Pulsatility Index of Popliteal Artery in Patients with Isolated Calf Vein Thrombosis: A Novel Technique for Detecting Thrombosis.

BACKGROUND: To investigate the usefulness of popliteal artery spectral doppler findings as a complimentary approach to isolated calf vein thrombosis (DVT). MATERIAL/METHODS: We included consecutive patients presenting with symptomatic and sonographically proven acute isolated calf DVT. Patients with thrombosis of any other vein were excluded. We classified calf vein into into four main types. We investigated how many of these four vessels had DVT and compared them with respect to the pulsatility index (PI) value of the popliteal artery. RESULTS: We evaluated spectral doppler characteristics of the popliteal artery on the same side as the isolated calf vein thrombosis as well as on the opposite side. The relationship between PI values of the popliteal artery and the number of thrombosed calf veins was investigated. In patients with 1 and/or 2 thrombosed veins, the mean PI was 6.03±0.54 on the side of cDVT and 5.68±0.39 on the opposite side (p=0.008), respectively. Inpatients with 3 and/or 4 thrombosed veins, the mean PI was 8.05±0.61 on the side of cDVT and 6.34±0.47 on the opposite side (p=0.001), respectively. CONCLUSIONS: Venous doppler sonography for the evaluation of calf DVT may be limited by patient characteristics such as obesity, edema, and tenderness., Arterial PI can be used as a complimentary technique for the detection of venous thrombosis in such of cases.

The evaluation of morphometry of the mastoid process using multidetector computed tomography in a living population.

The aim of this study was to examine the relationships of the bony landmarks on the lateral surface of the mastoid process (MP). It was also the target of this study to reveal the importance of sexual dimorphism in terms of the mastoid triangle. Our study was performed on 140 (70 women, 70 men) multidetector computed tomography images obtained from patients who underwent radiologic examination at the Department of Radiology of Meram Medical Faculty, Necmettin Erbakan University. The height of the MP was measured using 2 different ways. The distance between the mastoid apex and the midpoint of the distance of the porion and the mastoid notch was measured (mastoid height 1). Then, the distance between the Frankfurt horizontal plane and the mastoid apex was measured (mastoid height 2). The distances between porion-mastoid notch, porion-mastoid apex, porion-asterion, asterion-mastoid apex, articular tubercle-asterion, articular tubercle-mastoid apex, as well as the right and the left MP were also measured. Finally, the angles between porion-mastoid apex-asterion, mastoid apex-asterion- porion, and asterion-porion-mastoid apex were measured. All data were analyzed statistically using the Student's t-test. According to the results of the measurements, all right and left parameters of the men were higher than the women's right and left sides except for the angle between asterion-porion-mastoid apex. In addition, all right and left parameters were almost the same in both sexes. Having the knowledge of measurements of the distances between the major landmarks of the temporal bone is essential to avoid possible complications during facial, mastoid, and especially sigmoid sinus surgeries.

The evaluation of morphometry of nasal bone and pyriform aperture using multidetector computed tomography.

INTRODUCTION: The aim of this study was to measure nasal bone (NB) and pyriform aperture (PA), morphometrically. Besides, the different types of NB and PA were classified and determined the sexual differences. MATERIALS AND METHODS: Our study was performed on 120 (60 women, 60 men) multidetector computed tomography images obtained from patients who underwent radiologic examination in the Department of Radiology of Meram Faculty of Medicine, Necmettin Erbakan University. The right, left, and median heights of NB; the superior and inferior widths of NB; the width of PA; and the distance between rhinion and anterior nasal spine (as the height of PA) were measured. Frontonasal and internasal angles were also determined. All data were analyzed statistically using Student's t-test. RESULTS: The other data of men were higher than of women except for the superior and inferior widths of NB and the frontonasal angle. We also determined the ratio of the height of PA to the height of NB on median plane and the ratio of the height of PA to the width of PA. They were found less than 2.0 in 64.2% and 100% of the cases, respectively. The NB and PA were classified into 8 and 7 different types, respectively. CONCLUSIONS: The knowledge of the morphometric data and different types of the NB and PA is essential for sex determination, all surgical procedures related to this area, and nasal reconstructions.

Where is the apex of the sacral hiatus for caudal epidural block in the pediatric population? A radio-anatomic study.

PURPOSE: Caudal epidural block (CEB), administered through the sacral hiatus, is a regional anesthetic technique commonly used in children. To facilitate and optimize pediatric CEB, morphometric data that may be important for the sacral hiatus have been obtained using multidetector computed tomography (MDCT). METHODS: This study is the first radio-anatomic study designed to address this topic in children. Images of 79 children (39 girls and 40 boys between 1 and 9 years old) were divided into three groups according to age [group I (ages 1-3), group II (ages 4-6), and group III (ages 7-9)] and were retrospectively examined. Data were gathered via 3D volume-rendered images. Measurements included the height and width of the sacral hiatus, S2-S4 (sacral vertebra) distance, the distances between the poles of the unfused spinous process of each sacral vertebra, and the dimensions of an imaginary triangle formed between the right and left posterior superior iliac spines (PSIS) and the apex of the sacral hiatus. RESULTS: The most frequently fused spinous process was at S2 level. The mean S2-S4 distance was 1.36 cm for group I, 1.78 cm for group II, and 2.17 cm for group III. There was not the imaginary equilateral triangle used in the method of finding the sacral hiatus for CEB, and the apex of this triangle did not occur at the standard level (S4) in most of the children. It was observed that the apex deriving from the most distal fused spinous process was at the level of S2 in one of two children. CONCLUSION: Dural puncture is inevitable for CEB applied at the S2 level. Consequently, CEB should be applied below this level (range, 1.36-2.17 cm) from the midpoint of the interspinous distance between the PSIS (at the same level with S2) in children aged 1-9 years.

The morphometrical analysis of the external carotid artery and its branches with multidetector computerized tomography angiography technique / Análisis morfométrico de la arteria carótida externa y sus ramas mediante la técnica de angiografía por tomografía computarizada multidetector

The external carotid artery (ECA) is the main artery of the head and the neck region. Carotid bifurcation (CB), which is one of the place where the atherosclerotic plaques are most commonly seen. The surgical procedure of these plaques which causes cerebral vascular accident (CVA) is carotid endarterectomy. In this surgical procedure, the knowledge of the anatomical courses and variations of the carotid artery increased the surgery performance. In our study, we aimed to introduce the course, the location and the variation of the ECA's and their branches. This study is carried out on multidetector computerized tomography angiography of the ECA's of 50 men and 50 women, totally 200 ECA's (100 right, 100 left). The measurement of the inner diameter of the common carotid artery (CCA) and the ECA was evaluated. The location of the CB was determined and its vertical distance to the gonion measured. We found that the superior thyroid artery (STA) originated from the CCA, the CB and the ECA. The vertical distances between the CB and the STA, lingual (LA), facial (FA) occipital (OA) were measured. The ECA and its branches were recorded. We believe that the assessment of the ECA morphometrically may comprise control groups of diseases related to the vessel diameter and this data may be used as reference in clinic and surgery. Knowing the anatomical details and variations is vital to prevent unpredictable complications in surgery.

La arteria carótida externa (ACE) es la principal arteria de la cabeza y de la región del cuello. La bifurcación carotídea (BC) es uno de los lugares donde las placas ateroscleróticas son más frecuentes. El procedimiento quirúrgico para tratar estas placas que causan el accidente vascular cerebral (AVC) es la endarterectomía carotídea. En este procedimiento quirúrgico, el conocimiento de los cursos anatómicos y variaciones de la arteria carótida aumenta el rendimiento de la cirugía. El objetivo de nuestro estudio fue presentar el trayecto, localización y variación de la ACE y sus ramas. El estudio se realizó mediante angiografía multidetector por tomografía computarizada de la ACE de 50 hombres y 50 mujeres, totalizando 200 ACE (100 derechas y 100 izquierdas). Se evaluaron el diámetro interior de la arteria carótida común (ACC) y la ACE. Se determinó la ubicación de la BC y se midió la distancia vertical hasta el gonion. Se observó que la arteria tiroidea superior (ATS) se originó desde la ACC, la BC y la ACA. Las distancias verticales entre la BC, y las arterias tiroídea superior, lingual (AL), facial (AF) y occipital (AO) fueron medidas. La ACE y sus ramas se registraron. Creemos que la evaluación morfométrica de la ACE puede comprender grupos de control de las enfermedades relacionadas con el diámetro de los vasos, y estos datos pueden ser utilizados como referencia clínica y quirúrgica. El conocimiento de los detalles anatómicos y variaciones es de vital importancia para evitar complicaciones imprevisibles en la cirugía.

Detection and quantification of the parenchymal abnormalities in emphysema using pulmo-CT.

We aimed to determine the degree and extent of parenchymal abnormalities on pulmo-CT in patients with emphysema. The study group consisted of 29 patients (18 male, 11 female; mean age 57.9+/-13). The diagnosis was based on clinical symptoms, pulmonary function tests (PFT) values, and chest CT findings. All of the patients CT scans were obtained during suspended deep inspiration from the apices to the costophrenic angles. The mean lung attenuation (MLD) and parenchymal abnormalities related to emphysema were quantitatively calculated with tables, histograms and graphics at the whole lung. The lung density measurements revealed a mean density of -898.48+/-51.37 HU in patients with emphysema and -825.1+/-25.5 HU in control group. In addition, mean percentage of subthreshold attenuation values was found as 12.03+/-15.75 and 1.07+/-0.83 in patients with emphysema and control group, respectively. Compared with control group, the patients with emphysema had a significantly lower inspiratory MLD (p<0.05). Additionally, statistically significant correlations were seen between the MLD and percentage of subthreshold values (r=0.44, p<0.05). In contrast, there was poor correlation between PFT measurements and the subthreshold values. In conclusion, pulmo-CT is a quick, simple method for quantitative confirmation of the presence of parenchymal abnormalities of lung as mosaic attenuation and should be used in combination with other radiological methods and PFT as it gives additional information to routine examinations in patients with emphysema.

Unusual congenital aortic anomaly with rare common celiamesenteric trunk variation: MR angiography and digital substraction angiography findings.

Magnetic resonance angiography and digital substraction angiography (DSA) findings in a case with a rare congenital thoracoabdominal aortic hypoplasia and common celiamesenteric trunk variation with occlusion of infrarenal abdominal aorta are described here. To our knowledge, this aortic anomaly has not been previously described in the English literature. DSA is the optimum imaging modality for determination of aortic hypoplasia, associated vascular malformations, collateral vessels, and direction of flow within vessels.

[Multidetector computed tomography in the diagnosis of parathyroid adenomas: contribution of contrast enhancement pattern to diagnosis]. / Paratiroid adenomu tanisinda çok dedektrlü BT: kontrast tutulum paterninin taniya katkisi.

PURPOSE: Contrast enhancement patterns of parathyroid adenomas in the arterial and venous phases were evaluated with multidetector computed tomography and specificity of the method to characterize the lesions was investigated. MATERIALS AND METHODS: Arterial and venous enhancement patterns of parathyroid adenomas were evaluated retrospectively with multidetector computed tomography in 12 patients. All adenomas were removed surgically and the diagnosis was confirmed histopathologically. An area from the mandibular angle to the aortic arch was scanned with 1.5 mm section thickness in the arterial phase (20 seconds delay time) and venous phase (70 seconds delay time) after bolus injection of 50 ml of iodinated contrast media. Arterial and venous contrast enhancement of parathyroid adenomas was evaluated in the axial and coronal reformat images. RESULTS: Ten (83.3%) of 12 parathyroid adenomas showed a heterogeneous enhancement with a hypodense small central area in the arterial phase and a homogeneous enhancement in the venous phase. However, two small lesions, four and five mm in diameter respectively, showed homogeneous contrast enhancement in the arterial phase unlike the larger lesions which displayed a hypodense center in this phase. CONCLUSION: Dynamic scanning with multidetector computed tomography after contrast administration may be helpful in characterizing parathyroid adenomas.

MR fluoroscopy-guided transthoracic fine-needle aspiration biopsy: feasibility.

The purpose of this study was to evaluate the feasibility of using an open-configuration magnetic resonance (MR) imaging system with MR fluoroscopic guidance to perform percutaneous transthoracic fine-needle aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsies were performed with MR fluoroscopic guidance in 14 patients. The masses were 2-7 cm in diameter (mean, 4.1 cm). The needle was positioned by using a free-hand technique with MR fluoroscopic guidance. The needle tip reached the target lesion, and biopsy was performed. Analysis of the biopsy specimens facilitated a specific diagnosis in all patients. Pneumothorax was noted in two patients (14%) with chronic obstructive pulmonary disease. Study results showed that the described MR fluoroscopy-guided transthoracic biopsy technique can be used safely and successfully for lung masses. MR fluoroscopy can be used to reach the target lesion easily and accurately.

Clinical value of color Doppler ultrasonography measurements of full-term newborns with perinatal asphyxia and hypoxic ischemic encephalopathy in the first 12 hours of life and long-term prognosis.

The cerebral blood flow velocities (CBFV) of infants with perinatal asphyxia and hypoxic ischemic encephalopathy (HIE) in the first 12 hours of their lives have been the chief focus of our concern in this study. Cerebral ischemia which can develop in the earlier hours of HIE, and the detection and diagnosis of this condition with color Doppler ultrasonography (cD-USG) will be put into discussion. Twenty-three full-term newborn infants who had perinatal asphyxia and HIE together with a control group constituting twenty full-term newborn infants who produced no problems, were included in our study. All of the infants underwent cD-USG in the postpartum period of the first 12 hours (mean 8.4 hours). Measurements being based upon peak systolic velocity (PSV), end diastolic velocity (EDV) and Pouecelout's resistive index (RI) in anterior and middle cerebral arteries were conducted. The infants, having been discharged from the unit they were followed up for mean 9.8 months in the outpatient clinic. PSV and EDV counts in the postpartum first 12 hours of 23 infants who were detected to have HIE were found to be significantly lower compared to the control group, whereas RI counts were found to be significantly higher (p < 0.05). The counts obtained from the right and left cerebral arteries of the infants with HIE were found to be corraleted with each others. The neonates in the patient group were observed to have gone through this prognosis: Three of them died, three of them had cerebral palsy, one of them had infantile spasms, and three of them had developmental retardation. When we compared the CBFV of the 10 neonates who had poor prognosis, retrospectively with the other 13 neonates who had good prognosis, PSV and EDV were found to be significantly lower and RI significantly higher (p < 0.05). In the light of the data we have obtained, cD-USG can be considered to be a highly practical device in evaluating CBVF of the infants with HIE. A skillful detection of the decrease in cerebral blood flow which can develop in the postasphyxial first 12 hours and the prospective treatments being based upon this approach would contribute to the diagnosis, treatment and prognosis of such cases.