Omer Karakas

The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis

This study aimed to evaluate the changes in spleen and liver diffusion-weighted magnetic resonance imaging (DWI) in chronic viral hepatitis patients. The study comprised 47 patients and 30 healthy volunteers. DWIs were obtained. Apparent Diffusion Coefficient (ADC) measurements were made by transferring the images to the workstation. The measurements of value b 1000 were made from a total of five points of the liver and three points of the spleen. Liver biopsy was performed on the 47 patients. The fibrosis stages of the patients were defined according to the METAVIR scoring system. Students t-test was used in the comparison of mean ages, liver and spleen ADC values between the patient and the control group. Kruskal-Wallis followed by Mann-Whitney U Test with Bonferroni adjustment was performed in the comparison of mean ADC values of the patients at different stages and the control group. A statistically significant difference was determined between the patient and control group in respect of liver and spleen mean ADC values (P<0.05). F3 group showed a significant difference compared to control and F1 and F4 group showed a significant difference compared to control, F1, F2 and F3 group in terms of the mean liver ADC value (P<0.01). F3 and F4 group showed a significant difference compared to control and F1 group in terms of the mean spleen ADC value (P<0.01). As a result we believe that the measurement of liver and spleen ADC values may be an indicator in the determination of the level of fibrosis.

Diffusion-Weighted MRI of the Testes in Patients With Varicocele: A Preliminary Study

OBJECTIVE This preliminary study aimed to evaluate changes in apparent diffusion coefficient (ADC) values of the testes in patients presenting with varicocele. SUBJECTS AND METHODS This cross-sectional study included 25 consecutively recruited patients with varicocele and 25 healthy control volunteers. The ADC values were measured in all participants. Kolmogorov-Smirnov tests were used to test the normality of the data distributions, and the data were expressed as arithmetic means and SDs. A one-way analysis of variance with a post hoc Bonferroni test was used to analyze normally distributed continuous data. Independent sample Student t tests were used to compare continuous variables between two groups. Furthermore, a Pearson correlation coefficient analysis was used to examine the association of venous diameters with mean ADC values in patients with varicocele. A two-sided p value < 0.05 was considered statistically significant. Sensitivities, specificities, and areas under the curve were calculated for the ADC values. RESULTS The ADC values associated with the ipsilateral testicular parenchyma of patients with varicocele were found to be lower than those of healthy volunteers. Moreover, the ADC values of the contralateral testicular parenchyma in patients with varicocele were also lower than those of healthy volunteers. The sensitivity and specificity of ADC values were 90% and 96%, respectively, for patients with varicocele and 89.5% and 96% for healthy volunteers. The mean ADC values were significantly negatively correlated with venous diameter. CONCLUSION The measurement of testicular ADC values may be used as a diagnostic indicator in the detection of testicular fibrosis.

The role of diffusion-weighted magnetic resonance imaging in the classification of hepatic hydatid cysts

The aim of the study was to classify different types of hepatic hydatid cysts (HHCs) by measuring the mean apparent diffusion coefficient (ADC) using diffusion-weighted magnetic resonance imaging (DWI). This prospective study comprised 44 patients. The 44 HHCs were classified using Gharbi ultrasonographic classification (GUC) and then T2WIs and DWIs were obtained. The ADC values were measured of the hydatid cyst (HC) subtypes. The distribution of the ADC values in the cyst groups was compared using the Kruskal-Wallis test for multi groups and the Mann-Whitney U test for paired groups. To evaluate the efficacy of ADC values in cyst diagnosis, receiver operating characteristic (ROC) analysis was performed. According to the GUC, there were 15 type 1, 11 type 2, 7 type 3, 5 type 4 and 6 type 5 HHCs. According to the ADC values in the paired comparisons, while types 1, 2 and 5 HCs were statistically differentiated from all other groups except the type 3 group, the type 4 group was differentiated from all other groups and the type 3 group was only differentiated from the type 4 group. When two groups were formed from the HHC subtypes with types 1, 2, and 3 in one group and types 4 and 5 in the other, a statistically significant difference was determined in the mean ADC values of these new groups. In conclusion the measurement of ADC values can be considered a promising parameter as an alternative to ultrasonography in the determination of subtypes of HHCs.

An Evaluation of Subacute Sclerosing Panencephalitis Patients with Diffusion-Weighted Magnetic Resonance Imaging

PurposeThis study aimed to evaluate the contribution of diffusion weighted magnetic resonance imaging to the diagnosis and staging of subacute sclerosing panencephalitis.Material and MethodThe study comprised 26 patients diagnosed with subacute sclerosing panencephalitis at our clinic who were undergoing regular follow-up, and a control group of 18 subjects. Clinical staging was determined by Risk and Haddad classification; 12 at Stage II and 14 at Stage III. Diffusion weighted magnetic resonance images were taken of six areas (frontal, parieto-occipital, cerebellar, deep white matter, thalamus and basal ganglia) and by calculating the apparent diffusion coefficient (ADC) values, and a comparison was made between the stages and with the control group.ResultsThe ADC values of all the areas of the subacute sclerosing panencephalitis patients were found to be significantly higher compared to the control group (p < 0.05). While the mean ADC values of the deep white matter, basal ganglia, frontal and parieto-occipital areas of the Stage II patients were found to be significant compared to the control group (p < 0.05), there was no significance in the other areas (p > 0.05). The ADC values of all the areas of the Stage III patients were found to be significantly high compared to the Stage II values (p < 0.05).ConclusionDiffusion weighted magnetic resonance imaging can be used with other diagnostic criteria to confirm diagnosis of subacute sclerosing panencephalitis and to reveal differences between the stages.

Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion.

PURPOSE We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. MATERIALS AND METHODS This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. RESULTS According to Lights criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4-33) was significantly higher than that of the transudates (median, 5; range, 2-15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CONCLUSION CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation.

Traumatic Fronto-Ethmoidal Encephalocele: A Rare Case

Encephalocele is defined as herniation of the brain tissue from a bone defect in the cranium. It may be congenital, traumatic, tumoural or develop spontaneously. Traumatic fronto-ethmoidal encephalocele is rare and should be kept in mind for patients who have suffered trauma. Early diagnosis is important in terms of preventing life-threatening complications such as meningitis. Encephalocele and cerebrospinal fluid (CSF) leakage can be easily determined with basic radiological imaging methods and clinical findings. The computed tomography (CT) and magnetic resonance imaging (MRI) findings are here presented of a case with traumatic encephalocele.

Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension

Background and Aim: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy. Setting and Design: Designed as a cross-sectional study. Materials and Methods: We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. Results: Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively). Conclusions: Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.

An evaluation of thyrotoxic autoimmune thyroiditis patients with triplex Doppler ultrasonography.

OBJECTIVE This study aimed to investigate the usefulness of blood flow parameters obtained from STA and CCA with Triplex Doppler ultrasonography (TDU) on patients with thyrotoxicosis. MATERIALS AND METHODS This cross-sectional study included consecutive 24 patients with thyrotoxicosis and 18 healthy controls. The thyroid gland blood flow parameters were evaluated with TDU. RESULTS The thyroid volumes and FT3, TRAb, 4-h and 24-h radioactive iodine uptake (RAIU) levels of Group 1 were significantly high compared to those of Group 2. The thyroid volumes and FT3, FT4 and TSH levels of both Group 1 and Group 2 showed a statistically significant difference compared to Group 3. STA-PSV values for Group 1, Group 2 and Group 3 were 138 cm/s, 54 cm/s and 37 cm/s, respectively. STA-EDV values for these groups were 60 cm/s, 25 cm/s and 15 cm/s, respectively. PSVR values for these groups were 1.01, 0.45, 0.34 cm/s, respectively. EDVR values for these groups were 1.29, 0.70 and 0.49 cm/s, respectively. In Group 1, STA-PSV, STA-EDV, PSVR and EDVR values were significantly high compared to those of Group 2. RAIU levels showed a significant positive correlation with the STA-PSV, STA-EDV and PSVR. CONCLUSION The thyroid gland blood flow parameters may be used in clinical diagnosis of patients with thyrotoxicosis.

Renkli akım doppler ultrasonografi ile tirotoksik otoimmün tiroiditli hastaların değerlendirilmesi

Objective: In this study, we aimed to examine the availability and the effects of differential diagnosis of thyroid gland morphological changes and blood flow patterns in patients with thyrotoxic phase Graves’ disease (BGD) and Hashimoto’s thyroiditis (HT) by color flow doppler ul trasonography (CDUS). Methods: This cross-sectional study was included 24 consecutive patients with thyrotoxicosis and 18 healthy controls. There were Basedow-Graves’ disease in 17 and Hashimoto thyroiditis in 7 of previously untreated 24 patients. Morphological information of thyroid gland was obtained by B-mode ultrasonography in all cases. Blood flow pattern of the thyroid gland was determined by CDUS. Results: The thyroid volumes and FT3, TRAb, 4-h and 24-h RAIU levels of the patients with Graves’s disease were significantly higher than the patients with HT. Whereas thyroid gland echogenicity was decreased in 14 of BGH cases, it was diminished in 2 patients with HT. Significant difference was found between BGD and HT groups in terms of thyroid gland echogenicity. In all patients with BGD and HT, echopattern was heterogenous. In all patients, blood flow patterns of thyroid gland were obtained by CDUS. Color flow doppler ultrasonography and pattern 3 blood flows were only observed in BGD. Significant difference was found between HT and BGD groups in blood flow pattern. Conclusion: Heterojen echopattern, decreased echogenicity, volume changes and type 3 blood flow pattern of thyroid gland obtained using B-mode Ultrasound and CDUS may be useful in the determination and differentiation of thyrotoxic BGD and HT diseases. J Clin Exp Invest 2013; 4 (1): 73-79 OZET

Cervicomediastinal Giant Cystic Hygroma: A Case Report

Cystic hygroma is a rare congenital malformation of the lymphatic system. It is most frequently detected in the head and neck region. Ultrasonography is performed as the first step for radiological diagnosis of these lesions. Magnetic resonance imaging provides important information for diagnosis and to guide treatment. In this paper, a case is reported of cervicomediastinal large cystic hygroma in a male infant.