Hakan Demirtaş

Leukoaraiosis and carotid artery stenosis: evaluation with CT angiography.

Objective We aim to determine the relationship between leukoaraiosis and carotid artery stenosis. Methods Carotid-cerebral multislice computed tomography angiographies of 194 patients (mean age, 63.5 years) were retrospectively evaluated. Presence and severity of leukoaraiosis and carotid artery stenosis were compared to each other. Carotid artery stenosis was defined by the criteria of the North American Symptomatic Carotid Endarterectomy Trial; leukoaraiosis was evaluated based on the European Task Force on Age-Related White Matter Changes criteria. Results The frequency of leukoaraiosis was 52%. The correlations between age and presence and severity of leukoaraiosis as well as the degree of carotid artery stenosis were significant. There was a significant relationship between the presence of leukoaraiosis and carotid artery stenosis; also, a positive correlation was found between the severity of the leukoaraiosis and the degree of carotid artery stenosis. Conclusions Leukoaraiosis is more common among the elderly. Significant relationship between the severity of leukoaraiosis and the degree of carotid artery stenosis points out that leukoaraiosis may be an advanced stage of atherosclerosis.

Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence.

To investigate the transthoracic computed tomography (CT)‐guided lung nodule biopsy complications and risk factors associated with the development of these complications.

Carotid and cerebral CT angiography using low volume of iodinated contrast material and low tube voltage

PURPOSE To evaluate image quality of carotid computed tomography angiography (CTA) using a low voltage (80kV) and low amount of iodinated contrast material. MATERIALS-METHODS A total of 101 patients referred for carotid CTA were randomly assigned to receive a specific protocol. In group A patients received intravenous administration of contrast material at a dose of 1mL/kg and CTA examinations were performed at 100kV. In group B, patients received intravenous administration of contrast material at a dose of 0.5mL/kg and CTA examinations were performed at 80kV. The same nonionic iodinated contrast material containing 370mg of iodine per mL was used in both groups. Attenuation values were measured from the center of specific arterial segments using regions of interest. Attenuation values above 300HU were accepted as significant. Institutional review board approval was obtained. RESULTS A total of 50 patients were included in group A (38 men, 12 women; mean age, 63.56 years±13.18 [SD]) and 51 patients in group B (33 men, 18 women; mean age, 59.60 years±16.63 [SD]). A total of 1615 arterial segments (1515 common carotid artery-middle cerebral artery and 101 aortic arches) were analyzed. Venous contamination was not observed in either group. The mean attenuation values of all arterial segments in both groups were greater than 300HU. Mean arterial attenuation value in group B (499.22HU±97.25 [SD]) was significantly greater than in group A (374.36HU±73.79 [SD]) (P<0.01). Hemodynamically significant stenosis (grade III stenosis or >70%) was detected in 2 segments in group A and in 3 segments in group B, while grade IV stenosis (occlusion) was detected in 2 segments in group B. Distal common carotid artery dissection was detected in 1 patient and aortic dissection was detected in 1 patient in group B. Total dose-length product (DLP) value was significantly greater in group A (225.74mGy·cm±21.80 [SD]) than in group B (116.60mGy·cm±21.22 [SD]) (P<0.01). The mean tube current was similar in group A (2013.11mAs±195.92 [SD]) and in group B (2096.64 mAs±309.03 [SD]) (P<0.05). CONCLUSION Carotid and cerebral CTA examinations using 128-section CT can be successfully obtained using an imaging protocol that combines low voltage and 50% reduction in the volume of iodinated contrast material. This provides good image quality with low radiation dose.

Eagle Syndrome Causing Vascular Compression with Cervical Rotation: Case Report

Summary Background Eagle syndrome is a condition caused by an elongated styloid process. Unilateral face, neck and ear pain, stinging pain, foreign body sensation and dysphagia can be observed with this syndrome. Rarely, the elongated styloid process may cause pain by compressing the cervical segment of the internal carotid and the surrounding sympathetic plexus, and that pain spreading along the artery can cause neurological symptoms such as vertigo and syncope. Case Report In this case report we presented a very rare eagle syndrome with neurological symptoms that occurred suddenly with cervical rotation. The symptoms disappeared as suddenly as they occurred, with the release of pressure in neutral position. We also discussed CT angiographic findings of this case. Conclusions Radiological diagnosis of the Eagle syndrome that is manifested with a wide variety of symptoms and causes diagnostic difficulties when it is not considered in the differential diagnosis is easy in patients with specific findings. CT angiography is a fast and effective examination in terms of showing compression in patients with the Eagle syndrome that is considered to be atypical and causes vascular compression.

CT-guided transthoracic biopsy: histopathologic results and complication rates

PURPOSE We aimed to investigate the effectiveness and complications of transthoracic CT-guided biopsy techniques. METHODS A total of 94 CT-guided percutaneous transthoracic biopsy procedures performed in 85 patients were retrospectively evaluated. Core biopsy technique was used in 87 procedures and transthoracic fine-needle aspiration biopsy was used in seven procedures. RESULTS Diagnostic results were achieved in 79 of 94 biopsy procedures. Pathology results were malignant in 54 patients, suspicious for malignancy in three patients, benign in five patients, and benign nonspecific in 17 patients. Specific diagnoses were obtained in 59 patients (62.8%) using core biopsy, but no specific diagnosis could be reached with transthoracic fine-needle aspiration biopsy. Complications included pneumothorax in 27 patients (28.7%) and parenchymal hemorrhage during and after the procedure in eight patients (8.5%). CONCLUSIONS CT-guided percutaneous transthoracic needle biopsy is a highly accurate procedure for histopathological diagnosis of thoracic masses. In addition, percutaneous transthoracic biopsy has an acceptably low complication rate and it reduces the need for more invasive surgical procedures.

Deadly portal was caught red-handed: the computed tomographic images of the source of pulmonary air embolism.

FIGURE 2. Air in right ventricle and pulmonary artery. A and B, Computed tomography scan images were rendered in minimum intensity projection method, and air was localized in right ventricle outlet (black arrow) and main, right, and left pulmonary artery (white arrow). C andD, Air located in right ventricle (black arrow) and right pulmonary artery (white arrow). Deadly Portal Was Caught Red-Handed The Computed Tomographic Images of the Source of Pulmonary Air Embolism

Evaluation of myocardial fat deposition by multislice computed tomography.

Aim To investigate correlations between myocardial fat deposition of unknown etiology and myocardial infarction, coronary artery stenosis, time after the infarction, aneurysmatic dilatation of arteries, and stenting or bypass operation. Patients and methods We evaluated coronary computed tomography angiographies of 266 patients presenting with history of myocardial infarction or having risk factors for coronary artery disease, analyzed the characteristics of myocardial fat, and compared the clinical parameters of patients with and without myocardial fat. Results 34 of the 266 patients had myocardial fat deposits. Of the 34 with myocardial fat, 47% had a history of myocardial infarction. Myocardial fat occurrence after myocardial infarction was statistically significant. Myocardial fat was more frequently associated with longer time after infarction and fewer coronary arteries involved, but without statistical significance. A bypass operation and myocardial fat deposition correlated with aneurysmatic dilatation of the coronary arteries and myocardial fat deposition within the area supplied by this artery. Conclusion Myocardial fat was detected in 34% of patients with myocardial infarction. Myocardial fat was significantly more frequent in patients who underwent a bypass operation and those who had aneurysmatic dilatation of the coronary arteries. The frequency of myocardial fat deposition increased with the involvement of fewer coronary arteries and longer time after infarction.

Bilateral cleft foot: Radiographic and prenatal ultrasound features of two siblings with a review of literature

Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is characterized by deformities like median deep clefts of distal extremities. Routine examination of feet during second-trimester ultrasound (US) may increase the detection rates of foot malformations. Many malformations can be diagnosed with 2-dimensional (2D) US, but 3-dimensional (3D) US also helps better understanding of the foot malformations. In the present study, we report the case of two brothers (a fetus and a 5-year-old) with cleft foot deformity. 2D and 3D second trimester US findings of one case and the foot radiography findings of the other are presented here.

Aspergilloma Mimicking Metastasis in a Case with Laryngeal Carcinoma

Introduction: Aspergilloma is a fungal ball which is composed of hyphal structure fungus, fibrin, mucus and cellular debris and settled in a pre-existing pulmonary cavity or an ectatic bronchial. It may cause colonization in patients with an immunosuppressive and underlying lung disease. Although chest radiography provides valuable information, it can be scanned more effectively by computed tomography (CT). Monitoring fungal ball within the cavity in CT provides establishing the diagnosis. Case report: However, in this case report, we presented a case with operated laryngeal carcinoma whom we first had considered to have metastasis and who had received a diagnosis of aspergilloma in CT and Positron emission tomography (PET). Conclusion: Imaging findings may remain limited in definitive diagnosis of aspergilloma. Therefore, surgical resection will allow for both pathological diagnosis and treatment.

Vertebral Artery Dolichoectasia with Fusiform Aneursym Presented By Internuclear Ophthalmoplegia: A Case Report

Dolichoectasia is a term used to describe marked widening, tortuosity and elongation of an artery. Intracranial vertebral and basilar arteries are most commonly involved. Vertebrobasilar dolichoectasia is usually asymptomatic. Cranial nerve compression and cerebral ischemia findings are frequently seen in symptomatic patients. However, vertebrobasilar artery dolichoectasia with internuclear ophthalmoplegia (INO) clinical presentation has not been reported in literature yet. In our case, we report of a 67 year old female who had symptoms of diplopia, left abducens palsy and headache with no prior medical or family history of cerebrovascular disease. She has been presented with INO due to left vertebrobasilar dolichoectasia. Atypical presentation of INO is rare and vertebral artery dolichoectasia as the underlying aetiology, like in our case is even rarer and has not been seen in literature so far.