Esra Ozkavukcu

Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

PURPOSE To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. MATERIALS AND METHODS Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n=16) studies accompanied by MR portography (n=13), dynamic CE CT (n=3) or dynamic CE MRI (n=2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. RESULTS All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. CONCLUSION MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

Orbital wall infarction mimicking periorbital cellulitis in a patient with sickle cell disease

Orbital wall infarction and subperiosteal haematomas are unusual manifestations of sickling disorders. Here we report an 11-year-old girl with sickle cell anaemia having multiple skull infarctions including the orbital bony structures associated with subperiosteal haematomas. The diagnosis was made by MRI, which showed bone marrow changes and associated haemorrhagic collections. The patient was successfully managed without surgical intervention.

Pelvic retroperitoneal angioleiomyoma mimicking a uterine mass.

Angioleiomyoma (vascular myoma) is a rare type of leiomyoma originating from smooth muscle cells and containing thick-walled vessels. There are only a few cases of retroperitoneal angioleiomyoma reported in the literature. Herein, we present the ultrasonography, magnetic resonance imaging and histopathological findings of an asymptomatic patient with a pelvic retroperitoneal angioleiomyoma which radiologically mimicked a uterine mass.

Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population

OBJECTIVE To address the possible risk factors, eventual pregnancy outcomes, and probable troubles in follow-ups of pregnancies complicated by an isolated single umbilical artery and to provide data on Turkish cases in such an aspect that ethnic divergences may have influence. MATERIAL AND METHODS A total of 16568 singleton pregnancies that were delivered between May 2006 and May 2013 were retrospectively screened. Ninety-three fetuses were found to have an isolated single umbilical artery. One-hundred pregnancies that did not show any structural or chromosomal abnormalities were randomly selected from the rest of the cases to establish the control group. IBM SPSS Statistics 20.0 software was utilized for statistical analysis. Non-parametric data were analyzed with Mann-Whitney U test and were presented as means±standard deviations. P values less than 0.05 were statistically significant. For the adjustment of confounding factors, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression analysis. RESULTS The incidence of small for gestational age (SGA) fetuses and hypertensive disorders in pregnancy was found to be significantly higher in cases with an isolated single umbilical artery (p<0.001 and p=0.022, respectively). Maternal smoking was found to be independently associated with the occurrence of an isolated single umbilical artery (OR: 3.556; 95% CI: 1.104-11.45). The risk of preterm birth was not higher in the study group (OR: 0.538; 95% CI: 0.576-2.873). The incidence of cases who underwent cesarean delivery because of non-reassuring fetal heart trace was similar in the study and control groups (p=0.499). CONCLUSION Attention should be paid to the development of hypertensive disorders in cases with a diagnosis of an isolated single umbilical artery, and parents should be counseled properly, including the information on increased risk of SGA. Strict follow-up of pregnancies complicated with an isolated single umbilical artery in terms of preterm birth seems unfeasible except in cases with accompanying risk factors for preterm labor.

An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings

Brucellosis is an endemic zoonotic disease in which neurobrucellosis occurs in 5-10% of cases. Variable clinical and radiological manifestations of neurobrucellosis can mimic those of other diseases. In this report, we present unusual clinical and magnetic resonance imaging (MRI) findings in a patient with neurobrucellosis and unilateral abducens nerve palsy. Her MRI showed punctate leptomeningeal enhancement of the cerebellum on contrast-enhanced T1-weighted images, and a focal area of hyperintensity in the splenium of the corpus callosum on T2-weighted images.

The effect of nuchal cord on nuchal fold thickness measured in the second trimester.

PURPOSE To find out whether nuchal cord causes an effect on the nuchal skin fold thickness (NFT) measurements, or not. PATIENTS AND METHODS A total of 242 fetuses with normal outcomes that had undergone detailed second trimester US scan between 18 and 24 weeks of gestation were included in the study. NFT measurements were made on axial cranial US images passing through the cerebellum and cavum septi pellucidum. To detect nuchal cord, color Doppler imaging was performed on the axial views of the fetal neck. To investigate the differences in NFT measurements of the fetuses with or without nuchal cord, statistical analysis was performed using Mann-Whitney test. P < 0.05 was considered statistically significant. RESULTS The study group was divided into two groups: nuchal cord (+) (n: 26) and nuchal cord (-) (n: 216) fetuses. Mean NFT measurements were 4.66 ± 0.64 mm and 4.36 ± 0.79 mm for nuchal cord (+) and nuchal cord (-) fetuses, respectively. Median NFT measurement for nuchal cord (+) fetuses was 4.6mm, whereas it was 4.4mm for nuchal cord (-) fetuses. Statistically significant difference was denoted between two groups, in terms of NFT measurements (P = 0.049). CONCLUSION NFT measurements of fetuses with nuchal cord are higher than the NFT measurements of fetuses without nuchal cord. One can conclude that the nuchal cord (+) fetuses with no other anomalies but increased NFT should be re-scanned to see if the increased NFT resolves in the absence of nuchal cord.

Frequencies of perianal fistula types using two classification systems

PurposeThe aims of this study were to determine the frequencies of the perianal fistula subtypes according to the Parks and St. James’s University Hospital (SJUH) classification systems and to evaluate the adequacy of these two systems for classifying and reporting perianal fistulas.Materials and methodsMagnetic resonance imaging examinations of 52 patients (44 men, 8 women) with perianal fistula were reviewed retrospectively. The fistulas were classified according to the Parks and SJUH classification systems.ResultsAccording to the Parks system, 13 patients had intersphincteric (25%), 36 had transsphincteric (69.23%), and 2 had (3.84%) extrasphincteric fistulas. Only one fistula (a subsphincteric fistula) (1.92%) could not be classified. According to the SJUH system, 10 patients had grade 1 (19.23%), 2 patients had grade 2 (3.84%), 13 patients had grade 3 (25%), 21 patients had grade 4 (40.38%), and 5 patients had grade 5 (9.61%) perianal fistulas. The one (and only) subsphincteric fistula was left unclassified.ConclusionThe most common types are transsphincteric and intersphincteric fistulas. Although the two most commonly used classification systems are adequate for describing most perianal fistulas, there is a small percentage that is left unclassified.

The effects of isolated single umbilical artery on first and second trimester aneuploidy screening test parameters

Abstract Objective: Reliability of first and second trimester screening tests largely depends on accurate estimation of maternal serum marker values. Reduced reliability could lead redundant invasive tests or misdiagnosis. Adjustments of serum marker values for confounding factors like insulin-dependent diabetes, maternal weight or maternal rhesus status are essential. We aimed to investigate whether isolated single umbilical artery alters first and second trimester test parameters or not. Methods: Routine detailed obstetric ultrasonographies performed were retrospectively screened for this study. Among spontaneously conceived singleton pregnancies, women who were found to have single umbilical artery without any additional structural anomalies or aneuploidies were selected. First and second trimester screening test results were accessible for 98 and 102 of the cases with isolated single umbilical artery, respectively. Results: Among first trimester screening test parameters, PAPP-A (pregnancy-associated plasma protein A) MoMs were found significantly higher in isolated single umbilical artery group. AFP MoMs were found significantly elevated in isolated single umbilical artery group in second trimester quadruple tests. Conclusion: Existence of single umbilical artery could alter the estimation of MoM values of maternal serum markers. Reliability of prenatal screening tests could be improved by adjusting these parameters in accordance with isolated single umbilical artery.

Are caudate–right lobe ratio and splenic size correlated with the MELD score in cirrhotic patients?

AIM To determine the relationship between caudate-right lobe ratio (C/R) and model for end-stage liver disease (MELD) score. METHODS The study included 50 patients with cirrhosis and a control group of 20 patients. C/R was measured as described by Harbin et al. The size of the spleen was measured on coronal images. The Organ Procurement and Transplantation Network Web site was used for MELD score calculation. Aspartate to alanine aminotranferase (AST/ALT) ratio was calculated. RESULTS There was statistically significant difference between the two groups. C/R, the size of the spleen, and AST/ALT values were significantly correlated with MELD score. CONCLUSIONS There is a significant relationship between the C/R and MELD score.

Gray-scale and color Doppler US findings of amniotic sheets.

PURPOSE To identify the gray-scale and color Doppler ultrasonography (US) findings of amniotic sheets. MATERIALS AND METHODS Among 1201 pregnant patients who underwent detailed second trimester US, nine had amniotic sheets. An amniotic sheet was defined as a shelf-like structure in the uterine cavity with a free edge not attached to the fetus or umbilical cord. There was no major fetal anomaly observed in any patient. Eight patients had solitary amniotic sheets, and one patient had double sheets. All gray-scale and Doppler US features of amniotic sheets were noted. RESULTS The incidence of an amniotic sheet was determined to be 0.75% (ten amniotic sheets were observed in nine patients). On gray-scale US images, amniotic sheets were observed as bands of tissue that originated from the uterine wall with a triangular-shaped base that tapered toward the free edge. A three-layered appearance was identified in seven amniotic sheets. Using Doppler US images, four of ten sheets showed a low-resistance arterial flow, and five of ten sheets showed non-pulsatile venous flows. No vascularization was observed in one patient with a thin, membranous sheet. CONCLUSION Gray-scale US is sufficient for the diagnosis of amniotic sheets because of the typical US characteristics; however, Doppler US findings of amniotic sheets are highly variable. Thus, Doppler US may not be beneficial in the diagnosis of amniotic sheets.