Nevra Elmas

The role of diagnostic radiology in pancreatitis

Acute pancreatitis is a frequent inflammatory and necrotic process of pancreas and peripancreatic field. To detect the presence of infected or sterile necrotic components and hemorrhage of the pancreatic paranchyma is important for therapeutic approach. Chronic pancreatitis is characterized by irreversible exocrine dysfunction, progressive loss of pancreatic tissue and morphological changes of the pancreatic canal. Imaging modalities play a primary role in the management of both acute and cronic pancreatitis. CT and MR imaging confirm the diagnosis and detect the severity of disease. In chronic pancreatitis, MRCP after Secretin administration, Spiral CT and endoscopic US seems to replace diagnostic ERCP. However differentiation of pseudotumor of chronic pancreatitis from the pancreatic carcinoma is difficult with either imaging modalities.

CT findings of abdominal tuberculosis in 12 patients

Our purpose was to evaluate the Computed Tomography (CT) findings of the abdominal tuberculosis (TBC) retrospectively which was diagnosed histopatologically. This study included 12 patients. All patients were evaluated by abdominal CT study. Most findings of CT studies were mesenteric calcified or noncalcified lymphadenopathies, ascites, thickened intestinal wall located on the right lower quadrant of abdomen, thickening of peritoneum, mottled soft-tissue densities in omentum and mesenterium. In addition, one of the patients had bilateral calcified adrenal glands and one of them had calcified mass in adrenal gland. If peritoneal thickening, ascites, abdominal lymphadenophaties and thickened intestinal walls are obtained, TBC should be considered in differential diagnosis in developing countries.

Colorectal carcinoma: radiological diagnosis and staging

Colorectal carcinomas are the most common gastrointestinal tract tumors. 50-60% of the colorectal carcinomas originate in rectum and sigmoid colon. The new developments in imaging modalities have brought improvements in therapeutic aspects. The survival rates in these patients depend on the tumor penetration and the presence of regional lymph node or distant metastasis. The recurrence rates have decreased with the new operation techniques and preoperative radiotherapy, thus increasing the importance of accurate tumor staging. Double contrast barium enema studies enable the diagnosis while staging and follow-up is best done by topographic imaging techniques.

Evaluation of Treatment Response of Chemoembolization in Hepatocellular Carcinoma with Diffusion-Weighted Imaging on 3.0-T MR Imaging

PURPOSE To assess the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization with diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance (MR) imaging with a 3-T system. MATERIALS AND METHODS Between February 2010 and November 2010, 74 patients were treated with chemoembolization in our interventional radiology unit. Twenty-two patients (29%) who had liver MR imaging including diffusion and dynamic contrast-enhanced MR imaging on a 3-T system before and after transarterial chemoembolization were evaluated retrospectively. Tumor size, arterial enhancement, venous washout, and apparent diffusion coefficient (ADC) values of lesions, peritumoral parenchyma, normal liver parenchyma, and spleen were recorded before and after treatment. The significance of differences between ADC values of responding and nonresponding lesions was calculated. RESULTS The study included 77 HCC lesions (mean diameter, 31.4 mm) in 20 patients. There was no significant reduction in mean tumor diameter after treatment. Reduction in tumor enhancement in the arterial phase was statistically significant (P = .01). Tumor ADC value increased from 1.10 × 10(-3) mm(2)/s to 1.27 × 10(-3) mm(2)/s after treatment (P < .01), whereas the ADC values for liver and spleen remained unchanged. ADC values from cellular parts of the tumor and necrotic areas also increased after treatment. However, pretreatment ADC values were not reliable to identify responding lesions according to the results of receiver operating characteristic analysis. CONCLUSIONS After transarterial chemoembolization, responding HCC lesions exhibited decreases in arterial enhancement and increases in ADC values in cellular and necrotic areas. Pretreatment ADC values were not predictive of response to chemoembolization.

Correlative CT, MRI and histological findings of hepatic Echinococcus alveolaris: a case report

Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serologic, sonographic and CT findings. Literature review yielded only one report discussing the MRI findings of hepatic EA infestation. In this report, we present a case of hepatic EA infestation with its correlative CT, MRI and histological findings. CT showed hypodense mass involving more than half of the liver with rim and central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. On MRI, the portal vein branches were seen coursing through the lesion. Neither CT nor MRI demonstrated any contrast enhancement of the mass. On the histological examination, abundant fibrous and hyalinized tissue surrounding multiple small cysts were observed. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.

Stromal predominant type mesenchymal hamartoma of liver: CT and MR features

Mesenchymal hamartoma is a rare pediatric liver tumor. The tumor is mainly cystic but occasionally a solid component is seen. Therefore the tumor can be divided into two forms: (a) cystic predominant, and (b) stromal predominant. In this report, CT and MR features of stromal predominant type mesenchymal hamartoma are presented.

PEUTZ-JEGHERS SYNDROME : CT AND US DEMONSTRATION OF SMALL BOWEL POLYPS

A family affected with Peutz-Jeghers syndrome is reported with an emphasis on radiological findings. A patient showed extensive pigmentation around the lips, buccal mucosa, and nose. Another showed prolonged transient intussusception of a jejunal loop on barium meal examination, and massive rectal bleeding. In this patient, small bowel polyps could also be seen on ultrasonography (US) and computed tomography (CT). On CT several polyps, up to 3 cm in size, were detected along with a “carpeting” pattern of several loops presumably caused by multiple small polyps.

Unusually large cisterna chyli: US and MRI findings

We report a rare appearance of cisterna chyli appearing as a giant cystic structure on routine abdominal ultrasonography (US). Diagnosis was established with color Doppler US and after magnetic resonance imaging. This report describes an unusual appearance of the cisterna chyli that radiologists should be familiar with, especially on the routine conventional gray-scale US to avoid mistaking it for a pathologic condition.

Experience of the Izmir Pediatric Oncology Group on Neuroblastoma: IPOG-NBL-92 Protocol

This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkeys social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.

Mesenteric Castleman's disease: case report

An asymptomatic case of hyaline vascular–type Castlemans disease localized to the mesentery and detected incidentally by ultrasound is presented. Computed tomographic, angiographic, and histologic findings are reported. This type of Castlemans disease predominates in the thorax and is very rare in the mesentery.