Abstract Various processes, including benign or malignant (mostly metastasis) processes, contribute to the occurrence of multiple pulmonary nodules. For differential diagnosis, metastasis must be excluded as an etiological factor in patients who have multiple pulmonary nodules with a known primary malignancy. However, differential diagnosis of multiple pulmonary nodules caused by benign diseases and malignant processes is challenging. Multiple pulmonary nodules resulting from metastasis may mimic those resulting from infections, inflammatory processes, and rare benign diseases. Some rare diseases, such as pulmonary sclerosing pneumocytoma and pulmonary epithelioid hemangioendothelioma, or common diseases with a rare presentation of multiple nodules must be considered in the differential diagnosis of metastasis. In addition to the clinical and laboratory findings, radiological features are crucial for differential diagnosis. The size, density, location, and border characteristics (well-defined or poorly defined) of pulmonary nodules, as well as their internal structure (solid, subsolid, or ground glass nodule), growth rate during follow-up, and associated pulmonary and extrapulmonary findings are important for differential diagnosis along with clinical and laboratory data. This article summarizes the general features and imaging findings of these diseases, which less frequently present with multiple pulmonary nodules, and the clues that can be used to distinguish these diseases from metastasis. Critical relevance statement The radiological features, clinical findings, and temporal changes during follow-up are important in distinguishing non-metastatic causes of multiple pulmonary nodules from metastatic causes and guiding diagnosis and early treatment, especially in patients with primary malignancy. Key Points Multiple pulmonary nodules have a wide range of etiologies, including metastatic disease. Metastasis as an etiology must be excluded in patients with multiple pulmonary nodules. Correlation of radiological findings (nodule size, position, and associated findings) with clinical history is crucial for differential diagnosis. Graphical Abstract

AIMS:To assess the ability of computed tomography (CT) findings and radiomics analysis to differentiate mediastinal lymphadenopathies as sarcoidosis versus lymphoma. MATERIALS AND METHODS:94 patients with lymphoma and 97 patients with sarcoidosis, who had > 1cm mediastinal lymph node were included. Size, location of lymph nodes, and distribution of the largest lymph nodes in two groups were compared. A total of 636 lymphadenopathies in four different regions were segmented for radiomics. Lesion segmentation was semiautomatically performed with a dedicated commercial software package on chest CT images. 149 patients were grouped as a training cohort, while 42 patients who underwent CT in the oncology hospital were used for external validation. The least absolute shrinkage and selection operator (LASSO) analysis was used to perform feature selection. Using selected features, the classification performance of various data mining methods in separating groups of sarcoidosis and lymphoma was investigated. RESULTS:Distribution and size of lymphadenopathies were significantly different in sarcoidosis and lymphoma groups (<0.05). Radiomics and data mining methods showed excellent performance in differentiating lymph nodes of sarcoidosis and lymphoma according to both the largest lymphadenopathy and lymphadenopathies in four different mediastinal regions (AUC >0,95). CONCLUSIONS:Distribution and size of lymphadenopathies can help differential diagnosis in patients with sarcoidosis and lymphoma. CT radiomics analysis can discriminate the lymph nodes of sarcoidosis and lymphoma with great performance regardless of lymph node size and location and it can be used safely in the diagnosis of these diseases, which can sometimes be challenging to distinguish from each other.

Coronavirus disease 2019 (COVID-19) is associated with pneumonia and has various pulmonary manifestations on computed tomography (CT). Although COVID-19 pneumonia is usually seen as bilateral predominantly peripheral ground-glass opacities with or without consolidation, it can present with atypical radiological findings and resemble the imaging findings of other lung diseases. Diagnosis of COVID-19 pneumonia is much more challenging for both clinicians and radiologists in the presence of pre-existing lung disease. The imaging features of COVID-19 and underlying lung disease can overlap and obscure the findings of each other. Knowledge of the radiological findings of both diseases and possible complications, correct diagnosis, and multidisciplinary consensus play key roles in the appropriate management of diseases. In this pictorial review, the chest CT findings are presented of patients with underlying lung diseases and overlapping COVID-19 pneumonia and the various reasons for radiological lung abnormalities in these patients are discussed.

PURPOSE:The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS:This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS:The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION:ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Objectives: This prospective study was planned to compare the predictive value of dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in locally advanced breast cancer patients (LABC) receiving neoadjuvant chemotherapy (NAC). Methods: Twenty seven patients with LABC [median age: 47, (26-66)] underwent a dynamic 18F-FDG PET study at baseline, and after 2-3 cycles of (NAC) were included (interim). Maximum standardized uptake value (SUVmax) values and SUV ratios for the 2nd, 5th, 10th, and 30th minutes and dynamic curve slope (SL) values and SL ratios were measured using 18F-FDG dynamic data. In addition, the values of SUVmean (2minSUVmean), SULpeak (2minSULpeak), metabolic volume (2minVol), and total lesion glycolysis (2minTLG) were measured for the first 2 min. Percent changes between baseline and interim studies were calculated and compared with the pathological results as the pathological complete response (PCR) or the pathological non-complete response (non-PCR). Receiver operating characteristic curves were obtained to calculate the area under the curve to predict PCR. Optimal threshold values were calculated to discriminate between PCR and non-PCR groups. Results: Baseline study SUV 30 (p=0.044), SUV 30/2 (p=0.041), SUV 30/5 (p=0.049), SUV 30/10 (p=0.021), SL 30/2 (p=0.029) and SL 30/5 (p=0.027) values were statistically significant different between PCR and non-PCR groups. The percentage changes of 2minVol between PCR and non-PCR groups were statistically significant. For the threshold value of-67.6% change in 2minVol, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.2%, 77.8%, 63.6%, 93.3%, and 80.7%, respectively (area under the curve: 0.826, p=0.009). Conclusion: Semiquantitative parameters for dynamic 18F-FDG PET can predict PCR. % changes in 2minVol can identify non-responding patients better than other parameters.

On February 6, two major earthquakes with magnitudes of 7.8 and 7.7 on the Richter scale hit Turkey and Northern Syria causing more than 50,000 deaths. In the immediate aftermath of the earthquakes, our major tertiary medical referral center received dozens of cases of crush syndrome, presenting with a variety of imaging findings. Crush syndrome is characterized by hypovolemia, hyperkalemia, and myoglobinuria that can lead to rapid death of victims, despite their survival of staying under wreckage for days. The typical triad of crush syndrome consists of the acute tubular necrosis, paralytic ileus, and third-space edema. In this article, we focus primarily on characteristic imaging findings of earthquake-related crush syndrome and divided them into two distinct subsections: myonecrosis, rapid hypovolemia, excessive third-space edema, acute tubular necrosis, and paralytic ileus, which are directly related to crush syndrome, and typical accompanying findings of earthquake-related crush syndrome. Lower extremity compression in earthquake survivors results in the typical third-space edema. In addition to the lower extremities, other skeletal muscle regions are also affected, especially rotator muscles, trapezius, and pectoral muscles. Although it may be relatively easy to better detect myonecrosis with contrast-enhanced CT scans, changing the windowing of the images may be helpful.

We investigated the prognostic value of interim and post-neoadjuvant chemotherapy (NAC) 18F FDG PET/CT and the complete pathological and metabolical response after NAC for disease-free survival (DFS) and overall survival (OS) in patients with locally advanced breast cancer (LABC) receiving NAC. Patients who were decided to receive NAC were evaluated with baseline (PET1), after 2-3 cycles of chemotherapy (interim-PET2), and after NAC-before surgery (PET3) with 18F FDG PET/CT. The primary tumor SUV and the total metabolic tumor volume (MTV) of the primary tumor+axillary lymph nodes were calculated and defined for PET1-2-3 as SUV1-2-3 and MTV1-2-3. We also calculated ??%SUV and ??%MTV for PET1-2 and PET1-3. The relation between parameters and survival was evaluated with Cox regression analysis. Patients were grouped as a complete metabolic response or not (metCR/nonmetCR) according to PET3 and as PCR/non-PCR according to the presence of residual invasive tumor as a result of pathology after NAC. Forty-two patients were analyzed (46.36??10.4 years old). The median follow-up time was 94.3 months. For DFS and OS, only MTV from post-NAC PET/CT was an independent predictor. For MTV3 ??? 2.1 mL vs. > 2.1 mL, 7-year DFS and OS were 81.3% - 50%, (p= 0.038) and 88.2% and 55.6%, (p= 0.042) respectively. Survival was statistically significantly different in the PCR/non-PCR patient groups. There was no difference in DFS between patients with metCR/non-metCR, only between groups for OS (Log-rank). MTV (??? 2.1mL vs. > 2.1mL) obtained from 18F FDG PET/CT after NAC-pre-surgery and complete pathological response might distinguish patients with poor prognosis.

DEAR EDITOR, Rheumatoid arthritis (RA) is a chronic inflammatory disorder that can have both articular and extraarticular involvement. Autoimmunity caused by the interaction of environmental and genetic factors is the principal driving force of the pathogenesis [1]. Thymic hyperplasia, which can accompany various rheumatic disorders, can be seen in two morphologies: true thymic hyperplasia or lymphofollicular hyperplasia, which can be associated with autoimmunity characterized by an increase in the size and weight of the thymus gland [2]. We report an RA patient with lymphoid cystic thymic hyperplasia and review the current literature focusing on the thymic abnormalities in RA.A 31-year-old man was admitted to our clinic with arthralgia and morning stiffness lasting 2–3 h in both hands and dyspnoea. He had lost 7 kg in the last 5 months. He had been using SSZ and NSAIDs, with a diagnosis of RA for 1 year. He had a 6pack-year smoking history. His medical history was unremarkable, and he denied using any illicit drugs. Joint examination revealed arthritis of bilateral second and third PIP joints, bilateral third and fourth MCP joints and bilateral wrists, pain, and limited movement of the left hip. Systemic examination revealed no further abnormalities. In laboratory investigations, anaemia (haemoglobin 11.5 g/dl), elevated ESR (104 mm/h), elevated CRP (20.7 mg/dl), positive RF (105 IU/ml) and positive anti-CCP (98.5 RU/ml) were found. Routine biochemistry, ANCA and ANA were all within normal limits. In addition, the Quantiferon-TB test was negative. In the chest radiograph, there was a radiodense mass-lesion appearance around the trachea. Thorax CT was ordered to rule out malignancy because of the suspicious mass-lesion appearance on chest radiography, weight loss and dyspnoea complaints. Thorax CT revealed a homogeneous thymus gland with soft tissue density 2.6 cm 4.5 cm 8.4 cm in size in the anterior mediastinum, with axillary lymphadenopathies (Fig. 1A and B). Its density was higher than expected for his age, but there was no sign of a cystic or solid mass in it. Trans-sternal extended thymectomy was performed by an experienced thoracic surgeon, and the thymectomy material was 20 cm 10 cm 1.5 cm in size and weighed 118 g (Fig. 1C). On macroscopic examination, multilocular cysts were found on the cut surface, many of which were filled with colloid-like material. Histopathological examination of the thymus revealed multiple cysts, hyperplastic lymphoid tissue with germinal centres, and Hassall corpuscles. The cysts were lined with thymic epithelium (Fig. 1D). Immunohistochemically, cytokeratin AE1/AE3 and p40 highlighted the epithelium of the cysts and Hassall corpuscles. Lymphoid markers revealed the mixed distribution of CD3þ and CD20þ cells and did not show monoclonal proliferation of B cells or T cells. Both CD20þ B cells and CD3þ T cells attacked the epithelium. Acquired multicystic thymic tissue with lymphoid hyperplasia was the pathological diagnosis. After the operation, MTX 15 mg/week and HCQ 2 200 mg/day were started, and SSZ was discontinued because the DAS-28 was 5.1. After 3 months, adalimumab 40 mg every 2 weeks was added to the treatment regimen owing to inadequate response (DAS-28 of 5.1). At the last control visit, there was one tender joint and no swollen joints. ESR was 20 mm/h and CRP 2 mg/dl. The DAS-28 score was 2.8, and a major clinical response was observed. However, owing to severe limitation of the left hip, left hip replacement was done 2 months later. The thymus, which is the main lymphoid organ responsible for the primary education of T cells, has a close relationship with autoimmune disorders. Dysregulation in thymic involution and T cell education process are proposed mechanisms for the pathogenesis of RA [3]. Another key structure, Hassal’s corpuscles in the thymus gland, is thought to play a role via regulatory T cells in the pathogenesis of autoimmune diseases, such as RA [4]. Apart from thymic epithelial neoplasms, thymic enlargement and absence of thymic involution were present in 20% of RA patients, and this rate was significantly higher in RA patients [5]. However, according to our literature review (with the following keywords in PubMed: arthritis and thymoma, arthritis and TH, arthritis and thymic cyst, RA and thymoma, RA and TH, RA and thymic cyst), we found that the coexistence of RA and thymic epithelial neoplasms was reported extremely rarely; three patients had thymoma, two had multilocular thymic cyst, one had mucosa-associated lymphoid tissue (MALT) lymphoma of the thymus and two had follicular hyperplasia of the thymus [6, 7]. Although we cannot confirm the link between the cystic thymic hyperplasia in our patient and the RA diagnosis, it would nevertheless be interesting to explore the association between thymic neoplasms and autoimmune rheumatic diseases further, based on the above findings. Besides, a recent study by Murata et al. [5] reported that prescription of biologic DMARDs was significantly higher in RA patients with thymic enlargement, similar to a former study by Meunier et al. [8]. Although there are no available data to suggest that RA patients with Key Message

Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functional lung (PREFUL) can provide functional information. This pictorial review aims to comprehensively define the radiological characteristics of each congenital lung disease in adults and to highlight differential diagnoses and possible complications of these diseases.

BACKGROUND:The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of invasive breast cancer in different histopathological types (invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) and mixed ductal-lobular carcinoma (MDLC)) and different histological grades. METHODS:A retrospective review was made of 1256 patients who underwent breast MRI at our hospital between January 2015 and December 2018. A total of 152 lesions (27 ILC, 102 IDC, 23 MDLC and 20 grade 1, 83 grade 2 and 49 grade 3) were included in the study. All the lesions were evaluated according to size, shape, margin, dynamic curve, ADC value and T2 signal intensity ratio (SIR). RESULTS:Most of the lesions tended to show type 2 and type 3 dynamic curve, type 1 dynamic curve was more commonly seen in ILC and grade 1 groups. IDC showed higher T2 SIR than the other types and grade 3 showed higher T2 SIR than other grades (p< 0,05) There was no statistically significant difference between the groups according to morphological features and mean ADC values (p > 0,05). CONCLUSION:T2 SIR and dynamic curve can help the radiologists predict histopathological findings while morphological features and ADC values were not helpful in distinguishing histological types and grades.

Objective To quantitatively evaluate computed tomography (CT) parameters of coronavirus disease 2019 (COVID-19) pneumonia an artificial intelligence (AI)-based software in different clinical severity groups during the disease course. Methods From March 11 to April 15, 2020, 51 patients (age, 18–84 years; 28 men) diagnosed and hospitalized with COVID-19 pneumonia with a total of 116 CT scans were enrolled in the study. Patients were divided into mild (n = 12), moderate (n = 31), and severe (n = 8) groups based on clinical severity. An AI-based quantitative CT analysis, including lung volume, opacity score, opacity volume, percentage of opacity, and mean lung density, was performed in initial and follow-up CTs obtained at different time points. Receiver operating characteristic analysis was performed to find the diagnostic ability of quantitative CT parameters for discriminating severe from nonsevere pneumonia. Results In baseline assessment, the severe group had significantly higher opacity score, opacity volume, higher percentage of opacity, and higher mean lung density than the moderate group (all P ≤ 0.001). Through consecutive time points, the severe group had a significant decrease in lung volume (P = 0.006), a significant increase in total opacity score (P = 0.003), and percentage of opacity (P = 0.007). A significant increase in total opacity score was also observed for the mild group (P = 0.011). Residual opacities were observed in all groups. The involvement of more than 4 lobes (sensitivity, 100%; specificity, 65.26%), total opacity score greater than 4 (sensitivity, 100%; specificity, 64.21), total opacity volume greater than 337.4 mL (sensitivity, 80.95%; specificity, 84.21%), percentage of opacity greater than 11% (sensitivity, 80.95%; specificity, 88.42%), total high opacity volume greater than 10.5 mL (sensitivity, 95.24%; specificity, 66.32%), percentage of high opacity greater than 0.8% (sensitivity, 85.71%; specificity, 80.00%) and mean lung density HU greater than −705 HU (sensitivity, 57.14%; specificity, 90.53%) were related to severe pneumonia. Conclusions An AI-based quantitative CT analysis is an objective tool in demonstrating disease severity and can also assist the clinician in follow-up by providing information about the disease course and prognosis according to different clinical severity groups.

Antifungal stewardship (AFS) is recommended to reduce the inappropriate use of antifungal drugs. In this study, the role of AFS in providing appropriate antifungal therapy was evaluated. This study included three periods, consisting of observation, feedback/education, and daily AFS activities. In the observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In the second period, monthly meetings were organized to provide feedback and education to physicians regarding antifungal therapy and the rate of adherence to the clinical guidelines. In the final period, a clinical pharmacist participated in daily ward rounds to evaluate the appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Four hundred eighteen episodes of antifungal therapy were evaluated. Baseline demographics of patients were similar in all three periods for age, gender, and the number of comorbidities. The indications for antifungal use were for prophylaxis in 22.7%, Candida infections in 58.6%, and invasive mold infections in 18.7%. During the third period, 157 (78.9%) recommendations were made and 151 (96.2%) were accepted. The overall appropriateness of antifungal use increased significantly for prophylaxis (30.8%, 17.9%, and 46.3%; P = 0.046) and treatment of fungal diseases (27.8%, 32.4%, and 71.9%; P < 0.001) between the first, second, and third periods, respectively. The 30-day mortality was not significantly changed between the three periods (19%, 15.6%, and 27.5%; P = 0.050). Appropriateness in antifungal therapy can be augmented by the integration of an AFS program. A team-based evaluation of fungal infections and assessment of patients by a clinical pharmacist with a therapeutic perspective may help to increase the quality of antifungal therapy.

Background Breast involvement of hematological malignancies is a very rare entity. Accurate diagnosis is essential for appropriate treatment. The aim of this study was to clarify the clinical and radiological findings of hematological malignancy breast involvement and to describe possible pitfalls in diagnosis. Results The images of 20 patients with breast involvement of hematological malignancies were retrospectively evaluated on ultrasonography, mammography, and magnetic resonance imaging (MRI) and the findings were reported. Bilaterality was seen only in cases with secondary involvement, and there was no marked difference between primary and secondary breast involvement of hematological malignancies. All patients underwent ultrasonography examination. According to ultrasonography, breast masses were most frequently irregular in shape (11/20, 55%) with non-circumscribed margins (11/20, 55%). Posterior acoustic enhancement was noted in 14 cases (70%). Posterior shadowing was not observed in any of the patients. Mammography was available in 10 patients. Microcalcification was not observed in any patient on mammography. MRI was available in four patients. Hyperintensity in T2-weighted images, type 2 or type 3 dynamic curve, and diffusion restriction were observed in all cases. Conclusions Hematological malignancies may mimic both benign breast lesions and breast carcinoma. Familiarity with the radiological features of hematological malignancies can help accurate diagnosis.

Aim: Breast cancer is one of the most important causes of mortality and morbidity in women. With the widespread use of screening mammography, the detection of non-palpable suspected cancerous lesions is increasing. Therefore, the use of vacuum-assisted breast biopsy in the management of breast lesions continues to increase. The aim of this study was to evaluate the histopathological results of suspicious microcalcifications which were diagnosed by vacuum-assisted needle biopsy on a stereotactic prone table and to compare the mammographic features of the microcalcifications with the histopathological results. Materials and Methods: The study included a total of 119 patients with a median age of 51 years (range, 33-77 years) who underwent stereotactic biopsy on a prone table because of suspicious microcalcifications between March 2010 and July 2014. Retrospective evaluation was made of the preoperative mammographic features, and the BI-RADS (Breast imaging-reporting and data system) scores of the microcalcifications and the vacuum biopsy and / or excisional histopathological results. Results: Stereotactic vacuum-assisted breast biopsy revealed that 52.1% of the lesions were benign and 47.9% were malignant. After vacuum-assisted stereotactic biopsy 61 patients underwent surgery. In 10 of these (16.3%) the final excisional histopathological diagnosis was benign, and in 51 (83.7%) malignancy was determined. Conclusion: Vacuum-assisted breast biopsy on a stereotactic prone table is a successful technique with a low failure rate for microcalcifications that are non-palpable and have no ultrasonographic findings.

Background/aim We aimed to analyze the usefulness of such a reserved area for the admission of the patients’ symptoms suggesting COVID-19 and compare the demographic and clinical characteristics of the patients with COVID-19 and without COVID-19 who were admitted to C1 during the first month of the COVID-19 outbreak in our hospital. Materials and methods A new area was set up in Hacettepe University Adult Hospital to limit the contact of COVID-19 suspicious patients with other patients, which was named as COVID-19 First Evaluation Outpatient Clinic (C1). C1 had eight isolation rooms and two sampling rooms for SARS-CoV-2 polymerase-chain-reaction (PCR). All rooms were negative-pressurized. Patients who had symptoms that were compatible with COVID-19 were referred to C1 from pretriage areas. All staff received training for the appropriate use of personal protective equipment and were visited daily by the Infection Prevention and Control team. Results One hundred and ninety-eight (29.4%) of 673 patients who were admitted to C1were diagnosed with COVID-19 between March 20, 2020, and April 19, 2020. SARS-CoV-2 PCR was positive in 142 out of 673 patients. Chest computerized tomography (CT) was performed in 421 patients and COVID-19 was diagnosed in 56 of them based on CT findings despite negative PCR. Four hundred and ninety-three patients were tested for other viral and bacterial infections with multiplex real-time reverse-transcriptase PCR (RT-PCR). Blood tests that included complete blood count, renal and liver functions, d-dimer levels, ferritin, C- reactive protein, and procalcitonin were performed in 593 patients. Only one out of 44 healthcare workers who worked at C1 was infected by SARS-CoV-2. Conclusion A well-planned outpatient care area and teamwork including internal medicine, microbiology, and radiology specialists under the supervision of infectious diseases specialists allowed adequate management of the mild-to-moderate patients with suspicion of COVID-19.

Purpose Triple-negative breast cancer (TNBC) has some distinctive features. The aim of the study was to compare clinical and breast magnetic resonance imaging (MRI) findings of TNBC with non-triple-negative breast cancer (nTNBC) in molecular subtypes such as ADC (apparent diffusion coefficient) values, T2-weighted (T2W) image intensity, shape, margin, lymph node involvement, grade, multifocality, multicentricity, bilaterality, and enhancement pattern differences between tumour subtypes. Material and methods A total of 141 patients who underwent breast biopsy at our institution between January 2010 and June 2018 were included in this study. Patients were divided into molecular subtypes according to hormone receptor status, and Ki-67 index. Tumour grade, enhancement patterns, age, lymph node involvement, ADC values, breast imaging reporting and data system (BI-RADS) category, bilaterality, multifocality, multicentricity, margin, shape, and T2W image intensity were evaluated for these subtypes. Results ADC values were higher in triple-negative tumours than in luminal A and luminal B tumours (p = 0.010 and p = 0.002, respectively). Circumscribed margin, type 2 enhancement curve, and rim enhancement were significantly higher in triple-negative tumours (p < 0.001). No significant difference was found between the groups in terms of other MRI findings including bilaterality, multifocality, multicentricity, shape, and T2W image intensity (p > 0.05). Conclusions ADC values, circumscribed margin, and rim enhancement can provide important information about the tumour’s biological behaviour and the course of the disease.

PURPOSE The aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data. METHODS Patients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU). RESULTS A total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP <82.45% (sensitivity, 83.1%; specificity, 84.2%) were related to severe pneumonia, VQAS >9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia. CONCLUSION Both SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia.

Objective: Ultrasonography guided core needle biopsy is a real-time, inexpensive method with higher patient comfort. The aim of this study was to evaluate ultrasonography findings of microcalcifications without accompanying mass and also to investigate the accuracy of ultrasonography guided core needle biopsy results. Materials and Methods: The study included a total of 54 patients, with microcalcifications observed on mammography and no accompanying mass, who underwent ultrasonography guided core needle biopsy and surgical excision. Core needle biopsy specimen x-rays were obtained from 23 patients. In 11 patients, the location of microcalcification was confirmed by mammography following the administration of contrast agent under ultrasonography guidance. Ultrasonography findings of microcalcifications were identified. The results of ultrasonography guided core needle biopsy were compared with the excisional pathology results. Results: The microcalcifications without accompanying mass were presented with punctate echogenous foci, hypoechoic area, small distortion, ductal abnormality or fibrocystic changes on ultrasonography. Hypoechoic area and distortion were seen more in malignant lesions, and fibrocystic changes and ductal abnormalities in benign lesions but the difference was not statistically significant. The agreement between ultrasonography guided core needle biopsy and the excisional pathology results was high (Kappa = 0.781). When a specimen x-ray was obtained or core needle biopsy was performed after confirming the location of the microcalcifications with the use of contrast agent, Kappa values were even higher (0.87 and 1, respectively). Conclusions: Microcalcifications can be seen with targeted ultrasonography imaging and ultrasonography guided core needle biopsy has high accuracy. Taking a specimen x-ray, or biopsy performed after identifying of the location of microcalcifications with a trace amount of contrast agent, can increase the accuracy of ultrasonography guided core needle biopsy.

Male breast hosts various pathological conditions just like "female breast." However, histo-anatomical diversities with female breast lead to many differences regarding the frequency and presentation of diseases, the radiologic appearance of lesions, the diagnostic algorithm, and malignity features.Radiological modalities may play an important role in evaluating male breast lesions. Although some imaging findings are non-specific, having knowledge of certain imaging characteristics and radiologic patterns is the key to reduce the number of differential diagnoses or to reach an accurate diagnosis.Male breast imaging is mostly based on physical examination and is required for the complaints of palpable mass, breast enlargement, tenderness, nipple discharge, and nipple-skin changes. The majority of the male breast lumps are benign and the most common reason is gynecomastia. Although it is difficult to exclude malignancy in some cases, gynecomastia often has distinguishable imaging features. Pseudogynecomastia is another differential diagnosis that may be confused with gynecomastia. The distinction is important for the treatment plan.Apart from gynecomastia, other male breast lesions form a highly heterogeneous group and can be classified based on "Tissue origin," "Histopathological type and behavior," and "Radiologic features" for both simplification and comprehensive understanding.This article mainly focuses on emphasizing the results of basic histo-anatomical differences of male and female breasts, classifying male breast lesions, covering the spectrum of male breast diseases, and assisting radiologists in recognizing the imaging findings, in interpreting them through a holistic approach, in making a differential diagnosis, and in being a part of proper patient management.