Bariatrik cerrahi sonrası viseral organ yağ infiltrasyon değişikliklerini izlemenin etkili yöntemi: İdeal IQ sekansı

Aim: The aim of this study is to demonstrate the efficiency of non-invasive imaging method-MR proton density fat fraction (PDFF); ideal IQ sequence- on detecting the effects of bariatric surgery on liver and pancreatic fatty infiltration. Materials and Methods: Thirty-nine patients (25 females, 14 males) who underwent bariatric surgery between May 2016 and April 2017 were analyzed retrospectively in this study. Body mass index (BMI) and body weight (BW) values of all patients were noted one week before and one month after bariatric surgery, and meanwhile an unenhanced upper abdominal MR imaging was performed. Liver fat fraction (LFF), pancreas fat fraction (PFF), liver volume (LV) and craniocaudal length of liver (LL) were measured with MR-PDFF and T2 weighted images. Changes in all parameters after the surgery were recorded and the correlation of these changes with the change in LFF was analyzed. Results: At the end of first month of bariatric surgery, a significant decrease on mean values of LFF and PFF has been observed along with a decrease of LV, LL, BW and BMI (p<0.0001). A moderate positive linear correlation was observed between LFF and PFF, LV, LL (r=0.69, 0.61, 0.49; respectively) while a weak positive linear correlation was noticed between LFF and BMI, BW (r=0.34, 0.21; respectively). Conclusion: Ideal IQ sequence enables quantitative analysis of fatty infiltration of the liver and pancreas and thus may be used as a non-invasive tool to monitor the positive effects of the bariatric surgery on fatty infiltration of these visceral organs in the postoperative period.Amaç: Bariatrik cerrahinin karaciğer ve pankreas yağ infiltrasyonu üzerindeki etkilerinin saptanmasında non-invaziv görüntüleme yönteminin-MR proton dansite yağ fraksiyonu (PDFF); ideal IQ sekansı-etkinliğini göstermeyi amaçladık. Gereç ve Yöntem: Bu çalışmada Mayıs 2016 ile Nisan 2017 tarihleri arasında obezite cerrahisi geçiren 39 hasta (25 kadın, 14 erkek) retrospektif olarak incelendi. Tüm hastaların vücut kitle indeksi (VKİ) ve vücut ağırlığı (VA) değerleri bariatrik cerrahiden bir hafta önce ve bir ay sonra kaydedildi ve bu esnada kontrastsız üst abdomen MR görüntülemesi yapıldı. MR-PDFF ve T2 ağırlıklı görüntülerle karaciğer yağ fraksiyonu (KYF), pankreas yağ fraksiyonu (PYF), karaciğer hacmi (KV) ve karaciğer kraniyokaudal uzunluğu (KKU) ölçüldü. Ameliyat sonrası tüm parametrelerdeki değişiklikler kaydedildi ve bu değişikliklerin KYF’deki değişiklik ile korelasyonu analiz edildi. Bulgular: Bariatrik cerrahinin 1. ayının sonunda KYF ve PYF ortalama değerlerinde anlamlı azalma ile birlikte KV, KKU, VA ve VKİ’de azalma gözlendi (p<0,0001). KYF ile PYF, KV, KKU arasında orta derecede pozitif bir doğrusal korelasyon gözlenirken (sırasıyla r=0,69, 0,61, 0,49), KYF ile VKİ, VA arasında (sırasıyla r=0,34, 0,21) zayıf bir pozitif doğrusal korelasyon fark edildi. Sonuç: İdeal IQ sekansı, karaciğer ve pankreasın yağ infiltrasyonunun kantitatif analizini sağlar ve bu nedenle postoperatif dönemde bariatrik cerrahinin bu viseral organların yağ infiltrasyonu üzerindeki olumlu etkilerini izlemek için non-invaziv bir araç olarak kullanılabilir

High-resolution diffusion-weighted imaging compared with conventional diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging with regard to image quality and assessment of breast cancer morphology

PURPOSETo evaluate the image quality and tumor morphology depiction ability of high resolution (HR) diffusion- weighted imaging (f-DWI) in comparison to conventional DWI (c-DWI) and dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) in the primary breast cancer setting.METHODSThe f-DWI, c-DWI, and DCE-MRIs of 160 malignant breast masses were evaluated retrospectively by two independent radiologists. Data on image quality [sharpness, distortion, and perceived signalto- noise ratio (SNR)], apparent diffusion coefficient (ADC) value, lesion size, and tumor morphology (shape, margin, and internal pattern) obtained on f-DWI, c-DWI, and DCE-MRI were compared. Consistency between the readers and imaging methods for morphological parameters was analyzed.RESULTSThe ADC values measured on f-DWI were significantly lower than those measured on c-DWI for both readers (P < 0.001 for each), whereas mean lesion size was significantly larger in c-DWI than in f-DWI and DCE-MRI for both readers (P < 0.001 for each). Higher consistency values were obtained for f-DWI compared with c-DWI when correlated with DCE-MRI for each morphological parameter. The least distorted images were obtained using DCE-MRI compared with c-DWI and f-DWI for both readers, whereas the highest distortion scores were obtained using c-DWI. Sharpness and perceived SNR scores were rated as significantly higher for f-DWI and DCE-MRI images compared with c-DWI by both readers (P < 0.001 for all). The concordance between c-DWI and DCE-MRI was fair to slight (κ = 0.15 to 0.41), whereas concordance between f-DWI and DCE-MRI was significantly better (κ = 0.68 to 0.87) for each reader and for all morphological parameters (P < 0.001). The highest concordance between the readers was achieved in margin assessment (κ = 0.87 to 0.89) regardless of the MRI method, followed by shape and internal pattern parameters (κ = 0.63 to 0.79).CONCLUSIONThe results demonstrated that f-DWI produces higher-quality images than c-DWI, enabling the morphological features to be identified in similar detail to that offered by HR DCE-MRI. Accordingly, f-DWI, as a method that highly correlates with DCE in determining the morphological characteristics of breast cancers, seems to have potential in the evaluation of breast tumors in patients for whom the use of contrast media is contraindicated

Abdominopelvik Ağrı: 137 Olgunun Prospektif Çalışması

Aim: This prospective study aims to evaluate the role of diffusionweighted magnetic resonance (DW-MR) imaging in patients presenting with acute abdominopelvic pain, who are decided a follow-up with conservative treatment after admission in the emergency department. Material and Method: A total of 137 consecutive patients with various causes of acute abdominopelvic pain were followed-up with DW-MR imaging to monitor the response to medical treatment after a primary diagnosis made by combination of DW-MR imaging and computed tomography (CT). Results: The demography of study population was as follows: mean age, 49.8; range, 19–84 years: 72 females, 65 males. For each follow-up DW-MR imaging review, the decision was made by three radiologists in consensus. All data regarding follow-up DW-MR imaging, clinical symptoms and laboratory results were documented. A total of 283 DW-MR scans were performed; 273 DW-MR scans were compatible with the clinical status, while 10 were disconcordant with the clinical status. 11 patients needed a CT scan and 16 patients underwent surgery. Conclusion: DW-MR imaging is a non-invasive and efficient technique that may be used with confidence to monitor patients with non-operated acute abdominopelvic pain during follow-up.Amaç: Bu prospektif çalışmada, difüzyon ağırlıklı manyetik rezonans (DAG-MR) görüntülemenin akut abdominopelvik ağrı ile acil servise baş vuran ve konservatif tedavi ile takip kararı verilen olgulardaki rolünün araştırılması amaçlanmaktadır. Materyal ve Metot: Toplam 137 olguda DAG-MR ve bilgisayarlı tomografi (BT) kombinasyonu ile ilk tanı konulduktan sonra, takipte tedavi yanıtı DAG-MR ile değerlendirildi. Bulgular: Çalışma popülasyonu; ortalama yaş 49,8, yaş aralığı 19–84, 72 kadın ve 65 erkek şeklinde idi. Takipte toplamda 283 DAG-MR tetkiki yapıldı. Bunlardan 273 tanesi klinik bulgular ile uyumluyken, 10 tanesi uyumsuzdu. 11 olguda BT ihtiyacı olurken, 16 tanesi opere edildi. Sonuç: DAG-MR görüntüleme invazif olmayan, etkili bir yöntem olup akut abdominopelvik ağrılı olguların takibinde güvenli bir şekilde kullanılabilir

Catheter Complication in Combined Spinal Epidural Anesthesia

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Contribution of diffusion-weighted imaging to conventional MRI for detection of haemorrhagic infarction in ovary torsion

Abstract Background To assess the role of DWI in differentiation haemorrhagic ovary infarction from non-haemorrhagic one. Methods For this prospectively designed study, of 117 female patients who presented with acute lower quadrant pain and underwent MRI for suspicion of ovary torsion, results of only 29 patients (mean age, 24.7; SD, ±5.7; age range, 18–37), with surgical and pathological confirmation of adnexal torsion, were included to the study. All patients underwent DWI after conventional MRI. Quantitative and qualitative analysis of both the torsed and contralateral normal ovary were performed. Results of conventional MRI and DWI were noted. Results At operation 15 patients were found to have haemorrhagic infarction while 14 had non-haemorrhagic infarction. Of the 29 patients, 17 torsed ovaries could be salvaged in a viable state. We found statistically significant correlation of the ADC values, between haemorrhagic and non-haemorrhagic ovary infarction. The ADC values were significantly lower in patients with haemorrhagic infarction than non-haemorrhagic ones (p < 0.001). Using an ADC threshold of 1.27, the sensitivity of DWI for haemorrhagic infarction was 0.93 and specificity 0.85. Conclusion DWI may be used with a significant success for the preoperative diagnosis of haemorrhagic infarction. This may be alerting for pre-emptive surgery in avoiding serious complications and preventing irreversible structural damage of the ovary

A comparison study of dual-energy spectral CT and 18F-FDG PET/CT in primary tumors and lymph nodes of lung cancer

PURPOSE We aimed to investigate whether there is a correlation between dual-energy spectral computed tomography (DESCT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters in primary tumor and metastatic lymph nodes in patients with newly diagnosed lung cancer. METHODS Primary tumor and metastatic lymph nodes of 68 patients diagnosed with lung cancer were evaluated retrospectively with 18F-FDG PET/CT and DESCT imaging. The histologic subtypes were adenocarcinoma (n=29), squamous cell carcinoma (SCC) (n=26), small cell lung cancer (SCLC) (n=11), and large cell neuroendocrine cancer (LCNEC) (n=2). In terms of PET parameters, SUVmax, SUVmean, SULmax, SULmean, SULpeak, and normalized SUL values were obtained for primary tumors and metastatic lymph nodes. In terms of DESCT parameters, maximum and mean iodine content (IC), normalized IC values, iodine enhancement (IE) and normalized IE values were calculated. RESULTS We found no correlation between DESCT and 18F-FDG PET/CT parameters in primary tumors and metastatic lymph nodes. In addition, no correlation was found in the analysis performed in any of the histologic subgroups. In patients with a primary tumor <3 cm, there was a moderate negative correlation between the parameters SUVmax-ICmax (r= -0.456, p = 0.043), SUVmean-ICmax (r= -0.464, p = 0.039) SULmean-ICmax (r= -0.497, p = 0.026), SUVmax-ICmean (r= -0.527, p = 0.020), SULmean-ICmean (r= -0.499, p = 0.025), and SULpeak-ICmean (r= -0.488, p = 0.029). CONCLUSION We consider that DESCT and 18F-FDG PET/CT indicate different characteristics of the tumors and should not supersede each other

The role of optic nerve sheath diameter measurement on CT in differentiating transient ischemic attack and acute ischemic stroke

Objective: This study aimed to determine if optic nerve sheath diameter (ONSD) measurement on computed tomography could differentiate transient ischemic attack (TIA) from acute ischemic stroke (AIS). Both TIA and AIS are the rings of the same disease chain. To exclude hemorrhagic stroke and stroke mimics in these patients, brain computed tomography (CT) remains the first step imaging modality.Patients and Methods: In this retrospective study, ONSDs of patients with TIA and AIS within three hours from symptom onset to initial CT was measured. The right, left, mean, and delta ONSD measurements were compared between AIS and TIA groups. Then diagnostic accuracy metrics were calculated.Results: A total of 196 patients (128 in the AIS group and 68 in the TIA group) were included. Both mean and delta ONSD of AIS patients were higher than those of the TIA group. The area under the receiver operating curve of mean and delta ONSD for predicting AIS were 0.746 with a sensitivity of 82.8% and a specificity of 42.7% (cut-off: 5.00 mm), and 0.826 with a sensitivity of 67.2% and a specificity of 86.8% (cut-off: 0.50 mm), respectively.Conclusion: Increased mean or delta ONSD measured on initial CT could alert emergency physicians for an impending stroke

Akut Karın Ağrısında Difüzyon Ağırlıklı MR Görüntüleme: Bilgisayarlı Tomografi Öncesi Difüzyon Ağırlıklı Görüntülemenin Tanısal Etkinliğini Araştıran 720 Olgulu Prospektif Çalışma

Çalışmamızda acil servise akut karın ağrısı şikayeti ile başvuran olguların değerlendirilmesinde difüzyon ağırlıklı manyetik rezonans görüntü- lemenin (DA-MRG) bilgisayarlı tomografiye (BT) katkılarının araştırılmasını amaçladık. Gereç ve Yöntem: Olgularımız Ağustos 2014 ve Kasım 2015 tarihleri arasında hastanemiz acil servisine başvuran 2365 hasta içeren gruptan seçilmiştir. Bunlardan 1680 olguya abdominal BT tetkiki yapıldı. Toplam 720 olguya (ortalama yaş, 50.17; yaş aralığı, 16-89; 379 kadın ve 341 erkek) BT öncesinde DA-MRG yapıldı. 960 olgu DA-MRG yapılmadığından çalışma dışında bırakıldı. Hamileler, 16 yaş atındaki çocuklar, üriner sistem taşı olguların çoğu ve barsak obstrüksiyonlu olgular da çalışmaya dahil edilmedi. Görüntülerin değerlendirme stratejisi şu şekilde yapıldı: 1-tek başına DA-MRG'nin değerlendirilmesi, 2-BT'nin tek başına değerlendirilmesi, 3-DA-MRG ve BT'nin beraber değerlendirilmesi. Her radyolog incelemeyi nihai tanıdan habersiz olarak yaptı. İncelemecilere klinik bulgular ve laboratuar verileri hakkında bilgiler verildi. Bulgular: Sonuç olarak akut abdominal ağrı tanısında kombine görüntüleme (DA-MRG ve BT) sensitivitesi ve doğruluğu tek başına BT'ye göre daha yüksek bulundu. Bu sonuç BT tetkiki kontrastsız yapıldığında daha da yüksek bulundu. Sonuç: DA-MRG akut karın ağrılarında özellikle kontrastsız olmak üzere BT'nin tanı doğruluğunu arttırabilecek invazif olmayan tekniktir.O bjective:We aimed to evaluate the contribution of diffusion-weighted magnetic resonance imaging (DW-MRI) to computed tomography (CT) in patients with acute abdominal pain admitted to the emergency department. Material and Method:Between August 2014 and November 2015, a total of 2365 patients with acute abdominal pain were admitted to the eme rgency department. 1680 of those underwent CT imaging. In 720 patients (mean age, 50.17; range, 16-89 years: 379 females, 341 males) DW-MRI was performed before CT scans. 960 patients who had no diffusion imaging were excluded from this study. Pregnant women, children under the age of 16 years old, most of urinary stones and all of bowel obstructions were also excluded from this study. The strategy of imaging review was as follows: 1-evaluation of DW-MRI alone, 2-evaluation of CT alone, and 3-evaluation of both modalities (DW-MRI and CT images). Images were evaluated by different radiologists with at least 5 years of experience in abdominal imaging interpretation, blind to the final diagnosis. Every reader was aware of the clinical symptoms and laboratory results of pat ients. Results: The sensitivity and accuracy of combined imaging (DW-MRI and CT) was higher than CT alone for the detection of cause in acute abdominal pain. This was dramatically higher in non-enhanced CT (NECT) rather than contrast-enhanced CT (CECT) scanning. Conclusion: DW-MRI is a noninvasive technique that may be used to improve the accuracy of CT in many cause of acute abdominal pain, especially in patients undergoing nonenhanced CT scans