Publications by authors named "Cesur Samanci"

50 Publications

Use of volumetric CT scanning to predict tumor staging and survival in pancreatic cancer patients that are to be administered curative resection.

J Surg Oncol 2021 Mar 8. Epub 2021 Mar 8.

Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Background: This study evaluates the achievability of CT volumetry of pancreatic cancer and its correlation with pTNM stage and survival.

Methods: Tumor volume was measured from contrast enhanced CT images of 58 patients who undergo curative resection for pancreatic cancer using the Segment Editor module implemented in 3D-Slicer-a free open source software platform. Receiver operating characteristic (ROC) analysis was used to evaluate correlation between Tvol and pTNM staging.

Results: The preoperative images of 58 pancreatic adenocarcinoma patients were included. The mean Tvol of pancreatic cancer is an increasing trend with T stage (The mean T1vol = 1.75 cm , the mean T2vol = 11.43 cm , the mean T3vol = 14.98 cm , the mean T4vol = 19.6 cm ). There were statistical differences between volumes (p = .000). On ROC analysis, the area under the ROC curve (Az) of Tvol to differentiate T1 stage from ≥T2 stage was 0.966 (p = .000). At a cut-off value of 3.050 cm , sensitivity of 92.3%, and specificity of 83.3% were achieved. Az value of Tvol to differentiate ≤T2 from ≥T3 stage was 0.750 (p = .010). At a cut-off value of 10.250 cm , sensitivity of 72.7% and specificity of 66% were achieved. In addition Az value of Tvol to differentiate ≤T3 from ≥T4 stage was 0.652 and was not significant (p = .380). At a cut-off value of 11.2 cm , sensitivity of 66.7% and specificity of 63.6% were achieved.

Conclusion: CT volumetry in pancreatic cancer is feasible with excellent reproducibility. It is one of the prognostic factors affecting survival in operated patients with pancreatic cancer.
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http://dx.doi.org/10.1002/jso.26455DOI Listing
March 2021

The Diagnostic Value of Superb Microvascular Imaging in Prediction of Uterine Artery Embolization Treatment Response in Uterine Leiomyomas.

J Ultrasound Med 2021 Feb 18. Epub 2021 Feb 18.

Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey.

Objectives: We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound.

Methods: The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0-2 (hypovascular group) was compared to the hypervascular Grade 3 group.

Results: Twenty-eight women (mean age, 40.9 years; range, 33-53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements.

Conclusions: SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.
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http://dx.doi.org/10.1002/jum.15647DOI Listing
February 2021

CT visual quantitative evaluation of hypertensive patients with coronavirus disease (COVID-19): Potential influence of angiotensin converting enzyme inhibitors / angiotensin receptor blockers on severity of lung involvement.

Clin Exp Hypertens 2021 May 13;43(4):341-348. Epub 2021 Feb 13.

Department of Radiology, MD Radiology Assistant Professor Trakya University Medical Faculty, Turkey.

Objective: There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications.

Methods: : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups.

Results: In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) ( < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) ( < .001). Excellent agreement was established between the two blinded observers in the TSS measurements.

Conclusions: Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.
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http://dx.doi.org/10.1080/10641963.2021.1883051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885720PMC
May 2021

Does measurement of the jugular foramen diameter on MRI help to differentiate transverse sinus thrombosis from unilateral transverse sinus hypoplasia?

Radiol Med 2021 Mar 28;126(3):430-436. Epub 2020 Aug 28.

Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey.

Background And Purpose: The transverse sinus (TS) is a frequent location of cerebral venous thrombosis. However, unilateral TS hypoplasia is a frequent variation and radiological imaging pitfall in the diagnosis because it may mimic unilateral TS thrombosis. The purpose of this study is to find a cutoff value for bilateral jugular foramen (JF) diameter ratios on magnetic resonance imaging (MRI) for differentiating TS thrombosis from TS hypoplasia.

Materials And Methods: We retrospectively reviewed magnetic resonance venography results for 174 patients with reduced unilateral TS caliber resulting from either unilateral thrombosis (80 patients) or unilateral hypoplasia (94 patients). We calculated the ratio by proportioning the diameter of the JF ipsilateral to the TS with caliber reduction to the diameter of the contralateral JF. The Mann-Whitney U test was used to compare the ratios between thrombosis and hypoplasia groups, and the cutoff value was calculated by receiver-operating characteristic curve analysis.

Results: The ratio of bilateral JF diameters was lower in patients with hypoplasia than those with thrombosis (P < .01). The cutoff value to determine the diagnosis of TS hypoplasia with maximum accuracy was 0.638, with a sensitivity of 91.3% and specificity of 64.9%.

Conclusion: In equivocal cases, calculating the cutoff value by proportioning the diameter of JF ipsilateral to the TS with caliber reduction to the contralateral JF seems to be an efficient, quick, and straightforward method and valuable aid to differentiate TS thrombosis from TS hypoplasia.
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http://dx.doi.org/10.1007/s11547-020-01265-0DOI Listing
March 2021

The Relationship between Ocular Vascular Changes and the Levels of Malondialdehyde and Vascular Endothelial Growth Factor in Patients with Inflammatory Bowel Disease.

Ocul Immunol Inflamm 2020 Apr 7:1-5. Epub 2020 Apr 7.

Department of Gastroenterology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

: We evaluated ocular hemodynamic changes, malondialdehyde(MDA) and vascular endothelial growth factor (VEGF) levels in patients with IBD.: We used ocular color Doppler ultrasonography to analyze 56 eyes with Crohn's disease (CD), 62 eyes with ulcerative colitis (UC), 68 eyes of healthy volunteers. We measured peak systolic velocity (PSV),end-diastolic velocity (EDV),and the resistivity index (RI) of ophthalmic artery (OA) and central retinal artery (CRA). MDA and VEGF levels were measured in the plasma samples.: MDA levels were significantly higher in both UC and CD patients, whereas VEGF levels were only higher in the CD group ( = .003, < .001, = .01).The PSV and EDV of the OA were significantly lower in CD patients ( = .017, = .001). The EDV of the CRA was significantly lower in CD patients than UC patients and controls ( = .014, < .001).: CD patients exhibited decreased blood flow in both the OA and CRA. Ocular vascular flow was only affected in CD patients. We found that ocular ischemia may occur in CD patients even in the absence of any clinical finding.
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http://dx.doi.org/10.1080/09273948.2020.1740281DOI Listing
April 2020

Shearwave elastographic evaluation of uterine leiomyomas after uterine artery embolization: preliminary results

Turk J Med Sci 2020 04 9;50(2):426-432. Epub 2020 Apr 9.

Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey

Background/aim: We aimed to investigate the role of Shearwave Elastography (SWE) in the evaluation of response to uterine artery embolization (UAE) in patients with uterine leiomyomas.

Materials And Methods: SWE images of the dominant uterin leiomyomas were obtained before and 1.5 months after performing UAE in 33 women suffering from symptoms due to leiomyomas (menometrorrhagia, bulk related symptoms, pelvic pain). Leiomyomas were also evaluated by 2 observers for location and longest diameter in axial plane. Interobserver agreement in the quantitative SWE analysis was calculated using intraclass correlation coefficients.

Results: Thirty-three women (mean age, 39.7 years; range, 31–48 years) were examined with SWE 1.5 months after UAE. After treatment, 3 patients (9.1%) had fever, 1 patient had nausea and 29 patients (87.9%) had no complications. The post UAE stiffness measurements of leiomyomas (mean SWE ± SD = 13.34 ± 3.9kPa) were significantly lower than the pre UAE measurements (mean SWE ± SD = 17.16 ± 4.8kPa) (P < 0.001). There was excellent agreement between the 2 blinded observers in SWE measurements.

Conclusion: SWE values of leiomyomas after UAE significantly decreased. SWE, with its high reproducibility, could become a useful tool in the follow up of uterin leiomyomas after UAE.
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http://dx.doi.org/10.3906/sag-1908-171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164750PMC
April 2020

The Role of Diffusion-weighted Imaging in Patients with Gastric Wall Thickening.

Curr Med Imaging Rev 2019;15(10):965-971

Department of Radiology, Sultan Abdulhamid Han Training and Research Hospital, Haydarpasa, Istanbul, Turkey.

Background: Gastric cancer is the second leading cause of cancer death worldwide.

Aims: In the benign and malign gastric pathologies, we measured the Apparent Diffusion Coefficient (ADC) value from the thickened section of the stomach wall. We assessed the diagnostic value of ADC and we wanted to see whether this value could be used to diagnose gastric pathologies.

Study Design: This study has a prospective study design.

Methods: A total of 90 patients, 27 with malign gastric pathologies 63 with benign gastric pathologies with Gastric Wall (GW) thickening in multidector CT, were evaluated by T2 weighted axial MR imaging and Diffusion-Weighted Imaging (DWI). Measurements were made both from the thickened wall and from the normal GW. Also, a new method called GW/spine ADC ratio was performed in image analysis. The value found after ADC measurement from the GW was proportioned to the spinal cord ADC value in the same section.

Results: The ADC values measured from the pathological wall in patients with gastric malignancy (1.115 ± 0.156 x10-3 mm2/s) were significantly lower than the healthy wall measurements (1.621 ± 0.292 × 10-3 mm2/s) and benign gastric diseases (1.790± 0.359 x10-3 mm2/s). GW/spine ADC ratio was also lower in gastric malignancy group.

Conclusion: ADC measurement in DWI can be used to distinguish between benign and malign gastric pathologies.
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http://dx.doi.org/10.2174/1573405614666181115120109DOI Listing
October 2020

Diagnostic Capabilities of MRI Versus 18F FDG PET-CT in Postoperative Patients with Thyroglobulin Positive, 131I-negative Local Recurrent or Metastatic Thyroid Cancer.

Curr Med Imaging Rev 2019;15(10):956-964

Department of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Background: The detection of recurrence or metastasis might be challenging in patients, who underwent total thyroidectomy and radioactive iodine therapy for Differentiated Thyroid Carcinoma (DTC), with increased serum Thyroglobulin (Tg) levels and negative 131I whole body scan (131I-WBS) results.

Aims: The purpose of this study was to compare the ability of Magnetic Resonance Imaging (MRI) and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET-CT) to detect recurrence or cervical and upper mediastinal metastases in postoperative DTC patients who had negative 131I-WBS despite elevated serum Tg levels.

Study Design: This study has a retrospective study design.

Methods: We evaluated cervical and upper mediastinal MRI and 18F FDG PET-CT of 32 postoperative patients with DTC (26 patients with papillary thyroid carcinoma and 6 patients with follicular thyroid carcinoma).

Results: We evaluated 44 lesions in 32 patients. For all lesions, the Positive Predictive Value, (PPV) Negative Predictive Value (NPV), sensitivity, specificity, and accuracy of MRI were 81.4%, 76.4%, 84.6%, 72.2%, and 79.5% respectively. The PPV, NPV, sensitivity, specificity, and accuracy of 18F FDG PET-CT were 100.0%, 85.7%, 88.4%, 100.0%, and 93.1%, respectively.

Conclusion: Although we could not replace 18F FDG PET-CT, MRI might be used as an adjunct to 18F FDG PET-CT for the evaluation of recurrent or cervical and upper mediastinal metastatic thyroid cancers; however, MRI is inadequate for the detection of metastases in small lymph nodes.
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http://dx.doi.org/10.2174/1573405614666180718124739DOI Listing
October 2020

Videofluoroscopic and Manometric Evaluation of Oropharyngeal and Esophageal Motility Disorders.

Curr Med Imaging Rev 2020 ;16(1):65-69

Department of Radiology, Medical Faculty, Istanbul University Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.

Background: Esophageal motility studies are performed in patients who have dysphagia that is not explained by stenosis. Diagnosis can be challenging and requires expertise in the interpretation of tests and symptoms.

Aims: Our aim is to investigate the diagnostic value of videofluoroscopic swallowing study (VFSS) in combination with esophageal manometry.

Study Design: This study has a prospective study design.

Methods: 73 patients with dysphagia underwent videofluoroscopy in a standing position. Each subject swallowed barium boluses and findings were correlated with manometry findings.

Results: The study cohort was categorized into five groups according to their disease as achalasia (31.1%), presbyesophagus (4.1%), scleroderma (5.5%), neurogenic dysphagia (6.8%), and other diseases (54.4%), which included gastroesophageal reflux, diffuse esophageal spasm, cricopharyngeal achalasia, and diseases with nonspecific VFSS patterns. When evaluating VFSS, the perfect agreement was observed between two observers in the final diagnosis. (kappa: 0.91, p<0,001).

Conclusion: Although it does not replace manometry, VFSS is important as an additional useful imaging method in EMDs.
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http://dx.doi.org/10.2174/157340561501190611154916DOI Listing
November 2020

Double-Lumen Balloons, Are They Only Useful in Neurointerventions? Preliminary Outcomes of Double-Lumen Balloon-Assisted Embolization of Visceral Artery Aneurysms.

Vasc Endovascular Surg 2020 Apr 27;54(3):214-219. Epub 2019 Dec 27.

Fatih Sultan Mehmet Training and Research Hospital Radiology Department, Istanbul, Turkey.

Objectives: This study aimed to assess the feasibility and results of double-lumen balloon-assisted embolization of visceral artery aneurysms (VAAs).

Methods: Nine patients (mean age, 55.3 ± 10.8 years) diagnosed with VAA (superior mesenteric, n = 5; splenic, n = 2; renal, n = 2) and undergoing double-lumen balloon-assisted embolization were included in this study. Magnetic resonance angiogram (MRA) was used in the 6-month follow-up to assess the aneurysms and patency of the parent arteries.

Results: All patients were successfully treated with no reports of morbidity or mortality. Residual filling of the aneurysm neck was detected in 2 patients at the end of the procedure, but those parts were found to be stable in the sixth-month MRA. In 1 patient with renal aneurysm, a stent had to be deployed using a double-lumen balloon catheter because of the prolapse of the coil into the main artery. In another patient with a very large-necked superior mesenteric artery aneurysm, additional coils could be used at the same time thanks to the double-lumen balloon as the coils were not stabilized enough during embolization with the microcatheter coils. Liquid embolic agent was also used in this patient from the same lumen because of the large diameter of the aneurysm.

Conclusions: Double-lumen balloons, which are mostly used in neurointerventional procedures, can be efficiently used as in the treatment of VAAs due to their ability to deploy stent and perform coil-liquid embolization through 1 lumen.
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http://dx.doi.org/10.1177/1538574419896516DOI Listing
April 2020

Is there any relationship between carotid bifurcation geometry and hemodynamic depression after carotid stenting and angioplasty?

Int Angiol 2020 Feb 5;39(1):17-23. Epub 2019 Dec 5.

Department of Radiology, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Istanbul, Turkey.

Background: Hemodynamic depression (HD) is a condition that can be encountered after carotid stenting (CAS) and carotid angioplasty (CAP) due to manipulation of the carotid sinus. The aim of this study was to evaluate whether the carotid bifurcation geometry and angles, or changes in angles, were associated with this HD in patients undergoing CAS and CAP.

Methods: Sixty-two patients with a mean age of 71.1±7.4 years, who underwent CAS and CAP for carotid stenosis were included in the study. HD was defined as periprocedural hypotension (systolic blood pressure <90 mmHg) or bradycardia (heart rate <60 bpm). The effect of carotid bifurcation geometry, plaque morphology and risk factors on subsequent development of HD was analyzed with binary logistic regression models. ICA-CCA angle was measured from digital subtraction angiographies (DSA) before and after stent deployment by two radiologists. Interobserver agreement was calculated.

Results: Periprocedural HD was seen in 22 (35.5%) patients. Extension of carotid lesion to bulbus, preoperative internal carotid artery (ICA) angle, postoperative angular changes, pre-op systolic blood pressure, balloon-to-artery ratio and HD were significantly correlated. A significant difference was observed between the angle of ICA before and after the procedure between the patients with HD and those without HD.

Conclusions: Carotid anatomy and geometry may enhance the risk of HD independent of other factors and may be of help in very early identification of patients at high risk of developing HD after CAS and CAP.
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http://dx.doi.org/10.23736/S0392-9590.19.04294-9DOI Listing
February 2020

Comparison of FDG PET/MRI and FDG PET/CT in Pediatric Oncology in Terms of Anatomic Correlation of FDG-positive Lesions.

J Pediatr Hematol Oncol 2019 10;41(7):542-550

Departments of Nuclear Medicine.

The aims of our study were to compare F-18 fluorodeoxyglucose (FDG) positron-emission tomography/magnetic resonance imaging (PET/MRI) and PET/computed tomography (CT) in pediatric oncology patients in terms of anatomic correlation of FDG-positive lesions, and also to compare diffusion-weighted imaging (DWI) with PET to assess the correlation between apparent diffusion coefficient (ADC) values and standardized uptake value (SUV). Sequential PET/CT and PET/MRI images and/or whole-body DWI and ADC mapping in 34 pediatric patients were retrospectively analyzed. FDG-positive lesions were visually scored for CT, T1-weighted, T2-weighted, and DWI images separately in terms of anatomic correlation of FDG-avid lesions. Correlation analysis was performed for SUV parameters and ADC values. Among 47 FDG-positive lesions identified concurrently on PET/CT and PET/MRI, 37 were positive on CT and 46 were positive on at least one MRI sequence (P=0.012). Among 32 FDG-positive lesions for which DWI were available, 31 could be clearly depicted on DWI, resulting in significant difference compared with CT alone in the detection of FDG-positive lesions. No correlation was found between ADC and SUV. FDG PET/MRI exhibits better performance than PET/CT in terms of anatomic correlation of FDG-avid lesions. Therefore, PET/MRI may be more advantageous than PET/CT, not only due to reduced ionizing radiation dose but also for a better depiction of FDG-avid lesions in pediatric PET imaging.
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http://dx.doi.org/10.1097/MPH.0000000000001465DOI Listing
October 2019

Preliminary Results of Stent-Assisted Coiling of Wide-Necked Visceral Artery Aneurysms via Self-Expandable Neurointerventional Stents.

J Vasc Interv Radiol 2019 01 7;30(1):49-53. Epub 2018 Dec 7.

Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih/Istanbul, Turkey.

Purpose: To determine technical feasibility and results of stent-assisted coiling of visceral artery aneurysms (VAAs) with self-expandable LEO PLUS neurointerventional stent.

Materials And Methods: In this retrospective study, 11 consecutive patients (mean age 61.9 y ± 8.9; range, 45-76 y) with VAAs (splenic, n = 3; common hepatic, n = 2; renal, n = 5; celiac, n = 1) treated with neurointerventional stents were included. MR angiography was evaluated for aneurysmal occlusion and patency of the parent arteries.

Results: Technical success was 90.9%. A minor technical complication developed in 1 patient (9%), and thrombosis of the distal part of the stent was seen just after deployment in another patient, but it resolved after tirofiban injection. Complete occlusion was determined in all patients on MR angiography at 6-month follow-up.

Conclusions: Self-expandable LEO PLUS neurointerventional stents could become a useful tool in the treatment of VAAs. Studies with larger groups of patients, including control groups, are needed to assess the true outcome of this treatment method.
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http://dx.doi.org/10.1016/j.jvir.2018.07.027DOI Listing
January 2019

Evaluation of median nerve by shear wave elastography and diffusion tensor imaging in carpal tunnel syndrome.

Eur J Radiol 2018 Apr 9;101:59-64. Epub 2018 Feb 9.

Istanbul University, Cerrahpasa Medical Faculty, Department of Neurology, Turkey.

Purpose: The aim of the current study is to investigate the diagnostic role of shear-wave elastography and diffusion tensor imaging in patients with carpal tunnel syndrome.

Material And Methods: The study included a total of 77 wrists; 18 normal, 35 wrists with mild, 9 wrists with moderate and 15 wrists with severe carpal tunnel syndrome. Elastography of the median nerve was performed by defining the boundaries of a segment of the nerve at sagittal plane at the level of proximal carpal row. Additionally, the cross-sectional area of the median nerve was evaluated. Fractional anisotropy and apparent diffusion coefficient measurements were carried out by placing region-of-interest at three levels: at pisiform bone (carpal tunnel inlet), mid carpal tunnel, and hook of hamate (carpal tunnel outlet).

Results: Patients with carpal tunnel syndrome had higher elasticity values of median nerve (53.0 kPa; IQR 40.8-77.0 kPa) compared to control subjects. (36.8 kPa; IQR 31.0-39.9 kPa) Patients with moderate-severe carpal tunnel syndrome had higher elasticity values (82 kPa; IQR 64.0-95.5 kPa) compared to patients with mild carpal tunnel syndrome. (44 kPa; IQR 32.5-59.5 kPa) Patients with carpal tunnel syndrome had lower fractional anisotropy at mid-carpal level (0.382; IQR 0.330-0.495) compared to the control group. (0.494; IQR 0.434-0.537) Patients with moderate-severe carpal tunnel syndrome had lower fractional anisotropy values (0.366; IQR 0.331-0.407) and higher apparent diffusion coefficient values (1.509 mm/s; IQR 1.374-1.733 mm/s) compared to patients with mild carpal tunnel syndrome. (0,423; IQR 0.324-0.526 and 1.293 mm/s; IQR 0.967-1.514 mm/s) CONCLUSION: Shear-wave elastography and diffusion tensor imaging are helpful imaging modalities in diagnosing carpal tunnel syndrome and assessing its severity.
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http://dx.doi.org/10.1016/j.ejrad.2018.02.005DOI Listing
April 2018

Evaluation of parenchymal thyroid diseases with multiparametric ultrasonography.

Indian J Radiol Imaging 2017 Oct-Dec;27(4):463-469

Department of Radiology, VKV Amerikan Hospital, Istanbul, Turkey.

Aim: Differential diagnosis of parenchymal thyroid diseases by gray-scale ultrasound is quite difficult for a radiologist as the findings are very similar to each other. In this study we aimed to assess some quantitative spectral Doppler parameters, resistivity index (RI), acceleration time (AT), and quantitative elastography [shear wave velocity (SWV)] together to show their reliability for differential diagnosis of parenchymal thyroid diseases.

Materials And Methods: We retrospectively reviewed findings of 227 patients (179 females, 48 males) that underwent spectral Doppler ultrasound and acoustic radiation force impulse between October 2013 and March 2016. Ages of the patients were between 18 and 74 years (39.52 ± 12.67). Based on clinical and laboratory findings, patients were divided into five groups (N: Normal, EH: Early Hashimoto, H: Late Hashimoto, M: Nodular Thyroid Disease, HM: Hashimoto + Nodular Thyroid Disease). Detailed statistical analyses were done on parameters such as age, gender, volume information, and RI, AT (ms), SWV (m/s).

Results: No significant effect of gender or volume on the differentiation of disease pattern (Chi-square test: = 0.306, Kruskal-Wallis test: = 0.290) was found in this study. RI (0.41 ± 0.06) and SWV values (1.19 ± 0.18 m/s) were the lowest. AT values (>55 ms) were the highest in EH group (area under the curve: 0.913). Existence of H decreased RI and SWV values, while it extended AT in a different thyroid disease.

Conclusion: Thyroid parenchymal diseases could be classified and differentiated from each other by measuring RI, AT, and SWV values quantitatively. So, in suspicious cases, these parameters could be a reliable asset for differential diagnosis.
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http://dx.doi.org/10.4103/ijri.IJRI_409_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761175PMC
January 2018

Brachial Artery Wall Stiffness Assessment by Shear Wave Elastography: A Promising New Diagnostic Tool for Endothelial Dysfunction Detection.

J Ultrasound Med 2018 Aug 24;37(8):1977-1983. Epub 2018 Jan 24.

Department of Radiology, Yedikule Surp Pırgiç Armenian Hospital, Istanbul, Turkey.

Objectives: This study was designed to measure the changes in brachial artery wall stiffness by shear wave elastography (SWE) and evaluate the accuracy of SWE changes for detection of endothelial dysfunction.

Methods: Sixty-five consecutive participants (19 patients with atherosclerosis proven by coronary angiography, 16 healthy young adults, 15 patients with cardiovascular risk factors, and 15 healthy older adults between 50 and 60 years) were prospectively included in this study. They were examined in the same week by SWE, and flow-mediated dilatation was evaluated for each patient.

Results: The mean flow-mediated dilatation values ± 2 SDs after forearm occlusion were 8.54% ± 1.4% in healthy young adults, 7.61% ± 1.4% in healthy older adults, 5.83% ± 0.7% in patients with risk factors (P < .001), and 3.81% ± 2.4% in patients with atherosclerosis (P < .001, with respect to the risk factor group). There was a significant decrease in stiffness measurements in parallel with the increase in flow-mediated dilatation: 19.9% ± 6.3% in healthy young adults, 16.3% ± 5.1% in healthy older adults, 9.8% ± 5.4% in patients with risk factors (P < .05 with respect to the group with no risk factors), and 7.8% ± 6.4% in patients with atherosclerosis (P < .001 with respect to the healthy older adults).

Conclusions: Shear wave elastography in combination with flow-mediated dilatation could be a promising, widely available noninvasive diagnostic tool for detecting endothelial dysfunction.
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http://dx.doi.org/10.1002/jum.14548DOI Listing
August 2018

Apparent Diffusion Coefficient Measurement in Mediastinal Lymphadenopathies: Differentiation between Benign and Malignant Lesions.

J Clin Imaging Sci 2017 6;7:12. Epub 2017 Mar 6.

Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, K.M. Pasa, Istanbul, Turkey.

Objectives: We aimed to prospectively assess the diagnostic value of apparent diffusion coefficient (ADC) measurement in the differentiation of benign and malignant mediastinal lymphadenopathies.

Materials And Methods: The study included 63 consecutive patients (28 women, 35 men; mean age 59.3 years) with 125 mediastinal lymphadenopathies. Echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum was performed with b-factors of 0 and 600 mm/s before mediastinoscopy and mediastinotomy, and ADC values were measured. The ADC values were compared with the histological results, and statistical analysis was done. < 0.05 was considered statistically significant.

Results: The mean ADC value of malignant mediastinal lymphadenopathy (1.030 ± 0.245 × 10 mm/s) was significantly lower ( < 0.05) when compared to benign lymphadenopathies (1.571 ± 0.559 × 10 mm/s). For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.334 × 10 mm/s was used as a threshold value; area under the curve 0.848, accuracy 78.4%, sensitivity 66%, specificity of 86%, positive predictive value 76.7%, and negative predictive value of 79.2%. Interobserver agreement was excellent for ADC measurements.

Conclusions: ADC measurements could be considered an important supportive method in differentiating benign from malignant mediastinal lymphadenopathies.
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http://dx.doi.org/10.4103/jcis.JCIS_84_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360005PMC
March 2017

Elastography in Distinguishing Benign from Malignant Thyroid Nodules.

J Clin Imaging Sci 2016 29;6:51. Epub 2016 Dec 29.

Department of Radiology, Florence Nightingale Hospital, Istanbul, Turkey.

Aim: The aim of this study is to test the diagnostic success of strain elastography in distinguishing benign from malignant thyroid nodules.

Materials And Methods: The size, echogenicity, and halo integrity of 293 thyroid nodules and the presence of microcalcification in these nodules were evaluated on gray-scale examination. Doppler characteristics and elastography patterns were also evaluated and recorded. Nodules were classified in four categories (patterns 1-4) based on elastographic examination.

Results: According to the cytopathological findings, 222 nodules were benign, and 71 nodules were malignant. The risk of a nodule to be malignant was 3.8 times increased by hypoechogenicity, 7.7 times increased by the presence of microcalcification, and 11.5 times increased by the absence of halo. On Doppler patterns, the presence of central vascularity increased the malignancy risk of a nodule by 5.8 times. According to the receiver operating characteristic analysis, patterns 3 and 4 were malignant, and patterns 1 and 2 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of elastography were 100%, 80.2%, 61.7%, 100%, and 85%, respectively.

Conclusion: Strain elastography can be used as a noninvasive method in distinguishing benign from malignant thyroid nodules and in identifying the patients who would undergo surgery.
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http://dx.doi.org/10.4103/2156-7514.197074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209857PMC
December 2016

A preliminary study of shear wave elastography for the evaluation of unilateral palpable undescended testes.

Eur J Radiol 2017 Jan 24;86:248-251. Epub 2016 Nov 24.

Istanbul University, Cerrahpasa Faculty of Medicine, Department of Radiology, KMPasa, Istanbul, 34098, Turkey. Electronic address:

Objectives: We sought to compare unilateral palpable undescended testes and contralateral descended testes using shear wave elastography (SWE) to show potential quantitative differences in elasticity patterns, which might reflect the histologic features.

Methods: Approval for this prospective study was obtained from the local ethics committee. A total of 29 patients (mean age, 7.52 years; range, 1-18 years) with unilateral palpable undescended testes and contralateral descended testes were examined by greyscale ultrasonography and SWE between February 2015 and April 2016. The volume and the elasticity of each testicle were the main factors evaluated.

Results: There was no difference between undescended testes and contralateral descended testes in terms of volume. However, a significant difference was evident in SWE-derived quantitative data.

Conclusions: SWE seems to be a useful sonographic technique to predict histologic features of the undescended testicle, which might replace testicular biopsy in modern management of the undescended testis.
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http://dx.doi.org/10.1016/j.ejrad.2016.11.026DOI Listing
January 2017

Penile masses: Shear Wave Elastography correlated with Magnetic Resonance Imagining. A two cases report.

Med Ultrason 2016 Dec;18(4):515-517

Istanbul University, Cerrahpasa Medical Faculty, Istanbul University, Department of Radiology, Istanbul, Turkey.

Definitive diagnosis of penile masses usually depends on clinical symptoms and patient history but in some challenging cases the help of radiologic diagnostic tools is required. Although ultrasound is an effective tool for detecting penile masses, unlike magnetic resonance imagining, it is not able to differentiate benign and malignant pathologies. Shear wave elastography (SWE) is a novel method, which has the ability to differentiate malignant and benign tissues by giving quantitative information about tissue elasticity. In this paper we present two cases with penile masses to demonstrate the potential use of SWE in the differential diagnosis of penile masses.
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http://dx.doi.org/10.11152/mu-881DOI Listing
December 2016

A dilemma at gray scale thyroid ultrasound: microcalcification or not? Differentiation with Acoustic Radiation Force Impulse Imaging-Virtual Touch Imaging.

Med Ultrason 2016 Dec;18(4):452-456

Esitopatoloji Laboratories Department of Pathology, Istanbul, Turkey.

Aims: To evaluate the capacity of virtual touch imaging (VTI) of the acoustic radiation force impulse (ARFI) techniquein the differential diagnosis of micro-echogenicities in thyroid nodules.

Material And Methods: The study comprised 28patients. Gray scale and ARFI displacement maps were used during ultrasound examination.In the same session, fine needleaspiration biopsy (FNAB) samples were obtained from the dominant nodule hav-ing micro-echogenicities. Two radiologists blinded to the FNAB results and clinical data of the patients evaluated these images and rated ARFI echogenicities according to the degree of shining points on the displacement maps and classified them as isohypoechogenic, isohyperechogenic, and obvious hyperechogenic. To differentiate between benignancy and malignancy, "a new sign" was defined as follows: in the ARFI maps obtained by VTI, iso-echogenic or hyper-echogenic appearance of micro-echogenic foci was evaluated as benignancy and hypo-echogenic appearance of micro-echogenic foci was evaluated as malignancy.

Results: The FNAB results indicated 14 cases and benign nodules in the other 14 cases. Interobserver agreement between the two radiologists was highly significant for the classification of the micro-echogenic foci (Kappa=0.659, p<0.001). When we reclassified the hyperechoic and isohyperechoic foci as "benign" and isohypoechoic foci as "malignant", the interobserver agreement between the two radiologists increased (Kappa=0.772, p<0.001). The evaluation of the first and second radiologists were highly concordant with the gold standard pathology results (Kappa=0.786, p<0.001 and Kappa=0.714, p<0.001, respectively).

Conclusions: ARFI method with specific VTI features could be a very useful tool in the differentiation of malignant microcalcifications in thyroid nodules.
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http://dx.doi.org/10.11152/mu-872DOI Listing
December 2016

Evaluation of anterior mediastinal solid tumors by CT perfusion: a preliminary study.

Diagn Interv Radiol 2017 Jan-Feb;23(1):10-14

Department of Radiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

Purpose: We aimed to assess the role of computed tomography (CT) perfusion in differentiation of thymoma from thymic hyperplasia, lymphoma, thymic carcinoma, and lung cancer invading anterior mediastinum.

Methods: In this study, 25 patients with an anterior mediastinal lesion underwent CT perfusion imaging from January 2015 to February 2016. Diagnoses included thymoma (n=7), thymic hyperplasia (n=8), lymphoma (n=4), thymic carcinoma (n=3), and invasive lung cancer (n=3). Lymphoma, thymic carcinoma, and lung cancer were grouped as malignant tumors for statistical analysis. Values for blood flow, blood volume, and permeability surface were measured in CT perfusion.

Results: Blood flow and blood volume values were higher in thymoma in comparison to thymic hyperplasia; however, the difference was not statistically significant. Blood volume values were significantly higher in thymoma (mean, 11.4 mL/100 mL; range, 5.2-20.2 mL/100 mL) compared with lymphoma (mean, 5.3 mL/100 mL; range, 2.5-7.2 mL/100 mL) (P = 0.023). Blood flow and blood volume values were significantly higher in thymoma compared with non-thymoma malignant tumors (P = 0.025).

Conclusion: CT perfusion is helpful in differentiating thymoma from non-thymoma malignancies including lymphoma, thymic carcinoma, and invasive lung cancer involving the anterior mediastinum.
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http://dx.doi.org/10.5152/dir.2016.16093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214070PMC
May 2017

Is There Any Difference Between Seminomas and Nonseminomatous Germ Cell Tumors on Shear Wave Elastography? A Preliminary Study.

J Ultrasound Med 2016 12 25;35(12):2575-2580. Epub 2016 Oct 25.

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objectives: The purpose of this study was to evaluate the ability of shear wave elastography (SWE) to differentiate seminomas from nonseminomatous germ cell tumors.

Methods: Approval for this retrospective study was obtained from the local Ethics Committee of Istanbul University Cerrahpasa Medical School. Fifteen patients with malignant testicular lesions were examined by grayscale sonography, color or power Doppler sonography, and SWE between February 2011 and October 2015. The size of each lesion, Doppler signal parameters, echogenicity, presence of microlithiasis, unifocality or multifocality, and histopathologic findings were the main factors evaluated.

Results: The mean age of the patients was 33 years (range, 25-55 years). There were no differences between seminomas and nonseminomatous germ cell tumors in terms of Doppler signals, echogenicity, microlithiasis, or focality. Only the homogeneous and heterogeneous echogenicity patterns differed significantly. However, a significant difference was evident in SWE-derived quantitative data.

Conclusions: Seminomas and nonseminomatous germ cell tumors do not differ significantly on grayscale or Doppler sonography, except in terms of homogeneity. However, SWE seems to differentiate seminomas from nonseminomatous germ cell tumors.
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http://dx.doi.org/10.7863/ultra.15.12067DOI Listing
December 2016

In Vivo Evaluation of the Biomechanical Properties of Optic Nerve and Peripapillary Structures by Ultrasonic Shear Wave Elastography in Glaucoma.

Iran J Radiol 2016 Apr 31;13(2):e36849. Epub 2016 Mar 31.

Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Background: Primary open-angle glaucoma is a multifactorial serious disease characterized by progressive retinal ganglion cell death and loss of visual field.

Objectives: The purposes of this study were to investigate shear wave elastography (SWE) use in the evaluation of the optic nerve (ON) and peripapillary structures, and to compare the findings between glaucomatous and control eyes.

Patients And Methods: A case-controlled study, including 21 patients with primary open-angle glaucoma and 21 age-matched control subjects, was carried out. All of the participants had comprehensive ophthalmological exams that included corneal biomechanical measurements with ocular response analyzer. In vivo evaluation of the biomechanical properties of the ON and peripapillary structures were performed with SWE in all participants. The Kolmogorov-Smirnov test was used to analyze the normal distribution of data. Differences of parameters in ophthalmologic data and stiffness values of patients with and without glaucoma were evaluated using the Mann-Whitney U test.

Results: There were no statistically significant differences between the glaucoma and control groups in terms of age (P > 0.05) and gender (P > 0.05). Corneal hysteresis was lower in the glaucoma group (P < 0.05). Corneal compensated intraocular pressure and Goldmann correlated intraocular pressure were higher in the glaucoma group (P < 0.0001 for both). The mean stiffness of the ON and peripapillary structures were significantly higher in glaucoma patients for each measured region (P < 0.05).

Conclusion: The study evaluated the biomechanical properties of the ON and peripapillary structures in vivo with SWE in glaucoma. We observed stiffer ON and peripapillary tissue in glaucomatous eyes, indicating that SWE claims new perspectives in the evaluation of ON and peripapillary structures in glaucoma disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039735PMC
http://dx.doi.org/10.5812/iranjradiol.36849DOI Listing
April 2016

Laparoscopic Management of a Very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis.

Case Rep Surg 2016 22;2016:1489013. Epub 2016 Aug 22.

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey.

Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method.
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http://dx.doi.org/10.1155/2016/1489013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011207PMC
September 2016

A Very Rare Complication of Acute Appendicitis: Appendicovesical Fistula.

Case Rep Urol 2016 28;2016:4517029. Epub 2016 Apr 28.

Istanbul University Cerrahpasa Medical Faculty Department of Urology, 34098 Istanbul, Turkey.

Appendicovesical fistula (AVF) is an uncommon type of enterovesical fistula and a very rare complication of acute appendicitis. Herein, we report a case of 39-year-old male patient who presented with persistent urinary tract infection, recurrent abdominal pain, and pneumaturia. Imaging techniques including ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) were performed to identify the abnormality. However, definitive diagnosis of AVF was made by cystoscopy.
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http://dx.doi.org/10.1155/2016/4517029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864550PMC
May 2016

Defining the Collateral Flow of Posterior Tibial Artery and Dorsalis Pedis Artery in Ischemic Foot Disease: Is It a Preventing Factor for Ischemia?

Iran J Radiol 2016 Jan 13;13(1):e21819. Epub 2016 Jan 13.

Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Background: Critical limb ischemia, a worldwide prevalent morbidity cause, is mostly secondary to vascular insufficiency due to atherosclerosis. The disease presents with intermittent claudication, which can progress to critical limb ischemia requiring amputation. Research has emphasized that the quality or existence of the pedal arch have a direct effect on wound healing and, therefore, on limb salvage, through the mechanism of collateral vascularization to the ischemic regions.

Objectives: This study aimed to determine the existence and, if present, grade of retrograde blood flow from plantar arch to dorsal foot artery (dorsalis pedis artery, DPA). The correlation between clinical symptoms and presence of collateral flow were also investigated.

Patients And Methods: Study group consisted of 34 cases, which included patient group (n = 17, all male, mean age: 68 years) and control group (n = 17, all male, mean age: 66 years). After physical examination and lower extremity Doppler examination, spectral morphology of DPA flow was recorded, before and during manual compression of posterior tibial artery (PTA), for a period of 5 seconds. At the end, findings of Doppler ultrasound, computed tomography angiography, magnetic resonance angiography and, physical examination finding and symptomatology were gathered and analyzed.

Results: In the patient group, 31 lower limb arteries, of total of 17 cases, were included. After compression maneuver, DPA in 11 cases (six right, five left) showed retrograde filling from plantar arch. This retrograde flow support was triphasic in three cases, biphasic in five cases, and monophasic in three cases. In other DPAs of these 20 limbs, PTA based retrograde collateral flow was not determined. In nine of these 20 limbs, with no or diminished retrograde filling, symptoms were worse than in other cases. Contrarily, only two of 11 limbs, with retrograde collaterals, have claudication during walking.

Conclusion: In cases with critical atherosclerotic disease of anterior tibial artery, PTA-based biphasic or triphasic retrograde collateral flow prevents ischemia, whereas monophasic support or no retrograde flow remains incapable.
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http://dx.doi.org/10.5812/iranjradiol.21819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841861PMC
January 2016

Corkscrew Collateral Vessels in Buerger Disease: Vasa Vasorum or Vasa Nervorum.

J Vasc Interv Radiol 2016 May 21;27(5):735-9. Epub 2016 Mar 21.

Departments of Interventional Radiology, Istanbul University, Cerrahpasa Faculty of Medicine, Fatih, Istanbul 34098, Turkey.

Purpose: To investigate the origin of "corkscrew" collateral vessels around the occluded popliteal artery in patients with Buerger disease by Doppler ultrasound (US) and magnetic resonance (MR) imaging in tandem with digital subtraction angiography (DSA).

Materials And Methods: Between January 2013 and June 2015, 42 patients diagnosed with Buerger disease were identified retrospectively. Patients in whom occlusion of the popliteal artery was found on DSA of the lower extremity were subjected to Doppler US and MR imaging prospectively. Fifteen of 42 patients were identified as having the required characteristics, of whom 10 participated in the present study.

Results: Ten patients with occlusion of the popliteal artery were selected for inclusion, and 12 lower limbs of these patients were investigated. The study cohort comprised one woman and nine men with a mean age of 41 years ± 10 (standard deviation; range, 39-58 y). Corkscrew collateral vessels identified on DSA examinations were also identified on secondary imaging (Doppler US and MR imaging) in all patients except one in whom the popliteal artery was reconstituted after short-segment occlusion. The origin of the corkscrew collateral vessels was identified as the vasa nervorum of the tibial nerve in nine patients.

Conclusions: Data from the present study suggest that corkscrew collateral vessels at the knee level in patients with Buerger disease originate from the vasa nervorum of the tibial nerve rather than the vasa vasorum of the popliteal artery if the latter is occluded.
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http://dx.doi.org/10.1016/j.jvir.2016.01.133DOI Listing
May 2016