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Objectives: To compare high-pitch spiral (HPS) and prospectively-gated step-and-shoot (SAS) coronary CT angiography (CCTA) using third generation dual-source CT regarding objective and subjective image quality parameters and radiation exposure. Methods: Eighty pairs of patients matched for gender, age, heart rate and BMI were enrolled in this retrospective study. High-pitch spiral and prospectively ECG-gated sequential CCTA were performed using third generation dual-source CT. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the left ventricle were calculated for each group. Image quality were also scored using four-point scale. Student t-test was used to compare SNR, CNR and mean effective dose values (ED) and Wilcoxon test was used to compare image quality scores. Interrater aggreement were evaluated using Cohen’s kappa statistics. Results: Between-group differences in terms of age, gender, BMI, heart rate, and Agatston score were statistically not significant. Mean SNR and CNR was higher in prospective SAS protocol (16.5 ± 6.2 vs. 14.7 ± 4.9, p = 0.047 and 13.0 ± 5.2 vs. 11.2 ± 4.3, p = 0.02). Image quality scores showed no significant difference between two scan protocols (p > 0.05). Regarding radiation exposure, CT dose index (CTDIvol), dose length product (DLP) and ED was significantly lower for high-pitch group (p < 0.0001). Conclusions: HPS CCTA using DSCT enables > 70% dose reduction while maintaining the image quality compared to prospectively ECG-gated SAS protocol. Therefore, HPS CCTA protocol can be preferred in patients appropriate for prospective ECG-triggered protocol.

Objective: Conventional coronary angiography (CCA) and coronary computed tomography angiography (CCTA) are the most frequently used imaging modalities to diagnose coronary artery disease (CAD). The amount of radiation and genotoxic damage of these imaging methods showed variation with the improved technology. Thus we sought to compare the ionizing radiation doses and radiation-induced DNA damage in patients who were performed CCA and CCTA. Methods: A total of 76 patients (39 in CCA group, 37 in CCTA group) were enrolled. Patients undergoing CCTA were grouped according to the use of the flash technique (22 patients with CCTA-flash, 15 patients with CCTA-other). The effective radiation dose was recorded. Genotoxicity was compared with the chromosome aberration tests before and after imaging methods. Results: There was a significant difference between the groups in effective radiation doses given to patients. Radiation was lowest in the CCTA-flash group, followed by CCA, and non-flash CCTA group. There was no change in chromosome aberration rate after CCTA-flash group (p= 0.479). There was a significant increase in chromosome aberration rates after CCA and CCTA-other groups (CCA: p= 0.001; CCTA-other: p= 0.01). Conclusion: CCTA taken with flash technique in dual-energy CT devices delivers lower dose radiation than other groups. Due to this significant difference, radiation-induced genetic damage was significantly less in patients with CCTA undergoing flash technique.

Purpose: To evaluate the contribution of CT Bone Unfolding software to the diagnostic accuracy and efficiency for the detection of osteoblastic pelvic bone lesions in patients with prostate cancer. Methods: A total of 102 consecutive (January 2016-September 2019) patients who underwent abdominopelvic CT with prostate cancer were retrospectively evaluated for osteoblastic pelvic bone lesions, using commercially available the post-processing-pelvic bone flattening-image software package “CT Bone Unfolding.” Two radiologists with 3 and 15 years of experience in abdominal radiology evaluated CT image data sets independently in 2 separate reading sessions. At the first session, only MPR images and at the second session MPR images and additionally unfolded reconstructions were assessed. Reading time for each patient was noted. A radiologist with 25 years of experience, established the standard of reference. Results: In the evaluations performed with the MPR-Unfold method, the diagnostic accuracy were found to be 2.067 times higher compared to the MPRs method ( P < 0.001). The location of the lesions or the reader variabilities did not show any influence on accuracy ( P > 0.05) For all readers the reading time for MPR was significantly longer than for MPR-Unfold ( P < 0.05). For both methods substantial to almost-perfect inter-reader agreement was found (0.686-0.936). Conclusions: The use of unfolded pelvic bone reconstructions increases diagnostic accuracy while decreasing the reading times in the evaluation of pelvic bone lesions. Therefore, our findings suggest that utilizing unfolded reconstructions in addition to MPR images may be preferable in patients with prostate cancer for the screening of osteoblastic pelvic bone lesions.

Background/aim Pneumonia is the most serious clinical presentation of COVID-19. This study aimed to determine the demographic, clinical, and laboratory findings that can properly predict COVID-19 pneumonia. Materials and methods This study was conducted in the Gazi University hospital. All hospitalized patients with confirmed and suspected SARS-CoV-2 infection between 16 March 2020 and 30 April 2020 were analyzed retrospectively. COVID-19 patients were separated into two groups, pneumonia and nonpneumonia, and then compared to determine predicting factors for COVID-19 pneumonia. Variables that had a P-value of less than 0.20 and were not correlated with each other were included in the logistic regression model. Results Of the 247 patients included in the study 58% were female, and the median age was 40. COVID-19 was confirmed in 70.9% of these patients. Among the confirmed COVID-19 cases, 21.4% had pneumonia. In the multivariate analysis male sex (P = 0.028), hypertension (P = 0.022), and shortness of breath on hospital admission (P = 0.025) were significant factors predicting COVID-19 pneumonia. Conclusion Shortness of breath, male sex, and hypertension were significant for predicting COVID-19 pneumonia on admission. Patients with these factors should be evaluated more carefully for diagnostic procedures, such as thorax CT.

Background/aim: This study aimed to evaluate the clinical efficacy of radiofrequency ablation (RFA) and cryotherapy and to scrutinize the therapeutic success of the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score in terms of possible complications and the predictive status of oncological results.Materials and methods: Forty-five patients with biopsy-proven renal cell carcinomas (32 males, 13 females) treated with RFA and cryotherapy were included. Patients were 22-90 years old (average: 59.2 years). Statistical analyses were performed using SPSS for Windows. Results: A total of 79 lesions with dimensions varying between 0.9 and 4.5 cm (average: 2.2 cm) were ablated. Complete ablation was achieved for 72 (91.1%) lesions. Six repeat RFA sessions were applied for 4 (5%) lesions with residue/recurrence. The average RENAL nephrometry scores of lesions that underwent complete ablation and those that developed residue/recurrence were 6.3 and 7.7, respectively. The average recurrence-free survival time was 34.8 months (range: 3-55 months), while it was 44.6 months (range: 6-55 months) for cryotherapy and 28.6 months (range: 3-50 months) for RFA.Conclusions: Ablative therapies are minimally invasive and effective methods for treating small renal tumors. RENAL nephrometry scoring is a valuable system for standardizing renal tumors and evaluating the success of ablative therapies, possible complications, and oncological results.

AIMS: This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara. MATERIALS AND METHODS: Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated. RESULTS: Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients. CONCLUSIONS: Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

Background Coexistence of bronchiectasis with chronic obstructive pulmonary disease (COPD) may lead to the worsening of the functional parameters in exacerbations and may negatively affect the outcomes. Methods This study is a retrospective cross-sectional study that aims to investigate the relationships between bronchiectasis with COPD exacerbation and all-cause of mortality. We retrospectively enrolled 122 cases hospitalized for COPD exacerbation from 2010 to 2016. Patients who underwent thoracic tomography in the previous year of the index exacerbation were included in the study. Patients who admitted to the intensive care unit and patients with infected bronchiectasis and with conditions that mimic COPD exacerbation were excluded from the study. Demographic, clinical, and laboratory findings, comorbidities and the number of exacerbations in the previous year and the presence of bronchiectasis were recorded using hospital electronic registry. The radiological evaluation of bronchiectasis was made by the modified Reiff score (MRS). Results Bronchiectasis was found in 66 (54%) of 122 patients included in the study. The mean age was 67.5 +/- 10.3 in the whole group, 108 (88.5%) of the patients were male, and 14 (11.5%) were female. When patients were stratified according to the presence of bronchiectasis, no statistically significant difference was found in terms of comorbidity scores, respiratory functions, exacerbation parameters, laboratory values and all cause of mortality between the groups (p > 0.05). There was no statistical relation between the presence of bronchiectasis and long-term survival (log-rank test p = 0.83). Conclusions This study shows that patients with bronchiectasis did not cause a poor outcome in patients with COPD exacerbation.

Purpose: A zero coronary calcium score (CCS) is not able to provide a definite exclusion for coronary arterydisease (CAD). The goal of this study was to determine the prevalence and associated cardiovascular risk factorsof CAD in patients with zero CCS.Methods: Six hundred thirteen patients with zero CCS referred to coronary calcium score analysis (CCSA) andcoronary computed tomography angiography (CCTA) with suspicion of CAD were included. The descriptive,univariate, and multivariate analyses were used to determine the prevalence and predictors of CAD presence.Results: Among 613 patients, 17 patients (2.7%) have NCCP, and obstructive CAD was found in 3 patients(0.48%). Multivariate analysis revealed that male gender and older age (≥50 years) were significantly associatedwith the presence of noncalcified coronary plaques (NCCP) (p < 0.05). The receiver operating characteristic(ROC) curve analysis showed that the male gender and older age (≥50 years) model had 70.6% sensitivity and84.2% specificity for predicting NCCP.Conclusion: A non-negligible portion of patients with zero CCS had CAD. Male gender and older age (≥50 years)were independently associated with NCCP. Due to the high specificity value (84.2%) and negative predictivevalue (99.0%) of the male gender and older age (≥50 years) model, selective use of CCTA is recommended in<50 years old female patients to avoid unnecessary radiation exposure

Purpose: Conventional coronary angiography (CCA) and coronary computed tomography angiography (CCTA) are the most frequently used imaging modalities to diagnose coronary artery disease (CAD). The amount of radiation and genotoxic damages of these imaging methods showed variation with the improved technology. Thus we sought to compare the ionizing radiation doses and radiation-induced DNA damage in patients who were performed CCA and CCTA.Methods: 76 patients (39 in CCA group, 37 in CCTA group) were enrolled. Patients undergoing CCTA were grouped according to the use of flash technique (22 patients with CCTA-flash, 15 patients with CCTA-other). The effective radiation dose was recorded. Genotoxicity was compared with chromosome aberration test before and after imaging methods.Results: There was a significant difference between the groups in effective radiation doses given to patients. Radiation was lowest in the CCTA-flash group, followed by CCA, and non-flash CCTA group. There was no change in chromosome aberration rate after CCTA-flash group (p = 0.479). There was a significant increase in chromosome aberration rates after CCA and CCTA-other groups (CCA: p = 0.001; CCTA-other: p = 0.01). Conclusions: CTA which was taken with flash technique in dual-energy CT devices delivers lower dose radiation compared to other groups. Due to this significant difference, radiation-induced genetic damage was significantly less in patients with CCTA undergoing flash technique.

Angiotensin-converting enzyme (ACE)/Angiotensin (Ang) II pathway has crucial regulatory effects on circulatory hemostasis and immune responses. This pathway has a major role in the development of acute lung injury and acute respiratory distress syndrome (ARDS), which is a devastating complication of SARS-CoV-2 infection. The aim of this study is to investigate the serum ACE activity and its correlation with clinical features and the disease severity in patients with COVID-19. Patients with confirmed COVID-19 by detecting SARS-CoV-2 nucleic acid RT-PCR were included in the study. Demographic data, clinical features, laboratory and radiologic investigations were recorded. Patients were classified by disease severity; asymptomatic, mild, and severe pneumonia. The serum ACE activity was evaluated with an autoanalyzer based on a spectrophotometric method. Fifty-five patients (50.9% female) and 18 healthy subjects (33.3 % female) were enrolled in the study. The median age of patients was 40 years, ranging from 22 to 81 years. Eighteen healthy subjects were served as the control group. The baseline characteristics were comparable between groups. The median serum ACE activity of patients and controls (38.00 [IQR 21] U/L and 32.00 [IQR 24] U/L, respectively) and of between patients grouped by disease severity (38.5 [IQR 19], 36 [IQR 25], and 38 [IQR 22] U/L, asymptomatic, mild and severe pneumonia group, respectively) were similar. There was no correlation between the serum ACE activity and conventional inflammatory markers. In this study, we did not find an association between serum ACE activity and COVID-19 and serum ACE activity on admission did not reflect disease severity.

Background The aim of this study was to investigate the impact of vitamin K antagonist (VKA) therapy on coronary artery calcification (CAC) by comparing long-term VKA users with metallic prosthetic valves (MPVs) and VKA-free patients undergoing coronary calcium scoring for cardiovascular (CV) risk stratification. Methods A total of 108 patients (43 VKA users with MPV and 65 gender-, age-, and risk-factor-matched VKA-free patients) were included in the study. CAC was determined via computed tomography (CT) and quantified on the basis of the Agatston score. The VKA group comprised patients who had an MPV for longer than 5 years, which entailed long-term VKA use. Results Long-term VKA users had more calcified coronary arteries compared with the control group (178.1 +/- 278 vs. 61.1 +/- 130.6,p= 0.01). There was no difference between groups in terms of traditional CV risk factors. The mean duration of VKA use was 15 +/- 7 years for the patients with MPV. There was no correlation between the duration of VKA use and mean Agatston score (r= 0.2,p= 0.215). Conclusion With its unique selection of patient groups, our study extends the findings of previous research that long-term VKA use is related to CAC as detected via CT scanning. The longer and more potent VKA regimen required for MPV patients is the primary cause of CAC in this group.

Purpose Cytokines are major mediators of COVID-19 pathogenesis and several of them are already being regarded as predictive markers for the clinical course and outcome of COVID-19 cases. A major pitfall of many COVID-19 cytokine studies is the lack of a benchmark sampling timing. Since cytokines and their relative change during an infectious disease course is quite dynamic, we evaluated the predictive value of serially measured cytokines for COVID-19 cases. Methods In this single-center, prospective study, a broad spectrum of cytokines were determined by multiplex ELISA assay in samples collected at admission and at the third day of hospitalization. Appropriateness of cytokine levels in predicting mortality were assessed by receiver-operating characteristic (ROC) analyses for both sampling times in paralel to conventional biomarkers. Results At both sampling points, higher levels of IL-6, IL-7, IL-10, IL-15, IL-27 IP-10, MCP-1, and GCSF were found to be more predictive for mortality (p Conclusion Our study results suggest that single-sample-based cytokine analyzes can be misleading and that cytokine levels measured serially at different sampling times provide a more precise and accurate estimate for the outcome of COVID-19 patients.

Background/aim: When reading a chest CT, a radiologist needs to evaluate each rib one by one due to complex curvy shape, which makes reporting a tiresome and time-consuming task. A new curved planar reformat application that flattens ribs on a single plane may find a place in the radiology reporting room. This study aimed to evaluate the effect of a two-image set created by using the rib-flattening application on the performance of a radiologist in detecting sclerotic rib lesions in cancer patients. Materials and methods: The local Institutional Review Board approved this retrospective study.Two radiologists with different experience levels reviewed chest CT examinations of 106 patients 76 men, 30 women . We divided the patients into group A n = 54 , reviewed by a standard method, and group B n = 52 , reviewed by a standard method and the two-image set created on the rib-flattening application. Reading times, validity indices, and agreement levels with reference data were evaluated for both readers. Results: The median reading time of the junior examiner significantly decreased with the rib-flattening method 160.5 s vs. 70.0 s; P < 0.001 . Diagnostic indices of the senior reader were improved significantly at per patient level group A, AUC: 0.867; group B, AUC: 0.982; P = 0.046 . The new method showed better agreement levels kappa: 0.69 to 0.96 than the general method kappa: 0.53 to 0.91 .Conclusion: Based on improved agreement levels, reading times, and diagnostic validity indices we conclude that a two-image set consisting of an axial and a coronal flattened-rib image may be used in conjunction with an ordinary exam.

Highlights • Coronovirus 2019 (COVID-19) infection induces cytokine storm causing mortality. • Interleukin (IL)-18 is one of the key cytokines in the macrophage activation syndrome. • IL-18 elevated in COVID-19 patients and might be a therapeutic target., Background The effectual immune response is crucial to defeat viral infections. However, exuberant immune response with features of macrophage activation syndrome (MAS) lead detrimental consequences in COVID-19 patients. Interleukin (IL)-18 is one of the leading cytokines in MAS which has not been studied in COVID-19. Objective To investigate the association of IL-18 with the other inflammatory markers and disease severity in COVID-19 for predicting disease prognosis. Methods Patients with COVID-19 who had confirmed diagnosis with SARS-CoV-2 nucleic acid RT-PCR were enrolled into the study. Data on demographic and clinical characteristics, and laboratory values of CRP, ferritin, d-dimer and procalcitonin were measured on admission. Patients were followed up prospectively with a standardized approach until hospital discharge or death. Individuals were classified as asymptomatic, mild and severe pneumonia according to their clinical, laboratory and radiological characteristics. Worse outcome was defined as requirement of intensive care unit (ICU) admission or death. Blood samples were collected at enrollment and serum levels of IL-6 and IL-18 were determined by ELISA. Association between IL-18 and other inflammatory markers and prognosis were analyzed. Results There were 58 COVID-19 patients (50% male) with a median age of 43 (min 22-max 81) years. Twenty age and sex matched healthy subjects were served as control group. The study population was divided into three groups according to disease severity: asymptomatic (n = 20), mild pneumonia group (n = 27) and a severe group (n = 11). During follow up nine (15.5%) patients required ICU admission and three of them were died eventually. Serum IL-18 were correlated with other inflammatory markers and biochemical markers of organ injury; creatinine, liver enzymes and troponin. Serum IL-18 levels were remarkably higher in COVID-19 patients compared to healthy subjects with being highest in severe pneumonia group (p

Introduction: Invasive fungal infection (IFI) is a major cause of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. A previous history of IFI is not an absolute contraindication for allo-HSCT, particularly in the era of secondary antifungal prophylaxis (SAP). Prompt diagnosis and therapy are essential for HSCT outcome. Methodology: The charts of 58 allo-HSCT recipients [median age:29.5 (16-62); M/F:41/17] who had a previous history of IFI were retrospectively reviewed. Results: Possible IFI was demonstrated in 32 (55.2%), probable in 13 (22.4%) and proven in 13 patients (22.4%). All patients received SAP [liposomal amphoterisin B (n ꞊ 35), voriconazole (n ꞊ 17), caspofungin (n ꞊ 2), posaconazole (n ꞊ 1), combination therapy (n = 3)] which was started on the first day of the conditioning regimen. Treatment success was better in the voriconazole group when compared to the amphotericin B arm (100% vs 69.2%; p = 0.029). Development of breakthrough IFI was more frequent in patients on amphotericin B prophylaxis (42.4% vs 23.1%; p = 0.036). Clinical and radiological response were achieved in 13 of 18 patients (72.2%) who developed breakthrough infection. Overall survival of the study population was 13.5% at a median follow-up of 154 (7-3285) days. Fungal mortality was found to be 23%. Overall survival was better in the voriconazole arm, without statistical significance (90% vs 65.8%, p > 0.05). Conclusions: Secondary antifungal prophylaxis is considered to be an indispensible strategy in patients with pre-HSCT IFI history. Voriconazole seems to be a relatively better alternative despite an underlying necessity of larger prospective trials.

Objective: This study is planned to evaluate the effect of tomography proven bronchiectasis on chronic obstructive pulmonary disease (COPD) exacerbation and all cause of mortality. Method: Subjects hospitalized with COPD exacerbation between 2010 and 2016 were included in the study. Thorax computerized tomographies were retrospectively evaluated by radiologists to assess the existence and classification of bronchiectasis. Modified Reiff score was used for severity assessment. Patients’ demographics, comorbidities, symptoms, exacerbation patterns, labarotaries, spirometric and microbiological data, data on utilization of long-term oxygen therapy (LTOT) and non-invasive mechanic ventilation (NIMV) were recorded retrospectively. All cause of mortality was recorded at the date of 30th June of 2016. Effect of bronchiectasis on outcomes were examined. Results: 56 of 122 COPD patients had no bronchiectasis while 66 had bronchiectasis. 49 patients had severe bronchiectasis while 17 patients had mild disease. Age, Charlson index, median hospitalization duration, proportion of patients who grew pseudomonas aeruginosa in sputum were not significantly different between the groups (p>0.05). No relationship was found between bronchiectasis severity and outcomes. Bronchiectasis didn9t provide any significant effect on all cause of mortality at univariate analysis (p=0,978). Cox regression analysis revealed that Charlson index increased mortality (HR:1,58; p=0,044). Conclusion: Bronchiectasis had no effect on exacerbation and all cause of mortality in COPD.

We aimed to search if the renal parenchymal attenuation measurements on unenhanced CT scans could be useful in differentiating acutely obstructed kidneys from chronic cases or unobstructed kidneys.Unenhanced CT scans of 101 patients were retrospectively reviewed. Thirty-two patients with unilateral acute renal obstruction, 34 patients with unilateral chronic renal obstruction due to various reasons and 35 control subjects were included in the study. The parenchymal densities of both kidneys were measured, from the upper poles, middle portions, and lower poles of each kidney. The mean parenchymal densities of both kidneys were calculated in all three groups of subjects. Secondary signs of renal obstruction such as perinephric stranding, size of ureteral stone, degree of hydronephrosis were also noted for each kidney.The mean parenchymal attenuation value on the acutely obstructed side was lower than the unobstructed side, 24.21 ± 3.68 and 30.68 ± 4.75 respectively (p0.001). The mean parenchymal attenuation value on the acutely obstructed side (24.21 ± 3.68) was lower than both the chronically obstructed side (30.85 ± 4.53), and the control subjects (29.62 ± 3.03 on corresponding side). There was no statistically significant attenuation difference between right and left kidneys in the control group and chronic obstruction group.Renal parenchymal attenuation measurements and attenuation differences of both kidney of same patient could be useful in differentiating acute unilateral obstruction from chronic cases.

Summary Objectives Invasive fungal infections (IFI) are a significant cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Hepatosplenic candidiasis (HSC) is defined as a distinct form of invasive candidiasis, with liver, spleen, and kidney involvement, in patients with hematological disorders. Methods The charts of 255 patients (male/female 168/87; median age 35 (range 16–71) years) who were evaluated pre-HSCT at the Gazi University Hospital Stem Cell Transplantation Unit between 2003 and 2008, were retrospectively reviewed. Results HSC, which was demonstrated in six (2.3%) patients, was found to be more common in allogeneic HSCT recipients than in autologous HSCT recipients and in patients who had received two or more previous chemotherapy courses than in patients who had received fewer than two ( p >0.05). Patients with HSC tended to have a worse performance status than patients without HSC according to the World Health Organization ( p =0.001) and Karnofsky scale ( p =0.007). Pre-transplantation ferritin ( p =0.008) and acute phase reactant levels, including erythrocyte sedimentation rate ( p =0.025) and C-reactive protein ( p =0.007), were significantly higher in patients with HSC than in patients without HSC. Conclusions This study shows the predictive role of pre-transplantation ferritin levels in selecting a subset of patients at increased risk for HSC. Pre-transplantation risk assessment and targeted strategies might lower the morbidity and mortality of IFI in HSCT recipients.

A 45-year-old female was admitted with headache and vomiting. Cranial computed tomography (CT) demonstrated a callosal hematoma. Magnetic resonance imaging (MRI) showed no venous flow and thrombus replacing the inferior sagittal sinus (ISS) lumen. Under appropriate medical treatment and close follow-up she recovered quickly and, after 2 years, was doing well with corpus callosum infarcts. Isolated inferior sagittal sinus thrombosis is an extremely rare condition with only one previously reported case in the literature. Although it is very rare, isolated inferior sagittal sinus thrombosis should be considered in the differential diagnosis of non-traumatic corpus callosum hematoma.

Purpose: To report our results from a study of the endovascular treatment of flow restricting chronic atherosclerotic or catheter‐induced segmental iliac artery dissections with bare stents. Material and Methods: Thirty symptomatic patients with 32 lesions, including chronic atherosclerotic ( n = 21) and catheter‐induced ( n = 11) segmental arterial dissections, were treated with primary stenting. The common iliac artery was involved in 19 lesions and the external iliac artery in the remaining 13. Two patients had two lesions in the same vessel. Technical success was defined as restoration of the smooth contoured luminal patency with no more than 20% residual stenosis in diameter in atherosclerotic dissections associated with plaque formation or total obliteration of the false lumen in catheter‐induced dissections. Complete relief of, or marked improvements in, presenting symptoms, or at least single category improvement, was assessed for clinical success. Results: Technical success rate was 100%. No procedure‐related complications such as distal emboli or early occlusions were observed. Complete symptom relief was achieved in all patients with catheter‐induced dissection and in all but three cases with chronic spontaneous atherosclerotic dissection. In two cases, occlusion of the stents occurred during the follow‐up period. Clinical and radiological mean follow‐up for 24 months (range 3–55) revealed patency of all other stented segments. Cumulative primary patency rate was 97% over 12 months and 90% over 24 months. Conclusion: Endovascular treatment of chronic atherosclerotic and catheter‐induced short obstructive iliac arterial dissections with bare stents is safe and effective. Patency of the diseased arterial segment with a smooth lumen can be sustained for an extensive period.

Situs ambiguous with polysplenia is a situs abnormality characterized by the duplication of left-sided organs and presence of multiple spleens. Situs anomalies are rare conditions with a developmental origin where the inner organs are located other than in their normal localizations. Although seemingly difficult to define and categorize, they can be distinguished from each other by their features. In this article, our purpose is to present radiologic findings of a 25-year-old male, who has diagnosis of situs ambiguous with polysplenia, and to discuss situs abnormalities. (Gazi Med J 2012; 23: 97-9)

Purpose We report on the endovascular management of hemorrhage with stent-graft due to a misplaced central venous catheter in the vertebral artery (VA) during percutaneous internal jugular vein catheterization in a child. Methods A 16-year-old female was presented with the diagnosis of familial Mediterranean fever related chronic renal insufficiency. An attempt was made to place a central venous catheter via the right internal jugular vein without image guidance and the patient experienced dyspnea and pain at the catheter insertion site. Computerized tomography (CT) showed hemorrhage in the cervical region and upper mediastinum, also reformatted images showed that the catheter was passing through the proximal part of the VA and terminating in the right mediastinum. The catheter was removed during manual compression under angio-flouroscopic monitoring and ongoing extravasation was observed. A stent-graft was placed to the bleeding site of the VA. Results Angiography immediately after the stent-graft placement revealed complete disappearance of extravasation and patency of vertebral and subclavian arteries. Conclusion Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy.

Objective: To determine the frequency and degree of change in mammographic densities, and new solid or cystic formations in the breast tissue, during different types of hormone replacement therapy (HRT). Subjects and methods: This prospective study included 118 postmenopausal women, 88 under hormone replacement therapy and 30 control subjects. Four types of hormone therapies were compared for their effects on mammograms and sonograms obtained before and during therapy. Mean duration of follow-up was 16.92 +/- 7.65 months in the treated and 21.56 +/- 11.49 months in the control group. Density changes on mammograms were evaluated subjectively. Results: Density increase was recorded in 34% of the patients receiving HRT and in none of the control subjects (P < 0.01). Highest frequency of density increase was found in the groups treated with estrogen plus cyproterone acetate (46%) and with estrogen plus medroxyprogesterone acetate (43%). Frequencies of density increase in the tibolone users, and in estrogen alone users were 28% and 18%, respectively. Degree of density increase was evidently minimal in tibolone users, compared to others. New cysts occurred in six patients receiving HRT (6%)which was not statistically different from the control group (16%) (P > 0.05). New cyst formation was not related to the degree of density increase. New solid mass formation was not observed. Conclusion: Our findings show that mammographic density changes related to HRT are dependent on the selected hormone regimen. Formations of breast cysts or solid lesions do not seem to be related to HRT. (C) 1999 International Federation of Gynecology and Obstetrics.

The aim of this study was to assess the effectiveness of the modified test-bolus (mTB) method in computed tomography pulmonary angiography (CTPA). The Institutional Review Board approved this retrospective study. We reviewed 24 patients (nine men, 15 women; age range, 21–88 years) in whom CTPA was performed either by Bolus-Tracking (BT) (n = 12) or mTB (n = 12) methods. Pulmonary transit time (PTT) was used to determine scan delay time and contrast volume in the mTB group. The contrast volume, radiation dose, quantitative measures, and qualitative scores of enhancement were compared. The chi-squared test, Mann–Whitney U test, and κ statistics were used. The significance level was 0.05. The effective dose (P = 0.028) and contrast volume (P

OBJECTIVE Both computed tomography (CTA) and conventional angiography (CCA) can provide direct visualization of the coronary arteries. The aim of the present study was to compare the radiation exposure between CTA and CCA and to search whether this amount of radiation causes significant DNA damage. METHOD Seventy-two patients who underwent CTA or CCA were enrolled prospectively. We recorded the radiation dosage that was used during the procedures and calculated the effective dose (ED). We determined the sister chromatid exchange (SCE) level from the blood samples which were drawn from the patients before and after the procedures. The change in SCE is used as the measure of DNA damage induced by the radiation. RESULTS The patients in the CTA (n = 36) and CCA groups (n= 36) had similar baseline characteristics. The ED was higher in CTA examinations compared to CCA examinations (14.2 +/- 2.7 vs 6.4 +/- 3.1, P

OBJECTIVES: Our aim was to assess the effect of adaptive statistical iterative reconstruction (ASIR) on pediatric head computed tomography (CT) examinations. METHODS: We retrospectively reviewed 305 pediatric head CT examinations. The study population consisted of standard dose (STD, n = 152) examinations reconstructed with filtered back projection and low dose (LD, n = 153) examinations reconstructed with 30% (LD30) and 0% (LD0) ASIR. We compared groups by means of radiation dose, noise measures, and visual grading. Student t test, 1-way analysis of variance test, and Mann-Whitney U test were used for statistical analysis. RESULTS: The dose in the LD30 group was significantly lower (29%) than that in the STD group (P < 0.001). The noise in the white matter (P < 0.001), SNR (P < 0.001), and subjective image noise (P = 0.044) was significantly better in the STD group than those in the LD30 group. There was no significant difference between LD30 and STD groups in the sharpness (P = 0.141), diagnostic acceptability (P = 0.079), and artifacts (P = 0.750) and contrast-to-noise ratio (P = 0.718). CONCLUSIONS: In conclusion, we found that a blend of 30% ASIR in a 16-slice multidetector CT produces diagnostically acceptable pediatric head CT examinations with a 29% less dose.

Renal involvement of Behcet's disease is a rare clinical event generally appears as glomerular disease. Here, we present a 56-year-old patient with Behcet's disease having spontaneous renal hemorrhage clinically presenting with acute abdominal pain. The patient was a long sufferer of Behcet's disease with severe neurologic and vascular disorders related to the disease. The computed tomography (CT) demonstrated subcapsular and pararenal hematoma with active contrast extravasation. The patient was also using clopidogrel for his long-standing occlusive arterial disease. We think that both clopidogrel and Behcet's disease are the contributing factors of his clinical picture. Acute abdomen in patients with Behcet's disease must be taken seriously and CT must be first imaging modality of choice for outlining the exact cause.

Histoplasmosis is the most common mycotic infection in certain parts of American continent, but it is very rare in Europe being reported in a few cases that usually had an impaired cellular immunity or had history of traveling overseas. Infection is more likely to be disseminated in immunocompromised individuals and generally presents insidiously with nonspecific symptoms. We report an unusual case of acute histoplasmosis in an immunocompetent patient from Turkey which is an area of nonendemicity. This case report represents the radiological and clinical manifestations of disease and emphasizes need to be aware of this infection even in nonendemic regions.

A 76-year-old man who had undergone 2-vessel coronary artery bypass graft (CABG) operation 21 years ago was diagnosed with myasthenia gravis and had been under follow-up for the past 3 years. An anterior mediastinal mass was detected with chest x-ray, and he was consulted by a thoracic surgeon for a possible thymoma. Computed tomography (CT) scans revealed that the mass could be an aneurysm originating from saphenous vein graft (SVGA) or from the aorta. The patient was referred to the cardiovascular surgery department. The results of his physical examination were normal. ECG showed R-wave progression loss in leads V1 through V3 and sinus rhythm. Echocardiography showed mild apical hypokinesia with an ejection fraction of 57%. Although there was …

BACKGROUND AND PURPOSE: Most imaging techniques used for the evaluation of obstructive epiphora, such as DS DCG, rely on undesired ionizing radiation. We evaluated the efficacy of topical contrast-enhanced MR DCG in comparison with DS DCG in patients with obstructive epiphora who underwent balloon DCG or stent placement. MATERIALS AND METHODS: Thirty-six LDSs of 21 patients treated with balloon DCG ( n = 11) or stent placement ( n = 11) were examined with MR DCG and DS DCG. Contralateral LDSs ( n = 14) were also evaluated in patients with unilateral disease. A sterile 0.9% NaCl solution containing 1:100 diluted gadolinium chelate was instilled into conjunctival sacs. The 3D FSPGR sequence was used with a 1.5T scanner. MR and DS DCG findings were scored and compared according to morphology of the lacrimal sac, junction, and NLD and the presence of contrast media in the nasal cavity. RESULTS: Comparison of MR DCG and DS DCG findings showed no significant statistical differences in reference to anatomic locations according to the McNemar test ( P > .05). Good or very good agreement (κ value > 0.61) was observed according to the κ statistics. CONCLUSIONS: Topical contrast-enhanced MR DCG is an effective and reliable noninvasive method for evaluation of the LDS in patients treated with IR procedures. This method avoids both cannulation and ionizing radiation and can, therefore, be repeated as often as is necessary in these complex patients.

BACKGROUND AND PURPOSE: While CT has found wide use in medical practice, it is also a substantial source of radiation exposure and is associated with an increased lifetime risk of cancer. There is an urgent need for new approaches to reduce the radiation dose in CT. In this regard, ASIR is an alternative method to FBP. We assessed the effect of ASIR on dose reduction in adult head CT. MATERIALS AND METHODS: We retrospectively evaluated a sample of 149 adult head CT examinations that were divided into 2 groups, STD and LD. We lowered the tube current and used ASIR in the LD group. SNR and CNR were analyzed. Dose parameters were recorded while subjective image noise, sharpness, diagnostic acceptability, and artifacts were graded. The Student t test, the Mann-Whitney U test, and κ statistics were used for statistical analyses. RESULTS: We achieved a dose reduction of 31% in the LD group (STD, 2.3 ± 0.1 mSv; LD, 1.6 ± 0.1 mSv; P < .001). There was no significant difference in the noise measured in the air between the 2 comparison groups (P = .273). Noise in the CSF was higher in the STD group (P < .001), while the noise in the WM was higher in the LD group (P < .001). Differences in the CNR between groups were insignificant, but the STD group displayed better SNR values. There was no significant difference in the modal scores of diagnostic acceptability (P = .062) and the artifacts (P = .148) between the 2 groups. Better scores for subjective image noise (P < .001) and sharpness (P = .04) were observed in the STD group. CONCLUSIONS: ASIR appears to be useful in reducing the dose in adult head CT examinations. While the effect of ASIR on noise reduction observed in the present study of head CT is less than that reported previously in abdomen and chest CT, these findings encourage further prospective studies in larger patient samples.

44 year old male was admitted to hospital with chest pain. Complex coronary artery fistula drained into pulmonary artery was depicted but not clearly demonstrated with conventional angiography despite various projections. CT angiography was demonstrated that the fistula was fed by both left anterior descending (LAD) and right coronary artery (RCA) branches. A feeder aneurysm was found on a LAD branch. The fistula was associated with RCA and LAD artery via small caliber vessel web which was also associated with right ventricular outlet. 64-MDCT is superior to catheter angiography in its capability to demonstrate beyond the lumen of coronary arteries and extra-anatomical structures like fistulas. © 2011 Elsevier Ireland Ltd.

A 57-year-old man presented to the emergency room with light-headedness. There was no prior history of chest pain but his electrocardiography showed Q-waves, ST-segment elevation, and negative T-waves in V1-3. Echocardiography showed apical dyskinesia and an ejection fraction of 40–45%. Coronary angiography showed that the right and the circumflex artery …

The aim of this study was to emphasize the importance of preoperative surgical planning using 3D skull models in craniosynostosis surgery. By using 3D polymethyl methacrylate skull models manufactured using 3D tomography images, the authors previously showed that after fronto-parietal osteotomy, instead of fixing the fronto-parietal bone flap without rotation, angled advancement with horizontal osteotomy provides maximum increase in intracranial volume, in a bilateral coronal craniosynostosis model. After changing the operation technique using data gathered from previous studies, we reviewed two bilateral craniosynostosis patients operated with the new technique and compared it with two patients that were operated with the old technique. Comparing cranial indexes (CI), significant improvement was detected in both groups. The decrease in CI in the second group was slightly better than the first group. In the comparison of intracranial volume (ICV), there was an increase in ICV values in both groups. The percentage of increase between two groups was similar. The morphological outcome was satisfactory in all patients. There were no major or minor complications and morbidity. Current multislice tomography technology and stereolithographic procedures provide an excellent surgical simulation model to find new techniques and predict the outcome. These models should be used in all complex and syndromic craniosynostosis for both better results and reducing the operative time and associated blood loss.

Background: Pulmonary involvement due to inflammatory bowel disease (IBD) is frequent when evaluating a patient with IBD and pulmonary involvement remains complicated. Most of the patients are asymptomatic and the methods used are mostly invasive or expensive procedures. The aim of this prospective study is to evaluate the value of the fractional exhaled nitric oxide (FENO) level for the diagnosis of pulmonary involvement due to IBD and to investigate any correlation between FENO level and disease activity. Methods: Thirty-three nonsmoker patients with IBD (25 ulcerative colitis [UC] and 8 Crohn's Disease [CD]) who were free of corticosteroid treatment and 25 healthy subjects as a control group were enrolled in this study. All patients with IBD were investigated for pulmonary involvement with medical history, physical examination, chest roentgenogram, oxygen saturation, blood eosinophil levels, pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and FENO level. Results: Pulmonary involvement was established in 15 patients (45.5%) with IBD. The FENO level was higher in patients with pulmonary involvement than without pulmonary involvement and healthy controls independent from the pulmonary symptoms, eosinophil count, duration of disease, activity of disease, and surgery history (FENO: 32 ± 20; 24 ± 8; 14 ± 8 ppb, respectively) (P < 0.05). In addition, diffusion capacity (DLCO) was found to be significantly lower in patients with CD compared with UC (P < 0.05). Conclusions: This study showed that an increased FENO level may be used for identifying patients with IBD who need further pulmonary evaluation. Inflamm Bowel Dis 2009

The case of a 27-year-old male with recurrent respiratory papillomatosis including lung involvement is presented. Laryngotracheal papillomatosis with lung involvement is a rare entity associated with human papillomavirus infection. Computed tomography (CT) was essential in guiding diagnostic and therapeutic approaches. Knowledge about the findings of this disease is needed for correct diagnosis, since findings are nonspecific. Lesions may show malignant transformation; regular follow-up with CT is essential.

Increasing use of more aggressive treatment approaches in patients with hematologic malignancies leads to an increased frequency of invasive fungal infections, which is a major cause of transplant-related mortality in hematopoietic stem cell recipients. In this respect, the presence of an active fungal infection prior to transplantation may hinder subsequent hematopoietic stem cell transplantation (HSCT); which sometimes is the only curative treatment. We report here the results of 13 consecutive patients transplanted with active fungal infection. Thirteen patients (7 males and 6 females) with a median age of 34 years (range, 16-53 years) underwent 15 HSCT between September 2003 and April 2007. In this group of 15 patients, consisting of hematologic malignancies with high risk of relapse or severe aplastic anemia, 11 (73%) transplants performed in subjects with active invasive fungal infection (IFI) patients survived 30 days after transplantation. Three patients (1 patient with primary disease relapse, 1 patient with graft versus host disease [GVHD] complicated with fungal pneumonia, and 1 patient with severe sinusoidal obstruction syndrome and GVHD complicated with aspiration pneumonia) died on days +66, +74, and +62 posttransplantation, respectively, within the first 100 days of HSCT. After a median follow-up time of 306 days (range, 145-680 days), four of 13 (31%) patients with active IFI were alive and disease free. Among a population of HSCT recipients with a dismal prognosis without transplantation, performing the procedure despite active IFI saved a considerable proportion of the patients. The presence of active IFI did not seem to be an absolute contraindication for HSCT, particularly among high-risk patients in whom a treatment delay could be fatal.

Small bowel perforation secondary to phytobezoars is a rare clinical entity, which is not well-documented in the radiological literature. Sonographic and computed tomography (CT) findings of a case of closed small bowel perforation secondary to phytobezoars in a patient with previous gastric surgery are presented. Both abdominal ultrasound and CT examinations revealed a collection containing air at the left lower quadrant as well as neighboring intraluminal masses suggestive of bezoars. We propose that appropriate CT examination is a very useful imaging modality for evaluating this kind of bowel perforation.

Objective. Portomesenteric venous gas is a rare condition with an unclear pathogenesis. Most studies in the medical literature mention computed tomography (CT) as the primary imaging tool for this entity. The objective of this study was to outline the advantages and disadvantages of sonography in the evaluation of patients with portomesenteric venous gas. Methods. We describe 7 patients (3 female and 4 male; age range, 47‐83 years) with portomesenteric venous gas. Both CT and sonographic examinations were performed in each patient. Our patient population consisted of 2 patients with superior mesenteric artery occlusion, 3 with ischemia of the colon, small bowel, or both, 1 with gastric ulcer perforation, and 1 with ischemic bowel disease presumably secondary to complications of continuous ambulatory peritoneal dialysis. Results. Portal venous gas was observed in all 7 patients with sonography and in 6 patients with CT. Computed tomography was unable to show gas in the portal venous system in 1 patient. Sonography showed patchy hepatic gas accumulation (likely within small peripheral portal vein branches) with no correlative findings on CT. Computed tomography showed important associated findings, including pneumatosis intestinalis. Conclusions. In cases with portomesenteric gas, CT is the preferred modality for showing the underlying etiology. However, with its realtime imaging capability, sonography may also be a very valuable imaging modality in the evaluation of this entity. Key words: computed tomography; portal vein gas; portomesenteric gas; sonography.

Objective. The mechanisms of hemodynamic alterations in colorectal liver metastases are not clearly understood yet. Considering that an increase in liver size in patients with metastases could also result in an alteration in total liver flow, we aimed to analyze hemodynamic changes relative to the liver volume and to search for the possibility of any intrinsic factors affecting blood flow in patients with metastases. Methods. Twenty-eight patients with colorectal liver metastases and 20 control subjects with no liver disease were evaluated sonographically. All patients were examined prospectively by Doppler sonography and helical computed tomography. Hepatic hemodynamic parameters, including blood flow in the hepatic artery and portal vein, total blood flow to the liver, and Doppler perfusion index, were calculated, and values relative to liver volume were obtained. Hepatic perfusion changes in liver metastases were then compared with those in a control group. Results. The liver volume of the patients with liver metastases was greater than that of the control group (P = .003). Hepatic arterial blood flow rates were higher, whereas portal flow rates were lower, in patients with liver metastases compared with control subjects (P < .05). Total liver blood flow was not significantly different between the two groups. However, total blood flow relative to liver volume was significantly lower in the metastatic group (P < .001). Doppler perfusion index values in the patients with metastasis were significantly higher than in the control group (P = .000). Conclusions. Our findings may support the hypothesis that a humoral mediator-induced portal venous flow reduction causes perfusion changes in liver metastases from colorectal disease. However, an additional intrinsic hepatic hemodynamic event should also be present. Doppler perfusion index measurements can provide additional information in the evaluation of patients with colorectal liver metastases. Key words: colorectal cancer; Doppler sonography; helical computed tomography; liver metastases; liver volume.