Bircan Alan

Relation between coronary artery disease, risk factors and intima-media thickness of carotid artery, arterial distensibility, and stiffness index.

Atherosclerosis is a diffuse process that involves vessel structures. In recent years, the relation of noninvasive parameters such as intima-media thickening (IMT), arterial distensibility (AD), and stiffness index (SI) to cardiovascular diseases has been researched. However, we have not found any study that has included all these parameters. The aim of this study is to examine the relation between the presence of coronary artery disease (CAD) and its risk factors to AD, SI, and IMT, which are the noninvasive predictors of atherosclerotic process in the carotid artery. Included in the study were 180 patients who were diagnosed as having CAD by coronary angiography (those with at least ≥ 30% stenosis in the coronary arteries) and, as a control group, 53 persons who had normal appearing coronary angiographies. IMT, AD, and SI values of all the patients in the study were measured by echo-Doppler imaging (AD formula = 2 × (AoS-AoD)/PP × AoD, SI formula = (SBP/DBP)/([AoS - AoD]/AoD). Significantly increased IMT (0.82 ±0.1, 0.57 ±0.1, p < 0.05), decreased AD (0.25 ±0.9, 0.37 ±0.1, p < 0.05), and increased SI (13 ±4, 8 ±3, p < 0.05) values were detected in the CAD group compared to the control group. A significant correlation was found between IMT and presence of diabetes mellitus (DM), systolic blood pressure, total cholesterol, and presence of plaque in carotids, and age. In the coronary artery disease group there was a significant correlation between AD and age, systolic blood pressure, and HDL cholesterol levels, while there was no significant correlation with plaque development. A significant correlation was also found between stiffness index and systolic blood pressure and age; however, there was no relation between number of involved vessels and IMT, AD, and SI. We found sensitivity, specificity, and positive predictive and negative predictive values for CAD diagnosis to be 70%, 75%, 77%, and 66%, respectively. In CAD cases, according to data in this study, IMT and SI increased while AD decreased, and this was detected by carotid artery Doppler ultrasonography. Therefore, it was concluded that these cheaper, noninvasive, and easily available parameters could be used in early diagnosis of CAD.

Intima-Media Thickness and Arterial Distensibility in Behçet’s Disease

The etiology of Behçet’s disease, a systemic vasculitis, is unknown. Vascular involvement may be seen in 25% of patients with Behçet’s disease. Vasculitis make the prognosis of Behçets disease severe. The aim of this study is to examine the structural and functional changes and relations of these changes with progression and prognosis of Behçet’s disease. For this purpose, 40 patients with Behçet’s disease and 40 healthy volunteer control subjects were analyzed, additionally patients with Behçet’s disease were divided into 2 subgroups as those with vascular complications and those without vascular complications. Intima-media thickness and arterial distensibility were measured in all subjects with carotid artery ultrasonography. Carotid artery distensibility was significantly lower in the patient group compared to the control group (0.67 ±0.2, 0.93 ±0.4, p<0.05), and carotid artery IMT was significantly higher (0.59 ±12, 0.80 ±0.11, p<0.05). A statistically significant increase in IMT has been detected (0.77 ±11, 0.86 ±11, p<0.05) in patients with Behçet’s disease with vascular involvement compared to patients with Behçet’s disease without vascular involvement, arterial distensibility in patients with vascular disease was similar with those who has no vascular disease (0.69 ±0.25, 0.63 ±0.25, p>0.05). There was a significant negative linear regression between arterial distensibility and systolic blood pressure (SBP) (B=-1x10-2, p<0.05), and a significant positive linear regression has also been found between IMT and SBP and diastolic blood pressure (DBP) and pulse pressure (PP) (B=6.8x10-3 for SBP, p<0.05, B=6.9x10-3 for DBP, p<0.05, B=6x10-3 for PP, p<0.05). As a result, IMT increases and AD decreases in patients with Behçet’s disease compared to results in the control group. Although more studies are required for this subject, use of noninvasive parameters such as IMT and AD, which reflect the structural and functional characteristics of vasculature, may be useful to define disease progression and subjects at high risk.

Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions

Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions.

Assessment of Placental Stiffness Using Acoustic Radiation Force Impulse Elastography in Pregnant Women with Fetal Anomalies

Objective We aimed to evaluate placental stiffness measured by acoustic radiation force impulse (ARFI) elastography in pregnant women in the second trimester with a normal fetus versus those with structural anomalies and non-structural findings. Materials and Methods Forty pregnant women carrying a fetus with structural anomalies diagnosed sonographically at 18–28 weeks of gestation comprised the study group. The control group consisted of 34 healthy pregnant women with a sonographically normal fetus at a similar gestational age. Placental shear wave velocity (SWV) was measured by ARFI elastography and compared between the two groups. Structural anomalies and non-structural findings were scored based on sonographic markers. Placental stiffness measurements were compared among fetus anomaly categories. Doppler parameters of umbilical and uterine arteries were compared with placental SWV measurements. Results All placental SWV measurements, including minimum SWV, maximum SWV, and mean SWV were significantly higher in the study group than the control group ([0.86 ± 0.2, 0.74 ± 0.1; p < 0.001], [1.89 ± 0.7, 1.59 ± 0.5; p = 0.04], and [1.26 ± 0.4, 1.09 ± 0.2; p = 0.01]), respectively. Conclusion Placental stiffness evaluated by ARFI elastography during the second trimester in pregnant women with fetuses with congenital structural anomalies is higher than that of pregnant women with normal fetuses.

Renal acoustic radiation force impulse elastography in the evaluation of coronary artery disease

Background Renal insufficiency may occur in patients with coronary artery disease (CAD). Acoustic radiation force impulse (ARFI) is a method for quantifying tissue elasticity, which could be used as an additional diagnostic test for renal insufficiency and provide an additional contribution to the determination of CAD. Purpose To evaluate ARFI elastography with shear wave velocity (SWV) measurements in the diagnosis of mild-to-moderate chronic kidney disease (CKD) in CAD patients, and to analyze the relationship between the severity of CAD assessed by the Gensini scoring system and kidney stiffness. Material and Methods The study included 76 CAD patients and 79 healthy volunteers. SWV was measured for each kidney in the both groups. The CAD group was divided into two subgroups based on Gensini score: mild CAD and severe CAD. SWV values of the CAD patients were compared to those of the healthy volunteers; values of subgroups were also compared with each other. Results The patient group had significantly lower renal mean SWV values than those of the healthy group (1.87 ± 0.58 vs. 2.34 ± 0.38, P < 0.01). The SWV value decreased as the eGFR level decreased. Mean SWV values for kidneys of the patients with severe CAD were lower than those of the mild CAD patients (1.64 ± 0.39 vs. 2.42 ± 0.60, P < 0.01). Conclusion renal mean SWV values of CAD patients decreased in proportion to the reduction in eGFR, and the SWV values decreased as the severity of CAD increased. ARFI elastography is a novel technique for diagnosing CKD and defining illness severity in CAD patients.

Evaluation of Parathyroid Lesions With Point Shear Wave Elastography

The aim of our study was to evaluate the shear wave velocity (SWV) of parathyroid lesions by point shear wave elastography (SWE) and to compare their stiffness with that of thyroid nodules and normal thyroid parenchyma quantitatively.

Diagnosis of pre‐eclampsia and assessment of severity through examination of the placenta with acoustic radiation force impulse elastography

To assess the value of placental shear wave velocity (SWV) measurement by acoustic radiation force impulse (ARFI) imaging for the diagnosis of pre‐eclampsia and to determine the relationship between the SWV and the severity of pre‐eclampsia.

The Effect of ACE Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients With Myocardial Infarction

The authors investigated the relationship between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and the blood flow characteristics of common carotid (CCA) and brachial arteries (BA) by color Doppler ultrasound (CDUS) in patients with acute anterior myocardial infarction (AAMI). Sixty four patients (11 women and 53 men), aged 25 to 77 years, with AAMI were studied. The ACE genotypes were established. Peak-systolic (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCAs were measured by CDUS. All results were evaluated statistically. The ACE genotypes were distributed as follows: 43.8% DD, 43.8% ID, and 12.5% II. PSVs of BA and both CCAs were lower in patients with DD and ID than with II (p<0.05). EDVs of both CCAs were also lower in the same groups, but statistically not significant (p>0.05). IMTs of both CCAs did not differ among patients with various ACE genotypes (p>0.05). These results suggest that ACE I/D polymorphism influences Doppler blood flow parameters of both BA and CCA, but does not affect IMT of CCA.

Role of Acoustic Radiation Force Impulse (ARFI) Elastography in Determination of Severity of Benign Prostate Hyperplasia

Background The aim of this study was to investigate the potential contribution of acoustic radiation force impulse (ARFI) elastography to the determination of the severity of benign prostate hypertrophy (BPH) by performing shear wave velocity (SWV) measurements of the prostate using ARFI technology. Material/Methods Sixty BPH patients and 40 healthy volunteers were included in this study. SWV measurements of the prostate were performed by transabdominal ultrasonography (US), both in the BPH patients and control subjects. The BPH patients also underwent uroflowmetry measurements. Using the International Prostate Symptom Score (IPSS), the BPH patients were divided into two subgroups, a mild-to-moderate BPH group and a severe BPH group, to compare SWV values. Results The BPH patients had higher SWV values for the central area of the prostate compared to the control subjects (2.52±0.59 m/s and 1.47±0.42 m/s, p<0.01). The SWV values of the central area of prostate were higher in the severe BPH group compared to the mild-to-moderate BPH group (2.62±0.58 and 2.25±0.55, p=0.02). Conclusions Our ARFI elastography results indicated that the central prostate SWV values of BPH patients were significantly higher relative to those of a healthy control group. The central prostate SWV values increased in proportion to the increased severity of BPH. Measurement of SWV by ARFI technology constitutes a non-invasive alternative to other methods for the determination of BPH severity.

MRI-based evaluation of the factors leading to pituitary iron overload in patients with thalassemia major

AIM Given the lack of studies evaluating pituitary iron overload in patients with thalassemia major, we used magnetic resonance imaging (MRI) to evaluate these patients and the factors affecting the disease process. MATERIALS AND METHODS The 84 patients with β-thalassemia major who were included in this study were referred to our clinic for cardiac and hepatic T2(*) MRI. T2(*)-weighted images of the pituitary gland, heart, and liver were obtained using a 1.5-tesla MRI unit and a multi-echo gradient-echo sequence. Associations between pituitary T2(*), cardiac T2(*), hepatic T2(*), pituitary height, serum ferritin (SF) level, patient age, and other demographic findings were assessed. RESULTS Pituitary T2(*) values correlated with hepatic T2(*) values, cardiac T2(*) values, SF level, and patient age (P≤0.001, 0.001, 0.001, 0.01, respectively) but not with pituitary height (P=0.76). Pituitary and cardiac T2(*) values were lower in the subset of patients who underwent splenectomy (P=0.046 and P=0.002, respectively). CONCLUSION Pituitary iron overload rapidly increases during puberty and in this study correlated with cardiac and hepatic T2(*) values, patient age, SF level, and liver size, but not with the height of the pituitary. Pituitary iron overload also increases following splenectomy. Together, these findings indicate that numerous factors contribute to pituitary iron overload.