Demet Kiresi

Assessment of myometrial invasion in endometrial cancer by transvaginal sonography, Doppler ultrasonography, magnetic resonance imaging and frozen section.

Objective: We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler ultrasonography (TV-CDU). Methods: This prospective study included 64 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU. Results: Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion. Conclusions: Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.

Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: Imaging features

Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

Comparison of CT virtual cystoscopy of the contrast material-filled bladder with conventional cystoscopy in the diagnosis of bladder tumours

AIM To investigate the value of virtual cystoscopy using contrast material to fill the bladder during routine abdominopelvic computed tomography (CT) examinations for the detection of bladder tumours. MATERIALS AND METHODS Thirty-three consecutive patients (25 men and eight women; are range 51-82 years; mean age+/-SD, 65+/-7 years) who had painless macroscopic haematuria and were suspected to have bladder neoplasms were prospectively evaluated with virtual cystoscopy. After intravenous injection of contrast medium, the contrast material-filled bladders were examined with single-detector helical CT with 2-mm section thicknesses. Source CT data were transferred to a workstation for interactive navigation using surface rendering. All the patients also underwent conventional cystoscopy. RESULTS The results of virtual cystoscopy were compared with the findings from the conventional cystoscopy. Seventy-one of 78 bladder tumours detected with conventional cystoscopy in 28 patients were also shown on virtual images. The bladders of five patients appeared normal on both conventional cystoscopy and virtual cystoscopy. On virtual cystoscopy, seven of the 12 lesions that were < or =5 mm in diameter could be identified. The following statistical values for the identification of bladder lesions using virtual cystoscopy were calculated: sensitivity 94%, specificity 90%, positive predictive value 87%, negative predictive value 93%, and accuracy 93%. CONCLUSION CT virtual cystoscopy is a noninvasive technique that can be used successfully for detection of bladder tumours >5 mm in selected cases during daily routine abdominopelvic work.

The morphometric analysis of the V2 and V3 segments of the vertebral artery: Normal values on MDCT

A potential hazard in midline posterior fossa craniectomy may be the injury of vertebral artery. Thats why vertebral artery evaluation prior to surgery may prevent dangerous complications. Advancements in multidetector computed tomography (MDCT) have provided detailed demonstration of the vertebral artery at the craniocervical junction and its relationships with atlas and axis. We aimed to define the normal anatomic relationship of the V2 and V3 part of the vertebral artery on MDCT. In total, 33 patients underwent MDCT angiography scan with suspected cranial aneurysm. V2 and V3 segments of vertebral artery were evaluated. Eight measurements (B, C, D, E, G, H, X, and Y line) were taken from MDCT images. For B and C, a line initially passing through the body of axis and spinous process and determining the midline was formed. Then, the vertical distance of vertebral artery from the level of transverse foramen of axis and loop to this midline was measured. For D and G, the vertical distance of vertebral artery to the midline from the upper and lower margin levels of transverse foramen of atlas was measured after a line establishing the midline passing through the anterior and posterior tubercles of atlas was drawn first. For E, transverse diameter of vertebral artery was measured at the loop level of V2 segment. For H, the vertical distance at the point where vertebral artery entered dura in the line passing from the midline of foramen magnum at anterior-posterior plane was measured. For X and Y, two different points of horizontal part of the vertebral artery were determined. One of these two points was the lateral one which was the origin of the horizontal part in the transverse foramen, the other was the intersection point on atlas. Average distances for both sides from transverse foramen of the axis, the loop of axoatlantal part and the lower border of the atlas of the vertebral artery to the midline were 20.97 mm on the right, 22.29 mm on the left; 27.19 mm on the right, 28.34 mm on the left; and 25.75 mm on the right and 27.21 mm on the left, respectively. Average distances for both sides from the upper border of the atlas, and at its penetration through dura were 27.40 mm on the right, 28.94 mm on the left; and 10.90 mm on the right and 10.93 mm on the left, respectively. Distances between spinous process and intersection of vertebral artery with horizontal part were 35.79 mm on the right and 36.63 mm on the left laterally, and 22.27 mm on the right and 22.62 mm on the left medially. MDCT angiography is a powerful test to demonstrate the vasculature of the head and neck. Bony structures and adjacent vessel morphology can be evaluated by this technique. The evaluation of craniocervical region prior to surgery with MDCT may be helpful to avoid intraoperative vascular injuries.

A Case of Burkitt Lymphoma Re-presenting as Periportal Hepatic and Multiple Organ Infiltration

Burkitt lymphoma (BL) is a high-grade, B-cell-originated pediatric malignancy that is a type of non-Hodgkin lymphoma involving different organs. Mediastinal mass, ascites, peritoneal thickening, and infiltration of the small intestine, kidney, and liver were found in our patient. In this case, we describe the radiologic appearances and possible infiltration patterns of multi-organ BL. Also, we discuss infiltration of the periportal area, such as hypodense lesions in the liver, which is rarely seen in BL.

The Mandibular Landmarks about the Facial Artery and Vein with Multidetector Computed Tomography Angiography (MDCTA): an Anatomical and Radiological Morphometric Study

El objetivo de este estudio fue investigar el curso de los vasos faciales de acuerdo con varios puntos de referencias mandibulares en sujetos vivos mediante angiografia por tomografia computarizada multidetector (ATCM) para determinar si estos estan relacionados con el sexo y el lado. El estudio se llevo a cabo en el Departamento de Radiologia, Facultad de Medicina de Meram en Necmettin Erbakan (Konya, Turkey). En total, sesenta caras de 30 sujetos (15 hombres y 15 mujeres), que presentaban sintomas y signos de la enfermedad vascular fueron evaluados para explorar los vasos faciales por ATCM. Los parametros sobre los vasos faciales se midieron en relacion a puntos de referencia (angulo de la mandibula, proceso mental, foramen mental y linea mediana facial). La distancia desde el punto en el que la arteria facial aparece por primera vez en el margen inferior de la mandibula hasta el angulo mandibular de la arteria facial derecha y izquierda fueron 3,53±0,66 cm y 3,31±0,73 cm en hombres, respectivamente. En mujeres fueron 2,91±0,52 cm y 3,35± 0,48 cm. La ATCM es un examen nuevo, poderoso, seguro y no invasivo para demostrar la vascularizacion de la cabeza. Las estructuras oseas y la morfologia de los vasos vecinos pueden ser evaluados por esta tecnica en casos de trauma con sospecha de lesiones de los vasos y se puede considerar de seleccion en pacientes para realizar cirugias de colgajo.

Anatomic and radiologic analysis of the atlantal part of the vertebral artery

The horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial tip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (alpha) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/-S.D.) was 82.42+/-10.34 degrees and 83.21+/-10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean alpha angle was 81.64+/-10.15 degrees on the right and 83.77+/-10.65 degrees on the left. These angles varied with the position of the head.

The Morphometric Analysis of the Important Bone Structures on Skull Base in Living Individuals with Multidetector Computed Tomography

El objetivo de este estudio fue determinar datos morfometricos confiables de las estructuras oseas importantes de la base de craneo mediante tomografia computarizada multidetector (TCMD) y establecer las diferencias de estos datos en funcion del sexo y lateralizacion. Se realizo un estudio retrospectivo a partir de imagenes de TCMD obtenidas en el Departamento de Radiologia de la Facultad de Medicina Meram, Universidad de Necmettin Erbakan. Se evaluaron imagenes de 100 sujetos adultos (50 hombres y 50 mujeres), que no presentaban trauma craneal, cirugia o deformidad osea. Se midieron (i) altura y diametro anteroposterior de la fosa hipofisaria, (ii) longitud del condilo occipital y distancias intercondilares anterior y posterior, y (iii) el diametro sagital, transversal y el area del foramen magno. El resumen de los datos se expreso como Media±DE. La comparacion de los datos entre sexos y mediciones izquierda-derecha se realizo mediante la prueba t de Student, mientras que la relacion entre los distintos parametros mediante la prueba de correlacion de Pearson. Todos los parametros medidos, en el lado derecho e izquierdo, fueron mayores en hombres. Los valores mas altos se determinaron generalmente en el lado derecho en ambos sexos. Algunos parametros estuvieron altamente correlacionados en ambos sexos (P<0,001). Creemos que nuestros resultados pueden ser utiles al momento de realizar nuevos abordajes quirurgicos y en la evaluacion radiologica, relativas a la base de craneo.

Intrathoracic Extrapulmonary Hydatid Disease: Radiologic Manifestations

Hydatidosis is a parasitic disease caused by the larvae of Echinococcus granulosus and rarely by Echinococcus alveolaris. It is endemic to South America, North Africa, Asia, Australia, and the Middle East [1,2]. The definitive hosts are foxes and, less commonly, dogs and cats. Humans are infected by direct contact with an infected animal or by ingestion of contaminated food or fluids. Echinococcal embryos migrate through the intestinal mucosa, and, in 60%e70% of cases, reach the liver via the portal system [1]. They can then enter the systemic circulation via the porta caval anastomoses and be carried by the bloodstream to any organ or tissue in the body. Alternatively, the eggs can be inhaled and cause primary lung disease [2]. Intrathoracic extrapulmonary hydatid disease is very rare but can occur in the pleural space, extrapleural region, pleural fissure, chest wall, mediastinum, pericardium, myocardium, and diaphragm [1]. In this pictorial essay, we present the clinical manifestations and imaging features of patients with hydatid cysts (HC) in the extrapulmonary sites of the thorax.

Correlation of magnetic resonance imaging findings with hexamethylpropyleneamine oxime brain single photon emission computed tomography in ischemic stroke patients in the subacute stage

Purpose: To evaluate the correlation between magnetic resonance imaging (MRI) findings and 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) during the subacute stage in ischemic stroke patients. Material and Methods: The T1 and T2-weighted images and brain SPECT findings of 84 patients (mean age 60.69±12.47 years) with subacute cerebral ischemia during the period 1998–2004 were reviewed. All HMPAO SPECT and MRI studies were performed between 3 and 7 days (mean time delay 4.76±1.29 days) after the onset of stroke symptoms. Results: An ischemic lesion was seen both in T1 and T2-weighted images with perfusion defects above 60% (severe defect) according to count/pixel data of the lesion in HMPAO SPECT studies in 30 (90.9%) of 33 patients. Otherwise, the ischemic lesion was seen only on T2-weighted images with perfusion defects between 30% and 60% (moderate defect) in HMPAO SPECT studies in 25 (89.3%) of 28 patients. In 20 (87%) of 23 patients who had perfusion defects below 30% (mild defect) on HMPAO SPECT, only non-specific findings such as cerebral atrophy and/or periventricular ischemic-gliotic lesions could be seen in MRI. The difference between these ratios was statistically significant (P<0.01). Conclusion: Brain 99mTc-HMPAO SPECT findings indicate good correlation with MRI findings. When the ischemic lesions could be seen in both T1 and T2-weighted images, the patients frequently had severe perfusion defects. When only seen in T2-weighted images, the perfusion defect was moderate. When only non-specific findings were revealed by MRI, only mild perfusion defects were found by SPECT.