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Objective: Computed Tomography Urography (CTU) is an imaging method used to assess the kidneys, ureters, and bladder in the excretory phase by computed tomography (CT) with intravenous contrast media (IVCM). Our aim is to compare the five different methods performed for patient preparation prior to CTU, and to demonstrate their superiorities and disadvantages compared to each other. Materials and Methods: A total of 100 patients who underwent CTU scans with an indication as a result of their examinations were included in our study. These cases were randomly divided into 5 groups of 20. Water was applied to the first group. Saline was administered to the second group. In the third group, 0.1 mg/kg furosemide was administered intravenously following a 250 mL saline. Intravenous furosemide was administered to the fourth group. Intravenous furosemide was administered to the fifth group after they received water. Ureters were compared with each other according to the degree of opacification in proximal, medial, and distal segments in standard CTU. Results: By comparing the groups in pairs; there was a significant difference between Group II and the other four groups for the proximal ureter segment, and between Group II and Group III and IV for the medial and distal ureter segments (P

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Primary malignant mesothelioma of the liver is extremely rare, and radiologic features have been defined in only one case. We present radiologic findings of two cases which are pathologically proven as primary malignant mesothelioma of the liver. Malignant mesothelioma of the liver may be included in a differential diagnosis list if there is a heterogeneous, hemorrhagic and necrotic lesion in the liver, with peripheral serpiginous vascular structures and increasing septal enhancement in post-contrast images.

Benign intratesticular lesions are rare; thus, radiological diagnosis is important to avoid unnecessary surgical intervention. Testicular adrenal rest tumors (TART) are the nodular testicular lesions deriving from the adrenal remnant tissue reported in patients with congenital adrenal hyperplasia. We present ultrasonographic (US) and magnetic resonance imaging (MRI) findings of intratesticular adrenal rests in a 16-year-old patient with 11 beta hydroxylase deficiency. Scrotal ultrasonography demonstrated bilateral heterogenous hypoechoic lesions located around mediastinum testis and highly vascularized on powerDoppler US. On MRI the lesions were hyperintense on T1-weighted and hypointense on T2-weighted images and enhanced brightly on post-contrast images.

To determine the utility of apparent diffusion coefficient (ADC) values in differentiation of prostate cancer from normal prostate parenchyma and prostatitis we obtained ADC values of 50 patients at b 100, 600 and 1,000 s/mm(2) diffusion gradients. The ADC values of prostate cancer group were significantly lower than normal prostate and prostatitis group at b 600 and 1,000 s/mm(2) gradients. The ADC values at high diffusion gradients may be used in differentiation prostate cancer from normal prostate and prostatitis.

Fahr hastalığı, bilateral ve hemen daima simetrik olarak bazal ganglionlarda, subkortikal nükleuslarda ve beyaz cevherde kalsiyum ve diğer minerallerin depolandığı nadir bir hastalıktır. Klinik görünüm değişken olup nöbetler, rijidite ve demansla birlikte olabileceği gibi hiç bir nörolojik anormalliğin olmadığı olgular da olabilir. Fahr hastalığının tanısında yararlı bir görüntüleme tekniği olarak Bilgisayarlı Tomografi kullanılabilir. Biz, hastalıkla ilişkili bulgusu olmayan ve aşırı kalsifikasyonlara bağlı kognitif fonksiyon bozukluğu olan iki Fahr hastalıklı olgu sunuyoruz., Fahr's disease is a rare disorder where bilateral, almost symmetric, calcium and other mineral deposits occur in basal ganglia, subcortical nuclei and white matter. The clinical pattern is variable and may be associated with seizures, rigidity, and dementia. Also cases with Fahr's disease may present without neurological abnormalities. Computed tomography may be used to for the diagnosis of Fahr's disease as an useful imaging technique. We present two cases with Fahr's disease. One of them had no symptoms related to disease and the other patient had a cognitive function disorders due to extensive calcifications.

Duplications are rare congenital anomalies which can be found in the gastrointestinal system from mouth to anus. Bleeding, intussusception, intestinal obstruction, volvulus and malignancy can complicate cystic duplications. A perforated cecal duplication cyst was detected in a 7-year-old boy operated with the findings of acute abdomen. The cyst was totally excised and the case is presented as a rare cause of acute abdomen.. ©2005, Fırat Üniversitesi, Tıp Fakültesi, Duplikasyonlar gastrointestinal sistemde ağızdan anüse kadar herhangi bir yerde görülebilen nadir konjenital anomalilerdir. Kistik duplikasyonların kanama, invajinasyon, barsak obstrüksiyonu, volvulus, malignite gibi komplikasyonları görülebilir. Akut batın bulguları ile ameliyat edilen yedi yaşındaki erkek olguda, çekumda yerleşmiş ve perfore olmuş duplikasyon kisti tespit edildi. Total kist eksizyonu uygulanan olgu nadir bir akut batın nedeni olduğu için sunuldu.©2005, Fırat Üniversitesi, Tıp Fakültesi

A surgical sponge accidentally left in a surgical wound, called a textiloma or gossypiboma, is underreported in literature due to medicolegal consequences. Abdominal textiloma may be asymptomatic or present serious gastrointestinal complications such as bowel obstruction, perforation or fistula formation because of misdiagnosis. It may mimic abscess formation in early stage or soft-tissue masses in chronic stage. If there is an intraabdominal abscess resistant to catheter drainage in the postoperative period or an intraabdominal soft tissue mass with a history of previous surgery, textiloma should be included in the differential diagnosis.Whirl-like spongiform pattern especially on CT, well-defined border and fibrous capsule especially on MRI can help in the diagnosis of textiloma. We describe a case of intraabdominal textiloma mimicking abscess and soft tissue tumour on CT and MRI examination.

Stab injury of the thoracic aorta is a rare condition with high mortality rate. Patients must be evaluated carefully, and the diagnosis usually should be confirmed by radiological modalities. In this case, we report a 37-year-old man presented with a penetrating stab injury to the upper back and the thoracic aorta, and the diagnostic role of computed tomography is discussed.

ÖZET Alt ekstremite arteriyookluziv hastalıklarında dijital subtraksiyon anjiyografı (DSA) referans kabul edilerek manyetik rezonans anjiyografı (MRA) 'nin etkinliği değerlendirildi. Ocak 1997- Temmuz 1997 tarihleri arasında bölümümüze alt ekstremite arteriyookluziv hastalığı düşünülerek gönderilen yaşları 25 ile 73 arasında değişen (ortalama 53.3 yaş) 4 kadın, 35 erkek toplam 39 olguya sıralama gözetmeksizin DSA ve MRA tetkikleri yapıldı. MRA incelemesi 1.5-T Gyroscan MR üniti (Philips Medical Systems ) ile 2D TOF (TR / TE 23 / 5.4 ms, FA 20°-60°) tekniği ile abdominal aorta distalinden trifıkasyona kadar üç basamak halinde 4 mm'lik 100' er kesit alınarak yapıldı. Abdomen ve uylukta vücut koili, diz bölgesinde diz koili kullanıldı. Arteriyal ağaç 21 segmente (toplam 819 segment) bölünerek (distal abdominal aorta, sağ ve sol ana iliak, eksternal iliak, internal iliak, ana femoral, derin femoral, yüzeyel femoral, popliteal, anterior tibial, posterior tibial, peroneal) her bir segment açıklık (% 0), hafif stenoz (% 1-49), orta derecede stenoz (% 50-69), şiddetli stenoz (% 70-99) ve oklüzyon (% 100) açısından değerlendirildi. Tüm segmentlerin incelenmesinde her iki teknikle 662 segment normal, 10 segment hafif stenoz, 4 segment orta derecede stenoz, 7 segment şiddetli stenoz ve 121 segment tam oklüzyonolarak değerlendirildi. Yani 819 segmentin 804' ünde bulgular aynıydı. 2 segment DSA'da normal iken MRA'da tam oklüzyon ve 2 segment DSA'da hafif stenoz varken MRA'da normal olarak değerlendirildi. 11 segmentteki lezyonlar MRA ile, DSA'da izlenenden daha yüksek oranda değerlendirildi. Tüm segmentler göze alındığında MRA'nm sensitivitesi % 98.6, spesifitesi % 98, pozitif prediktif değeri % 91.6 ve negatif prediktif değeri % 99.6 olarak bulundu. Alt ekstremite arteriyookluziv patolojilerinde noninvaziv bir inceleme metodu olarak MRA, yüksek sensitivite ve spesifite ile kullanılabilir. 90 SUMMARY Magnetic Resonance Angiography in Lower Extremity Arterioocclusive Diseases The efficiency of magnetic resonance angiography (MRA) in lower extremity arterioocclusive diseases was investigated with the referance of digital substraction angiography (DSA). Both DSA and MRA were performed in 39 patients, 35 men and 4 women, who were transferred to Radiology Department with the suspicion of lower extremity arterioocclusive disease between January 1997 and July 1997. The mean age was 53.3 years (range 25 and 73). MRA examination was done with 1.5 -T Gyroscan MR unit (Philips Medical Systems) by using 2D TOF (TR /TE: 23/ 5.4 ms, FA 20°-60°) technique starting from distal aorta to the trifurcation in three steps, 100 slices were taken, each slice 4 mm. Body coil for abdomen and tight, knee coil for the knee were used. Arterial tree was divided into 21 segments (819 segments, totally) (distal part of abdominal aorta, right and left common iliac, external iliac, internal iliac, main femoral, deep and superficial femoral, popliteal, anterior tibial, posterior tibial and peroneal), and each segment was evaluated according to the percent of stenosis: 0 % open, 1-49 % slight stenosis, 50-69 % moderate stenosis, 70-99 % severe stenosis and 100 % complete occlusion.91 Six hundred-sixty two segments were normal, slight stenosis was detected in 10, moderate stenosis in 4, severe stenosis in 7 and complete occlusion in 121 in both techniques. The results were same in 804 of 819 segments. Two segments were normal in DSA but MRA revealed complete occlusion in those two segments.-On the contrary, DSA showed slight stenosis in two segments but those were normal in MRA. Eleven segments were overestimated in MRA when compared with DSA. The sensitivity and specificity of MRA were 98.6 % and 98 %, respectively. The positive predictive value was 91.6 % and the negative predictive value was 99.6 %. MRA, being a non-invasive method, can be used in lower extremity arterioocclusive diseases with very high sensitivity and specificity rates. 104

Abdominal cocoon, or sclerosing encapsulating peritonitis, is supposed to be rare cause of intestinal obstruction. It is characterized by totally or partially encasement of small bowel with a thick, fibrotic, cocoon-like membrane. We think this entity is not rare as previously thought. We reported two case-s clinical and imaging findings which diagnosed abdominal cocoon by surgery to increase awareness of this diagnosis. (C) 2013 Elsevier Inc. All rights reserved.

Cystic abdominal masses in children are not an infrequently encountered condition of childhood. These lesions usually present with large size and mimick each other with similar presenting symptoms. Imaging examinations have an important role to determine the type of the cystic abdominal masses, which is crucial for management of patients and presurgical planning. In this pictorial essay, we summarized the imaging features of common cystic abdominal masses of children, including cystic lesions arising from liver, biliary ducts, kidney, pancreas, bowel, ovary, mesentery, and miscellaneous tissues. (C) 2013 Elsevier Inc. All rights reserved.

Purpose: To investigate the effect of fat infiltration on the apparent diffusion coefficient (ADC) of liver, and assess the relationship between ADC and hepatic fat fraction (HFF). Materials and Methods: MRI scans of 120 consecutive patients were included in this retrospective study. Of these, 42 patients were included in the fatty liver group and 78 in the control group. ADC values were measured from a pair of diffusion-weighted (DW) images (b 0 mm(2)/s and 1000 mm(2)/s). HFFs were measured using T1W GRE dual-echo images. The difference between the ADCs of the two groups was assessed with the t-test. The relationship between HFF and ADC was determined using linear regression analysis and the Pearson correlation coefficient (r). Results: Mean HFFs were 0.85 +/- 2.86 and 13.67 +/- 8.62 in the control and fatty liver groups, respectively. The mean ADC of fatty liver group 1.20 +/- 0.22 x 10 (-3) mm (2)/s was significantly lower than that of the control group 1.32 6 0.23 x 10(-3) mm (2)/s (P = 0.02). Linear regression analysis revealed an inverse relationship between ADC and HFF (r = 0.39, P 5% HFF, and ADC and HFF exhibit an inverse relationship. Key Words: MRI; diffusion-weighted; fatty liver; imaging; chemical shift J. Magn. Reson. Imaging 2012; 35: 1108-1111. (C) 2011 Wiley Periodicals, Inc.

The aim of this study was to investigate the diagnostic role of the apparent diffusion coefficient (ADC) measurement in the diagnosis of focal parenchymal lesions and to understand the discriminating role of the ADC value for differentiating Fasciola lesions from other focal liver lesions.We measured ADC values of parenchymal lesions and liver parenchyma in 18 patients with Fasciola hepatica infestation at b 100, b 600, and b 1000 s/mm(2) gradients. We further measured average ADC values of hepatic metastases (n = 21), hepatocellular carcinomas (n = 21), cholangiocarcinomas (n = 7), hydatid cysts (n = 12), and focal nodular hyperplasia (FNH) (n = 12) and compared them with average ADC values for Fasciola hepatica.The differences between average ADC values of lesions (2.16 ± 0.36 × 10(-3) mm(2)/s) and parenchyma (1.64 ± 0.2 × 10(-3) mm(2)/s) at three gradients were statistically significant (P0.05). Mean ADC values of Fasciola hepatica lesions were significantly different from most of the other focal hepatic lesions, except FNH at all gradients and hydatid cyst at only the b 100 gradient.ADC measurement may be a complementary method in the diagnosis of Fasciola hepatica, and it may be used to differentiate these lesions from other focal liver lesions.

Background Nutcracker syndrome, also called left renal vein entrapment syndrome, is a cause of non-glomerular hematuria with difficulties in diagnosis. Multidetector computed tomography (MDCT) is a powerful tool to prevent unnecessary diagnostic procedures. Purpose To retrospectively determine the prevalence of nutcracker phenomenon and nutcracker syndrome seen in MDCT in consecutive patients. Material and Methods The institutional review board approved the study and waived the requirement for informed consent. Abdominal contrast-enhanced MDCT scans were reviewed from 1000 consecutive patients. MDCT scan assessment included renal vein diameter measurements and evaluation for the presence of anterior or posterior left renal vein entrapment. Electronic medical records and urine analysis reports of patients with left renal vein entrapment were reviewed. Student's t test was used to assess differences in renal vein diameter in patients with left renal vein entrapment. Results Left renal vein entrapment was observed in 10.9% (109), retro-aortic left renal vein in 6.5% (65), entrapment of left renal vein between superior mesenteric artery and aorta in 4.1% (41), and circumaortic left renal vein in 0.3% ( 3 ) of patients. Mean diameters of right (8.8±1.9 mm) and unentrapped left (8.9±1.8 mm) renal veins were not significantly different ( P = 0.1). The mean diameter of anterior entrapped left renal veins (10.3±2 mm) was significantly greater ( P = 0.04) than contralateral renal veins (8.6±2.1 mm) in their widest portion. In 8.8% of patients with the left renal vein entrapment, urine analysis showed isomorphic hematuria or proteinuria with no other known cause. Varicocele and pelvic congestion were seen in 5.5% of patients with the left renal vein entrapment. Conclusion Left renal vein entrapment is not a rare entity and renal nutcracker phenomenon might be underdiagnosed.

The purpose of our study was to evaluate the utility of the apparent diffusion coefficient (ADC) value measurement in the diagnosis of peritoneal metastases on diffusion weighted magnetic resonance imaging.Diffusion weighted imaging with conventional magnetic resonance imaging sequences was performed on twenty consecutive oncology patients (group I) with peritoneal metastases. The ADC values of the metastases, the peritoneal fat around the metastases (group I) and the peritoneal fat in patients with no malignancy (group II) at b(0-100), b(0-600), and (b 0-1000) s/mm(2) gradients were measured and compared.The apparent diffusion coefficient values of three gradients in peritoneal metastases (2.27±0.4; 1.67±0.7 and 1.09±0.4×10(-3) mm(2)/s at b 100, 600 and 1000 gradients, respectively) were significantly lower than the ADC values of the peritoneal fat around metastases (3.07±0.4; 2.07±0.4; 1.33±0.3×10(-3) mm(2)/s at b 100, 600 and 1000 gradients, respectively) (p0.05). There was no significant difference between the ADC values of peritoneal fat in the patients of group I and group II at the 3 diffusion gradients (p0.05).The measurement of ADC values may be used as a complementary diagnostic method in differentiating peritoneal metastases from peritoneal fat on Diffusion Weighted MRI (DWMRI DWMRI).Bu çalışmanın amacı difüzyon ağırlıklı manyetik rezonans görüntülemede (MRG) peritoneal metastazların tanısında görünür difüzyon katsayısı (ADC) değerlerinin yararlılığını değerlendirmektir.Peritoneal metastazı bulunan 20 onkoloji hastasına (grup 1) konvansiyonel MRG sekansları ile birlikte difüzyon ağırlıklı görüntüleme gerçekleştirildi. Peritoneal metastazların, metastaz çevresindeki yağ dokusunun ve malignansisi olmayanların (grup 2) peritoneal yağ dokusunun ADC değerleriPeritoneal metastazların 3 gradientte elde edilen ADC değerleri (Difüzyon ağırlıklı görüntülemede peritoneal metastazların peritoneal yağ dokusundan ayırtedilmesinde ADC değerlerinin ölçümü yardımcı bir tanı yöntemi olarak kullanılabilir.

Objective: To examine the effectiveness of apparent diffusion coefficient (ADC) values and to compare the reliability of different b-values in detecting and identifying significant liver fibrosis. Subjects and Methods: There were 44 patients with chronic viral hepatitis (CVH) in the study group and 30 healthy participants in the control group. Diffusion-weighted magnetic resonance imaging (DWI) was performed before the liver biopsy in patients with CVH. The values of ADC were measured with 3 different b-values (100, 600, 1,000 s/mm2). In addition, liver fibrosis was classified using the modified Ishak scoring system. Liver fibrosis stages and ADC values were compared using areas under the receiver-operating characteristic (ROC) curve. Results: The study group's mean ADC value was not statistically significantly different from the control group's mean ADC value at b = 100 s/mm2 (3.69 ± 0.5 × 10-3 vs. 3.7 ± 0.3 × 10-3 mm2/s) and b = 600 s/mm2 (2.40 ± 0.3 × 10-3 vs. 2.5 ± 0.5 × 10-3 mm2/s). However, the study group's mean ADC value (0.99 ± 0.3 × 10-3 mm2/s) was significantly lower than that of the control group (1.2 ± 0.1 × 10-3 mm2/s) at b = 1,000 s/mm2. With b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s for the diagnosis of liver fibrosis, the mean area under the ROC curve was 0.702 ± 0.07 (p = 0.0015). For b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s to diagnose significant liver fibrosis (Ishak score = 3), the mean area under the ROC curve was 0.759 ± 0.07 (p = 0.0001). Conclusion: Measurement of ADC values by DWI was effective in detecting liver fibrosis and accurately identifying significant liver fibrosis when a b-value of 1,000 s/mm2 was used.

The aim of this study was to evaluate the utility of apparent diffusion coefficient (ADC) values in differentiation between solid adrenal masses. The ADC values of 73 adrenal lesions (54 benign, 19 malignant) in 69 patients were measured at b 100, 600 and 1000 gradients on diffusion-weighted magnetic resonance imaging (DW-MRI). No statistically significant difference was found between ADC values of benign and malignant adrenal masses, nonadenomatous benign adrenal masses and malignant adrenal masses, adrenal adenomas and nonadenomatous lesions, adenomas and metastases, adenomas and pheochromocytomas, metastases and pheochromocytomas. ADC values are not helpful in the differentiation between solid adrenal masses. (C) 2014 Elsevier Inc. All rights reserved.

To determine the utility of different contrast enhancement phases (unenhanced, arterial, and venous), slice thicknesses (0.5, 3, and 5 mm), and planes (axial and coronal) in the evaluation of appendix vermiformis (AV) on multidetector computed tomography (MDCT), CT examinations of 600 patients were obtained. No significant difference was found between the different imaging planes, slice thicknesses, and contrast enhancement phases in terms of detection rates of AV. The mean diameter of AV in the axial plane (5.93 +/- 0.06 mm) was significantly lower than that in the coronal plane (6.18 +/- 0.06 mm). Evaluation of AV on MDCT is enhanced by combined interpretation on axial and coronal planes. (C) 2012 Elsevier Inc. All rights reserved.

To evaluate the utility of apparent diffusion coefficient (ADC) measurement in characterization of focal solid hepatic lesions and determine the role of ADC values in differentiation of solid benign and solid malignant hepatic lesions.Between June 2006 and December 2010, a total of 95 focal solid hepatic lesions in 95 consecutive patients were evaluated by abdominal MRI. Diffusion weighted MRI was performed with b 100, b 600 and b 1000 gradients with ADC measurements. Comparison of mean ADC values between solid benign (focal nodular hyperplasia and other solid benign lesions) and solid malignant lesion (hepatocellular carcinoma, metastasis, and cholangiocarcinoma) groups and between each benign and malignant lesion was done. The ROC analyses were performed in order to determine cut-off ADC values for differentiation of benign and malignant lesion groups at 3 different gradients.Twenty-six of 95 lesions were benign and 69 were malignant. Mean ADC values of solid benign lesions at b 100, b 600 and b 1000 gradients were 2.25±0.54×10(-3), 1.97±0.64×10(-3) and 1.52±0.47×10(-3) mm2/s, respectively. Mean ADC values of solid malignant lesions at b 100, b 600 and b 1000 gradients were 1.84±0.57×10(-3), 1.37±0.38×10(-3) and 1.08±0.22×10(-3) mm2/s, respectively. The ADC values of solid benign lesions were significantly higher than solid malignant lesions at all 3 gradients (P0.05). Differentiation of benign and malignant subtype lesions from each other in their groups did not yield as significant findings as comparing results between benign and malignant lesions.Although ADC measurements were not helpful for differentiating subtypes of solid benign or solid malignant lesions, ADC measurements at 3 different gradients may be useful in differential diagnosis of benign lesions from malignant ones.

Objectives: Our aim was to investigate the role of simultaneous apparent diffusion coefficient (ADC) measurement and diffusion-weighted MRI (DWMRI) in the diagnosis and differentiation of bladder masses. Methods: Weexamined 45 patients presenting with hematuria by dynamic and diffusion MRI (at b100, b600, b1000 gradients) and cystoscopy. Thirty healthy volunteers without hematuria were also included in the study. Results from imaging techniques were compared to cystoscopic and histopathologic findings. The ADC values of benign and malignant bladder masses, and bladder tissue in healthy subjects were measured and compared with each other. Results: The mean ADC values of benign (n = 10) and malignant lesions (n = 35) were significantly lower than the mean ADC values of adjacent bladder walls and bladder walls of healthy subjects at all 3 gradients (p < 0.05). However, no significant difference was detected between benign and malignant lesions (p > 0.05). Mean ADC values of invasive tumors were significantly lower than superficial malignancies at b600 and b1000 gradients. The mean ADC values of transitional cell tumors were significantly higher than squamous cell tumors at b100 and b600 gradients. Conclusion: Simultaneous measurement ofADC and DWMRI provided useful information in the diagnosis, staging and histopathological classification of bladder tumors.

Bu çalışmanın amacı, pelvik kitle ön tanısıyla alt batın Difüzyon Ağırlıklı MRG (DAG) tetkiki yapılan kadın hastalarda kitlelerinin malign-benign ayırımında DAG'nin tanıya katkısının klinikte kullanılabilirliğini araştırmaktır.Çalışmaya Ekim 2007 ile Ekim 2008'de, Radyoloji Anabilim Dalı MR Ünitesi'ne pelvik kitle ön tanısıyla alt batın MR tetkiki istenen 16?75 yaş aralığındaki toplam 125 olgu dâhil edildi. Bu hastalardan DAG ile sırasıyla b100, b600, b1000 gradient değerlerinde difüzyon ağırlıklı EPI görüntüler alındı. Pelvik kitle saptanan olgularda lezyonlardan ADC değerleri ölçüldü. Bir grup olgu yalnızca klinik olarak takip edilirken, diğer grup cerrahi işlem gördü. Cerrahiye giden olgulardan histopatoloji sonucu malign olarak gelen olgular ile benign olarak gelen olguların, kitle ADC değerleri karşılaştırıldı.Malign lezyon saptanan 35 olgunun lezyona ait ADC değerleri (b100, b600, b1000) (2.18x10?3; 1.47x10?3; 1.22x10?3), benign lezyon saptanan 90 olgunun lezyona ait ADC değerlerinden (b100, b600, b1000) (2.60x10?3; 2.05x10?3; 1.79x10?3 mm2/s) düşük olup aradaki fark istatistiksel olarak anlamlı bulunmuştur (p

Bu çalışmanın amacı, prostat kanseri ön tanısıyla pelvik dinamik kontrastlı MRG ve difüzyon ağırlıklı MRG (DAG) tetkiki yapılan hastalarda tespit edilen patolojik lezyonların malign-benign ayırımında DAG'ın tanıya katkısını araştırmaktır.Çalışmaya Ocak 2009 ile Ocak 2010 tarihleri arasında, Radyoloji Anabilim Dalı MR Ünitesi'ne prostat kanseri ön tanısı ve pelvik MR tetkiki istemiyle gelen 50?85 yaş aralığındaki toplam 50 olgu dahil edilmiş olup bu olguların 11'i normal prostat dokusu tanısı alan kontrol grubunu oluşturmaktadır. Olgularda sırasıyla b100, b600 ve b1000 gradient değerlerinde difüzyon ağırlıklı EPI görüntüler alınarak ADC değerleri ölçüldü.Transrektal Ultrasonografi (TRUS) eşliğinde yapılan biyopsi sonucu sitolojik olarak 11 olguya normal prostat dokusu, 9 olguya prostatit ve 20 olguya prostat adenokanseri tanısı kondu. On olguya ise radikal prostatektomi sonucu histopatolojik olarak adenokanser tanısı kondu. Cerrahiye ve biyopsiye giden olgulardan sitoloji ve histopatoloji sonucu prostat kanseri olarak raporlanan doku ile benign olarak saptanan dokuların ve prostatit odakları içeren dokuların ADC değerleri karşılaştırıldı.Prostat kanseri saptanan 30 olgunun kanserli dokularına ait ADC değerleri b100, b600, b1000 gradientlerinde sırası ile 2.06x10?3; 1.57x10?3; 1.35 x10?3 mm2/s ölçülmüş olup; bu değerler normal dokudan aynı gradientlerde ölçülen ADC değerlerinden (b100, b600, b1000), (2.43x10?3; 1.77x10?3; 1.47x10?3mm2/s) düşük olup aradaki fark istatistiksel olarak anlamlı bulundu (p=0.001). Prostatit saptanan olguların ADC değerleri (b100, b600, b1000), (2.25x10?3; 1.69x10?3; 1.48x10?3 mm2/s), prostat kanseri saptanan olguların ADC değerlerinden daha yüksek saptanmış olup aradaki fark istatistiksel olarak anlamlı bulundu (p=0.002). Prostatit saptanan dokulardaki ADC değerleri ile normal prostat dokusunda ölçülen ADC değerleri arasında ise istatistiksel olarak anlamlı fark bulunmadı (p=0.919). Sonuç olarak; ADC değerlerinin ölçümleriyle birlikte difüzyon MRG bir fonksiyonel görüntüleme yöntemi olarak prostat kanserinde kanser dokusu ile benign prostat dokusu ve prostatit ayırımında önemli katkılar sağlayabilmektedir.Anahtar Kelimeler: Manyetik rezonans görüntüleme (MRG), prostat kanseri, ADC, difüzyon ağırlıklı görüntüleme (DAG). The aim of this study is to investigate the contribution of diffusion-weighted magnetic resonance imaging (DWMRI) in the differentiation of pathological malignant and benign prostate lesions which were detected in patients screened for suspected prostate cancer by pelvic abdomen dynamic contrast-enhanced MRI and DWMRI.A total 50 patients aged between 50-85 years old who were suspected for prostate cancer and screened by pelvic MRI between January 2009 and January 2010 at Department of Radiology department included in our study. Eleven of these patients having diagnosis of normal prostate tissue were control group. The ADC values of patients were measured with diffusion-weighted EPI imaging at b100, b600, b1000 gradients values, respectively.Cytological examination transrectal ultrasonographic (TRUS) specimens biopsy results cytologically showed normal prostate tissue in 11 patients, prostatitis in 9 patients and adenocarcinoma in 20 patients. Histopathological results in 10 patients who underwent radical prostatectomies were diagnosed as adenocarcinoma.ADC values of the tissues reported cytologically and histologically as prostate cancer and normal tissue and prostatitis by surgery and biopsy were compared.ADC values measured in 30 patients with prostate cancer (b100, b600, b1000), (2.06x10-3; 1.57x10-3; 1.35x10-3 mm2/sec, respectively) were statistically significantly lower than ADC values measured in patients with normal prostate tissues (b100, b600, b1000), (2.43x10-3; 1.77x10-3; 1.47x10-3 mm2/sec, at b100, b600, b1000 gradients respectively), and these were statistically significant (p=0.001). ADC values measured in patients with prostatitis (b100, b600, b1000), (2.25x10-3; 1.69x10-3; 1.48x10-3 mm2/sec) were found higher than ADC values measured in patients with prostate cancer, and the difference was statistically significant (p=0.02). The difference between ADC values measured in patients with prostatitis and normal prostate tissue was not found statistically significant (p=0.919).As a result: diffusion MRI with measurement of ADC values as a functional imaging method may provide an important role for differentiation prostate cancer from normal prostate tissue and prostatitis.Keywords: Magnetic resonance imaging (MRG), prostate cancer, ADC, difussion weighted ımaging (DWI). 103

1. ÖZETBu çalışmada fokal karaciğer lezyonları (FKL) iki-boyutlu(2B) ve üç-boyutlu(3B) renkli Doppler ultrasonografi (RDUS), power Doppler ultrasonografi(PDUS) ve Dynamic Flow görüntüleme (DFG) ile değerlendirildi.Ocak 2004-Ocak 2005 tarihleri arasında FKL olan 33'ü kadın, 29'i erkektoplam 62 (yaş ortalaması 58.2±14.1 yıl) olgu çalışmaya kabul edildi. Patolojikinceleme veya lezyonların radyolojik görüntülemede tipik görünümlerine göre 14'übenign (%22.6), 48'si malign (%77.4) tanı aldı. 14 benign lezyonun 12'sihemanjiyom, 1'i lipom, 1'i inflamatuar pseudotümördü. 48 malign lezyonun 33'ümetastaz (%68.7), 15'i HCC kitlesiydi (%31.3).B-mod, RDUS, PDUS ve DFG görüntülemeleri 2-5 MHz multifrekans genişbant konveks şekilli tranduser ile yapıldı. (Toshiba Applio SSA 770A/80 Tokyo,Japonya) Olgulara 2B ve 3B RDUS, PDUS ve DFG incelemeleri yapıldı.Vaskülarizasyon paternleri, Tip I avasküler, Tip II peritümöral, Tip III intratümöralvaskülarite olarak sınıflandırıldı.Bu görüntüleme teknikleri ile 62 olgunun 51'ine tüm Doppler incelemeleriyapılabildi. 51 olgunun 38'inde tüm Doppler incelemelerinde aynı tipvaskülarizasyon paterni izlendi (20 tanesi Tip II, 17 tanesi Tip III, 2 tanesi Tip I). 2Bve 3B Doppler incelemeleri arasında aynı Doppler modalitesi için 2B RDUS ile 3BRDUS (p=0.005), 2B PDUS ile 3B PDUS (p=0.003), 2B DFG ile 3B DFG(p=0.001)arasında istatiksel olarak anlamlı farklılık izlendi.3B Doppler görüntüleme, 2B Doppler görüntülemelere göre üstün bir şekildeintratümöral akımı saptadığı izlendi. Dynamic Flow görüntüleme, özellikle 3BDynamic Flow görüntüleme diğer 3B Doppler tekniklerine göre istatistiksel olarak1anlamlı farklılık göstermemekle birlikte görsel olarak ve intratümöral akımıgöstermede üstün bir metot olduğu saptandı.Anahtar kelimeler: Üç-Boyutlu Doppler, Fokal Karaciğer Lezyonları, PowerDoppler, Dynamic Flow2 2. ABSTRACTASSESMENT OF THE FOCAL LIVER LESIONS WITH TWO- DIMENSIONALAND THREE-DIMENSIONAL COLOR DOPPLER ULTRASONOGRAPHY,POWER DOPPLER ULTRASONOGRAPHY AND DYNAMIC FLOW IMAGINGIn this study, vascular pattern of focal liver lesions (FCL) were evaluated bytwo- dimensional (2D) and three-dimensional (3D) color Doppler ultrasonography(CDUS), power Doppler ultrasonography (PDUS) and Dynamic flow imaging (DFI).Between January 2004-January 2005, 33 female and 29 male patients (total62) patients between ages of 16-78 years (mean 58.2±14.1 years) were included in tothe study. 14 benign (22.6%) and 48 malignant (%77.6) lesions were diagnosed bypathologic examination or typical radiological findings. In benign lesions, 12 lesions(85.7%) were hemangiomas, 1 (7.15%) lipoma and 1 (7.15%) inflammatorypseudotumor. In malign lesions, 33 lesions (68.7%) were hepatocellular carcinomaand 15 (31.3%) metastases.B-mode, CDUS, PDUS and DFI examinations were performed by ToshibaSSA 770A/80 Aplio device (Tokyo-Japan) using 2-5 MHz multifrequency wide-bandconvex shaped transducer. All patients were examined with 2D and 3D CDUS,PDUS and DFI. The vascular pattern on Doppler sonography was classified intothree types: avascular (Type I), peripheral vascular (Type II), and intratumoralvascular (Type III).All kind of Doppler imaging study were made 51 of 62 patients. The samevascular pattern were found in 38 (74.5 %) of 51 lesions (n= 20 type II, n=17 typeIII, n=2 type I). Significant differences were found in between 2D CDUS and 3DPDUS (p=0.005), 2D PDUS and 3D PDUS (p=0.003), 2D DFI and 3D DFI(p=0,001).33D Doppler imaging is better than 2D Doppler techniques for detectingintratumoral flow. There was no significant difference in between 3D DFI and other3D Doppler modalities. But visually, 3D DFI more clearly depicted intratumoralvascularity than the other Doppler modalities.Key words: Three-Dimensional Doppler, Focal Liver Lesions, Power Doppler,Dynamic Flow.4 80

l.OZET Hipertansiyonun retrobulber vasküler yapılar üzerindeki hemodinamik etkileri, renkli Doppler göz ultrasonografısi (RDGU) ile değerlendirildi. 01.08.2001-01.02.2002 tarihleri arasında hipertansiyon süreleri 1-30 yıl (ortalama 5.4 ± 5.5 yıl ) olan, sistemik hipertansiyon (HT) nedeni ile göz kliniğinde göz dibi muayenesi yapılan, yaşları 16 ile 85 arasında değişen (ortalama 50.3 ± 15 ) 50 olgu ile yaşlan 23 ile 69 yaş arasında değişen (ortalama 44.7 ± 1 1) 30 normotansif kişi çalışmaya dahil edildi. Her iki grubun iki gözünde de (160 göz) oftalmik arter (OA), santral retinal arter (SRA), posterior silier arter (PSA), piksistolik, end diastolik, rezistif indeks (Rİ), pulsatilite indeksi (Pİ) değerleri ölçüldü. Kişiler supin pozisyonunda, göz kapaklan kapalı, jel sürülerek, 7.5 MHz' lik lineer transdüser ile Toshiba Sonolayer SSH 140A renkli Doppler cihazı ( Tokyo/ Japonya ) ile değerlendirildi. Pİ değerlerinin; sağ SRA'da hipertansif grupta ortalama 1.30 ± 0.26 kontrol grubunda ortalama 1.15 ± 0.14 ( p= 0.004 ), sol SRA da hipertansif grupta ortalama 1.32 ± 0.30, kontrol grubunda ortalama 1.1 1 ± 0.19(p=0.0001) olduğu, Rİ değerlerinin; sağ PSA' da hipertansif grupta ortalama 0.64 ± 0.09 kontrol grubunda ortalama 0.63 ± 0. 09(p=0.013),sol PSA da hipertansif grupta ortalama 0.68 ± 0.09 kontrol grubunda 0.63 ± 0.06 (p=0.003) olduğu ve istatistiksel olarak anlamlı artış gösterdiği saptandı. Ayrıca sağ OA pik sistolik hızı hipertansif grupta ortalama 35.2 ± 9.2 cm /sn, kontrol grubunda 28.5 ± 7.5 (p=0.002), end diastolik hız hipertansif grupda ortalama 10.5 ± 4 kontrol grubunda 8.7 ± 7