Murat Acar

Integration of ultrasound findings with Alvarado score in children with suspected appendicitis

The aim of this study was to investigate the integration of ultrasound (US) findings with Alvarado score in diagnosing or excluding acute appendicitis.

Evaluation of Crohn’s disease activity by MR enterography: Derivation and histopathological comparison of an MR-based activity index

AIMS To compose a qualitative magnetic resonance imaging (MRI) activity index showing Crohn disease (CD) activity, and to compare magnetic resonance enterography (MRE) findings with histopathology results. MATERIALS AND METHODS Twenty-six patients (11 male and 15 female; mean age 36.7) who had MRE and colonoscopic biopsy between October 2011 and August 2012 were included in the study. On MRE the following parameters were evaluated: bowel wall thickness, bowel wall T2 signal, bowel wall contrast enhancement pattern and degree, length and number of involved bowel segments, perimural T2 signal, mesenteric inflammation, mesenteric lymph nodes and complications of CD. Each parameter was scored to calculate MRI activity index. Biopsy specimens were retrospectively evaluated, histopathologic and endoscopic acute inflammmation scores (AIS, eAIS) were calculated. Each parameter and total MRI activity index were compared with the pathology scores (AIS, eAIS) by Mann-Whitney U test and Spearman correlation. RESULTS Statistically significant positive correlation was found between AIS and eAIS, mural thickness and eAIS. Moderate correlation was found between MRI activity index and eAIS, mural enhancement degree and eAIS; and poor correlation was found between mesenteric inflammation score and eAIS, MRI activity index and AIS, however they were not statistically significant. CONCLUSIONS In CD, bowel wall thickness measured by MRE is best correlated with the histopathologic results which are accepted as the reference standard. In cases with high MRI activity index, eAIS is also generally high. MRI activity index which is measured simply and noninvasively can be used in the follow up of CD.

Isolated hepatic actinomycosis mimicking hepatocellular carcinoma: Case report and review

Actinomyces are a rare cause of the intra‐abdominal infection that results in chronic suppurative and infectious granulomatous disease. The liver is involved in 15% of cases with abdominal infection and comprises 5% of all cases. Major risk factors include previous surgery, abdominal trauma, gastrointestinal foreign body, gut lesions, and immunosuppression. Due to the insidious course of the disease, symptoms arise several months after onset of the disease. The diagnosis of liver actinomycosis relies on clinical manifestations and imaging findings. Thus, it is often misdiagnosed as a primary liver cancer or metastatic tumor. Here we describe a case of isolated hepatic actinomycosis that mimicked a hepatocellular carcinoma with pretreatment and posttreatment magnetic resonance imaging findings. The patient was cured with long‐term antibiotherapy.

Utility of diffusion-weighted magnetic resonance imaging in diagnosing hepatocellular carcinoma in cirrhotic liver

received: 18.06.2016 Accepted: 08.08.2016 1Department of Radiology, Ümraniye Training and Research Hospital, Istanbul, Turkey 2Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul 3Department of Radiology, King Hamad University Hospital. Bahrain Yazışma adresi: Ahmet Aslan, Department of Radiology, Ümraniye Training and Research Hospital, Istanbul e-mail: aslahmet@gmail.com INtrodUctIoN

Perianal Fistüllerde MR Görüntüleme

Fistül, iki organ ya da yapı arasındaki veya bir organla vücut yüzeyi arasındaki bağlantıyı ifade etmektedir. Perianal fistül, anal kanal ile perine cildi arasındaki bağlantıdır. Genellikle genç erkeklerde görülmekte olup erkeklerde 2-4 kat daha sık izlenmektedir [1]. Perianal fistül prevalansı %0,01 olarak verilmektedir [2]. En sık semptom akıntıdır [2]. Ağrı da sık görülür. Abse oluştuğu zaman perianal bölgede şişlik, kızarıklık, hassasiyet ve ısı artışı görülebilir. Yüksek yerleşimli supralevator abselerde bu bulgular nadir olup, ateş ve halsizlik gibi sistemik bulgular daha sık izlenir [3]. Önemli morbiditeye neden olan perianal fistüllerin tedavisi genellikle cerrahidir. Cerrahi sonrası rekürrensin önlenebilmesi için fistül traktusunun seyrinin doğru olarak saptanması ve ilişkili ikincil traktus ile abselerin preoperatif olarak tespit edilebilmesi gereklidir [4]. Bu komplikasyonların gösterilmesinde manyetik rezonans görüntüleme (MRG) doğruluğu en yüksek olan görüntüleme yöntemidir [5]. Preoperatif görüntüleme ile rekürrens önemli ölçüde azalmakta, fekal inkontinans gibi cerrahiye sekonder komplikasyonlar daha az görülmektedir. Radyolojik tanıda en sık anal endosonografi (AES) ve MRG yöntemleri kullanılmaktadır. Ultrasonografi, yapan kişinin beceri ve tecrübesine dayanmaktadır ve hassasiyeti deneyimli kullanıcılar tarafından gerçekleştirildiğinde bile MRG’ye göre düşüktür. Detaylı anatomik görüntülemeye olanak sağlayarak fistül ile anal sfinkter kompleksinin ilişkisini en iyi gösteren görüntüleme yöntemi MRG’dir [6]. Bu çalışmada perianal bölge anatomisi, görüntülemede kullanılan MRG protokolleri ve en sık kullanılan iki perianal fistül sınıflandırması (Parks ve St James Üniversite Hastanesi sınıflamaları) gözden geçirilecektir.

Acute aortic dissection mimicking acute abdomen in a 14-year-old boy

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14‐year‐old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.