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The article reports on the pros and cons of elastosonography in the evaluation of cervical lymph nodes.

Aim: To evaluate the role of gray scale ultrasonography (US) and real time elastosonography (RTE) in carpal tunnel syndrome (CTS).Materials and Methods: Both wrists of 18 healthy volunteers (n=36) formed the control group (Group 1) and 19 symptomatic outpatients of the neurology clinic constituted the patient group. According to nerve conduction study results, cases with mild CTS (n=15) formed Group 2; cases with moderate to severe CTS (n=20) formed Group 3. Cross sectional area (CSA) and strain ratio (SR) were measured at carpal tunnel inlet (CTI) and 4 cm proximal to the distal end of the radius (P). CSA and SR change score (CSACTI-CSAP; SRCTI-SRP), CSA and SR ratio score (CSACTI / CSAP; SRCTI / SRP) were calculated.Results: The median nerve was significantly stiffer in Group 2 compared to Group 1; also in Group 3 compared to Group 1 (p=0.000). For CSACTI, the difference was significant between Group 1 and Group 3 (p=0.000), also between Group 2 and Group 3 (p=0.001). For CSA change scores the difference was only significant between Group 1 and Group 3 (p=0.015). In the diagnosis of CTS the best cut-off value for CSACTI was 10.8 (p=0.001), 2.3 for SRCTI (p=0.000), 4.9 for the CSA change score (p=0.005), 0.05 for the SR change score (p=0.000), 1.3 for the the CSA ratio score (p=0.015) and 1.1 for the SR ratio score (p=0.000).Conclusion: SR measurements do not exclude patients even with mild CTS but cannot categorize disease severity. CSA measurements on the other hand can categorize disease severity. Therefore, the combined use of US and RTE is suggested. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study was to analyze the value of prostate gland volume measurement by transrectal ultrasonography (TRUS) in prediction of severity of lower urinary tract symptoms (LUTS). Material and methods: One hundred and one patients undergoing TRUS guided core needle prostate biopsy for the investigation of prostate cancer were prospectively evaluated. All patients had filled in the international prostate symptom score (IPSS) scala, has been tested for PSA and prostate volume measurement was done by TRUS prior to biopsy. According to their biopsy results, patients were divided into two groups: negative and positive for malignancy. Results: There was a significant but low correlation of 0.37 between IPSS and prostate volume measurement by TRUS (p=0.001). Serum free prostate specific antigen (fPSA), total PSA (tPSA), ratio of fPSA to tPSA and PSA density did not show a statistically significant correlation with IPSS (p>0.05). No statistically significant difference in IPSS between the benign and malignant groups (p=0.681) was found. In the benign group, mean IPSS was 14.59 ± 8.73, range: 0-35 while in the malignant group, mean IPSS was 15.33 ± 9.22, range: 3-28. Conclusions: Prostate volume measurement by TRUS is a poor predictor for the determination of the severity of LUTS therefore IPSS should be primarily considered for the determination of the severity of LUTS. Also, according to this study conducted with patients who were at their first set of prostate biopsy, IPSS cannot be used as a predictor of malignancy. PSA values were not related to IPSS. [ABSTRACT FROM AUTHOR]

Background: Renal transplantation is the treatment of choice in end-stage renal disease. Chronic allograft dysfunction is the leading cause of chronic allograft failure. Surveillance biopsy is the only reliable tool to detect early fibrosis in the allograft. There is a need for non-invasive methods for the detection of early development of renal allograft fibrosis. Aims: To analyse the reliability of sonographic elasticity index and resistive index measurements in the evaluation of renal transplant fibrosis using linear and convex transducers according to segmental anatomy. Materials and methods: Elasticity index and resistive index were measured in 28 renal transplants and correlated with clinical prognostic parameters. Donor age above 50 years old, post transplantation time over 60 months and serum creatinine level above 1.5 mg/dl were defined as poor prognostic parameters. Results: Renal transplant recipients with serum creatinine level above 1.5 mg/dl demonstrated higher mean elasticity index (p=0.006) with a convex probe and higher elasticity index in the middle segments both with a convex and a matrix linear probe (p=0.026, p=0.001). Renal transplant recipients with post-transplantation time of 60 months and more demonstrated higher resistive index values in the middle segments (p=0.016). Conclusions: Convex probe was able to detect the changes in mean stiffness better than the matrix linear probe. The measurements from subsegments might suggest that diffuse changes in stiffness can truly be detected in the middle segments or that fibrotic processes start from the middle segments of the renal transplants. Further studies correlated with histopathology are required to validate the findings. [ABSTRACT FROM AUTHOR]

Background: Malignancy is correlated with stiffness which is assessed by real time elastosonography (RTE). RTE is not used in routine practice. We aimed to establish the learning curve of RTE on radiology residents.Methods: Forty >/=1 cm solitary thyroid nodules referred to fine needle aspiration cytology were examined with RTE by a radiology specialist and two radiology residents separately. Patients with malignant and undetermined FNAC findings underwent surgery. Strain ratio and elasticity score results of the radiology residents were compared to the results of the radiology specialist taking the histopathology results as the reference. To establish the learning curve and compare the diagnostic accuracy of residents, Receiver Operating Characteric curves were generated and Area Under the Curve were calculated.Results: Thirty-four nodules were benign and the others were malignant. The radiology specialist had a very high correct class prediction for the differentiation of benign versus malignant thyroid nodules. Statistical analysis of the strain ratio measurements showed that one of the residents had similar results with the radiology specialist after the seventh patient and the other one after the fourth patient. On the other hand the elasticity score measurements of all examiners had low correct class prediction. CONCLUSÝONS: Strain ratio measurement by RTE is an easily learned sonographic method that can assist in the evaluation of benign versus malignant nature of the lesions. However, interpretation of the elasticity scores requires more expertise. The results of this preliminary study need to be verified with a larger sample population. [ABSTRACT FROM AUTHOR]

Schwannomas are well capsulated, benign, and slowly growing tumors which originate from Schwann cells of peripheral nerve sheath. The incidence of schwannomas in the axillary region is not common. This rarity causes misdiagnosis at the radiological evaluation. In this case we present the imaging and histopathological findings of a cystic schwannoma located in the axillary fossa of a 47-year-old female patient mimicking complex cyst, lymphadenopathy or hydatid cyst in radiological evaluation. Although lymphadenopathy, lymphatic malformation, lipoma, cyst, hidradenitis suppurativa or dermato?broma are the most frequent lesions to be considered, peripheral nerve sheath should also be kept in mind in the differential diagnosis of axillary masses. [ABSTRACT FROM AUTHOR]