Objectives The purposes of this study were to determine the benefit of the bronchiolitis ultrasound score (BUS) in predicting hospital admission in children with acute bronchiolitis and to characterize lung sonography findings. Methods This prospective observational study was performed in an academic pediatric emergency department. Children younger than 24 months presenting to the emergency department, diagnosed with acute bronchiolitis by 2 independent pediatricians were included in the study. Lung ultrasound was performed by a single sonographer, who was blinded to as much clinical information as possible. In addition, the treating physicians were blinded to the lung ultrasound findings. Logistic regression analysis models were used to identify admission predictors. Receiver operating characteristic analysis was used to evaluate the predictive value for effects of the BUS and the modified Bronchiolitis Severity Score on admission. Results The median age of the 76 patients diagnosed with acute bronchiolitis was 6 months (interquartile range, 3.6–10 months). Forty-two (55.3%) of the 76 patients enrolled were admitted. Lung ultrasound was compatible with acute bronchiolitis in 74 patients (97%). A significant correlation was determined between modified Bronchiolitis Severity Score and BUS in children with acute bronchiolitis (r = 0.698, P < 0.001). The most effective parameter in determining admission on logistic regression analysis, independently of other variables, was BUS (P = 0.044; adjusted odds ratio, 1.859; 95% confidence interval, 1.016–3.404). Bronchiolitis ultrasound score values of 3 or greater exhibited 73.81% sensitivity and 73.53% specificity, whereas BUS values of 4 or greater exhibited 50% sensitivity and 91.18% specificity. Conclusions Point-of-care lung ultrasound can accurately detect pulmonary anomalies in children with acute bronchiolitis, has a close correlation with clinical findings, and is a useful tool in predicting hospital admission.

Despite the lower diagnostic accuracy of DWI in NMEs, it could be helpful in the characterization of suspicious breast lesions of both mass and NME types.

No abstract

T he Breast Imaging Reporting and Data Systems (BI-RADS) lexicon (1) of AmericanCollege of Radiology (ACR) provides an efficient and standardized assessment and management of breast lesions. It also stratifies breast cancer risk for a given lesion by classifying them into categories 1 through 5 according to the degree of suspicion.According to this system, solid masses with a circumscribed margin, oval shape (including those with two or three gentle lobulations) and parallel orientation on ultrasonography (US) exam are classified as BI-RADS 3. These types of masses are commonly seen at diagnostic and screening examinations. In this category malignancy is highly unlikely (less than 2%) and a short interval follow-up is recommended (1). However, up to one-third of such masses undergo biopsy mainly because of radiologist, referring clinician, or patient concern about the substantial risk of malignancy (2-4). Many BI-RADS 3 masses are traditionally referred for biopsy if they are palpable, large in size, patient is of advanced age or has a positive family history for breast cancer.The BI-RADS 4 assessment is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. This category is largely indeterminate and highly variable in outcome. Breast lesions in this category carry 2% to 95% risk for malignancy (1). Thus, almost all recommendations for breast biopsies come from assessments made using this category. According to BI-RADS classification; category 4 is subgrouped as 4A, 4B, and 4C to better inform the clinicians, pathologists, and patients of the degree of concern. However, the criteria for distinguishing among these subcategories have not been well delineated. BI-RADS 4A designates lesions with a low suspicion for malignancy. In this group, a benign pathologic diagnosis is expected and considered concordant (1). Studies of several institutions by the use of their internal criteria revealed positive predictive value (PPV) of 7%-9% for 4A lesions, and more than 50% of the suspicious lesions fall into this category. On the other hand, BI-RADS 4B and 4C 287From the Department of Radiology (S.K.  sibel_ozy@ yahoo.com) Karadeniz Technical University, School of Medicine, Trabzon, Turkey. BREAST IMAGING ORIGINAL ARTICLE PURPOSE We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates. METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging charact...

Meningioma is a neoplasm derived from meningothelial cells. Grade1 meningiomas consist 9 different subtypes. One of the rare subtypes is metaplastic meningioma. Metaplastic meningioma could be defined as ''xanthomatous meningioma'' in the presence of prevalent xanthomatous changes. A 32 years old male patient had admitted to outpatient clinics with complaints of vertigo and tinnitus. Magnetic resonance imaging revealed a large mass of 7.4 cm in the right frontal region with an extra axial localization. Resection material demonstrated a neoplasm composed of classic meningothelial meningioma areas accompanied with areas of xanthomatous changes, containing cells with clear, vacuolated cytoplasm. EMA, Vimentin, and progesterone expression were evident in both xanthomatous and meningothelial meningioma areas. Additionally, CD68 positivity was also observed in xanthomatous areas. EMA positivity is a neoplastic marker for xanthomatous cells and is a critic marker to differentiate these cells from macrophages which is crucial for pathologists in differential diagnosis. Xanthomatous meningiomas are quite rare and our case presentation is the 7th one in the current literature.