Search

Objective: Systemic sclerosis (SSc) is a chronic disease that can cause interstitial lung disease (ILD), a poor prognostic factor in SSc patients. Given the concerns over radiation exposure from repeated CT scans, there is a growing interest in exploring radiation-free imaging alternatives like MRI for ILD evaluation. The aim of this study is to assess the efficacy of three-dimensional zero echo time (3D-ZTE) MRI in assessing SSc-related ILD compared to the thin-slice chest CT., Methods: This prospective single-center study investigated 65 SSc patients. SSc patients underwent CT, 3D-ZTE lung MRI, and pulmonary function tests (PFTs) within a week. Three independent reviews visually quantified ILD extent on ZTE and CT imaging and the correlation of ILD extent with PFTs was analyzed. Statistical analyses were performed, including the intraclass correlation coefficient (ICC), Kruskal-Wallis tests, Bland-Altmann analysis, and correlation analyses between imaging results and PFTs., Results: ILD was detected in 45 patients via CT. 3D-ZTE MRI identified ILD in 41 (91.1%) of these cases, demonstrating a strong correlation with CT in assessing ILD severity (r = 0.986, p < 0.001). The median ILD extent scores were 5% for CT and 6% for 3D-ZTE MRI. Interobserver reliability for 3D-ZTE MRI was excellent, with ICC values ranging from 0.853 to 0.969. The analysis also revealed significant negative correlations between ILD extent on ZTE MRI and lung function, particularly FVC., Conclusion: 3D-ZTE lung MRI is a reliable and radiation-free alternative to chest CT for evaluating SSc-related ILD, with a strong correlation in assessing total fibrosis and ground-glass opacities, though limitations remain in detecting fine reticulations and coarseness., Key Points: Question Can 3D-ZTE MRI replace thin-slice chest CT as a radiation-free method for assessing SSc-related ILD? Findings 3D-ZTE lung MRI showed an excellent agreement with thin-slice CT in evaluating ILD extent in SSc patients (r = 0.986, p < 0.001). Clinical relevance 3D-ZTE lung MRI provides a reliable, radiation-free alternative to CT for assessing ILD extent in SSc patients, ensuring safer longitudinal monitoring and management., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Furkan Ufuk. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors has significant statistical expertise. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: Not applicable. Methodology: Prospective Diagnostic or prognostic study Multicentre study/performed at one institution, (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Aim: To compare T1-weighted contrast-enhanced (T1+C) with fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) sequences to protect healthy brain tissue during meningioma treatment with Gamma-Knife radiosurgery (GKRS)., Material and Methods: After reviewing the data of 54 patients with solitary meningioma who underwent GKRS between January 2020 and June 2022, demographic characteristics were noted, tumor volumes on T1+C and FIESTA MRI sequences were measured, and sequences were compared. The patients were then divided into two groups according to the presence of invasion to intracranial venous sinuses (groups 1 and 2, respectively). SPSS 11.5 software was used for data analysis, with the level of significance set at 0.05., Results: While no significant age and tumor size differences were observed between groups 1 and 2, sinus invasion was significantly higher among males. Tumor volumes measured in both groups were significantly smaller on FIESTA sequences than on T1+C sequences., Conclusion: The T1+C sequence has been the primary imaging method because of meningiomas' high contrast enhancement feature. However, the T1+C sequence during GKRS planning is an effective imaging method in treating meningiomas; FIESTA sequences can more precisely delineate the tumor border. In this study, we consider that using the FIESTA/CISS sequence MRI for planning meningioma therapy with Gamma-Knife can reduce target volume and prevent irradiation of healthy brain tissue.

Background: Temporal bone is a region where fat suppression is difficult due to the inhomogeneity of various structures with different molecular properties., Introduction: We aimed to determine the most effective fat suppression sequence in order to increase the visibility of the inner ear region., Materials and Methods: The hybrid techniques and T1-Weighted mDIXON images of 40 patients with Magnetic Resonance (MR) imaging of the inner ear were prospectively compared by two experienced radiologists in terms of fat suppression efficacy. In all fat-suppressed sequences, the Signal to Noise Ratio (SNR), the spinal cord signal intensity / mean fat signal intensity ratio and spinal cord signal to noise ratio were calculated. The suppression efficacy of MR techniques for fat areas in the inner ear was visually graded., Results: Qualitative assessment of image quality due to fat suppression in the inner ear was made; the Dixon technique performed significantly better than SPAIR and SPIR techniques (p<0.0001). The mean signal intensity of the inner ear fat and SNR for the Dixon technique were significantly lower than that for SPIR and SPAIR techniques (p<0.0001). Inter-observer agreement regarding the assessment of the inner ear fat, mean signal intensity values and mean SNR values for fat suppression techniques was significant., Conclusion: The Dixon technique exhibited higher image quality and fat suppression efficiency than the hybrid techniques in the MR imaging of the inner ear., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Intrathyroidal ectopic thymus (IET) can be misdiagnosed as thyroid nodules., Purpose: The purpose of this study is to evaluate the sonoelastographic findings of IET in pediatric population., Methods: Twelve children who had been examined with ultrasound (US) and strain elastography between December 2012 and December 2019 were included in this retrospective study. The patients' demographics and ultrasonographic findings, including the location, margin, shape, diameters, volume, structure, vascularity, and elastography values of the lesions were evaluated., Results: Twelve lesions were detected in 12 asymptomatic patients (3 females and 9 males) with a mean age of 4.67 ± 2.27 years. The most common location of the IET was in posterior part and middle third of thyroid, and the most common appearance on US was a well-defined, ovoid-shaped, and predominantly hypoechoic solid lesion with punctate/linear branching hyperechogenities. The lesions were mostly hypovascular on Doppler US. The mean strain ratio on elastography was found to be 1.10 ± 0.04. In the follow-up of 7 patients with available information, there was no significant change in size or appearance of IET on US., Conclusion: IET should be considered in the differential diagnosis of the lesions within the thyroid. The first step to accurately diagnose an IET is to consider it in the differential diagnosis. In addition to US, strain elastography findings can be used to distinguish IETs from papillary thyroid cancers which can have similar US appearance, and help avoid unnecessary biopsies., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: To assess the prognostic value of pneumonia severity score (PSS), pectoralis muscle area (PMA), and index (PMI) on chest computed tomography (CT) in adult coronavirus disease 2019 (COVID-19) patients., Method: The chest CT images of COVID-19 patients were evaluated for the PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. The cross-sectional areas of the pectoralis muscles (PMA, cm 2 ) were also measured automatically on axial CT images, and PMI was calculated as the following formula: PMI = PMA / patient's height square (m 2 ). The relationship between clinical variables, PSS, PMA, sex-specific PMI values, and patient outcomes (intubation, prolonged hospital stay, and death) were investigated using multivariable logistic regression analysis. All patients were followed for more than a month., Results: One-hundred thirty patients (76 males, 58.46 %) were included in the study. Fifteen patients (11.54 %) were intubated, 24 patients (18.46 %) had prolonged hospital stay, and eight patients (6.15 %) died during follow-up. Patients with comorbidity had a higher mean of PSS (6.3 + 4.5 vs 3.9 + 3.8; p = 0.001). After adjusting the confounders, PSS was an independent predictor of intubation (adjusted Odds Ratio [OR]: 1.73, 95 % CI 1.31-2.28, p < 0.001), prolonged hospital stay (OR: 1.20, 95 % CI 1.09-1.33, p < 0.001), and death (OR: 2.13, 95 % CI 1.1-4.13, p = 0.026. PMI value was a predictor of prolonged hospital stay (OR: 0.83, 95 % CI 0.72-0.96, p = 0.038) and death (OR: 0.53, 95 % CI 0.29-0.96, p = 0.036). Incrementally increasing PMA value was a predictor of prolonged hospital stay (OR: 0.93, 95 % CI 0.89-0.98, p = 0.01) and intubation (OR: 0.98, 95 % CI 0.96-1, p = 0.036)., Conclusion: PSS, PMA, and PMI values have prognostic value in adult COVID-19 patients and can be easily assessed on chest CT images., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Non-thrombotic pulmonary embolism (NTPE) results from the embolization of non-thrombotic materials. It can often be a challenging diagnosis due to non-specific (similar to thrombotic pulmonary embolism) or uncommon clinical and imaging findings. Patients with NTPE often present to the emergency department with acute respiratory distress, and contrast-enhanced computed tomography (CT) of the chest and CT pulmonary angiography are the imaging modalities of choice for respiratory distress. Since the treatment of NTPE is entirely different from thromboembolism, its distinction is essential. Moreover, early diagnosis of NTPE is necessary. Radiologists must be familiar with the diagnostic findings of NTPE, and this article aims to review the imaging features of various causes of NTPE.

Background: Developmental venous anomalies (DVAs) can be determined on magnetic resonance imaging (MRI), and they may be associated with multiple sclerosis (MS) lesions., Purpose: The objective was to evaluate the MRI findings of DVAs in the brain, to compare the prevalence of them between MS patients and control subjects, and to investigate the correlation of DVA-associated fluid-attenuated inversion recovery (FLAIR) hyperintensities and MRI-derived parameters between MS patients and control subjects having DVA., Methods: Total 160 patients with a mean age of 45 ± 16 years who underwent multiparametric MRI including susceptibility-weighted imaging (SWI), diffusion-weighted imaging, 3D FLAIR, and contrast-enhanced imaging were included in this retrospective study. First, the presence of DVA was compared between the MS and control groups using the Chi-square test. Then, among the subjects having DVA, age, gender, and MRI-derived parameters such as the signal increase of DVA on FLAIR, location, and drainage of DVA were compared between the MS and control groups using Chi-square test., Results: The presence of DVA did not differ between the MS and control groups (P = 0.828). Signal increase around DVA on FLAIR (P = 0.03) and the age of less than 45 years demonstrated a significant correlation with MS group (P = 0.022)., Conclusion: In our study, DVAs were effectively detected using SWI and 3D contrast-enhanced T1-weighted imaging on MRI. The signal increase of DVA was better revealed on 3D FLAIR on MRI, and it was the only significant MRI-derived parameter in patients with MS., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Aim: To retrospectively evaluate the overall survival (OS) of patients with brain metastases (BMs) who had been treated with whole brain radiotherapy (WBRT) and Gamma Knife (GK) according to prognostic factors and prognostic index scores., Material and Methods: The study included 91 patients with BMs who had been treated with WBRT and/or GK between 2014 and 2017. The patients with BMs were retrospectively evaluated regarding age, sex, Karnofsky Performance Status (KPS), recursive partitioning analysis (RPA) class, basic score for BM (BS-BM), Graded Prognostic Assessment (DS-GPA) index, primary tumour type, extracranial metastases, primary tumour control, number of BMs, and brain metastasectomy. A univariate analysis of the OS was performed using the Kaplan-Meier method, supplemented by the log-rank test. We also applied a multivariate survival analysis using the Cox regression model., Results: The median OS for all patients with BMs was 6 months. Meanwhile, the median OSs for those with WBRT, GK, and WBRT-GK treatment were 6, 4, and 15 months, respectively (p=0.00). In the multivariate analysis, the female sex (p=0.030), brain metastasectomy (p=0.047), treatment with WBRT-GK (p=0.001), and the controlled primary tumour (p=0.007) significantly correlated with the OS. Furthermore, the BS-BM (p=0.022) was closely related with the OS compared to the RPA and DS-GPA in the multivariate analysis., Conclusion: The BS-BM was found to better predict the survival of patients with BMs according to the prognostic index scores in the multivariate analysis. Thus, our data suggest that the BS-BM is the most appropriate prognostic index.

Purpose: The aim of this study was to find the prevalence of emissary veins and to compare the visibility of these emissary veins with the anatomic variations of the dural venous sinuses detected in magnetic resonance venography (MRV)., Materials and Methods: All MR images of two hundred twenty patients were evaluated retrospectively. Posterior cranial fossa emissary veins diameter measurements were performed in the axial plane. The anatomic variations of the venous sinuses in MRVs of all patients were recorded. Accordingly, the presence of the emissary veins was compared with the dural venous sinus anatomic variations. p < 0.05 was considered statistically significant. An inter-observer reliability analysis was performed., Results: The prevalence of emissary veins in MRI was found in the right mastoid emissary vein (MEV) 82.7% and left MEV 81.4%. Occipital emissary vein (OEV) was present in 63 patients (28.6%) for the first radiologist (R1), and it was present in 61 patients (27.7%) for the second radiologist (R2) (K = 0.978). A statistically significant correlation was detected between the diameter of the left MEV and gender (p < 0.05) for both radiologists. There was a statistically significant difference between the left MEV and OEV and transverse sinus anatomic variations., Conclusion: MR imaging is a noninvasive and irradiating imaging method for detecting posterior fossa major emissary veins, and we recommend using MR imaging for preoperative evaluation of posterior fossa major emissary veins and related dural venous sinuses.

Sex determination is a major area of investigation in forensic anthropology. As technology has advanced, imaging methods such as computed tomography and magnetic resonance imaging are being investigated as alternatives to conventional forensic anthropological research techniques. This study aimed to investigate the suitability of three-dimensional (3D) modeling of volumetric cranial computed tomography (CCT) images for sex estimation from skull morphology. In this study, CCT angiography images from the Department of Radiology 2017 archives were used retrospectively, and 3D images were obtained after the reconstruction of 85 cases of CCT images. The sex-dependent morphological characteristics of the skull were evaluated by three blinded observers and scored on a scale of 1-5 points according to the "Standards for Data Collection from Human Skeletal Remains". The accurate sex estimation rates of the first, second and third observers were 91.8, 92.9 and 92.9%, respectively. The rate of accurate sex estimation for males was 98-100%, while this rate varied between 83.3-86.1% for females. Consistency in sex estimation between the three observers was 83.5%, with a Kappa value of 0.763 (z = 12.2; p = 0.0001*). The glabella was the most effective morphological trait used to estimate sex. The results of this study show that sex can be estimated from morphological features in volume-rendered CCT 3D images. Thus, sex can be estimated by digital images without the need for maceration processes, and the transfer of digital data in place of physical material will make it possible to gain expert opinions in forensic anthropology.

Trevor's disease, also known as dysplasia epiphysealis hemimelica, is a rare nonhereditary skeletal development disorder that affects epiphyses. This type of dysplastic lesion was first reported by Mouchet and Berlot in 1926 under the name 'tarsomegaly'. The main aim of this study is to raise awareness of Trevor's disease among orthopedic surgeons and underline some important aspects of treatment by a detailed presentation of four different possible manifestations of the disease. Four different treatment methods were used on four different patients (three localized in hindfoot ankle region and one classic Trevor's disease case). Treatment methods, localization of the sides involved, different characteristics of entire lower extremity, asymetry, distal femoral lateral epiphysis involvement, and hip involvement were analyzed thoroughly and the results were compared with those found in the most recent literature. Of our four patients, three were localized (hind foot ankle) cases and one was a classic dysplasia epiphysealis hemimelica with hemimelic distribution of the entire lower extremity. We used arthroscopic resection, observation, excision, and temporary hemiepiphysiodesis treatment methods in each of our cases. Clinical follow-up results were reported to be between good and excellent. In sum, our opinion is that the treatment for this condition should be customized according to lesion localization and lesion size. Majority of cases with ankle involvement show good prognosis following excision. Observation is also an alternative in patients who refuse surgery. If an intra-articular lesion is present, the surgeon should perform an arthroscopy for assessment of lesion surface. If the lesion is adapted to the joint curvature, it should be left alone and hemiepiphysiodesis should be considered for correction. The most risky involvements that are related to deformities and limb-length discrepancies are the hip and the knee. This is usually the result of corrective osteotomy targeted at the supracondylar femoral area in immature skeletons. Hemiepiphysiodesis might be a more feasible option in those cases as it provides the surgeon with the choice to remove the staples when necessary.

We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia).

The painful os peroneum syndrome is widely recognized. It is often the result of trauma. However degenerative changes between the os peroneum and the articular facet is much rarer and we could only find two other case reports in the literature. This report concerns a middle aged woman with chronic plantar-lateral foot pain and a limp secondary to degenerative changes between the os peroneum and its articular facet with cuboid. The aim of this study is to remind to orthopaedic surgeons about painful os peroneum syndrome and to highlight the rarity of our case. In our case the mid term result of the excision of the os peroneum with painful articulation appear good, providing symptomatic pain relief with little alteration in the function of the foot., (Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.). We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.

Fractures that split the humeral head are extremely rare, and usually, the split part is posteriorly dislocated. However, in our case, the split part was anteriorly dislocated and trapped between the anterior glenoid and the subscapularis muscle. In this case, the acquisition of preoperative CT results was vital to plan the exposure and reduction strategies. Open anatomic reduction and internal fixation should be considered as the first treatment of choice in young active adults., (2014 BMJ Publishing Group Ltd.)

Popliteal artery entrapment syndrome (PAES) is rare in young adults. Claudication of the young patient, which is often overlooked, is a very rare symptom for orthopedic surgeons. In elder patients, the physician might expect atherosclerotic claudication, however in young patients, popliteal artery entrapment syndrome (PAES) should be considered as a possibility in the cases of claudication. Here, an unusual presentation of an uncommon disease that is not widely known by orthopedic surgeons is reported.

Our patient was a 76-year-old female who has been operated on 2 times in 8 years for pelvic chondrosarcoma. The patient came to our clinic with a large mass in left iliac region which extended into the paravertebral area. Physical examination and preoperative imagining studies revealed a mass at the left iliac area that infiltrated sciatic notch and extended from posterior iliac region towards the anterior side of iliac bone through the sciatic notch and an incisional hernia including descending colon. The mass was also penetrating the abdominal cavity through the hernia. Surgical intervention was planned. Since the tumor infiltrated the sciatic nerve, hemipelvectomy was indicated. Patient refused hemipelvectomy. Therefore, palliative debulking surgery was considered. We treated the case with marginal excision and abdominal wall reconstruction employing prolene and vicryl suture materials in order to prevent a postoperative visceral herniation and local invasion. At the latest follow-up appointment in 2 years, the patient still had no signs of tumor recurrence. This case showed us that an incisional hernia can serve as a pathway for the recurrence invasion of the chondrosarcoma.

This report concerns an unusual cause of sciatica. The case presented is of a young man with myositis ossificans that resulted in sciatica and was treated with en bloc excision and low-dose radiotherapy and indomethacine. The aim of this study was to explain the different diagnostic properties of myositis ossificans around the hip and non-classic causes of sciatica.

This report concerns an unusual cause of anterior ankle impingement. The case of a young male with Trevor's disease mimicking an anterior spur of the ankle that resulted in anterior impingement and treated with ankle arthroscopy is presented. The aim of this study is to explain the different diagnostic properties of Trevor's disease from a classic anterior spur. Level of evidence IV.

We report a breast cancer patient with leptomeningeal carcinomatosis (LM) who showed an excellent objective and subjective response to letrozole, with a progression-free survival of 16 months. We think that despite the poor prognosis and short survival of patients with LM, early diagnosis and treatment with appropriate hormonal manipulation may improve the outcome and achieve prolonged palliation in selected hormone-positive breast cancer patients with LM. Possible clues predicting the response were also evaluated in the context of literature data.