Sadık Server’s research while affiliated with Group Florence Nightingale Hastaneleri and other places

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Publications (24)


Novel Application of Internal-External Drainage Catheter as Biliary Stent for Percutaneous Transhepatic Treatment of Biliary Strictures in Living Donor Liver Transplantation Recipient Patients
  • Article

August 2019

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23 Reads

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1 Citation

Transplantation Proceedings

Sadık Server

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Objectives: Although endoscopic management is considered as the first-line treatment for biliary strictures, it may be challenging in living donor liver transplant recipients due to the complex nature of duct-to-duct reconstruction. In this study we present the use of a pigtail drainage catheter as a biliary stent to treat biliary strictures after a living donor liver transplant. Methods: Twenty-seven patients with biliary strictures were treated with our novel technique. In this technique, a pigtail catheter was trimmed into 3 parts (proximal, middle, and distal portions). A suture string was passed through the distal hole of the middle portion, which was then reversed and used as a stent while the proximal portion was used as a pusher. Following balloon dilation of the stenotic segment, the distal, reversed middle, and proximal portions were loaded over the guidewire. After proper placement of the stent, the retractor suture string, pusher, and guidewire were removed. The stent was removed during the third or fourth month of placement through endoscopic retrograde cholangiopancreatography (ERCP) in all patients. Results: No significant complications developed during the procedure or follow-up period. Ten patients required re-stenting by ERCP during the same session. The mean follow-up period was 2 years. Cholestase enzymes and bilirubin levels were within normal limits in all patients during follow-up. Conclusion: Stents derived from drainage catheter facilitate treatment of biliary strictures in patients not eligible for the retrograde approach. This stent is cheap, easy to implement, can be easily removed by ERCP, and re-stenting can be applicable in retrograde if needed.


Value of Intravoxel Incoherent Motion for Hepatocellular Carcinoma Grading

July 2019

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31 Reads

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18 Citations

Transplantation Proceedings

Background: To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) parameters in estimation of hepatocellular carcinoma (HCC) grading. Materials and methods: Twenty-nine patients with histopathologically diagnosed as 42 HCC at explant were included in this retrospective study. All patients were examined by 1.5T magnetic resonance imaging with the use of 4-channel phased array body coil. In addition to routine pre- and postcontrast sequences, IVIM (16 different b factors varying from 0 to 1300 s/mm2) and conventional diffusion-weighted imaging (3 different b factors of 50, 400, 800 s/mm2) were obtained with single-shot echo planar spin echo sequence. Apparent diffusion coefficient (ADC) and IVIM parameters including mean D (true diffusion coefficient), D* (pseudo-diffusion coefficient associated with blood flow), and f (perfusion fraction) values were calculated. Histopathologically, HCC was classified as low (grade 1, 2) and high (grade 3, 4) grade in accordance with the Edmondson-Steiner score. Quantitatively, ADC, D, D*, and f values were compared between the low- and high-grade groups by Student t test. The relationship between the parameters and histologic grade was analyzed using the Spearman's correlation test. To evaluate the diagnostic performance of the parameters, receiver operating characteristic analysis was performed. Results: High-grade HCCs had significantly lower ADC and D values than low grade groups (P = .005 and P = .026, retrospectively); ADC and D values were inversely correlated with tumor grade (r = -0.519, P = .011, r = -0.510, P = .026, respectively). High-grade HCCs had significantly higher f values when compared with the low-grade group (P = .005). The f values were positively correlated with tumor grade (r = 0.548, P = .007). The best discriminative parameter was f value. Cut-off value of 32% of f values showed sensitivity of 75.6% and a specificity of 73.5%. Conclusion: ADC values and IVIM parameters such as f values appear to reflect the grade of HCCs.


The relationship of spleen stiffness value measured by shear wave elastography with age, gender, and spleen size in healthy volunteers

January 2019

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52 Reads

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28 Citations

Journal of Medical Ultrasonics

Purpose The aim of this study is to evaluate spleen stiffness values with shear wave elastography (SWE) quantitatively in healthy adults and investigate the relationship of spleen stiffness with age, gender, and spleen size. Methods This study included 65 healthy individuals. Spleen stiffness measurement was obtained with 2 dimensional (2-D) SWE method from the middle portion of spleen and calculated in kilopascals by taking the average of three valid measurements. Longitudinal and transverse spleen sizes were measured. The relationship of spleen stiffness with age, gender, and spleen size was investigated. The association between spleen size and age and gender was also evaluated. Results The mean spleen stiffness value was 13.82 ± 2.91 kPa, and the spleen stiffness was not affected by age, gender, or spleen size. Longitudinal spleen size was significantly lower in females than that in males. Moreover, there was a significant negative correlation between longitudinal spleen size and age (r = 0.247, p = 0.048). Conclusion Spleen stiffness can be quantitatively measured by 2-D SWE, and the spleen stiffness is not affected by age, gender, and spleen size. The values obtained in this study can be used as normal base values in examination of different spleen pathologies.



The value of imaging findings in prediction of microvascular invasion in hepatocellular carcinoma
  • Presentation
  • File available

October 2018

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64 Reads

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The sample image of the ROI placement. The ROI on the b 1000 s/mm² image was placed over the PVT at least covering 2/3 of diameter to prevent interference from the vascular and adjacent structures. Coverage area of the ROI is 293 mm²
A–D Malignant portal vein thrombus (white arrow) in a 72-year-old man with cirrhosis and HCC. A Axial T2W image shows thrombus in main portal vein; B Prominent contrast enhancement is seen in postcontrast T1W image; C ADC is calculated as 0.80 × 10⁻³ mm²/s; D IVIM parameters were acquired from trace sequences obtained 16 different b values of varying 0 to 1300 s/mm² and the f value is calculated as 41%
A–D Benign portal vein thrombus (white arrow) in a 50-year-old woman with cirrhosis. A Axial T2-weighted (W) image shows thrombus in the right portal vein; B contrast enhancement is not seen in postcontrast T1W image; C ADC is calculated as 1.08 × 10⁻³ mm²/s; D IVIM parameters were acquired from trace sequences obtained 16 different b values varying from 0 to 1300 s/mm² and the f value is calculated as 7%
Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus

September 2018

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32 Reads

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5 Citations

Abdominal Radiology

Purpose: To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) parameters in the differential diagnosis of portal vein thrombus (PVT). Methodology: Thirty-five patients with PVT were enrolled in this retrospective study. Precontrast axial in-phase and out-of-phase T1-weighted (W) turbo field echo (TFE), axial and coronal T2-W single-shot turbo spin echo, IVIM with b values between 0 and 1300 s/mm2 and conventional DWI with b factors of 50, 400, and 800 s/mm2 with single-shot echo-planar imaging, and postcontrast dynamic T1-W volumetric interpolated breath-hold examination images obtained with 1.5 T MR unit were evaluated. For quantitative analysis of conventional DWI, an ADC map was reconstructed from conventional DWI using all b values. For quantitative evaluation of IVIM, the SI was calculated from each b value. A specific software program was applied to calculate D (true diffusion coefficient), D* (pseudodiffusion coefficient associated with blood flow), and f (perfusion fraction). The differentiation between benign and malignant PVT was based on the criteria outlined in the study by Catalano et al. (Radiology 254:154-162, 2010). Results: The ADC values of the malignant PVT were significantly lower than those of benign PVTs (p = 0.005). Malignant PVTs had a tendency to show higher f values in comparison with benign PVTs without statistical significance (p = 0.750). The best discriminative parameter was ADC values, which demonstrated a sensitivity of 80.0% and a specificity of 72.7% with cut-off value of 1.00 × 10-3 mm2/s. Conclusion: ADC values might be more superior tool than IVIM parameters in differentiation between malignant and benign PVT.





Large-cell lung cancer originating from tracheal bronchus — A rare case

April 2016

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15 Reads

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3 Citations

Journal of the Pakistan Medical Association

Tracheal bronchus is a rarely seen congenital anomaly generally originating from the right lateral wall of the trachea and approximately 2 cm above the carina. It was firstly defined by Sandifort in 1785 and its frequency of incidence in normal population changes between 0.1% and 2%. There are two types called “Supernumerary” and “Displaced”. It is a rarely seen kind of tracheal anomaly although fairly well defined. The cases accompanied by lung cancer are seen more rarely. Nine cases of this association were reported in literature and tracheal bronchus-lung cancer association whose pathological result is undifferentiated large-cell carcinoma has not been stated so far. We present a 75 years old male patient as possibly the first case having tracheal bronchus and large-cell carcinoma association in literature.


Citations (12)


... 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]. ...

Reference:

MRI Apparent Diffusion Coefficient (ADC) as a Biomarker of Tumour Response: Imaging-Pathology Correlation in Patients with Hepatic Metastases from Colorectal Cancer (EORTC 1423)
Intravoxel Incoherent Motion of Colon Cancer Liver Metastases for the Response Assessment of Antiangiogenic Treatment: Results from a pilot study

Medical Principles and Practice

... As shown in our previous study [46], the ADC and D values of HCC were obviously elevated four weeks after TACE treatment, the D* value was significantly reduced, and the f value did not change significantly. Hectors et al [53] investigated the effect of yttrium 90 radioembolization on diffusion and perfusion in HCC. The authors performed multiparametric MRI including IVIM-DWI on 24 patients with HCC before (n = 24) and six weeks (n = 21) after radioembolization. ...

Intravoxel Incoherent Motion Parameters for Assessing the Efficiency of Locoregional Bridging Treatments before Liver Transplantation
  • Citing Article
  • August 2019

Transplantation Proceedings

... bile leaks, biliary strictures, cholangitis, biloma, cholangitic abscesses, bile duct stones/ casts, ischemic biliary injury, hemobilia, sphincter of Oddi dysfunction (SOD), etc) remain a significant catastrophe after adult to adult right lobe LDLT (A-ARLLDLT) leading to post-transplant morbidities, dysfunctions and mortalities. [1,2]; they may reach up to 60% of recipients [3][4][5][6][7][8][9][10][11]. ...

Novel Application of Internal-External Drainage Catheter as Biliary Stent for Percutaneous Transhepatic Treatment of Biliary Strictures in Living Donor Liver Transplantation Recipient Patients
  • Citing Article
  • August 2019

Transplantation Proceedings

... We noninvasively reviewed indices for NAFLD assessment, including six indices [fatty liver index (FLI), hepatic steatosis index (HSI), SteatoTest, lipid accumulation product (LAP), Index of Nash (ION), NAFLD-Liver Fat Score (LFS)] for liver steatosis and eight indices [AST to platelet ratio index (APRI), Fibrosis-4 (FIB-4), FibroTest, Fibrometer NAFLD, Enhanced Liver Fibrosis (ELF), Hepacore, BARD score, NAFLD fibrosis score (NFS)] for liver fibrosis (21,22). The FLI, HIS, and NFS were selected for this study because these indices can be calculated with only simple laboratory findings, body weight, and circumference using retrospective data. ...

The Utility of Noninvasive Scoring Systems for Prediction of Hepatic Steatosis in Liver Transplantation Donor Candidates
  • Citing Article
  • August 2019

Transplantation Proceedings

... Hepatic steatosis is associated with poor liver graft function and recipient outcome. Although liver biopsy is the gold standard for the estimation of steatosis, it is an invasive procedure and is associated with various complications [16]. So, non-invasive methods like BMI and LAI have been used for the assessment. ...

Body Mass Index and Unenhanced CT as a Predictor of Hepatic Steatosis in Potential Liver Donors
  • Citing Article
  • August 2019

Transplantation Proceedings

... Capsular interruption and irregular tumor margins could indicate microvascular invasion, a prognostic factor for posttransplant recurrence and metastases. 31 In contrast, volumetric analysis, including tumor volume and venous enhancement volume, was associated with progression in univariate analysis but not in multivariable analysis. This finding contradicts our previous studies that associated volumetric venous enhancement with HCC histology and patients' overall survival in both HCC and intrahepatic cholangiocarcinoma. ...

Value of Imaging Findings in the Prediction of Microvascular Invasion in Hepatocellular Carcinoma
  • Citing Article
  • August 2019

Transplantation Proceedings

... In recent years, IVIM imaging technology has been widely studied in the differential diagnosis of liver tumors, alternative pathological grading and degree of cirrhosis (22,23). IVIM imaging is a non-invasive functional imaging method to evaluate tumor angiogenic perfusion and diffusion of water molecules in tumors. ...

Value of Intravoxel Incoherent Motion for Hepatocellular Carcinoma Grading
  • Citing Article
  • July 2019

Transplantation Proceedings

... This finding highlights that the difference is linked to sex instead of simply reflecting anatomical differences between men and women. This finding aligns with previous studies that also reported larger spleen sizes in men compared to women (Hosey et al., 2006;Ehimwenma and Tagbo, 2011;Badran et al., 2015;Chow et al., 2016;Albayrak and Server, 2019). However, other studies have found no significant differences between sexes (Prassopoulos et al., 1997). ...

The relationship of spleen stiffness value measured by shear wave elastography with age, gender, and spleen size in healthy volunteers
  • Citing Article
  • January 2019

Journal of Medical Ultrasonics

... In line with our finding, a study found that ADC revealed 80% sensitivity and 72.7% specificity with a cutoff value of 1.00 × 10−3 mm2/s. 13 Also, another ROC curve in the Study revealed the cutoff value of ADC (⩽1) discriminated malignant from benign PVT with 100% sensitivity and 82.5% specificity. 14 Nevertheless, there is a study that stated an ADC value that discriminates among benign and malignant PVTs with a sensitivity of 22.2% due to the large range and significant overlap of ADC. ...

Diagnostic performances of intravoxel incoherent motion and conventional diffusion-weighted imaging in the differential diagnosis of benign and malignant portal vein thrombus

Abdominal Radiology

... Изследван е рискът от ПР дали може да бъде измерван като се използва стойността на съотношението на плацентарното преразтягане (SR), измерена през втория триместър, използвайки соноеластография в реално време [44]. При 70 бременни жени във втория триместър са използвани две различни тъкани като референти. ...

Is evaluation of placenta with real time sonoelastography during the second trimester of pregnancy an effective method for the assessment of spontaneous preterm birth risk?
  • Citing Article
  • April 2016

Clinical Imaging