Esref Kizilkaya

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.

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.

Role of apparent diffusion coefficient values and diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant thyroid nodules

OBJECTIVE The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). MATERIALS AND METHODS Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. RESULTS The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. CONCLUSION We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.

Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses?

OBJECTIVE To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses. MATERIALS AND METHODS Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria. RESULTS Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p<0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p<0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively. CONCLUSION PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.

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.

Multiple rice body formation in the subacromial-subdeltoid bursa and knee joint.

Multiple rice body formation is an uncommon disorder which resembles synovial chondromatosis both radiologically and clinically. The clinical symptoms are usually non-specific. We report on a pathologically proven multiple rice body formation in both the left subacromial-subdeltoid bursa and knee joint in a 4-year-old girl.

Synovial hemangioma of the knee invading the femur.

Synovial hemangiomas of the knee joint are rare. We report on a pathologically proven synovial hemangioma of the knee that invaded the femur.

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.

CT fluoroscopy-guided percutaneous needle biopsies in thoracic mass lesions

OBJECTIVE We aimed to evaluate the usefulness of computed tomographic (CT) fluoroscopy guidance for transthoracic needle biopsies. METHODS AND MATERIAL CT fluoroscopy-guided biopsies were performed in 81 patients with thoracic mass lesions. Interrupted CT fluoroscopy technique was used with 50-130 mA at 120 kV exposure parameters and slice thickness of 10 mm. We used aspirating needle in 41 patients, cutting needle in 28 patients, and both in 12 patients. We obtained adequate biopsy material in 69 patients at first attempt. Mean fluoroscopy time was 15.17 s and maximum procedure time was 18 min. RESULTS Adequate samples for pathological diagnosis were obtained in all lesions. Pathological diagnoses were malignant in 41 patients, benign in 27 patients, and suspiciously malignant in 13 patients. There was no significant difference between diagnostic accuracy of the needles in malignant and benign lesions. Complications were observed in 11 patients (13.5%). DISCUSSION AND CONCLUSION CT fluoroscopy-guided technique provides effective real-time needle biopsy in patients with small tumor size and with tumor located near blood vessels, and in non-compliant patients for diagnosing thoracic lesions.