Evaluation of Renal Artery Variations in Horseshoe Kidneys with Computed Tomography.

OBJECTIVE: Horseshoe kidney is the most common renal fusion anomaly, accounting for 90%. The study aims to explore the variations in the renal arteries of individuals with horseshoe kidney anomalies and contribute to the classification in the literature. MATERIALS AND METHODS: Computed tomography images of 145 individuals who had intravenous contrast-enhanced abdominal computed tomography for any reason and had horseshoe kidney anomalies were analyzed retrospectively, and the presence, origin, and number of accessory renal arteries were evaluated. Then, classification was performed according to the origin of the accessory arteries. RESULTS: In 145 individuals, 44 different combinations of the accessory artery according to the origin and number were obtained. Most common accessory artery combination was type 2a (M1). According to our classification, 13.1% of the patients were type 1, 57.2% were type 2, 17.2% were type 3, 10.3% were type 4, and 1.4% were type 5. CONCLUSION: The classifications of arterial variations in horseshoe kidney anomalies did not match each other in previous studies and did not comprise all patients because they were conducted with a small number of cases. A more comprehensive new classification was created in our study according to accessory artery origins with the help of previous studies.

Selective Transarterial Embolization for Intractable Hematuria Due to Bladder Carcinomas: A Single-Center Experience.

OBJECTIVE: Malignant bladder neoplasms can cause life-threatening persistent hematuria. Selective transarterial embolization is an effective way to achieve hemostasis in such patients. The purpose of our study is to share our experience in these patients and to evaluate the short- and long-term effectiveness of this procedure. METHODS: Twelve male patients with intractable hematuria due to bladder carcinoma were included in the study. A total of 17 selective transarterial embolization procedures (bilateral in 5 patients) were performed in 12 patients with microspherical particles and microcoils. RESULTS: Complete control of bleeding was achieved in 9 patients after the procedures whereas the need for transfusion continued in 3 patients. Approximately 75% bleeding control was achieved during our average 6-month (4- to 12-month) follow-up period. After the procedure, the patients had mild complaints that lasted for a few days, such as pain (66%), fever (42%), and nausea (50%). No major complications occurred. CONCLUSION: Selective transarterial internal iliac artery embolization is a reliable method that can be used for the palliative treatment of intractable hematuria due to bladder carcinomas.

Percutaneous ablation treatment in metastatic lung tumors: a single-center experience.

BACKGROUND: In recent years, many studies have proven that percutaneous thermal ablation is an effective second-line treatment method with low complication rates in early-stage non-small cell lung carcinoma and lung metastases. Radiofrequency ablation and microwave ablation are commonly used for this purpose. PURPOSE: To evaluate the factors affecting the success of the percutaneous thermal ablation treatment with technical success, complication rates, and long-term follow-up results in metastatic lung lesions. MATERIAL AND METHODS: Computed tomography (CT)-guided percutaneous ablation was performed for 70 metastatic lung lesions in 35 patients (22 men, 13 women; mean age = 61.34 years; age range = 41-75 years). Radiofrequency ablation was performed in 53/70 (75.7%) lesions and microwave ablation in 17/70 (24.3%) lesions. RESULTS: The technical success rate was 98.6%. Median overall survival, progression-free survival, and local recurrence-free survival of the patients were 33.9 months (range=25.6-42.1 months), 12 months (range=4.9-19.2 months), and 24.2 months (range=8.2-40.1 months), respectively. One- and two-year overall survival rates were 84% and 74%, respectively. Median progression-free survival times were 20.3 months and 11.4 months, respectively, according to the number of metastatic lung lesions being single and multiple, and the difference was statistically significant (P = 0.046). According to the number of lesions ≤3 and >3, the difference was also found statistically significant (P = 0.024) (14.3 months and 5.7 months, respectively). CONCLUSION: In conclusion, CT-guided percutaneous thermal ablation is a safe and effective treatment method in metastatic lung lesions. The number of lesions is the most important factor in predicting treatment success.

Evaluation of the self-expanding effect of carotid stents in the early postoperative period.

PURPOSE: To evaluate the expansion effect of self-expandable stents during the first week after carotid artery stenting (CAS) procedure and to examine the variation of the effect according to the carotid plaque type. METHODS: Seventy stenotic carotid arteries of 69 patients were stented by using self-expanding Wallstents with diameters of 7 and 9 mm, after detection of stenosis and plaque type by Doppler ultrasonography. Post-stent aggressive ballooning was avoided and residual stenosis rates were measured with digital subtraction angiography. After the stenting procedure, the caudal, narrowest, and cranial diameters of stents were measured with ultrasonography at 30 min, first day and first week. Stent diameter increase and change according to plaque type were evaluated. Two-way repeated measure ANOVA test was used for statistical analysis. RESULTS: A significant increase was observed in the mean stent diameter in the three stent regions (caudal, narrow, and cranial) from the 30th minute to the first and seventh days (p < 0.001). The most prominent stent expansion occurred in the cranial and narrow segments within the first day. In the narrow stent region; Stent diameter increase between 30th minute-first day, 30th minute-first week, and first day-first week were all significant (p < 0.001). At 30 min, first day, and first week, no significant difference was detected between plaque type and stent expansion in caudal, narrow, and cranial regions (p = 0.286). CONCLUSION: We think that keeping the lumen patency limited to 30% residual stenosis after CAS procedure by applying minimal post-stenting balloon dilatation and leaving the remaining lumen expansion to the self-expanding feature of the Wallstent might be a sensible approach in order to avoid embolic events and excessive carotid sinus reactions (CSR).

The relationship between ultrasonographic plaque morphology and histopathology of embolic material captured in the protective filter during carotid artery stenting.

PURPOSE: We aimed to correlate the presence or absence of embolic debris in filter-type embolic protection devices (EPD), which are frequently used during carotid artery stenting (CAS), with possible risk factors and ultrasonographic plaque features. MATERIALS AND METHODS: Eighty patients, who underwent CAS using a filter-type EPD in the period between July 2016 and March 2019, were included in our study. The modified Gray-Weale classification (mGWC) subtypes obtained in the pre-procedural ultrasonographic examinations were recorded. In addition, other patient-related risk factors considered to be related to a distal embolism were recorded. After the procedure the filters were evaluated to detect and examine embolic debris in the pathology clinic. The presence and features of embolic debris in the filters were recorded. RESULTS: In the examinations performed after CAS, embolic debris was macroscopically and microscopically detected in 22 (27%) and 34 (42.5%) of the filter-type EPDs, respectively. A significant correlation was found between the change in the mGWC category of stenotic plaques from type 5 to type 1 and the presence of embolic debris in the filter (p < 0.05). Furthermore, a significant relationship was found between stenotic segment length and the presence of embolic debris in the filter (p < 0.05). The presence of embolic debris was not statistically significantly related to predisposing risk factors for atherosclerosis (p > 0.05). CONCLUSIONS: During CAS, the likelihood of the presence of embolic debris in the EPDs increases as mGWC categories change from type 5 to type 1 and as the length of the stenotic segment increases.

An isolated traumatic renal artery pseudoaneurysm treated by renal artery stent insertion: a case report presenting a nephron-sparing approach.

Penetrating or blunt traumas can rarely lead to renal artery pseudoaneurysms (RAPs). Renal parenchymal lacerations usually accompany them, and nephrectomy is performed in these cases. Although angioembolization of the renal artery can negate the need for nephrectomy while treating the RAP, it is not a nephron-sparing procedure. Herein, we present a case of isolated (i.e. without accompanying renal laceration) left RAP. During conservative follow-up, the RAP enlarged, and subsequently, it was treated by renal artery stent insertion. An expandable covered stent was used during this procedure. The renal function was preserved without experiencing any complications.

Role of magnetic resonance spectroscopy in differential diagnosis of solitary pulmonary lesions.

PURPOSE: The aim of our study was to evaluate the availability of magnetic resonance spectroscopy (MRS) for the differentiation of benign or malignant pulmonary nodules and masses. METHODS: A total of 59 patients (45 male, 14 female) with pulmonary nodules and masses were included in this prospective study. MRS was applied to the pulmonary lesions of the patients and choline levels were determined. Afterwards CT-guided percutaneous needle biopsy was performed. According to the biopsy results, pulmonary lesions were benign in 25 patients and malignant in 34 patients. RESULTS: Choline levels were significantly higher in malignant lesions compared with benign lesions (p < 0.001). When the other conditions were kept constant, the probability of malignancy significantly increased by 17.38-fold (95% CI, 3.78-79.93) in those with choline levels >1.65 µmol/g compared to those with choline levels ≤1.65 µmol/g (p < 0.001). CONCLUSION: MRS is a noninvasive method that can be used in the differential diagnosis of pulmonary nodules and masses.

Advanced Magnetic Resonance Imaging Findings of Multinodular and Vacuolating Neuronal Tumor.

AIM: To present the magnetic resonance imaging (MRI) findings of a multinodular and vacuolating neuronal tumor (MVNT). MATERIAL AND METHODS: The authors identified four patients with MVNT in the hospital between January 2015 and October 2019. Both the clinical and radiological data of the patients were collected for analysis. RESULTS: Three patients complained of non-specific headaches. One patient had vertigo and imbalance. MRI sequences, including spectroscopy, perfusion, and DWI sequences, were retrospectively evaluated. The lesions were located in the subcortical and periventricular white matter of the parietal and temporal lobes, showed confluency, and comprised nodular pattern. The lesions appeared isointense to the cerebral cortex on T1 weighted imaging and hyperintense on T2 weighted and FLAIR sequences. None of the lesions showed diffusion restriction or contrast enhancement. Three of the lesions demonstrated a slight increase in choline peak and a slight decrease in N-acetyl aspartate peak. One lesion showed a noticeable increase in the Cho peak and a decrease in the NAA peak. CONCLUSION: Radiological features of MVNT are specific. Recognizing the MRI findings would help avoid unnecessary interventions in these patients, who are usually asymptomatic.

Evaluation of iliac venous variations with multidetector computed tomography.

PURPOSE: There are many variations of the iliac vein, and it is aimed to evaluate these variations using multidetector computed tomography (MDCT). METHODS: Pelvic MDCT images of 1071 adult patients (576 males; 495 females; age range 18-94 years; mean age 50.3 years) were retrospectively evaluated. Reconstruction images of the pelvic region in sagittal and coronal planes were evaluated. Except for the usual iliac venous anatomy, all types of iliac vein connections were defined as "iliac venous variation". RESULTS: Of the 1071 patients, 84.2% were considered as type 1 (usual). Different variations were observed in 15.8% of the patients, of whom, 63.9% of were male and 36.1% female, and this gender difference was statistically significant (p < 0.05). The rates of variations detected in the study were type 2 (49.7%), type 3 (29%), type 4 (4.7%), type 5 (6.5%), type 6 (4.8%), type 7 (1.8%) and type 8 (3.6%) respectively. New subtypes that we named as type 3c, type 6f, type 6 × and type 7b were first determined in our study. CONCLUSION: Knowledge and evaluation of iliac venous variations before pelvic surgery or interventional procedures is of importance in preventing possible complications.

Morphological evaluation of the coccyx with multidetector computed tomography.

PURPOSE: This study aims to evaluate the morphology of the coccyx in adults with multidetector computed tomography and to contribute to the classification of the coccyx using intercoccygeal and sacrococcygeal angle measurements. METHODS: The pelvic computed tomography images of 224 patients were retrospectively evaluated. The multiplanar reconstruction and 3D volume rendering images of the coccyx were obtained from all patients at sagittal and coronal planes. The morphology of the coccyx, number of bone segments, the presence of scoliosis, and presence of sacrococcygeal and intercoccygeal fusion were evaluated. After the measurement of coccygeal length, width, and thickness, intercoccygeal and sacrococcygeal angles were also calculated in all patients. RESULTS: The morphological classification showed that 136 patients (60.7%) had type 1, 65 patients (29%) had type 2, and 17 patients (7.6%) had type 3 coccyx. The intercoccygeal angle was zero degree in five patients (type 0) and one patient had retroverted coccyx (type 5). The coccyx had four segments in 155 patients (69.2%), three segments in 52 patients (23.2%), five segments in 15 patients (6.7%), two segments in one patient (0.4%), and one segment in one patient (0.4%). CONCLUSION: We determined patients with an intercoccygeal angle of zero degree, which is not mentioned in the literature before, and we propose to use the term "type 0" for these patients in the classification of coccyx. The coccygeal measurements and classification will be instructive for the radiologists and have a guiding role for the future studies.

Comparison of ultrasound and physical examination with computerized tomography in patients with blunt abdominal trauma.

BACKGROUND: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

Shear Wave Sonoelastography Findings of Testicles in Chronic Kidney Disease Patients Who Undergo Hemodialysis.

OBJECTIVE: Chronic kidney disease (CKD) is known to cause significant deterioration in the function of the testicles and sexual dysfunction in male patients who undergo hemodialysis. The aim of this study was to show the changes in the testicles that occur as a result of hypogonadism secondary to CKD and to analyze the elasticity of the parenchyma by shear wave sonoelastography. MATERIALS AND METHODS: In our study we included 28 male patients who undergo dialysis three times per week and 25 healthy volunteers. Firstly, B-mode ultrasonographic evaluation was performed in both testicles for structural analysis and to detect the presence of focal lesions. Afterward, the stiffness of the parenchyma was measured in kilopascals by shear wave sonoelastography. RESULTS: The CKD group had lower right, left, and mean testicular volumes (p<0.001). The CKD group also displayed greater right, left, and mean testicular parenchymal stiffness (p<0.001). CONCLUSION: CKD patients who undergo hemodialysis demonstrated significant changes in testicular size and stiffness in comparison to healthy volunteers.

Association Between Conjunctival and Corneal Calcification and Atherosclerotic Changes in the Carotid Artery in Maintenance Hemodialysis Patients.

PURPOSE: We aimed to investigate the association between atherosclerotic changes in the common carotid artery (CA) and conjunctival and corneal calcification (CCC) in maintenance hemodialysis (MHD) patients. METHODS: Fifty eyes of MHD patients with the highest CCC scores were enrolled. CCCs were scored according to the method described by Tokuyama et al. The eyes with the highest CCC scores were selected for further analysis. According to their CCC scores, the patients were classified into 3 groups: mild (0-2 score), moderate (3-5), and severe (6-10 score). Atherosclerosis of the common CA was evaluated by determination of intima-media thickness (IMT), peak systolic (PSV) and end diastolic (EDV) flow velocities, pulsatility index, and resistive index values by using Doppler ultrasonography. RESULTS: The mean IMT of the CA was 0.61 ± 0.09 mm in the mild group, 0.82 ± 0.16 mm in the moderate group, and 1.21 ± 0.32 mm in the severe group (P < 0.001). The PSV and EDV were significantly higher in the severe group than in the mild and moderate groups (all, P < 0.001). The CCC score was positively correlated with the duration of hemodialysis, ocular surface disease index score, IMT, PSV, EDV, lymphocyte, calcium, and sedimentation rate. In multiple stepwise linear regression analysis, IMT was the best predictive factor for the CCC score (R = 0.812, ß = 9.526 ± 1.05, and P < 0.001). CONCLUSIONS: Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.

Bilateral Wallerian Degeneration of the Pontocerebellar Tracts.

Wallerian degeneration is the process of progressive demyelination and disintegration of the distal axonal segment following the transection of the axon or damage to the neuron. We report a case of a patient with Wallerian degeneration of the pontocerebellar tracts. She had a history of a pontine infarction 3 months ago. Wallerian degeneration of pontocerebellar tracts is seen bilaterally and symmetrically and is more visible in the middle cerebellar peduncles. Along the middle cerebellar peduncles hyperintense signal was detected on T2 weighted images. Wallerian degeneration of pontocerebellar tracts is a rare entity. It can occur bilaterally after a large pontine infarction. Magnetic resonance imaging seems to be the most effective technique for detection of Wallerian degeneration. In this report we want to mention this rare entity and to prevent wrong diagnosis.