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Erdemir AG, Yurttutan N, Onur MR, İdilman İS, Öztürk MH, Ertürk ŞM, Çevikol C, Akpınar E. Radiological management and challenges of the twin earthquakes of February 6th. Emerg Radiol 2023; 30:659-666. [PMID: 37535144 DOI: 10.1007/s10140-023-02162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
Two major earthquakes measuring 7.8 and 7.7 on the Richter scale struck Turkey and Northern Syria on February 6, claiming more than 50,000 lives. In such an unprecedented disaster, radiologists were confronted with very critical tasks of stepping out of the routine reporting process, performing radiological triage, managing acute adverse events, and optimizing imaging protocols. In our experience, radiologists can take three different positions in such disasters: (1) in the scene of the disaster, (2) serving in teleradiology, and (3) working in tertiary hospital for transported patients. With this article, we aimed to describe the challenges radiologists face on the three main fronts and how we manage these challenges.
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Affiliation(s)
- Ahmet Gürkan Erdemir
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Nursel Yurttutan
- Department of Radiology, Faculty of Medicine, Kahramanmaraş University, Kahramanmaraş, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Mehmet Halil Öztürk
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Şükrü Mehmet Ertürk
- Department of Radiology, Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Can Çevikol
- Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Erhan Akpınar
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Erdemir AG, İdilman İS, Çifçi GÇ, Yıldız AE, Demirkazık F, Onur MR, Akpınar E, Aydıngöz Ü. Imaging in crush injury: a spectrum of findings in survivors of the twin earthquakes on February 6, 2023. Emerg Radiol 2023:10.1007/s10140-023-02147-4. [PMID: 37270438 DOI: 10.1007/s10140-023-02147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Ahmet Gürkan Erdemir
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
| | - İlkay Sedakat İdilman
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Gökçen Çoban Çifçi
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Adalet Elçin Yıldız
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Figen Demirkazık
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Erhan Akpınar
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Üstün Aydıngöz
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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Yar O, Onur MR, İdilman İS, Akpınar E, Akata D. Excessive z-axis scan coverage in body CT: frequency and causes. Eur Radiol 2020; 31:4358-4366. [PMID: 33241517 DOI: 10.1007/s00330-020-07510-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the frequency and causing factors of excessive z-axis coverage in body CT examinations. METHODS A total of 2032 body CT examinations performed between 1 March and 1 April 2018 in 1531 patients were included in this study. The over-scanned length values in the z-axis for each CT examination on each patient were determined by calculating the difference between the actual scanned length and optimal scan length in the z-axis. Over-scanning and over-scanning ratios were interrogated in terms of potential underlying factors that can be affected by patient demography, time, the throughput of CT, and the experience of technologists. RESULTS Over-scanned CTs in z-axis were 66% of all CTs performed. CT scans were over-scanned in the cranial side in 18.4% and caudal side in 48.5% of patients. Over-scanning was found to be more frequent in 55-64-year-old age group (74%), thorax CTs (89.2%), patients with consciousness change (88.9%), patients with misleading findings related to lung apex or diaphragm on the scout images (76.6%), CTs performed in day shift (66.8 %), in CT with low daily scan (72.4%), and CT scans performed by less-experienced technologists (75.9%). CONCLUSIONS Over-scanning in z-axis in body CT examinations is not infrequently encountered in routine practice. Awareness of causes of over-scanning in z-axis can be helpful to prevent over-scanning in CT and unnecessary ionizing radiation exposure in patients. KEY POINTS • Over-scanning in z-axis frequently occurs in body CT. • The frequency of over-scanning in caudal side is higher than cranial side. • Chest CT and any CT performed in following situation were more prone to over-scanning: older patients, patients with consciousness change, presence of misleading findings on the scout images related to lung apex or diaphragm, day shift, CT with low daily scan, less-experienced technologist.
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Affiliation(s)
- Ozan Yar
- Department of Radiology, Artvin Public Hospital, 08000, Artvin, Turkey
| | - Mehmet Ruhi Onur
- Hacettepe University Faculty of Medicine, Department of Radiology, Hacettepe Universitesi Tıp Fakultesi Hastanesi Sıhhiye, 06100, Ankara, Turkey.
| | | | - Erhan Akpınar
- Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Deniz Akata
- Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey
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Ünal E, İdilman İS, Karaosmanoğlu AD, Özmen MN, Akata D, Karcaaltıncaba M. Hyperintensity at fat spared area in steatotic liver on the hepatobiliary phase MRI. ACTA ACUST UNITED AC 2020; 25:416-420. [PMID: 31650968 DOI: 10.5152/dir.2019.18535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE We aimed to investigate the reasons for hyperintensity at fat spared area in steatotic liver at hepatobiliary phase (HBP) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver magnetic resonance imaging. METHODS Twenty-two patients with focal fat spared area demonstrating hyperintensity on HBP images were included. A region of interest was placed on in- and opposed-phase images at fat spared area and liver to measure the fat. The measurement was also performed on precontrast T1-weighted and HBP images. The signal intensities of spleen, kidney, muscle, intervertebral disc, and spinal cord were also recorded. RESULTS The mean fat fraction of liver and fat spared area was 24.86% (8%-46%) and 8.41% (1%-34%), respectively (P < 0.001). There was a significant positive correlation between liver parenchyma fat fraction and delta fat fraction (r=0.74, P < 0.001). The mean signal intensity values of fat spared areas were higher compared with liver on precontrast T1-weighted and HBP images (P < 0.001). The mean relative enhancement ratio of liver and fat spared areas were 0.98 (0.05-1.90) and 1.15 (0.22-2.03), respectively (P < 0.001). However, in 6 patients, the relative enhancement ratio of liver and fat spared areas were almost equal. The uptake of Gd-EOB at fat spared area was not correlated with the degree of steatosis (r = -0.01, P = 0.95). CONCLUSION Fat spared area in steatotic liver appears hyperintense on HBP images due to increased relative enhancement ratio and/or baseline hyperintensity on precontrast images.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | | | - Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Aktürk Y, Kurt A, İdilman İS. İzole inkompetan perforan venlerin sonografik değerlendirilmesi ve yaş, cinsiyet, vücut kitle indeksi, CEAP sınıflandırması ile korelasyonu. Cukurova Medical Journal 2018. [DOI: 10.17826/cumj.341853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Microvascular invasion is a crucial histopathologic prognostic factor for hepatocellular carcinoma. We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule, irregular tumor margin, peritumoral enhancement, multifocal tumor, increased tumor size, and increased glucose metabolism on positron emission tomography-computed tomography. In the presence of typical findings, microvascular invasion may be predicted.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine Ankara, Turkey; Department of Radiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
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