Halil Arslan

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Hallers cells) in 6%, spheno-ethmoid cells (Onodis cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.

Functional and radiological impairment in women highly exposed to indoor biomass fuels

Objective: The aim of this study was to describe the lung function and the computed tomographic features in a selected group of non‐smoking women with chronic obstructive pulmonary disease and biomass fuel exposure.

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures

ObjectiveThe purpose of this study is to describe the elastographic appearance of the Achilles tendon in healthy subjects and patients with surgically repaired complete ruptures.Materials and methodsNineteen Achilles tendons of 16 amateur footballers with surgically repaired complete ruptures and their contralateral asymptomatic Achilles tendons were assessed with ultrasound and real-time sonoelastography. Additionally, 40 asymptomatic Achilles tendons of 20 healthy amateur footballers were assessed. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to the elasticity features: type 1, blue (hardest tissue); type 2, blue/green (hard tissue); or type 3, green (intermediate tissue). In addition, three subtypes were determined: homogeneous, relatively homogeneous, and heterogeneous.ResultsMost of the Achilles tendons of the patients with surgically repaired complete ruptures were detected to have type 2 elasticity (64.9%), and the remaining had type 1 (35.1%). In contrast, most of the healthy tendons had type 2 (64.2%), and the remaining had either a type 3 (20.8%) or a type 1 (15%) elastographic pattern. All of the ruptured tendons had a heterogeneous structure, whereas all of the healthy Achilles tendons had a homogeneous or relatively homogeneous structure.ConclusionIn sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing.

Brucellar spondylodiscitis:MRI diagnosis

Early diagnosis of brucellar spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography (CT) scan provide insufficient data. Among 25 patients with brucellar spondylodiscitis studied by magnetic resonance imaging (MRI), 9 were in the acute stage and 16 were in the chronic stage. MRI is the investigation method of choice in diagnosing brucellar spondylodiscitis.

Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease

The aim of this study was to show reduction of the diaphragmatic excursion with MR fluoroscopy in patients with chronic obstructive pulmonary disease (COPD) and to compare the results with pulmonary function test (PFT). The study included 13 men and 10 women (average age 56.2) with COPD, and 9 men and 6 women (average age 55.8) as a control group. MR fluoroscopy images with Spoiled Gradient-echo pulse sequence was obtained during deep inspiration and expiration. After examination, over cine-loop display, the highest and lowest positions of the diaphragm were identified and the distance of excursion was measured. Differences in the diaphragmatic excursion between patient and healthy subjects were compared. We have also compared MR fluoroscopy results with PFT. In each person of both groups, excursion of the diaphragm was demonstrated clearly in cine-loop display. Differences of excursion between deepest and highest point of diaphragm were on average 26 and 20 mm, respectively, in the right and left side in patients and 69 and 56 mm in healthy group. Significant correlation was found between expiratory volume in 1 s and MR fluoroscopy results. MR fluoroscopy study showed that there were significant statistical differences in diaphragmatic excursion between patients with COPD and healthy subjects. Expiratory volume in 1 s is closely associated with the diaphragmatic excursion. MR fluoroscopy would seem to be a useful method for showing diaphragmatic excursion.

Peroral CT Enterography with Lactulose Solution: Preliminary Observations

OBJECTIVE The objective of our study was to evaluate lactulose solution as a new oral contrast agent with the use of peroral CT enterography to determine the adequacy of luminal distention and conspicuity of the bowel wall. CONCLUSION Peroral CT enterography performed with lactulose solution is a simple and noninvasive method of evaluating the small bowel by obtaining good distention. It can also be used at routine abdominal examinations as a negative contrast agent instead of iodinated oral contrast medium, especially for CT angiography.

The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses

OBJECTIVE To evaluate the efficacy of power doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess. MATERIALS AND METHODS 21 patients with soft tissue abscess were evaluated with gray scale imaging, color doppler sonography, power doppler sonography and computed tomography. In each case attempts were made using power doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings. RESULTS Peripheral hyperemia and increased vasculature were demonstrated with power doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration. CONCLUSION Power doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess.

Incidence of retro-aortic left renal vein and its relationship with varicocele.

The retro-aortic left renal vein (RLRV) is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Varicocele is defined as venous dilation of the pampiniform plexus, and the left side is the most commonly affected. Several theories concerning the possible aetiology of varicocele are reviewed in the literature, but RLRV was not mentioned as an aetiologic factor of varicocele. in this study we investigated the percentage of RLRVs and their relation with varicocele. A total of 1,125 contrast-enhanced abdominal CT scans was examined to identify RLRVs. RLRVs were found in nine women (1.6%) and ten men (1.7%). We performed scrotal Doppler ultrasonography (US) for all affected men except one. Varicocele of varying degrees was found in seven of the nine male patients with RLRV (77%). RLRV could be one of the aetiological factors in the development of varicocele, and the cases with RLRV should be examined by scrotal Doppler US for the presence of varicocele.

Evaluation of dynamic magnetic resonance imaging in assessing velopharyngeal insufficiency during phonation.

Background: Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated. Materials and Methods: A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed. Results: During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm2 preoperatively and 0.21 cm2 postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure. Conclusions: In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.

Real-Time Elastography for Distinguishing Angiomyolipoma From Renal Cell Carcinoma: Preliminary Observations

OBJECTIVE The objective of this study was to determine the diagnostic performance of sonoelastography for differentiating angiomyolipomas from renal cell carcinomas. SUBJECTS AND METHODS Twenty-eight angiomyolipomas and 19 renal cell carcinomas were prospectively examined with real-time elastography. Lesions were classified according to four elastographic patterns on the basis of the distribution of the blue area (representing no strain and hardest tissue component). The elasticity patterns and the strain ratios of the angiomyolipomas and renal cell carcinomas were evaluated independently by two observers. Diagnostic performance and interobserver agreement were analyzed. RESULTS All angiomyolipomas were classified as having a high-strain elastographic pattern (blue areas in < 50% of lesion, considered type 1 or type 2) by both radiologists, whereas 18 of 19 renal cell carcinomas were classified as having a low-strain elastographic pattern (blue areas in ≥ 50% of lesion, considered type 3 or 4) by both radiologists. The respective mean strain ratios measured by two radiologists were 0.15 ± 0.06 and 0.18 ± 0.09 for the angiomyolipomas and 0.64 ± 0.15 and 0.63 ± 0.19 for the renal cell carcinomas. There were significant differences between the elasticity patterns and strain ratios for angiomyolipomas and renal cell carcinomas (p < 0.001). Interobserver agreement was excellent for elasticity patterns and strain ratios, with a weighted kappa coefficient of 0.96 and an intraclass correlation coefficient score of 0.95. CONCLUSION Our results show that real-time elastography may be useful in differentiating angiomyolipomas from renal cell carcinomas, by use of both elasticity patterns and strain ratios.