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Objective: To determine the prevalence of sacroiliac joint (SIJ) involvement using magnetic resonance imaging (MRI) in Behcet’s disease (BD). Methods: This cross sectional study evaluated a total of 58 patients diagnosed with BD according to the International Criteria for Behcet’s Disease, as well as 50 age- and sex-matched healthy controls. The demographic data of the participants and the clinical and laboratory findings of the BD patients were recorded. All subjects underwent SIJ MRI. Bone marrow edema, synovitis, capsulitis, enthesitis, subchondral sclerosis, erosion, periarticular fat deposition, and ankylosis were evaluated. The images were assessed by two blinded radiologists who specialized in MRI. Interobserver reliability was evaluated using the Fleiss’ ?appa score. The images were recorded as present, absent and suspicious. Results: The study included 50 patients with BD (25 females, 25 males with a mean age of 39.7±12.2 years) and 50 healthy controls (25 females, 25 males with a mean age of 39.7±12.2 years). Of the BD patients, 4% also had musculoskeletal involvement. When analyzed using the kappa statistics, the overall kappa score for all MRI findings showed poor agreement. Its value ranges from 0.01 to 0.08. There was no statistically significant difference between the two groups in terms of the mean values of MRI images (p>0.05). Conclusion: The prevalence of SIJ involvement was not different between the BD patients and the healthy controls in our study. SIJ involvement was not a characteristic of BD

Objectives: This study aims to investigate if geometrical modelling in addition to three-dimensional (3D) modelling will standardize models and allow performing mathematical calculations easily for the compatibility of femoral implant curvature. Patients and methods: The study included 50 subjects (27 males, 23 females; mean age 55 years; range, 21 to 84 years). The femoral shaft intramedullary cavity was resembled into a chord of the ring cyclide, where the rotational radius was centered at its smallest radius. A 3D evaluation of the left femoral computed tomography data of the subjects was used to investigate the population parameters. The fitting was defined as being between the anterior and posterior border radii in the sagittal plane. Results: The best fitting radius of implants was in between 90 to 99 cm in 72% of subjects in our sample. These radii values were lower than the mean intramedullary and cortical centerline radii which had only 62% and 50% fittings, respectively, among our population sample. The bowing radii and the smallest intramedullary width increased with the femoral length. These values were not affected by gender. Conclusion: This modelling may have value for understanding femoral shaft intramedullary cavity geometry and may be a good tool to assess implant fitting. © 2020 Turkish Joint Diseases Foundation.

Objectives: This study aims to investigate the usability and reliability of our new axis in a three-dimensional modelling work and demonstrate if it is a reproducible method for anteversion measurement that sufficiently correlates with other computed tomography (CT)-derived gold standards including transepicondylar axis (TEA) and posterior condylar axis (PCA). Patients and methods: Three-dimensional solid models were derived from left femoral CT data of 100 participants (50 males, 50 females; mean age 57 years: range, 21 to 86). The newly proposed popliteal surface axis (PSA) was compared with TEA and PCA in terms of anteversion measurement on these solid models. Results: Popliteal surface axis was found as a reproducible reference axis in our study as it could be measured in 99% of our sample. The mean value of PSA based anteversion was (-) 1.8 degrees which was 10.7 degrees and 4.4 degrees for PCA and TEA, respectively. Popliteal surface axis was perfectly correlated with PCA and TEA for anteversion measurements (p

Introduction: The aim of this study was to investigate the prevalence and magnetic resonance imaging (MRI) findings of knee osteonecrosis (ON) in patients with arthralgia who received corticosteroid therapy. We also aimed to demonstrate the diagnostic performance of plain radiography in knee ON when MRI is accepted as the gold standard and to investigate the prevalence of accompanying femoral head ON in patients who underwent hip MRI., Methods: One hundred and sixty-two knee X-rays and MRI examinations of 136 patients with knee pain and a history of corticosteroid intake were retrospectively evaluated for the presence of ON. Localization, maximum size of dominant lesion, multiplicity of lesions, presence of bone edema, double-line sign and subchondral extension were evaluated in patients with ON. Accompanying femoral head ON was also investigated in patients who underwent hip MRI., Results: MRI revealed ON in 37 knees of 28 patients. The sensitivity and specificity of plain radiography in the diagnosis of knee joint ON was 29.73% and 98.40%, respectively. There were multiple lesions in 31 knees and subchondral space was affected in 24 knees. The double-line sign and bone marrow edema were present in most of the lesions. Of the 28 patients with knee ON, only 16 had hip joint MRI and five of these patients (31.3%) had femoral head ON., Conclusion: Plain radiography has low sensitivity but high specificity for the diagnosis of knee ON. Corticosteroid-induced ON tends to be multifocal, and a significant proportion of patients with knee ON during corticosteroid therapy have ON of the hip joint.

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Objectives: This study aims to investigate the usability and reliability of our new axis in a three-dimensional modelling work and demonstrate if it is a reproducible method for anteversion measurement that sufficiently correlates with other computed tomography (CT)-derived gold standards including transepicondylar axis (TEA) and posterior condylar axis (PCA).Patients and methods: Three-dimensional solid models were derived from left femoral CT data of 100 participants (50 males, 50 females; mean age 57 years; range, 21 to 86). The newly proposed popliteal surface axis (PSA) was compared with TEA and PCA in terms of anteversion measurement on these solid models.Results: Popliteal surface axis was found as a reproducible reference axis in our study as it could be measured in 99% of our sample. The mean value of PSA based anteversion was (-) 1.8° which was 10.7° and 4.4° for PCA and TEA, respectively. Popliteal surface axis was perfectly correlated with PCA and TEA for anteversion measurements (p

Microcephalic primordial dwarfism (MPD) is a group of autosomal recessive inherited single-gene disorders with intrauterine and postnatal global growth failure. Seckel syndrome is the most common form of the MPD. Ten genes are known with Seckel syndrome. Using genome-wide SNP genotyping and homozygosity mapping we mapped a Seckel syndrome gene to chromosomal region 4q28.1-q28.3 in a Turkish family. Direct sequencing of PLK4 (polo-like kinase 4) revealed a homozygous splicing acceptor site transition (c.31-3 A>G) that results in a premature translation termination (p.[=,Asp11Profs*14]) causing deletion of all known functional domains of the protein. PLK4 is a master regulator of centriole biogenesis and its deficiency has recently been associated with Seckel syndrome. However, the role of PLK4 in genomic stability and the DNA damage response is unclear. Evaluation of the PLK4-Seckel fibroblasts obtained from patient revealed the expected impaired centriole biogenesis, disrupted mitotic morphology, G 2 /M delay, and extended cell doubling time. Analysis of the PLK4-Seckel cells indicated that PLK4 is also essential for genomic stability and DNA damage response. These findings provide mechanistic insight into the pathogenesis of the severe growth failure associated with PLK4-deficiency. © 2017 European Society of Human Genetics All rights reserved.

Background: Femoral bowing plane (FBP) is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. Materials and Methods: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21-84 years). Results: The anteversion values were found as the angle between a distal condylar axis (DCA) and femoral neck anteversion axis (FNAA) along an imaginary longitudinal femoral axis (LFA) in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78-102°). On the other hand, FBP does not lie close to the sagittal femoral plane (SFP); instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P0 < 0.001; r = 0.680 and r = -0.682, respectively). Combined correlation is perfect (R[2] = 1) as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. Conclusions: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component positioning perpendicular to the FBP can be an alternate way in the replacement surgeries. In addition, it has been found that FBP lies externally rotated relative to the SFP. © 2017 Indian Journal of Orthopaedics | Published by Wolters Kluwer - Medknow.

Summary: This study explores the effect of supervised back extensor strength training on spinal pain, back extensor muscle strength, trunk-arm endurance, kyphosis, functional mobility, and quality of life (QoL) among sixty postmenopausal women with vertebral osteoporotic fractures. Purpose: To compare the effects of a 6-week supervised or home-based program of back-strengthening exercise on spinal pain, back extensor strength, trunk-arm endurance, kyphosis, functional mobility, and QoL in osteoporotic postmenopausal women with vertebral fractures. Methods: The study was designed as a randomized controlled clinical trial. Sixty osteoporotic postmenopausal women with vertebral fracture (mean age 60.3 ± 9.3 years) were included in the study. Subjects were randomly assigned into three groups (supervised program, home-based program, or control), each consisting of 20 subjects. The subjects underwent the 6-week exercise program which included strengthening exercise for the back extensor muscles. They performed three sets of 8, 10, or 12 repetitions for each of the exercises, biweekly ascending, three times per week. Spinal pain, back extensor strength, trunk and arm endurance, kyphosis, functional mobility, and QoL were measured at baseline and at the end of the exercise program. Results: Statistically significant improvements were demonstrated on spinal pain, muscle strength and endurance, functional mobility, and QoL for the supervised exercise program compared with control and home-based exercise groups (p < 0.01). Home-based exercise program did not provide a significant improvement compared with the control group except for mobility parameters of QoL. Conclusions: Six-week supervised back extensor strengthening training is superior to home-based program in terms of spinal pain, back extensor muscle strength, trunk endurance, functional mobility, and QoL for postmenopausal osteoporotic women with vertebral fractures. © 2019, International Osteoporosis Foundation and National Osteoporosis Foundation.

We aim to draw attention to occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis (RA) and to underline difficulties encountered during clinical and radiological diagnosis. A forty-seven years old man with RA for 4 years had occipital pain for 1 year without any history of trauma. Later, he developed weakness in the upper extremities, but he did not realize weakness in the lower extremities due to deformities. Contrast magnetic resonance imaging revealed a linear fracture of odontiod process and myelopathy. Cervical computed tomography scan revealed an old fracture border with separated and almost disappeared remnant of the tip of the odontoid without free particles in the cord. It was impossible to evaluate atlantoaxial and vertical subluxations with craniometric measurements due to destruction of the tip of odontoid. Following occipitocervical fusion and decompression and a rehabilitation program, his muscle strength improved; however, functional myelopathy stage did not change. Atraumatic fractures of the odontoid process may be more common than reported and may cause compression of the spinal cord or brain stem. Surgery is the treatment of choice but functional recovery is limited once neuronal damage has occurred. Erosion of the critical landmarks makes it difficult to diagnose and follow up atlantoaxial subluxation and/or vertical subluxation, therefore clinicians should consider radiographical follow-ups during the course of the disease. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd

Objective: To detect the musculoskeletal disorders of diabetes affecting the hand by ultrasonography (US) and to study the relationship of these changes with the arterial Doppler blood flow pattern. Materials & Methods: Both hands of 23 diabetic patients (age 53 ± 11.3 years) (10 female, 13 male) were examined by US and compared to age and sex matched control group (age 53 ± 11.1 years). Median nerve diameters, area and circumference measurements, flexor retinaculum thickness and tendinopathic changes as decrease in echogenicity, peritendinous fluid collection were studied. Arterial Doppler echo pattern of radial, ulnar and palmar arch arteries have also been studied. Clinical findings as arthralgia, numbness and limited joint mobility were recorded. Results: Patients group showed a significant increase (P

Objective: To investigate ultrasonographically the frequency of Achilles tendon (AT) involvement in patients with intermittent claudication due to lower extremity arterial ischemia. Materials and Methods: 70 lower extremity in 40 patients with unilateral (n=10) and bilateral (n=30) symptoms of intermittent claudication were studied. 60 age and sex matched asymptomatic lower extremities in 34 subjects served as a control group. Arterial Doppler ultrasonography was done to establish the diagnosis of occlusive arterial disease and the degree of obstruction was recorded. Tendinopathic changes of AT were assessed by ultrasonography (US). Results: Tendon thickness was increased in patient group (7.35+2.91mm) compared to control group (5.39 +1.21 mm). Tendinopathic changes like increased thickness, decreased echogenicity and loss of edge sharpness with intraperitenon fluid collection were seen in 54/70 heels in patient group. Among, tendinopathic changes increased thickness and hypoechogenicity has shown a significant correlation with stenotic changes of popliteal (P=0.027), tibialis posterior (P=0.27) and dorsalis pedis arteries (P=0,006), whereas no correlation was found with those of common and superficial femoral arteries. Conclusion: Tendiopathic changes can be seen in AT in occlusive distal arterial diseases of lower extremity. Ultrasonography may offer a good diagnostic modality in displaying these changes in patients with lower limb ischaemia

Aims: We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip. Materials and methods: Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer. Results: Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p

Objectives: To determine the amount of body fat tissue with skinfold thickness measurements is a common method to estimate the body composition. The other method used for this purpose is ultrasonography which is expensive and needs specialization to apply. In this study, validity of skinfold thickness measurements was investigated using ultrasonography.Methods: One hundred adult volunteers (50 males and 50 females) were used in this study. The ages of the subjects were 20 to 70, selected as10 males and 10 females for each decade. Subcutaneous fat thickness of the subjects were measured at seven body sites (submandibula, triceps, biceps, subscapula, suprailiac, thigh and calf) using a skinfold caliper and an ultrasound equipment. The measurements were made by the same person on the right side of the body, while the subject was standing in a upright position.Results: Mean ultrasonographic measurements were smaller than those performed using a skinfold caliper at all areas (p

The objective is to investigate the effect of obesity and hepatosteatosis on the Doppler waveform pattern of the hepatic veins. B-mode and duplex Doppler sonography of the liver and the right hepatic vein was performed in 102 obese subjects and 84 healthy volunteers. The severity of fatty infiltration was graded as mild, moderate and severe. The flow pattern of the right hepatic vein was classified as triphasic, biphasic and monophasic. The Doppler flow pattern in the right hepatic vein was triphasic in 56 (55%), biphasic in 27 (26%) and monophasic in 19 (19%) obese patients, whereas it was triphasic in 83 (99%) and biphasic in 1 (1%) control subject, achieving a statistical significance (Mann-Whitney U-test, P

Purpose: This study has two objectives: (1) using ultrasound (US) as a tool for measuring subcutaneous (S) and intra-abdominal; preperitoneal (P) and visceral (V) fat thickness. (2) Assessing the relationship between selected anthropometrical variables and US-measured S, P and V fat also evaluating the contribution of abdominal fat accumulation in development of liver steatosis. Methods and materials: Sixty-eight obese patients (aged 43.9±9.3 years) and 40 non-obese subjects (aged 34.03±9.0 years) were recruited to this study. Height, weight (W), waist (WC) and hip circumferences were measured. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. A linear-array probe (7.5 MHz) was used to measure S and P. A convex-array probe (3.5 MHz) was used for measuring V and assessing liver fatty infiltration. Results: In 45 (66%) patients, there were diffuse liver fatty changes. Liver steatosis showed significant correlation with V (r=0.57), P (r=0.38) and S (r=0.37). It also correlated with W (r=0.52), BMI (r=0.6), WC (r=0.45) (P

Objectives: To examine and compare the effects of massage and matrix rhythm therapy in young women on the peripheral blood circulation. Design: Randomized, double-blind, controlled trial. Setting: Pamukkale University in Denizli, Turkey. Patients: Fifteen healthy women age 19-23 years. Intervention: Matrix rhythm therapy was applied to the left lower extremity for a single 30-minute session. At least 1 week later, massage was applied to the left lower extremity for 30 minutes in a single session. The same physiotherapist applied both sessions. Outcome measures: The blood velocity (cm/s), artery diameter (mm), and blood flow (ml/min) of the popliteal and the posterior tibial arteries were measured with color Doppler ultrasonography. All images were evaluated by the same radiologist. Results: After matrix rhythm therapy and massage application, blood velocity, artery diameter, and blood flow in arteries increased. However, matrix rhythm therapy caused a more prominent increase in the amount of blood flow in the popliteal and in the posterior tibial artery than did massage. After matrix rhythm therapy application, the average increases in the blood flow rates in the popliteal and the posterior tibial arteries were 25.29%±16.55% and 34.33%±15.66%, respectively; after the massage, the increases were 17.84%±17.23% and 16.07%±10.28%, respectively. Conclusion: Matrix rhythm therapy and massage increased peripheral blood flow in young women. Matrix rhythm therapy method resulted in more prominent increases. © Mary Ann Liebert, Inc.

To evaluate the clinical significance of body fat distribution in childhood obesity, we investigated the associations of subcutaneous and intraabdominal (preperitoneal and visceral) fat, estimated by ultrasonography, with metabolic risk factors.Fifty-one obese (age 11.5+/- 2.6 years) and 33 non-obese (age 12.2+/- 2.7 years) children.Case control study.Ultrasonographic measurements of fat thickness [maximum and minimum preperitoneal fat thicknesses (Pmax, Pmin), maximum and minimum subcutaneous fat thicknesses (Smax, Smin), visceral fat thickness (V), triceps (Tr) and subscapular (Ss) skin fold thicknesses] were documented. Blood pressures, lipid profiles, fasting insulin levels, glucose/insulin ratio and HOMA IR (homeostasis model assessment for insulin resistance) were evaluated in both groups and these parameters were correlated with body fat distribution.In the obese group, fasting insulin level was correlated to Smin, Smax, and Pmin. HOMA, accordingly, was also correlated to Smin, Smax, and Pmin. Fasting insulin level and HOMA showed no correlation with either Pmax or visceral fat thickness.Abdominal subcutaneous fat thickness measurements were the best predictors of hyperinsulinemia (R2: 0.32).We did not observe a significant correlation between blood pressure, lipid parameters and body fat distribution in obese group. Abdominal subcutaneous fat thickness might be a better predictor of the risk for hyperinsulinemia in childhood obesity.

Ankylosing spondylitis (AS) primarily affects the spine and axial skeleton. Major extra‐articular manifestations include cardiovascular and pulmonary involvement, uveitis, enteric mucosal lesions, ...

Behcet’s disease is a multisystemic inflammatory disorder [1]. Parenchymal (65– 81%) and vascular (19–27.5%) forms were defined for neurological involvement [1, 2]. Sinus thrombosis and intracranial hypertension are the most common examples of the vascular form [1]. It is very uncommon that these two forms of the disease occur in the same individual [1]. In this report we present a case with neuro-Behcet’s disease (n-BD) that had signs of both clinical forms contemporaneously including aseptic meningitis, venous sinus thrombosis, intracranial hypertension and a callosal lesion. A 27-year-old male patient presented with headache, papilloedema and neck stiffness. In cranial MRI, superior sagittal sinus thrombosis, prominent meningeal contrast enhancement (figure 1) and a lesion of 1 cm in diameter located in the splenium of the corpus callosum enhancing with gadolinium on T1W and hyperintense on T2W (figure 2a) were seen. CSF pressure was measured as 600 cmH2O; a high lymphocyte count and an increased level of protein were detected. A ten year history of recurrent oral aphthus, genital ulcerations and positive pathergy test directed to Behcet’s disease. Methylprednisolone, azathioprine, acetazolamide were used. Symptoms and signs resolved completely in one year. Follow up MRI revealed complete recanalisation of the thrombosis and disappearance of the callosal lesion (figure 2b). This case shows that major clinical forms can be seen in the same patient synchronically in n-BD. Isolated hyperintense white matter lesion located in the splenium of the corpus callosum is another interesting point of the case. In the literature only one n-BD case with similar callosal involvement was found [3]. We saw reversible callosal lesions in multiple sclerosis and its variants and but in this patient a detailed history and CSF immunological analysis were not consistent with neither of them. Correspondence: Dr. Levent Sinan Bir Pamukkale Universitesi Tip Fakultesi Hastanesi Noroloji Anabilim Dali Kat 1 B105Kinikli 20070 Denizli Turkey E-Mail: sbir@pamukkale.edu.tr

Objective. The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. Methods. Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. Results. Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P

Hydatid disease, although known to occur in most body areas, is extremely rare in the female reproductive system. There are different modes of presentation for the disease; however, we report and discuss a case presented with cystic vesicles passing through the vagina, which is considered as a rare presentation for secondary involvement of the uterus and both ovaries. We confirmed diagnosis with radiological examinations and serological tests. We operated on the patient, and studied the excised cysts microscopically. The gynecologist should be aware of hydatid cyst when vaginally passing a grape like vesicle is presented by the patient. C1 Pamukkale Univ, Dept Radiol, Denizli, Turkey. Celal Bayar Univ, Infect Dis, Manisa, Turkey.

The aim of this study was to assess whether magnetic resonance imaging could predict the outcome of attempted vaginal delivery in a group of pregnant women whose parturition had to be induced by oxytocin. The signal intensity and morphology alterations in the cervix of 21 full-term pregnant women were analyzed before the induction of parturition. T2-weighted gradient echo sequences were utilized and signal intensity in the cervix was measured from the anterior and posterior lips of the cervix. An index indicating the brightness range of the cervix was formulated to overcome the effects of the individual intensity changes. Imaging features including the signal intensity and the evidence of effacement were correlated with the actual type of delivery performed. Images were also assessed visually by two independent radiologists. Statistical analysis of brightness indexes that were considered to have a predictive value as an indicator for possible delivery was not significant. However, visually assessed signal intensity of the cervix correlated strongly with the type of delivery. Effacement itself was the most reliable parameter in predicting the progress of the delivery. In conclusion, MR imaging seems to be useful for predicting normal parturition in full-term pregnant women who need oxytocin induction. However, the presence of effacement seems to be a more reliable and practical parameter that will be preferred in that prediction.

Çalışmamızın amacı, primeri bilinen olgularda difüzyon ağırlıklı MR görüntülemede (DA MRG) difüzyon kısıtlamasının ve ADC değerindeki değişikliklerin STIR sekansı ile saptanan vertebra metastazlarının tanısına olan katkısını değerlendirmek ve osteoblastik vertebra metastazların tanısındaki değerini ortaya koymaktır.Pamukkale Üniversitesi Tıp Fakültesi Radyodiagnostik Anabilim Dalı'nda, Ocak - Ekim 2008 tarihleri arasında başvurmuş vertebra metastazı ve/veya şüphesi olan ancak primer malign tanısı olan 40 hastaya öncelikle STIR MRG referans tetkik olarak çekildi sonra tüm vücut kemik sintigrafisi ve DA-MRG tetkikleri yapıldı. DA-MRG bulguları STIR MRG ve tüm vücut kemik sintigrafisi bulgularıyla karşılaştırıldı. DA-MRG' de difüzyon kısıtlamasının izlenmesinin vertebra metastazlarının saptanmasında duyarlılığı %88, özgüllüğü %96,9 olarak bulundu. Tüm vücut kemik sintigrafisi bulgularına göre DA-MRG' de difüzyon kısıtlaması izlenmesinin osteoblastik vertebra metastazlarının saptanmasında duyarlılığı %81, özgüllüğü %96,7 olarak bulundu. Metastaz saptanan vertebraların ADC değerlerinde metastaz saptanmayan vertebralara göre artış izlenmekte olup, istatistiksel olarak anlamlı bulundu. TVKS ve niteliksel DA-MRG ile karşılaştırıldığında ADC haritasında ölçülen ADC değerindeki artış vertebra matastazlarının saptanmasında en duyarlı tanı yöntemi olarak değerlendirildi.Primeri bilinen ve vertebra metastazı ya da süphesi olan olgularda DA-MRG vertebra metastazlarının saptanmasında yüksek duyarlılığa sahip, radyasyon ve kontrast madde kullanımı göstermeyen bir tetkik olması nedeniyle MRG kontraendikasyonu bulunmayan olgularda vertebra metastazlarının tanısında tercih edilebilecek bir tanı yöntemidir. From January 1, 2008 to October 31, 2008, 40 patients (29 men and 11women; age range 55 - 85 years; mean age 65,5 + 8,21 years ) with suspicion of vertebral metastasis were recruited to this study. All the patients were underwent STIR MRI, Diffusion weighted MRI (DW- MRI) and whole body bone scintigraphy examinations.The purpose of this study was to evaluate by DW MRI the presence of vertebral metastasis in patients with known primary malignant disease. DW MRI findings including diffusion restriction and changes at ADC value were assessed and correlated with the results of bone scintigraphy and STIR MRI sequence which was used as a reference test to detect vertebral metastasis.Diffusion restriction findings in DW-MRI showed a high sensitivity 88% and specificity 96,9%. Not only in determining vertebral metastasis but also when compared with whole body bone scintigraphy records (sensitivity 81% and specificity 85%). An increased in ADC values of metastatic vertebrae in comparison with the non metastatic vertebrae was found significant statistically.Due to the high sensitivity and specificity of DW MRI in determining vertebral metastasis without the need to use contrast media and ionizing radiation, DW MRI could be a safe and preferential modality in screening patients with suspected vertebral metastasis. 67

Bu çalışmada, el ve el bileklerinde poliartriti olan ve klinik olarak erkendönem RA tanısı düşünülen olgulara dinamik kontrastlı MRG (DKMRG)yöntemi uygulayarak sinovit, tenosinovit, kemik ödemi ve kemik erozyonubulgularını saptamak ve bu bulguları klinik takip sonuçları, bazı laboratuarbulgular ve statik MRG bulguları ile kıyaslayıp, erken RA tanısında dinamikkontrastlı MRG etkinliğini araştırmak amaçlanmıştır.Klinik olarak erken dönem romatoid artrit düşünülen 40 olgunun (33kadın, 7 erkek ortalama yaş 41±10yıl) el ve el bileğine statik MR ve IVkontrast enjeksiyonu sonrası DKMRG ile inceleme yapıldı. Kırk olgunun 28(%70)'inde DKMRG ile sinovit bulgusu saptandı. DKMRG ile sinovit saptanan28 olgudan 21 (%75)'ine klinik olarak erken dönem romatoid artrit tanısıkonuldu. Statik MRG bulguları ile DKMRG bulguları karşılaştırıldığında;DKMRG'nin erken RA'yı saptamada daha duyarlı bir yöntem olduğu bulundu.Erken RA tanısında özgüllüğü yüksek anti-CCP antikoru ile DKMRG'dekisinovit bulgusu istatistiksel olarak uyumlu bulundu. Bu yöntem ile tendonkılıfındaki sinoviyal kontrastlanma gösterilerek tenosinovit teşhis edildi. Kemikkisti ile kemik erozyonunun ayırımında DKMRG ile kontrastlanma pikisaptanıp iki bulgu arasında ayırımın yapılabileceği bulundu. İncelenen bazılaboratuar değerleri (RF, CRP, sedim) ve DAS 28 hastalık aktivite skoru ileDKMRG bulgularımız arasında uyum tespit edilmedi.Sonuç olarak; DKMRG yöntemi erken RA olgularının el ve el bileğindekisinovit bulgusunu saptayıp tanının erken dönemde konulmasında faydalıolabilir. Özellikle erken RA'da eklem değişikliklerinin tespitinde direkt grafiduyarlılığı düşük olduğu için, DKMRG bulguları hastalık tanısında kullanılanARA kriterlerindeki radyolojik kriterleri içinde önemli bir yer bulabilir. RA'nıntanısının erken dönemde konulması ile de tedaviye erken başlanıp hastalığınileriki döneminde gelişebilecek deformiteler önlenebilir. The purpose of this study was to assess the efficacy of contrastenhanced dynamic MRI (CEDMRI) in the diagnosis of early rheumatoidarthritis in patients with polyarthritis of hands and wrists. Synovitis,tenosynovitis, bone oedema and bone erosions determined by contrastenhanced dynamic MRI were compared with static MRI, clinical andlaboratory findings.Static and CEDMRI were performed to hands and wrists of 40 patients(33 women, 7 men; mean age: 41±10 years) suspected clinically as earlyrheumatoid arthritis. Synovitis was found in 28 of 40 patients (%70) who weretaken for the study group. Of these 21 of 28 (%75) patients were diagnosedas early rheumatoid artritis clinically. CEDMRI was found more sensitive inthe diagnosis of early rheumatoid arthritis when compared with static MRI.Anti-CCP antibody, which is highly specific for early rheumatoid arthritis,shown a significant statistical relation with synovitis determined by CEDMRI.On the other hand CEDMRI was found to be more sensitive in the diagnosisof tenosynovitis which is determined by the contrast enhacement of thesynovial tendon sheath. Differentiation between bone cysts and erosions alsocould be done by calculating the contrast peak enhancement of the tendonsheath. There were no significant statistical relationship between CEDMRIfindings and RF, CRP, ESR and DAS 28 disease activity score.In conclusion, CEDMRI could be a useful diagnostic modality in theearly assessment of RA by determining synovitis in the hands. Due to therelative low sensitivity of direct radiography in determining early joint changesCEDMRI findings can take an important part within the diagostic radiologicalcriteria of RA which in turn will help in the early diagnosis and treatment sothat may prevents the complication of the disease in the future. 64

8. ÖZET AMAÇ Bu çalışmada obez olan ve olmayan hastalarda US ile yağ tabakaları ölçüldü. Rutin çekilen diz MR'larında rekonversiyon varlığı araştırıldı. Obezite ile rekonversiyon ve yağ tabakaları ile rekonversiyon arasında ilişki olup olmadığı değerlendirildi. GEREÇ VE YÖNTEM Obez olan 53 kadın hasta ve obez olmayan 100 kadın hastanın US ile yağ tabakalar, diz MR'ı ile kemik iliğinde rekonversiyon varlığı, antropometik ölçümleri ve kan laboratuar (hemoglobin) bulguları alındı. BULGULAR Obez hasta grubunun %35,8'inde (n=19), obez olmayanlarda %16'sında (n=16) rekonversiyon bulundu.Tipl rekonversiyon 20 kişide, tip2 rekonversiyon 1 1 kişide, tip3 rekonversiyon 3 kişide, tip4 rekonversiyon 1 kişide izlendi. Anemisi olanlarda rekonversiyon %39,3 (n=ll), anemisi olmayanlarda rekonversiyon %19,2 (n=24) oranında saptandı. Menopoza girmeyenlerin %42,8'inde (n=30), menopoza girenlerin %1 6,7'sinde (n=5) rekonversiyon bulundu. Sigara içenlerin %28'inde (n=9), sigara içmeyenlerin %22'sinde (n=26) rekonversiyon saptandı. 39 9.SUMMARY PURPOSE In this study, the fat layers of obese and non-obese patients are measured ultrasonographically.Presence of bone marrow reconversion is investigated in subjects during their routine knee MRI. The relationship between both obesity and fat layers with reconversion is evaluated. MATERIALS AND METODS Fifty three obese women and 100 non-obese women were recruited to this study thickness of fat layers were measured with ultrasound, whereas reconversion of bone marrow was studied by MRI of knee. Also the anthropometric measurements and laboratuary findigs (hemoglobin) were taken. FINDINGS Reconversion is observed at 35,8 % of obeses (n=19) and 16 % of non- obese (n=16) patients. 20 patients are found to have type 1,11 patients type 2, 3 patients type 3, 1 patients type 4 reconversion. Reconversion is observed 39,5 % (n=l 1) of patients with anemia and 19,2 % (n=24) with non-anemic patients. Reconversion is observed 48,2 % (n=30) of premenopausel and 16,7 %(n=5) of menapausel women. 28 % (n=9) of smokers and 22 % (n=26) of non- smoking patients are found to have reconversion. 41 549