Publications by authors named "Fethi Emre Ustabasioglu"

28 Publications

  • Page 1 of 1

A rare case about pericardium: Left deviated heart and pericardial agenesis.

North Clin Istanb 2021 22;8(2):193-195. Epub 2021 Jan 22.

Department of Radiology, Trakya University Faculty of Medicine, Edirne, Turkey.

Congenital absence of the pericardium is not a common condition in daily practice. There are no obvious and clear symptoms. This condition, which is diagnosed incidentally, may cause some complications when not diagnosed. Therefore, imaging techniques, such as echocardiography, are essential. In this article, we present a rare case of pericardial agenesis.
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http://dx.doi.org/10.14744/nci.2019.05935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039098PMC
January 2021

Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: A retrospective study.

Acta Orthop Traumatol Turc 2021 Jan;55(1):67-72

Department of Medical Oncology, Trakya University, School of Medicine, Edirne, Turkey.

Objective: This study aimed to investigate the clinical, pathological, and prognostic characteristics of acral metastases in patients with malignant disease and to determine the impact of different types of acral metastasis treatment on patient survival.

Methods: In this retrospective study, 64 acral metastatic lesions in 46 patients (17 women, 29 men; mean age, 61.5 years; age range, 35-82 years) who were evaluated by the Bone and Soft Tissue Tumors Council of our institute from 2015 to 2019 were included. The patients' primary tumor site, tumor type, localization of acral metastases, main symptom, duration from the diagnosis of the primary tumor to the diagnosis of acral metastasis, duration from the diagnosis of acral metastasis to death, and survival data were analyzed. The diagnosis of acral metastasis was confirmed by histopathological evaluation in 38 patients and clinical and radiological assessment of the lesions in 8 patients. The treatment type for each acral metastasis was individualized by the institutional Bone and Soft Tissue Tumors Council and categorized into 3 groups: excisional surgery (amputations and resections), palliative surgery (prophylactic fixation, intralesional curettage, and bone cement augmentation), and non-surgical treatment (chemotherapy, radiotherapy, and hormone therapy).

Results: A total of 16 acral metastases (25%) were identified in the upper extremity and 48 (75%) in the lower extremity. The most common primary tumor site was the lungs (32.6%), and the most common tumor type was adenocarcinoma (43.2%). The most frequent symptom and the primary reason for admission was pain (58.7%). The mean duration between the diagnosis of primary tumor and the diagnosis of acral metastasis was 19.1 (range, 0-124) months. No significant correlation was determined between the primary tumor types and duration from the diagnosis of primary tumor to the diagnosis of acral metastasis (p=0.278). Acral metastases were treated by excisional surgery in 15 (32.6%) patients, palliative surgery combined with non-surgical treatment in 10 (21.7%) patients, and only non-surgical treatment modalities in 21 (45.7%) patients. No significant correlation existed between the treatment types and patient survival (p=0.058). At the final follow-up, 30 (65.2%) patients were dead owing to the disease. The mean overall survival of the entire study group was 24.9 (range, 3-55) months. The mean duration between the diagnosis of acral metastasis and death was 7.6 (range, 3-24) months in patients who were dead owing to the disease (p=0.012).

Conclusion: When the diagnosis of acral metastasis is established, it should be borne in mind that the most common primary tumor site and type are most likely the lungs and adenocarcinoma, respectively. The treatment type for acral metastasis may have no significant impact on patient survival, but the extensiveness of the disease may be a critical factor for survival.

Level Of Evidence: Level IV, Prognostic study.
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http://dx.doi.org/10.5152/j.aott.2020.20052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932733PMC
January 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

Quantitative Assessment of Salivary Gland Parenchymal Vascularization Using Power Doppler Ultrasound and Superb Microvascular Imaging: A Potential Tool in the Diagnosis of Sjögren’s Syndrome

Balkan Med J 2020 06 9;37(4):203-207. Epub 2020 Apr 9.

Department of Rheumatology, Trakya University School of Medicine, Edirne, Turkey

Background: Primary Sjögren’s syndrome is a chronic inflammatory autoimmune disease. Minor salivary gland biopsy is the gold standard for the diagnosis of primary Sjögren’s syndrome. Superb microvascular imaging, power Doppler ultrasound, and color Doppler of the salivary glands represent non-invasive, non-irradiating modality for evaluating the vascularity of the salivary glands in the diagnosis and follow-up of primary Sjögren’s syndrome.

Aims: To evaluate the efficacy of superb microvascular imaging and vascularity index in salivary glands for the sonographic diagnosis of primary Sjögren’s syndrome.

Study Design: Prospective case-control study.

Methods: Twenty participants with primary Sjögren’s syndrome and 20 healthy subjects were included in the study. Both parotid glands and submandibular glands were evaluated by superb microvascular imaging, power Doppler ultrasound, and color Doppler. The diagnostic accuracy of superb microvascular imaging was compared using these techniques.

Results: In the patient group, the vascularity index values of superb microvascular imaging in parotid glands and submandibular glands were 3.5±1.66, 5.06±1.94, respectively. While the same values were 1.0±0.98 and 2.44±1.34 in the control group (p≤0.001). In the patient group, the vascularity index values of power Doppler ultrasound in parotid glands and submandibular glands were 1.3±1.20 and 2.59±1.82, respectively. While the same values were 0.3±0.32 and 0.85±0.68 in the control group (p≤0.001). The superb microvascular imaging vascularity index cut-off value for the diagnosis of primary Sjögren’s syndrome in parotid glands that maximizes the accuracy was 1.85 (area under the curve: 0.906; 95% confidence interval: 0.844, 0.968), and its sensitivity and specificity were 87.5% and 72.5%, respectively. While the superb microvascular imaging vascularity index cut-off value for the diagnosis of primary Sjögren’s syndrome in submandibular gland that maximizes the accuracy was 3.35 (area under the curve: 0.873; 95% confidence interval: 0.800, 0.946), its sensitivity and specificity were 82.5% and 70%, respectively.

Conclusion: Superb microvascular imaging with high reproducibility of the vascularity index has a higher sensitivity and specificity than the power Doppler ultrasound in the diagnosis of primary Sjögren’s syndrome. It can be a noninvasive technique in the diagnosis of primary Sjögren’s syndrome when used with clinical, laboratory and other imaging methods.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2019.11.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285670PMC
June 2020

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

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

The relationship between computed tomographic obstruction index and pulmonary vein cross-sectional area in acute pulmonary embolism.

Radiol Med 2020 Mar 20;125(3):265-271. Epub 2019 Dec 20.

Department of Radiology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Purpose: To investigate whether the increased obstruction of the pulmonary arteries was associated with reduced pulmonary vein areas in acute pulmonary embolism (APE).

Method: We retrospectively analyzed a consecutive series of computed tomography pulmonary angiography studies of 107 patients with APE and 101 controls without APE between November 2010 and January 2019. The control and patient groups were compared with each other for differences between the mean cross-sectional areas of pulmonary veins. Further analysis was conducted by dividing the patient group into high-risk patients (≥ 20%) and low-risk patients (< 20%) according to the pulmonary arterial obstruction index. The mean cross-sectional area of the pulmonary veins in these two groups was compared.

Results: The mean cross-sectional areas of the 4 pulmonary veins at the ostium level (CSAPV) were significantly lower for the patient group (mean: 102.6 mm) compared with the control group (111.8 mm) (p < 0.001). CSAPV cutoff value for determining the diagnosis of APE that maximized the accuracy was 109.12 mm (AUC = 0.721; 95% CI 0.649-0.794); its sensitivity and specificity were 78.2% and 69.2%, respectively. CSAPV cutoff value for differentiating high-risk APE that maximized the accuracy was 102.6 mm (AUC = 0.634; 95% CI 0.525-0.743); its sensitivity and specificity were 61.9% and 53.8%, respectively.

Conclusions: There is a negative correlation between the CSAPV and thrombotic material burden in the pulmonary arteries of patients with APE. Hence, the CSAPV can be used as a diagnostic tool in the evaluation of the presence and severity of pulmonary embolism.
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http://dx.doi.org/10.1007/s11547-019-01119-4DOI Listing
March 2020

Comparison of skeletal muscle mass loss in patients with metastatic colorectal cancer treated with regorafenib or TAS-102.

J BUON 2019 Sep-Oct;24(5):2198-2204

Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Turkey.

Purpose: To assess whether regorafenib and TAS-102 treatments are associated with a change in Skeletal Muscle Area (SMA) as well as to compare Skeletal Muscle Mass (SMM) loss levels between regorafenib and TAS-102 treatments and prognostic significance in the patients with metastatic colorectal cancer (mCRC).

Methods: A total of 36 mCRC patients, who received regorafenib or TAS-102 in the third-line and subsequent settings were assessed in the analysis. SMM changes were assessed with CT scans findings, and they were categorized into two groups as SMM-loss (SMM decrease ≥2%) and SMM-stable (SMM change <2%).

Results: The SMM change after regorafenib therapy was significantly worse compared with TAS-102 therapy (p=0.001). The median overall survival (OS) was longer in SMM-stable group than in SMM-loss group (12.8 months; 95%CI:9.8-15.7) vs. 6.4 months; 95%CI:5.2-7.7, respectively;p=0.04). Cox regression analysis showed that SMM loss was independent prognostic indicator for OS (HR, 2.87; 95%CI: 1.07-7.42, p=0.03).

Conclusion: Although patients who received regorafenib had more SMM loss than those who received TAS-102, there was no difference in OS between drugs.
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April 2020

Cardiac Magnetic Resonance Imaging and Transthoracic Echocardiography: Investigation of Concordance between the Two Methods for Measurement of the Cardiac Chamber.

Medicina (Kaunas) 2019 Jun 9;55(6). Epub 2019 Jun 9.

Department of Biostatistics and Medical Informatics, School of Medicine, Trakya University, Edirne 22030, Turkey.

Cardiac magnetic resonance (CMR) imaging is the gold standard method for the detection of ventricular volumes and myocardial edema/scar. Transthoracic echocardiography (TTE) imaging is primarily used in the evaluation of cardiac functions and chamber dimensions. This study aims to investigate whether the chamber diameter measurements are concordant with each other in the same patient group who underwent TTE and CMR. The study included 41 patients who underwent TTE and CMR imaging. Ventricular and atrial diameter measurements from TTE-derived standard parasternal long axis and apical four-chamber views and CMR-derived three- and four-chamber views were recorded. The concordance between the two methods was compared using intra-class correlation coefficients (ICC) and Bland-Altman plots. Of the patients, 25 (61%) were male and the mean age was 48.12 ± 16.79. The mean ICC for LVDD between CMR observers was 0.957 (95% CI: 0.918-0.978), while the mean ICC between CMR and TTE measurements were 0.849 (95% CI: 0.709-0.922) and 0.836 (95% CI: 0.684-0.915), respectively. The mean ICC for the right ventricle between CMR observers was 0.985 (95% CI: 0.971-0.992), while the mean ICC between CMR and TTE measurements were 0.869 (95% CI: 0.755-0.930) and 0.892 (95% CI: 0.799-0.942), respectively. Passing-Bablok Regression and Bland-Altman plots indicated high concordance between the two methods. TTE and CMR indicated high concordance in chamber diameter measurements for which the CMR should be considered in patients for whom optimal evaluation with TTE could not be performed due to their limitations.
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http://dx.doi.org/10.3390/medicina55060260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631713PMC
June 2019

Three-dimensional transesophageal echocardiography vs cardiac magnetic resonance in the assessment of planimetric mitral valve area in rheumatic mitral stenosis.

Echocardiography 2018 10 7;35(10):1621-1625. Epub 2018 Jul 7.

Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Aim: Rheumatic heart disease is a common cause of valvular disease, especially in developing countries. Echocardiography is the gold standard investigation modality for cardiac valves. In rheumatic mitral stenosis (MS), three-dimensional transesophageal echocardiography (3D TEE) provides better alignment of the image plane at the mitral tips and more accurate and reproducible planimetric measurement of mitral valve area (MVA). Cardiac magnetic resonance (CMR) is a new method that provides evaluation of cardiac anatomy and function noninvasively. Previous studies showed strong correlation between planimetric MVA measured by two-dimensional transthoracic echocardiography and CMR. We aimed to compare the planimetric MVAs assessed by 3D TEE and CMR in rheumatic MS patients. To best of our knowledge, this is the first study that compares 3D TEE and CMR for the assessment of the planimetric MVA in rheumatic MS.

Methods: We retrospectively evaluated 28 rheumatic MS patients who underwent 3D TEE and ECG-gated CMR. 3D TEE planimetric MVAs were measured manually by multiplanar reconstruction (MPR) method and CMR planimetric MVAs were measured manually on short-axis cine images. Then, 3D TEE and CMR measurements were compared.

Results: A total of 28 patients' (mean age 44 ± 12, 82.1% female) planimetric 3D TEE MVAs (1.00 ± 0.20 cm ) and CMR MVAs (1.04 ± 0.17 cm ) were found to be highly correlated (P < 0.0001, r: 0.744) with Pearson correlation analysis. Bland-Altman analysis showed strong agreement between two techniques.

Conclusion: For the diagnosis and the follow-up of rheumatic MS, planimetric CMR MVA is an alternative noninvasive method which highly correlates with planimetric 3D TEE MVA.
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http://dx.doi.org/10.1111/echo.14096DOI Listing
October 2018

An unusual cause of chest pain: An isolated huge cardiac hydatid cyst.

J Clin Ultrasound 2018 May 27;46(4):262-264. Epub 2017 Jun 27.

Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Hydatid disease is a human parasitic infection caused by the larval stage of Echinococcus granulosus. The most common locations for hydatid cysts are the liver and lungs. Cardiac involvement is rare, and isolated cardiac hydatid cysts are even more unusual. We report the case a 48-year-old female patient with an isolated huge cardiac hydatid cyst involving both the left ventricular free wall and the pericardium, and presenting with atypical chest pain. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:262-264, 2018.
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http://dx.doi.org/10.1002/jcu.22518DOI Listing
May 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

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

The relationship between location-specific epicardial adipose tissue volume and coronary atherosclerotic plaque burden in type 2 diabetic patients.

Kardiol Pol 2017 13;75(3):204-212. Epub 2016 Dec 13.

Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Background And Aim: Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in the pathogenesis of coronary atherosclerosis. Due to its asymmetrical distribution, the relation between location-specific EAT measurements and coronary atherosclerosis remains unclear. Our study investigated the relationship between location-specific EAT volume and coronary atherosclerotic plaque burden that was detected by coronary computed tomography angiography (CCTA) in type 2 diabetic patients without coronary artery disease (CAD) history.

Methods: A total of 157 consecutive diabetic patients who had undergone CCTA were included retrospectively. After evaluation of the CCTA images, the study population was divided into two groups according to the presence of coronary atherosclerosis. In both groups, total and left atrioventricular groove EAT volumes were measured.

Results: Total and left atrioventricular groove EAT volumes were significantly associated with coronary atherosclerosis, but only left atrioventricular groove EAT volumes were an independent predictor for CAD. Also, total and left atrioventricular groove EAT volumes were positively correlated with C-reactive protein values (p = 0.0001/p = 0.0001) and the number of coronary atherosclerotic segments (p = 0.0001/p = 0.0001).

Conclusions: Left atrioventricular groove EAT volume is an independent predictor of CAD in type 2 diabetic patients without CAD history. Left atrioventricular groove EAT volume may be used to identify type 2 diabetic patients who may require early CAD intervention because of the potential risk of coronary atherosclerosis.
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http://dx.doi.org/10.5603/KP.a2016.0167DOI Listing
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

Evaluation of the Tibial Nerve with Shear-Wave Elastography: A Potential Sonographic Method for the Diagnosis of Diabetic Peripheral Neuropathy.

Radiology 2017 Feb 19;282(2):494-501. Epub 2016 Sep 19.

From the Departments of Radiology (A.S.D., F.E.U., S.B., O.K., I.M., F.K.) and Neurology (S.D., M.N., B.K., N.U.), Istanbul University, Cerrahpasa Medical School, 34300-Kocamustafapasa, Istanbul, Turkey.

Purpose To evaluate the value of shear-wave elastography (SWE) in the detection of diabetic peripheral neuropathy (DPN) of the tibial nerve. Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from all study participants. The study included 20 diabetic patients with DPN (10 men, 10 women), 20 diabetic patients without DPN (eight men, 12 women), and 20 healthy control subjects (nine men, 11 women). The tibial nerve was examined at 4 cm proximal to the medial malleolus with gray-scale ultrasonography and SWE. The nerve cross-sectional area (in square centimeters) and the mean nerve stiffness (in kilopascals) within the range of the image were recorded. Inter- and intrareader variability, differences among groups, and correlation of clinical and electrophysiologic evaluation were assessed with intraclass correlation coefficients, the Mann Whitney U test, and the Wilcoxon signed rank test. Results Between diabetic patients with and diabetic patients without DPN, mean age (60 years [range, 38-79 years] vs 61 years [range, 46-75 years], respectively), mean duration of diabetes (10 years [range, 1-25 years] vs 10 years [range, 2-26 years]), and mean body mass index (31.4 kg/m [range, 24.7-48.1 kg/m] vs 29.8 kg/m [range, 22.9-44.0 kg/m]) were not significantly different. Diabetic patients without DPN had significantly higher stiffness values on the right side compared with control subjects (P < .001). Patients with DPN had much higher stiffness values on both sides compared with both diabetic patients without DPN (P < .001) and healthy control subjects (P < .001). A cutoff value of 51.0 kPa at 4 cm proximal to the medial malleolus revealed a sensitivity of 90% (95% confidence interval [CI]: 75.4%, 96.7%) and a specificity of 85.0% (95% CI: 74.9%, 91.7%). Conclusion Tibial nerve stiffness measurements appear to be highly specific in the diagnosis of established DPN. The increased stiffness in subjects without DPN might indicate that the nerve is affected by diabetes. RSNA, 2016 Online supplemental material is available for this article.
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http://dx.doi.org/10.1148/radiol.2016160135DOI Listing
February 2017

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

A Rare Complication of Behcet's Disease: An Incidentally Detected and Spontaneously Thrombosed Sinus of Valsalva Aneurysm.

Ann Thorac Surg 2016 May;101(5):e171

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

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http://dx.doi.org/10.1016/j.athoracsur.2016.01.007DOI Listing
May 2016

Spinal epidural abscess as a complication of Crohn's disease.

Spine J 2016 Aug 25;16(8):e497-8. Epub 2016 Jan 25.

11. kisim, Yasemin Apt, D blok. Daire 35, 34158 Ataköy-Bakırkoy, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.spinee.2016.01.174DOI Listing
August 2016

Aneurysmal Bone Cyst of Sphenoid Bone and Clivus Misdiagnosed as Chordoma: A Case Report.

Brain Tumor Res Treat 2015 Oct 30;3(2):115-7. Epub 2015 Oct 30.

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

Aneurysmal bone cysts (ABCs) are benign and rapidly expanding bone destructive lesions of any bone. They are commonly localized in the metaphysis of long bones, whereas skull base ABCs are rare. We report a case of a 21-year-old man who had been misdiagnosed as chordoma and undergone surgery. However, histopathological examination revealed it to be an ABC.
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http://dx.doi.org/10.14791/btrt.2015.3.2.115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4656887PMC
October 2015

Shear wave elastography of placenta: in vivo quantitation of placental elasticity in preeclampsia.

Diagn Interv Radiol 2015 May-Jun;21(3):202-7

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

Purpose: We aimed to evaluate the utility of shear wave elastography (SWE) for assessing the placenta in preeclampsia disease.

Methods: A total of 50 pregnant women in the second or third trimester (23 preeclampsia patients and 27 healthy control subjects) were enrolled in the study. Obstetrical grayscale and Doppler ultrasonography, SWE findings of placenta, and prenatal/postnatal clinical data were analyzed and the best SWE cutoff value which represents the diagnosis of preeclampsia was determined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of preeclampsia were calculated based on SWE measurements.

Results: Mean stiffness values were much higher in preeclamptic placentas in all regions and layers than in normal controls. The most significant difference was observed in the central placental area facing the fetus where the umbilical cord inserts, with a median of 21 kPa (range, 3-71 kPa) for preeclampsia and 4 kPa (range, 1.5-14 kPa) for the control group (P < 0.01). The SWE data showed a moderate correlation with the uterine artery resistivity and pulsatility indices. The cutoff value maximizing the accuracy of diagnosis was 7.35 kPa (area under curve, 0.895; 95% confidence interval, 0.791-0.998); sensitivity, specificity, PPV, NPV, and accuracy were 90%, 86%, 82%, 92%, and 88%, respectively.

Conclusion: Stiffness of the placenta is significantly higher in patients with preeclampsia. SWE appears to be an assistive diagnostic technique for placenta evaluation in preeclampsia.
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http://dx.doi.org/10.5152/dir.2014.14338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463268PMC
February 2016

Ductal Carcinoma In Situ Detected by Shear Wave Elastography within a Fibroadenoma.

J Breast Cancer 2014 Jun 27;17(2):180-3. Epub 2014 Jun 27.

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

Fibroadenoma is the most common breast tumor in women. Malignant transformation occurs rarely within fibroadenoma at older ages. Clinicians, radiologists, and pathologists need to be aware of malignant transformation within fibroadenomas. Radiologic studies play an important role in the diagnosis of fibroadenoma; however, radiologic findings are often nonspecific for malignancy and may appear completely benign. We detected an occult ductal carcinoma in situ that originated inside a fibroadenoma by using shear wave elastography. We report shear wave elastography findings of ductal carcinoma in situ within fibroadenoma and discuss the diagnostic role of this modality.
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http://dx.doi.org/10.4048/jbc.2014.17.2.180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090322PMC
June 2014

Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome.

Eur Radiol 2014 Feb 25;24(2):434-40. Epub 2013 Sep 25.

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

Objectives: To measure the median nerve (MN) stiffness by quantitative shear wave elastography (SWE) at the carpal tunnel inlet and to determine whether SWE can be used in the diagnosis of carpal tunnel syndrome (CTS).

Methods: The study included 37 consecutive patients (60 wrists) with a definitive diagnosis of CTS and 18 healthy volunteers (36 wrists). The MN cross-sectional area (CSA) by ultrasound and stiffness by SWE were studied. The difference between CTS patients and controls, and the difference among subgroups based on electrodiagnostic tests were studied by the Student's t test. Interobserver variability and ROC analysis were performed.

Results: The MN stiffness was significantly higher in the CTS group (66.7 kPa) when compared to controls (32.0 kPa) (P < 0.001), and higher in the severe or extreme severity group (101.4 kPa) than the mild or moderate severity group (55.1 kPa) (P < 0.001). A 40.4-kPa cut-off value on SWE revealed sensitivity, specificity, PPV, NPV and accuracy of 93.3%, 88.9%, 93.3%, 88.9% and 91.7%, respectively. Interobserver agreement was excellent for SWE measurements.

Conclusions: Median nerve stiffness at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom shear wave elastography appears to be a highly reproducible diagnostic technique.

Key Points: • Clinical examination is important for diagnosis of carpal tunnel syndrome • Shear wave elastography (SWE) offers new clinical opportunities within diagnostic ultrasound • SWE is highly reproducible in evaluation of median nerve stiffness • Median nerve stiffness is significantly increased in carpal tunnel syndrome • Elastography could become useful in diagnosis of carpal tunnel syndrome.
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http://dx.doi.org/10.1007/s00330-013-3023-7DOI Listing
February 2014