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- ArticleAçık Erişim2024Assessing Femoral Head Medialization in Developmental Hip Dysplasia Type 1 and Type 2 Hip Separation
Aydin, Sonay; Durmaz, Onder; Fatihoglu, Erdem; Kadirhan, Ozlem; Karavas, Erdal
Background/Objectives: The prevalence of developmental hip dysplasia is estimated to be 0.1–2 per 1000 infants. Hip imaging by ultrasonography is considered to be the gold standard method for screening and detecting developmental dysplasia of the hip (DDH), as per the Graf categorization. The classification of hip differentiation into type 1 and type 2 is determined by the alpha angle, as assessed by the Graf classification. Type 1 hips are defined as those with an alpha angle exceeding 60 degrees, whilst type 2 hips are defined as those with measurements falling within the range of 50 to 59 degrees. Methods: The computerized patient card in our institution had a compilation of 208 hip photographs taken from 110 patients, with 98 of them being bilateral. The acquisition of these photos occurred from January 2020 to December 2020. A retrospective review was conducted on the ultrasound (US) scans, with a specific emphasis on the outcomes related to type 1 and type 2 hips. Results: There were 108 high-resolution US photos in the type 1 hip group and 100 high-resolution US images in the type 2 hip group. In terms of unilateral or bilateral cases, gender, or age, no statistically significant differences were seen between the two groups (p > 0.05). The FMD model exhibited a sensitivity of 86% and specificity of 70% in effectively predicting the presence of type 1 mature hips when the values surpassed 2.9 mm. The AUC (area under the curve) value achieved was 0.628. Conclusions: The process of diagnostic categorization may occasionally encounter challenges in accurately differentiating between type 1 and type 2 hip separation subsequent to a hip ultrasound examination. The findings of our analysis indicate that the assessment of the FMD is a highly successful method, demonstrating both high specificity and sensitivity in differentiating between various scenarios.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024Effectiveness of Apparent Diffusion Coefficient Values in Predicting Pathologic Subtypes and Grade in Non-Small-Cell Lung Cancer
Cinar, Hasibe Gokce; Memis, Kemal Bugra; Oztepe, Muhammet Firat; Fatihoglu, Erdem; Aydin, Sonay; Kantarci, Mecit
Background and Objective: The aim of this study is to evaluate the effectiveness of apparent diffusion coefficient (ADC) values in predicting pathologic subtypes and grade in non-small-cell lung cancer (NSCLC). Materials and Methods: From January 2018 to March 2020, 48 surgically diagnosed NSCLC cases were included in this study. To obtain ADC values, ADC maps were constructed, and a region of interest was put on the tumor. The values were measured three times from different places of the lesion, and the mean value of these measurements was recorded. All MRI scans were evaluated by two radiologists in consensus. Results: A total of 14 cases were squamous cell cancer, 32 cases were adenocarcinoma, and 2 cases were large cell carcinoma. The mean ADC values of adenocarcinoma, squamous cell carcinoma, and large cell cancer were 1.51 ± 0.19 × 10−3 mm2/s, 1.32 ± 0.15 × 10−3 mm2/s, and 1.39 ± 0.25 × 10−3 mm2/s, respectively. There were 11 grade 1, 27 grade 2, and 10 grade 3 NSCLC cases. The mean ADC value was 1.44 ± 0.14 × 10−3 mm2/s in grade 1 tumors, 1.25 ± 0.10 × 10−3 mm2/s in grade 2 tumors, and 1.07 ± 0.15 × 10−3 mm2/s in grade 3 tumors. The cut-off value to discriminate grade 2 from grade 1 tumors was 1.31 ± 0.11 × 10−3 mm2/s (85% sensitivity, 75% specificity). The cut-off value to discriminate grade 3 from grade 2 tumors was 1.11 ± 0.15 × 10−3 mm2/s (87% sensitivity, 69% specificity). Conclusions: ADC values can accurately predict NSCLC histopathologic subtypes and tumor grade.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Can the change of vasomotor activity in irritable bowel syndrome patients be detected via color Doppler ultrasound?
Kazci, Omer; Ege, Fahrettin; Aydemir, Huseyin; Kazci, Saliha; Aydin, Sonay
BACKGROUNDIrritable bowel syndrome (IBS) is one of the most frequently referred conditions to the gastrointestinal outpatient clinic. The pathophysiology of IBS has not been determined with certainty. Visceral hypersensitivity is indicated as one of the pathophysiologies. The sympathetic nervous system is primarily in charge of controlling the arteries, and its effect is vasospasm in the medium and large arteries, resulting in decreased blood flow.AIMTo demonstrate, using Doppler evaluation of the brachial artery, that sympathetic activity impairs vasomotor performance due to autonomic neuropathy, which we believe is associated with IBS.METHODSThere were 58 participants in the study. The control group consisted of 29 healthy patients, while the remaining 29 patients had been diagnosed with IBS. Patients who met the Rome IV criteria and had IBS were included in the study. People with known polyneuropathy or non-IBS chronic conditions that can progress were excluded from the trial, as were those with essential hypertension, diabetes mellitus, cardiovascular disease, or peripheral arterial disease, and patients diagnosed with anxiety or depression. Those with moderate to severe carpal tunnel syndrome or a median nerve lesion due to trauma were also excluded from the trial. A Doppler probe was used to measure the baseline diameter and flow rates of the brachial artery from 2 cm superior to the antecubital fossa. The Doppler probe remained stationary throughout the experiment, allowing for continuous measurements. Then, to activate the sympathetic fibers, an electrical stimulus for 5 s with an intensity of 10 mA and a frequency of 1 Hz was applied to the median nerve at the wrist level via the bipolar stimulus electrode. The artery diameter and flow rates were measured again immediately following the fifth stimulus.RESULTSIn healthy persons with no history of chronic illness, there was a statistically significant decrease in flow rate after stimulation (P < 0.001). In addition, stimulation resulted in a statistically significant reduction in the diameter of the brachial artery (P < 0.001). Patients diagnosed with IBS had statistically significant vasodilation and an increase in flow rate.CONCLUSIONSympathetic stimulation causes a reduction in vascular diameter and blood flow, whereas it has the reverse effect on IBS patients. In investigating the involvement of autonomic neuropathy in the development of IBS, significant changes in brachial artery Doppler parameters were observed before and after stimulation of the median nerve with low-current sensory stimulation. This method is thought to be more user-friendly and comfortable than other methods described in the literature.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Percutaneous management in hepatic alveolar echinococcosis: A sum of single center experiences and a brief overview of the literature
Eren, Suat; Aydin, Sonay; Kantarci, Mecit; Kizilgöz, Volkan; Levent, Akin; Senbil, Duzgun Can; Akhan, Okan
BACKGROUNDHepatic alveolar echinococcosis (HAE) is a serious zoonotic infection that affects humans. It may have a tumor-like appearance at times. Percutaneous treatment of HAE patients is extremely relaxing for them. HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae. It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period. The disease is endemic over central Europe, Asia, and North America.AIMTo characterize HAE patients who were treated percutaneously, their outcomes, and the major technical features of percutaneous treatment in HAE.METHODSPatients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study. Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded.RESULTSThirty-two patients underwent percutaneous cyst drainage, two patients underwent percutaneous biliary drainage, and four patients underwent percutaneous biliary drainage alone. Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver, as well as diseased and clogged bile ducts.CONCLUSIONPercutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial. Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery, even when the mass resolves with long-term treatment.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Diabetic neuropathy results in vasomotor dysfunction of medium sized peripheral arteries
Ege, Fahrettin; Kazci, Omer; Aydin, Sonay
BACKGROUNDThe effect of the sympathetic nervous system on peripheral arteries causes vasoconstriction when smooth muscle cells in the walls of blood vessels contract, which leads to narrowing of arteries and reduction of the blood flow.AIMTo compare sympathetic vasomotor activation of the brachial arteries in healthy subjects and patients with painful diabetic neuropathy; and therefore, to assess whether there is significant vasomotor dysfunction of medium sized arteries in diabetic neuropathy.METHODSThe study included 41 diabetic neuropathy patients and 41 healthy controls. Baseline diameter and flow rate of the brachial arteries were measured. Then, using a bipolar stimulus electrode, a 10 mA, 1 Hz electrical stimulus was administered to the median nerve at the wrist level for 5 s. The brachial artery diameter and blood flow rate were re-measured after stimulation.RESULTSIn the control group, the median flow rate was 70.0 mL/min prior to stimulation and 35.0 mL/min after stimulation, with a statistically significant decrease (P < 0.001), which is consistent with sympathetic nervous system functioning (vasoconstriction). In the diabetic neuropathy group, median flow rate before the stimulation was 35.0 mL/min. After stimulation, the median flow rate was 77.0 mL/min; thus, no significant decrease in the flow rate was detected. In the control group, the median brachial artery diameter, which was 3.6 mm prior to stimulation, decreased to 3.4 mm after stimulation, and this decrease was also statistically significant (P = 0.046). In the diabetic neuropathy group, the median brachial artery diameter increased from 3.4 mm to 3.6 mm following nerve stimulation. Once again, no narrowing was observed.CONCLUSIONOur research suggests that diabetic neuropathy results in significant vasomotor dysfunction of medium sized peripheral arteries. Physiological vasoconstriction in response to sympathetic activation is impaired in diabetic neuropathy.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023COVID-19-related cardiomyopathy: Can dual-energy computed tomography be a diagnostic tool?
Aydin, Fahri; Kantarci, Mecit; Aydin, Sonay; Karavas, Erdal; Ceyhun, Gokhan; Ogul, Hayri; Sahin, Cagri Emin; Eren, Suat
BACKGROUNDNo study on dual energy computed tomography (DECT) has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019 (COVID-19) patients. Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion, and these deficits can be shown via DECT with a perfect interrater agreement.AIMTo assess lung perfusion alterations in COVID-19 patients. To our knowledge, no study using DECT has been performed to evaluate possibly fatal cardiac/ myocardial problems in COVID-19 patients. The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases.METHODSTwo blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association's classification of the segmentation of the left ventricular myocardium. Additionally, intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. Following segment-by-segment analysis, perfusion deficiencies identified on the iodine map pictures on DECT were identified.RESULTSThe study enrolled a total of 87 patients. Forty-two of these individuals were classified as COVID-19 positive, and 45 were classified as controls. Perfusion deficits were identified in 66.6% (n = 30) of the cases. All control patients had a normal iodine distribution map. Perfusion deficits were found on DECT iodine map images with subepicardial (n = 12, 40%), intramyocardial (n = 8, 26.6%), or transmural (n = 10, 33.3%) anatomical locations within the left ventricular wall. There was no subendocardial involvement in any of the patients.CONCLUSIONMyocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion. These deficits can be shown via DECT with a perfect interrater agreement. Additionally, the presence of perfusion deficit is positively correlated with D-dimer levels.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Does the use of computed tomography scenogram alone enable diagnosis in cases of bowel obstruction?
Kadirhan, Ozlem; Kizilgoz, Volkan; Aydin, Sonay; Bilici, Esra; Bayat, Ekrem; Kantarci, Mecit
BACKGROUND Ileus is a pathological condition of the abdomen that presents as a medical emergency. It is characterized by potential complications such as perforation and ischemia, which can lead to significant morbidity and mortality if not promptly addressed. The successful management of ileus relies heavily on the timely and precise identification of the condition. While conventional radiography (CR) is commonly used as the primary diagnostic tool, its accuracy in identifying obstructions ranges from 46% to 80%. Furthermore, the diagnostic accuracy of identifying the location and etiology of intestinal obstruction by CR is limited, therefore making computed tomography (CT) the ideal imaging modality in this regard.AIM To determine the presence of acute bowel obstruction (BO) on abdominal CT scenogram images and the accuracy of determining its possible location, taking into account the experience of the observers.METHODS A retrospective screening was conducted on an ensemble of 46 individuals who presented to the emergency department between January 2021 and January 2022 with severe abdominal pain and were subsequently monitored for suspected ileus. The abdominal CT scans of these patients were assessed by three radiologists with varying levels of experience (1, 3, and 10 years) at different intervals (1 mo apart). The evaluation focused on determining the presence or absence of BO, as well as identifying the potential location of the obstruction (small bowel or large bowel). The study employed Kappa statistics to assess inter-observer variances, while the McNamer test was used to evaluate obstruction and segmentation discrepancies between observations. A significance level of P < 0.05 was determined to indicate statistical significance.RESULTS Out of the total sample size of 46 patients, 15 individuals (32.6%) were identified as female, while the remaining 31 individuals (67.4%) were identified as male. The ultimate diagnosis of 42 instances (91.3%) indicated ileus resulting from mechanical obstruction (MO). Among these patients, 14 (33%) experienced obstruction in the large bowel (LB), while 28 (66%) experienced obstruction in the small bowel (SB). The initial evaluation yielded sensitivity rates of 76.19%, 83.31%, and 83.33%, and diagnostic accuracy rates of 69.56%, 76.08%, and 80.43% for the detection of BO among the three observers. The initial study revealed that the average sensitivity of three observers in detecting the presence of ileus caused by MO was 80.94%, while the diagnostic accuracy was 75.35%. Based on the first evaluation, the senior observer demonstrated the highest sensitivity (85.71%), negative predictive value (92.60%), and diagnostic accuracy (80.43%) when accurately estimating the thick and thin segmentation, as per the final diagnosis. There was no statistically significant disparity observed in the sensitivities pertaining to the identification of ileus during the second assessment, as well as the precise determination of the segment level inside the LB or SB, when comparing the second and third observers. Nevertheless, although there was no statistically significant alteration in the detection rate of ileus by the first observer, there was a notable rise in the accuracy rate of segment estimating (73.91%). The senior assessor had a higher level of accuracy in assessing the existence of ileus and segmentation compared to the other evaluators in both evaluations. CONCLUSION The findings of our study indicate that the sensitivity and accuracy rates of abdominal CT scenogram scans in diagnosing acute MOs are similar to or greater than those of CR. Additionally, the study revealed that radiologists with more experience demonstrated a higher likelihood of accurately predicting the existence and potential localization of MO compared to their less experienced counterparts.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Chronic otitis media and middle ear variants: Is there relation?
Gökharman, Fatma Dilek; Senbil, Duzgun Can; Aydin, Sonay; Karavas, Erdal; Özdemir, Ozge; Yalçin, Arzu Gulsah; Kosar, Pinar Nercis
BACKGROUNDChronic otitis media (COM) is an inflammatory disease that lasts for a long time. It is common in developing countries. Hearing loss can result from COM. The relationship between variations in middle ear anatomy and COM was investigated in our study.AIMTo compare the prevalence of middle ear anatomic variations between the cases with COM and healthy individuals.METHODSThis retrospective study included 500 patients with COM and 500 healthy controls. The presence of those variants was determined: Koerner's septum, facial canal dehiscence, high jugular bulb, jugular bulb dehiscence, jugular bulb diverticulum, sigmoid sinus anterior location and deep tympanic recesses.RESULTSA total of 1000 temporal bones were examined. The incidences of these variants were respectively (15.4%-18.6%), (38.6%-41.2%), (18.2%-4.6%), (2.6%-1.2%), (1.2%-0%), (8.6%-0%), (0%-0%). It was observed that only high jugular bulb (P < 0.001) and anteriorly located sigmoid sinus frequencies (P = 0.002) in the case group were statistically significantly higher than the control groups.CONCLUSIONCOM is a multifactorial disease and variants of middle ear have always been important in terms of potential risk for complication during surgery but rarely associated with COM as an etiology or as a consequence of the disease. We didn't find a positive correlation between COM and Koerner's septum and facial canal defect. We ended up with a significant conclusion with the variants of dural venous sinuses -high jugular bulb, dehiscence of jugular bulb, diverticulum of jugular bulb and anteriorly located sigmoid sinus- that have been studied less and frequently associated with inner ear illnesses.
RDL Kalıcı Kaydıİncele - Review ArticleAçık Erişim2023Mediastinal lesions in children
Çinar, Hasibe Gokce; Gulmez, Ali Osman; Üner, Cigdem; Aydin, Sonay
The mediastinum is where thoracic lesions most frequently occur in young patients. The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad. Congenital lesions, infections, benign and malignant lesions, and vascular diseases are examples of lesions. Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly. Our task is currently made simpler by radiological imaging techniques.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Detection of tracheal branching with computerized tomography: The relationship between the angles and age-gender
Kahraman, Sevket; Yazar, Mesut Furkan; Aydemir, Hueseyin; Kantarci, Mecit; Aydin, Sonay
BACKGROUND The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis, treatment and interventional interventions in areas such as anesthesia, thoracic surgery, pulmonary physiology. AIM To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography (CT) and minimum intensity projection (MinIP) technique, which is a non-invasive method. METHODS Our study was carried out retrospectively. Patients who underwent contrast and non-contrast CT examination, whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained, were included in the study. Measurements were made in the coronal plane of the lung parenchyma. In the coronal plane, right main bronchus-left main bronchus angle, right upper lobe bronchus-intermedius bronchus angle, right middle lobe bronchus-right lower lobe bronchus angle, left upper lobe bronchus-left lower lobe bronchus angle were measured. RESULTS The study population consisted of 1511 patients, 753 pediatric (mean age: 13.4 +/- 4.3; range: 1-18 years) and 758 adults (mean age: 54.3 +/- 17.3; range: 19-94 years). In our study, tracheal bifurcation angle was found to be 73.3 degrees +/- 13.7 degrees (59.6 degrees-87 degrees) in the whole population. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls (74.6 degrees +/- 12.9 degrees vs 71.2 degrees +/- 13.9 degrees, P = 0.001). In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9 degrees +/- 12.9 degrees vs 75.8 degrees +/- 14.7 degrees, P < 0.001). CONCLUSIONS Our study, with the number of 1511 patients, is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data, measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique. Study data will not only be a guide during invasive procedures, but it can also guide studies to be done with imaging methods.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023A complementary comment on primary hepatic angiosarcoma: A case report
Gulmez, Ali Osman; Aydin, Sonay; Kantarci, Mecit
BACKGROUND This article examines primary hepatic angiosarcoma (PHA) and fat-poor angiomyolipoma (AML), two uncommon vascular cancers. Clinical decisions in these situations are frequently aided by pathology reports and imaging techniques. Uncommon malignant tumors of the vascular endothelium include PHA. Another diagnosis that should not be overlooked when employing contrast-enhanced MR and contrast-enhanced computed tomography (CT) imaging techniques is fat-poor AML, one of the uncommon vascular tumors of the liver. In both conditions, biopsy is the primary means of diagnosis.CASE SUMMARY In our article, besides the diagnosis of PHA, fat-poor AML, one of the other rare vascular tumors of the liver, is mentioned. In the case, a 50-year-old female patient with VHL Syndrome was admitted to our hospital with nonspecific lesions such as right upper quadrant pain, weight loss, and nausea. Abdominal ultrasonography (US) revealed a hypoechoic heterogeneous lesion with occasional faint contours. In computed tomography, it was observed as a hyperdense nodular lesion in segment 4. Magnetic resonance imaging (MRI) revealed that the lesion did not contain fat. In connection with the known history of VHL Syndrome, we first evaluated the possibility of AML. Thereupon, a histopathological sample was taken and the diagnosis was made as fat-poor AML with 5% fat content.CONCLUSION In conclusion, PHA in our case report and fat-poor AML in our clinic are two uncommon liver vascular malignancies with comparable incidences. Important imaging techniques like contrast-enhanced US (CEUS), CECT, and CEMRI give us substantial advantages in both cases. However, a biopsy is used to provide the final diagnosis.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Can Shear Wave Elastography Help Differentiate Acute Tonsillitis from Normal Tonsils in Pediatric Patients: A Prospective Preliminary Study
Ece, Bunyamin; Aydin, Sonay
Shear wave elastography (SWE) is a non-invasive imaging technique used to quantify the elasticity/stiffness of any tissue. There are normative SWE studies on tonsils in healthy children in the literature. The purpose of this study is to analyze the palatine tonsils in children with acute tonsillitis using ultrasound and SWE. In this prospective study, pediatric patients aged 4–18 years diagnosed with acute tonsillitis and healthy children were included. Those with antibiotic use, chronic tonsillitis, adenoid hypertrophy, and having chronic disease, immunodeficiency, and autoimmune disease, or any rheumatological disease were excluded. The volume and elasticity of palatine tonsil were measured via ultrasound and SWE. The study included 81 (46 female, 35 male) acute tonsillitis patients, and 63 (38 female, 25 male) healthy children between the ages of 4 and 18. Elasticity (kPa) values of tonsils were found significantly higher in the tonsillitis group (SWE-R: 25.39 ± 4.64, SWE-L: 25.01 ± 4.17) compared to the normal group (SWE-R: 9.71 ± 2.37, SWE-L: 9.39 ± 2.19) (p < 0.001). In the tonsillitis group, a significant positive correlation was found between tonsil volume and elasticity (r: 0.774, p: 0.002). In conclusion, in pediatric patients with acute tonsillitis, higher kPa values were obtained with SWE in the palatine tonsils.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Quadruple-Rule-Out Computed Tomography Angiography (QRO-CT): A Novel Dual-Energy Computed Tomography Technique for the Diagnostic Work-Up of Acute Chest Pain
Cetin, Turkhun; Kantarci, Mecit; Irgul, Baris; Aydin, Sonay; Aydin, Fahri; Koseturk, Taner; Levent, Akin
Background: Computerized tomography (CT) has been increasingly utilized in the differential diagnosis of acute chest pain. Combining the triple rule out CT angiography (TRO-CT) approach with dual-energy CT (DECT) can enhance the diagnostic capability by identifying myocardial perfusion deficiencies. This combination can yield a quadruple-rule-out computed tomography angiography (QRO-CT) technique. The aim of this study is to determine the efficacy of the QRO-CT. Methods: Intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. The myocardial dark spots on the color-coded iodine map were identified as perfusion deficiencies. Pulmonary arteries and aorta were also evaluated. Results: The study population consisted of 211 patients. The sensitivity, specificity, and positive and negative predictive values of QRO-CT for pulmonary embolism were 93.5%, 100%, 100%, and 95.3%, respectively. For obstructive coronary artery disease, the values were 96.1%, 93.4%, 89.2%, and 97.7%, respectively. For myocarditis, the values were 69.2%, 100%, 100%, and 93.6%, respectively. Conclusions: the QRO-CT method may successfully evaluate myocardial perfusion deficits, hence expanding the differential diagnosis capabilities of the standard TRO-CT method for myocarditis. It can provide useful information on myocardial perfusion, which may influence the choice to perform invasive catheterization in cases of coronary artery obstruction.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023A pediatric right lower quadrant pain case**
Uner, Cigdem; Tokur, Oǧuzhan; Aydin, Sonay; Gökharman, Fatma
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Shear Wave Elastography-Correlated Dose Modifying: Can We Reduce Corticosteroid Doses in Idiopathic Granulomatous Mastitis Treatment? Preliminary Results
Ece, Bunyamin; Aydin, Sonay; Kantarci, Mecit
Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease treated with local and systemic corticosteroids. This study aims to evaluate the efficacy of reducing corticosteroids doses in IGM cases based on shear wave elastography (SWE) tissue stiffness measurements. This prospective study included IGM patients who received systemic or local corticosteroids between January 2020 and September 2022. A 20% or more reduction in tissue elasticity values (kPa) was considered a positive response to treatment in the study group, and the corticosteroids dose was reduced. The control group was dosed routinely. All patients were followed for 2 years to compare treatment efficacy, duration, total corticosteroids dose, recurrence, and side effects. There were 12 patients (9 local/3 systemic corticosteroids) in the study group and 24 patients (17 local/7 systemic corticosteroids) in the control group. Ten (83.4%) out of 12 patients in the study group were successfully treated by reducing corticosteroid doses with follow-up, and 2 (16.6%) out of 12 patients were reverted to the initial treatment protocol due to an increase in elasticity values during the follow-up. Nevertheless, successful treatment results were obtained in these two patients without reducing the corticosteroid dose. When compared to the control group, the median corticosteroid dose in the study group was significantly lower in patients using both local (p < 0.01) and systemic (p < 0.01) corticosteroids. A significant negative correlation was found between the rate of decrease in elasticity values and the median dose of corticosteroids (r = −0.649, p < 0.05) and the median treatment time (r = −0.751, p < 0.01). Side effects due to corticosteroids were found to be significantly lower in the study group (p < 0.05). According to our first and preliminary results, the SWE-correlated dose-modifying technique may reduce corticosteroid doses and side effects without significantly compromising treatment efficacy.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Inferior vena cava agenesis, bilateral double renal veins, and left circumaortic renal vein: A rare case and brief review of the literature
Karavas, Erdal; Aydin, Sonay; Unver, Edhem; Kadirhan, Ozlem; Kantarci, Mecit
The improper embryologic development of the inferior vena cava (IVC) is a rare congenital defect that affects about 4% of the population. IVC agenesis is one of the less common variations, with an estimated prevalence ranging from 0.005% to 1%. We present a rare instance of IVC agenesis, bilateral double renal veins, and left circumaortic renal vein that manifested as lower extremities deep vein thrombosis. While anomalies of the IVC and renal veins are exceedingly rare, they should be considered during retroperitoneal procedures to avoid major consequences, particularly venous bleeding caused by incorrect damage. Anatomical variance of the IVC and renal veins is critical for procedures such as ureteral surgery, sympathectomy, radical nephrectomy, and organ transplantation. The clinical significance of these aberrations stems from the possibility of mistakes during imaging. They play a significant role in the diagnosis and treatment of venous thromboembolic disease.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Quantitative Analysis of Supraspinatus Tendon Pathologies via T2/T2* Mapping Techniques with 1.5 T MRI
Ece, Bunyamin; Yigit, Hasan; Ergun, Elif; Koseoglu, Enver Necip; Karavas, Erdal; Aydin, Sonay; Kosar, Pinar Nercis
The aim of this study was to quantitatively assess supraspinatus tendon pathologies with T2/T2* mapping techniques, which are sensitive to biochemical changes. Conventional magnetic resonance imaging (MRI) and T2/T2* mapping techniques were applied to 41 patients with shoulder pathology, and there were also 20 asymptomatic cases included. The patients were divided into two groups: tendinosis and rupture. The supraspinatus tendon was divided into medial, middle, and lateral sub-regions, and the T2/T2* values were measured in both the coronal and sagittal planes for intergroup comparison. Intra-class and inter-class correlation coefficients (ICCs) were calculated to assess test reproducibility. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value in each group. A total of 61 patients (27 males and 34 females)—including 20 asymptomatic individuals, 20 with tendinosis, and 21 with rupture—were evaluated using T2/T2* mapping techniques. In the rupture group, there were significant differences in the values of the lateral region (p < 0.001), as well as in the middle and medial regions (p < 0.05) of the supraspinatus tendon compared to the tendinosis and asymptomatic groups. These were determined using both T2* and T2 mapping in both the coronal and sagittal plane measurements. In the tendinosis group, there were significant differences in the values of the lateral region with T2* mapping (p < 0.001) in both the coronal and sagittal planes, and also with the T2 mapping in the coronal plane (p < 0.05) compared to the asymptomatic groups. The cut-off values for identifying supraspinatus pathology ranged from 85% to 90% for T2 measurements and above 90% for T2* measurements in both planes of the lateral section. The ICC values showed excellent reliability (ICC > 0.75) for all groups. In conclusion, T2 and T2* mapping techniques with 1.5 T MRI can be used to assess tendon rupture and tendinosis pathologies in the supraspinatus tendon. For an accurate evaluation, measurements from the lateral region in both the coronal and sagittal planes are more decisive.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Thyroid malignancy in children: where does it locate?
Cinar, Hasibe Gokce; Uner, Cigdem; Kadirhan, Ozlem; Aydin, Sonay
Objective: As far as we know, in English literature, a limited number of studies has examined the relationship between the location of the nodule and malignancy risk. The studies were performed with adults and their results were mainly inconsistent. We aim to evaluate the potential association between the location of the thyroid nodules and risk for malignancy in the pediatric population. Materials and methods: Patients younger than 18 years old with a pathological diagnosis were included. Nodules were divided into 5 categories according to the Thyroid Imaging Reporting and Data System (TI-RADS) algorithm. The location of the nodules was recorded: Right lobe, left lobe, isthmus, upper pole, lower pole, and middle. Thyroid glands were divided into 3 equal longitudinal areas to define upper, lower, and middle portions. Results: Ninety-seven nodules of 103 children were included. The mean age of the population was 14.9 ± 2.51 years (7-18 years). Eighty-one participants were female (83.5%) and 16 male (16.5%). Fifty nodules were benign (51.5%) and 47 nodules were malignant (48.5%). We did not detect a significant correlation between the risk of malignancy and location of the nodule as right or left lobes or isthmus (P = 0.38). Rate of malignant nodules were significantly higher in middle lobe (23%, P = 0.002). Being located at middle part of thyroid gland increases the possibility of malignancy 11.3 times (OR = 11.3, P = 0.006). Conclusion: Nodule location can be used as a predictor for thyroid malignancy in pediatric patients, similar to adults. Middle lobe location increases the risk of malignancy. Using nodule location along with TI-RADS categorization can increase the efficacy of malignancy prediction.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Shear-wave elastography of palatine tonsils: A normative study in children
Aydin, Sonay; Senbil, Duzgun Can; Karavas, Erdal; Kadirhan, Ozlem; Kantarci, Mecit
Background: Shear-wave elastography (SWE) was used to determine normal elasticity values of palatine tonsils (PTs) in children and adolescents who did not have any health problem, and the relationship between these values and various parameters influencing this result was examined. Methods: The current prospective study has been approved by the local Institutional Review Board. Our study included 122 people aged 2-18 years. SWE values for both PTs, as well as gender, age, and body mass index (BMI), were recorded. The Kolmogorov-Smirnov test was used to determine whether the data had a normal distribution. Numerical variables with a normal distribution are reported as mean ± standard deviation, while variables with a nonnormal distribution are reported as medians with minimum and maximum values. Numbers and percentages are used to report categorical variables. Results: The study group's average age was 10.77 ± 4.35 years. The mean SWE values were 9.89 ± 2.494 kPa for the right PT and 9.57 ± 2.631 kPa for the left PT. Both PT volumes were found to be 1.6 ± 0.9 mm 3. There was no significant correlation between the SWE values obtained and age, height, weight, and BMI. Tonsil dimensions show a positive correlation with age, height, weight, and BMI. Conclusion: PT dimensions have a positive correlation with age, height, weight, and BMI, but not with SWE values. SWE may be a reliable diagnostic criterion independent of anthropometric values.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023There Is No Relation between Epitympanic Recess Volume and Chronic Otitis Media
Gokharman, Fatma Dilek; Kocak, Omer; Irgul, Baris; Kosar, Pinar; Aydin, Sonay
Background: Chronic otitis media is recurrent infection of the middle ear and mastoid air cells in the setting of perforation of the tympanic membrane. Risk factors for chronic otitis media include predisposing characteristics such as gender, allergies, Eustachian tube dysfunction, history of acute otitis media, and upper respiratory tract infection. The purpose of this study was to evaluate the potential relationship between chronic otitis media and epitympanic recess volume. Materials and Methods: A total of 197 patients with chronic otitis media had their epitympanic recess volume compared to the epitympanic volume of 99 healthy controls. The epitympanic recess volume was measured via the 3D volumetric measurement tool of the local PACS. Epitympanic recess volume measurement was performed using axial sections in a plane starting from the level of the malleus head–anvil body in the craniocaudal direction to the tegmen tympanum. Results: It was shown that patients with bilateral involvement had an epitympanic recess volume of 75.00 mm3, compared to 72.30 mm3 in those with unilateral chronic otitis media. The healthy control group’s median value for the epitympanic recess was 74.73 mm3. Conclusions: Epitympanic volume values did not differ substantially between patients with chronic otitis media and healthy persons, and epitympanic volume was not recognized as a predisposing factor (p = 0.686).
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