Rationale and Objectives: Cystic lung disease may be accurately diagnosed by imaging interpretation of specialist radiologists, without other information. We hypothesized that with minimal training non-specialists could perform similarly to specialist physicians in the diagnosis of cystic lung disease. Methods: 72 cystic lung disease cases and 25 cystic lung disease mimics were obtained from three sources: 1) a prospective acquired diffuse lung disease registry, 2) a retrospective search of medical records and 3) teaching files. Cases were anonymized, randomized and interpreted by 7 diffuse lung disease specialists and 15 non-specialist radiologists and pulmonologists. Clinical information other than age and sex was not provided. Prior to interpretation, non-specialists viewed a short PDF training document explaining cystic lung disease interpretation. Results: Correct first choice diagnosis of 85% -88% may be achieved by high-performing specialist readers and 71% -80% by non-specialists and lower-performing specialists, with mean accuracies in the diagnosis of LAM (91%, p < 0.0001), BHD (93%, p < 0.0001), PLCH (89%, p < 0.0001) and LIP (92%, p < 0.0001). A strategy based on cyst appearance: simple cysts (LAM), peri-septal cysts (BHD), bizarre-shaped cysts (PLCH) and vascular indented cysts (LIP) gave non-specialists accuracies of 90% (p < 0.0001), 94% (p < 0.0001

Aim In this study, we aimed to compare the strain (SE) and shear wave elastography (SWE) findings of the quadriceps tendons (QT) of the patients with chronic kidney disease (CKD) and healthy volunteers (HV), and estimate the reliability of the evaluations. Materials and Methods Twenty‐nine HV and twenty‐seven patients with CKD were enrolled. All sonoelastographic examinations were performed separately by two observers. The QT thickness (QTT), SWE, and SE findings including the tissue elastic modulus (EM), shear wave velocity (SWV), and the elasticity patterns were obtained and compared. Interobserver agreement was evaluated to test the reliability of the findings. Results The QT in CKD patients is thinner than HV (p = 0.001 for both observers). The elasticity patterns of QT were mostly intermediate stiffness for both observers (p < 0.05 for both observers). The mean EM values in the patient group were significantly higher than HV for both observers (p < 0.05 for both observers). The mean SWVs were significantly higher in the patient group (p < 0.05 for both observers). SWV showed weak, significant, and negative correlations with the hemodialysis (HD) duration (p < 0.05 for both observers). The interobserver agreements were moderate to excellent for QTT, EM, SWS, and SE patterns (p < 0.01 for all parameters). Conclusion QTT and its elasticity are decreased in patients with CKD. The QTT and SE patterns may be the choice to determine the elasticity in CKD patients with good reliability values rather than SWE. But, there is still debate on the reliability of sonoelastographic findings, to ensure standardization of the factors affecting reliability, they should be well understood.

Background. Internal carotid artery dissection (ICAD) is a rare but potentially devastating complication after trauma in the pediatric age group. The diagnosis of traumatic dissection is difficult and is usually recognized only when ischemic symptoms appear. We report a pediatric patient with ICAD due to blunt cerebrovascular injury (BCVI). Case. A 14-year-old boy suffered major trauma due to a motor vehicle accident. When the first aid team reached the accident site, he was intubated because of his low Glasgow Coma Score (GCS) and then transported to the nearest emergency department. Cranial computed tomography (CT) showed multiple fractures at the skull base and independent bone fragments in both carotid canals. On the 6th day; a brain magnetic resonance imaging (MRI) was performed to detect diffuse axonal injury. There was a loss of signal in the left internal carotid artery (LICA) tract but the limitation of diffusion was not associated with the same side, conversely there was a limitation of diffusion on the other side, affecting a very large area. CT angiography was performed in order to detect a filling defect and showed dissection in the LICA. The patient did not have any specific neurological symptoms associated with ICAD. Low-dose aspirin was utilized as anticoagulant therapy. On the 25th day of admission, the patient`s GCS was 14, neurologic examination showed no difference between the right and left sides. He was discharged on the 55th day of the accident and was walking without support. Conclusion. Our patient was a rare case in pediatrics due to having a clinically silent form of ICAD. It is very difficult to diagnose ICAD dissection during the early phase in cases with BCVI accompanied by multiple trauma. Even in the absence of typical neurological deficit, the possible presence of ICAD should be explored in patients with cranial fractures encompassing the skull base.

Objective: Kidney damage caused by type 2 diabetes mellitus (T2DM) can reduce renal elasticity. Limited number of data exist indicating whether early kidney damage causes stiffening of renal tissue. This comparative study aims to assess kidney elasticity in T2DM patients with or without moderate albuminuria, using ultrasound-based two-dimensional shear wave velocity (2D-SWV) measurements. Methods: Fifty-seven cases (40 T2D patients with stage 1 or 2 chronic kidney disease and 17 age- and sex-matched healthy controls) were included in this single-center prospective study. The T2DM patients were divided into those with moderate albuminuria (n=22) and those without albuminuria (n=18). Bilateral renal parenchymal 2D-SWV values were measured (separately) in the upper, middle, and lower kidney regions. Group data were compared using the t-test or Mann-Whitney-U test (whichever appropriate). Inter-observer agreement was assessed by deriving the intra-class correlation coefficient. Results: There was no difference between the T2DM and control groups in terms of the median age [55.5 (50-62) vs. 55 (48.5-59.5) years, p=0.48] and sex ratio [18 (45%) males vs. 10 (58.8%) females, p=0.34]. The average regional 2D-SWV values were all similar between the groups (all p>0.05). The average 2D-SWV values were similar between the subgroups with and without albuminuria. The inter-observer agreement was good (intra-class correlation coefficient=0.66, 95% CI 0.19-0.88, p=0.006). Conclusion: Kidney elasticity does not seem to be compromised in patients with diabetes and preserved estimated glomerular filtration rate with or without moderate albuminuria

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Background: Thyroid ultrasonography is the first and perhaps most fundamental step for the radiological distinction of benign and malignant nodules. In this study, 2 radiologists reviewed the sonoelastographic and Doppler images of thyroid nodules and evaluated for the intraobserver and interobserver reliability. Purpose: We aimed to determine confusing nodule identifiers and sonographic features differently defined by observers. Methods: A total of 157 nodules in 91 patients (male/female, 72:19) with ages ranging from 18 to 72 years old were included in the study. Ultrasonographic images and video clips of the nodules were obtained and presented to 2 reviewers unaware of the cytopathology results. Two observers defined the characteristics of the nodules based on previously determined criteria. Then, intraobserver and interobserver correlation coefficients were calculated for each subcategory. Results: In the grayscale ultrasonographic examination, varying degrees from low to high interobserver correlation coefficients were obtained for different subcategories (between κ = 0.359 and κ = 0.821). In color Doppler examination, we obtained medium correlation coefficients (κ = 0.493 and κ = 0.553). On the other hand, there was a high correlation coefficient in tissue compression elastography (κ = 0.617 and κ = 0.638). According to our study results, elastographic pattern, shape of the nodule, presence of echogenic foci, and pathological lymph nodes are better predictors to determine the malignant potential of thyroid nodule with higher interobserver correlation. Therefore, these criteria may be used primarily for the evaluation of thyroid nodules. The intraobserver correlation coefficient was higher in the practitioner with longer experience, suggesting the importance of professional practice period on the decisionmaking process.

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