Asli Koktener

Anatomic evaluation of the xiphoid process with 64-row multidetector computed tomography.

ObjectiveThe aim of this study was to evaluate the interindividual variations of the xiphoid process in a wide adult group using 64-row multidetector computed tomography (MDCT).Materials and methodsIncluded in the study were 500 consecutive patients who underwent coronary computed tomography angiography. Multiplanar reconstruction (MPR), maximum intensity projection (MIP) images on coronal and sagittal planes, and three-dimensional volume rendering (VR) reconstruction images were obtained and used for the evaluation of the anatomic features of the xiphoid process.ResultsThe xiphoid process was present in all patients. The xiphoid process was deviated ventrally in 327 patients (65.4%). In 11 of these 327 patients (2.2%), ventral curving at the end of the xiphoid process resembled a hook. The xiphoid process was aligned in the same axis as the sternal corpus in 166 patients (33.2%). The tip of the xiphoid process was curved dorsally like a hook in three patients (0.6%). In four patients (0.8%), the xiphoid process exhibited a reverse S shape. Xiphoidal endings were single in 313 (62.6%) patients, double in 164 (32.8%), or triple in 23 (4.6%). Ossification of the cartilaginous xiphoid process was fully completed in 254 patients (50.8 %). In total, 171 patients (34.2%) had only one xiphoidal foramen and 45 patients (9%) had two or more foramina. Sternoxiphoidal fusion was present in 214 of the patients (42.8%).ConclusionsSignificant interindividual variations were detected in the xiphoid process. Excellent anatomic evaluation capacity of MDCT facilitates the detection of variations of the xiphoid process as well as the whole ribcage.

A new radiological approach to cyclic mastalgia: Venous doppler ultrasound

OBJECTIVE To evaluate the role of the venous system in cyclical mastalgia. MATERIALS AND METHODS 25 healthy women and 39 women with cyclic mastalgia underwent venous Doppler examination in both pre- and postmenstrual period. Upper-outer quadrant veins of breast were evaluated. The impedance indices of both groups were compared in both the premenstrual and postmenstrual period. RESULTS During the premenstrual period, venous impedance indices were significantly higher in the patients with cyclic mastalgia (p=0.004) than in the control group. After the menstrual period, there was no difference in venous impedance indices between the groups. CONCLUSION Excessive tissue oedema might be responsible for both a tension-mediated pain and a compression of the venous system thereby showing higher impedance than that in control group.

Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids

OBJECTIVES: The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS: A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS: Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm2, respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1%) and control (43.3%) groups. Bone fracture was identified in four patients with asthma (8.6%) and in six patients from the control group (10%). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS: There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.

IGF-I levels and visceral fat accumulation in colonic neoplasia

BACKGROUND IGF-I, visceral obesity, IGF binding protein-3 and insulin are reported to be potential risk factors for colorectal carcinogenesis. Many studies report a relation between obesity, insulin resistance and the risk of colon cancer. This study investigates the association between IGF-I levels, insulin resistance and visceral fat accumulation in patients with colon cancer and adenoma. METHODS In this cross sectional study, 48 sequential patients were diagnosed with either colorectal adenoma or carcinoma were enrolled. The control subjects were 30 sequential subjects. Serum IGF-I, HOMA insulin resistance index and visceral fat were measured in patients with colorectal adenoma and carcinoma. RESULTS Serum IGF-I levels were significantly higher in patients with colorectal adenoma and carcinoma compared with controls. Visceral fat accumulation was lower in colorectal carcinoma group compared with colorectal adenoma group, but no statistically significant difference was observed among them and controls. No statistically significant difference was observed in HOMA insulin resistance index, fasting insulin and fasting glucose concentrations among the three groups. No correlation was found between insulin resistance and serum IGF-I levels and visceral fat accumulation. Logistic regression analysis showed that plasma IGF-I concentration was significantly associated with colorectal adenoma and carcinoma. Body mass index and waist circumference were associated with colorectal, carcinoma but were not associated with adenoma. CONCLUSION In our study we found that, IGF-I levels are associated with colorectal adenomas and carcinomas, independent of insulin resistance and visceral fat accumulation; supporting the hypothesis that an increase in IGF-I levels may be a factor involved in the development of colon cancer.

Interatrial shunt: diagnosis of patent foramen ovale and atrial septal defect with 64-row coronary computed tomography angiography

PurposeThe aim of this study was to investigate the frequency with which interatrial shunts are found during routine coronary computed tomography (CT) angiography and to describe imaging characterizations of patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA).Materials and methodsA total of 1081 adult patients were evaluated retrospectively for interatrial shunting; 77 were excluded from the study. CT diagnosis of PFO was defined as (1) a channel-like appearance of the interatrial septum (IAS) and (2) a contrast agent jet flow from the left atrium (LA) to the right atrium (RA). ASD was defined as (1) the IAS resembling a membrane with a hole and (2) a contrast jet flow between the two atria. ASA was identified by detecting a minimum 10-mm protrusion of the LA beyond the IAS into the RA.ResultsAmong 1004 patients, 86 patients (8.6%) were diagnosed to have PFO. Another 23 patients (2.3%) had a hole in the IAS and were diagnosed as having ASD: 21 with an ostium secundum-type ASD and 2 with the sinus venosus type. ASA accompanied ASD in three patients.ConclusionElectrocardiography-gated CT using the saline-chaser contrast injection technique that is routinely used for coronary arterial imaging can be used to detect interatrial shunts. The technique can also serve as a method for differentiating PFO, ASD, and ASA.

The cisterna magna size in normal second-trimester fetuses

Abstract Objective: The purpose of this study was to evaluate cisterna magna size of the fetuses between 16 and 24 weeks of gestation, and to establish a normogram for cisterna magna measurements during gestation. Methods: A prospective study of normal singleton pregnancies was established. Measurement of the fetal cisterna magna was performed by transabdominal ultrasonography between 16 and 24 weeks of gestation in 194 fetuses. Results: A linear correlation was obtained between gestational age (GA) and cisterna magna (R2=0.75, P<0.0001). A linear correlation was also found between biparietal diameter and cisterna magna (R2=0.74, P<0.0001). The normal mean (±SD) for each gestational week was defined. Conclusion: The present data offer the normal range of the cisterna magna. Cisterna magna measurement may provide normative data for fetal growth and development. Abnormal measurement of cisterna magna may be a clue for posterior fossa pathologies or a chromosomal disorder.

Incidentally found retroperitoneal ganglioneuroma in an adult.

The ganglioneuroma is a very rare tumor arising from sympathetic nerve system. An asymptomatic retroperitoneal ganglioneuroma was found incidentally in a 35-year-old woman. Ultrasonography, computed tomography, and magnetic resonance imaging showed a retroperitoneal mass extending to the left adrenal gland, and surrounding abdominal aorta, celiac axis, left renal and adrenal arteries, and veins. The tumor was resected and histologic examination showed ganglioneuroma.

Spontaneous urinary extravasation: detection rate with 64-row multidetector computed tomography in patients presenting with acute abdomen

The aim of this study was to detect the rate of spontaneous urinary extravasation (SUE) with computed tomography (CT) in patients presenting with acute abdomen. Seven hundred thirteen abdominal CT examinations with i.v. contrast media requested mainly from the emergency department and urology clinics for sudden onset abdominal pain, flank pain, nonspecific abdominal pain with nausea and vomiting, and renal colic between September 2007 and August 2011 were retrospectively reviewed. Only adult patients were included in the study. Three patients with SUE were detected. One had a mid-ureteral stone while the etiology for the other two patients was unknown. Two of the patients were treated conservatively; one was treated with stenting with a double-j catheter. SUE should be considered in the differential diagnosis of patients presenting with acute abdomen and perinephric–periureteral fluid collection inconsistent with stone size and who are occasionally stone free. Early and precise diagnosis of SUE plays an important role in the management protocol of patients presenting with acute abdomen.

Inborn Errors of Metabolism Presenting in Childhood

Neurodegenerative and neurometabolic disorders may cause significant morbidity and mortality in children. Imaging is important in early diagnosis of metabolic disorders and in determining the extent of brain injury. Especially after the development of new techniques such as diffusion‐weighted magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), neuroimaging plays more important role in the diagnosis and management of these disorders. In these disorders, usually a mutation causes a clinically significant block in one or more metabolic pathways. This blockage usually results in either a deficiency of the product or in an accumulation of substrate with damage induced by either storage or toxicity. The presenting symptoms are usually nonspecific. In some of the metabolic disorders, long‐term dietary or medical treatment options are available, and to make an early diagnosis in these disorders is important before the brain damage occurs. Prompt diagnosis, particularly in treatable disorders, is crucial to prevent neurological sequelae or death. If treatment is indeed available, neuroimaging also provides a baseline in evaluation of the efficacy of treatment. Therefore, the neuroradiologist should be aware of these disorders to prevent devastating results of delayed diagnosis. Metabolic disorders affecting the central nervous system, both gray and white matter can be classified by involvement of the primary cellular organelle as lysosomal, peroxisomal, mitochondrial disorders, or biochemical classification can be made as amino acid and organic acid metabolism defects or primary white matter disorders. This article presents the neuroimaging features of relatively more common metabolic disorders.

Diagnosis and percutaneous treatment of partial subclavian steal: Doppler ultrasonography and phase contrast magnetic resonance angiography findings and a brief review of the literature

A 66-year-old woman presented with back pain and arm claudication. Severe stenosis of the left proximal subclavian artery was detected incidentally by thorax computed tomography. Doppler ultrasonography and phase contrast magnetic resonance angiography (PCMRA) evaluation revealed partial subclavian steal. The stenosis was successfully treated with percutaneous stenting. Imaging findings are described and a brief review of the literature emphasizing the role of PCMRA in diagnosing partial steal is discussed.