Serap Gültekin

Vascular Loops at the Cerebellopontine Angle: Is There a Correlation with Tinnitus?

BACKGROUND AND PURPOSE: Tinnitus is a common disorder, and the etiology remains mostly unclear. The purpose of this study was to investigate the causative effect of the vascular loop and compression of the vestibulocochlear nerve at the cerebellopontine angle in patients with unexplained tinnitus. MATERIALS AND METHODS: This study was approved by our institutional review board. Written informed consent was obtained from all participants. Fifty-eight patients with unexplained tinnitus and 44 age- and sex-matched asymptomatic controls were examined with temporal MR imaging. Besides the tinnitus and control groups, a third group was formed by asymptomatic sides of patients with unilateral tinnitus. A 3D fast imaging employing steady-state acquisition (3D-FIESTA) sequence was performed in addition to the regular pre- and postcontrast axial and coronal sequences. The anatomic type of vascular loop, the vascular contact, and the angulation of the vestibulocochlear nerve at the cerebellopontine angle (CPA) were evaluated by 2 experienced neuroradiologists. The χ2 test was used for statistical analysis. RESULTS: No statistically significant differences were found between the patient and control groups for the anatomic type of vascular loop, the vascular contact, and the angulation of the vestibulocochlear nerve at the CPA (P > .05). CONCLUSION: Although 3D-FIESTA MR imaging correctly shows the anatomic relationships of the vestibulocochlear nerve, its vascular compression cannot be attributed as an etiological factor for tinnitus.

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients

AIM Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures. PATIENTS AND METHODS We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9+/-5.57 years (age range: 59-81 years). The mean follow-up period was 78.8+/-26.6 months (range: 48-118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system. RESULTS We found good-to-excellent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59+/-17.95 (25-94), 121.30+/-42.99 degrees (range: 30-170 degrees ) and 30 degrees (range: 0-80 degrees ), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p<0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r=0.872, p<0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r=-0.853, p<0.001). CONCLUSION In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction.

Characterization of Hyperechoic Focal Liver Lesions Quantitative Evaluation With Pulse Inversion Harmonic Imaging in the Late Phase of Levovist

The aim of this study was to evaluate hyperechoic focal liver lesions with pulse inversion harmonic imaging in the late phase of SH U 508A (Levovist; Schering AG, Berlin, Germany) and to determine whether quantitative evaluation improves the characterization of the lesions.

Staging of hip avascular necrosis: is there a need for DWI?

Background No comprehensive study has been performed to stage avascular necrosis of the hip using diffusion-weighted imaging (DWI). Purpose To determine apparent diffusion co-efficient (ADC) alterations in hip avascular necrosis (AVN) and to determine variations of ADC values according to stages of disease. Material and Methods The study is approved by our institutional review board and local ethical committee. Written informed consent was present for each subject. Thirty-five femoral heads of 21 cases affected by AVN were included in the study. Control group consisted of both femoral heads of 10 healthy volunteers. The hips affected by AVN were staged according to Ficat and Arlet classification system from I to IV. All cases underwent to routine hip magnetic resonance imaging (MRI) and DWI performed with a single-shot fast spin echo sequence at a b value of 600 s/mm2. The ADC values were calculated automatically by placing ROIs on AVN lesions in affected patients and both femoral heads of control group. The median ADC value obtained from femoral heads of control group and that from AVN lesions were compared by Mann-Whitney U test. The median ADC values of AVN lesions at different stages were compared by Kruskal-Wallis test. Results The median ADC value of normal bone measured in control group was 185.5 ± 133.2 x 10−6 mm2/s. The median ADC value measured in hip avascular necrosis lesions was 988.0 ± 332.7 x 10−6 mm2/s. ADC values in hip AVN lesions were statistically significantly higher than normal bone marrow (P < 0.01). The median ADC values of hips with avascular necrosis at stage I, II, III, IV were 817.5 ± 172.1 x 10−6 mm2/s, 902.0 ± 181.0 x 10−6 mm2/s, 1200.0 ± 363.2 x 10−6 mm2/s and 1024.0 ± 324.0 x 10−6 mm2/s, respectively. There was no statistically significant difference among AVN lesions at stages I, II, III and IV (P > 0.05). Conclusion Although DWI is a promising imaging tool that provides valuable diagnostic information in hip AVN, it fails to distinguish between different stages, and therefore is of limited value.

The Role of Late-Phase Pulse Inversion Harmonic Imaging in the Detection of Occult Hepatic Metastases

Objective. The purpose of this study was to investigate the efficacy of late‐phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal. Methods. Thirty‐two patients (21 women and 11 men; age range, 20–87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir‐enhanced magnetic resonance imaging was performed as part of the clinical workup. Results. After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow‐up and CT. Conclusions. Late‐phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.

Nodular Sclerosing Adenosis Mimicking Malignancy in the Breast: Magnetic Resonance Imaging Findings

nonspecific as in other body parts. CT and MRI owing to the excellent contrast with the surrounding tissue, have been reported to be helpful in the evaluation of the location and extent of the lesion. On CT, the mass appears a well-defined lesion with distinct nodular or lobular architecture and heterogenous enhancement. On MRI, DFSP shows variable signal intensity compared with skeletal muscle and lower than fat on T1WI. The mass shows intermediate to higher signal compared with the fat on T2WI. STIR or other fat suppressing methods may be useful when the signal of the tumor is about the same as that of the surrounding fat. In our case, preoperative imaging, MRI and CT, well demonstrated the extent of the mass (Fig. 2). CT and MRI may yield more useful clinical information in the evaluation of large protruding masses, over other modalities such as sonography, or mammography. Given the superficial nature of the tumor, clinical information needed can be obtained via physical examination, but imaging may provide crucial information especially on the extent of the disease, because complete excision is important, given the high local recurrence rate of the tumor.

Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation

OBJECTIVES We compared open reduction-internal fixation (ORIF) and closed reduction-internal fixation (CRIF) with respect to operation and radiation exposure times in the treatment of displaced supracondylar humeral fractures in children. METHODS This retrospective study included 124 children (76 boys, 48 girls) who underwent surgical treatment for displaced supracondylar humeral fractures (Gartland type 3). Of these, 52 patients (mean age 7.5 + or - 2.8 years) underwent ORIF, and 72 patients (mean age 6.1 + or - 2.5 years) underwent CRIF. Operation and fluoroscopy times were recorded in both groups. Final assessments included range of motion, varus- valgus angulation, neurovascular findings, and cosmetic appearance. Functional and cosmetic results were assessed using the criteria of Flynn et al. after a mean follow-up period of 49.3 + or - 18.6 months and 50.4 + or - 17.9 months in the ORIF and CRIF groups, respectively. RESULTS Radiographical union was obtained in all the patients within six weeks postoperatively. The two groups did not differ with respect to functional and cosmetic results (p>0.05), with excellent-good results accounting for 90.3% in the CRIF group, and 86.6% in the ORIF group. The mean operation times were 44.2 + or - 12.6 and 28.3 + or - 8.2 minutes, and the mean fluoroscopy times were 36.0 + or - 15.3 and 11.7 + or - 4.5 seconds, in the CRIF and ORIF groups, respectively, both being significantly longer in the former (p=0.000). CONCLUSION As extended fluoroscopy use increases radiation exposure, ORIF sems to be more convenient for the treatment of displaced supracondylar humeral fractures.

Waist Circumference as a Predictor of Failure of Sonographic Estimation of Fetal Birth Weight.

Objective: Several factors may interfere with the success of fetal birth weight (BW) prediction. In this study we tried to determine the most probable factors that may lead to unsuccessful BW estimation. Methods: 200 consecutive pregnancies between 34 and 41 weeks of gestation were enrolled for the study. All subjects underwent sonographic fetal BW estimation before membrane rupture or engagement of presented part. Sonography was performed by the same sonographer blinded to the study design. Failure of estimation was determined when deviation was found to be >15%. Results: Both amniotic fluid index (AUC = 0.768, p < 0.001) and maternal waist circumference (AUC = 0.698, p = 0.004) were significant predictors for failure of estimation. Optimal cut-off values were 80 mm for amniotic fluid index (77% sensitivity, 65% specificity) and 105 cm for maternal waist circumference (70% sensitivity, 61% specificity). The number of pregnancies with anteriorly located placenta was significantly higher in the group with failed estimation (12/20 vs. 39/180, p = 0.001). Conclusion: Amniotic fluid volume, body mass index, maternal waist circumference and placental location may all cause failure of fetal weight estimation and may need to be adjusted. Moreover, our results indicate that waist circumference may be a more reliable predictor of failure of fetal weight estimation compared to body mass index.

Elastosonographic evaluation of patients with a sonographic finding of thickened endometrium

OBJECTIVE To evaluate if elastosonography of the endometrium can differ between normal endometrial tissue and abnormal pathology. STUDY DESIGN One hundred and six women with a sonographic finding of thickened endometrium were enrolled in this study. All patients underwent B-mode scanning and elastosonography, performed by the same operator who was blinded to the study design. After sonographic evaluation, all patients underwent endometrial tissue sampling via dilatation and curettage. Histopathological results indicated that 22 patients had endometrial hyperplasia, 20 patients had endometrial polyps, and 64 patients had normal pathology results, with or without abnormal uterine bleeding. Groups were formed according to histopathological results, and ultrasonographic findings (strain ratio, endometrial thickness) were compared. RESULTS Median age was 46 [interquartile range (IQR) 4] years, 37 (IQR 10) years and 36 (IQR 10) years for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively. Median age of the endometrial hyperplasia group was significantly higher compared with the endometrial polyps and normal pathology groups (p<0.001). Median parity was 3 (IQR 2), 2 (IQR 1) and 3 (IQR 1) for the endometrial hyperplasia, endometrial polyps and normal pathology groups, respectively; differences between the groups were not significant (p=0.102). No differences were found between the groups in terms of endometrial thickness (p>0.05). When elastosonographic strain (B/A) ratios were compared between the groups, the endometrial hyperplasia and endometrial polyps groups had significantly lower B/A ratios (higher elasticity) than the normal pathology group (p<0.001). There was no significant difference in B/A ratios between the endometrial hyperplasia and endometrial polyps groups (p>0.05). CONCLUSION The elasticity of endometrial tissue, measured non-invasively via elastosonography, was similar in women with endometrial polyps and endometrial hyperplasia, but differed significantly compared with women with normal pathology who had a sonographic finding of thickened endometrium and abnormal bleeding as the presenting complaint. According to these results, elastosonography cannot be used as a diagnostic tool to differentiate between endometrial hyperplasia and endometrial polyps. However, elastosonography can be used to differentiate between pathological endometrial changes and normal endometrium in patients presenting with a sonographic finding of thickened endometrium.

Brain, Head, and Neck

MRI in neuroradiology has evolved in the last 30 years, becoming faster, more precise, and more specific. The latest additions, including magnetic resonance spectroscopy (MRS), diffusion imaging, diffusion tensor imaging, functional MRI, and dynamic susceptibility contrast perfusion imaging, have expanded the applications for MR imaging. Currently, fluid attenuation inversion recovery (FLAIR) imaging, thin-section 3D volumetric imaging with spoiled gradient techniques, and the others mentioned above permit not only the precise localization of brain lesions, but also the evaluation of their metabolic profile, their location relative to eloquent regions of the cortex and subcortical white matter, and the relative blood volume and permeability of the vasculature that supplies the lesion. Thus, cellular, vascular, functional and anatomic information are obtained in one examination session and are available to treating physicians in their office, operating room, or radiation therapy suite.