Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Background:It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complica-tions during percutaneous abdominal interventions. Aims:The aim of this study was to map the inferior epigastric ves-sels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. Study Design: Retrospective comparative study.Methods:Coronal reconstructed two-detector computed tomogra-phy images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and dis-tal). Vein and artery arrangements were documented.Results:The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides were 4.01 and 4.47 cm at the umbilical level, 3.81 and 4.26 cm at the midlevel, and 5.62 and 5.51 cm at the origin level. On both sides, measurement differences between the three levels were highlysignificant (p<0.05). In addition, a total of 56 IEA bifurcations were depicted in all 200 patients. Thirteen of the 56 bifurcations occurredonly on the right side, 11 only on the left side, and 32 on both sides.Conclusion:It is important to be attentive to the IEA's course, at different midline levels, when attempting percutaneous interventions via an abdominal approach

Lumbar opening pressure and radiologic scoring in idiopathic intracranial hypertension : is there any correlation?

Background: To investigate correlation between lumbar opening pressure (LOP) and radiological scores based on cranial MRI and contrast-enhanced MR venography in patients with idiopathic intracranial hypertension (IIH). Material/Methods: Patients with IIH who underwent brain MRI and contrast-enhanced MR venography before measurement of LOP between 2010-2014 were evaluated retrospectively. Three experienced radiologists (blinded to LOP values) evaluated a total of 51 patients. They reached a consensus on the presence or absence of 6 radiological findings identified in the literature as characteristic for IIH: empty sella, perioptic dilation, optical tortuosity, flattening of the posterior globe, swelling of the optic disc, and bilateral transverse sinus stenosis. The radiological score was obtained by giving 1 point for the presence of each finding, with the highest possible score of 6 points. The correlation between the calculated radiological scores and LOP was evaluated. Results: There was no significant correlation between LOP and radiological scores (r=0.095; p=0.525, Spearman's rank coefficient). Similarly, no significant correlation was detected between LOP and each of the radiological findings (partial empty sella [p=0.137], perioptic dilation [p=0.265], optical tortuosity [p=0.948], flattening of the posterior globe [p=0.491], swelling of the optic disc [p=0.881], and bilateral dural sinus stenosis [p=0.837], Mann-Whitney U test). Conclusions: There was no significant correlation between LOP and reliable radiological features of IIH

Superparamagnetic iron oxide enhanced magnetic resonance imaging on differential diagnosis of focal liver lesions

Tıpta Uzmanlık TeziSon yıllarda karaciğerde kitle saptanan hastalarda kesin tanıya yaklaşımda MR görüntülemede organ spesifik kontrast maddeler uygulanarak doğru tanı oranı yükseltilmeye çalışılmaktadır. Ayrıca bu metod, bilinen malignitesi olan hastalarda karaciğer metastazı varlığı yanı sıra metastatik lezyon sayısı, evreleme ve tedavi planlanmasında önemli rol oynamaktadır. Çalışmamızın amacı, MR görüntülemede fokal karaciğer kitlelerinde kontrast madde olarak kullanılan süperparamanyetik demir oksit (SPFeO) preparatının tanı değerini araştırmaktır. Çalışma kapsamına alınan 20 olgunun T1A FLASH ve çift eko TSE T2A sekansları pre- ve post-kontrast olarak incelendi. 11 olguda metastaz, 4 olguda hemanjiom, 4 olguda HCC ve 1 olguda lezyonun biri hemanjiom, diğeri metastazla uyumlu bulundu. Lezyonlardan yapılan sinyal intensite ölçümlerine göre her iki sekansda elde edilen kontrast öncesi ve kontrast sonrası S/N oranları, lezyon-karaciğer kontrastı, C/N oranları ve oranlarda yüzde değişim, kısa ve uzun TE sekanslarda Sİ değişimi ve lezyon-karaciğer Sİ oranları için "Tanımlayıcı istatistikler" hesaplandı, değişkenlerin normal dağılıma uygunluğu "Tek Örneklem Kolmogorov Smirnov testi" ile incelenerek; değişkenlerin pre- ve post-kontrast kıyaslamaları Wilcoxon Signed Ranks Test ile yapıldı. Sadece hemanjiom saptanan olgularda her sekansda S/N oranları (p=0,043) ve çift eko TSE T2A sekansda uzun TE'de Sİ değişimi (p=0,043) anlamlı bulundu. Hemanjiom saptanan olgularda lezyon-karaciğer kontrastı ve lezyon-karaciğer Sİ oranları T1A FLASH ve çift eko TSE T2A sekansda kısa TE'de T2A sekansda anlamlı bulunurken (p=0,043), metastaz olgularında ise tüm sekanslarda anlamlı idi (p=0,002). Metastaz ve HCC olgularında çift eko TSE T2A sekansda kısa TE'de diğer sekanslara oranla C/N oranlarında belirgin yüzde artış saptanırken, hemanjiom olgularında ise C/N oranlarında kontrast sonrasında özellikle çift eko TSE T2A sekansda uzun TE'de azalma belirlendi. Sonuç olarak, karaciğerde gerek lezyon tespiti ve sayısının belirlenmesi, gerekse benign (özellikle hemanjiom) ve primer ya da metastatik malignite ayrımında SPFeO ile MR görüntüleme noninvaziv bir radyolojik metod olarak kullanılabilir.In recent years, the use of organ-specific contrast agents improved the characterization of focal hepatic lesions and resulted in higher diagnostic accuracy. Also this method improved, the accuracy for detection of metastatic lesions, for staging and have critical role for the management of treatment. Purpose of our study was to determine the value of superparamagnetic iron oxide (SPIO) enhanced MR imaging in focal liver lesions. In the present study, T1-weighted FLASH MR images and T2-weighted double-echo TSE MR images were performed to 20 patients, before and after contrast injection. Metastases were detected in 11 patients, hemangioma were detected in 4 patients, HCC were detected in 4 patients and in 1 case there were two lesions, one of them was metastasis while the other was considered as a hemangioma. Signal intensity measurements obtained from two sequences, unenhanced and enhanced image data ?Defining statistics? were calculated for S/N, lesion-liver contrast, C/N ratios and percentage of changes in the ratios, signal intensity changes in short and long TE sequences and signal intensity rate for lesion/liver ratio were analyzed for individual patients with the Wilcoxon Signed Ranks Test. In cases that we found only hemangiomas, in all sequences, S/N ratios (p=0,043) and T2-weighted double-echo TSE with long TE SI change (p=0,043) were significant. In cases with hemangioma in T1-weighted FLASH MR images and T2-weighted double-echo TSE with short TE, lesion-liver contrast and lesion-liver SI changes were significant in T2- weighted MR images (p=0,043). In metastases changes were significant in all sequences. (p=0,002). In cases with metastasis and HCC T2-weighted double-echo TSE with short TE there is an increase in the C/N ratio according to other sequences. While in the cases with hemangiomas T2-weighted double-echo TSE with long TE there is an decrease in the C/N ratios. In conclusion, superparamagnetic iron oxide (SPIO) enhanced MR imaging can be used as a non-invazive radiologic technique for the detection focal liver lesions, determining the number of lesions and differential diagnosis of benign lesions (especially hemangioma) from primary or metastatic malign lesions

Dumbbell Shaped Transforaminal Paravertebral Meningioma

Dambıl tümörler iki veya daha fazla spinal alanı tutan tümörlerdir. Dambıl tümörlerin büyük kısmını schwannomlar oluşturur. Spinal menenjiomların dambıl tümor olarak prezente olması oldukça nadirdir. Spinal dambıl tümör şeklinde prezente olan menenjiomların görüntüleme yöntemleri ile ayırıcı tanısının yapılması hem cerrahi öncesi doğru tedavi planlaması, hem de cerrahi sonrası olası rekürensleri engelleme açısından önemlidir.Dumbbell tumors are tumors of two or more regions of the spinal column. The majority of the dumbbell tumors are schwannomas. The presentation of spinal meningiomas as a dumbbell tumors are very rare. The diagnosis of Dumbbell-shaped meningiomas with imaging methods is important for preoperative accurate treatment planning and to prevent its postsurgical recurrences

Efficacy of Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography (3D CE-MRA) in the Diagnosis of Thoracic Outlet Syndrome

Objective: The purpose of this study is to evaluate the effect of various upper extremity positions (adduction-abduction) on vascular structures in contrast-enhanced three-dimensional MR angiographic studies performed in patients with thoracic outlet syndrome.Materials and Methods: Twenty-two consecutive patients with clinical symptoms of neurovascular thoracic outlet syndrome were examined by 1.0 T MR unit. Examinations were studied by three-dimensional contrast-enhanced MR angiography with the arms positioned in abduction and adduction in the same patients. Results: In twenty-one of 44 subclavian arteries, impingement or stenosis with different degrees were found. Majority of lesions were localized in the costoclavicular region. Venous phase sequences of contrast-enhanced MR angiography showed compression of the subclavian vein in the 17 areas.Conclusion: Thoracic outlet syndrome remains controversial in both diagnosis and treatment, particulary in patients with no muscle atrophy, hand ischemia findings or venous stasis symptoms. Three-dimensional contrast-enhanced MR angiography is noninvasive and requires neither ionizing radiation nor administration of iodinated contrast material- and may be used to diagnose early compression findings and stenosis of the subclavian vessels

Superparamagnetic Iron Oxide Enhanced Magnetic Resonance Imaging in the Detection of Malignant Liver Lesions

Objective: To determine the value of superparamagnetic iron oxide (SPIO)-enhanced MR imaging in malignant liver lesions.Materials and Methods: Twenty patients with various hepatic masses or metastases were investigated with 1 tesla MR. T1-weighted FLASH and double- echo TSE T2-weighted sequences were applied before and after contrast injection. “Defining statistics” were prepared according to pre and postcontrast signal intensity measurements. Results: In this study there were 11 patients with metastases, 4 patients with hemangioma, 4 patients with HCC and one patient with a hemangioma and a metastasis at the same time. In cases wheret we found only hemangiomas, in all sequences, S/N ratios (p=0.043) and T2-weighted double-echo TSE with long TE SI change (p=0.043) were significant. While in the hemangiomas in T2-weighted double-echo TSE with long TE there is an decrease in the C/N ratios; in cases with metastasis and HCC, compared to other sequences significant increase in C/N ratio in T2-weighted double-echo TSE with short TE sequences was detected.Conclusion: SPIO-enhanced MR imaging can be used as a non-invasive radiologic technique for the detection focal liver lesions, to determine the number of lesions and also has a value in differentiating the benign lesions (especially hemangiomas) from primary tumors or metastatic malignant lesions

A Rare Cause of Headache and Increased Intracranial Pressure: Primary Leptomeningeal Melanomatosis

Primary leptomeningeal melanomatosis is a rare central nervous system neoplasm originating from leptomeningeal melanocytes. The cases can be presented with focal neurologic deficit, seizure, neuropsychiatric symptoms or increased intracranial pressure symptoms along with encephalitis or meningitis. Diagnosis can be made upon imaging studies, cytopathologic examination of cerebrospinal fluid and biopsy. Biopsy can return false negative since the leptomeningeal involvement is not diffuse. In this study, a case is presented who admitted to hospital with leptomenengitis symptoms such as headache, fever and altered state of consciousness and developed additional neurologic signs after months. First biopsy came out as normal while the second one did as positive. This case has been found worth presenting since this is a tumor of rare existence and the diagnosis was made upon the second biopsy

A retrospective analysis of anaerobic bacteria isolated in 236 cases of pleural empyema and their prevalance of antimicrobial resistance in Turkey

WOS: 000442664700022PubMed ID: 30146848Background: Parapneumonic effusions usually occur secondary to an infection and produce pus (empyema) that accumulates in the pleural space. We aimed to evaluate the prevalence of anerobes in patients with empyema and to assess their resistance patterns for seven antimicrobials. Methods: Pleural fluid specimens from 236 patients were inoculated on Schaedler agar. Anaerobic bacteria were identified via API 20 A. Susceptibility testing for penicillin, ampicillin + sulbactam, amoxicillin + clavulanate, cefoxitin, clindamycin, metronidazole, and imipenem were performed with the E-test. Results: There were 118 anaerobic bacterial strains detected in 66 (27.9%) of the 236 specimens. Gram-positive anaerobic cocci were detected in 54.23% and the predominant cocci were 41 Peptostreptococcus spp, (34.75%) followed by 17 P. acnes (14.41%) and 6 C. tertium (5.08%). The Gram-negative anaerobes were B. fragilis (28, 23.73%), P. melaninogenica (8, 6.78%), P. intermedia (4, 3.39%), F. nucleatum (6, 5.08%), F mortiferum (5, 4.24%), and P. asaccharolytica (3, 2.54%). All anaerobic strains were susceptible to ampicillin + sulbactam, amoxicillin + clavulanate, and imipenem. The highest MIC was found to be> 256 mu g/mL for penicillin in B. fragilis strains, 128 mu g/mL for cefoxitin in P. melaninogenica strains, 32 mu g/mL for clindamycin and 64 mu g/mL for metronidazole in P. acnes strains. Clindamycin resistance was detected in 46.6% B. fragilis, and 17.6% for P. acnes. Thirty-eight (32.2%) strains produced beta-lactamase. Conclusions: The use of antimicrobial agents for thoracic empyema should be based on the isolated pathogens and their resistance profiles. Clinicians should be aware of the wide diversity of anaerobic genera and species in cases of pleural empyema.Istanbul University Research Found [BYP-900/19.012.006]This study was supported by Istanbul University Research Found. Project no BYP-900/19.012.006