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Öğe 3-T MRI of the biliary tract variations(Springer France, 2013) Onder, Hakan; Ozdemir, Muhammed Siddik; Tekbas, Guven; Ekici, Faysal; Gumus, Hatice; Bilici, AslanThe gallbladder and the biliary tract are structures in close connection with the adjacent organs and may show a number of variations and anomalies. It is therefore important for surgical purposes to know their anatomy and variations in detail. Various methods are used in the imaging of the variations of the biliary tract and its pathologies, including ultrasonography, computed tomography; direct cholangiographic methods like endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, intravenous cholangiography and T-tube cholangiography, as well as indirect methods like magnetic resonance cholangiopancreatography (MRCP) or cholescintigraphy. The aim of this study is to investigate the frequency of the anatomic variations of the biliary tract using 3-T MRCP and to compare the findings with the data in the literature. For the purposes of this study, patients who underwent MRCP at our hospital (Dicle University Hospital) between November 2009 and February 2012 were investigated retrospectively. A total of 590 patients (between 6 and 88 years of age; mean age: 51 +/- A 9 years) were included in the study. The MRCP imaging was carried out with an magnetic resonance imaging (MRI) device supplied with 3-T magnetic power and by obtaining T2-weighted images through the single-shot fast spin echo technique using the standard body coil. The axial and coronal source images and the reformatted images were evaluated together in terms of the possible anatomic variations. Among the 590 patients included in the study, of 233 (39.5 %) showed anatomic variations at different levels in the intra- and extrahepatic biliary tracts. Among these variations, a right posterior hepatic duct insertion to the left hepatic duct at the level of the bifurcation has been observed in 71 patients (12.1 %), trifurcation was observed in 30 patients (5.1 %) and insertion into the main hepatic duct at the proximal aspect of the cystic duct was observed in 18 patients (3.1 %). At the level of the cystic duct, medial insertion of the cystic duct was viewed in 58 patients (9.8 %), distal medial insertion was seen in 40 patients (6.8 %), a short cystic duct was detected in 10 patients (1.7 %), pancreatobiliary junction anomaly was viewed in two patients (0.4 %) and duplicate anatomic variations have been observed in 42 patients (7.2 %). MRCP studies conducted using 3-T MRI devices may reveal similar or greater numbers of variations when compared to the existing MRCP studies in the literature. 3-T MRI shows a couple of variations. Pointing out these anatomical variations before the surgical intervention may prevent possible iatrogenic traumas. Donors with unsuitable variations for liver transplant may be spotted out at an early phase through the MRCP and certain operations with a high morbidity rate may thus be avoided.Öğe Clinical and multidetector computed tomography findings of patients with median arcuate ligament syndrome(Elsevier Science Inc, 2012) Gumus, Hatice; Gumus, Metehan; Tekbas, Guven; Onder, Hakan; Ekici, Faysal; Cetincakmak, Mehmet Guli; Bilici, AslanObjectives: The present study aimed to present the clinical and multidetector computed tomography (MDCT) findings of patients who were diagnosed with the median arcuate ligament (MAL) syndrome on MDCT retrospectively. Methods: Seven hundred forty-four patients in whom MDCT angiography was performed were retrospectively analyzed for investigating incidental MAL syndrome. Results: Twenty-one patients were shown to have MAL syndrome. Of 21 patients, 18 with MAL syndrome were asymptomatic. Three patients had some symptoms. On MDCT angiography, proximal narrowing of the arteries was observed in 21 patients. Conclusions: MDCT is a minimally invasive and useful tool for the diagnosis of MAL syndrome. (c) 2012 Elsevier Inc. All rights reserved.Öğe Course anomalies of extracranial internal carotid artery and their relationship with pharyngeal wall: an evaluation with multislice CT(Springer France, 2012) Ekici, Faysal; Tekbas, Guven; Onder, Hakan; Gumus, Hatice; Cetincakmak, Mehmet Guli; Palanci, Yilmaz; Bakir, SalihThe goal of our study was to measure the prevalence of anomalies in the extracranial segment of internal carotid artery (ICA), to measure the carotid-pharyngeal distance (CPD). Computed tomography (CT) angiography images of 607 patients were retrospectively examined. The course anomaly and CPD were obtained at different image plane. The patients were divided into four groups according to their age. The incidence of course anomaly in ICA was shown to be 60.3 %. Prevalence of course anomaly showed an increase with age (p < 0.001). Women had more ICAs with a course anomaly than men (p < 0.001). Mean CPD among all ICAs was found to be 11.13 mm. When CPD values were compared between the groups, group 1 and group 2 did not have a significant difference, however, there was a significant difference between other groups (p < 0.05). The CPD significantly decreased with age (p < 0.001). In ICAs that showed a straight course, the mean CPD was 13.0 mm, while in ICAs that showed course anomaly, the mean CPD was determined to be 9.49, showing a significant difference (p < 0.05). In conclusion, the number of ICAs that show a course anomaly increases with age, while the CPD decreases. The CPD is decreased in groups that show anomalies. The detection of a decreased CPD before surgery may lower the chance of a perioperative hemorrhage due to artery damage during pharyngeal procedures. Hence, while reporting neck CT angiographies, it may be valuable to also report the presence of ICA anomalies and CPD.Öğe Display with 64-detector MDCT angiography of cerebral vascular variations(Springer France, 2013) Hamidi, Cihad; Bukte, Yasar; Hattapoglu, Salih; Ekici, Faysal; Tekbas, Guven; Onder, Hakan; Gumus, HaticeThe aim of this study was to assess the cerebral variations and observe their frequency in the patients who have undergone angiographies with the state of the art 64-slice multidetector computed tomography (MDCT) angiography technique due to various reasons. 500 patients (253 women, 247 men) who had CT scan in the period of April 2008 to March 2010 at Dicle University Medicine Faculty Hospital Radiology Unit were surveyed in this study. Patients who had CT scan with brain CT angio protocol were evaluated using multiplanar, maximum intensity projection (MIP) and volume rendering (VR) images in work station. 773 variations were totally detected among 500 patients. Variations were categorized as Willis polygon, fenestration and other variations. Frequent variations were detected at Willis polygon and posterior communicating artery (PCOA) hypoplasia was detected as the prevalent variation. In the present study, we have demonstrated that cerebral vascular variations are frequent and that these variations can be detected in a non-invasive manner using the MDCT angiography. The results obtained from our study may serve as preoperative guidelines for the units performing surgical procedures.Öğe 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, HaticeThe 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.Öğe Easy Retrieval of Escaping Onyx Fragment with Percutaneous Manual Aspiration(Springer, 2011) Duymus, Mahmut; Gur, Serkan; Onder, Hakan; Oguzkurt, Levent[Abstract Not Available]Öğe The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function(Springer, 2013) Gur, Serkan; Ozkan, Ugur; Onder, Hakan; Tekbas, Guven; Oguzkurt, LeventTo determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 +/- A 5 years; range 42-67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4-25) before the procedure to 20 (range 1-25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.Öğe Endovascular Treatment of Infrarenal Abdominal Aortic Lesions With or Without Common Iliac Artery Involvement(Springer, 2013) Onder, Hakan; Oguzkurt, Levent; Gur, Serkan; Tekbas, Guven; Gurel, Kamil; Coskun, Isa; Ozkan, UgurTo evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery. Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography. Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy. Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.Öğe Endovascular treatment of surgically implanted arterial graft thrombosis by using manual aspiration thrombectomy(Turkish Soc Radiology, 2013) Onder, Hakan; Oguzkurt, Levent; Ozkan, Ugur; Gurel, Kamil; Gur, Serkan; Andic, Cagatay; Tekbas, GuvenThe purpose of this study was to present our experience with guiding catheters in manual aspiration thrombectomy of occluded infra-aortic bypass grafts. This material was designed as a guiding catheter but was also used for thrombus aspiration. Six consecutive patients (all male; mean age, 61.0 +/- 5.7 years; range, 54-68 years) who underwent manual aspiration thrombectomy at the discretion of the operator for infra-aortic bypass graft thrombosis between 2002 and 2010 were retrospectively reviewed. The angiographic success described as either stenosis or residual thrombus less than 30% was 67%. Primary patency was 50%, and secondary patency was 66.7%. Additional stents were needed in four lesions of three patients. Manual aspiration thrombectomy is intended to remove both soft acute blood clots and hard organized embolic and thrombotic obstructions. Manual aspiration thrombectomy appears to be a safe and effective method for treating delayed graft thrombosis. This method provides an alternative to surgical thrombectomy, especially for patients who are not good candidates for the surgery.Öğe Endovascular Treatment of Veno-Occlusive Behcet's Disease(Springer, 2012) Tekbas, Guven; Oguzkurt, Levent; Gur, Serkan; Onder, Hakan; Andic, CagatayTo retrospectively evaluate the outcome of endovascular treatments for patients with chronic veno-occlusive disease in different vascular beds secondary to Behcet's disease (BD). There are few case reports on the subject, and this is the largest study to date. From January 2001 through October 2009, chronic venous occlusions were treated in 10 patients (all male [age range 18-76 years]) with BD using percutaneous transluminal angioplasty and/or stent placement. All patients were symptomatic and had chronic iliofemoral deep venous thrombosis (DVT; n = 5), central venous occlusion (n = 3), or Budd-Chiari syndrome (BCS; n = 2). All patients met criteria of the International Study Group on Behcet's Disease. Two of five patients with DVT had unsuccessful recanalization attempts. Three patients had successful recanalization with stent placement. All three veins were occluded within 1 month with unsuccessful reinterventions. Three patients with chronic central venous occlusion had successful recanalization with percutaneous transluminal angioplasty (n = 1) and stent placement (n = 2). Two patients had reocclusion with successful reintervention. Two BCS patients had successful treatment with stent placements. Overall technical success was 69%, and no procedural complications were encountered. None of the patients with chronic DVT had patent veins; however, all patients with central venous occlusion or BCS had patent veins on color Doppler ultrasonography at follow-up ranging from 3 to 48 months after intervention. Endovenous treatment for chronic iliofemoral DVT due to BD had a poor outcome. However, long-term outcome after endovenous treatment for upper-extremity central venous occlusion and BCS syndrome was good.Öğe Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography(Springer Wien, 2012) Tekbas, Guven; Gumus, Hatice; Onder, Hakan; Ekici, Faysal; Hamidi, Cihad; Tekbas, Ebru; Gulicetincakmak, MehmetPulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14-89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.Öğe Giant Right Coronary Artery and Coronary Sinus Aneurysm due to Fistula(Texas Heart Inst, 2011) Tekbas, Guven; Onder, Hakan; Tekbas, Ebru; Yavuz, Celal; Bilici, Asian[Abstract Not Available]Öğe Hydatid cyst-like intra-abdominal esophageal duplication cyst in an endemic region(Aves, 2011) Gumus, Metehan; Onder, Akin; Firat, Ugur; Kapan, Murat; Onder, Hakan; Girgin, Sadullah[Abstract Not Available]Öğe Image-Guided Subcutaneous Port Implantation in Patients with Malignant Diseases(Modestum Ltd, 2014) Onder, Hakan; Tekbas, Guven; Turmak, Mehmet; Inal, Ali; Ekici, Faysal; Gumus, Hatice; Onder, AkinTo present the results of our retrospective study on 49 totally implantable subcutaneous venous ports inserted in angiography unit under ultrasound and fluoroscopic guidance. 49 subcutaneous venous chest ports were placed in 48 patients (mean age, 49.3 +/- 16.7 years). One patient underwent port implantation twice. All the ports had single lumen catheters. The procedures were performed under ultrasound and fluoroscopic guidance in angiography unit. All ports were placed on the anterior chest wall. The technical success rate was 100%. There was no procedure-related minor or major complication. There was no early complication (in the first month). Late complications occurred at a rate of 8.3% (n:4). In patients with malignant diseases, radiological implantation of subcutaneous venous ports can be performed with similar or lower complication rates, as compared to the surgical literature, due to the obvious advantage of imaging guidance. Hence, port implantation with imaging guidance may become a more preferred implantation method in the future.Öğe An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings(Assoc Radiology & Oncology, 2013) Onder, Hakan; Ekici, Faysal; Adin, Emin; Kuday, Suzan; Gumus, Hatice; Bilici, AslanBackground. Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn't have biliary obstruction or cholestasis. Radio logically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.Öğe Indirect biliary drainage as an alternative solution for biloma due to complicated biliary drainage(Aves, 2012) Tekbas, Guven; Ekici, Faysal; Boyuk, Abdullah; Onder, Hakan; Gumus, Hatice; Arikanoglu, ZulfuPancreas cancer has increased morbidity and mortality. It generally result in biliary obstruction which life threatening importance. Main biliary drainage method is endoscopic retrograde cholangiopancreatography. When endoscopic retrograde cholangiopancreatography is not successful, second preferred method is percutaneous biliary drainage. Percutaneous biliary drainage has some complications which is an invasive procedure. A complication of percutaneous biliary drainage due to patient iatrogenity which was not ever reported in the literature biliary drainage according to our literature research. In these circumstances an alternative solution is indirect biliary drainage.Öğe Investigation of the retrorenal colon frequency using computed tomography in patients with advanced scoliosis(Springer France, 2014) Onder, Hakan; Dusak, Abdurrahim; Sancaktutar, Ahmet Ali; Goya, Cemil; Bulut, MehmetThe aim of this study is to investigate the frequency of retrorenal colon in patients with advanced scoliosis. The existence of retrorenal colon was retrospectively investigated in 550 patients with vertebral scoliosis who had undergone abdominal CT scans at our institution between January 2008 and March 2012. The investigation was also carried out on a control group of 200 patients without scoliosis. Among the 550 patients with scoliosis, 100 patients had advanced scoliosis necessitating treatment. Among these 100 patients with advanced scoliosis, retrorenal colon was detected in a total of 25 patients (25 %). The variation was observed on the right side in eight patients (two males, six females) (8 %), on the left side in 15 patients (five males, ten females) (15 %), and bilaterally in two patients (both females) (2 %). In the control group consisting of 200 individuals, retrorenal colon was detected in seven subjects (3.5 %), among which six were on the left and one was on the right. The difference between the incidence of retrorenal colon observed in the patients with advanced scoliosis and those without scoliosis was found to be statistically significant (p < 0.001). Since the frequency of retrorenal colon in patients with advanced scoliosis is significantly higher than the control group without scoliosis, the risk of experiencing complications during renal interventions including renal biopsy is also higher. Therefore, these patients should undergo a detailed CT examination before these procedures, and renal interventions should be planned according to findings.Öğe Is there any significance of lung cancer histology to compare the diagnostic accuracies of 18F-FDG-PET/CT and 99mTc-MDP BS for the detection of bone metastases in advanced NSCLC?(Termedia Publishing House Ltd, 2014) Inal, Ali; Kaplan, Muhammed Ali; Kucukoner, Mehmet; Urakci, Zuhat; Dostbil, Zeki; Komek, Hail; Onder, HakanAim of the study: Bone scintigraphy (BS) and fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in histological subgroups of non-small cell lung cancer (NSCLC) remains ambiguous. The aim of this study was to compare the efficacy of 18F-FDG-PET/C and Tc-99m-methylene diphosphonate (Tc-99m-MDP) BS in the detection of bone metastases of patients in NSCLC. Specifically, we compared the diagnostic accuracies of these imaging techniques evaluating bone metastasis in histological subgroups of NSCLC. Material and methods: Fifty-three patients with advanced NSCLC, who had undergone both 18F-FDG-PET/CT and BS and were eventually diagnosed as having bone metastasis, were enrolled in this retrospective study. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG-PET/CT and BS were 90.4%, 99.4%, 98.1%, 96.6%, 97.0% and 84.6%, 93.1%, 82.5%, 93.2, 90.8%, respectively. The. statistics were calculated for 18F-FDG-PET/CT and BS. The kappa-value was 0.67 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the kappa-value was 0.65 in adenocarcinoma, and 0.61 in squamous cell carcinoma between 18F-FDG-PET/CT and BS. The kappa-values suggested excellent agreement between all patients and histological subgroups of NSCLC. Conclusions: 18F-FDG-PET/CT was more favorable than BS in the screening of metastatic bone lesions, but the trend did not reach statistical significance in all patients and histological subgroups of NSCLC. Our results need to be validated in prospective and larger study clinical trials to further clarify this topic.Öğe Is unilateral breast enlargement always a sign of cancer?(Wiley, 2011) Tekbas, Guven; Oguzkurt, Levent; Gurel, Kamil; Ozkan, Ugur; Gur, Serkan; Onder, HakanBreast swelling is caused by many etiological factors, but should alert central vein occlusion in hemodialysis patients when the permanent vascular access is in the same arm. The swelling of the breast is caused by venous hypertension in the venous plexus draining the breast. Endovascular treatment relieves venous hypertension and related clinical signs. Additional diagnostic workup or invasive interventions such as a biopsy should be avoided in such patients, as diagnosis is straightforward with the presence of a functioning arteriovenous fistula in the same arm.Öğe ISOLATED PRIMARY HYDATID CYST OF THE BREAST: CASE REPORT(Aves, 2012) Onder, Akin; Kapan, Murat; Girgin, Sadullah; Akgul, Omer Lutfi; Onder, Hakan; Akyuz, YilmazThe causative agent of hydatid cyst disease is Echinococcus granulosus. Hydatid cysts are usually located in the liver and the lungs; they are very rarely seen in the breasts. Herein, a 62-year-old woman with isolated left breast hydatid cysts is presented. The patient had the complaint of painless mass in the left breast for one year. Imaging methods revealed a mobile lesion with smooth margins. Under local anesthesia, the mass was totally removed. Pathological examination made the diagnosis of hydatid cyst. The patient received mebendazole treatment for 3 months. During follow-up visits, no recurrence was found.
