Publications by authors named "Fatma Bilge Ergen"

24 Publications

  • Page 1 of 1

Characteristics of femoroacetabular impingement morphology and relation with skeletal maturity among asymptomatic adolescents.

Acta Orthop Belg 2021 Mar;87(1):47-54

The aim of this study was to analyze presence of the morphological characteristics and prevalence of FAI in asymptomatic adolescents and assess the relation of skeletal maturation with development of FAI morphology. Abdominopelvic computed tomography (CT) of 265 adolescents (9-19 years old) who were admitted to the emergency department between 2011 and 2016 were evaluated retrospectively. Radial reformatted CT images from the femoral neck were created using the multiplanar reconstruction (MPR) method. The femoral neck was divided into 12 segments and alpha angle (AA), femoral head-neck ratio (FHNR) and center-edge angle (CEA) were measured from each segment. Additionally, images were evaluated for the physiological status (open or closed) of the triradiate- cartilage and proximal femoral epiphyses. 204 hips from 102 patients (32 females, 70 males) were retrospectively reviewed. There were 27 (26.5%) patients with cam-type morphology and 18 (17.6%) patients with pincer-type morphologies. No statistically significant difference was detected between the prevalences of cam and pincer morphologies between the two genders. Cam deformity was most frequently seen in anterosuperior segment. All of the patients (100%) with pincer-type morphology and 88% of the patients with cam-type morphology had closed triradiate cartilage, 89% of the patients with cam morphology and 83% with pincer morphology had open proximal femoral physis. Our results showed that prevalence of cam and pincer-type morphology in asymptomatic adolescents is similar to asymptomatic adults. Our findings also indicate that cam- and pincer-type FAI morphologies likely develop during late adolescence after closure of triradiate cartilage and before closure of proximal femoral physis. Level of Evidence - 3.
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March 2021

Spinal involvement in juvenile idiopathic arthritis: what do we miss without imaging?

Rheumatol Int 2021 Jun 11. Epub 2021 Jun 11.

Department of Pediatrics, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. Enthesitis-related arthritis (ERA) has been one of the most controversial subtypes of JIA with a higher risk of axial involvement.  Our aim was to assess the frequency and spectrum of MRI findings of spine involvement in patients with JIA and determine if the axial involvement is always clinically symptomatic in patients with positive MRI findings. In this retrospective cross-sectional observational study we included known or suspected JIA patients who underwent spinal MRI examination between 2015 and 2017 and followed up in the Pediatric Rheumatology outpatient clinic. The demographic and clinical data were reviewed from the medical charts and electronic records. All patients were grouped as clinically symptomatic and asymptomatic for spinal involvement and MRI findings were re-evaluated for presence of inflammatory and erosive lesions. Of the 72 JIA patients, 57 (79.2%) were diagnosed with ERA, and 15 (20.8%) with non-ERA subtypes of JIA. Overall, 49 (68%) patients with JIA had positive spinal MRI findings (inflammatory and/or erosive lesions). Twenty-seven (47%) ERA patients were clinically symptomatic for spine involvement and among them, 19 (70.3%) had positive spinal MRI findings. Although 30 ERA (53%) patients were clinically asymptomatic, 23 of them (77%) had positive spinal MRI findings, as well. Eleven (73%) patients diagnosed with non-ERA JIA subtypes were clinically symptomatic for spine involvement at the time of MRI. Among them, four (36.3%) had inflammatory and/or erosive lesions on spine MRI. Four (26%) non-ERA patients were clinically asymptomatic for spine involvement, but three (75%) of them showed positive findings on spinal MRI. Inflammatory and/or erosive lesions of the thoracolumbar spine could exist in patients with JIA, regardless of the presence of symptoms. Not only because the significant proportion of ERA patients show asymptomatic axial involvement but also the presence of axial involvement in patients who were classified as non-ERA depending on current ILAR classification underlines the necessity of using MRI for accurate classification of patients with JIA.
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http://dx.doi.org/10.1007/s00296-021-04890-8DOI Listing
June 2021

Value of shoulder US compared to MRI in infants with obstetric brachial plexus paralysis.

Diagn Interv Radiol 2021 May;27(3):450-457

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Purpose: Children with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability due to development of unbalanced muscular strength. Our major goal in this study is to compare the accuracy of physical examination and ultrasonography (US) in determination of glenohumeral instability in infants with BPBI compared with magnetic resonance imaging (MRI) as a gold standard, and to investigate the role and value of US as a screening modality for assessing glenohumeral instability.

Methods: Forty-two consecutive patients (mean age, 2.3±0.8 months) with BPBI were enrolled into this prospective study. Patients were followed up with physical examination and US with dynamic evaluation in 4-6 weeks intervals. Patients who developed glenohumeral instability based on physical examination and/or US (n=21) underwent MRI. Glenohumeral instability was defined as alpha angle >30° and percentage of posterior humeral head displacement >50%. Diagnostic accuracy of physical examination and US was calculated and quantitative parameters were compared with Wilcoxon test.

Results: Glenohumeral instability was confirmed with MRI in 15 of 21 patients. Accuracy and sensitivity of physical examination and US were 47%, 66% and 100%, 100%, respectively in determination of glenohumeral instability. No significant difference was found for the alpha angle (p = 0.173) but the percentage of posterior humeral head displacement was statistically significant between US and MRI (p = 0.028).

Conclusion: Our results indicate that US with dynamic evaluation is a good alternative for MRI in assessment of glenohumeral instability in infants with BPBI, since it is highly accurate and specific, and quantitative measurements used for glenohumeral instability were comparable to MRI. US can be used as a screening method to assess glenohumeral instability in infants with BPBI.
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http://dx.doi.org/10.5152/dir.2021.19642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136539PMC
May 2021

A Revisited Diagnosis of Collagen VI Related Muscular Dystrophy in a Patient with a Novel COL6A2 Variant and 21q22.3 Deletion.

Neuropediatrics 2020 12 14;51(6):445-449. Epub 2020 Jul 14.

Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

The genetic etiology of collagen VI related muscular dystrophies is heterogenous. Genomic deletions in one allele involving or both and unmasking a pathogenic variant in the second nondeleted allele have been described in the etiology. We aimed to report the clinical and molecular findings of a 13-year-old boy with ring chromosome 21 who presented to our clinic with easy fatigability, muscle weakness, and waddling gait. Phenotypic delineation along with chromosomal microarray analysis and DNA sequencing were performed. Affymetrix CytoScan Optima array platform and DNA sequencing revealed a 2,202 kb de novo deletion at 21q22.3, including and , and a novel heterozygous variant at position c.2875G > A;p.(Glu959Lys) in , respectively. Before his admission to our center, the patient was evaluated for hypotonia elsewhere when he was 15 months old. He was diagnosed with ring chromosome 21 on peripheral blood karyotype analysis; however, no further assessment was performed at that time. He had normal growth with mild dysmorphic facial features, distal laxity, gastrocnemius hypertrophy, proximal muscle weakness, increased lordotic posture with mild flexion contractures at the knees, and gait disturbance. Although the phenotype does not fit into classical Ullrich congenital muscular dystrophies, muscle magnetic resonance imaging (MRI) revealed a complementary pattern consistent with collagen VI related myopathies. Genetic testing confirmed the clinical diagnosis as well. This patient yet represents another example of the effect of large genomic deletions leading to recessive disorders through unmasking a pathogenic variant in the second nondeleted allele.
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http://dx.doi.org/10.1055/s-0040-1714125DOI Listing
December 2020

Denosumab treatment in aneurysmal bone cyst: Evaluation of nine cases.

Pediatr Blood Cancer 2018 Apr 29;65(4). Epub 2017 Dec 29.

Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: Aneurysmal bone cyst (ABC) is a benign bone tumor. Curettage and bone grafting is the common treatment. Here, we retrospectively evaluate nine patients treated with denosumab.

Procedure: Nine patients with ABC, mostly pelvic and vertebral, treated with denosumab were analyzed retrospectively. A 70 mg/m denosumab dose was used weekly in the first month, and then monthly. Clinical and radiological responses to treatment were evaluated.

Results: In all patients, clinical symptoms including pain and limping regressed completely within 3 months. Radiological evaluation revealed changes in lesion size and content. In six patients, overall volume reduction in the range of 18-82% was detected. Decreases in the size and number of cysts were detected in eight patients. In five patients, fat signal appeared on follow-up imaging. No major side effects were observed during treatment. Median follow-up time after treatment was 15 months. At 5 months, severe hypercalcemia was observed in two patients due to rebound increase in osteoclastic activity. Subsequent to denosumab treatment, three patients underwent surgery for clinical or radiological recurrence.

Conclusions: Our results showed that denosumab provided a meaningful clinical and radiological improvement in ABC. It may be a treatment option, especially in spinal and pelvic tumors with potentially high surgical morbidity. However, late rebound hypercalcemia may restrict its use. Studies with more cases are required for routine use of denosumab in ABC.
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http://dx.doi.org/10.1002/pbc.26926DOI Listing
April 2018

Ultrasonography-Guided Injection for Quadriceps Fat Pad Edema: Preliminary Report of a Six-Month Clinical and Radiological Follow-Up.

J Belg Soc Radiol 2016 Sep 21;100(1):78. Epub 2016 Sep 21.

Inonu University School of Medicine, TR.

Purpose: To investigate efficacy and safety of ultrasonography-guided local corticosteroid and anesthetic injection followed by physical therapy for the management of quadriceps fat pad (QFP) edema.

Materials And Methods: We prospectively evaluated 1671 knee MRI examinations in 1542 patients for QFP edema with mass effect, which was present in 109 (6.5%) knees. Participants were assigned into injection and therapy groups (both received the same physical therapy program). Injection group was first treated with ultrasonography-guided QFP injection of 1 mL corticosteroid and 1 mL local anesthetic agent. Patients were evaluated at baseline and 1-, 2-, 6-month follow-up for pain using static and dynamic visual analogue scale (VAS), suprapatellar tenderness, and QFP edema on MRI.

Results: Final sample size consisted of 19 knees (injection group, 10; therapy group, 9) in 17 patients. An overall improvement was detected in both groups between baseline and final assessments. The injection group fared better than the therapy group in static VAS scores (3.33 ± 1.70 versus 0.56 ± 1.33), while there was no such difference for dynamic VAS. Incidence of suprapatellar tenderness decreased in both groups, statistically significantly in the injection group (from 100% to 0%). Pain reduction was greater in the injection group at the first month (88.9% - 90% good response versus 50% - 66.7% good response, ), whereas there was no such superiority at the sixth month. No severe adverse events were identified.

Conclusion: Ultrasonography-guided local injection followed by physical therapy is safe in the management of QFP edema; however, it is not superior to stand-alone physical therapy program in the long term.
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http://dx.doi.org/10.5334/jbr-btr.1148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854272PMC
September 2016

MRI of lower extremity impingement and friction syndromes in children.

Diagn Interv Radiol 2016 Nov-Dec;22(6):566-573

Department of Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.

Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon-lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data.
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http://dx.doi.org/10.5152/dir.2016.16143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098953PMC
May 2017

Etanercept treatment in five cases of refractory chronic recurrent multifocal osteomyelitis (CRMO).

Joint Bone Spine 2015 Dec 14;82(6):471-3. Epub 2015 Jul 14.

Department of Pediatric Rheumatology, Hacettepe University, Faculty of Medicine, Sıhhiye, 06100 Ankara, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jbspin.2014.11.010DOI Listing
December 2015

Rice bodies within the neuropathic hip in a child with congenital insensitivity to pain.

Pediatr Radiol 2015 Apr 26;45(5):782-3. Epub 2014 Oct 26.

Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06100, Ankara, Turkey,

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http://dx.doi.org/10.1007/s00247-014-3203-xDOI Listing
April 2015

Demystifying ABER (ABduction and External Rotation) sequence in shoulder MR arthrography.

Diagn Interv Radiol 2014 Nov;20(6):507-10

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

ABduction and External Rotation (ABER) sequence in magnetic resonance (MR) arthrography of the shoulder is particularly important to better depict abnormal conditions of some glenohumeral joint structures and surrounding tissues by making imaging possible under a stress position relevant to pathologic conditions. Among the structures and tissues better depicted in this position are articular surface of the supraspinatus tendon, anteroinferior portion of the glenoid labrum, and anterior band of the inferior glenohumeral band. Despite these benefits of the ABER sequence, it is either not being used extensively as part of shoulder MR arthrograms or, when utilized, not properly assessed, mostly due to some practical difficulties in setting up the sequence and unfamiliarity with the alignment of structures displayed on MR images. In this technical note, we aimed to explain the ABER sequence planning in a step-by-step manner with emphasis on scout series set-up, and also present an outline of anatomic landmarks seen on ABER images.
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http://dx.doi.org/10.5152/dir.2014.14117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463282PMC
November 2014

Intraosseous pseudotumor in a child with hypofibrinogenemia.

Pediatr Radiol 2014 Nov 7;44(11):1458-61. Epub 2014 May 7.

Department of Pediatric Radiology, Hacettepe University Medical School, Fakülteler Mah. Dirim sok 22/3, Cebeci, 06590, Ankara, Turkey,

Intraosseous pseudotumor (i.e. chronic, encapsulated, hemorrhagic fluid collection that can be seen in any portion of the tubular bones) is an uncommon complication of severe hemophilia; however, it can occur with other rare bleeding disorders. We present the case of an 11-year-old girl with hypofibrinogenemia who had multiple intramedullary lesions that were consistent with intramedullary pseudotumor associated with this rare bleeding disorder. Percutaneous biopsy of a pseudotumor is contraindicated due to the high prevalence of complications, including life-threatening bleeding. Therefore, radiologists should make the diagnosis with characteristic MR imaging findings in a patient with a severe coagulation disorder.
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http://dx.doi.org/10.1007/s00247-014-3004-2DOI Listing
November 2014

CT assessment of asymptomatic hip joints for the background of femoroacetabular impingement morphology.

Diagn Interv Radiol 2014 May-Jun;20(3):271-6

From the Departments of Radiology Hacettepe University School of Medicine, Ankara, Turkey.

Purpose: The purposes of this study were to assess the presence of cam and pincer morphology in asymptomatic individuals with a negative femoroacetabular impingement test, and to determine and compare the ranges of alpha angle using two measurement methods.

Materials And Methods: In total, 68 consecutive patients who underwent abdominopelvic computed tomography (CT) for reasons other than hip problems were the patient population. Patients who had a positive femoroacetabular impingement test were excluded. Alpha angle measurements from axial oblique (AN) and radial reformat-based images (AR) from the anterior through the superior portion of the femoral head-neck junction, as well as femoral head-neck offset, center-edge angle, acetabular version angle measurements, and acetabular crossover sign assessment, were made.

Results: Overall prevalences of cam (increased alpha angle, decreased femoral head-neck offset) and pincer morphology (increased center-edge angle, decreased acetabular version) were 20.0%, 26.8%, 25.8%, and 10.2% of the hips, respectively. The mean AR ranged from 41.64° ± 4.23° to 48.13° ± 4.63°, whereas AN was 41.10° ± 4.44°. The values of AR were higher than AN, and the difference was statistically significant (P <0.001). The highest AR values were measured on images from the anterosuperior section of femoral head-neck junction.

Conclusion: In asymptomatic subjects, higher alpha angle values were obtained from radial reformatted images, specifically from the anterosuperior portion of the femoral head-neck junction compared with the axial oblique CT images. Other measurements used for the assessment of cam and pincer morphology can also be beyond the ranges that are considered normal in the general population.
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http://dx.doi.org/10.5152/dir.2013.13374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463341PMC
July 2015

Fat fraction estimation of the vertebrae in females using the T2*-IDEAL technique in detection of reduced bone mineralization level: comparison with bone mineral densitometry.

J Comput Assist Tomogr 2014 Mar-Apr;38(2):320-4

From the *Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey; † Department of Radiology, Göztepe Teaching and Research Hospital, Istanbul, Turkey; ‡GE Healthcare, Istanbul, Turkey; and §Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: The aim of this study was to use the T2*-iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification (IDEAL) technique to estimate vertebral fat fraction (FF) and compare it with bone mineralization levels in females.

Materials And Methods: Forty-five (mean age, 49.5 years) consecutive women who underwent magnetic resonance imaging and spinal dual-energy x-ray absorptiometry bone mineral density (BMD) examination constituted the study population. Depending on t scores derived from dual-energy x-ray absorptiometry, the vertebrae were classified into 3 groups (1, healthy; 2, osteopenia; and 3, osteoporosis). The Spearman ρ test was used to investigate the presence of correlation between FF and BMD. Analysis of covariance was performed to compare the differences among the groups. The FF cutoff value for the prediction of osteoporosis/osteopenia was evaluated with the receiver operating characteristic curve analysis.

Results: We found a moderate negative correlation between BMD (grams per square centimeter) and FF (r = - 0.42), and it was statistically significant (P < 0.001). The FF mean of age-corrected group 1 (45.17%; SD, 1.3) was lower than that of groups 2 (51.77%; SD, 0.69) and 3 (50.82%; SD, 1.5), and the difference was statistically significant (P < 0.001, P = 0.021). The area under the receiver operating characteristic curve for FF was 0.80 (95% confidence interval, 0.72-0.86). The optimal cutoff point was obtained as 39%, and for this cutoff point, the sensitivity and the specificity were 93% and 60.3%, respectively.

Conclusions: The T2*-IDEAL technique can be used as an alternative technique in estimation of FF, and it is possible to detect reduced bone mineralization of the vertebrae by estimation of FF value with this technique.
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http://dx.doi.org/10.1097/RCT.0b013e3182aa4d9dDOI Listing
May 2014

Charcot foot in diabetes and an update on imaging.

Diabet Foot Ankle 2013 20;4. Epub 2013 Nov 20.

Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.

Charcot neuroarthropathy (CN) is a serious complication of diabetes mellitus that can cause major morbidity including limb amputation. Since it was first described in 1883, and attributed to diabetes mellitus in 1936, the diagnosis of CN has been very challenging even for the experienced practitioners. Imaging plays a central role in the early and accurate diagnosis of CN, and in distinction of CN from osteomyelitis. Conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, and positron emission tomography are the imaging techniques currently in use for the evaluation of CN but modalities other than magnetic resonance imaging appeared to be complementary. This study focuses on imaging findings of acute and chronic neuropathic osteoarthropathy in diabetes and discrimination of infected vs. non-infected neuropathic osteoarthropathy.
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http://dx.doi.org/10.3402/dfa.v4i0.21884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837304PMC
November 2013

Bilateral fused os intermetatarseum presenting as dorsal foot pain: a case report.

Surg Radiol Anat 2014 Jul 12;36(5):503-5. Epub 2013 Sep 12.

Department of Radiology, Medical Faculty, Hacettepe University, 06100, Ankara, Turkey,

Purpose: Os intermetatarseum is a rare accessory bone of the forefoot and usually situated between the base of the first and second metatarsals. Most of the cases are asymptomatic and diagnosed incidentally. Here, we report a rare form of os intermetatarseum presented with bilateral dorsal foot pain and to the authors' knowledge, it is the first case which includes computerized tomography (CT) and magnetic resonance imaging (MRI) findings.

Methods: A 23-year-old male complained of localized bump at the dorsum of the both feet underwent bilateral anteroposterior foot radiograms which was unremarkable and then CT and MRI were performed.

Results: MRI of both feet demonstrated osseous structures in relation with medial os cuneiforme. Computerized tomography demonstrated bilateral os intermetatarsea fused with medial os cuneiforme.

Conclusions: It is important for radiologist to know that os intermetatarseum can be presented as dorsal foot pain. Due to its position, it is difficult to demonstrate os intermetatarseum in plain radiographs, CT and MRI should be performed in clinically suggestive cases.
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http://dx.doi.org/10.1007/s00276-013-1203-4DOI Listing
July 2014

A critical overview of the imaging arm of the ASAS criteria for diagnosing axial spondyloarthritis: what the radiologist should know.

Diagn Interv Radiol 2012 Nov-Dec;18(6):555-65. Epub 2012 Apr 6.

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

The Assessment in SpondyloArthritis international Society (ASAS) defined new criteria in 2009 for the classification of axial spondyloarthritis (SpA) in patients with ≥ 3 months of back pain who were aged <45 years at the onset of back pain. This represents a culmination of a number of efforts in the last 30 years starting with the 1984 modified New York criteria for ankylosing spondylitis, followed by the 1990 Amor criteria and the 1991 European Spondyloarthropathy Study Group criteria for SpA. The importance of new ASAS criteria for radiologists is that magnetic resonance imaging (MRI) takes center stage and is one of the major criteria for the diagnosis of axial SpA when active (or acute) inflammation is present on MRI that is highly suggestive of sacroiliitis associated with SpA. According to the new criteria, sacroiliitis on imaging plus ≥ 1 SpA features (such as inflammatory back pain, arthritis, heel enthesitis, uveitis, dactylitis, psoriasis, Crohn's disease/colitis, good response to non-steroidal anti-inflammatory drugs, family history for SpA, HLA-B27 positivity, or elevated C-reactive protein) is sufficient to make the diagnosis of axial SpA. A number of rules and pitfalls, however, are present in the diagnosis of active sacroiliitis on MRI. These points are highlighted in this review, and a potential shortcoming of the imaging arm of the ASAS criteria is addressed.
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http://dx.doi.org/10.4261/1305-3825.DIR.5732-12.0DOI Listing
November 2013

Right foot congenital infantile fibrosarcoma treated only with chemotherapy.

Pediatr Blood Cancer 2010 Apr;54(4):618-20

Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey.

Congenital infantile fibrosarcoma (CIF) is a rare tumor in childhood. The 5-year survival rate for CIFs is high and has been reported between 84% and 93%, but limb-amputation/disarticulation is still a major problem. We report the case of a male newborn with a mass in his right foot. X-ray and MRI revealed a mass destroying all tarsal, metatarsal, and phalangeal bones. The patient was treated only with VAC chemotherapy and is able to walk normally.
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http://dx.doi.org/10.1002/pbc.22389DOI Listing
April 2010

Visualization of the biliary tract using gadobenate dimeglumine: preliminary findings.

J Comput Assist Tomogr 2008 Jan-Feb;32(1):54-60

Department of Radiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.

Objective: To compare contrast-enhanced magnetic resonance (MR) cholangiography (CE-MRC) performed with gadobenate dimeglumine with T2-weighted MRC (T2-MRC) for visualization of the bile ducts in nondilated biliary systems.

Materials And Methods: Twenty consecutive patients who underwent MR imaging (MRI) of the liver and pancreas with nondilated intrahepatic ducts were included in this retrospective study. T2-weighted MRC was performed using a multislice, high-resolution fat-suppressed half-Fourier acquisition turbo spin-echo sequence. Contrast-enhanced MR cholangiography was performed using a fat-suppressed 3-dimensional fast low-angle shot sequence acquired 1 to 1.5 hour after intravenous administration of gadobenate dimeglumine. For image interpretation, the biliary system was divided into 8 segments. Two readers graded visualization of each segment on T2-MRC and CE-MRC using a 5-point scale (0, nonvisualization; 4, excellent visualization). Final opinion for each sequence was rendered by consensus. Superiority of visualization was assessed using the McNemar test and comparing adequately (visualization scores 3 and 4) and inadequately (visualization scores 0, 1, and 2) visualized segments of the ducts on both sequences. Interobserver variability was assessed with kappa statistics.

Results: Overall and segment-based evaluation revealed superior visualization of biliary segments with CE-MRC compared with T2-MRC. We also found a statistically significant difference between the 2 sequences for overall and for right hepatic duct and cystic channel visualization (P < 0.05). A high concordance between readers 1 and 2 both for T2-MRC and CE-MRC was achieved (85.8% and 89.4%, respectively).

Conclusions: Gadobenate dimeglumine can be used as an alternative intrabiliary contrast agent for contrast-enhanced MR cholangiography in nondilated biliary systems in patients with normal excretory liver function tests.
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http://dx.doi.org/10.1097/RCT.0b013e3180616b87DOI Listing
March 2008

Magnetic resonance imaging of the rotator interval in patients on long-term hemodialysis: correlation with the range of shoulder motions.

J Comput Assist Tomogr 2007 Nov-Dec;31(6):970-5

Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey.

Objective: To assess the rotator interval of patients on long-term hemodialysis with magnetic resonance imaging (MRI) for the presence of adhesive capsulitis and to correlate these findings with shoulder motions.

Methods: Seventeen shoulders in 16 patients (mean age, 53.8 years) on hemodialysis (range of duration, 4-28 years) who had pain and limited range of shoulder motion underwent MRI. Rotator interval was inspected in 3 regions (subcoracoid area, above the subscapularis muscle, and around the biceps tendon) on sagittal magnetic resonance images with regard to increased nonfatty soft tissue intensity as none, mild, moderate, and marked. Magnetic resonance images were evaluated by 2 musculoskeletal radiologists with consensus. Ranges of motion for external and internal rotation and abduction and forward flexion were assessed either normal or mildly, moderately, and severely limited.

Results: Increased nonfatty soft tissue intensity within the rotator interval fat was observed in 11 shoulders (65%). Very strong positive correlation was found between the limitation of external rotation and the presence of nonfatty soft tissue infiltrating all 3 areas of the rotator interval fat (rs, between 0.81 and 0.96; P < 0.001). Strong positive correlation was found between the hemodialysis duration and the presence of nonfatty soft tissue infiltrating all 3 areas of the rotator interval fat (rs, between 0.68 and 0.71; P
Conclusions: Long-term hemodialysis results in adhesive capsulitis-like MRI findings in the shoulder joint with nonfatty soft tissue infiltration in the rotator interval that is related to hemodialysis duration. The degree of MRI obliteration of the rotator interval fat strongly correlates with the range limitation of some shoulder motions.
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http://dx.doi.org/10.1097/RCT.0b013e31805930f4DOI Listing
January 2008

Intercoccygeal angle and type of coccyx in asymptomatic patients.

Surg Radiol Anat 2007 Dec 26;29(8):683-7. Epub 2007 Sep 26.

Department of Radiology, Hacettepe University, School of Medicine, Sihhiye, Ankara, Turkey.

Purpose: To assess the intercoccygeal angle of asymptomatic patients (without coccydynia), to study if there is a difference of angle between types of coccyx and between genders with the same type of coccyx.

Materials And Methods: Ninety-two patients (42 females, 50 males, range of ages 8-86, mean 50) who underwent computed tomography (CT) angiography and colonoscopy were included in the study. CT images with slice thickness of 1 or 1.5 mm were evaluated with 3D sagittal reformats and intercoccygeal angle, type of coccyx were examined.

Results: Twenty-one females and 18 males had type 1 coccyx with mean intercoccygeal angle 36.4 degrees +/- 10.56 (33.29 degrees for females and 40.05 degrees for males) and the difference of the angles between genders is statistically significant (P = 0.044). Among 36 patients (14 were females and 22 were males) with type 2 coccyx demonstrated mean intercoccygeal angle of 56.36 degrees +/- 10.8. 15 patients were shown to have type 3 coccyx and the mean intercoccygeal angle was 72.1 degrees +/- 31.86. No significant difference of angles was seen between genders. Type 4 coccyx was not seen and two coccyx could not be classified. There was a significant difference of intercoccygeal angle between the groups overall.

Conclusion: Type 1 is the most common coccyx type in asymptomatic patients. Significant difference of intercoccygeal angle was defined between the types of coccyx. These values may be reference for the patients underwent surgery for the coccydynia and a new classification may be needed since exceptional shape of coccyx exists that could not be defined according to the known classification.
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http://dx.doi.org/10.1007/s00276-007-0262-9DOI Listing
December 2007

Tendon abnormalities mimicking metastatic disease in patients with prostate cancer.

Clin Nucl Med 2007 Aug;32(8):599-602

From the Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.

We present plain x-ray examination, bone scintigraphy, computed tomography, and magnetic resonance imaging of 2 patients diagnosed with prostate cancer who complained of hip pain. Bone scintigraphy was suggestive for metastases. Further radiologic investigation revealed benign etiologies for the hip pain; calcific tendinitis of the vastus lateralis and tendonosis of the gluteus medius tendon were visualized.
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http://dx.doi.org/10.1097/RLU.0b013e3180a1acc3DOI Listing
August 2007

Sonographic evaluation of entheseal sites of the lower extremity in patients undergoing hemodialysis.

J Clin Ultrasound 2007 Oct;35(8):417-23

Department of Radiology, Hacettepe University, School of Medicine, Sihhiye 06100, Ankara, Turkey.

Purpose: To evaluate the entheseal sites of the lower extremities in patients on hemodialysis using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) and to correlate the findings with the duration of hemodialysis and patient scores.

Methods: Forty-nine patients who were on hemodialysis for at least 2 years were grouped according to duration of hemodialysis. Total GUESS scores; total enthesophyte, erosion, and bursitis scores; and tendon thicknesses were calculated, compared between groups, and correlated with duration of dialysis.

Results: There was a statistically significant correlation between duration of hemodialysis and total GUESS score (p < 0.001, r = 0.81) and also between the total enthesophyte and erosion scores (p < 0.001). If severe enthesitis was defined as a total GUESS score of more than 18, receiver operating characteristic (ROC) curve analysis revealed that a cutoff point of 10 years for the duration of hemodialysis would predict severe enthesal damage with 83% sensitivity and 93% specificity (area under the ROC curve, 0.92; 95% confidence interval, 0.83-1.00).

Conclusion: Hemodialysis results in entheseal site changes that worsen with extended duration of hemodialysis, especially after 10 years.
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http://dx.doi.org/10.1002/jcu.20411DOI Listing
October 2007

Magnetic resonance fistulography for the demonstration of anovaginal fistula: an alternative imaging technique?

J Comput Assist Tomogr 2007 Mar-Apr;31(2):243-6

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Anovaginal fistulae (AVF) are frequently seen in patients with inflammatory bowel disease, especially in Crohn disease with active colonic inflammation. Herein, we report a 21-year-old woman with Crohn disease suffering from vaginal discharge and anal pain. Although clinical presentation was very suggestive of AVF, physical examination and colonoscopy were inconclusive. We used an alternative technique and performed magnetic resonance fistulography by applying rectal contrast for the demonstration of AVF.
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http://dx.doi.org/10.1097/01.rct.0000237807.65381.a8DOI Listing
May 2007

Unilateral perirenal fibrosis.

J Comput Assist Tomogr 2005 Jul-Aug;29(4):477-80

Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey.

A case of multifocal fibrosclerosis with an extremely unusual unilateral perirenal involvement is reported. Computed tomography and magnetic resonance imaging findings of unilateral perirenal fibrosis are discussed.
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http://dx.doi.org/10.1097/01.rct.0000164516.76772.11DOI Listing
August 2005
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