Ceyla Basaran

MRI Features of Posterior Reversible Encephalopathy Syndrome in 33 Patients

We report the clinical and radiological features of posterior reversible encephalopathy and compare our findings to the literature.

MR Cholangiopancreatography with T2-Weighted Prospective Acquisition Correction Turbo Spin-Echo Sequence of the Biliary Anatomy of Potential Living Liver Transplant Donors

OBJECTIVE The objective of our study was to evaluate the ability of a respiratory navigator-triggered T2-weighted turbo spin-echo (TSE) sequence with a prospective acquisition correction (PACE) technique for MR cholangiopancreatography (MRCP) to depict the biliary anatomy of living donor liver transplantation (LDLT) donors. SUBJECTS AND METHODS Forty potential LDLT donors who ranged in age from 19 to 54 years were prospectively evaluated with preoperative MRCP. MRCP was performed with a 1.5-T magnetic field using T2-weighted PACE TSE sequence. MRCP source data sets were processed with maximum-intensity-projection (MIP) and shaded surface display (SSD) algorithms. Findings were compared with intraoperative cholangiography. Biliary anatomy was classified according to the classification proposed by Huang and colleagues. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRCP for the detection of aberrant biliary anatomy were calculated. RESULTS Intraoperative cholangiography and biliary exploration revealed that 27 donor candidates (67.5%) had conventional and 13 (32.5%) had aberrant biliary anatomy. Two donors (5%) had type B biliary anatomy; eight donors (20%), type C; two donors (5%), type D; and one donor (2.5%), unclassified. The sensitivity of MRCP source data sets in differentiating aberrant biliary anatomies from nonaberrant ones was 100%, the specificity was 88.9%, and the accuracy was 92.5%. PPV and NPV were 81.3% and 100%, respectively. The sensitivity of MIP images in differentiating aberrant biliary anatomies was 100%, the specificity was 88.9%, and the accuracy was 92.5%. PPV and NPV were 81.3% and 100%, respectively. The sensitivity, specificity, accuracy, PPV, and NPV of the SSD images in detecting aberrant biliary anatomies were 100%, 77.8%, 85%, 68.4%, and 100%, respectively. CONCLUSION Preoperative MRCP using a respiratory navigator-triggered T2-weighted TSE sequence with a PACE technique accurately depicts the biliary anatomy in LDLT donors and may guide intraoperative management of the biliary tract.

Postpartum sacral stress fracture: an unusual case of low-back and buttock pain.

Low-back and buttock pain is a common complaint during pregnancy and the postpartum period and is usually attributable to mechanical lesions of the pelvis. Sacral stress fractures are unusual but important causes that should be considered in differential diagnosis. To date, only eight postpartum sacral stress fractures have been reported in the literature. A 32-yr-old woman presented with low-back and right buttock pain that started 15 days after uneventful cesarean section delivery. Imaging studies revealed a right sacral stress fracture. Lumbar spine and femoral neck bone mineral density were normal and, except for pregnancy and lactation, no risk factors for osteoporosis were identified. There was no history of trauma, excessive weight gain, strenuous physical activity, or contribution of mechanical factors. The question remains whether this is an insufficiency fracture or a fatigue fracture. Clinicians should consider sacral fracture during pregnancy and the postpartum period as a diagnostic possibility in patients with low-back and/or buttock pain.

Early Assessment of Renal Resistance Index and Long-Term Renal Function in Renal Transplant Recipients

Background. The effect of the intrarenal arterial resistance index (RI) on long-term renal functions is not well known. We examined the predictive value of intrarenal RI on long-term allograft outcomes. Methods. We retrospectively investigated 121 stable renal transplant recipients, followed for a mean of 63.21 ± 19.9 months after renal transplant. Patients with complications during the first six months after transplant were not included. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first four weeks after transplant. Results. Older recipient age, high pulse pressure, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses revealed that renal RI and donor age were independent predictors of allograft outcome. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had an RI of 0.7 or more than they were in patients who had an RI of less than 0.7 (p = .005). Development of chronic allograft nephropathy (CAN) was significantly higher in patients who had an RI of 0.7 or more (p = .02). Conclusions. Renal RI determined within the first month after renal transplant predicts long-term allograft function and development of CAN in renal transplant recipients.

Magnetic Resonance Colonography for the Evaluation of Colonic Inflammatory Bowel Disease : Correlation With Conventional Colonoscopy

Objective: To identify and evaluate quantitative parameters of colonic inflammation in patients with inflammatory bowel disease (IBD) compared with conventional colonoscopy (CC). Methods: Retrospectively, 37 consecutive patients who underwent MR colonography (MRC) from March 03- April 06 were included in this study. Patients with suspected and known IBD (n = 22) constituted the study group (SG) and those evaluated for colonic polyps (n = 15) constituted the control group. All patients in the SG underwent CC. Magnetic resonance colonography was performed using a gadolinium-enhanced coronal 3-dimensional gradient-echo sequence. The colon was divided into segments, and each segment was evaluated in consensus by 2 abdominal radiologists blinded to the CC findings. Readers assessed the bowel wall thickness index, the signal intensity index of colonic wall, and the caliber of vasa recta in all segments. Indices calculated from colonoscopically diseased and nondiseased segments were compared using Mann-Whitney U test. Receiver operator characteristic analysis was used to determine the use of these indices in predicting the presence of colonic inflammation. Results: There were 60 colonoscopically diseased and 33 nondiseased segments in the SG. For all 3 MR indices, there was a significant difference (P < 0.05) in these indices between diseased and nondiseased segments. Bowel wall thickness index, signal intensity index, and vasa recta values of 0.074, 118% and 0.25 mm, respectively, had 63% sensitivity and 80% specificity for predicting colonic inflammation. Conclusions: Inflammatory changes in the colon can be demonstrated on MRC in patients with IBD with moderate sensitivity and high specificity using quantitative parameters.

Correlation of dynamic multidetector CT findings with pathological grades of hepatocellular carcinoma.

PURPOSE Our objective was to examine whether different vascularization patterns seen during three phases of dynamic multidetector computed tomography (MDCT) of the liver correlated with the histopathological differentiation findings of hepatocellular carcinoma (HCC) in chronic liver disease patients. MATERIALS AND METHODS Dynamic MDCT images from 46 patients (38 males and 8 females; ages between 1 and 90 years; mean age, 53) pathologically diagnosed with HCC were retrospectively evaluated. Lesions were divided into three groups according to MDCT enhancement patterns. Pathologically determined differentiation degrees were compared with contrast enhancement patterns in the hepatic arterial, portal venous, and hepatic venous phases. RESULTS Lesion characterization was as follows: Type 1 (6 patients), hypoattenuating in the hepatic arterial and hepatic venous phases and hyperattenuating in the portal venous phase; Type 2 (10 patients), hypoattenuating in all phases; and Type 3 (30 patients), hyperattenuating in the hepatic arterial and portal venous phases and hypoattenuating in the hepatic venous phase. Patients were pathologically classified as having either well-differentiated (n=32) or poorly differentiated HCC (n=14). All patients with poorly differentiated HCC had a Type 3 enhancement pattern. All patients with Type 1 and 2 enhancement patterns had well-differentiated HCC. There was a significant correlation between pathological differentiation degrees and radiological enhancement (P = 0.003). CONCLUSION Dynamic MDCT revealed that poorly differentiated HCC patients all had hypervascular enhancement patterns, and hypovascular- type enhancement was present in all patients with well-differentiated HCC. Imaging patterns of dynamic MDCT scanning in HCC patients may be helpful for follow-up examinations and for determining clinical prognosis.

Relationship of Renal Resistive Index and Cardiovascular Disease in Renal Transplant Recipients

BACKGROUND Cardiovascular disease is the primary cause of death in renal transplant recipients, and elevated renal allograft resistive index (RI) has been associated with patient survival. OBJECTIVE To evaluate the predictive value of intrarenal RI on atherosclerotic disease. PATIENTS AND METHODS Ninety-seven patients who had undergone renal transplantation between 1999 and 2001 and had stable renal function were included in the study. Patients with renal artery stenosis, urinary tract obstruction, clinical symptoms of acute rejection, or chronic allograft nephropathy were excluded. Clinical and laboratory information was obtained from the medical records and included demographic data, medications used, body mass index, blood pressure, and laboratory values. Intrarenal RI and carotid intima-media thickness (IMT) were determined using Doppler ultrasonography. RESULTS At linear regression analysis, RI was significantly correlated with recipient age, C-reactive protein concentration, systolic blood pressure, pulse pressure, body mass index, smoking, and carotid IMT. At multivariate linear regression analysis, only pulse pressure was an independent predictor of intrarenal RI. CONCLUSION Intrarenal RI is associated with traditional cardiovascular risk factors and carotid IMT. Elevated intrarenal graft RI may be predictive of cardiovascular disease in renal transplant recipients without complications.

Spontaneous spleen rupture and rectus sheath hematoma in a patient with Klippel-Trenaunay syndrome: Report of a case

We report a case of Klippel-Trenaunay syndrome (KTS) with serious morbidity caused by the rupture of hemangiomas of the spleen and inferior epigastric artery (IEA). A 40-year-old woman, who had suffered from edema and varicose veins in her left leg and toes since birth, underwent emergency laparotomy and splenectomy for a spontaneous splenic rupture. Pathological examination revealed hemangiomatosis of the spleen. She presented again 40 days later with a rectus muscle hematoma, which computed tomography revealed to be actively bleeding. Arteriography confirmed a bleeding IEA, which was then embolized. Hematological investigation revealed a heterozygous form of factor VIII and fibrinogen deficiency. The patient recovered well and was asymptomatic at her 1-year follow-up. We report this case to reinforce that investigations for KTS should involve all organ systems, and include detailed hematologic tests. By defining coagulation and vascular abnormalities, life-threatening bleeding episodes may be prevented.

MRI of recurrent isolated cerebral Whipple's disease.

Whipples disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipples disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipples disease in a 68-year-old man with atypical presentation and MRI findings.

Unusual association of tethered cord, filum terminale lipoma, and myxopapillary ependymoma.

Study Design. Case report. Objective. We report a 67-year old man with a known filum terminale lipoma causing a tethered cord extending to the subcutaneous fat tissue and a newly diagnosed concomitant ependymoma, revealed on lumbar magnetic resonance imaging (MRI). Summary of Background Data. The coexistence of filum terminale lipoma and ependymoma is very rare. The underlying reason of this coexistence is still unknown. The patients with known filar lipoma causing a tethered cord can be underdiagnosed clinically even though new symptoms develop. Methods. Case study with lumbar MRI. Results. The patient was operated, and both of the ependymoma and filum terminale lipoma were removed. The pathologic examination was consistent with the MRI findings. Three months after surgery, the patient improved significantly. Conclusion. The coexistence of filum terminale lipoma and ependymoma is rare. Patients with relevant symptoms may be referred for an MRI study; however, especially patients with known filar lipomas causing tethered cord may be missed. Therefore, including these patients, a contrast-enhanced lumbar MRI must be performed to exclude any coexistence of filum terminale lipoma and ependymoma in the early course of the disease which can also help the surgeon in guiding the appropriate treatment.