Background and Purpose: This study aimed to assess the sensitivity and specificity of brain stem morphologic changes to differentiate the progressive supranuclear palsy (PSP) from Parkinson disease (PD) and multiple system atrophy (MSA), by single and combined magnetic resonance imaging (MRI) measurements. Materials and Methods: Peduncle angle (PA), pons area (P), mesencephalon area (M), middle cerebellar peduncles (MCPs), and superior cerebellar peduncles (SCPs) were measured in 14 PSP, 43 PD, 8 MSA patients, and 45 age-matched control participants on T1-weighted MRI. Neurologists clinically diagnosed all patients. Additionally, P/M ratio, MCPs/SCPs ratio, the previously defined Magnetic Resonance Parkinsonism Index, MRPI: (P/M) · (MCP/SCP), and also the Akdeniz Index (AKI) that we termed were calculated, AKI: (P/M) · (PA/180). Two blinded radiologists evaluated all MR images and inter-/intraobserver variations were measured. Results: Both M and SCPs were significantly lower and P/M, MCPs/SCPs, and PA were significantly higher in PSP patients than the other groups ( P < .001). This significance was related to patients with PSP and PD. But all single measurements showed some overlapping values. Therefore, previously defined MRPI was calculated and shown to distinguish patients (negative predictive values: 92%, sensitivity: 78%, specificity: 82%). In this study, interobserver correlation (0.68) was found low for MRPI. Therefore, we identified a more practical index: the Akdeniz Index, which has same diagnostic power with MRPI and higher interobserver correlation (0.91). Conclusion: The Akdeniz Index identified in our study is a practical index with high diagnostic power and can reinforce radiological distinguishing of PSP and PD, which are clinically difficult to distinguish.
Purpose To measure the degree of fatty liver using non-contrast enhanced chest computed tomography (CT) and investigate its relationship with the severity and prognosis of coronavirus disease 2019 (COVID-19) in adult patients. Methods This retrospective study included consecutive patients who had been diagnosed with COVID-19 using real-time reverse-transcription polymerase chain reaction (RT-PCR) and subsequently underwent non-contrast enhanced chest CT between October 10 and December 10, 2020. Hepatic attenuation values were measured from Couinaud segments 2, 4, and 8 based on the CT images and the relationships between these values and the Pneumonia Severity Score (PSS), requirement of hospitalization, and the length of hospital and intensive care unit (ICU) stay were analyzed. Results The study included 414 patients (182 were female, 43.96%), among whom 106 (25.6%) were diagnosed with hepatosteatosis (HS). In the patients with HS, the PSS scores were higher (10.8 ± 4.96 vs. 8.07 ± 5.12; p < 0.001), and 69 (65%) received inpatient care. Moreover, the number of HS patients who received inpatient care was 1.99 (95% confidence interval (CI) 1.26–3.15, p < 0.003) times higher than that of the non-HS patients. No significant difference was found between the HS and non-HS patients with regard to the length of hospital or ICU stay. Conclusion HS can be easily evaluated using non-contrast enhanced chest CT in COVID-19 patients and can be used as a prognostic marker to determine the requirement of hospitalization.
PurposeTo investigate whether the initial maximum standardized uptake value (SUVmax) on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has a prognostic significance in metastatic lung adenocarcinoma.Patients and methodsSixty patients (24 females, mean age: 57.9±12 years) with metastatic stage lung adenocarcinoma who used erlotinib and underwent 18F-FDG PET/CT at the time of diagnosis between May 2010 and May 2014 were enrolled in this retrospective study. The patients were stratified according to the median SUVmax value, which was found as 11. Progression-free survival (PFS) rates for 3, 6, and 12 months were examined for SUVmax values and epidermal growth factor receptor (EGFR) mutation status.ResultsThe number of EGFR-sensitizing mutation positive/negative/unknown was 26/17/17, respectively, and the number of patients using erlotinib at first-line, second-line, and third-line therapy was 15, 31, and 14 consecutively. The PFS rates of EGFR mutation positive, negative, and unknown patients for 3 months were 73.1%, 35.3%, and 41.2% (P=0.026, odds ratio [OR]=4.39; 95% confidence interval [CI]: 1.45–13.26), respectively. The PFS rates of EGFR positive, negative, and unknown patients for 6 months were 50%, 29.4%, and 29.4% (P=0.267, OR: 2.4; 95% CI: 0.82–6.96), respectively. The PFS rates of EGFR positive, negative, and unknown patients for 12 months were 42.3%, 29.4%, 23.5% (P=0.408, OR: 2.0; 95% CI: 0.42–5.26), respectively. Thirty-one of 60 patients had SUVmax values ≤11. The PFS rates for 3, 6, and 12 months were 70.5%/28% (P=0.001, OR=9.0; 95% CI: 2.79–29.04), 61.7%/8% (P<0.001, OR=28.35; 95% CI: 5.5–143), and 52.9%/8% (P<0.001, OR=18.69; 95% CI: 3.76–92.9) for low SUVmax (≤11) group/high SUVmax (>11) group, respectively.ConclusionInitial SUVmax value on 18F-FDG PET/CT is found to be a prognostic factor anticipating the response to erlotinib for 3, 6, and 12-month rates of PFS in both EGFR-sensitizing mutation and wild-type tumor group.
Objective: The purpose of this study is to clarify which morphologic variations of the hip on MRI are associated with the development of ischiofemoral impingement. Methods: Hip MRI’s of patients who have been referred to our department between 2016-2017 were retrospectively reviewed and assessed for pathological signal changes in the quadratus femoris muscle and ipsilateral hip or buttock pain. After assessment ischial angle, inclination angle, ischiofemoral space, quadratus femoris space, intertuberous distances and femur neck angle, femoral torsion angle and knee angle were measured and compared in 37 hips of 20 patients and 56 hips of 28 age-gender matched control subjects. Results: There were statistically significant differences between the patient and control groups in all MRI parameters except for intertuberous distances (p<0.05). Quadratus femoris space (p<0.001) and ischiofemoral space (p<0.001) were significantly lower and femoral torsion angle (p=0.02), femur neck angle (p=0.001), ischial angle (p=0.01) and inclination angle (p=0.03) values were significantly higher in patients compared with the control group. Conclusion: Decreased ischiofemoral space and quadratus femoris space; increased femoral torsion angle, femur neck angle, ischial angle and inclination angle are found to be associated with IFI on MRI. These pelvic anatomical variations may predispose to ischiofemoral impingement and kept in mind for patients with hip pain.
OBJECTIVE Appendicitis typically develops secondary to obstruction of appendiceal lumen and one of the causes of obstruction is appendicolith. Appendicolith has become a relevant issue due to heightened interest in the treatment of uncomplicated appendicitis with antibiotics. This study aimed to determine the prevalence of appendicolith in pediatric patients with appendicitis and to investigate the association between the presence of appendicoliths and radiological disease severity. METHODS Patients under the age of 18 diagnosed with appendicitis between March 2021 and April 2022 and had available preoperative computed tomography (CT) images were identified retrospectively. The presence of an appendicolith and if present, its longest diameter in the axial plane, its visibility on direct radiographs, appendiceal diameter, degree of inflammation, and the presence of perforation were evaluated. Radiological severity of inflammation was rated on a 3-point scale. RESULTS CT scans were available in 77 (32.1%) of 240 patients with histopathologically confirmed diagnosis of acute appendicitis. 39% (n=30) of the patients were girls and the median age was 13 years. The prevalence of appendicoliths detected on CT scans was 32.5% (n=25) and the median size of appendicoliths was 6 mm. In only 1 patient, appendicolith was detected by direct radiography. The median appendiceal diameter was significantly greater in the group with appendicoliths (10 mm vs. 8 mm; p=0.001). A moderate correlation was found between appendicolith size and appendiceal diameter (r=0.407, p=0.043). Perforation was present in 10.4% (n=8) of the patients with appendicitis and 25% (n=2) of them had appendicoliths. The presence of appendicoliths was not significantly associated with the occurrence of perforation (p=0.485). Periappendiceal inflammation scores were 1.52±0.74 in the group with appendicoliths and 1.42±0.63 in the group without appendicoliths (p=0.591). CONCLUSION The prevalence of CT-detected appendicoliths was 32.5% in pediatric patients with appendicitis. Patients with appendicoliths showed higher inflammation scores and greater appendiceal diameter than those without appendicoliths. These factors may be associated with poor outcomes in patients with appendicoliths treated with antibiotics. Therefore, knowledge of the prevalence of appendicoliths and questioning their presence may guide clinicians when deciding on the suitability of nonoperative treatment in a patient diagnosed with uncomplicated acute appendicitis.
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