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Objective: To evaluate the role of magnetic resonance (MR) diffusion tensor imaging (DTI) in the assessment of liver fibrosis andinflammation in chronic viral hepatitis by measuring apparent diffusion coefficient (ADC) and fractional anisotropy (Fa) values.Material and Methods: Twenty-seven patients (5 women and 22 men;mean age39.8±11.3) with hepatic fibrosis were included inour study. The relationship between ADC, Fa values and histological activity index (HAI) score were evaluated using Spearman’scorrelation coefficient. Patients were subgrouped as group A (fibrosis score 1) and group B (fibrosis score 3). The mean ADC and Favalues of groups A and B were compared using Student’s t-test. To evaluate the use of ADC and Fa values in distinguishing group Afrom group B, ROC analysis was applied; sensitivities and specificities were calculated.Results: Fa values correlated with HAI scores significantly (r=0.397, p

Objective: We aimed to present a case with a previous thyroid surgery, who developed an internal jugular vein thrombus due to papillary thyroid cancer (PTC) in the remnant tissue. Case: A 54-year-old female patient, with a previous subtotal thyroidectomy, presented with a mass on the left side of her neck. Thyroid ultrasound disclosed a heterogeneous nodule of 67x48x32 mm in the left thyroid lobe. An isoechoic tumor thrombus was observed extending intraluminally from the middle thyroid vein to the internal jugular vein. No lymph node or solid organ invasion were detected in the neck. Fine needle aspiration biopsy revealed cytological findings consistent with PTC. Total thyroidectomy, left sided central neck dissection and partial left jugular vein resection was performed. The pathologic examination revealed mid-differentiated unifocal encapsulated follicular variant of PTC. The whole-body scan performed after the postoperative treatment of 150 mCi of radioactive iodine, revealed multiple lung metastases. Conclusion: The presence of a tumor thrombus in the thyroid vein or internal jugular vein is strongly suspicious for malignancy even in the absence of malignant findings on cytology. It is an important finding that is highly suspicious for distant metastasis in the cytologically diagnosed patients.

Although many alternative methods are present, maintaining ideal volume status in peritoneal dialysis (PD) patients still rely on clinical evaluation due to lack of an evidence-based method. Lung ultrasound (LUS) is a new method for evaluation of hidden congestion in this group. LUS findings and its relationship with other volumetric methods are investigated in this observational cross-sectional study. In this observational cross sectional study, LUS was performed to all PD patients and compared with symptoms of hypervolemia, physical examination, vascular endothelial growth factor-C (VEGF-C), and N-terminal pro-brain natriuretic peptide levels, chest radiography, echocardiography, bioelectrical impedance analysis. Data of 21 PD patients were evaluated. There was correlation between number of B lines and VEGF-C levels (r = 0.447, P = .042), daily urine output (r = 0.582, P = .007) and left ventricle mass index (r = –0.456, P = .038). Correlations with all other parameters were not significant. Daily urine output and VEGF-C levels were significantly different when B lines were grouped into 2 according to the median level (P

Purpose: It is not clear if Hashimoto’s thyroiditis leads to Empty sella syndrome. In the present study, we aimed to investigate if Hashimoto’s thyroiditis was associated with Empty sella syndrome, and Hashimoto’s thyroiditis was a secondary cause od some cases of primary Empty sella syndrome. Material and Method: Eighty-one patients who were diagnosed with primary Empty sella syndrome were included in the study. All patients underwent thyroid ultrasonography and biochemical tests for thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti thyroid peroxidase, anti thyroglobulin, follicle stimulating hormone, luteinizing hormone, 17 β estradiol, growth hormone, insulin-like growth factor 1, adrenocorticotropic hormone and total testosterone for Hashimoto’s thyroiditis and pituitary hormone deficiency. Results: Out of 81 patients, thyroid disease was diagnosed in 34 (42%) patients; 18 of them had Hashimoto’s thyroiditis (22.2%) and 16 (19.8%) had central hypothyroidism. Among Hashimoto’s thyroiditis patients, 11 (13.6%) had hypothyroidism and 7 (8.6%) were euthyroid. Discussion: In conclusion, it is possible that some cases of primary Empty sella syndrome are caused by Hashimoto’s thyroiditis. It is recommended that the presence of Hashimoto’s thyroiditis should be investigated in patients with primary Empty sella syndrome. Further studies investigating anti-pituitary antibody in patients with primary Empty sella syndrome, are needed to further declare this relationship.

Evolution of intima media thickness and breast arterial calcifications as cardiovascular risk factor, effect of pregnancy and breast feeding Objective: The aim of retrospective study was to evaluate intima media thickness (IMT) of common carotid artery and breast arterial calcifications (BAC) as indicator of cardiovascular risk factors. We also aimed to evaluate contribution of pregnancy count and total time spent on breast feeding to BAC and IMT. Material and Method: This study included 40 patients with BCI and 40 patients without BCI, referred to Taksim Research and Education Hospital Radiology Clinic. All individuals cardiovascular risk factors were noted and common carotid artery IMT was measured with color doppler imaging. Number of pregnancies and time spent on breast feeding were also noted. Results: There was statistically significant relation between age and IMT, BCI both. Patients with increased IMT had higher cardiovascular risk factors compared to normal cases (1.82 against 1.33). There was not different cardiovascular risk factor value between BAC positive and negative patients (Same as 1.675). We could not find any effect of number of pregnancies and time spent on breast feeding to IMT and BAC. Conclusion: IMK was a better indicator of cardiovascular disease compared to BAC. We could not find any any effect of number of pregnancies and time spent on breast feeding to IMT and BAC.

Amaç: Fokal böbrek lezyonlarının benign, malign ayırımındagörünüşteki difüzyon katsayısı (apparent diffusion coefficient- ADC) ve fraksiyonel anizotropi (Fa) ölçümlerinin diagnostikperformanslarının belirlenmesi.Gereç ve Yöntem: Çalışmamıza, bilgisayarlı tomografi (BT)ve ultrason (US) gibi değişik görüntüleme modaliteleri ile tanıkonulan ve manyetik rezonans diffüzyon tensör görüntülemesi(DTI) yapılmış 21 hastada (9 kadın and 12 erkek ; ortalama yaş54,1 ), 25 fokal renal lezyon dahil edildi. Lezyonlar 6 solid renalhücreli karsinom (RCC), 1 kistik RCC, 1 anjiomyolipom (AML)ve 17 kistik lezyondan ( 16 Bosniak tip I kist, 1 Bosniak tip IIkist) oluşmaktaydı. ADC ve Fa ölçümleri iki radyolog tarafından,konsensusa varılarak yapıldı. Malign ve benign lezyonlara aitADC ve Fa değerleri ANOVA ve Tukey testleri kullanılarakkarşılaştırıldı. ROC analizi kullanıldı; sensitivite ve spesifitehesaplandı.Bulgular: Malign lezyonların ortalama ADC ve Fa değerlerisırasıyla 1.29±0.4 mm2/sn ve 0.34±0.1 ölçüldü. Benign lezyonlarınortalama ADC ve Fa değerleri sırasıyla 2.6±0.7 mm2/sn ve0.19±0.12 ölçüldü. Aralarındaki fark istatistiksel olarak anlamlı idi(P, Objectives: To determine the diagnostic performance of apparentdiffusion coefficient (ADC) and fractional anisotropy (Fa)measurements in differentiation of malignant from benign focalrenal lesions.Material and Methods: Twenty-one patients (9 women and 12men ; mean age 54,1 years) with 25 focal renal lesions diagnosedby different imaging modalities such as computed tomography(CT) and ultrasound (US) and examined with magnetic resonancediffusion tensor imaging (DTI) were included in the study. Therewere 6 solid renal cell carcinomas (RCC), 1 cystic RCC, 1angiomyolipoma (AML) and 17 cystic lesions ( 16 Bosniak typeI cysts, 1 Bosniak type II cyst). ADC and Fa measurements wereperformed by two radiologists, in consensus. The differences inADC and Fa values of malignant and benign renal lesions werecompared using ANOVA and Tukey tests. A ROC analysis wasapplied; sensitivities and specificities were calculated.Results: The mean ADC and Fa values of malignant lesionswere 1.29±0.4 mm2/sec and 0.34±0.1, respectively. The meanADC and Fa values of benign lesions were 2.6±0.7 mm2/secand 0.19±0.12, respectively. The differences were significant(P

Objective The differential diagnosis of Graves disease (GD) and silent thyroiditis (ST) is important for the selection of appropriate treatment. To date, no study has compared the diagnostic utility of color Doppler ultrasonography (CDUSG), Tc-99m (technetium-99m) pertechnetate uptake, and thyroid-stimulating hormone (TSH)-receptor antibody (TRAb) for the differential diagnosis of these two conditions. In the present study, we compared the diagnostic utility of inferior thyroid artery (ITA) peak systolic and end diastolic velocities (PSV and EDV) measured by CDUSG, Tc-99m pertechnetate uptake, and TRAb for differential diagnosis of GD and ST. Methods A total of 150 subjects with GD, 79 with ST, and 71 healthy euthyroid controls were included in the study. Diagnoses of GD and ST were made according to patient signs and symptoms, physical examination findings, the results of TRAb and Tc-99m pertechnetate uptake, and follow-up findings. All subjects underwent CDUSG for the quantitative measurement of ITA blood-flow velocities. Results The mean ITA-PSV and EDV in patients with GD were significantly higher than in ST patients. In receiver operating characteristic analysis, the sensitivity/ specificity of the 30 and 13.2 cm/s cutoff values of the mean ITA-PSV and EDV for discrimination of GD from ST were 95.3/94.9% and 89.3/88.6%, respectively. The sensitivity/specificity of the 1.0 international unit (IU)/L and 3% cutoff values of the TRAb and Tc-99m pertechnetate uptake analyses were 93.0/91.0% and 90.7/89.9%, respectively. Conclusion The measurement of ITA-PSV by CDUSG is a useful diagnostic tool and is a complementary method to the TRAb and Tc-99m pertechnetate uptake methods for differential diagnosis of GD and ST. (Endocr Pract. 2014;20:310-319)

Background:The objective of this study is to bring attention to the importance of differential diagnosis in adolescent patients with skeletal involvement and hypercalcemia.Case:A 17-year-old male patient with a complaint of severe leg pain was admitted to our hospital. Seven months before he had a fracture of his distal humerus after falling on to his left shoulder and was treated conservatively. Five months previously, he had a rupture of his quadriceps tendon. Magnetic resonance imaging (MRI) was performed for the quadriceps tendon rupture and was evaluated as polyostotic fibrous dysplasia (PFD). Doctors decided to operate for the ruptured tendon but they detected severe hypercalcemia in the pre-operative blood tests and noticed that the main disease was primary hyper-parathyroidisim (PHPT) which was caused by a giant parathyroid adenoma.ConclusionsGiant parathyroid adenoma can present in adolescent patients with multiple bone lesions and severe hypercalcemia. PHPT should be considered in the differential diagnosis of pathological bone fractures and benign bone tumors in every age. This may prevent patients from miss or delayed diagnosis of PHPT.

Summary Background and objectives Vascular calcification is associated with increased cardiovascular mortality in chronic hemodialysis patients. This prospective study investigated the relationship between serum osteoprotegerin, receptor activator of NF-kB ligand, inflammatory markers, and progression of coronary artery calcification score. Design, setting, participants, & measurements Seventy-eight hemodialysis patients were enrolled. Serum IL-1b, IL-6, TNF-a, osteoprotegerin, receptor activator of NF-kB, fetuin A, and bone alkaline phosphatase were measured by ELISA. Coronary artery calcification score was measured two times with 1-year intervals, and patients were classified as progressive or nonprogressive. Results Baseline and first-year serum osteoprotegerin levels were significantly higher in the progressive than nonprogressive group (17.3969.67 versus 12.9066.59 pmol/L, P=0.02; 35.17618.35 versus 24611.65 pmol/L, P=0.002, respectively). The ratio of serum osteoprotegerin to receptor activator of NF-kB ligand at 1 year was significantly higher in the progressive group (0.26 [0.15–0.46] versus 0.18 [0.12–0.28], P=0.004). Serum osteoprotegerin levels were significantly correlated with coronary artery calcification score at both baseline (r=0.36, P=0.001)and1year(r=0.36,P=0.001).Importantly,progressionincoronaryarterycalcificationscoresignificantly correlatedwith changein serumosteoprotegerin levels (r=0.39,P=0.001). In addition, serumreceptor activator of NF-kB ligand levels were significantly inversely correlated with coronary artery calcification scores at both baseline (r=20.29, P=0.01) and 1 year (r=20.29, P=0.001). In linear regression analysis for predicting coronary artery calcification score progression, only baseline coronary artery calcification score and change in osteoprotegerin were retained as significant factors in the model. Conclusions Baseline coronary artery calcification score and serum osteoprotegerin levels were significantly associated with progression of coronary artery calcification score in hemodialysis patients. Clin J Am Soc Nephrol 7: 965–973, 2012. doi: 10.2215/CJN.11191111

The use of electrocautery for tissue dissection is becoming increasingly popular, despite the associated risk of poor wound healing and excessive scarring. We conducted this study to compare the wound complications and early and late clinical results resulting from electrocautery versus the scalpel to create a cutaneous flap during thyroidectomy.The subjects of this study were 100 patients, randomized prospectively to either a scalpel group (group S, n = 50) or an electrocautery group (group E, n = 50).Thickness of tissue damage, postoperative thickness of the flap, discomfort in the neck 7 days after surgery, and hypoesthesia and paresthesia in the neck 3 months after surgery were significantly higher in group E than in group S. There were no significant differences in overall postoperative wound complications, postoperative pain, satisfaction with the cosmetic result, or overall outcome of the operation between the groups. Although the incidence of seroma was higher in group E (20%) than in group S (8%), the difference was not significant.Although electrocautery was associated with increased histological tissue damage, postoperative flap edema, discomfort, and other complications in the early stage, the clinical and cosmetic results of flaps made using electrocautery or a scalpel were similar and satisfactory 6 months after surgery.

Purpose. To determine the visualization rate of the appendix in children without appendicitis and investigate factors affecting it. Methods. Between January 2010 and April 2010, 205 consecutive children (103 boys and 102 girls; mean age: 9 years) without clinical signs of appendicitis were examined by ultrasound (US). The location of appendix was determined. The outer appendiceal diameter with and without compression was measured and the content of the lumen and mural vascularity on color Doppler was determined. The appendix diameter was correlated with age, weight, and height using Pearson correlation. For age, weight, and height, children with a visualized appendix were compared with those in whom the appendix was not visualized using Student's t test. Results. The appendix was visualized in 142 of 205 (69.3%) children. The mean diameters of the appendices without and with compression were 4.2 ± 0.9 mm and 3.5 ± 0.8 mm, respectively, with 53.5% of the appendices in the mid-pelvic location. Appendiceal lumen was empty in 35.2% of children. Only one appendix showed mural vascularity on color Doppler. There was no correlation between the diameter (compressed or noncompressed) of the appendix and age, weight, or height. Mean ± SD age, weight, and height of the children with a visualized appendix (8.6 ± 0.3 years, 29.9 ± 0.9 kg, 127.7 ± 1.7 cm, respectively) were significantly lower than those in children with a nonvisualized appendix (9.8 ± 0.4 years, 36.0 ± 1.8 kg, 134.7 ± 2.5 cm, respectively) (p < 0.05 for all three parameters). Conclusion. In the majority of the children, the appendix can be visualized with US. Age, weight, and height affect the visualization rate of the normal appendix. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

The purpose of this study was to compare the ultrasonographic features of benign nodules, follicular lesions and malignant nodules in the thyroids of patients who underwent fineneedle aspiration biopsy. We retrospectively analyzed the ultrasonographic features of 231 nodules, which were diagnosed as benign, follicular lesion or malignant nodules with respect to solitariness, echogenicity, echostructure, border characteristics, presence or absence of calcifications, internal vascularity and the presence of a halo. The ultrasono-graphic features of benign nodules, follicular lesions and malignant nodules were compared using the Fisher-Freeman-Halton exact test. Differences were statistically significant if p < 0.05. With regard to cytopathology, there were 186 benign nodules, 10 follicular lesions and 35 malignant nodules. The distribution of frequencies of the ultrasonographic features including hypoechogenicity [46/186 (24.7%), 4/10 (40%), 29/35 (82.9%)], solid echostructure [63/186 (33.9%), 7/10 (70%), 34/35 (97.2%)], irregular margin [29/186 (15.6%), 3/10 (30%), 27/35 (77.1%)], microcalcification [16/186 (8.6%), 2/10 (20%), 15/35 (42.9%)] and absence of a halo [55/186 (29.5%), 5/10 (50%), 33/35 (94.2%)] between benign nodules, follicular lesions and malignant nodules, respectively, was statistically significant (Fisher-Freeman-Halton, p < 0.05). The frequencies of solitariness [35/186 (18.8%), 2/10 (20%), 7/35 (20%)] and internal vascularity [101/186 (54.3%), 7/10 (70%), 21/35 (60%)] between benign nodules, follicular lesions and malignant nodules, respectively, were not statistically significant (p > 0.05). Ultrasound features including hypoechogenicity, solid echostructure, irregular margin, presence of microcalcification and absence of a halo might be effective in the differentiation of malignant nodules and follicular lesions from benign nodules.

Currently, it is unclear whether pheochromocytomas can be ruled out based on low intensity on T2-weighted sequences and signal loss on out-of-phase magnetic resonance imaging (MRI) sequences. Hence, in this study, we investigated whether biochemical screening for pheochromocytoma in patients with adrenal incidentalomas (AIs) showing MRI features not suggesting pheochromocytoma would prove beneficial.We performed MRI for 300 AIs in 278 consecutive patients. All patients were screened for pheochromocytoma with plasma metanephrine and normetanephrine. Patients with high plasma levels of metanephrine and/or normetanephrine were also assessed for pheochromocytoma by urinary metanephrines.Hyperintensity was detected on T2-weighted MRI sequences in 28 (9.3%) of the 300 AIs. Among these 28 incidentalomas, pheochromocytoma was diagnosed in 13 (46.4%) of the cases by histopathologic analysis. Hyperintensity on T2-weighted MRI was significantly higher in pheochromocytomas compared to the remaining AIs (P.001). All 13 pheochromocytomas were characterized by hyperintensity on T2-weighted sequences and the absence of signal loss on out-of-phase MRI sequences. Pheochromocytoma was not detected in any of the 272 AIs that appeared hypointense or isointense on T2-weighted MRI sequences or in the 250 cases with signal loss on out-of-phase sequences.The results of this study suggest that AIs that appear hypointense or isointense on T2-weighted MRI sequences and those with signal loss on out-of-phase sequences may not require routine biochemical screening for pheochromocytoma. Further studies including a higher number of pheochromocytomas are required to confirm our results.

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome is a rare condition characterized by chronic mesenteric ischemia, secondary to the compression of the celiac artery by the median arcuate ligament. Occasionally, in addition to the celiac artery, the superior mesenteric artery may be partially compressed by the median arcuate ligament. We report a case with complaints of chronic abdominal pain from compression of both the celiac artery and the superior mesenteric artery due to MALS, which was primarily detected by Doppler ultrasound. The diagnosis was confirmed with CT-angiography.

Introduction Ultrasound is the most frequently used imaging method to evaluate thyroid nodules. Sonographic characteristics of thyroid nodules which are concerning for malignancy are important to define the need for fine needle aspiration biopsy or open surgery. Objective To evaluate malignancy risk of solid thyroid nodules through sonographic scoring. The effects of nodule size ≥2 cm and associated pathologic cervical lymph node in scoring were examined in addition to generally excepted suspicious features. Methods Medical data of 123 patients underwent thyroid surgery were reviewed, and 89 patients (58 females, 31 males) were included in the study. The presence and absence of each suspicious sonographic feature of thyroid nodules were scored as 1 and 0, respectively. Total ultrasound score was obtained by adding the positive ultrasound findings. Differently from the literature, nodule size ≥2 cm and associated pathologic cervical node were added in scoring criteria. The diagnostic performance of nodule characteristics for malignancy and the effect of total US score to discriminate malignant and benign disease were calculated. Results A significant relationship was found between malignancy and hypoechogenity, border irregularity, intranodular vascularity, and microcalcification (p < 0.05). Pathologic cervical node was observed predominantly in association with malignant nodules. Positive predictive value of suspicious cervical node for malignancy was 67%, similar to microcalcification. Nodule size ≥2 cm was not distinctive for diagnosis of malignancy. The number of suspicious sonographic features obtained with receiver operating characteristic analysis to discriminate between malignant and benign disease was three. Conclusion Sonographic scoring of thyroid nodules is an effective method for predicting malignancy. The authors suggest including associated pathologic node in the scoring criteria. Further studies with larger cohorts will provide more evidence about its importance in sonographic scoring. Resumo Introdução A ultrassonografia é o método imagiológico mais frequentemente usado na avaliação de nódulos tireoidianos. As características ultrassonográficas dos nódulos tireoidianos que dizem respeito à malignidade são importantes para a definição da necessidade de uma biópsia por aspiração com agulha fina ou uma cirurgia aberta. Objetivo Avaliar o risco de malignidade de nódulos tireoidianos sólidos por meio de escore ultrassonográfico, verificar os efeitos de nódulos ≥ 2 cm, em associação com linfonodo cervical patológico, além de características suspeitas geralmente omitidas. Método Foram revisados dados médicos de 123 pacientes tratados com cirurgia da tireoide. Foram incluídos no estudo 89 pacientes (58 mulheres, 31 homens). Presença e ausência de cada característica ultrassonográfica suspeita de nódulo tireoidiano receberam pontuações de 1 e 0, respectivamente. O escore ultrassonográfico total foi obtido pela soma dos achados ultrassonográficos positivos. Diferentemente da literatura, nódulos ≥ 2 cm e nodo cervical patológico associado foram acrescentados nos critérios de pontuação. Foram calculados o valor diagnóstico das características dos nódulos para malignidade e o efeito do escore ultrassonográfico total na diferenciação entre doença maligna vs. benigna. Resultados Foi encontrada uma associação significante entre malignidade e hipoecogenicidade, irregularidade das margens, vascularidade intranodular e microcalcificação (p < 0,05). Nodo cervical patológico foi observado predominantemente em associação com nódulos malignos. O valor preditivo positivo de nodo cervical suspeito para malignidade foi de 67%, similar ao achado para microcalcificação. Diâmetro de nódulo ≥ 2 cm não foi fator diferenciador para diagnóstico de malignidade. O número de características ultrassonográficas suspeitas obtido com a análise da curva de características de operação do receptor (receiver operating characteristic, ROC) para discriminação entre doença maligna vs. benigna foi igual a 3. Conclusão O escore ultrassonográfico dos nódulos tireoidianos é método efetivo para predição de malignidade. Sugerimos a inclusão de nódulo patológico associado aos critérios de pontuação. Futuros estudos com coortes maiores proporcionarão mais evidências sobre sua importância no escore ultrassonográfico.

Ectopic cervical thymus (ECT) is an uncommon cause for cervical mass in the pediatric age group. Ultrasound and mag- netic resonance imaging findings of the mass (location along the thymic descent pathway along the thymopharyngeal tract and the identical echostructure and signal intensities to the native thymus in the superior mediastinum) would lead to the diagnosis. The diagnosis is confirmed by fine needle aspiration biopsy or histopathology after resection. The management of ECT is a conservative follow up, except in symptomatic cases with tracheal compression and histologically confirmed neoplasia where surgery is indicated. We present the case of ECT presenting as a left upper neck mass in a 12 year old girl.

We report a case of a 45-year-old man, complaining of swelling and pain in his epigastric region for the last 3 years. According to his medical history, he had undergone various investigations and treatments for gastro-oesophageal reflux, without relief. He had had a history of chronic repeated microtraumas to his sternum during 9 years of working as a carpenter, as a result of placing wood against his anterior chest wall and pushing the former into a plank cutting machine. On examination, a tender swelling was palpable as an immobile, hard mass showing minimal protrusion under the skin on the xiphoid process. He was diagnosed as having xiphoid syndrome. We prescribed anti-inflammatory medication and advised him to avoid pressure on his anterior chest wall, especially on the sternum, while cutting wood. At follow-up, the symptoms were relieved. Xiphoid syndrome may be seen in people performing hard physical work who incur sustained pressure or friction on their anterior chest wall. The case emphasizes the importance of the occupational history as well as clinical and radiological investigation of unusual conditions as mentioned above.

Objective - We aimed to investigate the importance of magnetic resonance imaging for the diagnostic process of the upper motor neuron involvement. Material and methods - Fifteen patients (Group 1) who were diagnosed with amyotrophic lateral sclerosis in the neurology department of the Sisli Etfal Hospital and 20 controls (Group 2) entered the study. Magnetic resonance imaging examinations were performed in the radiology clinic of the same hospital. T2 and proton density weighted axial images were obtained. These images were evaluated by two blind radiologists. The radiologists looked for two signs: the presence of a low signal intensity at the precentral cortex and the presence of symmetrical rounded foci of high signal intensity within the internal capsule on both T2 and proton density weighted images. Results - For the first sign there was no statistically significant difference between the two groups but for the latter one there was a statistically significant difference. Conclusion We think that the presence of the latter sign may make it possible for the radiologists to help the clinicians further in this difficult and confusing diagnosis.

Posterior nutcracker syndrome is caused by compression of the left renal vein between the abdominal aorta and the vertebral column. We present the case of a 14-year-old girl with vague left loin pain, mild haematuria and proteinuria. Diagnosis of this rare syndrome was achieved using color Doppler US and multidetector computed tomography (MDCT) angiography.SommarioLa sindrome da schiaccianoci posteriore è dovuta alla compressione della vena renale sinistra tra l’aorta addominale e la colonna vertebrale. Viene presentato il caso di una ragazza di 14 anni con lombalgia sinistra, lieve ematuria e proteinuria, in cui la diagnosi di questa rara sindrome è stata ottenuta con Eco-color Doppler e con l’Angio-TC.

Background Laparoscopic totally extraperitoneal hernia repair (TEP) has been compared with the open technique in several studies in terms of technical properties and perioperative outcomes. There are few studies that compare the long-term effects of each technique on testicular structure and function on the side of the hernia repair. The objective of this study is to investigate the effects at 6 months of the TEP and the Lichtenstein technique on testicular volume and arterial flow by the use of Doppler ultrasonography. Methods A total of 148 men with a unilateral hernia were randomized prospectively to undergo TEP or Lichtenstein repair. In both groups, unilateral resistive indices, pulsatile indices of capsular and intratesticular artery flow, and testicular volume (in milliliters) were measured preoperatively and 6 months postoperatively by the use of grayscale and color Doppler ultrasonography (CDUS). The primary outcomes of the study were postoperative findings from history, physical examination, and CDUS measurements at 6 months postoperatively. Demographics, clinical and operative data, CDUS measurements, and recurrence patterns were analyzed. Results Of 148 procedures, 134 cases consisting of 64 TEP and 70 Lichtenstein repairs were evaluated. Pre- and postoperative CDUS findings, rates of complications, and recurrence in both groups did not show any difference. Operative time was greater with a Lichtenstein repair (36 vs 30 minutes; P = .01). Conclusion Complications and recurrence rates and effects on testicular perfusion and testicular volume in both laparoscopic and open techniques are similar, whereas the laparoscopic approach has shorter operative time than open hernia repair.

Cyst of the canal of Nuck is a rare cause of inguinal swelling in woman. We report a case of a cyst of the canal of Nuck in which sonography showed a tubular cystic structure with internal septae localized within the inguinal canal. Magnetic resonance examination demonstrated that the mass was hypointense on T1-weighted and hyperintense on T2-weighted series and that there were fine hypointense septae inside the mass on the T2-weighted sequence. Diagnosis of cyst of the canal of Nuck was confirmed by surgery and subsequent histopathologic evaluation.SommarioLa cisti del canale di Nuck è una rara causa di tumefazione inguinale nelle donne. Riportiamo un caso di cisti del canale di Nuck in cui l'ecografia aveva evidenziato una struttura tubulare cistica caratterizzata da setti interni, localizzata nel contesto del canale inguinale. L'esame di RM aveva confermato la natura cistica della lesione, che appariva pertanto ipointensa in T1 e iperintensa con fini sepimentazioni ipointense nelle sequenze T2 pesate. La diagnosi di cisti del canale di Nuck è stata successivamente confermata all'intervento chirurgico e dall'esame isto-patologico.

Background Disordered mineral metabolism is implicated in the pathogenesis of vascular calcification in hemodialysis (HD) patients. Fibroblast growth factor 23 (FGF-23) is the main regulator of phosphate metabolism. In this prospective study, we aimed to investigate the association of serum FGF-23 with progression of coronary artery calcification in HD patients. Methods Seventy-four HD patients (36 male/38 female, mean age: 52 ± 14 years) were included. Serum FGF-23 levels were measured by ELISA. Coronary artery calcification score (CACS) was measured twice with one year interval. Patients were grouped as progressive (PG) (36 patients-48%) and non-progressive (NPG). Results Age, serum phosphorus, baseline and first year CACS were found to be significantly higher in the PG compared to NPG group. Serum FGF-23 levels were significantly higher in PG [155 (80–468) vs 147 (82–234), p = 0.04]. Patients were divided into two groups according to baseline CACS (low group, CACS ≤ 30; high group, CACS > 30). Serum FGF-23 levels were significantly correlated with the progression of CACS (ΔCACS) in the low baseline CACS group (r = 0.51, p = 0.006), but this association was not found in high baseline CACS group (r = 0.11, p = 0.44). In logistic regression analysis for predicting the PG patients; serum FGF-23, phosphorus levels and baseline CACS were retained as significant factors in the model. Conclusions Serum FGF-23 was found to be related to progression of CACS independent of serum phosphorus levels. FGF-23 may play a major role in the progression of vascular calcification especially at the early stages of calcification process in HD patients.

The compression of the proximal part of the celiac trunk by median arcuate ligament of the diaphragm during expiration is defined as median arcuate ligament syndrome. It is a rare cause of chronic mesenteric ischemia. We report two cases with this syndrome, primarily diagnosed by Doppler ultrasound. The diagnosis was confirmed with digital substraction and computed tomography angiography in both cases. The role of ultrasound in the diagnostic work up of this syndrome is discussed with regard to the recent literature.

The purpose of this study was to define the criteria for use in differentiating benign and malignant nodules with the help of the receiver operating characteristic analysis and to increase the objective diagnostic accuracy of ultrasonography.A total of 363 patients (307 women, 56 men) with 363 nodules (22 malignant and 341 benign nodules) were included in the study. The presence and absence of each US feature of the evaluated nodule - shape taller than wide, irregular margin, hypoechogenicity, microcalcification, and intranodular vascularity - were scored 1 and 0, respectively. The total ultrasound score was obtained by the summing up of each positive ultrasound findings for malignancy. The effect of the total US score in the discrimination of benign and malignant nodules was analysed using ROC analysis.The cut off values of US score at maximum sensitivity and specificity for nodules larger and smaller than one centimeter were two (Az: 0.783) and three (Az: 0.935), respectively. For nodules greater than one centimeter, the calculated diagnostic performances including sensitivity, specificity, positive predictive value and negative predictive value, and accuracy were 62.5%, 91.5%, 30.3%, 97.7%, and 89,9%, respectively. For nodules smaller or equal to one centimeter; the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 83.3%, 94.9%, 62.5%, 98.2% and 93.8%, respectively.Using ultraound, thyroid nodules can be characterized effectively. The number of the US features used in this distinction varies in respect to the nodule size.

OBJECTIVE: To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. METHODS: The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age- and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. RESULTS: The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. CONCLUSIONS: This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

We present a case of a 48-year-old female with a history of cholecystectomy and recurrent attacks of pancreatitis whose initial abdominal sonography (US) revealed multiple conglomerated stones in the descending part of the duodenum. Abdominal CT, MRI, and magnetic resonance cholangiopancreatography showed the same findings. The distended sacciform distal intramural segment of the common bile duct was protruding into the duodenum. The imaging findings explained the etiology of the patient's recurrent attacks of pancreatitis and led to surgical excision of the choledococele.

Renal involvement is a fairly frequent development in children with acute lymphoblastic leukemia, but palpable renal enlargement at time of diagnosis is very unusual. We report the case of a young girl who presented with enlarged kidneys and was diagnosed with this form of leukemia. This case is of interest because of the rarity of this presentation. The importance of renal biopsy in identifying the etiology of this patient’s nephromegaly is emphasized.

Penile Mondor's disease is an unusual condition, which is characterized by thrombosis in superficial dorsal penile vein. Here, we report the sonographic findings of this disease in a 35-year-old male along with the absence of right dorsal penile artery.

Duodenal duplication is a rare cause of acute pancreatitis in children. We report a case of acute pancreatitis in which abdominal sonography revealed an enlarged hypoechoic edematous pancreas with mildly dilated main pancreatic duct and a cystic structure with layered wall in the second part of duodenum. Abdominal CT yielded similar findings. The diagnosis of duodenal duplication was confirmed at surgery and subsequent histopathologic examination.

The aim of our study was to compare multidetector row computed tomography (CT) angiography (MDCTA) with digital subtraction angiography (DSA) in the detection and characterization of intracranial aneurysms. Between September 2005 and May 2007, 55 consecutive patients with suspected intracranial aneurysms underwent conventional DSA and MDCTA. Thirty-two women and 23 men were enrolled in the study. The mean patient age was 54 (range = 26-79 years). All MDCTA and DSA images were independently evaluated on a workstation by two radiologists, who had 8 and 6 years of experience in CT vascular imaging and angiography. Using DSA as the gold standard, the sensitivity and specificity of CT angiography was calculated for each reader with 95% confidence intervals. The sensitivity was also calculated for aneurysms smaller than 3 mm with 95% confidence intervals. The agreement between the readers for detecting aneurysms was calculated using kappa statistics. A kappa statistic greater than 0.75 was considered an excellent agreement beyond chance, a kappa statistic of 0.4-0.75, fair to good agreement, and a kappa statistic less than 0.4, poor agreement. At DSA, 64 aneurysms were present in 50 patients involved in the study; seven patients had two aneurysms each, and four patients had three aneurysms each. In five patients, no aneurysm was detected by using MDCTA and DSA, and evaluations were considered as true negative by MDCTA. These five patients also had negative findings at repeat DSA. For readers 1 and 2, the sensitivity of MDCT in detecting aneursyms were 96.9% (95% CI = 89.3-99.1%; 62 of 64) and 98.4 % (95% CI = 91.7-99.7%; 63 of 64), respectively. The spescificity was100% (95% CI = 99.7-100%; 1,256 of 1,256) for both readers. The kappa value indicating interobserver agreement was in the category of excellent (kappa = 0.99 (95% CI = 0.97-1). Regarding the aneurysms smaller than 3 mm, for readers 1 and 2, the sensitivities were 84.6% (95% CI = 57.8-95.7%; 11 of 13) and 92.3% (95% CI = 66.7-98.6; 12 of 13), respectively. MDCTA is accurate in the detection and characterization of intracranial aneurysms and can be used as a reliable alternative imaging technique to DSA. A strategy of using CT angiography as the primary method, with DSA reserved for any cases of uncertainty, appears safe and reliable.

Lymphangiomatosis is a rare disease with multifocal lymphatic proliferation that typically occurs during childhood and involves multiple parenchymal organs including the lung, liver, spleen, bone, and skin. Lymphangiomatosis may occur synchronously or metachronously with cystic hygroma of the neck. We present US, CT, and MRI findings of cystic hygroma of the neck associated with generalized lymphangiomatosis affecting bones and spleen in a 2-year-old girl.SommarioLa linfangiomatosi è una rara malattia caratterizzata da proliferazione multifocale del sistema linfatico che colpisce tipicamente i soggetti giovani e può interessare molti organi parenchimali tra cui il polmone, il fegato, la milza, le ossa e la pelle. La linfangiomatosi si può associare in sincronia o successivamente con l'igroma cistico del collo. Qui di seguito sono riportati i reperti ecografici, TC e di RM, di una bimba di 2 anni con igroma cistico del collo associato con linangiomatosi generalizzata delle ossa e della milza.

To determine the diagnostic accuracy of 3D-CTA using volume rendering (VR) in the detection of residual or recurrent cerebral aneurysms after clipping. Between January 2006 and November 2007, 45 patients (20 female, 25 male) with 50 intracranial aneurysms treated using titanium clips were enrolled in this study. IADSA and 3D-CTA were performed within 1 month after surgery in 27 (60%) patients, after 1 year in 12 (26%) patients and after 5 years in six (13%) patients. In blinded fashion, CTA and DSA images were independently interpreted by two senior neuroradiologists with 7 years of experience in vascular diagnostic neuroradiology. The diagnostic performance of MDCTA compared with DSA for the detection of aneurysm remnants was measured by receiver operating characteristic (ROC) analysis. The area under the ROC curve, 95% confidence interval (CI), sensitivity, and specificity were calculated. For the detection of residue–recurrent aneurysm; the sensitivity and specificity of MDCTA were 87.5% (95% CI = 52.9–97.8%) and 97.4% (95% CI = 86.5–99.5%) for the first reader and 87.5% (95% CI = 52.9–97.8%) and 100% (95% CI = 90.8–100%) for the second reader respectively. Receiver operating characteristic (ROC) analysis revealed good diagnostic performance for 3D-CTA (mean area under ROC curve (Az) = 0.98 and 0.99 for the first and the second observer, respectively) The kappa values extracted from the interobserver concordance analysis for agreement observers regarding the use of MDCTA for assessment of a remnant neck was 0.62. Using MDCTA, it is possible to demonstrate the status of intracranial aneurysms after surgical clipping in the immediate postoperative period as well as long-term follow-up with an high sensitivity and specificity when comparing with the findings of DSA.