Korgun Koral

University of Texas Southwestern Medical Center, Dallas, Texas, United States

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Publications (38)67.45 Total impact

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    ABSTRACT: Pleomorphic xanthoastrocytomas are rare astrocytic neoplasms of childhood and young adulthood. The purpose of this retrospective review was to evaluate MR imaging features of pediatric pleomorphic xanthoastrocytomas with an emphasis on diffusion MR imaging.
    AJNR. American journal of neuroradiology. 07/2014;
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    ABSTRACT: PurposeTo characterize the MRI features of the petromastoid canal in children with sensorineural hearing loss (SNHL) and in normal infants.Materials and Methods High resolution MRI examinations of 564 children who were evaluated for SNHL and brain MRI examinations of 112 infants who had normal studies were studied independently by two reviewers.ResultsIn SNHL group, visibility of the PMC decreased for right and left PMC (P < 0.001). The width of the right PMC significantly decreased as age increased (P < 0.0001). There was no relation between abnormalities of membranous labyrinth and cochlear nerve and PMC visibility in children with SNHL (p > 0.05). In the normal group, the PMC visibility decreased with increasing age (right P = 0.0001, left P = 0.001). In the normal group also, as age increased, the PMC width decreased for both PMCs (right, P = 0.0006; left, P = 0.03).Conclusion The PMC is more frequently visualized in young children. Its visibility and width are not associated with abnormalities of membranous labyrinth and cochlear nerves. J. Magn. Reson. Imaging 2014;39:966–971. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 04/2014; 39(4). · 2.57 Impact Factor
  • Korgun Koral
    Journal of Neurosurgery Pediatrics 10/2013; · 1.63 Impact Factor
  • Evan Walgama, Seckin O Ulualp, Korgun Koral
    JAMA otolaryngology-- head & neck surgery. 08/2013;
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    ABSTRACT: BACKGROUND AND PURPOSE:Although utility of diffusion MR imaging in the preoperative diagnosis of common pediatric cerebellar tumors is generally recognized, its added value has not been systematically studied previously. The purpose of this study was to evaluate the impact of diffusion MR imaging on the accuracy of preoperative diagnosis of common pediatric cerebellar tumors among reviewers with different experience levels.MATERIALS AND METHODS:Review of the neuro-oncology data base yielded 96 patients whose preoperative brain MR imaging included both diffusion MR imaging (b = 1000 s/mm(2)) and ADC maps. There were 38 pilocytic astrocytomas, 33 medulloblastomas, 17 ependymomas, and 8 atypical teratoid/rhabdoid tumors. Six reviewers (4 residents, 2 neuroradiologists) evaluated the examinations. Two sessions were conducted with each reviewer, without and with diffusion MR imaging data on 2 separate days. The impact of diffusion MR imaging on accuracy of diagnoses was assessed.RESULTS:In choosing the correct diagnosis of the 4 alternatives, performances of 5 of the 6 reviewers improved significantly with inclusion of the diffusion MR imaging data, from 63%-77% (P = .0003-.0233). The performance of 1 reviewer also improved, but the difference did not attain statistical significance (P = .1944). Inclusion of diffusion MR imaging data improved the likelihood of rendering a correct diagnosis (odds ratio = 3.16, 95% confidence interval = 2.07-4.00) over all tumor types. When embryonal tumors were regarded as a single group, the rate of correct diagnosis increased from 66%-83% with diffusion MR imaging data, and performances of all of the reviewers improved significantly (P = .0001-.05). The improvement in performances resulted from increased correct diagnoses of pilocytic astrocytomas, medulloblastomas, and atypical teratoid/rhabdoid tumors. There was no improvement in the correct diagnoses of ependymomas with inclusion of the diffusion MR imaging data.CONCLUSIONS:Diffusion MR imaging improves accuracy of preoperative diagnosis of common pediatric cerebellar tumors significantly among reviewers with differing experience levels.
    American Journal of Neuroradiology 06/2013; · 3.17 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess outcomes of medical and surgical treatment of intratonsillar abscess in children. MATERIALS AND METHODS: The medical charts of children with intratonsillar abscess were reviewed to obtain information on history and physical examination, imaging, management, and follow-up assessment. RESULTS: Eleven children (6 male, 5 female, age range: 4 to 18 years) were identified. The common complaints included sore throat, fever, and odynophagia. Asymmetric tonsil hypertrophy was present in 9 patients and erythema of tonsils in all patients. Peritonsillar fullness was present in three patients. One patient needed emergent intubation due to respiratory compromise. Computerized tomography scan documented unilateral intratonsillar abscess in 9 patients, bilateral intratonsillar abscess in one, and unilateral phlegmon in one. Inflammatory changes were observed in parapharyngeal space in all patients, retropharyngeal space in 1, and pyriform sinus and aryepiglottic folds in 2. Antibiotic treatment included clindamycin in 7 patients, ampicillin/sulbactam in one, and clindamycin plus ceftriaxone in 3. The patients with respiratory compromise underwent surgery prior to antibiotic treatment. Patients with isolated intratonsillar abscess or phlegmon had resolution of their symptoms with intravenous antibiotic treatment. Patients with combination of intratonsillar and peritonsillar abscess required incision and drainage of peritonsillar abscess. CONCLUSIONS: Clinically stable children with intratonsillar abscess or phlegmon respond to trial of intravenous antibiotic therapy. Surgical drainage can accomplish clinical resolution in the presence of combination of intra- and peri-tonsillar abscess, airway compromise, or unresponsiveness to medical treatment.
    Pediatrics International 05/2013; · 0.88 Impact Factor
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    ABSTRACT: Although intracerebral schwannomas are typically regarded as benign intracranial tumors, malignancy and recurrence have been reported among patients harboring such neoplasms. The available literature consists of case reports and small series that present variable characteristics distinguishing these unusual lesions. Little advancement has been made to further the understanding and management of these tumors. The authors present 3 cases from their institution that highlight the difference between typical benign intracerebral schwannomas and histopathological variants that may portend more aggressive behavior. Also provided is a review of the literature in the hope of gaining a better understanding of these rare tumors.
    Journal of Neurosurgery Pediatrics 05/2013; · 1.63 Impact Factor
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    ABSTRACT: Spontaneous perforation of the bile duct (SPBD) is a rare abnormality of the extrahepatic biliary tree in infants. Limited porta hepatis exploration and drainage of the bile-soiled peritoneum are often sufficient treatment. Here, we describe three cases of SPBD, one of which required complex multi-disciplinary interventions for restoration of biliary continuity. Three infants with bilious ascites from spontaneous biliary perforation were reviewed. Metrics included age, presenting symptoms, diagnostic tests, interventions performed, and outcomes. The presenting symptoms of all three infants were bilious ascites, sepsis, lethargy, anorexia, fever and persistent emesis. SPBD was confirmed pre-operatively by HIDA scan (hepatobiliary scintigraphy) in each case. Intra-operative, trans-cholecystic cholangiogram confirmed SBDP in two cases. Two of the infants were successfully treated with placement of a cholecystostomy tube and porta hepatis drains. The third infant, having failed multiple similar drainage procedures, required percutaneous transhepatic drainage of a persistent porta hepatis biloma. Ultimately percutaneous, transhepatic cannulation of the extra-hepatic biliary tree for prolonged stenting was required to successfully treat this biliary perforation. Complex spontaneous biliary perforation may require extensive interventions if the perforation fails to resolve with standard porta hepatis drainage. Access of the biliary tree via Interventional Radiology procedures for complex biliary disease of this type is novel and presents an alternative to traditional open surgical treatment and control of spontaneous biliary perforations.
    Journal of Pediatric Surgery 04/2013; 48(4):893-8. · 1.38 Impact Factor
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    ABSTRACT: Purpose. To describe clinical, radiologic, and histological features of a congenital hairy polyp arising from the palatopharyngeus muscle in a neonate. Methods. Chart of a 2-day-old female referred to a tertiary care pediatric hospital for assessment of intraoral mass was reviewed. Results. The child was born at 32 weeks and an intraoral mass was noted. The patient was transferred to tertiary care children's hospital on day 2 of life. The child had increased work of breathing at presentation and required continuous positive airway pressure. Physical examination revealed a pedunculated mass which was protruding into the oropharynx from the nasopharynx. MRI of the lesion documented a discrete bilobed mass which filled the posterior nasopharynx. The mass abutted the uvula and soft palate; however, the mass did not appear to be arising from the soft palate. Intraoperative exam showed a mass arising from the right palatopharyngeus muscle in the superior pole region of the tonsil. Histologic examination showed ectodermal and mesodermal derivatives confirming congenital hairy polyp. At 8-month followup, the surgical site was healed with no evidence of recurrent lesion. Conclusions. Congenital hairy polyp, though uncommon, should be considered in the differential diagnosis of oropharyngeal mass in neonates.
    Case reports in otolaryngology. 01/2013; 2013:374681.
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    ABSTRACT: We describe the diagnosis and management of a child with embryonal rhabdomyosarcoma of the auricle and emphasize both clinical and radiological findings of this rare condition. A nine-year-old boy presented for evaluation of a slowly enlarging left auricle mass. The mass was nodular, violaceous, semi-translucent, and hyperpigmented with an overlying pseudo-vesicular plaque. The mass appeared to involve the left cavum concha, root of the helix, superior aspect of the external auditory canal, the tragus and extend to a deep preauricular component. MR imaging documented a lobulated soft tissue mass surrounding the external auditory canal with superficial involvement of the pinna. Incisional biopsy of the mass suggested embryonal rhabdomyosarcoma. The tumor was completely removed by total auriculectomy and lateral temporal bone resection. The final diagnosis was embryonal habdomyosarcoma. Although rare, otolaryngologists, pediatricians, and radiologists need to consider rhabdomyosarcoma in the differential diagnosis of auricle mass in children.
    Pediatrics International 12/2012; 54(6):945-7. · 0.88 Impact Factor
  • Neuro-Oncology 11/2012; · 6.18 Impact Factor
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    ABSTRACT: We hypothesized that the silent cerebral infarcts (SCI), which affect up to 40% of children with sickle cell disease (SCD), could occur in the setting of acute anemic events. We conducted a prospective observational study of children with and without SCD hospitalized for an illness associated with acute anemia. We identified acute silent cerebral ischemic events (ASCIE) in 4/22 (18.2%) with SCD and in 2/30 (6.7%) without SCD, using diffusion-weighted magnetic resonance imaging (DWI). Children with ASCIE had lower hemoglobin concentration than those without (median 3.1 vs 4.4 g/dl, p=0.003). The unique temporal features of cerebral infarction on DWI permit estimation of incidence rates for ASCIE of 421 (95% C.I. 155-920) per 100 patient years during acute anemic events for all patients. For children with SCD, the estimated incidence was 663 (95% C.I. 182-1707) which is much higher than reported in longitudinal studies of silent or overt strokes in SCD. Acute anemic events are common in children with SCD and therefore could partially account for the high SCI prevalence. Some ASCIE (1/4 in our study) may be reversible. Alterations in management may be warranted for all children with severe anemia to identify unrecognized ischemic brain injury that may have permanent neurocognitive sequelae.
    Blood 09/2012; · 9.78 Impact Factor
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    ABSTRACT: Objective: To describe clinical, radiologic, and histological features of a foregut duplication cyst extending from the oropharynx to the thoracic inlet. Methods: The medical record of one-month-old female who was referred to a tertiary care pediatric hospital for assessment of a neck mass was reviewed. Data included relevant history and physical examination, diagnostic work up, and management. Results: The child presented with a left neck mass identified during prenatal ultrasound exam. The infant gradually developed choking, gagging, and noisy breathing with feeds. Physical examination revealed a neck mass, extending from left submandibular region to left clavicle, was well-marginated, painless, soft, immobile, and nonadherent to the skin. A computerized tomography of the neck demonstrated a unilocular cystic mass extending from the level of the posterior oropharyngeal airway to the thoracic inlet. The mass was excised and histopathologic diagnosis was foregut duplication cyst. Conclusion: Foregut duplication cyst, although uncommon in the neck region, should be considered in the differential diagnosis of neck mass in children.
    International Journal of Pediatric Otorhinolaryngology Extra 09/2012; 7(3):159–161.
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    ABSTRACT: A technique to retrieve double J stents was described in children in whom cystoscopic stent removal was not feasible. In three children, the caudal ends of the double J stents were retrieved via the percutaneous nephrostomy access. Capturing the caudal end of the double J stents for retrieval made removal feasible and easy.
    Clinical imaging 09/2012; 36(5):626-8. · 0.73 Impact Factor
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    ABSTRACT: Juvenile xanthogranulomas (JXG) are uncommon non-Langerhans cell histiocytic proliferations which arise most often in children. While most cases present as solitary cutaneous lesions, occasional cases involve extracutaneous sites. Rare examples of JXGs have been reported involving all levels of the neuroaxis. We present two cases of JXGs involving the nervous system, and review the literature. The first patient was a 14-year-old female with headaches and a mass involving the left trigeminal nerve; pathologic examination showed a JXG. At 11 months follow-up, after administration of systemic chemotherapy, the patient remained stable with residual tumor. The second patient was a 15-year-old female with leg weakness and numbness, who underwent complete surgical resection of a dural JXG. At eight months follow-up, she showed no evidence of tumor, and was able to walk without difficulty. Review of the literature revealed 38 previously published reports of JXGs involving the nervous system. The CNS was involved in the majority (75%) of cases. The clinical characteristics of JXGs arising in the CNS varied significantly from cases in the peripheral nervous system (PNS); CNS tumors occurred in younger patients, more often males, and were more likely to be associated with concurrent cutaneous and extra-nervous systemic lesions. The clinical outcomes were similar for CNS and PNS lesions, with the caveat that all three lethal JXGs occurred in the CNS. The clinical and radiologic presentation of JXGs is nonspecific, thus necessitating biopsy and pathologic examination to arrive at the diagnosis. The pathologic differential diagnosis includes a heterogeneous group of histiocytic proliferations; immunostaining for histiocytic markers CD68, factor XIIIa, and Fascin, and the absence of Birbeck granules and CD1a immunoexpression suggests the diagnosis of JXG. In many cases, total surgical resection is curative. However, some cases will require additional chemotherapy and/or radiotherapy.
    Neuropathology 05/2012; · 1.91 Impact Factor
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    ABSTRACT: The aim of this study was to identify clinically useful tumor/normal brain apparent diffusion coefficient (ADC) ratios for distinguishing common pediatric cerebellar tumors. Review of medical records revealed 79 patients with cerebellar tumors who underwent preoperative magnetic resonance imaging, including diffusion-weighted imaging sequences, and surgery. There were 31 pilocytic astrocytomas, 27 medulloblastomas, 14 ependymomas, and seven atypical teratoid/rhabdoid tumors. ADC values were measured by placing regions of interest on the solid tumor and normal brain parenchyma by two reviewers. Tumor/normal brain ADC ratios were calculated. Mean ADC values of the pilocytic astrocytomas were greater than those of ependymomas, whose mean ADC values were greater than those of medulloblastomas and atypical teratoid/rhabdoid tumors. Using a tumor/normal brain ADC ratio threshold of 1.70 to distinguish pilocytic astrocytomas from ependymomas, sensitivity of 92% and specificity of 79% were achieved. A tumor/normal brain ADC ratio threshold of 1.20 enabled the sorting of ependymomas from medulloblastomas with sensitivity of 93% and specificity of 88%. Tumor/normal brain ADC ratios allow the distinguishing of common pediatric cerebellar tumors.
    Academic radiology 04/2012; 19(7):794-800. · 2.09 Impact Factor
  • Korgun Koral, Kadriye M Koral, Fred Sklar
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    ABSTRACT: An angiocentric glioma of the right temporal lobe is presented in a 4-year-old male. Imaging characteristics of this newly codified glial neoplasm are discussed with a review of the literature.
    Clinical imaging 01/2012; 36(1):61-4. · 0.73 Impact Factor
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    ABSTRACT: Objective To describe clinical, radiologic, and histological features of a heterotopic glial tissue presented as a rare cause of lateral nasal wall mass in a child.Methods The medical record of 13-month-old male who was referred to a tertiary care pediatric hospital for assessment of a nasal mass was reviewed. Data included relevant history and physical examination, diagnostic work up, and management.ResultsThe child presented with a slowly growing nasal mass located on the right lateral nasal wall since the early days of life. The mass started to cause external deformity of the nose. The child had no difficulty breathing through nose, no epistaxis, no recurrent sinus infection, and no snoring. Physical examination revealed a mass located on the right lateral nasal wall causing displacement of the nose to the left. MRI of the face documented a lobulated mass located in the region of nasal process of the right maxillary bone. There was no definite intracranial extension. CT demonstrated a mild enlargement of the foramen cecum. Upon resection of the mass, histologic evaluation showed glial tissue intermixed with fibrous bands. Immunohistochemical staining documented positive glial fibrillary acid protein confirming heterotopic glial tissue. At 7 month follow-up, the surgical site was healed with no evidence of recurrent lesion.Conclusions Heterotopic glial tissue, although uncommon, should be considered in the differential diagnosis of a lateral nasal wall mass in children.
    International Journal of Pediatric Otorhinolaryngology Extra 12/2011; 6(4):416–418.
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    ABSTRACT: OBJECTIVES AND RATIONALE: Medulloblastoma/primitive neuroectodermal tumor (MB/PNET) is the most common malignant tumor of the central nervous system (CNS) in children. MB/PNET survivors are at an increased risk for developing second malignancies. Little has been reported on development of low-grade lesions of the calvarium in the radiation field in MB/PNET survivors. The purpose of this study was to assess the frequency of the low-grade bone lesion development in the radiotherapy field in pediatric MB/PNET survivors and describe the imaging characteristics of these lesions. Institutional review board approval was obtained for this retrospective review which was compliant with Health Insurance Portability and Accountability Act. Forty-one MB/PNET patients (29 male) who survived for at least 2 years after initiation of radiation therapy were included. The medical records were reviewed. The most recent available brain magnetic resonance imaging studies were evaluated. Three patients (7.3%) developed low-grade calvarial lesions and underwent resection and/or biopsy of the lesions. There were one Langerhans cell histiocytosis, one benign spindle cell lesion with myxoid change, and one fibrous dysplasia. Development of low-grade bone lesions of calvarium is not very rare in pediatric PNET/MB survivors. Bones in the radiation therapy field need to be carefully examined for assessment of secondary lesions.
    Academic radiology 11/2011; 19(1):35-9. · 2.09 Impact Factor
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    ABSTRACT: Children treated for perforated appendicitis can have significant morbidity. Management often includes looking for and draining postoperative fluid collections. We sought to determine if drainage hastens recovery. Children with perforated appendicitis treated with appendectomy from 2006 to 2009 were reviewed. Patients with postoperative fluid that was drained were compared with patients with undrained fluid with regard to preoperative features and postoperative outcomes. Statistical analyses included paired Student's t tests, Mann-Whitney U test, and linear regression. Five hundred ninety-one patients were reviewed. Seventy-one patients had postoperative fluid, of whom 36 had a drainage procedure and 35 did not. There was no significant difference in white blood cell count at the time of assessment for drainage (16.4 ± 4.0 vs 14.6 ± 4.9, P = .14), days with fever (3.5 ± 3.0 vs 2.9 ± 2.5, P = .35), or readmission rate (19% vs 31%, P = .28). After multivariate linear regression, larger fluid volumes were associated with prolonged length of stay (LOS) (P = .03). For fluid collections between 30-100 mL, there was no significant difference in LOS between the drain and no-drain groups (9.8 ± 3.5 vs 10.9 ± 5.2 days, P = .51). After appendectomy for perforated appendicitis, larger postoperative fluid collections are associated with prolonged LOS. Drainage of collections less than 100 mL may not hasten recovery.
    Journal of Pediatric Surgery 06/2011; 46(6):1126-30. · 1.38 Impact Factor

Publication Stats

76 Citations
67.45 Total Impact Points


  • 2006–2014
    • University of Texas Southwestern Medical Center
      • • Department of Radiology
      • • Department of Urology
      Dallas, Texas, United States
  • 2012
    • Geisel School of Medicine at Dartmouth
      • Department of Radiology
      Hanover, New Hampshire, United States
  • 2008
    • Children's Medical Center Dallas
      Dallas, Texas, United States