[Show abstract][Hide abstract] ABSTRACT: 320 Turkish adults (160 men, 160 women) who had undergone brain CT in the radiology clinic and showed no sign of maxillofacial pathology were analyzed in order to create a facial soft-tissue thickness database of the Turkish adult population. The soft-tissue thicknesses were measured at 31 landmarks, 10 midline and 21 bilateral anatomical landmarks. Average thickness values for each landmark as well as the standard deviation and range classified according to gender and age are reported.
The differences of these mean values related to age and sexes were calculated. The values were then statistically compared to the findings of the European and Korean adults.
Overall, the soft-tissue thickness measurements obtained in this study can be used as a database for the forensic craniofacial reconstruction of Turkish adult faces.
Forensic Science International 09/2014; 242:44–61. DOI:10.1016/j.forsciint.2014.06.012 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The aim of the study was to investigate the orbital anthropometric variations in the normal population using three-dimensional computed tomography (3D-CT) images and to define the effects of age and gender on orbital anthropometry.
Materials and methods:
Three-dimensional orbita CT of 280 patients, obtained for various reasons, were retrospectively evaluated in 772-bed referral and tertiary-care hospital between April 2011 and June 2012. Using 3D images, orbital width, height, biorbital-interorbital diameter and orbital index were measured. Measurements were obtained comparing right and left sides and male to female. The relation of the results with age and gender was analysed.
Right orbit was found to be wider than left (p < 0.0001). Male patients had wider (p < 0.0001) and higher (p = 0.0001) orbits. Right orbital index was found to be smaller than the left one (p = 0.005). No differences were found between the genders in terms of right and left orbital indexes (p > 0.05). Biorbital (p < 0.0001) and interorbital (p = 0.01) widths were found to be higher in males. There was no relation between the age change and the parameters defined (p > 0.05).
No relation was found between age and orbital measurements. It was concluded that orbital images obtained with 3D-CT may be used as a method for gender evaluation.
[Show abstract][Hide abstract] ABSTRACT: Gall bladder (GB) may be found in a variety of abnormal positions. Most of them are due to arrested development of embryonic growth at different stages. A 63-year-old female patient was admitted to our radiology unit for magnetic resonance imaging (MRI) of the liver for the lesions identified in abdominal ultrasonography (US) and computed tomography (CT). MRI showed that there was a lobulated heterogenous mass in the left lobe of the liver and a smaller one in the right lobe of the liver with the same appearance. The inferior pole of the liver was located in the pelvic space, and the GB, which contained sludges and stones, was lying down to the upper pelvic space. Hepatic masses were considered to be hemangiomas, and GB was diagnosed as ptotic GB with luminal sludge and stones. In this case, especially, MR imaging helped the surgeon to plan a proper approach to the GB in abnormal localization.
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to determine sinus measurements specific for the Turkish population using CT sagittal thin-slice reconstruction images and to clarify the three-dimensional anatomical features of the sphenoid sinus, along with its surrounding structures, that are relevant to performing an endoscopic sphenoidotomy.
Images of 300 patients (165 female, 135 male) were studied. The research was conducted on the axial plane with a 1 mm slice thickness and a 0.6 mm slice interval, and sagittal reconstruction was performed with a 0.4 mm slice interval. Measurements of the sinus were obtained, and the presence of Onodi cells was researched.
Line 1 was found to be significantly shorter in the Turkish patients of this study compared to studies of other populations. Lines 4 and 6 were found to be longer on the left side (Line 4 right: 18.8±3.6 mm, left: 19.3±3.4 mm, p=0.027; Line 6 right: 24.1±6.8 mm, left: 24.3±6.8 mm, p=0.008). Lines 2, 3, 4 and 6 were longer in men than in women (p<0.05).
In the Turkish population, Line 1 is shorter, so the risk of skull base perforation is greater. Lines 4 and 6 are longer on the left side; thus, choosing the left ostium in sinus dilation is safer. Because of sex differences regarding Lines 2, 3, 4 and 6, sex should be considered in sphenoid sinus procedures.
Eurasian Journal of Medicine 02/2013; 45(1):7-15. DOI:10.5152/eajm.2013.02
[Show abstract][Hide abstract] ABSTRACT: Aim: To evaluate the prevalence, spectrum, and significance of incidental lesions identified on electron beam tomography (EBT) renal angiography performed to investigate renovascular hypertension. Materials and methods: EBT renal angiography images of 148 cases were evaluated in terms of renal artery variations and renal artery stenosis. Extravascular renal findings, abdominal aorta, iliac artery, liver and gallbladder findings, vertebral lesions, and other intraabdominal organ findings were assessed during the examination. Results: No incidental finding was found in 30 cases (20.2%) in total. The most frequent incidental findings were benign ones without any clinical significance. A total of 13 (8.7%) clinically significant findings were identified. Conclusion: When evaluating renal EBT angiography, a detailed review of other systems as well as target organ assessment is of crucial importance as it may affect patient prognosis.
Turkish Journal of Medical Sciences 01/2013; 43(4):529-536. DOI:10.3906/sag-1207-10 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 58-year-old female patient presented to the hospital with hearing loss. In the chest radiography obtained before her ear surgery, volume decrease in the right hemithorax, elevation of the right diaphragm, and increase of ventilation in the right lung were detected. At the thorax CT-CT angiography, hypoplasia of the main pulmonary artery and its branches and arteriovenous malformation localized in the middle lobe of the right lung were detected. Thus, diagnosis of Swyer-James-Macleod syndrome associated with right lung middle lobe hypoplasia and arteriovenous malformation was made. This kind of association has not been reported earlier, so we are presenting it in the light of the literature knowledge.
Case Reports in Medicine 12/2012; 2012(4):959153. DOI:10.1155/2012/959153
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To evaluate the percentages of the left renal vein (LRV) variations and inferior vena cava (IVC) variations as well as the effect of gender on their frequencies.
Materials and methods:
Contrast-enhanced abdominal helical computed tomography (CT) examinations of 1204 patients were retrospectively evaluated.
The correspondent percentages of the total LRV variations, retroaortic left renal vein (RLRV), and circumaortic LRV were 5.2%, 3.1%, and 2.1%, respectively. A statistically significant correlation was found between RLRV variation and gender (P=.036).
Helical CT is an efficient, fast, easily applicable, and reliable imaging modality in demonstration of LRV variations and IVC variations.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the association of intramammarian arterial calcifications seen on mammography with coronary artery disease and its risk factors and to discuss intramammarian arterial calcifications value as a predictor of coronary artery disease.
Mammography was performed on 55 women over 40 years of age who have undergone coronary angiography and have not had a mammography in the past year. Coronary angiography results, coronary artery disease risk factors and intramammarian arterial calcifications are evaluated.
The prevalance of intramammarian arterial calcifications was 41.8%. A significant relationship between intramammarian arterial calcifications and coronary artery disease was indicated (OR 10,8, 95% Cl 3,02-38,59). The positive predictive value and negative predictive value of intramammarian arterial calcifications for coronary artery disease was 78.3% and 75% respectively. Also advancing age was found relevant with these calcifications (OR 1,15, 95% Cl 1,05-1,25).
The results support the present literature and suggest that mammography, already widely in use as a screening tool among women over 40, may be used simultaneously in coronary artery disease risk assessment. These results should be confirmed by further larger group controlled studies.
JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR) 07/2012; 95(4):229-34. DOI:10.5334/jbr-btr.626
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of apparent diffusion coefficient (ADC) calculation in differentiation between malignant and benign thyroid nodules.
A prospective study was conducted in 52 patients. Diffusion-weighted echoplanar imaging was performed and b factors were taken as 0 and 400 s/mm(2).
The mean ADC value for malignant thyroid nodules was 0.829±0.179×10(-3) mm(2)/s and that for benign thyroid nodules was 1.984±0.482×10(-3) mm(2)/s. The mean ADC value for malignant nodules was significantly lower than that for benign nodules (P=.0001).
ADC value calculation is an effective method in differentiation of malignant thyroid nodules from benign ones.
[Show abstract][Hide abstract] ABSTRACT: Heterotaxy syndrome is a rare, complex, and confusing type of the situs anomalies. It is not possible to estimate the degree of lateralization, isomerism, and rotational variation in these types of cases. Heart and abdominal organ anatomy is specific to the individual, and it should be defined specifically on the basis of each case due to possible cardiac and extracardiac surgical interventions in patients with heterotaxy syndrome. Here, we present our findings obtained from a 58-year-old female patient with heterotaxy syndrome. The main components of this rare variation consist of right-hand-sided aorta, aortic arc, cardiac apex, gall bladder and left-hand-sided inferior vena cava, stomach, and spleen (polysplenia, 3 foci) according to the midline. Besides, the components include left-dominant liver, right-hand-sided large intestines, and left-hand-sided small intestines.
Case Reports in Medicine 06/2012; 2012(4):840453. DOI:10.1155/2012/840453
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive tumor of the dermis and subcutaneous tissue that commonly appears on upper extremities and on the trunk. There is a slight male predominance and the lesion is commonly seen between the second and fifth decades of life. The tumor grows slowly over years and rarely metastasizes; however, local recurrence is frequent. The most common sites for metastasis are lymph nodes and the lungs. The treatment of the tumor is resection with wide margins (1,2). Here we present radiologic findings of DFSP with unusual presentation located in the deep skin over the breast, which was excised successfully and without local recurrence during a 36-month follow-up period. CASE REPORT A 36-year-old female with a palpable right breast mass located in the upper inner quadrant and change in skin color without a significant history was admitted to surgery department. She claimed that the mass had first appeared two years before and was slowly growing. She had no history of recent trauma or surgical operation. On inspection, a well circumscribed, plaque type lesion was observed, along with a violet-purple change in color of the skin over the right breast (Fig. 1). The patient reported neither systemic disease or known illness nor continuous drug usage. Physical examination was unremarkable except for a well-defined non-tender mass on the right breast. The left breast and bilateral axillaries were normal. The patient was referred for radiologic examination to exclude a primary breast tumor. Bilateral breast ultrasound (US) and color Doppler ultrasound (CDUS) was performed with a Toshiba, Powervision 6000 SSA-370A (Tokyo, Japan) with 6-11 MHz high frequency linear transducer.US demonstrated a 3.5x1.5 cm sized solid, hyperechogenic lesion with sharp margins in the subcutaneous fat tissue, without marked vascularity on CDUS (Fig. 2). The left breast and both axillaries were unremarkable. The right mammography (HFXPlus-Fischer Imaging, Denver, USA) on mediolateral oblique (MLO) projection showed a well-defined bilobulated density with irregular margins and no calcifications (Fig. 3). Based on the mammography and sonography findings, the mass was considered suspect of malignancy and breast magnetic resonance imaging (MRI) study was planned for further examination. A contrast-enhanced breast MRI was performed using a 1.5 tesla MR unit (Somatom Vision Plus, Siemens, Erlangen, Germany) at our institution. Unfortunately, the mass could not be demonstrated on either T1, T2 or postcontrast subtracted images (Fig. 4). The patient was referred to surgery department and wide excision of the mass was performed. On pathologic evaluation, spindle cells were seen to be arranged in a storiform pattern, with minimal pleomorphism (Fig. 5). Immunohistochemical stain with CD34 was positive (Fig. 6) and definitive histologic diagnosis was DFSP. On follow-up, 36 months after surgical treatment, the patient continued to be symptom free, with no signs of tumor recurrence. DISCUSSION Dermatofibrosarcoma protuberans is a rare fibrous tumor of the soft tissue, commonly arising from dermis and subcutaneous tissue, which was first described by Darier and Ferran in 1924 (3). It accounts for 0.1% of all malignant tumors and 1% of all soft tissue sarcomas. The tumor is mostly located on the trunk skin (50%-60%) and is more common in men than women. The majority of these tumors are less than 5 cm in diameter. It can be seen at any age but it is much more common between ages 20 and 50, however, there are few cases reported in early childhood. DFSP has an indolent growth pattern and its symptoms are mostly long lasting, spanning over months and years (1,2,4). DFSP poses a diagnostic challenge as the clinical symptoms and the radiologic signs are nonspecific. The tumor usually causes a red-purple change of color on the overlying skin on inspection, and if it presents with a red and irregular bordered lesion, it can mimic a hemangioma. When DFSP is located in the breast, it can be mistaken for primary breast tumor and the accurate diagnosis is difficult to reach. Usually after clinical evaluation, US is the first choice for imaging and CDUS is very helpful for vascular situation but neither of the modalities is specific for diagnosis. Shin et al. report that a diagnosis of DFSP should be considered if US reveals an oval mass in the subcutaneous tissue that is abutting against the skin and has a focal lobulated margin with hypoechogenicity or an irregular margin with mixed echogenicity (5).Although an echogenic macrolobulated oval mass located over the breast lying in the deep dermis and the subcutaneous tissue without marked vascularization was demonstrated, an exact diagnosis could not be made in the present study. Unfortunately, mammography was also found to be nonspecific, with macrolobulated density on MLO projection. Considering mammography and sonography findings, a primary breast tumor could not be excluded and the present case was classified as BI-RADS category 4. Computed tomography is not indicated unless bony invasion or pulmonary metastasis is suspected in some occasional cases. Although MRI is also nonspecific for the exact diagnosis of DFSP, it is useful for identifying the extent and location of the mass, especially in large recurrent tumors. In addition, the areas of hemorrhage within the tumor may be demonstrated by use of MRI and can suggest the diagnosis (6,7). Another current imaging modality, multivoxel proton [1H]) MR spectroscopy (MRS), is accepted as an adjunctive method to breast MRI on differential diagnosis of benign versus malignant tumors. A recent case study of DSFP located on the breast, reported by Ivanovic et al., did not show significant cholin peak on [1H] MRS (8). In the present case, the mass could not be demonstrated on either T1 or T2 weighted images, and there was no significant enhancement on post-contrast subtracted images on breast MRI examination. It is considered that the discrimination failed both on pre- and post-contrast images as the mass was probably carrying similar signal characteristics of the adjacent subcutaneous fat tissue in which the lesion developed. Complete surgical resection is accepted as the optimal treatment for primary or recurrent DFSP. Studies have shown that resection with wide margins is essential and recurrence rates after local resection are reduced while the excision margins are widened. The combination of adjuvant radiotherapy before or after the surgery is a treatment option, particularly in those who cannot undergo wide surgical excision for several reasons. In addition, there are some successful clinical reports on imatinib, a tyrosine kinase inhibitor, which can induce regression in patients with unresectable or metastatic DFSP (1,2,4). Proper follow-up seems critical since the most significant characteristic of the tumor is recurrence, and local recurrence generally occurs in the first 3 years after surgery. Sonographic evaluation and re-biopsy is advisable if suspicion occurs. In addition, mammography might be helpful in the diagnostic work-up in breast located tumors for periodic control of recurrence. In conclusion, DFSP is a rare soft tissue tumor of cutaneous origin that mostly occurs on the trunk and might be rarely seen on the breast skin and can be confused with primary breast tumors. We believe that the importance of the present case is to upgrade the awareness of this soft tissue tumor while keeping in mind the differential diagnosis of other breast tumors.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Epilepsy, a well-known mostly idiopathic neurologic disorder, has to be correctly diagnosed and properly treated. Up to now, several diagnostic approaches have been processed to determine the epileptic focus. OBJECTIVES: The aim of this study was to discover whether proton-MR-spectroscopic imaging (MRSI) aids in the diagnosis of temporal lobe epilepsy in conjunction with classical electroencephalography (EEG) findings. PATIENTS AND METHODS: Totally, 70 mesial temporal zones consisting of 39 right hippocampi and 31 left hippocampi of 46 patients (25 male, 21 female) were analyzed by proton MRSI. All patients underwent a clinical neurologic examination, scalp EEG recording and prolonged video EEG monitoring. Partial seizures on the right, left or both sides were recorded in all patients. All patients were under medical treatment and none of the patients underwent amygdalohippocampectomy and similar surgical procedures. RESULTS: The normal average lactate (Lac), phosphocreatine, N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), myo-inositol, glutamate and glutamine (Glx) peaks and Nacetyl aspartate/Cr, NAA/ Cho + Cr, Cho/Cr ratios were measured from the healthy opposite hippocampi or from the control subjects. The Lac, glutamate and glutamine (Glx), myo-inositol, phosphocreatine and NAA metabolites plus Cho/Cr ratio showed statistical difference between the normal and the epileptic hippocampi. Cho, Cr metabolites plus NAA/Cr, NAA/ Cho + Cr ratios were almost the same between the groups. The sensitivity of Proton-MR-Spectroscopy for lateralization of the epileptic foci in all patients was 96% and the specificity was 50%. CONCLUSIONS: Proton-MRSI can easily be considered as an alternative modality of choice in the diagnosis of temporal lobe epilepsy and in the future; Proton-MR-Spectroscopy may become the most important technique used in epilepsy centers.
[Show abstract][Hide abstract] ABSTRACT: Biliary microhamartomas, also known as bile duct hamartomas and von Meyenburg complexes, are benign neoplasms containing cystic dilated bile ducts embedded in fibrous stroma. They develop in hepatobiliary system, do not generally give clinical outcomes, and are detected incidentally. However, they can rarely show malignant transformation. Our aim was to report the contribution of computed tomography, routine magnetic resonance imaging, and magnetic resonance cholangiopancreatography in the diagnosis of biliary microhamartomas in a 61-year-old woman.
Case Reports in Medicine 01/2012; 2012(3):976078. DOI:10.1155/2012/976078
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to optimize and predict the most efficient magnetic resonance imaging (MRI) sequences; T1-weighted (T1W), T2-weighted (T2W), dynamic contrast-enhanced (DCE) T1W, diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) mapping sequences and proton MR spectroscopy (H-MRS) for the detection of prostate cancer.
After institutional review board approval and informed consent taken from all the patients, 40 patients with prostate cancer were included in this research. Two readers independently evaluated the results of T1W, T2W, DCE T1W, and DWI-ADC mapping sequences and proton H-MRS for the depiction of prostate cancer. Reference standard was the transrectal ultrasonography-guided biopsy and the surgical histopathological results. Statistical analysis was assessed by the Fisher exact t test, Wilcoxon signed rank test, variance analysis test with kappa (κ) values and receiver operating characteristics (ROC) curve for ADC values, choline (Cho)/citrate (Cit) and Cho+creatine (Cre)/Cit ratios for each observer.
Based on both readers' results, sensitivity declined to 31% and specificity to 75% for the T1W sequence, sensitivity declined to 43% and specificity to 67% for the DCE T1W sequence, sensitivity declined to 46% and specificity to 68% for the T2W sequence, sensitivity declined to 29% and specificity to 82% for the DWI-ADC mapping; and specificity was 49% for the Cho/Cit and Cho+Cre/Cit ratios, sensitivity was 69% for the Cho/Cit ratio, and sensitivity was 70% for the Cho+Cre/Cit ratio for H-MRS. The T2W sequence and H-MRS presented significant statistical differences for the depiction of prostatic cancer (P < 0.05), the most efficient sequence to detect prostatic cancer was H-MRS: Cho+Cre/Cit and Cho/Cit ratios.
Instead of using either sequences alone owing to low sensitivity and specificity rates, combined use of MRI techniques could easily improve the detection and staging of prostate cancer.
[Show abstract][Hide abstract] ABSTRACT: A prospective study was designed to figure out the percentages of the left renal vein variations using routine lumbar spinal magnetic resonance imaging (MRI) in patients with neurological problems.
Between March 2010 and October 2010, the study population was recruited from a total of 2,644 consecutive patients who would undergo a routine lumbar spinal MRI examination. In addition to the routine MRI sequences, axial, balanced turbo field echo sequence (BTFE-BH SENSE) was applied after detection of a left renal vein variation.
As the left renal vein variations, retroaortic left renal vein (RLRV) and circumaortic left renal vein were detected. The number of cases with the correspondent percentages of the total left renal vein variations, RLRV and circumaortic left renal vein were 71/2,644 (2.68%), 44/2,644 (1.66%) and 27/2,644 (1.02%), respectively. In cases with RLRV, the numbers of males and females with their correspondent percentages were 19/44 (43.2%) and 25/44 (56.8%), respectively. In cases with circumaortic left renal vein, the numbers of males and females with their correspondent percentages were 13/27 (48.1%) and 14/27 (51.9%), respectively. With Chi-square test, no statistically significant gender difference was found between the percentages of left renal vein variations (P = 0.83).
MRI is useful in detecting RLRV and circumaortic left renal vein. If a left renal vein variation is detected, an additional BTFE-BH SENSE sequence is suggested to confirm whether it is retroaortic or circumaortic.
[Show abstract][Hide abstract] ABSTRACT: It is important to diagnose retroaortic left renal vein (RLRV) before a probable retroperitoneal surgery in a case of a suspicious adrenal mass. Our purpose is to present the ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) findings in a case of left adrenal adenoma with a coincidental RLRV and to discuss the clinical importance of their imaging. Abdominal and scrotal US, abdominal CT and MRI were performed for a 50-year-old male patient who was referred with continuous abdominal pain, intractable hypertension, high levels of blood cortisol and proteinuria. On US, a hypoechoic solid mass measuring 4 × 3 cm in the left adrenal location and coincidental RLRV, besides multiple renal cysts, hepatomegaly, left-sided varicocele, and small-sized left testis were detected. CT and MRI also revealed the mass in the left adrenal gland which was consistent with adenoma. With CT and MRI, presence of RLRV was also verified.
Case Reports in Medicine 03/2011; 2011:867895. DOI:10.1155/2011/867895
[Show abstract][Hide abstract] ABSTRACT: To assess the most effective magnetic resonance imaging (MRI) sequence for the visualization of the 9th, 10th, and 11th cranial nerves (glossopharyngeal, vagus, and accessory nerves, respectively) in their intraforaminal/canalicular courses.
Balanced fast-field echo (b-FFE), 3D-T2W DRIVE, T2W 2D TSE and post-contrast T1W MRI sequences were all applied and we tried to get the best sequence for the exact assessment of the 9th, 10th, and 11th cranial nerves. Six hundred nerves of 100 patients without symptoms of neurovascular compression were examined using the above sequences. Imaging analysis was graded as: a) nerves analyzed by certainty (score of 2), b) nerves analyzed partially (score of 1), and c) nerves not identified (score of 0).
In all three nerves, the best sequence for the visualization of the cisternal and intraforaminal course was b-FFE, with 58%, 73%, 62%, and all together 64.3% success in showing the fascicles of the 9th-11th nerves. This sequence with a very short time of repetition, symmetrical and balanced gradient around the echo time allowed very fast imaging and a high signal to noise ratio. T2W TSE sequence was superior to the DRIVE T2W sequence in assessing the cisternal and intraforaminal part of all three nerves. Post-contrast T1W sequence was probably the worst sequence in showing all three nerves.
b-FFE gradient echo MRI sequence with high spatial resolution is the optimal sequence for determining the courses of 9th-11th cranial nerves.
[Show abstract][Hide abstract] ABSTRACT: The characteristics of Sprengel deformity, which is also called congenital high scapula, are malposition and dysplasia of the affected scapula, with possible omovertebral connection. The aim of the present study was mainly to present the magnetic resonance imaging (MRI) findings of two pediatric cases of Sprengel deformity. A 7-year-old girl and a 9-year-old boy with deformities in their right shoulder were studied. Plain radiographs were obtained. MRI was performed for both children. The fibrous omovertebral connection is depicted in its longest form in one plane. Omovertebral band is best screened in coronal and axial cross sections. We are introducing a new MRI sign which we named as "Ra's eye" to define the appearance of omovertebral band within the surrounding fat tissue.
Journal of Clinical Imaging Science 02/2011; 1(1):13. DOI:10.4103/2156-7514.76691