Ayşegül Altunkaş

The value of computed tomographic obstruction index in the identification of massive pulmonary thromboembolism

PURPOSE In this study, the pulmonary arterial computed tomography obstruction index ratio, which indicates the degree and extent of thrombotic arterial occlusion, was calculated in cases with pulmonary thromboembolism. Our objectives were to investigate the value of this index for the identification of cases with massive pulmonary thromboembolism and to search for correlations between this index and clinical parameters. MATERIALS AND METHODS Data from 68 patients were evaluated retrospectively. For the clinical evaluation, the Wells scoring system was used. Pulmonary computed tomographic angiography examinations were acquired using an eight-channel multidetector computed tomography. The presence of arterial filling defects was recorded, and the clot burden was quantified based on the degree and extent of thrombotic arterial occlusion. RESULTS According to the Wells scoring system, the patients were assigned to low (n = 14), moderate (n = 34), and high clinical (n = 20) possibility groups, and the difference among the mean pulmonary arterial computed tomography obstruction index ratios of the three groups was significant (P = 0.001). A positive correlation was observed between the pulmonary arterial computed tomography obstruction index ratio and the Wells score (r = 0.470, P < 0.001). The pulmonary arterial computed tomography obstruction index ratio cut-off point was determined to be 40% for the discrimination of massive and nonmassive cases (sensitivity, 72.7%; specificity, 91.4%). CONCLUSION We found that in cases where the pulmonary arterial computed tomography obstruction index ratio was above 40%, a diagnosis of massive pulmonary thromboembolism was demonstrated. Furthermore, a positive correlation between the obstruction index and the Wells score suggested the use of a clinical evaluation as a means of developing a recommendation regarding the thrombotic load.

Is evaluation of placenta with real-time sonoelastography during the second trimester of pregnancy an effective method for the assessment of spontaneous preterm birth risk? ☆

PURPOSE The aim of this study is to investigate the effectiveness of placental strain ratio (SR) values measured by real-time sonoelastography (SE) in the second trimester in the prediction of spontaneous preterm birth (sPTB). METHODS This study included 70 pregnant women who applied to our clinic for routine second-trimester screening. Placental SR measurements were performed with the SE method. Two different SR measurements were performed by taking two different tissues as references. The SR value measured when taking the rectus abdominis muscle as a reference was termed the muscle-to-placenta strain ratio (MPSR), while the SR value measured when taking subcutaneous tissue as a reference was termed the fat-to-placenta strain ratio (FPSR). Women whose gestational age at birth was less than 37 weeks 0 days were accepted as sPTB. The association between gestational age at birth and MPSR and FPSR was investigated. Receiver operating characteristics analysis was used to calculate the sensitivity and specificity of the elastographic outcomes. RESULTS There was a low-level negative correlation between MPSR and gestational age at birth (r=-0.300, P=.012) and there was a moderate-level negative correlation between FPSR and gestational age at birth (r=-0.513, P<.001). The multivariate linear regression analysis showed that the FPSR (β=0.609, P=.002) was the significant predictor for the sPTB. CONCLUSIONS Our data indicate that the FPSR value measured with real-time SE in the second trimester of pregnancy may be effective in the prediction of sPTB.

MRI findings of a postpartum patient with reversible splenial lesion syndrome (RESLES)

A 19-year-old female presented at the twentieth day postpartum with severe headache, nausea and vomiting. She had no history of hypertension. Ambulatory blood pressure measurement values were normal. Proteinuria was not detected. In blood analysis, D-dimer level was normal. In addition, MR venography for sinus vein thrombosis was normal. However, MR imaging of the brain showed a lesion measuring approximately 1.5 cm in diameter in the splenium of the corpus callosum (SCC) (Fig. 1a–c). The lesion was hyperintense on the T2A sequences and showed limitation of diffusion on the diffusion-weighted sequences. Although the patient’s complaints regressed within 1 week, there were no changes in the MRI findings at that time. The lesion was found to be completely healed on the control MRI examination 1 month later (Fig. 2a–c). Acquired lesions of the corpus callosum may be secondary to a wide variety of diseases. These include hydrocephalus, ischemia, disorders of the white matter, tumors and trauma. In recent years, the presence of specific reversible lesions involving the SCC has been associated with many different origins, such as infection, high-altitude cerebral edema, seizures, antiepileptic drugs and metabolic disorders [1]. This type of lesion is termed reversible splenial lesion syndrome (RESLES), which is a clinical radiological syndrome (Fig. 2). RESLES is a clinical condition that has recently been diagnosed with increasing frequency. There are currently no specific clinical diagnostic criteria; however, acute neurological disorders, mental-state changes, headache, nausea and radiological evidence of a splenial lesion support the diagnosis. The pathophysiology of splenial lesions is difficult to understand. Most studies on RESLES cases suggest cytotoxic edema in the SCC. This reversible pattern in the diffusion-weighted sequences is different from the subgroup of persistent ischemia that shows ADC reduction. A similar pattern is observed in hemiplegic migraines and venous sinus thrombosis [2]. A splenial lesion on MRI is the key radiological finding in this condition. On diffusion-weighted images, there is a typical limitation to the SCC. MRI findings are expected to regress spontaneously within a few weeks to months. Clinical conditions such as epilepsy, anticonvulsant withdrawal, acute disseminated encephalomyelitis, and causes of encephalomyelitis such as influenza A, mumps, varicella zoster, adenovirus and E. coli, have been considered as etiologies but could be identified in only a few patients [3]. Important etiological causes of splenial lesions in peripartum cases are sinus vein thrombosis, post-ictal state and preeclampsia–eclampsia. Curtis et al. reported a splenial lesion in a patient with visual symptoms for 6 weeks in the postpartum period [4]. Udaya et al. described a splenial lesion in a patient with postpartum psychosis [5]. Our patient did not have any symptoms other than headache, nausea and vomiting. In conclusion, clinicians should consider RESLES in patients presenting with peripartum headache, even in the absence of visual symptoms or psychosis. & Aysegul Altunkas aaltunkas@hotmail.com

A Comparison of Ultrasonography, Computerised Tomography, and Conventional MRI Findings for Splenic Nodules Associated with Type 1 Gaucher’s Disease with Diffusion-Weighted MRI Findings

A 26-year-old female patient with Type 1 Gauchers disease (GD) was admitted to our clinic with complaints of stomachache and signs of anemia. The patient underwent ultrasonography (US), computerised tomography (CT), and magnetic resonance imaging (MRI) scan. Imaging studies revealed massive hepatosplenomegaly, choledocolithiasis, and six nodules in the spleen with a mean size of 14 mm. The nodules appeared hyperechoic, hypoechoic, and of mixed echogenicity on the US and hypodense on the CT. While the nodules were observed to be iso-hypointense in T1-weighted (T1WI) images, they appeared to be hyperintense in the T2-weighted (T2WI) images. There were no diffusion restrictions in these nodules that appeared on the diffusion-weighted magnetic resonance imaging (DWI). A nodule located at the lower pole was observed to be hypointense in the T2WI images. The nodule located at the lower pole, which appeared hypointense in T2WI series, had restricted diffusion upon DWI. In this study, we aimed to present the properties of splenic GD nodules using US, CT, and conventional MRI, together with DWI. This case report is the first to apply US, CT, and conventional MRI, together with DWI, to the splenic nodules associated with Gauchers disease.

Is hemorrhage the reason in crimean-congo hemorrhagic fever patients with neurological signs and symptomsa

Purpose: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease can result in mortality varying from 3.0% to 50.0%. In this study, we wished to discuss computed tomography (CT) findings together with clinical and laboratory findings in patients who had disease-related neurological signs. Materials and Methods: The study included patients who were diagnosed with CCHF. Seventeen patients that had neurological signs were enrolled as the patient group. As a control group, 40 patients diagnosed with CCHF and did not have neurological signs were enrolled. Patients who had neurological signs were examined with brain CT. Radiological and clinical findings of both groups were compared. Results: There were pathological findings in three patients while brain CTs of 14 patients were evaluated as normal. Blood urea nitrogen, lactate dehydrogenase, creatine kinase, total bilirubin, neutrophil, activated partial thromboplastin time, and C-reactive protein levels were significantly higher in the group with neurological signs whereas platelet count and calcium levels were significantly lower in this group. Six of 57 patients died during the follow-up period. Six patients who died were in the group, in which central nervous system (CNS) imaging study was performed. Conclusion: As the presence of CNS signs is a bad prognostic indicator in CCHF, they should be investigated carefully.

Aortic Flow Propagation Velocity in Patients with Familial Mediterranean Fever: an Observational Study

Background and Objectives Systemic inflammation has an important role in the initiation of atherosclerosis, which is associated with arterial stiffness (AS). Aortic flow propagation velocity (APV) is a new echocardiographic parameter of aortic stiffness. The relationship between systemic inflammation and AS has not yet been described in patients with familial Mediterranean fever (FMF). We aimed to investigate the early markers of AS in patients with FMF by measuring APV and carotid intima-media thickness (CIMT). Subjects and Methods Sixty-one FMF patients (43 women; mean age 27.3±6.7 years) in an attack-free period and 57 healthy individuals (36 women; mean age 28.8±7.1 years) were included in this study. The individuals with atherosclerotic risk factors were excluded from the study. The flow propagation velocity of the descending aorta and CIMT were measured to assess AS. Results APV was significantly lower (60.2±16.5 vs. 89.5±11.6 cm/sec, p<0.001) and CIMT was significantly higher (0.49±0.09 vs. 0.40±0.10 mm, p<0.001) in the FMF group compared to the control group. There were significant correlations between APV and mean CIMT (r=-0.424, p<0.001), erythrocyte sedimentation rate (ESR) (r=-0.198, p=0.032), and left ventricle ejection fraction (r=0.201, p=0.029). APV and the ESR were independent predictors of FMF in logistic regression analysis (OR=-0.900, 95% CI=0.865-0.936, p<0.001 and OR=-1.078, 95% CI=1.024-1.135, p=0.004, respectively). Mean CIMT and LVEF were independent factors associated with APV in linear regression analysis (β=-0.423, p<0.001 and β=0.199, p=0.017, respectively). Conclusion We demonstrated that APV was lower in FMF patients and is related to CIMT. According to our results, APV may be an independent predictor of FMF.

Evaluation of morphological changes in pharynx with dynamic CT and MRI in snoring patients

BACKGROUND Identifying the craniofacial abnormalities that cause snoring and the narrowest area of the upper airway creating obstructions can help to determine the proper method of treatment. AIM To identify the factors that can cause snoring and the areas of the airway that are the most likely to collapse with upper airway imaging. MATERIAL AND METHODS Axial pharynx examinations with CT (computerized tomography) and magnetic resonance imaging (MRI) were performed to 38 patients complaining of snoring and 12 patients who did not complain of snoring. The narrowest areas of nasopharynx, hypophraynx, oropharynx, bilateral para-pharyngeal fat pad and para-pharyngeal muscle thickness were measured. RESULTS In snoring patients, the narrowest part of the upper airway was the retro-palatal region in the oropharynx, as measured with both imaging methods. When patients with and without snoring were compared, the former that a higher body mass index and neck diameter and a narrower oropharynx area. In dynamic examinations, we determined that as para-pharyngeal muscle thickness increased, medial-lateral airway diameter and the oropharynx area decreased. CONCLUSIONS The narrowest section of the airway is the retro-palatal region of the oropharynx, measured both with CT and MRI.

Bilateral Kalkeneal Apofiziti Bulunan Bir Olgunun MRG Bulguları

Calcaneal apophysitis (CA) is the most common cause of heel pain in patients before the ossification of calcaneal epiphysis. We report magnetic resonance imaging (MRI) findings of a case with bilateral CA. A 9 year-old male patient with bilateral foot pain was referred to our department for MRI. On bilateral foot MRI, bilateral decreased signal intensity on T1-weighted images, increased signal intensity on fat suppressed T2-weighted images that represents edema, subchondral erosions located tuber calcanei, insertion of Achilles tendon were detected. The diagnosis was bilateral calcaneal apophysitis. Severs disease or CA is an inflammation of the calcaneal apophysis believed to be caused by repetitive microtrauma from the traction of the Achilles tendon on the unossified apophysis. It frequently occurs before or during the peak growth spurt and often shortly after a child begins a new sport or season. It is usually seen among 8-15 age group. Patients typically have no features such as swelling, skin changes, erythema, or other local abnormalities. Osseous erosion at metaphysis of the neighboring to calcaneal apophysis is the finding of CA on MRI. Similar signal difference may be seen at the secondary apophysial ossification centers.