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    Accessory liver within the thoracic cavity
    (Springer France, 2018) Adin, Mehmet Emin; Cetincakmak, Mehmet Guli; Deniz, Muhammed Akif; Goya, Cemil
    Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.
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    Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children
    (Springer, 2015) Goya, Cemil; Hamidi, Cihad; Ece, Aydin; Okur, Mehmet Hanifi; Tasdemir, Bekir; Cetincakmak, Mehmet Guli; Hattapoglu, Salih
    Acoustic radiation force impulse (ARFI) imaging is a promising method for noninvasive evaluation of the renal parenchyma. To investigate the contribution of ARFI quantitative US elastography for the detection of renal damage in kidneys with and without vesicoureteral reflux (VUR). One hundred seventy-six kidneys of 88 children (46 male, 42 female) who had been referred for voiding cystourethrography and 20 healthy controls were prospectively investigated. Patients were assessed according to severity of renal damage on dimercaptosuccinic acid (DMSA) scintigraphy. Ninety-eight age- and gender-matched healthy children constituted the control group. Quantitative shear wave velocity (SWV) measurements were performed in the upper and lower poles and in the interpolar region of each kidney. DMSA scintigraphy was performed in 62 children (124 kidneys). Comparisons of SWV values of kidneys with and without renal damage and/or VUR were done. Significantly higher SWV values were found in non-damaged kidneys. Severely damaged kidneys had the lowest SWV values (P < 0.001). High-grade (grade V-IV) refluxing kidneys had the lowest SWV values, while non-refluxing kidneys had the highest values (P < 0.05). Significant negative correlations were found between the mean quantitative US elastography values and DMSA scarring score (r = -0.788, P < 0.001) and VUR grade (r = -0.634, P < 0.001). SWV values of the control kidneys were significantly higher than those of damaged kidneys (P < 0.05). Our findings suggest decreasing SWV of renal units with increasing grades of vesicoureteric reflux, increasing DMSA-assessed renal damage and decreasing DMSA-assessed differential function.
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    Acoustic Radiation Force Impulse (ARFI) imaging for the distinction between benign and malignant thyroid nodules
    (Springer-Verlag Italia Srl, 2015) Hamidi, Cihad; Goya, Cemil; Hattapoglu, Salih; Uslukaya, Omer; Teke, Memik; Durmaz, Mehmet Sedat; Yavuz, Mehmet Siddik
    The aim of the present study was to evaluate thyroid nodules using virtual touch quantification (VTQ) of force impulse acoustic radiation (ARFI) imaging and to investigate a cutoff value for the differentiation of malignant thyroid nodules. Ninety-five patients with quantitatively-assessed (VTQ) thyroid nodules were evaluated with ARFI imaging in this prospective study. ARFI imaging with VTQ was performed only on the nodules which were expected to undergo fine-needle aspiration biopsy (FNAB). All of the thyroid lesions were examined histopathologically. The mean shear wave velocity (SWV) value of the malignant nodules (3.18 +/- A 0.39 m/s) was higher than that of the benign nodules (2.11 +/- A 0.53 m/s). There was a statistically significant difference between the mean SWV values of benign and malignant nodules (p < 0.001). A SWV cutoff value of greater than 2.66 m/s yielded sensitivity and specificity values of 100 and 82.3 %, respectively, for diagnosis of malignant nodules. VTQ of ARFI imaging has high sensitivity and specificity for discriminating between benign and malignant thyroid nodules and may positively contribute to clinical evaluation of these nodules.
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    Acoustic Radiation Force Impulse Imaging for Evaluation of Renal Parenchyma Elasticity in Diabetic Nephropathy
    (Amer Roentgen Ray Soc, 2015) Goya, Cemil; Kilinc, Faruk; Hamidi, Cihad; Yavuz, Alpaslan; Yildirim, Yasar; Cetincakmak, Mehmet Guli; Hattapoglu, Salih
    OBJECTIVE. The goal of this study is to evaluate the changes in the elasticity of the renal parenchyma in diabetic nephropathy using acoustic radiation force impulse imaging. SUBJECTS AND METHODS. The study included 281 healthy volunteers and 114 patients with diabetic nephropathy. In healthy volunteers, the kidney elasticity was assessed quantitatively by measuring the shear-wave velocity using acoustic radiation force impulse imaging based on age, body mass index, and sex. The changes in the renal elasticity were compared between the different stages of diabetic nephropathy and the healthy control group. RESULTS. In healthy volunteers, there was a statistically significant correlation between the shear-wave velocity values and age and sex. The shear-wave velocity values for the kidneys were 2.87, 3.14, 2.95, 2.68, and 2.55 m/s in patients with stage 1, 2, 3, 4, and 5 diabetic nephropathy, respectively, compared with 2.35 m/s for healthy control subjects. Acoustic radiation force impulse imaging was able to distinguish between the different diabetic nephropathy stages (except for stage 5) in the kidneys. The threshold value for predicting diabetic nephropathy was 2.43 m/s (sensitivity, 84.1%; specificity, 67.3%; positive predictive value, 93.1%; negative predictive value 50.8%; accuracy, 72.1%; positive likelihood ratio, 2.5; and negative likelihood ratio, 0.23). CONCLUSION. Acoustic radiation force impulse imaging could be used for the evaluation of the renal elasticity changes that are due to secondary structural and functional changes in diabetic nephropathy.
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    Advantages of US in Percutaneous Dilatational Tracheostomy: Randomized Controlled Trial and Review of the Literature
    (Radiological Soc North America, 2014) Yavuz, Alpaslan; Yilmaz, Murat; Goya, Cemil; Alimoglu, Emel; Kabaalioglu, Adnan
    Purpose: To compare procedure times and complication rates of preincisional ultrasonographic (US) evaluation and perioperative US guidance in percutaneous dilatational tracheostomy (PDT) with those of the current standard of care, PDT performed without image guidance. Materials and Methods: Between December 2007 and January 2011, 341 patients were included in this institutional review board-approved study after informed consent was obtained from the patients or their relatives. The patients were divided randomly into two groups. In group A (n = 166), the possible causes of complications, such as aberrations of tracheal, thyroidal, and vascular structures, were determined with US, and tracheal measurements were performed by using US. The clinician's initial considerations at physical examination were compared with the US findings. PDT was subsequently performed with US guidance in suitable cases. In group B (n = 175), PDT was performed solely on the basis of physical landmarks. The procedure times and complication rates were compared across groups by using the Fisher exact test. Results: In group A, the puncture sites designated at the physical examination were reconsidered in 39 (23.8%) of 164 cases. The perioperative complication rates were slightly lower in group A (7.8% [12 of 154]) than in group B (15.0% [25 of 167]); however, the difference did not achieve statistical significance (P = .054). The mean procedure times for groups A and B were 24.09 minutes +/- 8.05 (standard deviation) (range, 14-68 minutes) and 18.62 minutes +/- 6.34 (range, 12-81 minutes), respectively (P = .001), and the numbers of patients in each group who required multiple puncture attempts were six (3.9%) of 154 and 23 (13.6%) of 169 (P = .003), respectively. Conclusion: The use of US guidance before and during PDT could render the procedure easier and safer, with fewer complications but a slightly longer procedure time. (C) RSNA, 2014
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    Anterior hepatic grooves accompanied by Chilaiditi sign: a retrospective radiological analysis of a neglected anatomical fact
    (Springer France, 2015) Yavuz, Alpaslan; Batur, Abdussamet; Bulut, Mehmet Deniz; Bora, Aydin; Goya, Cemil; Andic, Cagatay; Beyazal, Mehmet
    To evaluate anterior hepatic grooves (AHGs) associated with hepato-diaphragmatic mesocolic indentations (Chilaiditi sign) and to delineate the incidence and potential clinical significance of this association. Between November 2011 and June 2014, abdominal computed tomography examinations of 2,314 patients with varied indications were retrospectively reviewed. Patients were surveyed consecutively for the Chilaiditi sign and syndrome, and cases with grooves at the antero-inferior hepatic surface enclosing the adjacent mesocolic indents were determined. The incidence of AHGs and their predominance by gender and age were determined. The potential clinical significance of AHGs associated with Chilaiditi syndrome and their possible effect on liver volume were assessed. The incidences of AHGs were similar between genders (p = .461 and p = .646) and age (p = .113 and .621, respectively) among total cohort and patients with Chilaiditi sign, respectively. There was no significant correlation between AHGs and Chilaiditi syndrome (p = .506); no efficacies of AHGs to liver volume were assessed (p = .413). The AHGs are rare adaptive changes in shape of the liver without a significant effect on liver volume. This overlooked phenomenon is likely derived from the Chilaiditi sign, but has no significant correlation with Chilaiditi syndrome. Future studies with extended series are encouraged to reveal the possible significance of this phenomenon based on concerned surgical interventions.
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    Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: Is it a predisposing factor for rupture risk?
    (Int Scientific Information, Inc, 2013) Dusak, Abdurrahim; Kamasak, Kaan; Goya, Cemil; Adin, Mehmet E.; Elbey, Mehmet A.; Bilici, Aslan
    Background: A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture. Material/Methods: The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant. Results: General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs. Conclusions: Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space.
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    Assessment of Placental Stiffness Using Acoustic Radiation Force Impulse Elastography in Pregnant Women with Fetal Anomalies
    (Korean Radiological Soc, 2016) Alan, Bircan; Goya, Cemil; Tunc, Senem; Teke, Memik; Hattapoglu, Salih
    Objective: We aimed to evaluate placental stiffness measured by acoustic radiation force impulse (ARFI) elastography in pregnant women in the second trimester with a normal fetus versus those with structural anomalies and non-structural findings. Materials and Methods: Forty pregnant women carrying a fetus with structural anomalies diagnosed sonographically at 18-28 weeks of gestation comprised the study group. The control group consisted of 34 healthy pregnant women with a sonographically normal fetus at a similar gestational age. Placental shear wave velocity (SWV) was measured by ARFI elastography and compared between the two groups. Structural anomalies and non-structural findings were scored based on sonographic markers. Placental stiffness measurements were compared among fetus anomaly categories. Doppler parameters of umbilical and uterine arteries were compared with placental SWV measurements. Results: All placental SWV measurements, including minimum SWV, maximum SWV, and mean SWV were significantly higher in the study group than the control group ([0.86 +/- 0.2, 0.74 +/- 0.1; p < 0.001], [1.89 +/- 0.7, 1.59 +/- 0.5; p = 0.04], and [1.26 +/- 0.4, 1.09 +/- 0.2; p = 0.01]), respectively. Conclusion: Placental stiffness evaluated by ARFI elastography during the second trimester in pregnant women with fetuses with congenital structural anomalies is higher than that of pregnant women with normal fetuses.
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    Bilateral cleft foot: Radiographic and prenatal ultrasound features of two siblings with a review of literature
    (Elsevier Urban & Partner Sp Z O O, 2016) Durmaz, Mehmet Sedat; Demirtas, Hakan; Hattapoglu, Salih; Kara, Taylan; Goya, Cemil; Adin, Mehmet Emin
    Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is characterized by deformities like median deep clefts of distal extremities. Routine examination of feet during second-trimester ultrasound (US) may increase the detection rates of foot malformations. Many malformations can be diagnosed with 2-dimensional (2D) US, but 3-dimensional (3D) US also helps better understanding of the foot malformations. In the present study, we report the case of two brothers (a fetus and a 5-year-old) with cleft foot deformity. 2D and 3D second trimester US findings of one case and the foot radiography findings of the other are presented here. (C) 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Sp. z o.o.
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    A case of xanthogranulomatous pyelonephritis mimicking wilms tumor
    (Turkish National Pediatric Society, 2015) Tüysüz, Gülen; Tayfun, Funda; Canpolat, Fetiye; Zeytun, Hikmet; Goya, Cemil; Keleş, Ayşe Nur; Özdemir, Nihal
    Xanthogranulomatous pyelonephritis (XGPN) is a very rare, unusual variant of pyelonephritis characterized by destruction of renal parenchyma. It usually occurs in adults with a history of recurrent urinary tract infections. The condition is rare in children and the disease can imitate renal tumors. Here, we describe a 12-year-old boy who presented with abdominal pain. He did not have any history of urinary tract infection. Computed tomography and magnetic resonance imaging showed a cystic lesion in the left upper kidney. The patient underwent radical nephrectomy with a provisional diagnosis of Wilms tumor however histopathological examination of specimen revealed XGPN. Xanthogranulomatous pyelonephritis should be kept in mind in the differential diagnosis of renal lesions in childhood, during surgery if any suspicion from the diagnosis, a frozen biopsy should have been taken.
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    Çocuk cerrahisi kliniğinde ultrasonografinin yeri ve önemi
    (Dokuz Eylül Üniversitesi Tıp Fakültesi, 2014) Arslan, Serkan; Okur, Mehmet Hanifi; Zeytun, Hikmet; Basuguy, Erol; Arslan, Mehmet Şerif; Aydoğdu, Bahattin; Goya, Cemil
    Öz:Amaç: Son bir yılda çocuk cerrahisi kliniğimizde Ultrasonografi (USG) rehberliğinde yapılan işlemlerin ve çocuk cerrahları tarafından USG'nin kullanım alanlarının değerlendirmesi yapıldı. Klinisyenler tarafından USG'nin kullanımının ne derece yaygın olması gerektiği, radyologlar ve klinisyenlerin USG kullanımındaki yerlerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Bu çalışmada Ocak 2013-2014 yılları arasında 63 hasta geriye dönük olarak değerlendirildi. Üriner sistem patolojisi ve/veya santral damar yolu gibi girişimsel işleme gereksinim olan hastalar USG ile değerlendirildi. Üriner sistem ile ilgili patoloji olduğu düşünülen hastalara başvuruları sırasında poliklinikte, klinisyen tarafından USG ile hastaların böbrek, üreter, ve mesaneleri değerlendirildi. Daha sonra radyolog tarafından USG'leri tekrarlanarak ikinci kez değerlendirme yapıldı. Santral kateter gereksinimi olan hastaların karotis arter ve internal juguler ven USG ile görüntülendikten sonra 45 derece açı ile seldinger yöntemi ile kateterizasyon sağlandıktan sonra işlem sonlandırıldı. Üriner sistem patolojilerinde nefrostomi veya sistofiks gerekli olan hastalara USG eşliğinde kateter takıldı. Tüm bu işlemler Çocuk Cerrahisi Kliniğinde gerçekleştirildi. Bulgular: 2013-2014 yılları arasında 30'u erkek, 33'ü kız olmak üzere toplam 63 hastanın bilgileri geriye dönük olarak değerlendirildi. Hastaların 42'sine tanısal amaçlı USG yapılırken, 21 hastaya invaziv girişimler USG eşliğinde yapılmıştır. Sonuç: Üriner USG'ler her zaman hem radyolog, hem de klinisyen tarafından ayrı ayrı yapılarak çift kontrollü olarak değerlendirilmelidir. Ayrıca Santral Venöz Kateterizasyon (SVK), kateter ihtiyacı takılması gibi invaziv girişimlerin USG eşliğinde yapılması non invaziv olup işlem süresini kısaltmakta, hem de komplikasyonları azaltmaktadır. İnvaziv girişimler öğrenme eğrisine bağlı olarak değişmekle beraber yeterli sayıda tanısal amaçlı yapılan USG'lerden sonra yapılmalıdır.
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    Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions
    (Amer Inst Ultrasound Medicine, 2015) Teke, Memik; Goya, Cemil; Teke, Fatma; Uslukaya, Omer; Hamidi, Cihad; Cetincakmak, Mehmet Guli; Hattapoglu, Salih
    Objectives-Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions. Methods We prospectively examined 141 breast lesions in 122 patients. All lesions were classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography, BI-RADS for sonography, and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) pattern. Internal and marginal shear wave velocity (SWV) values for the lesions were noted. The sensitivity, specificity, accuracy, and positive and negative predictive values for VTI and Virtual Touch tissue quantification (VTQ Siemens Medical Solutions) were calculated. Results The marginal SWV values were statistically higher in malignant lesions (mean +/- SD, 5.41 +/- 1.37 m/s) than benign lesions (2.91 +/- 0.88 m/s; P < .001). When the SWV cutoff level was set at 4.07 m/s, and the higher of the internal and marginal values was adopted, the combination of VTI and VTQ showed 95.1% sensitivity, 99.0% specificity, and 97.8% accuracy. Conclusions Breast Imaging Reporting and Data System category 4 lesions are the main focus of research for early detection of breast cancer. Unfortunately, BI-RADS category 4 assessment covers a-wide range of likelihood of malignancy (2%-95%). This wide range reflects the necessity for a more specific imaging modality. The combination of. VTI and VTQ could increase the diagnostic performance of conventional sonography.
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    A comparison of acoustic radiation force impulse imaging and scintigraphy in the functional evaluation of the major salivary glands
    (Lippincott Williams & Wilkins, 2015) Tasdemir, Bekir; Goya, Cemil; Dostbil, Zeki; Sengul, Engin; Sezgin, Ilhan; Hattapoglu, Salih
    Purpose This study aimed to determine the efficacy of acoustic radiation force impulse (ARFI) imaging for the functional assessment of salivary glands by comparing ARFI with salivary gland scintigraphy. Materials and methods We prospectively evaluated 60 parotid (P) glands and 60 submandibular (SM) glands of 30 patients using salivary gland scintigraphy and ARFI elastography. The average pixel uptake and the excretion fraction (EF) in the P and SM glands were determined scintigraphically. The degree of stiffness in the P and SM glands at prelemon and postlemon stimulation periods were measured elastographically with ARFI. Changes in the degree of stiffness of the P and SM glands were also calculated with lemon stimulation. The scintigraphic and elastographic parameters were then compared statistically. Results We found a moderate linear correlation between the excretion function and the changes in the degree of stiffness of the P and SM glands induced by lemon stimulation (P<0.001, r=0.661; P<0.001, r=0.530, respectively). We also found a weak positive correlation between the EF and the degree of stiffness of the P and SM glands in the prelemon stimulation period (P=0.001, r=0.405; P<0.001, r=0.480, respectively). However, we did not find any significant correlation between other scintigraphic and elastographic parameters. Conclusion ARFI imaging may play a role in the determination of the EF of P and SM glands by measuring tissue elasticity changes with lemon stimulation. However, ARFI does not seem to be a suitable substitute for scintigraphy in the evaluation of the parenchymal function of P and SM glands. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
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    Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging
    (Springer Japan Kk, 2017) Teke, Memik; Teke, Fatma; Alan, Bircan; Turkoglu, Ahmet; Hamidi, Cihad; Goya, Cemil; Hattapoglu, Salih
    Purpose Differentiation of idiopathic granulomatous mastitis (IGM) from carcinoma with routine imaging methods, such as ultrasonography (US) and mammography, is difficult. Therefore, we evaluated the value of a newly developed noninvasive technique called acoustic radiation force impulse imaging in differentiating IGM versus malignant lesions in the breast. Methods Four hundred and eighty-six patients, who were referred to us with a presumptive diagnosis of a mass, underwent Virtual Touch tissue imaging (VTI; Siemens) and Virtual Touch tissue quantification (VTQ; Siemens) after conventional gray-scale US. US-guided percutaneous needle biopsy was then performed on 276 lesions with clinically and radiologically suspicious features. Malignant lesions (n = 122) and IGM (n = 48) were included in the final study group. Results There was a statistically significant difference in shear wave velocity marginal and internal values between the IGM and malignant lesions. The median marginal velocity for IGM and malignant lesions was 3.19 m/s (minimum-maximum 2.49-5.82) and 5.05 m/s (minimum-maximum 2.09-8.46), respectively (p < 0.001). The median internal velocity for IGM and malignant lesions was 2.76 m/s (minimum-maximum 1.14-4.12) and 4.79 m/s (minimum-maximum 2.12-8.02), respectively (p < 0.001). Conclusion The combination of VTI and VTQ as a complement to conventional US provides viscoelastic properties of tissues, and thus has the potential to increase the specificity of US.
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    The distribution of stylohyoid chain anatomic variations by age groups and gender: an analysis using MDCT
    (Springer, 2013) Ekici, Faysal; Tekbas, Guven; Hamidi, Cihad; Onder, Hakan; Goya, Cemil; Cetincakmak, Mehmet Guli; Gumus, Hatice
    The aim of this study is to investigate the frequency of the SHC variations, and the distribution of the SP lengths in different age and sex groups using MDCT. MDCT scans were performed in 805 patients (401 males, 404 females). The patients were divided into six groups according to their ages. The length of the styloid process (SP) and its angulation on the transverse (TA) and sagittal (SA) planes were measured. Structural variations of the SHC were observed by means of three-dimensional (3D) and multiplanar reconstruction (MPR) images. Absence of the styloid process (n = 10), double proximal origin (n = 13), segmentation (n = 223), complete ossification (n = 24), and an SP with three proximal parts in one patient were among the anomalies detected. The mean length of the SP was greater in males than in females (33.2 +/- A 13.2 vs. 29.6 +/- A 10.5 mm, P < 0.001). Elongated SP (ESP) was observed in 56 % of the patients in the study group, and this ratio was the highest in Group 3 with 65.4 % (P < 0.05). TA and SA were 70.2A degrees A A +/- A 4.1A degrees, 69.9A degrees A A +/- A 4.2A degrees and 86.6A degrees A A +/- A 6.5A degrees, 88.3A degrees A A +/- A 6.6A degrees for the right and left sides, respectively. Besides, 3D and MPR images also present detailed and reliable data to radiologists and surgeons for the evaluation of the SHC. ESP has been detected in more than half of the patients, being more frequent in males and in individuals in the fifth decade of life. For an accurate diagnosis, clinicians should consider the ESP while evaluating the patients in this age group.
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    Ectopia Cordis and Pentalogy of Cantrell: Report of Two Cases
    (Aras Part Medical Int Press, 2014) Bakacak, Murat; Bostanci, Mehmet Suhha; Serin, Salih; Goya, Cemil; Bakacak, Zeynep; Avci, Fazli
    Ectopia cordis (EC) is the presence of a live, beating heart outside the thorax and is one of the most unique congenital anomalies. EC has been a weak association noted with trisomy 18 and a few cases have been associated with other chromosomal abnormalities. Pentalogy of cantrell (PC) is a rare congenital syndrome of abdominal wall defect, lower sternal defect, diaphragmatic pericardial defect, anterior diaphragmatic defect, and intracardiac abnormalities. It has a rare frequency of about 1/100,000 births. The hallmark of this syndrome is an omphalocele associated with EC. Only a few patients with the full spectrum of the pentalogy have been described. Only very few patients survive attempts at surgical repair, the main causes of death being tachyarrhythmias, bradycardia, low blood pressure, rupture of the diverticulum, and heart failure. Early diagnosis is important about discuss the option of elective termination with the parents if intracardiac anomalies of incompatible with life are noted. We report two cases of PC diagnosed in early second trimester.
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    Effectiveness of the addition of the brain region to the FDG-PET/CT imaging area in patients with suspected or diagnosed lung cancer
    (Springer-Verlag Italia Srl, 2016) Tasdemir, Bekir; Urakci, Zuhat; Dostbil, Zeki; Unal, Kemal; Simsek, F. Selcuk; Teke, Fatma; Goya, Cemil
    Purpose We aimed to evaluate the effectiveness of the brain region imaging in FDG-PET/CT scanning of patients with suspected or diagnosed lung cancer. Materials and methods We performed the study retrospectively on the medical charts of 427 patients. We divided the FDG-PET/CT field of view (FOV) into four major imaging regions: brain, head-neck, abdomen and pelvis. Metastatic findings on these regions were checked and determined the potential of these findings to affect the chemotherapy or radiotherapy protocol or surgical management. If metastatic findings had a potential to modify these parameters, we named this situation as clinical contribution. Considering the number of bed positions of these regions, we calculated the clinical contribution of each region and named as effective clinical contribution. Then, we calculated the metastatic findings, clinical contribution, and effective clinical contribution ratios. Results We found different brain metastasis ratios for lung cancer, solitary pulmonary mass (SPM), and solitary pulmonary nodule (SPN) groups (8.7, 2.8 and 0.9 %, respectively). In addition, the clinical contribution and effective clinical contribution ratios in the brain region for these three groups were 6.4, 2.8, 0.0 and 6.4, 2.8, 0.0 %, respectively. The highest metastatic findings (30.6 %) and clinical contribution (9.8 %) ratios were found in the abdomen region of the lung cancer group. However, the highest effective clinical contribution ratio (6.8 %) was found in the brain region within the same group. Conclusions The addition of the brain region to the limited whole-body FOV in FDG-PET/CT scanning seems to be effective in the lung cancer and SPM groups, but not in the SPN group.
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    Evaluation of Parathyroid Lesions With Point Shear Wave Elastography
    (Amer Inst Ultrasound Medicine, 2016) Hattapoglu, Salih; Goya, Cemil; Hamidi, Cihad; Tasdemir, Bekir; Alan, Bircan; Durmaz, Mehmet Sedat; Teke, Memik
    Objectives-The aim of our study was to evaluate the shear wave velocity (SWV) of parathyroid lesions by point shear wave elastography (SWE) and to compare their stiffness with that of thyroid nodules and normal thyroid parenchyma quantitatively. Methods-Thirty-six patients considered to have parathyroid disorders by clinical and laboratory tests and scintigraphy were enrolled in the study between January 2012 and February 2015. Conventional sonography, Doppler sonography, and the Virtual Touch tissue quantification (VTQ) method of point SWE (Siemens Medical Solutions, Mountain View, CA) were conducted with a linear transducer (4-9 MHz) while the patients were in the supine position. Then we compared our VTQ measurements with pathologic results. Results-The 36 patients included 31 female and 5 male patients with a mean age +/- SD of 49 +/- 15.7 years (range, 15-79 years). The mean SWV of parathyroid hyperplasia lesions (n = 4) was 1.46 +/- 0.23 m/s, whereas the mean SWV of parathyroid adenomas (n = 32) was 2.28 +/- 0.50 m/s. The mean SWV of normal thyroid parenchyma (n = 36) was 1.62 +/- 0.20 m/s, and the mean SWV of benign thyroid nodules (n = 21) was 2.25 +/- 0.51 m/s. A significant difference was found between SWV values of normal thyroid parenchyma and parathyroid adenoma (P<.001). A cutoff value of 1.73 m/s for adenomas led to 90.0% sensitivity and 80.6% specificity. Conclusions-The VTQ method of point SWE may contribute to the discrimination of parathyroid adenomas from the thyroid gland. However, more comprehensive studies are needed.
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    Evaluation of postoperative undescended testicles using point shear wave elastography in children
    (Elsevier Science Bv, 2016) Hattapoglu, Salih; Goya, Cemil; Arslan, Serkan; Alan, Bircan; Ekici, Faysal; Tekbas, Guven; Yildiz, Ismail
    Purpose: To demonstrate the difference in tissue stiffness by comparing the value of the shear wave velocity (SWV) of postoperative undescended testicles with that of normal testes. Methods: This study included 39 patients and 30 healthy controls. US and p-SWE (VTQ) were performed using with a linear probe (4-9 MHz). Forty-seven operated undescended testicles comprised Group A, 27 testes with normal scrotal placement since birth in patient population comprised Group B. A total of 60 testes in 30 healthy controls were included as Group C. Finally, the testes of Group A, B, C were statistically compared in terms of the SWV and volume. Results: The shear wave values of the 47 testes in Group A were 0.75-2.8 (median, 1.1) m/s, and the SWVs of the 27 testes in Group B were 0.62-1.2 (median, 0.84) m/s. The SWVs of the 60 testes in Group C were 0.65-1 (median, 0.82) m/s. The testicular volumes of Group A ranged from 0.19 to 4.7 (median, 0.15) cm(3), Group B ranged from 0.34 to 8 (median, 0.74) cm(3) and Group C ranged as 0.4-15.5 (median, 0.91) cm(3). Conclusions: VTQ method of p-SWE is a new method that may reveal the difference in stiffness between scrotally placed testes and postoperative undescended testicles. (C) 2016 Elsevier B.V. All rights reserved.
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    Evaluation of Retrobulbar Blood Flow with Color Doppler Ultrasonography in Patients with Central Serous Chorioretinopathy
    (WILEY-BLACKWELL, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, 2014) Hamidi, Cihad; Türkçü, Fatih Mehmet; Goya, Cemil; Çetinçakmak, Mehmet Güli; Yüksel, Harun; Teke, Memik; Hattapoğlu, Salih; Bilici, Aslan
    Background. To compare retrobulbar blood flow in patients with central serous chorioretinopathy (CSC) and healthy subjects using color Doppler ultrasonography. Methods. Thirty patients (age 23-54 years) with a first episode of acute CSC and 30 healthy controls (age 30-44 years) were evaluated. The peak systolic blood flow velocity, end-diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were measured in the ophthalmic, posterior ciliary, and central retinal arteries. Results. The posterior ciliary and central retinal artery EDV were lower in the patient group than in the control group, whereas RI and PI values were significantly higher (p < .05). The ophthalmic artery peak systolic blood flow velocity and EDV were lower in the CSC than in the control group (p < .05) without significant difference in RI and PI. Conclusions. Color Doppler ultrasonography provides additional insights into the pathophysiology of CSC and may support the vasospasm hypothesis. (C) 2014 Wiley Periodicals, Inc.