Özlem Tokgöz

Diffusion-weighted imaging in the head and neck region: usefulness of apparent diffusion coefficient values for characterization of lesions.

PURPOSE We aimed to evaluate the role of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging for head and neck lesion characterization in daily routine, in comparison with histopathological results. METHODS Ninety consecutive patients who underwent magnetic resonance imaging (MRI) at a university hospital for diagnosis of neck lesions were included in this prospective study. Diffusion-weighted echo-planar MRI was performed on a 1.5 T unit with b factor of 0 and 1000 s/mm2 and ADC maps were generated. ADC values were measured for benign and malignant whole lesions seen in daily practice. RESULTS The median ADC value of the malignant tumors and benign lesions were 0.72×10-3 mm2/s, (range, 0.39-1.51×10-3 mm2/s) and 1.17×10-3 mm2/s, (range, 0.52-2.38×10-3 mm2/s), respectively, with a significant difference between them (P < 0.001). A cutoff ADC value of 0.98×10-3 mm2/s was used to distinguish between benign and malignant lesions, yielding 85.3% sensitivity and 78.6% specificity. The median ADC value of lymphomas (0.44×10-3 mm2/s; range, 0.39-0.58×10-3 mm2/s) was significantly smaller (P < 0.001) than that of squamous cell carcinomas (median ADC value 0.72×10-3 mm2/s; range, 0.65-1.06×10-3 mm2/s). There was no significant difference between median ADC values of inflammatory (1.13×10-3 mm2/s; range, 0.85-2.38×10-3 mm2/s) and noninflammatory benign lesions (1.26×10-3 mm2/s; range, 0.52-2.33×10-3 mm2/s). CONCLUSION Diffusion-weighted imaging and the ADC values can be used to differentiate and characterize benign and malignant head and neck lesions.

Color Doppler Evaluation of the Retrobulbar Hemodynamic Changes in Chronic Obstructive Pulmonary Disease: COPD and Retrobulbar Hemodynamic Changes.

The aim of this study was to evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography, and to compare the results with those of healthy control subjects. The control group consisted of 35 healthy subjects who had no systemic problems, while the study group consisted of 60 patients with the diagnosis of COPD. Patients with COPD were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Twenty patients of stage 1 COPD (mild airflow limitation), stage 2 COPD (moderate airflow limitation), or stage 3 COPD (severe airflow limitation) were included in the groups 1, 2, and 3, respectively. Measurements were performed in both eyes of each participant. Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA). The RI and PI measurements of the OA, CRA, and PCA were significantly higher in group 3 when compared to the control group and groups 1 and 2. These significances were not observed when PSV and EDV values were compared. There were also no significant differences between groups 1, 2, and control patients, when mean PSV, EDV, RI, and PI values of all arteries were compared. None of the above parameters showed statistical significance when mean RI, PI, PSV, and EDV were compared between left and right eyes. Severe (stage 3) COPD is associated with impaired retrobulbar hemodynamics. Increased hypoxia and vascular mediators may be suggested in etiology.

Changes in renal Doppler ultrasonographic parameters in patients managed with rigid ureteroscopy.

Background There has been no study evaluating the intrarenal hemodynamic changes after ureteroscopy in the published literature. Purpose To determine preoperative and postoperative intrarenal vascular parameters such as resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), measure changes on these values (ΔRI, ΔPI, ΔPSV, ΔEDV) after ureteroscopy (URS) and compare the outcomes with the results of normal contralateral kidneys, and finally investigate possible parameters that would affect renal vascular resistance changes. Material and Methods We prospectively studied 47 patients who underwent rigid URS. Preoperative grayscale and Doppler ultrasonography (CDUS) measurements were obtained 24 h before URS. Similarly, postoperative CDUS measurements were done 24 h after the operation. The degree of hydronephrosis and location of stones in the obstructed kidneys, diameters of both kidneys, and thickness of renal parenchyma were evaluated with gray-scale US followed by CDUS with calculation of the intrarenal RI, PI, PSV, and EDV values for each kidney. Results For the operated kidneys, statistically significant P values were noticed when RI and PI values were considered (P < 0.001). ΔRI and ΔPI of the operated kidneys were also significantly greater than the values for non-operated kidneys (P < 0.001).However, it was not the case for ΔPSV and ΔEDV values. In Spearman correlation coefficient analysis, ΔRI was found to be correlated with the parameters: “operative time” and “irrigation fluid volume”. No significant relation was documented between ΔRI and the other parameters: age, gender, side of ureteroscopy, stone location, and degree of hydronephrosis. Conclusion Significant changes in RI and PI values in patients treated with URS reveal that URS can cause a significant increase in renal vascular resistance. With the increase in operative time and irrigation fluid volume used during the operation, RI seems to be significantly increased.

Diagnostic values of detrusor wall thickness, postvoid residual urine, and prostate volume to evaluate lower urinary tract symptoms in men.

PURPOSE This prospective, controlled clinical study aimed to assess the diagnostic values of detrusor wall thickness (DWT), postvoid residual urine volume (PVR), and prostate volume in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS During an 18-month period, a total of 243 males were included in the study. Three groups were assessed due to their International Prostate Symptom Score (IPSS): men with normal lower urinary tracts (n = 51; control group), men with mild LUTS (n = 60; Group 1), and men with moderate to severe LUTS (n = 132; Group 2). DWT, bladder, and prostate volumes and PVR were measured by suprapubic ultrasonography. DWT was measured when the bladder was full (DWT-1) and when it was empty (DWT-2). RESULTS The mean age for the study population was 60.0 ± 0.6 years, while the mean IPSS for the whole group was 8.0 ± 0.4. Both the bladder and prostate volumes in Group 2 were statistically significantly higher than the control group and Group 1. The mean DWT-1 values were significantly lower in the control group when compared to Groups 1 and 2. However, when study groups were compared with each other, no statistical significance was noticed (1.12 vs. 1.17 mm). In contrast, the mean PVR and DWT-2 values were significantly different in each group. There was a significant correlation between IPSS questionnaire results and all individual parameters. CONCLUSION Suprapubic transabdominal ultrasonographic assessment of the lower urinary tract in a noninvasive manner allows the clinician to assess LUTS severity in men without morbidity. Additional studies are necessary to provide further conclusions regarding this clinical procedure.

Can Hounsfield unit values of the cortex and papillae determined by computed tomography demonstrate the possibility of kidney stone formation

PURPOSE This study is aimed at measuring HU values of the renal cortex and papillae in patients with nephrolithiasis and demonstrating renal changes associated with nephrolithiasis. MATERIALS AND METHODS Measurements were performed with regard to HU values of the cortex and papillae of 82 patients with unilateral nephrolithiasis and 81 patients in the control group at the level of the upper pole, middle region and lower pole of both kidneys. RESULTS When the HU values obtained from the upper pole, middle region and lower pole of the kidney with calculi and unaffected kidney in patients with nephrolithiasis were compared with those for the control group, the difference among the groups were found to be significant (p<0.001). A comparison of the cortex and papillae densities of the affected and unaffected kidneys in patients with unilateral nephrolithiasis were compared with regard to the upper pole and middle region, no statistically significant difference was observed with regard to both the cortex and papillae densities of the upper pole, middle region. However, in those patients with calculi in the lower pole, the region with calculi has a higher papillae density as compared to the unaffected region. CONCLUSION Both kidneys in patients with calculi have a comparatively high renal cortex and papillae densities. In the future, this information may be useful in predicting which patients may develop nephrolithiasis.

An unusual case of neuro-Behçet’s disease presenting with co-occurence of cerebral venous sinus thrombosis with basilar artery occlusion

Non-parenchymal neuro-Behçet disease generally affects cerebral venous sinuses, whereas intracranial intracerebral arterial involvement has been rarely reported. But co-involvement of both intracranial intracerebral artery and venous vascular systems in a patient at the same time has not been mentioned before. To the best of our knowledge, this case involving a 25-year-old male with a 7-year history of Behçet disease is the first reported of this type of involvement. He developed occlusion of the basilar artery together with thrombosis of the left sigmoid sinus, distal internal jugular vein, and straight sinus. He was successfully treated with a combination of high-dose steroid and cyclophosphamide. Cranial magnetic resonance angiography demonstrated the resolution of these abnormalities.

Urethral diverticulum presenting as a scrotal mass in a paraplegic male: Report of a case and review of the literature

Male urethral diverticula are rare and can be congenital or acquired. We report a case of acquired urethral diverticulum presenting as a scrotal mass in a paraplegic male. On physical examination, the scrotal mass mimicked a primary intrascrotal lesion. However, on retrograde urethrography, the correct diagnosis was made. The patient had a small incontinent spastic bladder with a history of prolonged catheterization. Eventually, the urethral diverticulum was excised including the affected segment of bulbous urethra. Pathologic examination revealed the diverticulum wall lined by granulation and chronic inflammatory tissue.

The investigation of correlation between semen analysis parameters and intraparenchymal testicular spectral Doppler indices in patients with clinical varicocele.

Objectives Our aim was to evaluate the effect of clinical varicocele on testicular microcirculation measured by spectral Doppler analysis and investigate the correlation between Doppler ultrasonographic findings and semen parameters. Methods Fifty patients who received a diagnosis of clinical varicocele in the Urology Department of our university hospital were enrolled in this prospective study. Varicocele grades were determined according to sonographic parameters, and a scrotal vein with a diameter of 2.5 mm or greater on color Doppler ultrasonography was included in the study. Spectral Doppler measurements of testicular arteries (peak systolic [PSV]/end-diastolic velocity [EDV], resistivity index [RI], pulsatility index [PI]) were measured from capsular and intratesticular branches of testicular arteries. All the patients were also assessed by semen analysis. Results Mean age was 29.08 ± 5.42 years (range, 18–45 years). Among the whole study population, 22 men had isolated left varicocele, and 28 had bilateral varicoceles. No statistically significant correlation was found between the Doppler parameters: RI, PI, and EDV, and semen analysis parameters: count, motility, volume, and morphology. On the other hand, both in unilateral and bilateral varicocele cases, PSV was found to be significantly correlated with sperm count (P < 0.05). Conclusions Spectral Doppler analysis can provide valuable information as a noninvasive method to assess the hemodynamic changes and testicular microcirculation status in cases of clinical varicocele. However, RI, PI, and EDV values of capsular and intraparenchymal branches of testicular arteries may not be used as indicators of semen parameter deterioration. Hopefully, PSV measurement may give more conclusive data to predict sperm count. In addition, the cutoff value for this index has to be determined for future studies.

The Doppler ultrasonographic evaluation of hemodynamic changes in hepatic vascular structures in patients with hepatosteatosis.

Summary Background The hemodynamic changes in hepatic vascular structures of hepatosteatosis patients were examined using Doppler ultrasonography. Material/Methods Ninety hepatosteatosis patients, classified as mild, moderate or severe, and 30 healthy volunteers were included in this 120-person study. The height, weight, liver size, blood lipids and blood liver function tests of the subjects were measured. Those values were compared in the patient and control groups. In the patient and control groups, color duplex Doppler ultrasonography was used to examine portal vein peak velocity, portal vein flow volume, hepatic artery resistive index (RI), hepatic artery pulsatility index (PI) and hepatic artery flow volume. Results Similarly to the degree of hepatosteatosis, increases in body mass index, liver size, liver enzyme levels and blood lipid levels were statistically significant (p<0.05). While the difference in portal vein peak velocity in the hepatosteatosis and control groups was not statistically significant, there was an increasing reduction in the degree of steatosis (p>0.05). As the degree of hepatosteatosis increased, there was a reduction in hepatic artery flow volume, portal vein flow volume and total flow volume that was not statistically significant. In the mild hepatosteatosis group, hepatic artery RI and PI values were statistically significantly lower than in the other groups (p<0.05). In the severe hepatosteatosis group, although the hepatic artery RI and PI values were not statistically significant, there was a minimal increase compared to the other groups. Conclusions It is believed that those results were caused by a reduction in liver compliance and hepatic vascular compliance, in addition to resistance increase in vascular structures.

The importance of renal Doppler ultrasonographic evaluation in acute ureteral obstruction in pregnant women.

I read the article by Dr. Pepe and associate with interest [1]. They evaluated 234 pregnant women asymptomatic in 204 cases and with unilateral renal colic in 30 by duplex Doppler and conventional Ultrasonography to detect possible renal/ureteral pathology. The mean intra-arterial resistive index (RI) and the difference of mean resistive index between both kidneys (delta RI) were measured from interlobar arteries as we did in our study published recently [2]. A renal RI [ 0.70 and/or a 10 % difference between the kidneys were considered as diagnostic of obstructive uropathy. The detected mean RI for obstructed kidneys was significantly higher than a mean RI of contralateral normal kidneys. Accordingly, we were interested in the changes in renal Doppler ultrasonographic parameters in patients managed with rigid ureteroscopy [2]. In urology practice, during a ureteroscopic operation, because of the irrigation fluid used, the irrigation pressures generated within the collecting system can be elevated, and can cause pyelovenous and pyelolymphatic backflow. This backflow may create a pressure on intrarenal vasculature and may also contribute to the increase in renal vascular resistance. Amount of the irrigation pressures transmitted to the renal pelvis, collecting ducts and subsequently to the parenchyma determine the degree of the vasoconstrictive response that would eventually lead to an increase in RI values. As we hypothesized, RI and delta RI values of the operated kidneys were found to be significantly greater than the values for non-operated kidneys. Delta RI was regarded as the mean difference between the postoperative and preoperative RI values in the same kidney. In contrast, in the study by Pepe et al., the difference in mean RI of the obstructed and contralateral kidneys was accepted as delta RI. In anyway, both studies reveal the importance of RI measurements in obstructed cases. In current clinical practice, Doppler ultrasonographic measurements and relevant RI values are not regarded as the primary diagnostic modalities in the functional evaluation of the urinary tract. If we accept ureteroscopic investigation somehow a simulation of a ureteral obstruction, in all suspected ureteral/ renal obstructions (whatever the cause is), evaluation via Doppler ultrasonography may guide the clinician to determine the obstructive degree of renal units. With the calculation of delta RI, increase in RI values in renal units when compared to contralateral ones should be determined, thereby the amount of obstructive stress/pressure on diseased kidney might be suspected. In clinical perspective, by this way, the clinician can have an idea of the obstructive degree of a certain pathology. Hence, treatment options would more readily and correctly be decided. For example, a ureteral stone in a pregnant woman might be treated with conservative medical expulsive therapy if delta RI is low, or it may be eliminated by endoscopic surgery within a short period of time if delta RI is high. Difficulty in determining a certain threshold value for delta RI remains a problematic issue, since delta RI values range just between 0.00 and 0.10 as in our study. Percent calculations, as Dr. Pepe preferred (10 % RI difference between kidneys), can rather be more suggestive and discriminative. In conclusion, we advice delta RI measurements in acute renal colic to determine the degree of obstructive stress on O. Tokgoz (&) Department of Radiology, School of Medicine, Bulent Ecevit University, Hastanesi S-Blok Kat:4, Kozlu, Zonguldak 67600, Turkey e-mail: h_tokgoz@hotmail.com