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Objective: This study was aimed at evaluating the intravoxel incoherent motion (IVIM) parameter alterations of liver metastases of colorectal carcinoma (CRC) during antiangiogenic bevacizumab combination therapy. Methods: Twenty-five patients with CRC liver metastases treated with bevacizumab in combination with FOLFOX-or-FOLFIRI protocols were enrolled in the study. MRI was performed using a 1.5-tesla scanner pre-treatment (PT) and at 3, 6, and 9 months of therapy. Routine abdominal MRI sequences and an IVIM-DWI (diffusion-weighted imaging) sequence were obtained. The IVIM-DWI sequence was executed with 16 b-values varying from 0 to 1,400 s/mm2. The mean values of apparent diffusion coefficient (ADC), true diffusion (D), pseudodiffusion (D*), and perfusion fraction (f) of each metastasis were obtained for all b-values, and the time-related changes were recorded to analyze the chronologic responses to antiangiogenic therapy. The RECIST 1.1 criteria were used for the evaluation of treatment response. Results: The diameters of the metastases diminished significantly at 9 months when compared with PT (p = 0.03). The D (p = 0.10) and ADC (p = 0.21) values of the metastases increased at 9 months of therapy. D* was the highest at 3 months (p =0.24); it decreased at 6 (p =0.97) and 9 months (p =0.87) of therapy. The f value had peaked at 3 months (p =0.51) and started to decrease thereafter. At 6 months, f decreased to the lowest values (p =0.12). Conclusion: IVIM parameters, particularly the perfusion fraction, may quantitatively reflect the response to antiangiogenic treatment. The antiangiogenic response manifests after 3 months of therapy before the RECIST-related response.

Background The purpose of this study was to determine the utility of some imaging findings in predicting microvascular invasion (MVI) and hepatocellular carcinoma (HCC) recurrence risk after liver transplantation. Method This retrospective study included 123 patients with histopathologically proven HCC at explant. All HCCs were classified as MVI positive (group I) or negative (group II) based on histopathological findings. In each group, multifocality, largest tumor size, bulging (tumor causing liver capsule expansion), beak sign (the acute angle between the tumor and liver parenchyma), and diffusion restriction on diffusion weighted images (DWI) were evaluated. These findings were compared between the groups by Student’s t test. The relation between the parameters and MVI was analyzed by using the Spearman’s correlation test. Results Of the total patients, 30.1% had MVI (group I) and 69.9% (group II) did not have MVI. Presence of beak sign (P ≤ .005), bulging sign (P = .002), and diffusion restriction (P = .045) were significantly more frequent in group I than group II. The beak sign, bulging sign, and diffusion restriction were correlated with presence of MVI. Largest tumor size and multifocality were higher in group I than group II, but the differences were not statistically significant. Conclusion Radiologists and transplant surgeons should be aware of some clue imaging findings, especially beak and bulging signs because these findings may predict the presence of MVI in HCC. These patients might benefit from histologic confirmation of the tumor characteristics through biopsy and subsequent bridging treatment options before liver transplantation to reduce the risk of recurrence.

Objectives Although endoscopic management is considered as the first-line treatment for biliary strictures, it may be challenging in living donor liver transplant recipients due to the complex nature of duct-to-duct reconstruction. In this study we present the use of a pigtail drainage catheter as a biliary stent to treat biliary strictures after a living donor liver transplant. Methods Twenty-seven patients with biliary strictures were treated with our novel technique. In this technique, a pigtail catheter was trimmed into 3 parts (proximal, middle, and distal portions). A suture string was passed through the distal hole of the middle portion, which was then reversed and used as a stent while the proximal portion was used as a pusher. Following balloon dilation of the stenotic segment, the distal, reversed middle, and proximal portions were loaded over the guidewire. After proper placement of the stent, the retractor suture string, pusher, and guidewire were removed. The stent was removed during the third or fourth month of placement through endoscopic retrograde cholangiopancreatography (ERCP) in all patients. Results No significant complications developed during the procedure or follow-up period. Ten patients required re-stenting by ERCP during the same session. The mean follow-up period was 2 years. Cholestase enzymes and bilirubin levels were within normal limits in all patients during follow-up. Conclusion Stents derived from drainage catheter facilitate treatment of biliary strictures in patients not eligible for the retrograde approach. This stent is cheap, easy to implement, can be easily removed by ERCP, and re-stenting can be applicable in retrograde if needed.

To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) parameters in the differential diagnosis of portal vein thrombus (PVT). Thirty-five patients with PVT were enrolled in this retrospective study. Precontrast axial in-phase and out-of-phase T1-weighted (W) turbo field echo (TFE), axial and coronal T2-W single-shot turbo spin echo, IVIM with b values between 0 and 1300 s/mm2 and conventional DWI with b factors of 50, 400, and 800 s/mm2 with single-shot echo-planar imaging, and postcontrast dynamic T1-W volumetric interpolated breath-hold examination images obtained with 1.5 T MR unit were evaluated. For quantitative analysis of conventional DWI, an ADC map was reconstructed from conventional DWI using all b values. For quantitative evaluation of IVIM, the SI was calculated from each b value. A specific software program was applied to calculate D (true diffusion coefficient), D* (pseudodiffusion coefficient associated with blood flow), and f (perfusion fraction). The differentiation between benign and malignant PVT was based on the criteria outlined in the study by Catalano et al. (Radiology 254:154–162, 2010). The ADC values of the malignant PVT were significantly lower than those of benign PVTs (p = 0.005). Malignant PVTs had a tendency to show higher f values in comparison with benign PVTs without statistical significance (p = 0.750). The best discriminative parameter was ADC values, which demonstrated a sensitivity of 80.0% and a specificity of 72.7% with cut-off value of 1.00 × 10−3 mm2/s. ADC values might be more superior tool than IVIM parameters in differentiation between malignant and benign PVT.

Amac: Diyabetli hastalarda baslica olum nedeni olan koroner arter hastaligi (KAH) hastalarin bir bolumunde sessiz seyreder. Bu calismanin amaci asemptomatik tip II diyabetli hastalarda gizli KAH prevalansini, mevcut plaklarin yayginligini, lokalizasyonunu ve ozelliklerini cok kesitli bilgisayarli tomografi anjiografi (CKBTA) ile degerlendirmektir. Gerec ve Yontem : Tip II diyabet tanili KAH acisindan asemptomatik olan 100 hasta CKBTA ile prospektif degerlendirildi. Kalsiyum skorlama amaciyla kontrastsiz goruntuler elde edildikten sonra i.v. kontrast madde verilerek 64 dedektorlu BT ile koroner anjiografik goruntuler alindi. Kontrastsiz goruntuler uzerinden koroner arter kalsiyum skoru hesaplandi ve plaklarin kalsiyum icerigi incelendi. Koroner angiografik goruntulerden elde edilen reformat goruntulerden ise plaklarin yayginligi, lokalizasyonu ve olusturduklari darlik dereceleri degerlendirildi. Kategorik degiskenlerin istatistiksel degerlendirilmesinde Pearson ki-kare testi ve Fisher gerceklik testi kullanildi. Bulgular: Calismaya dahil edilen 80 hastanin %72’si erkek (n=58) ve %27’si (n=22) kadindi. Ortalama yaslari 53±8 ve cekim esnasinda kalp hizlari ise 64±7 idi. 49 hastada (%61) aterosklerotik plak saptandi; Kalsifik plak en cok saptanan aterosklerotik plak tipiydi (%35), soft plak 9 (%11.3) hastanin en az bir koroner arter segmentinde saptandi. 14 (%17.5) hastada orta darlik, 11 (%13.7) hastada ciddi darlik ve boylelikle 25 (%31.3) hastada anlamli darlik (≥ %50) saptandi. Tek damar hastaligi (19, %23.7), iki damar hastaligi (15, %18.7), uc damar hastaligi (15, %18.7) saptandi. Sonuc: Diyabetli hastalarda asemptomatik KAH’in ortaya konmasinda CKBTA noninvazif ve guvenilir bir yontem olarak kullanilabilir

Background In living-donor liver transplantation, donor hepatic steatosis is crucial for both the donor and the recipient. Body mass index (BMI) and the unenhanced computed tomography liver attenuation index (CT LAI) are noninvasive methods to predict hepatic steatosis in living-donor liver candidates. Aim To analyze the diagnostic accuracy of CT LAI in conjunction with different BMI values for macrovesicular steatosis in living-donor liver candidates. Methods A total of 264 potential liver donors were included. The diagnostic accuracy of 2 CT LAI cut-offs and 3 BMI cut-off values for the assessment of hepatic steatosis ≥15% and ≤5% was determined. Results Using CT LAI, the area under the receiver operating characteristic curve was 0.97 (95% CI = 0.89–0.99) for hepatic steatosis ≥15% in donors with BMI Conclusions In donors with BMI 6, liver biopsy might be avoided. Biopsy may be reserved solely for donors with CT LAI value >0 and BMI ≥30 kg/m2 as the diagnostic accuracy of computed tomography for predicting hepatic steatosis decreases with increasing BMI.

Objective To evaluate the diagnostic accuracy of Intravoxel Incoherent Motion (IVIM) parameters for assessment of tumor response after locoregional treatment (LRT) of hepatocellular carcinoma (HCC). Methods Fifteen patients with HCC who had undergone LRTs (11 transarterial radioembolization, 4 transarterial chemoembolization) were included. In addition to routine upper abdominal magnetic resonance imaging sequences, IVIM with 16 different b values and conventional diffusion weighted imaging with 3 different b factors were obtained immediately before and 8 weeks after LRTs. Magnetic resonance imaging response was evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and HCCs were categorized into 2 subgroups, responders and nonresponders. Quantitatively, the number of diffusion-changes were calculated with apparent diffusion coefficient (ADC) and IVIM parameters, including mean D (true diffusion coefficient), pseudo-diffusion coefficient associated with blood flow, and f (perfusion fraction) values. Subsequently, the pre- and post-treatment parameters were compared using the Mann-Whitney U test. Results Considering all HCCs, a significant decrease was observed according to mRECIST criteria (–38.43 ± 16.49). The ADC and D values after LRTs were significantly higher than those of the preceding ones. The f values after LRTs were significantly lower than those of pre-treatment. In the responders group, ADC and D values were significantly increased and f values were significantly decreased after LRTs. No difference of statistical significance was achieved in the nonresponders group. Conclusions ADC values and IVIM parameters appear to reflect the response of LRTs as effectively as those of mRECIST. This promises new horizons in the management of pretransplant patients, especially in renal insufficiency clinical settings, owing to the elimination of contrast media administration.

The aim of this study is to evaluate spleen stiffness values with shear wave elastography (SWE) quantitatively in healthy adults and investigate the relationship of spleen stiffness with age, gender, and spleen size. This study included 65 healthy individuals. Spleen stiffness measurement was obtained with 2 dimensional (2-D) SWE method from the middle portion of spleen and calculated in kilopascals by taking the average of three valid measurements. Longitudinal and transverse spleen sizes were measured. The relationship of spleen stiffness with age, gender, and spleen size was investigated. The association between spleen size and age and gender was also evaluated. The mean spleen stiffness value was 13.82 ± 2.91 kPa, and the spleen stiffness was not affected by age, gender, or spleen size. Longitudinal spleen size was significantly lower in females than that in males. Moreover, there was a significant negative correlation between longitudinal spleen size and age (r = 0.247, p = 0.048). Spleen stiffness can be quantitatively measured by 2-D SWE, and the spleen stiffness is not affected by age, gender, and spleen size. The values obtained in this study can be used as normal base values in examination of different spleen pathologies.

Amaç: Biliyer kaçak (BK), canlı donör karaciğer nakli (CDKN) sonrası sık görülen komplikasyonlar arasındadır. Radyolojik yöntemler, tanıda ve tedavide önemlidir. Endoskopik yaklaşımlar BK’larda ilk basamak tedavi seçeneği kabul edilmekle birlikte günümüzde artan deneyim girişimsel radyolojik yaklaşımların rolunü de giderek arttırmaktadır. Çalışmamızda, CDKN sonrası gelişen BK’ların tanı ve tedavisinde deneyimimizi analiz etmeyi amaçlıyoruz. Gereç ve Yöntemler: Ocak 2015 – Aralık 2018 arasında merkezimizde gerçekleştirilen ardışık 361 CDKT olgu retrospektif olarak analiz edildi. BK şüphesi bulunan hastalarda kaçak tanısı ve yeri, safra yollarından ekskrete edilen gadoksetate disodyum kontrast madde kullanarak alınan manyetik rezonans kolanjiyopankreatografi (MRKP) ile gösterildi. Safra kaçakları, endoskopik, girişimsel radyolojik yaklaşımlar, cerrahi ve konservatif olarak tedavi edildi. Bulgular: Total 361 olgunun 27’sinde (%7,4) BK mevcut idi. BK’ların 26’sı (%96,2) anastomotik, 1’i ise (%3,7) kesi yüzey kaçağı idi. Bir hasta (%3,7) endoskopik, 23 hasta (% 85,1) girişimsel radyolojik, iki hasta (%7,4) cerrahi ve bir hasta (%3,7) konservatif yaklaşım ile tedavi edildi. Girişimsel radyolojik işlemler sırasında herhangi minor ve major komplikasyon gelişmedi. İşlem sonrasında ise 6 hastada (%26) minor komplikasyon [4 (%17,4) hafif kolanjitik atak, 2 (%8,6) hafif ödematöz pankreatit] gelişti. Sonuç: CDKT sonrası safra yollarının çoklu anastomozlu olması endoskopik tedavi yaklaşımlarını zorlaştırmaktadır. Girişimsel radyolojik yaklaşımlar deneyim gerektirmekle birlikte alternatif yöntem olarak uygulanabilir., Objective: Biliary leakage (BL) is one of the most frequent complications following living donor liver transplantation (LDLT). Radiological methods are important in diagnosis and treatment. Although endoscopic approaches are considered as the firstline treatment option in BL, nowadays, increasing experience is strengthening the role of interventional radiological approaches. In our article, we aim to analyze our experience in the diagnosis and treatment of BLs developed after LDLT. Material and methods: Between January 2015 and December 2018, 361 LDLT cases performed consecutive at our center were analyzed retrospectively. The leakage diagnosis and location was demonstrated by magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary excreted contrast agent gadoxetate disodium in patients with suspected leakage. BLs were treated by endoscopic, interventional radiological, surgical or conservative approaches. Results: Of the total 361 cases, 27 (7.4%) had BL. Twenty six (96%) of the BL were anastomotic and 1 (3,7%) was incision surface leakage. One patient (3.7%) was treated by endoscopic sphincterotomy methods, 23 (85,1%) patients by interventional radiological approaches, two patients (7.4%) by surgery and 1 patient (3,7%) by conservative approaches. There were no minor and major complications during interventional radiological procedures. After the procedure, minor complications (mild cholangitic attack) in 4 (17.4%), mild edematous pancreatitis in 2 (8,6%) developed in 6 (26%) patients. Conclusion: Endoscopic treatment approaches may be complicated in patients with multiple anastomosis of biliary tract after LDLT. Although interventional radiological approaches require experience, they can be performed as an alternative treatment method.

Benign tiroid dokusunun tiroidektomi sonrasinda ameliyat lojuna ve subkutan ekilmesi tiroid cerrahisinin nadir g.rulen bir komplikasyonudur. Bu durum literaturde endoskopik tirodektomi sonrasinda bildirilmistir. Bu yazida multinoduler guatr nedeniyle uygulanmis total tiroidektomiyi takiben multinoduler tiroid dokusunun subkutan ekilmesi olgusu sunuldu. Servikal subkutanoz tiroid dokusu ekilmesinin tanisi ve ayirici tanilari uzerinde tartisildi. Anahtar sozcukler: Boyun kitlesi; posstroidektomi ekilme; subkutan doku; tiroidektomi.

The aim of this study is to investigate the effectiveness of placental strain ratio (SR) values measured by real-time sonoelastography (SE) in the second trimester in the prediction of spontaneous preterm birth (sPTB).This study included 70 pregnant women who applied to our clinic for routine second-trimester screening. Placental SR measurements were performed with the SE method. Two different SR measurements were performed by taking two different tissues as references. The SR value measured when taking the rectus abdominis muscle as a reference was termed the muscle-to-placenta strain ratio (MPSR), while the SR value measured when taking subcutaneous tissue as a reference was termed the fat-to-placenta strain ratio (FPSR). Women whose gestational age at birth was less than 37 weeks 0 days were accepted as sPTB. The association between gestational age at birth and MPSR and FPSR was investigated. Receiver operating characteristics analysis was used to calculate the sensitivity and specificity of the elastographic outcomes.There was a low-level negative correlation between MPSR and gestational age at birth (r=-0.300, P=.012) and there was a moderate-level negative correlation between FPSR and gestational age at birth (r=-0.513, P.001). The multivariate linear regression analysis showed that the FPSR (β=0.609, P=.002) was the significant predictor for the sPTB.Our data indicate that the FPSR value measured with real-time SE in the second trimester of pregnancy may be effective in the prediction of sPTB.