Hasan Yerli

Qualitative and Semiquantitative Evaluations of Solid Breast Lesions by Sonoelastography

Our purpose was to determine whether the combination of a qualitative elasticity scoring method and a semiquantitative strain index method by sonoelastography is useful for differentiating between benign and malignant breast masses.

Value of Apparent Diffusion Coefficient Calculation in the Differential Diagnosis of Parotid Gland Tumors

Background: The differential diagnosis of parotid gland tumors is often difficult with conventional magnetic resonance imaging. Purpose: To determine whether the calculation of the apparent diffusion coefficient (ADC) is valuable for making the differential diagnosis of parotid tumors. Material and Methods: Thirty parotid masses in 28 patients and 24 healthy parotid glands in 12 controls were examined in this prospective study. Diffusion-weighted magnetic resonance imaging with echo-planar spin-echo sequences was used to evaluate each subject. The ADC of each tumor and each healthy parotid gland was calculated. Tumor diagnoses were confirmed by the results of histopathologic analysis. Results: The following types of masses were identified: 11 Warthin tumors, nine pleomorphic adenomas, seven malignant tumors, one basal cell adenoma, and two benign cysts. The mean ADC value for the Warthin tumors was 0.97±0.16×10−3 mm2/s, for the pleomorphic adenomas was 1.74±0.37×10−3 mm2/s, for the malignant tumors was 1.04±0.35×10−3 mm2/s, and for the normal parotid glands was 0.34±0.20×10−3 mm2/s. The respective ADC value for the single basal cell adenoma was 1.40×10−3 mm2/s. Statistically significant differences were identified between the subjects with pleomorphic adenoma and those with another type of parotid tumor, and between subjects with healthy parotid glands and those with a tumor. Conclusion: Calculating the ADC appears to be useful in differentiating pleomorphic adenomas from other types of parotid gland tumors.

Dynamic multislice computed tomography findings for parotid gland tumors.

Objective: Our aim was to research the enhancement features of parotid gland masses in detail and characterize if the masses were Warthin tumors, adenomas, or malignant tumors. Methods: The prospective study included 25 parotid tumors in 21 patients. Neck computed tomography (CT) was performed using a multislice CT unit. A full-neck CT examination was done at 30 seconds after completion of contrast injection, and then tumor-level images were obtained at 90 seconds and at 5 and 25 minutes. Computed tomography number (lesion density in Hounsfield units) was determined at each phase, and differences within and among tumor groups were statistically analyzed. Diagnoses were confirmed by histopathology. Results: There were 11 Warthin tumors, 8 pleomorphic adenomas, 5 malignant tumors, and 1 basal cell adenoma. Ten Warthin tumors showed rapid contrast enhancement at 30 seconds and rapid reduction of enhancement from the first to the fourth phase. The basal cell adenoma showed also a peak enhancement at 30 seconds. Seven pleomorphic adenomas showed increased enhancement through the first 3 phases. Four malignant tumors showed peak enhancement at 90 seconds. Statistically significant differences within and among tumor groups were determined. Conclusions: The data suggest that peak tumor enhancement at 30 and 90 seconds, respectively, might identify Warthin and malignant tumors. Increased enhancement through all phases might be an indicator for diagnosing pleomorphic adenomas.

Sonoelastographic Qualitative Analysis for Management of Salivary Gland Masses

Our aim was to investigate whether the use of a qualitative elasticity scoring method by sonoelastography is beneficial for management of salivary gland masses.

Comparison of three-dimensional ultrasound and magnetic resonance imaging diagnosis in surgically proven Mullerian duct anomaly cases

OBJECTIVE To determine and compare the diagnostic accuracy of 3-dimensional ultrasound (3D US) and magnetic resonance imagining (MRI) in patients with surgically diagnosed Mullerian duct anomaly (MDA). STUDY DESIGN Charts of patients with MDA were retrospectively evaluated. Patients who underwent both laparoscopic and hysteroscopic surgery and had 3D US and MRI examinations were included in the study. The diagnoses achieved via 3D US and MRI were compared with the surgical diagnoses to determine the diagnostic accuracy of these imagining techniques. RESULTS Twenty-nine patients were included in the study. Three-dimensional ultrasound detected 28 out of 29 (96%) patients correctly. Only one patient was diagnosed with a uterine septum instead of uterine arcuatus. Magnetic resonance imaging detected 23 out of 29 patients correctly (79%). The Kappa indexes of the 3D US and MRI were 0.896 and 0.592, respectively. CONCLUSION Our results indicate that 3D US has a higher diagnostic accuracy level than MRI in evaluating MDA, especially when used in experienced hands. However, additional, well-designed studies are needed to better compare the diagnostic accuracy of the 3D US and MRI.

Extended Field-of-View Sonography: Evaluation of the Superficial Lesions

Objective To evaluate the usefulness of extended-field-of-view 2-dimensional ultrasonography technique in superficial lesions. Methods During a 6-month period, 44 patients with superficial lesions on various parts of their bodies were evaluated with extended-field-of-view ultrasonography in addition to routine traditional 2-dimensional ultrasonography. If the diagnosis could not be made without the extended-field-of-view images, it was considered diagnostic. The radiologist decided if the extended-field-of-view ultrasonography helped spatial orientation, communicate findings, or compare the contralateral side in a single image, or if it was useful for follow-up evaluation. Results By using extended-field-of-view imaging including the surrounding anatomy, 22 musculoskeletal, 8 scrotal, 8 thyroid, 2 breast, and 4 abdominal wall lesions were documented successfully as a single image. Nevertheless, no new cases were diagnosed solely based on the extended-field-of-view images. Extended-field-of-view ultrasonography was considered helpful for spatial orientation in 25 cases (56.8%), for comparing the contralateral side in 16 cases (36.3%), and for communicating findings in 20 cases (45.4%). It was useful for follow-up evaluation in 13 cases (29.5%). Conclusions None of the extended-field-of-view images was diagnostic. However, they did provide valuable additional information and better documentation of the lesions.

Benign paroxysmal positional vertigo after radiologic scanning: a case series

IntroductionBenign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. It is frequently seen in elderly patients, and the course of the attack may easily mimic cerebrovascular disease. A BPPV attack after a radiologic examination has not been reported previously. We report the cases of two patients who had BPPV attacks after radiologic imaging.Case presentationThe first patient with headache and tremor was admitted to the radiology department for cranial computed tomography (CT) imaging. During scanning, she was asked to lie in the supine position with no other head movements for approximately 10 minutes. After the cranial CT imaging, she stood up rapidly, and suddenly experienced a vertigo attack and nausea. The second patient was admitted to the radiology department for evaluation of his renal arteries. During the renal magnetic resonance angiography, he was in the supine position for 20 minutes and asked not to move. After the examination, he stood up rapidly with the help of the technician and suddenly experienced a vertigo attack with nausea and vomiting. The results of standard laboratory analyses and their neurologic examinations were within normal limits and Dix-Hallpike tests showed rotatory nystagmus in both cases. An Epley maneuver was performed to the patients. The results of a control Dix-Hallpike tests after 1 Epley maneuver were negative in both patients.ConclusionRadiologists and clinicians must keep in mind that after radiologic imaging in which the patient is still for some time in the supine position and then helped to stand up rapidly, a BPPV attack may occur.

The metaplastic variant of Warthin tumor of the parotid gland: dynamic multislice computerized tomography and magnetic resonance imaging findings with histopathologic correlation in a case

Metaplastic Warthin tumor is a rarely seen subtype of Warthin tumor. It can resemble squamous carcinomas histopathologically, because it contains atypical squamous cells on the necrotic surface. Making a diagnosis can become easier by knowing this entity of Warthin tumor well and by correlating the radiologic findings with pathology. In this case presentation, imaging features of a metaplastic Warthin tumor are presented together with its histopathologic findings. When a solid mass with peripheral enhancing cystic-necrotic component and well defined contour and capsule that shows early enhancement and washout is identified with imaging methods in parotid gland, metaplastic Warthin tumor should be indicated in the differential diagnosis before the histopathologic evaluation.

Dynamic sonography and CT findings of unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland

Congenital agenesis of the submandibular gland is uncommon. We report dynamic sonography and CT findings of the unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland tissue through the mylohyoid gap. The dynamic sonography examination applied at rest and during the modified Valsalva maneuver demonstrated hypertrophied sublingual gland prolapsing to the anterior part through the mylohyoid gap. This may be the first reported case describing dynamic sonography findings of this entity. CT confirmed the agenesis of the left submandibular gland and compensatory hypertrophy of the ipsilateral sublingual gland.

The diagnostic importance of evaluation of solid breast masses by sonoelastography

OBJECTIVE The aim of this study was to determine whether the use of a scoring method by sonoelastography in solid breast masses is helpful in differentiating benign and malignant lesions. MATERIAL AND METHODS One hundred and eighty solid breast masses in 155 patients (147 benign, 33 malignant) were prospectively evaluated in a two-year period. For each lesion, B-mode sonography and sonoelastography images were obtained. Elasticity scores of the lesions were determined with a 5-point scoring method by sonoelastography. The findings were compared with histopathology. The diagnostic performances of the sonoelastographic scoring and B-mode sonography methods were determined. RESULTS The mean scores on sonoelastography were 2.61±0.62 for benign lesions and 3.73±0.69 for malignant lesions. When a cutoff point between scores 3 and 4 was used, accuracy, sensitivity, specificity, positive and negative predictive values for B-mode sonography were found as 81%, 89%, 79%, 46% and 97%, respectively; these were 87%, 73%, 91%, 69% and 92% for the sonoelastographic scoring method. CONCLUSION After B-mode sonography analysis, the evaluation with the 5-point scoring method by sonoelastography might be a complementary method that increases specificity when differentiating between benign and malignant solid breast masses.