Mehmet Incedayi

Value of diffusion-weighted MRI in the differentiation of benign and malign breast lesions.

ZusammenfassungEINLEITUNG: Ziel unserer Studie war es, zu prüfen, ob eine diffusionsgewichtete MR Bildgebung (DWI) in der Differenzierung von benignen und malignen Läsionen der Brust nützlich ist. MATERIAL UND METHODEN: Es wurden 41 Frauen in die Studie eingeschlossen. Bei 45 Läsionen wurde die Diagnose bioptisch gestellt, wobei 25 (55,5 %) malign und 20 (44,5 %) gutartig waren. Der apparente Diffusions Koeffizient (ADC) dieser Läsionen wurde prospektiv mit dem histopathologischem Ergebnis verglichen. ERGEBNISSE: Als Schwellenwert zur Erkennung maligner Läsionen wurde ein ADC von 1,0×10–3 mm2/s erhoben. Die Sensitivität dieses Wertes lag bei 95 %, die Spezifität bei 100%. Der positive Voraussagewert bei 100 %, der negative bei 94 %, die Treffsicherheit -Rate bei 97 %. SCHLUSSFOLGERUNGEN: Die DWI verbessert die diagnostische Treffsicherheit der konventionelle MRI der Brust. ADC Messungen können bei der Differenzierung von malignen und benignen Läsionen der Brust nützlich sein.SummaryINTRODUCTION: Our purpose was to determine whether diffusion-weighted MR imaging (DWI) could be used in differentiation of benign and malign breast lesions. MATERIALS AND METHODS: 41 women patients were included in the study. 45 lesions were diagnosed by biopsy; 25 (55.5%) of these lesions were malignant and 20 (44.5%) were benign. The apparent diffusion coefficient (ADC) values of these lesions were prospectively compared with their histopathological results. RESULTS: Differentiation of the malignant and benign masses revealed that the threshold value of the ADC was 1.0×10–3 mm2/s, its sensitivity was demonstrated as 95%, specificity as 100%, positive predictive as 100%, negative predictive as 94% and accuracy rate as 97%. CONCLUSIONS: DWI improves diagnostic accuracy of the conventional breast MRI. ADC measurements may be useful for differentiation of the malign and benign masses.

Is it possible to differentiate between hydatid and simple cysts in the liver by means of diffusion-weighted magnetic resonance imaging?

OBJECTIVE Our aim was to evaluate the contribution of diffusion-weighted imaging to the differentiation of hydatid cysts (HCs) from the simple cysts and to the identification of the HC subtypes. MATERIALS AND METHODS A total of 37 patients were included in this retrospective study. Fifty of these patients had diagnosed liver cysts (28 HCs and 22 simple cysts) of at least 1 cm in size. All of the cysts were examined with sonography and magnetic resonance imaging, and the HCs were classified according to the World Health Organization criteria. RESULTS Twenty-eight of the total 50 cysts were HCs, and 22 were simple cysts. When the apparent diffusion coefficient (ADC) values of all HCs were compared with the ADC values of the simple cysts, a statistically significant relationship was found (P=.001). The optimal ADC threshold value was established as 2.5 s/mm(2). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were 60%, 95%, 94%, 65% and 76%, respectively. CONCLUSION Diffusion-weighted imaging-magnetic resonance imaging is a considerably helpful technique for differentiating between HCs and simple cysts and for differentiating between HC subtypes.

High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status.

OBJECTIVE The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results. METHODS We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed. RESULTS The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation. CONCLUSIONS There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.

The incidence of left atrial diverticula in coronary CT angiography

PURPOSE The aim of this study was to characterize the frequency and location of left atrial diverticula by using multidetector computed tomography (MDCT). MATERIALS AND METHODS Cardiac imaging was performed for 454 patients using 64MDCT. Most patients were being examined for coronary artery disease. All images were interpreted by two radiologists on a three-dimensional workstation using multiplanar reformatting, maximum intensity projection, and volumerendering. Diverticula were characterized by localization and diameter. RESULTS A total of 207 atrial diverticula were diagnosed in 186 (41%) of the 454 patients in this study. The diameters of left atrial diverticula ranged from 2 mm to 16 mm, with an average diameter of 5.2 mm. Left atrial diverticula were located anterosuperiorly in 166 patients (36.6%), anteriorly in four patients (0.9%), anteroinferiorly in three patients (0.7%), inferolaterally in one patient (0.2%), inferomedially in two patients (0.4%), laterally in two patients (0.4%), posterosuperiorly in one patient (0.2%), and superiorly in seven patients (1.5%). CONCLUSION Left atrial diverticula are frequently detected during routine cardiac computed tomography angiography examinations. From the Departments of Radiology, and Cardiology, GATA Haydarpasa Teaching Hospital, İstanbul, Turkey.

Posterior reversible encephalopathy syndrome in a child with Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis that affects the gastrointestinal and central nervous systems and the kidneys. The disease primarily affects children, but may occur in elderly children with allergic purpura and also in adults. Central nervous system involvement may be the first sign; however, it is rarely encountered. Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of encephalopathy, headache, visual disturbance and seizures. Its radiological signs can be observed in grey and white matter at the posterior region of the cerebral hemispheres. HSP should be considered in children with PRES in the presence of rash, joint and gastrointestinal symptoms. We reported a 5-year-old patient who developed acute renal failure and PRES by reason of HSP.

Optimized imaging techniques for testicular masses: fast and with high accuracy

SummaryObjectiveThe purpose of this study is to determine the effectiveness of the diffusion-weighted magnetic resonance imaging (DWI) of the differentiation of benign and malignant testicular masses.MethodsFifteen male patients who admitted to our clinic with the diagnosis of testicular mass detected by ultrasound were enrolled to this study. The patients were between 20 and 61 years old (mean 25.7). Apparent diffusion coefficient (ADC) values were measured from ADC maps of lesion and normal testicular tissue. In addition, mean signal intensity (SI) measurements were obtained by using b: 1,000 of normal testicular tissue and lesion with three regions of interest (ROI). SI ratio values are obtained by dividing the value lesion SI to the normal testicular parenchyma SI. Histopathology of orchiectomy materials and ADC values and lesion SI rates were compared statistically.ResultsThere were no significant correlation (p = 0.97) between ADC values of benign and malign lesions and histopathological diagnosis in Student’s t test. There were statistically significant relationship with the histopathology of the lesion and the SI ratio in Student’s t test (p = 0.027).ConclusionsDWI is an effective method in differentiation of benign and malignant testicular masses. Important information can be obtained about nature of testis masses with quantitative measurements of the ADC and ratio of SI.ZusammenfassungZielDer Zweck dieser Studie ist es, die Wertigkeit der Diffusions-gewichteten Magnetresonanz Bildgebung (DMB) in der Differenzierung von benignen und malignen Hodentumoren zu erfassen.MethodikFünfzehn Männer, die an unsere Klinik mit im Ultraschall festgestellten Hodentumoren zugewiesen worden waren, wurden in die Studie aufgenommen. Das Alter der Patienten lag zwischen 20 und 61 Jahren (im Mittel 25,7). Apparente Diffusionskoeffizienten (ADK) wurden von Gebieten der Läsion und vom normalen Hodengewebe gemessen. Zusätzlich wurde Messungen der mittleren Signalintensität (SI) von Gebieten der Tumoren mit drei regions of interest (ROI) und vom normalen Hodengewebe durchgeführt. Die SI Quotienten wurden durch Division des SI Werte, die über der Läsion erhoben wurden, durch die im normalen Hodenparenchym gemessenen errechnet. Die Pathohistologie des Orchiektomie Materials wurden mit den ADK sowie mit den Tumor SI Quotienten statistisch verglichen.ErgebnisseIm Student’s t-Test bestand keine signifikante Beziehung (p = 0,97) zwischen den ADK Werten und den benignen, beziehungsweise den malignen Tumoren. Die Beziehung zwischen dem pathohistologischem Ergebnis und den SI Quotienten war im Student t-Test signifikant (p = 0,027).SchlussfolgerungenDie DMB ist eine Methode, die zur Differenzierung von malignen und benignen Hodentumoren gut geeignet ist. Wichtige Informationen über die Art des Hodentumors können mit quantitativen Messungen der ADK und den SI Quotienten gewonnen worden.

Retroperitoneal ancient schwannoma: multidetector CT findings

A 24-year-old man presented to our clinic complaining of right iliac fossa pain. Abdominal examination showed a non-tender, firm mass with well-defined borders. The patient was not sure when the symptoms started. His urine analysis, routine haematological parameters and renal function tests were within normal limits. A direct urinary system graphy revealed a large mass in the right abdomen (figure 1). Multidetector CT of the abdomen verified a round, well-defined mass measuring 11 cm in …

Multimodality imaging of spermatic cord abscess

A 21-year-old man was admitted to the urology department due to swelling and pain in the left inguinal region. On initial physical examination, he was slightly febrile, and areas of induration with tenderness were palpated in the left inguinal region and left hemiscrotum. Laboratory tests showed leukocytosis (14 000/mm3) and elevated C reactive protein (12 mg/dL). On ultrasound left epididymo-orchitis and expansion of the left inguinal canal were seen. In addition, a cystic tubular mass with wall thickness that had displaced the bladder …

Massive bilateral renal angiomyolipomatosis and multifocal micronodular pneumocytes hyperplasia associated with tuberous sclerosis: a case report.

ZusammenfassungDie tuberöse Sklerose ist eine autosomal dominant vererbte Erkrankung, die durch verschiedene hamartomatöse Veränderungen in verschiedenen Organen gekennzeichnet ist. Der Befall der verschiedenen Organe (neurologische (subependymale und corticale Veränderungen), renale (Angiomyolipome) und pulmonale (mikronoduläre Hyperplasie der Pneumozyten) Beteiligung) kann durch bildgebende Verfahren der Radiologie entdeckt werden. Wir berichten über eine 49-jährige Patientin mit tuberöser Sklerose mit multiplen Organbefall und massiven bilateralen Angiomyolipomen.SummaryTuberous sclerosis (TS) is an autosomal-dominant disorder characterized by a variety of hamartomatous lesions in various organs. Various organ involvements can be detected with radiology: neurologic involvement (cortical tubers, subependymal nodules and white matter abnormalities), renal involvement (angiomyolipoma) and pulmonary involvement (pulmonary lymphangioleiomyomatosis, multifocal micronodular pneumocyte hyperplasia). Here, we are reporting a case of tuberous sclerosis with multiple organ involvement and massive bilateral AMLs in a 49-year-old female patient.

Avulsion Fracture of the Anterior Inferior Iliac Spine Mimicking a Bone Tumor: A Case Report

This is a case of a 17-year-old boy who was admitted to the clinic suffering from right hip-inguinal region pain which began after a soccer match. He had an avulsion fracture in the anterior inferior iliac spine and CT/MR images showed similarities to a bone tumor. These fractures are especially seen in the apophyses which are within the ossification process. The radiological appearance of these fractures during the healing period may be involved with bone tumors. In the control MRI of the patient after one year, the fracture was almost healed completely. Treatment is generally conservative. Good results have been reported with rest, analgesic and anti-inflammatory drugs. Familiarity with radiological findings of these avulsion fractures in this region not only protects the patient from invasive procedures but also avoids the involvement of the practitioner in legal consequences resulting from a misdiagnosis of sarcoma.