Sabri Yilmaz

Crohn Disease Activity Evaluated by Doppler Ultrasonography of the Superior Mesenteric Artery and the Affected Small-Bowel Segments

To reveal the disease activity in Crohn disease by gray scale and Doppler ultrasonography of the superior mesenteric artery (SMA) and the affected bowel segments.

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.

Hepatic pseudolesion around the falciform ligament: prevalence, aberrant venous supply, and fatty infiltration evaluated by multidetector computed tomography and magnetic resonance imaging.

Purpose: The aim of this study was to determine the prevalence and aberrant venous supply (inferior veins of Sappey) of hypoattenuating hepatic pseudolesions seen around the falciform ligament on portal-dominant phase multidetector computed tomography (MDCT) and the frequency of fatty infiltration of these pseudolesions on chemical-shift magnetic resonance imaging. Materials and Methods: Portal-dominant phase abdominal MDCT examinations of 728 patients were evaluated for the presence of a pseudolesion around the falciform ligament, and those with a presumed pseudolesion underwent chemical-shift magnetic resonance imaging to detect the fatty infiltration. Reconstructed MDCT images were investigated for the presence of an inferior vein of Sappey, and 30 patients without a pseudolesion were evaluated as a control group. Results: A total of 160 pseudolesions were detected around the falciform ligament in 146 (20%) patients. The longest diameter of the pseudolesions was in the craniocaudal direction in most patients (61%). An inferior vein of Sappey supplying these pseudolesions was depicted in 40 (27%) patients, and it was highly significant (P = 0.001) compared with the controls for the presence of a pseudolesion around the falciform ligament. Fatty infiltration was found in 47 (29%) patients. Conclusions: Hepatic pseudolesions around the falciform ligament are frequently encountered on portal-dominant phase MDCT images. Detection of craniocaudal extension, inferior veins of Sappey, and fatty infiltration of these pseudolesions, which were firstly described in this article, with the largest subject group based on cross-sectional imaging, might be valuable in excluding true tumors.

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.

Combination of unicuspid aortic valve, aortic coarctation, and aberrant right subclavian artery in a child: MR imaging and CTA findings.

Unicuspid aortic valve is a rare, but well-described congenital valve anomaly in the pediatric population. However, series of congenital unicuspid aortic valves in adults are limited. The estimated incidence of congenital unicuspid aortic valve in an adult echocardiographic population was reported to be about 0.02% [1]. It is often discovered during surgery or autopsy and can easily be mistaken for a bicuspid aortic valve, which, in contrast, is a common congenital cardiac anomaly occurring in up to 2% of live births [2, 3]. Multiplanar and biplanar transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are widely used diagnostic imaging tools for aortic valve abnormalities. Multiplanar TEE is found to be much more sensitive and specific in determining the anomalies [3]. A few cases of unicuspid aortic valve with coexisting anomalies detected by echocardiography have been reported [1, 4]. However, to the best of our knowledge, the combination of unicuspid aortic valve with aortic coarctation and aberrant right subclavian artery has not been reported previously. Furthermore, we assume that this is the first case report depicting magnetic resonance (MR) imaging and computed tomography angiography (CTA) findings of unicuspid aortic valve with coexisting anomalies.

A rapidly increasing abdominal girth in a young patient: MDCT findings of Budd-Chiari syndrome.

From the Department of Radiology, Department of Gastroenterohepatology, and Department of General Surgery, Transplant Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey This section features outstanding photographs of clinical materials selected for their educational value or message, or possibly their rarity. The images are accompanied by brief case reports (limit 2 typed pages, 4 references). Our readers are invited to submit items for consideration.

Mapping of internal mammary vessels by multidetector computed tomography for parasternal transthoracic intervention guidance.

Objective: To measure the distances between the internal mammary arteries (IMAs) and the sternum for determining a route for parasternal transthoracic interventions. Methods: Coronal reconstructed multidetector computed tomography images of 202 patients were evaluated to measure the distances between the IMAs and sternum at 3 levels (manubrium, midsternal corpus, and distal sternal corpus). The arrangements (2 veins-single artery or single vein-single artery) were documented. Results: The most frequently encountered arrangement (42.1%) was a single vein and single artery on both sides. Mean distances on the right and left sides were 10.2 and 10.1 cm at the manubrium, 14.5 and 14.3 cm at the midsternal corpus, and 17.9 and 17.5 cm at distal sternal corpus, respectively. Conclusion: To be aware of the courses of the IMAs at different sternal levels is important during attempts at transthoracic intervention via a parasternal approach.