Search

Background: In this study, we aimed to image pulmonary venous return anomalies and associated cardiovascular and pulmonary abnormalities by high-pitch low-dose computed tomography (CT) in children. Materials and methods: Forty-one patients with total or partial anomalous pulmonary venous return anomalous between May 2012 and June 2019 were retrospectively reviewed. The anomalies were determined using high-pitch low-dose CT. The patients’ mean age was 3 years (6 months to 15 years), and 24 of them were female. Results: There were 10 patients with total pulmonary venous return anomalies (TPVRA) and 31 patients with partial pulmonary venous return anomalies (PPVRA). Six (60%) patients with TPVRA had the supracardiac type, 2 (20%) had the cardiac type, and 2 (20%) had the mixed type. All patients with TPVRA had a large atrial septal defect (ASD), 1 patient also had patent ductus arteriosus, and 1 patient had right cardiac hypertrophy. Forty cases of PPVRA were found in 31 patients. Twenty-seven (67%) of them were right-sided, and 13 were left-sided (33%). Twenty (65%) patients also had an additional cardiovascular anomaly (ASD in 12 patients, persistent superior vena cava in 4 patients, patent ductus arteriosus in 3 patients, and aortic coarctation in 2 patients). Of the 27 patients with right-sided PPVRA, it drained into the superior vena cava in 19 patients, the right atrium in 5 patients, and the inferior vena cava in 3 patients. In left-sided cases, the anomalous pulmonary vein drained into the left innominate vein in 9 patients, and in 4 patients, there were accessory pulmonary veins that drained into the left innominate vein. Many of the patients had additional lung anomalies, including pneumonic infiltration (n = 12), atelectasis (n = 8), and lobar emphysema (n = 5), and some of these findings coexisted. Conclusions: Anomalous pulmonary venous drains and associated cardiac and extra-cardiac anomalies can be detected reliably and quickly with high-pitch low-dose CT without sedation in paediatric patients.

Amaç: İdiopatik granülomatöz mastit (İGM) memenin sebebi tam olarak bilinmeyen kronik enflamatuar bir hastalığıdır. Kesin tanısı görüntüleme yöntemlerinin yanı sıra histopatolojik olarak granülomatöz inflamasyonla beraber kronik lobülit saptanması ve diğer etkenlerin dışlanması ile konur. Bu çalışmamızda İGM’nin görüntüleme bulgularını vurgulayarak tanı ve tedavi sürecine nasıl katkı sağlayabileceğini gözden geçirmeyi amaçladık. Gereç ve Yöntem: 2017 Ekim-2019 Mart tarihleri arasında genel cerrahi polikliniğine memede akıntı, kızarıklık, ısı artışı, ele gelen sertlik, meme cildinde yara şikayeti ile başvuran, klinik muayene ve görüntüleme bulguları granulamotöz mastit şüphesi taşıyan ve biyopsi sonucu granulomatöz mastit olarak rapor edilen 57 olgu dahil edildi. 40 yaş altı olgularda Ultrason (US) ve 40 yaş üstü ise mamografi (MG) ve /veya US bulguları retrospektif olarak değerlendirildi. Manyetik rezonans görüntüleme (MRG) yapılan olgularda MRG bulguları da not edildi. Bulgular: MG bulguları non-spesifik ve değişken olmakla birlikte, çoğunlukla rastladığımız bulgu fokal asimetri idi. US’da en sık rastlanan bulgu tubuler uzanım gösteren ve birbirleriyle birleşme eğiliminde olan hipoekoik lezyonlar şeklindeydi. Abse drenajında ve tedavi takibinde de US’nin tekrarlanabilir fonksiyonel bir metod olduğu görüldü. MRG bulguları, meme başı retraksiyonu, ciltte kalınlaşma, kitlesel ve/veya kitlesel olmayan kontrastlanmalar, periferal kontrastlanan abse formasyonları ile aksiller lenf adenopatiler olarak özetlenebilir. Sonuç: İGM nedeni kesin olarak bilinmeyen, kronik enflamatuar bir meme hastalığıdır. Doğru tanı ve uygun tedavi hastaların yaşam kalitesi ve çoğunluğu genç hasta grubunda olması nedeniyle de meme estetiği açısından oldukça önem arz etmektedir. Radyolojik görüntüleme bulguları klinik bulgularla birlikte değerlendirildiğinde tecrübeli kliniklerde hızlı bir şekilde doğru histopatolojik tanıya ulaşılarak tanı ve tedavi sürecine önemli katkıda bulunabilir kanaatindeyiz., Objective: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease of the breast, the reason of which is not exactly known. In addition to imaging modalities, a definitive diagnosis of IGM is made by histopathologically identifying granulomatous inflammation with chronic lobulitis and the exclusion of other factors. We aimed to review how IGM can contribute to the diagnosis and treatment process by emphasizing the imaging findings. Material and Methods: Between October 2017 and March 2019, a total of 57 cases were included in the study, applied to the general surgery with complaints, whose clinical examination and visualization findings caused suspicion of granulomatous mastitis and biyopsy result was reported as granulomatous mastitis. Ultrasound (US), MG and/or MRI findings were evaluated. Results: The most common finding we found was focal asymmetry on MG. The most common findings were hypoechoic lesions with tubular extension. US also was a repeatable functional method in the diagnosis, drainage and treatment follow-up of concomitant abscess formations. Breast MRI findings are; thickening of the breast skin, nipple retraction, mass and/or non-mass enhancements, abscess and lymphadenopathies. Conclusion: The cause of IGM is not known precisely. Accurate diagnosis and appropriate treatment are of great importance in terms of patients' quality of life and breast aesthetics as the majority of patients are in the young patient group. When the radiological visualization findings are evaluated together with the clinical findings, we believe that the correct histopathological diagnosis can be made in the experienced clinics and it can contribute significantly to the diagnosis and treatment process.

Amaç: Koroner arter varyasyonları nadir görülmekle birlikte egzersiz esnasında ani ölüme yol açabilmektedir. Sözkonusu varyasyonların tanımlanması bir takım ciddi komplikasyonları önlemede yol gösterici olabilmektedir. Çalışmamızın amacı koroner arter çıkış varyasyonlarının sıklığını ve klinik açıdan önemini vurgulamak; aynı zamanda son yıllarda gelişen BT teknolojileriyle bu varyasyonların saptanabilirliğini ortaya koymaktır. Gereç ve Yöntem: Çalışmaya risk faktörü nedeniyle veya koroner arter hastalığı düşünülen ve bu nedenle kliniğimizde koroner BT anjiyografi tetkiki yapılan 1256 olgu dahil edildi. Retrospektif olarak planlanan çalışmada olgulardaki koroner arter varyasyonları tespit edilerek tanımlandı.Yüksek çıkımlı sağ koroner arter (RCA)- sol koroner arter (LCA), ayrı ostiumlardan çıkış gösteren sol ön inen arter (LAD) ve sol sirkumfleks arter (Cx), karşı koroner sinüsten çıkış gösteren arterler ve RCA’dan çıkış gösteren Cx arterler değerlendirildi. Bulgular: Toplam 31 olguda (% 2.50 ) koroner arter varyasyonu tespit edildi. Yüksek çıkımlı koroner arter sıklığı RCA ve LCA için sırasıyla % 0.16, % 0.40 olarak tespit edildi. LAD ve Cx arterin ayrıostiumlardan çıkma sıklığı % 0.64 olarak saptandı. Sol sinüs Valsalva’dan köken alan RCA sıklığı % 0.48 oranında görülürken; Cx arter ve LCA’nın sağ sinüs Valsalva’dan köken alma sıklığı sırasıyla %0.16, % 0.24 olarak hesaplandı. RCA’dan çıkış gösteren Cx sıklığı % 0.32 olarak hesaplandı. Tek koroner arter anomalisi sıklığı ise % 0.08 oranında gözlendi. Sonuç: Koroner arter varyasyonları toplumun yaklaşık % 2’sinde görülen ve çeşitlilikleri fazla olan anomalilerdir. Klinik olarak asemptomatik olabilecekleri gibi infarkt veya ani ölümlere yol açabilen anomaliler de bulunmaktadır. Özellikle koroner arterlerin pulmoner arterden köken alması, anormal kökenli koroner arterlerin interarteriyel seyir göstermesi gibi anomalilerin ani ölüme yol açabilme potansiyelleri nedeniyle tanısı ve uygun tedavisi önemlidir. ÇKBT (Çok Kesitli Bilgisayarlı Tomografi) koroner anjiyografi ile koroner arter varyasyonları yüksek duyarlılıkta saptanabilmektedir., Objective: Although the coronary artery variants are rare, they may cause sudden death during the exercise. The description of these variants may be helpful prevention of some complications. The objective of our study was to emphasize the incidence and the clinical importance of origin variations of coronary artery and demonstrate the detectability of them with CT technology. Material and Methods: A total of 1256 patients, who were suspected to have coronary artery disease and underwent CT angiographic examination in our clinic, were included in this retrospective study. All coronary artery variants observed in the patients were determined and defined. The high take-off right coronary artery (RCA) – left coronary artery (LCA), left anterior descending artery (LAD) and left circumflex artery (Cx) originating from different ostia, arteries originating in the contralateral coronary sinus and Cx arteria originating in RCA were evaluated. Results: We determined coronary artery variants in 31 patients (2.50%). The incidence of the high take-off coronary artery was 0.16% and 0.40% for RCA and LCA respectively and LAD and Cx artery originating in different ostia was 0.64%. The incidence of RCA originating in the left sinus of Valsalva was 0.48%; Cx artery and LCA originating in the right sinus of Valsalva was 0.16% and 0.24%; Cx artery originating in RCA 0.32% and single coronary artery anomaly was 0.08%. Conclusion: The coronary artery variants are encountered in approx. 2% of the population. The diagnosis and appropriate treatment are important because of their potential to cause sudden death. The coronary artery variants can be detected with MDCT.

Aim: The purpose of this paper was to evaluate rare cases of anomalous origins of the ophthalmic artery (OA) according to magnetic resonance angiography (MRA) findings. Methods: This retrospective study included 80 patients diagnosed with anomalous OA origins between March 2015 and July 2018 from a sample of 16,024 patients. The patients included 47 females and 33 males with a mean age of 38.16 years (range 18–62 years). Three-dimensional time-of-flight (3D-TOF) MRA was performed for all patients. Results: Eighty (0.5%) patients had anomalous OA origins. The most common type of OA origin anomaly was the right OA originating from the middle meningeal artery (0.17%). Twelve (0.07%) patients had OAs with an extradural origin. Conclusions: Anomalous origins of the OA are rare. 3D-TOF MRA is a noninvasive imaging method that can be applied for the diagnosis of OA anomalies. Some OA variations can have a protective effect against ocular complications in vaso-occlusive events. Therefore, it is critical to know the variant anatomy of OAs.

Amac: Primer hiperparatiroidizmin (PHP) en onemli nedeni paratiroid adenomlaridir. Sebep, cogunlukla tiroid bezi cevresinde yerlesmis paratiroid bezlerinden kaynaklanan adenomlar olmakla birlikte daha nadir olarak ektopik yerlesim de gorulebilmektedir. Tedavide altin standart cerrahi olarak adenomun eksizyonudur. Cerrahi basariyi etkileyen en onemli faktorlerden birisi ise preoperatif olarak adenomun dogru olarak lokalize edilebilmesidir. Bu calismada amac, ROLL tekniginin paratiroid adenomlarinin cerrahi tedavisinde tedaviye katkisini arastirmaktir. Gerec ve Yontemler: Calismaya Kasim 2017 ile Ekim 2019 yillari arasinda, klinik ve laboratuvar verileri nedeniyle yonlendirilen veya insidental olarak saptanan, ultrasonografi ve/veya sintigrafi bulgulariyla preoperatif olarak net olarak lokalize edilen ve ROLL teknigi kullanilarak cerrahi eksizyon yapilan 40 olgu dahil edilmistir. Herhangi bir nedenle ROLL teknigi uygulanamayan veya ultrasonografide preoperatif net olarak lokalize edilemeyen olgular calisma disi birakilmistir. Calismaya dahil edilen tum olgulara ait preoperatif ve postoperatif PTH (parathormon) ve Ca (kalsiyum) degerleri retrospektif olarak incelenerek ROLL tekniginin tedavi surecine katkisi arastirilmistir. Bulgular: Calismaya dahil edilen tum olgularda postoperatif PTH ve Ca degerlerinde anlamli dusus oldugu saptandi. Tum olgularin histopatolojik sonucu paratiroid adenomu olarak teyit edildi. ROLL teknigi uygulanarak operasyon yapilan olgularda operasyon suresi anlamli olarak azalmis olup bu nedenle daha kisa anestezi ve daha erken hastane cikisi saglanmistir. Postoperatif kontrollerde yalnizca 3 olguda PTH degerlerinde yukselme saptanmis olup diger olgularda takipte herhangi bir problem saptanmamistir. Sonuc: Paratiroid adenomunun cerrahi eksizyonunda ROLL teknigi, tedavi suresine ve surecine olumlu katkilar saglayabilen, guvenli yardimci bir yontemdir.

Superb microvascular imaging (SMI) is an innovative color Doppler technique that is used to evaluate low-velocity blood flow in particular. Our purpose in this study was to examine the sensitivity and specificity of SMI for assessing occlusion of the hepatic artery after liver transplantation. Ninety-five prospective patients who underwent liver transplantation were included in our study between April 2014 and February 2018. The patients were assessed with color power Doppler sonography and SMI method examinations in this study. Those who were suspected of having hepatic artery occlusion were assessed with computed tomography angiography. Computed tomography angiography was used in all the patients who were suspected of having occlusion of the hepatic artery on power Doppler and SMI method. The hepatic artery was considered to be patent and have normal flow on color Doppler examination in 72 (75.7%) of the total 95 patients. The hepatic artery was not observed in 23 (24.2%) of the patients with color Doppler sonography. In 3 of those 23 patients, arterial flow was detected with power Doppler sonography (31%). The sensitivity of SMI for the detection of hepatic artery occlusion was 100%, the specificity was 97.87%, the positive predictive value was 33.33%, and the negative predictive value was 100%. Thus, SMI is a noninvasive technique that is easy to use and has high sensitivity in patients who have undergone liver transplantation. In patients who are suspected of having hepatic artery occlusion with Doppler ultrasound, SMI can detect hepatic artery occlusion without the need for invasive techniques.

BackgroundParaglenoid labral cysts (PLCs) around the shoulder are uncommon. Magnetic resonance imaging (MRI) is the primary imaging modality for the description of PLCsPurposeThe purpose of this study was to evaluate PLCs in the posterior part of the glenoid bone via MR arthrography as well as to describe associated labral abnormalities.Material and MethodsThis retrospective study included 14 patients, diagnosed with 15 posterior PLCs at MR arthrography between 2007 and 2012. Conventional MRI and MR arthrography were used for all patients.ResultsA total of 15 PLCs were detected in 14 patients with eight located on the right shoulder and six on the left shoulder. One case had two PLCs. While two cysts were multiloculated, the remaining 13 were seen as unilocated simple cysts. Moreover, 14 of 15 posterior PLCs (60%) were associated with labral tears at MR arthrography. The cysts in proximity to the glenoid labrum were posterosuperior in 33.3% (n = 5), mid-posterior in 36.7% (n = 7), and postero-inferior in 20% (n = 3). The majority of patients with posterosuperior and mid-posterior cysts had an associated superior labral tear from anterior to posterior (SLAP) lesions. Four of six patients with mid-posterior cysts had minimal denervation atrophy in the infraspinatus muscle.ConclusionPosterior PLCs are mostly associated with posterior labral defects. The majority of cysts localized in the posterosuperior and mid-posterior were also associated with SLAP lesions. Denervation atrophy in the infraspinatus muscle may frequently accompany mid-posterior PLCs.

Purpose To evaluate the contribution to the diagnosis of the giant arachnoid granulations (AGs) of three-dimensional (3D) high-resolution magnetic resonance (MR) imaging sequences such as T2-weighted sampling perfection with application optimized contrasts using different flip-angle evolution (SPACE) and post-contrast T1-weighted magnetization prepared rapid gradient echo (MPRAGE). Materials and Methods Patients with 45 giant AGs were included in this retrospective study. All the patients were performed 3D T2-weighted SPACE and contrast enhanced MR venography sequences, as well as conventional cerebral MR imaging sequences. Post-contrast T1 weighted MPRAGE sequence were performed on 38/45 patients. All cerebral MR examinations were reviewed by the 2 neuroradiologists. Each GA was evaluated carefully to assess location and mean diameter. Results The most common location for giant AGs was at both transverse sinuses. Fluid signal feature within the giant AGs was not isointense to CSF on SE T1 and FLAIR MR imaging in 32 of 45 giant AGs. There were cerebral herniation into AG in 10 (22.2 %) of 45 giant AGs. 33 (73.3 %) of 45 giant AGs had central vein finding into AG in contrast enhanced MR venography. Signal void phenomenon into AG in 3D T2-weighted SPACE MR sequence was identified in 28 (62.2 %) of 45 giant AGs. Conclusions Fluid within giant AGs had no completely CSF-like signal intensity on conventional and 3D high-resolution MR imaging sequences. Majority of CSF-incongruent fluid within giant AGs on conventional sequences is mostly due to intra-AG CSF flow.

The adrenal gland is a common site of disease, with an abnormality prevalence as high as 9% in autopsy series. With the increasing use of CT, adrenal lesions are frequently found in the daily practice of radiology and are diagnosed in up to 5% of CT examinations performed for varied reasons. Imaging features on CT can establish a specific diagnosis of many of these lesions, including myelolipoma, hematoma and cysts. Once a diagnostic dilemma, now adenomas can be accurately diagnosed using unenhanced CT, chemical shift magnetic resonance imaging and CT contrast washout analysis. Because the adrenal gland is also a frequent site of metastasis, recent literature has focused on imaging characterization of adrenal masses for differentiation of adenomas from metastases. In patients without known malignancy, most adrenal lesions are benign and a specific diagnosis can now be made on the basis of imaging features. It is important to understand the prevalence of adrenal abnormalities because the gland is a common site of disorders, and the increased use of cross-sectional imaging has increased the frequency of detection of adrenal lesions. The prevalence of disease is important in predicting the risk of malignancy when an adrenal mass is discovered in a patient without known cancer. Detection of adrenal gland diseases has increased substantially with the advent and widespread use of imaging techniques. Although several imaging modalities can be used, CT has a central role in both detection and differential diagnosis of an adrenal lesion. The aim of this article is to review the CT findings of adrenal gland diseases.

Purpose: In the assessment of recurrent bladder tumors, diagnostic efficiency of virtual cystoscopy carried out by multidetector computed tomography (MDCT) was investigated and compared with the criterion standard of conventional cystoscopy. Materials and Methods: Twenty-seven patients between 39 and 83 years who had undergone transurethral resection because of bladder tumors were assessed using virtual and conventional cystoscopy. Virtual cystoscopy was performed using a 16-MDCT (Aquilion, Toshiba Medical Systems, Tokyo, Japan) in the supine and prone positions. After axial scanning, the 2-dimensional axial images were assessed, followed by coronal and sagittal multiplanar reconstruction of the images. In addition, virtual cystoscopy and cystographic investigations were performed using software in which volume-rendering technical algorithms shaded the surface display. In the images obtained, the existence and localization of lesions, morphological features, environment invasions, involvement of lymph nodes, and, if any, metastases of abdomen were assessed. Results: For bladder pathologies, the sensitivity and specificity of CT cystography coupled with virtual cystoscopy were 91% and 92%, respectively. The percentage of correct diagnoses using CT cystography was 92%. In addition to bladder pathologies, we investigated liver metastases, kidney cysts, fluid in abdomen, and lymphadenopathies. Conclusions: Using MDCT with virtual cystoscopy to assess primary bladder tumors and, in particular, to determine tumor recurrence after transurethral resection is a minimally invasive method that can be used in the long-term follow-up care of patients. Copyright © 2010 by Lippincott Williams & Wilkins.