The Correlation of Intraabdominal Pressure With Renal Resistive Index.

BACKGROUND: To evaluate the correlation between intraabdominal pressure (IAP) measured via the bladder and renal resistive index (RRI) measured by Doppler ultrasonography (USG). METHODS: Eighty consecutive surgical patients were included into this study. Before Doppler USG evaluation, IAP was measured by a Foley catheter via the bladder. The left and right RRI, the diameters of the inferior vena cava and portal vein were measured by colored Doppler USG. Spearman correlation analysis was used to evaluate the correlation between different measurements. Intraabdominal hypertension (IAH) was defined as of IAP ≥ 12 mmHg. Significantly different variables from the univariate analysis between patients with and without IAH were entered into backward stepwise binary logistic regression analysis of IAH as the dependent variable. P values < 0.05 were accepted as statistically significant. RESULTS: In total, 80 patients were included into study. In 27 patients (34%) IAP was normal and in 53 patients (66%) IAH was diagnosed. The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between RRI and IAP (P < 0.001). Patients with IAH were more likely to be diabetic and had abdominal incisional hernia compared with patients with normal IAP (P < 0.05). The results of the multivariate logistic regression analysis revealed right RRI as the only independent predictor of IAH (B: 57.04, S. E.: 13.7, P < 0.001). CONCLUSIONS: There is a strong correlation between IAP and RRI. RRI can be an alternative, noninvasive technique for the diagnosis and follow-up of IAH after further evaluations in different patient groups.

Can arteriovenous malformation prevent the diagnosis of brain death?

We present a case of a 14-year-old boy with spontaneous intracranial hemorrhage that was referred to us to confirm the diagnosis of brain death with cerebral angiography. In the left carotid angiogram, there was no arterial flow above the craniovertebral junction. But in the right carotid angiogram, there was arterial flow up to the level of posterior communicating artery. Right posterior cerebral artery was filled with contrast medium via patent posterior communicating artery and later, an opacifying arteriovenous malformation (AVM) was detected which was also seen in the vertebral angiogram. Although the angiographic findings of the patient did not confirm the angiographic criteria for the diagnosis of brain death, it could not be also excluded because the only cerebral flow was the filling of the AVM and no other cerebral perfusion was detected.

Diagnosis of acute pancreatitis by diffusion-weighted magnetic resonance imaging.

Diffusion-weighted magnetic resonance imaging has emerged as a successful technique in the early diagnosis of acute pancreatitis. An 82-year-old male patient suspected of acute pancreatitis refused to undergo intravenous contrast-enhanced abdominal computed tomography due to a history of previous allergic reactions to contrast medium. He was imaged with diffusion-weighted magnetic resonance imaging without the use of oral or intravenous contrast material. Diffuse hyperintensity in the pancreas with a relevant apparent diffusion coefficient map showing diffuse hypointensity was demonstrated. The findings were interpreted as restricted diffusion and were diagnostic for acute pancreatitis. Diffusion-weighted magnetic resonance imaging, an imaging modality that does not involve ionizing radiation and does not require the use of contrast material, can successfully demonstrate the manifestations of acute pancreatitis.

[Angiographic evaluation of branching pattern and anatomy of the aortic arch]. / Arkus aorta anatomisinin ve dallanma paternindeki varyasyonlarin anjiyografik olarak degerlendirilmesi.

OBJECTIVE: The study aimed to investigate anatomical variations in branching pattern and anatomy of the aortic arch, and the prevalence of each type. METHODS: Between September 2011 and November 2013, angiographic studies of 270 patients (144 male, 126 female) were analyzed retrospectively for variations in branching pattern and anatomy of the aortic arch. Patient mean age was 59.8 years (range, 13-88). Branching variations were found and divided into subtypes. Patients were also classified according to arch anatomy. Incidence of variations and types of aortic arch were statistically analysed. RESULTS: Analysis of the 270 patients revealed six types of branching pattern. Type I, classical pattern arch with three branches (TB, LCC, LS), was observed in 198 cases (73.3%). Type II (bovine arch), the most commonly observed variation, in which LCC originates from TB, was observed in 58 cases (21.5%). Type III, in which the left vertebral artery arises from the arch, was seen in seven cases (2.6%). Type IV, a combination of types II and III, was observed in three cases (1.1%). Type V, common origin of common carotids, LS and aberrant RS, was found in three cases (1.1%). Type VI (avian type), arch with only two branches, was observed in one case (0.4%). When patients were classified according to aortic arch anatomy, Type 1, Type 2 and Type 3 were observed in 195, 40 and 35 patients respectively. CONCLUSION: Knowledge of the variations and anatomy of the aortic arch is essential during interventional procedures and neck-thorax surgery.

The use of bronchial arteries in the characterization of primary lung cancer: an MDCT study.

OBJECTIVE: The purpose of this study was to discuss the use of ipsilateral bronchial artery dilatation when a solitary lung mass is detected on multidetector computed tomography (MDCT). MATERIALS AND METHODS: We retrospectively evaluated 55 patients with solitary lung mass. An MDCT scanner was used for the study. Location and the greatest size of the tumor, and ipsilateral bronchial artery caliper (dilated if >2 mm) were noted for each patient. TNM staging of each patient with primary lung cancer was also recorded. Statistical analyses were applied to both groups using SPSS 17.0. χ test was used for the statistical analyses. RESULTS: Statistically strong correlation was observed between ipsilateral bronchial artery dilatation and primary lung carcinoma. Among the 11 benign lung masses, only 2 (18%) showed ipsilateral bronchial artery dilatation. But 39 (88.6%) of the 44 primary lung carcinoma patients and 36 (92.3%) of the 39 primary lung carcinoma patients with predominantly extramediastinal (lung) location showed ipsilateral bronchial artery dilatation on MDCT. When only predominantly extramediastinal lesions were taken into account, sensitivity of the study was 92.31%, specificity was 81.82%, positive predictive value was 94.74%, and negative predictive value was 75%. CONCLUSIONS: Lesion characterization and accuracy was very high when the only criteria of bronchial artery dilatation are taken into account. Sensitivity and negative predictive value were higher in the patients with extramediastinal lesions.

The role of diffusion weighted MR imaging in the diagnosis of acute pancreatitis.

OBJECTIVE: To understand the utility of Diffusion-weighted MR imaging (DWI) in the diagnosis of acute pancreatitis. CONCLUSION: DWI can analyse the major manifestations of acute pancreatitis without any contrast agent use and may replace Abdominal CT and routine Pancreas MRI as a primary investigation tool for acute pancreatitis.

The role of elastosonography, gray-scale and colour flow Doppler sonography in prediction of malignancy in thyroid nodules.

BACKGROUND: Ultrasound is as a noninvasive method commonly used in the work-up of thyroid nodules. This study aimed to evaluate the usefulness of sonographic and elastosonographic parameters in the discrimination of malignancy. PATIENTS AND METHODS: 150 thyroid nodules were evaluated by gray-scale, Doppler and elastosonography. The cytological analysis revealed that 141 nodules were benign and 9 were malignant. RESULTS: Orientation of the nodule was the only sonographic parameter associated with malignancy (p = 0.003). In the strain ratio analysis the best cut-off point was 1.935 to discriminate malignancy (p = 0.000), with 100% sensitivity, 76% specificity, 100% negative predictive value, 78.5% positive predictive value and 78% accuracy rate. There was a statistically significant correlation between the elasticity score and malignancy (p = 0.001). Most of the benign nodules had score 2 and 3, none of them displayed score 5. On the other hand, none of the malignant nodules had score 1 and 2, most of them displaying score 5. CONCLUSIONS: A change in the diagnostic algorithm of the thyroid nodules should be considered integrating the elastosonographic analysis.

The role of elastosonography in the differentiation of parotid gland lesions: report of three cases and review of the literature.

BACKGROUND: The parotid gland is the mostly affected site among major salivary gland tumors in up to 85% of cases. Preoperative knowledge of the tumour nature is crucial since it influences the surgical procedure and patient's morbidity, especially the risk of facial nerve palsy. Ultrasonography is commonly used as the first line imaging modality for the salivary gland lesions. A pitfall is that the histologic pleomorphism often reflects an imaging pleomorphism. CASE REPORT: HEREIN WE AIMED TO PRESENT THE ROLE OF ELASTOSONOGRAPHY IN THREE PAROTID LESIONS: a case of benign pleomorphic adenoma, a Wharthin's tumour and a malignant parotid tumour. CONCLUSIONS: Our findings show that malignant parotid lesion was the stiffest lesion according to elastosonography. Wharthin's tumour demonstrated soft elastosonographic features. The pleomorphic adenoma was also interpreted as stiff by elastosonography suggesting that the elastosonographic features of pleomorphic adenoma may resemble those of malignant lesions limiting the utility of the technique.

Superselective arterial embolization of pseudoaneurysm and arteriovenous fistula caused by transurethral resection of the prostate.

BACKGROUND: Pelvic vascular lesions such as pseudoaneurysms and arteriovenous fistulas associated with the internal pudendal artery are uncommon. The most common cause is traumas including those of iatrogenic origin. Surgical treatment is complicated due to location of the lesions and endovascular approach is usually the first choice among the treatment options. CASE REPORT: A 79-year-old patient was admitted with massive hematuria following transurethral resection of prostate for benign prostatic hyperplasia. Doppler US and angiography revealed a pseudoaneurysm and arteriovenous fistula originating from the right internal pudendal artery. It was successfully treated with coil embolization. CONCLUSIONS: Arteriovenous fistulas and pseudoaneurysms concerning internal pudendal artery may occur as complications of prostate operations. Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice.

The role of MR imaging with half Fourier acquired single shot turbo spin echo sequence in the diagnosis of lung lesions in comparison with multislice CT.

OBJECTIVE: To compare the diagnostic values of magnetic resonance imaging using Half Fourier Acquired Single Shot Turbo Spin Echo sequence and multidetector computed tomography in patients with pathologically examined pulmonary lesions. METHODS: The retrospective, descriptive study was conducted at Radiology Department, Diskapi Research Hospital, Ankara, Turkey, and comprised records of patients with pathologically examined pulmonary lesions between May 2009 and March 2012. Patients were divided into three groups and examined by both multidedector computed tomography and magnetic resonance imaging. During the imaging, patients were not administered any intravenous contrast medium. Electrocardiogram gating and breath holding were not performed in echo sequence. Pulmonary lesions were evaluated on the basis of their dimensions, numbers, differentiation from atelectasis and consolidation, invasion to the thoracic wall-mediastinal structures and presence of lymphadenopathies. RESULTS: Sensitivity of all patients was 50% (p = 0.214) and specificity of CT and MRI were 82.5% (p = 0.134) for the detectability of submilimetric nodules. For differentiation of the mass from atelectasis and consolidation, the sensitivity of computed tomography was statistically more significant compared to magnetic resonance imaging (86.6%; p = 0.035). For the invasion of the mass to the mediastinal structures and the thoracic wall, the sensitivity of magnetic resonance imaging was statistically more significant compared to tomography (86.6%; p = 0.035). CONCLUSION: HASTE sequence can be used to determine the invasion of the pulmonary mass to the mediastinal structures and the thoracic wall since it is more sensitive than computed tomography. It can also be used to detect submilimetric nodules. It has equal sensitivity and specificity compared to computed tomography. But computed tomography is superior for the differentiation of the mass from atelectasis and consolidation.

Proton magnetic resonance spectroscopy of periventricular white matter and hippocampus in obstructive sleep apnea patients.

BACKGROUND: The purpose of this study was to diagnose the hypoxic impairment by Magnetic resonance spectroscopy (MRS), an advanced MR imaging technique, which could not be visualised by routine imaging methods in patients with obstructive sleep apnea (OSA). MATERIAL/METHODS: 20 OSA patients and 5 controls were included in this prospective research. MRS was performed on these 25 subjects to examine cerebral hypoxemia in specific regions (periventricular white matter and both hippocampi). Polysomnography was assumed as the gold standard. Statistical analysis was assessed by Mann-Whitney U test and Receiver operating characteristics (ROC) curve for NAA/Cho, NAA/Cr and Cho/Cr ratios. RESULTS: In the periventricular white matter, NAA/Cho ratio in OSA patients was significantly lower than in the control group (p<0.05). There were no statistical differences between the OSA and the control group for NAA/Cho, NAA/Cr and Cho/Cr ratios for both hippocampal regions. Additionally, Cho/Cr ratio in the periventricular white matter region of OSA group was higher than in the control group (p<0.05). CONCLUSIONS: Hypoxic impairment induced by repeated episodes of apnea leads to significant neuronal damage in OSA patients. MRS provides valuable information in the assessment of hypoxic ischemic impairment by revealing important metabolite ratios for the specific areas of the brain.

Different Faces of Rathke's Cleft Cyst.

Rathke's cleft cysts (RCC) are rare benign cystic lesions that might present with different imaging features, potentially posing a problem in the radiological diagnosis of cystic sellar lesions. The purpose of this pictorial review is to present an overview of the radioclinical features of RCC through four clinical cases with different radiologic findings confirmed by pathology, as well as reviewing the common differential diagnosis to be considered. The subjects are women, aged 11 to 73 who underwent recent transsphenoidal surgical resection with a postoperative follow-up period of a few months to three years.

SMART Syndrome: Case Report and Review of the Literature.

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare condition characterized by stroke-like deficits, seizures, and headache that can occur years after radiation therapy (RT) to the brain. RT is a cornerstone in the treatment of primary brain tumours and is indicated in more than 90% of patients. It is therefore essential to be aware of this entity to prevent misdiagnosis leading to inappropriate treatment. In this article, typical imaging findings of this condition are presented through a case report and review of the literature.

Detection of prostate cancer with magnetic resonance imaging: optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging apparent diffusion coefficient mapping sequences and MR spectroscopy, correlated with biopsy and histopathological findings.

PURPOSE: The aim of this study was to optimize and predict the most efficient magnetic resonance imaging (MRI) sequences; T1-weighted (T1W), T2-weighted (T2W), dynamic contrast-enhanced (DCE) T1W, diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) mapping sequences and proton MR spectroscopy (H-MRS) for the detection of prostate cancer. MATERIALS AND METHODS: After institutional review board approval and informed consent taken from all the patients, 40 patients with prostate cancer were included in this research. Two readers independently evaluated the results of T1W, T2W, DCE T1W, and DWI-ADC mapping sequences and proton H-MRS for the depiction of prostate cancer. Reference standard was the transrectal ultrasonography-guided biopsy and the surgical histopathological results. Statistical analysis was assessed by the Fisher exact t test, Wilcoxon signed rank test, variance analysis test with kappa (κ) values and receiver operating characteristics (ROC) curve for ADC values, choline (Cho)/citrate (Cit) and Cho+creatine (Cre)/Cit ratios for each observer. RESULTS: Based on both readers' results, sensitivity declined to 31% and specificity to 75% for the T1W sequence, sensitivity declined to 43% and specificity to 67% for the DCE T1W sequence, sensitivity declined to 46% and specificity to 68% for the T2W sequence, sensitivity declined to 29% and specificity to 82% for the DWI-ADC mapping; and specificity was 49% for the Cho/Cit and Cho+Cre/Cit ratios, sensitivity was 69% for the Cho/Cit ratio, and sensitivity was 70% for the Cho+Cre/Cit ratio for H-MRS. The T2W sequence and H-MRS presented significant statistical differences for the depiction of prostatic cancer (P < 0.05), the most efficient sequence to detect prostatic cancer was H-MRS: Cho+Cre/Cit and Cho/Cit ratios. CONCLUSION: Instead of using either sequences alone owing to low sensitivity and specificity rates, combined use of MRI techniques could easily improve the detection and staging of prostate cancer.

Study of the left renal variations by means of magnetic resonance imaging.

PURPOSE: A prospective study was designed to figure out the percentages of the left renal vein variations using routine lumbar spinal magnetic resonance imaging (MRI) in patients with neurological problems. METHODS: Between March 2010 and October 2010, the study population was recruited from a total of 2,644 consecutive patients who would undergo a routine lumbar spinal MRI examination. In addition to the routine MRI sequences, axial, balanced turbo field echo sequence (BTFE-BH SENSE) was applied after detection of a left renal vein variation. RESULTS: As the left renal vein variations, retroaortic left renal vein (RLRV) and circumaortic left renal vein were detected. The number of cases with the correspondent percentages of the total left renal vein variations, RLRV and circumaortic left renal vein were 71/2,644 (2.68%), 44/2,644 (1.66%) and 27/2,644 (1.02%), respectively. In cases with RLRV, the numbers of males and females with their correspondent percentages were 19/44 (43.2%) and 25/44 (56.8%), respectively. In cases with circumaortic left renal vein, the numbers of males and females with their correspondent percentages were 13/27 (48.1%) and 14/27 (51.9%), respectively. With Chi-square test, no statistically significant gender difference was found between the percentages of left renal vein variations (P = 0.83). CONCLUSIONS: MRI is useful in detecting RLRV and circumaortic left renal vein. If a left renal vein variation is detected, an additional BTFE-BH SENSE sequence is suggested to confirm whether it is retroaortic or circumaortic.

Effects of transcutaneous electrical nerve stimulation on rats with post-operative ileus.

BACKGROUND: Post-operative ileus (POI) is a type of bowel dismotility causing accumulation of gas and fluid. Transcutaneous electrical nerve stimulation (TENS) has been frequently used for medical applications such as pain treatment and nervous stimulation. In this experimental animal model of POI, our aim is to investigate the effects of TENS on POI, and to demonstrate histopathological changes in rat intestine after TENS application. METHODS: The present study is an experimental animal model of POI. Sixteen Wistar-Albino male rats in two groups were used and laparotomy was performed. After colorectum and small intestine were manipulated, activated charcoal and Nile red were ad-ministered by oral gavage. Electrodes were placed to the abdomen skin of the rats and TENS method was used. Rats in two groups were sacrificed on 24 h. The esophagus, stomach, and all intestines of the rats were resected and a direct X-ray and computerized tomography scan, and 'J' images were taken, and the progression of active coals was measured radiologically. Histopathological and microscopic evaluation was performed. RESULTS: The median of activated charcoal measure was 429 mm (178-594) in TENS group, 203 mm (149-313) in the control group, respectively, and these were statistically significant (p=0.004963). There was a significant difference between the two groups in terms of histopathological necrosis (p=0.041). In addition, the amount of Nil Red (550 nm) in the GI track is increased after 8 h of gavage with sequential applications of TENS. CONCLUSION: This study demonstrated the protective and therapeutic efficacy of TENS in POI in a rat model by radiologically and histopathologically. In clinical practice, TENS may be examined on POI. Further studies are warranted to validate and generalize our findings, and to assess the impact of TENS for post-operative pain also.

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.

CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma.

BACKGROUND/OBJECTIVE: Despite extensive published research, the surgical approach to penetrating abdominal trauma patients is still under debate. Computed tomography-guided tractography (CTT) is an imaging modality in which water soluble iodinated contrast medium is administered into the site of the injury in the CT unit. The aim of this study was to determine the diagnostic accuracy of the CTT. METHODS: A retrospective evaluation was made of patients admitted to the Emergency Department with penetrating abdominal trauma and who underwent CTT. Contrast enhanced abdominal CT and CTT reports, surgical findings and clinical results were examined. RESULTS: Evaluation was made of a total of 101 patients comprising 89 males (88.1%) and 12 females (11.9%). CTT was determined to have 92.8% sensitivity, 93.6% specificity, 97% positive predictive value, and 85.5% negative predictive value. In 27 patients (26.7%) where the CTT indicated passage through the peritoneum, no parenchymal organ injury was present. Only one patient (2.9%) without peritoneal penetration on CTT had organ injury at exploration. No procedure-related morbidities developed. CONCLUSION: CTT is a safe imaging modality for the evaluation of hemodynamically stable patients. Compared to other imaging modalities, there is clearer demonstration of whether or not the peritoneum is intact. However penetration on CTT does not exactly correlate with organ injury.

Correlation of pelvic fractures and associated injuries: An analysis of 471 pelvic trauma patients.

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures. METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically. RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215). CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient's hemodynamic status is stabilized.