Serkan Aribal

High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status.

OBJECTIVE The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results. METHODS We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed. RESULTS The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation. CONCLUSIONS There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.

Avulsion Fracture of the Anterior Inferior Iliac Spine Mimicking a Bone Tumor: A Case Report

This is a case of a 17-year-old boy who was admitted to the clinic suffering from right hip-inguinal region pain which began after a soccer match. He had an avulsion fracture in the anterior inferior iliac spine and CT/MR images showed similarities to a bone tumor. These fractures are especially seen in the apophyses which are within the ossification process. The radiological appearance of these fractures during the healing period may be involved with bone tumors. In the control MRI of the patient after one year, the fracture was almost healed completely. Treatment is generally conservative. Good results have been reported with rest, analgesic and anti-inflammatory drugs. Familiarity with radiological findings of these avulsion fractures in this region not only protects the patient from invasive procedures but also avoids the involvement of the practitioner in legal consequences resulting from a misdiagnosis of sarcoma.

Utility of MR imaging in the evaluation of colon cancer

Computed tomography (CT) is preferred in the staging of colon carcinoma and magnetic resonance (MR) in staging rectal carcinoma. Narad et al. reported that the sensitivity and specificity of CT are 90 and 69%, respectively, in distinguishing stage T1–T2 and T3–T4 colon carcinoma [3]. In that study they also reported that the sensitivity and the specificity of CT are 77 and 70%, respectively, in distinguishing stage T1–T3ab and T3cd– T4 colon carcinoma. The present study could look for the sensitivity and the specificity of MR in distinguishing stage T1–T3ab and T3cd–T4 colon carcinoma. Thus, the value of MR in the determination of the T-stage for decisions concerning neoadjuvant chemotherapy usage could be evaluated. The desmoplastic reaction around the peritumoral tissue in colorectal carcinoma could falsely lead to overstaging of the tumor [4]. Nevertheless, we think that diffusion-weighted imaging (DWI) could be used to distinguish a peritumoral desmoplastic reaction from tumoral invasion. Less signal intensity when compared to the tumor, especially in the b 800–1000 sn/mm series of DWI and delayed enhancement in dynamic contrast-enhanced series, suggests a desmoplastic reaction. However, it is known that artifacts due to colonic motion affect colonic DWI images. To minimize this, the patient can be given intravenous scopolamine butylbromide (20 mg; Buscopan, Boehringer Ingelheim Japan, Tokyo, Japan) before the procedure, and periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) DWI imaging can be used. The authors mentioned in the study that contrastenhanced imaging does not help with the T staging, and there is no need to use it, but we want to highlight the potential benefits of using contrast material in tumor We have read the interesting article of Inoue et al. entitled “MRI can be used to assess advanced T-stage colon carcinoma as well as rectal carcinoma” [1] published in the December 2016 issue of the journal. The study included important information that was very useful for us. However, we would like to make a few contributions. It is important to demonstrate that the tumoral lesion is either limited within the colonic wall (T1–T2 stage) or exceeding the colonic wall through the pericolonic tissue (T3–T4 stage) to make the most appropriate decision on surgical treatment in colon carcinoma (D2 and D3 resection, respectively). Combined resection can also be a choice in the present approach in stage T3 and T4 if needed. Using neoadjuvant chemotherapy in the treatment of colon carcinoma is not a routine protocol yet. However, current studies suggest that neoadjuvant chemotherapy has some potential benefits and has a positive impact on extending the survival rates in stage T3c,d and T4 colon carcinoma [2, 3]. However, studies on this topic are already underway.

The role of coronary CT angiography in diagnosis of patent foramen ovale.

PURPOSE We aimed to examine the incidence of patent foramen ovale (PFO) and atrial septal aneurysms (ASA) in the Turkish population using coronary computed tomography angiography (CTA); assess the feasibility of coronary CTA for PFO diagnosis by conducting a comparison with transthoracic echocardiography (TTE); and determine the diagnostic role and characteristics of the interatrial tunnel, free flap valve (FFV), and shunts. METHODS The present study was conducted retrospectively and included a sample of 782 patients. Coronary CTA results for all patients were evaluated for the following parameters: the presence of PFO, the degree of contrast jet (if present due to PFO), ASA existence, free flap valve (FFV) length, and PFO tunnel diameters (1 and 2). Coronary CTA and TTE results for PFO detection were also compared for 19 patients who underwent both procedures. RESULTS PFO was present in 118 patients (15%). In 19 patients who underwent both CTA and TTE, the shunt was present in 15 patients on TTE compared with nine patients on CTA. The sensitivity and specificity of CTA for shunt existence were 53% (8/15) and 75% (3/4), respectively. FFV was observed on CTA in 118 patients (15%). No significant relationship was observed between shunt existence and FFV length (P = 0.148), or between shunt existence and tunnel diameter-1 (P = 0.638) or diameter-2 (P = 0.058). ASAs were present in 16 patients (2%), while accompanying PFO was present in three patients (2.4%). CONCLUSION Coronary CTA constitutes a more practical and efficient alternative to TTE for PFO diagnosis. Further, it allows the clear visualization of anatomical details of the interatrial tunnel, shunts, and associated abnormalities and detects ASAs.

Quadrofurcation of the left main coronary artery.

A 45-year-old man was admitted to our hospital’s cardiology service suffering from an intermittent chest pain and exertional dyspnoea. The patient was referred to our computed tomography (CT) department to make further evaluation with coronary computed tomography angiography (CTA). In his coronary CTA exam, there were no significant stenosis. But we saw an interesting view at the side of the left main coronary artery (LMCA) division. An early well-developed first obtuse marginal (OM1) branch of left circumflex artery (LCX) was mimicking quadrofurcation of LMCA with the other three main branches; LCX, left anterior descending artery (LAD) and ramus intermediate (RI) (Figs. 1A–D). Occasionally, the LMCA trifurcates into the LAD, LCX, and RI. There are many anatomical variations of coronary arteries. While some of them are very important and life-threatening, the others have no clinical importance. Although the variation in our case belonged to the second group which has no clinical importance, it should be considered before possible coronary arterial interventions. Multislice ECG-gated cardiac CT is rapidly emerging as a useful noninvasive tool for the evaluation of the coronary arterial tree. Multislice CT may be superior to catheter angiography in defining the ostial origin, proximal course, and termination of the coronary arteries and may be the ‘gold standard’ for detecting coronary anomalies. We demonstrate an interesting coronary variation with 320-multidetector CT in our case.

RE: Distinguishing between Renal Cell Carcinoma and Fat Poor Angiomyolipoma in Diffusion-Weighted Imaging

We have read with interest the article of Ding et al. (1), entitled “Comparison of biexponential and monoexponential model of diffusion-weighted imaging for distinguishing between common renal cell carcinoma and fat poor angiomyolipoma”, which was published in the Nov-Dec. 2016 issue of the journal. The study provides useful information. However, we would like to add a few comments. Angiomyolipoma (AML), the most common tumor of mesenchymal origin, is characterised morphologically by abnormal vessels, smooth muscle cells and fatty tissue (1). It is considered as neoplasia based on the metastatic potential of some epithelioid type AMLs. Most epithelioid type AMLs are benign; but lesions with hypercellularity, atypia, and necrosis, are considered as potentially malignant Letter to the Editor

An alternative imaging modality to scintigraphy in noninvasive diagnosis of splenosis in patients with post-traumatic splenectomy: Diffusion weighted imaging

Splenoziste difüzyon ağırlıklı görüntüleme • 377 Date submitted: Jan 03, 2016 • Date accepted: Mar 08, 2016 • Online publication date: 30 Aralık 2016 *Sultan Abdülhamid Eğitim ve Araştırma Hastanesi/İstanbul/Türkiye **SBÜ Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Mevki BinasıAnkara/Türkiye ***Mareşal Çakmak Devlet Hastanesi/Erzurum/Türkiye ****Girne Asker Hastanesi/Girne/Kuzey Kıbrıs Türk Cumhuriyeti *****Nedip Cengiz Eker Devlet Hastanesi/Muğla/Türkiye

Posterior fossa arachnoid cyst herniation through craniocervical junction.

A 36-year-old female patient presented with a history of intermittent headache. Magnetic resonance imaging (MRI) showed a well-defined, extraaxial cystic mass lesion located in the left retrocerebellar part of the posterior fossa which was compitable with an arachnoid cyst (Fig. 1a, b). Although arachnoid cysts are a not infrequent occurence in daily neuroradiological practice, this arachnoid cyst demonstrated partial herniation through the foramen magnum. To the best of our knowledge, it is an unusual feature of this lesion (Fig. 2a, b). As a matter of fact, we did not encounter any case report in the medical literature describing a herniation of cranial arachnoid cyst through the foramen magnum into the cervical spinal canal, as it was seen in our patient. Furthermore, the images also showed a Chiari Type 1 malformation (Fig. 2c). Most of Chiari type 1 malformations are congenital. In rare cases, Chiari malformations can be acquired during life due to the spaceoccupying conditions, especially within the posterior fossa (mass lesions, hematomas, etc) [1, 2]. Because the arachnoid cyst in our patient is located in the left side of the posterior fossa, while the tonsillar herniation is nearly symmetric on both the sides (Fig. 2d), we consider that the arachnoid cyst and the tonsillar herniation are coexistence in our case. Because we believe the patient’s headache to be related to both the herniated arachnoid cyst and the Chiari

Congenital cervicothoracic spondyloptosis in a 7-month-old patient.

A 7-month-old patient presented with cervicothoracic bulge recognized by the parents. Cervicothoracic computed tomography and magnetic resonance imaging were performed to demonstrate the pathology. Distinct anterior displacement and inferior slippage of cervical vertebral block over subjacent thoracic vertebrae, impaction of the thoracic vertebral block into the enlarged cervical spinal canal, and multilevel posterior fusion defects throughout the cervical vertebrae were seen in his CT images (Fig. 1). Spinal cord was angulated and thickened at the level of impaction by the thoracic vertebral block, and there were irregularity and increased focal nodular signal intensity in the anterior part of the distal

Back pain due to spinal metastatic leiomyosarcoma

A 25-year-old female patient presented with severe back pain. Contrast-enhanced thoracic magnetic resonance imaging revealed a large mass lesion at the body of the T11 vertebra and adjacent paravertebral soft tissues including the retroaortic area. The lesion was hypointense on T1-weighted images and hyperintense on T2-weighted images (Fig. 1A–C, E, and F). After intravenous contrast medium administration, the lesion showed diffuse and significant contrast enhancement (Fig. 1D and G). Computed tomography-guided percutaneous core needle biopsy was performed for the definitive diagnosis (Fig. 2, Left). The histopathologic diagnosis of the lesion was reported as metastatic leiomyosarcoma. The patient was given a neoadjuvant chemotherapy as the first step of treatment. The soft tissue component of the lesion demonstrated a marked decrease in size on her control contrast-enhanced thoracic MRI performed at the end of this chemotherapy protocol (Fig. 2, Middle and Right). After this initial treatment, T11 corpectomy operation was performed so as to resect the bony part of the lesion.