Ersin Ozturk

Sacroiliac Joint Injections Performed With Sonographic Guidance

Objective. To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra‐articular sacroiliac joint injections in patients with sacroiliitis. Methods. Thirty‐four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra‐articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. Results. Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra‐articular), and 14 (23.3%) were missed. The successful intra‐articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. Conclusions. Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists, this technique is safe, rapid, and reproducible.

Sonographic appearances of the normal ulnar nerve in the cubital tunnel

To investigate the sonographic characteristics of the normal ulnar nerve in the cubital tunnel, as well as any differences related to age, sex, and dominant arm.

Retroaortic left renal vein: multidetector computed tomography angiography findings and its clinical importance.

Purpose: To evaluate the appearance, type, frequency, and clinical importance of retroaortic left renal vein (RLRV) in patients examined with multidetector computed tomography (MDCT) angiography. Material and Methods: A total of 1856 patients who underwent CT with urological symptoms (hematuria, flank and abdominal pain, left gonadal vein varicocele) (n = 889) or with symptoms other than urological ones (n = 967) were prospectively evaluated for the presence of RLRV. CT was performed with 110 ml of iodinated contrast material through the antecubital vein at a rate of 3.5 ml/s. Late arterial and early venous phase volumetric data sets were acquired at 30 and 65 s, respectively, from the start of the intravenous injection of contrast medium. In addition to axial images, multiplanar reconstructions (MPR), maximum-intensity projection (MIP), and three-dimensional volume-rendering (3D VR) images were used to assess left renal vein anomalies. Left renal vein anomalies were classified into four types according to their appearance: I) RLRV joining the inferior vena cava (IVC) in the orthotopic position; II) RLRV joining the IVC at level L4–L5; III) circumaortic or collar left renal vein; IV) RLRV joining the left common iliac vein. Results: RLRV was detected in 68 (3.6%) of the 1856 patients, with 26, 22, 17, and three of types I, II, III, and IV, respectively. Forty-four of the 68 patients with RLRV (65%) were in the group with urological symptoms, while 24 patients (35%) were in the group without urological symptoms. Compression of the RLRV was found in 16 patients in the urological symptoms group, while compression was detected in only three patients in the other group. This difference was statistically significant (P<0.05). The most common urological symptom was hematuria. The frequency of urological symptoms was higher in groups II and IV compared to the other groups. Conclusion: MDCT angiography with axial, MPR, MIP, and 3D VR images is effective in the detection of vascular renal anomalies such as RLRV. Diagnosing RLRV and differentiating it from other pathologic conditions causing hematuria is important in order to avoid complications during retroperitoneal surgery or interventional procedures.

MRI findings of intracranial tuberculomas

PURPOSE Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis. METHODS We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients. RESULTS A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient. CONCLUSION MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

Diffuse pneumocephalus associated with infratentorial and supratentorial hemorrhages as a complication of spinal surgery.

A 23-year-old woman was transferred to our department with loss of consciousness 6 h after undergoing rod placement for thoracolumbar scoliosis. Both computed tomography and magnetic resonance imaging of the brain revealed diffuse pneumocephalus and infra- and supratentorial hemorrhages. The pedicular screw tracts were analyzed with computed tomography and misplacement of a screw was noticed. It was thought that inadvertent dural injury had occurred at the time of insertion. The patient was re-operated and the dural tear was repaired. To our knowledge, this is the first description of these uncommon complications in one patient after spine surgery.

Value of diffusion-weighted MRI in the differentiation of benign and malign breast lesions.

ZusammenfassungEINLEITUNG: Ziel unserer Studie war es, zu prüfen, ob eine diffusionsgewichtete MR Bildgebung (DWI) in der Differenzierung von benignen und malignen Läsionen der Brust nützlich ist. MATERIAL UND METHODEN: Es wurden 41 Frauen in die Studie eingeschlossen. Bei 45 Läsionen wurde die Diagnose bioptisch gestellt, wobei 25 (55,5 %) malign und 20 (44,5 %) gutartig waren. Der apparente Diffusions Koeffizient (ADC) dieser Läsionen wurde prospektiv mit dem histopathologischem Ergebnis verglichen. ERGEBNISSE: Als Schwellenwert zur Erkennung maligner Läsionen wurde ein ADC von 1,0×10–3 mm2/s erhoben. Die Sensitivität dieses Wertes lag bei 95 %, die Spezifität bei 100%. Der positive Voraussagewert bei 100 %, der negative bei 94 %, die Treffsicherheit -Rate bei 97 %. SCHLUSSFOLGERUNGEN: Die DWI verbessert die diagnostische Treffsicherheit der konventionelle MRI der Brust. ADC Messungen können bei der Differenzierung von malignen und benignen Läsionen der Brust nützlich sein.SummaryINTRODUCTION: Our purpose was to determine whether diffusion-weighted MR imaging (DWI) could be used in differentiation of benign and malign breast lesions. MATERIALS AND METHODS: 41 women patients were included in the study. 45 lesions were diagnosed by biopsy; 25 (55.5%) of these lesions were malignant and 20 (44.5%) were benign. The apparent diffusion coefficient (ADC) values of these lesions were prospectively compared with their histopathological results. RESULTS: Differentiation of the malignant and benign masses revealed that the threshold value of the ADC was 1.0×10–3 mm2/s, its sensitivity was demonstrated as 95%, specificity as 100%, positive predictive as 100%, negative predictive as 94% and accuracy rate as 97%. CONCLUSIONS: DWI improves diagnostic accuracy of the conventional breast MRI. ADC measurements may be useful for differentiation of the malign and benign masses.

Split-cord malformation and accompanying anomalies.

OBJECTIVE To present the magnetic resonance imaging (MRI) appearances of spinal split-cord malformation (SCM) and to investigate the various types of congenital spinal disorders associated with SCM. MATERIALS AND METHODS MR examinations of 23 patients with SCM were carried out in our hospital between June 2002 and May 2007 and retrospectively analysed. RESULTS Nineteen (82.6%) patients were diagnosed as type I SCM, while four (17.4%) were diagnosed as type II SCM. The most commonly involved site of SCM was the dorsolumbar area (47.8%) while cervical involvement was the least common (4.3%). No accompanying congenital spinal disorders were detected in four patients (17.4%). In 19 patients (82.6%), congenital spinal disorders accompanying SCM were detected, the most common of which was a low-lying cord, found in 14 patients (60.9%). Other anomalies included hydromyelia in seven patients (30.4%), lipoma in six (26%), meningomyelocele in four (17.4%), thick filum in three (13%) and dermoid cyst in three (13%). CONCLUSION In preoperative planning for SCM, its characteristics and those of the accompanying anomalies should be determined. MRI is a valuable tool for making such determinations.

Hepatic arterial mapping by multidetector computed tomographic angiography in living donor liver transplantation.

Purpose: Our aims were to present the hepatic arterial variations that were detected with computed tomographic angiography (CTA) and confirmed by operation in living liver donors and to emphasize the usefulness of CTA in the assessment of hepatic arterial anatomy. Materials and Methods: The donors of 100 patients (46 women and 54 men) who had undergone a living donor liver transplantation in a (blinded) hospital between July 2004 and June 2007 were evaluated. The age of the donors ranged from 18 to 63 years (mean, 39 years). The CTA images obtained by a 16-slice multidetector CT before the transplantation procedure were retrospectively evaluated for arterial variations, and the results were compared with the results of the operation. Results: In 59 donors (59%), classic hepatic arterial anatomy was observed. In the remaining 41 donors (41%), various arterial variations were determined. In 11 of the donors (11%), variations were not compatible with the description of Michels classification. In all of our patients, CTA findings were confirmed with operational findings. Our complication rate was 1%. Only 1 of the patients who had undergone the transplantation developed hepatic arterial thrombus, and the remaining 99 patients had no arterial complications. Conclusions: The course of the vascular structures before live donor liver transplantation is essential for planning and success of the operation. Our study showed that multidetector CTA can be used successfully in hepatic artery imaging of liver transplantation donors as a noninvasive method.

Evaluation of cochlear nerve size by magnetic resonance imaging in elderly patients with sensorineural hearing loss

PurposeWe aimed to determine any differences, if present, between the cross-sectional area of the cochlear nerve (CN) of elderly patients with sensorineural hearing loss (SNHL) and of young patients with normal hearing.Materials and methodsThe study group included ten patients with age-related SNHL. Fourteen volunteer individuals with normal hearing were recruited as the control group. T1-weighted, T2-weighted and parasagittal three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) reconstruction images of all cases were evaluated. Images were examined for any abnormality of CN. The data obtained for each ear with clinical, radiological and audiometric examinations were evaluated.ResultsThe mean CN cross-sectional area was measured as 0.0252 cm2 in the control group, whereas that in the SNHL group was 0.0232 cm2. Although speech discrimination scores showed significant differences, no statistically significant difference was observed for the CN cross-sectional area (p=0.0616). Likewise, there was no difference in CN calibre between male and female patients.ConclusionsThe 3DFT-CISS sequence yields superior results in CN imaging. Acquired SNHL may not present with significant changes in CN size on magnetic resonance imaging (MRI).RiassuntoObiettivoDeterminare se esistono differenze, in misure effettuate su sezioni trasversali di immagini di risonanza magnetica, tra l’area del nervo cocleare (CN) in pazienti anziani con perdita dell’udito di tipo neurosensoriale (SNHL) e soggetti giovani con udito normale.Materiali e metodiIl gruppo di studio comprende 10 pazienti con perdita dell’udito di tipo neurosensoriale. Sono stati reclutati, come gruppo di controllo 14 volontari con udito normale. Sono state effettuate acquisizioni T1 e T2 dipendenti e tridimensionali in steady state (3DFTCISS). Le immagini sono state valutate per la ricerca di qualsiasi anormalità del nervo cocleare. Sono stati valutati per ogni caso i dati clinici, radiologici e audiometrici.RisultatiL’area sulla sezione trasversale del CN nel gruppo di pazienti con SNHL era pari a 0,0232 cm2 mentre nel gruppo di controllo era pari a 0,0252 cm2. Sebbene i punteggi di discriminazione del linguaggio mostrassero differenze significative, non è stata evidenziata nessuna differenza statisticamente significativa per l’area trasversale del CN (p=0,0616). Altrettanto, non vi era alcuna differenza del calibro del CN tra soggetti di sesso maschile e femminile.ConclusioniLa sequenza 3DFT-CISS ottiene risultati superiori nella visualizzazione del CN. La SNHL acquisita può non presentare cambiamenti significativi delle dimensioni del CN alla risonanza magnetica.

Osteochondritis dissecans of the tarsal navicular.

A 27-year-old male athlete presented with chronic right dorsal midfoot pain and limitation in midfoot movements. Computed tomography and magnetic resonance imaging demonstrated an nondisplaced osteochondral fragment within the proximal articular surface of the tarsal navicular. Imaging findings of this disease are presented and discussed.