Cem Balci’s research while affiliated with Cleveland Clinic Abu Dhabi and other places

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Publications (9)


The Role of 18F-FDG PET/MRI in the Assessment of Primary Intrahepatic Neoplasms
  • Article

February 2020

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26 Reads

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16 Citations

Academic Radiology

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Kourosh Yaghouti

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[...]

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Cem Balcı

Rationale and Objectives To evaluate the results of 18F-FDG PET/MRI in relation to the histopathologic subtypes and histologic grades of mass-forming primary intrahepatic neoplasms. Materials and Methods We retrospectively evaluated 18F-FDG positron emission tomography/magnetic resonance imaging (PET/MRI) results for 39 patients with histopathologically confirmed primary hepatic neoplasms, 15 with mass-forming intrahepatic cholangiocarcinoma (ICC) and 24 with hepatocellular carcinoma (HCC). The apparent diffusion coefficient (ADC) and standardized uptake value (SUV) were analyzed in relation to the histopathologic diagnosis and histologic grade, including calculating the sensitivity and specificity of the imaging findings. Results The median SUV of ICC (6.0 [interquartile range, 5–10]) was significantly higher than that of HCC (4.0 [2.62–6.50]) (p = 0.002). An area under the curve (AUC) of 0.79 (95% confidence interval 0.649–0.932) had a sensitivity of 86.7% and a specificity of 67% at the best cut-off SUV of 4.41 to differentiate between ICC and HCC. ADC values did not differ significantly between HCCs and ICCs (p = 0.283). Both SUV and ADC values differed significantly between low-grade (well- and moderately differentiated) and high-grade (poorly differentiated) HCCs. Combining ADC and SUV further improved differentiation of low- from high-grade HCCs to a significant level (0.929). The SUV did not differ significantly between ICC histologic grades (p = 0.280), while the ADC differed significantly only between well and poorly differentiated ICCs (p = 0.004). Conclusion Assessing primary hepatic neoplasms with 18F-Fluorodeoxyglucose PET/MRI may help to predict tumor grade and differentiate between types of intrahepatic neoplasms.


Fig. 1. Sixty-six-year-old female patient with stage IV metastatic colorectal carcinoma. a-d Liver metastases on T2-weighted axial images at PT and 3, 6, and 9 months of therapy, respectively. e-h ADC maps of the lesion. i-l IVIM images of the lesion with 16 different b-values (from 0 to 1,400 s/mm 2 ) at PT and 3, 6, and 9 months of therapy.
Quantitative analysis of IVIM parameters and comparison of pre-treatment values with values at 3, 6, and 9 months post-treat- ment in the 16 liver metastases
Quantitative analysis of IVIM parameters for the different disease response groups ADC, 10 -3 mm 2 /s D*, 10 -3 mm 2 /s D, 10 -3 mm 2 /s f
Intravoxel Incoherent Motion of Colon Cancer Liver Metastases for the Response Assessment of Antiangiogenic Treatment: Results from a pilot study
  • Article
  • Full-text available

January 2020

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70 Reads

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8 Citations

Medical Principles and Practice

Purpose: To evaluate the Intravoxel Incoherent Motion (IVIM) parameter alterations of liver metastases of colorectal carcinoma (CRC) during antiangiogenic bevacizumab combination therapy. Methods: Twenty-five CRC liver metastases who were all treated with bevacizumab in combination with FOLFOX-or-FOLFIRI protocols were enrolled in the study. MRI was performed in a 1.5T scanner pre-treatment (PT) and at the 3rd, 6th, and 9th months of the therapy. Routine abdominal MRI sequences and an IVIM-DWI (diffusion weighted imaging) sequence were obtained. IVIM-DWI sequence was executed with 16 b-values varying from 0-to-1400s/mm2. The mean values of apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) of each metastases were obtained for all b-values and the time related changes were recorded to analyze the chronologic responses to antiangiogenic therapy. The RECIST1.1 criteria were used for the evaluation of treatment response. Results: The diameters of the metastases diminished significantly at 9th month when compared with PT (p=0.03). D (p= 0.10) and ADC (p= 0.21) values of the metastases increased at the 9th month of therapy. D* was the highest at 3rd month (p=0.24), and a decreased at 6th (p= 0.97) and 9th months (p= 0.87) of therapy. The f had the highest peak at 3rd month (p=0.51), and started to decrease after 3rd month. At the 6th month f decreased to lowest values (p=0.12). Conclusion: IVIM parameters, particularly the perfusion fraction may quantitatively reflect the response of antiangiogenic treatment. The antiangiogenic response manifests after the 3rd month of the therapy before the RECIST related response.

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Distribution of malignant tumors for different body regions
Added Value of Contrast Medium in Whole-Body Hybrid PET/MRI: Comparison Between Contrast-Enhanced and Non-Contrast-Enhanced Protocols

June 2019

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52 Reads

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2 Citations

Medical Principles and Practice

Objective: To compare the diagnostic ability and time efficiency of contrast-enhanced (CE) whole body FDG PET/MRI protocol and non-contrast-enhanced (NCE) protocol. Subjects and methods: Ninety-three patients with known primary tumors underwent whole-body hybrid FDG PET/MRI during the follow-up of their malignancies with the use of NCE and CE protocols. The NCE PET/MRI protocol consisted of diffusion-weighted (b = 0 s/mm2 and 800 s/mm2) and T1-weighted Turbo Flash in the axial plane and T2-weighted HASTE sequence in the coronal planes (∑ = 25 minutes). The CE PET/MRI protocol was performed by acquiring axial serial CE 3D FS VIBE images in the upper abdomen, completing the whole body in late phase in the axial plane (∑ = 30 minutes). Results: There was a statistically significant difference between the total number of lesions detected by the CE protocol (median 2, IQR 0-14) and that detected by the NCE protocol (median 1, IQR 0-5) (p < 0.001). More malignancies were detected in the abdomen (p < 0.001) and brain (p < 0.001) with the CE PET/MRI protocol, whereas no significant difference was present when comparing the two protocols in the detection of malignancies in the head and neck (p = 0.356), thorax (p = 0.09), lymph nodes (p = 0.196) and bone (p = 0.414). Conclusion: The CE FDG PET/MRI protocol enables fast and accurate detection of malignancies compared to NCE FDG PET/MRI protocol particularly in the upper abdomen and brain. The diagnostic ability and time efficiency can be increased with the proposed short CE protocol in place of the whole body PET/MRI protocol.


Dramatic Response to Catumaxomab Treatment for Malign Ascites Related to Renal Cell Carcinoma With Sarcomotoid Differentiation

April 2014

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257 Reads

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5 Citations

American Journal of Therapeutics

Refractory malignant ascites (MA) is a common complication in cancer patients. Renal cell carcinoma (RCC) is rarely present with peritoneal ascites, which is commonly associated with carcinomas of the gastrointestinal and female reproductive tracts; including especially ovarian high-grade serous carcinoma. Currently, chemotherapy and paracentesis represent the most widely used methods to relieve the symptoms. Recently, intraperitoneal therapy with catumaxomab-a trifunctional hybrid antibody-has been introduced for the treatment of MA. The benefit of this treatment has been demonstrated in patients with distinct abdominal malignancies. In this case report, we present the first case of successful catumaxomab treatment against MA in a patient with advanced RCC with sarcomatoid differentiation. After the second administration of catumaxomab, paracentesis became no longer necessary. Catumaxomab might represent a safe treatment option for MA in the course of metastatic RCC with sarcomatoid differentiation.


CT and MRI findings of sarcomatoid cholangiocarcinoma

October 2012

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38 Reads

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22 Citations

Cancer Imaging

Computed tomography (CT) and magnetic resonance imaging (MRI) findings for a case of intrahepatic sarcomatoid cholangiocarcinoma is presented. A 48-year-old man with upper abdominal pain underwent contrast-enhanced CT and MRI. A 13 × 10 × 7 cm mass was seen in the left liver lobe, which had hypodense internal architecture on CT and mixed signal intensities on both T1- and T2-weighted images with an overwhelmingly hypointense signal on T1-weighted images and a hyperintense signal on T2-weighted images. The lesion had heterogeneous enhancement on both CT and MRI. A satellite nodule with the same imaging features was distinctive for the lesion.


Locally metastatic mucinous rectal adenocarcinoma: Imaging diagnosis with DW-MRI in comparison with PET-CT

June 2012

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97 Reads

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1 Citation

Oncology Letters

A 56-year-old male patient with locally advanced mucinous rectal cancer underwent neoadjuvant chemoradiotherapy. Follow-up imaging with positron emission tomography-computed tomography (PET-CT) revealed a local response to chemoradiotherapy, whereas diffusion-weighted magnetic resonance imaging (DW-MRI) showed newly presented sacral bone metastasis. Histopathologically confirmed bone metastasis and the local tumor were surgically removed. Repeat DW-MRI revealed tumor recurrence in the sacral excision zone eight months after surgery, which was reconfirmed by histopathology. This case shows the superior imaging ability of DW-MRI in the diagnosis of mucinous tumors in comparison to PET-CT.


This figure demonstrates a mass lesion located in the left lobe of the liver close to hilus (a) hypointense on T1-weighted MR image, (b) heterogenous hyperintense on T2-weighted image, and (c) heterogenous contrast enhancement on contrast-enhanced fat-saturated T1-weighted image. (d) MRCP image demonstrates the mass that originated from left main bile duct and causes significant bile duct dilatation at the periphery of the liver (arrows). The lesion was considered to be a cholangiocarcinoma with MRI and MRCP findings and also confirmed surgically.
MRCP image demonstrates (a) a calculus (white arrow) located in the distal common bile that does not cause bile duct dilatation. This calculus was not detected during the MRI examination and received a false negative diagnosis. (b) ERCP image demonstrates the calculus (black arrow). This calculus was extracted during the procedure.
MRCP image demonstrates an irregular heterogenous hypointense region in the distal common bile duct (arrow). On MRI, this region evaluated as benign pathology such as calculus and sludge. ERCP image demonstrates a filling defect in this region (arrow). This filling defect was determined as Fasciola hepatica and extracted during the procedure.
T2-weighted (a), contrast-enhanced T1-weighted MRI (b), and MRCP slices demonstrate significant stenosis in the common bile duct at the level of pancreas head (white arrow) and bile duct dilatation proximal to the stenosis. Any mass lesion is not seen at the stenosis level. On MRI and MRCP, the cause of stenosis considered as chronic pancreatitis because of pseudocysts located in corpus and tail of the pancreas (asterisk). (d) ERCP demonstrates the malignant character of stricture (black arrow), and the result of biopsy was adenocarcinoma of the pancreas.
In a case who had undergone laparoscopic cholecystectomy operation 3 years ago, MRCP image demonstrates (a) stricture at hilar level (arrows) and mild dilatation of left main hepatic duct. Although this case had received false positive diagnosis as malignant stricture with MRI and MRCP findings, during ERCP, benign stricture developed secondary to cholecystectomy was diagnosed (arrows). Balloon dilatation and stent replacement was performed during ERCP procedure, and the result of biopsy was benign.
Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

March 2012

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1,372 Reads

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13 Citations

In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18-86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method.


Fulminant abdominal gas gangrene in metastatic colon cancer

February 2012

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24 Reads

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6 Citations

Oncology Letters

We report a case of fulminant abdominal gas gangrene in a patient with metastatic colon cancer. A 39-year-old patient with descending colon, high-grade adenocarcinoma and coexisting liver and lymph node metastases received two courses of chemotherapy. The patient developed sudden acute abdominal symptoms accompanied by septic shock parameters. The imaging findings on computed tomography were characteristic for abdominal gas gangrene, involving liver metastases, portal vein and lymph nodes with associated pneumoperitoneum. The patient succumbed to the disease within hours following the onset of symptoms.


MRI assessment of chronic pancreatitis

November 2010

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41 Reads

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60 Citations

Diagnostic and interventional radiology (Ankara, Turkey)

Magnetic resonance imaging (MRI) plays an important role in the assessment of chronic pancreatitis. By standard MRI techniques, decreased parenchymal signal on T1-weighted fat-suppressed images and delayed gradual enhancement on serial contrast enhanced images represent fibrotic changes caused by chronic inflammation. Magnetic resonance cholangiopancreaticography (MRCP) can reveal ductal changes, including side branch ectasias, that are related to tissue fibrosis and destruction. The exocrine function of the gland and an increased number of side branch ectasias can be evaluated with secretin-stimulated MRCP. Diffusion weighted imaging is an emerging technology that can complement standard MRI to assess the parenchymal changes associated with chronic pancreatitis. The same technique can also quantify the parenchymal response to secretin stimulation. This article reviews standard imaging techniques and new advancements in MRI technology as they relate to the assessment of chronic pancreatitis.

Citations (8)


... So far, small studies have been performed in patients with hepatobiliary neoplasms, including pCCA. It was reported that simultaneous hybrid FDG-PET/ MRI has promising benefits over conventional preoperative imaging with CT and MRI/MRCP or combined with PET/CT [14][15][16][17]. In the study of Obmann et al. on sixteen patients with hepatobiliary neoplasms, FDG-PET/MRI correctly changed the cTNM stage in 22% of patients with consequent change in management in 11% of patients with extrahepatic cholangiocarcinoma [14]. ...

Reference:

Hybrid FDG-PET/MRI for Diagnosis and Clinical Management of Patients with Suspected Perihilar Cholangiocarcinoma: A Feasibility Pilot Study
The Role of 18F-FDG PET/MRI in the Assessment of Primary Intrahepatic Neoplasms
  • Citing Article
  • February 2020

Academic Radiology

... A number of small prospective studies describe the use of ADC in assessing response of colorectal liver metastases compared to standard Response Evaluation Criteria In Solid Tumours (RECIST) criteria. These studies failed to detect correlation between changes in ADC and lesion size change after 14 days of treatment [3], and noted that ADC change showed an early increase with subsequent decrease, 3 months after treatment [4]. Most importantly, average changes in responding lesions were small compared with the measurement error, suggesting that the techniques as implemented were not reliable enough to predict therapy response at the individual lesion and patient level [5]. ...

Intravoxel Incoherent Motion of Colon Cancer Liver Metastases for the Response Assessment of Antiangiogenic Treatment: Results from a pilot study

Medical Principles and Practice

... Abdominal seeding from RCC has been rarely reported [7,8]. Most of the studies to date were case reports or series [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]; therefore, the radiologic or histologic characteristics of primary and seeding lesions are unclear and the prognostic impact is also uncertain. Increased knowledge of this uncommon manifestation of RCC may benefit radiologic investigation or therapeutic planning in daily practice. ...

Dramatic Response to Catumaxomab Treatment for Malign Ascites Related to Renal Cell Carcinoma With Sarcomotoid Differentiation
  • Citing Article
  • April 2014

American Journal of Therapeutics

... Thus, identifying S-HCC is important for proper patient management and treatment planning. However, as the literature was restricted to either small case series or case reports [11][12][13], there was an unclear concept of CT imaging features of S-HCC, leading to a dilemma for clinical diagnosis of S-HCC preoperatively. ...

CT and MRI findings of sarcomatoid cholangiocarcinoma
  • Citing Article
  • October 2012

Cancer Imaging

... They can also arise from the soft tissue surrounding the rectum with contiguous involvement of the sacrum [51]. Such isolated sacral lesions with no distant metastasis can still be surgically resected [52]. Our patient presented with urinary dysfunction and back pain and was diagnosed based on MRI showing a large presacral mass with a destructive lesion in the sacrum, and needle biopsy confirmed the diagnosis. ...

Locally metastatic mucinous rectal adenocarcinoma: Imaging diagnosis with DW-MRI in comparison with PET-CT

Oncology Letters

... 8,18 HPVG often occurs when the barrier function in the gastrointestinal tract is destroyed, leading to bacterial translocation. 19,20 This forms a reliable basis for understanding the pathophysiology of HPVG complicated by septic shock. In Patient 1, inert gas diffusion was the main cause of HPVG, which developed secondary to inappropriate decompression during diving. ...

Fulminant abdominal gas gangrene in metastatic colon cancer
  • Citing Article
  • February 2012

Oncology Letters

... Compared with conventional MRI using non-specific CAs, hepatobiliary MRI is known to have considerable advantages in the diagnosis not only of tumours, but also of other liver diseases and related clinical usage, such as biliary tract imaging for pre/post-operative assessment, assessment of liver function and toxicity, and staging of fibrosis and sinusoidal obstruction syndrome [12][13][14]43,44,52,53 . Moreover, a comparative study carried out in macaque monkeys for further verification of the utility of MnFe 2 O 4 -EOB-PEG vs Gd-EOB-DTPA nanoparticles has shown the presence of stronger enhancement in the liver parenchyma and bile duct (CNR: 22.03 vs 3.81 and 19.79 vs 1.88, respectively) and a faster speed (delay time of 10 min vs 30 min) for hepatobiliary MRI. ...

Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

... The normal pancreas exhibits a higher T1 signal intensity compared to other solid organs, attributed to its abundance in proteinaceous material within the acinar cells containing rough endoplasmic reticulum [30][31][32][33]. A decreased T1 signal indicates the loss of acinar cells, replaced by fibrosis [16]. ...

MRI assessment of chronic pancreatitis
  • Citing Article
  • November 2010

Diagnostic and interventional radiology (Ankara, Turkey)