Tuba Selçuk Can

Purpose: This study aimed to evaluate the diagnostic performance of ultrasound attenuation imaging (USAT) in detecting and grading hepatosteatosis in obese pediatric patients, and to compare its findings with conventional B-mode ultrasonography and relevant laboratory parameters. Methods: This prospective cross-sectional study enrolled 95 obese or morbidly obese children aged 8 to 18 years who presented to a pediatric endocrinology clinic with a preliminary diagnosis of hepatosteatosis. All patients underwent both B-mode ultrasonography and USAT using the Mindray Resona9 device. Hepatosteatosis was graded using device-specific attenuation cutoff values for USAT and standard echogenicity-based criteria for B-mode ultrasonography. Laboratory parameters, including alanine aminotransferase (ALT), triglycerides (TG), and homeostasis model assessment of insulin resistance (HOMA-IR), were recorded for each patient. Results: USAT identified hepatosteatosis in 70 of 95 patients (73.7%), whereas B-mode ultrasonography detected steatosis in only 36 of 95 (37.9%). Among the 59 patients classified as steatosis-free by B-mode ultrasonography, USAT identified steatosis in 36 (61%; P P <0.05 for all). Conclusions: USAT is capable of detecting low-grade hepatic steatosis in obese children more effectively than conventional B-mode ultrasonography and shows significant correlations with key metabolic laboratory parameters. Given its objectivity, excellent reproducibility, and practical ease of use, routine incorporation of USAT alongside B-mode ultrasonography is warranted in the evaluation of hepatic steatosis in the pediatric population.

Reply: Does superb microvascular imaging reflect Hashimoto’s thyroiditis or thyroid functional status? - Diagnostic and Interventional Radiology

Background: Risk stratification for ventricular arrhythmias in hypertrophic cardiomyopathy (HCM) remains challenging, particularly in patients who do not fulfill conventional high-risk criteria. This study aimed to investigate the association between cardiovascular magnetic resonance (CMR)-derived phenotypic characteristics and non-sustained ventricular tachycardia (NSVT) in patients with HCM. Methods: A total of 69 consecutive patients with HCM who underwent comprehensive CMR imaging and 24 h Holter monitoring were retrospectively analyzed. CMR assessment included phenotypic characteristics of the left ventricle, mitral valve apparatus, and papillary muscles, as well as late gadolinium enhancement (LGE). Ventricular arrhythmic events were defined as the presence of a premature ventricular complex burden >10%, NSVT, and/or sustained ventricular tachycardia. Univariable logistic regression and multivariable Firth penalized logistic regression analyses were performed to identify variables associated with NSVT. Results: The study population had a mean age of 57.5 years, and 23 patients (33.3%) were female. Ventricular arrhythmic events were detected in 16 patients (23.1%), all of whom had NSVT. Median LGE burden was 4%. LGE was present in 43 patients (62.3%), including papillary muscle (PM)-LGE in 13 patients (19.0%). Anterolateral PM–septum systolic contact was observed in 7 patients (10.0%). In univariable analysis, maximal left ventricular wall thickness (OR 1.29, 95% CI 1.09–1.53; p = 0.004), abnormal chordal attachment (OR 5.56, 95% CI 1.09–28.19; p = 0.039), anterolateral PM mobility (OR 1.45 per 0.1-unit increase, 95% CI 1.10–1.91; p = 0.009), anterolateral PM–septum systolic contact (OR 31.20, 95% CI 3.38–288.0; p = 0.002), and PM-LGE (OR 9.60, 95% CI 2.50–36.84; p < 0.001) were associated with NSVT. In the four-variable Firth penalized logistic regression model, abnormal chordal attachment (OR 9.09, 95% CI 1.18–67.42; p = 0.036), anterolateral PM–septum systolic contact (OR 23.08, 95% CI 2.18–385.17; p = 0.008), and PM-LGE (OR 17.26, 95% CI 2.37–176.64; p = 0.004) remained associated with NSVT. Given the limited number of events, these multivariable findings should be considered exploratory. Conclusions: CMR-derived PM abnormalities were associated with NSVT in patients with HCM. In particular, PM-LGE, abnormal chordal attachment, and anterolateral PM–septum systolic contact emerged as exploratory CMR characteristics that warrant further evaluation in larger prospective studies.

This study aimed to examine and compare optic nerve elasticity (ONE) and optic nerve sheath diameter (ONSD) in amblyopic eyes and healthy fellow eyes. This prospective, observational study was conducted between October 2019 and December 2019. A total of 21 patients diagnosed with unilateral amblyopia were included in the study. The ONSD of both eyes of each patient was measured by ultrasonography, and ONE was measured by shear-wave elastography. The results were compared between healthy eyes and amblyopic eyes. Eleven female and 10 male patients were included in the study, and the median age of the patients was 25 (interquartile range [IQR]: 20–31) years. The mean ONSD of amblyopic eyes (2.37 ± 0.36) was significantly lower than that of healthy eyes (2.54 ± 0.39) ( P = .014). Although the median ONE value of the amblyopic eyes (2.73 [IQR = 1.52–3.84]) was higher than that of healthy eyes (2.63 [IQR = 1.70–4.65]), this difference was not significant ( P = .931). Mean ONSD values were significantly lower in amblyopic eyes compared with healthy fellow eyes, whereas no significant difference was observed in ONE values between the 2 groups. These findings suggest that reduced ONSD may represent a structural alteration associated with amblyopia. However, because of the cross-sectional design and limited sample size, the biological and clinical significance of these findings remains uncertain and requires further investigation in larger prospective studies.

Vascularity assessment in Hashimoto’s thyroiditis: a prospective comparative study with power Doppler and superb microvascular imaging - Diagnostic and Interventional Radiology

This study aimed to identify the phenotypic features contributing to the development of left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM) and to evaluate the genotype‒phenotype relationship. This cross-sectional study included 96 patients diagnosed with HCM (mean age: 56.9 ± 13.5 years, 32.3% female). The patients were divided into hypertrophic nonobstructive cardiomyopathy (HNCM; n = 60) and hypertrophic obstructive cardiomyopathy (HOCM; n = 36) groups. All patients underwent CMR. Patients (n = 77) who had previously provided formal approval underwent a genetic examination that included 18 genes. The anterior mitral leaflet (AML) length/LVOT diameter ratio, posterior mitral leaflet (PML) length/LVOT diameter ratio, and anterolateral papillary muscle (AL-PM) mobility were associated with LVOTO, independent of the basal IVS thickness, abnormal chordal attachment, and bifid PM. An AML length/LVOT diameter ratio of ≥ 2.30, a PML length/LVOT diameter ratio of ≥ 1.83, and an AL-PM mobility of ≥ 57.7% were predictors of LVOTO, with good sensitivity and specificity. Positive variants (VUS, LP, and P) were detected in 37.7% (29 of 77) of the patients who underwent genetic testing. The LP/P variant was detected in 20.8% (16 of 77) of patients. Three groups (variant-negative, VUS, and LP/P groups) had significant differences in the LVOT diameter (median 14, 12, and 10 mm, respectively; p = 0.021), AML length (mean 25.3, 26.5, and 27.5 mm, respectively; p = 0.029), AML length/LVOT diameter ratio (median 1.74, 2.33, and 2.85, respectively; p = 0.006), PML length/LVOT diameter ratio (median 1.29, 1.82, and 2.10, respectively; p = 0.045), and abnormal chordal attachment (6.3%, not observed, and 31.3%, respectively; p = 0.009). The AML length/LVOT diameter ratio, PML length/LVOT diameter ratio, and AL-PM mobility were associated with LVOTO. In addition, genetic testing results may provide information regarding the phenotypic expression of patients with HCM. Graphical Abstract

Purpose: In this study, we aimed to evaluate the differences in vascularity between the testis on the inguinal hernia (IH) side and the contralateral healthy testis by performing preoperative and postoperative (first month) examinations with superb microvascular imaging ultrasonography (SMI USG), and to compare results with power Doppler (PD) USG. Methods: In this prospective cohort study, 35 patients diagnosed with IH between April 2023 and July 2023 who were hospitalized in the general surgery ward of a tertiary hospital for IH surgery were evaluated. Results: The postoperative vascular index (VI) values obtained by SMI were found to be significantly lower than preoperative VI values in both operated and non‐operated testes ( p < 0.001). The VI values obtained with PD in the postoperative period were significantly lower in the operated and nonoperated testes on both sides compared with the VI values obtained in the preoperative period ( p < 0.001 and p = 0.029, respectively). There was a significant difference between preoperative and postoperative VI difference values obtained by SMI and PD on the operated side ( p = 0.015). Conclusion: In our study examining patients who had undergone IH surgery, testicular vascularity was assessed more precisely with the SMI USG method compared with the PD method.

Aim: For about a few years, COVID-19 infection has continued to play a significant role in our lives as a serious threat and concern with the increase in the number of cases. During this pandemic stage, chest CT has been proven to have great importance for rapid and accurate diagnosis and a pivotal role in assisting the clinical management of patients with uncertain clinical scenarios. Material and Methods: The present retrospective study aimed to inform the clinicians who referred chest CT and the radiologists reporting these CTs about the frequency and variety of non-COVID-19 findings in patients who underwent chest CT examination with the suspicion of COVID-19 pneumonia. This retrospective study was approved by our Institutional Ethics Committee. The requirement for written informed consent was waived. Our study included 6669 patients who applied to the emergency room with the suspicion of COVID-19 infection between March 20th and April 20th, 2020. The inclusion criteria were patients who had suspicious symptoms of having COVID-19 infection and/or had close contact with a patient with COVID-19 infection and (ii) patients who underwent chest CT. They evaluated CT scans individually, and all non-COVID-19 findings (NCF) were recorded manually Results: The study population consisted of 6669 consecutive patients (males 55.5% and females 44.5%). The overall mean age was 41.7 years [SD 15.1]. There were incidental non-COVID-19 findings in 3159 (47.4%) patients and none in 3510 (52.6%) patients Conclusions: CT examinations performed in patients with suspected COVID-19 pneumonia should be examined in detail regarding clinically significant findings. It is vital to take necessary precautions in advance regarding pathologies that may be clinically significant regarding appropriate treatment and follow-up planning at the appropriate time. It is crucial that the clues are stated in the radiology report so that the clinician can make appropriate management regarding these pathologies.

Aim: Sonoelastography is a non-invasive imaging method used to evaluate the mechanical properties of any tissue. The clinical value of method, the usage of which is increasingly prevailing, is gradually increasing and on account of having newly entered the application field, it is becoming a potential in the research area. Shear wave (SW) propagates faster in stiffer and lower elastic tissues. Studies on liver fibrosis musculoskeletal, breast, prostate, testis, and thyroid nodules accept this principle. In this study, aimed to determine the average values using the point shear wave elastography (pSWE) technique in normal healthy individuals and to determine the relationship of these values with age, gender, body mass index (BMI), and the spleen dimensions. Method: In 2019, patients who had visited the internal medicine service and those who have been directed to this clinics for grayscale ultrasound (US) for various reasons are voluntarily included in the study. The research was carried out consecutively on the same day by two specialist doctors who had 10 and 15 years of experience in ultrasonography and 3-year experience in elastography. Results: 39 (39%) of the 100 patients who participated in the study were men, and 61 (61%) were women. And the ages varied between 32-75 years (y) (54,5±9,5). The average spleen stiffness was found to be 89,2±43,3 kilopascal (kPa) (14,2-152,3) by the first observer and 89,4±41,1 kPa (14,4-151,1) by the second observer. Conclusion: To facilitate the common clinical usage and to evaluate the change in the stiffness of the spleen in different patients, first of all, it is required to determine the normal values of the stiffness of the spleen in healthy individuals using sonoelastography. In this study, the average spleen parenchyma stiffness was detected as higher than in previous studies. The values obtained in this study can be used to function as a comparison to determine the spleen stiffness. They can be used as referential to examine the different spleen pathologies in the clinical environments that use Esaote myLab device and pSWE method.

Objective: Fat accumulation in the liver and pancreas are clinical manifestations of metabolic syndrome associated with inflammation. It aimed to investigate the effects of the computed tomography (CT) estimated non-alcoholic fatty liver disease (NAFLD) and non-alcoholic fatty pancreas disease (NAFPD) on the development of acute pancreatitis in this study. Patients and methods: This retrospective and cross-sectional study consisted of 194 participants admitted to the hospital with an abdominal pain complaint and underwent an abdominal CT scan during the investigation of the differential diagnosis. Medical database records of patients were investigated. Groups were consisted of according to the presence of acute pancreatitis as study and control. Attenuation measurements of the liver and pancreas were determined according to abdominal CT. Results: A statistical significance was observed for the development of acute pancreatitis when patients with normoglycemia were compared to patients with prediabetes and diabetes. Percentages of NAFLD and NAFPD according to the median of CT attenuation difference between pancreas and spleen values were elevated in the study group. A logistic regression model revealed that prediabetes, type 2 diabetes, NAFLD, and NAFPD, according to median value, were risk factors for acute pancreatitis (p<0.001, =0.001, =0.02, and =0.022). Discussion: NAFLD and NAFPD, according to the median value of patients without pancreatitis, were determined as independent risk factors for the development of acute pancreatitis.