks, particularly from respiratory tract infections. Hence, vaccination becomes pivotal for IEI patients. This study aims to examine the vaccination and respiratory tract infection rates in a diverse IEI patient cohort undergoing immunoglobulin replacement therapy (IGRT)., Materials and Methods: We retrospectively evaluated IEI patients on IGRT at a tertiary care center. Data on vaccinations and respiratory infections were extracted from medical records., Result: : The study included 33 patients (mean age= 37.7 ± 11.4 years; 17 male). The most common clinical phenotype in our cohort was primary antibody deficiencies (90.9%). Only two patients had a genetic diagnosis, both of whom were brothers diagnosed with Wiskott-Aldrich syndrome (WAS). Almost half (48.5%) of our patients had bronchiectasis and 81.8% were on prophylactic antibiotics. All patients with IEI included in the study were regularly receiving IGRT. The vaccination rate of patients against respiratory tract infections was 42.4%, 57.6%, and 78.8% for influenza, pneumococcus, and COVID-19, respectively. Only one patient (7.1%) who received the influenza vaccine developed an upper respiratory tract infection. However, viral panel analysis could not be performed for this patient as they did not present to the hospital. The COVID-19 vaccination rate was notably higher than that of other vaccines, likely due to increased awareness during the pandemic, aided by public advisories and media influence., Conclusions: We observed higher vaccination rates for the COVID-19 vaccine compared to other vaccines (influenza and pneumococcal vaccines). Although we observed the potential impact of social and governmental influence in increasing vaccination rates, it is crucial to acknowledge that vaccination decisions in IEI patients must be individualized.

Objectives: The aim of this study was to assess lacrimal gland involvement in primary Sjögren's syndrome (pSS) using lacrimal gland gray-scale ultrasound (LGUS) and two-dimensional shear wave elastography (2D-SWE)., Methods: Eighty-five pSS patients with a mean age of 51.16 ± 10.61 years and 84 sex- and age-matched healthy subjects with a mean age of 50.94 ± 11.05 years were included in the study. Lacrimal gland parenchymal findings and 2D-SWE values were compared between the two groups and the correlations of LGUS parameters with clinical findings, dry eye tests, and minor salivary gland biopsy (MSGB) were further investigated., Results: LGUS parenchymal grade was 0 in 14 (16.5%), 1 in 45 (52.9%), 2 in 23 (27.1%), and 3 in 3 patients (3.5%) in the pSS group, while in the control group, parenchymal grades were 0 (57.1%) and 1 (42.9%). The mean 2D-SWE value of pSS patients was significantly higher than the control group (p < 0.05) and increased parallel with lacrimal parenchymal grade. The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in pSS patients (AUC 0.901, sensitivity 70.6%, specificity 97.6%), while the diagnostic performance of LGUS was much lower (AUC 0.769, sensitivity 83.5%, specificity 57.1%). LGUS and 2D-SWE values were found to be correlated with dry eye tests and MSGB results (p < 0.05)., Conclusions: LGUS and 2D-SWE are both useful for assessing the lacrimal gland involvement in pSS patients; however, 2D-SWE has a better diagnostic performance than LGUS and found to be correlated with dry eye tests., Clinical Relevance Statement: Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are imaging modalities that can be used to demonstrate parenchymal involvement of the lacrimal gland in primary Sjögren's syndrome (pSS)., Key Points: • Gray-scale US and two-dimensional shear wave elastography (2D-SWE) have been widely used in the recent decade to assess gland involvement in patients with primary Sjögren's syndrome (pSS). • The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in primary Sjögren's syndrome (pSS) patients. • Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are both useful for assessing the lacrimal gland in primary Sjögren's syndrome (pSS) patients; however, two-dimensional shear wave elastography (2D-SWE) has a better diagnostic performance than lacrimal gland ultrasound (LGUS)., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Aim: We aimed to evaluate the effectiveness of combining 2-dimensional shear wave elastography (2D-SWE) with ultrasonography (US) in diagnosing acute appendicitis in patients with suspected acute appendicitis., Methods: Clinical and laboratory findings, gray-scale US and 2D-SWE imaging features, operation information, and pathology results of 48 patients diagnosed with acute appendicitis who presented with right lower quadrant pain were prospectively evaluated. We compared the findings to the US and SWE imaging features of 79 asymptomatic patients., Results: Mean Alvarado score and appendix diameter were statistically significantly higher for acute appendicitis (p < 0.001). In patients with acute appendicitis, mesenteric lymphadenopathy and fat stranding were also more frequent (p < 0.001). The mean velocity and kPa values for appendix and mesenteric fat were statistically significantly higher in acute appendicitis (p < 0.001)., Conclusion: In the diagnosis of acute appendicitis, 2D-SWE increases the diagnostic performance of gray-scale US in the differentiation of inflamed and normal appendixes., (© 2022. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Aim: Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes., Material and Methods: We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume., Results: Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging ( p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes ( p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes., Conclusions: The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes., Competing Interests: Conflict of interest: The authors do not report any financial or personal connections with other persons or organizations which might negatively affect the contents of this publication and/or claim authorship rights to this publication., (© 2023 Fatih Ates et al., published by Sciendo.)

Objectives: This study aims to evaluate the effect of quercetin on fracture healing in an open fracture model in rats., Materials and Methods: A total of 80 Wistar-Albino male rats were used in this study. The rats were divided into 10 groups. Daily oral treatment of 100 mg/kg of quercetin dissolved in corn oil were given to four groups, whereas the other four group of control rats were treated with corn oil only. Histopathological and radiological examinations of fracture healing were performed at the end of Weeks 2 and 4 in these rats, while biomechanical and biochemical examinations were performed at the end of Weeks 4 and 6, since harder callus was required. Among the rats in the last two group that were not subjected to the open fracture model, one group was given only quercetin for three weeks and the other for six weeks, and the biochemical markers in the blood were compared between these two groups. Computed tomography images were taken for radiological evaluation. The modified Lane and Sandhu scoring system was used for histological evaluation. The 3-point bending test was performed for biomechanical evaluation. For biochemical evaluation, plasma alkaline phosphatase (ALP), acid phosphatase (AP), total antioxidant status (TAS) and total oxidant status (TOS) levels were measured., Results: Radiologically, there was no significant difference between the early-stage results of quercetin and control groups (p=0.247), while quercetin caused a significant increase in callus tissue in terms of latestage results (p=0.012). Histopathologically, there was no significant difference in the early stage (p=0.584); however, in the late stage, a borderline significant increase was observed in the quercetin group compared to the control group (p=0.091). Biomechanical analysis showed that quercetin significantly increased the fracture strength in the healing bone both in the early period (p=0.036) and in the late period (p=0.027). Among biochemical markers, TOS and AP were found to be significantly decreased in the quercetin group. In the non-operated and quercetin given groups, TAS levels was significantly higher (p=0.001) and AP levels were borderline significantly lower at the end of Week 6 (p=0.063)., Conclusion: Quercetin did not have a significant effect on bone healing in the early period, but significantly promoted bone healing in the late period in rats. We recommend the use of quercetin, a strong antioxidant, in cases with high oxidative stress and conditions such as diabetes, smoking, and malnutrition which may inhibit fracture union, although further clinical studies are needed to confirm these findings.

Background: Fetal ultrasonographic evaluation is a routine part of pregnancy follow-up, and examination of orbital structures is also part of the routine evaluation. Although orbital developmental anomalies are common in the neonatal period, diagnosis in the intrauterine period is not common. To our knowledge, three cases with a diagnosis of congenital orbital epidermal cysts have been reported in the literature, and two of them had fetal imaging findings. In this article, we present the prepostnatal imaging findings of a case diagnosed with orbital cyst in the fetal period and histopathologically diagnosed as epidermal cyst in the neonatal period., Case Report: A 25-year-old woman applied for ultrasonography (USG) examination at 22 weeks of gestation. A 35x45 mm cystic lesion causing proptosis, without solid component and vascularity, surrounding the optic nerve and causing its thinning was observed in the left orbit. In fetal magnetic resonance imaging (MRI), the intraorbital cystic lesion, which was hyperintense on T2W images and hypointense on T1W images, had no relationship with intracranial structures and no solid component. The lesion of the patient, followed up with a multidisciplinary approach, was shown similarly with computed tomography (CT) and magnetic resonance imaging (MRI) in the postnatal period. Subsequently, the patient underwent globe-sparing surgery, and the pathological diagnosis was made as the epidermal cyst., Conclusion: Orbital epidermal cysts are rarely seen, and detection in the fetal period is even rarer. It should be considered in the differential diagnosis of orbital cystic lesions that cause proptosis in fetal and neonatal periods., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls., Methods: Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI., Results: Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001)., Conclusion: CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients., Competing Interests: CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported., (Copyright © 2023 by The Korean College of Rheumatology. All rights reserved.)

Purpose: This study aims to investigate the usability of ultrasonography (US) and shear wave elastography (SWE) in detecting remnant thyroid tissue (RTT) within the first three postoperative months in patients who underwent total thyroidectomy (TT) for differentiated thyroid cancer (DTC) and who were scheduled for radioiodine (RAI) ablation therapy., Methods: Sixty-nine patients who underwent a TT operation due to DTC were included in the study. The participant's thyroid surgical bed was first evaluated by thyroid scintigraphy and then by greyscale US and SWE to investigate RTT. The participants were divided into two groups, those with and those without RTT. SWE quantitative data were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values for stiffness and velocity in distinguishing RTT., Results: A total of 149 regions were analysed in 69 participants (43 females, 26 males). The average time elapsed after the operation was 65.2 ± 24.1 days. RTT was determined by scintigraphy and US-SWE in 38 (55%) patients. The stiffness and velocity values were significantly higher in the group with RTT than in the group without RTT. To distinguish RTT from the thyroid bed, the best cut-off values for stiffness and velocity were 15.7 kPa and 2.12 m/s, respectively., Conclusions: US with SWE can detect RTT in the early postoperative period in patients who have undergone TT due to DTC and who are scheduled for RAI treatment. The use of US and SWE will be particularly beneficial in patients with RTT but who have false-negative Tg levels and RTT that is not I-131 avid., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Purpose: In this study, we aimed to determine vascular changes in the testes in patients with varicocele using the two-dimensional color superb microvascular imaging vascular index (2DcSMIVI) and compared them with those of the normal contralateral testes of the same patients as well as the normal testes of control subjects without varicocele., Methods: A total of 114 participants and 228 testes were included in the study. 63 patients with varicocele and 51 asymptomatic volunteers were included. In total, 70 testes with varicocele (group A), 56 normal contralateral testes (Group B), and 102 bilateral normal testes were classified (Group C). Participants' testicular volume and 2DcSMIVI values were obtained via superb microvascular imaging. Testes with varicocele were graded according to Sarteschi classification., Results: Statistically significant differences in mean testicular volume were observed among the three groups. The volume and 2DcSMIVI values of the varicocele side testes were significantly lower than those of groups B and C. Significant differences were also observed between Sarteschi grade and 2DcSMIVI values in group A., Conclusion: We can determine impaired microcirculation of varicocele side testes quantitatively with the 2DcSMIVI technique, and obtained VI values can be used effectively in diagnosis and follow-up of the damage in testes. Our results show that 2DcSMIVI values can play a significant role in the evaluation of testicular blood flow as a predictive sign of testicular damage., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Background/objective: Behçet disease (BD) is not a single unique entity but a syndrome with different clinical phenotypes that can involve arterial and venous vessels of all sizes. To date, there has been no specific test or serum marker to measure and determine the severity of BD, and diagnosis remains based on clinical findings. This study aimed to assess lower extremity venous wall thickness (VWT) measured by ultrasound and laboratory findings and diagnostic performance in patients with BD., Methods: A total of 106 participants were recruited from the rheumatology department in this single-center, case-control study. Participants meeting the eligibility criteria were divided into healthy controls (n = 52) and BD (n = 54). The VWT values of the common femoral vein, great saphenous vein, and popliteal vein were measured using ultrasonography. Laboratory data were obtained from the electronic registration database. Venous wall thicknesses and laboratory findings in patients with BD and healthy subjects were compared., Results: Venous wall thickness of the lower extremity veins was higher in the BD group and higher in those with a history of deep vein thrombosis than in those without. The mean leukocyte, monocyte, erythrocyte sedimentation rate (ESR), C-reactive protein, plateletcrit (PCT), red cell distribution width (RDW), mean platelet volume (MPV) values, and monocyte-to-lymphocyte ratio (MLR) were higher in BD patients than in the control group. There was a correlation among increased VWT, ESR, PCT, MPV, RDW, and MLR., Conclusions: C-reactive protein, ESR, MPV, PCT, MLR, RDW, and VWT can be used to assist in the diagnosis of BD., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in assessment of the anterior urinary bladder wall in pediatric patients with acute cystitis (AC)., Methods: The anterior bladder wall of 157 patients (age range 13-84 months, mean 43.62 ± 17.79 months) whose clinical and laboratory findings were proven of AC and 150 healthy asymptomatic participants (age range 13-84 months, mean 43.88 ± 18.11 months) with normal laboratory values were examined using cSMI. VI measurements were performed by manually drawing the contours of the anterior bladder wall using the free region of interest with 2-dimensional cSMI VI (2DcSMIVI) mode. The quantitative 2DcSMIVI values of the symptomatic group and the asymptomatic group were compared. The correlation between the 2DcSMIVI values and the anterior bladder wall thickness (BWT) were analyzed., Results: The mean 2DcSMIVI values of the BWT were significantly higher in symptomatic group when compared to the asymptomatic group (p<0.001). AC can be diagnosed with a 93% sensitivity, 92% specificity when 3.25% 2DcSMIVI designated as the cutoff value. There was a significant positive correlation between 2DcSMIVI values and BWT (p<0.001)., Conclusion: Two-dimensional cSMI VI can be used effectively in children as an imaging method in the diagnosis of AC., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic necrotizing granulomatous vasculitis in the spectrum of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Nevertheless, EGPA has specific clinical, biological and histological properties different from other AAVs [microscopic polyangiitis (MPA) and granulomatous polyangiitis (GPA)]. Recently, thanks to the studies conducted to understand the pathophysiology of EGPA, unlike neutrophils in other AAVs, the main cells involved in EGPA have been observed to be eosinophils. The key role of eosinophils in EGPA and recent development of targeted agents to treat other eosinophil-related diseases have created new therapeutic opportunities for EGPA. Conventional treatment of EGPA relies mainly on agents that decrease inflammation. Cornerstone therapy is systemic glucocorticoids, used as monotherapy or in combination with immunosuppressive agents. However, new therapeutic approaches are needed especially for persistent asthma symptoms, refractory disease, relapses and problems associated with corticosteroid dependence. Recently, the first large-scale randomized controlled clinical trial on polyangiitis and eosinophilic granulomatosis has demonstrated the efficacy of eosinophil-targeted biotherapy anti-interleukin-5 (IL-5) mepolizumab, and is approved for the management of EGPA. This finding opens a new era for EGPA management. This review provides an overview of eosinophilic granulomatosis with polyangiitis in the light of new targeted biological therapies.

Aim: To explore the ability of dynamic susceptibility contrast perfusion imaging (DSC-PI) to detect isocitrate dehydrogenase (IDH) gene mutation in gliomas., Material and Methods: Preoperative DSC-PI data on histopathologically proven gliomas obtained between January 2015 and December 2019 were reviewed retrospectively. All magnetic resonance imaging (MRI) examinations were performed using a 1.5-T scanner. The maximum relative cerebral blood volume (rCBVmax), percentage signal recovery (PSR), and normalized PSR of tumor cores were calculated. Differences in these values between IDH-mutant and wild-type gliomas were compared, and receiver operating characteristic curves were generated., Results: The patients (32 females, 47 males) were aged 21-76 years (mean 50.7 ± 15 years). The rCBVmax and all PSR values differed significantly between patients with IDH-mutant and those with wild-type tumors (p < 0.01 for all comparisons)., Conclusion: The rCBVmax and PSR values obtained by DSC-PI may facilitate noninvasive detection of the IDH mutation status of gliomas. PSR provided more reliable values for differentiation of IDH-mutant gliomas from wild-type gliomas.

Objectives: The aim of this study was to investigate the wholeness, thickness, and elastography measurements of the iliopsoas tendon using shear wave elastography who underwent open reduction surgery for unilateral developmental dysplasia of the hip., Patients and Methods: Between January 2011 and December 2016, a total of 15 patients (2 males, 13 females; mean age: 24.6±26.3 months; range, 3 to 98 months) who underwent surgical treatment for unilateral DDH were retrospectively analyzed. In addition to demographic data, clinical findings such as muscle strength, range of motion, and the presence of limping were recorded. Ultrasound elastography was used to examine the thickness, shear wave velocity and elasticity of the iliopsoas tendons., Results: The mean follow-up was 92.6±30.2 (range, 44 to 120) months. Full range of motion of the hips was observed in all patients. Hip flexor muscles' strength was 5/5 in bilateral. No hip dislocation or limping was not detected in any of the patients. Ultrasound examinations revealed that tenotomized iliopsoas tendons were intact in all patients. The mean muscle thickness was lower in operated sides, indicating no statistically significant difference. The mean velocity and elasticity were statistically significantly higher in the operated sides., Conclusion: This is the first study using shear wave ultrasonography for iliopsoas tenotomy of the patients underwent open reduction for developmental hip dysplasia. Re-adhesion of the iliopsoas tendons provided wholeness while healing as a more rigid and thinner structure compared to the intact sides.

Background: Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the morphometric structures in the shoulder joint make it easier to explain the cause of the various shoulder problems. The objective of this study is putting emphasis on the importance of acromion types, os acromiale presence and acromial morphometric measurements in the aetiology and diagnosis of shoulder pain., Materials and Methods: A retrospective study, based on 100 patients of both genders who presented with the complaints of shoulder pain and underwent magnetic resonance imaging, was conducted. Within this scope, types of acromion, slope of acromion, length of acromion, length of coracoid process, the distance between acromion and coracoid process, lateral acromial angle (LAA), critical shoulder angle (CSA), acromial index (AI) and acromiohumeral distance were measured. The data were analysed considering the gender and acromion types and the presence of os acromiale is investigated., Results: The most common acromion was type II (curved) (frequency rate 62%) while the rate of type I (flat) and type III (hooked) acromions were 21% and 17%, respectively. The length of acromion and coracoid process were found to be significantly longer in males, while no significant difference between genders in terms of the distance between acromion and coracoid process were observed. Furthermore, while negative correlation between LAA and AI as well as LAA and CSA were observed; positive correlation between AI and CSA was found. In addition, there was negative correlation between slope of acromion and acromiohumeral distance. Besides, acromiohumeral distance was significantly higher in males. Regarding the presence of os acromiale, it was observed in 3 women out of 59 and 2 men out of 41, which indicated no significant difference between genders., Conclusions: It is evaluated that the morphometric measurement is of importance in contributing clinically in distinguishing the problems that may occur according to gender and acromion types.

Purpose: The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements., Methods: A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett's perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett's PV diameter and the presence of reflux in Cockett's PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs., Results: The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P < 0.001). A significant and positive relation was seen between increased PV diameter and SWE values (P < 0.001) and there was a significant relationship between the presence of perforating vein insufficiency and increase in PV diameter. A statistically significant increase was detected in SWE values for the PV for those with reflux in the great saphenous vein (P < 0.001). The best cut-off values that can be used to detect perforating vein insufficiency were found 34.600 for kPa and 3.375 for m/s., Conclusion: SWE may be used effectively in addition to conventional Doppler ultrasound examination in diagnosing and following perforating vein insufficiency., (© 2020. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Objective: To assess coronary artery calcification (CAC) in patients with acute pulmonary embolism and determine whether this correlates with right ventricular dilation (RVD) and mortality., Methods: Computed tomography pulmonary angiography scans of 330 patients were used to perform retrospective assessment of the pulmonary artery computed tomography obstruction index (PACTOI), the right/left ventricle diameter ratio, the diameter of the pulmonary trunk, and the ordinal CAC score., Results: Age (P < 0.001), urea level (P < 0.001), D-dimer level (P = 0.006), diameter of the pulmonary trunk (P < 0.001), and PACTOI (P < 0.001) were significantly higher in the RVD-positive patient group. We found a significant relation between increased CAC score and increased mortality (P = 0.038). Left-sided CAC was detected much more often in RVD-positive patients (P = 0.008)., Conclusions: Coronary artery calcification is common in patients with acute pulmonary embolism, especially when those patients are also RVD-positive. A significant relation was found between RVD and left-sided CAC., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To evaluate the diagnostic performance of the RSNA structured reporting language for chest CT findings in patients with COVID-19., Material and Methods: Patients with suspected COVID-19 who underwent chest CT and RT-PCR tests were enrolled consecutively in this retrospective study, regardless of symptoms. Imaging findings were categorized as "typical", "indeterminate", "atypical", or "negative" according to RSNA reporting language and compared to RT-PCR. "Single, round GGO" and "single, peripheral GGO," do not fit the reporting language, were also analyzed as "indeterminate" patterns., Results: Of the 1186 patients included in the analysis, the diagnosis of COVID-19 was confirmed in 388 patients. Of the 388 patients, CT findings were categorized as "typical" in 248, "indeterminate" in 77, and "negative" in 63. The sensitivity, specificity, and accuracy of "typical" findings were 63.9, 99.0, and 87.5% for COVID-19, respectively. In addition to the "typical" findings, the highest diagnostic accuracy of 92.2% was achieved when the "single, peripheral GGO" and "single, round GGO" were considered to be CT-positive., Conclusion: The RSNA reporting language has significant diagnostic performance for identifying COVID-19 pneumonia. CT findings that do not exactly fit the RSNA reporting language, such as "single, round GGO" and "single, peripheral GGO" improve diagnostic performance., (© 2021. Japan Radiological Society.)

Aim: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in the assessment of thyroid surgical bed for remnant thyroid tissue (RTT)., Material and Methods: We evaluated the thyroid surgical bed of 65 patients who had underwent total thyroidectomy (TT) due to papillary carcinoma (PC) using thyroid scintigraphy and cSMI. Color SMI was also performed for the examination of the thyroid parenchyma of 39 healthy asymptomatic participants. VI measurements were performed by manually drawing the contours of the RTT in those with remnant thyroid, the thyroid surgical bed in the patients' group without remnant thyroid, and normal thyroid parenchyma in the control group, using the free region of interest (ROI) with 2-dimensional color SMI VI (2DcSMIVI) mode. The volume of ROI was measured and echogenicity was evaluated. The quantitative 2DcSMIVI values of the surgical bed with RTT (Group A), the surgical bed without RTT (Group B) and normal thyroid of healthy asymptomatic participants (Group C) were compared., Results: The mean 2DcSMIVI values of Group A was significantly higher than Group B and C (p=0.001). The presence of RTT can be diagnosed with 89.1% sensitivity and 87.5% specificity when 1.75 2DcSMIVI is designated as the cut-off value., Conclusion: The 2DcSMIVI is an effective imaging technique that can be used for the diagnosis of RTT.

Objectives: The aim of this study was to investigate the efficacy of 2-dimensional (2D) shear wave elastography (SWE) in the diagnosis of acute cystitis (AC) in children., Methods: Between June 2019 and March 2020, 126 children with AC and 126 healthy participants were prospectively investigated by 2D SWE and B-mode ultrasound. Elastographic measurements were performed by drawing the contours of the posterior wall of the bladder between the ureter orifices using a free region of interest. The quantitative 2D SWE values of the patients and the healthy group were compared., Results: The mean 2D SWE values of the bladder wall were significantly higher in patients with AC compared to the healthy group (P = .001). On B-mode ultrasound imaging, the bladder wall thickness of patients with AC was higher than that in the healthy group (P = .001). On 2D SWE, when the cutoff value used was 9.25 kPa, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.1%, 88.1%, 89.3%, and 92.6%, respectively, whereas when the cutoff value used was 1.72 m/s, the sensitivity, specificity, positive predictive value, and negative predictive value were 90.5%, 88.9%, 89.1%, and 90.7%. There was a statistically significant positive correlation between the 2D SWE values and wall thickness measurements (P < .001)., Conclusions: Two-dimensional SWE is a noninvasive, fast, and effective imaging method to evaluate the bladder wall in children with AC., (© 2020 American Institute of Ultrasound in Medicine.)

Aim: We compared the two-dimensional shear-wave elastography (2D-SWE) values between the testes with same side operated inguinal hernia (IH) and the contralateral testes, as well as the testes of healthy volunteers without IH., Material and Methods: A total of 189 participants (117 unilateral [117 testes] and 8 bilateral operated IH patients [16 testes] and 64 healthy volunteers [128 testes]), providing a total of 378 testicles, were investigated prospectively. All patients underwent B-mode ultrasonography (US) and 2D-SWE examinations. Operation type, the period between diagnosis and operation, the period since the operation, testes volumes, and 2D-SWE values were compared., Results: The B-mode US finding of the testes were normal in all participants. The mean testes' volume of same side operated IH was significantly lower comparing to contralat-eral testes and the healthy group (p<0.001). The 2D-SWE values of the testes with same side operated IH were significantly higher comparing to the contralateral testes and the healthy group (p<0.001). There was a statistically significant correlation between 2D-SWE values and IH severity, as well as the duration of the hernia (p=0.001). There was no significant correlation between the IH severity and testes volume (p=0.285). No significant difference was found between the direct and indirect IH in terms of testicular volume and SWE values and between the duration of the hernia, the time after sugery, testicular volume and SWE values according to operation techniques(p>0.005)., Conclusions: The 2D-SWE can be used as an effective imag-ing method to evaluate testicular stiffness with objective numerical values, to estimate the severity of histologic damage in patients with operated IH.

Objectives: The first aim was to evaluate the stiffness of thyroid parenchyma with shear wave elastography (SWE) in patients with Graves disease (GD) and compare the elastographic values with those of asymptomatic volunteers. The second aim was to evaluate whether there was a correlation between SWE values and grayscale ultrasound (US) and laboratory parameters., Methods: In this prospective study, the thyroid gland parenchyma of 50 patients whose clinical and laboratory findings were indicative for GD and 54 asymptomatic participants with normal laboratory values was examined by SWE. Grayscale US images of the thyroid and submandibular gland were recorded. The volume of the thyroid gland was measured. Elastographic measurements were performed with a free region of interest. The quantitative SWE values (meters per second and kilopascals) of the patient and control groups were compared. A correlation analysis between the SWE values and grayscale US and laboratory parameters was performed., Results: The median (range) SWE values of the thyroid gland in patients with GD were significantly higher than those of the control group [17.34 (12.58-56.15) versus 12.05 (7.72-23.67) kPa and 2.28 (1.83-4.12) versus 1.92 (1.55-2.61) m/s; P < .001 for both comparisons]. When 14.5 kPa or 2.115 m/s was designated as the cutoff value, GD could be diagnosed with a high sensitivity and specificity. We showed a negative weak correlation between the SWE values and parenchymal echogenicity in the GD group., Conclusions: Shear wave elastography can be used as an effective imaging method with high sensitivity and specificity rates in the diagnosis of GD., (© 2020 American Institute of Ultrasound in Medicine.)

Aim of the Study: To determine the parenchymal vascularity of the thyroid gland with color superb microvascular imaging in patients with Graves' disease, and compare the vascularization index values with healthy subjects., Materials and Methods: The thyroid glands of 37 patients whose laboratory and clinical findings were consistent with Graves' disease, and 40 asymptomatic subjects with normal laboratory values, were examined using color superb microvascular imaging. Measurements of the vascularization index were performed with a free region of interest which was drawn along the outer margin of the gland on the color superb microvascular imaging mode. The vascularization index values obtained in the Graves' disease and control groups were compared. A correlation analysis was performed between the vascularization index values and laboratory and grayscale US parameters., Results: The median vascularization index value of the thyroid parenchyma in patients with Graves' disease was significantly higher than in the asymptomatic group [median (min-max); 12 (2.3-32.1) vs 5.04 (1.1-10.8), p <0.001]. When the cutoff value of the vascularization index is determined as 6.3, Graves' disease can be diagnosed with 83.8% sensitivity and 70% specificity., Conclusions: The vascularization index obtained with color superb microvascular imaging can be a quantitative indicator of parenchymal vascularity in the diagnosis of Graves' disease, and serve as a supportive tool., Competing Interests: Conflict of interest The authors do not report any financial or personal connections with other persons or organizations which might negatively affect the contents of this publication and/or claim authorship rights to this publication., (© Polish Ultrasound Society.)

Purpose: The purpose of this study was to determine quantitative testicular tissue stiffness values in normal and infertile men using shear wave elastography (SWE), and to evaluate the relationship between infertility and testicular stiffness value., Methods: In total, 100 testes of 50 infertile patients with abnormal semen parameters were classified as group A, and 100 testes of 50 control subjects were classified as group B. These two groups were compared in terms of age, testicular volume, and SWE values. The group B testes were randomly chosen from patients who had applied for ultrasonography for any reason, and who had no testis disease and no history of infertility., Results: The mean age of the patients was 27.83 years, and no significant difference in age was found between the groups (P = 0.133). No significant difference in testicular volume was found between the groups (P = 0.672). The SWE values were significantly higher in group A than in group B (P = 0.000 for both m/s and kPa values). SWE values had a negative correlation with mean testicular volume in group A (for m/s values: P = 0.043; for kPa values: P = 0.024)., Conclusion: SWE can be a useful technique for assessing testicular stiffness in infertile patients to predict parenchymal damage in testicular tissue that leads to an abnormality in sperm quantity. In addition, decreased testicular volume, together with increased SWE values, can reflect the degree of parenchymal damage.

Purpose: We aimed to investigate the use and effectiveness of Shear-Wave Elastography (SWE) in Hashimoto's Thyroiditis (HT) diagnosis and compare the SWE values in HT patients with asymptomatic volunteers., Methods: The thyroid gland parenchyma of 74 patients whose clinical and laboratory findings and ultrasonography (US) features were indicative of HT and 75 healthy, asymptomatic participants with normal laboratory values were examined using SWE. Their thyroid parenchymal echoes and thyroid gland volume were measured using B-mode US examination. Elastographic measurements were made by plotting the boundaries of thyroid gland by hand, using Free Region of Interest (ROI). The quantitative SWE values [meters/second (m/s) and kilopascal (kPa)] were compared betweent the patients and the controls. The correlation analyses between the SWE measurements and the autoantibodies [Anti-thyroid peroxidase antibody (TPOAbs) and anti-thyroglobulin antibodies (TgAbs)], thyroid-stimulating hormone (TSH), freetriiodothyronine (fT3), free-thyroxine (fT4), and thyroglobulin levels were performed., Results: The mean thyroid SWE measurement values of HT group were significantly higher than the asymptomatic group (p < 0.001). This study proposes 29.45 kPa or 2.77 m/s as a sensitive-spesific cut-off value for HT. We revealed significant positive association between SWE values and TgAb levels, gland volume, TgAb, TPOAb levels, and a significant negative association between SWE and echogenicity (p < 0.001)., Conclusion: In the assessment of HT, SWE is a highly sensitive imaging method to estimate the degree of fibrosis and to provide objective numerical values.

Aim of the study: This study aimed to examine the role of superb microvascular imaging and shear wave elastography for the pre-surgical evaluation of common parotid tumors. Material and methods: This single-center prospective study included 37 patients with parotid gland lesions. After institutional review board approval, grayscale, shear wave elastography and superb microvascular imaging ultrasound examinations were performed prior to biopsy or operation. The diagnosis of the lesions was based on cytological/pathological evaluation after the ultrasound examinations. Pleomorphic adenomas and Warthin tumors were compared using the Mann-Whitney U test. A receiver operating characteristic curve analysis was performed to obtain a cut-off value. A multivariate regression analysis was carried out. Results: The mean age of the patients (11 female, 26 male) was 48.2 ± 18. The shear wave elastography parameters of the lesions were not significantly different between pleomorphic adenomas and Warthin tumors, while the vascular index obtained by using superb microvascular imaging was significantly different ( p = 0.012). The mean vascular index was 2.9 ± 3.1 in pleomorphic adenomas, and 9.5 ± 9.5 in Warthin tumors. A cut-off value of 4.05 for the vascular index discriminated pleomorphic adenoma and Warthin tumors with 68% sensitivity and 72% specificity (the area under the curve was 0.768). Conclusion: Superb microvascular imaging is a novel ultrasound imaging technique which is useful for the discrimination of pleomorphic adenomas and Warthin tumors., (© Polish Ultrasound Society.)

Objectives To define thyroid gland vascularity index (VI) values in healthy children with the superb microvascular imaging (SMI) method and to assess whether or not there is a correlation with potential factors that may affect these values. Methods This prospective study included a total of 138 children, their ages varying from 3-17 years. Cases were divided into three subgroups according to age: 3-6, 7-12 and 13-17 years. Gender, age, height, weight, body mass index (BMI), thyroid-stimulating hormone (TSH) and free thyroxine (fT4) values were recorded. Volume and SMI measurements were performed with a 14 L5 mHz linear transducer. VI measurements were performed in the transverse and longitudinal planes and correlation with basic descriptive data was researched. Results Mean age was 11.14 ± 3.34 years and BMI was 19.95 ± 4.92. VI values were 4.59 ± 2.34 in the right lobe and 4.23 ± 2.73 for the left lobe, with no significant difference identified. There were no significant differences in mean VI for all parenchyma regarding gender and age groups. While there was no correlation identified with mean VI for all parenchyma with TSH and fT4, there was, however, a negative correlation with BMI. Conclusions Reference VI values for normal thyroid glands in healthy children and adolescents were defined with the SMI method. There was no correlation between the VI values and age, gender, volume, TSH and fT4 values, while there was a negative significant correlation with BMI.

Objective: Carbon monoxide (CO) poisoning is one of the most common poisonings worldwide. The affinity of hemoglobin for CO is significantly higher than that for oxygen, and the formation of carboxy-hemoglobin leads to a decrease in the capacity of blood to transport oxygen to tissues, tissue hypoxia, and early perfusion changes in the affected tissue. This study aimed to investigate the utility of arterial spin labeling perfusion imaging (ASL-PI) in revealing cerebral vascular hemodynamic changes in patients presenting to the emergency room with CO poisoning and to compare findings with those from diffusion-weighted imaging (DWI)., Method: This study was conducted between November 2016 and May 2019 and was approved by the local ethics committee. DWI and ASL-PI examinations were performed in 83 patients who presented to the emergency room with CO poisoning. Four regions-the cerebral cortex, basal ganglia, cerebral white matter, and cerebellum-were evaluated for alterations in perfusion and diffusion, and findings from DWI and ASL-PI were compared., Results: The study group included 39 (50.6%) females and 38 (49.4%) males, with a mean (±SD) age of 40.08 ± 20.41 years (range, 7-86 years). DWI revealed restricted diffusion in 10 regions in 6 (7.8%) patients, including the basal ganglia (n = 2), cerebral white matter (n = 2), cerebral cortex (n = 3), and the cerebellum (n = 3). ASL-PI revealed hypo-perfusion in 64 regions in 36 (46.8%) patients, including the basal ganglia (n = 21), cerebral white matter (n = 12), cerebral cortex (n = 23), and cerebellum (n = 7)., Conclusion: ASL-PI provided additional information when used to identify perfusion changes in the brains of individuals who experienced CO poisoning and was superior to DWI as it revealed early changes in the brain. Considering its limitations, ASL-PI can be routinely used with DWI in cases of CO poisoning., Competing Interests: Declaration of competing interest The authors declare that there are no financial or other relations that could lead to a conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to investigate the diagnostic performance of two-dimensional (2D) shear wave elastography (SWE) in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS)., Methods: Fifty-three patients with pSS and 30 healthy volunteers were included. The echogenicity of all submandibular and parotid glands was evaluated with B-mode ultrasound, and their elasticity was assessed with 2D SWE. The mean and standard deviation of the shear wave speed and elasticity modes on 2D SWE were calculated., Results: The mean shear wave speed and elasticity mode values for the submandibular and parotid glands were significantly higher in the patients with pSS (P < .05). The mean elasticity of the shear wave speed mode was best able to differentiate the parotid glands of patients with pSS from those of healthy volunteers at a cutoff value of 2.48 m/s, whereas the mean elasticity of the elasticity mode was best able to differentiate the submandibular glands of patients with pSS from those of healthy volunteers at a cutoff value of 21 kPa., Conclusions: Two-dimensional SWE is an effective technique for assessment of the parenchyma of the salivary glands in patients with pSS and predicts interstitial fibrosis and the severity of histologic damage., (© 2019 by the American Institute of Ultrasound in Medicine.)

We aimed to determine histological damage in patients with varicocele by comparing the elasticity of their affected testes with that of their normal contralateral testes as well as normal testes of control subjects without varicocele using shear wave elastography (SWE). In total, 48 patients with varicocele (96 testes) and 52 control subjects (104 testes) were included in this study. Shear wave elastography values were measured in the longitudinal plane using an oval region of interest that covered as much of the testicular contours as possible. Fifty testes with varicocele were classified as group A, 46 normal contralateral testes of the same patients as group B, and 104 normal testes of control subjects as group C. The normal group C testes were randomly chosen from patients who had applied for ultrasonography for any reason and agreed to participate in the study. The testicular volume and SWE values were compared between these 3 groups. The average age of the patients was 28.45 years, and no significant difference in age was found between the 3 groups (P = 0.665). A significant difference in the testicular volume was found between groups A and C (P = 0.014). The SWE values were significantly higher in group A than in groups B and C (P < 0.001). No significant correlation was observed between the testicular volume and SWE values in any of the groups. Our results showed that SWE can be used as an effective technique to assess testicular stiffness in patients with varicocele to predict interstitial fibrosis and the severity of histological damage.

The study aimed to investigate the effectiveness of the vascularization index (VI) obtained using superb microvascular imaging (SMI) technique in the diagnosis of Hashimoto thyroiditis (HT). The thyroid glands of 80 patients with HT and 107 healthy, asymptomatic participants were examined using SMI. The thyroid parenchyma echogenicity was evaluated, and the thyroid gland volume was measured. Vascularization index measurements were performed by manually drawing the contours of the thyroid parenchyma using the free region of interest with color 2-dimensional SMI VI mode. The quantitative VI values of the patients and the asymptomatic group were compared. Correlations between VI values and thyroid autoantibodies and thyroid hormone levels were analyzed. The mean VI value of the thyroid gland was 4.74% ± 1.96% in the asymptomatic group and 12.45% ± 5.87% in HT patients with a statistically significant difference (P < 0.001). Hashimoto thyroiditis can be diagnosed with 86.3% sensitivity and 82.2% specificity when 6.00% VI value was designated as the cutoff value. There was a positive significant correlation between the VI value and the thyroid-stimulating hormone, antithyroglobulin antibodies, anti-thyroid peroxidase antibody levels (P < 0.05); however, no significant correlation was found between the VI values and thyroglobulin and free thyroxine levels (P > 0.05). There was a significant negative correlation between the VI values and the parenchyma echogenicity and positive significant correlation between the thyroid gland volume and the antithyroglobulin antibody and anti-thyroid peroxidase antibody levels (P < 0.05). The VI obtained using the SMI technique can be effectively used as an imaging method for the diagnosis of HT because of its high sensitivity and specificity in representing objective, quantitative numerical values.

We aimed to determine the difference in tissue stiffness, which might reflect histologic damage, by comparing the potential of the shear wave elastography (SWE) values of operated undescended testes (OUT) with those of undescended testes (UT) and normal testes. A total of 120 patients (235 testes) were enrolled in the current study. Quantitative SWE values were measured by manually drawing contours of the entire testis structure with a free region of interest. A group of 66 OUT were classified as group A. Operation age and the period passed over the operation time and SWE values were compared among the testes assigned to group A. The 50 testes having inguinal canal placement were classified as group B, and the 119 testes whose sonography findings were normal were classified as group C. These 3 groups were compared in terms of the SWE values and volume. The SWE values of group A were significantly higher than those of groups B and C (P < 0.001). The SWE values of group B were significantly higher than those of group C (P < 0.001). The SWE values of OUT were significantly higher than those of the contralateral normal testes and UT (P < 0.001). There were no significant differences among operation age and period passed over the operation time and SWE values in the OUT (P > 0.05). There was no significant correlation between SWE values and testes' volume (P > 0.05). The SWE technique can be used effectively as a new parameter to assess stiffness of the OUT and UT to predict interstitial fibrosis and the severity of histologic damage.

Introduction: Shear wave elastography (SWE) is a new technology and non-invasive ultrasound device that can measure tissue rigidity and elasticity., Objective: This controlled prospective study aimed to demonstrate using SWE whether there was a difference between the elasticity of testes with non-communicating (NC) hydrocele in infants and toddlers and elasticity of controls' testes without hydrocele, and to reveal quantitative values of elasticity reflecting histological findings., Material and Methods: Testes of 37 cases at an average age of 6.32 months and diagnosed with NC hydrocele between December 2016 and April 2017 were evaluated for hydrocele and testicular volumes, and testes elasticity through ultrasonography and SWE., Results: Of all cases, 15 had bilateral hydroceles, while 22 were diagnosed with unilateral hydrocele. Testes with NC hydrocele (n = 52) in infants and toddlers were compared with testes without hydrocele (n = 36) in controls. Median hydrocele volume of 52 testes with NC hydrocele was 5.0 cm 3 (0.2-37). Median volume of testes with hydrocele was 0.6 cm 3 (0.2-1.5) in the study group, and 0.5 cm 3 (0.3-1) in controls (P = 0.577). Although median elastography values were measured as 1.67 m/s (1.29-2.59) and 10.0 kPa (2.1-23) in patients, those of controls were found to be 1.61 m/s (1.27-2.34) and 8.25 kPa (5.1-18.9) (P = 0.03, P = 0.005, respectively). While there was no between-group difference in testes volumes, a statistically significant difference was observed in SWE-derived quantitative data (Summary Table)., Discussion: As a novel elastographic method, SWE is used to track shear waves passing through tissues by quantifying the elasticity of structures and nodules, such as liver fibrosis, and to improve the characterization of breast and thyroid nodules. Shear wave elastography was assessed to be a beneficial ultrasonography tool to predict the histologic features of undescended testicles, which might replace testicular biopsy in the modern management of undescended testes. This study also quantitatively measured whether there was a change in testicular tissues with NC hydrocele through SWE, and found that SWE values of testes with NC hydrocele were significantly higher compared with those of controls, despite the absence of a significant difference in testes volumes., Conclusions: The present study confirmed that quantitative changes in testes elasticity can reliably be evaluated through SWE. Non-communicating hydrocele may be damaging to testicular tissues. More definitive results will be achieved with further comprehensive studies including larger patient populations. It is believed that the operation age of children with NC hydrocele can be re-evaluated in the future., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

We investigated the effectiveness of shear wave elastography (SWE) in patients with lower extremity superficial venous insufficiency (VI). A total of 138 symptomatic patients, 51 asymptomatic volunteers, and a total of 359 lower extremities (257 symptomatic, 102 asymptomatic) were examined. All participants underwent Doppler ultrasound (US) evaluation to determine VI and SWE measurements performed by manually drawing vein wall and perivenous tissue with free region of interest at the great saphenous vein (GSV) and small saphenous vein (SSV). The GSV, SSV diameter, VI, and volume flow of reflux were compared with the SWE values. The SWE values of the symptomatic group for GSV and SSV were significantly higher than those of the asymptomatic control group regardless of whether VI was detected by Doppler US (P < 0.001). There was a statistically significant increase in SWE values for the symptomatic group who were diagnosed as having reflux in GSV and SSV (P < 0.001). A significant positive correlation between increased GSV, SSV diameter, and SWE values was seen (P < 0.001). Venous insufficiency can be diagnosed with a 84.7% sensitivity and 84.2% specificity when 2655 m/s was designated as cutoff value, and with a 85.4% sensitivity and 84.2% specificity when 22,350 kPa was designated as the cutoff value in GSV. Venous insufficiency can be diagnosed with a 84.3% sensitivity and 82.4% specificity when 2845 m/s was designated as cutoff value, and with a 85.7% sensitivity and 84.4% specificity when 27,100 kPa was designated as the cutoff value in SSV. Shear wave elastography may be used effectively in addition to conventional Doppler US examination in diagnosing and following VI.

Aims: The aim of this study was to compare the diagnostic performance of superb microvascular imaging (SMI) and power Doppler imaging (PDI) for the differentiation of intraductal breast lesions., Materials and Methods: A total of 54 intraductal breast lesions (39 benign, 10 atypical, and 5 malignant) in 53 patients were examined using B-mode ultrasonography, PDI, and SMI. Vascularity grading, distribution of microvessels, and penetrating vessels were evaluated using each Doppler technique. The diagnostic performances of both methods were compared., Results: SMI was more efficient in detecting flow signals than PDI (p=0.004). The highest diagnostic accuracy rates were achieved with SMI using vascular grading. When hypervascularity was used as a cut-off value to differentiate malignant and atypical lesions from benign lesions, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.6%, 80.7%, 66.6%, 80.7%, and 75.6%for PDI, and 86.6%, 76.9%, 68.4%, 90.9%, and 80.4% for SMI, respectively., Conclusions: SMI is more sensitive than PDI for detecting subtle blood flow in intraductal breast lesions with statistical significance. This novel and promising vascular imaging technique may be helpful in B-mode ultrasonography to distinguish intraductal breast lesions.

Aim: We aimed to investigate the effectiveness of shear wave elastography (SWE) in the diagnosis of acute pancreatitis (AP)., Material and Methods: The pancreatic parenchyma of 50 patients whose clinical and laboratory findings were indicative of AP and of 70 healthy, asymptomatic volunteer participants with normal laboratory values was examined using SWE.Computed tomography was performed in all patients with AP on admission. Elastographic measurements were performed by manually drawing the contours of the pancreatic parenchyma using the free region of interest. The quantitative SWE values (meters/second [m/s], kilopascal [kPa]) of the patients and asymptomatic volunteers group were compared., Results: The mean SWE value of the pancreatic parenchyma was 2.60 ± 1.63 m/s in the asymptomatic volunteers and 3.48 ± 0.52 m/s in patients with AP, with a statistically significant difference (p<0.001, t=-3.685). The mean SWE value of the pancreatic parenchyma was 23.77±6.72 kPa in the asymptomatic volunteers and 45.71 ± 10.72 kPa in patients with AP, indicating a significant difference (p<0.001, t=-3.685). AP can be diagnosed with a sensitivity and specificity of 98.0% when 29.45 kPa was designated as cut-off value and with a 96.0% sensitivity and 98.3% specificity when 2.77 m/s was designated as the cut-off value. The superiority of SWE was found over B-mode US and CECT in the diagnosis of AP on admission. Conclusion: SWE can be used as an effective imaging method with high sensitivity and specificity for the diagnosis of AP. It may be used as an important imaging method to assist in the diagnosis of AP especially when B-mode US and CECT findings are normal.

Purpose: Superb micro-vascular imaging (SMI) is a new blood flow (BF) technique recently developed to outface the limitations of conventional Doppler imaging techniques (CDIT). SMI can observe micro-vascular BF and low-velocity BF. SMI is available in two modes as color SMI (cSMI) and monochrome SMI (mSMI). To evaluate testicular BF, we have compared color Doppler (CD), power Doppler (PD), cSMI, and mSMI techniques., Patients and Methods: A total of 156 patients (310 testes) were included in the study. We evaluated BF in the testes via CD, PD, cSMI, and mSMI techniques in a heterogenous patient group. Doppler examination was performed by observing the whole testis parenchyma within the examination area at the testicular hilus level at all examinations. Spot and linear flow color encoding determined in testis parenchyma were separately counted for every examination., Results: SMI was found to be superior in all age groups and testis volumes for showing the BF. When we sequenced the examinations to show the BF in testis according to their priorities, it was found that mSMI > cSMI > PD > CD. As the testis volume decreases, a significant increase is observed in mSMI when compared to other examinations in showing vascularity in pediatric age groups, in cases diagnosed with undescended testis, and in cases that underwent surgery for undescended testis., Conclusions: SMI renders more detailed vascular information on BF in the testes than CDIT. In particular, as the testis volume decreases, the priority of SMI showing BF increases. SMI should be a part of vascular examination in pediatric patients with small testis volume.

Objective: The aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE)., Materials and Methods: Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI)., Results: PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001)., Conclusion: PVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination., Competing Interests: Conflict of Interest: Authors have no conflict of interest to declare.

Hydatid disease is caused by the larvae of Echinococcus granulosus . Domestic dogs and cats are the primary carriers of echinococcal organisms. In some particular regions of the world, this parasitic infection is still endemic. Despite the fact that hydatid disease is most frequently located in the liver (50%-70% of cases) and the lungs (20%-30% of cases), it can occur in any organ or tissue. However, intracardiac localization of hydatid cyst is very rare and it is found in less than 2% of the cases. Cardiac involvement can be caused by systemic or pulmonary circulation or direct spread from adjacent structures. After the cardiac hydatid cyst remained asymptomatic for many years, the cyst opens into the pericardium, causes cardiac tamponade, and mimics acute coronary syndrome, or it may get into the circulation and cause anaphylactic shock, which happens rarely. Because clinical signs and symptoms of cardiac hydatid cyst are not specific and varied, it may be difficult to diagnose this disease . It is critical to diagnose cardiac involvement early and perform prompt surgical intervention . Imaging findings of a patient who had a left ventricular wall cardiac hydatid disease are presented here.

Molybdenum cofactor deficiency is an extremely rare and fatal metabolic disorder that should be considered in the differential diagnosis of hypoxic-ischemic encephalopathy. Magnetic resonance imaging findings are useful in diagnosis. The short-echo-time magnetic resonance spectrum was characterized by a total loss of signal and lipid and lactate peaks. In this case, conventional magnetic resonance imaging and magnetic resonance spectroscopy findings of this extremely rare disease whose pathophysiology was not known were presented.

Objectives: The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis., Methods: A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared., Results: When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001)., Conclusions: The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging., (© 2017 by the American Institute of Ultrasound in Medicine.)

Background/aim: To evaluate the diagnostic performance of strain elastography (SE) combined with B-mode ultrasound in distinguishing between idiopathic granulomatous mastitis (IGM) and malignant breast lesions. Materials and methods: Seventy-seven malignant breast lesions and 36 IGM were assessed using B-mode ultrasound and SE. Ultrasonographic findings for all the breast lesions were classified based on the 2013 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS-US), and the SE findings were evaluated based on the strain ratio and a five-point scale. The diagnostic performances of B-mode ultrasonography, SE, and the combination of both methods were compared. Results: Significant differences in strain ratio and elastography scores were found between IGM and malignant breast lesions. When the lesions were assessed with B-mode ultrasound alone, in order to distinguish between IGM and malignant breast lesions, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94.8%, 66.7%, 85.9%, 85.7%, and 85.8%, respectively. However, when assessed with a combination of B-mode ultrasonography and SE, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 96.1%, 100%, 100%, 92.3%, and 97.3%, respectively. Conclusion: The combination of SE and B-mode ultrasound has better diagnostic performance in the differentiation of IGM and malignant breast lesions than B-mode ultrasonography alone.

Background: Peripheral arterial disease is an atherosclerotic disease characterized by an increase in morbidity and mortality. For these reasons early diagnosis of peripheral arterial disease is important. Ankle-brachial systolic pressure index measurement is frequently used in screening studies. Evaluating waveforms of distal lower extremities with Doppler ultrasound can be used as a screening program and provides more accurate information on peripheral arterial disease., Aim: We investigate the prevalence of peripheral arterial disease, compare the efficacy of Doppler ultrasound evaluation of distal lower extremity waveforms and ankle-brachial systolic pressure index measurement in screening programs, and discuss the importance of early diagnosis of asymptomatic cases., Material and Methods: A total of 457 patients over the age of 65 (between 65 and 94, mean age: 71.4) including 270 males and 187 females were examined with Doppler ultrasound, had ankle-brachial systolic pressure index measurement taken and were screened for peripheral arterial disease. The correlation between Doppler ultrasound findings and ankle-brachial systolic pressure index was examined., Results: According to the Doppler ultrasound findings, in the aortoiliac ( r = 0.648) and femoropopliteal ( r = 0.564) area, there is a medium level of correlation between severe stenosis and occlusions and a low ankle-brachial systolic pressure index value, and a low level of correlation between such abnormalities in the tibioperoneal region ( r = 0.116) and a low ankle-brachial systolic pressure index value. Therefore, while the sensitivity of ankle-brachial systolic pressure index increases in proximal stenosis, it decreases in distal stenosis., Conclusion: Despite the fact that ankle-brachial systolic pressure index is a diagnostic test commonly used in screening studies, evaluation of distal arteries by means of Doppler ultrasound provides more accurate information in terms of the identification of peripheral arterial disease.

Objectives: The aim of our study was to evaluate the shear wave velocity (SWV) of parathyroid lesions by point shear wave elastography (SWE) and to compare their stiffness with that of thyroid nodules and normal thyroid parenchyma quantitatively., Methods: Thirty-six patients considered to have parathyroid disorders by clinical and laboratory tests and scintigraphy were enrolled in the study between January 2012 and February 2015. Conventional sonography, Doppler sonography, and the Virtual Touch tissue quantification (VTQ) method of point SWE (Siemens Medical Solutions, Mountain View, CA) were conducted with a linear transducer (4-9 MHz) while the patients were in the supine position. Then we compared our VTQ measurements with pathologic results., Results: The 36 patients included 31 female and 5 male patients with a mean age ± SD of 49 ± 15.7 years (range, 15-79 years). The mean SWV of parathyroid hyperplasia lesions (n = 4) was 1.46 ± 0.23 m/s, whereas the mean SWV of parathyroid adenomas (n = 32) was 2.28 ± 0.50 m/s. The mean SWV of normal thyroid parenchyma (n = 36) was 1.62 ± 0.20 m/s, and the mean SWV of benign thyroid nodules (n = 21) was 2.25 ± 0.51 m/s. A significant difference was found between SWV values of normal thyroid parenchyma and parathyroid adenoma (P < .001). A cutoff value of 1.73 m/s for adenomas led to 90.0% sensitivity and 80.6% specificity., Conclusions: The VTQ method of point SWE may contribute to the discrimination of parathyroid adenomas from the thyroid gland. However, more comprehensive studies are needed.

Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is characterized by deformities like median deep clefts of distal extremities. Routine examination of feet during second-trimester ultrasound (US) may increase the detection rates of foot malformations. Many malformations can be diagnosed with 2-dimensional (2D) US, but 3-dimensional (3D) US also helps better understanding of the foot malformations. In the present study, we report the case of two brothers (a fetus and a 5-year-old) with cleft foot deformity. 2D and 3D second trimester US findings of one case and the foot radiography findings of the other are presented here., (Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)