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Tuncel DA, Pekoz BC, Koc AS, Sumbul HE. Point Shear Wave Elastography Detected Liver Stiffness Increased in Pediatric Patient With Thalassemia Major. Ultrasound Q 2024; 40:82-86. [PMID: 38436375 DOI: 10.1097/ruq.0000000000000675] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
ABSTRACT Transient elastography (TE) and point shear wave elastography (pSWE) are 2 elastographic ultrasound examinations used in liver stiffness (LS) measurement. It was shown that the LS value detected by TE in pediatric β-thalassemia major patients has increased, and there was no LS evaluation obtained with pSWE in literature. Thus, in this study, it was aimed to evaluate LS with pSWE examination in children with thalassemia major and to determine LS-related parameters in these patients. Sixty-three schoolchildren with a diagnosis of β-thalassemia major and 21 healthy controls between the ages of 7 and 18 years were included. In addition to routine anamnesis, physical examination, and laboratory examinations, renal and liver ultrasounds were performed. Liver stiffness values were measured by pSWE examination. Serum levels of urea, aspartate-aminotransferase, alanine-aminotransferase, iron, and ferritin were significantly higher in patients, and serum creatinine, iron binding capacity, and hemoglobin levels were found to be significantly lower (P < 0.05 for each). Liver stiffness values were significantly higher in patients compared with healthy controls. In linear regression analysis, serum iron and iron binding capacity values were found to be closely related with LS (P < 0.001 vs. β = 0.482 and P = 0.047 vs. β = 0.237, respectively). Liver stiffness values obtained by pSWE examination increase significantly in patients. According to the results of our study, in addition to the previously known TE method, we think that the LS evaluation obtained by pSWE, a new method that can make more accurate measurements, can be used in the possible early detection of target organ damage in children with thalassemia major.
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Affiliation(s)
| | | | | | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Kisla Ekinci RM, Cakir Pekoz B, Taner S. Utility of renal resistive index measurement in juvenile systemic lupus erythematosus: a cross-sectional single-center study. Clin Rheumatol 2023; 42:2849-2854. [PMID: 37481634 DOI: 10.1007/s10067-023-06711-8] [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: 04/19/2023] [Revised: 05/30/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with a complex etiopathogenesis. Renal involvement is the most common and devastating complication of the disease. Renal resistive index (RRI) was suggested as a noninvasive biomarker for lupus nephritis in previous studies. This is the first study to investigate the role of RRI measurement in juvenile SLE patients. METHODS This cross-sectional study included 25 juvenile SLE patients and 25 healthy controls. Demographic and clinical features were recruited from the medical files of the patients. RRI measurements were performed with color Doppler ultrasonography from intrarenal arteries when Doppler angles were 30-60 in right and left kidneys. RESULTS Of 25 (19 female, 6 male) SLE patients, nineteen (76%) patients had urinary abnormalities during follow-up, and renal biopsy was performed in 14 patients, of which 9 (64.3%) had class 2 and 5 (35.7%) had class 4 lupus nephritis. RRI was found significantly higher in SLE group than healthy controls. RRI did not differ between SLE patients, grouped according to the presence of renal involvement and class IV lupus nephritis. RRI did not correlate with serum creatinine, GFR, spot urine protein/creatinine, and albumin/creatinine ratio. CONCLUSIONS Although RRI was found significantly higher in juvenile SLE, it is not affected by GFR, proteinuria level, or the renal biopsy results, even the presence of proliferative nephritis. The underlying pathogenetic mechanisms of increased RRI in SLE should be clarified in further studies. Key Points • Renal resistive index (RRI) is a parameter derived from renal Doppler ultrasound imaging and shows the intrarenal arterial resistance. • This study reveals that RRI is increased in juvenile systemic lupus erythematosus. • RRI was previously related with renal involvement, particularly class 4 lupus nephritis in adults. However, RRI was not affected by the presence or degree of renal involvement in juvenile SLE patients in our study.
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Affiliation(s)
- Rabia Miray Kisla Ekinci
- Department of Pediatric Rheumatology, Adana City Training and Research Hospital, Adana, 01331, Turkey.
| | - Burcak Cakir Pekoz
- Department of Radiology, Adana City Training and Research Hospital, Adana, 01331, Turkey
| | - Sevgin Taner
- Department of Pediatric Nephrology, Adana City Training and Research Hospital, Adana, 01331, Turkey
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Cakir Pekoz B, Dilek O, Koseci T, Tas ZA, Irkorucu O, Gulek B. Can peritumoral edema evaluated by Magnetic Resonance Imaging before neoadjuvant chemotherapy predict complete pathological response in breast cancer? Scott Med J 2023; 68:121-128. [PMID: 37161314 DOI: 10.1177/00369330231174230] [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] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS The complete pathological response (pCR) following neoadjuvant chemotherapy (NAC) in breast cancer is essential for the accurate prediction of prognosis. We aimed to evaluate the efficacy of the presence and type of peritumoral edema detected by magnetic resonance imaging (MRI) in predicting pCR to NAC in breast cancer patients. METHODS AND RESULTS One hundred five patients with the diagnosis of invasive carcinoma were evaluated by MRI before NAC. Edema was evaluated in fat-suppressed T2-weighted images. The patients were categorized into three groups: patients with no peritumoral edema, patients with peritumoral edema, and patients demonstrating subcutaneous edema. The cases were categorized as being pCR and non-pCR. Molecular subtypes, lymphovascular invasion (LVI), tumor size, and apparent diffusion coefficient (ADC) were evaluated. A positive relationship was found between the presence of edema and tumor size. Subcutaneous edema was found to be statistically higher in non-pCR patients. While the number of pCR patients with subcutaneous edema was 17 (30.4%), the number of non-pCR patients with subcutaneous edema was 26 (53.1%) (p = 0.018). LVI was found to be statistically higher in patients with edema. The number of edema-negative and LVI (+) patients was 4 (15.4%), while the number of edema-positive and LVI (+) patients was 28 (35.4%) (p = 0.042). Intratumoral and peritumoral ADC values were significantly higher in tumors with edema. CONCLUSION The presence of subcutaneous edema and LVI may be utilized for the prediction of pCR outcomes in breast cancer patients scheduled for NAC treatment.
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Affiliation(s)
- Burcak Cakir Pekoz
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Okan Dilek
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Tolga Koseci
- Department of Medical Oncology and Internal Medicine, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Zeynel Abidin Tas
- Department of Pathology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Oktay Irkorucu
- Department of Clinical Sciences, University of Sharjah, College of Medicine, Sharjah, United Arab Emirates
| | - Bozkurt Gulek
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Pekoz BC, Koc M, Kucukosmanoglu M, Koc AS, Koca H, Dönmez Y, Sumbul HE. Evaluation of Liver Stiffness After Atrial Septal Defect Closure. Ultrasound Q 2022; 38:165-169. [PMID: 35420064 DOI: 10.1097/ruq.0000000000000611] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In this study, we aimed to evaluate the liver stiffness (LS) values and the right ventricle (RV) functions after atrial septal defect (ASD) closure treatment. Sixty-six patients were included (38 female, 28 male) in the study. Patients were grouped into 3 subgroups (group I = 21 patients without ASD closure, group II = 38 patients who underwent ASD closure, and group III = 11 patients with ASD and Eisenmenger syndrome). After 1-year follow-up of the patients who underwent ASD closure, LS was assessed using the liver elastography technique. Echocardiographic changes and LS changes over time were compared. Absolute Δ-LS and Δ-liver size were found to be significantly decreased in group II compared with the other groups. While liver size, LS levels, RV and left ventricle (LV) dimensions, and tricuspid regurgitation pressure gradient were found to be significantly decreased; the tricuspid annular plane systolic excursion and the LV ejection fraction were significantly increased in group II. In addition, Δ-LV and Δ-RV dimensions and Δ-tricuspid regurgitation pressure gradient values were statistically significant and Δ-tricuspid annular plane systolic excursion and LV ejection fraction values were statistically higher in group II compared with the other groups. In conclusion, our study demonstrates that the LS is another parameter, which significantly decreases in patients treated with ASD occluder devices and can be used as an objective follow-up parameter in addition to classic echocardiographic measurements.
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Affiliation(s)
| | | | - Mehmet Kucukosmanoglu
- Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | | | | | | | - Hilmi Erdem Sumbul
- Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Sumbul HE, Avci BS, Bankir M, Pekoz BC, Gulumsek E, Koc AS. Ovarian Stiffness Is Significantly Increased in Polycystic Ovary Syndrome and Related With Anti-Mullerian Hormone: A Point Shear Wave Elastography Study. Ultrasound Q 2022; 38:83-88. [PMID: 35020692 DOI: 10.1097/ruq.0000000000000592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/25/2022]
Abstract
OBJECTIVES Parenchymal stiffness obtained by point shear-wave elastography (pSWE) in solid organs is used as a sign of damage in these organs. However, its clinical use and whether patients with polycystic ovary syndrome (PCOS) have increased ovarian tissue stiffness are still unclear. The aim of this study is to determine the parameters related to ovarian stiffness and whether there is an increase in ovarian stiffness in patients with PCOS compared with healthy controls. METHODS Forty-five women who were followed up regularly with the diagnosis of PCOS and 30 healthy controls similar to age and sex were included in this study. In addition to the routine follow-up parameters for PCOS, serum homeostatic model assessment of insulin resistance and anti-Mullerian hormone (AMH) levels were examined in all patients, and pSWE examination was performed with pelvic ultrasound (US) and ElastPQ technique. RESULTS Serum dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment of insulin resistance, and AMH were higher in PCOS compared with healthy controls (P < 0.001). Right, left, and mean ovary stiffness and volumes were significantly higher in PCOS group than healthy controls (P < 0.001). Correlation analysis was performed between mean ovary stiffness and dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment, and AMH and ovary volumes (P < 0.01 for each one). In linear regression analysis, only AMH was found to be related to mean ovary stiffness (P < 0.001 and β = 0.734). CONCLUSIONS Ovarian stiffness value obtained by ElastPQ technique and pSWE method increases in PCOS patients compared with healthy controls and is closely related to serum AMH levels. In patients with PCOS, in addition to the conventional US, ovarian stiffness measured by pSWE may be an auxiliary examination in the follow-up of the disease. However, it was concluded that the ovarian stiffness measurement obtained in our current study should be supported by studies involving more patients and the transvaginal US method.
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Affiliation(s)
| | | | | | - Burcak Cakir Pekoz
- Department of Radiology, Adana City Research and Training Hospital, Health Science University, Adana
| | | | - Ayse Selcan Koc
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Sarigecili E, Taner S, Ucar HK, Pekoz BC. A rare case of pontine and extrapontine myelinolysis in a pediatric patient with chronic renal failure. Childs Nerv Syst 2021; 37:1025-1027. [PMID: 32504171 DOI: 10.1007/s00381-020-04720-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
Osmotic demyelination syndrome (ODS) is a very rare condition in childhood occurring usually secondary to the rapid increase of serum sodium levels. This situation occurring secondary to the rapid correction of hyponatremia can be seen more rarely in the form of extrapontine myelinolysis and even the coexistence of these two conditions besides central pontine demyelinolysis. However, osmotic demyelination syndrome due to the rapid correction of hyponatremia in chronic renal failure (CRF) patients is very rare depending on existing uremia. In this article, we present an extremely rare case of pontine and extrapontine myelinolysis, which occurred in a pediatric patient with chronic renal failure, secondary to the rapid correction of hyponatremia. In the diffusion and cranial magnetic resonance imaging (MRI), bilateral symmetrical caudate, putamen, and thalamus involvements and hyperintense linear lesions at the pons, cortical, and subcortical areas were revealed. It was evaluated as pontine and extrapontine myelinolysis. This clinical situation presents that the presence of severe hyponatremia and extremely rapid correction of it can develop pontine and extrapontine myelinolysis even though it is very rare in uremic patients.
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Affiliation(s)
- Esra Sarigecili
- Department of Pediatric Neurology, Adana City Education and Research Hospital, Adana, Turkey.
| | - Sevgin Taner
- Department of Nephrology, Adana City Education and Research Hospital, Adana, Turkey
| | - Habibe Koc Ucar
- Department of Pediatric Neurology, Adana City Education and Research Hospital, Adana, Turkey
| | - Burcak Cakir Pekoz
- Department of Radiology, Adana City Education and Research Hospital, Adana, Turkey
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Gulumsek E, Pekoz BC, Koc AS, Aslan MZ, Ali Ozturk H, Arici FN, Sumbul HE. Liver Stiffness Is Increased in Polycystic Ovary Syndrome and Related With Complement C1q/Tumor Necrosis Factor-Related Protein 3 Levels: A Point Shear Wave Elastography Study. Ultrasound Q 2020; 37:133-137. [PMID: 33337585 DOI: 10.1097/ruq.0000000000000537] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Nonalcoholic fatty liver disease is very common in patients with polycystic ovary syndrome (PCOS). In patients with PCOS, the clinical use of liver stiffness (LS) and whether LS increases or decreases are still unclear. The purpose of this study was to determine the parameters related to LS and whether there is an increase in LS in patients with PCOS compared with healthy controls. Thirty-eight women diagnosed with PCOS according to Rotterdam criteria and 28 healthy age- and sex-matched controls were included in this study. In addition to routine follow-up parameters for all patients, serum homeostatic model assessment of insulin resistance (HOMA-IR) and complement C1q/tumor necrosis factor-related protein 3 (CTRP3) levels were measured, and point shear wave elastography was performed. Body mass index; waist circumference; systolic blood pressure; serum glucose, alanine aminotransferase, highly sensitive C-reactive protein, and dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels; and luteinizing hormone/follicle-stimulating hormone ratio were higher in PCOS group compared with healthy controls (P < 0.05). Serum CTRP3 levels were lower in patients with PCOS (P < 0.05). Liver stiffness value was significantly higher in PCOS group than healthy controls (P < 0.001). Positive correlation was found between LS and waist circumference as well as calcium, dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels (P < 0.05 for each one). Negative correlation was found between LS and CTRP (P < 0.01 for each one). In linear regression analysis, only CTRP3 level was found to be related to LS (P < 0.001 and β = 0.734). Liver stiffness value obtained by point shear wave elastography increases in patients with PCOS compared with healthy controls and is closely and negatively related to serum CTRP3 levels.
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Affiliation(s)
| | | | | | - Muhammed Zubeyir Aslan
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Huseyin Ali Ozturk
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Fatih Necip Arici
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Cakir Pekoz B, Pekoz MT, Analan PD. Intraneural Vascular Resistive Index of the Median Nerve as a Predictor of Severity of Carpal Tunnel Syndrome. Eur J Ther 2020. [DOI: 10.5152/eurjther.2020.20030] [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: 11/22/2022]
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Koc AS, Pekoz BC, Donmez Y, Yasar S, Ardic M, Gorgulu FF, Icen YK, Sumbul HE, Koc M. Usability of Achilles tendon strain elastography for the diagnosis of coronary artery disease. J Med Ultrason (2001) 2019; 46:343-351. [PMID: 30783822 DOI: 10.1007/s10396-019-00931-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/14/2018] [Accepted: 01/15/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE There are close relationships between major coronary artery disease (CAD) risk factors and Achilles tendon thickness (AT-T) and AT strain ratio (AT-SR). Our aim was to evaluate the diagnostic importance of AT-T and AT-SR as obtained by ultrasonography (USG) and strain elastography (SE) for predicting CAD. MATERIALS AND METHODS One hundred and eighty-four patients scheduled to undergo coronary angiography were included in the study. Achilles tendon USG (B-mode and SE) and laboratory tests were performed on all patients. The patients were divided into two groups, i.e., patients with and without CAD. RESULTS The patients with CAD (72.8%) were more likely to be male, exhibited higher frequencies of diabetes mellitus (DM) and hyperlipidemia, exhibited higher levels of basal creatinine and glucose, and had higher AT-T and AT-SR values (p < 0.05 for all). Age, DM, AT-T, and AT-SR independently predicted the probability of CAD in a logistic regression analysis (p < 0.05 for all). Age (each year), DM (presence), AT-T (each 1 mm), and AT-SR (each 0.1) increased the CAD risk by 3.4%, 2.9 times, 47.1%, and 16.0%, respectively. ROC analysis revealed AUCs of 0.665 and 0.730 for the AT-T and AT-SR values, respectively (p < 0.05). The AT-SR cutoff value of 1.2 predicted the presence of CAD with 75.4% sensitivity and 72.7% specificity. CONCLUSIONS AT-SR is a simple, inexpensive, noninvasive, reproducible, and objective parameter for the prediction of CAD. We think that AT-SR evaluation should become a part of conventional USG assessments in patients who are at a high risk of CAD.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
| | - Burcak Cakir Pekoz
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yurdaer Donmez
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Simge Yasar
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mustafa Ardic
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Feride Fatma Gorgulu
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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