Publications by authors named "Gamze Durhan"

25 Publications

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Errors, discrepancies and underlying bias in radiology with case examples: a pictorial review.

Insights Imaging 2021 Apr 20;12(1):51. Epub 2021 Apr 20.

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

Interpretation differences between radiologists and diagnostic errors are significant issues in daily radiology practice. An awareness of errors and their underlying causes can potentially increase the diagnostic performance and reduce individual harm. The aim of this paper is to review both the classification of errors and the underlying biases. Case-based examples are presented and discussed for each type of error and bias to provide greater clarity and understanding.
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http://dx.doi.org/10.1186/s13244-021-00986-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056102PMC
April 2021

Subcutaneous Fat Tissue: Which Region Is More Appropriate for the Measurement?

Authors:
Gamze Durhan

Ann Am Thorac Soc 2021 Feb 24. Epub 2021 Feb 24.

Hacettepe University, 37515, Department of Radiology, Ankara, Turkey;

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http://dx.doi.org/10.1513/AnnalsATS.202101-054LEDOI Listing
February 2021

Magnetic resonance imaging findings of invasive breast cancer in different histological grades and different histopathological types.

Clin Imaging 2021 Feb 10;76:98-103. Epub 2021 Feb 10.

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

Background: The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of invasive breast cancer in different histopathological types (invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) and mixed ductal-lobular carcinoma (MDLC)) and different histological grades.

Methods: A retrospective review was made of 1256 patients who underwent breast MRI at our hospital between January 2015 and December 2018. A total of 152 lesions (27 ILC, 102 IDC, 23 MDLC and 20 grade 1, 83 grade 2 and 49 grade 3) were included in the study. All the lesions were evaluated according to size, shape, margin, dynamic curve, ADC value and T2 signal intensity ratio (SIR).

Results: Most of the lesions tended to show type 2 and type 3 dynamic curve, type 1 dynamic curve was more commonly seen in ILC and grade 1 groups. IDC showed higher T2 SIR than the other types and grade 3 showed higher T2 SIR than other grades (p< 0,05) There was no statistically significant difference between the groups according to morphological features and mean ADC values (p > 0,05).

Conclusion: T2 SIR and dynamic curve can help the radiologists predict histopathological findings while morphological features and ADC values were not helpful in distinguishing histological types and grades.
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http://dx.doi.org/10.1016/j.clinimag.2021.01.039DOI Listing
February 2021

Predictors of mortality in rheumatoid arthritis-associated lung disease: A retrospective study on ten years.

Joint Bone Spine 2021 05 20;88(3):105133. Epub 2021 Jan 20.

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey. Electronic address:

Objectives: Rheumatoid arthritis (RA)-associated lung involvement is a cause of mortality. This study aimed to evaluate mortality rate and mortality-associated factors in RA patients with high-resolution computed tomography (HRCT)-proven lung involvement.

Methods: Patients followed-up for RA between 2010 and 2018 were evaluated regarding HRCT-proven lung involvement. The present study was designed as a single-centre, retrospective and descriptive study. The HRCT reports of patients were re-evaluated for three major patterns: UIP, nonspecific interstitial pneumonia (NSIP), and isolated airway disease (AD). Mortality rates and its associated factors (demographic characteristics, RA-related factors and lung-involvement-related factors) were determined.

Results: The study included 156 patients (females, 68.3%) with radiologically confirmed RA-associated lung disease. The mean age was 55.5 (12.1) years at RA diagnosis and 62.7 (9.7) years at the diagnosis of lung involvement. The patterns of lung involvement on HRCT were UIP in 89 (57.0%) patients, NSIP in 51 (32.7%) patients, and isolated AD in 16 (10.3%) patients. The RA patients were followed-up for a mean of 10.2 (7.4) years and they were followed-up for a mean of 4.5 (3.7) years after interstitial lung disease (ILD) diagnosis. Overall, 40 (25.6%) patients died. The 5-year survival rate was 78%. Multivariate analysis revealed UIP pattern (log-rank test, P<0.01), pleural effusion (log-rank test, P<0.05), and a shorter time interval (<3 years) between the diagnoses of RA and RA-ILD (log-rank test, P<0.01) to be independent predictors of mortality.

Conclusions: In addition to the UIP, a known risk factor, pleural effusion and the short time between the diagnoses of RA and ILD were also found to be associated with mortality.
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http://dx.doi.org/10.1016/j.jbspin.2021.105133DOI Listing
May 2021

Does Internal Mammary Node Irradiation for Breast Cancer Make a Significant Difference to the Diameter of the Internal Mammary Artery? Correlation with Computed Tomography.

Breast Care (Basel) 2020 Dec 22;15(6):635-641. Epub 2020 Jun 22.

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

Objective: Lymphatic irradiation in breast cancer improves locoregional control and has been shown to decrease distant metastasis. However, irradiation also accelerates the formation of atherosclerosis and can cause stenosis, not only in the coronary arteries but also in the internal mammary artery (IMA). The aim of this study was to investigate the effects of radiation on IMAs via computed tomography (CT).

Methods: We reviewed the data of 3,612 patients with breast cancer treated with radiotherapy (RT) between January 2010 and December 2016. We included 239 patients with appropriate imaging and nodal irradiation in the study. All patients were treated with lymphatic irradiation of 46-50 Gy, and a boost dose (6-10 Gy) to the involved internal mammary nodes (IMNs) when imaging studies demonstrated pathological enlargement. Bilateral IMA diameter and the presence of calcification were assessed via thin contrast-enhanced CT and those of ipsilateral irradiated IMAs were compared with those of contralateral nonirradiated IMAs.

Results: The mean diameter of irradiated IMAs was significantly shorter than that of nonirradiated IMAs, regardless of laterality. All vascular calcifications were determined on the irradiated side. A boost dose of radiation to the IMNs and radiation technique did not significantly affect the IMA diameter or the presence of calcification.

Conclusions: The diameter of the IMA is decreased due to RT regardless of laterality, radiation technique, and administration of a boost dose. Evaluation of vessels on CT before coronary artery bypass graft or flap reconstruction can help the surgeon select the most appropriate vessel.
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http://dx.doi.org/10.1159/000508244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768163PMC
December 2020

COVID-19 pneumonia: the great radiological mimicker.

Insights Imaging 2020 Nov 23;11(1):118. Epub 2020 Nov 23.

Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although the reference diagnostic test is a real-time reverse transcription-polymerase chain reaction (RT-PCR), chest-computed tomography (CT) has been frequently used in diagnosis because of the low sensitivity rates of RT-PCR. CT findings of COVID-19 are well described in the literature and include predominantly peripheral, bilateral ground-glass opacities (GGOs), combination of GGOs with consolidations, and/or septal thickening creating a "crazy-paving" pattern. Longitudinal changes of typical CT findings and less reported findings (air bronchograms, CT halo sign, and reverse halo sign) may mimic a wide range of lung pathologies radiologically. Moreover, accompanying and underlying lung abnormalities may interfere with the CT findings of COVID-19 pneumonia. The diseases that COVID-19 pneumonia may mimic can be broadly classified as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). We summarize the imaging findings of COVID-19 and the aforementioned lung pathologies that COVID-19 pneumonia may mimic. We also discuss the features that may aid in the differential diagnosis, as the disease continues to spread and will be one of our main differential diagnoses some time more.
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http://dx.doi.org/10.1186/s13244-020-00933-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681181PMC
November 2020

Radiological manifestations of thoracic hydatid cysts: pulmonary and extrapulmonary findings.

Insights Imaging 2020 Nov 11;11(1):116. Epub 2020 Nov 11.

Department of Radiology, Hacettepe University Faculty of Medicine, 06410, Ankara, Turkey.

Hydatid cyst caused by the larval form of Echinococcus is a worldwide zoonosis. The lungs and liver are the most common sites involved. While the lung parenchyma is the most common site within the thorax, it may develop in any extrapulmonary region including the pleural cavity, fissures, mediastinum, heart, vascular structures, chest wall, and diaphragm. Imaging plays a pivotal role not only in the diagnosis of hydatid cyst, but also in the visualization of the extent of involvement and complications. The aim of this pictorial review was to comprehensively describe the imaging findings of thoracic hydatid cyst including pulmonary and very unusual extrapulmonary involvements. An outline is also given for the findings of complications and differential diagnosis of thoracic hydatid cyst.
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http://dx.doi.org/10.1186/s13244-020-00916-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658283PMC
November 2020

Correlation of thrombosed vessel location and clot burden score with severity of disease and risk stratification in patients with acute pulmonary embolism.

Anatol J Cardiol 2020 10;24(4):247-253

Departments of Chest Diseases, Faculty of Medicine, Hacettepe University; Ankara-Turkey.

Objective: Computed tomography pulmonary angiography (CTPA) is used for the main diagnosis in acute pulmonary embolism (APE). Determining the thrombus location in the pulmonary vascular tree is also important for predicting disease severity. This study aimed to analyze the correlation of the thrombus location and the clot burden with the disease severity and the risk stratification in patients with APE.

Methods: The study included patients with APE diagnosed by CTPA who were admitted to the hospital between January 28, 2016, and July 1, 2019. Data collected were markers of severity in APE, including patient demographics, comorbidities, length of hospital stay, pulmonary embolism severity index (PESI) score, modified PESI score, Wells score, risk stratification according to the American Heart Association, systolic blood pressure (SBP), right ventricle diameter to left ventricle diameter ratio, pulmonary arterial pressure, brain natriuretic peptide, troponin, D-dimer, and plasma lactate levels, and vessel location of the thrombus, clot burden score, ratio of the pulmonary artery trunk diameter/aortic diameter, superior vena cava diameter (SVC) by CTPA, and survival. All parameters were analyzed in correlation with clot load and vessel location.

Results: Thrombus vascular location was found to be correlated with risk stratification and negatively correlated with SBP. Simplified Mastora score was correlated with risk stratification, SVC diameter, and D-dimer and negatively correlated with SBP. Occlusion of both the pulmonary artery trunk and any pulmonary artery with thrombus was associated with massive APE.

Conclusion: The level of the occluded vessel on CTPA may provide the ability to risk-stratify, and the clot burden score may be used for assessing both risk stratification and cardiac strain.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.55013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585957PMC
October 2020

Visual and software-based quantitative chest CT assessment of COVID-19: correlation with clinical findings.

Diagn Interv Radiol 2020 Nov;26(6):557-564

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

Purpose: The aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data.

Methods: Patients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU).

Results: A total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP <82.45% (sensitivity, 83.1%; specificity, 84.2%) were related to severe pneumonia, VQAS >9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia.

Conclusion: Both SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia.
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http://dx.doi.org/10.5152/dir.2020.20407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664745PMC
November 2020

Lung and kidney perfusion deficits diagnosed by dual-energy computed tomography in patients with COVID-19-related systemic microangiopathy.

Eur Radiol 2021 Feb 29;31(2):1090-1099. Epub 2020 Aug 29.

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

Objectives: There is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction.

Methods: Thirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs).

Results: DECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03).

Conclusions: We found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies.

Key Points: • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients.
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http://dx.doi.org/10.1007/s00330-020-07155-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455509PMC
February 2021

Imaging findings and classification of the common and uncommon male breast diseases.

Insights Imaging 2020 Feb 18;11(1):27. Epub 2020 Feb 18.

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

Male breast hosts various pathological conditions just like "female breast." However, histo-anatomical diversities with female breast lead to many differences regarding the frequency and presentation of diseases, the radiologic appearance of lesions, the diagnostic algorithm, and malignity features.Radiological modalities may play an important role in evaluating male breast lesions. Although some imaging findings are non-specific, having knowledge of certain imaging characteristics and radiologic patterns is the key to reduce the number of differential diagnoses or to reach an accurate diagnosis.Male breast imaging is mostly based on physical examination and is required for the complaints of palpable mass, breast enlargement, tenderness, nipple discharge, and nipple-skin changes. The majority of the male breast lumps are benign and the most common reason is gynecomastia. Although it is difficult to exclude malignancy in some cases, gynecomastia often has distinguishable imaging features. Pseudogynecomastia is another differential diagnosis that may be confused with gynecomastia. The distinction is important for the treatment plan.Apart from gynecomastia, other male breast lesions form a highly heterogeneous group and can be classified based on "Tissue origin," "Histopathological type and behavior," and "Radiologic features" for both simplification and comprehensive understanding.This article mainly focuses on emphasizing the results of basic histo-anatomical differences of male and female breasts, classifying male breast lesions, covering the spectrum of male breast diseases, and assisting radiologists in recognizing the imaging findings, in interpreting them through a holistic approach, in making a differential diagnosis, and in being a part of proper patient management.
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http://dx.doi.org/10.1186/s13244-019-0834-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028902PMC
February 2020

Can Radiologist and Pathologist Reach The Truth Together in The Diagnosis of Benign Fibroepithelial Lesions?

Eur J Breast Health 2019 Jul 1;15(3):176-182. Epub 2019 Jul 1.

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

Objective: Benign fibroepithelial lesions (BFL) lesions of the breast are various and predominantly benign, although a few can be locally aggressive. Definitive diagnosis of some BFL can be challenging from core needle biopsy (CNB). Radiological findings can help guide the management of the lesions. The aim of this study was to investigate the accuracy rate of CNB results and evaluate the radiological findings of the most common BFL according to the final excision pathology results. The secondary aim was to assess the contribution of the imaging findings to CNB results.

Materials And Methods: A retrospective review was made of 266 patients diagnosed with suspicious BFL, conventional fibroadenoma, complex fibroadenoma, cellular fibroadenoma and benign phyllodes tumor (PT). The study included 132 patients who underwent surgical excision. The radiological and histopathological findings were evaluated.

Results: While 66 patients were diagnosed with more descriptive results on CNB, the other 66 patients were diagnosed with suspicious BFL. Agreement between CNB and excisional pathology was good, when CNB provided a definite diagnosis. While conventional and complex fibroadenoma were observed to have hypo or normal vascularity, cellular fibroadenoma and PT showed hypervascularity. Oval shaped and homogeneous internal echo pattern were significantly associated with conventional fibroadenoma. A heterogeneous internal echo pattern was seen in complex fibroadenomas and PT.

Conclusion: CNB often reaches the correct diagnosis alone when it gives a definite diagnosis. The radiological findings which help in the differentiation of BFL are hypervascularity, oval shape and internal heterogeneity. More accurate results can be obtained when histopathological and radiological findings are evaluated together.
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http://dx.doi.org/10.5152/ejbh.2019.4656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619778PMC
July 2019

Imaging Findings and Clinicopathological Correlation of Breast Cancer in Women under 40 Years Old.

Eur J Breast Health 2019 Jul 1;15(3):147-152. Epub 2019 Jul 1.

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

Objective: The aim of this study was to evaluate the clinical, imaging and histopathological features of breast cancer in patients aged under 40 years of age. The relationship between radiological characteristics and histopathological features was also investigated.

Materials And Methods: The study included 131 patients aged under 40 years, diagnosed pathologically with breast cancer. A retrospective evaluation was made of the imaging and clinicopathological findings and the relationship between pathological and imaging findings was investigated.

Results: Most of the cancers were detected from clinical symptoms, especially a palpable mass (76.3%). The most common histological type of tumor was invasive ductal carcinoma and 64.8% of the tumors were high grade tumors. The predominant features were irregular borders (92.4%), microlobulated-angulated contours (43.5%), hypo-homogeneous internal echogenicity (80.9%) on ultrasonography, and the presence of a mass (41.2%) and suspicious microcalcifications (40.2%) on mammography. Magnetic resonance imaging commonly showed mass enhancement (66.7%) with type 2 or 3 dynamic curve (92.6%). High-grade tumors were associated with posterior acoustic enhancement (p: 0.03) while low-grade tumors presented with spiculated margins more than high grade tumors (p: 0.04).

Conclusion: Breast cancer in women aged under 40 years usually presents with a self-detected palpable mass and can show different imaging findings according to the histological grade. Ultrasonography is the main modality for the diagnosis of breast cancer in young women, but mammography and magnetic resonance imaging can help in both diagnosis and evaluation of the extent of disease.
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http://dx.doi.org/10.5152/ejbh.2019.4606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619779PMC
July 2019

Comparison of MRI and US in Tumor Size Evaluation of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

Eur J Breast Health 2019 Apr 1;15(2):119-124. Epub 2019 Apr 1.

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

Objective: Magnetic resonance imaging (MRI) and ultrasonography (US) are commonly used in the pre-surgery determination of tumor size and the follow-up of breast cancer patients treated with neoadjuvant chemotherapy (NAC). The aim of this study was to compare the efficiency of preoperative MRI and US in tumor size evaluation of patients with breast cancer after NAC to guide clinicians on the appropriate treatment plan.

Materials And Methods: The study included a total of 75 patients who had undergone radiological follow-up, surgical treatment and pathological examination in our hospital between 2013 and 2016. Of these, 28 patients were followed-up with MRI and 47 with US. The dimension evaluations in pathology examination and on both MRI and US were based on the longest dimension of the tumor.

Results: There was no statistically significant difference between the tumor size measured pathologically and the size measured preoperatively on MRI (p=0.379). The tumor size measured on US before surgery was significantly smaller than the size measured in pathology (p=0.004). MRI did not overestimate by more than 10 mm in any patient, whereas US overestimated in 4 patients (8.6%). The correlation coefficient of MRI was higher than that of US (0.927 and 0.687, respectively).

Conclusion: MRI is superior to US in preoperative tumor size evaluation of patients receiving NAC.
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http://dx.doi.org/10.5152/ejbh.2019.4547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456278PMC
April 2019

Regression in local recurrence in the contralateral breast following mastectomy in bilateral locally advanced breast cancer: A comparison of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios.

Turk J Surg 2018 3;34(2):140-142. Epub 2018 Jan 3.

Department of General Surgery and Surgical Oncology, Ankara University School of Medicine, Ankara, Turkey.

The neutrophil-to-lymphocyte ratio is clinically accepted as a marker of systemic inflammatory response. In breast cancer patients, neutrophil-to-lymphocyte ratio can be used as an important prognostic indicator of survival. In routine laboratory tests, the platelet-to-lymphocyte ratio can also be examined in addition to neutrophil-to-lymphocyte ratio. Although the effects on breast cancer survival of platelet-to-lymphocyte ratio, which is accepted as the twin of neutrophil-to-lymphocyte ratio, are not as widely accepted as those of neutrophil-to-lymphocyte ratio, platelet activation is known to be a feature of cancer. Here, we present the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of a patient with locally advanced cancer of the left breast who underwent a simple mastectomy that reduced the tumor load. Following surgical therapy, a remarkable regression was observed in the local recurrence area of the right mastectomy site; at the same time, the patient's neutrophil-to-lymphocyte ratio and PLR values significantly decreased.
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http://dx.doi.org/10.5152/UCD.2016.3214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048647PMC
January 2018

Do Histopathological Features and Microcalcification Affect the Elasticity of Breast Cancer?

J Ultrasound Med 2017 Jun 27;36(6):1101-1108. Epub 2017 Feb 27.

Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.

Objectives: The aim of this study was to evaluate any association between histological grade, molecular subtypes of breast cancer, and strain elastography, and to investigate whether microcalcification affects the stiffness of tumor in breast cancers with the same histological grade.

Methods: Between April 2015 and March 2016, 94 lesions of 94 patients with the diagnosis of invasive ductal carcinoma were included in the study. Strain elastography was performed on all patients before biopsy. Histological grades (Grades 1, 2, and 3), molecular subtypes (luminal A, luminal B, Her-2, and basal-like), and strain ratio (SR) were compared. In the same histological grades, patients were divided into two groups according to the presence of microcalcifications, and the groups were compared with each other.

Results: Compared with Grades 1 (20.5) and 2 (23.7), Grade 3 (11.7) showed lower SR values (Grade 3-2, P = .01; Grade 3-1, P = .2). The groups with microcalcification had slightly higher SR in all histological grades, but not of statistical significance. In molecular subtypes, luminal A and B demonstrated higher SR, whereas HER2 and basal-like had lower SR (P > .05 for all group comparisons).

Conclusions: Grade 3 invasive ductal carcinomas are different from other grades with lower SR values. The presence of microcalcifications and molecular subtypes do not affect elasticity like a high histological grade does.
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http://dx.doi.org/10.7863/ultra.16.06064DOI Listing
June 2017

Imaging Findings in Patients with Granulomatous Mastitis.

Iran J Radiol 2016 Jul 31;13(3):e33900. Epub 2016 May 31.

Pathology Department, Ankara Training and Research Hospital, Ankara, Turkey.

Background: Granulomatous mastitis (GM) is a rare inflammatory breast disease that may mimic the clinical characteristics and radiologic imaging findings of breast carcinoma. Considering the importance of making a correct diagnosis, careful radiologic evaluations and recognition of imaging features are necessary.

Objectives: The aim of this study was to review the radiological findings and diagnostic value of the imaging in GM.

Patients And Methods: This retrospective study involved a total of 29 patients who were diagnosed with GM between 2009 and 2013 and who underwent mammography (MG) and/or ultrasound (US) examination in addition to magnetic resonance imaging (MRI) before diagnosis.

Results: Among 14 patients over 35 years of age who underwent MG imaging, focal asymmetric, ill-defined nodular, or diffusely increased densities were detected in nine (64.3%), two (14.3%), and one (7.1%) subjects, respectively, while there were no pathological findings in two (14.3%) patients. In the overall group of 29 patients, US showed heterogeneous hypoechoic lesions with tubular extensions in 16 (55.2%), well-demarcated heterogeneous hypoechoic lesions in eight (27.6%), parenchymal heterogeneous appearance in three (10.3%), and a heterogeneous hypoechoic lesion with irregular margins in one (3.4%), with another (3.4%) patient having normal US findings. MRI findings included lesions consistent with solitary or multiple separate or confluent abscesses with marked peripheral ring enhancement in 25 (86.2%) patients, accompanied by intensity changes suggesting edematous inflammation in the peripheral parenchyma, as well as non-mass-like heterogeneous segmental and regional contrast enhancement. Four (13.8%) patients had non-mass-like segmental and regional contrast enhancement only. A histopathological diagnosis of GM was established in all patients with biopsy.

Conclusion: GM presents with a wide range of conventional radiological findings, hampering the diagnosis. In patients with inconclusive conventional findings, MRI may assist in the differential diagnosis and assessment of the extent of disease. However, a definitive diagnosis and relevant treatment require histopathological confirmation.
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http://dx.doi.org/10.5812/iranjradiol.33900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107257PMC
July 2016

Placental Elasticity and Histopathological Findings in Normal and Intra-Uterine Growth Restriction Pregnancies Assessed with Strain Elastography in Ex Vivo Placenta.

Ultrasound Med Biol 2017 01 12;43(1):111-118. Epub 2016 Oct 12.

Department of Obstetrics and Gynecology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.

The aim of this study was to investigate the differences of placental elasticity between intra-uterine growth restriction (IUGR) and normal pregnancies to show whether or not there is any association between histopathological changes and placental elasticity. Fifty-five human placentas were collected at delivery, including 25 with IUGR and 30 controls. Strain elastography (SE) was performed ex vivo and all placentas were examined histopathologically. Elasticity index (EI) and histopathological findings were compared between groups. The placental stiffness and presence of histopathological changes were higher in the IUGR group than in controls (p < 0.05). Also, histopathological findings were associated with decreased EI values, but no specific patterns of histologic abnormalities were identified except villitis and delayed villous maturity. Distinct reduced placental elasticity could be the result of the cumulative effects of all the histologic findings in IUGR.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2016.08.037DOI Listing
January 2017

Influence of cigarette smoking on white matter in patients with clinically isolated syndrome as detected by diffusion tensor imaging.

Diagn Interv Radiol 2016 May-Jun;22(3):291-6

Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.

Purpose: Cigarette smoking has been associated with increased occurrence of multiple sclerosis (MS), as well as clinical disability and disease progression in MS. We aimed to assess the effects of smoking on the white matter (WM) in patients with clinically isolated syndrome (CIS) using diffusion tensor imaging.

Methods: Smoker patients with CIS (n=16), smoker healthy controls (n=13), nonsmoker patients with CIS (n=17) and nonsmoker healthy controls (n=14) were included. Thirteen regions-of-interest including nonenhancing T1 hypointense lesion and perilesional WM, and 11 normal-appearing white matter (NAWM) regions were drawn on color-coded fractional anisotropy (FA) maps. Lesion load was determined in terms of number and volume of WM hyperintensities.

Results: A tendency towards greater lesion load was found in smoker patients. T1 hypointense lesions and perilesional WM had reduced FA and increased mean diffusivity to a similar degree in smoker and nonsmoker CIS patients. Compared with healthy smokers, smoker CIS patients had more extensive NAWM changes shown by increased mean diffusivity. There was no relationship between diffusion metrics and clinical disability scores, duration of the disease and degree of smoking exposure.

Conclusion: Smoker patients showed a tendency towards having greater number of WM lesions and displayed significantly more extensive NAWM abnormalities.
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http://dx.doi.org/10.5152/dir.2015.15415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859748PMC
May 2017

Spontaneous Isolated Celiac Artery and Superior Mesenteric Artery Dissections: A Rare Case.

Pol J Radiol 2015 13;80:470-2. Epub 2015 Oct 13.

Department of Radiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey.

Background: Arterial dissection is defined as the cleavage of the arterial wall by an intramural hematoma. Reports of dissection of the celiac and/or superior mesenteric artery are rare; as far as we know, only 24 cases of spontaneous isolated celiac trunk dissection, and 71 cases of spontaneous isolated superior mesenteric artery dissection have been reported.

Case Report: The case presents a 48-year-old male with a sudden-onset epigastric pain. A Computed Tomography Angiography of the thoracoabdominal aorta was applied and dissections of both the celiac artery and SMA were determined. A conservative therapeutic approach was preferred and the patient was discharged with anticoagulant and antihypertensive therapy.

Conclusions: Although rare, spontaneous isolated celiac artery and superior mesenteric artery dissections must be kept in mind in the differential diagnosis of the epigastric pain in the emergency room. Contrast-enhanced Computed Tomography Angiography examination is the method of choice in the diagnosis.
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http://dx.doi.org/10.12659/PJR.895048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610684PMC
November 2015

Assessment of the effect of cigarette smoking on regional brain volumes and lesion load in patients with clinically isolated syndrome.

Int J Neurosci 2016 Sep 13;126(9):805-811. Epub 2015 Aug 13.

c 3 National Magnetic Resonance Research Center (UMRAM) , Bilkent University , Ankara , Turkey.

Purpose: Smoking has been associated with an increased risk of developing multiple sclerosis, disease progression and clinical disability. We detected the effects of smoking on regional brain volumes and lesion load in patients with clinically isolated syndrome using quantitative magnetic resonance imaging.

Materials And Methods: Smoker patients (n = 16), smoker healthy controls (n = 13), non-smoker patients (n = 17) and non-smoker healthy controls (n = 14) underwent magnetic resonance imaging and neocortical volumes were measured. Lesion load was calculated in terms of number and volume of white matter hyperintensities.

Results: Smoking was associated with increased gray matter volumes in several regions of the brain. A tendency towards greater lesion load in smoker patients was found. Smoking duration was significantly negatively correlated with intracranial volume and left hemisphere cortical gray matter volume. There was no relationship between regional brain volumes and clinical disability scores, lesion load duration of the disease and degree of smoking exposure.

Conclusions: Clinically isolated syndrome related regional brain atrophy might vary in extent and severity with smoking. Despite increased lesion load, less cortical and deep gray matter damage with a possible neuroprotective effect occurs in smoking.
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http://dx.doi.org/10.3109/00207454.2015.1073727DOI Listing
September 2016

Does coronary calcium scoring with a SCORE better predict significant coronary artery stenosis than without? Correlation with computed tomography coronary angiography.

Eur Radiol 2015 Mar 3;25(3):776-84. Epub 2014 Dec 3.

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

Objective: To determine effectiveness of coronary artery calcium score (CACS) alone and combined with Systematic Coronary Risk Evaluation (SCORE) in adult patients for significant coronary artery stenosis by using computed tomography coronary angiography (CTCA) as reference standard.

Methods: Two thousand twenty-one patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA. Patients were examined with dual-source CT and were grouped according to their age, gender, CACS, and estimated SCORE risk. Coronary plaque existence and degree of stenosis were assessed with CTCA. Sensitivity, specificity, and ROC curves were analyzed.

Results: CACS was the single independent variable in estimating relative risk of critical stenosis and had superior outcome when compared with SCORE risk in logistic regression and ROC curve. Area under the ROC curve was greatest in the interval between 50-59 years. When SCORE was combined with CACS in patients with zero CACS, percentage of significant stenosis increased from 1.4% to 7.0% in patients with high or very high SCORE risk, and decreased to 0.9 % in patients with low or moderate SCORE risk.

Conclusions: CACS combination with SCORE risk predicts coronary artery stenosis. When CACS is zero, CTCA can be performed in patients with high or very high SCORE risk.
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http://dx.doi.org/10.1007/s00330-014-3477-2DOI Listing
March 2015

Pyelolymphatic backflow demonstrated by an abdominal CT: A case report.

Pol J Radiol 2014 14;79:6-8. Epub 2014 Jan 14.

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

Background: Pyelolymphatic backflow phenomenon, which is a subtype of pyelorenal backflow, is a rare condition that occurs during the acute phase of urinary obstruction. Pyelorenal backflow has already been described in humans with retrograde pyelography. Our report presents a rare case of pyelolyphatic backflow demonstrated by a computed tomography.

Case Report: A 67-year-old man with a history of bladder carcinoma was admitted to the emergency department due to right-sided flank pain and hematuria. Hematuria resolved after insertion of a 3-way urinary catheter, but flank pain persisted. As a result, an abdominopelvic CT was performed. CT revealed numerous tiny, serpiginous tubular structures connected with each other and filled with urine. They began intrarenally and extended caudally surrounding the ureter in the retroperitoneum. Subsequently, the patient underwent an ultrasound-guided nephrostomy to decompress the collecting system of the right kidney. Antegrade pyelography revealed minimal hydroneprosis. However, no leakage from the ureter to the retroperitoneum was observed, proving that the changes demonstrated by a CT were due to pyelolymphatic reflux caused by increased pressure in the collecting tubules filling the lymphatics with opaque urine.

Conclusions: This report presents a very rare case of pyelolymphatic reflux demonstrated by a CT. We present this case report as a reminder that although rare, pyelolymphatic reflux can occur as a result of obstruction without manifestations of hydronephrosis and it can be confused with leakage from the ureter.
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http://dx.doi.org/10.12659/PJR.889930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905711PMC
January 2014

Mesenteric angiography of patients with gastrointestinal tract hemorrhages: a single center study.

Diagn Interv Radiol 2011 Dec 4;17(4):368-73. Epub 2011 Jan 4.

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

Purpose: This retrospective study was designed to investigate the transcatheter mesenteric angiography of patients with gastrointestinal (GI) bleeding and to determine the most important variables that should be monitored in patients with GI bleeding prior to transcatheter arteriography.

Materials And Methods: In this study, we evaluated the transcatheter mesenteric angiography results of patients with massive GI bleeding (defined as hypotension, tachycardia, and a greater than 4-unit blood transfusion requirement in 24 h) seen between 2005 and 2009. Detailed clinical follow-up and accessible hospital data from 45 procedures were examined from 42 patients (two procedures were performed in three patients) between 24 and 85 years old (mean age, 57.6 years). The present study included 33 males and 9 females. Angiography was performed for lower GI bleeding in 22 patients, upper GI bleeding in 15 patients, and upper/lower (multiple origins) GI bleeding in five patients. Imaging work-ups, including endoscopic interventions, and follow-ups with patients after the procedure were evaluated in detail. Several variables recorded prior to the procedure, including the clinical status, etiological cause of the bleeding, bleeding parameters (e.g., international normalized ratio, platelets), imaging workup, gender, season, and angiography time, were examined.

Results: Embolization was performed in 24 (53%) of the 45 procedures. Overall, the technical success rate of the diagnostic arteriograms was 100%, and no major complications occurred. For the embolizations, coils were used in 17 patients (70%), polyvinyl alcohol particles were used in six patients (25%), and n-butyl cyano-acrylate was used in one patient (4%). The detection rate of mesenteric arteriographies to examine GI bleeding performed outside of normal working hours was significantly greater than the detection rate of the arteriographies performed during normal working hours (P = 0.050). Low platelet levels or a prolonged prothrombin time were not associated with the mesenteric arteriography results (P = 1.00). Interestingly, the intermittent nature of GI bleeding was the most challenging part of detection, which made management of the bleeding difficult. Blind embolization of the left gastric artery was only helpful in preventing massive bleeding in three out of eight patients with upper GI bleeding.

Conclusion: Endoscopy for upper gastrointestinal bleeding and scintigraphy for lower gastrointestinal bleeding are important steps in the management and outcome of transcatheter angiography. Computerized tomography angiography is a promising tool for the treatment of both upper and lower GI bleeding, and this procedure has become part of the imaging toolset. In addition, angiography performed outside of working hours had a higher rate of clinical success than the angiographies performed in working hours, most likely secondary to much appropriate timing of arteriogram in terms of critical bleeding intervals.
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http://dx.doi.org/10.4261/1305-3825.DIR.3963-10.1DOI Listing
December 2011