Quantitative Ultrasound Elastography of Breast: A Review and Update with Emphasis on Shear Wave Imaging (ARFI)

Elastography is a method which determines the stiffness of tissues with the help of ultrasound technology and exhibits more quantitative data according to palpation that made during physical examination. Elastography has relatively entered to routine use in the breast evaluation with imaging techniques. Although palpation has a very long history, elastography has been used since 1990s. Elastography is used as an adjunct to conventional gray scale ultrasound and can identify the stiffness of the tissues non-invasively. Today, it is used as two separate technological modalities: strain elastography and shear wave elastography. The aims of these modalities are to increase the sensitivity of the separation between malignant and benign lesions, reduce the unnecessary biopsy processes and to provide a more accurate Breast Imaging Reporting and Data System (BIRADS) categorization of the breast lesions. In this article, we aimed to review the clinical utilization and benefits of elastography in differantial diagnosis of breast lesions, BIRADS categorization, and biopsy decision making in the light of current literature.

Diffusion Tensor Imaging without Complex Statistical Analysis Could Be Helpful for Diagnosis

Objective: Thanks to fast developing technology, visualization of fiber tracts at brain is possible. But with the new developments, data processing and interpretation are becoming more difficult. Actually interpretations in these fields are mostly in-group analysis and are generally not useful on the basis of individual patient evaluations. In these regards, we investigated our cases with diffusion tensor imaging (DTI) and tried to show if the data could be interpreted simply by radiologist’s eye or not. Material: Our study consisted of 31 cases that were evaluated in our center with 3 Tesla Magnetic Resonance Imaging (MRI) units. Cranial DTI studies performed for ischemia, posttraumatic axonal injury, congenital malformation, neoplasia, autism, mental retardation and epilepsy. Cranial DTI was performed to demonstrate effected fiber tracts in neoplasia and ischemia cases and was applied to identify any gross anomaly in microstructural anatomy beside normal conventional MRI in other cases. DTI images were evaluated, along with fused conventional T1 weighted 3D high-resolution images and FA maps. DTI were performed at the first administration of the patients. Results: In addition to chronic ischemic focuses in patients with ischemia, DTI-FA images showed us relevant signal changes secondary to Wallerian degeneration in two cases. In traumatic brain injury cases, though being isointense on conventional sequences, FA values showed decreased values at the levels of the axonal discontinuity. Major abnormalities of association and projection fibers in congenital malformation cases were visualized at both 3D-DTI fused images and FA map images. Displacement, infiltration, destruction fibers were clearly visualized in neoplasia cases. However, any objective abnormality wasn’t reported at any cases diagnosed with motor mental retardation, epilepsy or neuropsychiatric diseases. Conclusion: Colored DTI images and FA maps are helpful in the way of diagnosis in most cases with organic pathologies;it is possible to obtain diagnostic information by vivacious images.

Power Doppler Vocal Fremitus Breast Sonography: Differential Diagnosis with a New Classification Scheme—Power Doppler Vocal Fremitus Examination of Breast Lesions

Purpose: In this study, unlike the previous studies, and Power Doppler vocal fremitus test (PDVFT) is utilized and is evaluated in subcategories to assess its role in the differentiation of benign and malignant lesions. Materials and Methods Thorough the 161 lesions of 147 patients are included in this prospective study. During PDVFT, it is determined that eight different fremitus patterns have broken out according to the colour aliasing during patient’s vocal phonation. It is also grouped as, according to the lesion color aliasing pattern during vibration: (c) for central, (p) for peripheral, (d) for perilesional-desmoplastic, (e) for eccentric, (h) for heterogenous-hierarchic, (s) for septal, (t) for total, (z) for absent-zero. Thereafter, the patterns and histopathological results of the lesions are correlated and analysed statistically. Results Out of 161 lesions, (benign: 133 and malignant, 28 cases) totally 189 patterns are encountered. None of the patterns z, t, s or e was detected in any of the malignant lesions. Specific values for different patterns have been obtained which changing between 29% and 100%. After adding the PDVFT finding, the newly generated BIRADS scheme has the accuracy value as high 91%. Conclusion When it is classified according to the colour aliasing pattern(s) of lesion in PDVFT;the “p” pattern is seen about the same ratio in both malign lesion and benign lesion (nonspecific patterns);“c, d, h” patterns mostly related with malignancy, whereas “e, s, t, z” patterns related with benignity. With adding the PDVFT findings;accuracy of well known BIRADS categorization and lesion demarcation were also improved successfully.

Quantified Magnetic Resonance Spectroscopy in the Diagnosis of Burning Mouth Syndrome

Purpose: To investigate potential pathological differences in major brain metabolites in burning mouth syndrome (BMS). Materials and Methods: We prospectively evaluated eight patients and six healthy controls with single voxel magnetic resonance (MR) spectroscopy throughout 2017 using 3-Tesla MR unit. Metabolite levels measured from the left posterior paracingulate white matter. Raw images were processed with Tarquin version 4.3.10 and area under curve values were automatically calculated for GABA (γ-Aminobutyric acid), Ins (myo-inositole), tNAA (N-Acetylaspartate), tCho (total choline), tCr (total creatine) and GLx (glutamine + Glutamat). Major metabolite levels and all metabolites ratio to tCr calculated and compared between two groups using Mann-Whitney U test. Results: GABA/tCR value of the patients (0.589 ± 0.194, median = 0.515) was significantly higher than control group (0.230 ± 0.067, median = 0.220) (P = 0.002). tNAA/tCR value of the patients (1.106 ± 0.218, median: 1.205), was significantly lower than the control group (1.538 ± 0.401, median: 1.705) (P = 0.028). No significant difference was observed between two groups in terms of all other metabolites (P > 0.05). Conclusion: We demonstrated increased GABA and decreased NAA in the left posterior paracingulate region in BMS patients. We suggest that these metabolite alterations in central nervous system might play a key role in the etiology of the disease by inhibiting the suppression of burning sensation.

Nasal Cavity Masses:Clinico-Radiologic Collaborations,Differential Diagnosis by Special Clues

Purpose: Nasal cavity may contain wide variety of masses within, that differs this organ from the rest of the body. Primary nasal cavity masses consist of 0.2% - 0.8% of all malignancies. This paper aims to emphasize the main characteristics of different nasal cavity masses on cross-sectional images which may cause symptoms varying from simple nasal obstruction to metastatic invasion. We tried to solve the diagnostic bias by focusing on the special clues with the aid of the striking images caused by the same appearence of nasal cavity masses on cross-sectional radiologic images. Materials and Method: 66 retrospective dataset of patients (male: 35, female: 31, mean age: 43 years) were reviewed by the cross-sectional images. All cases had nasal passage obstruction and all cases had previously undergone maxillofacial imaging (computerized tomography, CT (n = 43);magnetic resonance imaging, MRI (n = 21);positron emmision tomography, PET/CT (n = 2)). Results: Totally, 48 benign and 18 malignant cases which have distinct pathologies were reviewed. All the lesions occupying space through the nasal cavity were demonstrated on cross-sectional images. With the typical cross-sectional images, an algoritm was made to help the differential diagnosis and presented as a scheme to presume the most feasible diagnosis. Conclusion: Sinunasal masses may have the worst prognosis on late diagnosis because of the probability of early invasion of the basicranial structures or cranial nerves. Verification of the neoplasm by the specific cross-sectional images, either benign or malignant, could be done at once.

A practical approach to imaging characteristics and standardized reporting of COVID-19:A radiologic review

Novel coronavirus(2019-nCoV),also known as severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),is a pathogen that has caused a rapidly spreading pandemic all over the world.The primary mean of transmission is inhalation with a predilection for respiratory system involvement,especially in the distal airways.The disease that arises from this novel coronavirus is named coronavirus disease 2019(COVID-19).COVID-19 may have a rapid and devastating course in some cases leading to severe complications and death.Radiological imaging methods have an invaluable role in diagnosis,follow-up,and treatment.In this review,radiological imaging findings of COVID-19 have been systematically reviewed based on the published literature so far.Radiologic reporting templates are also emphasized from a different point of view,considering specific distinctive patterns of involvement.

Current Radiological Approach in Thyroid Nodules

The aim of this paper is to review the radiological evaluation of thyroid nodules detected with ultrasonography (US), thoroughly and in harmony with the clinical-endocrinological-surgical management. In this review, we tried to summarize the radiological evaluation of nodules detected in the thyroid in compliance with recently published and accepted guidelines, including the most advanced sonographic protocols, emphasizing the indications of cross-sectional imaging when needed. In this review important aspects were demonstrated with tables, illustrations and take-home points and technical aspects were emphasized with images and diagrams. We believe that this review, which is concluded with an extensive summary with the support of most recent sources, is an up-to-date and comprehensive evaluation of the broad spectrum of thyroid nodule radiology. We think that the management of any kind of nodule that can be encountered during the US examination can be done successfully by going through the paths described in the pictures, tables and texts in this article.

Differentiation of malignant and benign lesions of the osseous spinal axis with three dimensional computed tomography image appearences: dirty interface sign

Purpose: We aimed to make a fast and accurate distinction of malignant and benign lesions in cases with predominantly solitary or multifocal involvement using latest technology software and hardware systems in computed tomography. Materials and Methods: 53 cases were included in the study. Primary (n = 42, 31 benign, 11 malignant) or metastatic (n = 11) tumors were detected at various locations in the bone structure of the cervical to coccygeal vertebrae in all cases. 3D CT images taken using the same system and biopsy or post-operative histopathology findings were available for all cases. Thin section images taken retrospectively from the archives were converted to 3D images using the same program and parameters, which were then recorded in the same window settings by two radiologists. Only 3D images were then analyzed to investigate the presence or absence of the dirty interface sign. Results: Dirty interface sign was present in 17 malignant lesions and absent in the remaining 5 lesions. As for benign lesions, the sign was present in only two lesions and the remaining 29 were negative for the sign. There was a high level of consistency between the two radiologists. In conclusion, malignant and benign lesions affecting the bone spinal axis were distinguished based on the presence or absence of the dirty interface sign with 77.3% sensitivity, 93.5% specificity and 86.8% accuracy. Conclusion: When evaluated with standard bone window views, 3D views can be used successfully for the distinction of malignant and benign bone tumors. At least, 3D views generated using low dose regimes in highly developed systems can be used with similar purpose to that of diffusion weighted MRI sequences that give roughly outlined but fast and accurate information about the lesion.

Determination of Metastatic Axillary Lymph Node in Breast Cancer: Differentiation with Dynamic MRI Examination by Signal Intensity-Time Curves

Purpose: We aimed to evaluate the role of dynamic magnetic resonance imaging (MRI) in the detection of axillary lymph node metastasis based on the signal intensity-time curves. Materials and Methods: The data of 120 patients (benign patients, n = 91;malignant patients, n = 29) who underwent dynamic breast MRI were reviewed. The lymph nodes with the strongest criteria for malignancy (morphological-dynamic properties) were included in the analysis. Signal intensity-time curves were plotted by the software. Results: Of 29 patients with breast cancer, axillary lymph nodes were involved in 21 and not involved in the remaining 8. There was no significant difference between benign and malignant cases in terms of the distributions of Type Ia, Type Ib and Type IV curves (p = 0.12), whereas a significant difference was found between benign and malignant cases in terms of the distributions of Type II and III curves (p Conclusion: On dynamic MRI studies, benign and metastatic lymph nodes display different signal intensity-time curves.

The Relationship between Dental Indentation and Maxillary Sinusitis

Purpose: To determine the relationship between the dental root indentation and maxillary sinusitis. Methods: We assessed the records of the patients who underwent paranasal sinus computed tomography imaging for suspected sinusitis. Results: We identified a total of 52 patients with a pre-diagnosis of maxillary sinusitis. Dental indentation was detected in 58 of 104 (55.7%) sinuses. Forty six of 58 sinuses (79.3%) with dental indentation had mucosal thickening higher than 2 mm. The difference between the groups was statistically significant (p = 0.007). Conclusion: Dental indentation should be kept in mind as a reason for chronic maxillary sinus inflammation, if an underlying cause cannot be identified.

Differentiation of Exophytic Renal Masses with Determination of the Angular Interface with Renal Parenchyma in US and CT

Purpose: To determine whether benign exophytic renal masses can be distinguished from malignant lesions by using the angular interface sign in ultrasonography (US) and computerized tomography (CT). Materials and Methods: A total of 71 cases with exophytic renal mass (2 cm or greater) were examined on the basis of angular interface in US (n = 23), CT (n = 21) and US + CT (n = 16) between January 2008 and June 2010 were included in this study. The renal interface relationships were examined by 2 radiologists and classified as having angular or wide interface. Results: No statistically significant difference was found between the findings of two readers. There was almost perfect interobserver agreement for the interface sign. For cystic lesions, the angular interface sign was determined in all but two Bosniak category 1 cases. Also, the angular interface sign was positive in all but one Bosniak category 2 - 3. For cystic lesions with solid component and pure solid lesions, in the benign group, the angular interface sign was positive in all except three cases (vascular malformation, oncocytoma and Xanthogranulomatous pyelonephritis). In the malignant group, the angular interface sign was determined in only two RCC cases;in other primary or metastatic malignant lesions there was a wide interface sign. Conclusion: Exophytic renal masses can be differentiated as malignant or benign with 87% accuracy using only the angular interface sign in US or CT and also in opposition to dynamic-contrast examinations. This method entails a lack of additional radiation or contrast media exposure, time-saving, and costeffectivity.

Cranial Magnetic Resonance Spectroscopy: An Update of Metabolites and a Special Emphasis on Practical Points

Magnetic resonance spectroscopy (MRS) could be used for dozens of metabolites [1]. In this paper we will focus especially on proton (hydrogen) MRS. Generally published literatures consist of reviews and articles about metabolites are long, complicated and emphasise on physical or on technical data. But with this article, we will try to explain basically how MRS could be used in daily practice of radiologists. First of all we tried to search all current literature only referencing the main ones to make this review and we want all of our colleagues to give feedback about this review. With collection of all these trick points and line up to appropriate order, it is possible to make this review a common guide for radiologists and a useful tool while reporting MRS.