MRI-based evaluation of the factors leading to pituitary iron overload in patients with thalassemia major.

AIM: Given the lack of studies evaluating pituitary iron overload in patients with thalassemia major, we used magnetic resonance imaging (MRI) to evaluate these patients and the factors affecting the disease process. MATERIALS AND METHODS: The 84 patients with ß-thalassemia major who were included in this study were referred to our clinic for cardiac and hepatic T2(*) MRI. T2(*)-weighted images of the pituitary gland, heart, and liver were obtained using a 1.5-tesla MRI unit and a multi-echo gradient-echo sequence. Associations between pituitary T2(*), cardiac T2(*), hepatic T2(*), pituitary height, serum ferritin (SF) level, patient age, and other demographic findings were assessed. RESULTS: Pituitary T2(*) values correlated with hepatic T2(*) values, cardiac T2(*) values, SF level, and patient age (P≤0.001, 0.001, 0.001, 0.01, respectively) but not with pituitary height (P=0.76). Pituitary and cardiac T2(*) values were lower in the subset of patients who underwent splenectomy (P=0.046 and P=0.002, respectively). CONCLUSION: Pituitary iron overload rapidly increases during puberty and in this study correlated with cardiac and hepatic T2(*) values, patient age, SF level, and liver size, but not with the height of the pituitary. Pituitary iron overload also increases following splenectomy. Together, these findings indicate that numerous factors contribute to pituitary iron overload.

Use of acoustic radiation force impulse elastography to diagnose acute pancreatitis at hospital admission: comparison with sonography and computed tomography.

OBJECTIVES: To compare the diagnostic success rate of acoustic radiation force impulse (ARFI) elastography with those of sonography and computed tomography (CT) for acute pancreatitis at hospital admission. METHODS: B-mode sonography and ARFI elastography were performed on 88 patients with symptoms of acute pancreatitis and 50 healthy control participants who were admitted to our hospital between February 2013 and July 2013. Acute pancreatitis was verified in the 88 patients based on clinical and laboratory findings. Computed tomography was performed on 41 patients, and the CT results from these patients were compared with those of ARFI elastography. The appearances of the pancreases of the patients were classified into 6 groups using visual color encodings obtained with ARFI elastography. The elasticity values of pancreatic head, body, and tail regions were evaluated with Virtual Touch imaging and Virtual Touch tissue quantification (Siemens Medical Solutions, Mountain View, CA). The success rates of sonography, CT, and ARFI elastography for diagnosing acute pancreatitis at hospital admission were compared. RESULTS: Forty-six of the 88 patients had a diagnosis of pancreatitis by B-mode sonography; pancreatitis was diagnosed in all patients by ARFI elastography; and 10 of 41 patients could not be diagnosed by CT. The sensitivity and specificity of Virtual Touch tissue quantification were 100% and 98%, respectively, when a cutoff value of 1.63 m/s was used. The control group had color scores of 1 or 2, whereas all patients with pancreatitis had color scores of 3 to 6 on color scale evaluation with Virtual Touch imaging. CONCLUSIONS: Acoustic radiation force impulse elastography is a rapid, radiation-free, and noninvasive tool for diagnosis of acute pancreatitis at initial hospital admission, with a higher success rate for diagnosis of acute pancreatitis than the grayscale sonography and CT.

Evaluation of retrobulbar blood flow with color doppler ultrasonography in patients with central serous chorioretinopathy.

BACKGROUND: To compare retrobulbar blood flow in patients with central serous chorioretinopathy (CSC) and healthy subjects using color Doppler ultrasonography. METHODS: Thirty patients (age 23-54 years) with a first episode of acute CSC and 30 healthy controls (age 30-44 years) were evaluated. The peak systolic blood flow velocity, end-diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were measured in the ophthalmic, posterior ciliary, and central retinal arteries. RESULTS: The posterior ciliary and central retinal artery EDV were lower in the patient group than in the control group, whereas RI and PI values were significantly higher (p < .05). The ophthalmic artery peak systolic blood flow velocity and EDV were lower in the CSC than in the control group (p < .05) without significant difference in RI and PI. CONCLUSIONS: Color Doppler ultrasonography provides additional insights into the pathophysiology of CSC and may support the vasospasm hypothesis.

The association between varicocele and ankylosing spondylitis via color duplex sonography.

OBJECTIVE: To evaluate the relationship between varicocele and ankylosing spondylitis (AS) via color duplex sonography (CDS). METHODS: Thirty male patients (age range 18-40 years, mean age 30.27 years) with AS and 30 male healthy controls (age range 20-36 years, mean age 27.23 years) were evaluated for varicocele using CDS. RESULTS: Vein diameter in right and left pampiniform plexus (PP) in the AS group was significantly higher than in the control group (p < 0.001 and p = 0.003, respectively). The incidence of varicocele was observed as 33.3 % in the AS group and 10 % in the control group. However, the difference was statistically significant (p = 0.028). The rate of right, left, and bilateral varicocele was 3.3 % (1 patient), 23.3 % (7 patients), and 6.6 % (2 patients), respectively, in the AS group, versus 0, 10, and 0 % in the control group (p = 1.000, p = 0.166, and p = 0.492, respectively). CONCLUSIONS: The incidence of varicocele in AS patients is higher than in control subjects, and the difference is statistically significant. Therefore, varicocele must be taken into consideration and investigated in patients with AS.

Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: is it a predisposing factor for rupture risk?

BACKGROUND: A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture. MATERIAL/METHODS: The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant. RESULTS: General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs. CONCLUSIONS: Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space.

The distribution of stylohyoid chain anatomic variations by age groups and gender: an analysis using MDCT.

The aim of this study is to investigate the frequency of the SHC variations, and the distribution of the SP lengths in different age and sex groups using MDCT. MDCT scans were performed in 805 patients (401 males, 404 females). The patients were divided into six groups according to their ages. The length of the styloid process (SP) and its angulation on the transverse (TA) and sagittal (SA) planes were measured. Structural variations of the SHC were observed by means of three-dimensional (3D) and multiplanar reconstruction (MPR) images. Absence of the styloid process (n = 10), double proximal origin (n = 13), segmentation (n = 223), complete ossification (n = 24), and an SP with three proximal parts in one patient were among the anomalies detected. The mean length of the SP was greater in males than in females (33.2 ± 13.2 vs. 29.6 ± 10.5 mm, P < 0.001). Elongated SP (ESP) was observed in 56 % of the patients in the study group, and this ratio was the highest in Group 3 with 65.4 % (P < 0.05). TA and SA were 70.2° ± 4.1°, 69.9° ± 4.2° and 86.6° ± 6.5°, 88.3° ± 6.6° for the right and left sides, respectively. Besides, 3D and MPR images also present detailed and reliable data to radiologists and surgeons for the evaluation of the SHC. ESP has been detected in more than half of the patients, being more frequent in males and in individuals in the fifth decade of life. For an accurate diagnosis, clinicians should consider the ESP while evaluating the patients in this age group.

Display with 64-detector MDCT angiography of cerebral vascular variations.

PURPOSE: The aim of this study was to assess the cerebral variations and observe their frequency in the patients who have undergone angiographies with the state of the art 64-slice multidetector computed tomography (MDCT) angiography technique due to various reasons. METHODS: 500 patients (253 women, 247 men) who had CT scan in the period of April 2008 to March 2010 at Dicle University Medicine Faculty Hospital Radiology Unit were surveyed in this study. Patients who had CT scan with brain CT angio protocol were evaluated using multiplanar, maximum intensity projection (MIP) and volume rendering (VR) images in work station. RESULTS: 773 variations were totally detected among 500 patients. Variations were categorized as Willis polygon, fenestration and other variations. Frequent variations were detected at Willis polygon and posterior communicating artery (PCOA) hypoplasia was detected as the prevalent variation. CONCLUSIONS: In the present study, we have demonstrated that cerebral vascular variations are frequent and that these variations can be detected in a non-invasive manner using the MDCT angiography. The results obtained from our study may serve as preoperative guidelines for the units performing surgical procedures.

3-T MRI of the biliary tract variations.

PURPOSE: The gallbladder and the biliary tract are structures in close connection with the adjacent organs and may show a number of variations and anomalies. It is therefore important for surgical purposes to know their anatomy and variations in detail. Various methods are used in the imaging of the variations of the biliary tract and its pathologies, including ultrasonography, computed tomography; direct cholangiographic methods like endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, intravenous cholangiography and T-tube cholangiography, as well as indirect methods like magnetic resonance cholangiopancreatography (MRCP) or cholescintigraphy. The aim of this study is to investigate the frequency of the anatomic variations of the biliary tract using 3-T MRCP and to compare the findings with the data in the literature. MATERIALS AND METHODS: For the purposes of this study, patients who underwent MRCP at our hospital (Dicle University Hospital) between November 2009 and February 2012 were investigated retrospectively. A total of 590 patients (between 6 and 88 years of age; mean age: 51 ± 9 years) were included in the study. The MRCP imaging was carried out with an magnetic resonance imaging (MRI) device supplied with 3-T magnetic power and by obtaining T2-weighted images through the single-shot fast spin echo technique using the standard body coil. The axial and coronal source images and the reformatted images were evaluated together in terms of the possible anatomic variations. RESULTS: Among the 590 patients included in the study, of 233 (39.5 %) showed anatomic variations at different levels in the intra- and extrahepatic biliary tracts. Among these variations, a right posterior hepatic duct insertion to the left hepatic duct at the level of the bifurcation has been observed in 71 patients (12.1 %), trifurcation was observed in 30 patients (5.1 %) and insertion into the main hepatic duct at the proximal aspect of the cystic duct was observed in 18 patients (3.1 %). At the level of the cystic duct, medial insertion of the cystic duct was viewed in 58 patients (9.8 %), distal medial insertion was seen in 40 patients (6.8 %), a short cystic duct was detected in 10 patients (1.7 %), pancreatobiliary junction anomaly was viewed in two patients (0.4 %) and duplicate anatomic variations have been observed in 42 patients (7.2 %). CONCLUSION: MRCP studies conducted using 3-T MRI devices may reveal similar or greater numbers of variations when compared to the existing MRCP studies in the literature. 3-T MRI shows a couple of variations. Pointing out these anatomical variations before the surgical intervention may prevent possible iatrogenic traumas. Donors with unsuitable variations for liver transplant may be spotted out at an early phase through the MRCP and certain operations with a high morbidity rate may thus be avoided.

An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings.

BACKGROUND: Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. CASE REPORT: We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn't have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. CONCLUSIONS: Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

Facial vein aneurysm associated with sialadenitis.

A 20 year-old man presented with pain and swelling of the left submandibular area. Neck sonography revealed enlargement of the submandibular gland, coarsening of its echotexture with a few calculi and a multiloculated cystic lesion. Doppler sonography revealed venous flow within the cystic lesion and aneurysmal dilatation of the adjacent facial vein. CT angiography confirmed the facial vein aneurysm. We hypothesize that inflammation of the gland had weakened the wall of the adjacent facial vein, causing aneurysmal dilatation.

Multidetector CT imaging of arterial supply to sinuatrial and atrioventricular nodes.

PURPOSE: The aim of this study is to depict anatomic characteristics of sinuatrial nodal artery (SANA) and atrioventricular nodal artery (AVNA) of the heart with multidetector computed tomography. METHODS: In our study, 400 patients referred to radiology departments of two institutions for coronary CT angiography were retrospectively evaluated. 350 patients had been examined by dual-source 64-slice CT, and 50 patients by 64-section multidetector CT. Transverse sections with a thickness of 0.6 mm were used in dual-source 64-slice CT studies, and 0.8 mm were used in 64-section multidetector CT examinations for the evaluation of coronary arteries and conduction system branches. Anatomic origin, localization of the origin, diameter, number, course, and variants of the SANA and AVNA were examined with coronary multidetector CT angiography. RESULTS: SANA and AVNA could be imaged by multidetector CT in all patients. There was a single SANA in 383 (95.7%) patients, and two SANAs in 17 (4.2%) patients. Two hundred thirty-three (58.2%) patients had one SANA originating from right coronary artery (RCA), 149 (37.2%) patients had one SANA originating from left circumflex (LCX) artery, and one patient had a SANA originating from the aorta. AVNA originated from distal RCA in 351 patients (87.7% of all patients), and from distal LCX artery in 49 patients (12.3% of all patients). CONCLUSIONS: The arteries that supply the sinuatrial node and atrioventricular node can be imaged with multidetector CT. These arteries have variations in number, origin and course.

Course anomalies of extracranial internal carotid artery and their relationship with pharyngeal wall: an evaluation with multislice CT.

PURPOSE: The goal of our study was to measure the prevalence of anomalies in the extracranial segment of internal carotid artery (ICA), to measure the carotid-pharyngeal distance (CPD). METHODS: Computed tomography (CT) angiography images of 607 patients were retrospectively examined. The course anomaly and CPD were obtained at different image plane. The patients were divided into four groups according to their age. RESULTS: The incidence of course anomaly in ICA was shown to be 60.3 %. Prevalence of course anomaly showed an increase with age (p < 0.001). Women had more ICAs with a course anomaly than men (p < 0.001). Mean CPD among all ICAs was found to be 11.13 mm. When CPD values were compared between the groups, group 1 and group 2 did not have a significant difference, however, there was a significant difference between other groups (p < 0.05). The CPD significantly decreased with age (p < 0.001). In ICAs that showed a straight course, the mean CPD was 13.0 mm, while in ICAs that showed course anomaly, the mean CPD was determined to be 9.49, showing a significant difference (p < 0.05). CONCLUSION: In conclusion, the number of ICAs that show a course anomaly increases with age, while the CPD decreases. The CPD is decreased in groups that show anomalies. The detection of a decreased CPD before surgery may lower the chance of a perioperative hemorrhage due to artery damage during pharyngeal procedures. Hence, while reporting neck CT angiographies, it may be valuable to also report the presence of ICA anomalies and CPD.

Blue rubber bleb nevus syndrome: imaging of small bowel lesions with peroral CT enterography.

Blue rubber bleb nevus syndrome (BRBNS) is a rare entity that consists of multiple venous malformations involving several organ systems, particularly the skin and the gastrointestinal tract. The diagnosis is based on clinical findings; however, imaging is required to investigate the extent of involvement and complications. A 17-year-old patient, with multiple blue skin nevus, was admitted to the emergency room of our hospital with severe gastrointestinal bleeding and melena. Upper endoscopy showed two wine-color vascular lesions in the duodenum, and colonoscopy revealed multiple lesions in the colon. Peroral CT enterography demonstrated multiple (more than 30) contrast-enhanced polypoid small bowel lesions, ranging in size from 5 to 16 mm. Some lesions contained millimetric calcifications representing phleboliths. The patient also had three pancreatic lesions which showed homogenous enhancement on the delayed images. Our findings show that peroral CT enterography is useful to demonstrate the extent of small bowel lesions of BRBNS. This is the first report of pancreatic involvement of BRBNS.

64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease.

OBJECTIVE: The purpose of our study was to investigate whether CT venography (CTV) performed after CT pulmonary angiography (CTPA) using 64-MDCT provides additional findings in the diagnosis of thromboembolic disease. MATERIALS AND METHODS: Three hundred six consecutive patients in whom pulmonary embolism (PE) was clinically suspected were included in the study. The study group was classified according to the diagnostic quality of the CTPA examinations, the presence or absence of PE and deep venous thrombosis (DVT), and the most proximal localization that the embolus could lodge in the pulmonary artery. RESULTS: The diagnostic quality of CTPA was insufficient in 5.9%, acceptable in 8.2%, and excellent in 85.9% of the patients. The diagnostic quality of CTV was insufficient in 11.4%, acceptable in 47.4%, and excellent in 41.2%. The percentages of nondiagnostic examinations for CTPA and CTV were 5.2% and 10.8%, respectively. Acute PE and acute DVT were observed in 25.2% and 18.0%, respectively. The percentage of subsegmental emboli among patients with acute PE was 15.6%. The percentage of patients with thromboembolic disease was 29.1%. Of patients who were diagnosed as having thromboembolic disease, 13.5% (12 of 89 patients) had DVT only. Of all patients, 3.9% (12 of 306) had only isolated DVT. The number of patients with subsegmental PE who had DVT was two (0.7% all patients). CONCLUSION: As in MDCT scanning with a smaller number of slices, the combination of CTV with CTPA in 64-MDCT results in a small but definitive increase in the percentage of patients with a diagnosis of thromboembolic disease.

Multidetector computed tomography findings of double-outlet right ventricle associated with multiple cardiac and visceral anomalies.

A 25-year-old woman who had undergone the Blalock-Taussig shunt operation for double-outlet right ventricle (DORV) in her childhood was admitted to our hospital with mild cyanosis and dyspnea on exertion. To evaluate the precise complex anatomy of this abnormality, we carried out multidetector computed tomography (MDCT) angiography. MDCT clearly revealed both an occluded Blalock-Taussig shunt and a complex cardiac anatomy, including DORV, a doubly committed ventriculoseptal defect, pulmonary stenosis, persistent left superior vena cava, minor aortic arch anomalies, and total anomalous hepatic venous drainage. To our knowledge, our report is the first description of such a complex cardiac anatomy to be revealed with MDCT.

Treatment of hypertension from renal artery entrapment by percutaneous CT-guided botulinum toxin injection into diaphragmatic crus as alternative to surgery and stenting.

OBJECTIVE: Our objective was to describe the technique and outcome of CT-guided injection of botulinum toxin into the diaphragmatic crus in a patient with hypertension caused by left diaphragmatic crus compression of the left renal artery. CONCLUSION: After the procedure, the patient's hypertension disappeared. We propose this technique, which directly targets inhibition of overactivity of the diaphragmatic crus, for treatment of hypertension caused by diaphragmatic compression of the renal artery as an alternative to surgery and renal artery stenting.

Extrahepatic abdominal hydatid disease caused by Echinococcus granulosus: imaging findings.

OBJECTIVE: The classical findings in hydatid disease caused by Echinococcus granulosus with liver or lung involvement are well known. However, diagnosing hydatid disease at unusual locations may be challenging because of variable imaging appearances depending on the host reaction. The purpose of this pictorial essay is to review the sonographic, CT, and MRI features of extrahepatic abdominal hydatid disease including intraperitoneum, retroperitoneum, diaphragma, bone, and soft tissue of the abdomen. CONCLUSION: Extrahepatic abdominal hydatid lesions have nearly identical imaging features, including the presence of cyst wall calcification, daughter cysts, and membrane detachment. The combinations of radiologic and serologic tests especially in patients living in the endemic areas contribute to the diagnosis. Despite their rarity, being familiar with the spectrum of radiologic findings in these unusual sites is helpful to improve diagnostic accuracy.

The effect of ACE gene polymorphisms on Doppler blood flow parameters of carotid and brachial arteries in patients with myocardial infarction.

The authors investigated the relationship between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and the blood flow characteristics of common carotid (CCA) and brachial arteries (BA) by color Doppler ultrasound (CDUS) in patients with acute anterior myocardial infarction (AAMI). Sixty four patients (11 women and 53 men), aged 25 to 77 years, with AAMI were studied. The ACE genotypes were established. Peak-systolic (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCAs were measured by CDUS. All results were evaluated statistically. The ACE genotypes were distributed as follows: 43.8% DD, 43.8% ID, and 12.5% II. PSVs of BA and both CCAs were lower in patients with DD and ID than with II (p<0.05). EDVs of both CCAs were also lower in the same groups, but statistically not significant (p>0.05). IMTs of both CCAs did not differ among patients with various ACE genotypes (p>0.05). These results suggest that ACE I/D polymorphism influences Doppler blood flow parameters of both BA and CCA, but does not affect IMT of CCA.

Follow-up results in tuberculous cervical lymphadenitis.

OBJECTIVE: To investigate the efficacy of medical antituberculous treatment in patients with tuberculous cervical lymphadenitis (TCL). METHODS: In the period 1996-2002, 73 TCL patients were reviewed and the results of clinical and laboratory testing were documented. The efficacy of a four-drug chemotherapy regimen was investigated. RESULTS: Purified protein derivatives (PPD) skin test results were positive in 58 (79 per cent) patients. Chest X-rays revealed changes consistent with tuberculosis in nine (12.3 per cent) patients. The mean duration of medical treatment was 10.04 months. In follow-up evaluation, 14 (20 per cent) patients were considered suspicious for resistant TCL and total excision of all nodes was performed. Histopathology confirmed TB in only 10 of these cases. CONCLUSION: The high incidence of residual disease in our study indicates that medical treatment (at least nine months of four combined antituberculous drugs) did not seem to be effective. If lymphadenopathy persists, total surgical excision of lymph nodes should be the treatment of choice.

Diagnosis of pre-eclampsia and assessment of severity through examination of the placenta with acoustic radiation force impulse elastography.

OBJECTIVE: To assess the value of placental shear wave velocity (SWV) measurement by acoustic radiation force impulse (ARFI) imaging for the diagnosis of pre-eclampsia and to determine the relationship between the SWV and the severity of pre-eclampsia. METHODS: A prospective study was performed at a center in Turkey between August 2014 and March 2015. The study included consecutive pregnant women in the second or third trimester diagnosed with pre-eclampsia and healthy pregnant women without pre-eclampsia of similar ages. Patients with pre-eclampsia were divided into two groups (severe or mild disease) on the basis of revised American College of Obstetricians and Gynecologists criteria. All patients underwent ARFI, and the SWV was measured at several placental locations. RESULTS: Overall, 86 women were enrolled (42 with pre-eclampsia, 44 controls). Minimum, maximum, and mean SWV values were significantly higher in the pre-eclampsia group than in the control group (P<0.001 for all). These values were also significantly higher among patients with severe pre-eclampsia than among patients with mild pre-eclampsia (P<0.001 for all). CONCLUSION: Measurement of the placental SWV with ARFI imaging is a useful additional method for the diagnosis of pre-eclampsia and for determination of the disease severity.