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Pancreatic divisum is the most common anomaly of the pancreas. Pancreatic divisum associated with malignant tumor is rarely seen. The ampulla of Vater is formed by the union of the common bile duct and the pancreatic duct. The incidence of malignant tumor in the ampulla of Vater is very low. Adenomas and carcinomas are more common. Neuroendocrine tumors originate from enterochromaffin cells of the neuroendocrine system. Ampullary neuroendocrine tumors are very rare and preoperative diagnosis is very difficult. In the literature, the emphasis on imaging characteristics of similar cases is limited. Herein, we present a rare case of pancreatic divisum associated with ampullary neuroendocrine tumor and its characteristics of computed tomography and magnetic resonance imaging.

Purpose:The purpose of this study is to investigate the role of diffusionweighted magnetic resonance imaging (MRI) in differentiation of benign and malignant breast lesions.Materials and Methods:A total of 40 breast lesions (28 benign, 12 malignant) were scanned by routine dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI). The apparent diffusion coefficient (ADC) values of the lesions and normal breast tissue were measured and compared between benign and malignant groups. Also, lesions in benign and malignant groups were seperated according to dynamic contrast enhancement patterns and ADC values were compared. The results were evaluated at different cut-off values by receiver operating characteristic (ROC) curve analysis.Results:The mean ADC values were calculated as 0.83 ± 0.3x10-3 mm2/s in malignant lesions, and 1.35 ± 0.2 x10-3 mm2/s in benign lesions. The mean ADC value of the malignant lesions was statistically significantly lower than that of the benign lesions (p0.05). In ROC curve analysis, when the cut-off value was taken as 1.01 ± 0.25x10-3 mm2/s (b=1000), the sensitivity was 92.3%, the specificity was 92.5%, and the positive predictive value (PPV) was 85.7%.Conclusions:In differentiation of benign and malignant breast lesions, ADC value is a helpful parameter, that could be used together with the morphological criteria and the dynamic contrast enhancement pattern of the lesions. We suggest the routine use of DWI in breast MRI.

Midgut volvulus mezenter kökünün süperior mezenterik arter etrafında rotasyonuyla oluşan nadir görülen bir malrotasyondur.Çoğunlukla İnfantlarda görülmesine rağmen erişkinlerde de görülebilmektedir.Çok kesitli bilgisayarlı tomografi başta olmak üzere, ultrasonografi, ince barsak grafisi tanıda önemli katkılar sağlamaktadır. Biz semptomatik olarak tedavi edilen midgut volvuluslu erişkin olguyu sunduk ve literatürü tartıştık.

Objectives: To evaluate the effectiveness of ultrasound (US) guided percutaneous abscess drainage in the treatment of adult patients with perforated appendicitis and to estimate the success rate. Material and methods: Pre-interventional computed tomography examinations of patients (n=63) who had abscess formation due to perforated appendicitis were reviewed retrospectively. A total of 15 patients [6 (40%) women and 9 (60%) men] with a mean age of 42±21 (SD) years who underwent US-guided percutaneous abscess drainage were enrolled in this study. Abscess volume, location, catheter duration and follow-up results were recorded. The treatment effectiveness of US-guided percutaneous abscess drainage was investigated. Results: A total of 15 patients were included. Abscess formations were in right lower quadrant (n=10) and deep pelvic area (n=5). The mean abscess volume was 235 mm3 (range: 20 - 1180). The mean catheter duration was 12.2 ± 7.8 days (range: 3 - 30). Five patients (5/15, 33%) were treated non-surgically with complete response. In remaining 10 patients (10/15, 67%), surgical management was required because of recurrent abscess (3/15, 20%) and progression in abscess volume (7/15, 47%). The technical success rate and the clinical success rate was 100%, and 33%, respectively. Conclusion: Because of our low clinical success rate with 33%, we recommended US-guided percutaneous abscess drainage in perforated appendicitis for some selected patients with high risk surgery.

Objective: To evaluate T2-weighted BLADE tecnique for evaluating intra-abdominal organs and lesions, especially the gastrointestinal wall and pathologies, and to compare the findings with HASTE. Material and Methods: Sixty patients (mean age: 47.2 years, range 19-88) (32 males, 28 females) referred to our institution for upper abdominal Magnetic Resonance Imaging (MRI) examinations with various indications between January 2015 and May 2015 were included in our study. All examinations were performed on a 1.5 Tesla MR device and no anti-peristaltic drug was administered. Images were retrospectively and independently evaluated by two radiologists. A qualitative evaluation was performed to assess images regarding the presence of artifacts and diagnostic quality, the anatomical detail of the upper abdominal organs and structures (contour sharpness, contrast of tissue, parenchyma and internal wall structure) and any present pathologies and lesions in the organs (lesion contour sharpness and size, internal structure properties, morphological characteristics). A quantitative evaluation was performed to calculate the contrast-to-muscle ratios (CMR) of the internal organs and lesions. The distribution of the variables was statistically checked by Kolmogorov Smirnov test. Paired-samples t- test was used for quantitative data. Results: BLADE was significantly associated with reduced artifacts (p Conclusion: In upper abdominal MRI examination, artifacts, especially movement artifacts, were significantly reduced by BLADE, yielding more valuable data for the evaluation of the gastrointestinal system wall structure and its pathologies, especially considering the organs near to the diaphragm and retroperitoneal organs as well as vascular structures.

Background: Non-alcoholic fatty liver disease (NAFLD) is very common and serious disease. It begins as a simple hepatosteatosis but can progress to cirrhosis. The early detection of portal hypertension (HT) can be helpful in the management of these patients. Aims: To evaluate radiologic findings of portal hypertension at computed tomography (CT) of patients with non-alcoholic fatty liver disease for early diagnosis. Methods and materials: Images of 225 cases who underwent non-enhanced abdominal CT were reviewed. The patients with the difference between hepatic and splenic attenuation (CT L-S) > 10 were enrolled in hepatosteatosis group. The remainings formed control group. The relationship between two groups about diameters of portal and splenic veins, craniocaudal (CC) span of liver, splenic index, caudate lobe/right lobe (C/RL) ratio was analyzed statistically by Mann–Whitney U Test and Student’s t-test. Results: Total 213 cases, as hepatosteatosis (n = 149) and control (n = 64) groups, were involved in this study. Liver CC span, splenic index and C/RL ratio between two groups were found to be statistically significant (p

Background: Although endoscopic retrograde cholangiopancreatography (ERCP) is accepted as the gold standard, there is a place for magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) in the diagnosis of obstructive biliary disorders. Aim: To compare the findings of MRCP with ERCP in patients with obstructive biliary disorders and to investigate the diagnostic efficacy of MRCP combined with DWI. Study design: Retrospective, analytic, cross-sectional study. Methods: The MRCP images of 126 patients who underwent both MRCP and ERCP owing to biliary obstruction were reviewed. Nine patients were excluded because of incomplete diagnostic workup or a long period (>3 months) between MRCP and ERCP. Ninety-two patients underwent DWI, which was also evaluated. The sensitivity, specificity and accuracy of MRCP and DWI were analysed. Results: The sensitivity, specificity and accuracy of MRCP according to ERCP results as the gold standard was 97%, 71% and 93% for assessment of biliary dilatation; 100%, 94.7% and 97.5% for the diagnosis of choledocholithiasis; 93.7%, 100% and 99% for the identification of benign strictures; 100%, 100% and 100% for the diagnosis of malignant tumours; and 100%, 100% and 100% for the detection of complicated hydatid cysts; respectively. The sensitivity and specificity of DWI for the diagnosis of malignant tumour was 100%. In the detection of choledocholithiasis, the sensitivity and specificity of DWI was 70.8% and 100%. Conclusions: MRCP is an alternative, non-invasive, diagnostic modality, comparable with ERCP for the evaluation of pancreaticobiliary diseases. DWI can be helpful for diagnosis of choledocholithiasis and tumours.

Aim:To investigate the role of non-contrast magnetic resonance imaging (MRI) and findings of quantitative MRI in the evaluation of pancreatic lipomatosis in patients undergoing bariatric surgery.Methods:Pre-operative and post-operative MRI findings and laboratory test results of 44 obese patients, who underwent sleeve gastrectomy, were reviewed retrospectively. Liver craniocaudal length, hepatic and pancreatic region of interest (ROI) ratios at in-phase and out-of phase sequences (in-phase/out-of phase), pancreas/spleen ROI ratio on T2-weighted sequence (T2 ratio) and thickness of subcutaneous fat were estimated. The relationship between pre-operative and postoperative findings was analyzed.Results:A total of 44 (41 female, three male) patients with a mean age of 42 were included in the study. Liver length, hepatic and pancreatic in-phase/out-of phase ratios, pancreas/spleen T2 ratio and thickness of subcutaneous fat in the post-operative period were found to be lower than those in the pre-operative period (p

Small intestine tumors are extremely rare. They account for approximately 1-5% of all gastrointestinal tumors. However, the risk of development of small intestine tumor increases in patients with celiac disease. Celiac disease is also known as gluten-sensitive enteropathy. Lymphoma is the most common small intestine tumor in patients with Celiac disease. Adenocarcinoma and adenoma of the small intestine are less common. Adenocarcinoma is frequently seen in the proximal segments of the small intestine. The prognosis of adenocarcinoma is worse than lymphoma. In the literature, there are few reported cases of duodenal adenocarcinoma in patients with Celiac disease and the imaging findings were not emphasized enough. For this reason, in this study, computed tomography and magnetic resonance imaging findings in a patient with duodenal adenocarcinoma associated with Celiac disease are presented.

Objectives:An accurate pretherapeutic evaluation of laryngeal carcinoma is required for treatment planning as well as for evaluation and comparison of the results of different treatment modalities. The purpose of our study was to determine whether microlaryngoscopic findings and CT imaging correlate with histopathological findings or not.Material and Methods:In this study, thirty-five cases of laryngeal cancer with deeply invading up to the limits of larynx or extralaryngeal extension were studied. Each patient had a history, clinical evaluation (including microlaryngoscopy and biopsy), and CT examination. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT images. The histological findings were compared with the clinical and CT findings. The impact of each diagnostic method on pretherapeutic evaluation was analyzed.Results:Clinical evaluation alone failed to identify tumour invasion of the laryngeal cartilages and of the extralaryngeal soft tissues, resulting in a low staging accuracy (57%). The combination of clinical evaluation and an additional CT imaging resulted in significantly improved staging accuracy (86%).Conclusion:An interdisciplinary evaluation of clinical, endoscopical, and radiological findings is mandatory to detect the involvement of deep laryngeal or extralaryngeal tissues.