Mesut Bulakci

Comparison of diagnostic value of multidetector computed tomography and X-ray in the detection of body packing

OBJECTIVE Radiologists and other clinicians are facing an increasing number of illegal drug-related medical conditions. We aimed to draw attention to this growing global problem and to highlight some of the important points related to diagnosis and follow-up of body packing. We compare the diagnostic performance of unenhanced multidetector CT (MDCT) and abdomen X-ray for the detection of drug-filled packets. MATERIALS AND METHODS Sixty-seven suspects, who underwent both CT and X-ray examinations, have been included in the study. All MDCT and X-ray images were independently and retrospectively reviewed by two observers with different degrees of experience in abdomen imaging. Fifty-two of them were identified as body packers finally. Interobserver agreement, sensitivity, specificity, positive and negative predictive value were calculated. RESULTS Two types of packets with different characteristics were identified in all body packers. Type 1 packets (solid-state drug) were found in 41 patients and type 2 packets (liquid cocaine) in 11 patients. All statistical analyses concern the detection of any packets. That is, the whole evaluation has been performed per patient. Sensitivity/specificity values of type 1 and type 2 packets for MDCT were 100-98%/100-100% and 100-100%/100-100%, respectively. Besides, sensitivity/specificity values of type 1 and type 2 packets for X-ray were 93-90%/100-91% and 64-45%/73-71%, respectively. In addition, interobserver agreements for detection of any packets were excellent (κ=0.96) and good (κ=0.75) for interpretation of MDCT and X-ray, respectively. CONCLUSION Unenhanced MDCT is a fast, accurate and easily used diagnostic tool with high sensitivity and specificity for the exact diagnosis of body packing.

Detection of body packing by magnetic resonance imaging: a new diagnostic tool?

PurposeIn this study, we aimed to describe non-contrast abdominal MRI findings in body packers and emphasize the role of this imaging technique in diagnosis of body packing.Materials and methodsNon-contrast abdominopelvic MRI was performed at the radiology department in 16 suspected body packers that were brought to our hospital, and 13 of them were diagnosed with body packing. We evaluated the presence, location, and shapes of packets as well as signal characteristics on T1- and T2-weighted images.ResultsWe came across two types of packets: those containing solid substances (10 cases) and those filled with liquid cocaine (3 cases). Both types were accurately diagnosed with the help of MRI. Only 1 suspected body packer received a false positive diagnosis.ConclusionAbdominopelvic MRI is a reliable and valuable method of diagnosing body packing.

Final destination of an ingested needle: the liver.

Foreign body ingestion is a common problem in children, but it is also seen among adults. Most foreign bodies pass through the gastrointestinal tract without causing complications. Perforation of the gut by a foreign body, followed by migration of the foreign body to the liver is quite rare. Herein we report a case of inadvertent ingestion of a sewing needle that perforated the duodenum and migrated to the liver. The patient was monitored weekly with abdominal radiographs, but displacement of the needle could not be observed. At follow-up, right upper quadrant pain was noted. Two weeks later, computed tomography revealed that the needle was completely buried into the right lobe of the liver. Ultrasonographic examination successfully showed the extracapsular displacement of the needle. Eventually, laparoscopic removal of the needle was easily performed.

The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study

AbstractPurpose This study investigated the sonographic properties of drug packets containing narcotic drugs and the diagnostic role of ultrasonography in detecting body packing in comparison with CT.Methods Forty-five suspects admitted to our hospital for diagnosis and management were routinely evaluated by non-contrast CT for the presence of drug packets. A single radiologist blind to CT data independently performed the abdominal ultrasonographic scans.ResultsThirty-five of 45 suspects were carrying packets. In positive cases, two types of packets with different properties were noted. Twenty-eight cases had type 1 packets (solid form drug) and 7 had type 2 packets (liquid form cocaine). The sensitivity, specificity, positive, and negative predictive values of ultrasonography for detecting drug packets were 91%, 70%, 91%, and 70%, respectively. Ultrasonography accurately determined the presence or absence of packs in 39 of 45 suspects.ConclusionUltrasonography was found to have a high sensitivity but a low specificity in suspected cases. A negative ultrasonography cannot rule out the diagnosis of body packing. However, it may be preferred as the initial imaging method or for follow-up of suspected cases as a radiation-free, easy-to-use, and inexpensive technique.

Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update

Alveolar echinococcosis is a parasitic disease limited to the northern hemisphere. The disease occurs primarily in the liver and shows a profile mimicking slow-growing malignant tumors. Echinococcus multilocularis infection is fatal if left untreated. It can cause several complications by infiltrating the vascular structures, biliary tracts, and the hilum of the liver. As it can invade the adjacent organs or can spread to distant organs, alveolar echinococcosis can easily be confused with malignancies. We provide a brief review of epidemiologic and pathophysiologic profile of alveolar echinococcosis and clinical features of the disease. This article focuses primarily on the imaging features of alveolar echinococcosis on ultrasonogra-phy, computed tomography, magnetic resonance imaging, diffusion-weighted imaging and positron emission tomography-computed tomography. We also reviewed the role of radiology in diagnosis, management, and follow-up of the disease.

Imaging Appearances of Paratesticular Fibrous Pseudotumor.

Summary Background In this paper the clinical and radiological features of three cases with paratesticular fibrous pseudotumor were presented after a retrospective analysis of medical archives of our hospital. Case Report Each of the three cases had unilateral, multiple nodular lesions with smooth borders accompanied by a hydrocele. On sonographic examination, the lesions showed echogenicity similar to, or slightly lower than, the testis, and the two large lesions had posterior acoustic shadowing. Color Doppler ultrasound examination of two cases showed intralesional vascularity of mild-to-moderate degree. All lesions appeared hypointense compared to testicular tissue on T1W and T2W magnetic resonance images. Moderate-to-high enhancement was observed in the diffuse pattern after intravenous injection of contrast material. An intraoperative pathological examination was performed and local excision carried out in all three cases. Conclusions Fibrous pseudotumor is a rare benign paratesticular lesion, which can be confused with malignant masses. Imaging procedures play an important role in correct diagnosis. Unfamiliarity with imaging findings of paratesticular fibrous pseudotumor may eventuate in an unnecessary orchiectomy.

Efficacy of ultrasound-guided core-needle biopsy in the diagnosis of hepatic alveolar echinococcosis: a retrospective analysis

Background: This study retrospectively analyzed the clinical data, laboratory results, imaging findings, and histopathological features of 28 patients who underwent ultrasound-guided core-needle biopsy from a hepatic lesion and were diagnosed with alveolar echinococcosis. Results: Among 28 patients included in the study, 16 were females and 12 were males. The mean age of the studied population was 53 ± 16 years, and the age range was 18–79 years. The most common presenting symptom was abdominal pain, which was observed in 14 patients. A total of 36 lesions were detected in the patients’ livers, out of which 7 had a cystic appearance. Hepatic vascular involvement, bile duct involvement, and other organ involvement were depicted in 14, 5, and 7 patients, respectively. The average number of cores taken from the lesions was 2.7, ranging between 2 and 5. In histopathological evaluation, PAS+ parasitic membrane structures were visualized on a necrotic background in all cases. Regarding seven patients, who were operated, the pathological findings of preoperative percutaneous biopsies were in perfect agreement with the pathological examinations after surgical resections. None of the patients developed major complications after biopsy. Conclusion: Ultrasound-guided core-needle biopsy is a minimally invasive, reliable, and effective diagnostic tool for the definitive diagnosis of hepatic alveolar echinococcosis.

Spontaneous thrombosis of uterine artery pseudoaneurysm: Follow‐up with doppler ultrasonography and interventional management

Iatrogenic uterine arterial injury is one of the possible causes of pseudoaneurysm formation occurring during pelvic or obstetrical surgery. Cesarean delivery is the commonest cause. Repeat vaginal bleeding is the most frequent symptom, but fever and lower abdominal pain have also been reported. Doppler sonography (US) has been used to detect a pelvic pseudoaneurysm. Transcatheter arterial embolization of the uterine artery is a highly effective, relatively minimally invasive method for treating such condition. A 21-year-old primigravida was admitted to our hospital with a history of repeated vaginal bleeding following a Cesarean section that she underwent 2 months earlier. Transvaginal color Doppler US (TV-CDUS) examination showed a 14 mm 12 mm pseudoaneurysm arising from the left uterine artery at the isthmic level. The pseudoaneurysm was located in the myometrium and had a thin, peripheral rim-like thrombosis (Figure 1). Catheter angiography performed 2 days later did not reveal filling of the pseudoaneurysm, and there was no extravasation of contrast. TV-CDUS immediately after angiography revealed a spontaneous total thrombosis of the pseudoaneurysm (Figure 2). The patient was clinically stable and vaginal bleeding had ceased for 36 hours. Because most of the pseudoaneurysm had thrombosed spontaneously and there was no angiographic finding, conservative management was recommended. On follow-up TV-CDUS 2 days later, a complete thrombosis of the pseudoaneurysm was observed but, 1 day later, the patient was readmitted with vaginal bleeding. Taking into account a possible hemorrhage from the other probably injured uterine artery (which could be occult on angiography and could also be due to rebleeding of the thrombosed pseudoaneurysm), transarterial embolization of both uterine arteries with gelfoam was undertaken. The patient has not suffered from any vaginal bleeding after the embolization. A pseudoaneurysm of the uterine artery is a rare complication of pelvic surgery but may result in life-threatening complications such as massive vaginal hemorrhage. In general, pseudoaneurysms are thrombosed in a centripetal manner (from the periphery to the center) like in our case. CDUS can elegantly demonstrate the sequence of steps leading to the complete thrombosis of the pseudoaneurysm. In some circumstances, a pseudoaneurysm cannot be demonstrated on angiography. Transarterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage. In our case, according to TV-CDUS findings, the pseudoaneurysm completely thrombosed in a short period of time, and angiography was negative. We could not exclude hemorrhage from the contralateral uterine artery (which may have been injured during previous surgery), so bilateral uterine arteries were embolized. In conclusion, a spontaneous thrombosis of a uterine artery pseudoaneurysm can occur. TVCDUS provides sufficient information to detect and follow-up the progress of the thrombosis.

Superparamagnetic iron oxide-enhanced magnetic resonance imaging in a case of spleen hamartoma.

Objective: To emphasize the contribution of superparamagnetic iron oxide (SPIO) contrast agent in the diagnosis of the splenic hamartoma. Clinical Presentation and Intervention: A 63-year-old female was admitted to our hospital with diffuse abdominal pain. An ultrasound examination revealed a 5 × 4 cm solid lesion in the spleen. Dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of the abdominal findings was consistent with a splenic hamartoma. SPIO-enhanced MRI was then performed and it confirmed the diagnosis. The lesion showed a decrease of signal intensity on T2-weighted images. Conclusion: This case showed that SPIO-enhanced MRI was useful for establishing a noninvasive diagnosis of the splenic hamartomas.

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality

BACKGROUND Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. AIMS In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. STUDY DESIGN Retrospective cross-sectional study. METHODS Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts- 4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. RESULTS Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. CONCLUSION CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates.