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Background Breast density is an important variable that can change the sensitivity of mammography. It can be analyzed with using the 4th and 5th editions of the Breast Imaging and Reporting Data System (BI-RADS) recommendations from the American College of Radiology (ACR). Purpose To define the intra- and inter-reader agreement levels of breast density assignments performed by readers with different experience levels using two versions of BI-RADS. Material and Methods The breast density assessments of 330 women were conducted by two readers with different levels of experience (one breast radiologist and one resident). Each reader independently defined the breast density four times—twice using the 4th edition and twice using the 5th edition. Assessments were analyzed on four- and two-category scales. Results The intra-reader agreement of the breast radiologist for the 4th and 5th editions of BI-RADS was almost perfect (k = 0.90 and k = 0.87, respectively.) The resident had similar results (k = 0.88 and k = 0.87, respectively). The agreement between the breast radiologist and resident for the 4th and 5th edition of BI-RADS was substantial (k = 0.70 and k = 0.63, respectively). There was a statistically significant difference with the two-category scale analysis between the dense and non-dense for both readers and versions of BI-RADS (McNemar’s test, P Conclusion Although there were high intra- and inter-reader agreement levels when using both versions, the percentage of women having dense breasts increased when using the 5th edition, and the difference was statistically significant. There were no differences found with regard to the readers’ level of experience in all analyses.

Aim: Preoperative breast magnetic resonance imaging (MRI) findings can provide rich information about the prognosis of the disease. Morphologic and dynamic features are especially used for it. We aimed to compare peritumoral, prepectoral, and diffuse edema identified in MRI with histopathologic findings, and to show how prognostic information can be gathered from the identification of edema.Methods: We conducted a retrospective cohort study with forty-six women who underwent breast DCE-MRI as part of the pre-surgical evaluation between January and August 2018 were included in the study. Signal enhancements similar to water that were localized to the prepectoral or peritumoral areas or diffuse enhancements on T2A-weighted sequences were considered as edema. The presence of edema was compared with clinicopathologic parameters such as cancer type, tumor size, histologic grade, ER-PR receptor positivity, Her2 positivity, Ki-67 labelling index and lymphovascular invasion.Results: The mean age of the participants was 53.15±11.75 (range, 27-80) years. Eleven patients had diffuse edema, 27 patients had peritumoral edema, and 5 patients had prepectoral edema. Nineteen luminal A cancers, 17 luminal B, 9 triple-negative, and 1 Her2 cancer were seen. Peritumoral edema was associated with lymphovascular invasion positivity (p=0.002). Tumor size and the level of Ki-67 was associated with peritumoral edema (p=0.001, p=0.009). The odds of observing prepectoral edema showed no statistically significant difference in the presence of lymphovascular invasion positivity and other parameters. The presence of diffuse edema showed significant differences depending on tumor size measurements (p=0.026).Conclusion: Edema in breast MRI can provide information about histopathologic findings, particularly about lymphovascular invasion. The authors suggest that different edema types could be mentioned in radiology reports as a matter of routine given that such findings can provide information about the prognosis.

The most commonly used radiological method for age estimation of living individuals is X-ray. Computed tomography is not commonly used due to high radiation exposure, which raises ethical concerns. This problem can be solved with the use of magnetic resonance imaging (MRI), which avoids the use of ionizing radiation. The purpose of the present study was to evaluate the utility of MRI analysis of the proximal humeral epiphyses for forensic age estimations of living individuals. In this study, 395 left proximal humeral epiphyses (patient age 12–30 years) were evaluated with fast-spin-echo proton density–weighted image (FSE PD) sequences in a coronal oblique orientation on shoulder MRI images. A five-stage scoring system was used following the method of Dedouit et al. The intra- and interobserver reliabilities assessed using Cohen’s kappa statistic were κ = 0.818 and κ = 0.798, respectively. According to this study, stage five first appeared at 20 and 21 years of age in males and females, respectively. These results are not directly comparable to any other published study due to the lack of MRI data on proximal humeral head development. These findings may provide valuable information for legally important age thresholds using shoulder MRI. The current study demonstrates that MRI of the proximal humerus can support forensic age estimation. Further research is needed to establish a standardized protocol that can be applied worldwide.

Background Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. Materials and methods Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. Conclusion Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.

Objective Shear wave elastography (SWE) is a user-independent ultrasonographic technique that evaluates tissue elasticity. It is used especially in the evaluation of thyroiditis and thyroid nodules when it is capable of distinguishing malignant from benign thyroiditis in adults. To date, no studies have evaluated SWE in pediatric thyroid patients. The aim of this study was to measure the elasticity of normal thyroid tissue in children and adolescents using SWE and to investigate its role in the diagnosis of pediatric autoimmune thyroiditis. Methods In total, 113 healthy children of whom 66 (58.4%) were girls and 57 children with autoimmune thyroiditis of whom 45 (78.9%) were girls were evaluated by SWE after B-mode ultrasound. The quantitative evaluation of normal thyroid tissue in healthy children and those with autoimmune thyroiditis was performed using shear wave velocity (SWV) values (m/s). Thyroid antibodies were consistent with autoimmune thyroiditis. Data were compared using descriptive and analytical statistics and receiver-operating characteristic curves. Results The mean ± standard deviation (range) of SWV value in thyroid parenchyma of the healthy children was 1.82±0.3 m/s (1.32-2.37) m/s. There was a significant positive correlation between age and SWV values which increased with age. The average SWV value of thyroid parenchyma in children with autoimmune thyroiditis was 3.7±1.2 (2.59-6.25) m/s which was statistically significantly greater than in healthy children (p=0.00). The cut-off value for elasticity with the highest diagnostic accuracy was 2.39 m/s; sensitivity and specificity were 97.4% and 100% respectively. There was no correlation between elasticity, thyroid function tests and autoantibody concentrations (p>0.05). Conclusion SWE is a useful imaging method that can be used with routine ultrasonography in evaluation of the thyroid in children.

There is no consensus about the measurement techniques to determine the tibial torsion by using MRI. The primary research question of this study was to find out which MRI-based tibial torsion measurement method is more reliable and reproducible. Secondly, we compared tibial torsion values measured by three measurement methods in T1- and T2-weighted images. We retrospectively analyzed voluntary children performed MRI for determination of the lower limb torsional alignment after the surgical treatment between January 2013 and December 2013. Thirty-four extremities of 17 patients were included in the present study. The mean age of patients was 7.3 years (range 3–12 years). The transmalleolar, posterior intermalleolar and anterior talus angles were used for the measurement of tibial torsion. All tibial torsion measurements were calculated by three blinded observers in T1- and T2-weighted images, and these measurements were repeated blindly after 2 months. All measured intra- and interobserver intra-class correlations were greater than 0.60. The best scores were achieved with the anterior talus angle. It was followed by the posterior malleolar angle and the intermalleolar angle, respectively. Furthermore, there were no statistically significant differences between tibial torsion values measured by each observer in T1- and T2-weighted images of each method. MRI-based tibial torsion measurements were reliable and reproducible for all three methods. But we think that the anterior talus angle and the posterior malleolar angle are easier and more successful in determination of the tibial torsion. Also, both T1- and T2-weighted images can be used successfully for this purpose.

The goal of our study was to determine the diagnostic value of diffusion-weighted magnetic resonance imaging in the identification of acute mild pancreatitis with low Ranson scores. The study group included 22 healthy subjects and 40 patients with mild acute pancreatitis. Patients with Ranson scores of 1-3 were included in the present study. There was a significant reduction in mean pancreatic apparent diffusion coefficient among the acute pancreatitis patients (1.46±2.80×10(-3)mm(2)/s) relative to the healthy subjects (1.69±2.26×10(-3)mm(2)/s). Diffusion-weighted imaging improves diagnosis of mild acute pancreatitis and enables the differentiation of acute pancreatitis from other diseases involving abdominal pain and other nonspecific findings.

In recent years, methods by which to decrease radiation exposure during age estimation have gained importance and become a main research area in the forensic sciences. Imaging tools such as X-ray and computed tomography (CT) are accepted as the main diagnostic methods for evaluation of the epiphysis in living individuals; however, radiation exposure and superimposition are the main disadvantages of these techniques. Magnetic resonance (MR) imaging provides an advantage in terms of preventing radiation exposure. In this study, we performed an MR analysis of the degree of fusion of the distal tibia and calcaneal epiphysis and investigated the utility of this technique in the Turkish population. Using the three-stage method described by Saint-Martin et al., we retrospectively evaluated 167 MR images (97 males, 70 females; mean age, 17.7 +/- 4.8 years for males and 17.6 +/- 4.9 years for females; age range of all subjects, 8-25 years). Intraobserver and interobserver evaluation showed good repeatability and consistency of this method. Stages 2 and 3 ossification of the distal tibial epiphysis first occurred at age 14 and 15 years in males and 12 and 14 years in females, respectively. Stages 2 and 3 ossification of the calcaneal epiphysis first occurred at age 14 and 16 years in males and 10 and 12 years in females, respectively. When performed alone, MR analysis of the distal tibial and calcaneal epiphysis offers limited information for forensic age estimation. However, we suggest that MR analysis can be used as a supportive method when it is necessary to avoid repeated radiation exposure.

Amaç: Adli yaş tayini özellikle çocuklar ve genç erişkinler başta olmak üzere cezai ve sivil hakların belirlenmesinde çok önemlidir. Günümüze kadar tanımlanan ve güvenilirliği ve geçerliliği kabul edilmiş metotlar olsa da özellikle radyasyon maruziyetine dayalı etik tartışmalar önemlidir. Son yıllarda kişileri radyasyon maruziyetinden koruyan manyetik rezonans görüntüleme (MR) kullanımı denenmektedir. Bu çalışmanın amacı distal radial epifizin MR ile analizinin yaş tahmininde kullanılabilirliğini araştırmaktır. Gereç ve Yöntem: Çalışmada 12-20 yaş grubuna ait 198 el bileği MR retrospektif olarak değerlendirilmiştir. Çalışmamızda daha önce Dvorak tarafından profesyonel sporcuların değerlendirmesinde kullanılan distal radial epifiz MR değerlendirme yöntemi kullanılmıştır. Bulgular: Tespit edilen ilk görülme yaşları kadınlarda evre 2 de 13, evre 3 ve 4 de 14, evre 5 de 15 ve evre 6 da 16 yaştır. Erkeklerde ise evre 2 ve 3 de 14, evre 4’te 15, evre 5 ve 6’da 16 yaştır. Sonuç: Distal radius epifizinin Dvorak metodu ile analizi non-iyonize bir yöntem olarak 13-16 yaşlarda ilk görülme yaşları açısından başarılı olmakla birlikte 17 ve 18 yaşlar için çalışma popülasyonumuzda veri sunamamıştır. Gerek yöntemin gerekse çalışma popülasyonlarının genişletildiği çalışmalara ihtiyaç vardır.

Building a reliable biological profile from decomposed remains depends heavily on the accurate estimation of sex. A variety of methods based on every single skeletal element have been developed over the years for different populations employing both osteological and virtual methods. The latter seem to be a reasonable alternative in countries lacking osteological reference collections. The current study used 3D virtual models of calcanei from CT scans of living adults to develop a sex estimation method for contemporary Turkish. Four hundred and twenty eight calcanei CT scans were analysed. The sample was divided in two subsamples: an original (N = 348) and a validation sample (N = 80) with similar distribution of males and females. Nine classical measurements were taken using the 3D models of the calcanei and two different statistical methods (Discriminant function analysis and Binary logistic regression) were used. Classification accuracy ranged from 82% to 98% for the validation sample and it was consistently high using any of the two methods. Sex bias seems to be lower for most of the logistic regression equations compared to the discriminant functions. These results, however, need further testing to be verified. Based on the results of this study we recommend the use of both methods for sex estimation from the measurements of the calcaneus bone in a Turkish population. (C) 2017 Elsevier B.V. All rights reserved.

To investigate the relationship between diffusion tensor imaging (DTI) parameters such as fractional anisotropy (FA), mean diffusivity (MD), relative anisotropy (RA), and volume ratio (VR) values, and prognostic factors of invasive breast cancer.This retrospective study examined 63 patients with pathologically confirmed invasive breast cancers. The patients underwent pre-operative diffusion-weighted magnetic resonance imaging (MRI) at 3.0 Tesla. The relationship between DTI parameters and tumor size, histologic and nuclear grade, axillary lymph node status, lymphovascular and perineural invasion status, estrogen receptor (ER), progesterone receptor (PR), CERB-B2, and Ki-67 were analyzed.Patients with lymph node metastasis (p = 0.018; p 0.05) and/or lymphovascular invasion (p = 0.001; p 0.01) and/or histologic grade 3 tumors (p 0.05) had statistically significantly low MD values. There was a statistically significant relationship between ER and MD (r = 0.452, p 0.01), PR and MD (p = 0.001, p 0.01); CERB-B2 and RA (p = 0.047, p 0.05); Ki-67 and RA (p = 0.026; p 0.05); Ki-67 and VR (p = 0.021; p 0.05); and lymphovascular invasion and FA (p = 0.045, p 0.05) values.DTI parameters of malignant masses in breast cancer patients correlate with tumor size, lymph node status, histologic grade, lymphovascular invasion, Ki-67, CERB B2, ER, and PR.

Objective: The aim of the this study is to evaluate usefulness of results of measurements via computerized tomography of frontal sinus dimensions in sex determination.Materials and methods: In Bakirkoy Training and Research Hospital subjects who had performed maxillofacial computed tomography were included. Transvers diameters (width) were measured from axial images, anterior-posterior (depth) and cephalo-caudal diameters (height) were measured from sagittal reformatted images. Measurements were performed for both left and right frontal sinuses. The size of frontal sinuses on both sides were obtained using these parameters. These values were evaluated with independent t test .The variables were evaluated discrimination function analysisResults: For study 400 subjects were evaluated (200 male and 200 female). 400 case (female/male: 200/200, mean age: 30.12 ± 10.2) All values for left and right transvers, cephalo-caudal and antero-posterior measurements showed significant difference between sex. Male sex had significant increased valued then female sex. (p

This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12–30 years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman’s rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho = 0.664, p < 0.001; males: 0.631, p < 0.001; females: rho =0.651, p < 0.001). The intra- and inter-observer reliability assessed using Cohen’s kappa statistic was κ = 0.898 and κ = 0.828, respectively. The earliest age of epiphysis closure was 17 years for females and 18 years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure

To compare efficancy of three-dimentional SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolutions) and CISS (constructive interference in steady state) sequences in the imaging of the cisternal segments of cranial nerves V-XII.Temporal MRI scans from 50 patients (F:M ratio, 27:23; mean age, 44.5±15.9 years) admitted to our hospital with vertigo, tinnitus, and hearing loss were retrospectively analyzed. All patients had both CISS and SPACE sequences. Quantitative analysis of SPACE and CISS sequences was performed by measuring the ventricle-to-parenchyma contrast-to-noise ratio (CNR). Qualitative analysis of differences in visualization capability, image quality, and severity of artifacts was also conducted. A score ranging 'no artefact' to 'severe artefacts and unreadable' was used for the assessment of artifacts and from 'not visualized' to 'completely visualized' for the assesment of image quality, respectively. The distribution of variables was controlled by the Kolmogorov-Smirnov test. Samples t-test and McNemar's test were used to determine statistical significance.Rates of visualization of posterior fossa cranial nerves in cases of complete visualization were as follows: nerve V (100% for both sequences), nerve VI (94% in SPACE, 86% in CISS sequences), nerves VII-VIII (100% for both sequences), IX-XI nerve complex (96%, 88%); nerve XII (58%, 46%) (p0.05). SPACE sequences showed fewer artifacts than CISS sequences (p0.002).

Objective The objective of this study was to calculate the mastoid cell volume of infants using computed tomography imaging. Methods We calculated the mastoid cell volumes of 87 infants younger than 1 year classified into 4 age groups. Results There were significant (P = 0.0001) differences in the ear mastoid cell volumes (cm(3)) among the 0- to 3-, 4- to 6-, 7- to 9-, and 10- to 12-month age groups. Generally, the mastoid cell volume increased with age. Conclusions Mastoid cell volume correlates with the age of infants up to 1 year. We plan to expand this study and determine cutoff values for the mastoid cell volumes of infants.

Objective: We aimed to determine the usefulness of the apparent diffusion coefficient (ADC) values for the differential diagnosis of hepatocellular carcinomas and most common metastatic liver tumors and we aimed to compare the characteristic properties. We also aimed to detect novel lesions on ADC maps before the lesion is clinically and radiologically detected by conventional methods. Materials and Methods: We evaluated characteristic properties, contrast enhancement patterns of liver metastasis of malignancies like adenocancer, renal cell carcinoma (RCC), gastrointestinal stromal tumor (GIST) and hepatocellular carcinoma (HCC) on magnetic resonance imaging (MRI) and diffusion weighted (DW) imaging. ADCs were measured both from the cystic and solid parts of the tumoral lesions. Solid and cystic parts were grouped seperately and compared individually. Results: 48 cases, (60% male and 40% female) with ages ranging between 48 and 81 were involved. 28 of them had liver metastasis and 20 of them had HCC. MRIs between the years 2009 and 2012 were analyzed. Among mean ADC values measured from solid contrast-enhancing parts, values of the HCC group were significantly higher than the metastasis group (p=0.004). Also, in metastasis group consisting of many distinct primaries, there were differences in ADC values. A retrospective analysis for follow-up cases showed that the ADC values of the parencyhma where a lesion will appear on later follow-up images were lower than the adjacent parenchyma. Conclusion: We believe that this method may be useful to detect early metastasis. Studies with larger patient groups could give more significant results which would enable diffusion imaging method to be used in this area.

Elasticity measurements of tissues can be valuable in the diagnosis and management of various diseases. The aim of this study was to determine the elasticity values for normal liver, kidney, and spleen of healthy newborns and infants using shear wave elastography (SWE) imaging.A total of 50 healthy term newborns and infants (19 girls and 31 boys; mean age 20.1 days, range 1 to 70 days) were examined by an experienced pediatric radiologist using SWE. None of them had any liver, kidney or spleen disease, or any other systemic disease that could affect these organs secondarily. All newborns and infants had a normal abdominal ultrasound scan.Age, sex, weight, height, and body mass index had no significant effects on shear wave velocity (SWV) values of liver and spleen. The SWV values of both kidneys decreased with age, weight, height, and body mass index. The mean SWV values were 1.70 m/s (range: 1.23-2.43 m/s) for the liver, 1.69 m/s (range: 0.8-2.40 m/s) for the right kidney, 1.70 m/s (range: 0.9-2.49 m/s) for the left kidney, and 2.03 m/s (range: 1.28-2.48 m/s) for the spleen.Shear wave elastography can be used to measure liver, kidney, and spleen elasticity in newborns and infants. The standard values for abdominal organs allow differentiation of healthy versus pathological tissue. We measured the normal values of SWE in healthy newborns and infants as reference data.

Introduction Erectile dysfunction (ED) is a common health problem among males, and radiology has limited use in its diagnosis and treatment. Shear wave elastography (SWE) is a new sonographic technique. In this study, we examined the significance of SWE in the diagnosis of ED. Methods The study included a total number of 70 participants. The mean age of the participants was 54.14 ± 8.03 years (range: 39 and 71 years old). We composed two groups. Group 1 had 35 patients who presented to the urology clinic in our hospital complaining of ED, and had a score of 17 or lower from the International Index of Erectile Function (IIEF) questionnaire. Group 2 consisted of 35 healthy volunteers who did not have ED. SWE measurements were performed from corpus cavernosum penis in both groups, and the results were noted. Differences between the groups were evaluated statistically. Results The difference between the mean SWE measurements of two groups (Group 1: 20.94 ± 6.23 kPa and group 2: 24.63 ± 7.58 kPa) was found to be statistically significant ( p = 0.027; p 0.05). Conclusions Due to its high specificity and positive predictive value, SWE can offer useful data in the radiologic evaluation of ED cases.

The goal of this study was to measure corpus cavernosum (CC) penis rigidity with shear wave elastography (SWE) in healthy volunteers and to evaluate the change of rigidity with age.SWE was performed in 60 healthy volunteers (age range 20-71, mean 47±12,83 years). Volunteers were divided into 2 groups by age (Group 1 age50, group 2 age ≥50). We assessed SWE in 3 parts of penis (proximal, middle and glans penis) on both sides of CC. All values of SWE (in kilo Pascal) were noted along with volunteers' ages. The measurements were done both with transverse (T) and longitudinal (L) sections. We compared all SW values of penis parts and their alterations with age.The shear wave elastography values of CC penis increased with increasing age (p0,01). There was no significant difference between both sides of CC penis (p0,05). We calculated no significant difference between T and L sections of all parts of penis (p0,05).SWE can provide noninvasive quantitative data of CC penis rigidity and its alteration with age. These data may create a new approach in the evaluation process and treatment options for penile pathologies.

The utilization of radiological imaging methods in anthropometric studies is being expanded by the application of modern imaging methods, leading to a decrease in costs, a decrease in the time required for analysis and the ability to create three-dimensional images. This retrospective study investigated 400 patients within the 18-45-years age group (mean age: 30.7 +/- 11.2 years) using cranial computed tomography images. We measured 14 anthropometric parameters (basion-bregma height, basion-prosthion length, maximum cranial length and cranial base lengths, maximum cranial breadth, bizygomatic diameter, upper facial breadth, bimastoid diameter, orbital breadth, orbital length, biorbital breadth, interorbital breadth, foramen magnum breadth and foramen magnum length) of cranial measurements. The intra- and inter-observer repeatability and consistency were good. From the results of logistic regression analysis using morphometric measurements, the most conspicuous measurements in terms of dimorphism were maximum cranial length, bizygomatic diameter, basion-bregma height, and cranial base length. The most dimorphic structure was the bizygomatic diameter with an accuracy rate of 83% in females and 77% in males. In this study, 87.5% of females and 87.0% of males were classified accurately by this model including four parameters with a sensitivity of 91.5% and specificity of 85.0%. In conclusion, CT cranial morphometric analysis may be reliable for the assessment of sex in the Turkish population and is recommended for comparison of data of modern populations with those of former populations. Additionally, cranial morphometric data that we obtained from modern Turkish population may reveal population specific data, which may help current criminal investigations and identification of disaster victims. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

The investigation of ossification regions in the skeletal system is a basic method for forensic age estimation. Although X-ray examination is commonly used in living subjects, magnetic resonance imaging (MRI) has gained importance because of its high resolution and its avoidance of radiation exposure. In this study, we investigated the utility of MRI in the evaluation of Spheno-occipital synchondrosis (SOS) fusion degree as a method to estimate age. The MRI findings of 1078 subjects (455 were male and 623 were female) aged 7-21years were retrospectively evaluated according to a five-stage method. We found that SOS fusion started two years earlier in female subjects. The average age for stage 5 SOS fusion was 18.43 +/- 1.84years in male subjects and 17.78 +/- 2.20years in female subjects. Our results show that MRI in the determination of SOS fusion degree is an efficient non-invasive method to estimate age and avoids the disadvantages of radiation exposure incurred by X-ray or computed tomography examinations.

To evaluate the usefulness of diffusion- weighted MRI (DWI) in the detection and staging of liver fibrosis and inflammation.DWI was performed with b-factors of 0, 500 and 1000 s/mm². ADC values were obtained by placing circular regions of interest in four segments of the liver. Differences between the study (n = 34) and control groups' (n = 25) ADC values were examined. Further, this study investigated if and how ADC values were related to fibrosis stages and histological activity index (HAI) scores.The mean ADC value of the liver was smaller in the study group compared with the control group (P 0.001). Spearman rho correlation analyses showed lower ADC values were associated with higher fibrosis and HAI scores (P 0.01). There were statistically significant differences in liver ADC values between each combination of fibrosis stages (e.g. stages 0 and 1, 0 and 2) except for stages 1 and 2.ADC values prove to be a valuable technique for the diagnosis of liver fibrosis and inflammation. They can also be useful in fibrosis staging, particularly in distinguishing later stages of fibrosis from intermediate and early stages.Diffusion Weighted MRI is a promising technique for diagnosis of liver fibrosis. Apparent Diffusion Coefficients provide valuable information for staging of liver fibrosis. DWI may offer alternative to biopsy for assessing liver fibrosis.

re we re sig ni fi cant dif fe ren ces in ADC va lu es for cysta de no mas and car ci no mas (p< 0.031) as well as for der mo id cysts and en do met ri o mas-he morr ha gic cysts (p< 0.05). The ADC va lu es of func ti o nal cysts-cysta de no mas did not dif fer. Conc lu si on: The ADC va lu es of be nign and ma lig nant ova ri an le si ons over lap con si de rably. The DWI do es not pro vi de ad di ti o nal in for ma ti on to con ven ti o nal se qu en ces for dis cri mi na ti on of be nign and ma lig nant mas ses.

Objective: Our purpose was to determine whether the apparent diffusion coefficient (ADC) measurement could be used to identify benign or malignant parotid tumors. Material and Methods: In this research 22 patients with 25 parotid gland tumors and 10 controls with 20 healthy parotid glands were studied. Diffusion-weighted magnetic resonance imaging (DW-MRI) with b factors of 0.500 and 1.000 sec/mm(2) on a 1.5 T unit was used. The calculated ADCs values of the parotid gland tumors were compared with histological features of the tumors. Results: The study included 25 parotid gland tumors which consisted of 17 benign masses (10 pleomorphic adenomas, 6 Warthin tumors, 1 canalicular adenoma) and 8 malignant masses (4 lymphomas, 2 carcinoma ex pleomorphic adenomas, 1 adenoid cyctic carcinoma, 1 mucoepidermoid carcinoma). The mean ADC values of the control group, benign and malignant masses were 0.27 +/- 0.13 x 10(-3) mm(2)/sec, 1.51 +/- 0.32x10(-3) mm(2)/sec, 1.05 +/- 0.26 x10(-3) mm(2)/sec, respectively (p

Background Penile fracture is a surgical emergency defined as rupture of the tunica albuginea. Although most cases can be diagnosed with clinical evaluation, it has been stated in the literature that diagnosis in as many as 15% of cases can be challenging. In uncertain cases, imaging can help determine diagnosis. Methods Present study included 20 cases where diagnosis could not be made with certainty and magnetic resonance imaging (MRI) was performed. MR images were examined for tunical rupture and accompanying pathologies. When rupture was observed, localization and length of rupture were noted. All patients underwent degloving surgery. All imaging findings were compared to surgical findings. Results MRI revealed 19 tunical ruptures. In 1 case, hematoma was seen with no sign of penile fracture. No urethral injuries were found. All MRI findings were confirmed during surgery. Conclusion Performing MRI in clinically equivocal cases can provide crucial data to make precise diagnosis and improve patient management.

Forensic age estimation based on staging of ossification of the medial clavicular bone is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. In the present study, we analyzed the stages of ossification of the medial clavicular epiphyses on thin-sliced (1 mm) computed tomography (CT) images using the substages defined within stages 2 and 3. The retrospective CT analysis involved 193 subjects (129 males, 64 females) ranging in age from 13 to 28 years. Spearman’s correlation analysis revealed a positive correlation between age and ossification stage in both male and female subjects. Stage 3c was first observed at 19 years of age in both sexes and may thus serve as a valuable forensic marker for determining an age of 18 years. Although further research is needed on the ossification stages of the medial clavicular epiphyses, the present findings could contribute to existing reports on observers’ experiences using CT analysis of ossification combined with analysis of substages.

Objective The aim of this study was to evaluate the capability and the reliability of diffusion-weighted imaging (DWI) in the changes of kidneys occurring after extracorporeal shock wave lithotripsy (ESWL) treatment for renal stones. Materials and Methods A total of 32 patients who underwent ESWL treatment for renal stone disease between June and December 2011 were enrolled in this prospective study. Color Doppler ultrasonography (CDUS) and DWI were performed before and within 24 hours after ESWL. DWI was obtained with b factors of 0, 500 and 1000 s/mm2 at 1.5 T MRI. Each of Resistive index (RI) and ADC values were calculated from the three regions of renal upper, middle and lower zones for both of the affected and contralateral kidneys. Paired sample t test was used for statistical analyses. Results After ESWL, the treated kidneys had statistically significant lower ADC values in all different regions compared with previous renal images. The best discriminative parameter was signal intensity with a b value of 1000 s/mm2. The changes of DWI after ESWL were noteworthy in the middle of the treated kidney (p0.05). Conclusion DWI is a valuable technique enables the detection of changes in DWI after ESWL treatment that may provide useful information in prediction of renal damage by shock waves, even CDUS is normal.

Background: Gynecomastia is the development of a fibroepithelial structure in the male breast as a result of many benign and malignant effects. In this study, after the confirmation of gynecomastia diagnosis in the male cases with swelling, mass and tenderness in the breast using ultrasound and mammography examinations, its etiology was clarified by laboratory tests. In case of suspicion, the diagnosis was confirmed using Fine-Needle Aspiration Biopsy (FNAB). The adequacy of ultrasound and mammography was discussed with the obtained information and the information in the literature, and the etiological and radiological classification was done.Methods: Ultrasound and mammography examinations were performed on 74 male patients with growth, palpable masses or pain in the breast. Biochemistry and hormone analysis were performed with imaging methods in the cases of possible gynecomastia. Biopsy was performed on the cases with the suspicion.Results: Gynecomastia were divided into three types in ultrasonic and mammographic examination. The most frequent gynecomastia was observed as Type 3 (51.43%) in ultrasonic examination and as diffuse type (61.42%) in mammographic examination. Pain and tenderness accompanied with swelling at the breast were present in 37.84% of the cases. 31.42% had pubertal gynecomastia, 25.71% had gynecomastia secondary to drug use, and 15% had idiopathic gynecomastia.Conclusions: Combined use of ultrasound and mammography in the diagnosis and classification of gynecomastia is highly sufficient and biopsy should be performed if malignancy is suspected.

Objectives We aimed to evaluate the electroencephalography (EEG) and diffusion weighted magnetic resonance (DWMR) findings obtained after a seizure in the acute period and to find out whether DWMR had any contribution to determine lateralization of epileptogenic activity. Methods Consecutive 43 patients with a seizure admitted to emergency department between July 2016 and February 2017 were evaluated, retrospectively. Patients whose seizures occurred in the last three days were included in the study. Demographic and clinical features, EEG and radiologic findings of the patients were evaluated. Results Mean age of total 43 patients was 48.12 ± 29.7 (18–80) years and 26 (60.5%) of them were female, 17 (39.5%) were male. Patients were divided into 3 groups regarding the classification of epileptic seizures; generalized (n = 17), partial (n = 23) and unclassified seizures (n = 3). Ten patients (23.3%) had the diagnosis of epilepsy previously. Abnormalities in EEG and DWMR were detected in 55.8% and 16.3% of the patients, respectively. In addition, 6 patients of the 7 with MR abnormalities were from partial seizures and 1 patient from generalised seizures groups. Areas of diffusion restriction were consistent with the localization of EEG abnormalities in 4 out of 7 patients. Discussion EEG is a valuable tool in supporting the diagnosis of epilepsy and classification of seizures. DWMR may be used in epilepsy patients to detect the areas that could be the cause of the epileptogenic activity in the post-ictal acute phase. Conclusions Further studies with higher number of patients may investigate the relationship between EEG and DWMR abnormalities. Significance This study may draw attention to relationship between neurophysiological and radiological findings in the acute period after a seizure.

We aimed to show the utility and reliability of sternal morphometric analysis for sex estimation. Sex estimation is a very important step in forensic identification. Skeletal surveys are main methods for sex estimation studies. Morphometric analysis of sternum may provide high accuracy rated data in sex discrimination. In this study, morphometric analysis of sternum was evaluated in 1 mm chest computed tomography scans for sex estimation. Four hundred forty 3 subjects (202 female, 241 male, mean age: 44 ± 8.1 [distribution: 30–60 year old]) were included the study. Manubrium length (ML), mesosternum length (2L), Sternebra 1 (S1W), and Sternebra 3 (S3W) width were measured and also sternal index (SI) was calculated. Differences between genders were evaluated by student t-test. Predictive factors of sex were determined by discrimination analysis and receiver operating characteristic (ROC) analysis. Male sternal measurement values are significantly higher than females (P

Acute abdomen can be defined as a clinical condition often requires emergency surgical therapy and characterized by severeabdominal pain with tenderness that develops over a short period of time, generally less than 24 hours. There are a variety ofconditions that can present clinically with acute abdomen such as: inflammatory, vascular, mechanic, traumatic. In many cases,the clinical presentation is similar, independent of etiology. The radiological imaging plays very important role to determine theneed for operative intervention and initiate appropriate therapy. Our aim is to describe the computed tomography findings of themost common conditions of acute abdomen excluding trauma and pediatric or obstetric patients.

The analysis of ossification points plays a considerable role in forensic age estimation. Although traditional methods are still in use, researchers are working on different age estimation procedures especially within the development of radiologic methods. One of these methods is to define spheno-occipital synchondrosis fusion degree. Spheno-occipital synchondrosis, an important growth point on cranial base, provides noteworthy information about age estimation through its late stage ossification nature. This study aimed to investigate spheno-occipital synchondrosis fusion degree for age estimation in the Turkish population. In our study, 1-mm-sectioned computed tomography images of 638 (399 men and 139 women) subjects within the age of 10 to 25 years were retrospectively examined. It is stated in our study that spheno-occipital syncondrosis fusion begins superiorly and progresses inferiorly until it is completed. Spheno-occipital syncondrosis is known to be totally open at the mean (SD) age of 11.5 (1.5) years in men and 10.7 (0.8) years in women. In addition, fusion degree is known to be increased with age. Fusion starts approximately 2 years earlier in women than in men, and the process of fusion completes at the age of 17 years in both sexes. An analysis of fusion degree between sex groups showed significance at the age of 11 to 15 years, and Spearman rank correlations indicate a significant positive relationship between age and degree of spheno-occipital fusion (P < 0.001; men, rho = 0.714; women, rho = 0.698). Consequently, 5-staged analysis of spheno-occipital synchondrosis fusion degree in use with 1-mm computed tomography images will be helpful for age estimation between 11 and 17 years.

The purpose of this study was to retrospectively describe demographic characteristics and computed tomography (CT) imaging findings of craniofacial fibrous dysplasia (FD).Between February 2010 and February 2013, we retrospectively studied 64 patients described as FD at CT imaging. Site of involvement and CT imaging findings of craniofacial FD were recorded for each patient.Our patients are described as FD at CT imaging with the following findings: expansion, ground glass density, expansion and sclerosis, expansion with sclerosis and lytic appearance, expansion and lytic appearance, and only sclerosis. Expansion was the main feature which was seen with other findings (85%). The most common finding was ground glass density and the least appearance was expansion with lytic areas and only sclerosis.Our study has shown that it is very effective to know about CT findings and localizations of craniofacial FD to reduce unnecessary biopsy rates and increase the true diagnosis.

Gender determination is an important step in identification. For gender determination, anthropometric evaluation is one of the main forensic evaluations. In the present study, morphometric analysis of maxillary sinuses was performed to determine gender. For morphometric analysis, coronal and axial paranasal sinus computed tomography (CT) scan with 1-mm slice thickness was used. For this study, 140 subjects (70 women and 70 men) were enrolled (age ranged between 18 and 63). The size of each subject's maxillary sinuses was measured in anteroposterior, transverse, cephalocaudal, and volume directions. In each measurement, the size of the maxillary sinus is significantly small in female gender (P < 0.001). When discrimination analysis was performed, the accuracy rate was detected as 80% for women and 74.3% for men with an overall rate of 77.15%. With the use of 1-mm slice thickness CT, morphometric analysis of maxillary sinuses will be helpful for gender determination.

The variability of anthropometric measures, such as the degree of ossification, among societies should be taken into account when estimating age. The degree of ossification of the medial clavicle can be determined with thin-section computed tomography (CT), which is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. The purpose of this retrospective study was to investigate the applicability of thin-section CT analysis of the degree of ossification of the medial clavicle in a Turkish population. We evaluated the CT images (1-mm slice thickness) of 503 patients (362 male, 141 female; age, 10-35 years) using the Schmeling five-stage method. The Spearman's correlation analysis revealed a positive correlation between age and ossification stage in both male and female patients (total group: rho = 0.838, p < 0.001; male: rho = 0.831, p < 0.001; female: rho = 0.856, p < 0.001). The linear regression analysis results indicated that the ossification stage of the medial clavicle is a good predictor when estimating age (r (2) = 0.735 for all patients, 0.734 for male patients, 0.741 for female patients). Sex differences in ossification stages were observed only for stage 1 and 4 ossification. We believe that future research could expand the database on this topic and contribute to improvements in this measurement method.

The aim of this single-center prospective study is to investigate the silent and clinically apparent cerebral embolic events after transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO).Although transcatheter closure of ASD and PFO is a widely accepted technique and has been proven to be safe and effective with different kinds of devices, there are few studies in the literature that report the peri-interventional cerebral embolism risk and neurological complications. In this study, we investigated the peri-interventional cerebral embolism incidence with diffusion-weighted magnetic resonance imaging (DW-MRI) and its relation to patients' clinical neurologic examination findings and plasma neuron-specific enolase (NSE) levels.Sixteen patients with hemodynamically significant ASD and 14 symptomatic PFO patients underwent transcatheter closure procedures with new-generation PFO or ASD occluder devices. All cases were examined with DW-MRI before and after the transcatheter closure procedure. Patients were clinically examined for any signs of neurologic deficit at the time of MRI studies. Blood samples for NSE, a marker of brain tissue damage involved in an ischemic event, were taken before the procedure and at 12 and 24 hours after the procedure.Successful transcatheter closure of PFO or ASD was achieved in all patients. In the DW-MRI exam following the procedure, a new microembolic lesion was found in only 1 of 30 patients (3.3%). None of the patients had positive clinical neurological exam findings. NSE levels after the procedure were found to be not correlated with presence of DWMRI lesion and intervention times.With the new-generation ASD and PFO occluder devices, the incidence of clinically silent peri-interventional cerebral embolic lesions after transcatheter closure of ASD and PFO is low. Plasma NSE levels offered no additional benefit for monitoring ischemic events after ASD and PFO transcatheter closure procedures.

Background: Cervical cancer is the second most common female malignancy worldwide. Although its incidence has decreased in developed countries due to screening with Papanicolaou test, it is still the leading cause of cancer-related female death in developing countries. Aims: The aim of this study was to determine whether the apparent diffusion coefficient (ADC) measurements calculated from diffusion-weighted imaging (DWI) images had any contribution in differentiation of normal cervical tissue from malignant lesions preoperatively, and whether there was a correlation between the mean ADC values and tumor type, grade, or stage in malignant lesions. Study Design: Case-control study. Methods: Mean ADC values in 25 patients who had cervical cancer proved histopathologically, and 20 patients with otherwise normal uterus were compared. Also in the study group, mean ADC values were compared between histopathologic subtypes, tumor grades, and stages. Results: In the study group the mean ADC values (0.96±0.15x10-3 mm2/s) were statistically lower than that of the control group (1.67±0.17x10-3 mm2/s) (p0.05). There was also no significant difference between the mean ADC values of the tumor grades (p>0.05). The mean ADC values in early stage cervical cancer (0.86±0.05x10-3 mm2/s) were significantly lower than the mean ADC values in late stage disease (0.98±0.06x10-3 mm2/s) (p

Among solid organ blunt traumas, the liver and spleen are mostly subject to injury. In addition, the liver is also commonly injured in penetrating traumas because of its size, location, and the ease of injury to the “Glisson Capsule”. Several enzymes are known to be elevated following trauma. In our study, we evaluated the correlation between the levels of serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and gamma-glutamyl transpeptidase in 57 patients with blunt trauma to the liver and compared these values to the American Association for the Surgery of Trauma trauma grading system. Additionally, we compared the enzyme level elevations in these patients to the enzyme levels of 29 healthy subjects. As expected, we found significant elevations in enzyme levels of trauma patients compared to the control group. The calculated point estimates were not significantly different between grades 1 and 2 trauma. However, grade 3 trauma group showed a significant increase in enzyme levels.

Our purpose was to determine whether quantitative diffusion-weighted MR imaging (DWI) could be used in discrimination of benign and malignant primary solid and cystic renal tumors.A total of 105 consecutive patients with renal masses and 30 healthy controls were enrolled in this prospective study. Dynamic contrast enhanced routin renal images and DWI (with b factors of 0, 500 and 1000 s/mm(2)) was performed at 1.5 T unit. Renal masses were divided into two groups as cystic or solid and all cystic lesions were prospectively assigned to a Bosniak classification number. The median apparent diffusion coefficient (ADC) values along with b 500 and 1000 signal intensities of normal kidneys, solid components of mixed renal masses and total of cystic lesions were calculated.The mean ADC value of normal renal parenchyma in control group was 2.18 ± 0.13 × 10(-3)mm(2)/s. Solid renal tumors had significant lower ADC values (median: 1.16 ± 0.27 × 10(-3)mm(2)/s), in contrast to cystic tumors (median: 2.73 ± 0.44 × 10(-3)mm(2)/s). The mean ADC value of the Bosniak Category I cysts was significantly higher (3.09 ± 0.14 × 10(-3)mm(2)/s) than normal renal parenchyma (p0.01). A statistical significance was achieved between the signal intensity of Bosniak Category I and Category II-III cysts with b 1000 (p0.05). Among the different histologic subtypes of renal cell carcinoma, the mean ADC value of chromophobe cell carcinoma (1.41 ± 0.09 × 10(-3)mm(2)/s) was significantly higher than that of papillary cell carcinoma (0.90 ± 0.16 × 10(-3)mm(2)/s) and clear cell carcinoma (1.23 ± 0.13 × 10(-3)mm(2)/s).Accurate assessment of renal masses is important for establishing whether tumors require surgical intervention or not. While MRI is a useful modality as an investigative tool for diagnosing, characterizing and staging renal masses, DWI contributes additional value by promising differentiation benign from malignant renal tumors, even histologically subtyping of renal cell cancer.

Objectives: To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis. Methods: 119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm2 and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps. Results: Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p < 0.001). The best discriminative parameter was signal intensity (b 500). With a cut-off value of 56 for the signal intensity the ratio had a sensitivity of 99% and a specificity of 97%. The cut-off ADC value at 1.66 mm2/s had a sensitivity of 97% and a specificity of 99%. Conclusion: DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis. © 2010 European Society of Radiology.

Background Hemobilia is a rare cause of upper GI bleeding and the reasons for the majority of the cases are iatrogenic. It is also one of the rarest vascular complication following laparoscopic cholecystectomy but acute pancreatitis due to postcholecystectomic hemobilia as a late complication of cholecystectomy is not yet described. Case Presentation We presented the case of a 32-year-old female, admitted to our emergency surgery clinic with hematemesis, jaundice and abdominal pain who had a history of laparoscopic cholecystectomy 4 months ago. Patient was diagnosed as acute pancreatitis and obstructive jaundice caused by postcholecystectomic hemobilia. Afterwards she is successfully treated by ERCP, angiographic identification and embolization of right hepatic artery pseudoaneurysm. Conclusions We presented that postcholecystectomic hemobilia may cause acute pancreatitis and acute pancreatitis caused by postcholecystectomic hemobilia should also be included to the rare complications which may occur following cholecystectomy.

The purpose of this study was to evaluate the feasibility of diffusion-weighted imaging in the diagnosis of the urinary bladder and prostate carcinomas. The apparent diffusion coefficient (ADC) values of the malignant and normal tissues were correlated.A total of 23 patients with 14 urinary bladder carcinomas and 9 prostate carcinomas, and 50 healthy controls with normal ultrasonographic urinary bladder and prostate gland imaging findings were enrolled in the study. The ADC values were reported as the mean +/- standard deviation. Student's t test was performed to compare the ADC values of the normal and pathological tissues. Diffusion-weighted imaging (DWI) was performed with b factors of 0, 500, and 1000 s/mm(2), and the ADC values of the normal tissues and lesions were calculated.The mean ADC value of the urinary bladder wall of the control group and bladder carcinomas were (2.08 +/- 0.22 x 10(-3)mm(2)/s) and (0.94 +/- 0.18 x 10(-3)mm(2)/s), respectively. In addition, the ADC values of the normal peripheral (2.07 +/- 0.33 x 10(-3)mm(2)/s), transitional zones (1.46 +/- 0.23 x 10(-3)mm(2)/s) of the prostate, seminal vesicles (2.13 +/- 0.13 x 10(-3)mm(2)/s) and the prostate carcinomas (1.06 +/- 0.17 x 10(-3)mm(2)/s) were calculated. The comparison of mean ADC values of the peripheral-transitional zones of the prostate, normal bladder wall-bladder carcinomas, and peripheral zone prostate carcinomas were statistically significant (P0.01).The present study demonstrated that ADC measurement has a potential ability to differentiate carcinomas from normal bladder wall and prostate gland.

Göç olgusu insanlık tarihi kadar eskidir. Ancak Sanayi Devrimi'nden bu yana göçler nitelik değiştirmiş ve işgücü göçü şekline dönüşmüştür. Türkiye'de içgöçler sanayileşmenin ortaya çıkardığı bir olgu değildir. Daha çok kırların iticiliği ile başlamış, daha sonraları şehirlerin çekiciliği ve iletici faktörler etkili olmuştur. İçgöçler yeni kentli nüfusun dayanışma ihtiyacını belirgMeştiımiştir. İçgöçlerin sonucunda oluşan hemşehri dernekleri, sivil toplum örgütlerinin ilk örnekleri olarak ortaya çıkmışlardır. Hemşehri dernekleri üyeleri arasında birliği, dayanışmayı, aynı yöreden gelenler arasında yöresel kültürü paylaşmayı ve toplumsal olaylar karşısında katılımı olanaklı kılmaktadırlar. Örnek olarak Sivas Dayanışma Demeği (SİDAD) üyesi sosyo- ekonomik-kültürel ve toplumsal dayanışma bakımından incelenmeye çalışılmış, hipotezler İstanbul Üniversitesi Bilgi-İşlem Merkezinde SPSS (Statistical Package For The Social Sciences) paket programı kullanılarak çözümlenmiş ve yorumlanmaya çalışılmıştır. 190 486