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BACKGROUND CONTEXT: Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system. PURPOSE: To report migration patterns of extruded lumbar disc fragments. STUDY DESIGN: A review of magnetic resonance (MR) images. PATIENT SAMPLE: A total of 1,020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation. OUTCOME MEASURES: Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes and their association with age, gender, body mass index (BMI), and the level of herniation. METHODS: High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered ''migrated.'' The migration patterns observed were rostral or caudal in the vertical plane and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane. RESULTS: In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (p!.001 for both). Radiculopathy was significantly more frequent in caudal migrations than in rostral migrations (78.9% vs. 65.1%, p!.001). There was no significant association between gender or BMI and migration patterns in the vertical plane. In the horizontal plane, central, paracentral, subarticular, foraminal, and extraforaminal migrations were reported in 17.3%, 74.2%, 4.3%, 2.5%, and 1.8% of the patients, respectively. The youngest (median age 39 years, interquartile range [IQR] 13 years) and the oldest (median age 55 years, IQR 15 years) groups of patients (p!.001) had the most formainal and extraforaminal migrations, respectively. Radiculopathy was present in 66.5%, 76.8%, 88.6%, 96%, and 27.8% of the patients with central, paracentral, subarticular, foraminal, and extraforaminal migrations, respectively (p!.001). No significant association was found between gender, BMI, or the level of herniation and migration pattern in the horizontal plane. CONCLUSIONS: Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively.

To review the knowledge of radiographers and examine the possible sociodemographic and situational contributors to this knowledge. Methods: A questionnaire survey was devised and distributed to a cohort of 120 radiographers. Each questionnaire contained two sections. In the first section, background data, including sex, age, highest academic level, grade point average (GPA), length of time from graduation, work experience as a radiographer and the status of previous refresher course(s), were collected. The second section contained 17 multiple-choice questions concerning radiographic imaging parameters and safety issues. Results: The response rate was 63.8%. In univariate analytic model, higher academic degree (p , 0.001), higher GPA (r 2 5 0.11; p 5 0.001), academic workplace (p 5 0.04) and taking previous refresher course(s) (p 5 0.01) were significantly associated with higher knowledge score. In multivariate analytic model, however, higher academic degree (B 5 1.62; p 5 0.01), higher GPA (B 5 0.50; p 5 0.01) and taking previous refresher course(s) (B 5 21.26; p 5 0.03) were independently associated with higher level of knowledge. Age, sex, length of time from graduation and work experience were not associated with the respondents' knowledge score. Conclusion: Academic background is a robust indicator of a radiographer's professional knowledge. Refresher courses and regular knowledge assessments are highly recommended. Advances in knowledge: This is the first study in the literature that examines professional knowledge of radiographers in terms of technical and safety issues in plain radiography. Academic degree, GPA and refresher courses are independent predictors of this knowledge. Regular radiographer professional knowledge checks may be recommended.

Objective To investigate the prognostic validity of the right ventricular to left ventricular diameter (RVD/LVD) ratio and Qanadli pulmonary artery obstruction score (PAOS) in hemodynamically stable patients with no pre-existing comorbidities. Methods Sixty-three patients with no previous comorbidity were recruited for this study. The RVD/LVD ratio was calculated based on axial image measurements obtained from contrast-enhanced non-electrocardiography-gated spiral computed tomography (CT) pulmonary angiographic studies. Patients were followed up for 60 days after the initial CT and study variables including demographic data, the RVD/ LVD ratio and PAOS were compared between deceased cases and survivors via univariate and multivariate statistical models. Results The 60-day mortality rate was 22.2 %. The deceased and surviving groups were comparable for PAOS, whereas both the median age and RVD/LVD ratio were significantly higher in the first group. In multivariate analysis, however, age was the only significant, independent predictor of 60-day mortality (p=0.02, Exp(B)=1.06). At a cutoff age of 63 years the 60-day mortality was predicted with a sensitivity and specificity of 64.3 % and 69.4 %, respectively. Conclusions The RVD/LVD ratio and PAOS are not independent predictors of mortality in hemodynamically stable patients with acute PE and no pre-existing comorbidities. Key points • Patients with pulmonary embolism and no pre-existing comorbidity were studied. • The PAOS alone cannot predict mortality in these patients. • Right ventricle strain is not an independent prognostic factor for mortality in pulmonary embolism. • Age is the only independent predictor of death in pulmonary embolism.

To determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease. Overview of Literature: Recently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation. Methods: Magnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]). Results: Mean DEP was significantly higher in the case group at the L5-S1 level (2.73±0.23 mm vs. 2.21±0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31±0.13 mm in the cases vs. 1.28±0.08 mm in the controls, p=0.78), L2-L3 (1.45±0.12 mm in the cases vs. 1.37±0.08 mm in the controls, p=0.58), L3-L4 (1.52±0.13 mm in the cases vs. 1.49±0.10 mm in the controls, p=0.88), and L4-L5 (2.15±0.21 mm in the cases vs. 2.04±0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients. Conclusions: End plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease.

Introduction: Preventing or reversing hearing loss is challenging in Ménière's disease. Betahistine, as a histamine agonist, has been tried in controlling vertigo in patients with Ménière's disease, but its effectiveness on hearing problems is not known. Objective: To examine the effect of betahistine on hearing function in not-previously-treated patients with Ménière's disease and to define possible contributors in this regard. Methods: A total of 200 not-previously-treated patients with definite unilateral Ménière's disease received betahistine by mouth (initial dose, 16 mg three times a day; maintenance dose, 24-48 mg daily in divided doses). Changes in indicators of hearing status before and six months after treatment were documented. Hearing loss was considered as the mean hearing level >25 dB HL at five frequencies. Results: The mean duration of disease was 3.37 years. Six months after treatment the mean hearing level decreased by 6.35 dB compared to that at the baseline (p < 0.001). Both patients' age and the duration of disease correlated negatively with the improvement in hearing function. Post treatment hearing loss was independently associated with age, the initial hearing level and the chronicity of disease. The corresponding optimal cutoff points for predicating a persistent hearing loss 6 months after treatment were 47 years, 38 dB HL, and 1.4 years, respectively. Conclusion: Oral betahistine was significantly effective in preventing/reversing hearing deterioration in patients with Ménière's disease. Age, the hearing level on admission, and the disease duration were independent predictors of hearing status after treatment.

Background Because of a degenerative component, degenerative rotatory scoliosis seems different from congenital and idiopathic subtypes of the disease. This study aims to examine the orientation of facet joints, as a known cause of degeneration, in patients with degenerative rotatory scoliosis. Methods Lumbar magnetic resonance (MR) images and plain radiographs of 52 symptomatic patients (mean age, 50.17 years) with degenerative rotatory lumbar scoliosis (mean curve, 19.22 degrees) and 50 healthy individuals were reviewed. Facet joint angles in rotated segments and the minimum neural foramen width at all lumbar levels were measured by three observers and the average was recorded. Results The maximum vertebral rotation was most frequent at L4-L5 (75 %), and the majority was of type I (84.6 %) according to the Nash-Moe classification. At all lumbar spinal levels the mean facet joint angles were significantly higher on the side of rotation (L2-L3, 57.92 degrees; L3-L4, 45.00 degrees; L4-L5, 43.88 degrees) compared to those on the contralateral side (L2-L3, 20.42 degrees; L3-L4, 15.48 degrees; L4-L5, 13.12 degrees) and in controls (L2-L3, 30.21 degrees; L3-L4, 40.81 degrees; L4-L5, 45.20 degrees) (p < 0.001 for all comparisons). The mean facet joint angle increased significantly from L4-L5 to L2-L3 in cases and reversely in controls. The mean minimum neural foramen width was 1.29 ± 0.85 mm on the side of rotation, 5.50 ± 1.09 mm on the contralateral side, and 6.78 ± 1.75 mm in controls (p < 0.001). Conclusions Substantial asymmetries and abnormal orientations in facet joints were documented in patients with degenerative rotatory lumbar scoliosis. Such asymmetries may adversely affect neural foramen width.

Objectives: To compare the diagnostic performance of ultrasonography and CBCT against CT in detecting orbital floor fractures. Methods: A total of 120 orbits with clinical suspicion of isolated orbital floor fractures underwent multislice CT scanning with coronal reconstruction; orbital ultrasonography using a standard machine equipped with a 7-to 10-MHz linear transducer; and CBCT. Patients with severe head and face injuries were not included. The diagnostic performance of ultrasonography and CBCT was reported assuming conventional CT as the imaging method of choice. Results: According to CT findings, fractures of the floor were present in 39 orbits. The sensitivity, specificity, positive-predictive value and negative-predictive value of ultrasonography in detecting orbital floor fractures were 87.2%, 100%, 100% and 94.2%, respectively. The corresponding values for CBCT were 97.4%, 97.5%, 95.0%, and 98.8%, respectively. Areas under the receiver operator characteristics curves of orbital floor fracture detection were 0.94 for ultrasonography and 0.98 for CBCT. Conclusions: When conventional CT cannot be performed in patients with clinically suspected orbital floor fracture and no severe or complex head and face injuries, CBCT could be used in detecting fractures as a reliable surrogate. Because of a lower sensitivity of ultrasonography, however, its use is limited in this regard.

To assess reproducibility of volume and diameter measurement of intraductal papillary mucinous neoplasms (IPMNs) on MRI images. Three readers measured the diameters and volumes of 164 IPMNs on axial T2-weighted images and coronal thin-slice navigator heavily T2-weighted images using manual and semiautomatic techniques. Interobserver reproducibility and variability were assessed. Interobserver intraclass correlation coefficients (ICCs) for the largest diameter measured using manual and semiautomatic techniques were 0.979 and 0.909 in the axial plane, and 0.969 and 0.961 in the coronal plane, respectively. Interobserver ICCs for the volume measurements were 0.973 and 0.970 in axial and coronal planes, respectively. The highest intraobserver reproducibility was noted for coronal manual measurements (ICC 0.981) followed by axial manual measurements (ICC 0.969). For the diameter measurements, Bland-Altman analysis revealed the lowest interobserver variability for manual axial measurement...

To investigate whether volumetric enhancement on baseline MRI and volumetric oil deposition on unenhanced CT would predict HCC necrosis and response post-TACE. Of 115 retrospective HCC patients (173 lesions) who underwent cTACE, a subset of 53 HCC patients underwent liver transplant (LT). Semiautomatic volumetric segmentation of target lesions was performed on dual imaging to assess the accuracy of predicting tumour necrosis after TACE in the whole cohort and at pathology in the LT group. Predicted percentage tumour necrosis is defined as 100 % - (%baseline MRI enhancement - %CT oil deposition). Mean predicted tumour necrosis by dual imaging modalities was 61.5 % ± 31.6%; mean percentage tumour necrosis on follow-up MRI was 63.8 % ± 31.5 %. In the LT group, mean predicted tumour necrosis by dual imaging modalities was 77.6 % ± 27.2 %; mean percentage necrosis at pathology was 78.7 % ± 31.5 %. There was a strong significant correlation between predicted tumour necrosis and volumetric...

The relationship between curve correction and spinal length gain in adolescent idiopathic scoliosis was examined. A total of 102 patients who underwent posterior spinal correction and fusion alone or in combination with anterior spinal correction and fusion (ASF) were studied. The Cobb angle correction, increase in the main thoracic length, T1–L5 spinal length gain, and T1–L5 spinal length gain/Cobb angle correction were reported. The length gain/Cobb angle correction value was not significantly associated with sex, fusion approach, and the number of fused levels. Surgical T1–L5 spinal length gain (mm) equaled (70.20)−(3.51)×(degrees of Cobb angle correction)+(0.08)×(degrees of Cobb angle correction)2.

Objectives To evaluate the added value of diffusion-weighted imaging (DWI) on MRI in differentiating serous from mucinproducing pancreatic cystic neoplasms (PCNs). Methods One hundred seventeen patients with PCN measuring ≥ 10 mm were included. Three readers independently evaluated MRI with and without the use of apparent diffusion coefficient (ADC). Logistic regression was used to analyze whether confidence scores were different with the use of different image sets. Diagnostic performance with and without ADC was compared. Results DWI/ADC improved confidence in 44.8%, 73.6%, and 78.2% of patients by the three readers in distinguishing serous from mucin-producing PCNs. The use of ADC increased the probability of a higher confidence in the differentiation as compared to morphological imaging for all three readers (p < 0.001). Odds ratio for increase in the diagnostic confidence with the use of ADC for the three readers with decreasing years of experience were 5.8, 6.8, and 12.7. The diagnostic accuracy of morphological MRI with ADC was higher than that without ADC for two of three readers with lesser experience (87.2% vs. 80.8%; 91.5% vs. 80.8%). Conclusion DWI may have added value as a complementary tool to conventional morphological MRI in differentiating between serous and mucin-producing PCNs with possibly greater value for readers with less experience in reading abdominal MRI. Key Points • Optimal management of PCNs requires differentiation of serous from mucin-producing PCNs. • ADC measurements allow increased confidence in differentiating serous from mucin-producing PCNs. • ADC measurements increase the accuracy in diagnosing serous versus mucin-producing PCNs. Keywords Magnetic resonance imaging. Diffusion MRI. Pancreas. Cysts. Mucin Abbreviations ADC Apparent diffusion coefficient BD-IPMN Branch duct intraductal papillary mucinous neoplasm CE-MRI Contrast-enhanced magnetic resonance imaging CT Computed tomography DWI Diffusion-weighted imaging FNA Fine needle aspiration FS Fat saturation GRE Gradient echo IPMN Intraductal papillary mucinous neoplasm MCN Mucinous cystic neoplasm Electronic supplementary material The online version of this article (

ancreatic ductal adenocarcinoma (PDAC) is the 12th most common cancer and the fourth most common cause of cancer death in the United States [1]. Most patients present with advanced disease at the time of diagnosis, and the overall 5-year survival rate lags at 8%. Only 10-20% of patients present at the localized disease stage, at which time complete surgical resection followed by adjuvant chemotherapy can offer the best chance of survival, with a 5-year survival rate of 32% [2]. Therefore, one important opportunity for improving patient prognosis lies in earlier disease detection. CT is the most commonly used imaging modality for the initial evaluation of suspected pancreatic cancer. The reported sensitivity for detection of PDAC on CT ranges from 76% to 96% [3-9]. CT features of early PDAC can be subtle and missed by even experienced radiologists. Early signs of PDAC

Objectives To examine the value of baseline 3D-ADC and to predict short-term response to treatment in patients with hepatic colorectal metastases (CLMs). Methods Liver MR images of 546 patients with CLMs (2008-2015) were reviewed retrospectively and 68 patients fulfilled inclusion criteria. Patients had received systemic chemotherapy (n = 17), hepatic trans-arterial chemoembolization or TACE (n = 34), and 90 Y radioembolization (n = 17). Baseline (pre-treatment) 3D-ADC (volumetric) of metastatic lesions was calculated employing prototype software. RECIST 1.1 was used to assess short-term response to treatment. Prediction of response to treatment by baseline 3D-ADC and 2D-ADC (ROI-based) was also compared in all patients. Results Partial response to treatment (minimum 30% decrease in tumor largest transverse diameter) was seen in 35.3% of patients; 41.2% with systemic chemotherapy, 32.4% with TACE, and 35.3% with 90 Y radioembolization (p = 0.82). Median baseline 3D-ADC was significantly lower in responding than in nonresponding lesions. Area under the curve (AUC) of 3D-ADC was 0.90 in 90 Y radioembolization patients, 0.88 in TACE patients, and 0.77 in systemic chemotherapy patients (p < 0.01). Optimal prediction was observed with the 10th percentile of ADC (1006 × 10 −6 mm 2 /s), yielding sensitivity and specificity of 77.4% and 91.3%, respectively. 3D-ADC outperformed 2D-ADC in predicting response to treatment (AUC; 0.86 vs. 0.71; p < 0.001). Conclusion Baseline 3D-ADC is a highly specific biomarker in predicting partial short-term response to treatment in hepatic CLMs. Key Points • Baseline 3D-ADC is a highly specific biomarker in predicting response to different treatments in hepatic CLMs. • The prediction level of baseline ADC is better for 90 Y radioembolization than for systemic chemotherapy/TACE in hepatic CLMs. • 3D-ADC outperforms 2D-ADC in predicting short-term response to treatment in hepatic CLMs.

Acute pancreatitis (AP) is caused by acute inflammation of the pancreas and adjacent tissue and is a common source of abdominal pain. The current CT and MRI evaluation of AP is mostly based on morphologic features. Recent advances in image acquisition and analysis offer the opportunity to go beyond morphologic features. Advanced MR techniques such as diffusion-weighted imaging, as well as T1 and T2 mapping, can potentially quantify signal changes reflective of underlying tissue abnormalities. Advanced analytic techniques such as radiomics and artificial neural networks (ANNs) offer the promise of uncovering imaging biomarkers that can provide additional classification and prognostic information. The purpose of this article is to review recent advances in imaging acquisition and analytic techniques in the evaluation of AP.

Recurrent acute pancreatitis is characterized by frequent episodes of inflammation in the pancreas. The most common causes are alcohol abuse and gallstones but approximately 30% of cases are defined as idiopathic because initial evaluation fails to detect the etiology. In these patients, extensive laboratory and imaging evaluations usually lead to the uncovering of an occult biliary duct stone or sphincter of Oddi dysfunction as the main reason for frequent pancreatitis. We report a 42-year-old female with a longstanding history of acute recurrent pancreatitis in the setting of pancreas divisum due to its rarity. We focus on appropriate investigations by application of specialized laboratory and radiological modalities because determining the etiology is a crucial step in patient management.

Magnetic Resonance Imaging (MRI) contrast agents most commonly agents used in diagnosing different diseases. Several agents have been ever introduced with different peculiar characteristics. They vary in potency, adverse reaction and other specification, so it is important to select the proper agent in different situations. We conducted a systematic literature search in MEDLINE/PUBMED, Web of Science (ISI), Scopus, Google Scholar by using keywords &quot;gadolinium&quot; and &quot;MRI contrast Medias&quot;, &quot;Gadofosvest&quot;, &quot;Gadobenate&quot; and &quot;Gadoxetate&quot;. The most frequent contrast media agents made based on gadolinium (Gd). These are divided into two categories based on the structure of their chelating parts, linear agents and macrocyclic agents. All characteristics of contrast media factors, including efficiency, kinetic properties, stability, side effects and the rate of resolution are directly related to the structure of chelating part of that formulati...

誗AIM: To examine the effect of prophylactic tamsulosin in male candidates of cataract surgery on general anesthesia in preventing urinary retention. 誗METHODS: In this double blind clinical trial, 67 male candidates of cataract surgery under general anesthesia randomly received oral tamsulosin (0. 4mg daily for one week prior to cataract surgery, n = 32) , or placebo (n = 35). Rates of post-operative urinary retention and floppy iris syndrome were compared between the two groups. 誗 RESULTS: The two groups were matched for the patients蒺 age (tamsulosin group: 68. 16 依 8. 72 years, placebo group: 71. 37 依 8. 60 years, P = 0. 38). Postoperative urinary retention occurred less frequently in tamsulosin receivers (3. 1% vs 48. 6% , P < 0. 001, Odds ratio = 29. 28, 95% CI 3. 59-238. 79). There was only one case (2. 9%) with floppy iris syndrome in the control group (P = 0. 52, Odds ratio = 1. 03 95% CI 0. 97-1. 09). 誗 CONCLUSION: Short-term prophylactic administration of oral tamsulosin before cataract surgery on general anesthesia is effective in preventing post-operative urinary retention without increasing the risk of floppy iris syndrome.