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Objectives: This study aims to focus on the radiological severity of covid-19 pneumonia in patients with rheumatic musculoskeletal diseases (RMD). Materials and Methods: A total of 342 Polymerase Chain Reaction positive patients were retrospectively reviewed. The patients were divided into two groups in terms of the presence of RMD. Chest Computed Tomography (CT) severity scores, demographic characteristics, hospitalization, intensive care unit (ICU) requirement, length of stay at the hospital were compared between RMD and non-RMD groups. Typical and atypical findings on CT images were identified with their incidence in both groups of patients. Results: Age and female gender were significantly higher in the RMD group (p=0.001, p=0.041). The average CT-severity score was higher in the RMD group, but the difference was not statistically significant (p=0.081). ICU transfer and mortality rates were higher in the RMD, whereas no difference was found in hospitalization rates and length of stay (p=0.002, p=0.036, p=0.280, p=0.168). Ground glass opacities, superimposed consolidation, and crazy paving patterns were the most common typical findings seen on both groups. Atypical CT findings for covid-19 pneumonia were found to be higher in the RMD group than in the non-RMD group. Conclusion: Chronic inflammation and the use of immunosuppressive drugs constitute a vulnerability to infections in RMD patients. In this study, mortality and ICU requirements were found to be higher in patients with RMD. Similarly, the higher rate of atypical chest CT findings in the RMD group may be of particular importance in the diagnosis and differential diagnosis of covid-19 pneumonia in this patient group. © 2021 Ankara Yildirim Beyazit University. All Rights Reserved.

Introduction: Almost half of the cystic renal lesions are still overdiagnosed and overtreated. New clinical and radiological parameters are needed to distinguish the malignant Bosniak 3 lesions from the benign ones. We aimed to evaluate the clinical and radiological parameters that may be related to malignancy risk for Bosniak category 3 renal cysts. Materials and Methods: Patients who underwent surgical resection of a histopathologically confirmed Bosniak 3 renal cyst between March 2007 and September 2019 were evaluated. Two experienced uro-radiologists have reevaluated the last preoperative computed tomography and/or MRI images of the patients and reclassified the lesions according to the Bosniak classification. They also reported cystic features such as nodularity, septation, focal thickening, enhancement, and calcification. Clinical, pathological, and oncological outcomes were recorded. Then patients were divided into 2 groups as Group 1 (benign pathology) and Group 2 (malignant pathology) according to final histopathological report. Results: A total of 79 patients were included in this study. Mean follow-up time was 47 ± 34 months. There were 30 patients in Group 1 and 49 patients in Group 2. Hypertension (p = 0.001) and smoking history (p = 0.008) were more common in malignant group. Among the radiological findings, lower tumor diameter (p = 0.024), presence of cyst wall enhancement (p = 0.025), presence of nodularity (p = 0.002), and presence of focal thickening (p = 0.031) were found to be statistically significant for malignancy. Most of the tumors were at pathological T1 stage and Fuhrmann Grade 1–2. Only nodularity was found to be independent predictive factor for malignancy in multivariate analysis. Conclusion: Clinical factors including hypertension and smoking, radiological factors including lower lesion size, cyst wall enhancement, nodularity, and focal thickening were predictors for malignancy of Bosniak 3 cysts.

Background/aim: To emphasize the role of cochlear implantation CI in the auditory rehabilitation of patients with otosclerosis OS and share our surgical experiences on this rare group of patients. Materials and methods: Retrospective analysis of the patients who have a diagnosis of otosclerosis and implanted between January 1998-May 2019 was performed. Preoperative and postoperative clinical, radiological, audiological and surgical findings are presented. Results: Among 2195 patients who have been implanted in our institution, 12 0.54% met the diagnostic criteria of OS according to their preoperative clinical, radiological, audiological and peroperative surgical findings. Electrode insertion was performed via "round window membrane and cochleostomy"in 8 and 4 patients, respectively. No major complications occured. All patients showed satisfactory performances by means of audiometric scores postoperatively. Nonauditory stimulation NAS which manifested as "facial twitching"was a challenging problem in one patient during the surgery and subsided after the operation. Conclusion: Our experience on CI in patients with OS revealed that the implantation was a relatively safe procedure and had satisfactory impact on audiological performances.

Aims Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for the management of patients with COVID‐19–suspected symptoms. Pandemic related workload and level of experience on covid‐dedicated chest CT scans might have affected the diagnostic performance of on‐call radiologists. The aim of this study was to reveal the interpretation errors (IEs) in chest CT reports of COVID‐19–suspected patients admitted to the Emergency Room (ER). Methods Chest CT scans between March and June 2020 were re‐evaluated and compared with the former reports and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments’ workload, COVID‐19–related educational activities have been examined. Results Out of 5721 Chest CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included in this study. PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in “normal” and “typical for covid” groups whereas lowest in “atypical for covid” and “not covid” groups. 5%‐25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding the number of chest CT scans performed, radiologists’ workload has found to be increased six‐folds. With the re‐evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in the “not covid” class (60%) regardless of PCR positivity. COVID‐19 and radiology entitled educational activities along with the ER admission rates within the first two months of the pandemic have seemed to be related to the decline of IEs within time. Conclusion COVID‐19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest CT reporting. This workload and concomitant factors have effects on diagnostic challenges in COVID‐19 pneumonia.

Aim of work This study investigates the factors related to metastasis detection in a sentinel lymph node biopsy (SLN) in patients without clinical axillary involvement. Patients and methods The medical records of patients who underwent an SLN biopsy after diagnosis with early-stage breast cancer were evaluated retrospectively. The study sample included 64 patients divided into two groups according to the histopathological examination of the SLN biopsy: Group I (positive for axillary metastasis) and Group II (negative for axillary metastasis). Results The frequency of lymphovascular invasion was significantly higher in Group I (57%) than in Group II (13%) (p = 0.003). The progesterone receptor status (p = 0.036), tumor T-stage(p = 0,047), and Ki-67 index differed significantly (p = 0.045) between the two groups. While in univariate analysis, lymphovascular invasion, T-stage and KI-67 index were significant, in multivariate analysis only lymphovascular invasion was found to be significant. No significant differences were found in terms of estrogen receptor and HER2 considering tumor invasion type, histologic grade, vascular invasion, neural invasion, multifocality or bilaterality, hormone receptor status, menopause status, total number of lymph nodes, presence of non-sentinel lymph nodes and the number of SLNs in the groups (p > 0.05). Conclusions The results of this study indicate that lymphovascular invasion is associated with axillary metastasis, based on an SLN biopsy.

Aims Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for management of patients with COVID-19 suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have effected diagnostic performance of on-call radiologists. The aim of this study is to reveal the interpretation errors in chest-CT reports of COVID-19 suspected patients admitted to the ER. Methods COVID-19 dedicated chest-CT scans which were performed between March and June 2020 were re-evaluated and compared with the former reports of these scans and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments’ workload, COVID-19 related educational activities have examined. Results Out of 5721 Chest-CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included to this study. RT-PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in “normal” and “typical for covid” groups whereas lowest in “atypical for covid” and “not covid” groups. 5-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding number of chest CT scans performed, radiologists’ workload have found to be increased six-folds compared to the same months of the former year. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in “not covid” class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of pandemic have seem to be related with the decline of IEs within time. Conclusion COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest-CT reporting. This workload and concomitant factors have possible effects on diagnostic challenges in COVID-19 pneumonia.

Objective: Thyroid nodule is the most common disease of the thyroid gland and is closely associated with thyroid cancer. The gold standard method in diagnosis is Fine Needle Aspiration Biopsy (FNAB). Although the relationship between nodules containing microcalcification and malignancy is well known, there is no consensus on the relation of nodules with macrocalcification to malignancy and the adequacy of FNAB. In this study, it was aimed to compare the results of FNAB of nodules with and without macrocalcification in US examination. Methods: In this retrospective study, 466 nodules undergoing FNAB of 450 patients who applied for biopsy were included in the study. The demographic characteristics of the patients, US features of the nodules and cytopathology results of FNAB in the Bethesda classification were recorded. Nodules were divided into two main groups as calcified and non-calcified. US features and cytopathology results of the groups were compared. Results: Transverse sizes of calcified nodules were found to be larger than non-calcified ones (p = 0.003). In addition, solid composition, hypoechoic and prominent hypoechoic echogenicity, and irregular border feature were found with a higher rate in the calcified group (p

The most common site for metastasis in patients with breast cancer is the bone. In this case series, we investigated patients whose surgical and medical treatment for primary breast cancer was conducted at our center and first disease recurrence was limited to only 1 bone. We analyzed 910 breast cancer patients, 863 had no metastasis and 47 cases had a single bone metastasis ≥ 6 months after their first diagnosis. Demographic, epidemiological, histopathological and intrinsic tumor subtype differences between the non-metastatic group and the group with solitary bone metastases and their statistical significance were examined. Among established breast cancer risk factors, we studied twenty-nine variables. Three variables (Type of tumor surgery, TNM Stage III tumors and mixed type (invasive ductalcarsinoma + invasive lobular carcinoma) histology) were significant in multivariate logistic regression analysis. Accordingly, the risk of developing single bone metastasis was approximately 15 times higher in patients who underwent mastectomy and 4.8 and 2.8 times higher in those with TNM Stage III tumors and with mixed type (invasive ductal carcinoma + invasive lobular carcinoma) histology, respectively. In conclusion, the risk of developing single bone metastasis is likely in non-metastatic patients with Stage III tumors and possibly in mixed type tumors. Knowing this risk, especially in patients with mixed type tumors, may be instrumental in taking measures with different adjuvant therapies in future studies. Among these, treatment modalities such as prolonged hormone therapy and addition of bisphosphonates to the adjuvant treatments of stage III and mixed breast cancer patients may be considered.

Objectives: The aims of this study were to evaluate the biopsy methods used in terms of safety, and effectiveness as well as incidence, and severity of complications. Materials and Methods: This study was conducted as a prospective, observational study with the participation of five centers in Turkey. Any patient complaints and/or complications were also recorded. The patients’ pain severity was determined by an established scoring method. Results: This research included 221 chronic hepatitis patients and 12 physicians. With regard to the biopsies, 71.9% were ultrasound-guided and 28.1% were blind biopsies. 71% of patients had complaints (mostly pain) and 19.9% developed complications; however, no mortality occurred. It was observed that patient’s complaints were significantly correlated with the physician’s age, level of biopsy experience, and number of biopsies performed yearly. It was determined that the biopsy method was not affective factor in terms of the development of severe pain after biopsy. The use of a 16G biopsy needle was found to increase the probability of severe pain occurrence by about eight times. Conclusion: Severe pain was not affected by the biopsy method or patient-specific factors, and was a result of the size of the biopsy needle used and the characteristics of the practitioner.

Notrofil/lenfosit oraninin abdominal yag dagilimi, karaciger yaglanmasi ve karaciger hacmine olan etkisi OZET Amac: Bu calismada notrofil/lenfosit oraniyla bilgisayarli tomografiyle (BT) elde olunan karaciger yaglanmasi, viseral yaglanma volumu (VYV), subkutan yaglanma volumu (SYV) ve karaciger volumu (KV) arasindaki iliskiyi inceledik. Yontem: Asiri alkol tuketim hikayesi olmayan, kontrastsiz abdomen BT incelemesi icin basvuran 97 olgu (58 erkek, 39 kadin ortalama yas ± SD: 45.5 ± 1.5) calismaya dahil edildi. Ozel bilgisayar yazilimlari kullanilarak ve BT kesitlerindeki dansite degerlerine gore olgular karaciger yaglanmasi olan ve yaglanmasi olmayan (kontrol) grubu olmak uzere iki gruba ayrildi. Her bir olgunun vucut kitle indeksi (VKI), diabetes mellitus (DM), hipertansiyon ve dislipidemi hikayesi olup olmadigi sorgulandi ve N/L oranlari kaydedildi. Her bir olgunun ozel bilgisayar yazilimi kullanilarak VYV, SYV ve KV'leri olculdu. Bulgular: Karaciger yaglanmasiyla DM, VYV, SYV, BMI ve KV arasinda anlamli iliskiler bulundu. Ancak beklentimizin aksine karaciger yaglanmasi olan hastalarin ve kontrol hastalarinin N/L oranlari sirasiyla 3,48 ± 2,6 ve 3,40 ± 4,3 bulundu ve fark istatistiksel olarak anlamsizdi (p=0.909). Karaciger yaglanmasi olan hastalarin ortalama KV’si kontrol hastalarina gore daha yuksek bulundu (p

Purpose This retrospective study was conducted to evaluate the relationships between pancreas divisum, biliary duct anatomical variations and pancreaticobiliary tumors using magnetic resonance cholangiopancreatography (MRCP). Materials and method The MRCP examinations of 1628 patients were retrospectively reviewed for the presence of pancreas divisum, biliary duct anatomical variations and pancreaticobiliary tumors. Of these, 90 patients (31 men, 59 women) with a mean age of 62.6 years ± 15.8 (SD) (range: 22–101 years) had pancreas divisum. MRCP images were analyzed by two independent readers with discordances resolved by consensus opinion. Results A total of 1538/1628 patients (94.5%) had a dominant duct of Wirsung; of them 54/1538 patients (3.5%) had pancreaticobiliary tumors. A total of 90/1628 patients had pancreas divisum; of them, 7/90 patients (7.8%) had pancreaticobiliary tumors, including intrapancreatic mucinous neoplasm (n = 3), ampullary carcinoma (n = 2), pancreas carcinoma and gallbladder carcinoma (n = 1 each). Pancreaticobiliary tumors were more frequent in patients with pancreas divisum than in those with a dominant duct of Wirsung (P = 0.0383). Conclusions The results of our study suggest that patients with pancreas divisum and biliary anatomical variations are more likely to develop pancreaticobiliary tumors and should be followed up closely using MRCP. However, our results should be confirmed by further prospective studies.

Objective To evaluate the histopathologic correlation of recently described subclassification of Bosniak category 3 cysts (3s and 3n). Materials and Methods A total of 106 patients who underwent partial/radical nephrectomy due to a complex renal cyst (≥Bosniak 3) were retrospectively reviewed. All the scans of the patients were reevaluated by 2 experienced uroradiologists. Bosniak 3 cysts were reclassified as 3n (nodularity on the cyst wall/septae) and 3s (septated cysts without nodularity) as described in a recently published paper. Group 1 consisted of patients with Bosniak 3s, Group 2 consisted of patients with Bosniak 3n, and Group 3 consisted of patients with Bosniak 4 cysts. Three groups were compared according to patients' characteristics, radiological findings, histopathologic results, and survival outcomes. Results There were 52 patients in Bosniak 3 group and 54 patients in Bosniak 4 group. Mean follow-up was 35.3 months. Among Bosniak 3 cysts, 37 lesions were classified in 3s and 15 were classified in 3n. Malignancy was higher in 3n group than 3s (86.7% vs 54.1%, P= .026). Lesion size was significantly lower for malignant cysts compared to benign ones in the patients with Bosniak 3 lesions (44.2 ± 27.5 vs 80 ± 55.9 P= .005). In the subgroups, malignant lesions were significantly smaller than benign lesions in 3s group similar to general Bosniak 3 group. Most of the Bosniak 3 lesions were organ confined and low grade. Conclusion The subclassification of Bosniak 3 cysts as 3s and 3n can help to differentiate highly suspicious malignant lesions from the relatively less suspicious ones.

Objective To evaluate the utility of magnetic resonance images (MRI) in the selection of treatment procedures for intermediate–advanced laryngeal cancers. Material and method This study included patients with histologically proven laryngeal squamous cell carcinoma defined as cT3 and T4a at our tertiary academic care hospital. All scans were evaluated by two radiologists experienced in head and neck cross-sectional studies. Signal patterns in MRI sections of laryngeal compartment subsites were delineated as T1w, T2w hyperintensity, and T2w intermediate signals, and were compared with the postoperative pathological results. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated. Results The study included 51 patients with a mean age of 62.55 ± 9.14 (range, 45–80) years. Tumor was glottic in 12 (23.5%) patients, supraglottic in 19 (31.4%) patients, glottic-supraglottic in 11 (21.6%) patients, transglottic in 9 (27%) patients. The posterior paraglottic space had the strongest specificity of MRI according to tumor infiltration in the histologic analysis (specificity 96.9% and sensitivity 78.6%). The specificity of MRI was poor for tumor infiltration in thyroid cartilage (specificity 70.0%). Spearman's test demonstrated that there was a statistically significant correlation between the MRI-based prediction scores of all subunites and the findings of histopathologic analyses (mean±SD: 4.96±4.46–5.53±4.38, respectively, R2: 0.711, p Conclusion The high specificity values of the predictions, which were MRI-based in all subsites, indicated that MRI could provide an important contribution for defining tumor infiltration and the presurgical assessment of patients with tumors of the larynx.

Purpose This study aims to compare three guidelines according to their diagnostic accuracy in the management of thyroid nodules. Methods A total of 540 patients with 597 thyroid nodules were enrolled in this study. Sonographic images were classified and scored with the American Thyroid Association (ATA-2015), American College of Radiology (ACR), and European Thyroid Association (EU) Thyroid Imaging, Reporting, and Data Systems (ACR-TIRADS and EU-TIRADS) guidelines. Fine-needle aspiration biopsy (FNAB) was performed, and cytopathological results were reported with the Bethesda system. Outcomes of these three classification systems were then correlated with Bethesda results. Results FNAB procedures revealed a total of 447 benign and 45 malignant nodules. With guideline dedicated FNAB criteria; 38 malignant nodules could have been diagnosed with ATA-2015, which is followed by 34 nodules with ACR-TIRADS, and 31 nodules with EU-TIRADS. Nonetheless, 301 benign nodules would have been biopsied with ATA-2015, 143 benign nodules with ACR-TIRADS, 222 benign nodules with EU-TIRADS. The accuracy rate was found to be highest with ACR-TIRADS (59.93 %); while 55.20 % with ATA-2015 and 51.25 % with EU-TIRADS. The sensitivity and specificity ratios of these guidelines were as follows; ATA-2015 (82.22, 53.47), ACR-TIRADS (48.89, 60.63), and EU-TIRADS (86.67, 48.99). A total of 23 nodules (3.8 %) could not be classified with ATA-2015. Conclusion Diagnostic strengths, unnecessary recommended FNAB rates, and categorization capabilities differ among various guidelines. Clinicians and interventional radiologists should keep in mind these features in the management of thyroid nodules.

It is important for surgical purposes to know the biliary tract anatomy and its variations in detail. The aim of the study was to evaluate the frequency of anatomical variations of the biliary tract at hepatic bifurcation level and also at cystic duct level using magnetic resonance cholangiopancreatography (MRCP). A total of 1041 patients (between 16 and 102 years of age, 600 women 441 men with mean age of 60.6) were included in the study. The MRCP imaging was carried out with a 1.5 Tesla magnetic resonance imaging (MRI) device by using heavily T2-weighted sequences. Among the 1041 patients included in the study, 424 (40.7 %) showed anatomical variations at different levels of the biliary tree, and 12 of these patients (1.15 %) had two anatomical variations. Typical anatomy was present in 57.2 % of the females and 62.1 % males. The highest incidence of variation at the level of bifurcation was trifurcation with 133 patients (12.8 %) and at the level of cystic duct was the medial cystic duct insertion with 56 patients (5.37 %). Trifurcation and medial cystic duct insertion seem to be more frequent in females compared to males. It is necessary to have the knowledge of these variations to avoid possible complications and also help to achieve the most effective result. MRCP is a helpful and noninvasive technique of diagnosing bile duct variations; a preoperative description of these variations may prevent various surgical complications, and we recommend a routine preoperative MRCP especially before laparoscopic cholecystectomy, liver resection surgery and liver transplant surgery.

Atypical hemolytic uremic syndrome is a rare and progressive disease caused by uncontrolled alternative complement activation. Dysregulatıon of the complement activation results in thrombotic microangiopathy and multiorgan damage. A 29-yearold woman who was admitted with complaints of vomiting and headache was detected to have acute renal failure with microangiopathic hemolytic anemia (MAHA). After the diagnosis of atypical hemolytic uremic syndrome (aHUS), she was treated with plasma exchange (PE) and hemodialysis (HD). She has experienced hypertensionrelated posterior reversible encephalopathy syndrome (PRES) at the second plasma exchange. She was initiated on eculizumab therapy because of no response to PE on the 34th days. Her renal functions progressively improved with eculizumab treatment. Dependence on dialysis was over by the 4th month. Dialysis free-serum Creatinine level was 2.2 mg/dL [glomerular filtration rate (e-GFR): 30 mL/min/1.73 m2] after 24 months. Neurological involvement (PRES, etc.) is the most common extrarenal complication and a major cause of mortality and morbidity from aHUS. More importantly, we showed that renal recovery may be obtained following late-onset eculizumab treatment in patient with aHUS after a long dependence on hemodialysis.

Findings of surface-based morphometry studies in major depressive disorder (MDD) are still inconsistent. Given that cigarette smoking is highly prevalent in MDD and has documented negative effects on the brain, it is possible that some of the inconsistencies may be partly explained by cigarette use. The aim of the current study was to examine the influence of cigarette smoking on brain structure in MDD. 50 MDD patients (25 smokers and 25 non-smokers) and 22 age, education, gender and BMI matched nonsmoker healthy controls underwent structural magnetic resonance imaging. Thickness and area of the cortex were measured using surface-based morphometry implemented with Freesurfer (v5.3.0). The non-smoker MDD patients had significantly increased cortical thickness, including in the left temporal cortex (p < 0.001), right insular cortex (p = 0.033) and left pre- and postcentral gyrus (p = 0.045), compared to healthy controls. We also found decreased cortical thickness in MDD patients who smoked compared to non-smoking patients in regions that overlapped with the regions found to be increased in non-smoking patients in comparison to controls. Non-smoker MDD patients had increased surface area in the right lateral occipital cortex (p = 0.009). We did not find any region where cortical thickness or surface area significantly differed between controls and either smoker MDD patients or all MDD patients. The findings of the current study suggest that cigarette smoking is associated with cortical thinning in regions found to be increased in patients with MDD. However, these results should be considered preliminary due to methodological limitations. (C) 2016 Elsevier Ltd. All rights reserved.

The objective of this study is to investigate the correlation between inferior turbinate size and paranasal sinus opacification on computerized tomography (CT) scans. Paranasal sinus CT scans of a total of 185 patients (92 males, 93 females) were examined in terms of sinus opacification. Sizes of the inferior turbinates were measured using stereological method and these sizes in normal and opacified paranasal sinuses are compared using one-way analysis of variance. Scans of 185 patients (93 female, 92 male) aged between 12 and 84 (mean 37.85 ± 16.27) years were examined in this study. Sizes of the inferior turbinates were found to be increased significantly in case of opacification of ipsilateral maxillary and anterior ethmoid sinuses (p = 0.000 and p = 0.4, respectively) on both sides. On the other hand, such a relationship could not be demonstrated for sizes of inferior turbinates with opacified or non-opacified posterior ethmoid, frontal and sphenoid sinuses. In conclusion, the combination of CT and the Cavalieri principle can provide an unbiased, direct, and assumption-free estimate of the regions of interest. The presented method can be efficiently applied without any need for special software, additional equipment, or personnel than that required for routine CT in daily use. Paranasal sinus disease, especially the inflammatory diseases of maxillary and anterior ethmoid sinuses, must be carefully investigated in cases with inferior turbinate hypertrophy.

Background The study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP). Patients and methods We retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study. Results Among the 1158 patients included in the study, 54 (4.6%) patients showed pancreas divisum, 13 patients (1.2%) were defined as ansa pancreatica. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most commonly observed pancreatic duct configuration was Type 3 in 528 patients (45.6%) where 521 patients (45%) had Type 1 configuration. Conclusions Vertical course (p = 0.004) and Type 2 (p = 0.03) configuration of pancreatic duct were more frequent in females than males. There were no statistically significant differences between the gender for the other pancreatic duct variations such as pancreas divisium, ansa pancreatica and course types other than vertical course (p > 0.05 for all). Variants of pancreas divisum and normal pancreatic duct variants were not associated with morphologic findings of chronic pancreatitis by using the Cambridge classification system. The ansa pancreatica is a rare type of anatomical variation of the pancreatic duct, which might be considered as a predisposing factor to the onset of idiopathic pancreatitis.

Background The anatomy of the paranasal sinus is significantly different between adults and children, and surgeons must be aware of these differences to safely perform pediatric functional endoscopic sinus surgery. The purpose of this study was to determine the normal dimensions of the paranasal sinuses during development using magnetic resonance imaging (MRI) data compiled from the largest cohort to date. Methods The records of 2025 children, aged 0–18 years, who underwent cranial MRI, were examined retrospectively and 1452 patients with no history of sinus disease were included in the study. Coronal, axial, and sagittal images were used to measure the dimensions of the frontal, maxillary, ethmoid, and sphenoid sinuses, and the sinus volume index was measured. Patients were divided into 10 cohorts based on their age at the time of the scan. Results No difference between left and right one-dimensional measurements and volume indexes for the maxillary, sphenoid, ethmoid, and frontal sinuses was observed in any age group. Initial signs of pneumatization were observed at birth for the maxillary and ethmoid sinuses, at 9 months for sphenoid sinus, and after the age of 5 years for the frontal sinus. Conclusion These results will help physicians correlate the clinical and radiographic findings of pediatric patients who are being evaluated for sinus disease and potential surgical intervention. Knowledge of the variations in the size of the paranasal sinuses is essential for determining the significance of incidental findings.

Objective. The purpose of this study was to evaluate the role of a slow embryonic heart rate in embryos before 7 weeks’ gestation as a marker in screening for chromosomal abnormalities. Methods. Fifty-seven embryos before 7 weeks’ gestation with slow heart rates were compared with 1156 embryos of the same gestational period with normal heart rates. Embryos that showed an increased risk of chromosomal abnormalities in the screening blood tests underwent invasive analysis for abnormal karyotype detection. Results. The rates of first-trimester death were 15.8% for pregnancies with slow embryonic heart rates (9 of 57) and 2.5% for those with normal heart rates (29 of 1156). Because of the increased risk of chromosomal abnormalities, amniocentesis was performed on 6 with slow embryonic heart rates and 61 with normal embryonic heart rates. After karyotype analysis, there were 2 fetuses with trisomy 21 in each group, which represented significantly higher percentage of embryos with trisomy 21 in the slow–heart rate group compared with the normal–heart rate group (P < .05). Conclusions. When a slow embryonic heart rate is detected before 7 weeks’ gestation, there is a higher likelihood of chromosomal abnormalities. Key words: embryo; fetus; first trimester; heart rate.

WOS: 000370846700008, PubMed ID: 26668530, Objective: Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. In this study, the results of 164 consecutive patients with mid-and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented. Material and Methods: The staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. The surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemotherapy comprised 5-fluorouracil (450 mg/m(2)/d) and leucovorin (20 mg/m(2)/d) bolus at days 1-5 and 29-33. Results: Nine patients (13%) in Group NA achieved pathologic complete response (pCR). In Group NA and Group A, lo-coregional recurrence (LRR) rates were 6.7% and 30.8%, (p

In this case report, an unusual patient with biliary fascioliasis without showing any hepatic involvement by ultrasonography, computed tomography and magnetic resonance imaging is presented. The purpose of this case report is to make a distinction between the two stages of the disease (hepatic fascioliasis and biliary fascioliasis) and to describe the ultrasonographic, computed tomographic, magnetic resonance imaging and magnetic resonance cholangiographic findings in hepatobiliary fascioliasis and to discuss the role of noninvasive imaging techniques in diagnosis.

Objective Tuffier's line is defined as the line connecting the highest points of both iliac crests, which generally passes through either the body of the fourth lumbar vertebra or the intervertebral space between fourth and fifth vertebrae. In this study, we assessed the radiological correlation of the level of Tuffier's line with changes in age and sex. Methods In this study, antero-posterior pelvic X-rays of 590 patients aged 18 and older were retrospectively analyzed. It is revealed that Tuffier's line crosses the vertebral column at one of three levels, which are the L4 vertebral body, L4-L5 vertebral interspace and L5 vertebral body. Patients' sex, age and vertebral level of the Tuffier's line were recorded. Data was analyzed using the chi-square test. Results The assessment of the X-rays of 317 female patients showed that Tuffier's Line passes through the L4 vertebral body in 115 (37.8%), through the L4-L5 intervertebral space in 126 (40%) and through the L5 vertebral body in 76 (22.2%) patients. A Tuffier's line passing through the level of the L5 vertebral body was found to be statistically significant in female patients (p=0.00). No significant relevance was found between male gender and the level of Tuffier's line in 273 male patients. It is found that the height of the vertebral levels that Tuffier's line crosses does not correlate with mean age of the groups (p=0.939). Conclusion It should be considered that Tuffier's line can cross at vertebral levels other than anticipated. The level of Tuffier's line should be precisely determined with supplementary radiological methods, such as AP pelvic X-ray in addition to physical examination, to reduce the complications in association with regional anaeshesia and to achieve sensorial block levels sufficient to sustain a comfortable surgery, particularly in female patients who carry higher cardiac and respiratory risks.

Fibroadenoma of the breast is an uncommon cause of breast lumps in men. Only a few cases have been reported in the literature, the majority of which were prescribed estrogen. We present herein the first case of a fibroadenoma of the breast in a 68-year-old man with adenocarcinoma of the rectum and polyposis coli. In this case, there was neither estrogen treatment nor any other medications which have been discussed in the literature as inducing fibroadenomas. Fibroadenomas in men without hormone treatment and with normal hormone levels are extremely rare and the developmental mechanism of the breast fibroadenoma in this man is under question.

Myxopapillary ependymomas are slow-growing and highly vascular tumours that occur almost exclusively in the cauda equina [Gerber S, Ollivier L, Leclere J, et al. Imaging of sacral tumours. Skeletal Radiol 2008;37:277–89; Shors SM, Jones TA, Jhaveri MD, Huckman MS. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics 2006;26:111–6]. Their clinical manifestations are frequently nonspecific, such as low back pain, leg or sacral pain. Lower motor neuron symptoms such as weakness of lower limbs, loss of sensation, and erectile and sphincter dysfunction can be caused by disruption of the cauda equina by a spinal tumour, which is termed cauda equine syndrome [Shors SM, Jones TA, Jhaveri MD, Huckman MS. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics 2006;26:111–6]. Faecal incontinence as the first symptom of a primary spinal tumour is rare, although it has been reported with lumbar schwannoma of the cauda equina, metastatic spinal deposits, and lumbosacral intraspinal lipomas. Ependymomas are not frequently associated with this symptom, however. Here we report a case of a myxopapillary ependymoma presenting with faecal incontinence and discuss the radiological appearance of myxopapillary ependymomas.

The authors report a case of holoprosencephaly with cyclopia, diagnosed prenatally at a gestational age of 19 weeks. The patient’s clinical history was normal, except for aspirin usage for her headache. The sonographic diagnosis was based on the intracranial finding of fused thalami with no visible midline structures and facial abnormalities, including cyclopia, proboscis, and absence of the nose. These findings are characteristic of alobar holoprosencephaly. With the informed consent of the patient, the pregnancy was terminated by induction after proper counseling. Postmortem examination of the abortus material confirmed the presence of cyclopia and a proboscis.

Objective: To establish whether there is both objectively and subjectively improved recovery in children receiving endoscopic-assisted adenoidectomy, compared with children receiving curettage adenoidectomy. Study Design: Prospective, randomized, double-blinded study. Methods: Thirty-eight patients who underwent adenoidectomy alone or in combination with tonsillectomy before the planned tympanomastoid surgery with an age range from 8 to 12 years were enrolled in the study. Children were prospectively and randomly assigned into two groups: the endoscopic-assisted adenoidectomy and the curettage adenoidectomy. The main subjective parameters were the nasopharyngoscopy and the symptom improvement scale, whereas the main objective parameter was the midsagittal reformatted images of the temporal bone computerized tomographies of patients who underwent adenoidectomy before the planned tympanomastoid surgery. To adequately compare the utility of one technique versus the other, blood loss and operative time were also reviewed. Results: Evaluation of the temporal bone computerized tomographies of patients by adenoidal/nasopharyngeal ratios revealed a statistically significant difference with a mean ratio of 0.41 in the cureattage and 0.30 in the endoscopic-assisted group. However, both groups had a significant improvement in the symptom improvement scale with no evidence for a significant difference between the endoscopic-assisted and curettage groups. Conclusions: Although, objective outcomes reveal that endoscopic-assisted adenoidectomy technique was superior to curettage adenoidectomy in reducing adenoidal size after surgery, subjectively no differences were noted between two methods. Laryngoscope, 2010

In this retrospective study, we evaluated the contribution and role of diffusion-weighted imaging (DWI) in differentiating acute and chronic forms of brucellar spondylodiscitis. We also describe the characteristics and some indistinguishable features of brucellar spondylodiscitis on magnetic resonance imaging (MRI) to emphasise the importance and limitations of MRI.MRI examinations of 25 patients with brucellar spondylodiscitis were retrospectively reviewed and analysed by two experienced radiologists. Signal and morphological changes were assessed. The imaging characteristics of acute and chronic forms of spondylodiscitis were compared. Both discriminative imaging findings of brucellar spondylodiscitis and some uncommon findings were interpreted.Of 25 patients with spinal brucellosis, eight had thoracic, ten had lumbar, five had both thoracic and lumbar and two had both lumbar and sacral vertebral involvement. We detected posterior longitudinal ligament elevation in 11 patients, epidural abscess formation in 11 and paravertebral abscess formation in nine. Ten patients had cord compression and eight had root compression. Three patients had facet-joint involvement, and one had erector spinae muscle involvement. Eight patients (32%) were in the acute stage, six (24%) in the subacute stage and 11 (44%) in the chronic stage. Vertebral bodies, vertebral end plates and intervertebral disc spaces were hypointense and hyperintense in the acute stage, whereas they were hypointense and heterogeneous in the subacute and chronic stages on T1- and T2-weighted images, respectively. In the acute stage on the DWI series, vertebral bodies, end plates and discs were all hyperintense but hypointense in the chronic stage.Although conventional MRI has several advantages over other imaging modalities and is very useful in the differential diagnosis between brucellar spondylodiscitis and other spinal pathologies, it has some difficulties in discriminating acute and chronic forms of spondylodiscitis. DWI is a sensitive, fast sequence that has the potential for differentiating acute and chronic forms of spondylodiscitis, which makes it crucial in spinal imaging.

Background. Echinococcosis is a zoonotic disease that occurs mainly in endemic areas. Recurrent hydatid cyst (RHC) and its diagnosis present insidious problems for surgeons. The aim of this study was to evaluate the diagnosis and surgical management of RHC in Turkey, where the disease is endemic. Methods. We conducted a comprehensive study of 146 patients with abdominal hydatid cysts that were managed surgically between 1997 and 2007. Among those patients, RHC arose in 14 (9.5%) of cases. Results. The female to male patient-ratio was 6 to 8 and median age was 47.4 years. Patients’ symptoms included abdominal pain, nausea, fever, and jaundice. Cysts reoccurred in patients sporadically between 4 months and 22 years. Abdominal US, CT, and MRI were utilized for the diagnosis in 14 (100%), 11 (78.5%), and 2 (14.2%) patients respectively, demonstrating the RHC of the liver and concomitant cysts (splenic region, mesentery of the colon and perivesical) in all cases, respectively. The recurrent cysts (with a mean diameter of 12 cm) were removed using partial pericystectomy, introflexion, and total cystectomy surgical techniques. Postoperative morbidity occurred in 14% of patients. Conclusions. Especially in endemic countries like Turkey, RHC should be included in the differential diagnosis of cystic masses in abdominal organs that were previously treated for hydatid cysts. Surgery still remains the treatment of choice for RHC with early management and proper perioperative evaluation contributing to a high cure rate.

Conventional MR sequences are sometimes not helpful in differentiating benign from pathologic fractures. Our aim was to evaluate the usefulness of single-shot echo-planar imaging sequences (diffusion-weighted imaging (DWI)/SSH-EPI) with low b value in differentiating malignant metastatic tumor infiltration of vertebral bone marrow from benign vertebral fracture edema.A total of 47 patients, 20 with benign fractures and 27 with tumor infiltration, were included in this prospective study. Diffusion-weighted MR images were obtained by single-shot echo-planar imaging technique with diffusion gradient (b = 300 s/mm2; TR/TE, 1,400/100), using a 1.5 T MR scanner. T1- and T2-weighted images and short inversion time inversion-recovery images were available for all 64 lesions. The lesions on DWI/SSH-EPI were categorized as having hypo-, iso-, or hyperintense signal intensity relative to normal vertebrae by two experienced radiologists.We evaluated signal intensity patterns on DWI/SSH-EPI in 64 lesions, which showed low signal intensity on T1-weighted images in both benign fractures and metastasis. With the exception of sclerotic metastases in two patients, malignant metastatic tumor infiltration was hyperintense with respect to normal bone marrow on diffusion-weighted images; all but four benign vertebral fractures were isointense with respect to normal bone marrow.Single-shot echo-planar imaging sequences (DWI/SSH-EPI) with low b value provided excellent distinction between metastatic tumor infiltration and benign vertebral fracture edema. Hyperintense signal intensity on DWI/SSH-EPI was highly specific for the diagnosis of metastatic tumor infiltration of the spine.

Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract. One to three percent of GISTs occur in the esophagus. GISTs have a great potential for diffuse intra- abdominal spread and liver metastasis, which are the two most common modes of dissemination. Metastases to other sites, especially the bones and lung, are relatively rare. Never has an esophageal GIST been documented to present with pulmonary and bone metastases. We present an unusual case of an esophageal GIST with pulmonary and bone lesions. We include a review of the literature.

Pentalogy of Cantrell is a rarely seen syndrome that, in full form, includes a midline supraumbilical abdominal defect, defect of the lower sternum, deficiency of the diaphragmatic pericardium, deficiency of the anterior diaphragm, and congenital cardiac anomalies. Cases not fulfilling these criteria but including various combinations of them, provided that they include at least either a sternal defect or intracardiac and ventral abdominal wall abnormalities, are regarded as variants of the classic form. A case of a variant of Cantrell's pentalogy detected by sonography at 21 weeks' gestation is presented. Clinical examination of the aborted fetus confirmed the sonographic findings. Because of the poor prognosis of the condition, early antenatal sonographic diagnosis is important because it may allow for elective abortion before viability.

To evaluate the efficacy of color Doppler sonography in detecting possible differences in blood flow patterns and B-mode sonographic characteristics between malignant and benign cervical lymph nodes.During a period of 10 months, the palpable cervical lymph nodes of 39 patients were prospectively evaluated with B-mode and color Doppler sonography. The echogenity, contour, ratio of longitudinal diameter to the transverse diameter and the presence of a hilus were evaluated by B-mode sonography. Capsullary and intranodal arterial flow rates were measured and maximal systolic, end-diastolic, mid-systolic flow velocities with pulsatility, resistivity and acceleration indices were obtained. Final diagnosis was established by excisional biopsy (n:34) and clinical follow-up (n:5).The lymph nodes in 20 cases were malignant and in 19 cases were benign. The B-mode contour characteristics and presence of a hilus in malignant and benign lymph nodes were statistically significant (P0.05), but there were no significant differences between the ratio of longitudinal diameter to the transverse diameter (P0.05), echogenity (P0.05) and the diameters of lymph nodes (P0.05). Flow patterns were obtained in 14 malignant (70%) and 10 benign (52.6%) cases. The maximal systolic, end diastolic, mid-systolic flow velocities and pulsatility, resistivity, acceleration indices did not differ statistically (P0.05).In the differentiations of benign and malignant cervical lymph nodes, the B-mode and color Doppler sonography are limited methods and can not replace biopsy.

Summary Aim: We aimed to determine the inter- and intraobserver variabilities between breast radiologists and a general radiologist in categorizing mammographic lesions using the Breast Imaging Reporting and Data System (BI-RADS), and to evaluate the effects of the histopathologic results on the variability. Methods: Mammograms from 142 women who underwent biopsy were evaluated. 3 breast radiologists (2 with >10 years experience and 1 with 1 year experience) and 1 general radiologist retrospectively reviewed mammograms twice within an 8-week interval. Inter- and intra-observer variabilities were assessed with Cohen’s kappa statistic, and the positive predictive value for final assessments was calculated. Results: The intra-observer variability for mass and calcification assessments was moderate to almost perfect (kappa values: 0.41–1) for breast imagers and was fair to substantial for the general radiologist (kappa values: 0.21–0.8). Inter-observer agreement between the breast imagers was higher than between the breast and general radiologists. There was no apparent difference in agreement between observers for malignant and benign subgroups. Conclusions: The differences in intra- and inter-observer agreement between the breast imagers and the general radiologist affirm the utility of the BI-RADS lexicon. The histopathologic results of the lesions do not affect the agreement. BI-RADS is a simple and adequate tool for assessing mammograms, even after only 1 year of training.

WOS: 000278603300005, PubMed ID: 22933898, Background. The aim of the study was to investigate the value of diffusion weighted MR imaging in the diagnosis of Modic type 1 change, which may be confused with the acute infectious spondylodiscitis on conventional MR imaging. Patients and methods. Twenty-seven patients with erosive intervertebral osteochondrosis, Modic type 1 and 18 patients with spondylodiscitis were included in this retrospective study. All images were acquired using on 1.5 Tesla MR units. Lumbar spinal MR imaging of 45 patients were retrieved from a digital database of a radiology record system and evaluated by one experienced radiologist. Patients with Modic type 1 change had CT slices obtained from the diseased disc space and the affected vertebrae. Results. Bone marrow adjacent to the vertebral end plate in both Modic type 1 change and acute spondylodiscitis were hypointense on T1-weighted images. On T2-weighted images corresponding levels of vertebral end-plates showed hyperintense signal intensity in both group. All the patients with spondylodiscitis and Modic type 1 change were hyperintense and hypointense on diffusion-weighted MR images, respectively. Conclusions. Our findings suggest that diffusion weighted MR imaging is an useful method in differentiating Modic type 1 changes from acute spondylodiscitis, both of which may mimic each other, either on clinical or conventional MRI findings.

Background. Xanthogranulomatous cholecystitis (XGC) is a rare, benign, chronicinflammatory disease of the gallbladder. Its importance lies in the fact that imaging studies and intraoperative appearance that may be confused with tumour of the gallbladder. This study aimed to evaluate pre-and intraoperative findings of XGC and to remind it in difficult cholecystectomy patients. Patients and methods. The clinical data of 24 patients with XGC overa period of 7 years were analyzed retrospectively (mean age, 53 years (32-68) M/F ratio 1:1.4). Results. The clinical symptoms were abdominal pain, nausea and jaundice in 79%, 62% and 12% of the patients. Preoperative ultrasonography for 24 patients revealed gallstone (95.8%) and bile sludge (8%). Pericholecystic fluid, polyp and tumour of the gallbladder was present in 20%, 4% and 4% of the patients. The gallbladder was thickened (>3mm) in 10 patients. On computed tomography, all patients showed abnormal findings. The intraoperative findings were as follows: gallstones (100%), chronic cholecystitis (54%), hydropic gallbladder, emphysematous gallbladder, adhesions of the gallbladder to adjacent organs and tumoural mass of gallbladder. Conclusions. XGC is difficult to diagnose pre-or intraoperativelyand remains a challenge in medical practice. The definitive diagnosis depends on the histopathologic examination.