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We report a rare case of Gemella morbillorum associated pyogenic liver abscess in an immunocompetent 57-year-old female patient in this document. Gemella morbillorum is a gram-positive cocci found in the upper respiratory, genitourinary and gastrointestinal system microbiota. The bacterium is a member of the genus Gemella, and rare causative agent of endocarditis, brain abscess and bacteremia as an opportunistic pathogen. To the best of our knowledge,we present the first case of G. morbillorum associated pyogenic liver abscess in Turkey. The pathophysiology, diagnostic method and treatment of liver abscesses vary depending on the etiology. G. morbillorum is rare, but should be kept in the back of the mind while treating a patient with pyogenic liver abscess.

Background: The histopathological differentiation of renal neoplasms can be challenging via imaging. Objectives: To evaluate differences in histogram parameters on apparent diffusion coefficient (ADC) maps and to investigate the efficacy of histogram analysis in differentiation of oncocytomas from malignant renal neoplasm (MRN) subgroups. Patients and Methods: In this cross-sectional, retrospective study, the texture parameters of diffusion-weighted magnetic resonance images (DW-MRI) were evaluated in 65 patients with renal tumors (nine cases of oncocytoma and 59 cases of MRN) for a histological analysis. Results: A total of 68 lesions from 50 male and 15 female patients, with a median age of 55.4 years, were examined in this study. There were significant differences in the mean, median, and peak ADC values, as well as ADC percentiles, between the oncocytoma and MRN subgroups. Regarding the histopathological features of the lesions, 9 (11.5%) cases of oncocytomas, 23 (29.5%) cases of clear cell renal carcinoma (ccRCC), 14 (17.9%) cases of papillary renal cell carcinoma (pRCC), 12 (15.4%) cases of chromophobe renal cell carcinoma (chRCC), and 10 (12.8%) other tumors (including four cases of transitional cell carcinoma, four cases of non-Hodgkin’s lymphoma, and two cases of primitive neuroectodermal tumor) were identified. Significant differences were found in the mean and median ADC values between the oncocytoma, pRCC, chRCC, and other MRN subgroups. Moreover, significant differences were found in the mean and median ADC values between the ccRCC, pRCC, and chRCC subgroups. There were also significant differences in the percentiles of mean and median ADCs between oncocytomas and pRCC, chRCC, and other MRN subgroups. However, there were no significant differences in the mean and median ADCs (including the percentile histogram analysis) or the peak ADC between the oncocytoma and ccRCC groups. The mean, median, and percentile of ADC for renal masses were superior to kurtosis, skewness, and entropy. Conclusion: Although differentiation between ccRCC and oncocytoma was not possible by only measuring the mean, median, and peak ADC values, the histogram analysis of ADCs may improve differentiation between the MRN subgroups. Clearly, ADC cannot be used to differentiate between oncocytomas and MRNs.

We analysed the correlation of 18F-fluorodeoxyglucose uptake into primary tumours using the maximum standardised uptake value (SUVmax) and the mean apparent diffusion coefficient (ADCmean) values i...

Bagirsak perforasyonu, akut batini isaret eden tehlikeli bir problemdir. Bilgisayarli tomografi (BT), akut batini olan hastalari degerlendirmede kullanilan onemli bir metoddur. BT, anotomik detaylari ve bagirsak duvarini gostermekte, cevre mezenterde bagirsak hastaligi ile ilgili ikincil isaretleri degerlendirmekte ve peritonel kavitede oral kontrast sizintilari ya da az miktarda ekstraluminal havayi saptamaktadir. Bu makalenin amaci, kolorektal kanserli hastada FOLFIRI tedavisine bagli olarak akut batinin BT bulgularini aciklamaktir. Ilginc olarak, bu hastanin radyolojik bulgularinin aciliyeti olmasina ragmen, hasta kendini iyi hissetmekte ve klinik olarak acil bir problemi bulunmamaktadir.

Hemochromatosis is an autosomal recessive disease that is one of the most important reasons for iron overload. Sickle cell disease is a hemoglobinopathy that occurs as a result of a homozygous mutation in the hemoglobin gene. Erythrocyte transfusion is frequently used in the treatment of this disease. Iron overload as a result of transfusion is important in the mortality and morbidity of sickle cell anemia patients as well as in other hemoglobinopathies. In this study, the effect of hemochromatosis gene (HFE) p.H63D and p.C282Y mutations on transfusion-related cardiac and liver iron overload in sickle cell disease patients who carry homozygous hemoglobin S mutation has been investigated.This is a prospective single-center cross-sectional study in patients with homozygous hemoglobin S mutation between the years 2008 and 2013. The patients were divided into two groups. The first group (group A, n=31) was receiving chelation therapy and the second group (group B, n=13) was not. Direct and indirect iron loads were analyzed by magnetic resonance imaging and biochemically, respectively. HFE gene mutations were analyzed by polymerase chain reaction-restriction fragment length polymorphism method. Statistical analyses were performed by independent samples t-test.p.H63D mutation was detected in 10 (32.3%) patients in group A and in only 1 patient (7.7%) in group B. When the 2 groups were compared for iron overload, iron deposition in the liver was significantly higher in group B (p=0.046). In addition, in group A, iron deposition was significantly higher in HFE mutation carriers compared to patients without the mutation (p=0.05).Results of this study showed that HFE gene mutations are important in iron deposition in the liver in patients with sickle cell disease.Amaç: Hemokromatozis, demir birikiminin önemli nedenlerinden biri olan otozomal resesif bir hastalıktır. Orak hücreli anemi, hemoglobin genindeki homozigot mutasyon sonucu ortaya çıkan bir hemoglobinopatidir. Eritrosit transfüzyonu, bu hastalığın tedavisinde sıklıkla kullanılmaktadır. Transfüzyonun yarattığı demir yükü diğer hemoglobinopatilerde olduğu gibi orak hücreli anemi hastalarının mortalite ve morbiditesinde önem kazanmaktadır. Bu çalışmada hemokromatozis geni (HFE) p.H63D ve p.C282Y mutasyonlarının, homozigot hemoglobin S mutasyonu taşıyan orak hücreli anemi hastalarında, kalp ve karaciğerde transfüzyonla ilişkili demir yüklenmesine olan etkisi araştırılmıştır. Gereç ve Yöntemler: Bu çalışma, homozigot hemoglobin S mutasyonu olan hastalarda 2008-2013 yıllarını kapsayan prospektif, tek merkezli kesitsel bir çalışmadır. Hastalar şelasyon tedavisi alan (n=31) ve almayan (n=13) olarak iki gruba ayrıldı. Hastalarda direk ve endirekt demir yükü sırasıyla manyetik rezonans görüntüleme ve biyokimyasal olarak analiz edildi. HFE geni mutasyon analizi polimeraz zincir reaksiyonu-restriksiyon fragment uzunluk polimorfizmi yöntemleri ile gerçekleştirildi. İstatistik analizi Independent samples t-testi uygulanarak gerçekleştirildi. Bulgular: p.H63D mutasyonu grup A’da 10 hastada (%32,3), grup B’de ise sadece 1 (%7,7) hastada saptandı. Demir birikimi açısından gruplar karşılaştırıldığında karaciğerde demir birikiminin grup B’de istatistiksel olarak anlamlı derecede yüksek olduğu görülmüştür (p0,05). Grup A’da, mutasyonu olan bireylerde olmayanlara göre karaciğerdeki demir birikiminin istatistiksel olarak anlamlı derecede yüksek olduğu görülmüştür (p=0,05). Sonuç: Bu çalışmanın sonucu HFE genindeki mutasyonların, orak hücreli anemi hastalarında karaciğerde demir birikimi üzerinde etkili olduğunu göstermektedir.

PubMedID: 30908322 Computed tomography (CT) radiation dose reduction is vital without compromising image quality. The aim was to determine the effects of patient characteristics on the received radiation dose and image quality in chest CT examinations and to be able to predict dose and image quality prior to scanning. Consecutive 230 patients underwent routine chest CT examinations were included. CT examination and patients input parameters were recorded for each patient. The effect of patients' demographics/anthropometrics on received dose and image quality was investigated by linear regression analysis. All parameters were evaluated using an artificial neural network (ANN). Of all parameters, patient demographics/anthropometrics were found to be 98% effective in calculating dose reduction. Using ANN on 60 new patients was more than 90% accurate for output parameters and 91% for image quality. Patient characteristics have a significant impact on radiation dose and image quality. Dose and image quality can be determined before CT. This will allow setting the most appropriate scanning parameters before the CT scan. © Lippincott Williams & Wilkins.

We analysed the correlation of

Pulmonary meningothelial- like nodules (MLNs) are usually detected incidentally during pathologic evaluation of resected pulmonary parenchymal specimens and autopsies. These nodules are generally asymptomatic and most often single. Diffuse pulmonary involvement by MLNs is less frequently described. MLNs are benign lesions and have been associated with neoplastic and non-neoplastic pulmonary conditions and occasionally with extrapulmonary diseases. We report a case of a female patient presenting with multiple and bilateral pulmonary nodules diagnosed with "diffuse pulmonary meningotheliomatosis" by video-assisted thoracoscopic surgery (VATS). Diffuse pulmonary meningotheliomatosis should be included in the differential diagnosis of diffuse bilateral lung nodules in the radiologic studies.

Background Diffusion-weighted imaging (DWI) is commonly used to distinguish between benign and malignant liver lesions. However, different b-values are recommended. Purpose To determine the most suitable b-value in DWI for differentiation of benign and malignant liver lesions. Material and Methods A total of 124 lesions in 89 consecutive patients (43 men, 46 women; age, mean ± standard deviation, 58 ± 14 years) with a pathological or radiological diagnosis of malignant or benign focal liver lesions after magnetic resonance imaging (MRI) were included in this study. Routine abdominal MRI and DWI were performed using seven b-values (0, 50, 200, 400, 600, 800, 1000 s/mm2). Lesions were analyzed for benignity/malignity using apparent diffusion coefficient (ADC) values with 10 b-value combinations and by measuring the lesion/normal parenchyma ADC ratio. Results Mean ADC values were significantly different between malignant and benign lesions for all b-value combinations ( P = 0.000). The best b-value combination was 0 and 800 (Az = 0.935). Using lower b-values such as 0 and 50 together with higher b-values ≥600 s/mm2 was beneficial (Az = 0.928 and 0.927). Mean ADC values were approximately 13% (1–15%) higher in total when b = 0 and b = 50 s/mm2 were included in multiple b-value combinations. Conclusion In DWI, we recommend the use of b-values of 0 and 800 s/mm2 as two b-values, or b = 0, 50, 600, 800, and 1000 s/mm2 as multiple b-values for distinguishing between benign and malignant liver lesions. Mean ADC value is 13% higher in total by additional use of b = 0 and b = 50 s/mm2 in multiple b-value combinations.

Background We retrospectively evaluated the results of surgical treatment for anterior abdominal wall -desmoid tumours. Methods Records for 13 patients operated on for desmoid tumours from 1997-2013 were searched for age, gender, abdominal/pelvic surgical history, pregnancy, Gardner's syndrome, pre-operative radiological examinations, tumour size, multifocality, surgical procedure, tumour presence at surgical margins, recurrence, morbidity, and mortality. Local recurrence-free survival probabilities were estimated by the Kaplan-Meier method and stratified by various clinicopathological variables. Results There were 11 female (84,6%) and 2 male (15,4%) patients with a median age of 36 years. Seven (53,8%) -patients had previous abdominal/pelvic surgery, five (38,5%) had a history of pregnancy, and one (7,6%) had Gardner's Syndrome. Two (15,3%) patients had multifocality on their pre-operative radiological examinations. Mean tumour -diameter was 4,6 cm (SD 3,2 cm ; range 2-12 cm). After the excision of the masses in five (38,5%) patients, synthetic materials were used to close the abdominal wall defects. Two (15,3%) patients with positive surgical margins after -surgery were re-operated. Three (23%) patients required a second surgical intervention after the mass excisions were performed. Mean follow-up time was 56,7 months. Recurrence was observed in three patients during follow-up. Increased tumour size, history of previous abdominal/pelvic surgery, and the presence of multifocality had a negative effect on local recurrence-free survival. There was no mortality during follow-up. Conclusions Desmoid tumours are characterized by high recurrence, even after proper surgical excisions. Preoperative differential diagnoses of these tumours should be done and a post-operative follow-up protocol should be followed.

Purpose To explore the optimal b value in diffusion-weighted imaging (DWI) for differentiation of benign and malignant abdominal lesions. Materials and Methods A total of 108 consecutive patients (age 60 ± 12.5 years) with 127 pathologically confirmed diagnoses of abdominal lesions were included. Single-shot echoplanar imaging (SH-EPI) DWI (1.5T) with seven b values and eight apparent diffusion coefficient (ADC) maps were obtained. The lesions were analyzed visually on DWI and ADC maps for benignity/malignity using a 5-point scale and by measuring the ADC values and ADC lesion/normal parenchyma ADC ratio. ROC analysis was used to evaluate the diagnostic accuracy of ADC for differentiating between benign and malignant lesions. Pathology results were the reference standard. Results Differentiation between malignant and benign lesions using visual scoring was successful at b values of 600 or higher (sensitivities, specificities, and accuracies were 100/93.8/92.5, 84.7/82.6/80.4, and 94.4/89.7/88.1, respectively, for b600, 800, and 1000). The mean ADC values of malignant lesions were significantly lower than those of benign lesions for all b-value combinations except b0 and 50 s/mm2 (P = 0.032 for b0 and 50 s/mm2, P = 0.000 for other b values). The best b-value combination was 0 and 600 s/mm2 and multiple b2. The lesion/normal parenchymal ADC ratio for b600, b1000, and multiple b2 better distinguished between benign and malignant lesions. Conclusion In DWI, the optimal b value is 600 s/mm2; multiple b values of 600 s/mm2 and higher are recommended to differentiate between benign and malignant abdominal lesions. The lesion ADC/normal parenchyma ADC ratio is more accurate than using lesion ADC only. J. Magn. Reson. Imaging 2014;40:559–566. © 2013 Wiley Periodicals, Inc.

Background Standards for abdominal diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) measurements, and analysis are required for reproducibility. Purpose To identify optimal internal comparison standards for DWI to normalize the measured ADC for increased accuracy of differentiating malignant and benign abdominal lesions. Material and Methods We retrospectively studied 97 lesions (89 patients; age, 57 ± 13 years) with histopathologically confirmed abdominal disease. Seven normal body parts/contents (normal parenchyma, spleen, kidney, gallbladder bile, paraspinal muscle, spinal cord, and cerebrospinal fluid [CSF]) were assessed as internal references for possible use as comparison standards. Three observers performed ADC measurements. Statistical analyses included interclass correlation coefficients (ICCs), Mann–Whitney and Kruskal–Wallis tests, and coefficient of variation (CV). ROC analyses were performed to assess diagnostic accuracy of lesion ADC and normalized ADC for differentiating lesions. Pathology results were the reference standard. Results Mean and normalized ADCs were significantly lower for malignant lesions than for benign lesions ( P Conclusion The normal parenchyma from a lesion-detected organ can be used as an internal comparison standard for DWI. CSF can be used as a generalizable in plane reference standard.

To determine the feasibility of diffusion-weighted imaging in evaluation of pancreatic lesions and in differentiation of benign from malignant lesions.Descriptive study.Baskent University Adana Teaching and Research Center, Adana, Turkey, between September 2013 and May 2015.Forty-three lesions [pancreas adenocarcinoma (n=25)], pancreatitis (n=10), benign lesion (n=8)] were utilized with diffusion-weighted magnetic resonance imaging with multiple b-values. Different ADC maps of diffusion weighted images by using b-values were acquired.The median ADC at all b values for malignant lesions was significantly different from that for benign lesions (p0.001). When ADCs at all b values were compared between benign lesions/normal parenchyma and malignant lesions/normal parenchyma, there was a significant statistical difference in all b values between benign and malignant lesions except at b 50 and b 200 (p0.05). The lesion/normal parenchyma ADC ratio for b 600 value (AUC=0.804) was more effective than the lesion ADC for b 600 value (AUC=0.766) in differentiation of benign and malignant lesions. The specificity and sensitivity of the lesion/normal parenchyma ADC ratio were higher than those of ADC values of lesions. When the ADC was compared between benign lesions and pancreatitis, a significant difference was found at all b values (p0.001). There was not a statistically significant difference between the ADC for pancreatitis and that for malignant lesions at any b value combinations (p0.05).Diffusion-weighted magnetic resonance images can be helpful in differentiation of pancreatic carcinoma and benign lesions. Lesion ADC / normal parenchyma ADC ratios are more important than lesion ADC values in assessment of pancreatic lesions.

Background Limited data are available regarding the use of diffusion-weighted (DW) magnetic resonance imaging (MRI) with multiple b values for characterization of renal lesions. Purpose To demonstrate and compare the diagnostic performance of DW-MRI with multiple b values for renal lesion characterization. Material and Methods Sixty-three lesions (36 malignant, 27 benign) in 60 consecutive patients (48 men, 12 women; age 60 ± 12.5 years) with solid/cystic renal lesion diagnosed after MRI were included prospectively. Single-shot echo-planar DW abdominal MRI (1.5T) was obtained using seven b values with eight apparent diffusion coefficient (ADC) maps. Contrast-to-noise ratios (CNRs), signal intensities, lesion ADCs, and lesion/normal parenchyma ADC ratios were analyzed. Receiver-operating characteristic analysis was performed. Results The mean signal intensities of malignant lesions (at b0, 50, and 200s/mm2) were significantly lower than those of benign lesions ( P < 0.05). The mean ADC values at all b value combinations of malignant lesions were significantly lower than those of benign lesions ( P < 0.000), excluding the ADC value at b50 s/mm2. ADC with all b values could better distinguish between benign and malignant lesions. A 1.35 × 10−3 mm2/s threshold ADC value permitted this distinction with 85.2% sensitivity and 65.6% specificity. The lesion/normal parenchyma ADC ratio was more effective than the lesion ADC. Conclusion In addition to the ADC value, the signal intensity curve on DW images using multiple b values could be helpful for differentiation of malignant and benign renal lesions.

Radiation recall pneumonitis (RRP) occurs in a previously irradiated field and is triggered by certain cytotoxic drugs, principally chemotherapeutic agents such as erlotinib. Erlotinib is a reversible epidermal growth factor receptor tyrosine kinase inhibitor (TKI) and is an effective second-line treatment for patients with advanced-stage non-squamous-cell lung cancer. Previously, only 2 cases of radiation recall after erlotinib treatment have been reported. Here, we report a case of RRP caused by treatment with erlotinib 4 months after palliative definitive hypofractionated radiation therapy (RT).A 58-year-old male patient with non-small cell lung cancer (adenocarcinoma) was treated with polychemotherapy, palliative RT (30 Gy in 10 fractions), and erlotinib thereafter.Dosimetric analysis obtained from a 3-dimensional conformal RT planning system revealed that the volume of lung receiving at least 20 Gy (V20) was 21.2% and the mean lung dose was 12.7 Gy. These data indicate that systemic administration of a TKI, even after palliative RT, may lead to unexpected toxicity when the radiation field encompasses visceral organs.We conclude that the use of a TKI after RT may trigger radiation pneumonitis. Although evidence is limited, we advise clinicians to be cautious of RRP after erlotinib treatment.

Tuberous sclerosis complex (TSC) is an inherited multisystem disorder; it may involve kidney, brain, skin, lungs, and liver. We report a 37-year-old female TSC patient presenting with skin lesions (angiofibromas, molluscum pendulum). Radiologic examination revealed additional brain and renal lesions consisting of tumors, cysts, and angiomyolipomas. Treatment with rapamycin disclosed improvement in skin lesions. The number and volume of angiofibromas and molluscum pendulum reduced progressively in 6 months. During the ninth month of treatment, magnetic resonance imaging was repeated for renal and brain lesions. Imaging results showed reduction in tumor and angiomyolipoma volumes. Oral rapamycin therapy can improve renal, brain, and skin lesions in TSC disease. Therefore, it may be an alternative therapy for TSC patients.

We aimed to retrospectively evaluate morbidity, mortality and treatment outcomes in 12 cases of Morgagni hernia diagnosed with multidetector computed tomography (MDCT) and treated appropriately. This is a retrospective study and data on the demographics, presenting symptoms, MDCT images, operative approach, morbidity and mortality were collected from hospital records. Of 12 patients with a mean age of 60 years, ten were female. The diagnosis was made with MDCT before surgery. All hernias were unilateral and located in the right part of the thorax. The contents of the hernias were omentum and colon in the majority of the patients, and the contents of the hernia as diagnosed with CT was confirmed at surgery. Six patients had surgery. Of these, one had emergency surgery for hernia, two laparoscopic hernia repair, three transabdominal repair and one transthoracic repair. MDCT is a good imaging technique to be used before surgery in that it is fast and non-invasive, helps to make an accurate diagnosis of Morgagni hernias and provides detailed information about the contents of the hernia and accompanying complications. Modern surgical techniques, including laparoscopy, help to achieve the repair of Morgagni hernias safely with short hospital stay and with little morbidity and mortality.

Objective To present the prevalence and imaging findings of patients with hydatid disease (HD) showing features of migration or herniation of the hydatid cysts (HCs) and underline the clinical significance of this condition. Materials and methods Between May 2003 and June 2006, 212 patients with HD were diagnosed by abdomen and/or thorax CT, searched for migrating or herniating HC. Imaging findings of 7 patients (5 women, 2 men with an age range of 19–63 years; mean ± S.D., 44 ± 19 years) with HD showing transdiaphragmatic migration (6 subjects) or femoral herniation (1 subject) were evaluated. Diagnosis of all the patients were established by pathologic examination and migration or herniation was confirmed by surgery in all patients. Results Liver HD were identified in 169 (79.7%) of 212 patients with HD. Transdiaphragmatic migration of HCs were identified in 6 (3.5%) of the 169 patients with liver HD. In one patient, femoral herniation of the retroperitoneal HC into the proximal anterior thigh was identified. All of these seven patients exhibiting migration or herniation of HCs had active HCs including ‘daughter cysts’. Two patients had previous surgery because of liver HD and any supradiaphragmatic lesion was not noted before operation. Findings of migration or herniation were confirmed by surgery. Conclusion Active HCs may show migration or herniation due to pressure difference between the anatomic cavities, and in some of the patients, by contribution of gravity. Previous surgery may be a complementary factor for migration as seen in two of our patients. The possibility of migration or herniation in patients with HD should be considered before surgery.

The aims of this study were to present the prevalence, imaging and clinical findings, and possible causes of portal venous system aneurysms.From 1998 to 2006, a total of 38 portal venous system aneurysms identified in 25 patients were retrospectively reviewed. The data of seven patients diagnosed using color Doppler sonography or CT before March 2004 were not consecutive, but the data recorded thereafter comprised the analysis of 4,186 consecutive patients who underwent routine abdominal MDCT. The patients were 14 men and 11 women (mean age -/+ SD, 53 -/+ 17 years).The prevalence of portal venous system aneurysm among 4,186 consecutive patients was 0.43%. There were no differences with respect to patient age, patient sex, and intrahepatic or extrahepatic location of aneurysm between those with and those without portal venous system aneurysm. Seven of the 25 patients with portal venous system aneurysm were symptomatic because of portal vein thrombosis, and six of them had recurrence. These patients had significantly larger aneurysms than those without symptoms. Four of those seven symptomatic patients evaluated for thrombophilia had an underlying defect. Other associated findings were splenomegaly (n = 16), portal hypertension (n = 8), cirrhosis (n = 3), psoriasis (n = 2), portal vein variation (n = 1), chronic pancreatitis (n = 1), and cutis laxa (n =1).Portal venous system aneurysms were rare in our study group but occurred more frequently than previously thought. All thrombosed aneurysms, most with a recurrence, were symptomatic and larger in patients with symptoms of portal venous system aneurysm than in those without symptoms. There were no differences among patients with portal venous system aneurysm and those without portal venous system aneurysm with respect to patient age and patient sex. Among those with aneurysms, there was no difference between subjects with intrahepatic versus extrahepatic aneurysms. A thrombophilic defect probably played a role in development of thrombosis in the portal venous system aneurysm.

Background: Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hytadid disease. The aim of this study was to evaluate the problems of complicated pulmonary hytatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical theraphy and the delay of surgical treatment in pulmonary hydatid disease. Methods: Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approache in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%). Results: In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3–17 days). The mean follow up was 18.4 months with no recurrence. Conclusion: Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.

We report the cases of 3 patients with brucellar gonadal abscess who were examined with gray-scale and color Doppler sonography. In these 3 cases, sonography revealed a thick-walled avarian (n = 2) or testicular (n = 1) abscess. Duplex Doppler sonography indicated a low-resistance type of flow in all 3 patients. The diagnosis of brucellar gonadal abscess is difficult, because it may have a misleading tumor-like appearance. Awareness of the imaging findings of gonadal abscess in patients with brucellosis and correlation with the results of serologic testing can allow early diagnosis, especially in endemic areas.

Purpose The study sought to evaluate the potential of diffusion-weighted magnetic resonance imaging to detect changes in liver diffusion in benign and malignant distal bile duct obstruction and to investigate the effect of the choice of b-values on apparent diffusion coefficient (ADC). Methods Diffusion-weighted imaging was acquired with b-values of 200, 600, 800, and 1000 s/mm2. ADC values were obtained in 4 segments of the liver. The mean ADC values of 16 patients with malignant distal bile duct obstruction, 14 patients with benign distal bile duct obstruction, and a control group of 16 healthy patients were compared. Results Mean ADC values for 4 liver segments were lower in the malignant obstruction group than in the benign obstruction and control groups using b = 200 s/mm2 ( P < .05). Mean ADC values of the left lobe medial and lateral segments were lower in the malignant obstruction group than in the benign obstructive and control groups using b = 600 s/mm2 ( P < .05). Mean ADC values of the right lobe posterior segment were lower in the malignant and benign obstruction groups than in the control group using b = 1000 s/mm2 ( P < .05). Using b = 800 s/mm2, ADC values of all 4 liver segments in each group were not significantly different ( P > .05). There were no correlations between the ADC values of liver segments and liver function tests. Conclusion Measurement of ADC shows good potential for detecting changes in liver diffusion in patients with distal bile duct obstruction. Calculated ADC values were affected by the choice of b-values.

The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women.

Summary: Intracranial lipomas (ICLs) are rare congenital malformations associated with some central nervous system anomalies and clinical findings. The aims of this study were to assess the locations, associated malformations, and imaging and clinical findings of patients with ICLs. Based on published reports, the neuroradiologic features, clinical symptoms and signs, differential diagnosis, and surgical indications are discussed. Seventeen cases of ICL were reviewed, on which the results of neurologic and radiologic examinations were based, including computed tomography (CT) and magnetic resonance imaging (MRI) findings. A total of 20 lipomas were observed in 17 patients. The locations of the lipomas were interhemispheric fissure and/or callosal (45%), choroid plexus and/or intraventricular (15%), pericallosal (10%), the quadrigeminal plate and/or superior cerebellar cistern (10%), the prepontine cistern (10%), hypothalamic and/or suprasellar (5%), and the Sylvian fissure (5%), respectively. Associated midline anomalies were observed in 3 patients with callosal and/or pericallosal lipoma and in 1 patient with a Sylvian fissure lipoma. Two patients had epilepsia. One patient had a lipoma of the quadrigeminal plate cistern causing obstructive hydrocephalus by compression and partial obstruction of the aqueduct. Presenting complaints and results of the neurologic examinations were not associated with lipomas in the other 14 patients. CT and MRI easily showed the fatty content of the ICLs and associated anomalies in all patients. ICLs are mostly located midline and discovered incidentally. Sometimes, there are associated midline anomalies and vascular variants; the most common associated neurologic symptom is epilepsy. They rarely require surgical intervention.

This article describes the clinical presentation and mammographic, gray-scale and color Doppler sonographic findings for three women with idiopathic granulomatous mastitis. In each case, a complete history was obtained, a thorough physical examination was performed, and routine laboratory tests were done. Two of the three lumps were tender at the time of presentation; the third was not painful. All three patients had diabetes mellitus. Mammography was done in two cases, and both showed asymmetric density in the area of the palpable mass. Ultrasonography showed multiple hypoechoic lesions in two patients and intraductal papillomatous lesions in one patient. In two cases, there was increased vascularization within and around the lesions. Radiologic findings in cases of idiopathic granulomatous mastitis are non-specific; histopathologic analysis is necessary for a definitive diagnosis.

Gallstone-induced ileus is a rare complication of cholelithiasis, and gastric outlet obstruction is even rarer. We describe the multidetector computed tomographic diagnosis of small bowel obstruction resulting from a gallstone impacted in the distal ileum and of gastric outlet obstruction from a gallstone impacted in the pyloric antrum (Bouveret syndrome).

Dyke-Davidoff-Masson Syndrome (DDMS), also called cerebral hemiatrophy, is a clinical condition characterized by hypoplasia or atrophy of one of the cerebral hemispheres during the fetal period or early childhood, accompanied by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis, and learning difficulties. The description of DDMS has been used in the presence of associated radiologic findings. In this paper, we present 2 siblings: one admitted to our hospital with seizures and diagnosed with DDMS and the other with a history of seizures, similar presentation of a neurologic examination and electrophysiology testing, but with normal results on magnetic resonance imaging. We present these cases to demonstrate similar symptoms and physical and electrophysiologic features in 2 siblings with similar clinical presentations with different magnetic resonance imaging findings. © 2009 Lippincott Williams & Wilkins, Inc.

Interrupted inferior vena cava (IVC) is a rare developmental defect. IVC interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Here, we report the imaging findings of a patient with an interrupted IVC with diffuse collaterals between the infrarenal IVC and large renal veins, left gonadal, and perirectal haemorrhoidal-portal collateral veins with associated haematochezia. Depending on the haemodynamic changes, interrupted IVC may cause possible different clinical findings as presented here.

We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

Sneddon syndrome is a rare disorder, that ischaracterized by livedo reticularis and multiple ischemic cerebralinfarcts. It is accepted as a variant of antiphospholipid antibodysyndrome. Intracerebral, subarachnoid, and intraventricularhemorrhages have rarely been reported. We reported a femalediagnosed as Sneddon syndrome with the clinical, radiologic,and histopathologic findings who presented with intracerebralhemorrhage. The brain computed tomography and magneticresonance imaging of the case, digital arterial biopsy convenientwith vasculopathy, showed hemorrhage extending into theventricle, focal hemorrhage areas in the right centrum semiovaleand parietal cortical localization, cerebral and cerebellar acute-subacute infarcts. Angiography revealed stenosis in the A1segment of the right anterior cerebral artery. It must beconsidered in unusual intracranial hemorrhage.Key Words: Sneddon syndrome, vasculitis, intracranial hemor-rhage(Neurosurg Q 2006;16:71–73) S neddon syndrome is a disease characterized by livedoreticularis (LR) and cerebrovascular disease, and hasbeen firstly described by Sneddon in 1965. This raredisorder is accepted as a variant of antiphospholipidantibody syndrome. It generally occurs sporadically, buta few familial cases have also been reported.

Deyronie disease is a connective tissue disorder that involves the formation of plaques in the tunica albuginea. 1 Fibrin deposition associated with microvascular injury may be the initial step in the formation of these plaques. 2 In most cases, only a single plaque forms, and the lesion is located in the dorsum of the penis. 3 To our knowledge, only 1 case report in the literature documents a Peyronie plaque involving the entire tunica albuginea of the penis. That report by Narita and coworkers 4 described the autopsy finding of extensive tunica albuginea involvement by a Peyronie plaque in a man who had died of metastatic malignant thymoma. This report documents the case of a living patient with a Peyronie plaque involving the entire tunica albuginea of the penis.

Hydatid cysts rarely involve the musculoskeletal system. We present the case of a 23-year-old man with a primary hydatid cyst between the femur and the quadriceps muscle in his left thigh. No cysts were located in the adjacent femur or quadriceps muscle. Cyst resection with sparing of the surrounding muscles, combined with anthelmintic therapy, was curative. In regions where hydatidosis is endemic, hydatid cysts should be included in the differential diagnosis of any unusual soft-tissue swelling. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:358–360, 2004

In the presented case, the radiologic, endoscopic and surgical findings of a gossypiboma that migrated into the stomach are presented. A 63-year-old woman presented with epigastric pain, and her clinical and laboratory findings were compatible with pancreatitis. Upper gastrointestinal endoscopy revealed a foreign body at the greater curvature of the stomach. Computed tomography and magnetic resonance imaging showed a mass consistent with a gossypiboma that had migrated into the stomach transmurally. This is a first case of a gossypiboma diagnosed endoscopically.

Malignant fibrous histiocytoma is the second most common soft-tissue sarcoma in adults. After the extremities, the retroperitoneal space is the second most common site of this tumor. A 50-year-old man presented with a right retroperitoneal, thick-walled, cystic multilocular mass measuring 10 × 10 cm that was thought to be a type CE 5 hydatid cyst preoperatively. However, the postoperative histopathology did not agree with the radiological findings and instead showed a malignant fibrous histiocytoma. The computed tomography and ultrasound/Doppler ultrasound findings of this retroperitoneal mass mimicked a type CE 5 hydatid cyst. We present this case because the surgical management of these two lesions differs and misdiagnosis can be problematic.

Purpose: To explore the optimal b value in diffusion-weighted (DW)-MRI for differentiation of benign and malignant gynecological lesions. Materials and Methods: Consecutive 58 patients (66 lesions) with pathologically confirmed diagnosis of gynecological disease were included in the study. Routine pelvic MRI sequences were used for defining the lesions and reviewed independently for benignity/ malignity. Single-shot echoplanar imaging (SH-EPI) DW-MRI with eight b values and nine apparent diffusion coefficient (ADC) maps were obtained. The lesions were analyzed qualitatively on DW-MRI for benignity/malignity on a five-point-scale and quantitatively by measurement of apparent diffusion coefficient (ADC) values. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of ADC values for differentiating between benign and malignant lesions. Pathology results were the reference standard. Results: Differentiation between benign and malignant gynecological lesions using visual scoring was found to be successful with b values of 600, 800, or 1000 s/mm2. The mean ADC values of malignant lesions were significantly lower than those of benign lesions for all b value (P < 0.005). The ADCs with b = 0 and 600, 0 and 1000 s/mm2, 0, 600, 800 and 1000 s/mm2, and all b values were more effective for distinguishing malignant from benign gynecological lesions (Az = 0.851, 0.847, 0.848, 0.849, respectively). Using ADC with b = 0, 600, 800, and 1000 s/mm2, a threshold value of 1.20 × 10−3 mm2/s permitted this distinction with a sensitivity of 83%, a specificity of 81%. Conclusion: DW-MRI is an important method, and the optimal b values are between 600 and 1000 s/mm2 for differentiation between benign and malignant gynecological lesions. J. Magn. Reson. Imaging 2012;35:650-659. © 2011 Wiley Periodicals, Inc.

Purpose We examined the relationship between portal venous velocity and hepatic-abdominal fat in patients with nonalcoholic fatty liver disease (NAFLD), using spectral Doppler ultrasonography (US) and magnetic resonance imaging (MRI). Materials and Methods In this prospective study, 35 patients with NAFLD and 29 normal healthy adults (control group) underwent portal Doppler US. The severity of hepatic steatosis in patients with NAFLD was assessed by MRI through chemical shift imaging, using a modification of the Dixon method. Abdominal (intra-abdominal and subcutaneous) fat was measured by MRI. Results The difference in portal venous velocity between the patients with NAFLD and the control group was significant (p < 0.0001). There was no correlation between the degree of abdominal or hepatic fat and portal venous velocity (p > 0.05). There were strong correlations between the hepatic fat fraction and subcutaneous adiposity (p < 0.0001), intraperitoneal fat accumulation (p = 0.017), and retroperitoneal fat accumulation (p < 0.0001). Conclusion Our findings suggest that patients with NAFLD have lower portal venous velocities than normal healthy subjects.

PubMedID: 22196757 Objectives: The aim of this study was to determine the normal values of subregions of corpus callosum and ventricles in healthy adult people in our population using magnetic resonance imaging (MRI) and to establish gender differences. Methods: The MRI of 52 healthy individuals (29 females and 23 males) aged 20-50 years was obtained. The measurements were performed from MRI on a workstation. The midsagittal images were used for measurements of the subregions of corpus callosum and axial images were for lateral and third ventricles. Results: The mean values of the widths of genu, body, splenium, and height of the corpus callosum were 13.28±2.10, 7.64±1.07, 12.52±1.35, and 25.47±2.20 mm, respectively in females; whereas, the same measurements were 13.23±2.41, 6.89±2.12, 11.90±1.94, and 25.03±3.38 mm, respectively in males. Moreover, the mean value for the longitudinal dimension of the brain was 150.12±5.04 mm, while that for the corpus callosum was 71.27±3.70 mm in females. Additionally, the mean frontal horn width of the lateral ventricle and the transverse inner diameter of the skull were 34.06±3.05 and 130.76±6.71 mm in females and 34.03±2.78 and 129.96±10.61 mm in males, respectively. Due to these measurements, the values of Evans index which is reflecting the lateral ventricle enlargement were estimated to be 0.25±1.90 and 0.25±1.14 in females and males, respectively. According to our last measurement result, the mean values for the third ventricle width were 3.79±0.85 and 4.12±0.94 mm in females and males, respectively. These findings show that there are differences between the averages of some indices of corpus callosum of our population and the other populations. © W. S. Maney & Son Ltd 2011.

Purpose To present chest radiography and thoracic computed tomography (CT) findings for patients with pandemic influenza A (H1N1) from November-December 2009 and to explore any differences compared to previously reported imaging findings. Materials and methods Fifty-two hospitalized patients with pandemic influenza (H1N1) were included in the study. All of the patients underwent chest radiography, and 28 patients were also evaluated by thoracic CT. Group 1 comprised 24 (46%) patients with no identified risk factors for H1N1 influenza infection. Group 2 comprised the remaining 28 (54%) patients with identified risk factors. The distribution of lung involvement, consolidation, ground-glass opacity (GGO), lymph nodes, and pleural effusion were evaluated. Results Abnormal findings were observed in 85% of the patients. Bilateral lung involvement was present in 80% of the patients. The most common finding was a mixture of GGO and air-space consolidation. Lower zone predominance occurred in 89% of group 1 and 85% of group 2 patients. The involvement was observed most frequently in the peripheral and central perihilar areas of the lung in 80% of the patients. The extent of disease was greater in group 2 patients with the involvement of three or more lung zones in 62% of the patients. Conclusion The most common imaging finding for lung involvement was a mixture of air-space consolidation and GGO with a patchy pattern and lower/middle zone predominance. Pulmonary involvement of the disease was more extensive than that described in previous reports.

The aim of this study was to evaluate the relationship between renal resistive index and inflammation in untreated hypertensive patients. Sixty-one hypertensive patients (male/female: 38/23, aged 45.8 +/- 8.3 years, and mean hypertension duration 28.2 +/- 35.6 months) and 40 (male/female: 23/17, aged 42.7 +/- 8.5 years) healthy control subjects were included in the study. Renal resistive index was positively correlated with age (P = 0.016, r = 0.308), pulse pressure (P = 0.022, r = 0.294), C-reactive protein (P = 0.00, r = 0.757), urinary albumin excretion (P = 0.003, r = 0.371) and negatively correlated with creatinine clearance (P = 0.042, r = -0.262) in the hypertensive group. The hypertensive group was further divided in two groups according to the renal resistive index; 0.60. In the > 0.60 group, age (48.0 +/- 7.3 versus 42.8 +/- 8.9 years, P = 0.01) and C-reactive protein levels (7.4 +/- 1.5 versus 4.0 +/- 1.6 mg/L, P = 0.01) were higher, and creatinine clearance (95.5 +/- 22.1 versus 109.1 +/- 25.3 mL/min, P = 0.04) was lower than the < 0.60 group. Renal resistive index was higher in the nondippers than the dippers (0.61 +/- 0.04 versus 0.58 +/- 0.03, P = 0.003). Renal resistive index is associated with inflammation and may be a useful marker, together with albuminuria, in hypertensive patients when evaluating hypertensive renal damage.