Radiology

Purpose: Multidetector computed tomography (MDCT) is used in the diagnosis of pancreatic ductal adenocarcinoma (PDAC), but it may be inadequate in some cases. Tumor detection can be improved using rapid kVswitching dual-energy CT (rsDECT) and iodine maps. Our aim this study is to evaluate tumor conspicuity in PDAC cases using rsDECT and iodine maps.
Methods: Ninety cases with PDAC were evaluated rsDECT. Tumor contrast (HU) differences, tumor size, CNR (contrast-noise ratio), and noise were measured at 70 keV, individual CNR-energy level, and 45 keV, respectively. Quantitative differences in contrast gain D70-CNR and DCNR-45 were compared. On iodine maps, the iodine concentration measured in the tumor and parenchyma was normalized to the aorta as normalized iodine concentration (NIC) and compared.
Results: The median optimized viewing energy level was 51 keV. The mean ± SD tumor contrast values were 62 ± 20, 115 ± 48, and 152 ± 48 HU (p < 0.001); the largest axial diameters were 36.6 ± 5.1, 37.9 ± 4.2, and 38.3 ± 3.7 mm (p = 0.015); the CNRs were 1.83 ± 0.72, 3.37 ± 0.93, and 2.36 ± 0.56; and the image noise levels were 23.7 ± 6.8, 39.3 ± 11.6, and 59.5 ± 17.2 (p < 0.001) (p < 0.001) for 70 keV, optimized energy level, and 45 keV, respectively. The mean ± SD contrast gain D70-CNR was 63 ± 12; and DCNR-45 was 31 ± 26 HU (p < 0.001). NICtumor and NICparenchyma values were 0.62 ± 0.03 and 1.36 ± 0.05 mg/mL, respectively (p = 0.004).
Conclusion: The use of low energy levels on rsDECT and iodine maps improves tumor conspicuity. This situation may be help better detection of pancreatic tumors.

Background: Testicular microlithiasis (TML) is thought to cause microstructural changes in the parenchyma of the testis, but it is difficult to demonstrate this by ultrasonography. It may be possible to evaluate microstructural changes in the testis by Acoustic Radiation Force Impulse (ARFI) elastography, which measures tissue stiffness. Purpose: To assess the tissue stiffness of testicles of children with TML and to compare them with the healthy control group. Material and Methods: Between November 2015 and May 2016, 25 pediatric patients with TML and 24 healthy children were enrolled in the study (mean age for TML and control group 6.7 AE 3.17 and 7.9 AE 4.18 years, respectively). Testicular volumes and mean shear wave velocity (SWV) values were calculated and compared with each other in both groups. Results: There was no significant difference in average testicular volumes between the TML group and the control group (1.14 cm 3 , 1.21 cm 3 , respectively; P ¼ 0.986). Mean SWV of the testicles with TML and normal testicles with control group was 1.18 AE 0.22 cm/s and 0.88 AE 0.11 cm/s, respectively. The SWV of the testicles with TML was higher than the normal testicles and this was statistically significant (P < 0.001). Conclusion: This study has shown that tissue stiffness in patients with TML is increased compared to the normal population. ARFI elastography helps the early detection of microstructural changes in TML and can be used for screening and follow-up.

Parathyroid glands are endocrine glands that secrete parathyroid hormone (PTH) and regulate calcium and phosphor metabolism. The overexpression of PTH is called hyperparathyroidi (HPT) and is classified as primer, secondary and tertiary. Primer HPT (PHPT) is the most common cause of parathyroid adenomas (80-85%). Juvenile PHPT developed during adolescence is quite rare. The incidence of bone lesions in all age groups is reported to be 10-20% in PHPT patients and 5% in juvenile PHPT patients. It is known that in patients with bone lesions, regression occurs in lesions after parathyroidectomy. In this case report, we aimed to present the imaging findings of long bones and left 5th metacarpal bone multiple Brown tumors which is a rare presentation of parathyroid adenoma in adolescent patient and regression after parathyroidectomy. P arathyroid glands are two endocrine glands, usually located in vicinity of the upper and lower poles of the thyroid gland. Parathyroid glands secrete parathormone (PTH) and regulate calcium-phosphorus metabolism. PTH plays an important role in bone mineral balance. The overexpression of PTH is termed as hyperparathy-roidism (HPT) and is classified as primer, secondary and tertiary hyperparathyroidism. Primary HPT (PHPT) develops as a result of due to adenoma (80-85%), hyperplasia (10-15%) and parathy-roid carcinoma (<0.5%) [1]. Secondary HPT is also due to overexpression of PTH secondary to hypocalcemia or vitamin D deficiency. Tertiary HPT develops as a result of autonomy acquired by the parathyroid glands as a result of long-lasting secondary HPT [2]. Juvenile PHPT in the adolescent period is very rarely seen, and a limited number of cases have been reported in the literature [3]. The incidence of bone lesions in PHPT was reported to be 10-20%, and in juvenile PHPT as 5% [4]. The most commonly identified bone lesions are bone resorption, bone cysts, Brown tumors, and generalized osteopenia. Bone lesions are often seen in facial bones, ribs and pelvic bones, and they are rare in long bones. Brown tumors are reactive lesions that result in disruption of the balance between bone formation and destruction in favor of bone resorption due to the direct effect of PHT. Diagnosis is difficult and radiologically confused with giant cell tumor, bone metastasis or multiple myeloma [5]. In this case report, we aimed to present the imaging findings of a large number of Brown tumors in the long bones and the fifth metacarp of the left hand, which have a rare manifestation of parathyroid adenoma in the adolescent patient that regresses after parathyroidectomy. Cite this article as: Aslan S., Ceyhan Bilgici M., Bernay R. F., Aydın H. M., Selçuk M. B. Parathyroid adenoma presenting with multiple Brown tumors in an adolescent patient. North Clin Istanb UNCORRECTED PROOF

A 47-year-old woman was admitted to our hospital with the complaints of intermittent neck pain lasting for 2 years, which had worsened in last 3 months and more severe at nights. Rota-tional neck movement and flexion of the neck had recently become painful. There was no history of neck trauma. Physical examination revealed tenderness to touch on the posterior aspect of the upper neck and no other abnormality on neurologic examination. Cervical spine computed tomography scan revealed centrally hypodense area surrounded by sclerotic rim at dens axis and sclerotic changes involving odontoid process of the axis (Figure, Left to Right). Based on the computed to-mography findings, patient's medical history, and positive ace-tylsalicylic test, the diagnosis of the osteoid osteoma of the dens axis was made. The patient refused surgery for fear of surgical risks, and we prescribed celecoxib 200 mg/d to the patient. At the 6-month follow-up, the patient was free of symptoms.

Heterotopic pancreas (HP) is localized pancreatic tissue that has no relation to orthotopic pancreas and has its own channel and vas-cular structures. Usually, the submucosa is located in the upper gastrointestinal tract; mesenteric placement is rarely reported. It is frequently asymptomatic and is detected incidentally in imaging, laparotomies, or autopsies. Rarely, pancreatitis may be the cause of small bowel obstruction, massive gastrointestinal bleeding, and malignant transformation. However, this has usually been reported in localized submucosal HP cases. The imaging findings are typical, and the diagnosis can be verified without the need for a histopatho-logical diagnosis. In this case report, we aimed to present the imaging findings of asymptomatic HP located in the proximal jejunum mesentery of a 44-year-old woman. To avoid unnecessary surgical procedures, the characteristic imaging findings of HP are understood and should be considered in the differential diagnosis of masses seen in the mesentery.

Introduction Cerebral cortical venous aneurysm also known as cerebral varix is a rare entity that usually occurs in relation to high-flow draining veins of arteriovenous fistulas, arterio-venous malformations, and venous angioma. Isolated cerebral varix is an extremely rare entity. Case report We present a 1-year-old male with isolated cere-bral varix. During follow-up, the varix thrombosed spontaneously without causing any neurological deficits. Conclusion To the best of our knowledge, spontaneous asymptomatic thrombosis of an isolated cerebral varix without any clinical finding was reported for the first time in the literature.