Mehmet Araç

The radiographic joint space width in clinically normal hips: effects of age, gender and physical parameters

OBJECTIVE The aim of the study was to assess the relationship of the radiographic joint space width (JSW) in the hip with age and a variety of physical parameters in a clinically non-arthritic population in order to identify potential age-related changes. DESIGN One hundred and eighteen patients (58F/60M, age range 20-79 years) who underwent supine abdominal radiography for non-rheumatological indications and had no hip pain were evaluated. Height, weight and leg lengths were measured. JSW was quantified manually by a dial caliper, and femoral head diameters were determined for each hip. RESULTS Overall, JSW was 3.61mm+/-0.58 (mean+/-SD) in the right (R) and 3.63mm+/-0.59 in the left (L) hip (range 2.34-6.1mm). There was no age-related decline in the JSW, either by decade (P=0.5 and 0.6, for R and L hips, respectively), or by individual age (Spearmans rho=-0.108 and 0.057, P=0.3 and 0.5 for R and L hips, respectively); similarly, no age-related changes were observed when each gender was analyzed separately. Women had significantly narrower hip JSW than men (P=0.001 and 0.01, R and L hips, respectively). However, gender was no longer significant after height was taken into account (P=0.26 and 0.45, for R and L hips, respectively). JSW correlated significantly with height, weight (which also correlated with height) (r=0.31/0.27 and 0.29/0.28 for height and weight R/L, respectively, P<0.004 for each), but not with body mass index (P=0.62 and 0.57, R and L, respectively). Hip JSW significantly correlated also with femoral head diameter and leg length (r=0.38/0.29 and 0.25/0.19 for femoral head and leg length, R/L, respectively). CONCLUSIONS No effect of aging was detected on the radiographic JSW of the hip among normal individuals even at advanced ages. In contrast, height, femoral head diameter and leg length were directly related to JSW.

Cost‐effectiveness of Computed Tomography in the Evaluation of Patients With Headache

We report a retrospective study to determine the cost‐effectiveness of cranial computed tomogrsphy in patients with headache without neurological finding. Five hundred ninety‐two neurologically normal patients were examined between 1990 and 1993 for the complaint of headache. Examination results were reevaluated from written report and image archive systems. Results were divided into three groups. In group P0, we included patients with normal cranialcomputed tomography findings. In group P1, patients showed some minor pathologies like ischemic or atrophic changes. These findings neither explained the reason for headache nor changed the clinical or therapeutic approach. The third group (P2) was to include patients with gross intracranial pathology like space‐occupying lesions or bleeding. Five hundred forty‐six of 592 patients were in the P0group (92%), and the remaining 46 patients were in the P1group (8%). No patient was found to have serious intracranial pathology detected by computed tomography. Cost of detection of a case with significant pathology was calculated. It is our opinion that computed tomography is an unrewarding technique in the evaluation of patients with chronic headache whose neurological examinations are normal.

Clinical approach to graft hepatic artery thrombosis following living related liver transplantation

Abstract: Hepatic artery thrombosis (HAT) has an occurrence rate of 1.7–26% following living donor liver transplantation (LDLT) and is one of the most common reasons for graft loss and mortality in this population. There is a higher incidence of HAT in pediatric recipients. The aim of this case report is to discuss clinical approaches for the treatment of HAT occurring in the early post‐operative period after LDLT. An 11‐month‐old, 7.8‐kg female with cirrhosis secondary to biliary atresia underwent LDLT at Gazi University Hospital in Ankara. The graft was a left lateral segment from her father with a left hepatic artery (HA) of 2 mm diameter and a graft weight/recipient body weight ratio of 2.0%. After an uneventful early post‐operative period, HAT was diagnosed by Doppler ultrasonography (USG) on the fifth post‐operative day. Following angiographic evaluation, immediate exploration and reanastomosis was performed using an operation microscope. Post‐operatively, the HA was patented by Doppler USG and graft function returned to normal. Now, 42 months later, the patient continues to do well with normal graft function, using a regimen of tacrolimus monotherapy for immunosuppression. In countries which have very limited resources for urgent re‐transplantation, given their serious donor shortage, graft salvage may be the only option for patient survival when HAT occurs. In these circumstances, early diagnosis and immediate revascularization may be the only method for graft salvage. A daily routine of Doppler USG examination in the early post‐operative period may provide a method for the early diagnosis of HAT, before liver enzymes are elevated and hepatic necrosis has begun.

Characterization of Hyperechoic Focal Liver Lesions Quantitative Evaluation With Pulse Inversion Harmonic Imaging in the Late Phase of Levovist

The aim of this study was to evaluate hyperechoic focal liver lesions with pulse inversion harmonic imaging in the late phase of SH U 508A (Levovist; Schering AG, Berlin, Germany) and to determine whether quantitative evaluation improves the characterization of the lesions.

Quantitative and qualitative comparison of standard-dose and low-dose pediatric head computed tomography: a retrospective study assessing the effect of adaptive statistical iterative reconstruction.

Objectives Our aim was to assess the effect of adaptive statistical iterative reconstruction (ASIR) on pediatric head computed tomography (CT) examinations. Methods We retrospectively reviewed 305 pediatric head CT examinations. The study population consisted of standard dose (STD, n = 152) examinations reconstructed with filtered back projection and low dose (LD, n = 153) examinations reconstructed with 30% (LD30) and 0% (LD0) ASIR. We compared groups by means of radiation dose, noise measures, and visual grading. Student t test, 1-way analysis of variance test, and Mann-Whitney U test were used for statistical analysis. Results The dose in the LD30 group was significantly lower (29%) than that in the STD group (P < 0.001). The noise in the white matter (P < 0.001), SNR (P < 0.001), and subjective image noise (P = 0.044) was significantly better in the STD group than those in the LD30 group. There was no significant difference between LD30 and STD groups in the sharpness (P = 0.141), diagnostic acceptability (P = 0.079), and artifacts (P = 0.750) and contrast-to-noise ratio (P = 0.718). Conclusions In conclusion, we found that a blend of 30% ASIR in a 16-slice multidetector CT produces diagnostically acceptable pediatric head CT examinations with a 29% less dose.

The Role of Late-Phase Pulse Inversion Harmonic Imaging in the Detection of Occult Hepatic Metastases

Objective. The purpose of this study was to investigate the efficacy of late‐phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal. Methods. Thirty‐two patients (21 women and 11 men; age range, 20–87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir‐enhanced magnetic resonance imaging was performed as part of the clinical workup. Results. After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow‐up and CT. Conclusions. Late‐phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.

Bilateral perirenal urinoma with mediastinal extension

We report a unique case of adult-type polycystic kidney disease (PKD) having bilateral chronic perirenal fluid collection with unusual extension. Fluid collections at both sides are connected across the midline anterior to the abdominal aorta and inferior vena cava. In addition, supradiaphragmatic extension through aortic hiatus was well demonstrated by computed tomography (CT). Anatomical boundaries and relations between two perirenal spaces are evaluated.

Unenhanced urinary CT: Value of parenchymal attenuation measurements in differentiating acute vs. chronic renal obstruction

OBJECTIVE We aimed to search if the renal parenchymal attenuation measurements on unenhanced CT scans could be useful in differentiating acutely obstructed kidneys from chronic cases or unobstructed kidneys. MATERIAL AND METHODS Unenhanced CT scans of 101 patients were retrospectively reviewed. Thirty-two patients with unilateral acute renal obstruction, 34 patients with unilateral chronic renal obstruction due to various reasons and 35 control subjects were included in the study. The parenchymal densities of both kidneys were measured, from the upper poles, middle portions, and lower poles of each kidney. The mean parenchymal densities of both kidneys were calculated in all three groups of subjects. Secondary signs of renal obstruction such as perinephric stranding, size of ureteral stone, degree of hydronephrosis were also noted for each kidney. RESULTS The mean parenchymal attenuation value on the acutely obstructed side was lower than the unobstructed side, 24.21 ± 3.68 and 30.68 ± 4.75 respectively (p<0.001). The mean parenchymal attenuation value on the acutely obstructed side (24.21 ± 3.68) was lower than both the chronically obstructed side (30.85 ± 4.53), and the control subjects (29.62 ± 3.03 on corresponding side). There was no statistically significant attenuation difference between right and left kidneys in the control group and chronic obstruction group. CONCLUSION Renal parenchymal attenuation measurements and attenuation differences of both kidney of same patient could be useful in differentiating acute unilateral obstruction from chronic cases.

Digital subtraction sialography: technique, advantages and results in 107 cases

Sialographic examinations with the digital subtraction technique were performed in 107 salivary glands (90 parotid and 17 submandibular) of 99 patients. Diagnostic and technical advantages of the digital imaging and subtraction for sialography were investigated. Superior quality enabled detailed imaging of the entire ductal system. Reduced radiation exposure, short examination time and almost painless examinations with good patient tolerance proved to be the major advantages of digital subtraction sialography as a diagnostic tool.

Retrocardiac Isolated Dextrogastria

Isolated situs inversus of the stomach is an extremely rare congenital anomaly. We hereby report a case of this uncommon anomaly in retrocardiac location associated with esophageal and gastric fundus