A Rare Triplet Found in a Patient With Drug-Resistant Hypertension: Adnexal-Adrenal Sex Cord-Stromal Tumors and Castleman's Disease.

Adrenal and ovarian sex cord-stromal tumors which originate from the ovarian stroma and adrenal cortex, have an extremely low incidence even alone. Castleman's disease is also one of the rare causes of non-neoplastic lymphadenopathy. The aim of this case report was to contribute to the literature by identifying the coexistence of these three pathologies, which are encountered with a low incidence even alone. A 46-year-old female patient had experienced drug-resistant hypertension. In the laboratory test, electrolyte imbalance was detected. Imaging modalities revealed left adrenal and adnexal mass lesions as well as a right paraspinal intramuscular nodular lesion. When hypertension and electrolyte imbalance were evaluated together with their etiology, it was thought that the left adrenal lesion, which also has a chemical shift, may be compatible with functional adenoma. Left adrenalectomy was planned. The ovarian lesion and right paraspinal intramuscular lesion were also excised during the same session with the suspicion that the ovarian lesion may be hormone-active neoplasia and the intramuscular lesion may be a metastasis. The diagnosis of adnexal-adrenal sex cord-stromal tumors and unicentric Castleman's disease were made histopathologically. Radiologically, it should be kept in mind that the radiological manifestations of adrenal sex cord-stromal tumors can be confused with adrenal adenomas. Even when these extremely rare tumors are encountered, avoiding the "satisfaction of search" plays a crucial role in the identification of additional pathologies that can explain the etiology.

A case of mediastinal mesenchymal tumor resembling hemopericardium.

Mediastinal neoplasms are rare in the elderly, and clinical suspicion is the first and most important step of differential diagnosis. Mediastinal tumors can be misdiagnosed because their symptoms or signs can overlap with cardiovascular diseases, which have a higher prevalence among the older population. The diagnostic process should be managed with multimodality imaging and clinical judgement. Here, the case of a 74-year-old male patient, who presented with shortness of breath, is examined. A chest X-ray revealed an increased cardiothoracic ratio, and he was diagnosed with hemopericardium following an emergent chest computed tomography. In the echocardiography, it was suspected that a hyperechogenic area adjacent to the heart might be due to a mass, and further examinations confirmed a mediastinal neoplasm. A surgical biopsy was performed, and it was determined to be a mesenchymal tumor. To conclude, clinicians should keep in mind the possibility of paracardiac neoplasm in the elderly, as well as in other age groups, when encountering mediastinal widening so that the patient can be protected from unnecessary interventions such as pericardiocentesis.

Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach.

INTRODUCTION: Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients. OBJECTIVE: The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients' therapeutic approach. METHODS: The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8-12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required. RESULTS: Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients' mean age was 56 (27-93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented. CONCLUSION: Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.

MRI Findings of Borderline Retroperitoneal Serous Cystadenocarcinoma.

Retroperitoneal serous cystadenocarcinoma is an extremely uncommon lesion. Here, we present MR imaging findings of a 40-year woman who was admitted to the hospital due to abdominal pain. The patient was evaluated with abdominal Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Abdominal CT revealed a 13x18 cm large retroperitoneal and cystic mass with polypoid projections. MRI was superior than CT in showing polypoid projections. Contrast enhanced MRI detected enhancement of thin septations and cyst appearance inner the cyst. Diffusion-weighted MRI showed restricted diffusion in the polypoid component with contrast enhancement. Therefore, we thought malignant lesion. The findings of contrast-enhanced CT and MRI were helpful in the diagnosis of those lesions. In addition, diffusionweighted MRI with multiparametric modalities played unlimited role in the assesment of the differential diagnosis.

Prognostic values of ADCmean and SUVmax of the primary tumour in cervical cancer patients treated with definitive chemoradiotherapy.

We analysed the correlation of 18F-fluorodeoxyglucose uptake into primary tumours using the maximum standardised uptake value (SUVmax) and the mean apparent diffusion coefficient (ADCmean) values in magnetic resonance imaging (MRI) with the clinical and pathological factors in patients with cervical cancer who were treated with concurrent chemoradiotherapy. The patients were stratified according to the primary tumour pre-treatment ADCmean and SUVmax cut-off values. There were significant correlations between the SUVmax of the primary tumour and tumour size, and the treatment response. The correlation between the ADCmean and FIGO stage, tumour size, and the lymph node metastasis was significant. The SUVmax was significantly and inversely correlated with the ADCmean for cervical cancer (r = -0.44, p <.001). In the multivariate analysis, the primary tumour ADCmean, treatment response and the lymph node metastasis emerged as significant independent predictors of both OS and DFS, and of the primary tumour SUVmax for DFS. Tumour size has a borderline significance for OS. High SUVmax and low ADCmean of the primary tumour are important predictive factors for identifying high-risk patients with cervical cancer who are treated with definitive chemoradiotherapy. These results point to a future role for the diffusion-weighted MRI and for 18F-fluorodeoxyglucose positron emission tomography, not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy for individual patients. Impact statement What is already known on this subject? A negative correlation between primary tumour SUVmax derived from positron emission tomography (PET/CT) and ADCmin derived from diffusion weighted magnetic resonance imaging (DW-MRI) in various cancer types and cervical cancer has been demonstrated. However, the prognostic value of primary tumour SUVmax and ADCmean in cervical cancer patients treated with definitive chemoradiotherapy is not well studied yet. What the results of this study add? The patients with high-risk features (larger tumours, extensive stage, lymph node metastasis) had higher primary tumour SUVmax and lower ADCmean values. Primary tumour ADCmean and lymph node metastasis emerged as significant independent predictors of both overall and disease-free survival. This study demonstrated that the functional biomarkers delivered from PET-CT and DW-MRI are important in predicting the treatment outcomes in the squamous cell carcinoma of cervix treated with definitive chemoradiotherapy, where clinical and radiological findings are very important, since these patients are not staged surgically. What are the implications of these findings for clinical practice and/or further research? Based on these findings, there may be a future role of DW-MRI and FDG/PET-CT not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy (ChRT) for individual patients.

Utility of Diffusion Weighted Magnetic Resonance Imaging with Multiple B Values in Evaluation of Pancreatic Malignant and Benign Lesions and Pancreatitis.

OBJECTIVE: To determine the feasibility of diffusion-weighted imaging in evaluation of pancreatic lesions and in differentiation of benign from malignant lesions. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Baskent University Adana Teaching and Research Center, Adana, Turkey, between September 2013 and May 2015. METHODOLOGY: Forty-three lesions [pancreas adenocarcinoma (n=25)], pancreatitis (n=10), benign lesion (n=8)] were utilized with diffusion-weighted magnetic resonance imaging with multiple b-values. Different ADC maps of diffusion weighted images by using b-values were acquired. RESULTS: The median ADC at all b values for malignant lesions was significantly different from that for benign lesions (p<0.001). When ADCs at all b values were compared between benign lesions/normal parenchyma and malignant lesions/normal parenchyma, there was a significant statistical difference in all b values between benign and malignant lesions except at b 50 and b 200 (p<0.05). The lesion/normal parenchyma ADC ratio for b 600 value (AUC=0.804) was more effective than the lesion ADC for b 600 value (AUC=0.766) in differentiation of benign and malignant lesions. The specificity and sensitivity of the lesion/normal parenchyma ADC ratio were higher than those of ADC values of lesions. When the ADC was compared between benign lesions and pancreatitis, a significant difference was found at all b values (p<0.001). There was not a statistically significant difference between the ADC for pancreatitis and that for malignant lesions at any b value combinations (p>0.05). CONCLUSION: Diffusion-weighted magnetic resonance images can be helpful in differentiation of pancreatic carcinoma and benign lesions. Lesion ADC / normal parenchyma ADC ratios are more important than lesion ADC values in assessment of pancreatic lesions.

Long Segment Intestinal Invagination in an Adult Case.

How to cite this article: Karadeli E, Parlakgumus A, Tok S, Erbay G. Long Segment Intestinal Invagination in an Adult Case. Euroasian J Hepato-Gastroenterol 2017;7(1):99-100.

Abdominal CT Findings in Patients with Primary Lymphoma Causing Small Bowel Obstruction.

The purpose of this study was to investigate retrospectively CTfindings in patients with primary lymphoma causing small bowel obstruction. CTscans of 11 patients with small bowel lymphoma were separately analysed in terms of affected section of the small bowel, focality, wall thickness, pattern and degree of contrast enhancement, lymphadenopathy, organ involvement, perforation, and the presence of intraabdominal fluid. Eight patients had diffuse large B-cell lymphoma, and one patient each had marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), T-cell lymphoma, and anaplastic T-cell lymphoma. Affected sections of the bowels involved were jejunum (n=5, 45.4%), ileum (n=2, 18.1%), and one case (9%) each of distal ileum, distal jejunum, distal jejunum and ileum, and distal jejunum and colon. Primary gastrointestinal (GI) lymphoma is an uncommon disease, that may lead to small bowel obstruction sometimes.

Repair of calcified left ventricular pseudoaneurysm of long duration.

Cardiac pseudoaneurysm is a contained rupture of the myocardium limited by pericardial adhesions or the epicardial wall. Cardiac pseudoaneurysm may cause sudden death with a mortality of 30-45% in the first year, mostly resulting from rupture. Coronal and axial T2-weighted magnetic resonance images of a 65-year-old male patient admitted with dyspnoea, coughing and chest pain, present for the last 10 days, revealed a large pseudoaneursym of the left ventricle. Coronary bypass and left ventricular restoration operation was performed. The patient was eventlessly discharged 8 days after operation. He is in NYHA Class I 21 months postoperatively. The interval between myocardial insult and establishment of diagnosis is unknown in our patient. This is a patient whose left ventricular rupture had been contained for a very long time, possibly years, because a heavily calcified thick pseudoaneurysm wall was encountered during operation, making this case rare in the literature.

Internal comparison standard for abdominal diffusion-weighted imaging.

Background Standards for abdominal diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) measurements, and analysis are required for reproducibility. Purpose To identify optimal internal comparison standards for DWI to normalize the measured ADC for increased accuracy of differentiating malignant and benign abdominal lesions. Material and Methods We retrospectively studied 97 lesions (89 patients; age, 57 ± 13 years) with histopathologically confirmed abdominal disease. Seven normal body parts/contents (normal parenchyma, spleen, kidney, gallbladder bile, paraspinal muscle, spinal cord, and cerebrospinal fluid [CSF]) were assessed as internal references for possible use as comparison standards. Three observers performed ADC measurements. Statistical analyses included interclass correlation coefficients (ICCs), Mann-Whitney and Kruskal-Wallis tests, and coefficient of variation (CV). ROC analyses were performed to assess diagnostic accuracy of lesion ADC and normalized ADC for differentiating lesions. Pathology results were the reference standard. Results Mean and normalized ADCs were significantly lower for malignant lesions than for benign lesions ( P < 0.001). ICC was excellent for all internal references. Gallbladder had the lowest CV. Receiver operating characteristic (ROC) analyses showed that normalized ADCs obtained using normal parenchyma were better than lesion ADCs for differentiating malignant and benign abdominal lesions (area under the curve [AUC], 0.808 and 0.756, respectively). The normalized ADCs obtained using CSF shows higher accuracy than lesion ADCs (0.80 and 0.76, respectively) for differentiating between malignant and benign abdominal lesions. Conclusion The normal parenchyma from a lesion-detected organ can be used as an internal comparison standard for DWI. CSF can be used as a generalizable in plane reference standard.

Predicting tumor recurrence in patients with cervical carcinoma treated with definitive chemoradiotherapy: value of quantitative histogram analysis on diffusion-weighted MR images.

Background Further research is required for evaluating the use of ADC histogram analysis in more advanced stages of cervical cancer treated with definitive chemoradiotherapy (CRT). Purpose To investigate the utility of apparent diffusion coefficient (ADC) histogram derived from diffusion-weighted magnetic resonance images in cervical cancer patients treated with definitive CRT. Material and Methods The clinical and radiological data of 50 patients with histologically proven cervical squamous cell carcinoma treated with definitive CRT were retrospectively analyzed. The impact of clinicopathological factors and ADC histogram parameters on prognostic factors and treatment outcomes was assessed. Results The mean and median ADC values for the cohort were 1.043 ± 0.135 × 10-3 mm2/s and 1.018 × 10-3 mm2/s (range, 0.787-1.443 × 10-3 mm2/s). The mean ADC was significantly lower for patients with advanced stage (≥IIB) or lymph node metastasis compared with patients with stage

Evaluation of malignant and benign renal lesions using diffusion-weighted MRI with multiple b values.

BACKGROUND: Limited data are available regarding the use of diffusion-weighted (DW) magnetic resonance imaging (MRI) with multiple b values for characterization of renal lesions. PURPOSE: To demonstrate and compare the diagnostic performance of DW-MRI with multiple b values for renal lesion characterization. MATERIAL AND METHODS: Sixty-three lesions (36 malignant, 27 benign) in 60 consecutive patients (48 men, 12 women; age 60 ± 12.5 years) with solid/cystic renal lesion diagnosed after MRI were included prospectively. Single-shot echo-planar DW abdominal MRI (1.5T) was obtained using seven b values with eight apparent diffusion coefficient (ADC) maps. Contrast-to-noise ratios (CNRs), signal intensities, lesion ADCs, and lesion/normal parenchyma ADC ratios were analyzed. Receiver-operating characteristic analysis was performed. RESULTS: The mean signal intensities of malignant lesions (at b0, 50, and 200s/mm(2)) were significantly lower than those of benign lesions (P < 0.05). The mean ADC values at all b value combinations of malignant lesions were significantly lower than those of benign lesions (P < 0.000), excluding the ADC value at b50 s/mm(2). ADC with all b values could better distinguish between benign and malignant lesions. A 1.35 × 10(-3) mm(2)/s threshold ADC value permitted this distinction with 85.2% sensitivity and 65.6% specificity. The lesion/normal parenchyma ADC ratio was more effective than the lesion ADC. CONCLUSION: In addition to the ADC value, the signal intensity curve on DW images using multiple b values could be helpful for differentiation of malignant and benign renal lesions.

Phenotypic subgroups of polycystic ovary syndrome have different intra-renal resistance symptoms.

OBJECTIVE: The polycystic ovary syndrome (PCOS) is known to be related with increased metabolic and cardiovascular risks. Various phenotypic subgroups of PCOS have been proven to have metabolic and endocrine disorders with varying degrees of severity However, intra-renal vascular resistance, which is an indirect indication of atherosclerosis, remains unknown in PCOS subgroups. In this study we examined whether PCOS subgroups have different intra-renal resistance symptoms. MATERIAL AND METHODS: 98 PCOS patients (diagnosed according to the Rotterdam criteria) 30 controls were included in the study The diagnosis of PCOS was established in the presence of at least two of the following criteria: 1-oligo and/or amenorrhea (OM); 2-clinic and/or biochemical signs of hyperandrogenism (HA); 3-polycystic ovarian morphology (PCO) detected by transvaginal ultrasonography 37 patients (Group 1) met all three criteria (HA+OM+PCO), 29 patients (Group 2) met two of the criteria including hyperandrogenism (HA+OM or HA+PCO) and the remaining 32 patients (Group 3) had no hyperandrogenism but fulfilled the other two criteria; PCO+OM. Renal Doppler ultrasonography and hormonal/biochemical analyses were carried out. The first outcome measure was designated as the differences in the renal resistive index (RRI) values of the groups, and the second outcome measure was designated as the relation of RRI with the insulin resistance and lipid profile. RESULTS: In Group 1, the RRI and the homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly higher than in Group 3 and controls (P < 0.031, P < 0.001, respectively after adjusting for age and BMI). The RRI and HOMA-IR values in Group 3 were similar to those of the control group. It was determined that RRI has a positive correlation with HOMA-IR (r = 0.784, P < .0001) and BMI (r = 0.645, P < .0001). CONCLUSIONS: In this study we demonstrated that PCOS subgroups have metabolic and endocrine disorders and cardiovascular risks of varying degrees of severity Moreover, we showed that there was no increase of metabolic and cardiovascular risks in PCOS patients without hyperandrogenism.

Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey.

OBJECTIVE: The musculoskeletal system is one of the most commonly affected systems in brucellosis. The objective of this study was to determine the frequency, types, and clinical features of osteoarticular involvement among cases with brucellosis in the Central Anatolia region of Turkey and to establish the differences between patients with and without osteoarticular involvement. METHODS: Included in this study were 202 patients with Brucellosis presented between June 2003 and June 2009. The diagnosis of osteoarticular system complications was established by physical examination and radiological findings obtained by diagnostic imaging tools. Magnetic resonance images of thoracic, lumbar or sacral vertebrae were acquired from patients with back pain, low back pain and sacro-iliac joint pain. RESULTS: Osteoarticular involvement was noted in 94 patients (46.5%). The most common sources of infection are employment in farming and/or consumption of un-pasteurized milk or dairy products, especially fresh cheese in 53 (75.7%) cases. The mean age is 46.7±18 years. Sacroiliitis is the most frequent osteoarticular involvement (60.6%), 82.4% of which is bilateral. Sacroiliitis was followed by spondylodiscitis in 36 (38.3%), peripheral arthritis in 15 (16%), bursitis in 1(1.1%) case. Patients with osteoarticular involvement received medical treatment for at least three months. CONCLUSION: The ratio and anatomical region of osteoarticular involvement in brucellosis show variability among countries. In this study, it is demonstrated that sacroiliitis is the most common form of osteoarticular involvement in the Central Anatolia region of Turkey. In endemic countries such as Turkey, this disease should be included in the differential diagnosis for patients with symptoms of sacroiliitis, spondylodiscitis or those with articular pain.

Chest radiography and CT findings in patients with the 2009 pandemic (H1N1) influenza.

PURPOSE: To present chest radiography and thoracic computed tomography (CT) findings for patients with pandemic influenza A (H1N1) from November-December 2009 and to explore any differences compared to previously reported imaging findings. MATERIALS AND METHODS: Fifty-two hospitalized patients with pandemic influenza (H1N1) were included in the study. All of the patients underwent chest radiography, and 28 patients were also evaluated by thoracic CT. Group 1 comprised 24 (46%) patients with no identified risk factors for H1N1 influenza infection. Group 2 comprised the remaining 28 (54%) patients with identified risk factors. The distribution of lung involvement, consolidation, ground-glass opacity (GGO), lymph nodes, and pleural effusion were evaluated. RESULTS: Abnormal findings were observed in 85% of the patients. Bilateral lung involvement was present in 80% of the patients. The most common finding was a mixture of GGO and air-space consolidation. Lower zone predominance occurred in 89% of group 1 and 85% of group 2 patients. The involvement was observed most frequently in the peripheral and central perihilar areas of the lung in 80% of the patients. The extent of disease was greater in group 2 patients with the involvement of three or more lung zones in 62% of the patients. CONCLUSION: The most common imaging finding for lung involvement was a mixture of air-space consolidation and GGO with a patchy pattern and lower/middle zone predominance. Pulmonary involvement of the disease was more extensive than that described in previous reports.

Diffusion-weighted MR imaging of kidneys in patients with systemic lupus erythematosus: initial experience.

To evaluate kidney perfusion and diffusion in patients with systemic lupus erythematosus (SLE) and define any correlation between laboratory features of renal involvement and apparent diffusion coefficients (ADCs). We studied 35 patients with SLE and 30 healthy volunteers. Ten of the patients were diagnosed as having lupus nephritis. Transverse diffusion-weighted multisection echo-planar magnetic resonance imaging was created with the following diffusion gradient b values: 0, 111, 222, 333, 444, 556, 667, 778, 889, and 1,000 s/mm(2). Statistical analyses to compare ADCs of kidneys between patients in the study and control groups were done with the independent sample t test. The Pearson correlation analysis was used to evaluate the relation between the renal function variables and the ADCs. There was statistically significant difference between the ADC(low) values and the urine protein levels (P < 0.05) in the patients with SLE. Also, there was a significant correlation between the duration of nephritis and urine protein levels in the patients with SLE (P < 0.01). There was no statistically significant differences regarding ADCs, serum creatinine levels, and GFRs among patients with SLE and controls. Our patients had mild SLE and this might be the reason that no statistically significant differences were found between ADCs, and laboratory features of renal involvement among patients with SLE and controls. Larger series and more diffusion experience may be valuable for future studies.

Extraperitoneal pelvic myolipoma.

Myolipoma is a very rare adipocytic tumor occurring most frequently in adults, and usually is located in the retroperitoneum or abdomen. It has been described in the retroperitoneum, spinal cord, orbita, breast, round ligament, subcutaneous tissue, pericardium, rectus sheath of the abdominal wall, and abdominal cavity with attachment to the abdominal wall. Most of these tumors are discovered incidentally and are large when discovered. Radiological findings are nonspecific due to the nonlipomatous component of the tumor. We present radiological findings of a large extraperitoneal pelvic myolipoma adjacent to the anterior abdominal wall, detected incidentally in an elderly woman with a presenting complaint of intractable hiccups.

Inner ear lipoma.

Intracranial lipomas are uncommon congenital malformations that are often asymptomatic. They are very rarely seen in the inner ear. There are a few case reports in the literature related to intravestibular lipoma. It was also defined in the internal auditory canal and the cerebellopontine angle. We present here a case of an inner ear lipoma that diffusely infiltrated the cochlea, vestibule and the semicircular canals. To our knowledge, this is the first reported case in the literature.

Acute sarcoid myositis with unusual radiologic findings.

A 59-year-old man presented with bilateral calf pain and swelling for two weeks. Ultrasound and magnetic resonance imaging examination showed multiple bilateral, nodular, and spindle- shaped lesions in the gastrocnemius and soleus muscles. On physical examination, hyperpigmented, papular lesions were noticed; biopsy of the skin of his right elbow showed granulomatous inflammation. His angiotensin converting enzyme level was markedly elevated. Computed tomography showed diffuse interstitial thickening, miliary nodules, and traction bronchiectases throughout the lung parenchyma. Ophthalmologic examination showed uveitis in his left eye. Based on the lung, eye, and skin findings, a clinical diagnosis of sarcoidosis was made. After two months of corticosteroid treatment, his muscle lesions largely resolved.

Diffusion-weighted MRI of the kidneys in patients with familial Mediterranean fever: initial experience.

PURPOSE: To evaluate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of renal function in patients with familial Mediterranean fever (FMF). MATERIALS AND METHODS: Thirty healthy volunteers who had no history of renal disease, hypertension or vascular disease and 60 patients with FMF were included in the study. Transverse diffusion-weighted multisection echo-planar MRI was performed with the following diffusion gradient b values: 0, 111, 222, 333, 444, 556, 667, 778, 889 and 1000 s/mm(2). The apparent diffusion coefficient (ADC) values, urine protein and serum creatinine levels, and glomerular filtration rates of the healthy volunteers, patients with renal involvement, and patients without were compared by using ANOVA test. ADCs of the kidneys were calculated separately for low (ADC(low); b = 0, 111, 222, 333 s/mm(2)), average (ADC(avg); of all b values), and high (ADC(high); b = 778, 889, 1000 s/mm(2)) b values to enable the differentiation of the relative influence of perfusion fraction and true diffusion. ADC(high) reflects almost only diffusion, whereas ADC(low) is composed of both diffusion and perfusion. RESULTS: There was statistically significant difference between ADC(low) values of the FMF patients with renal involvement and the control group (P < 0.05). Negative correlation was found between the duration of disease and ADC(low) values of the kidneys (r = -0.223, P = 0.087). CONCLUSION: DW-MRI of the kidneys might allow early detection of the renal changes in patients with FMF. This might prevent the progression of disease by giving proper medical treatment. Further studies with larger numbers of FMF patients and more experience on MRI technique are required to help define more conclusively the precise role of DW imaging in detection of renal changes.