Publications by authors named "Fatih Gulsen"

38 Publications

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

A case of proximal partial priapism successfully treated with autologous clot embolisation.

Andrologia 2020 Apr 22;52(3):e13510. Epub 2020 Jan 22.

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

Partial priapism is a rare disorder in literature and generally described as a contusion or thrombosis of the cavernous body of the penis secondary to blunt trauma. Because of the rarity of disease, there is not much information about the treatment. Conservative management with nonsteroidal anti-inflammatory drug is often applied treatment. Here, we presented a proximal partial priapism treated successfully with autologous clot embolisation secondary to pelvic trauma.
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http://dx.doi.org/10.1111/and.13510DOI Listing
April 2020

The effect of shear-wave elastography on functional results and muscle stiffness in patients undergoing non-selective and selective open kinetic chain exercises.

Turk J Phys Med Rehabil 2019 Mar 30;65(1):40-50. Epub 2019 Jan 30.

Department of Radiology, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Turkey.

Objectives: This study aims to assess the effect of shear-wave elastography (SWE) on vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle performances and functional outcomes of patients with patellofemoral pain syndrome (PFPS) undergoing non-selective open kinetic chain exercises (NSOKCE) and selective open kinetic chain exercises (SOKCE).

Patients And Methods: This randomized-controlled clinical trial included a total of 40 patients with PFPS (20 males, 20 females; mean age 46.5±9.8 years, range, 27 to 65 years) and 40 healthy controls (20 males, 20 females; mean age 36.3±11.2 years, range, 23 to 71) between February 2013 and August 2014. The participants in each group were randomized into subgroups according to NSOKCE or SOKCE for six weeks. The VMO and VL muscles were assessed with the SWE, thigh circumferences were measured, and the Visual Analog Scale (VAS) and Lysholm Knee Scale (LKS) scores were obtained.

Results: The OKCE alleviated pain, improved LKS scores, and increased the thigh circumference in PFPS patients. While the healthy controls were able to increase the resting muscle tone of their VMO, the patients with PFPS failed in their both knees. Similarly, resting as well as contracted VMO and VL muscles' functions were improved significantly by both NSOKCE and SOKCE in the healthy controls. The NSOKCE improved the VAS scores in the PFPS group. The increase in the muscle mass of the affected sides of PFPS patients were more evident with NSOKCE.

Conclusion: Our study results show that NSOKCE planning can be preferred over SOKCE, thanks to its contribution to pain improvement and increase in the thigh circumference in the conservative treatment of PFPS.
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http://dx.doi.org/10.5606/tftrd.2019.2534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648173PMC
March 2019

Prognostic value of ADC measurements in predicting overall survival in patients undergoing Y radioembolization for colorectal cancer liver metastases.

Clin Imaging 2019 Sep - Oct;57:124-130. Epub 2019 May 29.

Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey.

Aim: To assess the ability of diffusion-weighted imaging (DWI) in predicting the overall survival in patients who underwent Yttrium 90 radioembolization (Y-RE) for colorectal liver metastases (CLM) with other well-established clinical and imaging parameters by comparing the pre- and post-treatment apparent diffusion coefficient (ADC) values of the lesions.

Methods: A total of 81 metastatic lesions of 27 consecutive patients who underwent DWI before and after the Y-RE session were enrolled in the study. ADC values were calculated from the entire (ADC) and peripheral (ADC) tumor on pre- and post-treatment DWI, and any relative increase in ADC >0% accepted as a functional imaging response. The impact of functional imaging response in addition to other well-known parameters including Response Evaluation Criteria in Solid Tumors (RECIST), hepatic tumor burden, Eastern Cooperative Oncology Group performance status (ECOG-PS) and the presence of extrahepatic metastases in predicting overall survival (OS) was assessed using Kaplan-Meier curves and Cox-regression analyses.

Results: The median OS of the patients was 10 months (range, 6-20 months) while the median OS of the responders being significantly longer than the non-responders for ADC and ADC (median 11 vs 7 months, P = 0.003; median 12 vs. 7 months, P < 0.0001, respectively). The RECIST score was also significantly affected the OS (progressive or stable disease median 8 months vs. partial response 15 indent months, P = 0.019). The other parameters including hepatic tumor burden, gender, ECOG score, the involvement of the liver lobes, and the presence of extrahepatic metastases were not associated with the OS. In multivariate analysis, only ADC remained as an independent predictor of OS (P = 0.003, HR = 19.878).

Conclusion: Any increase in relative ADC or ADC values after Y90-RE treatment was associated with longer OS in CLM patients, and DWI seems to be valuable imaging biomarker in predicting OS in CLM patients during the early post-interventional period after Y-RE.
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http://dx.doi.org/10.1016/j.clinimag.2019.05.015DOI Listing
January 2020

Comparison of PERCIST and RECIST criteria for evaluation of therapy response after yttrium-90 microsphere therapy in patients with hepatocellular carcinoma and those with metastatic colorectal carcinoma.

Nucl Med Commun 2019 May;40(5):461-468

Departments of Nuclear Medicine.

Objective: Yttrium-90 (Y) microsphere therapy has been increasingly used to treat hepatocellular carcinoma (HCC) and liver metastasis of colorectal cancer (mCRC). This study aims to compare two different criterias used for therapy response evaluation following Y therapy within the same group of patients.

Patients And Methods: A total of 21 patients with HCC and 19 patients with mCRC were included in this study, with 36 and 42 liver lesions, respectively. The lesions were evaluated before and after therapy by CT or MRI and fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT. Several metabolic parameters were analyzed including maximum and mean standardized uptake values, peak standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis. Tumor volume was determined using CT or MRI images for all lesions, and the applied activity was estimated to deliver 120±20 Gy for the treated lobe. Six weeks after Y microsphere therapy, F-FDG PET/CT scan was performed to evaluate tumor response using PERCIST and RECIST criteria. Overall survival was calculated using Kaplan-Meier method.

Results: A total of 78 liver lesions were treated without any major complication. The mean tumor volumes of HCC lesions calculated by CT or MRI before and after therapy were 84.38 and 86.62 cm, respectively. The average MTV of these lesions on PET images was calculated as 68.142 mm before therapy and 56.945 mm after treatment. In patients with mCRC, the mean tumor volume was 52.32 cm before therapy and 54.52 cm after therapy. The average MTV was calculated as 41.720 mm before and 44.967 mm after therapy for the same patient group. Response Evaluation Criteria In Solid Tumors (RECIST) and PET Response Criteria In Solid Tumors incompatibility was seen in seven of 36 lesions in HCC-diagnosed patients and seven of 42 lesions in patients with mCRC. The mean overall survival was calculated as 13.09 months in patients with HCC and 10.6 months in patients with mCRC.

Conclusion: Y therapy response can be evaluated by both RECIST and European Organization for Research and Treatment of Cancer criteria. However, RECIST and European Organization for Research and Treatment of Cancer incompatibility can be seen. The anatomic methods for evaluating HCC response is relatively more accurate, whereas the metabolic parameters guided by PET/CT scan showed greater importance in response to evaluation of liver mCRC.
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http://dx.doi.org/10.1097/MNM.0000000000001014DOI Listing
May 2019

Preoperative arterial embolization of endobronchial glomus tumor before endoscopic removal.

Diagn Interv Imaging 2018 Sep 30;99(9):579-580. Epub 2018 Mar 30.

Istanbul University Cerrahpasa Medical Faculty, Department of Pathology, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.diii.2018.03.002DOI Listing
September 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

Central venous catheter insertion into the false lumen of a complicated aortic dissection.

Scott Med J 2017 Aug 20;62(3):115-118. Epub 2017 Jun 20.

1 Associate Professor, Department of Radiology, Cerrahpasa University Faculty of Medicine, Turkey.

Thoracic endovascular repair is considered the first-line treatment in complicated acute type B dissection. Central venous catheters provide valuable vascular access during endovascular treatments. However, central venous catheters are not without complications. Herein, we report a case of central venous catheter insertion into the false lumen of a complicated acute type B aortic dissection by direct aortic puncture. The tip of the central venous catheter was in the false lumen. The central venous catheter was left in place initially and was removed after graft stent deployment. This case illustrates the importance of image guidance during central venous catheter insertion, which may further complicate an already complicated aortic dissection case.
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http://dx.doi.org/10.1177/0036933017715962DOI Listing
August 2017

Bronchial artery enlargement may be the cause of recurrent haemoptysis in Behçet's syndrome patients with pulmonary artery involvement during follow-up.

Clin Exp Rheumatol 2016 Sep-Oct;34(6 Suppl 102):92-96. Epub 2016 Oct 11.

Department of Internal Medicine, Division of Rheumatology, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.

Objectives: Haemoptysis occurring in a Behçet's syndrome (BS) patient with pulmonary artery involvement (PAI) during follow-up is usually regarded as PAI relapse. However, bronchial artery enlargement (BAE) may be the source of haemoptysis in some patients.

Methods: A chart review at the end of December 2014 revealed 118 patients with PAI in our centre since 1979. Nine (all men) had recurrent haemoptysis during follow-up which could not be explained with relapse of PAI.

Results: Haemoptysis recurred a median of 1.5 years (IQR: 9 months-5 years) during follow-up. Thorax CT scans did not show relapse of PAI or emergence of BAE. The patients were treated empirically but continued to complain of occasional haemoptysis thereafter. BAE was detected in 8 patients after a median follow-up of 9 years (IQR: 5-12 years). Six patients underwent bronchial artery embolisation that was repeated in 3. One patient with severe pulmonary hypertension died 3 weeks later. The remaining 5 are under follow-up for between 5 months-9 years. Pulmonary infarction and mild hemiparesis occurred in 2 patients after embolisation. One patient died with haemoptysis before undergoing embolisation. Another one with small BAE is under follow-up for 8 years without embolisation. The source of bleeding could not be determined in 1 patient who is now haemoptysis free for 5 years.

Conclusions: BAE may be the source of recurring and fatal haemoptysis in BS patients with PAI during follow-up. Embolisation appears to be a life-saving procedure.
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February 2017

Endovascular treatment of inadvertent left internal mammarian artery to great cardiac vein fistula.

Hellenic J Cardiol 2016 Mar-Apr;57(2):138-40. Epub 2016 Apr 21.

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

Inadvertent left internal mammarian artery to coronary sinus anastomosis is a rare complication of coronary artery by-pass graft surgery. Management of this iatrogenic complication is controversial with conservative, surgical and endovascular options possible. Endovascular treatment offers a minimally invasive approach with a wide variety of embolic agents with different success rates. Herein we present a case of an iatrogenic left internal mammarian artery to coronary sinus anastomosis treated by detachable coil embolization. Use of detachable coil offers more precise deployment that is essential in the treatment of an iatrogenic left internal mammarian artery to coronary sinus anastomosis which can present challenges due to high flow rates and coil migration.
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http://dx.doi.org/10.1016/j.hjc.2016.03.008DOI Listing
June 2017

Vasa Nervorum Feeders of Vascular Malformation.

J Vasc Interv Radiol 2016 Jul;27(7):1046

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

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http://dx.doi.org/10.1016/j.jvir.2016.03.041DOI Listing
July 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

Ultrasound-Guided Percutaneous Nephrostomy Performed on Neonates and Infants Using a "14-4" (Trocar and Cannula) Technique.

Cardiovasc Intervent Radiol 2015 Dec 6;38(6):1617-20. Epub 2015 Jun 6.

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

Purpose: Percutaneous nephrostomy (PCN) catheters are placed under combined ultrasound and fluoroscopic guidance in the interventional radiology suite and present unique challenges in neonates and infants. The purpose of this study was to demonstrate feasibility of PCN using a "14-4" (trocar and cannula) technique on neonates and infants.

Materials And Methods: Between September 2009 and June 2014, data for 27 kidneys from consecutive 22 neonates or infants who underwent PCN catheter placement using the "14-4" technique were retrospectively analyzed. The median age at the time of placement of the PCN catheters was 11 days (range 5-300 days). There were 18 males and 4 females. All procedures were performed in the interventional radiology suite but without using fluoroscopy.

Results: Unilateral PCN was performed on 17 out of 22 patients, while bilateral drainage was performed on five patients. The technical success rate was 100%. The median duration of PCN catheter was 75 days (range 10-138 days). Minor macroscopic hematuria not requiring blood transfusion was present in two of the patients in which the hematuria lasted in 2 days.

Conclusion: Placement of PCN catheters using a "14-4" technique with ultrasound as the sole imaging modality is a technically feasible and desirable option for neonates or infants. The technique obviates the need for ionizing radiation and potentially could be performed in the ultrasound room or even at the bedside.
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http://dx.doi.org/10.1007/s00270-015-1144-xDOI Listing
December 2015

Effectiveness of extracorporeal shock wave lithotripsy on intrahepatic biliary calculi developing after choledochal cyst surgery: A case report.

Turk J Gastroenterol 2015 May;26(3):274-6

Department of Pediatric Surgery, İstanbul University, Istanbul University Cerrahpaşa Medical Faculty, İstanbul, Turkey.

The development of intra- and extrahepatic bile duct stones has been reported as one of the most serious complications after choledochal cyst excision with biliary-enteric reconstruction through Roux-en-Y hepaticojejunostomy (HJ). Here, we report our experience with extracorporeal shock wave lithotripsy (ESWL) in a case of giant intrahepatic stones developing after choledochal cyst surgery. ESWL is an excellent therapeutic modality for large intrahepatic biliary calculi, and after dilating the HJ anastomosis percutaneously, it can be offered as first-line therapy to these patients.
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http://dx.doi.org/10.5152/tjg.2015.0045DOI Listing
May 2015

Evolution of computed tomography findings in secondary aortoenteric fistula.

Iran J Radiol 2015 Apr 22;12(2):e22759. Epub 2015 Apr 22.

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

Aortoenteric fistula is a rare but significant clinical entity associated with high morbidity and mortality if remain untreated. Clinical presentation and imaging findings may be subtle and prompt diagnosis can be difficult. Herein, we present a patient who initially presented with abdominal pain and computed tomography showed an aortic aneurysm compressing duodenum without any air bubbles. One month later, the patient presented with gastrointestinal bleeding and computed tomography revealed air bubbles within aneurysm. With a diagnosis of aortoenteric fistula, endovascular aneurysm repair was carried out. This case uniquely presented the computed tomography findings in progression of an aneurysm to an aortoenteric fistula.
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http://dx.doi.org/10.5812/iranjradiol.22759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393498PMC
April 2015

Evaluation of Liver Stiffness After Radioembolization by Real-Time ShearWave™ Elastography: Preliminary Study.

Cardiovasc Intervent Radiol 2015 Aug 21;38(4):957-63. Epub 2014 Nov 21.

Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, KMPasa, Fatih, Istanbul, 34098, Turkey,

Purpose: To evaluate the effect of ShearWave(™) elastography (SWE) for the assessment of liver fibrosis after radioembolization (RE) in patients with liver malignancies.

Materials And Methods: We prospectively examined the effects of SWE before and after RE in 17 adult patients, from June 2012 to September 2013. All patients underwent SWE within 1 month before and 3 months (96.3 ± 22.9 days) after RE. Measurements were taken in segments III, IV, V, and VI (lateral/medial left lobe and anterior/posterior right lobe, respectively). Liver stiffness was studied in the 39 treated segments.

Results: The mean stiffness of liver tissue according to the pre-RE SWE measurements was not different from the post-RE SWE measurements in the segments that did not undergo RE. Conversely, segments treated with RE were significantly stiffer according to the post-RE SWE measurements (mean SWE 17.4 kPa) than according to the baseline measurements (7.0 kPa) (p < 0.001). Patients with hepatocellular carcinoma and preexisting infection with hepatitis B and C viruses had higher pre-embolization stiffness, and the post-embolization stiffness of the treated segments in these patients was higher than that in the remainder of the study population.

Conclusion: These data suggest that SWE measurements of liver stiffness increase as early as the third month after RE. SWE could be used as a noninvasive complementary imaging method for preliminary assessment of liver fibrosis before and after RE.
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http://dx.doi.org/10.1007/s00270-014-1021-zDOI Listing
August 2015

Clear cell variant of solid pseudopapillary neoplasm of pancreas diagnosed by fine needle aspiration: A case report and review of the literature.

Cytojournal 2013 27;10:26. Epub 2013 Dec 27.

Department of Interventional Radiology, Istanbul University, CERRAHPASA Medical School, Istanbul, Turkey.

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of uncertain malignant potential, predominantly affecting young adult females. We report a case of clear cell variant of SPN, which was diagnosed by fine needle aspiration biopsy. The aspirate was highly cellular and exhibited delicate branching papillary structures with central capillaries covered with several layers of plasmacytoid tumor cells. Acinar and rosette-like formations, as well as single neoplastic cells were also observed. An unusual cytologic feature was the presence of large, clear cytoplasmic vacuoles. The diagnosis of SPN was confirmed by characteristic immunocytochemical staining pattern including nuclear staining for β-catenin, cytoplasmic staining for vimentin and lack of reactivity for cytokeratin.
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http://dx.doi.org/10.4103/1742-6413.123785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927077PMC
February 2014

Aggressive vertebral hemangioma as a rare cause of myelopathy.

J Back Musculoskelet Rehabil 2014 ;27(2):125-9

Department of Interventional Radiology, Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey.

Vertebral hemangiomas (VHs) are common lesions in the adult population. They are usually asymptomatic and found incidentally on radiological imaging. New-onset back pain followed by subacute progression of thoracal myelopathy is the most common presentation in patients with neurological deficit. Differential diagnoses would include metastasis, multiple myeloma, lymphoma, Paget disease, osseous tumors such as Ewing sarcoma or hemangioblastoma and blood dyscrasia. We present a 41 year-old-male patient with thoracal VH causing myelopathy that completely improved after rehabilitation program with embolization and vertebroplasty procedures.
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http://dx.doi.org/10.3233/BMR-130425DOI Listing
January 2015

Mixed hepatocellular carcinoma and hepatoblastoma: cytohistopathologic findings and differential diagnosis.

Acta Cytol 2013 6;57(1):91-5. Epub 2012 Dec 6.

Department of Pathology, Istanbul University, Istanbul, Turkey.

Background: Hepatocellular carcinoma (HCC) accounts for approximately 80% of all the primary malignant tumors of the liver. Hepatoblastoma (HBL) is the most common primary malignant neoplasm of the liver in childhood, and extremely rare in adults. To the best of our knowledge, this is the first report of an adult case with cytopathologic description of a combined HCC and HBL, occurring in a noncirrhotic liver.

Case: A 24-year-old male was admitted to the hospital with right-sided abdominal pain. Masses in the liver were detected radiologically. Fine-needle aspiration biopsy and core-needle biopsy revealed a malignant hepatocellular tumor with features of both HCC and HBL.

Conclusion: In the present case among the distinct HCC cell groups, areas of smaller and more primitive cells consistent with embryonal type HBL and some other groups of cells with intermediate morphology were observed. These findings suggested the probable single stem cell origin of the tumor with differentiation to both cell groups rather than a combination of two different tumors. Therefore, the term 'malignant hepatocellular tumor' could also be considered to define this particular tumor. This case provides support to the previous reports in which HBL areas are described in HCC.
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http://dx.doi.org/10.1159/000339275DOI Listing
March 2013

A rare case of gastrointestinal stromal tumor presenting with closed perforation of the small intestine.

Turk J Gastroenterol 2012 Jun;23(3):253-7

İstanbul University Cerrahpaşa School of Medicine, Department of General Surgery, İstanbul, Turkey.

Gastrointestinal stromal tumors are very rare mesenchymal tumors of the gastrointestinal tract with variable clinical presentations depending on the tumor size and anatomic site. The currently used diagnostic modalities cannot establish a preoperative diagnosis with 100% certainty. The treatment of choice includes complete surgical excision and/or chemotherapy. In this paper, we present a very rare case of gastrointestinal stromal tumor presenting with closed perforation of the small intestine. The patient was successfully managed with surgical excision of the tumor with segmental bowel resection and adjuvant chemotherapy. Although rare, it must be kept in mind that gastrointestinal stromal tumors can also present with closed bowel perforation.
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http://dx.doi.org/10.4318/tjg.2012.0288DOI Listing
June 2012

Cross-sectional area of the labrum: role in the diagnosis of anterior acetabular labral tears.

Eur Radiol 2012 Jun 10;22(6):1350-6. Epub 2012 Feb 10.

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34300, Istanbul, Turkey.

Objective: To investigate the utility of ultrasound cross-sectional area (CSA) measurements for diagnosing acetabular labral (AL) tears.

Methods: The study included qualitative/quantitative ultrasound examinations of 55 hips in 52 patients with a presumed diagnosis of AL tear and 56 hips in 28 healthy volunteers. MR arthrography examinations were available only for the patients and were reviewed for the presence of AL thickening and tear.

Results: The CSA of the anterior labrum was significantly larger in patients with an AL tear on MR arthrography than those in healthy volunteers (P < 0.01). The CSA cut-off value in determining labral thickening that maximises accuracy was 34.7 mm(2), and sensitivity, specificity and accuracy were 86.7%, 74.1% and 77.5%. Direct signs of AL tear on ultrasound had sensitivity, specificity and accuracy of 34.9%, 91.7% and 47.3%. The CSA cut-off value that maximises the accuracy of the AL tear was 40.6 mm(2), and sensitivity, specificity and accuracy were 58.1%, 91.2% and 78.4%.

Conclusions: Ultrasound detects the thickened labrum frequently observed in MR arthrography studies, especially in patients with dysplastic hips. Although specificity of the method of detecting AL tears is high, sensitivity is low, with an overlap between subjects with AL tear and controls.

Key Points: • Labral degeneration is frequent in dysplastic hips • Thickened labra are frequently observed on MR arthrograms • Labral thickening can be depicted by quantitative ultrasound measurements • The sensitivity is low with overlap between subjects with AL tear and controls.
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http://dx.doi.org/10.1007/s00330-012-2384-7DOI Listing
June 2012

The use of Onyx for embolization of peripheral vascular malformations in pediatric patients.

Pediatr Surg Int 2012 May 22;28(5):477-87. Epub 2012 Jan 22.

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

Purpose: The management of congenital peripheral vascular malformations (VMs) can present a difficult therapeutic challenge. Endovascular transcatheter embolization of peripheral VMs is widely accepted as a first therapeutic option for many VMs. However, data describing the use of Onyx are limited in children with peripheral VMs. Our aim is to retrospectively evaluate the results of transcatheter arterial embolization with Onyx for peripheral VMs in children.

Materials And Methods: We analyzed clinical and imaging records of 16 patients who underwent 25 embolization procedures by using Onyx for peripheral VMs. In eight cases, embolization procedures were performed once; in seven cases, twice; and in one case, thrice.

Results: Embolization was technically complete in 4 patients and incomplete in 12 patients. Clinically, complete success was achieved in nine patients, and partial success was achieved in six patients. In one patient, reflux to the anterior and posterior tibial arteries caused peripheral ischemia, and the patient was referred to undergo plastic surgery. There were no complications in the other 15 patients.

Conclusion: With future studies to better characterize the safety profile of this agent in peripheral vasculature, embolization with Onyx may become a valuable treatment option for peripheral VMs in pediatric patients.
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http://dx.doi.org/10.1007/s00383-012-3052-3DOI Listing
May 2012

Ultrasound-guided intervention around the hip joint.

AJR Am J Roentgenol 2012 Jan;198(1):W95; author reply W96

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http://dx.doi.org/10.2214/AJR.11.7627DOI Listing
January 2012

Ultrasound-guided injection for MR arthrography of the hip: comparison of two different techniques.

Skeletal Radiol 2013 Jan 14;42(1):37-42. Epub 2011 Oct 14.

Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University, 34090, Istanbul, Turkey.

Objective: The purpose of this study was to prospectively evaluate the two different ultrasound-guided injection techniques for MR arthrography of the hip.

Materials And Methods: Fifty-nine consecutive patients (21 men, 38 women) referred for MR arthrographies of the hip were prospectively included in the study. Three patients underwent bilateral MR arthrography. The two injection techniques were quantitatively and qualitatively compared. Quantitative analysis was performed by the comparison of injected contrast material volume into the hip joint. Qualitative analysis was performed with regard to extraarticular leakage of contrast material into the soft tissues. Extraarticular leakage of contrast material was graded as none, minimal, moderate, or severe according to the MR images. Each patient rated discomfort after the procedure using a visual analogue scale (VAS).

Results: The injected contrast material volume was less in femoral head puncture technique (mean 8.9 ± 3.4 ml) when compared to femoral neck puncture technique (mean 11.2 ± 2.9 ml) (p < 0.05). The chi-squared test showed significantly more contrast leakage by femoral head puncture technique (p < 0.05). Statistical analysis showed no difference between the head and neck puncture groups in terms of feeling of pain (p = 0.744) or in the body mass index (p = 0.658) of the patients.

Conclusion: The femoral neck injection technique provides high intraarticular contrast volume and produces less extraarticular contrast leakage than the femoral head injection technique when US guidance is used for MR arthrography of the hip.
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http://dx.doi.org/10.1007/s00256-011-1306-0DOI Listing
January 2013

Percutaneous treatment of an infected aneurysmal sac secondary to aortoesophageal fistula with a history of stent-graft treatment for thoracic aortic aneurysm.

Cardiovasc Intervent Radiol 2012 Jun 19;35(3):690-4. Epub 2011 Aug 19.

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

A 68-year-old man who was subjected to stent-grafting of a descending thoracic aortic aneurysm (TAA) 4 months previously was admitted to our hospital with constitutional symptoms, including high fever, sweating, nausea, vomiting, weight loss, and backache. An infected aneurysmal sac was suspected based on computed tomography (CT) findings, and an aortoesophageal fistula (AEF) was identified during esophagoscopy. CT-guided aspiration was performed using a 20-G Chiba needle, confirming the presence of infection. For treatment of the infected aneurysmal sac, CT-guided percutaneous catheter drainage in a prone position was performed under general anesthesia with left endobronchial intubation. Drainage catheter insertion was successfully performed using the Seldinger technique, which is not a standard treatment of an infected aneurysmal sac. Improvement in the patient's clinical condition was observed at follow-ups, and CT showed total regression of the collection in the aneurysmal sac.
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http://dx.doi.org/10.1007/s00270-011-0256-1DOI Listing
June 2012

Endovascular stent-graft placement for ruptured dissecting aortic aneurysm in an adolescent patient with systemic lupus erythematosus: case report.

Emerg Radiol 2011 Dec 19;18(6):499-502. Epub 2011 Aug 19.

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

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http://dx.doi.org/10.1007/s10140-011-0978-zDOI Listing
December 2011

Percutaneous sclerotherapy of peripheral venous malformations in pediatric patients.

Pediatr Surg Int 2011 Dec 5;27(12):1283-7. Epub 2011 Aug 5.

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

Purpose: To report the efficacy of percutaneous puncture and sclerosis using polidocanol in the treatment of venous malformations (VMs) in pediatric patients.

Patients/methods: Between March 2007 and February 2011, a series of 19 patients with VMs on the upper and lower extremities had undergone a total of 89 sessions of intralesional sclerotherapy using polidocanol. All the procedures were performed in an angiographic suite under general anesthesia in order to maintain sedation for facilitating the procedure. For each injection, approximately 1 ml of 2% polidocanol was injected for each centimeter of the diameter of the lesion, with a maximum of 6 ml. Injection of the sclerosant was guided by real-time sonography and fluoroscopy.

Results: After the treatment, the symptoms completely resolved in four patients (21%). Clinical symptoms, such as bulging and pain were improved in 12 out of 19 patients (63%). They remained unchanged in three patients (16%). During the procedures, no major complications were encountered. The minor complications (65%) encountered were swelling and pain after treatment which were resolved by taking NSAID within a few days.

Conclusion: In pediatric patients, sonographically guided percutaneous puncture and fluoroscopically guided sclerosis using 2% polidocanol is effective, less invasive and safe for the treatment of VMs, with a high success rate and minimal complications.
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http://dx.doi.org/10.1007/s00383-011-2962-9DOI Listing
December 2011

Testicular arteriovenous malformation: gray-scale and color Doppler ultrasonography features.

Case Rep Med 2011 13;2011:876206. Epub 2011 Jul 13.

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

Intratesticular arteriovenous malformations (AVMs) are extremely rare benign incidental lesions of the testis. Ultrasonography (US) generally reveals a hypoechoic solid mass within the testicular parenchyma. We describe a patient with intratesticular AVM which was found incidentally during workup for infertility. The gray-scale and Doppler US appearance of an intratesticular AVM and the differential diagnosis have been presented. Based on the gray-scale, US appearance differentiation from malignant testicular tumors is difficult. Doppler US examination aids in the diagnosis by demonstrating the vascular nature of the tumor.
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http://dx.doi.org/10.1155/2011/876206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139914PMC
November 2011

Anatomical variations of the carotid-vertebral arteries: "double-vessel" sign on Doppler ultrasonography.

J Clin Ultrasound 2011 Oct 5;39(8):487-92. Epub 2011 Apr 5.

Department of Radiology, Istanbul University, Istanbul, Turkey.

We describe the "double-vessel" sign and its relevance for the diagnosis of carotid and vertebral arterial anatomical variations in a series of four patients with stroke. In these four patients, two arteries could be seen at the expected location of the common carotid artery (CCA), leading to the diagnosis of anatomical variations including separate origin of internal and external carotid artery from the aortic arch on the left side and from the brachiocephalic trunk and the subclavian artery on the right side, early bifurcation of the CCA on both sides, and an aberrant course of the vertebral artery on the left side. The presence of two arteries at the expected location of the CCA should raise the suspicion of carotid or vertebral arterial variations.
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http://dx.doi.org/10.1002/jcu.20800DOI Listing
October 2011

Posttraumatic high-flow priapism in children treated with autologous blood clot embolization: long-term results and review of the literature.

Pediatr Radiol 2011 May 3;41(5):627-32. Epub 2010 Dec 3.

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

Background: Usually high-flow priapism is caused by perineal or penile blunt trauma with direct cavernosal artery injury and formation of an arterial-lacunar fistula. Rarely, cavernosal artery injury may result from penetrating trauma. Treatment of high-flow priapism is not considered an emergency because patients are at low risk for permanent complications. For this type of priapism there are several options for treatment including embolization or surgical ligation.

Objective: To describe the technique of superselective transcatheter embolization with the use of autologous blood clot and to discuss the long-term results.

Materials And Methods: Seven children with a mean age of 10 years suffering from high-flow priapism were treated with superselective transcatheter embolization with autologous blood clot. In all cases, colour Doppler US was performed to demonstrate increased cavernous blood flow with definitive diagnosis established by superselective arteriography. After the angiographic diagnosis, superselective transcatheter embolization of the fistula with autologous blood clot was performed during the same session. The children were followed up on a monthly basis up to 1 year with clinical findings and penile colour Doppler US examinations. After 1 year, they were followed up annually with clinical assessment only. The mean follow-up period was 6.0 years.

Results: Following embolization complete detumescence was achieved in all but one child, who was treated with a second embolization 3 d after the initial session. In addition, for one child a second session of embolization was performed due to the recurrence of partial erection during the 1 week period after the initital embolization. In both cases, complete detumescence was achieved after the second embolization, and no recurrence of priapism was observed in the follow-up period.

Conclusion: Selective arterial embolization with autologous clot achieved treatment for high-flow priapism in this study with 100% occlusion rate with a maximum of two sessions and no signs of erectile dysfunction were observed in any of the children during long-term follow-up.
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http://dx.doi.org/10.1007/s00247-010-1912-3DOI Listing
May 2011