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Background Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications. Purpose To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods. Material and Methods We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated. Results A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group ( P = 0.03). Murphy finding and diabetes status were similar between the two groups ( P = 0.086 and P = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients ( P = 0.045); with no significant difference in cases of complicated cholecystitis ( P = 0.499). Conclusion Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.

To evaluate the diagnostic performance of chemical shift magnetic resonance imaging (MRI) in distinguishing hepatocellular carcinomas (HCCs) from non-hepatocellular malignant tumours (non-HCCs) of the liver.Patients with a diagnosis of malignant liver tumours examined at 3 T MRI were included in this retrospective study. Forty-seven HCCs and 75 non-HCCs that were studied with chemical-shift MRI between January 2012 and October 2016 were retrieved from the radiology database. Two blinded observers measured the signal intensities of the tumours, adjacent normal-looking liver parenchyma, and spleen on chemical-shift MRI. The fat quantification for HCCs, non-HCCs, and adjacent normal-looking liver parenchyma were calculated by using the spleen as a reference standard. The subtraction scores were calculated by subtracting fat percentages in liver parenchyma from those in tumours. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the fat percentage subtraction scores in distinguishing HCCs from non-HCCs were calculated.According to the optimal cut-off value acquired from both readers, a subtraction score-0.26 was considered to be a HCC. Fat signal percentage subtraction scores were ≥-0.26 in 45 of 47 HCCs and were-0.26 in 69 of 75 non-HCCs. The sensitivity, specificity, PPV, and NPV of fat signal percentage subtraction score to differentiate HCCs from non-HCCs were found to be 95.7%, 89.3%, 84.9%, and 97.1%, respectively.Intracytoplasmic lipid in HCCs demonstrated by quantitative chemical-shift MRI may be a potentially powerful imaging biomarker to distinguish HCCs from the other malignant liver tumours.

Pancreatic pseudocyst is the most common cystic lesion of the pancreas seen following acute and chronic pancreatitis in 2-10% and 10-30%, respectively. Imaging findings vary depending on the age and severity of the attack. Infection, hemorrhage and rupture are the most frightening complications. The possibility of spontaneous recovery is consider­ably low. A 63-year old male patient who has history of longstanding alcohol consumption presented to the emer­gency department with complaints of abdominal pain. On computerized tomography (CT), an encapsulated and round peripancreatic collection with a size of approximately 8.5x7.5 cm was detected in pancreatic head. In the literature, no article is published mentioning coexistence of complication such as infection, hemorrhage and rupture. We present the association of these three complications observed in our case. J Clin Exp Invest 2016; 7 (2): 203-206

The surgical and the radiological advances in liver tumors in last two decades have made some malignant tumors operable which were considered inoperable and have completely changed the expectations from radiology. However, accurate staging, that is performed by imaging modalities, has critical importance in the selection of patients who can benefit from resection. Radiologists and referring physicians, therefore, should be aware of the current concepts in imaging liver tumors. This report updates both the changing role of radiology in hepatic neoplasms and the appropriate use of radiological modalities in liver tumors.

Ultrasonographic (US) differential diagnosis of enlarged loops in the foetal abdomen may be inconclusive in some cases. We report a case of foetal intestinal atresia that was diagnosed with MRI. In a 32 weeks old fetus, US revealed enlarged loops filling the entire foetal abdomen which did not allow further evaluation. On MRI, the anteriorly located distended loops were hyperintense on HASTE images and hypointense on 2D FLASH images suggesting small bowel atresia. Fetus died in utero and pathology confirmed the diagnosis. MR can be used as complementary diagnostic tool in cases of enlarged loops in foetal abdomen.

PURPOSE The aim of our study was to assess the contribution of various magnetic resonance imaging (MRI) sequences in determining the type of perianal fistula and in obtaining critical information for surgical decisions, as well as to define the optimal combination of sequences for readers with varying levels of experience. MATERIALS AND METHODS The study included 33 MRI examinations in 26 patients with suspected perianal fistula. The following sequences were obtained in both the coronal and axial planes: thin slice, high resolution T1-weighted (W) spin echo; T2-weighted turbo spin echo; short tau inversion recovery (STIR); and native and contrast enhanced T1-weighted gradient echo fast low-angle shot (FLASH) images with fat suppression (FS-CE-T1W-GRE). The examinations were interpreted by three radiologists with varying degrees of experience in two different sessions, and the inter-reader agreement was assessed. Seventeen of the patients underwent surgery. The agreement between the surgical findings and the MRI results were evaluated. RESULTS A statistically significant concordance between the fistula classification and surgery was achieved with the FS-CE-T1W-GRE sequence for Reader 1 (Cramer's V=0.701, P = 0,022) and Reader 3 (Cramer's V=0.716, P = 0,043). For Reader 2, statistically significant concordance between fistula classification and surgery was achieved with the FS-CE-T1W-GRE (Cramer's V=0.703, P = 0,011) and the T2W images (Cramer's V=0.648, P = 0,027). For all sequences, there was statistically significant agreement between readers for fistula classification, internal opening location, and the presence of sinus tracts, abscess, a horseshoe component, and inflammation. CONCLUSION For experienced readers, combining FS-CE-T1W-GRE images with either T2W or STIR images collected in both the coronal and axial planes was sufficient to make an assessment before deciding the surgical extent of the procedure.

Purpose The purpose of this study is to identify the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the classification of liver hydatid cysts (HCs) and their differentiation from simple cysts and liver abscesses. Materials and methods Twenty-two patients that were sent to our department with preliminary diagnoses of HCs or abscess were included in the study. Thirty lesions were evaluated. MRI included T1-weighted fast gradient echo, T2-weighted half-Fourier acquisition single-shot turbo spin echo, and DW single-shot echo planar pulse sequencing (b, 0, 50, and 1000 s/mm²). The apparent diffusion coefficient (ADC) values (mm²/s) of the HCs, abscesses, and simple cysts were calculated. Results No statistically significant difference was found between the ADC values of type 1 and 3 (P > 0.05) HCs and of simple cysts and type 1 HCs (P > 0.05). The ADC values of abscesses were significantly lower than those of type 1 and type 3 HCs, and simple cysts. No statistically significant difference was found between the ADC values of abscesses and type 4 HCs (P > 0.05). Type 4 lesions exhibited significantly lower ADC values in comparison to type 1 and 3 HCs. Conclusion DW-MRI helps differentiate type 4 lesions from other cysts and can distinguish abscesses from hydatid cysts other than type 4 as well as from simple cysts. Type 1 HCs cannot be differentiated from simple cysts using ADC values alone, and type 4 lesions are indistinguishable from abscesses.

To determine the role of ultrasonography (US) and computed tomography (CT) in the evaluation of ascites etiology.From 2000-2006, patients admitted to the Radiology Department, Uludag University Medical School Hospital, Bursa, Turkey, were studied to determine the etiology of ascites, or those in whom ascites was determined during the course of other investigations were evaluated using US and CT. Existence of septa-debris, accompanying organ pathology, omental involvement, intestinal wall thickening, peritoneal implant, lymph node, diameter of portal vein, thickening of gall bladder wall, pleural effusion, collateral vascular structure, and cavernous transformation were also investigated.A total of 30 cases were included. Causes were determined to be malignant in 15 (50%) cases and 15 (50%) benign. The US was significantly superior to CT in the evaluation of gall bladder thickening. Omental thickening, thickening of intestinal wall, and peritoneal implant development were seen significantly more frequently in malignant compared to benign cases, while thickening of the gall bladder wall was seen more frequently in benign cases. Ascites density of malignant cases detected in slices without contrast was higher than in benign cases. The probability of malignancy was 98% when omental thickening, thickening of intestinal wall, and peritoneal implant were present together in the same case.Although CT and US may help to evaluate ascites, however, the differential diagnosis of ascites etiology remains a challenge.

Polyarteritis nodosa is a multisystem disease primarily involving the small and medium-sized vessels. Prognosis depends on the presence and severity of visceral involvement. Thrombosis and aneurysm formation commonly occur in kidney and gastrointestinal tract. Although hepatic involvement is also common, hepatic aneurysmal rupture with intrahepatic or perihepatic hematoma formation is infrequent. Hemobilia secondary to aneurysmal rupture is a very rare condition. We present a case of polyarteritis nodosa accompanied by hemobilia and intestinal hemorrhage secondary to hepatic and mesenteric aneurysmal rupture.

A rare case of thoracoabdominal duplication is reported. Radiological workup including US, CT and MR provided the correct diagnosis. The US revealed the cystic nature of the lesions, whereas CT and MR showed their relationship with the diaphragm and each other. Coronal- and sagittal-plane MR images were helpful in demonstrating the extension of the lesions. The patient was discharged after an uneventful surgery and recovery. The histological evaluation revealed the cyst lined with single-layered columnar epithelium and the cyst wall contained submucosal mucous glands with underlying smooth muscle and also some mature chondroid elements with bronchogenic origin. Radiological findings and differential diagnosis are discussed.

OBJECTIVE. ne purpose of this study was to assess the advantages of the image subtraction technique in chemical shift MRI for the differentiation of adrenal adenomas from nonadenomas. SUBJECTS AND METHODS. Thirty-five patients with 42 adrenal masses (eight metastases and 34 nonfunctioning adenomas) underwent chemical shift MRI using a double-echo fast low-angle shot sequence. Subsequently, opposed-phase chemical shift MR images were subtracted from in-phase images, The subtraction images were assessed quantitatively and qualitatively. For quantitative assessment, the signal intensity values of the adrenal masses were measured by one investigator with manually defined regions of interest. Qualitative assessment of the subtraction images was performed independently by two investigators, who reported their confidence in diagnosing adenomas versus nonadenomas based on signal intensity of the adrenal masses on subtraction images. RESULTS. The mean signal intensities were significantly different between adenomas and metastases on subtraction images (213 vs 18: p < 0.0001). There was no overlap in signal intensities between adenomas and metastatic tumors, The accuracy in distinguishing adenomas from metastatic tumors was 100% if the cutoff value of the signal intensity selected was 36-106. Quantitative results corresponding to 100% specificity were also observed, with similar sensitivity. No difference in interpretation between the two investigators occurred. CONCLUSION. Chemical shift subtraction MRI provides a high confidence level in distinguishing adrenal adenomas from adrenal metastases. The image subtraction technique also facilitates quantitative and qualitative evaluation of adrenal masses in chemical shift MRI.

Solid and papillary epithelial neoplasm of the pancreas is a very rare low-grade malignant neoplasm with only 126 cases reported in the literature and seen mostly in young female patients. Surgical excision means cure in cases before malignant degeneration developed. Its characteristic findings are typical location in the tail of the pancreas, peripheral capsule formation, hypodensity on CT images, and hyperintense internal signal characteristics on T1-weighted MR images secondary to hemorrhage and accumulation of methemoglobine molecule. These findings are enough for the preoperative diagnosis that may lead to early surgery and cure. We present the CT and MR findings of this very rare neoplasm in a case report.

Aims—To determine the eYcacy of dacryocystoplasty with balloon dilatation in the treatment of complete and partial obstruction of the lacrimal drainage system. Methods—The procedure was performed on 26 patients with epiphora due to complete (n=16) or partial (n=10) obstruction of the lacrimal drainage system. A flexible tipped guide wire was introduced through the superior canaliculus into the inferior meatus and manipulated out of the nasal cavity. A 3 mm balloon was then introduced in a retrograde direction over the guide wire and dilated at the obstruction site. Results—The procedure was technically successful in all patients with partial obstruction, but unsuccessful in four of 16 cases with complete obstruction. Reobstruction occurred in eight of 12 patients with complete obstruction, and in five of 10 patients with partial obstruction. The overall success rate was 25% for complete and 50% for partial obstructions. The mean follow up was 14 months (8‐37 months). Conclusion—Although the balloon dacryocystoplasty is a simple and minimally invasive technique, the outcome from our study indicates that it is not advisable for treatment of complete obstruction of the lacrimal drainage system. Balloon dilatation may prove suitable for the treatment of patients with partial obstruction below the level of the lacrimal sac, especially in those who are poor candidates for surgery, or who do not wish to undertake dacryocystorhinostomy. Even in the partial obstruction group the success rate was only 50%, so that further modification to the technique and controlled studies are likely to be required before it could be recommended for general use. (Br J Ophthalmol 1999;83:692‐696)

A prospective study was undertaken to assess the value of both T2-weighted spin-echo (SE) and contrast-enhanced dynamic gradient-echo (GRE) sequences using MR imaging in differentiating the deep myometrial invasion from lower stages produced by endometrial carcinoma. For the correlation of MR findings with the histopathologic findings, patients who had no myometrial invasion (stage 1 a) and patients in whom tumors were confined to the superficial myometrium (stage 1 b) at pathologic examination were combined as lower stages. Twenty patients with endometrial carcinoma were studied using both techniques. The absence of any detectable tumor (stage 1 a) or the presence of a tumor confined to inner half of myometrium (stage 1 b) and extention of tumor to the outer half of myometrium (stage 1 c) were used as the diagnostic criteria. In pathologic examination of excised specimens, deep myometrial invasion was detected in 9 of 20 patients. The sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of T2-weighted SE in differentiating deep myometrial invasion from combined lower stages were 88, 91, 90, 88, and 91 %, respectively, whereas corresponding values for contrast-enhanced dynamic GRE sequences were 78, 100, 90, 100, and 85 %. Statistical difference between two sequences did not reach a significant level. We conclude that in cases of absence of visible junctional zone with SE sequence, contrast-enhanced dynamic GRE MR imaging may be helpful.

Purpose: A nomogram for hepatic spiral CT (SCT) was constructed based on randomization of patients into a prospective study using four different injection protocols. Its utility in a separate prospective randomized trial was subsequently evaluated in a new group of patients. Method: Thirty-nine patients randomized into four groups underwent SCT (Somatom-Plus S; 24 s exposure, 10 mm collimation, 10 mm/s) using 90 mi Omnipaque 240 (22 g I) at 2.5, 4, 5, or 6 ml/s. Peak and mean aortic and liver enhancement and time to peaks were measured and correlated with patients' age, weight, dose, rate, and contrast agent concentration, and a nomogram was constructed. In the validation experiment, 20 new patients were randomized to nomogram-guided and control groups for contrast dose administration during SCT. All patients underwent SCT (Somatom-Plus S; 32 s exposure, 10 mm collimation, 10 mm/s) using 90 mi Omnipaque 240 or 140 mi Hypaque 60 at 1.5-6 ml/s. Peak and mean aortic and liver enhancement and time to peaks were measured and correlated with patients' age, weight, dose, rate, and contrast agent concentration. Mean and peak aortic and hepatic enhancements were measured and rated by three blinded reviewers, Results: Peak hepatic enhancement occurred 32 s after termination of contrast bolus administration in all groups. Correlation between the predicted and actual enhancement was very good (r = 0.7-0.9). Ninety-eight percent of the nomogram-guided group had optimal timing and utilized 10% less contrast agent than the control group. Conclusion: The phenomenon of peak hepatic enhancement occurring 32 s after the termination of contrast bolus regardless of injection rate may be of use in a nomogram for optimal contrast delivery for hepatic SCT. United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) - CA 09536 United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) - T32CA009536

Spontaneous choledochoduodenal fistula (CDDF) is a rare form of biliary enteric fistula which usually occurs as a complication of duodenal peptic ulcer disease. the more common form is cholecystoduodenal fistula (CCDF) which is generally associated with gallbladder disease. We report on a case of ulcerogenic CDDF diagnosed by upper gastrointestinal barium study, ultrasonography, and gastroduodenal endoscopy

Rationale and Objectives. We conducted a prospective study of 131 patients to evaluate the contrast agent dose-response relationship for liver spiral computed tomography (CT) and to test the hypothesis that spiral CT scanning provides greater enhancement than does dynamic CT scanning. Methods. Patients were assigned to one of two control groups (dynamic CT) or to one of five experimental groups (spiral CT). Dynamic CT patients received 150 ml and spiral CT patients received either 75, 100, or 150 ml of diatrizoate meglumine. All groups had a monophasic injection rate of 2.5 ml/sec. Hepatic enhancement was compared among experimental and control groups. Results. In the experimental groups, there was a linear dose-response relationship (p < .0001) among the enhancements achieved for the three dosages. The enhancement of the last slice of liver for the spiral CT versus dynamic CT groups receiving 150 mi was significantly greater (p = .002). Peak, first liver slice, and average liver enhancement values were higher with spiral CT scanning, but the difference was not statistically significant (power > .55). Conclusion. Using uniphasic injection rates and identical doses of contrast agent, spiral CT scanning has the advantage of improved enhancement of the last part of the liver to be imaged.

Tuberculosis (TB) of spleen is rare and usually occurs in miliarv form. Macronodular form is extremely rare, Immunodeficiency associated with alcoholism IV drug abuse, diabetes, cancer, corticosteroid therapy, and AIDS are prominent risk factors. Early diagnosis and treatment are important, because untreated abdominal TB carries a 50% mortality rate. We report US and CT of five cases with splenic TB. Our cases showed multiple small hypoechoic and hypodense nodules on US and CT, respectively, except one case whose US was normal. All cases also had extrasplenic involvement. The diagnosis of TB was established in two cases by cervical and in one case by submandibular lymph node biopsy, in one case by peritoneal biopsy, and in one case by a typical spinal lesion at L2–3. The US and CT findings are not specific for TB, but especially in endemic regions TB should be included in the differential diagnosis of Splenic lesions.