İlhan Erden

The diagnostic value of colour doppler ultrasound in central venous catheter related thrombosis

AIM This prospective study was performed to establish the correlation between colour Doppler ultrasound (US) observations and venography in detecting catheter-related thrombosis. METHOD Forty-four patients with subclavian venous catheters were studied. The sensitivity and specificity of colour Doppler US was determined for the diagnosis of central venous thrombosis and compared with contrast venography. Criteria considered to show the presence of catheter-related thrombosis included visualization of thrombus (T), absence of spontaneous flow (S), absence of phasicity of flow with respiration (P), incompressibility of the vein with probe pressure (C) and visualization of increased venous collaterals (V). RESULTS Analysing each variable separately, P had the highest sensitivity (94%) and S had the highest specificity (100%). The best combinations for diagnosis were T+P, P+S, and T+P+S with a sensitivity of 94% and specificity of 88%. Overall diagnostic value of colour Doppler US had a sensitivity of 94% and specificity of 96%. CONCLUSION Colour Doppler US is a reliable method for detecting central venous catheter-related thrombosis, especially if several parameters are evaluated in combination.

Granulocytic sarcoma. Cranial and breast involvement

The term granulocytic sarcoma designates an infrequent solid tumor composed of aggregates of immature granulocytic precursors in extramedullary sites. The lesion generally occurs either during the natural course of acute myelogenous leukemia or after a remission has been achieved; however, it may rarely represent the initial manifestation of the disease. We present radiologic features of cranial and breast involvement of granulocytic sarcoma in a 13-year-old female with acute myelogenous leukemia. The cranial lesion appeared nearly isointense with cortical gray matter on T1- and T2-weighted magnetic resonance (MR) images, and enhanced homogeneously after the injection of gadolinium. MRI showed a well-delineated lobulated mass in the left breast, which had a heterogeneous hyperintense signal and remarkable contrast enhancement.

Radiographic, CT, and MRI findings in primary pulmonary angiosarcoma

We report a rare instance of primary pulmonary angiosarcoma presenting as a large solitary mass in the left upper lobe with mediastinal invasion. In particular, we emphasize the magnetic resonance (MR) imaging features, which included a markedly heterogeneous pattern consisting of hyperintense areas scattered throughout a background of intermediate signal intensity, rendering the lesion a cauliflower-like appearance especially on T2-weighted images. Being unreported so far in primary pulmonary angiosarcomas, these distinct MR imaging findings may be helpful in the differentiation of these neoplasms from lung cancers.

An unusual cause of hydrocephalus: aqueductal developmental venous anomaly.

Vascular malformations are infrequent causes of aqueductal stenoses, developmental venous anomaly (DVA) being the rarest among them. DVAs, also known as venous angiomas, are congenital in origin and characterized by dilatation of vessels in the superficial and deep venous system. Although they are usually clinically silent, they can be complicated by hemorrhage, seizures and neurologic deficits. Herein, we report MR imaging findings of a 7-year-old girl whose hydrocephalus was due to an abnormal vein coursing through the aqueduct.

Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

PURPOSE To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. MATERIALS AND METHODS Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n=16) studies accompanied by MR portography (n=13), dynamic CE CT (n=3) or dynamic CE MRI (n=2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. RESULTS All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. CONCLUSION MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

Orbital wall infarction mimicking periorbital cellulitis in a patient with sickle cell disease

Orbital wall infarction and subperiosteal haematomas are unusual manifestations of sickling disorders. Here we report an 11-year-old girl with sickle cell anaemia having multiple skull infarctions including the orbital bony structures associated with subperiosteal haematomas. The diagnosis was made by MRI, which showed bone marrow changes and associated haemorrhagic collections. The patient was successfully managed without surgical intervention.

MR peritoneography in complications of continuous ambulatory peritoneal dialysis

BackgroundWe evaluated the usefulness of magnetic resonance (MR) peritoneography for the examination of complications from continuous ambulatory peritoneal dialysis (CAPD).MethodsMR peritoneography was performed in 20 patients who had suspected CAPD-related complications. Patients who had active peritonitis were not included in the study. Before MR imaging, a mixture of 2000 mL of peritoneal dialysis solution and 20 mL of gadopentetate dimeglumine was instilled into the peritoneal cavity. MR imaging was performed on a 1.0-Tesla system using a body coil. Axial, coronal, and sagittal fat-saturated fast spoiled gradient echo (repetition/echo times, 100/6.3 ms; flip angle, 90 degrees), axial fat-saturated T2-weighted fast spin echo (repetition/echo times, 6000/107 ms), and coronal fat-saturated T2-weighted fast spin echo (repetition/echo times, 3000/96.2 ms) images of the abdomen and the pelvis were obtained. After drain-age, triplanar fat-saturated fast spoiled gradient echo images were repeated with the same parameters.ResultsHomogeneous distribution of the dialysate in the peritoneal cavity was detected in 18 patients (90%). In 12 patients (60%), fluid leaks were discovered peripheral to the exit site, tunnel, and site of peritoneal entrance of the catheter. Fluid leaks through the abdominal wall in five patients (25%), retroperitoneum in one patient (5%), and a previous operation site in one patient (5%) were demonstrated. No abnormal finding was detected in three patients (15%) who had clinically suspected complications, whereas a dialysate leak was found in two patients (10%) who had no significant finding at physical examination.ConclusionsMR peritoneography provides detailed information about the anatomic distribution of dialysate leaks in patients treated with CAPD and poses no risks associated with ionizing radiation and nephrotoxic contrast medium.

A rare cause of cervical spinal stenosis: posterior arch hypoplasia in a bipartite atlas

Abstract. We describe CT and MRI of a previously unreported combination of atlantoaxial anomalies consisting of posterior arch hypoplasia in a bipartite atlas with an os odontoideum, in a 30-year-old woman presenting with neck and left arm pain. MRI showed the os odontoideum, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. CT revealed a bipartite atlas with midline clefts in anterior and posterior arches, thickening in the anterior arch and hypoplasia of the posterior arch with incurving of both hemiarches. Flexion and extension radiographs demonstrated atlantoaxial instability.

Intrabiliary Rupture of Hepatic Hydatid Cysts: Diagnostic Accuracy of MR Cholangiopancreatography

OBJECTIVE The purpose of this study was to establish the role of MR cholangiopancreatography (MRCP) in the diagnosis of biliary rupture in hepatic hydatid disease. We sought to determine whether the morphologic features of cysts and bile duct abnormalities detected on MRCP are specific enough for identification of intrabiliary rupture. CONCLUSION If one of the following MRCP findings of apparent connection between hydatid cyst and biliary system, deformation of cyst, focal defect in cyst wall, or beaklike projection extending from cyst wall was present in a patient with hepatic hydatid cyst, the sensitivity of MRCP was 91.7% and the specificity was 82.8% for identification of intrabiliary rupture.

Hippocampal malrotation with normal corpus callosum in a child with Opitz syndrome

We present cranial magnetic resonance imaging (MRI) findings in a 6-year-old boy with Opitz syndrome. The electroencephalogram revealed epileptiform abnormalities in both frontal regions. MRI showed normal callosal development, but a rounded shape of the left hippocampus due to malrotation. The temporal horn was slightly dilated on the left side. These features were consistent with isolated hippocampal malrotation.