Erhan Akpinar

Initial experience on utility of gadobenate dimeglumine (Gd-BOPTA) enhanced T1-weighted MR cholangiography in diagnosis of acute cholecystitis.

To investigate the feasibility of the use of gadobenate dimeglumine (also known as Gd‐BOPTA) ‐enhanced T1‐weighted MR cholangiography in diagnosis of acute cholecystitis.

The detrimental effect of aging on leptomeningeal collaterals in ischemic stroke.

BACKGROUND Aging is associated with decreased penumbral salvage in patients with ischemic stroke. Another critical factor that determines the fate of penumbra tissue is the degree of collateral circulation, which decreases significantly with aging in experimental models of stroke. In this study, we sought to identify whether these observations could be translated to humans and, therefore, analyzed the effect of patient age on extent of leptomeningeal collaterals in patients with ischemic stroke. METHODS Computed tomography angiography (CTA) source images were used to assess the degree of collateral circulation in a retrospective series of patients with proximal middle cerebral artery (MCA) occlusion. Bivariate and multivariate analyses were used to explore the relationship between patient age and degree of collateral circulation. RESULTS A total of 70 patients were included into the study. Older age (P = .005), history of hypertension (P = .036), higher admission National Institutes of Health Stroke Scale (NIHSS) scores (P = .013), and increased time to CTA (P = .013) were associated with inadequate collaterals in bivariate analyses. In multivariate analysis, older age (P = .008) and higher NIHSS scores (P = .032) remained as the only significant independent variables that were associated with inadequate collaterals. A 10-year increment in patient age increased the odds of inadequate collateral circulation by 1.87 (95% confidence interval: 1.18-2.97). CONCLUSION Our findings show that there is a significant interplay between patient age and adequacy of leptomeningeal collateral circulation in patients with proximal MCA occlusion. The relationship could contribute to adverse tissue outcome and thereby to unfavorable clinical outcome observed in elderly patients with ischemic stroke.

ENDOVASCULAR MANAGEMENT OF LIFE-THREATENING RETROPERITONEAL BLEEDING

Background:  The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings.

Unusual imaging findings in Wilson's disease

Abstract. We present unusual imaging findings in the liver of a patient with Wilsons disease . On US, the liver contours were irregular and its echogenicity was increased with multiple, small hypo- and hyperechoic nodules. Prominent perihepatic fat layer was noted to be increased in thickness. On CT and MR, multiple, small, enhancing nodules were detected in the liver in the early arterial phase after administration of intravenous contrast material. Biopsy was consistent with chronic parenchymal liver pathology with dysplastic changes but without evidence of hepatocellular carcinoma. To our knowledge, dysplastic nodules enhancing at the arterial phase and thickened perihepatic fat layer have not been previously reported in patients with Wilsons disease.

Emergency admissions due to swallowed foreign bodies in adults.

AIM To study a retrospective analysis of patients who presented to the emergency departments (ED) with complaints related to foreign body ingestions. METHODS Patients older than 16 years of age who presented to the ED between January 1(st) and December 31(st) of 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts. RESULTS A total of 100 patients presented with a complaint of foreign body ingestion during the study period. Overall, an X-ray was performed on 75 patients, and a fiberoptic evaluation was performed on 45 patients. A foreign body was detected in 46 (46%) patients. The diagnostic yield of the X-ray was 27 (36%) out of 75 patients, while the diagnostic yield of the fiberoptic evaluations was 21 (47%) out of 45 patients. The detected foreign bodies were mostly located in the esophagus (17 out of 46 foreign bodies detected). When the types of ingested foreign bodies were evaluated, 52 (52%) patients reported ingesting food, and 19 (19%) patients reported swallowing pins. An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases. In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation, the foreign material was detected and removed. CONCLUSION Plain radiography is helpful in the localization of radiopaque swollen foreign bodies, while fiberoptic methods are useful as both diagnostic and therapeutic tools, regardless of radiopacity.

Elevated admission blood pressure and acute ischemic lesions in spontaneous intracerebral hemorrhage.

Concomitant acute ischemic lesions are detected in a subset of patients with intracerebral hemorrhage (ICH). In this study, our aim was to analyze the pattern of acute ischemic lesions detected by diffusion-weighted imaging (DWI) in patients with ICH, and to use this information, in combination with clinical characteristics of patients, to understand the underlying mechanisms of these lesions. We retrospectively analyzed patients with a diagnosis of ICH who underwent DWI within 14 days of symptom onset. We compared demographic, clinical, and imaging characteristics in patients with and without acute ischemic lesions. We also assessed the number, location, and topographic distribution of DWI bright lesions. Acute ischemic lesions were detected in 15 of 86 patients (17.4%); the lesions had a small, dot-like appearance in 13 patients (87%) and were located in an arterial territory separate from the incident ICH in 12 patients (80%). Patients with acute ischemic lesions had higher admission systolic, diastolic, and mean arterial blood pressure levels; greater periventricular leukoaraiosis burden; more microbleeds, and lower admission Glasgow Coma Scale score. In multivariate analyses, admission mean arterial blood pressure (P < .01) and Glasgow Coma Scale score (P =.03) remained as the only significant variables associated with DWI lesion positivity. Our findings highlight the role of elevated admission blood pressure in the development of concomitant acute ischemic lesions in patients with ICH. The pattern of DWI bright lesions, together with a trend toward an increased burden of leukoaraiosis and microbleeds in patients with acute ischemic lesions, suggest an underlying dysfunctional cerebral microvasculature in the etiology of these lesions.

Diffusion tensor MR imaging in pediatric head trauma.

Purpose: We propose to investigate the fractional anisotropy (FA) values in pediatric patients with closed head trauma and correlate them with the initial Glasgow Coma Scale (GCS). Materials and Methods: A retrospective evaluation of 24 pediatric patients (15 men, 9 women; mean age, 13 years; range, 2-18 years) who underwent both unenhanced head computed tomography and cerebral magnetic resonance imaging (MRI), including the tensor diffusion sequence, within 30 days of the incident. Twenty-two atraumatic control patients (9 men, 13 women; mean age, 9 years; range, 4-17 years) were randomly selected from the records of the radiology department within the same period. Fractional anisotropy measurements were taken from each of 6 major white matter volumes. Data extracted from the record of each subject included GCS, initial head computed tomographic results, and length of hospital stay. Kruskal-Wallis and t tests were used for statistical evaluation. Results: The mean acute score on the GCS was 9.7 ± 5. Mean duration of hospitalization days was 8.7 ± 10. Statistically significant differences in mean FA values between trauma and control subjects were noted in corpus callosum. Trauma patients with positive findings on MRI and with GCS less than 10 also had lower FA values than patients with GCS greater than 10 and patients who had normal MRI findings. There was a negative correlation between time to discharge and FA values. Conclusions: In pediatric head trauma, MRI diffusion FA measurements can show abnormalities despite normal-appearing brain MRI findings. Larger investigations are required to verify the stability of correlations.

Bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer: computed tomography findings and endovascular management

A case of bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer is reported. The patient presented with massive hemoptysis, diagnosis was made with multidetector computed tomography, and the pseudoaneurysm was successfully embolized with platinum coils. Hemoptysis ceased following the procedure.

Multidetector CT of bronchial and non-bronchial systemic arteries.

We evaluate the use of multidetector row computed tomography (MDCT) angiography for the depiction of bronchial and non-bronchial systemic arteries (NBSAs), which frequently become enlarged as a secondary finding in a wide array of chronic lung diseases and other diseases that affect the pulmonary vascular system. MDCT angiography has enabled radiologists to provide thin-slice axial images, multi-planar reconstructions, interactive maximum intensity projections, and volume-rendered images to evaluate the origin and course of the abnormal bronchial arteries and enlarged NBSAs that may be the cause of hemoptysis. Embolization of the bronchial arteries is the primary treatment option in patients with massive hemoptysis. Precise localization of the bleeding vessel(s) prior to catheter arteriography not only is the most important factor for prompt and successful embolization but also prevents the recurrence of hemoptysis from missed NBSAs during procedures.

Utility of multidetector CT in an emergency setting in acute mesenteric ischemia.

Prompt diagnosis of acute mesenteric ischemia is a dilemma which is unfortunately generally made at the irreversible phase of intestinal damage. Besides conventional diagnostic imaging modalities contrast enhanced multidetector computed tomography angiography enables fast and detailed evaluation of the mesenteric circulation and abdominal viscera which provides accurate and rapid diagnosis in the emergency room.