Mesut Ozgokce

The Role of Dynamic Magnetic Resonance Imaging in the Evaluation of Pulmonary Nodules and Masses

Objective: The aim of our study was to determine whether or not dynamic magnetic resonance imaging (MRI) with kinetic and morphological parameters can reveal significant differences between malignant and benign pulmonary lesions, and thus to evaluate the use of dynamic MRI in the management of pulmonary nodules. Patients and Methods: Thirty-one patients (4 women and 27 men) underwent 1.5 T MRI, where 10 consecutive dynamic series were performed every 30 s by using 3D fast low-angle shot sequences. The percentage increase in the signal intensity of the lesions was determined for each time point. Time-enhancement curves of the lesions were drawn and classified into four types: A, B, C and D. Early peak (EP) and maximum peak (MP) values of the curves were calculated and compared with the diagnoses of the patients. The usefulness of these parameters was tested statistically. In addition to the comparison of the parameters between the groups, receiver-operating characteristic analysis was used to assess sensitivity, specificity, and both positive and negative predictive values of EP and MP parameters. Results: Of the 31 pulmonary lesions, 16 (52%) were malignant. These showed a stronger enhancement with higher median values of EP and MP (77.08 and 123.15, respectively) than those corresponding to the benign lesions (14.45 and 32.53, respectively). There were significant differences between the benign and malignant lesions (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 75, 93, 92 and 78% for EP and 93, 86, 88 and 93% for MP, respectively. Conclusion: A combination of kinetic and morphological evaluation in dynamic MRI provided accurate differentiation between benign and malignant pulmonary lesions. It was a useful and noninvasive method of evaluating pulmonary nodules.

Ultrasound-guided shoulder MR arthrography: comparison of rotator interval and posterior approach

PURPOSE The purpose of this study was to prospectively evaluate the two different ultrasound-guided injection techniques for magnetic resonance (MR) arthrography of the shoulder. METHODS AND MATERIALS This study included 100 patients [50 rotator interval group (n=50) vs. 50 posterior approach group (n=50)]. All procedures were performed by the same radiologist. The two injection techniques were compared. The discomfort during and after arthrography was evaluated. Extraarticular contrast media extravasation was graded according to the MRI findings. The number of injection attempts, effect of contrast media extravasation rate on diagnostic quality and procedure times were recorded. RESULTS There were no significant difference between the posterior and rotator interval puncture groups with regard to pain (P=.915), procedure times (P=.401) or attempt scores (P=.182). There were significantly more contrast media extravasations with rotator interval approach than posterior approach (P<.05). CONCLUSION Both techniques were successful and well tolerated by patients. Posterior injection technique provided a more effective route with decreased extravasation rate and easier approach compared to the rotator interval approach.

Ultrasound Elastography for Distinction Between Parathyroid Adenomas and Thyroid Nodules

The aim of this study was to detect the level of stiffness of parathyroid adenomas and to distinguish them from benign and malignant thyroid nodules using ultrasound elastography with acoustic radiation force impulse imaging.

Magnetic Resonance Arthrography of the Glenohumeral Joint: Ultrasonography-Guided Technique Using a Posterior Approach

OBJECTIVE The purpose of this study was to assess the efficacy and feasibility of ultrasound (US)-guided magnetic resonance (MR) arthrography of the glenohumeral joint via a posterior approach. MATERIALS AND METHODS Thirty-four patients (18 males and 16 females) who were suspected to have glenohumeral joint pathology were examined using MR arthrography. The patients ranged in age from 21 to 85 years, and the average age was 45±15.9 years. A Toshiba Xario US unit was utilized. Ultrasonography examinations were conducted using a broad-band 5-12 MHz linear array transducer. Gadolinium was injected into the shoulder joint using an 18-20 gauge needle. MR imaging was performed within the first 30 min after the injection. RESULTS The injection of gadolinium into the shoulder joint was successfully accomplished in all 34 patients. Major contrast media extravasation outside the joint was depicted in only two patients (5.9%). No major complications were encountered. CONCLUSION Ultrasonography is an effective alternate guidance technique for the injection of gadolinium into the glenohumeral joint for MR arthrography. US-guided arthrography via a posterior approach to the glenohumeral joint is safe, accurate, well tolerated by patients and easy to perform with minimal training.

Congenital absence of the portal vein in a patient with multiple vascular anomalies.

A 15-year-old male patient accepted to emergency department with nausea, vomiting, sleepiness, and severe epigastric pain. The patient has a history of mild mental retardation since his childhood. Physical examination showed epigastric tenderness. Laboratory findings were consistent with mildly increased liver enzymes and hyperammonemia. Result of abdominal ultrasound was suboptimal due to lack of patient cooperation. Patient underwent abdominal and thoracic computed tomography (CT) examination to investigate the possible causes of hyperammonemia and liver disease. The CT scan showed the absence of portal vein with direct connection of portomesenteric system with systemic venous circulation. There were also various arterial and venous anomalies along with multiple hepatic masses. Whole anatomy of the thorax and abdomen was delineated with multiplanar reformatted images and maximum intensity projection technique. Imaging findings are consistent with Type Ib Abernethy malformation. The patient also underwent brain magnetic resonance imaging to investigate the presence of central nervous system changes due to hyperammonemia.

Sleep Apnea and Fatty Liver Are Coupled Via Energy Metabolism

Background Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by intermittent hypoxia. Non-alcoholic fatty liver disease is the most common cause of chronic liver disease worldwide. We aimed to evaluate the relationship between OSA and fatty liver. Material/Methods We enrolled 176 subjects to this study who underwent polysomnography (PSG) for suspected OSA. The control group included 42 simple snoring subjects. PSG, biochemical tests, and ultrasonographic examination were performed all subjects. Results The simple snoring and mild, moderate, and severe OSA groups included 18/42 (42.86%), 33/52 (63.5%), 27/34 (79.4%), and 28/48 (79.2%) subjects with hepatosteatosis, respectively. There were significant differences in hepatosteatosis and hepatosteatosis grade between the simple snoring and the moderate and severe OSA groups. Logistic regression analysis showed that BMI and average desaturation were independently and significantly related to hepatic steatosis. Conclusions Our study shows that BMI and the average desaturation contribute to non-alcoholic fatty liver in subjects with OSA. In this regard, sleep apnea may trigger metabolic mitochondrial energy associated processes thereby altering lipid metabolism and obesity as well.

Polyorchidism and adenomatous hyperplasia of the rete testis: a case report with sonographic and magnetic resonance imaging findings and review of literature

Supernumerary testis or polyorchidism is a rare congenital anomaly with about 200 reported cases in the literature. It may be associated with cryptorchidism, testicular torsion and neoplasms. Ultrasonography and magnetic resonance imaging are effective noninvasive methods of accurately detecting polyorchidism. In most cases, ultrasonography is diagnostic and magnetic resonance imaging plays confirmatory role by providing additional information if complicated with neoplasia. We report a case of 16‐year‐old man with right supernumerary testis associated with adenomatous hyperplasia of the rete testis, its sonographic and magnetic resonance imaging findings and management.

Spontaneous Rupture of the Middle Fossa Arachnoid Cyst into the Subdural Space: Case Report

Summary Background Arachnoid cysts are congenital, benign and intra-arachnoidal lesions. A great majority of arachnoid cysts are congenital. However, to a lesser extent, they are known to develop after head trauma and brain inflammatory diseases. Arachnoid cysts are mostly asymptomatic and they can develop anywhere in the brain along the arachnoid membrane. Case Report Arachnoid cysts form 1% of the non-traumatic lesions which occupy a place and it is thought to be a congenital lesion developed as a result of meningeal development abnormalities or a lesion acquired after trauma and infection. There is a male dominance at a rate of 3/1 in arachnoid cysts which locate mostly in the middle fossa. Our patient was a 2-years-old boy. Conclusions As a conclusion, spontaneous subdural hygroma is a rare complication of the arachnoid cysts. Surgical intervention could be required in acute cases.

Cerebral dural arteriovenous fistula that causes intermittent headache.

A 45-year-old man underwent multislice computed tomography for complaint of intermittent diffuse headaches of 3 years in duration. A computed tomography-angiography axial slice image revealed dilated intraosseous diploic veins, or extatic dural arterial branches (Fig. 1A). A computed tomography 3-dimensional image showed feeding vessels (the internal maxillary, middle meningeal, superficial temporal, or occipital arteries) on the calvarium (Fig. 1B). Catheter angiogram was carried out and showed connections between meningeal arteries and dural sinuses, which resulted in the diagnosis of dural arteriovenous fistula (Fig. 2). In this case surgical management was performed and the patient remained well after the procedure. Dural arteriovenous fistulas (DAVFs) are a rare but potentially treatable neurological condition resulting from abnormal connections between meningeal arteries and dural sinuses. Dural arteriovenous fistulas account for approximately 10–15% of all intracranial vascular malformations and occur most commonly along the transverse and sigmoid sinuses. Cognard defined 5 types of DAVFs based exclusively upon the pattern of venous outflow: type I, located in the main sinus,with antegrade flow;type II, in the main sinus, with reflux into the sinus (II a), cortical veins (II b), or both (II a + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. Dural arteriovenous fistulas can be clinically grouped into benign (asymptomatic, bruit, headache, tinnitus or ocular symptoms), and aggressive (hemorrhage or dementia). Blood flow return to the brain is called “cortical venous reflux.” Dural arteriovenous fistula draining retrograde into cortical veins exhibits a much higher incidence of hemorrhage or venous infarction. Increased pressure within the dural venous sinuses may result hemorrhage or nonhemorrhagic neurologic deficits. Intracranial hemorrhage has been reported in up to 35–42% of DAVFs and is thought to be caused by the rupture of congested cortical veins (secondary to retrograde venous drainage). This hemorrhage may be intraparenchymal or within the subarachnoid/subdural space. Treatment varies depending on the type and location of the fistula. Some fistulas can be embolized through endovascular approach or, alternatively, surgery to clip or separate the abnormal connection can be performed. From the Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey (M. Kantarci, Ü. Bayraktutan, M. Özgökçe, S. Eren, and A. Levent); Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey (S. Albayram). ISSN 0017-8748 doi: 10.1111/j.1526-4610.2012.02093.x Published by Wiley Periodicals, Inc. Headache

Uterin Lipoleiomyoma: MR Findings

Summary Background Uterine lipoleiomyoma is a rare and specific type of leiomyoma. Case Report A 60-year-old postmenopausal woman presented with abdominal pain. Her pelvic ultrasound demonstrated a normal- sized uterus with a well- circumscribed, heterogeneous mass located in the anterior corpus. A pelvic MRI revealed a mass including hyperintense areas on T1-weighted images and hypointense on fat-suppressed T1-weighted images, compatible with lipoleiomyoma. Conclusions Uterine lipoleiomyomas are often misdiagnosed pre-operatively and it is important to distinguish leiomyomas from other tumors for prevention from supererogatory surgery. Imaging plays an important role for the exact differentiation.