Ercument Ciftci

Diffusion-Weighted Imaging in the Differential Diagnosis of Simple and Hydatid Cysts of the Liver

OBJECTIVE The purpose of our study was to evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of simple and hydatid cysts of the liver, particularly in the completely liquid type of hydatid cyst. SUBJECTS AND METHODS Eighty-two cysts (43 simple cysts, 39 hydatid cysts) were included in this prospective study. DWI was performed using a breath-hold single-shot echo-planar spin-echo sequence, and apparent diffusion coefficients (ADCs) were calculated. On DW trace images, the signal intensity of cysts was visually compared with the signal intensity of the liver using a 3-point scale: 0, isointense; 1, moderately hyperintense; and 2, significantly hyperintense. Quantitatively, signal intensity of the cysts, cyst-to-liver signal intensity ratios, ADC of the cysts, and cyst-to-liver ADC ratios were compared between the groups. The statistical significance was determined using the Mann-Whitney U test. RESULTS On trace DWI (b = 1,000 s/mm2), most hydatid cysts (37/39, 95%) were hyperintense, whereas most simple cysts (40/43, 93%) were isointense with the liver. Three simple cysts (7%) were moderately hyperintense and two hydatid cysts (5%) were isointense. Quantitatively, both the signal intensity and cyst-to-liver signal intensity ratio of the hydatid cysts were significantly higher than those for simple cysts (p < 0.001). The cutoff value at 1.5 yielded a sensitivity of 77%, a specificity of 86%, and positive predictive value of 83% for the cyst-to-liver signal intensity ratio. The ADC and cyst-to-liver ADC ratio of the hydatid cysts were significantly lower than those of simple cysts (p < 0.005). For the completely liquid type in particular, we observed statistically significant differences in signal intensity, signal intensity ratio, ADC, and ADC ratios from those of simple cysts (p < 0.005). With a cutoff value of 1.5, signal intensity ratio had a sensitivity of 81%, specificity of 86%, and positive predictive value of 74%. CONCLUSION DWI may help in the differential diagnosis of hydatid and simple cysts of the liver.

Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging

Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging Background. The aim of the study was to evaluate the role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of lung lesions. Patients and methods. Sixty-seven patients with lung lesions (48 malignant, 19 benign) were included in this prospective study. Signal intensities (SIs) were measured in diffusion-weighted MR images that were obtained with b=0, 500 and 1000 s/mm2 values. Apparent diffusion coefficient (ADC) maps were calculated by using images with b=0 and 1000 s/mm2 values. The statistical significance was determined using the Student-t test. Results. The SIs of malignant lesions were significantly higher than those of benign lesions (p<0.004 for b=0 s/mm2 and p<0.000 for the other b values). Using b=500 s/mm2, SI≥391 indicated a malignant lesion with a sensitivity of 95%, specificity of 73% and positive predictive value of 87%. Using b=1000 s/mm2, SI≥277 indicated a malignant lesion with a sensitivity of 93%, specificity of 69% and positive predictive value of 85%. There was no significant difference between malignant and benign lesions regarding ADC values (p=0.675). There was no significant difference in SIs or ADC values between small cell carcinoma and non-small cell carcinoma. When comparing undifferentiated with well- partially differentiated cancers, SIs were higher with all b values, but the difference was statistically significant only with b=1000 s/mm2 (p<0.04). Conclusions. Diffusion-weighteted MR trace image SI is useful for the differentiation of malignant versus benign lung lesions.

Silent cerebral infarction in chronic heart failure: Ischemic and nonischemic dilated cardiomyopathy

Objectives Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and nonischemic DCM. The purpose of this study was to evaluate prevalence and related parameters of silent cerebral infarction in patients with ischemic and nonischemic DCM. Methods Patients with ischemic and nonischemic DCM (53 male, 19 female, aged 62 ± 12 years) were included in the study. Etiology of DCM was ischemic in 46 and nonischemic in 26 patients. Fifty-six age- and gender-matched healthy volunteers served as a control group for comparison of SCI prevalence. Results Prevalence of SCI was 39%, 27%, and 3.6% in ischemic, nonischemic DCM, and control group, respectively (ischemic DCM vs control group, p < 0.001, nonischemic DCM vs control group, p = 002). In patients with nonischemic DCM, the mean age of the subjects with SCI was significantly higher than that of subjects without lesions (67 ± 5 years vs 53 ± 13, p < 0.001), whereas in ischemic DCM NHYA Functional Class was statistically higher in patients with SCI than without SCI (p = 0.03). In both groups, patients with SCI had lower systolic functions than patients with normal MRI findings. In multivariable logistic regression analysis, restrictive type of diastolic filling pattern was found as an independent factor for SCI occurrence on the whole patient population (OR: 16.5, 95% CI: 4.4–61.8, p < 0.001). Conclusion SCI is common in patients with both ischemic and nonischemic DCM. In univariate analysis, both groups have similar systolic and diastolic characteristics in the occurrence of SCI. Logistic regression analysis revealed that restrictive diastolic filling pattern is an independent risk factor in the occurrence of SCI for the whole patient population.

Pneumatization of the inferior turbinate

Pneumatization of the inferior turbinate is an extremely rare intranasal anatomical variation. Only a few cases have been reported yet. In this paper we present two cases, one unilateral and one bilateral case with pneumatization of the inferior turbinate.

Multifocal bone tuberculosis presenting as a breast mass: CT and MRI findings

Abstract. Chest wall involvement is an uncommon manifestation of musculoskeletal tuberculosis. We present computed tomography and magnetic resonance imaging findings in a case with multifocal musculoskeletal tuberculosis presenting as a breast mass. These radiological modalities are not diagnostic without histopathological confirmation, but they are valuable guides to surgery in defining the extent of disease involvement.

MRI findings of myositis in Behçet disease

We report the magnetic resonance imaging findings in a case of localized myositis in a 23-year-old man with long-standing Behçet disease.

Aortoesophageal Fistula Secondary to Thoracic Endovascular Aortic Repair of a Descending Aortic Aneurysm Rupture

PURPOSE We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture. CASE REPORT A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery. CONCLUSION AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.

Conventional and diffusion-weighted MRI of extrahepatic hydatid cysts.

PURPOSE To evaluate the value of conventional and diffusion-weighted (DW) magnetic resonance imaging (MRI) in the diagnosis of extrahepatic hydatid cysts. MATERIALS AND METHODS Forty-one extrahepatic hydatid cysts (12 renal, 6 pulmonary, 5 peritoneal, 4 bone, 3 soft tissue, 3 pancreatic, 2 splenic, 2 retroperitoneal, 1 adrenal, 1 scrotal, 1 diaphragmatic, and 1 cardiac) were included in this retrospective study. After a series of routine conventional MRI, DW imaging was performed using a breath-hold, single-shot, echo-planar, spin echo sequence with three b factors (0, 500 and 1,000 s/mm(2)), and apparent diffusion coefficient (ADC) maps were created. On DW trace images, signal intensity of the cysts was visually compared to the signal intensity of the muscle with the use of a 3-point scale: 0, isointense; 1, moderately hyperintense; 2, significantly hyperintense. For quantitative evaluation, signal intensity ratio and ADC of the cystic lesions were calculated. RESULTS On conventional MR images, all but 3 patients had concomitant liver involvement. Three of them were disseminated. On DW trace images (b = 1,000 s/mm(2)), most hydatid cysts (86%) were hyperintense, while five hydatid cysts (14%) were isointense. Quantitatively, the mean ADC of the hydatid cysts was 2.8 x 10(-3) +/- 0.5 mm(2)/s. CONCLUSION DW imaging may help in the differential diagnosis of extrahepatic hydatid cysts.

An unusual type of lateral compression injury of the pelvis tilt fracture with anterior displacement.

Tilt fracture is the most unusual variant of pelvic lateral compression injury. The major problem was reported to be protrusion of the pubic ramus into the perineum by posterior-inferior displacement of the fragment. Tilt fragment with anterior and inferior displacement has not been reported in English speaking literature to our knowledge. Anterior tilt fragment can cause significant morbidity in terms of vascular injury, pelvic stability and acetabular fracture.

Renal artery aneurysm in a hypertensive child treated by percutaneous coil embolization

A 16-year-old boy was admitted to our hospital with uncontrolled hypertension. A left renal artery aneurysm was detected on colour Doppler US and CT. Renal arteriography demonstrated the aneurysm and focal renal parenchymal areas of decreased perfusion. The renal artery aneurysm was successfully treated by transcatheter coil embolization.