Şeyma Ünüvar

Background/Objectives: To compare computed tomography (CT)-derived body composition parameters across hormonal subtypes of adrenal adenomas and investigate their associations with hormonal activity. Methods: This retrospective study included 171 patients with unilateral adrenal adenomas categorized as Cushing syndrome (CS), mild autonomous cortisol secretion (MACS), non-functioning adenoma (NFA), or primary aldosteronism (PA). Adipose tissue and skeletal muscle parameters were quantified on CT images at the third lumbar vertebral (L3) level. Comparisons were adjusted for age, sex, and body mass index, and associations between hormonal and body composition parameters were assessed. Results: After adjustment, significant differences in non-psoas skeletal muscle index (SMI) were observed among the groups. Non-psoas SMI was lower in the CS group than in all other groups and in the MACS group than in the NFA and PA groups. Muscle attenuation was significantly reduced only in the CS group. In multivariable analyses adjusted for age, sex, and BMI, higher post-dexamethasone cortisol levels were independently associated with lower skeletal muscle parameters, with the strongest association observed for non-psoas SMI (β = −0.396, p < 0.001). Adipose tissue parameters did not differ significantly among hormonal subtypes. In exploratory analyses, aldosterone levels and the aldosterone-to-renin ratio were positively associated with the visceral-to-subcutaneous fat area ratio. Conclusions: Cortisol excess in adrenal adenomas was associated primarily with alterations in skeletal muscle mass and quality, particularly within the non-psoas compartment. Adipose tissue parameters demonstrated more heterogeneous associations with hormonal activity. These findings support further investigation of CT-derived body composition parameters across hormonal subtypes of adrenal adenomas.

We present a 56-year-old male patient with Poland syndrome and a patent urachus anomaly who underwent F-18 FDG PET/CT imaging for the evaluation of treatment response in high-grade urothelial bladder carcinoma. The patent urachus can mimic malignancy due to urinary activity, but the development of primary or metastatic tumors in this region is a point to consider. Poland syndrome is a rare syndrome involving thoracic deformities.

Objective: This study investigated the ability of dynamic breast magnetic resonance imaging (MRI) to predict pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) in locally advanced breast cancer with marker placement and compared MRI findings with the gold standard postoperative pathology. Methods: We retrospectively evaluated Dynamic Contrast-Enhanced MRI exams of 85 breast masses in 71 NACT patients with ultrasonography-guided marker placement (2020-2023). Two radiologists, blinded to pathology, assessed the radiologic treatment response (rR) on MRI using RECIST 1.1. Pathological evaluation defined pCR as absence of invasive carcinoma. Statistical analysis provided Kappa, sensitivity, specificity, PPV, and NPV. Results: Post-NACT MRI showed 52.9% radiological complete response (rCR), while pathology confirmed 45.2% pCR. Strong concordance between rR and pathological response (pR) was observed (p <0.001, ĸ = 0.740). MRI’s diagnostic performance yielded 80% sensitivity, 94.7% specificity, 95% positive predictive value (PPV) and 80% negative predictive value (NPV). False negatives related to microscopic tumors, docetaxel effects, artifacts, low histological grade, and luminal subtype. False positives linked to HER2 positivity, granulation, and fibrosis. Conclusion: MRI effectively correlates with pR post-NACT in marker-placed breast cancers, showing high specificity. For patients with MRI-evaluated complete response, pCR might be confirmed non-surgically by vacuum-assisted biopsy, though larger, long-term studies are needed for validation.

İdiyopatik granülomatöz mastit memenin nadir görülen, sıklıkla unilateral olma eğiliminde olan, kronik, inflamatuar benign hastalığıdır. Memenin diğer granülomatöz hastalıklarından farkı altta yatan belirlenmiş bir etiyolojinin olmamasıdır. Ancak etiyolojide laktasyon, hormonal değişiklikler, travma, enfeksiyonlar ve otoimmünite suçlanmaktadır. İdiyopatik granülomaöz mastit; bakteriyel mastit, sarkoidoz, tüberküloz, vaskülitik hastalıklar (granülomatozis polianjitis, poliarteritis nodosa), diyabetik mastopati ve inflamatuar meme kanseri gibi çok sayıda benign ve malign hastalığı taklit edebildiğinden, doğru tanı için klinik, radyolojik ve patolojik korelasyon gerekmektedir. İdiyopatik granülomatöz mastit tanısı daha çok bir dışlama tanısıdır. Reprodüktif çağda olan, laktasyon süreci geçirmiş, memede ele gelen kitle ve aynı zamanda eşlik eden inflamasyon bulgularıyla (ağrı, ateş, kızarıklık gibi) gelen kadın hasta en sık prezantasyon şeklidir. Radyolojik bulgular ışığında, histopatolojik bulgular ile birlikte değerlendirilerek doğru tanıya gidilebilir. İdiyopatik granülomatöz mastitin radyolojik bulguları nonspesifik olabilmektedir. Ancak ön tanı oluşturmak, hastalığın yaygınlığını belirlemek ve malign lezyonlardan ayırt etmek konusunda radyolojik bulgular oldukça yardımcıdır. Mamografide, en sık düzensiz sınırlı kitle veya asimetrik opasite artışı; ultrasonografide, hipoekoik tübüler yapılar ve eşlik eden düzensiz sınırlı hipoekoik kitlesel lezyon; manyetik rezonans görüntülemede ise kitlesel olmayan segmental dağılım gösteren kontrastlanan alanlar, heterojen kontrastlanan kitle, eşlik eden düzgün sınırlı, rim tarzı kontrastlanan apseyi temsil eden lezyonlar şeklinde görülmektedir. Eğer klinik ve radyolojik olarak idiyopatik granülomatöz mastitten şüphelenilirse, ön tanıyı desteklemek için histopatolojik doğrulama kullanılabilir. Günümüzde, eksizyona kıyasla daha az invaziv olması ve yüksek tanısal verimliliği nedeniyle sıklıkla kor iğne biyopsisi tercih edilmektedir. Histopatolojik olarak meme lobüllerini ve lobülü çevreleyen yağlı dokuyu tutan, Langerhans tipi dev hücrelerin ve epiteloid histiyositlerin eşlik ettiği steril granülomların bulunduğu inflamasyon şeklinde görülür.

Background/Objectives: This study aimed to evaluate the diagnostic accuracy of Apparent Diffusion Coefficient (ADC) values, derived from Diffusion-Weighted Imaging (DWI), in differentiating benign and malignant ascites. Methods: This retrospective study included 150 patients (85 benign, 65 malignant) who underwent abdominal MRI. All patients were scanned on a DWI sequence (b-values: 0, 500, and 1000 s/mm²). Two experienced radiologists, blinded to clinical and cytological outcomes, measured the mean ADC (ADCmean) from three distinct ROIs and the minimum ADC (ADCmin) from the area of lowest signal intensity on the ADC map. The diagnostic performance of ADC parameters and the Serum-Ascites Albumin Gradient (SAAG) was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: The mean values of ADCmean (3162 ± 204 × 10⁻⁶ mm²/s) and ADCmin (2885 ± 148 × 10⁻⁶ mm²/s) in the malignant group were significantly lower than those in the benign group (3596 ± 239 and 3322 ± 218 × 10⁻⁶ mm²/s; p = 0.006 and p = 0.0016, respectively). Inter-observer agreement was good for both ADCmean (ICC = 0.844) and ADCmin (ICC = 0.879). In the ROC analysis, ADCmin demonstrated the highest diagnostic performance (AUC: 0.930). An optimal cut-off value for ADCmin of ≤ 2983 × 10⁻⁶ mm²/s yielded 81.5% sensitivity and 85.8% specificity. The diagnostic performance of ADCmin was found to be superior to that of ADCmean (AUC: 0.877) and SAAG (AUC: 0.919). Conclusions: ADC values derived from DWI, particularly ADCmin, represent a highly accurate, non-invasive, and reproducible biomarker for differentiating benign from malignant ascites. The identified ADCmin threshold provides quantitative parameter that can aid in patient triage, especially when cytology is inconclusive, potential surrogate for fluid characterization.

Background/Objectives: To investigate the importance of ADC, SUVmax, and SUVmax/ADC values in the prognosis and biological behavior of prostate cancer. Methods: In this retrospective study, ADC measurements in diffusion MRI were made by two radiologists by correlating the lesions with the highest SUVmax value from Ga-68 PSMA PET/CT examinations of 81 patients with prostate cancer. The quantitative values were compared with histopathological grade, presence of perineural invasion, and lymph node and bone metastasis. Results: For D’Amico high-risk patients, a statistically significant difference among the ADC, SUVmax, and SUVmax/ADC measurements was reported (p < 0.001). Cut-off values were defined as 0.52 (×10⁻³ mm²/s) for ADC, 9.73 for SUVmax, and 20.28 for the SUVmax/ADC ratio (AUC = 0.887, 0.747, 0.817, respectively) for the high-risk categories. The Youden indices were 0.643, 0.405, and 0.437, respectively. In logistic regression, the SUVmax/ADC ratio was a significant predictor of the high-risk group (AUC = 0.844, p = 0.002), demonstrating superior performance to a model with individual ADC and SUVmax values (AUC = 0.796, p = 0.006). For the advanced-grade group, the SUVmax and SUVmax/ADC ratios differed significantly (p < 0.001). The CAPRA score showed significant correlations with all imaging biomarkers: negatively with ADC (rho = −0.456, p < 0.001) and positively with SUVmax (rho = 0.359, p = 0.001) and the SUVmax/ADC ratio (rho = 0.441, p < 0.001). The presence of perineural invasion had no significant correlation with any of the variables (p > 0.05). The presence of bone metastases and PSA and free PSA levels differed significantly (p = 0.003, p = 0.001, respectively). In the presence of lymph node metastasis, SUVmax and SUVmax/ADC ratios were found to be significant (p = 0.019, p = 0.01, respectively). In the survival (OS) analysis, a low ADC value was found to be associated with shorter survival (median OS: 61 vs. 106 months). Conclusions: Among advanced-grade and high-risk prostate cancer patients, ADC, SUVmax, and SUVmax/ADC values can be employed as alternative prognostic factors for predicting the biological behavior of the disease.

Introducstion: The distinction between benign and borderline epithelial ovarian tumors is important because treatment and follow-up strategies differ. Objective: We aimed to evaluate benign, borderline, and malignant epithelial ovarian tumors using MRI features and contributed to the preoperative evaluation. Methods: MRIs of 81 patients (20 bilateral), including 31 benign, 27 borderline, and 23 malignant, who had pelvic imaging between 2013-2020, were evaluated retrospectively. The evaluation was made blindly to the pathology result by two radiologists with MRI scoring and features that we determined. MRI evaluation was performed with T1 TSE, T2 TSE, fat-suppressed T2 TSE, and before and after contrast T1 fat-suppressed and non-fat-suppressed TSE images. The numbers and findings obtained in scoring were evaluated by Chi-Square, ordinal logistic regression, and 2 and 3 category ROC analysis. Results: The total score varied between 7 and 24. Among the three groups, a significant difference was found in terms of T1, T2 signal intensity (p <0.01), size (p = 0.055), solid area (p <0.001), septa number (p <0.05), ovarian parenchyma (p = 0.001), ascites (p <0.001), peritoneal involvement (p <0.001), laterality (p <0.001), contrast enhancement pattern (p 0.05). Cut-off values were found as 11.5 and 18.5 in the 3-category ROC analysis performed for the score (VUS: 0.8109). Patients with a score below 11.5 were classified as benign, those between 11.5-18.5 as borderline, and those over 18.5 as malignant. Conclusion: The differentiation of borderline tumors from benign and malignant tumors by MRI scoring will contribute to the preoperative diagnosis.

Coronavirus disease 2019 (COVID-19) is an outbreak causing pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and computed tomography (CT) images are a significant part of the diagnosis of COVID-19 related pneumonia. Typical chest CT findings are bilateral peripheral ground-glass opacities (GGO) with or without consolidation. Although rare, atypical CT findings have been described, no case of COVID-19 causing multiple solid pulmonary nodules has been reported. In this article, atypical CT findings of a 45-year-old female patient with multiple solid pulmonary nodules mimicking metastasis diagnosed with COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR).

Extramedullary plasmacytoma (EMP) occurs as a result of abnormal proliferation of plasma cells outside the bone marrow. Breast plasmacytomas are rare. Radiologically, they can be confused with benign and malignant lesions of the breast. It is important to be able to diagnose EMP in the breast since the treatment strategy is different from that of other lesions and allows for the diagnosis and early treatment of multiple myeloma (MM) relapse. We report imaging and clinicopathological findings of an EMP case in which a 65-year-old patient with MM in remission presented with breast masses.