Showing papers in "Diagnostic and Interventional Radiology in 2006"

Renal artery origins and variations: angiographic evaluation of 855 consecutive patients

Abstract: Purpose To determine angiographically the origins and variations of renal arteries. Materials and methods The study included 855 consecutive patients (163 females, 692 males; mean age, 61 years) living in the Cukurova region of Turkey, who underwent either aortofemoropopliteal (AFP) angiography for the investigation of peripheral arterial disease, or renal angiography for renovascular hypertension, and were prospectively evaluated. Renal arteries were visualized by non-selective catheterization during AFP angiography and by selective or non-selective catheterization during renal angiography. Locations of renal artery origins and renal artery variations, including the presence of extra renal arteries and division patterns were analyzed on angiograms. Results The origin of main renal arteries off the aorta was between the upper margin of L1 and lower margin of L2 vertebra in 98% of the patients, and in 74%, this was the origin of extra renal arteries. The most common location for renal artery origin was the L1-L2 intervertebral disc level. A single renal artery was present in both kidneys in 76% of patients. Renal artery variations included multiple arteries in 24%, bilateral multiple arteries in 5%, and early division in 8% of the cases. Additional renal arteries on the right side were found in 16% and on the left side in 13% of cases. Of all the extra renal arteries, the percentage of accessory and aberrant renal arteries were 49% and 51%, respectively. Conclusion Renal arteries originated between the first and the second lumbar vertebral levels in most patients. Extra renal arteries were quite frequent. These results should be kept in mind when a non-invasive diagnostic search is performed for renal artery stenosis, or when renal surgery related to renal arteries is performed.

Subcutaneous venous port implantation in adult patients: a single center experience.

Abstract: PURPOSE To present the midterm follow-up results of subcutaneous venous chest ports in adult patients. MATERIALS AND METHODS Between January 2001 and November 2005, 476 subcutaneous venous chest ports were placed in 472 adult patients. Five patients underwent port implantation twice. All the ports had single lumen catheters. The procedures were performed under intravenous sedation as well as local anesthesia. All ports were placed on the anterior chest wall, except one, which was placed on the trapezius muscle. RESULTS The technical success rate was 99.8%. The procedure- related minor complication rate was 0.63% (total: 3 cases; 1 hematoma during local anesthesia application, and 2 early hematomas) and there were no major complications. Mean duration of catheter usage was 376 days (total: 178,997 catheter days; range: 2 to 1522 catheter days). Late complications occurred at a rate of 10.7% (51 cases). Among those 51 cases, 36 (7.6%) developed minor complications in which port removal was not needed; however, 15 ports (3.15%) had to be removed due to major complications. Seven ports (1.47%) were explanted due to treatment-resistant bacteremia and sepsis, in addition to 2 other ports (0.42%) because of port pocket infections. An additional 6 ports (1.26%) required explantation for the following reasons: skin necrosis (0.21%); incision dehiscence (0.21%); broken or torn catheter (0.42%); jugular vein thrombosis (0.21%); thrombosis of superior caval vein (0.21%). CONCLUSION 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, we think that port implantation with imaging guidance will become the preferred implantation method in the future.

Angiographic findings and endovascular embolization in Dieulafoy disease: a case report and literature review.

Abstract: Dieulafoy disease is an unusual cause of gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery commonly located in the proximal stomach. Since this disease first described in 1884, it has been rarely discussed in radiology literature. We describe a case of an elderly patient with multiple medical problems presented with upper and lower GI hemorrhage. Repeated upper GI endoscopies revealed a large fundal clot but otherwise were unremarkable. Angiography showed anomalous short gastric artery originating normally from the splenic artery. The latter was embolized with microcoils and Gelfoam. Following embolization, the frequency and amount of bleeding decreased although did not totally stop and the patient underwent elective partial gastrectomy. The diagnosis was made histologically. Therefore, Dieulafoy disease can represent a diagnostic and therapeutic challenge. It should be suspected if a patient with GI hemorrhage is found to have extravasation from a dilated tortuous artery that appears normal otherwise with no associated large draining veins. Transcatheter selective arterial embolization has a reported role in the literature as a less invasive therapeutic option compared to surgery.

Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis.

Abstract: Acute portal vein thrombosis (PVT) is a rare clinical condition that can cause portal hypertension and bowel infarction. Early diagnosis and treatment of PVT is crucial for the restoration of portal venous flow and reduction of morbidity and mortality. We report a successful treatment of acute PVT which was seen following splenectomy, utilizing catheter directed transhepatic thrombolysis. No complication was encountered related to the procedure. Thrombolytic therapy via transhepatic route proved to be a safe and effective method in the treatment of PVT.

Contrast agents used in MR imaging of the liver.

Abstract: Several categories of contrast agents with different biodistributions are currently available for magnetic resonance imaging of the liver They improve lesion detection and characterization by increasing lesion-liver contrast These agents include nonspecific extracellular gadolinium chelates, reticuloendothelial system- specific iron oxides, hepatocyte-selective agents, and combined perfusion and hepatocyte-selective agents This article describes the currently used contrast agents in magnetic resonance imaging of the liver, summarizes their mechanisms of action, biodistributions, and safety profiles Additionally, it reviews their main clinical indications, administration and imaging techniques, and the appearances of common hepatic lesions in contrast-enhanced studies

The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women.

Abstract: PURPOSE To determine the frequency of pelvic varicose veins with transvaginal ultrasound and associated lower extremity venous insufficiency with Doppler ultrasound in women with chronic pelvic pain of undetermined origin. MATERIALS AND METHODS A total of 100 women with chronic pelvic pain of undetermined origin lasting more than 6 months were included in the study. The presence of anechogenic and non-pulsatile vascular structures demonstrating flow in Doppler ultrasound with a diameter > 5 mm in parauterine and paraovarian localizations was accepted as pelvic varicose veins. In all patients, lower extremity venous systems were examined with Doppler ultrasound to assess possible associated venous insufficiency. Chi-square test was used for statistical analysis. RESULTS Pelvic varicose veins were discovered with transvaginal ultrasound in 30 of 100 patients. This association was shown to be statistically significant. Various degrees of associated lower extremity venous insufficiency were also discovered in 21 of these 30 patients. CONCLUSION This study has shown that the presence of pelvic varicose veins in women with chronic pelvic pain is not infrequent, and in the majority of cases, they are associated with lower extremity venous insufficiency. Since the diagnosis of lower extremity venous insufficiency plays an important part in deciding the course of treatment, lower extremity Doppler ultrasound must be included in the evaluation when pelvic varicose veins are discovered.

Congenital true pancreatic cyst: a rare case.

Abstract: Congenital true pancreatic cysts are very rarely seen in children. We report magnetic resonance imaging features of a case of congenital true pancreatic cyst with a high level of enzymatic activity which, to the best of our knowledge, have not previously been reported. A 4-month-old boy was admitted to our clinic with a history of abdominal swelling for one month. A mobile, smooth, non-tender mass was palpated on the left side of the abdomen during physical examination. Ultrasonography and MR imaging revealed a bilocular cystic mass sized 9.5 x 8 x 6 cm. The spleen was displaced superiorly, whereas the left kidney was displaced posteriorly. Obliteration of the peripancreatic fat planes between the cystic mass and tail of the pancreas was observed. During abdominal surgical exploration, the pancreatic tail was larger than normal, and a pancreatic cyst arising from the tail of the pancreas was observed. Total cystectomy was performed with distal pancreatectomy. Although it is extremely rare in children, congenital true pancreatic cysts should be diagnostically considered in cases involving a cystic mass neighboring the pancreas. MR imaging is not helpful in differential diagnosis of other cysts originating from neighboring organs. Total excision with distal pancreatectomy and splenic preservation are advised for distal pancreatic cysts.

Direct contrast-enhanced 3D MR venography evaluation of upper extremity deep venous system.

Abstract: PURPOSE To investigate the diagnostic value of direct contrast-enhanced three dimensional magnetic resonance (3D MR) venography in mapping the deep venous system of the upper extremities and to plan potential interventional procedures. MATERIALS AND METHODS Nineteen cases with the diagnoses of end-stage renal disease with multiple hemodialysis catheter access were examined. Direct contrast-enhanced 3D MR venograms were obtained with 1.5 Tesla device with 3D-FSPGR pulse sequence and using body coil following the manual injection of gadolinium solution prepared by diluting 20 ml of contrast substance in 200 ml saline with a proportion of 1:10 through intravenous access opened symmetrically in antecubital fossa. In the workstation, evaluation was performed on three-dimensional images, two-dimensional multiplanar reformats and maximum-intensity projection method obtained from the source images. Intravenous DSA was performed on all the patients, and two radiologists evaluated MR venograms and conventional angiograms independently from each other. Results of MR venography and conventional angiography were then compared. RESULTS In all cases, the MR venograms obtained were capable of supporting the diagnoses. Venous pathologies were found in 16 cases. In three cases central veins were evaluated to be patent. Results of MR venography and conventional angiography were consistent with each other (100% sensitivity and 100% specificity). CONCLUSION Direct contrast-enhanced 3D MR venography is a well-tolerated sensitive technique in explaining the cause of the malfunctioning arterio-venous fistulas and in pre-surgical planning before placing new catheters or creating fistulas. It is possible to obtain high-quality images with this technique as an alternative to invasive angiography.

Clinical outcomes of neonatal hypoxic ischemic encephalopathy evaluated with diffusion-weighted magnetic resonance imaging.

Abstract: Purpose Detection of early phase neurological deficit in babies with hypoxic-ischemic encephalopathy (HIE) is the most important step to determine the appropriate preventive treatment methods. Diffusion-weighted imaging (DWI) is the most sensitive radiological modality to detect ischemic changes in the brain, in their earliest phase. Herein, we present the results of our study about the role of DWI in the diagnosis and determining the prognosis of HIE in neonates. Materials and methods The study included 36 cases (4 preterm, 32 term babies) who were diagnosed with HIE within 24 hours of birth and classified according to modified Sarnat staging. They were examined for the presence of neurological sequelae at 3 and 6 months of age with electroencephalography (EEG), visual evoked potential (VEP), brainstem auditory evoked potential (BAEP), and Denver II developmental screening tests. All 36 patients underwent conventional magnetic resonance (MR) imaging and DWI within the first 24 hours of birth; survivors underwent repetitive imaging exams at the end of the first week and then after a month. Results Seventeen stage I cases (47%), 12 stage II cases (33%), and 7 stage III cases (20%) were detected. DWI obtained within the first 24 hours showed high sensitivity (100%) in detecting the permanent neurological sequelae but with very low specificity (20%). The negative predictive value of DWI in this period was 100%; however, in DWI obtained at the end of the first month, not only its sensitivity was preserved, but its specificity reached 80%. The negative predictive value of DWI in this period was preserved and the positive predictive value improved. The importance of DWI in detecting sequelae at the end of the first month was also demonstrated by McNemar (p=0.250) and Kappa (Kappa=0.719) tests. There was no difference between conventional MR imaging and DWI in detecting sequelae at the end of first month. Conclusion DWI is superior to other imaging modalities in detecting ischemia; not only because of its high sensitivity in the early phase, but also because of its high sensitivity and specificity in the late phase. Moreover, with its high negative predictive value, DWI can be used for excluding the possibility of sequelae development in the early phase of HIE cases for medico-legal purposes.

Diffusion weighted MR findings of brain involvement in tuberous sclerosis.

Abstract: PURPOSE Diffusion Weighted Imaging (DWI) is effective in identifying microstructural cerebral parenchymal changes. We studied the diffusion characteristics of hamartomas and normal white matter in cases with tuberous sclerosis (TS). MATERIALS AND METHODS Diffusion weighted images of 6 TS cases (ages between 3 - 15 years, mean 9.0 years, SD 4.4 years) that presented to our center for magnetic resonance (MR) imaging have been retrospectively evaluated. In addition to 56 non-calcified hamartomas of TS patients, apparent diffusion coefficient (ADC) values measured from frontal, parietal normal white matter, and basal ganglions of TS patients were compared with values obtained from 9 normal subjects (ages 1 - 13 years, mean 8.9 years, SD 3.4 years). Hamartomas were divided into 3 subgroups based on their locations, and the ADC values measured in these groups were compared. RESULTS ADC values of all hamartomas were between 838 and 2230, with a mean value of 1408 mm (2)/sec x 10(-3) (SD: 273.2); ADC values of the white matter of normal subjects were between 695 and 857, with a mean value of 776.1 mm (2)/sec x 10(-3) (SD: 44.23) (p < 0.0001). ADC values of subependymal nodules, white matter hamartomas, and subcortical tubers were 838-2230 (mean: 1440.5 mm (2)/sec x 10(-3); SD: 526.46), 1046-1622 (mean: 1328.6 mm (2)/sec x 10(-3); SD: 189.4), and 981-1973 (mean: 1417.4 mm (2)/sec x 10(-3); SD: 219.5), respectively (p = 0.666). CONCLUSION Diffusion characteristics of white matter hamartomas resulting from TS clearly differ from those of normal white matter, but no significant difference was observed in ADC values of these lesions based on their locations. Moreover, the ADC measurements of normal white matter in these cases did not differ from those of the control group, indicating that the disease does not cause a common explicit damage in white matter and central gray matter, other than hamartomas, which can be detected by DWI. DWI may only be used in the differential diagnosis of hamartomas from secondary lesions with T1 and T2W signal intensities similar to those of hamartomas and with different diffusion characteristics.

Low dose CT: practices and strategies of radiologists in university hospitals.

Abstract: PURPOSE We surveyed the practices and policies of the radiology departments of academic institutions in Turkey regarding the use of low dose CT in daily practice. MATERIALS AND METHODS Surveys were mailed electronically to radiology departments of 40 university hospitals. Information gathered included modifications of standard protocols for dose reduction according to body parts being examined or depending on specific patient groups such as children, pregnant, or slim patients. RESULTS Thirty-three radiology departments (82%) responded. Twenty-eight (85%) reported that they modify CT scanning parameters in order to reduce the patient dose. Of these, 5 (18%) reported that they always modulate the scan parameters, 10 (36%) often, 11 (39%) sometimes, and 2 (7%) seldom. Reduced dose CT is applied mostly in pediatric and pregnant patients, reported by 93% and 57% of respondents, respectively. The most common body part for the application of low dose CT was chest examination followed by imaging of paranasal sinuses, abdomen, and CT-guided interventions. The most common modification for dose reduction is using low mA, followed by increasing the pitch value. CONCLUSION Most respondents are aware of low dose CT, but the frequency of application varies considerably in routine practice. Reduced mA and increased pitch are the most commonly used modifications.

A spinal dermoid tumor that ruptured into the subarachnoidal space and syrinx cavity.

Abstract: The widespread use of computed tomography (CT) and magnetic resonance (MR) imaging has increased the preoperative diagnosis of dermoid tumors and detection of their complications. In particular, cases of ruptured dermoid tumors, which may manifest as emergent conditions with variable clinical pictures, have typical CT and MR imaging findings. In this report, we present a case of a spinal dermoid tumor, which ruptured into the syrinx cavity and subarachnoidal space.

Iatrogenic femoral arteriovenous fistula: endovascular treatment with covered stent implantation and 4-year follow-up.

Abstract: Puncture site complications such as arteriovenous fistula after femoral arterial catheterizations are becoming more common with the increasing number of endovascular procedures being performed by interventional radiologists and cardiologists. Covered stent placement with endovascular technique for these lesions represents an appealing treatment alternative because it is only minimally invasive and requires less hospitalization and recovery time compared to surgical repair. Herein, we present an adult patient with a post-catheterization deep femoral artery- to-femoral vein fistula, which was successfully treated with a balloon-expandable Jostent peripheral stent-graft placement. Fourth year follow-up angiography showed the covered stent to be patent.

Frontal sinus osteoma associated with pneumocephalus.

Abstract: The most common causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumours, congenital neuroenteric cysts, and dural defects. Here, we present a case of a frontal sinus osteoma associated with longstanding pneumocephalus.

Unenhanced multidetector CT evaluation of urinary stones and secondary signs in pediatric patients.

Abstract: he incidence of urinary stone disease in the pediatric population is less than in adults (1). While renal colic is the main finding in adults, it is observed in only 15% of children (2). While child-hood stone disease is continuing to decrease in developed countries, it remains endemic in some parts of the world (2). Radiological imag-ing has a very important role in the evaluation of stone patients. For this reason, direct urinary system graphy, ultrasonography, intravenous pyelography, computed tomography (CT), and magnetic resonance im-aging (MRI) might be used (3). All of these imaging methods have some advantages and disadvantages. Unenhanced spiral CT was first used by Smith et al. in 1995 to evaluate urinary stones (4). Unenhanced spiral CT is more sensitive and specific in defining ureteral stones compared to other imaging methods. In diagnosis of ureteral stones in adults, find-ings secondary to the urinary system obstruction may be used as con-tributory (5).In our study, urinary system stones and the incidence of findings secondary to ureteral stones were retrospectively evaluated with unen-hanced multi-detector CT (MDCT) in a pediatric population.Materials and methodsThe study included 87 pediatric patients (33 girls: 37.9%; 54 boys: 62.1%) with a mean age of 89 months (rang: 5 months to 16 years) that were scanned with MDCT, utilizing stone protocols, between January 2004 and June 2005 after referral from various departments in our hos-pital. One of the patients had a solitary kidney. Two radiology special-ists retrospectively performed the evaluations of the CT investigations using PACS (picture archiving and communication systems). In CT in-vestigations, the presence and localization of the stones, secondary signs associated with the ureteral stones, and the presence of concomitant urinary system and extraurinary pathologies were evaluated. Secondary signs associated with the ureteral stones, such as hydronephrosis, ure-teral dilatation proximal to the stone, renal enlargement, perinephritic edema, tissue rim sign, decreased renal density, and periureteral edema, were evaluated.In CT, a stone was recognized by visualization of the calcific densi-ties in the kidneys and ureter (6-7). In diagnosis of hydronephrosis, in order to exclude extrarenal pelvis situations, dilation of the upper and lower pole calices were taken into consideration (6). Proximal ureteral dilatation was distinguished by visualization of the ureter distal to the stone with normal caliper, which was dilated proximally, and by visualization of the continuation of the proximally-dilated ureter with the renal pelvis. For enlarged kidneys, parenchymal thickness of both kidneys, in the sections traversing mid zone planes, and the length of the kidneys were measured and asymmetrical increases were not-ORIGINAL ARTICLE

Effects of overweight on luminal diameter, flow velocity and intima-media thickness of carotid arteries.

Abstract: PURPOSE To the best of our knowledge, there are only a few previous studies on the effects of overweight on extracranial carotid arteries. We aimed to investigate the effects of overweight on flow velocities, luminal diameters and intima media thicknesses (IMTs) of the common and internal carotid arteries (CCA, ICA). MATERIALS AND METHODS A prospective study on color duplex sonography of the extracranial arteries was performed in 71 adults, ages between 25-58 years old. The body mass index (BMI) was found to be normal in 24 (group 1) and high in 47 (group 2) subjects of the study group. Flow velocity (FV), luminal diameter and IMT of carotid arteries of all the participants were measured. RESULTS There were significant differences between group 1 and group 2 in the following parameters; luminal diameters of the right CCAs were significantly larger in group 2, peak-systolic FV of ICAs were significantly lower in group 2 than in group 1 and ICA end-diastolic FVs were significantly lower in group 2 than in group 1. CONCLUSION The present data shows that there is a correlation among carotid artery luminal diameter, FVs and overweight. In the overweight subjects, the increased luminal diameter and decreased FVs can point at the early stage of atherosclerosis. The influence of adiposity on atherosclerosis is very complex and varies with gender and age, therefore we need larger series and further investigation.

Prenatal diagnosis of intracranial pial arteriovenous fistula and endovascular treatment during the neonatal period.

Abstract: We present a case with prenatal diagnosis of an intracranial high-flow pial arteriovenous fistula that was draining into the vein of Galen in the third trimester of pregnancy. The child was treated by transcatheter embolization with N-butyl 2-cyanoacrylate (NBCA) via the umbilical artery in the early neonatal period due to intractable cardiac failure. Hydrocephalus developed and a ventriculoperitoneal shunt was placed. At the time this report was prepared, the patient was 20 months old and without cardiac failure, but with a delay in neurological development. Prenatal diagnosis and endovascular treatment in the early neonatal period is important in preventing heart failure and resultant mortality due to such high-flow vascular malformations. To the best of our knowledge, the combination of prenatal diagnosis of an intracranial high-flow pial arteriovenous fistula draining into the vein of Galen and endovascular treatment in the early neonatal period is presented here for the first time.

Multifocal skeletal tuberculosis involving the lumbar spine and a sacroiliac joint: MR imaging findings.

Abstract: Sacroiliac joint tuberculosis is rare; its coexistence with vertebral tuberculosis is even rarer, with only a few such patients reported in the literature We present magnetic resonance (MR) imaging findings of a patient with vertebral and sacroiliac joint tuberculosis, who had paravertebral, iliopsoas, and buttock abscesses accompanied by a gluteal pus-draining sinus tract MR imaging is the most sensitive and specific imaging modality for diagnosing sacroiliitis at its early stage Sacroiliac joint tuberculosis can reach advanced stages with extensive joint destruction and periarticular abscesses if diagnosis and treatment are delayed A high index of clinical suspicion is required for an early diagnosis The addition of a coronal SPIR T2-weighted sequence to the routine MR imaging evaluation of patients studied for lumbar disk disease may be useful for recognizing sacroiliac joint pathology at an earlier stage

Evaluation of parenchymal changes at the operation site with early postoperative brain diffusion-weighted magnetic resonance imaging

Abstract: Purpose To evaluate diffusion changes in the brain parenchyma at the operation site during the first 24 hours following surgery Materials and methods The study group consisted of 52 patients, 39 who had tumor resection surgery and 13 who had epilepsy surgery Early postoperative magnetic resonance imaging (MRI) included diffusion-weighted imaging (DWI) and routine contrast-enhanced cranial MRI, together with T2* weighted images on a 3T system DWI findings and the presence of hemorrhage in the brain parenchyma were evaluated Correlation between the findings, the primary lesion leading to surgery, and operation site were evaluated Results Diffusion restriction in the parenchyma surrounding the resection cavity was seen in 17 tumor patients (327%, n=52) and in 8 epilepsy patients (154%, n=52) DWI showed increased diffusion in 7 patients and no abnormality in 4 patients Twenty patients showed restricted diffusion pattern related to hemorrhage (385%, n=52) Conclusion Restricted diffusion was the most common abnormality observed in the early postoperative DWI of brain parenchyma at the operation site after surgery, which suggested tissue injury caused by surgery Yet, hemorrhaging in the operation bed can constitute another cause of a reduced apparent diffusion coefficient (ADC) value Increased diffusion and normal diffusion can also be observed, though rarely

Secondary interventions following endovascular repair of abdominal aortic aneurysm.

Abstract: Purpose To review the outcomes of endovascular abdominal aortic aneurysm repair (EVAR) procedures, to determine the incidence of adverse events, and to assess the need for secondary radiological/surgical interventions. Materials and methods Data from 57 consecutive patients entered in a prospective EVAR database were studied. In addition to database interrogation, case notes and radiology records were reviewed. Frequency and outcome of complications were evaluated after stent-graft placement (mean follow up 20 months). Results Overall, 24 adverse events were recorded in 57 patients (42%). The events were endoleaks (14/24), stent migrations (3/24), deployment problems (2/24), limb occlusions (2/24), limb kink (1/24), and femoro-femoral crossover occlusions (2/24). Of all the endovascular patients studied, 23% (13/57) required secondary interventions to maintain aneurysm exclusion. The mean time to secondary intervention in this series was 14 months. Conclusion Over 40% of EVAR procedures were associated with suboptimal clinical outcomes, and more than 20% of the patients required secondary interventions within 5 years of surgery. This high incidence of late secondary intervention is a cause for concern and emphasizes the need for lifelong follow-up.

Doppler ultrasound evaluation of the structural and hemodynamic changes in the brachial artery following two different exercise protocols.

Abstract: PURPOSE Examine the effects of incremental and submaximal exercise on structural and hemodynamic changes in the brachial artery flow parameters using Doppler ultrasonography. MATERIALS AND METHODS Twenty four healthy sedentary males (aged 19.54+/-0.59) performed submaximal (15 minutes heart rate to 75% maximal) and incremental (workload was increased 20W every 3 minutes until exhaustion) exercises by upper extremity ergometer. Before and after exercises the brachial artery diameter, peak systolic maximum velocity (Vmax), end-diastolic minimum velocity (Vmin) and time-averaged mean flow velocity (Vmean), volume blood flow and flow waveform patterns were recorded in a controlled environment. RESULTS The diameter of the brachial artery, flow velocities, and blood flow increased significantly after each exercise protocol (p < 0.001). The Vmax (p < 0.05), Vmean (p < 0.01), and volume blood flow (p < 0.01) after the incremental exercise were significantly higher than those measured after the submaximal exercise. However, no significant differences were noted between the two exercise protocols when arterial diameters and Vmin were concerned. The flow pattern was monophasic in all subjects after incremental exercise. Nevertheless, the flow pattern remained triphasic in two of the subjects after submaximal exercise. CONCLUSION Blood flow velocities played important role in hemodynamic mechanism than conduit arterial diameter during arm exercises. Changes in conduit artery diameter did not significantly contribute to blood flow increase during high and moderate intensity exercises. There is minimal variation in waveform shapes of normal individuals after exercise. Doppler ultrasonography proved a practical tool in the studies of the dynamic responses of blood flow and vascular resistance during rest and exercises.

Evaluation of radiotherapy response of cervical carcinoma with gray scale and color Doppler ultrasonography: resistive index correlation with magnetic resonance findings.

Abstract: PURPOSE To investigate the role of the resistive index measured with transvaginal color Doppler ultrasonography (TVCDUS) for assessing the radiotherapy response of cervical carcinoma and to compare it with magnetic resonance findings. MATERIALS AND METHODS A total of 13 patients with advanced stage cervical carcinoma (>IIA) underwent magnetic resonance imaging (MRI) and TVCDUS exams 6 months prior to and 6 months after radiotherapy. Pre- and post-treatment resistive indices obtained from the central and peripheral zones of the tumor were compared. These values were also compared with MRI findings and resistive indices obtained from the control group. RESULTS Tumoral masses could be visualized in all patients with B-mode TVCDUS prior to the treatment. Resistive indices before and after treatment were 0.200.82 (mean: 0.52 ± 0.15), and 0.70-0.99 (mean: 0.81 ± 0.14), respectively. Eleven out of 13 patients responded to the treatment completely and no mass was detected in MRI and TVCDUS. Investigations were performed in areas with flow within the tumorfree cervix. A residual mass was noted in 2 patients with MRI and TVCDUS. There was a statistically significant difference between complete response to the treatment and increased resistive indices (P = 0.001). In 2 patients with residual masses, no increase in resistive indices was detected. The mean resistive index of the control group was 0.65 ± 13 and the difference was statistically significant compared to the resistive indices of the patients prior to the treatment. CONCLUSION Since there was a significant correlation between the MRI findings and resistive indices, the spectral parameters obtained with TVCDUS were a good alternative to such an expensive modality as MRI in the evaluation of the response of cervical cancer to the treatment.

Evaluation of the splenic vein diameter and longitudinal size of the spleen in patients with Gamna-Gandy bodies.

Abstract: PURPOSE The aim of this retrospective study was to compare the splenic vein diameter and longitudinal size of the spleen in patients with portal hypertension in whom Gamna-Gandy bodies were present in their spleen with those of cirrhotic patients without Gamna-Gandy bodies and a control group. MATERIALS AND METHODS Between July 2001 and February 2006, patients in whom Gamna-Gandy bodies were detected in their spleen and the number of patients who had been undergone magnetic resonance (MR) imaging with the diagnosis of chronic liver disease were determined. A total of 43 cases with Gamna-Gandy bodies were noted. Out of these patients, a case of lymphoma was excluded from the study. Additional 3 cases with splenic vein thrombosis were not included in statistical analysis. Accordingly, the splenic vein diameter and longitudinal size of the spleen in 39 patients (group 1: 12 women, 27 men; mean age, 38.5 years) with portal hypertension in whom Gamna-Gandy bodies were detected in their spleen on T1-weighted gradient-echo MR images between July 2001 and February 2006 were measured. The values obtained were compared with those of 29 cirrhotic patients without Gamna-Gandy bodies (group 2: 14 women, 15 men, mean age 48.2 years) and control group (group 3: 13 women, 18 men, mean age 46.8 years). The differences between the groups were analyzed with ANOVA and student-t test. RESULTS Gamna-Gandy bodies were detected in 6.3% (42/670) of patients with chronic liver disease. The mean longitudinal axis of the spleen (20.2+/-4.2 cm) in group 1 was significantly greater (p<0.001) than in group 2 (14.4+/-3.9 cm). The mean splenic vein diameter was significantly larger in group 1 (14.3+/-4.0 mm) than those in groups 2 and 3 (11.2+/-3.2 mm and 7.8+/-1.4 mm, respectively). CONCLUSION The splenic vein diameter and longitudinal size of the spleen in portal hypertensive patients with Gamna- Gandy bodies are significantly larger than that of cirrhotic patients without Gamna-Gandy bodies and that of control group.

Kozlowski type spondylometaphyseal dysplasia: a case report with literature review.

Abstract: Spondylometaphyseal dysplasia is a type of bone dysplasia characterized by vertebral and metaphyseal changes of varying severity. Diagnosis of the disease is difficult because the severity of bone involvement differs and symptoms change according to the age of the patient. In this study, radiographic findings of a 16 month-old male patient diagnosed as Kozlowski type spondylometaphyseal dysplasia is reported.

Omphalopagus conjoined twins: ultrafast MR imaging findings.

Abstract: Conjoined twins are a rare and often catastrophic obstetrical event. Although ultrasonography is widely used in the diagnosis of conjoined twins, it may fail to demonstrate the details in fetuses with complex anomalies, especially during late pregnancy. We present an omphalopagus conjoined twins case evaluated by HASTE magnetic resonance imaging, which showed the conjunction site and cranial anomalies, and aided antenatal counseling and neonatal surgical planning.

Bronchial artery embolization: experience with 10 cases.

Abstract: PURPOSE: To report our experience with 10 cases of bronchial artery embolization (BAE). MATERIALS AND METHODS: The study included 18 cases (11 men and 7 women between 21 and 81 years of age, average 52 years), whose massive hemoptyses could not be controlled with conservative and bronchoscopic methods and were sent to the digital subtraction angiography unit between August 2002 and May 2004. Of these 18 cases, BAE was performed in 10 (7 men and 3 women between 21 and 78 years of age, average 54.2 years). An aortogram with a 5F pigtail catheter and a selective bronchial angiogram with a 4F glide Cobra (C2) catheter was obtained in every case. The same C2 catheters that had been used for bronchial angiography were also used for BAE in 7 cases. Hydrophilic microcatheters were additionally needed for BAE in the other 3 cases. Particles > 250 microns (polyvinyl alcohol [PVA], Embosphere microspheres), mechanical coils, or a combination of both were used for BAE. RESULTS: The etiologies of 10 cases in which BAE was performed were tuberculosis (n=3), sarcoidosis (n=3), bronchiectasis (n=2), and malignancy (n=2). Arterial bronchial pathology was also seen in the non-selective angiographic studies of 4 of the 10 BAE cases. Hemoptysis was controlled in all BAE cases in the first session. Recurrences were observed in 2 cases that were embolized with only mechanical coils during the first month follow-up and hemoptysis was again controlled with microparticle embolization with Embosphere microspheres. All 10 cases were followed- up for 1-21 months (average, 8 months). CONCLUSION: Non-selective angiographic examination alone, is not sufficient enough to detect the vascular pathology causing a massive hemoptysis. A selective study must be performed in every case. The cost of angiography can be lowered by using the same 4F glide C2 catheter for BAE. It may not be safe to use only mechanical coils in BAE cases. There is a need for studying additional cases to have more definitive conclusions.

Hepatic artery aneurysm presenting with hemobilia in a patient with Behçet's disease: treatment with percutaneous transcatheteral embolization.

Abstract: We herein report a case of hemobilia caused by a hepatic artery aneurysm. A 40-year-old male patient with a history of Behcet's disease with a thrombus hanging out of the papilla of Vater had a large hepatic aneurysm in angiography. The hepatic artery feeding the aneurysm was embolized. Endovascular treatment can treat patients with hepatic artery aneurysms caused by Behcet's disease.

MR cholangiopancreatography findings of heterotopic pancreatic tissue in the distal common bile duct.

Abstract: Heterotopic pancreas is defined as the presence of pancreatic tissue at sites other than the pancreas. Involved sites may be the stomach, duodenum, proximal jejunum, ileum, congenital duodenal web, Meckel's diverticulum, ampulla of Vater, and the main pancreatic duct. We report the magnetic resonance cholangiopancreatography findings of a patient who had biliary obstruction due to heterotopic pancreas tissue at the distal common bile duct.

Assessment of Doppler waveform patterns and flow velocities of hepatic veins in children with acute viral hepatitis.

Abstract: PURPOSE To evaluate hepatic vein flow patterns and velocities in children with acute viral hepatitis and to compare the findings to a group of healthy children, with duplex sonography. MATERIALS AND METHODS Forty children with acute viral hepatitis were enrolled in group 1 and forty healthy children were enrolled in group 2 (control group). Both groups underwent gray scale and duplex sonography. Hepatic venous Doppler flow patterns were categorized as triphasic, biphasic, or monophasic. Peak systolic velocities of hepatic veins were recorded. RESULTS In group 1, hepatic venous flow was triphasic in 61.6%, monophasic in 26.6%, and biphasic in 11.6% of the patients. These figures were 88.3%, 8.3%, and 3.3%, respectively, for the controls in group 2. Group 1 had fewer patients with only a triphasic flow pattern, but had a higher percentage of monophasic and biphasic flow patterns. There was a triphasic flow pattern in all three hepatic veins in 50% of group 1 and in 80% of group 2. Differences in flow patterns of hepatic veins between the groups were found to be significant according to the student t-test (p < 0.01), and this was independent of age, gender, feeding status, and activity. CONCLUSION Similar to reports of chronic liver disease or diffuse liver disease, significant differences in the flow patterns of hepatic veins were found in children with acute viral hepatitis. Hepatic vein flow patterns were frequently monophasic or biphasic in group 1, especially when accompanied by change in hepatic echogenicity. There was no significant difference in the flow velocities of the hepatic veins between group 1 and group 2.

Cephalopagus conjoined twins presented with encephalocele: diagnostic role of ultrafast MR imaging.

Abstract: Conjoined twinning is a rare abnormality and cephalopagus is a very rare form of conjoined twins We report a case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasonography and ultrafast magnetic resonance (MR) imaging at 24 weeks of the gestation Ultrafast MR imaging can provide image quality superior to two dimensional ultrasonography and should be considered an adjunct to ultrasound for antenatal characterization of some anomalies To the best of our knowledge, this is the first case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasound and ultrafast MR imaging