Ravza Yilmaz

Cardiac Hydatid Disease: CT and MRI Findings

OBJECTIVE The purpose of this article is to review the CT and MRI findings of cardiac hydatid disease. CONCLUSIONS CT and MRI are helpful for localizing and defining the morphologic features of hydatid cysts. Specific signs include calcification of the cyst wall, presence of daughter cysts, and membrane detachment. CT best shows wall calcification, whereas MRI depicts the exact anatomic location and nature of the internal and external structures.

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

PURPOSE We aimed to evaluate the utility of cardiac magnetic resonance imaging (MRI) for the diagnosis of infective endocarditis (IE). METHODS Sixteen patients with a preliminary diagnosis of IE (10 women and six men; age range, 4-66 years) were referred for cardiac MRI. MRI sequences were as follows: echo-planar cine true fast imaging with steady-state precession (true-FISP), dark-blood fast spin echo T1-weighted imaging, T2-weighted imaging, dark-blood half-Fourier single shot turbo spin echo (HASTE), and early contrast-enhanced first-pass fast low-angle shot (FLASH). Delayed contrast-enhanced images were obtained using three-dimensional inversion recovery FLASH after 15±5 min. The MRI features were evaluated, including valvular pathologies on cine MRI and contrast enhancement on the walls of the cardiac chambers, major thoracic vasculature, and paravalvular tissue, attributable to endothelial extension of inflammation on contrast-enhanced images. RESULTS Fourteen valvular vegetations were detected in eleven patients on cardiac MRI. It was not possible to depict valvular vegetations in five patients. Vegetations were detected on the aortic valve (n=7), mitral valve (n=3), tricuspid and pulmonary valves (n=1). Delayed contrast enhancement attributable to extension of inflammation was observed on the aortic wall and aortic root (n=11), paravalvular tissue (n=4), mitral valve (n=2), walls of the cardiac chambers (n=6), interventricular septum (n=3), and wall of the pulmonary artery and superior mesenteric artery (n=1). CONCLUSION Valvular vegetation features of IE can be detected by MRI. Moreover, in the absence of vegetations, detection of delayed enhancement representing endothelial inflammation of the cardiovascular structures can contribute to the diagnosis and treatment planning of IE.

Unusual Location of Primary Hydatid Cyst: Soft Tissue Mass in the Parapharyngeal Region

Hydatid cyst is a cyclozoonotic infection caused by the cestode Echinococcus granulosus. Hydatid cyst in the head and neck region is very rare, even in countries where echinococcus infestation is endemic. We report the case of a 17-year-old male patient presenting with a hydatid cyst in the parapharyngeal and neck region. There was no pulmonary or hepatic involvement. The definitive therapy comprised excision of the cystic mass and postoperative medical treatment.

Infarct characteristics by CMR identifies substrate for monomorphic VT in post-MI patients with relatively preserved systolic function and ns-VT.

The extent of peri‐infarct zone (PIZ) by contrast‐enhanced cardiac magnetic resonance (ce‐CMR) has been related to inducibility of ventricular arrhythmia in patients with ischemic cardiomyopathy. However, this relationship has not been established in postmyocardial infarction (post‐MI) patients with relatively reserved left ventricular (LV) systolic function yet. In this study, we investigated myocardial scar size and characteristics and its relationship with ventricular arrhythmia inducibility in patients with relatively preserved LV systolic function.

Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update

Alveolar echinococcosis is a parasitic disease limited to the northern hemisphere. The disease occurs primarily in the liver and shows a profile mimicking slow-growing malignant tumors. Echinococcus multilocularis infection is fatal if left untreated. It can cause several complications by infiltrating the vascular structures, biliary tracts, and the hilum of the liver. As it can invade the adjacent organs or can spread to distant organs, alveolar echinococcosis can easily be confused with malignancies. We provide a brief review of epidemiologic and pathophysiologic profile of alveolar echinococcosis and clinical features of the disease. This article focuses primarily on the imaging features of alveolar echinococcosis on ultrasonogra-phy, computed tomography, magnetic resonance imaging, diffusion-weighted imaging and positron emission tomography-computed tomography. We also reviewed the role of radiology in diagnosis, management, and follow-up of the disease.

Epidermal inclusion cyst of the larynx.

AbstractEpidermal inclusion cyst (EIC) is a benign cyst filled with keratin fibers, which can develop in any part of the body. It is commonly seen in the skin, especially on the face, scalp, neck, and trunk, and has the tendency to slowly grow toward deeper epidermis parts and to cause cystic expansion. Epidermal inclusion cysts are not common in mucosal sites such as the larynx; however, these can arise owing to squamous metaplasia of the glands. We present a 52-year-old man with a laryngeal EIC. This is a very rare case in the literature of EIC in the larynx.

Evaluation of right ventricular function in patients with tetralogy of Fallot using the myocardial performance index and isovolumic acceleration: a comparison with cardiac magnetic resonance imaging.

BACKGROUND Assessment of right ventricular function is a key point in the follow-up of operated patients with tetralogy of Fallot. Cardiac magnetic resonance assessment of right ventricular function is considered the gold standard. However, this technique is expensive, has limited availability, and requires significant expertise to acquire and interpret the images. Myocardial performance index and isovolumic acceleration have recently been studied for the assessment of right ventricular function and are shown to be simple yet powerful tools for assessing patients with right ventricular dysfunction of various origins. METHODS In this study, the integrity of myocardial performance index and isovolumic acceleration obtained by tissue Doppler imaging echocardiography to quantify right ventricular function was assessed in 31 patients operated for tetralogy of Fallot. Myocardial performance index and isovolumic acceleration measurements were compared with the parameters derived by cardiac magnetic resonance imaging. RESULTS In this study, a significant correlation has not been detected between cardiac magnetic resonance-originated right ventricular ejection fraction, pulmonary regurgitation fraction and myocardial performance index, isovolumic acceleration obtained by tissue Doppler imaging echocardiography from the lateral tricuspid annulus of the right ventricle. CONCLUSION We have concluded that when evaluated separately, myocardial performance index and isovolumic acceleration obtained from tissue Doppler imaging echocardiography can be used in the long-term follow-up of patients who have been operated for tetralogy of Fallot, but that they do not show correlation with cardiac magnetic resonance-originated right ventricle ejection fraction and pulmonary regurgitation fraction.

No association between scar size and characteristics on T-wave Alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia.

OBJECTIVE Microvolt T-wave Alternans (TWA) is associated with abnormal repolarization and predicts arrhythmic mortality in patients with previous myocardial infarction (MI). Infarct tissue size and heterogeneity characterized by cardiac magnetic resonance (CMR) has been shown to be associated with arrhythmogenic substrates and sudden cardiac death. Although both delayed enhancement-CMR (de-CMR) and TWA are useful in risk stratification of post-MI patients with preserved left ventricular function, the relationship between scar size and TWA has not studied yet. In this study, we aimed to study the relation between TWA and scar size and characteristics assessed with CMR in post-MI patients (pts) with relatively preserved systolic function presented with nonsustained VT. METHODS This observational cross-sectional study was enrolled 36 post-MI patients with mild-systolic dysfunction and non-sustained ventricular tachycardia. Eight pts were excluded. Both TWA and contrast enhanced CMR were performed. Left ventricular ejection fraction (LVEF), dense scar, peri-infarct zone and total scar masses were assessed and these values to left ventricular (LV) mass ratios were calculated. Infarct ratios and characteristics were determined and compared among patients with negative TWA and those with positive TWA. RESULTS For the positive (n=12) vs. negative (n=16) TWA patients there were no significant difference between LVEF (44.9 ± 5.4% vs. 44.0 ± 3.2%, p=NS) and LV masses (121.89 ± 26.56 g vs. 106.14 ± 21.16 g, p=NS). The ratio of scar core to LV mass (3.37 ± 0.68% vs. 3.31 ± 1.01%, p=NS), peri-infarct zone to LV mass (23.61 ± 7.93% vs. 21.64 ± 9.08%, p=NS), total scar to LV mass (26.98 ± 7.86% vs. 24.96 ± 9.62%, p=NS) were all similar. CONCLUSION There were no association between scar size and infarct heterogeneity and prevelance of TWA in post-MI patients with relatively preserved LVEF with non-sustained VT. Our data suggest that these two modalities may reflect different arrhythmogenic mechanisms in this cohort.

Prevalence of Hepatic Pseudolesions around the Falciform Ligament in a Paediatric Population

This study investigated the prevalence and features of hepatic pseudolesions around the falciform ligament in 320 children undergoing contrast-enhanced abdominal multidetector computed tomography. Aberrant venous drainage was investigated using thin-section computed tomography images. Pseudolesions around the falciform ligament were detected in 63 patients (20%). The longest diameter was in the craniocaudal direction in 41 (65%) patients (lesions). An inferior vein of Sappey supplying the pseudolesions was seen in 11 patients (17%). Thirteen patients of the 63 patients (21%) with pseudolesions who had a history of extrahepatic malignancy were also examined by ultrasound; in two of the 13 patients the lesions were isoechoic and, in the remainding 11 patients, they were hyperechoic. It was concluded that hepatic pseudolesions around the falciform ligament occur frequently in the paediatric population on CT images. Detection of the longest diameter in the craniocaudal direction and the presence of an inferior vein of Sappey and fatty infiltration should be sufficient to exclude true lesions and make further evaluations unnecessary.

Predictive Value of Doppler Ultrasound in Childhood Pneumonia

This study aimed to determine the predictive value of intercostal and pulmonary artery Doppler flow patterns in the outcome of childhood pneumonia. Pneumonia was classified according to type of pleural effusion and the ultrasound features of consolidations. Doppler flow patterns of intercostal and pulmonary arteries were analysed and correlated with pneumonia type and hospital stay. Of 83 pneumonia cases, 55 were uncomplicated and 28 were complicated. Pleural effusion was present in 54 cases, with 29 non-septated and 25 septated cases. Patients with uncomplicated pneumonia did not have abnormal Doppler flow patterns, compared with 64% (18 of 28) of patients with complicated pneumonia. Doppler ultrasound patterns in childhood pneumonia were correlated with pneumonia type and may be predictive of pneumonia outcome.