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Various benign and malignant pathologies/conditions can cause compression of the extrahepatic biliary system. Anatomical and/or topographic variations of the hepatic artery have long been recognized as a possible cause of the EBS compression. However, anatomical and/or topographic variations, other than the hepatic artery's, should also be considered during the evaluation of the EBS compression. We, herein, report a unique case of the distal common bile duct compression by tortuous and enlarged inferior pancreaticoduodenal artery branches due to severe stenosis of the celiac trunk orifice.

The aims of the present study were to determine the subclinical coronary atherosclerosis and myocardial dysfunction in patients with non-alcoholic fatty liver disease, who were asymptomatic for cardiac disease.A total of 61 non-alcoholic fatty liver disease patients were enrolled in the study. The 10-year probability of cardiovascular events was evaluated according to the pooled cohort equation risk score (atherosclerotic cardiovascular disease). The coronary artery calcium score was measured. Conventional echocardiographic examination was followed by 2- and 3-dimensional speckle tracking echocardiography.Patients with non-alcoholic steatohepatitis had significantly higher insulin resistance (P = .018), serum alanine aminotransferase (P = .002) and aspartate aminotransferase levels (P = .021), hepatic steatosis (P = .023), and fibrosis (P = .001) than non-alcoholic fatty liver disease patients. The mean Atherosclerotic Cardiovascular Disease score was 7.5% ± 6.9% and 37% of the patients had medium and high cardiovascular disease risk. Cardiovascular disease (1) was found in 30% of the patients. Interestingly, 56% had significant and extended atherosclerotic plaques. Among the patients with moderate-to-high atherosclerotic cardiovascular disease scores, 63% had significant atherosclerotic plaques and 21% had extensive plaque burden. The presence of non-alcoholic steatohepatitis did not significantly affect cardiovascular risk. Non-alcoholic steatohepatitis was deleterious on left ventricle diastolic functions. Mean A velocity in non-alcoholic steatohepatitis patients was significantly increased compared to non-alcoholic fatty liver disease patients (87.0 ± 17.5 cm/s vs. 72.3 ± 13.6 cm/s, P = .002). Mean E/e' ratio was 8.1 ± 2.0. Submyocardial fibrosis detected had a slightly higher occurrence in non-alcoholic steatohepatitis patients than in non-alcoholic fatty liver disease patients (P = .530).The presence of non-alcoholic steatohepatitis did not significantly increase the risk of cardiovascular disease and subclinical myocardial dysfunction in asymptomatic patients for cardiac disease compared to non-alcoholic fatty liver disease patients.

Polen apertür tipi, şekli, boyutu, polar eksen uzunluğu, ekvatoral eksen uzunluğu, P/E oranı, kolpus uzunluğu, sekzin ve nekzin kalınlığı, S/N oranı, süslenme tipi, lümen şekli ve genişliği ışık ve taramalı electron mikroskobu kullanılarak belirlenmiştir. 19 oymağa ait 30 cinsten 43 takson için 3 nitel ve 8 nicel polen karakterine dayalı olarak Gover’s genel benzerlik katsayısı ve UPGMA kullanılarak çok değişkenli bir analiz gerçekleştirilmiştir. İncelenen tüm taksonlarda, polen taneleri genellikle küçük veya orta büyüklükte ve trikolpat olup, Matthiola longipetala’nın dışında belirgin bir apertüre sahiptir. Polen şekli prolat-sferoidalden perprolata kadar değişiklik göstermiştir. Ekzin süslenmesi mikroretikülat, retikülat veya makroretikülattır. Bazı türlerde retikülat süslenme mikroretikülat ile, bazı türlerde de makroretikülat süslenme ile birlikte bulunmuştur. Bazı cinslere ait taksonların dendogram üzerinde birbirine yakın olarak konumlanışı, Brassiceae, Alysseae, Sisymbrieae ve Camelineae gibi bazı oymakların kısmen desteklendiğini göstermektedir. Dendrogramda birbirine yakın konumlanan yakın akraba olan bazı oymakların bazı önceki moleküler çalışmalarda kısmen desteklenmesi dikkate değerdir. Ekzin süslenmesine ek olarak, polen boyutu, şekli, sekzin ve nekzin kalınlığı ve kolpus uzunluğu en kullanışlı karakterlerdir. Bu karakterler familya içindeki bazı cinsleri, türleri kısmen de oymakları tanımlamak ve ayırt etmek için kullanılabilir. Bu karakterler ayrıca, bazıları burada ilk kez incelenen bazı Brassicaceae taksonlarının polen taneleri hakkında ayrıntılı bilgi sağlamakta olup, elde edilen bu bilgiler gelecekteki polen çalışmalarında karşılaştırmalar için yararlı olacaktır., Pollen aperture type, shape, size, polar axis length, equatorial axis length, P/E ratio, colpus length, thickness of the sexine and nexine, S/N ratio, ornamentation type, and lumen shape and width were determined by using light and scanning electron microscope. A multivariate analysis was carried out using the Gover’s general similarity coefficient and UPGMA based on 3 qualitative and 8 quantitative pollen characters for 43 taxa belonging to 30 genera and 19 tribes. In all of the taxa studied, the pollen grains were generally small or medium-sized, tricolpate, except in Matthiola longipetala, with an inconspicuous aperture. The shape varied from prolate-spheroidal to perprolate. The exine ornamentation was microreticulate, reticulate, or macroreticulate. In some species, reticulate ornamentation was found together with microreticulate, and in some others, with macroreticulate ornamentation. It was seen that some taxa belonging to some genera placed near each other in the dendogram partially supported some tribes, such as Brassiceae, Alysseae, Sisymbrieae, and Camelineae. It is notable that some closely-related tribes were placed near each other on the dendrogram, which partially supports some previous molecular studies. In addition to exine ornamentation, the pollen size, shape, sexine and nexine thickness, and colpus length were the most useful characters. These characteristics can be used to identify and distinguish some genera, species and partly tribes within the family. They also provide detailed information on the pollen grains of some Brassicaceae taxa, some of which were studied herein for the first time, and this knowledge will be useful for comparisons in future pollen studies.

OBJECTIVE: This study aimed to evaluate the effect of prostate volume and lesion size on the clinically significant prostate cancer (csPCa) detection rates of transrectal ultrasonography (TRUS)-guided prostate biopsies, performed by a cognitive targeting method for sampling peripheral zone lesions. MATERIAL AND METHODS: We retrospectively enrolled 219 consecutive patients, who underwent multiparametric magnetic resonance imaging with a 3-T scanner and had peripheral zone lesions suspected for prostate cancer. All of these patients underwent combined cognitive targeted biopsy of suspicious lesions and TRUS-guided systematic biopsy. The detection rates of csPCa according to different lesion diameters (

BACKGROUND: To evaluate the frequency of pathological findings determined on magnetic resonance (MR) enterography (MRE) in patients with Crohn’s Disease. METHODS: A retrospective analysis of the MRE images was made in 34 female and 41 male patients (mean age 41 years) with Crohn’s disease. The prevalence of bowel wall (mural thickening, mural edema, mural fat deposits, mucosal enhancement, ulceration, cobblestone appearance, pseudopolyps) and mesenteric fatty tissue alterations (fatty tissue proliferation, mesenteric hypervascularity, enlarged lymph nodes, peri-enteric inflammation, reactive fluid), complications due to penetrating (fistula, sinus tract, abscess) and stenosing processes (fibrotic and inflammatory stenosis, obstruction, dilatation), and involvement of the colon were determined. RESULTS: The most frequently observed changes in the bowel wall and mesenteric fatty tissue were mural thickening (98.7%) and enlargement of mesenteric lymph nodes (76%), respectively. Stenosis was the most common complication (76%). The most frequently seen pathology of the colon was ileocecal valve thickening and enhancement (74.7%). CONCLUSION: MR enterography is a useful imaging modality for the evaluation of changes in both the mesenteric fatty tissue and the bowel wall. As there is no use of ionizing radiation, MR enterography should be the preferred imaging modality during follow-up of patients with Crohn’s disease.

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

To reveal the MR enterography (MRE) findings that distinguish backwash ileitis (BWI) from terminal ileitis due to Crohn's disease (CD) and to determine the usability of barium studies manifestations (ileocecal valve (ICV) gaping, terminal ileum dilatation) in MRE for the diagnosis of BWI in ulcerative colitis (UC) patients by pointing at the diagnostic performance of these imaging findings.The study population consisted of patients who were diagnosed as ulcerative colitis (UC), and underwent 1.5 T MRI between August 2011 and November 2017 to rule out small bowel involvement. The matched controls were comprised of Crohn's patients examined at the same period. Ileocolonoscopic/ histopathologic findings were accepted as reference standard. Mural/extramural changes in bowel segments, ileocecal valve (ICV) gaping, terminal ileum dilatation, restricted diffusion and anatomical extent of involvement were evaluated. In UC patients, the association between ICV gaping and terminal ileum dilatation and BWI was assessed by χ2 test. The diagnostic accuracy of these two findings in BWI was determined.Sixty patients were included in the study (30 UC; 30 CD; mean age, 43 years in both groups). Ileocecal valve gaping and terminal ileum dilatation were significantly more frequent among BWI patients (p 0.001) in UC. Patients with BWI showed a higher rate of pancolitis (88.9%). Median terminal ileum wall thickness was found to be significantly greater in patients with CD (p 0.001).In patients with definite diagnosis of UC, ileocecal valve gaping and terminal ileum dilatation suggest the development of BWI. However, these findings cannot be use to differentiate cause of terminal ileitis in patients with unconfirmed diagnosis and do not give reliable information about the causative factor of ileitis.

Background and Aims: Perihepatic fluid caused by liver and non-liver pathologies can be observed through imaging. This condition is not specific to a particular pathology and can occur with different mechanisms. This study aimed to investigate the relationship between the presence of minimal perihepatic fluid in magnetic resonance cholangiopancreatography and liver function tests and biliary obstruction, which is one of the etiological factors that can be detected through magnetic resonance cholangiopancreatography. Materials and Methods: Patients who underwent magnetic resonance cholangiopancreatography in the department of radiology in our hospital in 2017 were retrospectively screened. Sixty-two patients with minimal peripheral fluid were included in the study group, and randomly selected 62 patients without perihepatic fluid were included in the control group. Liver function tests (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, lactate dehydrogenase, total/direct/indirect bilirubin) of the patient and control groups were compared. Perihepatic fluid thickness, distribution pattern, localization according to liver lobes, presence and degree of intrahepatic bile duct dilatation, and presence of choledocholitiasis, periportal edema, perisplenic fluid were recorded, and the relationship with perihepatic fluid was evaluated. Results: All laboratory values except lactate dehydrogenase were significantly higher in the patient group than in the control group (p = 0.131 and p ≤ 0.011, respectively). The number of patients with higher laboratory values was higher in the patient group than in the control group (p ≤ 0.037). The difference between the two groups as regards intrahepatic bile duct dilatation and presence of perisplenic fluid was significant (p = 0.01 and p < 0.001, respectively). Alkaline phosphatase values correlated with the degree of intrahepatic bile duct dilatation (r = 0.349, p = 0.05). Conclusions: The presence of minimal fluid around the liver detected by magnetic resonance cholangiopancreatography may indicate impairment in liver function tests and should alert clinicians of pathologies that can cause cholestasis., Giriş ve Amaç: Karaciğer ve karaciğer dışı patolojilere bağlı görüntülemede perihepatik alanda sıvı görülebilmektedir. Belirli bir patolojiye spesifik olmayan bu durum değişik mekanizmalar ile oluşabilmektedir. Bu çalışmanın amacı manyetik rezonans kolanjiyopankreatografide minimal perihepatik sıvı varlığı ile karaciğer fonksiyon testleri ve manyetik rezonans kolanjiyopankreatografide ortaya koyulabilecek etiyolojik faktörlerden olan biliyer obstrüksiyon ile arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: Hastanemiz Radyoloji bölümünde 2017 yılında manyetik rezonans kolanjiyopankreatografi yapılan hastalar retrospektif olarak tarandı. Minimal perihepatik sıvısı olan 62 hasta çalışma grubuna, perihepatik sıvısı olmayan ve rastgele seçilen 62 hasta kontrol grubuna dahil edildi. Hasta ve kontrol grubuna ait karaciğer fonksiyon testleri (aspartat aminotransferaz, alanin aminotransferaz, alkalen fosfataz, gama-glutamil transpeptidaz, laktat dehidrogenaz, total/direkt/indirekt bilirübin) karşılaştırıldı. Perihepatik sıvı kalınlığı, dağılım paterni, karaciğer loblarına göre lokalizasyonu, intrahepatik safra kanallarında genişleme varlığı ve derecesi, koledok taşı, periportal ödem, perisplenik sıvı varlığı kaydedildi ve perihepatik sıvı ile arasındaki ilişki değerlendirildi. Bulgular: Perihepatik sıvısı olan hasta grubunda laktat dehidrogenaz dışında tüm laboratuvar değerleri kontrol grubuna göre anlamlı olarak yüksekti (p = 0.131 ve p ≤ 0.011, sırasıyla) ve perihepatik sıvısı olan grupta kontrol grubuna göre daha fazla hastada laboratuvar değerlerinde yükseklik saptandı (p ≤ 0.037). İntrahepatik safra kanallarında genişleme ve perisplenik sıvı varlığı açısından iki grup arasındaki fark istatistiksel olarak anlamlı idi (p = 0.01 ve p < 0.001, sırasıyla). Alkalen fosfataz değerleri ile intrahepatik safra kanalları genişleme derecesi korelasyon göstermekteydi (r = 0.349, p = 0.05). Sonuç: Manyetik rezonans kolanjiyopankreatografide karaciğer çevresinde minimal düzeyde sıvı varlığı karaciğer fonksiyon testlerinde bozukluğa işaret edebilir ve kolestaza neden olabilecek patolojiler açısından uyarıcı olmalıdır.

Background/aim: We aimed to present the magnetic resonance cholangiopancreatography (MRCP) findings of biliary tractcomplications after liver transplantation.Materials and methods: Seventy-five patients who underwent MRCP in our department between July 2011 and July 2015 after livertransplantation were retrospectively evaluated. The MRCP images were reevaluated by three radiologists in consensus. Diagnosticconfirmation of MRCP findings was obtained with direct cholangiographic examinations or with clinical, radiological, and laboratoryfindings and concordance between MRCP findings and the final diagnosis was investigated.Results: Twenty-seven of the 75 patients had normal MRCP findings and at least one type of biliary tract complication was detected on theMR images of 48 patients. These complications included anastomotic stricture, dilatation of the biliary tract, nonanastomotic stricture,biliary leakage, cholangitis, biloma, abscess due to cholangitis, biliary stone-sludge, and donor-to-recipient bile duct disproportion.Thirty of the 75 patients were followed only by clinical and laboratory findings without further imaging. Forty-five patients underwentdirect cholangiographic examinations. At the end of the follow-up period, 28 of the 75 patients were considered free of biliary tractcomplications, and at least one bile duct complication was diagnosed in 47 patients.Conclusion: With its high sensitivity and specificity, MRCP should be the first choice of method in the diagnosis and follow-up ofbiliary complications after liver transplantation.

The purposes of this study were to discern imaging findings that distinguish Behçet disease from small-bowel Crohn disease, to find initial performance estimates for these findings, and to evaluate the diagnostic value of MR enterography (MRE) for detecting intestinal Behçet disease.The MRE examinations of 30 consecutively registered patients with established intestinal Behçet disease were reviewed by two blinded readers. The frequencies of MRE findings were compared with those obtained for 30 control subjects with small-bowel Crohn disease who were matched for sex and age. The performance estimates were generated with ileocolonoscopic and histopathologic findings as the reference standard.Polypoid pattern and homogeneous mural enhancement were the findings seen more frequently in Behçet disease (p = 0.000) than in Crohn disease (p = 0.003). Stricture formation, long-segment disease, and involvement of more proximal ileal segments favored small-bowel Crohn disease. The ROC AUCs for polypoid pattern and homogeneous mural enhancement in the detection of intestinal Behçet disease were 0.806 and 0.779. The accuracy of MRE was 70.00% (95% CI, 50.60-85.27%); sensitivity, 57.14% (95% CI, 34.02-78.18%), and specificity, 100% (95% CI, 66.37-100%).MRE has potential for use as a radiation-free alternative for clarifying the cause of nonspecific gastrointestinal symptoms in patients with known Behçet disease. However, additional studies are needed to determine the actual value of MRE in patients with Behçet disease and to validate the clinical usefulness of the technique in the detection of unknown intestinal Behçet disease.

Background/aims Hydatid disease remains an important global socioeconomic health problem, particularly in the endemic areas. Although half of the patients show no symptoms, hydatid cysts should be treated because of their fatal complications. The aim of this study is to present the long-term results of percutaneous treatment of hydatid disease using the Ormeci technique. Materials and methods Forty-nine patients with 54 cystic lesions were diagnosed with hydatid disease. Twenty-seven of the 54 hydatid cysts located in the spleen were punctured with a 22-gauge Chiba needle through the parenchyma of the spleen under sonographic guidance as a one-step procedure. For every 1 cm of the long diameter of the cyst lesion, 3 cc of fluid from the cysts was aspirated. For each centimeter of the long diameter, 2 cc of pure alcohol (96%) and 1 cc of polidocanol (1%) were injected into the cysts. Five out of 27 patients did not participate in the follow-up. Results The 22 patients who were treated using the percutaneous Ormeci technique were followed up for a mean±SD (median) of 50.32±65.30 (26.00) months (minimum 4 and maximum 298 months). All patients except one were successfully treated. No deaths or major complications were noted. Seven patients experienced minor complications. Conclusion Percutaneous treatment with the Ormeci technique is a safe, effective, cheap, and reliable method that does not interfere with splenic functions, and this outpatient procedure should be the method of choice for a surgery alternative.

Adrenal gland disorders can be asymptomatic and detected incidentally via imaging techniques such as ultrasound, computed tomography (CT), positron emission tomography, and magnetic resonance imaging. Fusion anomaly is a condition that can be attributed to errors in the developmental process and may be detected via these imaging modalities. We present a case of butterfly adrenal gland in a 61-year-old man with CT and magnetic resonance images. In our patient, this anomaly is also accompanied by unilateral renal agenesis and a diaphragmatic defect. Positron emission tomography-CT, contrast-enhanced CT, and magnetic resonance images are presented. To the best of our knowledge, this is the second case in which coexistence of unilateral renal agenesis and butterfly adrenal gland anomaly in an adult patient has been documented. Keywords: Butterfly adrenal gland, Unilateral renal agenesis

A broad spectrum of disease, from benign processes to life-threatening pathologies, can cause anal pain. MR imaging (MRI) has become increasingly widely used method over the past two decades for the evaluation of individuals with anorectal symptoms. Although imaging is rarely necessary to determine the etiology of the majority of cases, MRI is particularly useful as a noninvasive method of excluding severe neoplastic conditions. In this article, MRI findings of a number of pathologies such as anal and perianal neoplasms, hemorrhoidal disease, arteriovenous malformation of the perianal region, and anal sphincter lesions (defects, scarring, atrophy) which may lead to fecal incontinence are presented.

Objective In this retrospective study, we aimed to evaluate MR enterography (MRE) findings, MR index of activity (MaRIA) and laboratory markers in Crohn patients with enteroenteric fistula. Methods Institution’s electronic medical records (laboratory, pathology, ileocolonoscopy results and discharge summary) were reviewed and MR images retrieved from the PACS were reanalyzed in Crohn patients assessed at Gastroenterology Clinic of our university between July 2011 and July 2016. MR enterography and clinic parameters of 38 Crohn patients with enteroenteric fistula and 48 Crohn patients without enteroenteric fistula were compared. Results Of the findings, perienteric inflammation was seen only in fistula group. The mean wall thickness was significantly greater; perienteric fluid, mural hyperenhancement, cecal contraction, thickening of ileocecal valve, and colonic involvement were significantly more common in fistula patients. There was no significant difference between groups with regards to MaRIA index and perianal disease. In patients with enteroenteric fistula, there was significant association between the presence of hypoalbuminemia and presence of ileitis at ileocolonoscopy. In the overall study population, there was a positive correlation between the MaRIA and CRP values at the time of the MRE. Conclusions Perienteric mesenteric inflammation and fluid collection are common in enteroenteric fistulization. MaRIA indices and laboratory findings of patients with enteroenteric fistula are not significantly different from those without fistulas.

Background/aim: This study aimed to differentiate rectal mucinous carcinoma (MC) from nonmucinous rectal adenocarcinoma (AC) using mean apparent diffusion coefficient (mADC) values obtained with diffusion-weighted imaging.Materials and methods: Sixty-two pathologically confirmed rectal AC (n = 44) and MC (n = 18) patients were included in this study. The two groups underwent pelvic MRI to determine the local staging baseline for rectal tumors. Once the region of interest (ROI) was determined, a border was drawn around each hyperintense tumor (b = 1000 s/mm2 images). Following a repeat of this procedure for each patient, the ROIs were recorded to apparent diffusion coefficient (ADC) maps, and mADC values were measured. The mADC was determined per slice, followed by a calculation of whole tumor volume ADC mean using the individual mADC values. The Mann?Whitney test was performed to compare mADCs for the two groups. A receiver operating characteristic (ROC) curve was generated to determine the differentiating capacity of ADCs from MC to AC. Results: The mADC was higher in MC (1.631 ± 0.375 x 10-3 mm2/s) (range: 0.95-2.36 x 10-3 mm2/s) than in AC (0.921 ± 0.157 x 10-3 mm2/s) (range: 0.6-1.48 x 10-3 mm2/s) (P < 0.001). mADCs were effective in distinguishing MC from AC (area under the ROC curve, 0.972 (95% CI : 0.928-1.00)). A threshold of 1.27 x 10-3 mm2/s was set that corresponded with high sensitivity (94.4%) and specificity (97.7%). Twelve MCs (67%) were predominantly hypointense, and 6 MCs (33%) were seen as mixed signal intensity lesions. Forty ACs (91%) were observed as hyperintense lesions, and 4 ACs (9%) had mixed signal intensity. There was a significant difference in the signal intensities between MC and AC (c2 = 54.7, P < 0.001).Conclusion: MCs and ACs show different diffusion characteristics, which can be distinguished with high sensitivity and specificity and can help to improve prognostic treatment options.

Aim:In this study we aimed to evaluate the accuracy of preoperative rectal cancer staging in our center, using 1.0 Tesla Magnetic resonance imaging (MRI) with phased-array coils and determine if the results can be improved by adopting thin-section MRI techniques.Materal and Methods:Eighty-four patients with biopsy proven rectal cancer were prospectively evaluated by MRI using either the standard (8 mm sections in all planes) or the thin-section protocol (additional 5 mm sections in oblique axial plane perpendicular to the long axis of the tumor). Patients undergoing surgery with or without neoadjuvant therapy (standard MRI, n=15 and thin-section MRI, n=22) were included in the analysis. TNM stage, circumferential resection margin (CRM) and adjacent organ involvement were compa-red with histopathologic findings.Results:In the thin-section group, estimation of tumor stage was 59% accurate, showing fair agreement with histopathology (κ=0.38, p

OBJECTıVE: To compare the morphometric data relating to the muscular structures of the anal canal, in patients with chronic anal fissure and in control group, examined at a 3.0 Tesla MR system.Forty-seven consecutive patients with chronic anal fissure and randomly selected 40 patients who had no claims for perianal disease during their life time were included in the study. T2-weighted sagittal, high-resolution (HR) T2-weighted, and contrast-enhanced fat-suppressed T1-weighted oblique axial and oblique coronal images were retrospectively analyzed by two observers in consensus. Thickness of sphincteric muscles, anal canal length, anorectal angle, thickness of anococcygeal ligament, depth of Minor triangle, width between subcutaneous sphincters, vascularity of posterior commissure, visibility of posterosuperior projection of external sphincter, and angle between the distal anal canal and posterosuperior projection of external sphincter (H angle) in patients and in controls were compared and analyzed using t test, Mann-Whitney U test, and Spearman correlation.The patients with chronic anal fissure had longer anal canal (51.50 mm ± 0.91 vs. 44.11 mm ± 0.71; p = 0.000), thicker internal anal sphincter muscle at mid-anal level (4.18 ± 0.15 vs. 3.39 ± 0.07; p = 0.007), and wider space between subcutaneous external sphincters (11.39 ± 0.50 vs. 6.89 ± 0.22; p = 0.000). In patients, there was a positive correlation between H angle and external sphincter thickness at proximal (r = 0.347; p = 0.021), middle (r = 0427; p = 0.000), and distal (r = 0.518; p = 0.000)) levels of the anal canal. CONCLUSıON: 3.0 Tesla MR imaging provides detailed information about the morphometric changes in the anal sphincter muscles in patients with chronic anal fissure.

OBJECTIVE: To investigate the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) in differentiating prostate cancer (PCa) from prostatitis foci. MATERIALS AND METHODS: This retrospective analysis included 81 biopsy-proven lesions (44 prostatitis and 37 PCa). Normalized T2-signal intensity (nT2SI) and SI on diffusion-weighted imaging (b=1000 and 2000 mm(2)/s), apparent diffusion coefficient (ADC) values, peak SI, SI at the end of the dynamic curves, mean peak time, mean enhancement percentage, and washout percentage obtained from dynamic contrast-enhanced imaging (DCEI) were measured. RESULTS: nT2SI (3.8 vs. 3.2, p=0.003) and ADC values (0.685×10(−3) mm(2)/s vs. 0.874×10(−3) mm(2)/s, p

Magnetic resonance elastography (MRE) is a constantly advancing technique for assessment of stiffness of tissues with newer technology and sequences. It is being increasingly used for the assessment of liver fibrosis. In this article, we discuss the advantages of MRE over biopsy and noninvasive methods such as US elastography in the assessment of liver fibrosis. Image acquisition and interpretation of liver MRE is also discussed.

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

This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical settting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality. (C) 2014 Published by Elsevier Masson SAS on behalf of the Editions francaises de radiologie.

Resume La pancreatite aigue est une maladie inflammatoire aigue du pancreas qui peut egalement affecter les tissus environnants ou les organes distants. La Classification d’Atlanta de la pancreatite aigue, presentee en 1992, repartit les patients en groupes affectes de forme legere ou severe sur la base de criteres cliniques et biochimiques. Recemment, la terminologie et le schema de classification etablis lors du Symposium initial d’Atlanta ont ete revises et un nouveau texte de consensus a ete proposee par le Groupe de travail sur la classification de la pancreatite aigue (Acute Pancreatitis Classification Working Group). D’une maniere generale, une imagerie est recommandee pour confirmer le diagnostic clinique, explorer l’etiologie et effectuer une gradation de l’etendue de la severite de la pancreatite aigue. L’echographie constitue la modalite d’imagerie de premiere ligne dans la plupart des centres pour la confirmation du diagnostic de pancreatite aigue et l’elimination d’autres causes d’abdomen aigu, mais elle presente des limites dans un cadre clinique aigu. La tomodensitometrie permet non seulement d’etablir le diagnostic de la pancreatite aigue, mais egalement de determiner le stade de severite de la maladie. L’imagerie par resonance magnetique a conquis un role encore plus important dans le diagnostic de la pancreatite aigue. Elle est particulierement utile chez les patients presentant des allergies a l’iode, pour caracteriser des epanchements et evaluer des anomalies ou des deconnexions des canaux pancreatiques. L’objectif de cet article de synthese est de presenter un apercu de la pancreatite aigue, de clarifier les confusions terminologiques, de souligner le role de l’echographie, de la tomodensitometrie et de l’imagerie par resonance magnetique en fonction du contexte clinique correct et de comparer les avantages et les limites de chacune de ces modalites.

Resume La classification d’Atlanta de la pancreatite aigue, presentee en 1992, divise les patients en groupes affectes de formes legeres et severes sur la base de criteres cliniques et biochimiques. Recemment, la terminologie et le schema de classification proposes lors du Symposium initial d’Atlanta ont ete revises, et une nouvelle declaration de consensus a ete etablie par le Groupe de travail sur la classification de la pancreatite aigue (Acute Pancreatitis Classification Working Group). Les principaux changements comprennent la subdivision des epanchements liquidiens aigus en « epanchement liquidien peripancreatique aigu » et « epanchement liquidien pancreatique/peripancreatique postnecrotique aigu » (epanchement necrotique aigu) en fonction de la presence de debris necrotiques. Les epanchements liquidiens retardes ont de meme ete subdivises en « pseudokyste » et en « necrose pancreatique circonscrite » ( walled-off necrosis ). L’utilisation appropriee des nouveaux termes decrivant les epanchements liquidiens est importante pour la prise de decision chez les patients atteints de pancreatite aigue. L’objectif de cet article de synthese est de presenter un apercu des complications de la pancreatite aigue, en soulignant leur signification pronostique et leur impact sur la prise en charge clinique, et de clarifier les confusions terminologiques concernant les epanchements liquidiens pancreatiques.

AMAC: Bu calismadaki amacimiz, renal hucreli kanser (RHK) ' in papiller ve seffaf alt tiplerinin ayirt edilmesinde difuzyon agirlikli goruntuleme (DAG) ' nin yararliligini saptamaktir.YONTEMLER: Papiller tip ve seffaf hucreli tip RHK ' li toplam 16 olgu retrospektif olarak degerlenmistir. Inceleme 3 Tesla alan gucune sahip manyetik rezonans cihazinda gerceklestirilmistir. Renal kitle konturlari T2 agirlikli goruntulerden de faydalanilarak sinirlanmis ve kistik-nekrotik dejenerasyon alanlari disarida kalacak sekilde elle cizilen ilgi alani (freehand ROI) kullanilarak kitlelerin solid komponentlerinin b=50 sn/mm2 ve b=1000 sn/mm2 DAG'lerde gorunur difuzyon katsayi (apparent diffusion coefficient =ADC) degerleri ve ortalama sinyal intensite (SI) degerleri ile bobregin normal parankiminin ortalama SI degerleri olculmustur. Normal parankimin SI degerlerinin olcumu icin ROI kortikomeduller bileskeye yerlestirilmistir.BULGULAR: Ortalama ADC degeri papiller RHK' larda (0.991 ± 0.143×10ˉ³ mm²/sn) seffaf hucreli RHK' lardan istatistiksel olarak anlamli derecede dusuktu (1.296 ± 0.277 × 10ˉ³ mm²/sn) (p

Anal complaints are very common in the general population and are caused by a variety of disorders mostly benign in nature. The aim of this article is to provide the radiologist with a detailed description of the MRI anatomy and technique, and an overview of the various diseases most commonly presenting with anal pain, by descriptions and illustrative examples of MRI features of each entity.

Objective We aimed to investigate the MR imaging findings of patients with hematologic malignancies who have symptoms suggesting perianal infection and to demonstrate the importance of imaging. Subjects and methods The study included 36 patients with hematologic malignancies who underwent anorectal MR imaging in our department between September 2011–May 2016. Two radiologists experienced in abdominal radiology viewed the MR images in consensus. Abscesses, fistulous or sinus tracts, signal alterations and contrast enhancement in keeping with an inflammation and edema in the perianal region were recorded. Results Perianal abscess was found in 16 of the 36 patients. In 10 of these 16 patients there was also extensive inflammatory signal alterations in perianal and/or perineal soft tissues. In six of the 36 patients perianal fistula was detected. A sinus tract was seen at the level of subcutaneous external anal sphincter in one patient. Inflammatory signal alterations in the surrounding soft tissues were present in three of these seven patients. There were abscesses in labium majus in two patients and in one patient there were perineal abscesses with accompanying inflammatory signal alterations. In six of the 36 patients no abscess or fistula/sinus tract was seen. There were only inflammatory signal alterations with contrast enhancement in perianal or subcutaneous tissues. In two patients presenting with perianal pain and hemorrhoids, minimal inflammatory changes were detected on MR images. There were two patients with normal MR imaging findings. Conclusion As digital examination of the anorectum and rectoscopy are avoided in neutropenic patients, MR imaging, which clearly demonstrates the perianal pathology should be preferential.

To assess the diagnostic value of dynamic TA total of 28 patients with suspected biliary leakage who underwent routine TIn each patient, visualization of bile ducts was sufficient in the HBP. The accuracy, sensitivity and specificity of dynamic Gd-EOB-DTPA-enhanced T1w MRC in the detection of biliary leaks were 92.9%, 90.5% and 100%, respectively (p 0.001). 19 of 28 patients had bile leak findings in T1w Gd-EOB-DTPA-enhanced MRC [HBP group: N = 7 (36.8%), DP group: N = 12 (63.2%)]. There was no statistically significant difference in terms of laboratory test results and the presence of bile duct dilatation between HBP and DP group (p 0.05). Three patients, each of them in DP group, showed normal laboratory test results and bile duct diameters.Dynamic T1w Gd-EOB-DTPA-enhanced MRC is a useful non-invasive diagnostic tool to detect bile leak. Advances in knowledge: Prolonged DP imaging may be required for bile leak detection even if visualization of biliary tree is sufficient in HBP and liver function tests, total bilirubin levels and bile duct diameters are normal.

The purpose of this article is to determine the added diagnostic value of T1-weighted gradient-echo in-phase images obtained during MRCP in the detection and differentiation of hepatolithiasis and intrahepatic pneumobilia.Intrahepatic bile ducts in 47 patients were scored in terms of their possibility of containing biliary stone and air. MRI was performed with a 1-T system for 32 patients and with a 3-T system for 15 patients. Two radiologists independently reviewed two sets of MRI scans: set 1 included T2-weighted MRCP images, and set 2 included T2-weighted MRCP images plus T1-weighted gradient-echo in-phase images. The diagnostic performances of set 1 and set 2 in the evaluation of the bile ducts containing air or stone and bile ducts containing neither of them were analyzed using the area under the receiver operating characteristic curve (AUC) for clustered data. The sensitivities and specificities of both image sets to detect intrahepatic stone or air were also calculated and compared.For the diagnosis of hepatolithiasis, the AUC obtained from set 2 (0.983) was significantly higher than that obtained from set 1 (0.879; p = 0.037). For the diagnosis of pneumobilia, the AUC obtained from set 2 (0.965) was also significantly higher than that of set 1 (0.765; p = 0.002). With use of percutaneous transhepatic cholangiography, ERCP, and CT as the reference standards, the sensitivity of set 2 (97.1%; 95% CI, 91.1-100%) was significantly higher than that of set 1 (74.3%; 95% CI, 56.7-91.9%) in detecting intrahepatic stones (p = 0.011). For the detection of pneumobilia, the sensitivity of set 2 (98.5%; 95% CI, 95.4-100%) was also significantly higher than that of set 1 (70.8%; 95% CI, 57.7-83.3%; p = 0.000).The addition of T1-weighted gradient-echo in-phase images to standard MRCP sequences improves the detection and differentiation of hepatolithiasis and intrahepatic pneumobilia.