Mustafa Koplay

Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease and is a major public health problem worldwide. It is a spectrum that includes simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Recently, NAFLD prevalence in children and adolescents has increased too. The increasing prevalence has resulted in NASH-related chronic liver disease. Therefore, early diagnosis and treatment is quite important. Although liver biopsy is still the gold standard for diagnosis and staging of NAFLD, particularly for the diagnosis of NASH, imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging with chemical shift imaging and especially magnetic resonance spectroscopy and elastography have been increasingly approved as noninvasive alternative methods. The aim of this review is to analyze the diagnostic accuracy and limitations of the imaging methods and recent developments in the diagnosis of NAFLD.

Congenital left ventricular wall abnormalities in adults detected by gated cardiac multidetector computed tomography: clefts, aneurysms, diverticula and terminology problems.

OBJECTIVES Our aim was to evaluate congenital left ventricular wall abnormalities (clefts, aneurysms and diverticula), describe and illustrate imaging features, discuss terminology problems and determine their prevalence detected by cardiac CT in a single center. MATERIALS AND METHODS Coronary CT angiography images of 2093 adult patients were evaluated retrospectively in order to determine congenital left ventricular wall abnormalities. RESULTS The incidence of left ventricular clefts (LVC) was 6.7% (141 patients) and statistically significant difference was not detected between the sexes regarding LVC (P=0.5). LVCs were single in 65.2% and multiple in 34.8% of patients. They were located at the basal to mid inferoseptal segment of the left ventricle in 55.4%, the basal to mid anteroseptal segment in 24.1%, basal to mid inferior segment in 17% and septal-apical septal segment in 3.5% of cases. The cleft length ranged from 5 to 22 mm (mean 10.5 mm) and they had a narrow connection with the left ventricle (mean 2.5 mm). They were contractile with the left ventricle and obliterated during systole. Congenital left ventricular septal aneurysm that was located just under the aortic valve was detected in two patients (0.1%). No case of congenital left ventricular diverticulum was detected. CONCLUSION Cardiac CT allows us to recognize congenital left ventricular wall abnormalities which have been previously overlooked in adults. LVC is a congenital structural variant of the myocardium, is seen more frequently than previously reported and should be differentiated from aneurysm and diverticulum for possible catastrophic complications of the latter two.

Comparison of Clinical Characteristics and Outcomes of Patients with COPD Exacerbation with or without Venous Thromboembolism

Background: Although some studies evaluated venous thromboembolism (VTE) prevalence in patients with chronic obstructive pulmonary disease (COPD), they contain no detailed description of the patients’ characteristics. Objectives: It was the aim of this study to investigate the frequency and clinical characteristics and outcomes of VTE in patients with COPD exacerbation. Methods: Between October 2004 and February 2005, 120 consecutive patients were included in the study. On admission, Doppler examination of lower extremities in all cases and spiral computed tomography of the thorax in cases with a suspicion of pulmonary thromboembolism were performed. A questionnaire was used to take a detailed history. In addition to routine laboratory tests, chest X-ray, postbronchodilator spirometry, arterial blood gas analysis and serum levels of D-dimer and C-reactive protein were evaluated, as well as dyspnea score and performance status before exacerbation. The hospitalization durations and mechanical ventilation requirements were also recorded. Results: VTE was determined in 16 cases (13.3%). In patients with VTE, the travel history was higher (p < 0.001), the dyspnea score worse (p = 0.005), the duration of hospitalization longer (p < 0.001) and the mechanical ventilation requirement increased (p < 0.001); a change in mental status was highly associated with the presence of VTE (p < 0.001). Conclusions: It seems that VTE occurrence was higher in the presence of a risk factor causing immobility such as travel history and increased dyspnea. The cases with severe disease are more likely to have VTE. Preventive measures may be considered in such patients because their hospitalization stay and mechanical ventilation requirement are increased.

An investigation of the association between coronary artery dominance and coronary artery variations with coronary arterial disease by multidetector computed tomographic coronary angiography.

Purpose: Depending on the perfusing interventricular septum of the arteries, there are 3 types of circulation dominance: right, left, and balanced. In this study, coronary artery branches supplying the ventricular septum were investigated in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. In addition, the association of coronary artery variations with coronary arterial disease was investigated. Materials and Methods: The study included 325 consecutive patients (214 men and 108 women, with a mean age of 59 ± 14 years) who underwent MDCT coronary angiography. Multidetector computed tomography was performed with a 16-detector-row computed tomographic scanner. The type of dominance, coronary arterial diseases, and coronary artery variations were recorded. Results: In our study, the types of coronary circulation were right, left, and balanced in 227 (70%), 40 (12.5%), and 58 (17.5%) patients, respectively. Dominance of right circulation was detected in 150 of 217 (69%) of men and in 77 of 108 (71%) of women; dominance of left circulation was found in 26 of 217(12%) of men and in 14 of 108 (13%) of women; balanced/codominance circulation was found in 41 of 217 (19%) of men and in 17 of 108 (16%) of women. However, no significant differences were detected between the sexes for the type of coronary circulation. Coronary artery disease was determined in 68 patients (20.9%) by MDCT, and coronary artery variations were also determined in 34 patients (10.4%). Both the number and the rate of coronary artery variations were significantly higher among the patients with left artery dominance. Conclusions: Knowledge of coronary artery variations and pathologies is important in planning the treatment and in interpretation of findings of cardiovascular diseases. Our study indicated that, although right dominance circulation is more common in general population, both the coronary diseases and coronary artery variations are more common in individuals with left dominance circulation.

Comparison of apparent diffusion coefficient values among different MRI platforms: a multicenter phantom study

PURPOSE We aimed to compare apparent diffusion coefficient (ADC) values among magnetic resonance imaging (MRI) scanners from different vendors. MATERIALS AND METHODS We used a custom-made phantom solution consisting of distilled water, 0.9% NaCl, 25% NaCl, and shampoo for diffusion-weighted MRI (DW-MRI) examinations. DW-MRI was performed with similar sequence parameters using six different 1.5 Tesla MR scanners (scanners A-F). ADC maps were automatically constructed for all DW-MR images (b factors of 0 and 1000 s/mm(2)). ADC measurements were performed using regions of interest and seven different software programs, including four different postprocessing workstations, two different picture archiving and communication systems, and operator console software for each MR scanner. RESULTS The ADC values generated by scanners A and F were higher and those of scanner B were lower than those generated by the other scanners (P = 0.002). The intravendor difference in the ADC values averaged from scanners D, E, and F was statistically significant (P < 0.001). The difference between the ADC values obtained by scanners C and E was not statistically different (P = 0.15). CONCLUSION ADC values may differ among different MRI systems used for DW-MRI. Thus, the MRI vendor should be considered when using DW-MRI in a clinical setting.

Association Between Serum Vitamin B12 Levels and the Degree of Steatosis in Patients With Nonalcoholic Fatty Liver Disease

Purpose A relationship between liver diseases and serum vitamin B12 levels was observed in previous reports. The purpose of this study was to determine if a similar relationship existed between vitamin B12 and nonalcoholic fatty liver disease (NAFLD), a common chronic liver disorder. Materials and Methods A total of 45 consecutive patients with NAFLD formed the NAFLD group, whereas 30 healthy controls (HC) formed the HC group. The subjects in all of the groups were of similar age and body mass index (BMI). A fatty liver is described in 3 ultrasonographic grades. Fasting blood samples were obtained, and serum vitamin B12 levels were measured. In addition, liver enzymes including aspartate aminotransferase, alanine aminotransferase (ALT), and alkaline phosphatase, and folic acid and other serum parameters were evaluated. The Mann-Whitney U test, χ2 test, and Spearman correlation analysis were used to compare the vitamin B12 levels and other serum parameters in both groups. Results The mean ± SD age and BMI of the NAFLD were 47.2 ± 11.2 and 28.8 ± 3.5. The mean ± SD age and BMI of the HC were 47.1 ± 8.8 and 27.7 ± 2.9, respectively. The serum aspartate aminotransferase and ALT levels of the patients with NAFLD were statistically higher compared with those of the controls (P = 0.001). The levels of vitamin B12 and folate were statistically lower in the NAFLD patients compared with those of the controls (P < 0.05). We found that there was a reduction of vitamin B12 levels, especially in grade 2 to grade 3 hepatosteatosis. In addition, in the Spearman correlation analysis between the vitamin B12 levels and ALT, the grade of fatty liver and the liver dimension were found to have an important negative correlation. Conclusion The serum vitamin B12 levels were significantly lower in the patients with NAFLD than in those of the control group; however, these still remain in the reference range. Consequently, low vitamin B12 levels may be associated with NAFLD especially in grade 2 to grade 3 hepatosteatosis.

Diagnostic efficacy of diffusion‐weighted MRI for pre‐operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma

To determine the diagnostic accuracy of diffusion‐weighted magnetic resonance imaging (DW‐MRI) for the pre‐operative assessment of patients with endometrial carcinoma and to assess myometrial and cervical invasion as well as pelvic lymph node metastasis.

An investigation of the anatomical variations of left atrial appendage by multidetector computed tomographic coronary angiography

PURPOSE The left atrial appendage (LAA) is usually known as a long, tubular, hooked structure derived from the left atrium. However, it varies widely in terms of anatomical shape. In this study, anatomical shape variations of the LAA were investigated and classified in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. MATERIALS AND METHODS The study included 320 consecutive patients (223 men and 97 women, with a mean age of 58 years) who underwent MDCT coronary angiography. MDCT was performed with a 64-detector-row computed tomographic scanner. LAA anatomical variations were classified as five main types and further divided into subtypes. In addition, we gave the classifications descriptive names according to the anatomical external appearance of the LAA: horseshoe (type 1), hand-finger (type 2a), fan (type 2b), wing (type 2c), hook (type 3), wedge (type 4) and swan (type 5) shapes. The types and subtypes of the LAA variations and the presence of thrombus were recorded. RESULTS In our study, the LAA tip orientation was used and the LAA was divided into type 1, type 2a, 2b, 2c, type 3, type 4 and type 5 in 44 (13.8%), 65 (20.3%), 155 (48.4%), 8 (2.5%), 27 (8.4%), 6 (1.9%) and 15 (4.7%) patients, respectively. LAA thrombus was detected in four patients (1.25%), who had classified LAA shapes of type 2a and type 2b. CONCLUSIONS The LAA has multiple anatomical shape variations. We demonstrated previously undefined new shape types of LAA. Knowledge of LAA variations is important in order to avoid procedure-related complications when ablative treatment is to be performed or if surgical procedures are indicated in this region. MDCT coronary angiography provides important and detailed information about determining and evaluating these variations before undertaking a planned procedure in this region.

Isolated omental hydatid cyst: clinical, radiologic, and pathologic findings

Hydatid disease (HD) is a parasitic disease that is most commonly caused by the larval stage of Echinococcus granulosus. It is still a severe public health problem in the world and most commonly involves the liver and the lungs. However, HD can occur in almost any part of the body. Isolated omental hydatid cyst is one of the least common sites. Information about the appearance of cysts within the omentum is limited because of their extremely rare occurrence. In the evaluation of HD, clinical findings, serologic tests, and imaging methods such as plain radiography and ultrasonography are useful. This report describes the clinical, radiologic, and pathologic findings of omental hydatid cyst in addition to a literature review.

Multiple renal arteries: variations demonstrated by multidetector computed tomography angiography.

Objective: To present a case of a rare variation of the renal artery and multiple (7) renal arteries by multidetector computed tomography (MDCT) angiography. Clinical Presentation and Intervention: A 36-year-old male patient was admitted to our hospital as a potential living donor for renal transplantation. An MDCT angiography was performed using a 16-detector row CT scanner to obtain a detailed image of vascular structures and associated pathologies. The MDCT clearly revealed the presence of 3 right and 2 left renal arteries arising from the abdominal aorta. Additionally, the accessory renal artery arose from the inferior mesenteric artery on the left side and from the common iliac artery on the right side. Conclusion: This case highlights the importance of awareness of renal artery variations if surgical procedures are indicated in this region.