Fatih Ors

Imaging findings in idiopathic granulomatous mastitis: A review with emphasis on magnetic resonance imaging

Objective To describe magnetic resonance (MR) imaging features of patients with a histologic diagnosis of idiopathic granulomatous mastitis (IGM). Methods Dynamic contrast-enhanced MR imaging was performed with a 1.5-T MR unit. Postprocessing of images included subtraction and calculation of time-intensity curves of the enhancing regions at several points in all patients. Results In addition to granulomatous inflammation, biopsy slides of 5 patients demonstrated abscess formation without a specific organism (aseptic abscess). One patient had a fibrotic tissue component. Magnetic resonance imaging findings were heterogeneously enhancing areas with (n = 5) and without (n = 1) multiple ring-like enhanced abscesses and a circumscribed lesion with heterogeneous contrast enhancement (n = 1). Time-intensity curves showed a benign pattern in all but 1 patient. Conclusion Idiopathic granulomatous mastitis has a number of appearances on MR imaging. Magnetic resonance imaging with measurement of time-signal intensity curves may support the findings of ultrasonography and mammography in distinguishing benign inflammatory breast disorders from malignant ones; however, biopsy still remains the only method of definite diagnosis.

High-resolution CT findings in patients with pulmonary tuberculosis: correlation with the degree of smear positivity.

Background There are data about the relationship between morphologic findings on high-resolution computed tomography (HRCT) and the number of acid-fast bacilli (AFB) on sputum smears in patients with pulmonary tuberculosis (PTB). It was also shown that existence of cavities and airspace consolidation might be related to smear positivity in PTB patients. However, there is no study suggesting a relationship between AFB on sputum smears and radiologic extent of disease based on HRCT findings. Aim In this study, we investigated a relationship between the degree of smear positivity and radiologic extent of disease based on HRCT findings and, the degree of smear positivity and different pulmonary parenchymal changes on HRCTs of the PTB patients. Methods Sixty-one male patients with PTB (mean age: 22±3.2) were included into the study. HRCT images were assessed for patterns, distribution, and profusion of pulmonary abnormalities. Dividing the lungs into 3 zones, profusion of abnormalities was assessed. A profusion score was given. Patients were divided as smear positive and smear negative and compared for the scores of HRCT findings. Smear-positive patients were divided into 4 groups as per grading of the sputum AFB smear: group I (sputum 1+), group II (sputum 2+), group III (sputum 3+), and group IV (sputum 4+). Correlations were investigated between the degree of smear positivity and the scores of HRCT findings. Results A significant correlation between radiologic extent of the disease based on HRCT and the degree of smear positivity was found (r=0.63, P=0.0001). There were also significant correlations between the degree of smear positivity and the scores of different HRCT findings. Nodule, cavity, and bronchial lesions are the most important contributors of the predictive properties of the total score. There was significant differences for the scores of HRCT findings between smear-positive and smear-negative patients. Conclusions Our study suggests that radiologic extent of disease based on HRCT findings in patients with PTB correlated with the degree of smear positivity. Different HRCT findings such as nodule, cavitation, ground-glass opacity, consolidation, and bronchial lesion are significantly associated with smear-positive PTB. Particularly, nodules, cavities, and bronchial lesions might be predictors of smear positivity in patients with PTB. This study also suggests that the thickness of cavity wall and the distance of cavity from central airways might be related to the degree of smear positivity.

Plasma fetuin-A is associated with endothelial dysfunction and subclinical atherosclerosis in subjects with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome (MetS) is closely associated with an increased risk of cardiovascular disease. Fetuin‐A is associated with MetS and NAFLD. We investigated the relationship of circulating fetuin‐A level with markers of endothelial dysfunction and presence of carotid atherosclerosis in subjects with NAFLD.

Median arcuate ligament syndrome: multidetector computed tomography findings.

Objective: We aimed to describe the clinical and multidetector computed tomography (MDCT) angiography findings of celiac, mesenteric, and renal artery entrapment by the median arcuate ligament. Materials and Methods: Patients (n = 453) who underwent MDCT abdominal aorta angiography in a period of 3 years were retrospectively reviewed for vascular compression by median arcuate ligament known as median arcuate ligament syndrome. The MDCT examinations were performed with 16-slice (n = 292) and 64-slice scanners (n = 161). The median arcuate ligament itself and adjacent vascular branches of abdominal aorta were assessed for compression by 2 different radiologists who are experienced on MDCT angiography more than 3 years. Both axial, multiplanar reformatted images and 3-dimensional angiographies were used for interpretation. Results: Twelve patients were found to have clinically significant vessel entrapments by median arcuate ligament; 6 of them with celiac artery, 4 of them with renal artery, and 2 of them with both celiac and mesenteric artery involvement. Patients with celiac and mesenteric vessel entrapments presented with epigastric pain. All patients with renal artery entrapment had resistant hypertension. The MDCT showed the proximal narrowing caused by compression of median arcuate ligament. The proximal portions of renal arteries pulled down and in toward the aorta, with mild to moderate narrowing. Conclusions: The MDCT exanimation with multiplanar images and 3-dimensional angiography is a noninvasive imaging technique that can be used with high accuracy in the diagnosis of median arcuate ligament syndrome.

Mean platelet volume and its relationship with carotid atherosclerosis in subjects with non-alcoholic fatty liver disease.

Abstract Background. Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is an emerging risk factor for atherothrombosis. Aims. The aim of this study was to investigate the levels of MPV in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus, and hypertension. In addition, the possible relationship between MPV and carotid artery intima media thickness (CIMT), a well known marker of subclinical atherosclerosis, was also studied. Methods. MPV and CIMT levels were measured in 60 biopsy-proven NAFLD subjects and 54 healthy controls. Age and sex were similar between two groups. Results. Body mass index and waist circumference levels were higher in the NAFLD group when compared to the controls. There were no differences between the two groups regarding LDL cholesterol levels, whereas HDL cholesterol levels were lower in the NAFLD group. MPV and CIMT levels were not different between the two groups. According to the correlation analyses, CIMT levels were positively correlated to age in patients with NAFLD. However, no significant correlation was found between MPV and CIMT levels. Conclusions. The results of this study do not show any difference in MPV levels between subjects with NAFLD and controls. These finding suggests that in the absence of other metabolic risk factors, MPV might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.

Central neurocytoma: proton MR spectroscopy and diffusion weighted MR imaging findings

PURPOSE To present proton magnetic resonance spectroscopy and diffusion-weighted imaging (DWI) findings of central neurocytoma (CN). METHODS AND MATERIALS Imaging findings of seven patients with the histopathological diagnosis of CN (five male and two female; age range, 21-28 years of age) were evaluated retrospectively. In addition to conventional magnetic resonance imaging features, we also assessed the metabolite ratios and tumor normalized apparent diffusion coefficient (NADC), which was calculated by dividing the tumor apparent diffusion coefficient (ADC) values by normal ADC. Approval from our institutional review board was obtained for this review. RESULTS The tumor choline/creatine ratios were 5.17+/-2.38, while N-acetyl aspartate/choline and N-acetyl aspartate/creatine ratios were 0.33+/-0.15 and 1.84+/-1.38, respectively. On DWI, tumors had heterogeneous hyperintense appearances when compared with the contralateral parietal lobe white matter and tumor NADC values were 0.63+/-0.05. CONCLUSION Significantly increased choline/creatine and decreased N-acetyl aspartate/choline ratios with lower NADC values in CN resemble high-grade gliomas and complicate the diagnosis. Familiarity its physiologic features would help to presurgical diagnosis of ventricular and exraventricular CNs.

Endothelial dysfunction and fetuin A levels before and after kidney transplantation

Background. Endothelial dysfunction (ED) has a major role in the cardiovascular outcome of patients with chronic kidney disease (CKD). The aim of this study was to investigate the relation between fetuin A levels and ED in kidney transplant recipients. Methods. Forty-two living donor kidney transplant recipients, 21 (11 male) on cyclosporine A and 21 (10 male) on tacrolimus-based regimes, were studied. Forty-two (21 male) healthy subjects were enrolled as controls. Fetuin A, highly sensitive C-reactive protein (hsCRP) levels, brachial artery endothelium-dependent vasodilatation (FMD), nitroglycerine mediated dilatation (NMD), and carotid intima-media thickness (CIMT) were measured before transplantation and on the 30th and 90th days posttransplant. Results. Pretransplantation serum fetuin A concentrations and FMD values of patients were significantly lower than those of the controls (P<0.001 for both). These were significantly increased in the 30th and 90th days posttransplantation There was a significant positive correlation between Fetuin A and FMD levels both before and after kidney transplantation (r=0.534, r=0.576; respectively, P<0.001 for both). Carotid intima-media thickness and hsCRP levels decreased after transplantation (P<0.001 for all). According to the regression analysis, fetuin A, intact parathyroid hormone, and hsCRP levels were the independent determinants of FMD. Conclusion. The results of the present study suggest that low serum fetuin A levels in CKD may contribute to impaired endothelial functions in CKD. Future studies should clarify the role of fetuin A levels in cardiovascular outcomes of CKD.

Nasal cavity volume changes after rapid maxillary expansion in adolescents evaluated with 3-dimensional simulation and modeling programs

INTRODUCTION The purpose of this study was to evaluate the effects of rapid maxillary expansion on nasal cavity volume by using 3-dimensional simulation and modeling programs. METHODS The study group consisted of 15 patients (9 boys, 6 girls; mean age, 13.86 years) with maxillary constriction. Computed tomography scans were obtained before treatment and 6 months after the end of expansion. All computed tomography data were transferred to a computer, and the nasal cavity and maxillary teeth were segmented by using the Mimics and Simplant Ortho software programs (both, Materialise, Leuven, Belgium). Paired samples t tests were used to compare pretreatment and posttreatment nasal cavity volumes and maxillary areas. Data analysis was performed by using the software program SPSS for Windows (version 15.00; SPSS, Chicago, Ill). RESULTS Rapid maxillary expansion treatment induced significant increases in nasal cavity volume (P ≤ 0.001) and maxillary transverse dimensions (P ≤ 0.001). CONCLUSIONS Both anterior-to-posterior and coronal-to-cranial expansions were observed after rapid maxillary expansion treatment, with the direction of expansion most likely affected by resistance from the cranial bones.

Measurement accuracy of a computer-assisted three-dimensional analysis and a conventional two-dimensional method

OBJECTIVE To determine the differences between manual and cephalometric measurements on different sections of the human skull, which were obtained using computer-assisted three-dimensional (3D) analysis and conventional two-dimensional (2D) techniques. MATERIALS AND METHODS Measurements were carried out on 13 dry human skulls, then 2D cephalograms and 3D computed tomographic (CT) images were obtained. Anatomic landmarks were determined and marked with clay before CT images were taken, and the same landmarks were marked with the help of metallic balls and pins for lateral and frontal cephalograms. Manual, lateral/frontal cephalometric, and computer-assisted 3D cephalometric measurements were compared statistically. One-way analysis of variance and Tukey Honestly Significant Difference tests were used to compare the results among the groups. RESULTS All measurements were statistically insignificant between the computer-assisted 3D and manual measurements. On the other hand, the differences between the conventional 2D and the manual measurements were statistically significant. The greatest amount of magnification was found at the Nasion-Menton distance (14.6%), which was located at the farthest distance from the central x-ray beam in the lateral cephalogram (P < .01). For the same reason, the greatest enlargement (16.2%) was observed in the distance between the zygomaticomaxillary sutures on the conventional frontal cephalogram (P < .01). CONCLUSIONS The computer-aided 3D cephalometric measurements were found to be more accurate than the conventional cephalometric measurements. The results revealed that 3D cephalometric measurements were consistent with the manual measurements. In addition, the magnification and distortion might limit the results of conventional cephalometric measurements.

Value of magnetic resonance imaging in the depiction of intravenous leiomyomatosis extending to the heart.

Intravenous leiomyomatosis is a seldom neoplasia characterized by invasion of venous channels by a benign smooth muscle tumor originating either from a uterine myoma or from vessel wall. Extension to the heart may cause mechanical obstruction and is frequently misdiagnosed as a right-atrial myxoma. We present a case of recurrent intravenous leiomyomatosis with previous hysterectomy because of uterine leiomyoma which have different magnetic resonance characteristics than that of the former reports.