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Bozkurt E, Yigman S, Adsay V, Gurses B, Tellioglu G, Bilge O. Primary angiosarcoma of the Pancreas - A case Report and review of the literature. Acta Chir Belg 2024; 124:73-80. [PMID: 38265358 DOI: 10.1080/00015458.2024.2309718] [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: 03/10/2023] [Accepted: 01/20/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Angiosarcomas are malignant neoplasms that originate from endothelial cells. The symptoms exhibit a non-specific nature, and achieving a preoperative diagnosis is frequently challenging. They are seldom encountered in the abdomen, and their occurrence in the pancreas is even rarer. METHODS Here we document a 67-year-old man with pancreatic angiosarcoma and analyse the literature to outline the clinicopathologic characteristics of this rare phenomenon. RESULTS This patient with family history of pancreas cancer presented with abdominal pain, and the CT-scan revealed a 4 cm mass at the neck of the pancreas but CA19-9 was normal. Radiologic findings were unusual for ordinary pancreas cancer. Fine-needle aspiration biopsy through endoscopic ultrasound revealed "undifferentiated malignant cells for which the diagnosis of "carcinoma" was favoured. Total pancreatectomy, splenectomy and portal vein reconstruction were performed and epithelioid angiosarcoma were diagnosed. Despite an uneventful postoperative period, discharge on postoperative day 8 without any complications, as well as diligent post-discharge clinical care, the patient died 65 days postoperatively, attributed to the presence of extensive metastasis. A comprehensive literature search has identified a limited number of documented cases of primary pancreatic angiosarcoma, with only ten cases reported to date. CONCLUSIONS Pancreatic angiosarcomas are very rare and prone to misdiagnosis. The formation of a more demarcated but high-grade tumour with necrosis is a feature that distinguishes angiosarcomas from ordinary carcinomas of this organ. Pathologic diagnosis is also highly challenging closely resembling undifferentiated carcinomas. Angiosarcomas are highly aggressive when they occur in the pancreas. Prompt diagnosis at an early stage is crucial as surgery with curative intent serves as the primary treatment approach.
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Affiliation(s)
- Emre Bozkurt
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Samet Yigman
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Gurkan Tellioglu
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Orhan Bilge
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
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Karahacioglu D, Taskin OC, Esmer R, Armutlu A, Saka B, Ozata IH, Rencuzogullari A, Bugra D, Balik E, Adsay V, Gurses B. Performance of CT in the locoregional staging of colon cancer: detailed radiology-pathology correlation with special emphasis on tumor deposits, extramural venous invasion and T staging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04203-0. [PMID: 38446179 DOI: 10.1007/s00261-024-04203-0] [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: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To investigate the performance of computed tomography (CT) in the local staging of colon cancer in different segments, with emphasis on parameters that have been found to be significant for rectal cancer, namely, extramural venous invasion (EMVI) and tumor deposits (TDs). METHODS CT and pathology data from 137 patients were independently reviewed by radiology and pathology teams. The performance of CT in categorizing a given patient into good, versus poor prognostic groups was assessed for each segment, as well as the presence of lymph nodes (LNs), TDs and EMVIs. Discordant cases were re-evaluated to determine potential sources of error. Elastic stain was applied for EMVI discordance. RESULTS The T staging accuracy was 80.2%. For T stage stratification, CT performed slightly better in the left colon, and the lowest accuracy was in the transverse colon. Under-staging was more common (in 12.4%), and most of the mis-staged cases were in sigmoid colon. According to the first comprehensive correlative analysis, the sensitivity, specificity, and accuracy of CT for detecting TDs were found to be 57.9%, 92.4%, 87.6%, respectively. These figures were 44.7%, 72.7%, and 63.5% for LN, and 58.5%, 82.1% and 73% for EMVI. The detection rate was better for multifocal EMVI. The detection rate was also comparable (although substantially underestimated) for LNs, with the half of the LNs missed by CT being < 5 mm. Four patients that were classified as TD by CT, disclosed to be LNs by pathology. Correlative analysis led to refinement of the pathology criteria, with subsequent modifications of the initial reports in 13 (9.5%) patients. CONCLUSION Overall, CT performed well in the evaluation of colon cancer, as did TD and EMVI. It is advisable to include these parameters in CT-based staging. Radiologists should be aware of the pitfalls that occur more commonly in different segments.
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Affiliation(s)
- Duygu Karahacioglu
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey.
| | - Orhun Cig Taskin
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Rohat Esmer
- Koç University School of Medicine, Istanbul, Turkey
| | - Ayse Armutlu
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Burcu Saka
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Ibrahim Halil Ozata
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
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Yıldız AB, Vehbi S, Copur S, Gurses B, Siriopol D, Karakaya BAD, Hasbal NB, Tekin B, Akyıldız M, van Raalte DH, Cozzolino M, Kanbay M. Kidney and liver fat accumulation: from imaging to clinical consequences. J Nephrol 2024; 37:483-490. [PMID: 38133740 DOI: 10.1007/s40620-023-01824-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Recent studies indicate that accumulation of adipose tissue in various organs such as liver and kidney may contribute to the pathophysiology of metabolic syndrome. We aim to investigate the association between kidney and liver adipose tissue accumulation, assessed by the magnetic resonance imaging (MRI) proton density fat fraction technique, along with its relation to clinical and biochemical parameters. METHODS We included 51 volunteers with phenotypical features of metabolic syndrome (mean age = 34 years, mean body-mass index = 26.4 kg/m2) in our study in which liver and kidney adipose tissue accumulation was assessed via MRI-proton density fat fraction along with multiple other clinical and biochemical parameters such as estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio, serum lipid profile, liver function tests and body-mass index (BMI). RESULTS Our results from the univariate linear regression analysis indicate that both the kidney and liver scores were positively correlated with markers such as BMI, urine albumin-to-creatinine ratio, triglycerides (p < 0.001) and negatively correlated with eGFR (p < 0.05). In multivariate analysis, urine albumin-to-creatinine ratio (p < 0.05), triglycerides (p < 0.01), eGFR (p < 0.05) and BMI (p < 0.001) were found to be independently associated with kidney and liver fat accumulation, respectively (R2 = 0.64; R2 = 0.89). There was also a positive correlation between kidney and liver fat accumulation. CONCLUSION We have found a significant association between adipose tissue accumulation in liver and kidney and the parameters of metabolic syndrome. Moreover, the presence of a strong association between kidney and liver fat accumulation and kidney function parameters such as urine albumin-to-creatinine ratio and eGFR may be an indicator of the clinical significance of parenchymal fat accumulation.
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Affiliation(s)
- Abdullah B Yıldız
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sezan Vehbi
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Department of Nephrology, "Saint John the New" County Hospital, "Stefan Cel Mare" University of Suceava, Suceava, Romania
| | | | - Nuri B Hasbal
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey
| | - Bahar Tekin
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Murat Akyıldız
- Division of Gastroenterology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, Location VUMC, Amsterdam, The Netherlands
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, Milan, Italy
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey.
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Esen B, Seymen H, Gurses B, Armutlu A, Koseoglu E, Tarim K, Ertoy Baydar D, Sarikaya AF, Canda AE, Balbay D, Kordan Y, Tilki D, Esen T, Demirkol MO. The role of PSMA PET/CT to predict upgrading in patients undergoing radical prostatectomy for ISUP grade group 1 prostate cancer. Prostate 2024; 84:32-38. [PMID: 37661579 DOI: 10.1002/pros.24621] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the additive role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) independent from multiparametric magnetic resonance imaging (mpMRI) and clinical-pathological parameters to predict pathological upgrading in patients with ISUP grade group (GG) 1 prostate cancer (PCa) at prostate biopsy. MATERIALS AND METHODS A total of 41 patients who underwent robotic radical prostatectomy (RP) for GG1 disease at prostate biopsy with preoperative PSMA PET/CT and mpMRI images available for central review were included in the study. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of pathological upgrading (GG ≥ 2). RESULTS Final RP pathology revealed upgrading in 26 patients (65.9%); to GG 2 disease in 25 cases and GG 4 disease in one case. International Society of Urological Pathology (ISUP) upgrading rates for prostate imaging-reporting and data system (PIRADS)-5, PIRADS-4, and PIRADS ≤ 3 lesions were 78%, 74%, and 38%, respectively. Fourteen out of 15 (93.3%) patients with an SUVmax ≥ 5.6 and all patients with an SUVmax ≥ 6.5 (n = 10) had pathological upgrading. The upgrading rate in patients with SUV < 5.6 was 46.2% (12/26). Intraprostatic SUVmax ≥ 5.6 was found as the only independent predictor of pathological upgrading in multivariate analysis. CONCLUSION High prostatic PSMA uptake was found to be a very reliable predictor of pathological upgrading, but low PSMA uptake cannot exclude pathological upgrading. Intraprostatic PSMA uptake along with previously known mpMRI and biopsy-related parameters should be considered when making a treatment decision in patients with GG1 PCa at prostate biopsy.
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Affiliation(s)
- Baris Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Hulya Seymen
- Department of Nuclear Medicine, School of Medicine, Koç University, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey
| | - Ayse Armutlu
- Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey
| | - Ersin Koseoglu
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Kayhan Tarim
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Abdullah Erdem Canda
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
- RMK AIMES, Rahmi M. Koc Academy of Interventional Medicine, Education, and Simulation, Istanbul, Turkey
| | - Derya Balbay
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Derya Tilki
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Esen
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Mehmet Onur Demirkol
- Department of Nuclear Medicine, School of Medicine, Koç University, Istanbul, Turkey
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Guzelbey T, Demirbaş ZE, Gurses B. The Evaluation of Renal Iron Deposition With a 3 Tesla MRI Device in Beta-Thalassemia Major Patients. Cureus 2023; 15:e36179. [PMID: 37065363 PMCID: PMC10103619 DOI: 10.7759/cureus.36179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Background and objective Beta-thalassemia is the most frequent monogenic disease in the world. In beta-thalassemia major (BTM) patients, blood transfusions for severe anemia usually cause iron overload, leading to increased morbidity and mortality. In this study, we aimed to examine the iron overload in the kidneys of BTM patients with a 3 Tesla (3T) MRI device and assess the relationship between iron overload in the liver and heart as well as serum ferritin levels. Methods This was a retrospective study covering the period between November 2014 and March 2015. MRI was performed on 21 patients with BTM who were receiving blood transfusions and chelation therapy. The control group (n=11) included healthy volunteers. A 3T MRI device (Ingenia, Philips, Best, The Netherlands) using a 16-channel phased array SENSE-compatible torso coil was used. Three-point DIXON (mDIXON) sequence and the relaxometry method were employed to measure iron overload. Both kidneys were analyzed via mDIXON sequence for atrophy or variations. Afterward, the images in which renal parenchyma could be distinguished best were selected. Iron deposition was analyzed via the relaxometry method using a unique software (CMR Tools, London, UK). All data were analyzed using IBM SPSS Statistics v.21 (IBM Corp., Armonk, NY). The Kolmogorov-Smirnov test, independent samples t-test, Mann-Whitney U test, and Pearson's and Spearman's rho correlation coefficient were used. A p-value <0.05 was considered statistically significant. Results There was a statistically significant relationship between beta-thalassemia patients who had cardiac iron deposition and those who did not in terms of T2* time (p=0.02). In contrast, there was no similar relationship for liver iron deposition (p>0.05). Renal T2* values were significantly different between the patient and control groups (p=0.029). T2* times were significantly different between patients who had ferritin levels below 2500 ng/ml and those with ferritin levels above 2500 ng/ml (p=0.042). Conclusion Based on our findings, 3T MRI is a safe and reliable tool for screening iron overload in BTM patients as it makes distinguishing between renal parenchyma and renal sinus much easier and as it is more sensitive to iron deposition.
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Altinmakas E, Dogan H, Taskin OC, Ozoran E, Bugra D, Adsay V, Balik E, Gurses B. Reply to Letter to the editor. Abdom Radiol (NY) 2022; 47:3642-3643. [PMID: 35852569 DOI: 10.1007/s00261-022-03617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Emre Altinmakas
- Division of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hakan Dogan
- Division of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
| | - Orhun Cig Taskin
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Ozoran
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Division of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey.
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Altinmakas E, Dogan H, Taskin OC, Ozoran E, Bugra D, Adsay V, Balik E, Gurses B. Extramural venous invasion (EMVI) revisited: a detailed analysis of various characteristics of EMVI and their role as a predictive imaging biomarker in the neoadjuvant treatment response in rectal cancer. Abdom Radiol (NY) 2022; 47:1975-1987. [PMID: 35332398 DOI: 10.1007/s00261-022-03495-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/07/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess whether size, diameter, and large vein involvement of MR-detected extramural venous invasion (MR-EMVI) have an impact on neoadjuvant therapy response in rectal adenocarcinoma. METHODS 57 patients with locally advanced rectal adenocarcinoma scanned with MRI before and after neoadjuvant therapy were included. Two abdominal radiologists evaluated the images with special emphasis on EMVI, on initial staging and after neoadjuvant treatment. The sensitivity and specificity of MRI for detection of rest EMVI were determined. The association of various MR-EMVI characteristics including number, size, and main vein involvement with treatment response was investigated. In subjects with discordance of radiology and pathology, elastin stain was performed, and images and slides were re-evaluated on site with a multidisciplinary approach. RESULTS At initial evaluation, 17 patients were MR-EMVI negative (29.8%) and 40 were MR-EMVI positive (70.2%). Complete/near-complete responders had less number (mean 1.45) and smaller diameter of MR-EMVI (mean 1.8 mm), when compared with partial responders (2.54 and 3.3 mm; p < 0.005). The sensitivity of MRI for rest EMVI detection was high, specificity was moderate, and in one patient elastin stain changed the final decision. In five patients with rest MR-EMVI positivity, carcinoma histopathologically had a distinctive serpiginous perivascular spread, growing along the track of vascular bundle, although it did not appear in intravascular spaces. CONCLUSION This study demonstrates that not only the presence, but also size and number of EMVI that may be significant clinically and thus these parameters also ought to be incorporated to the MRI evaluation and prognostication of treatment response. From pathology perspective, tumors growing alongside major vessels may also reflect EMVI even if they are not demonstrably "intravascular."
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Affiliation(s)
- Emre Altinmakas
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hakan Dogan
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey
| | - Orhun Cig Taskin
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Ozoran
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey.
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Boge M, Gurses B, Vural M, Yilmaz S, Goksel S, Bilge O. Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: A case report. Int J Surg Case Rep 2017; 40:69-72. [PMID: 28942226 PMCID: PMC5612805 DOI: 10.1016/j.ijscr.2017.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023] Open
Abstract
The panreatic IPMN and neuroendocrine carcinoma is very unusual. The IPMN component of our patient has high grade dysplasia, which is very rare. In presence of contrast enhancing nodular foci, while evaluating IPMN on imaging studies, possibilty of neuroendocrine tumor should be in mind.
Introduction Intraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature. Presentation A 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma. Discussion The concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated IPMNs were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association. Conclusion Although the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.
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Affiliation(s)
- M Boge
- Koç University, School of Medicine, Department of Radiology, Turkey
| | - B Gurses
- Koç University, School of Medicine, Department of Radiology, Turkey.
| | - M Vural
- American Hospital, Department of Radiology, Turkey
| | - S Yilmaz
- American Hospital, Department of Pathology, Turkey
| | - S Goksel
- Acibadem Health Group, Department of Pathology, Turkey
| | - O Bilge
- Koç University, School of Medicine, Department of General Surgery, Turkey
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Guzelbey T, Gurses B, Ozturk E, Ozveren O, Sarsilmaz A, Karasu E. Evaluation of Iron Deposition in the Adrenal Glands of β Thalassemia Major Patients Using 3-Tesla MRI. Iran J Radiol 2016; 13:e36375. [PMID: 27853501 PMCID: PMC5107262 DOI: 10.5812/iranjradiol.36375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/25/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022]
Abstract
Background Beta-thalassemia major (β-TM) patients need blood transfusions, which result in iron deposition. To regulate chelation therapy, iron load has to be measured. With MRI, the amount of signal loss and T2* decay time shortening are used for iron quantification. Objectives The aim was to measure adrenal iron load with T2* relaxometry using MRI, and to compare it with liver and cardiac iron and serum ferritin, and to find out whether adrenal iron could be predicted from those parameters. Patients and Methods Between October 2014 and March 2015, MRI was performed in 21 patients with β-TM, recieving blood transfusions and chelation therapy. The control group (n = 11) included healthy volunteers with no known history of adrenal, hematologic, chronic disease, and blood transfusion. Results Among patients, there was no significant correlation between plasma ferritin and adrenal T2*. Significant difference was detected among T2* values of adrenals between the patient and control groups. There was no significant correlation between adrenal gland and liver T2* in β-TM patients, moderate correlation was detected between adrenal T2* and cardiac T2*. Conclusion Adrenal iron in β-TM can be reliably measured in 3 Tesla MRI. The results highlight the absence of correlation between adrenal iron deposition both with serum ferritin and hepatic iron.
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Affiliation(s)
- Tevfik Guzelbey
- Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey
- Corresponding author: Bengi Gurses, Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey, E-mail:
| | - Erman Ozturk
- Department of Hematology, School of Medicine, Koc University, Istanbul, Turkey
| | - Olcay Ozveren
- Department of Cardiology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Aysegul Sarsilmaz
- Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Ebru Karasu
- Department of Radiology, School of Medicine, Yeditepe University, Istanbul, Turkey
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Yencilek E, Sarsılmaz A, Kilickesmez O, Koyuncu H, Eryildirim B, Gurses B, Bastug Y, Erihan B. The Daily Resistive Index measurement useful tool in the estimation of the optimal time interval between two Shock Wave Lithotripsy sessions. Med Ultrason 2015; 17:175-179. [PMID: 26052567 DOI: 10.11152/mu.2013.2066.172.dyr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE : To monitor the impact of Shock Wave Lithotripsy (SWL) on the renal resisive index (RI) and to investigate the potential of the RI measurement for the estimation of the optimal duration between 2 SWL sessions. MATERIAL AND METHODS Thirty patients with single pelvis renalis stone were included. Participitants were grouped according to their age as group 1 (<40 years, mean age 36.2+/-3.9 years) and group 2 (>/=40 years, mean age 55.4+/-6.5 years). RI measurement was performed in of all patients prior to SWL. After SWL, RI was monitored daily until RI returned to their pre-SWL values. RESULTS The mean stone size was 2 8.97+/-3.62 in group 1 and 10.08+/-4.67 mm in group 2 (p=0.077). Following SWL, the RI value of both goups increased and the higher RI value was measured at the 24th hour as compared with their pre-SWL values (p<0.001). In day 2 RI of the groups declined, but the differences were still statistically different from their pre-SWL RI values (p<0.001). However, on the third day, RI of group 1 was close to their pre-SWL level (p=0.143). But, in group 2, RI value returned to their pre-SWL limits on day 4 (p=0.229). CONCLUSIONS RI measurement gives important data regarding SWL related acute renal trauma and should be used as an US marker for recovery after SWL.
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Affiliation(s)
- Esin Yencilek
- Department of Radiology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.
| | - Aysegul Sarsılmaz
- Department of Radiology, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - Ozgur Kilickesmez
- Department of Radiology Istanbul Education Hospital, Istanbul, Turkey
| | - Hakan Koyuncu
- Department of Urology, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - Bilal Eryildirim
- Department of Urology Kartal Lutfi Kırdar Education and Research Hospital, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Yeditepe University Medical Faculty, Istanbul, Turkey
| | - Yavuz Bastug
- Department of Urology Beykoz State Hospital, Istanbul, Turkey
| | - Bilger Erihan
- Department of Urology, Yeditepe University Medical Faculty, Istanbul, Turkey
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11
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Yildirim D, Bozkurt IH, Gurses B, Cirakoglu A. A new parameter in the diagnosis of vascular erectile dysfunction with penile Doppler ultrasound: cavernous artery ondulation index. Eur Rev Med Pharmacol Sci 2013; 17:1382-1388. [PMID: 23740453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Our aim is to introduce the cavernous artery ondulation index (CA-OI) as a new parameter that could be accepted as an indirect indicator of vascular hemodynamics and also gives us information about the efficiency of erection. PATIENTS AND METHODS A total of 27 patients with erectile dysfunction were evaluated with penile Doppler ultrasonography (PDUS). After injection of papaverine intracavernously, arterial diameter and peak-systolic and end-diastolic velocities were measured. For measuring at a standart time, five minutes after injection, bilateral cavernosal arteries were examined and gray scale and color Doppler US images through the long axis were recorded at the mentioned phases. Cavernosal artery ondulation index (CA-OI) showing the amount of ondulation was calculated for each subject using these images. RESULTS In 9 of total 27 patients, erection could not pass the tumescence phase with 3 flaccid phases, while the remaining 18 had full erection. Mean CA-OI values were measured as 2.51±0.37 mm, 3.15±0.38 mm, and 2.68±0.09 mm in normal, arterial insufficiency and venous insufficiency groups, respectively. CONCLUSIONS It is possible to differentiate the arterial insufficiency by using the cut-off value of CA-OI ≥ 2.5 values as a criteria.
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Affiliation(s)
- D Yildirim
- Department of Radiology and Department of Urology, Kasimpasa Military Hospital, Istanbul, Turkey.
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12
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Yildirim D, Ekci B, Gurses B, Sahin M, Gumus T. Dynamic power Doppler ultrasonography of anterior abdominal wall hernias: confirmation of incarceration. J Med Ultrason (2001) 2013; 40:33-8. [PMID: 27276922 DOI: 10.1007/s10396-012-0384-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Power Doppler ultrasonography (PD-US) is a motion-sensitive modality that can display flow characteristics regardless of the direction. This increased motion sensitivity can be used as a parameter to show the tissue motion on artificially generated fremitus images. This study aimed to confirm any signs of incarceration in abdominal wall hernias proven by herniorrhaphy by examination with dynamic PD-US (during manual compression-decompression maneuvers). METHODS Twenty-seven patients with anterior abdominal wall hernia with a narrow neck (<1 cm in diameter) were examined firstly with gray-scale ultrasonography (GS-US), and then with dynamic PD-US. Two independent radiologists, who were blinded to the real-time images showing the orientation and motion of the hernia neck, completed the examinations. These images were evaluated for any signs of incarceration, as well as the orientation of the hernia neck. RESULTS Orientations of the hernia neck were not described on GS-US images in 13 lesions and on dynamic PD-US images in 3 lesions. While the GS-US examination revealed incarcerated hernia in four of the patients, the dynamic PD-US examination revealed an additional seven patients with symptoms associated with incarceration. CONCLUSION Dynamic PD-US may show the orientation of the hernia neck and any sign of incarceration more accurately and clearly than conventional GS-US. Being informed about these features preoperatively is of utmost importance. Thus, anterior abdominal wall hernias should be examined by dynamic PD-US.
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Affiliation(s)
- Duzgun Yildirim
- Department of Radiology, Iskenderun Military Hospital, Iskenderun, Turkey.
| | - Baki Ekci
- Department of General Surgery, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Bengi Gurses
- Department of Radiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Mutlu Sahin
- Department of General Surgery, Iskenderun Military Hospital, Iskenderun, Turkey
| | - Terman Gumus
- Department of Radiology, VKV American Hospital, Istanbul, Turkey
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13
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Yildirim D, Gurses B, Gurpinar B, Ekci B, Colakoglu B, Sahin M, Kaur A. The value of ultrasound elastography-guided fine-needle aspiration biopsy of thyroid nodules in reducing nondiagnostic results. J Med Ultrason (2001) 2012; 40:169-74. [PMID: 27277108 DOI: 10.1007/s10396-012-0407-2] [Citation(s) in RCA: 6] [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: 05/28/2012] [Accepted: 09/05/2012] [Indexed: 11/30/2022]
Abstract
Fine-needle aspiration biopsy (FNAB) is an important tool for diagnosing thyroid nodules; however, nondiagnostic results are a problem with FNAB. We evaluated the optimal targeting area of thyroid nodules for FNAB by using ultrasound elastography (USE) to reduce nondiagnostic results. Between December 2008 and November 2010, 96 consecutive prospective subjects scheduled to undergo FNAB were included in the study. Initially, the dominant nodule was evaluated with ultrasound, after which USE was performed. FNABs were performed from both the red (hard foci) and the green (soft foci) color-coded areas using the same technique according to the USE maps. The cellularity of all the specimens was evaluated cytopathologically. Nondiagnostic results from the red and green color-coded areas were compared by Chi-square test. In the red color-coded regions on USE images, the diagnostic rate was 76.0 % and the nondiagnostic rate was 24.0 %. In the green color-coded regions on USE images, the diagnostic rate was 53.1 % and the nondiagnostic rate was 46.9 %. Seven nodules were malignant and 89 were benign. Nondiagnostic results were significantly fewer in red color-coded regions (P = 0.0001). USE can help to enhance the cellularity of biopsy of thyroid nodules to reduce the nondiagnostic results if the red color-coded (less elastic or hard) areas are preferred.
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Affiliation(s)
- Duzgun Yildirim
- Department of Radiology, Kasimpasa Military Hospital, Istanbul, Turkey. .,Department of Radiology, Iskenderun Military Hospital, Hatay, Turkey.
| | - Bengi Gurses
- Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Berk Gurpinar
- Department of Otolaryngology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Baki Ekci
- Department of Surgery, Yeditepe University Hospital, Istanbul, Turkey
| | - Bulent Colakoglu
- Department of Radiology, VKV American Hospital, Istanbul, Turkey
| | - Mutlu Sahin
- Department of Surgery, Iskenderun Military Hospital, Hatay, Turkey
| | - Ahmet Kaur
- Laboratory of Cytopathology, E-sitopatoloji, Istanbul, Turkey
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14
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Yildirim D, Tamam MO, Sahin M, Ekci B, Gurses B. Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign. Rev Esp Med Nucl Imagen Mol 2012; 32:86-91. [PMID: 22743109 DOI: 10.1016/j.remn.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/03/2012] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax). MATERIALS AND METHODS Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity. RESULTS Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively. CONCLUSION In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.
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Affiliation(s)
- Duzgun Yildirim
- Kasimpasa Military Hospital, Department of Radiology, Istanbul, Turkey
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15
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Yildirim D, Gurses B, Gurpinar B, Ekci B, Colakoglu B, Kaur A. Nodule or pseudonodule? Differentiation in Hashimoto's thyroiditis with sonoelastography. J Int Med Res 2012; 39:2360-9. [PMID: 22289555 DOI: 10.1177/147323001103900636] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Fine needle aspiration biopsy (FNAB) is the gold standard for the diagnosis of lymphoma in Hashimoto's thyroiditis and is able to differentiate between benign, inflammatory or malignant nodules, classifying them as either true nodules or pseudonodules. This technique is, however, invasive. The present study aimed to differentiate pseudonodules from true nodules by sonoelastography, a non-invasive technique, in 54 patients with Hashimoto's thyroiditis. The accuracy of sonoelastography to differentiate between true or pseudonodules was compared with the gold standard FNAB and with grey scale ultrasonography. The nodules were categorized into three groups: non-demarcated hypoechogenic, demarcated hyperecho genic, and demarcated hypoechogenic. Sono elastography findings were concordant with the cytopathological results and demonstrated that sono elastography was able to detect true thyroid nodules often misdiagnosed by conventional grey scale ultrasonography. Sonoelastography was found to have increased sensitivity for true nodule diagnosis compared with conventional grey scale ultrasonography and may eliminate unnecessary FNABs being carried out.
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Affiliation(s)
- D Yildirim
- Department of Radiology, Iskenderun Military Hospital, Iskenderun, 31200 Antakya, Turkey.
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16
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Yildirim D, Dergin G, Tamam C, Moroglu S, Gurses B. Indirect measurement of the temporomandibular joint disc elasticity with magnetic resonance imaging. Dentomaxillofac Radiol 2011; 40:422-8. [PMID: 21960399 PMCID: PMC3528143 DOI: 10.1259/dmfr/98030980] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 05/25/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The radiological evaluation of the temporomandibular joint (TMJ) consists of demonstrating the morphological features of the disc and the condyle in closed and open mouth positions using MRI. We aimed to determine elasticity of the disc by measuring the amount of elongation during mouth opening. METHODS The study population included 49 patients. Coronal T(1) and multiplane oblique T(2) weighted gradient recalled echo sequences were acquired in open and closed mouth positions. Biconcave TMJ disc lengths were measured on sagittal oblique images in both positions. Elongation ratio (ER) was calculated for each patient. According to the findings, TMJs are classified into subgroups: normal (N), dislocated with reduction (DWR), pure DWR (p-DWR), DWR with additional findings (DWR-a) and dislocated without reduction (DWOR). Statistical analysis was performed using the χ(2) test and receiver operating characteristic analysis. RESULTS Out of 98 discs, 22 of them were evaluated as N, 60 as DWR (28 p-DWR, 32 DWR-a) and 16 as DWOR. There was no significant difference among the disc lengths in three subgroups at the closed mouth position (P = 0.15), whereas there was significant difference in the open mouth position (P = 0.0001). There was significant difference among subgroups as far as ER is concerned (P < 0.05). CONCLUSIONS ER is a strong indicator of elasticity. Compared with the N group, elasticity of the disc was not significantly different in the p-DWR group but the disc elasticity was very degraded in DWR-a and in DWOR. A negative conversion or one smaller than 1.4 mm means a compromised disc, although sometimes it will possess normal anatomical configurations or signal characteristics.
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Affiliation(s)
- D Yildirim
- Kasimpasa Military Hospital, Department of Radiology, Beyoglu, Istanbul, Turkey.
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17
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Yildirim D, Gurses B, Tamam C, Karaaslan E, Ersen A, Ince U. Imaging findings after fascial injection of tetanus vaccine. Med Ultrason 2011; 13:161-164. [PMID: 21655544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Adverse reactions to vaccines vary from mild to fatal. Local reactions are often due to hypersensitivity to the adjuvant substances in the vaccine. This case report aims at illustrating the imaging findings of a fascial injection of the tetanus vaccine. A 14 year-old boy, vaccinated 6 months previously presented with a mass lesion in the left deltoid area. Magnetic resonance imaging and ultrasonographic evaluations were performed and the findings were characteristic for fascial granuloma. The histopathologic examination confirmed the diagnosis. In our knowledge, this is the first case of granuloma post intrafascial injection of tetanus vaccine which was MRI and ultrasonographic evaluated and histopathologicly confirmed.
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Affiliation(s)
- Duzgun Yildirim
- Kasimpasa Military Hospital, Department of Radiology, Istanbul, Turkey
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18
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Gurses B, Ekci B, Akansel S, Kabakci N, Kucuk S, Kovanlikaya I. Primary epiploic appendagitis: the role of computed tomography in diagnosis. Australas Radiol 2007; 51 Spec No.:B155-7. [PMID: 17875142 DOI: 10.1111/j.1440-1673.2007.01782.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Primary epiploic appendagitis is a rare entity that occurs due to torsion and inflammation of the epiploic appendages. Clinically, this entity may be mistaken for acute abdomen with resultant unnecessary surgery. In contrast to acute surgical abdomen, epiploic appendagitis usually does not require surgical treatment; most of the patients resolve with conservative management. Diagnosis can be achieved with imaging modalities of which computed tomography is the gold standard procedure. Herein, a patient who presented with acute abdomen like clinical picture, with the computed tomography demonstration of primary epiploic appendagitis, is presented.
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Affiliation(s)
- B Gurses
- Yeditepe University Hospital, Department of Radiology, Istanbul, Turkey.
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19
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Esen G, Yilmaz M, Gurses B, Ozguroglu M, Demir G, Mandel N, Bese N, Aydogan F, Altug A. US and MRI Findings in chest wall recurrences in breast cancer patients treated with mastectomy. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80086-8] [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: 10/24/2022] Open
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20
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Adaletli I, Albayram S, Gurses B, Ozer H, Yilmaz MH, Gulsen F, Sirikci A. Vasculopathic changes in the cerebral arterial system with neurobrucellosis. AJNR Am J Neuroradiol 2006; 27:384-6. [PMID: 16484415 PMCID: PMC8148790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Brucellosis is a zoonotic disease characterized by multisystem involvement. Nervous system involvement is rare, with a reported incidence of 3%-13%. Brucellosis can also be manifested in the form of vasculopathy. Cerebral vasculopathy due to brucellosis is a very rare entity, with only a few cases reported in the literature. We present a patient with neurobrucellosis who had involvement of cerebral vasculature demonstrated by angiography.
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Affiliation(s)
- I Adaletli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Abstract
Inflammatory pseudotumor (IPT) is a rare disease that usually occurs in the lung. Patients with IPT are usually asymptomatic, with a solitary pulmonary nodule or mass detected on routine chest roentgenogram. IPT can behave as a malignant tumor both clinically and radiologically. Cough, fever, dyspnea, and hemoptysis are the usual presenting symptoms. This report describes the case of a 37-year-old man with a 4-month course of dysphagia secondary to lower esophageal invasion by the posterior mediastinal extension of a lung IPT.
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Affiliation(s)
- Canan Akman
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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23
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Mihmanli I, Kantarci F, Yilmaz MH, Gurses B, Selcuk D, Ogut G, Altug A, Uysal O. Effect of diffuse fatty infiltration of the liver on hepatic artery resistance index. J Clin Ultrasound 2005; 33:95-99. [PMID: 15756667 DOI: 10.1002/jcu.20095] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study was conducted to evaluate the effect of various degrees of diffuse fatty infiltration of the liver on the hepatic artery resistance index. METHODS One-hundred forty subjects were examined using standard color and spectral Doppler sonography protocols. Fatty infiltration of the liver was identified and graded sonographically. The patients were grouped (n = 35 in each of 4 groups) according to the degree of diffuse fatty infiltration of the liver as follows: normal (group 1), mild (group 2), moderate (group 3), and severe (group 4). The resistance index calculated for each patient was the mean of 3 measurements. Mean resistance index of the hepatic artery was then calculated for each group. RESULTS The mean resistance index was 0.81 +/- 0.04 for group 1, 0.79 +/- 0.06 for group 2, 0.75 +/- 0.05 for group 3, and 0.73 +/- 0.05 for group 4. We found a statistically significant (p < 0.05) decrease in resistance index when comparing groups 3 and 4 with groups 1 and 2 separately. CONCLUSIONS Hepatic artery resistance index decreases as the severity of diffuse fatty infiltration increases.
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Affiliation(s)
- Ismail Mihmanli
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Kocamustafapasa Street, 34300-Istanbul, Turkey
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24
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Esen G, Gurses B, Yilmaz MH, Ilvan S, Ulus S, Celik V, Farahmand M, Calay OO. Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol 2005; 15:1215-23. [PMID: 15690206 DOI: 10.1007/s00330-004-2605-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 11/10/2004] [Accepted: 11/19/2004] [Indexed: 02/02/2023]
Abstract
The purpose of this study is to evaluate the accuracy of gray scale and Doppler US findings in the detection of axillary metastases in breast cancer patients with no palpable lymph nodes. One-hundred and ninety-eight lymph nodes detected in 83 women were evaluated. The size and longitudinal/transverse axis ratios of each node were documented. Absence of echogenic hilum, asymmetrical cortical thickening, and presence of peripheral flow were prospectively considered signs of malignancy. Histopathologically, there were 93 malignant and 105 benign nodes. The above criteria and a low longitudinal-transverse axis ratio were statistically significant for malignancy. In lymph nodes smaller than 1 cm, only asymmetric cortical thickening and presence of peripheral flow were significant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 86.49, 93.62, 91.43, 89.8 and 90.48%, respectively. In conclusion, US is successful and reliable in the determination of axillary metastatic involvement in nonpalpable and small lymph nodes. Inclusion of axillary US in the preoperative diagnostic evaluation would be complimentary to sentinel node biopsy, and also could eliminate the need for it in patients with positive US results, after confirmation with biopsy.
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Affiliation(s)
- Gul Esen
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University, Turkey.
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25
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Mihmanli I, Kantarci F, Kulaksizoglu H, Gurses B, Ogut G, Unluer E, Uysal O, Altug A. Testicular Size and Vascular Resistance Before and After Hydrocelectomy. AJR Am J Roentgenol 2004; 183:1379-85. [PMID: 15505307 DOI: 10.2214/ajr.183.5.1831379] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to determine whether there is an association between hydroceles and testicular size and vascular resistance. SUBJECTS AND METHODS Twenty-three patients with a mean age of 42.8 years who had a unilateral idiopathic hydrocele and who underwent unilateral hydrocelectomy were included in the study. Testicular size and resistive (RI) and pulsatility (PI) indexes of the intratesticular arteries on the involved and uninvolved sides were measured before and after the hydrocelectomy. RESULTS We found statistically significant differences in the testicular volumes between the normal side (mean +/- SD, 15.40 +/-3.41 mL) and the side with the hydrocele (20.67 +/- 4.01 mL) before surgery (p < 0.001) and in the volumes in the side with the hydrocele before (20.67 +/- 4.01 mL) and after (16.20 +/- 2.99 mL) surgery (p < 0.001). No such a difference in volume was seen in the normal side before (15.40 +/- 3.41 mL) and after (15.28 +/- 3.24 mL) surgery (p = 0.200). The mean decrease in volume in the testis with the hydrocele after hydrocelectomy was 21%. There were statistically significant differences of RI and PI values between the normal testis (0.59 +/- 0.07 and 1.02 +/- 0.34, respectively) and the testis with hydrocele (0.79 +/- 0.11 and 1.70 +/- 0.56, respectively) before surgery (p < 0.001). In the testis with the hydrocele, we found a statistically significant decrease in RI and PI values (0.62 +/- 0.05 and 1.00 +/- 0.14, respectively) of intratesticular arteries after surgery (p < 0.001). The mean decreases in RI and PI values after hydrocelectomy were 21% and 36%, respectively. CONCLUSION There is an association between the development of an idiopathic hydrocele and testicular size and vascular resistance. We believe that the increase in volume and vascular resistance is due to an increase in impedance to venous and lymphatic flow.
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Affiliation(s)
- Ismail Mihmanli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34300, Turkey
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26
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Kantarci F, Mihmanli I, Aksoy H, Barutca H, Gurses B, Kaynak K. Duplication of the superficial femoral artery diagnosed primarily on the basis of color Doppler ultrasonography. J Ultrasound Med 2003; 22:641-643. [PMID: 12795561 DOI: 10.7863/jum.2003.22.6.641] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Variations of the lower extremity venous system are common, and radiologists may frequently be confronted with such variations during daily clinical practice. However, variations in the arterial system of the lower extremity are extremely rare. The profunda femoris artery and arteries of the cruris are mainly subject to variation. This report describes an extremely rare arterial variation, duplication of the superficial femoral artery (SFA), in terms of the radiologic findings, clinical importance, and embryologic basis.
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Affiliation(s)
- Fatih Kantarci
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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