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    Diffusion-weighted MR imaging of pleural fluid
    (Springer, 2004) Baysal, T; Bulut, T; Gökirmak, M; Kalkan, S; Dusak, A; Dogan, M
    The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm(2)) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42+/-0.76x10(-3) mm(2)/s. Exudates had a mean ADC value of 3.18+/-1.82x10(-3) mm(2)/s. The optimum cutoff point for ADC values was 3.38x10(-3) mm(2)/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements (r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.
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    Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey
    (Karger, 2000) Senyigit, A; Babayigit, C; Gökirmak, M; Topçu, F; Asan, E; Coskunsel, M; Isik, R
    Background: Inhabitants of the southeast of Turkey (ST) have been exposed since childhood to inhalation of asbestos, from a material containing tremolite, used for whitewashing. This has resulted in an increased incidence of malignant pleural mesothelioma (MPM). Objectives: To review the epidemiological features of MPM cases in ST; to calculate and compare the incidence with the previously reported ones. Subjects and Methods: The study included 176 MPM cases from different places in ST. The incidence of MPM was calculated for those places according to the distribution of the cases. Results: In the previously identified regions of asbestos (region 1) where the population had been informed of the danger with the soil some decades ago, the MPM incidence was decreased, as compared to the previous reports. The annual incidence of MPM in these places was found to be 42.9 per million in this study while it had been reported to be 105.5 per million in the previous studies. In contrast, the incidence that was reported previously to be 2.75 per million in the regions where asbestos exposure had not been identified before (region 2] was found to be 8.6 per million in this study. In region 2 the incidence of MPM increased even in the second ha If of the last decade (5.9 versus 11.9 per million). Conclusions: Use of asbestos-containing soil continues in different places in ST. Even if the use of this soil is abandoned today, MPM will be an important health problem in this region till the third or fourth decades of this century. Informing the villagers of the danger and preventing the use of this soil may result in a considerable decrease in the incidence of MPM. Copyright (C) 2000 s. Karger AG, Basel.