Publications by authors named "Mehmet Guli Çetincakmak"

36 Publications

Relationship Between Pituitary Siderosis and Endocrinological Disorders in Pediatric Patients with Beta-Thalassemia.

Cureus 2021 Jan 23;13(1):e12877. Epub 2021 Jan 23.

Radiology, Dicle University School of Medicine, Diyarbakir, TUR.

Introduction Excess iron accumulation occurs mainly in organs such as reticuloendothelial cells, the pituitary gland, and the pancreas in beta-thalassemia because of blood transfusions. In the present study, it was aimed to investigate the relationship between T2* values on magnetic resonance imaging (MRI) and clinically diagnosed pituitary endocrinological disorders in children with thalassemia major. Methods This study enrolled patients diagnosed with beta-thalassemia at pediatric hematology outpatient clinics. In the study, in addition to the medical history of the patients, routinely performed tests, including hemoglobin electrophoresis, routine biochemical tests, and tests for pubertal development (follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, etc.), as well as iron deposition measured by hepatic MRI T2* (STAR) sequence, were retrospectively assessed. A total of 29 patients were enrolled. Results Hypothyroidism was detected in 34.6% (9/26) of patients, short stature in 37% (10/27), and pubertal retardation in 50% (14/28) of the patients. There was no significant correlation between hypothyroidism and pituitary MRI T2* values. No significant correlation was found between laboratory parameters and pituitary MRI examination. Although the sensitivity of T2* levels could rise above 80%, their specificity remained low. This is one of the major limitations of the pituitary MR T2* study for the prediction of short stature. The best lower cut-off level of MR T2* to predict short stature was found 14.6 ms. Conclusion The diagnostic specificity pituitary MR examination levels for short stature were detected as low. Thus, the clinical standardization and validation of pituitary MR T2* values examination are needed before clinical follow-up and multifaceted studies are needed.
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http://dx.doi.org/10.7759/cureus.12877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899051PMC
January 2021

Evaluation of the relationship between splenic iron overload and liver, heart and muscle features evident on T2*-weighted magnetic resonance imaging.

Adv Clin Exp Med 2020 Apr;29(4):475-480

Department of Radiology, Medical School, Dicle University, Diyarbakir, Turkey.

Background: Splenic iron overload is the most common clinical condition in patients with thalassemia. However, few studies of the effects of splenectomy have been published.

Objectives: To evaluate the relationship between splenic iron overload and liver, heart and muscle features visible in T2*-weighted magnetic resonance imaging, and to investigate the effects of splenectomy on these tissues in patients with beta-thalassemia major (TM).

Material And Methods: We retrospectively included 131 patients (76 male and 55 female) diagnosed with TM. All radiological assessments were performed with the aid of a Philips Achieva 1.5T scanner running a multiecho gradient-echo sequence. Hepatic and splenic T2* values were assessed in the same gradient multiecho series. Muscle T2* values were assessed in the shoulder girdle muscles adjacent to the heart area. The relationships among splenic T2*, hepatic T2*, cardiac T2* and muscle T2* parameters, serum ferritin levels, age and other parameters were evaluated.

Results: The splenic T2* value correlated with serum ferritin level and the hepatic T2* value (p < 0.001 and p < 0.001, respectively). The splenic T2* value did not correlate with age, cardiac or muscle T2* values, or with spleen size (p = 0.27, 0.21, 0.99, and 0.39, respectively). The muscle T2* value correlated weakly with the serum ferritin level (p = 0.022). The cardiac T2* value was lower and the liver size greater in patients who had undergone splenectomy compared with those who had not (p < 0.001 and 0.001, respectively).

Conclusions: Splenic iron overload correlated with hepatic overload and the serum ferritin level. Splenectomy increased cardiac iron overload and triggered liver enlargement. However, the muscle iron overload was low and the muscles were therefore unaffected by splenectomy.
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http://dx.doi.org/10.17219/acem/116758DOI Listing
April 2020

Accessory liver within the thoracic cavity.

Surg Radiol Anat 2018 Sep 2;40(9):1085-1091. Epub 2018 Jun 2.

Department of Radiology, School of Medicine, Dicle University, Diyarbakir, Turkey.

Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.
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http://dx.doi.org/10.1007/s00276-018-2046-9DOI Listing
September 2018

Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients.

Clin Imaging 2017 Jan - Feb;41:106-111. Epub 2016 Oct 27.

Department of Radiology, Dicle University School of Medical Science, Diyarbakir, Turkey.

The aim of this study is to show the frequency of incidentally found (pulmonary thromboembolism) PTE in oncological patients and evaluate dispersion of incidents in terms of underlying primary tumor and seek risk factors associated with incidental PTE. Among one thousand oncology patients, 46 (4.6%) individuals found to have incidental PTE. Of positive patients, the highest proportion (24%) was belong to breast cancer group (n=11). The most common location for pulmonary emboli was the lower lobe branch of right pulmonary artery (n=33, 71.7%). Evident PTE had not been reported in final radiology reports of 21 cases.
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http://dx.doi.org/10.1016/j.clinimag.2016.10.018DOI Listing
January 2017

MRI-based evaluation of the factors leading to pituitary iron overload in patients with thalassemia major.

J Neuroradiol 2016 Jul 12;43(4):297-302. Epub 2016 Apr 12.

Department of Radiology, Medical School, Dicle University, Diyarbakir, Turkey. Electronic address:

Aim: Given the lack of studies evaluating pituitary iron overload in patients with thalassemia major, we used magnetic resonance imaging (MRI) to evaluate these patients and the factors affecting the disease process.

Materials And Methods: The 84 patients with β-thalassemia major who were included in this study were referred to our clinic for cardiac and hepatic T2(*) MRI. T2(*)-weighted images of the pituitary gland, heart, and liver were obtained using a 1.5-tesla MRI unit and a multi-echo gradient-echo sequence. Associations between pituitary T2(*), cardiac T2(*), hepatic T2(*), pituitary height, serum ferritin (SF) level, patient age, and other demographic findings were assessed.

Results: Pituitary T2(*) values correlated with hepatic T2(*) values, cardiac T2(*) values, SF level, and patient age (P≤0.001, 0.001, 0.001, 0.01, respectively) but not with pituitary height (P=0.76). Pituitary and cardiac T2(*) values were lower in the subset of patients who underwent splenectomy (P=0.046 and P=0.002, respectively).

Conclusion: Pituitary iron overload rapidly increases during puberty and in this study correlated with cardiac and hepatic T2(*) values, patient age, SF level, and liver size, but not with the height of the pituitary. Pituitary iron overload also increases following splenectomy. Together, these findings indicate that numerous factors contribute to pituitary iron overload.
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http://dx.doi.org/10.1016/j.neurad.2016.03.001DOI Listing
July 2016

Quantitative volumetric assessment of pulmonary involvement in patients with systemic sclerosis.

Quant Imaging Med Surg 2016 Feb;6(1):50-6

1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey.

Background: Computed tomography (CT) is the gold standard for assessing interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). In this study, we performed a quantitative calculation of ILD severity by examining the lung volume of SSc patients.

Methods: The present study was performed retrospectively on 38 patients with SSc who were referred to our clinic. Patients were divided into two groups based on high-resolution computed tomography (HRCT): patients with ILD and patients without ILD.The percentage of lower lobe volume (PLLV) was calculated using HRCT. In addition, we evaluated the PLLV in all patients according to age, diffusing capacity of the lung for carbon monoxide (DLCO) and spirometric findings, and assessed the relationships among these factors.

Results: PLLV of the right lung in patients with ILD was reduced when compared with patients without ILD (P=0.041). The PLLV of the right lung in patients with ILD was negatively correlated with age and forced vital capacity (FVC; P=0.01 and P=0.012, respectively).

Conclusions: The PLLV of the right lung may decrease in SSc patients with ILD. In these patients, the PLLV may be a quantitative parameter indicating damage in the lung.
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http://dx.doi.org/10.3978/j.issn.2223-4292.2016.02.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775241PMC
February 2016

Primary and Metastatic Liver Malignancy: Utility Low and High B Value (1600-2000) in 3 Tesla MRI.

Hepatogastroenterology 2015 Jun;62(140):962-5

Background/aims: To determine the utility of the quantitative apparent diffusion coefficient (ADC) values at various b values, in the differentiation of malignant hepatic masses on 3.0 Tesla (T) MRI.

Methodology: We evaluated 81 consecutive patients presenting with 529 malignant masses in the liver. Of those patients 27 had a primary hepatic malignancy while the other 54 patients had metastases in the liver. Quantitative ADC values of malignant hepatic masses was measured at four b values (b 400, b 800, b 1600, b 2000 mm2/s) on MR-DWI. We compared the primary and metastatic tumors within their groups and also with each other in terms of their ADC values.

Results: In 4 various b value measurements, the mean ADC values of the primary and metastatic hepatic masses were 1. x 10(-3), 1.06 x 10(-3), 0.87 x 10(-3), and 0.736 x 10(-3)mm2/ seconds, 1.30 x 10(-3), 1.10 x 10(-3), 0.84 x 10(-3), and 0.715 x 10(-3) mm2/seconds respectively. There was no significant difference between mean ADC values of HCCs and metastases at b 400, 800, 1600 and 2000 gradients (P > 0.05).

Conclusions: The ADC values obtained at intermediate (400, 800) and high (b 1600, 2000) diffusion gradients are not helpful in differentiation between HCCs and liver metastases.
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June 2015

Evaluation of the glucocorticoid, mineralocorticoid, and adrenal androgen secretion dynamics in a large cohort of patients aged 6-18 years with transfusion-dependent β-thalassemia major, with an emphasis on the impact of cardiac iron load.

Endocrine 2016 Jul 2;53(1):240-8. Epub 2016 Feb 2.

Department of Adolescent Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

The variable presence of adrenal insufficiency (AI) due to hypocortisolemia (HC) in patients with thalassemia is well established; however, the prevalence of adrenocortical hypofunction (ACH) in the zona glomerulosa and zona reticularis of the adrenal cortex is unknown. To establish the prevalence of ACH, we examined the cortisol response to 1-µg and 250-µg ACTH tests, plasma aldosterone (A)/plasma renin activity (PRA) ratio, and serum dehydroepiandrosterone sulfate (DHEAS) levels in a large cohort of patients with thalassemia, and to investigate the impact of total body iron load (TBIL) on adrenocortical function. The setting used was University hospital and government-based tertiary care center. One hundred twenty-one (52 females) patients with β-thalassemia major (β-TM) and 72 healthy peers (38 females) were enrolled. The patients underwent a 250-µg cosyntropin test if their peak cortisol was <500 nmol/L in a 1-µg cosyntropin test. Magnetic resonance imaging (MRI) was performed to assess the MRI-based liver iron content and cardiac MRI T2* iron. The associations between ACH and TBIL were investigated. The patients with thalassemia had lower ACTH, cortisol, DHEAS, and A/PRA values compared with the controls (p < 0.001). Thirty-nine patients (32.2 %) had HC [primary (n = 1), central (n = 36), combined (n = 2)], and 47 (38.8 %) patients had reduced DHEAS levels; 29 (24.0 %) patients had reduced A/PRA ratios. Forty-six (38.0 %) patients had hypofunction in one of the adrenal zones, 26 (21.5 %) had hypofunction in two adrenal zones, and 9 (7.4 %) had hypofunction in all three zones. Patient age and TBIL surrogates were significant independent parameters associated with ACH. Cardiac MRI T2* iron was the only significant parameter that predicted the severity of ACH at a cut-off of 20.6 ms, with 81 % sensitivity and 78 % specificity. Patients with thalassemia have a high prevalence of AI due to HC and zona glomerulosa and zona reticularis hypofunction. TBIL surrogates can predict ACH, but cardiac iron was the only surrogate that was adequately sensitive to predict the severity of ACH.
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http://dx.doi.org/10.1007/s12020-016-0872-2DOI Listing
July 2016

Effect of airway dynamics on the development of larynx cancer.

Laryngoscope 2016 05 15;126(5):1136-42. Epub 2015 Sep 15.

Department of Otolaryngology, Dicle University, Diyarbakir, Turkey.

Objectives/hypothesis: This study aimed to investigate and measure airway dynamics in anatomical regions where laryngeal cancer was most common in comparison to other regions of the larynx, thereby determining the effect of airway dynamics on the development of laryngeal cancer.

Study Design And Methods: Pulmonary function test airflow data and larynx anatomy measurement data obtained by three-dimensional computed tomography. A healthy male adult was modeled by simulation using the ANSYS program. Analysis of air flow rates, pressure, and force were also made.

Results: The supraglottic region average pressure was higher when compared to the subglottic region and clearly lower when compared to the glottic region. The subglottic had the lowest pressure and force levels. The glottic region was the first ranked location for laryngeal cancer; the supraglottic region was the second; and the frequency of laryngeal cancer was much lower in the subglottic region. Our data suggests that the high pressure and force contribute to an increased amount of contact and interaction between toxic particles and mucosa and to increased diffusion of the particles, leading to an increased carcinogenic effect and frequency of cancer.

Conclusion: Laryngeal cancer was found more frequently in regions with an increased pressure and force stress and reduced air velocity, with a subsequent increase in penetration of the inhaled toxic agents. These findings demonstrate the importance of basic physical fluid mechanics in cancer pathogenesis.

Level Of Evidence: NA. Laryngoscope, 126:1136-1142, 2016.
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http://dx.doi.org/10.1002/lary.25645DOI Listing
May 2016

Which type of reaction in retained surgical sponge is more dangerous?

Ann Ital Chir 2015 Jul-Aug;86(4):378-82

Background: Retained surgical sponge is a term to define forgotten surgical sponges during operation. RSS causes two kinds of reactions in the body. The first one is to develop an abscess through exudative inflammatory reaction in early phases and second one is to form a mass through aseptic inflammatory reaction which can stay asymptomatic for months, even for years. In this study we aimed to investigate the time of hospital admission, type of reaction and effect of need for bowel resection on prognosis in patients with retained surgical sponge.

Methods: In the study, we scanned the files of 18 patients with retained surgical sponge who had been operated at Dicle University Medical Faculty General Surgery Clinic between January 1994 and July 2012, retrospectively.

Results: Need for intestine resection was higher in patients who were operated in the early phase (p:0.034). Morbidity and duration of hospital stay were significantly higher (respectively P:0.02, P:0.007) in patients who had underwent intestine resection.

Conclusion: In patients with retained surgical sponge, need for intestine resection is increased due to exudative reaction in the early phase. This increase is giving rise to morbidity rates and prolonged hospital stay.

Key Words: Morbidity, Retained surgical sponge.
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September 2017

Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions.

J Ultrasound Med 2015 Jul;34(7):1201-8

Departments of Radiology (M.T., G.G., C.H., M.G.Ç., S.H., B.A., G.T.), Radiation Oncology (F.T.), and General Surgery (Ö.U.), Dicle University, Medical School, Diyarbakır, Turkey.

Objectives: Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions.

Methods: We prospectively examined 141 breast lesions in 122 patients. All lesions were classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography, BI-RADS for sonography, and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) pattern. Internal and marginal shear wave velocity (SWV) values for the lesions were noted. The sensitivity, specificity, accuracy, and positive and negative predictive values for VTI and Virtual Touch tissue quantification (VTQ; Siemens Medical Solutions) were calculated.

Results: The marginal SWV values were statistically higher in malignant lesions (mean ± SD, 5.41 ± 1.37 m/s) than benign lesions (2.91 ± 0.88 m/s; P < .001). When the SWV cutoff level was set at 4.07 m/s, and the higher of the internal and marginal values was adopted, the combination of VTI and VTQ showed 95.1% sensitivity, 99.0% specificity, and 97.8% accuracy.

Conclusions: Breast Imaging Reporting and Data System category 4 lesions are the main focus of research for early detection of breast cancer. Unfortunately, BI-RADS category 4 assessment covers a wide range of likelihood of malignancy (2%-95%). This wide range reflects the necessity for a more specific imaging modality. The combination of VTI and VTQ could increase the diagnostic performance of conventional sonography.
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http://dx.doi.org/10.7863/ultra.34.7.1201DOI Listing
July 2015

Acoustic radiation force impulse imaging for evaluation of renal parenchyma elasticity in diabetic nephropathy.

AJR Am J Roentgenol 2015 Feb;204(2):324-9

1 Department of Radiology, Dicle University School of Medical Science, Yenisehir, Diyarbakir, Turkey.

OBJECTIVE. The goal of this study is to evaluate the changes in the elasticity of the renal parenchyma in diabetic nephropathy using acoustic radiation force impulse imaging. SUBJECTS AND METHODS. The study included 281 healthy volunteers and 114 patients with diabetic nephropathy. In healthy volunteers, the kidney elasticity was assessed quantitatively by measuring the shear-wave velocity using acoustic radiation force impulse imaging based on age, body mass index, and sex. The changes in the renal elasticity were compared between the different stages of diabetic nephropathy and the healthy control group. RESULTS. In healthy volunteers, there was a statistically significant correlation between the shear-wave velocity values and age and sex. The shear-wave velocity values for the kidneys were 2.87, 3.14, 2.95, 2.68, and 2.55 m/s in patients with stage 1, 2, 3, 4, and 5 diabetic nephropathy, respectively, compared with 2.35 m/s for healthy control subjects. Acoustic radiation force impulse imaging was able to distinguish between the different diabetic nephropathy stages (except for stage 5) in the kidneys. The threshold value for predicting diabetic nephropathy was 2.43 m/s (sensitivity, 84.1%; specificity, 67.3%; positive predictive value, 93.1%; negative predictive value 50.8%; accuracy, 72.1%; positive likelihood ratio, 2.5; and negative likelihood ratio, 0.23). CONCLUSION. Acoustic radiation force impulse imaging could be used for the evaluation of the renal elasticity changes that are due to secondary structural and functional changes in diabetic nephropathy.
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http://dx.doi.org/10.2214/AJR.14.12493DOI Listing
February 2015

A single imaging modality in the diagnosis, severity, and prognosis of pulmonary embolism.

Biomed Res Int 2014 14;2014:470295. Epub 2014 Dec 14.

Department of Radiodiagnostics, Dicle University Medical Faculty, 21281 Diyarbakir, Turkey.

Introduction: This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement.

Materials And Methods: The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score.

Results: Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r = 0.531, P < 0.001), PAOI (r = 0.296, P < 0.001), and pulmonary artery diameter (r = 0.659, P < 0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death.

Conclusion: PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.
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http://dx.doi.org/10.1155/2014/470295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279180PMC
August 2015

The Role of Acoustic Radiation Force Impulse Elastography in the Differentiation of Infectious and Neoplastic Liver Lesions.

Ultrason Imaging 2015 Oct 7;37(4):312-22. Epub 2015 Jan 7.

Department of Medical Oncology, School of Medical Science, Dicle University, Diyarbakir, Turkey.

We aimed to evaluate the effectiveness of acoustic radiation force impulse (ARFI) elastography in differentiating between hepatic lesions. The prospective study included 117 patients with liver masses. Shear wave velocity (SWV) values for lesions were determined by ARFI imaging and compared statistically. The difference between SWV values for benign and malignant hepatic masses was significant (p < 0.01). The threshold SWV value for malignant hepatic lesions was established at 2.52 m/s, and the sensitivity and specificity of this cut-off value were 97% and 66%, respectively. We concluded that ARFI elastography provides supplementary data that aid in the differential diagnosis of liver masses.
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http://dx.doi.org/10.1177/0161734614566697DOI Listing
October 2015

Sonographic findings of hepatobiliary fascioliasis accompanied by extrahepatic expansion and ectopic lesions.

J Ultrasound Med 2014 Dec;33(12):2105-11

Departments of Radiology (M.T., H.Ö., C.H., C.G., M.G.Ç., S.H.), Microbiology (M.Ç.), and General Surgery (B.V.Ü.), Medical School, Dicle University, Diyarbakir, Turkey.

Objectives: The aim of the study was to describe the sonographic findings of hepatobiliary fascioliasis with extrahepatic expansion and ectopic lesions.

Methods: The study included 45 patients with fascioliasis. All diagnoses were confirmed via serologic enzyme-linked immunosorbent assays. Sonographic findings in the hepatobiliary system, extrahepatic expansion, and ectopic lesions were defined.

Results: The most common hepatic lesions were subcapsular localized, small, confluent, multiple hypoechoic nodules with poorly defined borders. We also detected ectopic lesion in 5 patients (11.1%) and live parasites in the gallbladder and bile duct in 11 (24.4%).

Conclusions: The large spectrum of entities in the differential diagnosis of hepatobiliary fascioliasis may lead to misdiagnosis and incorrect treatment. However, the diagnosis can be made when the characteristic sonographic features are seen, such as heterogeneity of the liver with multiple poorly defined hypoechoic-isoechoic lesions and multiple echogenic nonshadowing particles in the gallbladder or common bile ducts. Nonetheless, the differential diagnosis of fascioliasis versus other hepatic lesions may still be difficult. In these situations, pathologic confirmation should be performed to exclude the possibility of malignancy.
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http://dx.doi.org/10.7863/ultra.33.12.2105DOI Listing
December 2014

Imaging features of cerebral and spinal cystic echinococcosis.

Radiol Med 2015 May 21;120(5):458-65. Epub 2014 Nov 21.

Department of Radiology, Medical School, Dicle University, Yenişehir, Diyarbakir, 21280, Turkey,

Purpose: The main objective of this study was to describe the characteristic imaging features of cerebral and spinal hydatid disease (HD) in magnetic resonance imaging (MRI) and computed tomography (CT) in order to provide more effective differential diagnoses in endemic regions. We also aimed to use MRI and CT to evaluate whether the World Health Organization's (WHO) new classification of hepatic cystic echinococcosis (CE) could be used in the classification of cerebral HD.

Materials And Methods: We retrospectively reviewed the CT and MR images of 30 patients who were diagnosed with cerebral and spinal HD between 1990 and 2014. The imaging findings were noted. All hydatid cysts were classified according to the WHO classification of hepatic CE, consisting of six types.

Results: The study group consisted of 49 CEs in 27 patients with cerebral HD and 12 CEs in three patients with spinal HD. Of the cysts, 14 were type CL (cystic lesion), 29 were type CE1, 11 were type CE2 and seven were type CE3. In other words, 54 cysts were in the active group and seven were in the transition group. Most of the cysts were type CL and CE1.

Conclusions: Even though characteristic imaging features could be used in the differential diagnosis of HD, sometimes the differentiation of HD from other cystic lesions may be difficult. The use of WHO classification will provide standardisation of uniform treatment modality, as the treatment of HD, according to the stage of the disease, may be surgical or medical.
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http://dx.doi.org/10.1007/s11547-014-0475-zDOI Listing
May 2015

The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity.

Diagn Interv Radiol 2014 Nov;20(6):453-8

Department of Radiology, Dicle University School of Medicine, Diyarbakır, Turkey.

Purpose: The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis.

Methods: Abdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis.

Results: The Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6-1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37-4.78 m/s) for acute appendicitis.

Conclusion: ARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation.
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http://dx.doi.org/10.5152/dir.2014.13439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463284PMC
November 2014

[Fascioliasis and brucellosis in same patient].

Turkiye Parazitol Derg 2014 ;38(3):197-200

Dicle Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Diyarbakır, Türkiye.

Brucellosis is a zoonotic infectious disease that can affect many organs and systems and leads to very different clinical circumstances. Brucellosis is rare in association with various infectious agents. Fascioliasis is a zoonotic disease caused by Fasciola hepatica, popularly referred to as a large leaf-shaped liver fluke. This case is a 39-year-old male patient, and his complaints began a week ago, which were chills, fever, abdominal pain, nausea, vomiting, weakness, sweating, and widespread pain. The patient was considered brucellosis in the preliminary diagnosis. Rose Bengal test and Wright test (1/640) were detected as positive. Due to patients having elevated liver enzymes, abdominal ultrasound was taken. A liver lesion was seen with abdominal ultrasound. So, abdominal computed tomography (CT) was taken. The CT result report came in the form that at the left lobe of the liver segment 2, largely necrosis that showed no contrast enhancement, approximately 61x63 mm in size (compatible with fascioliasis) is viewed. The patient's IHA test results, required for fascioliasis, were detected as 1/320 positive. Especially for zoonotic diseases in areas with high endemicity, it should be considered that more than one infectious agent can be present together in high-risk patients.
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http://dx.doi.org/10.5152/tpd.2014.3352DOI Listing
November 2014

Primary pulmonary mucosa-associated lymphoid tissue lymphoma accompanied by a hydatid cyst.

Respir Care 2014 Nov 15;59(11):e186-9. Epub 2014 Jul 15.

Department of Radiology, Medical School, Dicle University, Diyarbakır, Turkey.

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http://dx.doi.org/10.4187/respcare.03113DOI Listing
November 2014

The role of quantitative measurement by acoustic radiation force impulse imaging in differentiating benign renal lesions from malignant renal tumours.

Radiol Med 2015 Mar 6;120(3):296-303. Epub 2014 Aug 6.

Department of Radiology, Dicle University, School of Medical Science, Diyarbakir, Turkey.

Purpose: The purpose of this preliminary study was to prospectively evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) imaging for differentiating benign lesions from malignant renal tumours.

Materials And Methods: Sixty patients with renal lesions were enrolled in the study; mean patient age was 49.52 ± 20.46 years (range 1-83 years) and patients included 30 men and 30 women. Lesions were categorised as benign (n = 19), malignant (n = 36) and infectious (n = 5) in origin. The shear wave velocities (SWVs) of the tumours and the intact parenchyma were determined by ARFI quantification, and the differences in the SWVs were compared among groups. The final diagnoses were determined via pathologic (n = 33), clinical (n = 13) and imaging findings (n = 14). The SWV values of the renal tumours were analysed according to the final diagnoses.

Results: The mean SWV value of the normal renal parenchyma was significantly different from that of all other lesions (p < 0.01). There was a significant difference between the SWV values of benign renal lesions including haematomas and the malignant renal lesions (p = 0.033). However, the SWV values of the infectious lesions and leiomyoma corresponded well with the malignant lesions. A Receiver operating characteristic (ROC) analysis demonstrated a cut-off value of 2.34 m/s between benign and malignant lesions, while sensitivity and specificity were determined to be 88 and 54 %, respectively.

Conclusion: ARFI elastography with ARFI quantification may be useful for differentiating benign renal lesions from malignant renal tumours.
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http://dx.doi.org/10.1007/s11547-014-0443-7DOI Listing
March 2015

Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children.

Pediatr Radiol 2015 Jan 27;45(1):55-61. Epub 2014 Jul 27.

Department of Radiology Medical School, Dicle University, Diyarbakir, Turkey.

Background: Acoustic radiation force impulse (ARFI) imaging is a promising method for noninvasive evaluation of the renal parenchyma.

Objective: To investigate the contribution of ARFI quantitative US elastography for the detection of renal damage in kidneys with and without vesicoureteral reflux (VUR).

Materials And Methods: One hundred seventy-six kidneys of 88 children (46 male, 42 female) who had been referred for voiding cystourethrography and 20 healthy controls were prospectively investigated. Patients were assessed according to severity of renal damage on dimercaptosuccinic acid (DMSA) scintigraphy. Ninety-eight age- and gender-matched healthy children constituted the control group. Quantitative shear wave velocity (SWV) measurements were performed in the upper and lower poles and in the interpolar region of each kidney. DMSA scintigraphy was performed in 62 children (124 kidneys). Comparisons of SWV values of kidneys with and without renal damage and/or VUR were done.

Results: Significantly higher SWV values were found in non-damaged kidneys. Severely damaged kidneys had the lowest SWV values (P < 0.001). High-grade (grade V-IV) refluxing kidneys had the lowest SWV values, while non-refluxing kidneys had the highest values (P < 0.05). Significant negative correlations were found between the mean quantitative US elastography values and DMSA scarring score (r = -0.788, P < 0.001) and VUR grade (r = -0.634, P < 0.001). SWV values of the control kidneys were significantly higher than those of damaged kidneys (P < 0.05).

Conclusion: Our findings suggest decreasing SWV of renal units with increasing grades of vesicoureteric reflux, increasing DMSA-assessed renal damage and decreasing DMSA-assessed differential function.
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http://dx.doi.org/10.1007/s00247-014-3072-3DOI Listing
January 2015

Use of acoustic radiation force impulse elastography to diagnose acute pancreatitis at hospital admission: comparison with sonography and computed tomography.

J Ultrasound Med 2014 Aug;33(8):1453-60

Departments of Radiology (C.G., C.H., S.H., M.G.Ç., M.T., A.B.) and Internal Medicine (M.S.D., M.K.), Medical School, Dicle University, Diyarbakır, Turkey.

Objectives: To compare the diagnostic success rate of acoustic radiation force impulse (ARFI) elastography with those of sonography and computed tomography (CT) for acute pancreatitis at hospital admission.

Methods: B-mode sonography and ARFI elastography were performed on 88 patients with symptoms of acute pancreatitis and 50 healthy control participants who were admitted to our hospital between February 2013 and July 2013. Acute pancreatitis was verified in the 88 patients based on clinical and laboratory findings. Computed tomography was performed on 41 patients, and the CT results from these patients were compared with those of ARFI elastography. The appearances of the pancreases of the patients were classified into 6 groups using visual color encodings obtained with ARFI elastography. The elasticity values of pancreatic head, body, and tail regions were evaluated with Virtual Touch imaging and Virtual Touch tissue quantification (Siemens Medical Solutions, Mountain View, CA). The success rates of sonography, CT, and ARFI elastography for diagnosing acute pancreatitis at hospital admission were compared.

Results: Forty-six of the 88 patients had a diagnosis of pancreatitis by B-mode sonography; pancreatitis was diagnosed in all patients by ARFI elastography; and 10 of 41 patients could not be diagnosed by CT. The sensitivity and specificity of Virtual Touch tissue quantification were 100% and 98%, respectively, when a cutoff value of 1.63 m/s was used. The control group had color scores of 1 or 2, whereas all patients with pancreatitis had color scores of 3 to 6 on color scale evaluation with Virtual Touch imaging.

Conclusions: Acoustic radiation force impulse elastography is a rapid, radiation-free, and noninvasive tool for diagnosis of acute pancreatitis at initial hospital admission, with a higher success rate for diagnosis of acute pancreatitis than the grayscale sonography and CT.
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http://dx.doi.org/10.7863/ultra.33.8.1453DOI Listing
August 2014

The role of initial radiologic and clinical manifestations in predicting the prognosis for pneumonia caused by H1N1 influenza virus.

J Thorac Dis 2014 Jun;6(6):752-9

1 Department of Radiology, Medical School, Dicle University, Diyarbakir, Turkey ; 2 Department of Radiology, Medical School, Yüzüncü Yıl University, Van, Turkey.

Objective: The aim of this study is to investigate the prognostic values of initial radiologic findings and preexisting medical conditions in pneumonia caused by H1N1 influenza virus that were obtained during the novel swine-origin influenza A (H1N1) virus (S-OIV) pandemic spread.

Methods: Thirty-nine patients hospitalized due to H1N1 infection between September and December 2009 were retrospectively evaluated regarding the radiologic and clinical aspects. The thoracic computed tomography (CT) findings of all patients were assessed and accompanying conditions that may raise the morbidity were stated. The patients were divided into two groups as those who needed the intensive care unit administration and those treated with brief hospitalization; initial radiologic findings and preexisting medical situations of patients were compared among both groups respectively in terms of their prognostic value.

Results: In 39 patients with H1N1 infection (21 males and 18 females; mean age of 53.9±14 in range between 19 and 99 years); the necessity of intensive care was significantly higher in patients with solely chronic obstructive pulmonary disease (COPD) (P=0.008, Odds ratio: 27) or co-existence of COPD and malignity (Odds ratio: 13); however, no statistically significant difference between two groups was observed regarding the radiologic facts or other combinations of accompanying medical conditions in terms of any effects to the prognosis.

Conclusions: In the H1N1 (S-OIV) pandemic, we observed that merely the contribution to the diagnostic process; the radiologic features have no significance as being prognostic indicator. Additionally; the superposition of H1N1 infection in patients with either COPD or COPD by malignity was stated to be a potential risk factor in terms of increased morbidity.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2014.04.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073361PMC
June 2014

Evaluation of retrobulbar blood flow with color doppler ultrasonography in patients with central serous chorioretinopathy.

J Clin Ultrasound 2014 Oct 18;42(8):481-5. Epub 2014 Apr 18.

Department of Radiology, Medical School, Dicle University, Diyarbakir, Turkey.

Background: To compare retrobulbar blood flow in patients with central serous chorioretinopathy (CSC) and healthy subjects using color Doppler ultrasonography.

Methods: Thirty patients (age 23-54 years) with a first episode of acute CSC and 30 healthy controls (age 30-44 years) were evaluated. The peak systolic blood flow velocity, end-diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were measured in the ophthalmic, posterior ciliary, and central retinal arteries.

Results: The posterior ciliary and central retinal artery EDV were lower in the patient group than in the control group, whereas RI and PI values were significantly higher (p < .05). The ophthalmic artery peak systolic blood flow velocity and EDV were lower in the CSC than in the control group (p < .05) without significant difference in RI and PI.

Conclusions: Color Doppler ultrasonography provides additional insights into the pathophysiology of CSC and may support the vasospasm hypothesis.
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http://dx.doi.org/10.1002/jcu.22156DOI Listing
October 2014

Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life.

J Clin Med Res 2014 Feb 13;6(1):44-52. Epub 2013 Dec 13.

Department of Family Physician, Dicle University Faculty of Medicine, Diyarbakir, Turkey.

Background: The aim of this study was to evaluate sleep quality and the related variables in patients with rheumatoid arthritis (RA).

Methods: Ninety-four patients diagnosed with RA and fifty two healthy controls were enrolled in the study. Disease activity was assessed through the Disease Activity Score (DAS) 28 scale. All patients were assessed using the Rheumatoid Arthritis Quality of Life and Health Assessment Questionnaire scales, together with the Beck Depression Inventory. Radiological damage was calculated with the modified Larsen method. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of the sleep disturbance.

Results: The patients with RA had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance domains and the total PSQI score compared to the healthy control group. According to the results of Spearman's analysis, there was a significantly correlation between the age, disease activity, CRP, pain, fatigue, depression, functional disability, quality of life, radiological damage, menopause status, duration of morning stiffness, ESR levels and the sleep disturbance. The logistic regression analysis indicated that depression and DAS 28 scores were predictors for poor sleep quality.

Conclusion: The sleep quality is disturbed in patients with RA. The poor sleep quality is especially associated with the disease activity and depression.
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http://dx.doi.org/10.4021/jocmr1648wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881989PMC
February 2014

Migration of two swallowed foreign bodies to different locations in the same case.

Ulus Cerrahi Derg 2014 9;30(4):228-30. Epub 2013 Jul 9.

Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey.

Foreign body ingestion can be seen at all ages, especially in childhood. Most swallowed foreign objects are disposed from the body without any health problems through defecation. It is rare that a foreign object perforates the intestine and migrates into the liver or peritoneum. In our case two unintentionally swallowed needles pierced the intestine and were located in the left lobe of the liver and small intestine mesentery. Foreign objects were detected in the abdomen of a 20-year-old female patient during examination performed for abdominal pain that lasted for three months. After a follow up period of three weeks the patient's complaints continued. She underwent laparotomy and both needles were removed in one session. It should be kept in mind that swallowed foreign objects can sometimes perforate the gastrointestinal system and may be located in different organs in the abdomen.
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http://dx.doi.org/10.5152/UCD.2013.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379800PMC
May 2015

The association between varicocele and ankylosing spondylitis via color duplex sonography.

Mod Rheumatol 2014 Jan;24(1):162-5

Department of Radiology, Medical School, Dicle University , Yenişehir, 21280 Diyarbakır , Turkey.

Objective: To evaluate the relationship between varicocele and ankylosing spondylitis (AS) via color duplex sonography (CDS).

Methods: Thirty male patients (age range 18-40 years, mean age 30.27 years) with AS and 30 male healthy controls (age range 20-36 years, mean age 27.23 years) were evaluated for varicocele using CDS.

Results: Vein diameter in right and left pampiniform plexus (PP) in the AS group was significantly higher than in the control group (p < 0.001 and p = 0.003, respectively). The incidence of varicocele was observed as 33.3 % in the AS group and 10 % in the control group. However, the difference was statistically significant (p = 0.028). The rate of right, left, and bilateral varicocele was 3.3 % (1 patient), 23.3 % (7 patients), and 6.6 % (2 patients), respectively, in the AS group, versus 0, 10, and 0 % in the control group (p = 1.000, p = 0.166, and p = 0.492, respectively).

Conclusions: The incidence of varicocele in AS patients is higher than in control subjects, and the difference is statistically significant. Therefore, varicocele must be taken into consideration and investigated in patients with AS.
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http://dx.doi.org/10.3109/14397595.2013.854047DOI Listing
January 2014

Adult diagnosis of Swyer-James-Macleod syndrome: retrospective analysis of four cases.

Respir Care 2014 Apr 11;59(4):e51-4. Epub 2013 Sep 11.

Department of Pulmonology.

Swyer-James-Macleod syndrome (SJMS) is a rare constrictive bronchiolitis with air-flow obstruction and a decreased number and diameter of ipsilateral peripheral pulmonary vessels. This syndrome is characterized by unilateral hyperlucency on chest radiography. Computed tomography provides useful additional information. The diagnosis is usually made in childhood but sometimes occurs in adulthood. The disease often presents with dyspnea, decreased exercise tolerance, cough, hemoptysis, and recurrent pulmonary infections. SJMS may be confused with asthma or pulmonary embolism due to similar symptoms and may result in inappropriate therapy. This case series examined the clinical and imaging spectrum of four patients who were diagnosed with SJMS in adulthood.
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http://dx.doi.org/10.4187/respcare.02552DOI Listing
April 2014

Naxos disease: an unusual cause of cardiomyopathy.

Turk Kardiyol Dern Ars 2013 Apr;41(3):265

Department of Cardiology, Dicle University, Diyarbakır, Turkey.

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http://dx.doi.org/10.5543/tkda.2013.61580DOI Listing
April 2013

A case of cerebral sinus venous thrombosis resulting in mortality in severe preeclamptic pregnant woman.

Case Rep Obstet Gynecol 2013 24;2013:402601. Epub 2013 Feb 24.

Department of Gynecology and Obstetrics, Dicle University School of Medicine, 21280 Diyarbakir, Turkey.

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality.
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http://dx.doi.org/10.1155/2013/402601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595662PMC
March 2013