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Background Previous studies have shown that pelvimetry can be valuable in predicting surgical difficulties in rectal cancer operations. However, its usability in predicting circumferential resection margin (CRM) involvement remains debatable. This study investigated the factors affecting CRM status and the importance of computed tomography (CT) pelvimetry in predicting CRM involvement in laparoscopic resection of middle and lower rectal cancer. Methodology In this study, we retrospectively investigated the data of 111 patients who underwent a laparoscopic operation for middle and lower rectum cancer at Ankara University Faculty of Medicine, Department of Surgical Oncology between January 2014 and January 2020. The predictive value of CT pelvimetry and other variables on the CRM status was analyzed. Results The following four pelvic parameters differed significantly between the genders: transverse diameter of the pelvic inlet (p = 0.024), anteroposterior diameter of the pelvic outlet (p = 0.003), transverse diameter of the pelvic outlet (p0.001), and pelvic depth (p0.001). The effect of pelvic anatomic parameters on CRM involvement was not found to be significant. It was found that tumor height from the anal verge (p = 0.004), tumor size (p0.001), and gender (p = 0.033) were significant risk factors for CRM involvement. Survival was poor in patients with male gender (p = 0.032), perineural invasion (p0.001), and grade 3 tumor. Conclusions In this study, no benefit was found in predicting CRM positivity from CT pelvimetry in the laparoscopic resection of middle and lower rectal cancer. Besides, tumor height from the anal verge, tumor size, and gender were important factors for CRM positivity. Although our study sheds light on this issue, prospective randomized studies with larger sample sizes are needed.

Objectives:The purpose of this study is to demonstrate the variability of the diffusion values in different anatomical regions of the brain.Materials and Methods:3T diffusion MR images of 190 patients underwent brain imaging were evaluated. Patients were divided into groups according to ages: 20-29, 30-39, 40-49, 50-59, 60-69. The ROIs were placed in the frontal, temporal, occipital, parietal lobes, cerebellum, thalamus, to be of equal size in both hemispheres. The ADC values obtained were standardized by dividing by the ADC values obtained from the ventricle.Results:One hundred and ninety patients, 97 men and 93 women, aged between 20 and 69 years, were included in the study. The mean ADC values were: frontal lobe=726,8x10-3 mm2/sec (532-945x10-3 mm2/sec), cerebellum=680x10-3 mm2/sec (586-816x10-3 mm2/(609- 996x10-3 mm2/sec) in the temporal lobe=791,2x10-3 mm2/sec (448-945x10-3 mm2/sec), parietal=789,9x10-3 mm2/sec (671-935 x10-3 mm2/sec) and in the occipital=790,6x10-3 mm2/sec (690-973x10-3 mm2/sec). Significant differences were found in the frontal, temporal lobes and cerebellum (p=0.600, p=0.430, p=0.227, respectively) in the thalamus, parietal and occipital lobes when the whole brain was evaluated. 0.011, p=0.000, p=0.000). There was a significant difference between all age groups for all lobes. When the frontal lobe, cerebellum, thalamus, temporal, parietal and occipital lobes were evaluated, the highest ADC values were obtained between ages 60-69 (748±44×10-3 mm2/sec, 689±34×10-3 mm2/sec, 731±41x10-3 mm2/sec, 827+41x10-3 mm2/sec, 809+56x10-3 mm2/sec, 821+56x10-3 mm2/sec).Conclusion:In different anatomical regions of brain, diffusion values are different.

Introduction Thoracic giant masses do not have a clear definition. In some publications, giant thoracic mass definition is used in tumors whose long axis is> 10 cm and in other publications covering more than 50% of the hemithorax. In this study, demographic data of patients with a massive resectable giant thoracic mass and the difficulties and experiences experienced in the peroperative process were reviewed with a general perspective. Materials and Methods 14 giant intrathoracic masses operated at the department of Thoracic Surgery, School of Medicine, Ankara University were included in the study. The masses occupying more than half of the hemithorax and mediastinal lesions with a long axis of 15 cm or larger radiologically were included and evaluated. Result 9 (64.3%) of our patients were male and 9 (35.7%) were female. The average age was 49.2 ± 17.1(between18-68). The tumor localizations of our patients were determined as 9 (64.2%) hemithorax and 5 (35.8%) mediastinal. When the radiological and intraoperative dimensions were examined separately, it was observed that the mean of long axis of CT image is average 18 ± 3.8 cm (between 12 cm and 26 cm), and the mean of long axis of specimen is average 18.14 ± 3.6 cm (between 15 cm and 23 cm). The heaviest mass was average 844 ± 473 g (350 g-2204 g). Conclusions The surgical maneuvers and hence the excision of giant masses become difficult to operate due to the narrow localization of the masses and the frequent invasions of adjacent vascular structures and nerve tissues. However, complete resection of these slowly growing and generally encapsulated masses can provide the cure.

Purpose The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma. Materials and Methods Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI. Results Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger ( P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10−3 mm2/s vs 1.026 ± 0.246 × 10−3 mm2/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10−3 mm2/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients ( P < .001). Conclusion The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.

Objectives:Evaluation of kidney size and volume is very important in the diagnosis, treatment and follow-up of kidney diseases. Ultrasonography is the preferred imaging modality which provides a safe, reliable and affordable way of imaging the kidneys in the follow up of kidney diseases..In this study, we aimed to determine the kidney volume in normal adults and try to find out which of the physical features are more related with kidney volume.Materials and Methods:Between June 2005 and December 2008 177 patients referred for routine abdominopelvic ultrasonography (US) were included in the study. 16 patients who had renal masses, hydronephrosis and nephrolithiasis were excluded. Height, weight, body surface area (BSA) and body mass index (BMI) of the patients were recorded. Renal ultrasonography was performed and kidney sizes were evaluated in lateral decubitis position. Kidney sizes were measured on longitudinal and transverse scan. Ellipsoid formula was used to determine the kidney volume.Results:A total of 161 patients 69 (42,8%) male, 92 (57,5%) female were enrolled in the study. Mean kidney volume for right kidney was 125 mL and 134 mL for left kidney in women whereas it was 149 mL for right kidney and 155 mL for left kidney in men. There was a significant difference between right and left kidney volumes (p

OBJECTIVES: The purpose of this study was to investigate the relation between pancreatic steatosis and visceral adiposity. Furthermore, the study sought to explore the association between pancreatic steatosis, pancreas volume, hepatic steatosis, age, and sex in adults without prior history of pancreatic disease. The research also served to define a cut-off value of visceral fat tissue area (VFA) predicting fatty pancreas. MATERIAL AND METHODS: CT scans of 98 living-liver donor transplant patients without prior history of pancreatic disease were evaluated for the presence of fatty pancreas. Pancreas volume, VFA, subcutaneous-total FA, VFA/TFA ratios of the patients with and without fatty pancreas were quantified with a semi-automated model on CT. Coexistence of hepatic steatosis was also recorded. RESULTS: VFA, TFA and VFA/TFA were significantly greater in the fatty group (p

Objectives:The aim of this study is to evaluate the diagnostic value of mean and net enhancement attenuation values, net enhancement percentage in discrimination of Bosniak category 3 and 4 lesions on multiphasic computed tomography (CT).Materials and Methods:A search was performed through the PACS system using the key word “Bosniak cyst” to identify candidates for the study population. Twenty nine patients with Bosniak category 3 and 4 were enrolled in the study. Enhancement values were measured on precontrast, corticomedullary and nephrogram phases. Net enhancement attenuation value and net enhancement percentage were calculated. The presence of calcification on cyst wall/septa, renal vein thrombosis or lymphadenopathy and mean diameter of these complex cystic lesions were utilized.Results:Bosniak category 4 cysts had a significantly higher mean attenuation value compared with that of Bosniak category 3 cysts on corticomedullary and nephrogram phases (167.2±53.6 HU, 99.8±43 HU; p=0.001, p=0.023; respectively). Significant differences were observed between two pathologies with regard to net enhancement value and net enhancement percentage (p=0.003, p=0.015; respectively). By the use of ROC curve analysis, the cut off value of 131 HU for the mean attenuation value of Bosniak category 4 cyst on corticomedullary phase had the appropriate combination of sensitivity of 82% and specificity of 83% with the area under the cure being 0.848±0.081 (95% CI: 0.68-1).Conclusion:Bosniak category 4 cysts had larger net enhancement value and enhancement percentage. A value of >131 HU on corticomedullary phase can be a predictor value for Bosniak category 4 cysts.

Purpose The aim of this study was to investigate the impact of the primary location of colorectal adenocarcinoma on the lobar distribution of its hepatic metastases based on the streamline hypothesis. Material and methods The hospital database was utilised to identify the colorectal cancer patients. Eighty-six patients diagnosed with colorectal adenocarcinoma, who had hepatic metastases on the initial diagnostic stage or on the follow-up investigations, were enrolled the study. Computed tomography (CT) images of the study population were reviewed for the primary location of the colorectal tumour, and the side and number of hepatic metastases. Results A total of 481 metastases were counted on CT from 22 right-sided and 64 left-sided colon tumours. The ratio of right-to-left hemiliver involvement was 1.97 : 1 for whole study population. The right-to-left ratio was calculated as 1.55 : 1 for right colon tumours and 2.17 : 1 for left colon tumours (p = 0.106). In the subgroup analysis with unilobar metastatic patients, again there was no significant difference in terms of the colorectal tumours' primary location (p = 0.325). Conclusions The lobar distribution of hepatic metastases from colorectal adenocarcinoma may not be associated with the primary tumour localisation.

Objectives: To compare the diagnostic performance of a newly developed artificial intelligence (AI) algorithm derived from the fusion of convolution neural networks (CNN) versus human observers in the estimation of malignancy risk in pulmonary nodules. Methods: The study population consists of 158 nodules from 158 patients. All nodules (81 benign and 77 malignant) were determined to be malignant or benign by a radiologist based on pathologic assessment and/or follow-up imaging. Two radiologists and an AI platform analyzed the nodules based on the Lung-RADS classification. The two observers also noted the size, location, and morphologic features of the nodules. An intraclass correlation coefficient was calculated for both observers and the AI; ROC curve analysis was performed to determine diagnostic performances. Results: Nodule size, presence of spiculation, and presence of fat were significantly different between the malignant and benign nodules (p < 0.001, for all three). Eighteen (11.3%) nodules were not detected and analyzed by the AI. Observer 1, observer 2, and the AI had an AUC of 0.917 ± 0.023, 0.870 ± 0.033, and 0.790 ± 0.037 in the ROC analysis of malignity probability, respectively. The observers were in almost perfect agreement for localization, nodule size, and lung-RADS classification [κ (95% CI)=0.984 (0.961–1.000), 0.978 (0.970–0.984), and 0.924 (0.878–0.970), respectively]. Conclusion: The performance of the fusion AI algorithm in estimating the risk of malignancy was slightly lower than the performance of the observers. Fusion AI algorithms might be applied in an assisting role, especially for inexperienced radiologists. Advances in knowledge: In this study, we proposed a fusion model using four state-of-art object detectors for lung nodule detection and discrimination. The use of fusion of deep learning neural networks might be used in a supportive role for radiologists when interpreting lung nodule discrimination.

Background Cavitary lung disease (CLD) in renal transplant recipients is an infrequent complication causing high morbidity and mortality. We aimed to examine incidence, demographics and treatment properties of cavitary lung lesions in our renal transplant patient population. Methods We retrospectively examined renal transplant recipients, who were operated between January 2002-October 2013 and observed at Renal Transplantation Unit of Ankara University Faculty of Medicine. Demographic features, treatment and outcome of cavitary CLD were investigated. Results A total of 343 kidney recipients were studied, 7 (2.0%) of whom developed CLD. Median time to develop CLD was 15 months (min:1, max:115) after transplantation. 3 (42.8%) patients had experienced acute rejection and treated with anti-thymocyte globulin within 6 months prior to disease development date. No graft lost, but 2 (28.5%) patient lost was seen because of CLD. Conclusions Although developments in immunsuppression and antibiotic treatment in recent decades, cavitary lung disease is an important morbidity and mortality reason in renal transplant recipients.

Purpose We aimed to evaluate the frequency of bile duct branching pattern variations at the hepatic confluence in patients with pancreas divisum (PD). Methods A search was performed through the hospital database using the keyword "pancreas divisum" to identify patients. The magnetic resonance cholangiopancreatography (MRCP) images of 137 patients who were diagnosed with PD between August 2011 and November 2016 were retrospectively analyzed for the presence of bile duct variations. A control group of 137 patients without PD was established among patients investigated during the same period. Variations of the biliary tract were grouped into seven types according to the McSweeney et al. classification. Results Biliary tract variations were detected in 103 of a total of 274 patients. Fifty-eight PD patients (42.3%) and 45 control patients (32.8%) had bile duct variation at the hepatic confluence level. The patients with PD were more likely to have biliary tract variation compared with the control group; however, it was not statistically significant (P = 0.105). The most common variation in PD patients was type 3a variation (16.8%). Conclusion MRCP studies showed atypical bile duct confluence pattern in nearly half of both PD patients and controls. There was no statistically significant difference in the frequency of anatomic variations at bile duct confluence in patients with PD versus those without PD. Derivation of these structures from different outpouchings in early embryological life may explain this insignificant difference.

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly. Generally, it is seen on the right side and is associated with an atrial septal defect. Herein, we present a case of a 50-year-old male patient with a supracardiac type PAPVC detected during pneumonectomy for a right hilar mass. This is the second case report in the literature presenting surgical treatment of both lung cancer and PAPVC using pneumonectomy. Thoracic surgeons should be aware of this anomaly when they are planning to perform a major lung resection. If PAPVC and lung cancer are in the same lobe, anatomical lung resections including pneumonectomy can be safely performed.

ÖZETTiroid Nodüllerinde Ultrasonografi (US) ve Renkli Doppler Ultrasonografi (RDUS) BulgularıAmaç: Tiroid nodüllerinde ultrasonografi (US) bulgularına ek olarak renkli Doppler ultrasonografi (RDUS) bulguları ile birlikte malign-benign ayırımını yapabilmekGereç ve Yöntem: Çalışmamızda total yada subtotal tiroidektomi sonucunda patolojileri bilinen 60 nodül incelenmiştir. Nodüller patoloji sonuçlarına göre benign ve malign olmak üzere iki sınıfa ayrıldı. Nodüllerde gri mod US bulguları olarak; boyut, ekojenite, natür, kenar yapısı, mikrokalsifikasyon varlığı, periferik halo varlığı değerlendirilmeye alındı. RDUS bulguları olarak kan akım desenlerine ve rezistif indeks (RI) değerlerine bakıldı. İki patoloji grubu arasında parametreler açısından farklılıklara, parametrelerin duyarlılık, özgüllük ve pozitif-negatif tahmini değerlerine ve malignite ile ilişkilerine bakıldı.Bulgular: 60 nodülün 48 tanesi (%80) benign, 12 tanesi (%20) maligndi. Nodül boyutu, nodülün natürü ile malignite arasında istatistiksel ilişki saptanmamıştır (p=0,3; p=1). Mikrokalsifikasyon varlığı, periferik halo yokluğu, hipoekoik eko patterni, düzensiz kenar yapısı ile malign nodüller arasında istatistiksel olarak ilişki saptanmıştır. Periferik halo yokluğu malign nodül saptamada en yüksek duyarlılık (%91,7) ve seçicilik (%85,4) oranlarına sahip kriter olarak bulunmuştur. İnternal ile malign nodüller arasında istatistiksel ilişki saptanmıştır (p=0,001). İnternal kan akım deseninin malign nodül için duyarlılığı %66,7, seçiciliği %83,3 olarak bulunmuştur. RI değeri malign nodüllerde daha yüksek saptanmıştır (0,80±0,15). RI için cut off değeri 0,69 olarak bulunmuştur.Sonuç: US bulguları ile RDUS bulguları birlikte değerlendirildiğinde İİAB'ye gerek duyulmaksızın malign-benign nodül ayırımı yapılabilir ve gereksiz cerrahi işlem engellenebilir.Anahtar sözcük: İnternal kanlanma, RDUS, RI, tiroid nodülü, US SUMMARYUltrasonography (US) and Color Doppler Ultrasonography (CDU) Results for Thyroid NodulesPurpose: The aim of this study is to be able to differentiate malignant and benign thyroid nodules by using not only ultrasound (US) results but also using color doppler ultrasound (CDU) results.Materials and Methods: In this study total of 60 nodules which were obtained by total or subtotal thyroidectomy were evaluated. Based on the pathologic results, these nodules were classified into two groups as benign and malignant. The evaluation criteria?s for US were as follows; size, echotexture, internal morpohology, contour, presence of microcalcification, presence of halo sign. The evaluation criteria?s for CDU were vascular flow pattern and resistance index (RI). Based on these criteria?s statiscal calculations made for both malignant and benign nodules.Results: Out of 60 nodules 48 of them (80%) were found benign, 12 of them (20%) were found malignant. There was not any statistical correlation found between size of the nodule and nature of the nodule (p=0.3; p=1). On the other hand there was a statistical correlation between malignancy and microcalcification, absence of halo sign, hypoechoic echo pattern, contour irregularity. The most predictive finding for malignancy was found absence of halo signwith sensitivity 91.7% and specificity 85.4%. There was a statistical correlation between internal vascularization pattern and malignancy (p=0.001). The sensitivity of internal vascularization for malignant nodules was 66.7% and specificity was 83.3%. RI value was found to be higher for malignant nodules (0.80±0.15). The cut off point for RI value was found as 0.69.Conclusion: Based on combine results of US and CDU, the differentiation between malignant versus benign nodule can be made without needing fine needle aspiration biopsy. Thus unnecessary surgical operations can be prevented.Key Words: CDU, internal vascularization, RI, thyroid nodule, US 84

Introduction: subcapsular renal hematoma is a very rare complication of double-J stenting in urology practice. Infection, malposition and migration are well known stent complications, which may be monitored by blood and urine analyses and kidney ureter bladder radiographs. However, follow-up of patients with regular ultrasound examinations is crucial as unexpected and potentially fatal complications may take place at any time during or after stent insertion. case report: We present a rare case with chronic subcapsular renal hematoma diagnosed by ultrasonography, two weeks after the removal of double-J stent. conclusion: Ultrasonography is important to rule out stent malposition or other serious stent complications.