Publications by authors named "Ibrahim Inan"

22 Publications

  • Page 1 of 1

The Potential Role of Peritumoral Apparent Diffusion Coefficient Evaluation in Differentiating Glioblastoma and Solitary Metastatic Lesions of the Brain.

Curr Med Imaging 2021 Mar 16. Epub 2021 Mar 16.

Adiyaman University, Training and Research Hospital, Department of Radiology, Adiyaman. Turkey.

Objective: Differentiating glioblastoma (GBM) and solitary metastasis is not always possible using conventional magnetic resonance imaging (MRI) techniques. In conventional brain MRI, GBM and brain metastases are lesions with mostly similar imaging findings. In this study, we investigated whether apparent diffusion coefficient (ADC) ratios, ADC gradients, and minimum ADC values in the peritumoral edema tissue can be used to discriminate between these two tumors.

Methods: This retrospective study was approved by the local institutional review board with a waiver of written informed consent. Prior to surgical and medical treatment, conventional brain MRI and diffusion-weighted MRI (b = 0 and b = 1000) images were taken from 43 patients (12 GBM and 31 solitary metastasis cases). Quantitative ADC measurements were performed on the peritumoral tissue from the nearest segment to the tumor (ADC1), the middle segment (ADC2), and the most distant segment (ADC3). The ratios of these three values were determined proportionally to calculate the peritumoral ADC ratios. In addition, these three values were subtracted from each other to obtain the peritumoral ADC gradients. Lastly, the minimum peritumoral and tumoral ADC values, and the quantitative ADC values from the normal appearing ipsilateral white matter, contralateral white matter and ADC values from cerebrospinal fluid (CSF) were recorded.

Results: For the differentiation of GBM and solitary metastasis, ADC3 / ADC1 was the most powerful parameter with a sensitivity of 91.7% and specificity of 87.1% at the cut-off value of 1.105 (p < 0.001), followed by ADC3 / ADC2 with a cut-off value of 1.025 (p = 0.001), sensitivity of 91.7%, and specificity of 74.2%. The cut-off, sensitivity and specificity of ADC2 / ADC1 were 1.055 (p = 0.002), 83.3%, and 67.7%, respectively. For ADC3 - ADC1, the cut-off value, sensitivity and specificity were calculated as 150 (p < 0.001), 91.7% and 83.9%, respectively. ADC3 - ADC2 had a cut-off value of 55 (p = 0.001), sensitivity of 91.7%, and specificity of 77.4 whereas ADC2 - ADC1 had a cut-off value of 75 (p = 0.003), sensitivity of 91.7%, and specificity of 61.3%. Among the remaining parameters, only the ADC3 value successfully differentiated between GBM and metastasis (GBM 1802.50 ± 189.74 vs. metastasis 1634.52 ± 212.65, p = 0.022).

Conclusion: The integration of the evaluation of peritumoral ADC ratio and ADC gradient into conventional MR imaging may provide valuable information for differentiating GBM from solitary metastatic lesions.
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http://dx.doi.org/10.2174/1573405617666210316120314DOI Listing
March 2021

Primary breast tuberculosis: imaging findings of a rare disease.

Insights Imaging 2021 Feb 15;12(1):19. Epub 2021 Feb 15.

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

Breast tuberculosis is a rare form of extrapulmonary tuberculosis which tends to affect females of reproductive age, and is much rarer in males, postmenopausal women, and pre-pubescent girls. It is difficult to diagnose because it can mimic benign conditions such as a fibroadenoma, as well as malignant diseases like a carcinoma. It is also particularly difficult to distinguish breast tuberculosis from granulomatous mastitis, so other possible diagnoses should be ruled out first. The diagnosis of breast tuberculosis has three essential pillars: clinical examination, radiological evaluations, and histopathological sampling. Radiological evaluations are not only critical in diagnosis but are also important in the planning of the treatment and during the follow-up. This paper aims to review the imaging findings and the differential diagnosis of breast tuberculosis.
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http://dx.doi.org/10.1186/s13244-021-00961-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884561PMC
February 2021

Tension gastrothorax secondary to trauma in the emergency room: A case report.

Ulus Travma Acil Cerrahi Derg 2020 Sep;26(5):826-828

Department of Radiology, Biruni University Faculty of Medicine, İstanbul-Turkey.

In tension gastrothorax, the abdominal contents are displaced into the thorax, leading to a mediastinal shift that arises from the pressure placed on the intrathoracic region. This condition is often due to a congenital or acquired (secondary to surgery) diaphragmatic defect and is rarely seen secondary to trauma. A 40-year-old man presented to the emergency department after an in-vehicle traffic accident. He had no active complaint other than mild chest pain. On auscultation, breath sounds were audible in the left lung base and bowel sounds were heard. Computed tomography of the thorax revealed left-sided diaphragmatic hernia. The jugular vein was distended, and the patient became desaturated in the emergency room. Nasogastric decompression was performed, and the saturation improved. The patient underwent open surgery. Traumatic tension gastrothorax should be considered in the differential diagnosis of acute-onset severe respiratory failure. It can be diagnosed by rapid clinical and radiological evaluation.
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http://dx.doi.org/10.14744/tjtes.2019.94694DOI Listing
September 2020

WhatsApp as an Emergency Teleradiology Application for Cranial CT Assessment in Emergency Services.

J Coll Physicians Surg Pak 2020 Jul;30(7):730-734

Department of Radiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.

Objective: To evaluate the diagnostic agreement of transmitted images of cranial CT due to trauma, through WhatsApp software compared to workstation image-based diagnosis.

Study Design: Observational study.

Place And Duration Of Study: Department of Emergency Medicine, Adiyaman University Training and Research Hospital, from January 2017 to May 2018.

Methodology: A total of 94 cases that presented to the Emergency Department and underwent cranial CT were included in the study. CT images were video-recorded by the emergency physician using an Apple iPhone 7. The images were evaluated by two different radiologists using Samsung Galaxy Edge 7 and Samsung Note 8 mobile phones. Later, the radiological images were reviewed by two different radiologists at the PACS workstation. Then, the WhatsApp-mediated and final diagnoses were compared for various lesions to evaluate the interobserver agreement and diagnostic success of the use of WhatsApp software.

Results: In the assessment of the interobserver agreement, the kappa values were found to be 0.89 for normal findings, 0.84 for subdural hematoma, 0.73 for subarachnoid hemorrhage, 0.81 for epidural hematoma, 0.85 for fractures, 1 for parenchymal hematoma, and 0.68 for parenchymal contusion.

Conclusion: Although WhatsApp can be used in the evaluation of emergency cranial CT images, it is essential to note that some findings, especially those indicating fractures, subdural hematoma, and parenchymal contusion, can be overlooked. Key Words: Teleradiology, PACS, Medical software, Computed tomography, WhatsApp, Instant Messenger.
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http://dx.doi.org/10.29271/jcpsp.2020.07.730DOI Listing
July 2020

Cardiac compression of a hepatic cyst in polycystic liver disease: A rare cause of hemodynamic instability.

Turk J Emerg Med 2020 Apr-Jun;20(2):93-96. Epub 2020 Feb 26.

Department of Radiology, Biruni University, Istanbul, Turkey.

Polycystic liver disease (PLD) develops due to embryonic ductal plate malformation of intrahepatic bile ducts. Cysts in the liver can range from a simple compression effect to severe liver failure. The most common complication is rupture and inflammation of cyst. It can sometimes progress to the extent of pushing the heart to the left or compressing the inferior vena cava, thereby reducing the venous return. Here, we present a case with giant liver cyst-related symptoms that caused external compression of the right ventricle and atrium. A 71-year-old female patient was admitted to our emergency department with increasing dyspnea, chest pain, and abdominal distension. Her vital signs were as follows: temperature 38°C, pulse 140 beats/min, and blood pressure 70/40 mmHg. Her abdomen was distended, and there was minimal epigastric tenderness. Hepatomegaly was also present. Posteroanterior chest radiography revealed opacity that erased the right diaphragm contour at the right inferior hemithorax. In thoracoabdominal computed tomography, the heart was deviated toward the left due to the compression of a large cystic formation located in the hepatic right lobe, pushing the diaphragm to the superior. Piperacillin/tazobactam 3 g × 4.5 g treatment was initiated, and external drainage was performed by interventional radiology. Following this procedure, significant improvement was observed in the patient's condition. Her symptoms significantly improved, and the drainage catheter was removed on the seventh day. Hepatic cysts in patients with PLD may compress adjacent structures, and cardiac compression can be life-threatening if hemodynamic instability occurs.
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http://dx.doi.org/10.4103/2452-2473.279558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305665PMC
February 2020

Brucella and non-Brucella epididymo-orchitis: comparison of ultrasound findings.

Med Ultrason 2019 Aug;21(3):246-250

Radiology Department, BiruniUniversity Hospital, Istanbul, Turkey.

Aim: In brucellosis the male genitourinary system can be affected in a small number of patients. In this study we aimed to identify, discuss and compare the radiologic findings of 24 cases with Brucella epididymo-orchitis (BEO) and 285 cases with non-Brucella epididymis orchitis (NBEO).

Material And Methods: The study had a retrospective design. The area of involvement, side of involvement (left, right or bilateral), presence of abscess, hydrocele and testicular involvement pattern were analyzed and compared between the BEO and NBEO cases.

Results: The median age of the included cases was 33 years, with a minimum of 0 and maximum of 89. Epididymo-orchitis and isolated orchitis were more frequent in BEO cases while isolated epididymis involvement was more common in patients with non-BEO (p=0.0117). Bilateral involvement was present in 20.8% and 4.6% cases in the BEO and non-BEO groups, respectively (p=0.008). The frequency of abscess was significantly higher in BEO cases (p=0.003).

Conclusion: Although the radiological indications of BEO are similar to those of other types of epididymo-orchitis, abscess formation, bilateral involvement and testicular involvement contribute significantly to diagnosis.
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http://dx.doi.org/10.11152/mu-1871DOI Listing
August 2019

The role of radiologic, clinical and biochemical parameters in prediction of stroke mortality.

Neurosciences (Riyadh) 2019 Apr;24(2):110-114

Department of Emergency Medicine, Adiyaman University Training and Research Hospital, Adiyaman, Turkey. E-mail:

Objective: To assess National Institutes of Health Stroke Scale (NIHSS), stroke volume, biochemical, and blood parameters for the prediction of one-month mortality in stroke patients.

Methods: The study had retrospective design and 75 patients were involved that presented to a hospital Emergency Department between January 2016 and December 2017 in Adiyaman, Turkey diagnosed with acute ischemic cerebral infarction. The patients were divided into 2 groups according to whether mortality occurred within one month. Values for NIHSS, stroke volume, Glasgow Coma Scale, and blood parameters were compared between the groups.

Results: Values for Glasgow Coma Scale p=0.002, NIHSS p=0.001, stroke volume p=0.003, monocyte/HDL ratio p=0.047, neutrophils p=0.01, white blood cell p=0.007, calcium p=0.016, and albumin p=0.027 were statistically significant for the prediction of one-month mortality. There were no significant differences between the groups for other parameters.

Conclusion: The clinical, laboratory, and radiological findings individually provide significant support for the short-term prognosis of stroke. The evaluation of these results together can provide a clearer advance understanding of a prognosis to better manage the course of the disease and prevent death.
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http://dx.doi.org/10.17712/nsj.2019.2.20180021DOI Listing
April 2019

Evaluation of Ovarian Vascularity in Children by Using the "Superb Microvascular Imaging" Ultrasound Technique in Comparison With Conventional Doppler Ultrasound Techniques.

J Ultrasound Med 2019 Oct 28;38(10):2751-2760. Epub 2019 Mar 28.

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

Objectives: The aim of this study was to assess the feasibility of the novel "superb microvascular imaging" (SMI) Doppler ultrasound technique to detect ovarian vascularity in healthy children and to compare it with the conventional Doppler ultrasound techniques.

Methods: This prospective study included 140 girls, aged 3 to 18 years, for which an abdominal ultrasound study was requested in the pediatrics outpatient clinics for suspicion of nonovarian pathologies. Nineteen individuals were excluded from the study due to incomplete ultrasound scanning. For the remaining 121 cases, gray scale ultrasound evaluation was performed followed by color Doppler imaging, power Doppler imaging, advanced dynamic flow, color SMI, and monochrome SMI to detect the presence and degree of vascularity in the ovaries. Ultrasound scanning was performed for all participants by the same doctor by using curvilinear probe via the suprapubic approach, and the images were independently evaluated by 3 different observers. The images were assessed with regard to the degree of vascularity and the presence of artifacts.

Results: A total of 146 ovaries (42 right, 54 left, and 25 bilateral) were examined by sonography. The mean interrater agreement regarding the detection of vascularity was moderate for the color Doppler imaging, power Doppler imaging, advanced dynamic flow, and monochrome SMI techniques (κ = 0.514-0.551) and substantial for the color SMI technique (κ = 0.636) (P < .001). The techniques were found to be statistically significant for detecting vascularity: monochrome SMI > color SMI > power Doppler imaging > color Doppler imaging > advanced dynamic flow (P < .001).

Conclusion: SMI is a promising tool that can detect ovarian vascularity more effectively than the conventional Doppler ultrasound techniques.
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http://dx.doi.org/10.1002/jum.14983DOI Listing
October 2019

Contribution of the appendix sphericity index in predicting perforated acute appendicitis.

Ulus Travma Acil Cerrahi Derg 2019 Mar;25(2):123-128

Adıyaman University Faculty of Medicine, Training and Research Hospital, Department of Radiology, Adıyaman-Turkey.

Background: The purpose of the present study was to investigate the diagnostic value of the appendiceal sphericity index (SI) and appendix diameters in cases of perforated and non-perforated acute appendicitis.

Methods: Eighty-one patients who underwent computed tomography (CT) in our clinic and who were diagnosed with acute appendicitis after histopathological assessment between January 2015 and August 2017 were included in the study. According to their histopathological findings, the patients were divided into two groups: perforated and non-perforated appendicitis. The patients' CT images were re-evaluated with respect to perforation. Long axis and short axis of the appendix and the SI obtained by their proportions were calculated from the appropriate plane on CT. Their parameters and other CT findings as defined in the current literature were analyzed for statistical significance in the detection of perforation.

Results: The perforated and non-perforated appendicitis groups consisted of 20 and 61 patients, respectively. For wall defect, abscess, extraluminal air, free fluid, and appendicolith, the sensitivity values were 25%, 15%, 25%, 55%, and 50%, respectively, and the specificity values were 100%, 100%, 100%, 77%, and 70.5%, respectively. Sensitivity and specificity for the SI and long axis of the appendix were calculated as 85% and 90% and 85.2% and 73.8%, respectively (p<0.001).

Conclusion: Although there are many findings with high specificity in the diagnosis of perforation, their sensitivity is very low when evaluated separately. We consider that the measurement of long-axis length with high sensitivity and the evaluation of SI with high specificity and sensitivity will contribute significantly to the diagnosis of perforation.
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http://dx.doi.org/10.5505/tjtes.2018.29266DOI Listing
March 2019

Localized Breast Amyloidosis.

Eur J Breast Health 2019 Jan 24;15(1):63-66. Epub 2018 Oct 24.

Department of Pathology, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey.

Localized amyloidosis in the breast is a very rare disease and may mimic malignant lesions. A 60-year-old woman who had a history of breast-conserving surgery presents with a new a well-defined oval opacity accompanied by many round tight clustered micro- and macrocalcifications on mammograms. It could not be visualized sonographically due to the intense posterior acoustic shadowing of the fat necrosis areas and contrast enhancement was not detected in this area on the dynamic contrast enhanced magnetic resonance images. At pathological examination breast amyloidosis was detected. Amyloidosis of the breast is a rare disease, but it can mimic malignancy and should be included in the differential diagnosis.
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http://dx.doi.org/10.5152/ejbh.2018.4104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385720PMC
January 2019

The utility of ADC measurement techniques for differentiation of low- and high-grade clear cell RCC.

Pol J Radiol 2018 21;83:e446-e451. Epub 2018 Sep 21.

Department of Radiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Kadikoy, Istanbul, Turkey.

Purpose: To evaluate the diffusion properties of clear cell renal cell carcinoma (ccRCC) on magnetic resonance imaging (MRI) concerning their Fuhrman nuclear grades and sizes, and to compare the diagnostic performance of two ROI placement techniques for apparent diffusion coefficient (ADC) measurement (entire mass vs. only the darkest region of the mass).

Material And Methods: Fifty-one ccRCC were enrolled in the study and grouped into low-grade ccRCC (Fuhrman grade 1 and 2, = 37) and high-grade ccRCC (Fuhrman grade 3 and 4, = 14). Selective ADC (Sel-ADC) measurement was performed by placing a circular ROI that included the darkest region of the tumour on ADC map images. Extensive ADC (Ext-ADC) measurement was performed by drawing an ROI that covered the entire tumour.

Results: The Sel-ADC value was lower in high-grade ccRCC ( = 0.019), whereas the Ext-ADC value did not show a statistically significant difference ( = 0.42). Sel-ADC value of a ≤ 1.405 mm/s has a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy value of 78.6, 72.2, 73.87, 77.13, and 75.4, respectively, to differentiate high-grade from low-grade ccRCC. The size and Fuhrman grade of the ccRCC were inversely correlated with the Sel-ADC value; however, the correlations were weak ( = -0.322, = 0.021 and = -0.376, = 0.006, respectively). There was no difference between ADC values of small (≤ 4 cm) and large (> 4 cm) ccRCCs.

Conclusions: The ADC value of the darkest region in solid part of the ccRCC may play a role in predicting the nuclear grade of ccRCC.
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http://dx.doi.org/10.5114/pjr.2018.80207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334124PMC
September 2018

Relationship between serum Pentraxin 3 and pro-adrenomedullin levels with acute cholecystitis.

Am J Emerg Med 2019 07 15;37(7):1268-1272. Epub 2018 Sep 15.

Department of Internal Medicine, Adıyaman Training and Research Hospital, Turkey.

Objectives: The perforation of the gallbladder (GP) is one of the most significant complications of acute cholecystitis. A biochemical marker indicating the GP has not been determined fully to date. Pentraxin 3 and pro-adrenomedullin (Pro-ADM) proteins are novel acute phase reactants. We aimed to investigate the relationship between serum Pentraxin 3 and Pro-ADM and the GP in patients with acute cholecystitis.

Methods: This prospective cross-sectional study was conducted on patients with acute cholecystitis in a tertiary care emergency department during the six-month period. The acute cholecystitis patients were divided into two groups as with GP, and without GP. Additionally, patients with GP were evaluated according to pericholecystic fluid and gallbladder wall thickness. Serum levels of pro-ADM and pentraxin 3, WBC, CRP and sedimentation rate were measured in all patients.

Results: A total of 60 patients with acute cholecystitis were included in the study. Pro-ADM and pentraxin 3 levels were significantly higher in patients with GP and the with pericholecystic free fluid (p < 0.0001). There was no significant relationship between serum pentraxin 3 and pro-ADM with gallbladder wall thickness (p > 0.05) According to the ROC analysis, serum Pentraxin 3 levels of ≥4.9 ng/mL could predict GP with a sensitivity of 75% and a specificity of 85% and serum pro-ADM levels of ≥97 nmol/L with sensitivity and specificity of 100% and 95%.

Conclusion: Our study results reveal that serum Pentraxin 3 and pro-ADM may be novel biochemical parameters in the detection of GP in acute cholecystitis cases.
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http://dx.doi.org/10.1016/j.ajem.2018.09.024DOI Listing
July 2019

Diffusion-Weighted Imaging for the Discrimination of Benign and Malignant Breast Masses; Utility of ADC and Relative ADC.

J Belg Soc Radiol 2018 Feb 7;102(1):24. Epub 2018 Feb 7.

GOP Taksim Training and Educational Hospital, TR.

Purpose: To determine the contribution of apparent diffusion coefficient (ADC), and relative ADC (rADC) values to differentiate between benign and malignant breast masses.

Materials And Methods: Magnetic resonance imaging (MRI) of the breast with diffusion-weighted imaging (DWI) of patients with benign or malignant breast masses diagnosed either by histopathological findings or by follow-up imaging were evaluated retrospectively. Histopathological analyses were performed for 71 lesions (80.7%) while the remaining were followed up every six months for one year. DWI was performed using b-values of 0 and 1000 sec/mm, and ADC and rADC were calculated and compared. A receiver operating characteristic (ROC) curve and Youden index were used to evaluate the parameter's optimal threshold and diagnostic value. Statistical significance was set as p < 0.05.

Results: Eighty-eight lesions from a total of 81 patients, aged between 16 and 73 (mean age 42 ± 11.3) years were obtained and evaluated. Pathological results of 34 (38.6%) out of 71 lesions were malignant and 37 lesions (42%) were benign. Seventeen (19.3%) lesions remained stable at one-year follow-up and were accepted as benign breast masses. Mean ADC values of benign and malignant lesions were 1.584 × 10mm/sec and 0.884 × 10mm/sec (p < 0.05), respectively. Sensitivity and specificity of ADC were 88% and 87%, respectively at a cut-off value of 1.04 × 10mm/sec. Mean rADC was 0.931 for benign lesions and 0.557 for malignant lesions (p < 0.05). Sensitivity and specificity were 82% and 83% at a cut-off value of 0.639. No prominent superiority of rADC over ADC is identified in the differentiation of breast masses.

Conclusion: ADC and rADC values derived from DWI can be equally useful in clinical setting to differentiate benign from malignant breast masses.
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http://dx.doi.org/10.5334/jbsr.1258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032404PMC
February 2018

Sclerosing encapsulated peritonitis: typical imaging findings for easy diagnosis.

Ann Saudi Med 2018 May-Jun;38(3):230-232

Dr. Ibrahim Inan Department of Radiology, Istanbul Medeniyet Universitesi, Istanbul, Turkey, T: 050674444430, ibrinan@ gmail.com ORCID: http://orcid. org/0000-0003-2136-3604.

Sclerosing encapsulated peritonitis (SEP) is a rare disease characterized by intestinal encasement within a fibrocollagenous membrane. Diagnosis of SEP may be challenging due to a lack of specific symptoms. Demonstration of clustered intestinal segments surrounded by a membranous sac by various imaging modalities is crucial to reveal the presence of SEP. Radiologic examinations play an important role in the management of the disease. This case is not unusual. Our intention is to emphasize the role of the imaging findings of a patient with primary SEP that presented with recurrent intestinal obstruction.

Similar Cases Published: 118.
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http://dx.doi.org/10.5144/0256-4947.2018.230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074304PMC
October 2018

Real-Time Elastography for Differentiation of Breast Lesions.

Pol J Radiol 2017 17;82:664-669. Epub 2017 Nov 17.

Department of General Surgery, Uskudar State Hospital, Istanbul, Turkey.

Backroung: To investigate the diagnostic performance of the elastography-based strain index ratio in the differential diagnosis of malignant and benign breast lesions.

Material/methods: Seventy-nine breast masses that were classified as BI-RADS category 3, 4, and 5 on B-mode ultrasonography (US) were further prospectively evaluated by real-time sonoelastography (RTE). To obtain an optimal cut-off value of the strain ratio for differentiating between malignant and benign breast lesions, RTE findings were compared with histopathology of core needle biopsy samples or with ultrasound follow-up data of the analyzed masses.

Results: Seventy-nine breast lesions [BI-RADS category 3 (n=15), BI-RADS category 4 (n=34), and BI-RADS category 5 (n=30)] were classified as malignant (n=36) or benign (n=43). The mean strain index value was 6.59±3.44 (range 0.6-14) for malignant lesions and 2.79±2.16 (range 0.6-8.7) for benign lesions, respectively (p<0.05). As regards the detection of malignant lesions, US was characterized by sensitivity and specificity of 100% (CI 95%; 88-100) and 90% (CI 95%; 76-97), respectively. When an optimal value of the strain ratio (4.25) was obtained by ROC curve analysis, the sensitivity and specificity for diagnosing malignant lesions were 86% (CI 95%; 70-95) and 76% (CI 95%; 60-87), respectively.

Conclusions: RTE can play an important role in the differentiation between malignant and benign breast masses, but it should be used in conjunction with ultrasonography.
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http://dx.doi.org/10.12659/PJR.902596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894028PMC
November 2017

Radiological and endoscopic imaging methods in the management of cystic pancreatic neoplasms.

Acta Gastroenterol Belg 2017 Apr-Jun;80(2):283-291

Department of Radiology, Medical School of Istanbul Medeniyet University, Göztepe Training and Research Hospital.

The management of cystic pancreatic neoplasm (CPN) is a clinical dilemma because of its clinical presentations and malignant potential. Surgery is the best treatment choice ; however, pancreatic surgery still has high complication rates, even in experienced centers. Imaging methods have a definitive role in the management of CPN and computed tomography, magnetic resonance imaging, and endoscopic ultrasonography are the preferred methods since they can reveal the suspicious features for malignancy. Therefore, radiologists, gastroenterologists, endoscopists, and surgeons should be aware of the common features of CPN, its discrete presentations on imaging methods, and the limitations of these modalities in the management of the disease. This study aims to review the radiological and endoscopic imaging methods used for the management of CPN.
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April 2018

Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome.

J Med Ultrason (2001) 2018 Apr 26;45(2):287-294. Epub 2017 Oct 26.

Department of Radiology, SBU Adana Numune Training and Research Hospital, Ege Bagatur Bulvarı Serinevler Yüreğir, 01240, Adana, Turkey.

Purpose: In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction.

Materials And Methods: Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro-Wilk test was used in the assessment of normal distribution of parameters.

Results: The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively.

Conclusion: Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.
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http://dx.doi.org/10.1007/s10396-017-0839-9DOI Listing
April 2018

Is real-time elastography helpful to differentiate acute from subacute deep venous thrombosis? A preliminary study.

J Clin Ultrasound 2018 Feb 22;46(2):116-121. Epub 2017 Sep 22.

Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey.

Purpose: To detect and characterize changes in stiffness of thrombus in patients with acute and subacute deep venous thrombosis (DVT) by using real-time elastography (RTE).

Methods: Fifty-eight patients with acute or subacute DVT were prospectively evaluated by B-mode sonography (US), color Doppler US (CDUS), and RTE. Two radiologists evaluated the thrombus echogenicity, compressibility, and recanalization of the affected vein, and thrombus stiffness in consensus. The thrombi were classified into 3 groups as soft, intermediate, and hard on RTE images.

Results: The final study group consisted of 30 patients with acute DVT, among whom 10 were women (33%), and 19 patients with subacute DVT, among whom 6 were women (32%). The presence of hypoechoic thrombus, incompressible vein, and absence of recanalization on US and CDUS were significantly associated with acute DVT (P < .001 for all variables). The differences in elasticity pattern of the thrombi between acute and subacute DVT were not significant (P = .202).

Conclusion: Venous thrombus hardens with age; however, elastography pattern on RTE, in its present form, may not be able to differentiate acute DVT from subacute DVT.
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http://dx.doi.org/10.1002/jcu.22522DOI Listing
February 2018

A Severely Encrusted Forgotten Double J Ureteral Catheter.

Eurasian J Med 2017 Jun 28;49(2):158. Epub 2017 Apr 28.

Department of Radiology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey.

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http://dx.doi.org/10.5152/eurasianjmed.2017.17038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469847PMC
June 2017

Diffusion-weighted magnetic resonance imaging in cystic renal masses.

Can Urol Assoc J 2017 Jan-Feb;11(1-2):E8-E14. Epub 2017 Jan 12.

Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul, Turkey;; Department of Radiology, King Hamad University Hospital, Bahrain.

Introduction: We aimed to introduce the diagnostic value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) for distinguishing benign and malignant renal cystic masses.

Methods: Abdominal DWI-MRIs of patients with Bosniak categories 2F, 3, and 4 cystic renal masses were evaluated retrospectively. Cystic masses were assigned as benign or malignant according to histopathological or followup MRI findings and compared with apparent diffusion coefficient (ADC) values.

Results: There were 30 patients (18 males and 12 females, mean age was 59.23 ± 12.08 years [range 38-83 years]) with cystic renal masses (eight Bosniak category 2F, 12 Bosniak category 3, 10 Bosniak category 4). Among them, 14 cysts were diagnosed as benign and 16 as malignant by followup imaging or histopathological findings. For the malignant lesions, the mean ADC values were lower than for benign lesions (p=0.001). An ADC value of ≤2.28 ×10 mm/s or less had a sensitivity of 75% and a specificity of 92.86% for detecting malignancy.

Conclusions: ADC can improve the diagnostic performance of MRI in the evaluation of complex renal cysts when used together with conventional MRI sequences.
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http://dx.doi.org/10.5489/cuaj.3888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5262516PMC
January 2017

An unusual cause of acute abdomen-epiploic appendicitis: report of two cases.

North Clin Istanb 2015 25;2(2):171-174. Epub 2015 Sep 25.

Department of General Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Epiploic appendices, first described in 1543 by Vesalius, are fatty structures which are attached through the length of the colon and consisted of visceral peritoneum. Epiploic appendicitis is an uncommon and self-limiting disease. In this report, we aimed to present two patients with epiploic appendicitis.
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http://dx.doi.org/10.14744/nci.2015.25338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175099PMC
September 2015

An important clue in the sonographic diagnosis of internal carotid artery agenesis: ipsilateral common carotid artery hypoplasia.

Case Rep Radiol 2014 2;2014:516456. Epub 2014 Jul 2.

Department of Ophthalmology, Adana Numune Teaching and Research Hospital, 01240 Adana, Turkey.

A 42-year-old female patient, who had been diagnosed with an occlusion of her left internal carotid artery (ICA) following Doppler ultrasonographic (US) and digitally-subtracted angiographic (DSA) examinations performed in an outer healthcare center in order to eliminate the underlying cause of her complaint of amorosis fugax, later applied to our hospital with the same complaint. At Doppler US performed in our hospital's radiology department, her right common carotid artery (CCA) was normal, but her left CCA was hypoplastic. The right internal artery (ICA) was validated as normal. At the left side, however, the ICA was apparent only as a stump and it did not demonstrate a continuity. The diagnosis of ICA agenesis was confirmed by the utilization of Doppler US, CT, and DSA imaging, and it was concluded also that ipsilateral CCA hypoplasia could be evaluated as an important clue to the diagnosis of ICA agenesis.
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http://dx.doi.org/10.1155/2014/516456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102011PMC
August 2014