Oral Presentations - The Eurasian Journal of Medicine

Oral Presentations

S2 • Turkish Society of Magnetic Resonance 23rd Annual Meeting Eurasian J Med 2018; 50: (Suppl 1): S1-S137

O - 01

ASSESSMENT OF PANCREATIC ULTRASONOGRAPHY AND MRI FINDINGS IN RELATION TO GLUCOSE TOLERANCE TEST IN PATIENTS WITH BETA THALASSEMIA MAJORYASEMIN ALTINTAS

Private Adana Middle East Hospital, Adana, Turkey

Abstract

Objective: The most important cause of mortality is heart failure due to iron accumulation in beta thalassemia major and MRI have come into routine use in evaluation of the iron load. Objective of this study was to evaluate the correlation of ultrasonografi and MRI of the pancrease with glucose tolerance test.

Materials and Methods: This study sixty patients were included. Oral glucose tolerance test (OGTT) was performed in all the cases. Pancreas echogenicity was divided into three grades. Grade I, grade II and grade III. Pancreas MRI images were acquired using T2* GRE sequence parameters.

Results: OGTT impairment was defined in 5 cases, from the patient group and 1 case from the controls. Patient group, pancreas echogenicity was found as grade I in 21 cases (35%), grade II in 27 cases (45%) and grade III in 12 cases (20%). Control group, pancreas echogenicity was found as grade I in 29 cases (96.7%) and grade II in 1 case (3.3%). T2* values were between 1.0 and 35.8 ms in the patient group and between 23.4 and 53.1 ms in the controls.

Conclusion: In this study, increased echogenicity was observed by 65% and a statistically significant correlation was found between the pancreatic echogenicity increase and blood-glucose values. In this study, a significant negative correlation was found between T2* abnormality and fasting blood glucose. Glucose mechanism shows a correlation with pancreatic US and T2* MRI values. Pancreatic changes in beta thalassemia major patients can be evaluated with US and MRI.

Keywords: Beta thalassemia major, iron load, diabetes mellitus, pancreatic US and T2* MRI

O - 02

THE RELATIONSHIP BETWEEN AGE AND APPARENT DIFFUSION COEFFICIENT VALUES IN NORMAL SPLENIC PARENCHYMAHALE COLAKOGLU ER

Department of Radiology, Gaziantep University School of Medicine, Gaziantep, Turkey

Abstract

Objective: To evaluate the correlation between age and apparent diffu-sion coefficient values in normal spleen.

Materials and Methods: Between January 2017 and January 2018, 89 patients without abdominal MR imaging findings who underwent abdomi-nal 3 T diffusion weighted imaging, (b=0, b=600 s/mm2) were retrospec-tively included. ADC mean values of the spleen were measured at MR Workstation. Measurements were performed with 25 mm2 ROIs at the splenic hilus level. The average of four ADC mean measurements was calculated to reduce random variability in the measurements. Pearsons correlation coefficient test was used to evaluate the relationship between age and ADC mean values.

Results: Twenty-four of the patients included in the study were males and 65 were females. The mean age was 45.9 years (range, 19-76 years). The mean ADC value was 0.9+0.13x10-3 mm2/s (range, 0.66-1.2x10-3 mm2/sn). There was a negative correlation between age and ADC mean values (r=-0.526, p=0.001).

Conclusion: There was a negative correlation between age and ADC mean values. It may be necessary to consider age when assessing spleen s ADC values.

Keywords: Apparent diffusion coefficient, spleen, age

O - 03

DIAGNOSTIC PERFORMANCE OF MULTIPARAMETRIC MR IMAGING AT 3.0 TESLA IN DISCRIMINATING PROSTATE CANCER FROM PROSTATITIS: HISTOPATHOLOGIC CORRELATIONELIF PEKER1, DIDEM YASEMIN SONMEZ1, HABIP ESER AKKAYA2, SERHAT HAYME1, GUL AYSE ERDEN1, MEMET ILHAN ERDEN1 1Ankara University School of Medicine, Ankara, Turkey 2Karaman State Hospital, Konya, Turkey

Abstract

Objective: Aim of this study is to evaluate the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) in differentiating prostatitis foci from prostate cancer (PCa).

Materials and Methods: This retrospective study included 81 biopsy-proven lesions (37 PCa and 44 prostatitis). SI on DWI (b=1000 and 2000 s/mm2), normalised T2-signal intensity (nT2SI) and apparent diffusion coefficient (ADC) values, SI at the end of the dynamic curves, peak SI, mean enhance-ment percentage, mean peak time, and washout percentage obtained from dynamic contrast-enhanced imaging (DCEI) were evaluated.

Results: nT2SI (3.2 vs. 3.8, p=0.003) and ADC values (0.685 vs. 0.874x10-3 mm2/s, p<0.001) were significantly lower in the PCa group than the prostatitis group. The washout percentage was significantly different between prostatitis group than the PCA (4% vs. 12%, respectively, p=0.003). ADC values alone showed higher specificity and and sensitivity (75% and 80.5%, respectively) than all of the single and most of the combined criteria.

Conclusion: mpMRI of the prostate gland can be used to differentiate between, prostatitis, PCa and normal tissue. SI on DWI (b=2000 s/mm2), ADC values, nT2SI, and washout percentage were identified as MRI criteria for discriminating prostatitis from PCa. the ADC values alone, demonstrated higher sensitivity and specificity when compared with all of the single and most of the combined criteria.

DOI 10.5152/eurasianjmed.2018.02052018

Eurasian J Med 2018; 50: (Suppl 1): S1-S137 Turkish Society of Magnetic Resonance 23rd Annual Meeting • S3

Keywords: Prostate, prostate cancer, prostatitis, multiparametric MRI, diffusion MRI, T2 weighted imaging

O - 04

“T2-HYPOINTENSE DOT SIGN” HIGHLY SUGGESTIVE CLUE FOR THE DIAGNOSIS OF OVARIAN TORSION: A NOVEL SIGNTUMAY BEKI1, AHMET VEYSEL POLAT2 1 Zonguldak Atatürk State Hospital, Zonguldak, Turkey2 Ondokuz Mayıs University School of Medicine, Samsun, Turkey

Abstract

Objective: Early and accurate diagnosis is crucial for preserving the viabil-ity of the ovaries and for the appropriate management of patients with ovarian torsion. In this study, we aimed to investigate the reliability of “T2-Hypointense Dot Sign” in the diagnosis of ovarian torsion. We also aimed to compare the diagnostic capability of this sing with whirlpool sign in the detection of ovarian torsion.

Materials and Methods: The pelvic MRI images of 31 patients with surgi-cally proven ovarian torsion were accepted to analysis. Thirty patients with adnexal neoplasm and 15 patients with tuboovarian abscess comprised the control group. The MRI images of 76 patients were retrospectively evaluated by two independent radiologists for the presence of T2 hypoin-tense dot sign and whirlpool sign with using three point scale (0=definitely negative, 1=inconclusive, 2=definitely positive).

Results: T2 hypointense dot sign was more reliable than the whirlpool sign in the detection of ovarian torsion with the occurrence rate of 93.5% and 58%, respectively. Both signs were definitely negative in patients with adnexal neoplasm and tuboovarian abscess. “T2 hypointense dot sign” was definitely positive and definitely negative in 29 and two patients, respec-tively. The whirlpool sign was inconclusive and definitely negative in four and nine patients, respectively. Nevertheless, T2 hypointense dot sign was evident four and seven patients with inconclusive and definitely negative results for whirlpool sign, respectively.

Conclusion: The presence of ipsilateral “T2 hypointense dot sign” could be valuable clue for the accurate and early diagnosis of ovarian torsion on non-contrast MRI.

Keywords: Ovarian torsion, MRI, T2-Hypointense dot sign

O - 05

ASSESMENT OF CARDIAC AND HEPATIC IRON OVERLOAD IN THALASEMIA MAJOR PATIENTS WITH CARDIAC MAGNETIC RESONANCE IMAGINGMURAT BAYAV, NILGUN IŞIKSALAN OZBULBUL, DIDEM BAYAV

Department of Radiology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey

Abstract

Objective: In this study, assesment of cardiac and hepatic iron overload in thalasemia major patients with cardiac magnetic resonance imaging (MRI) T2* study was aimed.

Materials and Methods: 13 thalasemia major patient (7 female, 6 male) was included in this retrospective study. With General Electric DiscoveryTM MR750W 3 Tesla MRI scanner; myocard and liver iron overload was assessed with T2* sequance. Cardiac T2* time was measured at mid-sep-tum;<20 msec was accepted significant for siderosis. If T2* time was 10-20 msec, considered moderate siderosis;if T2* time was<10 msec, considered severe cardiac siderosis. Liver iron overload was categorised normal if T2* time was >11.4 msec; categorised mild if T2*time was 3.8-11.4 msec; cat-egorised moderate if T2* time was 1.8-3.8 msec; categorised severe if T2* time was<1.8 msec. Age, serum iron and ferritin levels, frequency of trans-fusion, chelation theraphy, co-morbid disease informations of patients was obtained and recorded from hospital information system (HIS).

Results: The age of the patients ranged between 9 and 59 years. Cardiac siderosis was detected in 4 patients (30.1%) within 13 total patients. 1 patient had modarate cardiac siderosis, 3 patients had severe cardiac sid-erosis. Except one patient, there was liver iron overload in all patients. 4 (30.1%) patients had mild iron overload, 6 (46.1%) patients had moderate iron overload, 1 patient (7.1%) had severe iron overload. In 13 patients, 12 patient had iron chelation theraphy. In 3 patients, serum ferritin level was <1000 ng/ mL. In this 3 patients, mild and moderate liver iron overload was detected, but there was no cardiac siderosis. Between serum ferritin levels and liver T2* time, there was no statistically significant correlation (p=0.12) Between serum ferritin levels and cardiac T2* time, there was a strong negative correlation (r=-0.762, p<0.05). There was no statistically significant correlation between cardiac T2* time and liver T2* time (p=0.24).

Conclusion: Cardiac T2* imaging is a successful and non-invasive modality, which can demonstrate cardiac siderosis; even before the myocardial dys-function emerged. In same session, measuring cardiac and liver T2* time simultaneously, in tranfusion dependent thalasemia major patiens can lead to the detection of iron overload before clinical manifestations and guide early onset of chelation theraphy.

Keywords: Cardiac iron overload, thalassemia major, cardiac MRI

O - 06

NON INVASIVE ASSESSMENT OF RENAL VASCULATURE USING INHANCE (3D INFLOW INVERSION RECOVERY) SEQUENCE OBTAINED WITH 3.0 T MR IN CASES OF RENOVASCULAR HYPERTENSIONYAVUZ METIN1, NURGUL ORHAN METIN1, EDA BEYKOZ CETIN1, ALI KUPELI2, MAKSUDE ESRA KADIOGLU1, OGUZHAN OZDEMIR1 1Department of Radiology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey2Department of Radiology, Muş State Hospital, Muş, Turkey

Abstract

Objective: To evaluate the diagnostic performance of inhance (3D inflow inversion recovery) MRA in the depiction of the renal vasculature and


in the detection of main renal artery diseases in cases of renovascular hypertension.

Materials and Methods: Unenhanced-MRA (inhance MRA) was per-formed in 73 patients (31 women, 42 men; mean [±SD] age, 54±17 years) with clinical suspicion of renovascular hypertension. All exami-nations were performed with a 3.0 T MR system (GE Discovery 750 T). Inhance-MRA was performed using a respiratory-triggered 3D fat saturated fast imaging employing steady state adquisition with inversion recovery pulses. Three radiologist independently evaluated the main renal artery, first order segmental branches and secondary order arteries within the renal parenchyma with the ‘inhance’ sequences, retrospectively. Each reader graded the MR image quality on a 4-point confidence scale based on the vessel signal intensity, sharpness and complete delineation of vessel borders. Also the pathologies of the main renal artery (stenosis, occlusion) were evaluated. After the independent reviews, a consensus was reached to resolve discrepancies. The consensus data was used as the reference for the unenhanced-MRA reading.

Results: More than one renal artery was found in 24 patients. There was early division in 15 patients. Three patients had both extra renal artery and early division variations. All of the variations could be detected correctly by all readers. In five patients, all readers detected stenosis at main renal arteries. In two patients, two readers found renal artery stenosis while one reader interpreted it as normal. In a patient two readers reported as normal while one found renal artery stenosis. MR image quality score was found signifi-cantly higher in imaging main renal artery for all readers, compared to first order branch and parenchymal branch (p<0.001).Intraclass correlation coef-ficient was found high for evaluating main renal artery disease (ICC=0.82) and the presence of vascular variations (ICC=0.96).

Conclusion: Inhance 3D Inflow Inversion Recovery sequence is a reliable diagnostic method to depict renal vasculature without using contrast material in a very short time. The normality, stenosis and variations in the main renal arteries can be easily detected by this method. This method can be used safely as an alternative to enhanced techniques in patients with renal insufficiency.

Keywords: Inhance inflow inversion recovery, magnetic resonance, renal artery disease

O - 07

1.5 TESLA PROSTAT MRI PI-RADS V2 RESULTS, CORRELATION WITH FUSION BIOPSYPINAR GULERYUZ KIZIL1, ALMILA COSKUN BILGE1, EMRE CAN CELEBIOGLU1, UTKU LOKMAN2, NEFISE CAGLA TARHAN1 1Department of Radiology, TOBB ETU Hospital, Ankara, Turkey2Department of Urology, TOBB ETU Hospital, Ankara, Turkey

Abstract

Objective: Prostate cancer is the most common type of cancer in men. Magnetic resonance imaging (MRI) now plays an important role in the detection, localization and staging of prostate cancer. In this study, we aimed to correlate the lesions reported as especially PI-RADS 3 and PI-RADS 4 with fusion biopsy at 1.5T prostate MRI.

Materials and Methods: Dynamic multiparametric imaging was per-formed with 1.5T MRI (Magnetom Symphony, Siemens) system in 16 patients (age range 45-77, age average 62) with high PSA values or rapid PSA elevation with touché findings, family history or previously reported

systematic biopsy benignity. PI-RADSv2 scoring system was used to grade the lesions. US-guided fusion biopsies combined with MRI findings of PI-RADS 3 and 4 lesions were performed separately.

Results: A total of 22 biopsies with PIRADS 2 (n=1), PIRADS 3 (n=11) and PIRADS 4 (n=10) lesions were performed in 16 patients. Of the lesions, 14 were in peripheral zone, 5 in transitional and 3 in central zone. Prostate adenocarcinoma was detected in 8 of 10 lesions scored with PI-RADS 4 (Picture 1), and 1 of 11 lesions scored with PI-RADS 3. The sensitivity of PI-RADSv2 for malignant lesion detection was 88,8%, specificity was 84,6%, accuracy was 86,3%. The negative predictive value (NPV) and positive predictive value (PPV) were calculated as 91,6 % and 80 %, respectively.

Conclusion: High incidence of malignant results in lesions scoring PI-RADS 4 in prostate MRI suggests that these patients should be direct-ed to biopsy. Fusion biopsy improves accuracy rates, avoids unnecessary systematic biopsies and complications. When the appropriate sequences were used in 1.5T MRI system, the rate of detection of non-malignant lesions was found to be high. Thus, the complications that may occur secondary to the extra invasive procedures are also prevented.

Keywords: PI-RADS v2, 1.5 Tesla Prostat MRI, Fusion biopsy

O - 08

CONTRIBUTION OF THE DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING ON TYPING OF LIVER CYST HYDATICOZLEM ARMAY1, CEYDA TURAN BEKTAS2, AYTUL HANDE YARDIMCI2 1Bitlis State Hospital, Bitlis, Turkey 2İstanbul Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: The purpose of this study is to provide classification of dif-ferent types of hepatic hydatid cysts by measuring the mean apparent diffusion coefficient (ADC) using diffusion-weighted magnetic resonance imaging (DWI).

Materials and Methods: The total of 60 patients (42 female,18 male) and 79 lesions included in the research conducted in İstanbul Research and Training Hospital between January 2014 and May 2015, had been diagnosed with hepatic cyst lesions for various reasons according to the hospitals archived records of abdominal MRI, and therefore had their diagnosis pathologically or serologically confirmed. ADC and EADC maps were obtained with values of b0 and b400 s/mm2 and ADC and EADC mean valuses were calculated for each lesions. Then the average value calculated for each cyst types are compared quantitatively.

Results: In our study for ADC values, we determined that statistically there was significant difference between types 1 and 4, between type 2 and type 4, type 3 and type 4 (p=0.001). When we compared EADC values we found that WHO type 4 lesions EADC values were obviously lower than who type 1, 2 and 5 lesions (p=0.001).In addition, we divided our patients lesions into two groups, active (types 1-2-3) and inactive (types 4-5). When we compared each groups mean ADC and EADC values, we determined the difference between active and inactive groups. When compared to inactive groups, lesions ADC values of active types were higher and EADC values were lower as shown by statistics.


Conclusion: Our study shows that ADC and EADC values may be useful for differentiaton of type 4 lesions from other classes, and seperation of active and inactive groups.

Keywords: Hydatid cyst, diffusion weighted magnetic resonance imaging, apparent diffusion coefficient

O - 09

COMPARISON OF APPARENT DIFFUSION COEFFICIENT VALUES BETWEEN MALIGNANT LESIONS AND NORMAL UTERINE CERVIX WITH 3T MRIFUNDA DINC ELIBOL1, SEZEN BOZKURT KODEOGLU2 1Department of Radiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey2Department of Gynecology and Obstetrics, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey

Abstract

Objective: The aim of the study was to measure and compare apparent dif-fusion coefficient (ADC) values of uterine cervix between cervical neoplasms and normal cervical tissues with 3-Tesla magnetic resonance imaging (MRI).

Materials and Methods: From April 2017 to February 2018, eleven con-secutive female patients having Diffusion-weighted MRI (DWI) with a diagnosis cervix neoplasia were included in this retrospective case-control study. The control group consisted of age-matched patients with normal cervical smear and having pelvic DWI due to other pathologies expect cervical pathologies and genital malignities. All examinations were performed by using a 3-T MR with 2 different b values (b=50, 800 s/mm2). A total of 22 patients (cervical neoplasia group n=11 and control group n=11) ADC measurements were performed on the axial ADC map three-times by the same radiologist.

Results: The mean age of total patients, neoplasia group, and the con-trol group was 50.9 (between 33-58), 51 and 50.8, respectively. There was no statistically significant difference in mean age between the two groups (p>0.05). Neoplasms were 6 squamous cell carcinoma, 1 adeno-carcinoma, 1 clear cell carcinoma, 1 carcinoma in situ, 2 LSIL. The means of cervix ADC values of age-match groups were 0.79±0.32 mm2/s and 1.51±0.11 mm2/s, respectively. There were statistically significant differ-ences between groups in term of cervical ADC values (p=0.00).

Conclusion: In pelvic DWI lower ADC values of uterine cervix indicate neoplasm of the cervix. Further study with large patient population is necessary to find out a cut-off value

Keywords: 3T, ADC, uterine cervix cancer, DWI

O - 010

ABDOMINAL PAIN IN PREGNANCY: THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF ACUTE APPENDICITISEZGI GULER1, TIMUR KOSE2, MAHMUT KUSBECI1, MUSTAFA HARMAN1, NEVRA ELMAS1

1Department of Radiology, Ege University School of Medicine, İzmir, Turkey2Department of Biostatistics, Ege University School of Medicine, İzmir, Turkey

Abstract

Objective: To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in pregnant patients with suspected acute appendicitis and to assess its role in identifying other causes of abdominal pain in this population.

Materials and Methods: A retrospective database search from 2011 through 2018 for MRI exams of pregnant patients due to abdominal pain was performed. Sixty-one patients (median age:30 years) were identified. MRI exams were reviewed and the patients’ electronic medical record for surgical, pathological, and clinical follow up were investigated. Cases were evaluated for presence of appendicitis, visualization of the appen-dix, and non-appendiceal causes of pain. Kappa statistic and McNemar test were used to determine agreement between MRI and pathological examinations. Subjective analysis of image quality of MRI sequences was performed in cases with proven appendicitis.

Results: Seven (11.5%) of 61 MRI exams were consistent with acute appendicitis and were proven on pathology. One patient who underwent appendectomy was found to have appendicitis which could not be identi-fied by MRI. The sensitivity and specificity of MRI were 87.5% and 100%, respectively. Radiological and pathological agreement was found to be excellent (Kappa:0.92). Non-appendiceal causes for the patient’s abdomi-nal pain were seen in 32 (52.4%) scans. In 13 cases (21.3%), appendix could not be visualized on MRI. Of these, none had a final diagnosis of appendicitis. For the subjective analysis of image quality of each separately viewed MRI sequence in detecting appendicitis, there was no statistical significant difference (p>0.05).

Conclusion: MRI shows a high diagnostic value in the assessment of pregnant patients with suspected appendicitis and provides a variety of diagnoses of acute abdominal pain.

Keywords: Pregnancy, abdominal pain, appendicitis, MRI

O-11

IS MRI BE PREFERRED IN PEDIATRIC PRESEPTAL AND POSTSEPTAL PERIORBITAL INFECTION DIFFERENTIAL DIAGNOSIS?FIGEN PALABIYIK1, NIGAR ERKOC1, ERCAN INCI1, NEVIN HATIPOGLU2 1Department of Radiology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey2Department of Pediatrics, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Objective: In children who referred to hospital with periorbital swelling to differentiate preseptal cellulitis and orbital infection requiring emergency diagnosis and treatment, clinically is difficult so radiologic imaging is used. In children orbita CT with contrast is preferred because it does not require anesthesia and is easy to use in emergency conditions. However orbital infections and intracranial complications are evaluated better with orbital MRI. We purposed to evaluate difference between radiological findings of orbita CT and MRI and the contributions of these findings to the treatment in pediatric patients who had periorbital infection diagnosis in hospital.


Materials and Methods: We evaluated 106 patients who referred to hospital with periorbital swelling. The study is included 28 patients of these who performed CT and MRI. The findings of orbital CT and MRI of the cases were evaluated according to the Chandler classification used for periorbital infections.

Results: 13 (46.4%) of cases were male, 15 (53.6%) of cases were female and mean age was 8.43. While 22 (78.5%) of all cases was detected paranasal sinusitis.There was no difference between two imagings in the diagnosis of preseptal cellulitis,in diagnosis of orbital cellulitis that MRI was found signifi-cantly superior (p<0.05). No significant difference between two imagings in diagnosis subperiostal abscess but in evaluation of abscess size there was sig-nificant difference and MRI evaluate subperiostal abscess size larger than CT.

Conclusion: CT is often used to distinguish between emergency presep-tal and postseptal periorbital infections in children. However orbita MRI is more effective modality in assessing orbital extension and subperiosteal abscess size.

Keywords: MRI, differential diagnosis, pediatric, periorbital infection

O - 012

ROLE OF MRCP IN EVALUATION OF PATIENTS WITH POST-CHOLECYSTECTOMY SYNDROMEDILAN ECE GEYLAN DURGUN, MURAT UCAR, NESRIN ERDOGAN, ALI CAN YALCIN, NIL TOKGOZ

Department of Radiology, Gazi University School of Medicine, Ankara, Turkey

Abstract

Objective: The recurrence or new development of upper abdominal symptoms and signs (right upper quadrant pain, indigestion, abnormal liver function tests, hyperbilirubinemia etc.) after cholecystectomy operation is called as post-cholecystectomy syndrome (PCS). Its prevalence among cholecystectomised patients is about %10-15. The aim of this study was to assess the role of magnetic resonance cholangiopancreatography (MRCP) in the evaluation of patients with PCS.

Materials and Methods: A retrospective study over a period of 7 years (between January 2011 and January 2018) was performed with 379 patients who have cholecystectomy history and recurrent upper abdomi-nal symptoms. Clinical data from hospital’s electronic medical record system and MRCP images of patients were retrieved and evaluated. The definitive diagnosis was confirmed by patient history, physical examination, laboratory tests, US, MRCP and ERCP all together and it was compared to MRCP diagnosis in order to asses accuracy of MRCP alone in PCS.

Results: The patients group consisted of 57 early PCS and 322 late PCS. Among the late PCS group the most common diagnosis was choledocolithia-sis (32%). Twelve patients were diagnosed with malignancy, 8 of them had cholangiocellular carcinoma. Among the early PCS group the most common diagnosis was postoperative collection (30%) followed by operation related biliary tree injury (24.5%). MRCP yielded an overall sensitivity of 98%, speci-ficity of 92%, accuracy of 94% for the diagnosis of causes of PCS.

Conclusion: MRCP is a noninvasive, useful and reliable method in the diagnosis of causes of PCS and should be recommended for a better management of these patients.

Keywords: Cholecystectomy, choledocolithiasis, MRCP

O - 013

CAN WE PREDICT THE TIMING OF HEPATOSPECIFIC CONTRAST AGENT APPEARANCE IN THE BILE DUCT BEFORE MRI?ERDEM YILMAZ1, OSMAN KOSTEK2 1Department of Radiology, Trakya University School of Medicine, Edirne, Turkey2Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey

Abstract

Objective: Gd-EOB-DTPA is highly effective in diagnosis of bile duct pathologies. However, in some patients, Gd-EOB-DTPA is seen in the bile ducts at 5 min, and in some patients it is not observed at 120 min. The purpose of this study is to predict the Gd-EOB-DTPA appearance time (Gd-AppTime) in bile ducts with ALBI, APRI, FIB4 scores and liver function (albumin, bilirubin) and transaminase levels before examination.

Materials and Methods: Thirty-five patients were screened. 2 patients were removed from the study because of hepaticojejenostomy. 33 patients were analysed for Gd-AppTime in intrahepatic bile ducts, com-mon hepatic duct, proximal and distal common bile duct, gallbladder and duodenum. Possible correlation between ALBI, APRI, FIB4 scores, liver function (albumin, bilirubin), and transaminase levels were investigated with Gd-AppTime.

Results: Thirty-three patients (19K, 14E) were included in the study. The mean age was 52±13 (min:20, max: 84). There was no significant cor-relation between age and Gd-AppTime (p>0.05). ALBI score correlated positively with Gd-AppTime in proximal common bile duct (r=0.373, p=0.03), but correlated negatively with albumin (r=-0.366, p=0.04). On the other side, Gd-AppTime in distal common bile duct showed a negative correlation only with the albumin (r=-0.394, p=0.02). There was a significant correlation between total examination time with ALBI (r=0.504, p=0.003) and albumin (r=-0.428, p=0.01).

Conclusion: Changes in liver function affect the Gd-AppTime and dura-tion of the examination. We believe that this relationship can be seen more strongly with larger population studies.

Keywords: Hepatospecific contrast agents, MRI, imaging time

O - 014

THE ACCURACY OF 3T MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN SUSPECTED CHOLEDOCOLITHIASISIBRAHIM ONDER YENICERI1, NESAT CULLU1, BURAK OZSEKER2, EMINE NESE YENICERI3 1Department of Radiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey2Department of Internal Diseases, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey3Department of Family Medicine, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey


Abstract

Objective: The purpose of this study was to investigate interobserver agreement during MRCP evaluation and the sensitivity and specificity of MRCP obtained with 3T scanners in cases of suspected bile duct obstruc-tion.

Materials and Methods: Totally 37 patients who had MRCP and ERCP were included. Choledochal pathology was divided into two groups regarding the presence of stones as “there is stone or not”. MRCP were performed with 3 Tesla system using respiratory triggered HASTE tech-nique in axial and coronal plane and with T2 SPACE sequence in coronal plane. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated separately for each observer. Cohen kappa analysis was performed for the correlation between the observers. The average of both observers was calculated for comparison with other studies.

Results: The mean age of the 37 patients who constituted the study population was 63.51 (14-91). The mean time between MRCP and ECRP was 5.46 days (1-15 days). Median choledoc diamater was 5 mm (3-8 mm) in 7 normal subjects and 11.65 mm (6-23 mm) in 30 choledocolitha-sis. Agreement between the observers was analysed and Cohen’s kappa value was evaluated as 0.84. For two observers, sensitivity of MRCP was 93% where as specificity was 75% for the first observer and 62% for the second.

Conclusion: In this study we found a high level of interobserver agree-ment in evaluating MRCP. MRCP has a high sensitivity in detecting cho-ledocolithiasis in 3T scanners.

Keywords: 3T MRI, choledocolithiasis, MRCP, ERCP

O - 015

EVALUATION OF MICROWAVE ABLATION TREATMENT EFFICIENCY OF LIVER GIANT CAVERNOUS HEMANGIOMAS WITH MRIMEHMET SEMIH CAKIR, MELIS BAYKARA ULUSAN, ILHAN NAHIT MUTLU, CEYDA TURAN BEKTAS, AYTUL HANDE YARDIMCI, OZGUR KILICKESMEZ

İstanbul Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: Microwave ablation (MA) is a newly developed interventional method as an alternative to endovascular embolization used as a classical method in the treatment of hepatic cavernous hemangiomas. The pur-pose of this study was to evaluate the role of MR imaging in the assess-ment of treatment response of liver hemangiomas after MA therapy.

Materials and Methods: All patients who underwent MA therapy for cavernous hemangioma who had pre- and post-interventional MR exami-nations at our hospital between 10/2016 and 04/2017 were included. A retrospective analysis of the institutional imaging database identified 10 patients (5 men, 5 women, mean age: 47.9 years).

Measurements of diameter and volume of lesions were performed on axial T2w FSE images with fat saturation. ADC values of normal liver parenchyma and of the hepatic hemangiomas were calculated using diffu-sion weighted images. Results were calculated and compared using paired t-test with a significance level of 0.05.

Results: Criteria of tumor response to treatment assessed with respect to RECIST criteria. The mean diameter and volume of hemangiomas showed a significant decrease following treatment (p<0.05). Though comparison of pre- and post-interventional T1 and T2 signals were statistically signifi-cant ADC values were not.

Conclusion: In the treatment of hepatic giant cavernous hemangiomas, the results of the MA procedure are confounding. The most appropri-ate sequence showing the ablation zone for diameter and volumetric measurements in MR scans is T2w FSE scans. ADC values do not pro-vide a clear benefit in the quantitative assessment of residual liver tis-sue. Significant regression is observed in lesion dimensions according to RECIST criteria.

Keywords: Cavernous hemangioma, microwave ablation, MR, liver

O - 016

DIAGNOSTIC PERFORMANCE OF MR IMAGING FINDINGS AND DIFFUSION WEIGHTED MRI IN THE DIFFERENTIATION OF ENDOMETRIOMAS FROM HEMORRHAGIC OVARIAN CYSTSAYTUL HANDE YARDIMCI, ORHAN KAYA, CEYDA TURAN BEKTAS, BURAK KOCAK, MEHMET SEMIH CAKIR, MELIS BAYKARA ULUSAN, OZGUR KILICKESMEZ


Abstract

Objective: To evaluate magnetic resonance imaging (MRI) feature of endometriomas and to determine sensitivity and specificity of the Diffusion Weighted MRI in helping to distinguish endometriomas from other hemorrhagic adnexal cystic lesions.

Materials and Methods: Seventy-one patients who underwent surgery for histopathologically confirmed endometrioma and twenty-five patients with hemorrhagic cyst were included in the this study. The following MRI findings were reviewed in 96 patients (87 lesions in 71 patients with endo-metrioma and 25 lesions in 25 patients with hemorrhagic cyst): lesion size, morphological appearance, T2-weighted (T2W) signal intensity, T1-weighted (T1W) signal intensity, DWI signals with apparent diffusion coefficient (ADC) calculated for b=600 s/mm, b=800 s/mm (2), T2 dark spot and T2 shading sign in cystic lesions. Sensitivity, specificity, and positive and negative predictive values of the T2 dark spot and T1 hyperintencity and T2 shading sign in distinguishing endometriomas from hemorrhagic lesions were calculated. ADC values were measured 50-100 mm2 ROI in the ADC map.

Results: In the endometrioma group, T2A shading and T2 dark spot find-ings were significantly higher; T1A hypointensity was significantly higher in the hemorrhagic cyst group. We observed significantly lower ADC values in endometriomas compared with hemorrhagic ovarian cysts in all b val-ues. Sensitivity, specificity, positive predictive value, and negative predictive value of ADC values of 2 x10-3 mm2 /sn for differentiating endometrio-mas from other hemorrhagic cystic ovarian masses were 88.9%, 96.5%, 96% and 98.88% respectively.

Conclusion: We suggest that DWI should be included in the routine MRI pro-tocol for the evaluation of endometriomas from hemorrhagic ovarian cysts. It


may help in the better disease evaluation in substantiation with clues from the symptomatology as well as signal intensity on the conventional MRI.

Keywords: DWI and ADC, endometrioma, hemorrhagic ovarian cyst, MRI

O - 017

MRI FINDINGS OF PREGNANT PATIENTS WITH ACUTE ABDOMINAL PAINATAKAN ARSLAN, CANAN TUNCER ALTAY, ISIL BASARA AKIN, MUSTAFA SECIL

Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Objective: Ultrasonography (US) is the basic imaging method in preg-nancy. US may not be thoroughly evaluated pelvic region in the advanced stage of pregnancy. Magnetic resonance imaging(MRI) is the main diagnos-tic tool for the evaluation of the pregnant women with acute abdominal pain. The purpose of this study to evaluate MRI findings of pregnant patients with acute abdominal pain.

Materials and Methods: The study group comprised 24 patients (mean age, 30.7±6.1) in whom abdominal MRI was performed for acute abdominal pain. These patients were consecutively referred to our department for abdominal MR imaging and evaluated between January 2010 and January 2018, retro-spectively. Abdominal MRI examinations were obtained with fast T2-weighted images (WIs), and T1-Wis. No contrast material was administered. Chi-square test was performed using SPSS V.24 for statistical analysis.

Results: MRI has revealed normal findings in 9 patients, renal mass in 1 patient, isolated pelvic fluid in 1 patient, acute appendicitis in 4 patients, ovar-ian torsion in 1 patient, benign ovarian or uterine mass in 3 patients, compli-cated over cyst in 2 patients, endometrioma in 1 patient and acute hepatitis in 1 patient. There were no statistically significant differences between acute abdomen etiologies in terms of patient age and gestational age (p>0.05).

Conclusion: Acute abdominal pain during pregnancy requires rapid and effective diagnosis because of the necessity of urgent surgical intervention and it can cause high mortality and morbidity in case of delayed diagnosis. MRI is main diagnostic method used in the evaluation of acute abdominal pain in pregnant patients.

Keywords: Pregnancy, MRI, acute abdominal pain

O - 018

DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING FINDINGS IN DETERMINING OF LIVER METASTASES IN PANCREAS CANCERMELIKE RUSEN METIN1, SINEM SIGIT IKIZ2 1Ankara Atatürk Training and Research Hospital, Ankara, Turkey2Nicosia Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Cyprus

Abstract

Objective: Pancreatic cancer (ca) is one of the most common, curable, and poorly prognostic tumors of the present day. A screening test that provides early diagnosis has not been established yet. In order to prevent

unnecessary operations, screening should be done optimally. The purpose of this study was to investigate the superiority of Diffuse weighted imaging (DWI) sequences and computed tomography (CT) findigns in detecting small liver metastases, in addition to determine early diagnosis and oper-ability criteria in pancreatic cancer.

Materials and Methods: 79 pancreatic masses with adenocarcinoma and pancreatic neuroendocrine tumor (panNET) according to pathol-ogy results were evaluated retrospectively between 2009-2017 years. Laparoscopy, operation, biopsy and follow-up correlations were investi-gated with CT and DWI MRI findings.

Results: The distribution of ADC values did not show a statistically sig-nificant difference (p=0.976) in measurements between primer Adeno ca and PanNET. Similarly, there was no statistically significant difference in ADC measurements from the metastases of both groups (p=0.140). In a total of 8 patients more number of metastases were detected in DWI than in CT (38.10%). In 3 patients with no metastases detected on CT, 1 metastasis was detected on DWI MRI. In 3 patients DWI MRI showed single metastasis but they were not observed in CT.

Conclusion: One of the functional imaging modalities, DWI generally improves staging in terms of diagnosis of pancreatic adenocarcinoma and PanNET lesions and determination of liver metastases. Functional radio-logic imaging should therefore be used as a part of MR imaging modalities, and liver metastases in pancreas CA. Thus, liver metastases not detected in CT can be detected with DWI MRI, preventing unnecessary operations and thus increase in morbidity and mortality.

Keywords: MRI, DWI, pancreatic cancer, liver metastases, CT

O - 019

COMPLIANCE WITH THE TECHNICAL STANDARDS PROPOSED BY PI-RADS V2 GUIDELINE IN PERFORMING MULTIPARAMETRIC PROSTATE MAGNETIC RESONANCE IMAGING IN UNIVERSITY AND TRAINING HOSPITALS IN TURKEY: PRELIMINARY RESULTSMEHMET COSKUN1, ALI FIRAT SARP2, SEBNEM KARASU1, MUSTAFA FAZIL GELAL1, ISMAIL BARIS TURKBEY3 1Department of Radiology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey 2Department Of Radiology, Osmangazi University School of Medicine, Eskisehir, Turkey3Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

Abstract

Objective: Prostate imaging reporting and data system version 2 (PIRADSv2) aims global standardization for acquisition and interpretation of multiparametric magnetic resonance imaging (mpMRI). The purpose of this study was to determine adherence to PIRADSv2 parameters in academic centers in Turkey.

Materials and Methods: Eighty four tertiary referral academic hos-pitals in Turkey were asked to report their technical parameters of their prostate mpMRI protocols. A total of 6, 9, 8 and 9 acquisition


parameters for axial T2W, diffusion weighed imaging (DWI), dynamic contrast enhancement (DCE) and other technical standards were queried, respectively.

Results: Forty two of 84 centers reported to perform prostate mpMRI (n=26 located in one of the biggest 3 cities [İstanbul, Ankara, İzmir]) either at 1.5 (n=28) or 3 (n=14) Tesla. Two (4.8%) centers reported use of endorectal coil. There was only one center (2.4%) that had complete adherence to all parameters of PIRADSv2. For axial T2, adherence to voxel dimension on frequency, phase encod-ing steps, maximum 3mm slice thickness (ST) were 7.1% (3), 40.5% (17), 73.8 (31), respectively. For DWI, adherence to minimal b value (b≥1400), maximal 4mm ST were 61.9% (26), 83.3%(35), respec-tively. Among 40 centers performing DCE, 24 centers use temporal resolution<10sec, whereas 8 centers use temporal resolution<7 sec. Repetition time was the most commonly compliant parameter (38/40) for DCE. The mean image acquisition time for axial T2, DWI and DCE were 234, 301 and 233sec respectively.

Conclusion: The adherence to technical parameters of PIRADSv2 was lower than expected in academic centers in Turkey.

Keywords: PIRADSV2, Multiparametric, Prostate, MRI, Parameter

O - 020

IMAGING OF ACUTE PANCREATITIS: UPDATE OF THE REVISED ATLANTA CLASSIFICATONFULDEM MUTLU1, AYDIN SEREF KOKSAL2, BILAL TOKA2 1İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey 2Sakarya University Training and Research Hospital, Sakarya, Turkey

Abstract

Objective: To familarise the radiologist with the Revised Atlanta classifi-cation system of acute pancreatitis with the help of pictorial review and encourage them to use it in their everyday practice.

Materials and Methods: 213 patients who got the diagnosis of acute pancreatitis between 2015 to 2017 years in Sakarya University Hospital were taken to our study. We evaluated the morphology of the pancreas, interstitial oedematous and necrotisan,severity of the pancreas and local complications. We also evaluated laboratory tests, APACHE, Ranson, BISAP, SIRS, PANCODE and CTSI scores.

Results: We evaluated 213 acute pancreatic patients. %86.7were inter-stitial oedematous pancreatitis, %13.1 were necrotisan pancreatitis. According to Revised Atlanta criterisation; %69.1 minimal severe, % 29.2 medium severe and %9.7 was highly severe pancreatitis. We also evaluate Ranson, BISAP, SIRS and APACHE scores.

Conclusion: The Revised Atlanta classification helps in standardizing the terminologies used in acute pancreatitis across a wide range of speciali-ties. It helps in precise documentation and reporting of the cases of acute pancreatitis and makes the role of the radiologist in dispensable. It also helps in stratifying the patients based on severity leading to effective man-agement and treatment planning. Imaging findings along with the duration of onset of symptoms help in clearly identfying the different type of col-lections. This further enhances the importance of the radiologist in the multi-disciplinary management of acute pancreatitis.

Keywords: Abdominal imaging, CT, MR, pancreatitis, revised Atlanta clas-sification

O - 021

ASSESSMENT OF THE HEPATIC VASCULAR STRUCTURES: DYNAMIC ENHANCED MRI VERSUS DYNAMIC ENHANCED CT IN HEALTHY LIVER AND DISEASED LIVERAYSEGUL SAGIR KAHRAMAN1, BAYRAM KAHRAMAN2, LEYLA KARACA1, ZEYNEP MARAS OZDEMIR1 1Department of Radiology, İnönü University School of Medicine, Malatya, Turkey2Department of Radiology, Malatya Park Hospital, Malatya, Turkey

Abstract

Objective: We aimed to examine the relative usefulness and accuracy of MRI in assessing hepatic vascular structures as compared to CT in healthy liver and diseased liver.

Materials and Methods: We prospectively assessed 48 donor candidates and 60 adult patients with liver disease who underwent dynamic enhanced MRI and dynamic enhanced CT concurrently. The results of CT were compared against MRI firstly for all subjects totally and than for donors and patients separately. Additionally results of qualitative and quantitative MRI findings were also compared between donors and patients.

Results: For all subjects included in this study, demonstration of each vascular structure was significantly better at CT, except for right portal vein (RPV) and right inferior hepatic vein (RIHV) that were demonstrated equally at CT and MRI. The furthest inferior performances of MRI were in visualizing segment IV artery and RIHV. For both CT and MRI, the demon-stration of venous structures was significantly better in donors, except for left hepatic artery that was demonstrated better in patients. The qualita-tive and quantitative MRI findings were not significantly different between healthy subjects and patients with liver disease.

Conclusion: A detailed study of hepatic vascular structures is crucially signifi-cant in many clinical conditions in particular, in partial liver resection, cadaveric liver transplantation, living-donor liver transplantation, and in interventional treatment of hepatic primary or secondary tumours. Although CT remains the initial modality of choice in evaluating hepatic vascular anatomy, MRI appears diagnostically equivalent and/or close and should be considered pri-mary single imaging modality particularly if there is any contraindication to ct.

Keywords: Chronic liver disease, magnetic resonance imaging, computed tomography

O - 022

DIAGNOSTIC VALUE OF CONVENTIONAL ENTEROCLYSIS AND FOLLOW-UP MR ENTEROGRAPHY IN ADVANCED STAGE AND COMPLICATED CROHN DISEASEDENIZ ESIN TEKCAN SANLI1, EMEL ESMERER2, UGUR KORMAN3


1Department of Radiology, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş, Turkey2Department of Radiology, Hakkari State Hospital, Hakkari, Turkey3Department of Radiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey

Abstract

Objective: To determinene the type, stage, complication and activa-tion signs of Crohns disease with both Enteroclysis (ECL) and Magnetic Resonance Enterography (MRE), and to assess the complementary role for the clinician to identify the treatment modalities.

Materials and Methods: In this study, we performed primary radiologic diagnostic imaging with conventional enteroclysis in 110 patients with pre-diagnosis of Crohns disease and 107 cases with clinical findings of reactivation and/or complications with follow-up and treatment with Crohns disease. Follow-up MR review was performed for complicated or advanced stage CH according to conventional ECL findings.

Results: ECL was superior in determining the type and stage of the disease while MRE was more indicative of the activation findings and complications of the disease.

Conclusion: ECL and MRE combination is the optimal imaging method that guides the clinician in selecting the medical/surgical treatment to be applied to the patient, complementing each other in determining activa-tion findings, the type-stage and complications of the disease by revealing the mural-extramural and intraabdominal involvement.

Keywords: Crohn disease, enteroclysis, magnetic resonance enterography

O - 023

ENDOMETRIUM-MYOMETRIUM JUNCTIONAL ZONE THICKNESS IN ENDOMETRIOMA PATIENTSAGAH BARAN1, ANIL INCEDERE2, OMER ERBIL DOGAN2, MUSTAFA SECIL1 1Department of Radiology, Dokuz Eylül University Hospital, İzmir, Turkey2Department of Gynecology and Obstetrics, Dokuz Eylül University Hospital, İzmir, Turkey

Abstract

Objective: Junctional zone (JZ) is known as a transition zone between the endometrium and the external myometrium. In this study, we aimed to inves-tigate JZ thickness in endometriosis patients comparing with the control group.

Materials and Methods: MR images of 53 premenopausal patients operated between May 2012 and October 2017 due to endometrioma/endometrio-sis (Group 1, n=22) or other benign ovarian causes (Group 2, n=31) were retrospectively evaluated. On sagittal T2W images, two measurements were performed at the thickest (maximum) and the thinnest (minimum) levels of JZ. The difference between the two was calculated (‘JZdif’). Groups were composed according to the presence of the hyperintense nodule, JZ greater than 8 mm and ‘JZdif’ greater than 4 mm. The two groups were evaluated statistically by Chi-square and Mann-Whitney U Tests.

Results: The mean JZ min thickness was 4.77 mm in Group 1 and 4.52 mm in Group 2; the mean max thickness was 8.00 mm and 5.52, respec-tively. The ‘JZdif’ value was 3.22 mm in Group 1 and 1.00 mm in Group 2). Statistically significant difference was found in the thickness of JZ (>8mm) and JZ difference (>4mm) groups (p values 0.012 and 0.017,

respectively). There was no significant difference between the two groups in CA-125 values and hyperintense nodule presence (p>0.05).

Conclusion: In this study; JZ thickness was found to be thicker in the endometriosis patients than in the control group. The difference between JZ max-min greater than 4 mm was observed in endometriosis patients.

Keywords: Junctional zone, endometriosis, MRI

O - 024

THE EFFECT OF AGING ON ADC VALUES OF UTERINE CERVIXFUNDA DINC ELIBOL, SEZEN BOZKURT KOSEOGLU

Department of Radiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey

Abstract

Objective: The aim of the study was to evaluate whether a change of apparent diffusion coefficient (ADC) values with aging in the uterine cer-vix with 3-Tesla magnetic resonance imaging (MRI) or not.

Materials and Methods: We searched female patients age between 18 to 70 having lower abdominal diffusion-weighed MRI (DWI) in radiology database from December 2017 to February 2018. Patients having gyne-cologic malignancies were not included the study. All DWI examinations were performed by using a 3-T MR with 2 different b values (b=50, 800 s/mm2). The ADC values of the cervix were measured on the axial ADC map three-times by the same radiologist who didnt know the age of the patients. All patients divided into three groups according to their ages: group 1 age between 18-39, group 2 age between 40-49 and group 3 age between 50-70. The mean of measured ADC values and standard deviations were calculated for each patient. To evaluate the correlation between the age of the patient and ADC value Pearson-correlation analysis was performed.

Results: A total of 96 women age between 18-70 (mean 41,31) were included the study. In age over 49 the mean of ADC value was 0.95±0.17 mm2/s and in age, under 50 years the mean of ADC values was over 1.26±0.19 mm2/s. There were statistically significant differences between groups in term of cervical ADC values (p=0.00). There was a negative correlation between age and ADC values.

Conclusion: In previous studies, ADC values have been shown to be decreased due to hypercellularity. In this study, we found a negative cor-relation between aging and ADC values. This may indicate that hypercellu-larity may occur with aging. When we are evaluating the ADC values of cervix we must take into account of patients age.

Keywords: DWI, ADC, aging, uterine cervix

O - 025

EVALUATION OF MRI FINDINGS IN LIRADS-TIV LESIONS ACCORDING TO MORPHOLOGIC CHARACTERISTICSISIL BASARA AKIN, HAKAN ABDULLAH OZGUL, CANAN ALTAY, FUNDA BARLIK OBUZ



Abstract

Objective: Hepatocellular carcinoma (HCC) is the most common epithelial primer malignant tumor of liver. In the world it is the most common fifth tumor and third death cause. Incidence is high in Asia and Africa where HBV and HCV prevalence is prominent. In Turkey the eti-ologies are HBV, HCV and alcoholic liver disease respectively. Magnetic resonance imaging (MRI) is an effective diagnostic method. American College of Radiology reported LIRADS in 2011 and revised in 2017 in order to be able to produce a common report language for cirrhotic patients detection. In recent classification, HCC lesions with thrombus at least in one vein are classified as LIRADS-TIV lesions. Herein we aimed to evaluate MRI findings in LIRADS-TIV lesions according to morphologic features.

Materials and Methods: MRI images of 20 patients with HCC between March 2017–March 2018 were evaluated. Venous invasions were classi-fied in 4 level (Level 1- one vein near to lesion, Level 2- right-left portal veins, Level 3- main portal vein, Level 4- Confluence-extrahepatic veins). Level 1-2 was Group 1, Level 3-4 was Group 2. Lesions were evaluated according to distribution (focal-infiltrative), microscopic fat-necrosis and washout. Qui-Square Test was applied, p<0.05 was statistical significant.

Results: Mean diameter was 10.75±64.73mm. Most common ethol-ogy was HBV. There was no statistical significance between two groups according to distribution, necrosis-washout. However microscopic fat content was statistically significant between groups (p<0.05).

Conclusion: Metastatic features are manifest in LIRADS-TIV lesions and LIRADS-TIV forms contraindication in terms of transplantation. Venous thrombus is low in lesions with microscopic fat content, which is a well differentiation criterion. MRI is effective method in detection. Studies of LIRADS-TIV tumors will be able to clarify the characteristics of larger series of patients.

Keywords: Hepatocelular carcinoma, LIRAD-TIV, magneticresonance imaging

O - 026

IMAGING OF ADRENAL ADENOMAS USING FIESTA BALANCED STEADY STATE FREE PRECESSION PULS SEQUENCEGOKHAN PEKINDIL, FATMA CAN

Department of Radiology, Celal Bayar University School of Medicine, Manisa, Turkey

Abstract

Objective: Although FIESTA sequence is routinely used in anatomic evalu-ation of upper abdominal imaging, we recently showed in a previous study that it could be revealed intracellular lipid content in cases such as liver hepatosteatosis. In this study, imaging findings of adrenal adenomas which have intracellular lipid content will be presented using FIESTA sequence first time in the literature.

Materials and Methods: Fifty cases with adrenal adenoma which had adrenal signal intensity index (ASII) over 20% in out of phase MR imaging using 1.5 T machine were retrospectively measured SI mean values using appopriate 3 ROIs in adrenal adenoma, liver, spleen and psoas muscle in coronal FIESTA slices. SI values of Adrenal adenom, liver, spleen and psoas

muscle were compared with SI values of ASII in out of phase images using Pearson correlation and T-test.

Results: Adenomas SI values of FIESTA sequence were showed poor negative correlation (-0.036) with ASII values of out of phase images, whereas correlations of adenoma/spleen SI with ASII were strongest negative (-0.264), adenoma/psoas SI with ASII were poorest negative (-0.011). All SI measurements of FIESTA sequence were well corraleted with each other. We also detected poor positive correlation (+0.102) between SI of adrenal adenomas using FIESTA and SI obtained in out of phase images.

Conclusion: Although FIESTA sequence showed poor correlation with out of phase MRI in detection of typical adrenal adenomas containing intracellular lipid, the best correlation was observed in using spleen SI/adenoma SI ratio and adenomas were apperaed as hypointense in FIESTA sequnece. However larger comperative studies including cases with lipid poor adenomas and non adenomas are required to evaluate diagnostic value of the results.

Keywords: Adrenal adenoma, FIESTA sequence, magnetic resonance imaging

O - 027

CORRELATION OF HEPATIC ARTERIAL AND PORTAL VENOUS ANATOMY WITH BILE DUCT VARIATIONSMELAHAT KUL, DIGDEM KURU OZ, AYSE ERDEN

Department of Radiology, Ankara University School of Medicine, Ibni Sina Hospital, Ankara, Turkey

Abstract

Objective: To correlate hepatic arterial (HA) and portal venous (PV) anatomy with variations of bile duct (BD) confluence.

Materials and Methods: A total of 225 liver donors, who underwent dynamic-enhanced CT at our institution from July 2011-March 2017, were retrospectively reviewed. Hepatic artery and PV anatomy were categorized according to classifications of Michel and Cheng et al., respec-tively. Bile duct variations were evaluated on MRCP images according to Mc Sweeney classification. Hepatic vascular anatomy was correlated with BD variations using chi- square test.

Results: The study population consisted of 159 patients. The most observed HA variations were type 3 in 16 and type 2 in 10 patients. Type 1 PV was detected in 132, type 2 PV in 4 and type 3 PV in 23 patients. A normal BD anatomy and variations were observed in 79 and 80 patients, respectively. Bile duct anatomy showed no significant correlation between both HA and PV anatomy (p>0.05). A positive correlation was found between segment 4 artery arising from right HA and presence of diverse BD variations. Segment 4 artery originating from left HA was significantly associated with normal BD anatomy (p=0.046).

Conclusion: Preoperative assessment of hepatic vascular and BD anato-my in liver donors is essential for safe liver transplantation. However, due to their thin caliber in MRCP, detection of BD variations can be challeng-ing. In such cases, the presence of segment 4 artery originating from right HA might be indicative of BD variation and should lead to more cautious biliary assessment.

Keywords: Liver donor, hepatic artery, portal vein, bile duct variations


O - 028

THE VALUE OF IMAGING FINDINGS FOR PREDICTING HEPATOCELLULAR CARCINOMA (HCC) RECURRENCE AFTER LIVING DONOR LIVER TRANSPLANTATION (LDLT)SADIK SERVER1, KROUROSH YAGHOUTI1, EMEL KAYA AUMANN1, TOLGA SAHIN2, NAGIHAN INAN1, UNAL AYDIN3, N. CEM BALCI1, YAMAN TOKAT3 1Department of Radiology, İstanbul Bilim University Sisli Florence Nightingale Hospital, İstanbul, Turkey2Department of Gastroenterelogy, İstanbul Bilim University Sisli Florence Nightingale Hospital, İstanbul, Turkey 3Department of Liver Transplantation, İstanbul Bilim University Sisli Florence Nightingale Hospital, İstanbul, Turkey

Abstract

Objective: HCC recurrence rate after LDLT remains a significant prob-lem in clinical practise. Although many potential risk factors have been described, a reliable preoperative method to estimate this risk has not been established. The purpose of this study was to determine the utility of imaging findings in predicting HCC recurrence after LDLT.

Materials and Methods: Eighty patients with 135 HCCs who were underwent CT and/or MRI included in this study. Twelve patients with 37 HCCs (group 1) had recurrence, while 68 patients with 98 HCCs (group II) had remained disease free. Following radiologic findings were evaluated by two radiologists: number of HCCs, largest tumor diameter, tumor margins, tumor internal homogeneity, arterial enhancement pattern, the presence or absence of tumor capsule, periportal LAP, bulging (tumor causing liver capsul expansion), and beak sign (the acute angle between the tumor and liver parenchyma).

Results: Number of HCCs were significantly higher and the distance from tumor to portal vein were significantly shorter in group 1 than those of group II. A tumor capsule was seen in 56,8% in group 1, and 78,6% in group II; LAP was seen in 56,8% in group 1, and 7,1% in group II, beak sign was seen in 29,7% in group 1, and 2.2% in group II. The bulging sign was more frequently seen in group 1.

Conclusion: Patient with beak sign in their pretransplant imaging exami-nations might benefit from histologic confirmation of the tumor through biopsy and subsequent bridge treatment such as TARE or TACE prior to liver transplantation.

Keywords: Liver transplantation, beak sign, HCC

O - 029

DIFFERENTIATION OF ADRENAL ADENOMAS FROM ADRENAL METASTASIS WITH INTRAVOXEL INCOHERENT MOTION MODELBEDRIYE KOYUNCU SOKMEN1, AYSEGUL OZ1, SOHEIL SABET1, SADIK SERVER1, SEZGI BURCIN BARLAS1, DOGUKAN SOKMEN2, NAGIHAN INAN1 1Department of Radiology, İstanbul Bilim University Sisli Florence Nightingale Hospital, İstanbul, Turkey2Department of Urology, Memorial Bahçelievler Hospital, İstanbul, Turkey

Abstract

Objective: Intravoxel incoherent motion is a diffusion weighted imaging method which can characterize the relation between signal intensity and b value. Regarding to this bieksponential model, IVIM would seperate the diffusion of water molecules from microcapillary perfusion of tissues. This technique may estimate the perfusion of tissues without intravenous contrast application. To investigate the value of an intravoxel incoherent motion (IVIM) diffusion perfusion model for differentiation between adrenal adenomas and adrenal metastasis.

Materials and Methods: We retrospectively evaluated thirty five adrenal lesions. Twenty five lesions were incidentally detected adenomas. Ten lesions were adrenal metastasis from primary oncologic malignancies. Fourteen lesions were bilateral. Mean age of all subjects was 61 years (range 43-81). All patients were examined by 1.5T MRI (Siemens, Magnetom Symphony, Erlangen, Germany) with the use of four-channel phased array body coil. In addition to routine pre- and postcontrast sequences, IVIM (16 dif ferent b factors of 0, 50, 100, 150, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300 s/mm2) and conventional DWI (3 different b factors of 50, 400, 800 s/mm2) were obtained using a free breath single-shot echo planar spin echo (EPI) sequence. The ADC maps reconstructed from conventional DWI (ADCcon). The mean D (true diffusion coefficent), D* (pseudo-diffusion coefficient associated with blood flow) and f (perfusion fraction) values also calculated from IVIM. Quantitatively, both ADCcon, D, D* and f values were compared between adenoma and metastase groups by Mann-Whitney U test.

Results: The f and D values were statistically higher in metastasis group (p<0.05). ADC and D* values of metastatic lesions were significantly lower than those of adenomas (p<0.05).

Conclusion: IVIM parameters such as f, ADC and D* values can provide significant diagnostic information about differentiation of adrenal adeno-mas and adrenal metastasis, based on different perfusion characteristics.

Keywords: Adrenal, metastasis, adenoma, intravoxel incoherent motion

O - 030

EFFECTIVENESS OF CT AND MRI METHODS IN EVALUATING LIVER STEATOSIS OF LIVING LIVER DONORSDIGDEM KURU OZ, AYSEGUL GURSOY CORUH, ILHAN ERDEN, AYSE ERDEN

Department of Radiology, Ankara University School of Medicine, Ankara, Turkey

Abstract

Objective: To investigate the efficacy of CT and MRI methods in quantify-ing liver fat.

Materials and Methods: Sixty-five patients who underwent CT and MR examinations as living donor candidates for liver transplantation from January 2017 to March 2018 were studied. Patients without histopathol-ogy were excluded. Patients body mass index (BMI) was noted. The liver attenuation index (LAI) obtained by ROI analysis from the liver and spleen parenchyma on non-contrast CT examination were calculated. In MR, the parenchyma fat signal fraction was obtained by ROI analysis from the in-out phase images and the proton density fat fraction (PDFF) map. MRI


and CT results were compared with pre- and / or intraoperative biopsy results. Spearman correlation coefficient and ROC (receiver operating characteristic) analysis were used for statistical analysis. Sensitivity, specific-ity, positive predictive value, negative predictive value and 95% confidence interval were calculated.

Results: A total of 30 patients (19 males, 11 females, mean age 34.7 years (range 19-55 years) were included in the study. The mean BMI of the patients was 26.9 (range 20-38). There was a significant correlation between, CT LAI, the parenchyma fat signal fraction and histopathologic results (r=-0.712, 0.508, 0.649, respectively). According to the presence or absence of steatosis, patients were divided into two groups. Cut-off values for CT, dual-echo technique and PDFF were determined as 6.25, 3.2, and 2.95, respectively. The area under curve was measured as 0.847, 0.831, 0.855, respectively. Sensitivity, specificity, positive predictive value (95% confidence interval), negative predictive value and accuracy were 0.833, 0.722, 0.667 (0.471-0.821), 0.867 and 0.77, respectively, for CT and 0.833, 0.778, 0.714 (0.519-0.856), 0.875 and 0.80 respectively, for, dual-echo technique and 0.909, 0.688, 0.667 (0.460-0.828), 0. 917 and 0.78 respectively, for PDFF.

Conclusion: Significant correlation of dual-echo technique, PDFF and CT outcomes with histopathology suggests that these noninvasive effective methods can be used as biopsy alternatives when living donor liver fat is graded.

Keywords: Liver donors, fat quantification, CT, MR

O - 031

EVALUATION OF ACUTE ABDOMEN WITH RAPID SEQUENCE MRALI HAYDAR BAYKAN, SUKRU SAHIN, IBRAHIM INAN, SAFIYE KAFADAR, SUKRU MEHMET ERTURK

Department of Radiology, Adıyaman Universty School of Medicine, Adıyaman, Turkey

Abstract

Objective: Acute abdominal pain is a clinical chart for which patients apply to emergency services and which often results in the need for surgical treatment.

Contrast-enhanced abdominal computed tomography (CT) and ultraso-nography are frequently used as first-step imaging methods in these cases.

In this study, it was aimed to compare the diagnostic performance of nonenhanced abdominal MR imaging in cases with acute abdomen pain, evaluation of compliance between observers and comparison with ultra-sonography and computed tomography.

Materials and Methods: Patients admitted to our emergency department with acute abdomen pain between January 2016-February 2018 were included in the study. Data obtained from computed tomography and/or ultrasonography examinations were recorded retrospectively.

MRI images were independently evaluated by two Radiology specialists and the results were recorded.

Results: 12 of the 25 cases included in the study were male (48%) and 13 were female (52%). The average age was 44.32±21.87. In 13 cases (52%) the treatment was surgical and 12 (48%) cases were conservative. MR sensitivity was 100% for the first observer, 92% for the second observer, BT sensitivity was 90%, ultrasound sensitivity was 61.5%. In the evaluation

of inter-observer harmony, there was a perfect compliance between the two observers (κ=0.901).

Conclusion: Abdomen MRI obtained without using contrast agent Computed Tomography and ultrasonography shows high diagnostic suc-cess in acute abdomen cases and high compliance between observers.

Although the cost is high, there are advantages that can be evaluated without using contrast agent, not containing ionizing radiation and not requiring Radiology Specialist.

Keywords: MRI, abdomen, emergency

O - 032

CORRELATION OF GD-EOB-DTPA ENHANCED DYNAMIC MRI WITH HISTOPATHOLOGICAL DIFFERENTIATION IN HEPATOCELLULAR CARCINOMAHUSEYIN TUGSAN BALLI1, FERHAT CAN PISKIN1, KIVILCIM ERDOGAN2, YUSUF CAN1, KAIRGELDY AIKIMBAEV1 1Department of Radiology, Cukurova University School of Medicine, Adana, Turkey 2Department of Pathology, Cukurova University School of Medicine, Adana, Turkey

Abstract

Objective: To evaluate the relationship between histological differentia-tion of the tumor and enhancement pattern in dynamic MRI (DMRI) with gadoxetine acid disodium (Gd-EOB-DTPA) in patients with hepatocellular carcinoma (HCC).

Materials and Methods: Between April 2015 and February 2018 Gd-EOB-DTPA DMRI of 32 patients with histopathologically proved HCC were evaluated retrospectively. Tumors’ morphological features, distribution, AFP values and enhancement pattern were qualitatively analyzed. The relative signal intensity ratio (RIR) and enhancement ratio (ER) were examined quantitatively by measuring signal intensi-ties of hepatic parenchyma and tumor in post-contrast hepatobiliary phase in DMRI.

Results: Thirty-two patients (median age 64.5) were evaluated. HCCs were diagnosed as well (n=14), moderately (n=9) and poorly differ-entiated (n=9) according to histopathological evaluation. AFP values were significantly higher in poorly differentiated tumors (p=0.030). There was no correlation between the enhancement pattern of the tumor, morphological features and tumor distribution with the his-tological differentiation (p=0.319, p=0.565, p=0.293, respectively). There was statistically significant relationship between signal intensity of the tumor and histopathological differentiation in hepatobiliary phase (p=0.027). However, there was no significant correlation between post-contrast RIR and ER with tumor histological differen-tiation (p=0.065, p=0.160, respectively).

Conclusion: In Gd-EOB-DTPA-enhanced dynamic MRI, the contrast enhancement in the hepatobiliary phase is an effective parameter for pre-dicting histologic differentiation in patients with hepatocellular carcinoma.

Keywords: Hepatocellular carcinoma, histopathologic differentiation, Gd-EOB-DTPA


O - 033

DIFUSSION WEIGHTED IMAGING OF HEPATOCELLULER CARCINOMA: RELATIONSHIP BETWEEN IMAGING CHARACTERISTICS, APPARENT DIFFUSION COEFFICIENTS AND HISTOPATHOLOGICAL GRADEHUSEYIN TUGSAN BALLI1, YUSUF CAN1, KIVILCIM ERDOGAN2, FERHAT CAN PISKIN1, KAIRGELDY AIKIMBAEV1 1Department of Radiology, Cukurova University School of Medicine, Adana, Turkey 2Department of Pathology, Cukurova University School of Medicine, Adana, Turkey

Abstract

Objective: To define correlation between histopathological grade of hepatocellular carcinoma (HCC) and diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC).

Materials and Methods: We retrospectively evaluated pathologically confirmed 33 patients with HCCs who underwent hepatic multipa-rametric dynamic MRI on 3.0-T platform, between September 2016 and January 2018. HCCs were diagnosed as well (n=13), moderately (n=11) and poorly (n=9) differentiated according to histopathological assessment. Two abdomen imaging experienced radiologists reviewed all the images and noted the signal intensity (SI) of each tumor on DWI images with b-values of 800 s/mm2. The mean ADC values were measured for each tumor. The relationships between SI values, ADC values on DWI, and histopathological differentiation of HCC were analyzed.

Results: All HCC nodules showed hyperintensity with comparison to the surrounding hepatic parenchyma on DWI. There was no significant correlation between ADC values (p=0.143) and SI values on DWI (p=0.765) with histopathological grade. Alfa fetoprotein (AFP) values exhibited correlation with histopathologic grade of the tumor with higher measured values in poorly differentiated group (p=0.009). Presence of macrovascular invasion, pseudo-capsule and necrotic component, number or distribution of lesions showed no relationship with tumor grade.

Conclusion: Quantitative analysis of SI and ADC values did not show correlation with histopathological grade in hepatocellular carcinoma. However, AFP values might be useful to define tumor biology with respect to pathological differentiation.

Keywords: Hepatocellular carcinoma, histopathological differentiation, diffusion weighted imaging

O - 034

PELVIC LEIOMYOMAS IN RARE LOCALIZATIONS AND MAGNETIC RESONANCE IMAGING FINDINGSNAMIK KEMAL ALTINBAS

Ankara University School of Medicine, Ankara, Turkey

AbstractThe aim of this study was to evaluate some rarely localized uterine fibroids and their magnetic resonance imaging findings with case samples. In this retrospective study, 65 cases diagnosed as leiomyo-mas via pelvic MR examination were collected from recorded data between January 2014 and August 2017. Locations, sizes and MR signal features of 5 patients’ masses were noted. Symptoms and complaints of the patients were recorded and discussed. The mean age of the patients was 45±6.16 years (37-53). An extra-uterine, and a giant fibroid and leiomyomas of the urinary bladder, uterine cervix, uterine isthmus were investigated. All patients underwent a laparotomy or laparoscopy, and the diagnosis was confirmed histopathologically. Pelvic fibroids based on their location, size and compression features lead to different symptoms and, diagnosis may sometimes be difficult. In this instance, the additional and problem-solving role of MRI should be kept in mind.

Keywords: Fibroid tumors, leiomyoma, magnetic resonance imaging

O - 035

MAGNETIC RESONANCE FINDINGS IN OVARIAN TORSIONAHMET AKCAY, FURKAN UFUK, DUYGU HEREK

Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey

Abstract

Objective: To evaluate the magnetic resonance imaging (MRI) findings of patients with ovarian torsion and compare these findings with ovarian salvageability.

Materials and Methods: Patients who were diagnosed with ovarian torsion and underwent MRI were retrospectively investigated. A total of only 10 patients (mean age, 26.7; SD,±10; age range, 14-42), with surgical confirmation of ovarian torsion, were included to the study. All patients underwent conven-tional MRI and 6 patients also underwent diffusion-weighted imaging (DWI) using a b-value of 600 s/mm2. Quantitative and qualitative analysis of both the torsed and contralateral normal ovary were performed.

Results: Of the 10 patients, 5 torsed ovaries could be salvaged in a viable state. The mean size of the torsed ovaries was found to increased more than 100% when compared to the contralateral normal ovary (60.8+19.3 mm vs. 25.8+3.4 mm). Peripheral rim of high signal intensity on T1 weighted imaging with fat saturation was found in 8 of the 10 patients. Of these 8 patients, 5 ovaries were found to be non-salvageable. Swirling of the vascular pedicle and free fluid around torsed ovaries was present in all cases. Torsion causes were ovarian fibroma in one case, endometrioma in two cases and > 4 cm ovarian cyst in two cases. In other cases, there were no lesions. Average apparent diffusion coefficient (ADC) values in torsed ovaries were found to be lower than the contralateral normal ovary (1.6 x 10-3 mm2/sn vs 2.1 x 10-3 mm2/sn).

Conclusion: Swirling of the vascular pedicle, free fluid around torsed ovaries and increased ovarian size by more than 2 times compared to the contralateral ovary are significant findings for ovarian torsion and these findings should be carefully investigated in patients with suspected torsion.

Keywords: Ovarian torsion, magnetic resonance imaging, emergency medicine, ovarian viability


O - 037

EVALUATION OF COCHLEAR NERVE SCALE WITH MRI IN PATIENTS WITH IDIOPATHIC UNILATERAL SENSORINEURAL HEARING LOSSHAKKI CANER INAN1, ONUR TAYDAS2 1Department of Ear, Nose and Throat, Erzincan Mengücek Gazi Training and Research Hospital, Erzincan, Turkey 2Department of Radiology, Erzincan Mengücek Gazi Training and Research Hospital, Erzincan, Turkey

Abstract

Objective: Sensorineural hearing loss is the result of pathologies in the inner ear, retrocochlear region, vestibulocochlear nerve or intracra-nial region. Imaging is applied to these patients to exclude congenital, infectious, inflammatory or tumoral pathologies. In recent years, it has become possible to evaluate the cochlear nerve with magnetic reso-nance imaging (MRI), especially through the “constructive interference in steady state (CISS)” sequence. The aim of this study was to evaluate the cochlear nerve diameter in patients with unilateral sensorineural hearing loss and to compare the diameters of the normal side with the hearing loss side.

Materials and Methods: A total of 21 patients with idiopathic unilateral sensorineural hearing loss were included in the study. MRI and audiogram were performed on all patients. Both cochlear nerve diameters were measured on axial thin-section CISS sequence images.

Results: The patients comprised 10 males and 11 females with a mean age of 52±11 years. Hearing loss was determined in the right ear in 5 patients, and in the left ear in 16. The average cochlear nerve diameter on the side with hearing loss was 0.13 mm and 0.19 mm on the unaffected side. There was a statistically significant difference between the two sides (p<0.001).

Conclusion: In patients with unilateral sensorineural hearing loss, MRI allows anatomically detailed assessment of the cochlear nerve, as well as excluding possible organic pathologies. Demonstration of decreased cochlear nerve diameter in idiopathic sensorineural hear-ing loss will contribute to elucidating the etiology of this disease in the future.

Keywords: Cochlear nerve, sensorineural hearing loss, magnetic reso-nance imaging

O - 038

DOES THE PERFORMANCE OF MAGNETIC RESONANCE IMAGING REACH TO COMPUTERIZED TOMOGRAPHY IN SHOWING BONE CHANGES IN THE TEMPOROMANDIBULAR JOINT?MEHMET COSKUN, NEZAHAT KARACA ERDOGAN, ATILLA HIKMET CILENGIR, MUHSIN ENGIN ULUC

Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Objective: Temporomandibular joint (TMJ) pain affects 5-12% of the population. Among the pain-related disorders in the musculoskeletal sys-tem, it is the second most common cause after back pain.

Computerized tomography (CT) is the best imaging method to show bone cortex and sclerosis in radiological evaluation while magnetic reso-nance imaging (MRI) is the standard imaging method to identify internal derangement related with joint disc. In this study, the performance of MRI was compared to CT which is adopted the gold standard in showing bone changes in TMJ.

Materials and Methods: Between April 2013 and August 2017, the patients who had both TMJ CT and MRI were included. The patients who were under 15, had acute trauma-traumatic dislocation, congenital anomalies, history of head and neck tumors and radiotherapy were excluded. Joint degeneration was staged using condylar-eminence sclerosis, subchondral cyst, condylar erosion, osteophyte, deformation and ankylosis criteria.

Results: Degeneration was not seen in 47 of 108 joints that provided the inclusion criteria. 34 joints were in stage 1, 19 were in stage 2, 8 were in stage 3, on CT evaluation. All stage 2 and 3 joints were detected on MRI however 26/34 (76.5%) stage 1 joints were defined with MRI.

Sensitivity and specificity of magnetic resonance imaging were 86.9% and 97.9%, respectively, when computerized tomography was accepted as the gold standard. Magnetic resonance imaging could not detect 23.5% of early stage (Stage 1) degenerative cases.

Conclusion: Magnetic resonance imaging was quite successful in showing bone degeneration, but early stage bone changes could be missed.

Keywords: CT, MRI, internal derangement, bone degeneration, osteoar-thritis, temporomandibular joint

O - 040

A CHALLENGING DIAGNOSIS ON MRI: ORBITAL IGG4-RELATED DISEASE AND LYMPHOMAELIF BULUT, KADER KARLI OGUZ

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey

Abstract

Objective: To investigate MRI features that may help to differentiate between orbital IgG4-related disease and lymphoma.

Materials and Methods: We retrospectively examined initial MRI stud-ies (3 and 1.5 Tesla) of 9 patients with orbital IgG4-related disease (F/M: 5/4) and 9 patients with orbital non-Hodgkin lymphoma (F/M: 4/5). The median age of the patients at the time of MRI was 51 (7-69) and 40 (6-62) years, respectively. Orbital lesions were evaluated with respect to location, T1 and T2 signal intensity, contrast enhancement and diffusion characteristics. T2 signal intensity ratio (SIR) of lesions to temporal cortex, ADC ratio of lesions to cortex and pons were also calculated. Fisher’s exact and Wilcoxon signed rank tests were performed to compare MRI findings between groups. Results with p-values ≤ 0.05 were considered to be statistically significant.

Results: Orbital involvement was unilateral in 8 patients in each group. The most frequent locations were lateral and/or superior extraconal


space in lymphoma (n=7), medial extraconal space and/or medial rectus muscle in IgG4-related disease (n=4). There was no significant difference in terms of T1 and T2 signal intensity, contrast enhancement pattern and T2 SIR between groups. The mean ADC values were 1.25±0.29 (×10-3 mm2/s) in IgG4-related lesions and 0.56±0.16 (×10-3 mm2/s) in lymphoma lesions. ADC values and ADC ratios were found significantly different between groups (p=0.01).

Conclusion: Although there is a considerable overlap in conventional MRI findings of orbital IgG4-related disease and lymphoma, ADC values and ADC ratios could be used to help differentiation.

Keywords: MRI, orbita, IgG4-related disease, lymphoma

O - 041

MRI PREVALENCE OF EXTRAMEDULLARY HEMATOPIESIS OF THE PARANASAL SINUSES IN CHILDREN WITH HAEMOGLOBINOPATHIES TANER ARPACI

Acıbadem University Vocational School of Health Services, Acıbadem Adana Hospital, Adana, Turkey

Abstract

Objective: Extramedullary hematopoiesis (EMH) develops in chronic anemies like thalassemia and sickle cell disease (SCD) as response to increased need for erithrocyte production. It most commonly occurs in liver, spleen and paravertebral regions. It is rare in head and neck but has been reported in paranasal sinuses (PNS), thyroid and lacrimal glands. Maxillary sinus is the most commonly involved PNS. Purpose of this study was to investigate magnetic resonance imaging (MRI) prevalence of EMH of PNS in pediatric patients with haemoglobin-opathies.

Materials and Methods: Medical records of 110 pediatric patients (69 thalassemia, 41 SCD) who were followed up for haemoglobinopathies between January 2010-March 2018 in our instution were evaluated. Thirty patients (16 thalassemia, 14 SCD) who underwent MRI of the brain, neck and PNS for any reason were included in the study (13 girl, 17 boy; age range 3-19; median age 14 years). MRI studies were retro-spectively reviewed.

Results: Four (13%) of 30 patients demonstrated EMH of PNS (2 girl, 2 boy; age range, 4-17; median age, 11 years). Three (18%) of 16 patients with thalassemia and 1 (7%) of 14 patients with SCD revealed EMH of PNS. Three (75%) of 4 were detected in maxillary sinus and one (25%) was in sphenoid sinus.

Conclusion: Patients with thalassemia demonstrated higher prevalence of EMH of PNS which was more frequently observed in maxillary sinus and defined as homogeneous soft tissue mass expanding the sinus wall, filling the sinus cavity and demonstrating signal intensity consistent with red bone marrow hyperplasia on MRI. It should not be confused with PNS tumors. Correct diagnosis prevents biopsy and other invasive procedures.

Keywords: Paranasal sinus, extramedullary hematopoiesis, thalassemia, sickle cell disease, magnetic resonance imaging

O - 042

SINONASAL SCHWANNOMAS:A CASE SERIES AND REVIEWEMIN DEMIREL, CIGDEM OZER GOKASLAN

Department of Radiology, Afyon Kocatepe University School of Medicine, Afyoni Turkey

Abstract

Schwannomas, also known as neurilemmomas or perineural fibroblastoma), are slow growing benign tumors and originate from the Schwann cells in the sheath of the myelinated nerve fibres first described by Verocay in 1908. These tumors can occur any location in the body but are compara-tively common (25-45%) in the head and neck region but involvement of the sinonasal region and pterygopalatine fossa is rare (4%).

These lesions are typically asymptomatic until they grow large enough to perform a mass effect on ambient structures, by means of that pro-ducing clinical symptoms. Primarily the patients experience nonspecific nasal symptoms (such as rhinorrhea,epistaxis and nasal obstruction) the physician try to conservative praxis means fail to improve the symptoms. Sinonasal anatomy cause the early clinical diagnosis of such tumors difficult until the sinonasal schwannomas are quite large.

Keywords: Sinonasal Schwannoma, MRI, head and neck radiology

O - 046

CRANIOCEREBRAL METASTASES IN CHILDREN WITH NEUROBLASTOMA: A SERIES OF 8 CASESMESUT SIVRI, HAVVA AKMAZ UNLU, NAZLI GULSUM AKYEL, AYSE GUL ALIMLI

Department of Radiology, University Of Health Sciences, Ankara Child Health And Diseases Hematology Oncology Training And Research Hospital, Ankara, Turkey

Abstract

Neuroblastoma is the third commonest childhood tumour after leukaemia and brain malignancies.that occur anywhere along the sympathetic chain, the vast majority arise from the adrenal gland. Craniocerebral neuroblastoma metastases may involve the calvaria, orbits, skull base, dura, brain, ventricles and leptomeninges.. Although neuroblastoma is common, involvement of the craniocerebral metastases, imaging findings and follow-up views are rarely reported in the literature. Generally, over the past several years, they pre-sented as a case report. The aim of this study is to present imaging findings of craniocerebral metastases in children with neuroblastoma in a series of 8 cases.

Keywords: CNS, neuroblastoma, metastas, MRI

O - 049

RADIOMICS APPLICATIONS ON MAGNETIC RESONANCE IMAGES: HOW I DO IT?ILKER OZGUR KOSKA

Ege University School of Medicine, İzmir, Turkey


Abstract

Objective: Radiomics is rising its popularity among imaging community. It is a way of quantifiying the pixel values which reflect the underlying tissue architecture revealed by imaging modalities. Statistical, model based or wavelet transformations and shape features by geometric model descriptors can be used for analysis. Then by combining this data with clinical or other relevant patient data, some computer based pattern recognition algorithms are applied in order to classify them under correct pathological label. Our aim is to demonstrate steps of this process.

Materials and Methods: Although it seems somewhat sophisticated for the unfamiliar, it is not a so complicated process. Either by using Matlab and writing a few lines of code or by using software packages such as MaZda or Weka which are commercial products or freeware, analysis of our data is an easy task. We demonstrated the process step by step from region of interest selection to preprocessing and feature extraction and finally classification by means of Bayesian or kNN calssifier or neural networks on magnetic resonance images of brain tumors.

Results: The steps applied are demonstrated by screen shots of Matlab based processing.

Conclusion: In the new artificial intelligence era, radiomics methods are strong tools for decision support purposes. Familiarity with these meth-ods may lead to more frequent usage of them by radiologists.

Keywords: Radiomics, artificial intelligence, texture analysis

O - 050

PATTERN RECOGNITION METHODS FOR RADIOMICS APPLICATIONS OF MRI IMAGESILKER OZGUR KOSKA


Abstract

Objective: Radiomics deals with the images as they are pieces of data and applies pattern recognition methods in order to classify them with correct labels. Supervised or unsupervised methods may be applied. With this study, our aim was introducing the most used pattern classifi-cation methods and provide some familiarity to them for non-technical staff.

Materials and Methods: Bayesian classification, kNN, artificial neural networks and support vector machine methods are introduced in an intuitive way.

Results: Aim of getting some familarity to these methods were provided by application of them to magnetic resonance image texture features and step by step examples

Conclusion: Machine learning methods are gaining importance and cur-rently ongoing extensive research by them dominates innovative aspect of imaging science. Getting some familarity with them will provide both understanding the publications on that area more clearly and opportunity for joining the community applying these methods.

Keywords: Machine learning, pattern classificaiton, magnetic resonance texture

O - 051

DWI FOR SOLITARY PULMONARY NODULE ASSESSMENTERDEM FATIHOGLU1, SUZAN BIRI2, SONAY AYDIN1, ELIF ERGUN1, PINAR KOSAR1 1Ankara Training and Research Hospital, Ankara, Turkey2 Koru Hospital, Ankara, Turkey

Abstract

Objective: The aim of this study is to assess magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), T2 weighted image (T2WI) and apparent diffusion coefficient (ADC) maps thresholds value before computed tomography (CT) -guided transthorasic biopsy in solitary pul-monary nodules (SPN) by describing tumoral cell density.

Materials and Methods: Patients who had SPN were prospectively evalu-ated with MRI (T1WI, T2WI) and DWI (b=0, b=500, b=1000). ADC maps were created for each patient. Before the biopsy, lesion muscle ratios (LMR) at T2WI, ADC value, lesion spinal cord ratio at each b values were noted. The measurements were correlated with the histopathological results.

Results: 53 patients included in the study, 30.2% (n:16) were female and 69.8% (n:37) were male. 17 lesions (32.1%) are benign and 36 lesions(67,9%) are malignant. The age varies between 40-82 years, with a mean of 61.7±9.1 years. The SPN diameters were between 10 - 30 mm, and the median was 24 mm. LSR0 and LMR values were not statisti-cally significant in detecting malignancy. LSR500 >0.53 value can predict malignancy with 100% sensitivity and 70.6% specificity. LSR1000 > 0.53 can predict malignancy with 88,9% sensitivity and 88,2% specificity. Setting the cut-off value at 0.9×10-3, ADC values had a sensitivity of 72,2 % and a specificity of 88,2% for predicting malignancy.

Conclusion: For SPN follow up, a new following up protocol can be established using DWI and ADC mapping, safely. Particularly, patients with benign nodules with low cell density can be followed up without invasive interventional procedures.

Keywords: Solitary pulmonary nodule, diffusion weighted imaging, benign-malign pulmonary nodule differentiation

O - 052

A PHANTOM STUDY AT 3-TESLA: FAT QUANTIFICATION WITH 3D-CAIPIRINHA-DIXON VS. 3D-STANDART-DIXONURAL KOC1, OKTAY ALGIN2, MUSTAFA TAHTACI3, BETUL OZBEK2

1Erzincan Mengücek Training and Research Hospital, Erzincan, Turkey2Ankara Atatürk Training and Research Hospital, Ankara, Turkey3Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey

Abstract

Objective: To evaluate the impact of 3D-CAIPIRINHA-DIXON on the detection and the quantification of fat content and to compare with 3D-STANDART-DIXON based on phantoms at 3.0T.


Materials and Methods: Nine fat-water phantoms were constructed with variation in fat content. All phantoms were examined on a 3T MR unit (Magnetom Skyra, Siemens Healthcare, Ger-many) with a 30-channel coil setup (with 18-channel body and 12-channel from the spine coils). All phantoms were imaged using both techniques (3D-DIXON with and with-out CAIPIRINHA (TR/TE−4.21/1.34 ms; spatial resolution−1.4×1.4×1.5 mm3). One radiologist placed a circular regions-of-interest (ROI) 5 cm2 within phantoms on these images. The ROIs were copied at the same position in the relevant slice for both Dixon sequences. 72 measurements had been done. Signal intensities and signal to noise ratios (SNRs) were calculated as mean signal divided by the standard deviation of noise and mean signal ratio of noise.

Results: The mean signal intensity indexes were not significantly different between the tech-niques with and without CAIPIRINHA (35.24±31.40; 34.72±31.16). SNR did statistically significantly differ between the tech-niques (p<0.001). SNR had lower values with CAIPIRINHA technique versus non-acceleration technique. Fat fraction SI and SNR values had no statistical significance between acceleration and non-acceleration tech-niques (p>0.316, p>0.456; respectively).

Conclusion: 3D-CAIPIRINHA-DIXON sequence (with PAT factor: 6) can be used for isotropic fat imaging with higher-resolution and improved/uniform fat suppression. At an acquisition time of 14 seconds, 3D-CAIPIRINHA-DIXON can be obtained in considerably less time than standard fat-saturated sequences.

Keywords: Caipirinha, dixon, phantom study, 3D, dixon, 3-tesla

O - 053

N-ACETYLCYSTEINE AND CORIANDRUM SATIVUM LEAF EXTRACT MAY REDIRECT GADOLINIUM TO KIDNEYS: PROMISING AGENTS AGAINST GADOLINIUM RETENTION IN BRAINTURKER ACAR1, EGEMEN KAYA2, DENIZ YORUK3, NESLIHAN DUZENLI4, RECEP SELIM SENTURK4, CENK CAN4, LOKMAN OZTURK3 1Department of Radiology, University of Health Sciences Bozyaka Training and Research Hospital, İzmir, Turkey2Department of Physiology, Ege University School of Medicine, İzmir, Turkey3Department of Anatomy, Ege University School of Medicine, İzmir, Turkey4Department of Pharmacology, Ege University School of Medicine, İzmir, Turkey

Abstract

Objective: Gadolinium based contrast agents (GBCA) have been shown to accumulate in brain despite normal kidney functions and this discov-ery drastically changed contrast media administration in the globe. As gadolinium is a heavy metal in the group of lanthanide, we hypothesized that drugs or herbs which were used previously to treat heavy metal or iron exposed rodents can similarly be used in GBCA administered rats. Therefore, in this preliminary study we aimed to reduce gadolinium levels in rodents after repetitive IV GBCA administration using several agents which were shown to have heavy metal or iron chelating properties.

Materials and Methods: Six group (n=6) of Wistar albino male rats were enrolled. Groups were arranged as Group 1: Control; Group 2: only GBCA

without specific agent or herb; Group 3: Meso-2,3-Dimercaptosuccinic acid (DMSA); Group 4: N-acetylcysteine (NAC); Group 5: Coriandrum Sativum extract (Cilantro) and Group 6: Deferoxamine. All GBCAs were administrated from lateral tail vein two times a week with a high dose protocol (2.5mmol/kg, Gadodiamide: Omniscan (R), GE Healthcare, Waukesha, WI) and a total of 15mmol were given to Group 2, 3, 4, 5 and 6. DMSA, NAC and Cilantro were given to group 3, 4 and 5 with oral gavage 100 mg/kg, 150 mg/kg and 200 mg/kg per day, respectively for 15 days following the first GBCA injections. Deferoxamine was administrated to rats of Group 6 intraperitoneally (IP) 100 mg/kg per day. All rats were sacrificed under high dose anesthesia after 3 weeks. One hemisphere of cerebrum and cerebellum, blood and right kidney from each rat were extracted and each tissue homogenate was sent to Inductively Coupled Plasma Mass Spectrometry (ICP-MS) which is the gold standard method in the quantitative analysis of gadolinium levels.

Results: Kruskal Wallis test revealed insignificant difference in total body, brain and right kidney weight in the whole study group. The lowest brain gadolinium levels were detected in Group 4 with a median value of 397.70 ng/gr. However, it was not statistically significant compared to Group 2 (p=0.831). The study groups did not demonstrated significant difference in terms of blood gadolinium levels. Kidney gadolinium levels were both higher in Group 4 and 5 which was about twice as much of than that of Group 2 (p=0.033). Group 4 and 5 provided a statistically significant gadolinium boost in kidneys compared to group 3 and group 6. Deferoxamine did not decrease gadolinium in brain-blood nor significantly increased in kidneys.

Conclusion: The rats exposed to both Gadodiamide and NAC have revealed the lowest brain gadolinium levels. However, we were not able to find a significant difference. This might be due to high dose GBCA protocol and low clearance time that we used as the methodology. It is well known that the gadolinium clearance is sup-plied by the renal excretion following GBCA injection. Interestingly, our preliminary study has shown that NAC and Cilantro increased kidney gadolinium levels compared to Group 2 and other treat-ment groups. Despite lack of urine analysis, these findings prove the potential promising role of NAC and Cilantro in the redistribution of gadolinium.

Keywords: Gadolinium deposition, gadodiamide, brain, kidney, N-acetylcysteine, coriandrum sativum

O - 054

WHO SHOULD PROVIDE SEDATION FOR CHILDEREN IN MRI ROOM? THE COMPRASION OF DIFFERENT HEALTHCARE PROVIDERSBASAK ALTIPARMAK2, FUNDA DINC ELIBOL1, MELIKE KORKMAZ TOKER2, ALI IHSAN UYSAL2 1Department of Radiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey2Department of Anaesthesiology and Reanimation, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey

Abstract

Objective: Magnetic resonance imaging (MRI) is a non-invasive diagnostic procedure which has distinct advantage over other imaging modalities. One of the most important factors for a successful MRI study is ability of


the patient to lie motionless. However, this becomes almost impossible for small children. In such conditions, a propor anesthetic sedation can deter-mine the quality of diagnostic image. In this study, we aimed to analyze the experiences of different healthcare providers during anesthetic sedation for children in MRI room.

Materials and Methods: After the institutional ethical committee approval, the patients who had sedation for MRI study in the last 5 years were detected from hospital database. The records were divided into two; children sedated by an anesthesiologist were enrolled in group 1, and children sedated by nonanesthesiology doctors (radiologists, paedia-tricians, emergency physicians) or nurses were enrolled in group 2. The demographic variables of the children, sedation drugs, and complications were recorded.

Results: The demographic variables were similar. The anesthesiologist had commonly prefered propofol in anesthetic agent combinations, however nonanesthesiology doctors and nurses had usually prefered midazolam. The most frequent complication was agitation in both groups (n=22), whereas it was significantly high in group 2 (p=0.03). The other frequent complications were bronchospasm (n=14) and respiratory depression (n=13). One cardiovascular collapse case which was sedated by a radiolo-gist was detected in group 2.

Conclusion: Although anesthetic sedation for children in MRI rooms pro-vides advantages for radiologists, it carries potential risks. All healthcare providers, regardless of their practice venue, should be experienced and trained.

Keywords: Childeren, sedation, anesthetic

O - 055

IS THERE A RELATIONSHIP BETWEEN LEFT RENAL VEIN VARIATIONS AND MALIGNANCY DEVELOPMENT?TAHA YUSUF KUZAN1, BEYZA NUR KUZAN1, TUGBA AKIN TELLI2, RABIA ERGELEN1, DAVUT TUNEY1 1Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey2Department f Oncology, Marmara University School of Medicine, İstanbul, Turkey

Abstract

Objective: Left renal venous variation (LRVV) can be observed 2.6–10.2% of population depending on the method of investigation. There is no comprehensive information in the literature on the relationship between LRVV and cancer development. The purpose of this study is to analyse the association between LRVV and malignancy development.

Materials and Methods: A total of 371 patients with a LRVV on abdomi-nal MRI or CT examination at Marmara University Pendik Training and Research Hospital between January 2015 and December 2016 were ret-rospectively evaluated in this study. To investigate the association between LRVV and malignancy, clinical and demographic data were recorded by means of Hospital Information System.

Results: Of the 371 patients, retroaortic LRVV were found in 277(74.6%) cases, while circumaortic LRVV were found in remaining 94(25.4%) cases. The patients’ mean age was 46.2±19.2 years (range, 4-92 years) and the female to male ratio was 3 to 2 (female=223, male=148). Of the cases with LRVV, 86 (23.1%) had malignancy, the most common of which were

gastrointestinal system(GIS) malignancy, which appeared in 31 (36.2%) cases and hematological malignancy which appeared in 28 (32.5%) cases. The malignity incidence was found statistically high in women %60.5(n:54) than men %39.5(n:32) (p=.006). There was no statistical difference in the retroaortic LRVV and circumaortic LRVV groups in terms of age, gender, malignancy frequency and types.

Conclusion: LRVV appears to be associated with high incidence of malig-nancy, especially GIS and hematologic malignancy, compared to the popu-lation. Further investigations are needed to understand the relationship between left renal vein variations and malignancy development.

Keywords: Variation, renal vein, retroaortic, circumaortic, cancer, com-puted tomography

O - 056

EFFICIENCY OF DIFFUSION WEIGHTED MRI ON DIFFERENTIATION OF SOLITARY PULMONARY NODULESILYAS DUNDAR1, MESUT OZGOKCE1, IBRAHIM AKBUDAK3, HANIFI YILDIZ2, SUMEYRA DEMIRKOL ALAGOZ1, HUSEYIN AKDENIZ1 1Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, Turkey2Department of Chest Diseases, Yüzüncü Yıl University School of Medicine, Van, Turkey3Batman Region State Hospital, Batman, Turkey

Abstract

Objective: In this study we aimed to investigate the efficiency of Apparent Diffusion Coefficient (ADC) scores on Diffusion Weighted Imaging (DWI) in MRI for malignant-benign differentiation of solitary pulmonary nodules (SPN) detected and followed up.

Materials and Methods: The DWI (b0-b200-b400-b800) of 37 patients (28 male (75.7%), 9 female (24.3%); mean age, 58.7±13.7; age range, 25–85) that SPN was detected with conventional methods was evalu-ated including ADC map in 1.5 Tesla MRI between 2015-2017. The ADC scores of nodules (5-30 mm in diameter) detected from images was calculated. Measurements were performed by the same radiologist who does not know the diagnosis. 19 (51.4%) patients were diagnosed with benign and 18 (48.6 %) with malignant lesions. All malign nodules and 9 of benign nodules were diagnosed histopathologically. The other benign nodules were correlated with follow up, morphology, PET-CT and dynamic contrast enhanced (DCE) MRI. The independent t test and the ROC curve were used to calculate the difference between the scores of malignant and benign nodules.

Results: On DWI, the mean score of malignant nodules 1.13±0.3(0.3-1.7) was significantly lower than benign nodules (1.83±0.49(1-2.7) (p<0.01), with an area under the ROC curve of 0.867±0.63 (95% CI, 0.744-0.990). When a score of 1,35 was considered as a threshold, the sensitivity and specificity were %84.2 and %78.8 respectively.

Conclusion: The signal intensity of pulmonary nodules may be useful for malignant and benign differentiation on DWI. In addition when the mor-phologies, DCE and the SUV-max values of the nodules is correlated, it will have a high diagnostic value.

Keywords: Pulmonary nodule, DWI, ADC


O - 057 CARDIAC MRI IN DIFFERENT CARDIOMYOPATHY TYPESZEYNEP AKBULUT, HASAN YIGIT, SONAY AYDIN, PINAR KOSAR

Ankara Training and Research Hospital, Ankara, Turkey

Abstract

Objective: Cardiomyopathies are classified into four main types: hyper-trophic, dilated, restrictive cardiomyopathies and arrythmogenic right ventricular cardiomyopathy. Cardiac MRI is a leading method to diagnose cardiomyopathies. We aim to determine normal ranges of T1 and T2 relaxation times. Also, we intend to define the efficacy of T1/T2 mapping to detect and differentiate cardiomyopathy subtypes.

Materials and Methods: 78 patients were included. The patients are classified into eight subgroup: 1-ischemic cardiomyopathy(3), 2-hyper-trophic cardiomyopathy (21), 3-dilated cardiomyopathy(6), 4- restric-tive cardiomyopathy(6), 5-myocarditis(15), 6-noncompacted cardio-myopathy(8), 7-unclassified cardiomyopathy(9), 8-Cardiomyopathy without CMRI sign(10). 30 healthy volunteers consist of the control group.

Results: In patients group, T1 values are higher than the control group. In dilated cardiomyopathy subgroup, T1 values are higher than the control group for both homogenius myocard and myocard with a lesion. In hypertrophic cardiomyopathy subgroup, T1 values are higher than the control group. In ischemic cardiomyopathy and myocarditis subgroups, both T1 and T2 values are higher than the control group. In restrictive cardiomyopathy subgroup, T1 values are higher than the control group for both normal myocard and myocard with a lesion. Both T1 and T2 values are higher than control group in myocard with a lesion.

Conclusion: To conclude; both T1 and T2 mapping are sufficient for dis-tinguishing normal and pathologic myocard. T1 values are more successful. Especially, using the native T1 and T2 mapping methods in combination, enables evaluating the myocard without using any contrast agent.

Keywords: Cardiomyopathy, T1, T2, MRI, mapping

O - 058

CAN T1 MAPPING BE USED INSTEAD OF TI SCOUT FOR NULLING THE MYOCARDIUMELIF PEKER, ZEHRA AKKAYA, BASAK GULPINAR, AYSEGUL GURSOY CORUH, MEMET ILHAN ERDEN


Abstract

Objective: Late gadolinium enhancement (LGE) imaging is the accepted application of cardiac MR imaging used to characterise myocardial tissue archi-tecture. TI scout images are used to `estimate´ the most appropriate inversion recovery time (TI) to null the signal intensity of normal myocardium in order to maximise the contrast between healthy and diseased myocardium. The performance of LGE images is mostly effected by the IR time selected.

T1 mapping is a novel emerging technique for quantitative myocardium characterisation (2). Signal intensity on a determined time can be calcu-

lated by the formula by Bloch et al. (3)

SI=Mz,eq(1-2e^(-TI/T1))

SI/Mz,eq=1-2 e^(-TI/T1)

1-(SI/Mz,eq)=2* e^(-TI/T1)

1-(SI/Mz,eq)/2=e^(-TI/T1)

((Mz,eq-SI)/Mz,eq))/2=e(-TI/T1)

SI of the nulled myocardium is equal to 0

½=e(-TI/T1)

ln(1/2)=-TI/T1

-0.69315=-TI/T1

TI=T1*0.69315

According to this formula TI can be calculated by multiplying T1 value with a constant number of 0.69315.

The aim of this study is to investigate different MOLLI schemes in order to estimate null point of the myocardium.

Materials and Methods: Seven patients were scanned at 1.5 T (Aera, Siemens Healthcare GmbH, Erlangen, Germany) scanner with an addi-tional single mid slice MOLLI 3(2)3(2)5 sequence after TI Scout images. Analysis was performed with region of interest placed conservatively within the septum.

Results: Mean TI estimate by T1 maps and TI scout and TI estimate selected for LGE showed positive correlation with each other (spearman: 0.986, p:0.000 and pearson: 0.986, p:0.000). Mean difference between TI estimate selected for LGE and MOLLI 3(2)3(2)5 was 9±5.

Conclusion: As a result, T1 mapping has been increasingly used for cardiac imaging in the last years. With MOLLI 3(2)3(2)5 null point of the myocar-dium can be calculated instead of estimating.

Keywords: T1 mapping, myocardium, null point, LGE, TI scout

O - 059

THE MR IMAGING OF 6 CARDIAC AMYLOIDOSIS AND REVIEW OF THE IMAGING LITERATUREKARABEKIR ERCAN

Ankara Atatürk Training and Research Hospital, Ankara, Turkey

Abstract

The imaging findings of 6 cardiac amyloidosis cases were evaulated with the MR imaging literature knowledge. The movement of left ventricle (LV), the thickness of LV myocardium, T1 map values of LV, and enhancement patterns after IV Gadoliniumand tagging feature of LV were assessed. They were clinically prediagnosed as cardiac amyloi-dosis by the cardiology department after echocardiographic and elec-trocardiographic evaluation. The laboratory findings of 6 cases were normal. There were no pathological diagnosis as a limiation. Cardiac MRI may be taken as an important diagnostic imaging modality in the diagnosis of amyloidosis.

Our findings were also similar with the findings of the literature

Keywords: Amyloidois, cardiac MRI, imaging findings


O - 060

SONOELASTOGRAPHIC EVALUATION OF THE SCIATIC NERVE IN PATIENTS WITH UNILATERAL LUMBAR DISC HERNIATIONUMUT ORKUN CELEBI1, VEYSEL BURULDAY1, MEHMET FAIK OZVEREN2, ADIL DOGAN3, MEHMET HUSEYIN AKGUL4 1Department of Radiology, Kırıkkale University School of Medicine, Kırıkkale, Turkey2Department of Neurosurgery, Kırıkkale University School of Medicine, Kırıkkale, Turkey 3Department of Radiology, Kahramanmaraş Sütçü Imam University School of Medicine, Kahramanmaraş, Turkey4Department of Neurosurgery, Kirikkale Yüksek Ihtisas Hospital, Kırıkkale, Turkey

Abstract

Objective: The aim of this study was to compare MRI results, strain elastogra-phy and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects

Materials and Methods: The study group included patients with com-plaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age and gender-matched control group was formed of healthy subjects. LDH was diagnosed, and foraminal level assessment was based on the MRI-based description recommended by the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neurology. 1.5 Tesla MRI unit was used to visualize nerve roots and herniation. The foraminal stenosis was assessed according to the Wildermuth staging. Sonoelastographic evalua-tions were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe.

Results: There were 40 patients (20 male, 20 female) with a mean age of 43.1±12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9±10.7 years in the control group (p>0.05). While blue (32.5%) and blue-green (47.5%) color codes were the most commonly observed in the involved side of LDH patients, green-yellow color codes were the most commonly observed in the non-involved side of LDH patients and both sides of healthy control subjects (p<0.05). The sciatic nerve stiffness assessed on both the axial and longitudinal planes of the involved side was significantly higher than that of non-involved side in the patient group and of both sides in the control group (p<0.001)

Conclusion: Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. SE and SWE seem to be a conve-nient and informative imaging tool to evaluate LDH in daily practice

Keywords: Sciatic nerve, ultrasound, peripheral nerve, strain elastography, shear wave elastography, low back pain

O - 061

EVALUATION OF CORRELATION BETWEEN THE CLINICAL AND MRI FINDINGS OF PATELLAR CHONDROMALACIA:INITIAL RESULTSDENIZ OZEL, CAGLAR KIR

University of Health Sciences, Okmeydanı Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: Chondromalacia is a common disease, also a normal outcome of aging. Individuals with this condition are often referred to the physician with unexplained knee pain. The underlying problem cannot be identi-fied most of the time so the sufferers go back with anti-inflammatory medications. Besides chondromalacia is identified with conventional MR imaging that is performed for many different reasons. Clinical diagnosis and its confirmation with imaging findings, in other words, their link seems improvable.

Materials and Methods: A total of 38 people including 26 female and 12 male were included in the study. Subjects with additional pathology that could be the cause of knee pain were excluded from the study for objectively evaluating the source of pain. Patients in pediatric age were also excluded from the study as maturation, patellar cartilage thickness, and signal intensity could be confusing. Visual analogue scale (VAS) and Kujala front knee pain score (AKPS) were recorded for clinical correla-tion. MR findings were assessed using a 1.5 Tesla MR device and knee coils. Axial, coronal and sagittal proton weighted (PW) and coronal T1 weighted sequences were obtained. The cross-sectional thickness was 4-5 mm without gaps. Chondromalacia classification system (MR grade), mean patellar thickness (MPT) were measured to evaluate the MR findings, and the patellar cartilage score (PCS) was defined to evaluate these two data together. PCS was defined as mean cartilage thickness / MR grade + 1. (+ 1 is aimed to avoid division by zero) Pearson correlation coefficient was calculated for correlation evaluation.

Results: Correlation coefficients are shown on the table.

Conclusion: When the correlation coefficients were compared, AKPS was found to be more valuable than VAS in evaluating the clinical correla-tions. This scoring is used to assess the pathology of anterior knee pain and is a more specific method. The most valuable finding in identifying patellar cartilage pathologies was PCS, in which the cartilage thickness and the signal intensity are evaluated together. We would like to inform that more objective results can be obtained after evaluating the cartilage thickness in addition to MR classification in patellar disease.

Keywords: Patellar chondromalacia, MR findings, clinical correlation

O - 062

QUANTITATIVE ASSESMENT OF PATELLAR CARTILAGE FOR EARLY CHONDROMALASIA BY USING T2 MAPPING AT 3TONDER TURNA1, ISIL FAZILET TURNA2, YUSUF CELIK3 1Department of Radiology, Biruni University School of Medicine, İstanbul, Turkey2Department of Physical Medicine and Rehabilitation, Acıbadem University Atakent Hospital, İstanbul, Turkey3Department of Biostatistics, Biruni University School of Medicine, İstanbul, Turkey

Abstract

Objective: The aim of the study was to evaluate the quantitative assess-ment of patellar cartilage for early chondromalasia by using T2 mapping at 3T magnetic resonance imaging (MRI).


Materials and Methods: Thirty patients (22 women, 8 men; mean age 47.67±9.557) with chondromalasia of ICRS (International Cartilage Repair Society) grade ≤2 and 69 normal subjects (43 women, 26 men; mean age 40.04±13.05) were examined by using a 3T MRI with an 15-channel knee coil. Chondromalasia was graded based on PD TSE images. T2 maps were calculated from a T2 star sequence. Medial and lateral facets of each patellar cartilage were divided into three zones. M1, M2, M3; for medial facet and L3, L2, L1; for lateral facet from medial to lateral. Region of interest (ROI) of 0.5 mm2 for each zones and a single ROI for entire cartilage were drawn to analyse mean T2 relaxation times (ms) and compare for both groups. ROC curves and AUCs (Area Under Curve) were performed to evaluate the diagnostic value of quantitative assesment of patellar cartilage for early chondromalasia diagnosis. P<0.05 was considered significant.

Results: Mean T2 relaxation times (ms) of entire cartilage/M1/M2/M3/L3/L2/L1 zones of chondromalasia patients were significantly higher than the ones of normal subjects (21.98/21.66/23.97/23.61/23.85/23.64/25.23 and 19.71/18.38/19.34/18.41/18.91/21.22/20.98, respectively). The best predictive accuracies for diagnosis of early chondromalasia was obtained at M3 [(AUC: 0.734; %95 CI: 0.620–0.848) (p<0.001)]and L3 [(AUC: 0.724; %95CI: 0.612–0.836), (p<0.001)].

Conclusion: T2 mapping might be a useful method for the detection of early chondromalasia at the patella.

Keywords: Cartilage, chondromalasia, patella, T2 mapping

O - 063

MRI CORRELATION IN SECONDARY KNEE OSTEONECROSIS PATIENTS WITH CLINICAL BENEFIT FROM HIPERBARIC OXYGEN THERAPYMUZEYYEN KALKAN1, GAMZE TURK1, ALI KOC1, MEHMET EMIN AKCIN1 1Department of Radiology, University of Health Sciences Kayseri Training and Research Hospital, Kayseri, Turkey 2Department of Undersea and Hypervaric Medicine, University of Health Sciences Kayseri Training and Research Hospital, Kayseri, Turkey

Abstract

Objective: The purpose of this study was to examine the MRI findings in secondary knee osteonecrosis (ON) patients with clinical benefit from hyperbaric oxygen therapy (HBO).

Materials and Methods: Eleven symptomatic secondary knee ON patients (18 knees) who had no surgery and had clinical benefit from HBO between 2016-2018 were included in this study. Knee joint was divided into medial and lateral femorotibial compartments. ON areas were calculated in axial and coronal planes in pre and post-HBO fat saturated T2W images, and compared. Statistical analysis was done by Wilcoxon test.

Results: Of 11 patients 3 were male and 8 were female. Mean age was 29±6.2. Most common involvement sites were lateral femoral condyle (n:17, 94.4%) and medial femoral condyles (n:13, 72.2%). Tibia was less commonly affected with medial tibial involvement in 5 patients and lateral tibial involvement in 4 patients. ON area measurements showed no sta-tistical difference between pre and post-HBO fat saturated T2W images in coronal and axial planes.

Conclusion: HBO enables clinical benefit in symptomatic secondary knee osteonecrosis patients. However, there was no statistically significant difference

in ON area sizes between pre-HBO and post-HBO MRI images at the end of the treatment. Studies with longer follow-up imaging and with larger sample sizes may be more helpful in demonstrating the effect of HBO on ON.

Keywords: Knee, secondary ostonecrosis, hyperbaric oxygen therapy, magnetic resonance imaging

O - 064

WHICH IS THE MOST AFFECTED MUSCLE IN LOMBER DISC DEGENERATION? MULTIFIDUS OR ERECTOR SPINA?PIRIL ERBAY OZTURK, NILUFER AYLANC

Çanakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey

Abstract

Objective: The aim of the study is to evaluate the relationship between the lumbar disc hernias and fatty degeneration of the paravertebral mus-culature, especially erector spina and multifidus.

Materials and Methods: Lumbar MR images of 392 patients with back pain complaints were retrospectively reviewed. Cases between the age of 18 and 64, LDH was detected in 205 patients as case group and 187 patients with-out LDH as the control group. In the case and control groups, the erector spina and multifidus muscles were compared in terms of fatty degeneration. Also, fatty degeneration rates of these muscles were examined according to age and gender characteristics and LDH levels in the groups.

Results: There was no statistically significant difference between the cases (42.0±12.4) and controls (41.3±12.4)in terms of the mean age (p=0.465). In cases with no significant statistical difference about gender (0.465), herniation was detected in the lower lumbar level, in L4-5 and L5-S1, higher than the LDH detected in upper levels. In the case and control groups, the degree of fatty degeneration in the erector spina and multifidus in the patients older than 40 years, was higher than the younger ones (p<0.05). In patients with upper lumbar level herniation moderate degeneration was observed in both muscle groups, whereas in patients with lower lumbar level hernia, degeneration was observed mildly in the multifidus and moderately in the erector spina similarly to patients with herniation in all levels.

Conclusion: Low back pain can be seen in patients both with LDH or without LDH. In particular, the degree of fatty degeneration in multifidus and erector spina muscles must be taken into consideration as it can vary according to the level of disc herniation. In a diagnostic process or follow up treatment, indicating the detailed grading of degeneration in radiology reports will contribute to the rehabilitation process of the patients and therefore to the treatment management.

Keywords: Lomber disc herniation, multifidus, erector spina, MRI

O - 065

SUBSCAPULAR TENDON RUPTURE AND SUBCORACOID IMPINGEMENT SYNDROME:A MAGNETIC RESONANCE IMAGING STUDYGULCIN DURUKAN GUNAYDIN, AHMET ASLAN

İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey


Abstract

Objective: We aimed to investigate the diagnostic value of coracohumeral anatomic measurements and other associated pathologies that may be helpful in the subscapular tendon rupture and subcoracoid compression syndrome on shoulder magnetic resonance imaging (MRI) examination.

Materials and Methods: 982 shoulder MRI examinations between December 2016 and July 2017 were reviewed retrospectively. 51 patients diagnosed with subscapular tendon rupture (study group) and 50 patients without subscapular tendon pathology (control group) on MRI, were ran-domly selected from among patients who had MRI examinations due to shoulder pain between the same dates. Gender and age matched control group were included in the study. Patients and control groups were evaluated comparatively for coracohumeral distance (CHD), coracoid overlap(CO), coracoglenoid angle(CGA), coracoglenoid distance and acromiohumeral dis-tance, subscapularis, supraspinatus, infraspinatus and biceps muscles patholo-gies, coracoid type and tuberculum cysts by a single operator

Results: For each group (control and study) 20 (39.2%) of the patients were male and 31 (60.8%) were female. The average age of the patients was 59.3 years(34-75 years). A statistically significant difference was found in the patients with transvers CHD, sagittal CHD, CGA and AHD values when compared to the control group (p<0.001). Concomitant supraspinatus, infraspinatus and biceps tendinosis and rupture were found in the patient group more than the control group (p<0.001). Also a statistically significant difference was found in the patient group compared to the control group in the protruded coracoid type and greater tuberosity cysts (p<0.005).

Conclusion: Coracohumeral distance and coracoglenoid angle measure-ments in routine shoulder MRI examination are important parameters for subcoracoid impingement syndrome. In addition, ancillary findings such as biceps tendinosis, rupture and tuberculum cysts help to diagnose the subscapular tendon tears.

Keywords: Subscapular tendon rupture, subcoracoid impingement syn-drome

O - 066

MRI FINDINGS OF RARE SOFT TISSUE TUMORSISIL BASARA AKIN1, BURCIN CEVIK TUNA2, ALI BALCI1 1Department of Radiology, Dokuz Eylül University School Of Medicine, İzmir, Turkey2Department of Pathology, Dokuz Eylül University School Of Medicine, İzmir, Turkey

Abstract

Objective: Soft tissue supports fat, muscle, nerves, subcutaneous and synovial structures. Percentages of benign and malignant soft tissue tumors (STT) are 0.3% and <%1 respectively. STTs are local aggressive with high metastatic potential. The purpose of this study is to evaluate magnetic resonance imaging (MRI) findings of rare STTs found in our archives.

Materials and Methods: Between 2010 January- 2017 December, patients who were diagnosed as STTs with MRI were included to study. Tumors were classified according to pathology, MRI findings (homogenei-ty-heterogeneity, T1-T2 signal), localization, fat, cyst, necrosis, hemorrhage contents and invasion. SPSS V.16 was used in statistical analysis; Chi-square and Mann-Whitney U tests were performed as descriptive tests.

Results: Eighteen patients were included in the study. Tumors were clas-sified to 3 groups as malignant (angiomatoid fibrous histiocytoma, epithe-lioid angiosarcoma, clear cell sarcoma, Hyalinizing spindle cell tumor with giant rozette), benign (granuloma annulare, hibernoma, intramuscular myxoma, intraneural perineuroma, pleomorphic hyalinizing angiectatic tumor, cellular myxoma, solitary fibrous tumor, benign parosteal osteo-chondromatous proliferation) and infection (mycobacterium fortuitum, aspergilloma, cyst hydatid). Of 50% malignant lesions had necrosis, het-erogeneity and invasion were 67%, hemorrhage was 33%. All malignant lesions located intramuscular region and none of them include fat tissue. Benign lesions had no necrosis and hemorrhage. Only cyst hydatid had specific MRI findings. There was no statistical significance in terms of age and size between benign-malignant tumors.

Conclusion: Although MRI is the most common method in diagnosis there is no specific MRI feature in STTs. However, MRI has prominent contribution in lesion localization, invasion degree, content of lesion and relation of lesions with surrounding tissue.

Keywords: Magnetic resonance imaging, rare, soft tissue tumors

O - 067

EVALUATION OF SLAP TYPE 5 LESIONS WITH OBLIQUE SAGITTAL MR-ARTROGRAPHYGOKHAN ONGEN, GOKHAN GOKALP

Department of Radiology, Uludağ University School of Medicine, Bursa, Turkey

Abstract

Objective: The aim of this study is to compare conventional MR-artrography sequences and thin slice oblique sagittal sequence ori-ented to the labrum in detecting Bankart and SLAP type 5 lesions.

Materials and Methods: Consequent patients undergone MR-artrography and surgery with shoulder instability between January 2013 and January 2018 were analyzed retrospectively. Demographic data and MR-artrography images were retrieved from PACS archives. Conventional sequences (T1-wieghted fat-saturation coronal and axial images with 3 mm slice thickness) and oblique sagittal sequence oriented to the labrum with 1 mm slice thickness) were evaluated. MR-artrography was accom-plished by an experienced musculoskeleteal radiologist. Results were com-pared with surgical outcomes. Sensitivity, specificity and positive predictive values (PPV) were calculated for both sequences.

Results: Bankart lesion (40 patients) and SLAP type 5 lesions (16 patients) were detected in 45 patients (40 patients male, 5 patients female; mean age 36.2 years). Sensitivity, specificity and PPV of conventional sequences in detecting Bankart lesion were 95%, 25% and 92%, respectively. These values for detecting SLAP type 5 lesion were 47%, 92.6% and 80%. Sensitivity, specificity and PPV of oblique sagittal sequences in detecting Bankart lesion were 75%, 100% and 100%, respectively. These values for detecting SLAP type 5 lesion were 82%, 100% and 100%.

Conclusion: While oblique sagittal MR-artrography sequence has lower sensitivity in detecting Bankart lesions when compared with conventional sequences, it has high accuracy in demonstrating anterior to superior extension of these lesions. For this reason, it has an important role in the evaluation of SLAP type 5 lesions.

Keywords: SLAP, Bankart lesion, MR-artrography


O - 068

EVALUATION OF SPINAL-PARASPINAL PARAMETERS TO DETERMINE SEGMENTATION OF THE VERTEBRAENUR HURSOY, ELIF PEKER, HABIP ESER AKKAYA, SENA UNAL, EZGI ANAMURLUOGLU, BILGESU ARIKAN, MEMET ILHAN ERDEN


Abstract

Objective: The purpose of the study is to compare the usefullness of parameters used for vertebra segmentation in lumbar MR examinations.

Materials and Methods: The lomber MR examinations of 143 patients were retrospectively evaluated. First images were evaluated for morphol-ogy and for the presence of transitional vertebrae, then counted from C2 vertebra to determine the exact segment of the vertebra.

Secondly, 14 parameters were evaluated in all cases: 1) Morphological characteristics - Vertebra corpus shape - Intervertebral disc shape (ODriscoll classification) -Lumbosacral angle - Dimensions of vertebra -Last costovertebral joint -Last facet joint 2) Levels of anatomic markers -Iliolumbar ligament Conus medullaris Celiac artery -Superior mesenteric artery Right renal artery -Aort bifurcation -Vena fava inferior confluence -Dural sac end-point

Results: Transitional vertebrae was detected in 13 patients. Percentage of errors made according to morphology was 11%. Levels and distribution differences of anatomic markers are shown in Table 1. In normal cases, the L5 vertebra is always rectangular, and the S1 vertebra is always trapezoi-dal. In the case of sacralisation, the difference between the end-plates of the transitional vertebra was significantly smaller than that of the actual S1, which is closer to the shaped rectangle, ie the true L5 vertebra (p=0.037). The S1-2 disc appears significantly more frequently in type 3 characteris-tics (p=0.013) than in the true L5-S1 disc. The mean of the lumbosacral angle is higher, although not statistically significant, in the case of variations. Therefore, if this angle increases, correlation with other findings can be made in terms of variation. The iliolumbar ligament is at the L5 vertebra level in all normal cases that can be evaluated.

Conclusion: Correct identification of vertebral levels is not always pos-sible according to morphology. However, helpful parameters can be used to determine exact segmentation of the vertebrae.

Keywords: Vertebrae, lumbalisation, sacralisation

O-069

INCREASED PREVALENCE OF PELVIC VENOUS CONGESTION SIGN ON SACROILIAC MRI IN WOMEN WITH CLINICALLY SUSPECTED SACROILIITISAHMET PEKER, GOZDE TOKATLI, ALI BALCI, ISIL BASARA AKIN, CANAN ALTAY


Abstract

Objective: Pelvic congestion syndrome (PCS) is the frequent condition that causes chronic pelvic pain in the reproductive women. MRI-defined pelvic venous congestion (PVC) sign is the important finding of PCS. The aim of this study is to compare the prevalence of PVC sign on sacroiliac and hip MRI in the reproductive women.

Materials and Methods: The study was performed with the retrospec-tive basis and between January 2010 and December 2017, a total of 727 MRI examinations (401 sacroiliac joint MRI and 326 hip joint MRI) were included into the study. Incidental findings of musculoskeletal and genito-urinary disorders were recorded. Besides 727 MRI examinations, after removing patients with the disorders that may cause pain, remaining 539 (322 sacroiliac and 217 hip) MRI examinations were analyzed separately.

Results: Four hundred one patients with sacroiliac MRI examination had 120 (29.9%) PVC sign and 326 patients with hip MRI examinations had 54 (16.6%) PVC sign (p<0.001, chi-square test). After removing patients with the disorders that may cause pain; 322 patients with sacroiliac MRI examination had 102 (31.7%) PVC sign and 217 patients with hip MRI examinations had 38 (17.5%) PVC sign (p<0.001, chi-square test). No sig-nificant differences were found between patients with acute sacroiliitis and patients without acute sacroiliitis in terms of PVC prevalence (p>0.05). There were also no significant differences between other comparable incidental findings.

Conclusion: The fact that a significantly increased PVC prevalence in patients with sacroiliac MRI may be attributed to that PCS may simulate clinically sacroiliitis.

Keywords: Sacroiliitis, pelvic congestion syndrome, pelvic venous conges-tion

O-070

MULTIPLE FACES OF LUNATEZEHRA AKKAYA, ELIF PEKER, BASAK GULPINAR, AYSEGUL GURSOY CORUH, GULDEN SAHIN


Abstract

Objective: Although the presence of an articular facet on lunate for hamate makes a type 2 morphology, correct assessment of lunate shape may be difficult since small facets are not always conspicuous on radio-graphs or routine MR images. The purpose of this study was to determine more precise parameters to assess lunate types and further evaluate their possible effects on triangular fibrocartilage (TFC), hamate and lunate articular surfaces.

Materials and Methods: Anteroposterior radiographs and T2-3D iso-metric DESS MRIs at 3.0 T MR of 118 cases with neutral ulnar variance were retrospectively analysed for articular cartilage effacement, presence of signs of hamatolunate degeneration and MRI findings at central part of TFC. The distance between cortices of lunate-hamate and capitate (C)-triquetrum (T) were measured on MRIs and radiographs and the LH/CT ratios were calculated. For statistical analyses a p value <0.05 was considered as significant.

Results: 72% of cases were female and 28% were male with a mean age of 38.5 (±13.5). The incidences of type 1 and type 2 lunates were 74.6% and 25.4% respectively. There were no statistical significance with respect


to lunate types and gender. Findings regarding hamatolunate degeneration were significantly higher in type 2 lunate group (p=0.003), however the LH/CT ratios showed no such correlation. When LH/CT ratios at MRI were analysed, a cut-off value of 0.907 showed high sensitivity and speci-ficity in determining type 2 lunate with significantly more accuracy than radiographic ratios (p<0.001). TFC pathologies showed no correlation with regard to lunate types (p=0.935).

Conclusion: A ratio of 0.907 for LH/CT in MRI may be a helpful tool in determining the lunate type where type 2 morphology is significantly more associated with hamatolunate arthrosis. TFC changes and lunate morphology showed no correlation.

Keywords: Hamatolunate degeneration, MRI, TFC, type 2 lunate

O-072

DETERMINATION OF MORPHOLOGICAL CHARACTERISTICS OF PRIMARY BREAST CANCER BY FOCUS DIFFUSION-WEIGHTED MRI: COMPARISON WITH CONVENTIONAL DIFFUSION WEIGHTED IMAGES AND DYNAMIC CONTRAST-ENHANCED MRIYAVUZ METIN, NURGUL ORHAN METIN, OGUZHAN OZDEMIR, FILIZ TASCI, MAKSUDE ESRA KADIOGLU, EDA BEYKOZ CETIN

Department of Radiology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey

Abstract

Objective: In this study, we aimed to compare the diagnostic accuracy and effectiveness of focus diffusion weighted imaging (f-DWI), conventional diffusion weighted imaging (c-DWI), and dynamic-contrast enhanced magnetic resonance imaging (DCE-MRI) in determining the morphological characteristics of primary breast cancer.

Materials and Methods: c-DWI, f-DWI and DCE-MRI of newly diagnosed 155 breast cancer patient’s images were evaluated retrospectively. Morphological features of the lesions and image quality were compared between all three imaging protocols by two radiologists. Also apparent diffusion coefficient (ADC) values of the lesions were compared between f-DWI and c-DWI.

Results: Evaluation by the two readers of all primary breast cancers for the mean ADC values were 82.5 and 88 for f-DWI, and 92.5 and 94.5 by c-DWI, respectively and the difference was statistically significant (p< 0.001). The least distorted images were obtained in DCE MR images compared to c-DWI and f-DWI for both readers. The highest distor-sion scores were obtained in c-DWI. Sharpness was rated as significantly higher for f- DWI and DCE MR images compared to c-DWI by all read-ers (p<0.001). Also, perceived SNR scores were significantly higher for f-DWI and DCE MR images than c-DWI for both readers (p<0.001).

Conclusion: f-DWI allows higher quality images than conventional one. This allows the morphological features to be identified at similar accuracy to dynamic contrast-enhanced images with high resolution.

Keywords: Diffusion-weighted imaging, focus, high resolution, magnetic resonance imaging

O-073

THE CONTRIBUTION OF 3 TESLA MRI TO THE PREOPERATIVE ASSESSMENT OF BREAST CANCERSENA UNAL1, EBRU DUSUNCELI ATMAN2, ELIF PEKER2, ILHAN ERDEN2, UMMAN SANLIDILEK2 1Department of Radiology, Erzurum District Training and Research Hospital, Erzurum, Turkey2Department of Radiology, Ankara University School of Medicine, Ankara, Turkey

Abstract

Objective: To define the contribution of MRI to preoperative assessment of newly diagnosed breast cancer patients.

Materials and Methods: In this study 31 breast cancer patients whose diagnosis had been proven histopatologically and examined with breast MRI were evaluated retrospectively. The size and the kinetic properties of the tumor, additional foci in the same breast, the existence of tumor in the other breast, extension to the chest wall and axillary lymph node metastasis were noted. These findings were compared with postoperative histopathological findings.

Results: In 10 patients multifocal disease was identified but only in 3 patients it was proven pathologically. In 1 patient MRI couldn’t identify the additional foci (sensitivity 66.6%, specificity 71.4%, positive predictive value (PPV) 20%, negative predictive value (NPV) 95.2%). In 2 patients MRI found multicentric foci and they were confirmed with pathology. Out of 6 patients with suspicious findings in the contralateral breast, 1 patient was diagnosed as cancer (sensitivity 100%, specificity 28%, PPV 16%, NPV 100%). 13 patients were evaluated as positive for axillary lymph node involvement. One of them didn’t have axillary lymph node metastasis in the pathology specimens. In 1 patient MRI couldn’t identify the axillary lymph node metastasis (sensitivity 92.3%, specificity 94.4%, PPV 92.3%, NPV 94.4%). Compared to histopathological measurements, we obtained a high reliability ratio (88%) for the lesion sizes.

Conclusion: MRI can be used to exclude additional foci in patients who have high risks for multifocal and contralateral disease. MRI may reveal false positive results and therefore the diagnosis must be proven with pathology before surgery.

Keywords: Breast cancer, breast MRI, preoperative assessment

O-074

MAGNETIC RESONANS IMAGING FEATURES OF TRIPLE NEGATIVE BREAST CANCERGULTEN SEZGIN, EMINE MERVE HOROZ, MERVE GURSOY BULUT, MELDA APAYDIN

Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Objective: To discuss the magnetic resonans imaging (MRI) features of triple negative breast cancer (TNBC)


Materials and Methods: Thirty-two patients with TNBC evaluated by MRI between 2010-2017 were identified via a radiology information sys-tem. Unifocal mass, rim enhancement and intratumoural T2 hiperintensity were evaluated. The scans were obtained on a 1,5-Tesla Optima 360 MR unit (General Electric Medical Systems, Milwaukee, WI, USA). Standard sequences were obtained which included T2 fat-supressed images, T1-weighted non-contrast images, dynamic contrast enhanced images, subtracted images and maximum intensity projection images.

Results: The mean age of patients was 51.3±12.4 years (range: 31-83 years). Sixteen of patients (50%) were invasive ductal carcinoma, 4 (12.5%) were invasive ductal carcinoma with ductal carcinoma in situ, 3 (9.4%) were invasive ductal and invasive lobular carcinoma and 9 (27.1%) were the other carcinomas (medullary, metaplastic, apocrine, adenoid cystic and saliva-like carcinoma). Unifocal mass was seen in 84.4% (27/32) of the patients. Non-mass like enhancement was seen in 3 (9.1%) patients and satellite malignant lesion was seen in 2 (6.5%) patients. Rim enhancement was seen in 60.3% (17/27), intratumoural T2 hiperintensity was seen in %68.75 (22/32) of the patients. Enhancement kinetic curve was washout pattern in 30 (93.5%) patients, and progressive pattern in 2 (6.5%) patients.

Conclusion: Triple negative breast cancers are receptor-negative and 11-20 percent of all breast cancers. Our study supports that TNBCs are most commonly seen as unifocal mass. Rim enhancement and intratu-moural T2 hiperintensity were the other common MRI features and this finding was compatible with literature

Keywords: Triple-negative breast cancer, mri findings, enhancement

O-075

ASSOCIATION OF BREAST CANCER SUBTYPES AND 3.0 TESLA DIFFUSION TENSOR MR IMAGING PARAMETERSSAFIYE TOKGOZ OZAL, AYSEGUL AKDOGAN GEMICI, ERCAN INCI

Bakırköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: To investigate relationship of breast cancer subtypes and the mean diffusivity (MD), fractional anisotropy (FA) measured by diffusion tensor imaging (DTI).

Materials and Methods: This retrospective study included 102 patients (age 51,37 ± 11,47 years) who underwent pre-operative contrast-enhanced 3T breast MRI and DTI, from september 2015 to february 2018. Patients were histopathologically confirmed invasive breast cancer. Histologic analysis parameters included tumor size, expression of estro-gen receptor (ER), human epidermal growth factor receptor 2 (HER2). Breast cancer is divided into the following molecular subtype: estrogen receptor positive and HER2 negative (luminal A, n=46); estrogen recep-tor positive and HER2 positive (luminal B, n=24); estrogen receptor negative and HER2 positive (HER2 enriched, n=13); estrogen receptor negative and HER2 negative (triple negative, n=18). Comparisons were made using Kolmogorov Smirnov and Kruskal Wallis H tests.

Results: A statistically significant difference was found between MD values of four subtypes of breast cancer. According to the binary comparisons to find the group that makes the difference; MD measurements in Luminal A and HER2 enriched subtypes were significantly different (p=0,038; p<0,01). There was no statistically significant relationship between breast cancer subtypes and FA measurements (p>0.05).

Conclusion: These findings suggest that MD values of breast invasive tumours may be further assessed as potential predictors of molecular subtypes of breast cancer.

Keywords: Diffusion tensor imaging, breast cancer, HER2

O-076

BACKGROUND PARENCHYMAL ENHANCEMENT AND BREAST DENSITY ON BREAST MRI: CORRELATION WITH TUMOUR CHARACTERISTICSAYSEGUL AKDOGAN GEMICI, SAFIYE TOKGOZ OZAL, ERCAN INCI

Bakırköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Abstract

Objective:To investigate the relationship between background paren-chymal enhancement (BPE) and breast density (BD) at breast MRI and histopathological features of invasive breast cancers.

Materials and Methods: A total of 112 women with unilateral invasive breast cancer who preoperatively underwent contrast enhanced breast MRI were included in the study. MRI studies were performed within the second week of the menstrual cycle to reduce the enhancement of nor-mal breast parenchyma. Two radiologists rated BD and BPE at breast MRI according to BI-RADS criteria in consensus. The relationship between BD and BPE was investigated, and compared with tumor subtype, ki 67 level and histologic grade of invasive breast cancers according to the level of BD and BPE.

Results: BPE was associated with breast density (p<0.01). Both breast density and BPE were not associated with molecular subtypes (p=0.309 and p=0.603). Women with high breast density tended to have increased rate of Her 2 positive tumours (p<0.01). No significant differences between BPE and reseptor positivity were found (p=0.315). Also no association between the histological tumour characteristics and BPE was observed.

Conclusion: We conclude that, in women with invasive breast cancer, there is an association between breast density and BPE on breast MRI. There is no correlation with BPE and reseptor positivity while high BD is associated with Her 2 positivity of the invasive breast cancer which is not suggested in the current literature.

Keywords: Breast cancer, MRI, background parenchymal enhancement, breast density

O-077

THE ROLE OF MRI FINDINGS WITH DIFFUSION-WEIGHTED IMAGING IN THE DIFFERENTIATING PURE MUCINOUS CARCINOMAS FROM FIBROADENOMAS


RAVZA YILMAZ, GULCIN AKKAVAK PALAZ ALI, YUNUS EMRE AKPINAR, ZUHAL BAYRAMOGLU, SELMAN EMIRIKCI, MUSTAFA TUKENMEZ

İstanbul University İstanbul School of Medicine, İstanbul, Turkey

Abstract

Objective: Although mucinous carcinoma is a rare breast cancer, distinc-tion from fibroadenomas may sometimes be challenging. The purpose of this study to differantiate pure mucinous carcinomas (P-MCs) from fibroadenomas (FAs) on magnetic resonance imaging (MRI) using breast imaging reporting and data system (BI-RADS) descriptors (5th edition) and apparent diffusion coefficient (ADC) value.

Materials and Methods: The study included 14 patients with patho-logically proven P-MCs and 16 patients with biopsy-proven FAs that was hyperintense on T2-weighted images between 2011 and 2017. All imaging studies were evaluated using the BI-RADS lexicon. Besides hyperintense signal on T2-weighted image, enhancing internal septation, the mean ADC values of masses and normal parenchyma were also evaluated.

Results: Irregular margins were observed more frequently in P-MCs (0/16, %0 vs. 6/14, %43 p<0,05) P-MCs also showed nonmass enhance-ment along with mass, septal enhancement, rim enhancement while none of FAs showed.(respectively; 4/14, %43; 4/14, %43; 7/14,%50, p<0,05) FAs showed circumscribed margins more frequently. (16/16, %100 vs. 6/14, %43, p<0,05). There was no statistically significant relation of mean ADC values between P-MCs and FA. (1,709±0,389 vs 1,757±0,213 m2/s) However P-MCs and FAs both showed significantly higher mean ADC values compared with the parenchma. (p<0,05) Rim enhancement was significantly higher in P-MCs. (7/14, %50 vs 0/16, %0, p<0,05)

Conclusion: P-MCs were most commonly very hyperintense masses with irregular margin and rim enhancement on MRI. Also nonmass enhancement along with mass, septal enhancement can be used to differantiate P-MCs from fibroadenoma. These findings may separete P-MCs from FA, however ADC values had no discriminatory power for P-MCs versus FAs.

Keywords: Pure mucinous carcinoma, fibroadenoma, ADC, breast imag-ing

O-078

CORRELATION OF DYNAMIC 3 TESLA MAGNETIC RESONANCE IMAGING AND ULTRASONOGRAPHY FINDINGS WITH HISTOPATHOLOGICAL RESULTS, OUR FIRST 3 TESLA EXPERIENCESUNAY SIBEL KARAYOL, DILEK SEN DOKUMACI

Department of Radiology, Harran University School of Medicine, Şanlıurfa, Turkey

Abstract

Objective: The aim of this study is histopathological comparison with the identification of the findings of dynamic magnetic resonance imaging (MRI) and ultrasound (US) findings in breast masses.

Materials and Methods: Among the June 2016-February 2018, in the Harran University Faculty of Medicine Radiology department with 3 T MRI (Magnetom Skyra, Siemens Healthcare, Erlangen, Germany) breast MR images who had US reports, evaluated respectively. The patients who had breast masses without histopathologic evaluation or BI-RADS 6 excluded from the study. 40 patients with histopathologi-cal data choosed up for the study. The US reports and MR images evaluated according to American College of Radiology BI-RADS Atlas Fifth Edition Quick Reference criteria. US findings examined with regard to shape, orientation, margin, posterior features, architectural distortion, vascularity, ductal changes and US BI-RADS; MRI findings evaluated according to backround parenchymal enhancement, shape, margin, internal enhancement characteristics, architectural distortion and kinetic curve assesment.

Results: There are 31 patients with benign and 9 with malign histo-pathological features. Shape, orientation, margin, posterior features, architectural distortion and BI-RADS in US were compatiable with pathology results (p<0.05). Vascularization of mass in US showed close relationship with the pathology (p=0.086). In MRI shape, margin and architectural distortion showed significant relationship with the pathol-ogy (p<0.05), kinetic curve assesment showed close relationship with the pathology(p=0.079). But background parenchymal enhancement and internal enhancement characteristics have no significant relationship with the pathology (p>0.05).

Conclusion: The results of our first morphological and kinetic analysis with 3 Tesla dynamic breast MRI and US findings show a significant rela-tionship with pathology.

Keywords: 3 Tesla, breast, MRI

O-079

DOES STRONG BACKGROUND PARENCHYMAL ENHANCEMENT ON MRI AFFECT THE TUMOR SIZE ESTIMATION WITH MRI IN BREAST CANCER PATIENTS?HULYA ASLAN, AYSIN POURBAGHER

Department of Radiology, Başkent University School of Medicine, Ankara, Turkey

Abstract

Objective: The purpose of this study was to evaluate whether the level of background parenchymal enhancement (BPE) would affect the correct tumor size estimation on MRI or not.

Materials and Methods: From January 2016 to February 2018, 49 patients having breast Magnetic Resonance Imaging (MRI) prior to surgery and primarily surgically treated breast carcinoma were included in the study. The patients were divided into two groups based on the level of BPE with consensus (mild/strong BPE). The Bias (d) was defined as the difference between the tumor sizes measured by MRI and histopathology. Two readers independently measured the tumor sizes on MRI manually. Then the mean bias was compared between the two groups.

Results: 49 patients were included in the study with a mean age of 53.46 years. 28 of the patients had mild and 21 of the patients had strong BPE. Mean tumor size was 19.20±6.79 at histopathology. For reader 1 the


mean (b) was 3.12±2.14 and 3.36±3.16 (mild and strong BPE groups, respectively). For reader 2 the mean (d) was 3.43±2.68 and 3.57±3.22 (mild and strong BPE groups, respectively). When we compared the mean (d) among the patients with mild and strong BPE, it did not show any significant difference for both of the readers (p values were 0.78 and 0.43 for readers 1 and 2, respectively).

Conclusion: The level of BPE may not affect the correct tumor size estimation on MRI.

Keywords: Background parenchymal enhancement, breast carcinoma, MRI

O-080

CORRELATION BETWEEN MRI AND HISTOPATHOLOGICAL FINDINGS OF SPICULATED BREAST CANCERSGOKHAN GOKALP, GOKHAN ONGEN

Department of Radiology, Uludağ University School of Medicine, Bursa, Turkey

Abstract

Objective: To compare the relationship between MRI and histopathologi-cal findings of spiculated and non-spiculated breast cancer.

Materials and Methods: Between January 2014 and January 2018, 90 women who had undergone image guide-biopsy with 50 spiculated and 40 non-spiculated masses were separated accoding to BI-RADS criteria on mammography. Estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki67 were used as markers to identify molecular subtypes of breast cancer. Pearson chi-square test was employed to measure statistical significance of correlations.

Results: There was no difference for age between two groups (p=0.331). The size of the masses were not different between the two groups (p=0.244). More hypointense signal features were detected in T2-weighted images for the spiculated masses (p=0.004). There was no difference between the two groups in terms of multifocal or multicentric involve-ment, non-mass type enhancement, peripheral rim enhancement and axillary lymph node involvement in the MRI (p=0.237, p=0.622, p=0.096, p=0.295 and p=0.764, respectively). ER and PR positivity were higher in the spiculated masses (p=0.027 and p=0.03, respectively). For the Ki67 index and HER2 positivity, statistically significant a difference were not found between two groups (p=0.571 and p=0.596, respectively).

Conclusion: ER and PR positivity are more common in the spiculated masses. This could be helpful to predict the course of the disease as well as the effectiveness of the treatment.

Keywords: Breast, cancer, spiculated, MRI, histopathological

O-081

THE CONTRIBUTION OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF FAT NECROSIS THAT CLINICALLY UNCLEAR AND CONVENTIONAL RADIOLOGIC FEATURES ARE UNCLEAR CASES

RAVZA YILMAZ, RANA GUNOZ COMERT, GULCIN AKKAVAK PALAZ ALI, MUSTAFA TUKENMEZ, ABDULLAH IGCI

İstanbul University, İstanbul School of Medicine, İstanbul, Turkey

Abstract

Objective: Fat necrosis is a relatively common benign entity in the breast. The reason is unknown in many cases; most likely the underlying cause may be trauma. Our aim is to evaluate the contribution of magnetic resonance (MR) imaging to clinically uncertain fat necrosis cases and to describe MR imaging features of this type of fat necrosis of the breast.

Materials and Methods: Present study included 16 cases where diagnosis could not be made with certainly on ultrasonography and mamography. Fat necrosis detected with MR imaging was histopathologically proven using US-guided biopsies.

Results: Traumatic fat necrosis presented as mass in all patients on MR imag-ing. Lesions were superficially evaluated in five patients (31%). The shapes of the masses were mostly irregular 8/16 (50%) and round 5/16 (31%). In 10 patients (63%), fat signal was observed in the mass. Edema was seen around the mass in 4 patients (25%). The internal enhancement pattern of masses was heterogenous 9/16 (56%), homogenous 5/16 (31%). Complete enhance-ment of fat necrosis was seen as the same as partial in 8 patients (50%). Architectural distortion were seen in 5 patients (31%) on MR imaging.

Conclusion: MR imaging has a wide spectrum of findings for fat necrosis and the appearance is the result of the amount of the inflammatory reaction, the liquefied fat, and the fibrosis. MR imaging is an informative tool for evaluating and diagnosing fat necrosis especially in cases that clinic uncertain and mam-mography and ultrasonography are suspicious for malignacy.

Keywords: Fat necrosis, breast, imaging, magnetic resonance imaging, trauma

O-082

IDIOPATHIC GRANULOMATOUS MASTITIS DYNAMIC BREAST MRI AND DIFFUSION-WEIGHTED MRI FINDINGS: CLINICAL AND RADIOLOGICAL CORRELATIONHAZAL SELVI OZTOPRAK, SEVGUL KOSE

Department of Radiology, Çukurova University School of Medicine, Adana, Turkey

Abstract

Objective: Idiopathic granulomatous mastitis is a rare disease that simu-lates breast cancer clinically and radiologically. We aimed to determine the relationship between dynamic breast MR imaging and diffusion-weighted imaging findings and recurrence or residual disease prevalence in patients with pathologically diagnosed idiopathic granulomatous mastitis with core needle biopsy and to compare ADC values with contralateral healthy breast parenchyma in the same patients.

Materials and Methods: In our study, 17 female patients (mean age 36+8; 27-57 years) with pathologically diagnosed granulomatous mastitis between 2016 and 2018 were included. This retrospective study was approved by Cukurova University Department of Radiology that imag-ing with 3 Tesla (3T) whole body MR system (Philips Achieva) 8 channel breast coil. Idiopathic granulomatous mastitis ADC values were compared with contralateral healthy breast ADC values. On dynamic contrast imag-


ing, lesion type, shape, contrast distribution and contrast pattern, pres-ence of reactive lymph nodes and presence of residual or recurrence in the follow-up of the patient and family history were evaluated.

Results: Diffusion weighted images showed significant decrease in ADC values compared to healthy breast tissue (p: 0,02). On dynamic contrast-enhanced MRI 5% of patients had mass like contrast enhancement, 52% of patient had segmental and 41% had diffuse contrast enhancement. %70 of patients had reactive lymph nodes. Recurrence or residual disease was observed in eight patients (47%) after treatment. There was no significant difference between contrast distribution, residual disease and presence of reactive lymph nodes with ADC values.

Conclusion: Idiopathic granulomatous mastitis generally has non-mass con-trast enhancement and limited diffusion. No significant correlation was found between the contrast enhancement pattern and ADC value with residual dis-ease or recurrence after treatment, family history, and lymph node presence.

Keywords: Breast, MRI, benign disease, ADC

O-083

COMPARISION OF MALIGNANT BREAST LESION SIZES ACCORDING TO MOLECULAR SUBTYPESISIL BASARA AKIN1, ATAKAN ARSLAN1, MERIH GURAY DURAK3, SULEYMAN OZKAN AKSOY2, ALI BALCI1, PINAR BALCI1 1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey2Department of General Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey3Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Objective: Breast cancer is the most common cancer diagnosed in the women. The tumor size plays an important role in determining the treat-ment method. The purpose of this study to compare preoperative tumor size measurements using digital breast thomosynthesis (DBT), ultraso-nography (US), magnetic resonance imaging (MRI) with the size of the pathologic specimen according to molecular subtypes.

Materials and Methods: 52 patients with primary breast cancer were analyzed retrospectively between 2017 January and 2018 January. Patients were divided into four groups by molecular subtypes as “Luminal A”, “Luminal B”, “Triple (-)” and “Her2 enriched”. Size of the pathologic speci-men was chosen as the sizing reference. Wilcoxon sign rank test was used to evaluate the correlation between size of the pathologic specimen and tumor size for every imaging method.

Results: Although there was no significant correlation between specimen size and the tumor sizes of DBT and US; MRI showed significant correla-tion for “Luminal A” molecular subtype of breast cancer. For “Triple (-)” and “Her2 enriched” subtypes, there was significant correlation between sizes of the specimen and US, DBT and MRI. Although, for “Luminal B” subtype, there was no correlation between specimen and MRI tumor size; DBT and US showed significant correlation.

Conclusion: In breast cancer, the size of tumor at the time of diagnosis is decisive for optimal treatment planning. Breast tumors have different imag-ing findings according to molecular subtypes. In optimal treatment planning, for measuring the closest size to actual size of tumor, appropriate imaging method which is suitable for molecular subtypes should be chosen.

Keywords: Breast cancer, thomosynthesis, ultrasonography, MRI, molecu-lar subtype

O-084

LACTATION EFFECT ON FINDINGS OF CONTRAST-ENHANCED AND DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING IN PATIENTS WITH IDIOPATHIC GRANULOMATOUS MASTITISAYSEGUL ALTUNKESER1, FATMA ZEYNEP ARSLAN1, MEHMET ALI ERYILMAZ2, MUSLU KAZIM KOREZ3 1Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey2Department of General Surgery, Health Sciences University Konya Training and Research Hospital, Konya, Turkey3Department of Biostatistics, Selçuk University School of Science, Konya, Turkey

Abstract

Objective: Idiopathic granulomatous mastitis (IGM) is a benign chronic inflammatory disease of the breast, yet the etiopathogenesis is not clearly understood. Lactation is considered as one of the most important risk factors. We investigated the effect of lactation on the findings of contrast-enhanced (CE)and diffusion-weighted magnetic resonance imag-ing (DW-MRI) in IGM and aimed to identify the most observed findings.

Materials and Methods: CE and DW-MRI of 40 patients with lactation history in the last 5 years and of 35 patients reporting no lactation history had been reevaluated retrospectively. Morphological features, enhancement pattern and kinetics of lesions were assessed based on BI-RADS. The presence of diffusion restriction was evaluated and apparent diffusion coefficient (ADC) values were obtained. MRI findings depending lactation status were compared.

Results: Non-mass contrast enhancement (NMCE) (p<0.02), clustered ring pattern (p<0.008) and fistula formation (p<0.035) were more fre-quently seen in patients with a lactation history than in patients reporting no lactation history. Mass and NMCE combination and abscess formation were the most common MRI findings. NMCE was regional and heteroge-neous and most of enhancement kinetics had type 2 contrast enhance-ment curve. Diffusion restriction was present in all of the lesions and the mean ADC values were 0.93±0.25x10-3 mm2/s.

Conclusion: Lactation status increases the incidence of NMCE, clustered ring pattern and fistula formation on MRI.

Keywords: Idiopathic granulomatous mastitis, contrast-enhanced mag-netic resonance imaging, diffusion-weighted imaging, lactation

O-085 PROBLEM SOLVING BREAST MRI IS REALLY PROBLEM SOLVING?ISIL BASARA AKIN, HANDE MELIKE HALAC, ALI BALCI, PINAR BALCI


Abstract

Objective: Magnetic resonance imaging (MRI) is used as problem solving method for BI-RADS 0 lesions that are diagnosed with mammography


(MG) or ultrasonography (US) and for screening patients with family his-tory. Our purpose was to evaluate the diagnostic capacity of breast MRI as a problem-solving and screening method.

Materials and Methods: In this retrospective study, 535 women included that had family history or were evaluated as BI-RADS 0 in MG and US and underwent breast MRI between July 2015 and July 2017. Patients were clas-sified into two groups according to MG an US findings. BI-RADS 0 patients [patients with BI-RADS 0 lesions, asymmetric fibroglandular tissue (AFT) and dense breast tissue] were included to group 1 and patients with family story were included to group 2. MRI findings of groups were evaluated.

Results: Number of patients in group 1 was 398 [217 (40.6%) AFT, 80 (15%) BIRADS 0 lesion and 101 (18.9%) dense breast tissue] and in group 2 was 249 (46.5%). Fifty [8 (1.5%) malignant, 42 (7.9%) benign] patients were redirected surgery as a result of MRI. Forty of 80 patients with BI-RADS 0 lesions were directed for surgery. According to MRI findings there was no statistical significance in both groups. However, p value of statistics was 0.07 and near to statistical significance.

Conclusion: MRI is a problem solving method in patients with BI-RADS 0 on MG-US and with intense family history. Although there was no sta-tistical significance in our study, for objective evaluation in patients with suspicious findings MRI is still a valuable diagnostic method.

Keywords: Breast MRI, family history, BI-RADS 0

O-086

MAGNETIC RESONANCE IMAGING FINDINGS IN LOBULAR PATHOLOGIES OF BREASTLEMAN GUNBEY KARABEKMEZ1, MELTEM YILDIRIM EROL1, MELTEM CETIN 2 1Yıldırım Beyazıt University School of Medicine, Ankara, Turkey 2Katip Celebi University School of Medicine, İzmir, Turkey

Abstract

Objective: In this study; it is aimed to discuss magnetic resonance imag-ing (MRI) findings of lobular type breast cancer and in situ cancer, which are relatively more difficult to diagnose among breast malignancies, and whose diagnostic accuracy is increased with magnetic resonance imaging (MRI) in particular.

Materials and Methods: We searched the 195 patients who have MRI and histopathological examination. Among these patients 14 with lobular pathological diagnosis were reviewed for MRI findings. Lesions’ sizes, morphological, dynamic enhancement properties and diffusion weighted imaging findings were evaluated.

Results: In the pathological evaluation:11 patients had invasive lobular carcinoma; with some of them have invasive ductal carcinoma, lobular carcinoma in situ (LCIS) or Ductal carcinoma in situ (DCIS), 2 patients had LCIS and 1 patient had lobular type mastitis. Morphological findings: 4 irregular shaper mass, 2 speculated bordered mass, 1 microlobulated contour, 3 ring like enhancement, 3 non-mass enhancement, 2 conglom-erating multiple masses, 1 ring like enhancing mass. Contrast enhance-ment patterns: 4 lesions Type2,8 lesions Type3, 1 lesion Type 1, 1 patient showed Type 3 (at invasive component) and Type 2 (at in situ compo-nent). When the diffusion weighted imaging properties were evaluated: 9 patients had restricted diffusion whereas 5 did not.

Conclusion: Lobular carcinomas may present as masses with irregular shape, speculated contours, non-mass enhancement and clustered-conglomerated lesions. Despite wash out is less common in lobular carcinoma in our patients Type 3 pattern was the most common kinetic property. This can be due to accompanying ductal component. Most of the lesions showed restricted diffusion. Non-mass enhancement was more frequent with LCIS and speculated border was with ductal component. Despite we found restricted diffusion in most of the lesions, lacking of this property does not exclude the diagnosis.MRI has an effective role with its high sensitivity in diagnosis of invasive lobular carcinoma and LCIS.

Keywords: Invasive lobular carcinoma, MRI findings

O-087

CAN ADC BE A PROMISING MAKER OVER CURRENT BREAST MRI PARAMETERS FOR EVALUATING BREAST MASSES?MESUT OZGOKCE1, NURI HAVAN2, FERHAT YUCE1, FATMA DURMAZ1 1Department of Radiology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey2Kartal Koşuyolu Yüksek Ihtisas Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: The purpose of our study was to show the correlation between three of the breast magnetic resonance imaging (MRI) diagnostic parameters and the histopatology of breast masses and invastigate the limitations of the MRI parameters for improving the diagnostic accuracy of the breast MRI.

Materials and Methods: 49 female patients in whom breast mass diagnosis were made and MRI was performed as a further examination technique were enrolled to this study. The morphological properties, enhancement kinetics and apparent diffusion coefficient (ADC) values of the solid lesions were compared withtheir histopathological results prospectively.

Results: 51 lesions that were diagnosed by biopsy were included in the study; 23 (45.1%) of these lesions were malignant and 28 (54.9%) of these lesions were benign. Five of 28 benign lesions (17.9%) had irregular con-tour and contours of the other 23 lesions (88.88%) were smooth. In 23 malignant lesions, two lesions (8.7%) had smooth border and macrolobu-lar shape, and contours of the other 21lesions (91.3 %) were spicular and irregular. Contrast enhanced MRI was performed in 47 lesions and the accuracy of type 3 enhancement was 92% and the accuracy of type 1 was 100%. The ADC values of 51 lesions demonstrated a good correlation with the histopathology; only in one patient the ADC value calculated as 1.1x10-³ mm²/s was assessed in the benign group but the histopathology was reported as invasive ductal carcinoma (IDC) in correlation with the morphology.

Conclusion: We believe that the combination of ADC value, lesion mor-phological property and contrast kinetics features can provide a higher diagnostic accuracy in breast MRI.

Keywords: Breast, imaging, magnetic resonance


O-088

BIRADS CATEGORIZATION AND HISTOPATHOLOGIC CORRELATION OF LESIONS DEFINED IN BREAST MRIFADIME GUVEN, SUAT EREN, AKIN LEVENT

Atatürk University School of Medicine, Erzurum, Turkey

Abstract

Objective: In this study, it is aimed to compare BIRADS categorization of imaging features of lesions identified in mammary MRI with histopatho-logic data.

Materials and Methods: 120 breast MRI cases carried out in our centre between November 2017 and February 2018 were included in the study. Findings detected on MRI were recorded. Later, the results of the biopsied cases were correlated with the imaging findings. MRI images were obtained by means of 3 T MR (Magneto or Magnetom Avanto Skyrun A: Healtcare Siemens, Erlangen, Germany). T1 and T2 weighted axial, fat-suppressed T2 sagittal, dynamic series and diffusion weighted images were obtained.

Results: A total of 120 cases were retrospectively reviewed. Of these, histopathologic results of the MRI findings of 55 patients with histopatho-logical examination were correlated. Additional focus investigations in 13 cases were aimed due to 13 BIRADS-6 lesions. In 5 cases, multifocal-multicentric breast Ca was detected. In 2 cases, additional focuses were detected on the opposite breast. There was only one focus in 6 cases, no additional focus was detected. Invasive ductal carcinoma in 11 cases, inva-sive lobular carcinoma in 2, and mixed type carcinoma in 1 were detected in 14 cases of BIRADS-5 lesions detected in MRI. Invasive ductal carci-noma in 12 cases and inflammation-mastitis in 8 cases were detected in 31 cases of BIRADS 4 lesions. Histopathological findings of no malignancy were reported in the remaining 11 cases.

Conclusion: Breast MRI is an important modality in directing the treat-ment approach when used in appropriate indications. Especially in deter-mining multifocality-multicentricity, sensitivity and specificity of detecting chest wall invasion is high. It can also be used for screening purposes in high risk groups.However, it should be kept in mind that if there is no appropriate indication, it may lead to unnecessary anxiety and interven-tional procedures.

Keywords: Breast MRI, BIRADS, Breast carcinoma

O-089

ROLE OF NATIVE T1 MAPPING IN THE DIFFERENTIATION OF FIBROADENOMAS FROM PHYLLODES TUMOR OF THE BREAST; PRELIMINARY RESULTSMEHMET GOKTEPELI, AHMET YALCIN, ONUR TAYDAS

Department of Radiology, Erzincan University School of Medicine, Erzincan, Turkey

Abstract

Objective: Fibroadenomas and phyllodes tumors of the breast are two different entities that have to be distinguished, because different treat-

ment approaches are present for both lesions. T1 mapping without con-trast administration (native T1 mapping) is a new MRI technique which is used for the detection of fibrosis in different studies. In this study we aim to evaluate the role of native T1 mapping in the differentiation of fibroadenomas from phyllodes tumors of the breast.

Materials and Methods: Twelve patients with histopathologically proven diagnosis of fibroadenomas (FA) (n=8) and phyllodes tumor of the breast (PT) (n=4) were included in this study so far. Breast MRI with native T1 mapping was performed to all patients using 1.5T MR scanner before the biopsy procedure (Siemens Aera, Siemens Healthcare, Germany). Images were analyzed in offline workstation and freehand ROIs belong the FA and PT groups were acquired. Different T1 relaxation times of both groups were compared statistically.

Results: Mean age of the study population was 46.7±5.6 years. Mean calculated T1 relaxation times for FA and PT groups were 948±236 and 1658±563 respectively. PT group had significantly higher T1 relaxations times compared to FA group (p<0.001).

Conclusion: According to our preliminary results, native T1 mapping is proved to be useful in distinguishing fibroadenomas from phyllodes tumors of the breast. We think that different T1 relaxation times belong to FAs and PTs reflect the diverse histologic natures of those entities which have different portion of fibrous tissue components. Further stud-ies with larger patient series are required to confirm our findings.

Keywords: T1 mapping, fibroadenoma, phyllodes tumor

O-090

IS THERE A RELATIONSHIP BETWEEN MIGRAINE DISEASE AND SKULL BASE ANGLES?NESE ASAL, MEHMET HAMDI SAHAN

Department of Radiology, Kırıkkale University School of Medicine, Kırıkkale, Turkey

Abstract

Objective: The aim of the study was to determine whether there were variability in the skull base according to magnetic resonance images in migraine patients.

Materials and Methods: A total of 130 magnetic resonans images, including 65 migraine and 65 control groups were retrospectively in the age range 18-50 years. Migraine patients were selected from patients who were diagnosed migraine according to the diagnostic criteria of the International Headache Society (International Headache Society 2013). The study included all migraine patients and no distinction was made between subgroups. Modified basal angle, clivo-axial angle in migraine and control groups were measured by a radiologist in magnetic resonans images. The independent t test was used to compare between the groups. The level of significance was set at p<0.05. In addition, basilar invagination (according to McGregor and Chamberlain line) was evaluated.

Results: The migraine group was 13 male, 52 female (mean age of male 30.38±11.5, mean age of female 32.54±9). The control group con-sisted of 15 males and 50 females (mean age of male 34.4±8.6, mean age of female 33.14±9.7). In the migraine group; the modified baseline angle average was 123.78±6.06°, and the clivo-axial angle average was 142.65±8.73°. In the control group; the modified baseline angle average was 121.6±5.5°, and the clivo-axial angle average was 153.66±6.35°.


Significant differences were detected between the groups. There was no difference between the genders for both groups. In the migraine group; according to McGregor line in 3 patients and McGregor and Chamberlain line in 2 patients, basilar invagination was observed. Basilar invagination was not detected in the control group.

Conclusion: Changes in the skull base angles (modified basal angle and clivo-axial angle) are observed in migraine patients according to magnetic resonance images.

Keywords: Magnetic resonans imaging, migraine, skull base

O-091

MAGNETIC RESONANCE SPECTROSCOPY FEATURES OF THE VISUAL PATHWAYS IN PATIENTS WITH GLAUCOMADIRENC OZLEM AKSOY1, JULIDE CANAN UMURHAN AKKAN2, ALPAY ALKAN1, AYSE ARALASMAK1, HAFIZE OTCU1, ISMAIL YURTSEVER1 1Department of Radiology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey 2Department of Ophthalmology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey

Abstract

Objective: Our aim is to investigate any metabolic changes on MRS through-out the visual pathway of the brain in patients with Glaucoma between patient and control group and correlate the results with clinical findings.

Materials and Methods: 87 cases were enrolled; 30 healthy controls, 25 glau-coma, 16 glaucoma suspect (GS) and 16 ocular hypertension (OHT) patients. A single voxel MRS on TE; 30 ms was performed by placing VOI on the Corpus Geniculatum Laterale (CGL) and primary visual cortex (VC). We enrolled peak values of metabolites as NAA, Cr, Cho and Ins on MRS. Thereafter, we correlated MRS results with age, intraocular pressure (IOP), retinal nerve fiber length (RNFL), mean deviation (MD) and cup disk ratio (CD).

Results: NAA values obtained from CGL in glaucoma and GS cases were lower than the healthy control group. Cho values at CGL in glaucoma are lower than GS and control. There was a negative correlation between NAA values of VC and CD in glaucoma cases. Additionally, there was a negative correlation between age and RNFL in both glaucoma and GS cases.

Conclusion: MRS may reveal neurodegeneration in LGB and VC in patients with glaucoma. Depiction of metabolic changes throughout the visual pathways via MRS will guide the treatment planning and follow-up in glaucoma and glaucoma suspect cases.

Keywords: Glaucoma, visual pathway, magnetic resonance spectroscopy, corpus geniculatum laterale, visual cortex

O-092

PERMEABILITY MRI IN GLIOMA GRADINGSONAY AYDIN, ELIF ERGUN, PINAR KOSAR


Abstract

Objective: MRI is successful in showing the anatomy probable pathologies of central nervous system. However, it can be inadequate in revealing physiologic and metabolic changes. Further MRI tech-niques, perfusion and permeability MRI, are the key to overcome the limitations. We intend to detect the efficacy of permeability and perfusion MRI techniques. And also, we want to enlarge the usage of permeability MRI

Materials and Methods: The patients who had a pathology result as primary brain glioma, at least one perfusion and permeability MRI study, performed before the surgery are included. Population consists of 38 patients. The permeability MRI (Ktrans, Ve), perfusion MRI values (CBV, CBF), and pathology results are noted. The patients are classified into two main groups:high and low grade.

Results: High grade group consists of 22 patients, low grade group 16 patients. Patients’ age varies between 9-79years, with a mean of 46.8 years. Mean CBV and CBF, median Ktrans and Ve is higher in high grade group. All parameters tend to elevate with grade, and have positive cor-relation. CBV >2.25, with a sensitivity and specificity of 100%, CBF >2.02, with a sensitivity and specificity of 100%, Ktrans>0.043, with a sensitivity of 81.82%, and specificity of 100%, and Ve>0.255, with a sensitivity and specificity of 100% can predict high grade.

Conclusion: To conclude, perfusion and permeability MRI, can be used safely for discriminating high and low-grade gliomas, and predicting glioma grades.

Keywords: Permeability, MRI, glioma, grading

O-094

ANALYSIS OF ADVANCED NEURORADIOLOGICAL IMAGES BY SPM8 AND VBMILKER OZGUR KOSKA


Abstract

Objective: Radiology is the seeing eye of medicine and should lead the innovation. Radiologists are facing to technology more than any other branch of medicine. Unfortunately either due to non familarity or lack of interest, use of advanced softwares is generally exception among radiolo-gists. Our aim was introducing SPM and VBM which allow us voxelwise analysis of images to our collegues willing to get familarity.

Materials and Methods: Voxelwise analysis of two or more groups of either structural MPRAGE or DTI or fMRI data were demonstrated step by step by screenshots of the process.

Results: Familarity to apply voxelwise analysis methods and resources to construct the environment for such analysis are provided.

Conclusion: Leading the innovation and pushing thel lead further away should be one of the skills of the radiologist in order to survive in the era of field competitions and artificial intelligence thread. We should make friends with technology and opportunities it offers.

Keywords: Voxelwise, spm, vbm, group analysis


O-095

MRI STUDIO, VOLBRAIN AND MRICLOUD: FREE RESOURCES FOR PROCESSING BRAIN MRIILKER OZGUR KOSKA


Abstract

Objective: Changes in volume of certain structures of brain in health and disease may be measured and analysed. Also construction and visu-alisation of fiber tracts and obtaining quantitative data such as fractional anisotropy or mean diffusivity may add some benefits to our research. Our aim was providing the ways to free resources and demonstrating how to use them efficiently.

Materials and Methods: MRI studio which allows construction of fiber tracts or determine numeric values such as FA or MD or provide visuali-sation tools obtained from group analysis of data and allow them to be projected onto anatomical images is introduced and a pipeline for analysis is demonstrated. Also obtaining volume information of various cortical, subcortical and white matter structures via Volubrain and MRI cloud is demonstrated.

Results: New opportunities for research on MRI of brain in health and disease by free resources is demonstrated step by step with accompany-ing screenshots.

Conclusion: Volbrain, MRIcloud and MRI studio are free applications which provide important tools for neuroradiological research

Keywords: Volubrain, MRI studio, brain volumes, fiber tracts

O-096

FLOW EVALUATION WITH 3D SPACE T2 AND 3D CISS SEQUENCES IN CASES WITH CYSTOCISTERNOSTOMY IN 3T MRIAYDAN ARSLAN1, MURAT BASARIR2, MEMET OZEK2, ALP DINCER1 1Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey 2Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey

Abstract

Objective: This study aimed to evaluate stoma and flow patency with 3D SPACE T2 and 3D CISS sequences in cases with cystocisternostomy in 3T MRI.

Materials and Methods: Sixty two patients (23 female, 39 male) with endoscopic cystocisternostomy who underwent 3T MRI units to determine flow patency between 2007 and January 2018 were reviewed retrospectively. The examination was evaluated together with the patients previous examinations. Primarily,flow and function in cystocisternostomy stoma, preoperative and postoperative arach-noid cyst volume difference and postoperative complications were evaluated. Findings were classified as open and functional, minimal

flow, closed. It was compared with postoperative results in cases we reported as closed. Arachnoid cysts were classified according to localization.

Results: The mean age of patients was 12.2 years (age range 2-44). A total of 106 examinations of 63 patients were evaluated. Flow pattern in 1 patient was not evaluated optimally due to motion artifact. It was excluded from study. In 13 patients, cystocisternostomy stoma was noted as closed.

Conclusion: 3D SPACE T2 and 3D CISS sequence in cases with cystocis-ternostomy are effective for evaluation of flow patency.

Keywords: Cystocisternostomy, 3D SPACE T2, 3D CISS, magnetic reso-nance imaging, cerebrospinal fluid

O-097

DIAGNOSTIC VALUE OF APPARENT DIFFUSION COEFFICIENT (ADC) IN DISTINGUISHING HAEMANGIOMAS FROM MALIGNANT VERTEBRAL LESIONSBEYZA NUR KUZAN, TAHA YUSUF KUZAN, RABIA ERGELEN, GAZANFER EKINCI

Marmara University School of Medicine, İstanbul, Turkey

Abstract

Objective: The aim of the study was to assess the values of ADC in vertebral haemangiomas and malign vertebral deposit in correlation with conventional MRI sequences.

Materials and Methods: A total of 81 patients with vertebral metastasis in 33 and vertebral haemangioma in 48 on abdominal MRI at our unity between January 2016 and Agust 2017 were ret-rospectively evaluated in this study. All imaging procedures were performed at 1.5T and 3T MRI scanners. The vertebral lesions cat-egorized as an malign deposit or haemangioma on conventional MRI sequences. To investigate the association between ADC values and lesion types, ADC values of malign deposits and the haemangioma were compared between the two groups. Mann-Whitney U test between the two groups were performed. Discriminative values of ADC for haemangioma and malign deposit were assessed using ROC curves analysis.

Results: Mean ADC values were higher in the haemangioma group (1.22906×10-6mm2/s±29.34) than the malignant group (0,42994×10-

6mm2/s±29,03) (p<0.01). There was a statistically significant dif-ference between mean ADC of haemangiomas and malign lesions in 1,5T and 3T MR, respectively (p<0.01, p<0.01). There was no statistically significant difference in the mean ADC of vertebral hae-mangiomas on 1,5T and 3T MRI (p=0.85). Similiarly, there was no statistically significant difference in the mean ADC of malign deposit on 1,5 T and 3T MRI (p=0.85). The best cutoff values for mean ADC were 0,956×10-6mm2/s. The AUC was 0.95 with 83.3% sensitivity and 93.9% specificity.

Conclusion: First, there is statically mean ADC difference in the haeman-giomas and malign deposit. Second, there is no difference haemangiomas and malign deposit mean ADC values on 1.5T or 3T MRI.

Keywords: Haemangioma, ADC, malign deposit


O-098

UNUSUAL CEREBELLOPONTINE ANGLE MASS: MRI FINDINGS GUIDENESRIN ERDOGAN, MURAT UCAR, NIL TOKGOZ


Abstract

Objective: Imaging is necessary to make differential diagnosis of cerebel-lopontine angle masses (CPA), describe extent of lesions and effect to cranial nerves, planning to surgery. Menengiomas and vestibular schwan-nomas are most common lesions. However some rare masses, only account for less than 1% each, like cavernoma, metastasis, chordoma, vascular lesions like aneurysm or paraganglioma can occur that location. The aims of this presentation are characterization and differentiation of unusual CPA masses with computer tomography (CT) and magnetic resonance imaging (MRI).

Materials and Methods: CPA is subarachnoid space, centered by internal auditory canal contains cranial nerves (from 5. cranial nerve to 9. Cranial nerve) and associated vessels. CPA lesions cause similar symptoms accord-ing to effect of cranial nerves and vascular structures related to mass effect, so preoperative diagnosis is possible only by imaging and unusual lesions are challenging to diagnose.

Results: CT and MRI are the modalities of choice for diagnosis of CPA lesions. It is important to begin with assessment of its intra or extra-axial origin to narrow the differential diagnosis. CT attenuation, adjacent bone reaction, signals characteristics at conventional and advanced MRI tech-niques and contrast enhancement are key imaging features to differentiate these lesions. After that we need to describe to origin location of masses, skull base or cistern.

Conclusion: Radiologist plays major role to diagnose CPA masses, espe-cially unusual ones. Contrast enhancement, shape, and origins with CT, conventional MRI and data from advanced technique like diffusion-weight-ed imaging (DWI) and perfusion imaging, it is easy to evaluate CPA lesions.

Keywords: Cerebellopontin angle, cisternography, internal auditory canal

O-099

COMPARISON OF FETAL BRAIN MRI AND POSTNATAL BRAIN IMAGING FINDINGS: WHERE DID WE GO WRONG?UMIT AKSOY OZCAN, SILA ULUS, DENIZ MUTLU, EZGI AYDIN, CEM DEMIRKIRAN, ALP DINCER

Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey

Abstract

Objective: To compare fetal brain magnetic resonance imaging (fbMRI) with the postnatal brain imaging findings (transfontanel ultrasound (TFUS), MRI, computed tomography (CT)) and to demonstrate the strengths and shortcomings of fbMRI in the clinical management of the neonatal period.

Materials and Methods: In this retrospective institutional review board (IRB) approved clinical study, we analyzed fbMRIs and included fetuses

with postnatal (1st year) imaging findings. Exclusion criteria were non-diagnostic image quality of the fbMRIs. The mean gestational age of the fetuses was 28.4 weeks at the time of the fetal MRI. The images were retrospectively analyzed by two experienced radiologists in consensus.

Results: Twenty-six cases were included in this study. For postnatal imag-ing 19 of them had TFUS, 6 had brain CT, and 5 had brain MRI. 3 cases had normal pre and postnatal brain imaging findings. 15 cases had central nervous system anomalies (CNS) in the fbMRI and normal postnatal brain imaging findings. CNS anomalies in the fbMRI and postnatal brain imaging were the same for 6 cases. 2 cases had additional anomalies in the post-natal brain imaging. The most common pathologies on the fbMRIs were ventriculomegaly (VM) (n=12), mega cisterna magna (n=3), and choroid plexus cysts (n=2). Of the 12 cases with VM, 10 had normal postnatal imaging findings.

Conclusion: Although fbMRI is a well-established and widely used valu-able prenatal imaging, it has shortcomings. Therefore, the clinicians should be notified about the potential cases that have postnatal follow-up imaging indication.

Keywords: Fetal brain magnetic resonance imaging, central nervous sys-tem anomalies, postnatal brain imaging, transfontanel ultrasound

O-0100

3T MR ANGIOGRAPHIC EVALUATION OF WILLIS POLYGON VARIATIONS USING VOLUME RENDERED-3D IMAGESDILEK SEN DOKUMACI, SUNAY SIBEL KARAYOL

Department of Radiology, Harran University School of Medicine, Şanlıurfa, Turkey

Abstract

Objective: To evaluate the Willis polygon variations using 3T MR angiog-raphy volume-rendered 3D (VR-3D) images.

Materials and Methods: We retrospectively reviewed the cranial MR angiography (CMRA) images of 153 patients who were referred to our radiology clinic between January 2017 and February 2018 for various ini-tial diagnosis such as headache, stroke. The axial images obtained with the TOF-3D-multislab method were transferred to a separate workstation. Volume-rendered 3D (VR-3D) images were created for each patient on this workstation using 3D software (Synapse, Fuji Medical Systems, Tokyo, Japan). These images and axial slices were analyzed for variations as pos-terior communicating artery (PcoA) hypoplasia / aplasia, anterior cerebral artery (ACA) A1 segment hypoplasia / aplasia, fetal posterior cerebral artery (FPCA), infundibular dilatation of PcoA, anterior communicating artery (AcoA) variations and other rare variations.

Results: The mean age of the patients was 36.65±21.70 (aged 1-79), 70 (45.8%) were female and 83 (54.2%) were male. Initial diagnosis included headache in 50%, stroke in 26%, epilepsy in 5.2%, aneurysm in 2.6% and ptosis and vasculitis in lesser proportions. 75 patients (49.01%) had a com-plete Willis polygon. 22.3% of the patients had unilateral and 22.9% had bilateral hypoplasic / aplasic PcoA. Unilateral hypoplasic / aplasic A1 was observed in 14.3% of the patients. FPCA was unilateral with 12.4% and bilateral with 5.2%. In addition, infundibular dilation of PcoA in 4 patients, H-shape AcoA in 3 patients, Y-shaped AcoA in 1 patient and fenestration in different localizations in 4 patients were detected.


Conclusion: CMRA images are widely evaluated with 3D MIP images. VR-3D images along with CMRA images can be used to evaluate Willis polygon variations.

Keywords: 3T MRI, Willis polygon, volume rendered

O-0101

MRI FEATURES AND ASSOCIATED ANOMALIES OF TETHERED CORD SYNDROMEMESUT SIVRI1, MEHMET SEDAT DURMAZ2 1Department of Radiology, Health Sciences University Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey2Department of Radiology, Konya Health Sciences University Training and Research Hospital, Konya, Turkey

Abstract

Objective: Tethered cord syndrome (TCS) is a congenital childhood dis-ease, which can also be seen in adults. If it is isolated, named as the primer, if accompanied by other anomalies, named as the secondary TCS. The aim of this study was to describe magnetic resonance imaging findings and accompanying anomalies with TCS of 240 patients.

Materials and Methods: MRI examination and associated anomalies of 240 patients with TCS were evaluated retrospectively between 2012 and 2017. Pediatric and adult age groups were assessed separately also.

Results: There were 114 pediatric and 126 adult patients. The female to male ratio was 2,2 (74 male, 166 female). The mean age was 25 years. The most frequent localization level of the conus was L4 (22%). Syringohydromyelia was found in 91 patients (37%), diastematomyelia in 85 patients (35%), lipoma in 29 patients (12%), myelomeningocele in 25 patients (%10), lipomeningomyelocele in 3 patients (1%), dermal sinus in 24 patients (10%), perinoeural cysts in 18 patients (7%), hemivertebrae in 16 patients (7%) and butterfly vertebra in patients (4%).

Conclusion: TCS is a complex syndrome may be associated with spinal abnormalities. MR is very useful in the evaluation of the TCS, identify accompanied lesions and evaluate associated bony dysraphisms.

Keywords: Magnetic resonance imaging, spinal dysraphism, tetheret cord syndrome

O-0102

PARAVERTEBRAL MUSCLE VOLUMES WITH TYPE I ADOLESCENT IDIOPATHIC SCOLIOSIS PATIENTSSERMIN TOK UMAY1, HULYA ASLAN2 1Department of Radiology, Dumlupınar University School of Medicine Evliya Celebi Training and Research Hospital, Kütahya, Turkey2Department of Radiology, Başkent University Faculty of Medicine Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey

Abstract

Objective: Adolescent idiopathic scoliosis (AIS) is the most common abnormality effecting spine in pediatric patients. Muscle imbalance has been suggested as a factor affecting the static and dynamic mechanical properties. Previous studies including patients with high Cobb angles

showed the fatty infiltration of muscles at different levels. The aim of this study was to compare the paravertebral muscle volumes at convex and concave sides and to analyze the relationship between the Cobb angles and the paravertebral muscle volumes among patients with type I ASI.

Materials and Methods: The magnetic Resonance Imaging (MRI) stud-ies of the 24 patients having a diagnosis of type I ASI with a Cobb angle lower than 25 ° from January 2015 to January 2018 were retrospectively included in the study. Measurements were done at at the level of the api-cal vertebra, upper end vertebra, and lower end vertebra.

Results: 12 of the patients demonstrated thoracic convexity to the right and 12 of the patients showed thoracic convexity to the left. The mean Cobb angle of the major thoracic curve was 22,21°.When the mean paravertebral muscle volumes at convex and concave sides were compared, it only showed significant difference at lower end vertebra level (p=0.01). There was a negatively (r=-0.31, p≤0.05) correlation between the Cobb angle and the paravertebral muscle volume at concave side. There was also a good positive correlation at the lower end vertebra level on convex side (r=0.78, p≤0.05).

Conclusion: Our results suggested that muscle volumes could be affected among patients with type I ASI.

Keywords: Magnetic resonance imaging, paraspinal muscles, scoliosis

O-0103

1P36 DELETION SYNDROME: NEURORADIOLOGIC FINDINGSSAFAK PARLAK1, EKIM GUMELER1, GULEN EDA UTINE2, KADER KARLI OGUZ1 1Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey2Department of Pediatric Genetics, Hacettepe University School of Medicine, Ankara, Turkey

Abstract

Objective: 1p36 deletion syndrome is the most common subtelomeric chromosomal deletion syndrome, with an estimated incidence of 1/5000-1/10000 at birth. Beside skeletal, genitourinary, gastrointestinal and cardiac anomalies patients often have severe neurological deficits. Diagnosis is suggested by clinical findings like characteristic facial appearance, global developmental delay and confirmed by detection of deletion of the most distal band of the short arm of chromosome 1(1p36). In previous studies polymicrogyria and periventricular nodular heterotopia have been linked to critical regions within 1p36. In this study we present the neuroradio-logic analysis of our cases of 1p36 deletion syndrome.

Materials and Methods: We evaluated retrospectively MR examinations of patients with 1p36 deletion syndrome confirmed with genetic analysis who were followed up and treated by our Pediatric Genetic Department.

Results: The study group consisted of 9 patients (F/M: 7/2) with a mean age of 17 months (min/max: 0.5/51months).We detected hypoplasia of the corpus callosum in all patients, abnormal multifocal T2 patchy signal in cerebral white matter in 7 patients (77%), ventriculomegaly in 7 patients (77%), enlargement of subarachnoid space in 5 patients (55%), delayed myelination in 2 patients (22%), cerebral atrophy in 1 patient and basioc-cipital hypoplasia in 1 patient. 2 patients (22%) had bilateral frontoparietal and perisylvian polymicrogyria.

Conclusion: Neuroimaging reveals bilateral polymicrogyria, hypoplasia of the corpus callosum, ventriculomegaly and abnormal patchy T2 hyperintensities


in the cerebral white matter. In patients with characteristic facial appearance, global developmental delay, neurological deficits and bilateral polymicrogyria, 1p36 deletion syndrome should be included in differential diagnosis.

Keywords: 1p36 deletion syndrome, magnetic resonance imaging, poly-microgyria

O-0104

PERFUSION MRI OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMAS; WHAT PERFUSION GRAPHICS TELL US?HAKAN CEBECI, YAHYA PAKSOY

Department of Radiology, Selçuk University School of Medicine, Konya, Turkey

Abstract

Objective: Differentiation of malignant brain tumors using MRI is still a challenging problem in routine clinical practice. Primary central nervous system lymphomas (PCNSL) and glioblastomas (GB) may show similar imaging features in conventional MRI. Perfusion MRI is adjunctive tool for evaluating brain tumors. DSC perfusion MRI is the mostly used perfusion MRI technique for brain tumor characterization. Diagnostic utility of con-trast leakage patterns in DSC perfusion MRI is shown in brain neoplasms.The aim of this study was to analyze rCBV values of PCNSLs and GBs and, also evaluate perfusion graphics in DSC perfusion MRI.

Materials and Methods: A retrospective study was performed includ-ing 21 patients with 26 brain tumor lesions. Mean rCBV of tumor core and peritumoral region in 13 PCNSL and 13 GB lesions were evalu-ated. Perfusion graphics were generated from ROIs placed in solid and/or enhancing part of tumor and peritumoral T2 hyperintense region. Perfusion curves were classified as returning to baseline, T1 dominant contrast leakage and T2* dominant contrast leakage. The curve types were compared with histology.

Results: Mean rCBV of tumor core in PCNSLs and GBs were 1.59 and 3.11 respectively. Mean rCBVof peritumoral areas in PCNSLs and GBs were 0.67 and 0.98 respectively. Nine lesions showed T1 dominant leak-age, 4 lesions showed a curve patern of returning to baseline, and 13 lesions showed T2* dominant leakage.

Conclusion: Tumor core and peritumoral regions show higher rCBV val-ues in GBs. T1 dominant leakage is predominantly seen in PCNSLs. This may be a useful sign for differentiation PCNSLs from GBs.

Keywords: Perfusion, glioblastoma, lymphoma

O-0105

MICROSTRUCTURAL WHITE MATTER ABNORMALITIES IN PATIENTS WITH MODERATE OBSTRUCTIVE SLEEP APNEA: A DIFFUSION TENSOR IMAGING STUDY USING TBSS ANALYSESKERIM ASLAN1, AYGUL GUZEL2, HEDIYE PINAR GUNBEY1, ONUR OZYURT3, LUTFI INCESU1

1Department of Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey2Department of Pulmonary Medicine, Ondokuz Mayıs University School of Medicine, Samsun, Turkey3Boğaziçi University, Institute of Biomedical Engineering, İstanbul, Turkey

Abstract

Objective: Previous diffusion tensor imaging (DTI) studies showed axonal and myelin damage in multiple white matter (WM) fibers in patients with severe obstructive sleep apnea (OSA). However, it is not clear whether there are WM changes in OSA people with moderate disease. The aim of this study is to investigate microstructural WM abnormality using DTI in untreated and newly diagnosed moderate OSA patients.

Materials and Methods: The study included in 21 moderate OSA patients (5 females, 16 males, mean age: 44.3±7.6 yr, mean AHI: 21.3 events / hour) and 21 age and sex matched controls, (16 males, mean age: 45.1±8.1 y). Following DTI, tract-based spatial statistics (TBSS) were used to investigate differences in fractional anisotropy (FA), apparent dif-fusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD) between the moderate OSA patients and control group.

Results: Compared with the control group, TBSS showed significant ADC reduction in corpus callosum, corona radiata, internal / external capsule, and superior longitudinal fasci- ulus in patients with moderate OSA (p<0.05). Compared with the control group, in addition to ADC reductions in white matter in moderate OSA patients, FA decrement and RD increment were detecded in extensive white matter tracts including cerebral peduncle, posteior thalamic radiations, fornix, superiorfronto-occipital fasciculus and sagittal stratum. Additionally FA reductions were also observed on middle cerebellar peduncle, tapetum and corticospinal tract (p<0.05). There was no difference in AD values between the con-trol group and moderate OSA patients (p>0.05).

Conclusion: In our study, we showed an injury in the white matter tracts that regulate memory, attention, respiratory, autonomic, cognitive, and emotional functions in the patients with moderate OSA. The results of this study showing the increase in RD values without any AD change sas-sociated with loss of myelin integrity in moderate OSA patients suggests that myelin is more affected than axons and susceptible to hypoxia in moderate OSA patients.

Keywords: Obstructive sleep apnea, diffusion tensor imaging, tract-based spatial statistics, fractional anisotropy, apparent diffusion coefficient, radial diffusivity

O-0106

DIAGNOSTIC CONTRIBUTION OF SUSCEPTIBILITY-WEIGHTED IMAGING IN CENTRAL NERVOUS SYSTEM SUPERFICIAL SIDEROSISBUNYAMIN GUNEY1, YUSUF KENAN CETINOGLU2, IBRAHIM ONDER YENICERI1, NESAT CULLU1 1Department of Radiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey2Department of Radiology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Objective: Superficial siderosis (SS) is a rare condition defined as hemo-siderin deposition along the leptomeninges in the superficial layers of the


brain as a result of recurrent subarachnoid hemorrhage. This study aimed to investigate the contribution of SWI to the diagnosis of SS and to deter-mine underlying causes of it.

Materials and Methods: T2-weighted turbo spin-echo (TSE) and SWI images of 16 patients with SS were evaluated retrospectively. Distribution, involvement pattern, the possible etiological cause of SS were reviewed on both T2-weighted TSE and SWI images. Diagnostic performance of T2-weighted TSE and SWI images were compared in the light of literature.

Results: SS pattern was diffuse in 14, focal in 2 patients. The localization of SS was limited in posterior fossa in 6, supratentorial compartment in 9 patients. One patient had involvement on both sides. A total of 16 patients, the cause of SS was found as vascular pathologies in 4, cerebral amyloid angiopathy (CAA) in 5, prior brain surgery in 2, brain metastasis in 1, methotrexate treatment in 1, and neurocysticercosis in 1. The cause of SS in two patients was not found. SS along with the leptomeninges in 616(37.5%) and parenchymal microhemorrhages in all CAA patients (31.2%) were only seen on SWI images. SWI also showed one devel-opmental venous anomaly and one cavernous malformation in separate patients which have not been seen in T2-weighted TSE images.

Conclusion: SWI is an essential MRI technique for determining the pres-ence of SS and its spread. It may also be useful in detecting microhemor-rhage and additional vascular anomalies.

Keywords: Susceptibility weighted imaging, superficial siderosis, MRI, Hemorrhage

O-0107

EVALUATION OF TOXIC EFFECTS OF CHEMOTHERAPY IN NON-SMALL CELL LUNG CANCER ON CEREBRAL WHITE MATTER USING DIFFUSION TENSOR IMAGING (DTI)SINEM AYDIN1, HACI MEHMET TURK2, TARIK DEMIR3, ALPAY ALKAN1, HAFIZE OTCU1, EZGI COBAN3 1Department Radiology, Bezmialem Vakif University School of Medicine İstanbul, Turkey2Department of Internal Medicine, Bezmialem Vakif University School of Medicine, İstanbul, Turkey3Department of Medical Oncology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey

Abstract

Objective: Examination of cerebral white matter alterations caused by chemotherapy (CT) in non-small cell lung cancer patients using DTI.

Materials and Methods: Patients are divided into three groups according to the received chemotherapy regimen: patients who took Cisplatin (group1), Carboplatin (group 2), and the other medications (group 3). Patients were scanned with a 1.5T MR equipment. Regions of interest along the following localizations were drawn bilaterally for evaluation of FA and ADC: inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus, forceps minor (FM), anterior thalamic radiation, anterior corona radiata, external capsule, inferior fronto-occipital fasciculus, genu and splenium of corpus callosum, cerebral white matter in frontal (FWM) and parieto-occipital regions (PWM). AD, MD and RD indices were calculated using eigenvalues.

Results: In the analysis of pre-and postCT DTI data of the group 1, there was a significant increase in FA value of the right ILF. (p=0.028). There was significant change in FA and RD values of the right FM (p=0.025 and p=0.017, respectively), and AD and MD values of right FWM (p=0.006

and 0.029, respectively) in the group 2. In the analysis of the differ-ences between group 1 and 2 we found increase of FA in the right ILF (p=0.053), and AD in the right FWM (p=0.021).

Conclusion: We concluded that in comparison of two CT regimens in NSCLC, WM changes like axonal degeneration and de-/dysmyelination may be more prominent in the fasciculi involving executive and cognitive functions in patients who received Cisplatin.

Keywords: Cancer chemotherapy protocols, carboplatin, cisplatin, diffu-sion tensor imaging, lung neoplasia

O-0108

CAN UNENHANCED MRI BE AN ALTERNATIVE FOLLOWING INCIDENTALLY DISCOVERED MENINGIOMAIBRAHIM ONDER YENICERI, NESAT CULLU, BUNYAMIN GUNEY

Department of Radiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey

Abstract

Objective: Incidentally discovered small meningiomas are usually followed. Contrast enhanced CT and MRI are generally used in imaging for meningio-mas. In the last time, There are some concerns about the use of gadolinium-based contrast agents. The purpose of this study is to investigate whether there is a difference in measurement between contrast enhanced T1W and the T2W series in MRI. Contrast-enhanced MRI images of 30 consecutive meningioma patients (20 female, 10 male, 33-85 years, mean 64.1 years) were evaluated by two independent radiologists. Meningioma sizes were measured as three dimensions by each observer in contrast T1A and T2E sequences. The average volume was calculated from the three-dimensional measurement with the formula AxBxCx0.52. Interobserver (contrast enhanced T1W and T2W) and intersequensiel correlations were per-formed for each observer from the calculated volumes.

Results: Two observers were found to have an average meningioma size of 10.43 cm3 (0.15-148). The p value was 0.995 (p <0.01) between con-trast enhanced T1W and T2W series for the first observer and 0.997 (p <0.01) between contrast enhanced T1W and T2A series for the second observer. The interobserver r value for both T2W series and T1W series were calculated to be 0.994. Correlations were quite good.

Conclusion: If the use of gadolinium is concerned, even if the renal func-tion is borderline or abnormal, kidney functions are normal even in cases of meningioma planned for follow-up (previously known), unenhanced imaging follow-ups can be discussed as an alternative if side effects of using multiple contrasts are to be avoided

Keywords: Meningioma, follow-up, unenhanced MRI

O-0109

PATTERNS OF HEMORRHAGE OF RADIATION NECROIS IN BRAINEKIM GUMELER, EMRE UNAL, RAHSAN GOCMEN

Hacettepe University School of Medicine, Ankara, Turkey


Abstract

Objective: To investigate the patterns of hemorrhage encountered on susceptibility-weighted imaging (SWI) in patients with radiation necrosis (RN) affecting brain parenchyma.

Materials and Methods: SWI images of patients who were diagnosed with RN between 2010 to 2017 were included in the study. The patients had received radiotherapy due to brain or head/neck tumors. The diagnosis of RN was made based on histopathological findings or by the lesion course on follow-up imaging. Only SWI sequence was used for detecting hemorrhage.

Results: Twenty-six lesions were detected in 21 patients. The indications for radiotherapy were brain metastasis (n=8), high grade glial tumor (n=5), low grade glial tumor (n=4), head/neck malignancies (n=3), and squamous cell carcinoma of the scalp (n=1). The mean time interval between RN and radiotherapy was 15.5 months (range, 3-84 months). The mean follow-up was 20.4 months (range, 1-84 months) following the diagnosis of RN. Petechial hemorrhages were found extending from center to periphery of the lesion with ring appearance on SWI images in twenty-two lesions (85%). In the remaining four lesions we detected nonspecific nodular foci of hemorrhage.

Conclusion: Differentiation of RN from tumor progression could be challenging. We found a unique hemorrhage pattern on SWI images that could be characteristic for RN. We consider that this pattern of hemorrhage occurs as a consequence of perivenular petechial hemor-rhages which are reported to be encountered in patients with RN in the literature. However, further studies investigating the imaging differences between the patients with RN and histologically proven tumor recur-rence, are warranted to support our results.

Keywords: Radiation necrosis, hemorrhage, brain

O-0110

MORPHOMETRIC STUDY OF BRAIN STRUCTURES IN FULL-TERM NEONATES BY CRANIAL SONOGRAPHY AND MAGNETIC RESONANCE IMAGINGBILAL EGEMEN CIFCI1, GOKCEN COBAN2, CENK ERASLAN2 1Department of Radiology, İzmir Atatürk Training and Research Hospital, İzmir, Turkey 2Department of Radiology, Ege University School of Medicine, İzmir, Turkey

Abstract

Objective: Cranial sonography (CS) was introduced into neonatology in the 1970s, the non-invasive nature of ultrasonography makes it an ideal imaging technique. The ability to be performed at bed side without dis-turbing infants and other is produce images without radiation. Structural brain abnormalities and intracranial findings in premature infants are rou-tinely evaluated on CS. However, routine morphometric measurements are uncertain in full-term healthy infants. The aim of this study was to evaluate and compare the normal morphometric measurements of third, right and left lateral ventricles (LV), biventricular (BV) diameter, diameter of the genu, body, splenium of corpus callosum (CC), anteroposterior (AP) diameter of CC and bipariatal (BP) diameter with CS and magnetic resonance imaging (MRI).

Materials and Methods: 131 healthy fullterm infants prospectively examined with CS through the anterior fontanelle on coronal and sagit-tal images by two radiologists. 46 fullterm infants brain retrospectively examined with MRI by a neuroradiologist.

Results: The mean value of the genu, body, splenium and AP diameter of CC was 4,8 mm, 3 mm, 4.4 mm, 43.54 mm on CS and 4.5 mm, 2.9 mm and 4.3 mm, 42.39 mm on brain MRI, respectively. The mean value of the BP, BV, third, right and left LV was 87.2 mm, 24.57 mm, 2.35 mm, 1.48, 1.48 on CS and 87.76 mm, 22.65 mm, 2.4 mm, 1.8 mm, 1.9 mm on MRI, respectively.

Conclusion: Routine morphometric measurements have not compared with CS and MRI yet. In our study, both techniques significantly permit safe and multiple serial scans to evaluate intracranial structures (p<0.001).

Keywords: Cranial sonography, brain MRI, morphometric measurement

O-0111

SPINAL FRACTURE CHARACTERISTICS IN ANKYLOSAN SPONDYLIT AND THE CONTRIBUTION OF MR IMAGINGFATMA CAN, FATIH DUZGUN, GULGUN YILMAZ OVALI, SEBNEM ORGUC, YUKSEL PABUSCU

Department of Radiology, Manisa Celal Bayar University School of Medicine, Manisa, Turkey

Abstract

Objective: Susceptibility to weak trauma has increased due to severe ankylosis that occure at the spine in Ankylosing spondylitis. The trauma affects the anterior-medial and posterior vertebral column due to the change of mechanical load distribution on the spine. We aimed to describe the fracture patterns and the contribution magnetic resonance imaging of ankylosing spondylitis trauma cases in our study.

Materials and Methods: Computed tomography (CT) and magnetic resonance (MR) images of 16 ankylosing spondylitis patients which with archived recorded trauma history were evaluated. Localization of frac-tures, affected bones and joints were classified. Spinal cord injury, pres-ence of epidural hemorrhage, and ligament rupture associated with frac-tures were evaluated on MR images. Data were analyzed using SPSS 18.

Results: In 16 male patients, the most frequent cervical region (43%), the second most affected thoracic region (31%), 43% of the cases were listesis developed and 75% had the entire anterior-mid-posterior vertebral column. Fractures of the facet joints were most detected in the posterior column fractures (68%). It was seen that 5 of 8 cases with vertebra corpus fracture were in the cervical region. In cases of compression fracture, the cervical and thoracic regions are affected by 94% more. CT and MR examinations were performed in 50% of the cases. 37% cord pressure, 31% myelopathy, 37% ligament damage and 25% epidural hemorrhage were determined.

Conclusion: Fractures affecting the Vertebra corpus in Ankylosing spon-dylitis, extending into the posterior elements and take in the whole ver-tebral column. Ankylosing spondylitis fractures are instable, and therefore CT imaging is important to define the localization of the fractures, MR imaging is important to define spinal cord injury and epidural hematoma.

Keywords: Ankylosing spondylitis, trauma, computed tomography, mag-netic resonans imaging


O-0112

THE MESENCEPHALONE INDEX CONTRIBUTION TO DIFFERENTIAL DIAGNOSIS OF PARKINSONISM SUBGROUPSCEMIL OKTAY1, S. SIBEL OZKAYNAK2, ESMA ESEROGLU AKSU3, KAMIL KARAALI1 1Department of Radiology, Akdeniz University Hospital, Antalya, Turkey 2Department of Neurology, Akdeniz University Hospital, Antalya, Turkey3Department of Public Health, Gazi University School of Medicine, Ankara, Turkey

Abstract

Objective: Early distinction between parkinsonian disorder subgroups is important because of differences in prognosis and treatment response. An accurate method for the diagnosis is needed. The purpose of our study was to assess morphologic changes of brainstem in the evaluation of parkinsonian disorders.

Materials and Methods: MRI of 14 patients with possible PSP, 43 patients with PD, 8 patients with probable MSA-P, and 45 age-matched controls were recruited in this retrospective study. Diagnoses were confirmed clin-ically. The pons area (P), mesencephalon area (M), middle peduncle width (MCP), superior peduncle width (SCP), and peduncle angle (PA) were measured from T1-MPRAGE images. In additon to this the P/M ratio, MCP/SCP ratio, the previously defined MR Parkinsonism Index [PI=(P/M).(MCP/SCP)] and also index that we termed the Akdeniz Index was cal-culated [AKI=(P/M).(PA/180)]. Two blinded radiologists evaluated all MR images. Interrater and interobserver variations were also measured.

Results: There was a statistically significant difference among the three groups. Further statistical evaluations showed that significant difference was due to results of PSP and PD patients. M and SCP were significantly smaller in PSP patients than PD patients otherwise P/M ratio, MCP/SCP ratio and PA were significantly larger in patients with PSP. PI and AKI indices were signifi-cantly higher in the PSP group than in the PH and MSA groups. When PI and AKI were compared, similar sensitivity and specificity values were obtained.

Conclusion: AKI ande PI can help distinguish patients with PSP from those with PD. However, because of the easy of measurement and the higher agreement between measurements, we believe that the use of AKI is appropriate.

Keywords: Parkinsonian disorders, PSP, progressive supranuclear palsy

O-0113

HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL ANALYSIS OF THE EFFECTS OF MAGNETIC RESONANCE CONTRAST AGENTS ON THE SPINAL CORD TISSUE OF RATSFATMA BEYAZAL CELIKER1, TOLGA MERCANTEPE2, ARZU TURAN1 1Department of Radiology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey2Department of Histology and Embryology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey

Abstract

Objective: Since the end of the 1980s, gadolinium-based contras agents (GBCAs), which are commonly used as contrast agents in magnetic reso-nance (MR) imaging systems, have been reported to cause accumulation in tissues, primarily the kidneys. Although linear nonionic (Gadodiamide) GBCAs were reported to play a role in multiple organ toxicity, it has been reported in recent studies that macrocyclic ionic (Gadoteric acid) GBCAs also cause toxicity in tissues. Under the light of this information, we aimed in this study to investigate histopathological and immunohistochemical effects of linear nonionic and macrocyclic ionic GBCAs on the spinal cord connecting the central nervous system and the peripheral nervous system.

Materials and Methods: In the study, 32 male Sprague dawley rats were used and were divided into four groups. No attempt was made to the healthy control group (Group 1). Serum physiologic 0.2 ml/kg was applied on the serum physiologic group (Group 2). After applying the contrast agent to the Gadodiamide group (Group 3) and Gadoteric acid group (Group 4) for five weeks with 0.2 ml/kg for four days a week from the tail vein, the groups were left untreated for five weeks. At the end of the tenth week, the rats were anesthetized, and samples were taken from the spinal cord. Measurements of gray-white ore areas in hematoxylin and eosin-stained spinal cord incisions after fixation (10% formalin) and routine histological follow-up were performed by two blinded histopa-thologists who were not at the tissue tracing stage. The data obtained by measurement of 40 different fields in each incision were evaluated by one-way ANOVA and Duncan test. p<0.05 was considered significant for all measurements.

Results: Control group neurons and oligodendrocytes cells were observed to be in normal structure. Perikaryons of neurons and oligodendrocytes cells were observed to be normal in the serum physiological group samples. In the samples of Gadodiamide and Gadoteric acid groups, peri-karyons and oligodendrocytes were present in typical structure and no pathology was found.

Conclusion: Repeated use of GBCAs does not cause pathological findings in the spinal cord tissue of rats. These findings do not differ according to the chemical composition of the contrast material (linear or macrocycles).

Keywords: Gadolinium-based contras agent, linear, macrocycles, spinal cord

O-0114

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME FOLLOWING BONE MARROW TRANSPLANTATIONGULHAN ERTAN

Department of Radiology, Medipol University School of Medicine, İstanbul, Turkey

Abstract

Objective: Following bone marrow transplantation (BMT), severe neurological complications are significant causes of morbidity and mortality. In children, hematologic diseases (esp. Acute leukemia), renal disorders, and cytotoxic drugs increase posterior reversible encephalopathy syndrome (PRES) prevalence. The limited literature of PRES in pediatric allogenic BMT patients reports a prevalence of 5.2%.


The aim of our study is to determine the prevalence of (PRES) in patients with neurological complications following BMT performed in our hospital and correlate this entity with clinical and radiological findings.

Materials and Methods: We retrospectively evaluated cranial CT and MR images 24/150 pediatric patients with neurological complications who received BMT in our hospital between January 2014-February 2018.

Results: In 8 out of 24 patients with post-BMT neurological complica-tions, (7 males and 1 female; average=15.2 years) PRES neuroradio-logical findings were present. In Table 1, clinical and MRI findings are summarized. In literature, seizure symptoms are more frequent in the pediatric group of PRES cases. In our cohort symptoms of seizure were diagnosed in 5 of 8 post-BMT cases along with severe headache in 3 of 8. Hypertension with correlating MRI finding was present in 7 of 8 cases. In the first 400 days following BMT, the prevalence was reported as 20%. In our study, PRES was clinically and radiologically diagnosed in 7 cases in the first 100 days and in 1 case on the 120th day after BMT. In cranial MRIs, holohemispheric involvement was observed in 3 of 24 patients, parieto-occipital in 5 of 24, cerebellar in 3 of 24, and brain-stem in 1 of 24. Hemorrhage was present in 2 of 24. Contrast enhancement in 2 of 24. There was no diffusion restric-tion excluding cytotoxic edema in all our cases, in keeping with the reported literature cases.

Conclusion: In hemato-oncologic diseases, especially when hypertension, change in consciousness, or seizure is present, PRES should be considered, and appropriate supportive care should not be delayed to prevent perma-nent neurological sequelae.

Keywords: Bone marrow transplantation, PRES, seizure

O-0115

COMPARISION OF THE DIAMETER OF TEMPORAL HORN OF LATERAL VENTRICULE IN THE PATIENTS WITH T2 HYPERINTENSE WHITE MATTER LESIONS TO NORMAL PATIENTSSEMA AKSOY

Private Hospital 34, İstanbul, Turkey

Abstract

Objective: Our aim is to compare temporal horn of lateral ventricule of the patients with nonspecific T2 hyperintense white matter lesions to the normal patients.

Materials and Methods: There were 40 patients (28 female and 12 male patients between the ages of 30-49) with cranial magnetic resonance imaging (Siemens; Era, Erlangen, Germany). Their neurological examina-tions were normal.

Results: There were T2 hyperintense white matter lesions in the cranial imaging of 23 patients. Seventeen patients had no abnormal lesion in the gray and white matter.

Conclusion: The diameter of temporal horns were calculated as the average of two horns. The mean value of temporal horn was 2,6

mm in the patients with T2 hyperintens white matter lesions. The diameter of temporal horn was detected 2,3 mm in normal patients. Nonspesific T2 hyperintense white matter lesions might be a sign of early aging of the brain.

Keywords: Aging, T2 hyperintense white matter lesions, cranial magnetic resonance imaging

O-0116

THE USEFULNESS OF SUSCEPTIBILITY WEIGHTED IMAGING FOR THE DIAGNOSIS AND EVALUATION OF THIS SEQUENCE WITH THE OTHER SEQUENCESSEMA AKSOY1, SAFIYE TOKGOZ OZAL2 1Private Hospital 34, İstanbul, Turkey2Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: My aim is to search the role of the susceptibility weighted imaging (swI). I also searched the role of the other sequences.

Materials and Methods: There were 108 cranial imaging (Siemes Era, Erlangen, Germany) of the patients with the ages of 0-92.

Results: There were 8 new lesion with hemorrhage or calcification. I cannot detect 3 of them in the other sequences. Four of them (grater than 4 mm) were detected in the b0 of diffusion weighted imaging and T2 wighted imaging. One lesion (a capiilary telangiecta-sia) was only detected swi and T1 imaging after contrast material.

Conclusion: Swi is useful for the detection of the lesions with calcification or hemorrhage especially lesser than 4 mm.

Keywords: Swi, cranial magnetic resonance imaging, diffusion

O-0117

ROLE OF PERITUMORAL APPARENT DIFFUSION COEFFICIENT VALUES IN DIFFERENTIAL DIAGNOSIS OF GLIOBLASTOMA FROM SOLITARY METASTASISMUSTAFA MAHMUT BARIS, AHMET PEKER, NURI KARABAY

Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Objective: It is often difficult to differentiate a solitary brain metas-tasis from glioblastoma based on conventional magnetic resonance (MR) imaging characteristics alone. On the other hand, some features like peritumoral edema volume and mass effect can be used in differ-ential diagnosis. Pathological researches showed that there are malign tumor cells in peritumoral edema of glioblastom, while there is none


in peritumoral edema of metastasis. Based on this information, we can expect that “apparent diffusion coefficient” (ADC) values may differ in peritumoral area of glioblastoma and metastasis. The pur-pose of our study to evaluate the effect of peritumoral ADC values in differential diagnosis.

Materials and Methods: We retrospectively reviewed MR images of patients with glioblastoma (n=26) or metastasis (n=18). Only patients with intra-axial supratentorial solitary metastatic lesion were included to metastasis group. ADC values measured in peritumoral area (adjacent to tumor border) in three different location using region of interest (ROI) in 1 cm diameter and mean values were calculated. Additionally, cerebrospinal fluid (CSF) ADC values were measured with same ROI for correction. Statistical analyses were performed with SPSS 15.

Results: Mean peritumoral ADC values were found 1.1x10-3 mm2/sn in glioblastoma group and 1.4x10-3 mm2/sn in metastasis group. Mean cor-rected values (peritumoral ADC/CSF ADC) were 0.38 in glioblastoma group and 0.11 in metastasis group. There was statistically significant dif-ference between two groups in corrected ADC values (p=0.001).

Conclusion: Measurement of peritumoral ADC values may contribute to the differential diagnosis of solitary brain metastasis from glioblastoma.

Keywords: Apparent diffusion coefficient, glioblastoma, metastasis, dif-ferential diagnosis

O-0118

ASSESSMENT OF HEMORRHAGE AND PARAMAGNETICAL SUBSTANCE ACCUMULATION IN BRAIN METASTASES BY SUSCEPTIBILITY WEIGHTED IMAGING (SWI)ABDURRAHMAN GOLBASI, ISMAIL SALK

Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey

Abstract

Objective: It has been reported that differential diagnosis of cerebral metastases can be made by evaluating intratumoral susceptibility signals (ITSS) in susceptibility weighted imaging (SWI). In our study, we aimed to make a differential diagnosis of cerebral metastases by measuring the ITSS in the SWI sequence.

Materials and Methods: In our study, MRI images were acquired from 77 patients between October 2012 and October 2017 with intracerebral metastases (23 patients with breast carcinoma (BC), 4 patients with malig-nant melanoma (MM), 42 patients with lung cancer (LC) and 8 patients with gastrointestinal adenocancer (GIS)) at 1.5 T MRI in our unit. On contrast-enhanced T1 weighted images, all enhancing lesions were carefully delineated and the outline transferred to the coresponding SWI images. On SWI images, the number of the pixels containing ITSS and the number of the pixels of entire lesion were recorded. The reference value to determine pixels containing ITSS was the average intensity value of the lateral ventricle. Subsequently, the ITSS percentages of all metastases were calculated.

Results: ITSS percentages in metastases were found 22.52% in LC, 47.61% in GIS, 11.85% in BC and 60.75% in MM. When the diagnostic value of ITSS percentages were compared in between tumor types, the area under the curve between LC-GIS was 0.734, the sensitivity was 0.61 and the specificity

was 0.79. Values were found respectively 0.808, 0.75, 0.76 between LC-MM; 0.589, 0.83, 0.40 between LC-BC; 0.634, 0.50, 0.92 between GIS-MM; 0.818, 0.83, 0.69 between GIS-BC and 0.884, 0.95, 0.75 between MM-BC.

Conclusion: In terms of differential diagnosis of the ITSS percentages measured in the SWI sequence, the diagnostic performance was very good between MM-BC, good between MM-LC, GIS-LC and GIS-BC, and poor between LC-BC and GIS-MM. Percentages of ITSS has high sensitiv-ity and specificity values to make a differential diagnosis between GIS-LC, GIS-BC, MM-BC and MM-LC

Keywords: SWI, malign melanoma, brain metastases, hemorrhage

O-0119

ABSENT NIGROSOME 1: DIAGNOSTIC ACCURACY IN PARKINSON DISEASEAYSE NUR SIRIN OZCAN1, EBRU BILGE DIRIK2 1Department of Radiology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey2Department of Neurology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey

Abstract

Objective: Newly recognised anatomic structure called nigrosome 1 include intense dopaminerjic neurons and absent in Parkinson disease (PD) bilaterally or unilaterally was depicted especially in 7 Tesla MRI researchs. We aim to demonstrate diagnostic accurancy of absent nigro-some 1 on substantia nigra in PD at 3 Tesla.

Materials and Methods: 46 subject including 26 healty control and 21 parkinson disease enrolled to the study. All subject underwent MRI scan include susceptibility weighted imaging (SWI) in addition to conventional sequences. SWI sequence was obtained parallel to the fourth ventricle.

Results: All healty control subject except one subject was showed nigro-some 1 bilaterally. In PD group 1 patient showed bilateral nigrosome 14 showed controlateral absent nigrosome and in 6 patient showed absent nigrosome bilaterally. Absent nigrosome 1 showed high sensitivity and specificity in PD diagnosis (p<0.05).

Conclusion: Altough PD diagnosis was based on clinical findings newly recognised anatomic structure nigrosome 1 could be used in PD diagnosis in controversial cases.

Keywords: Nigrosome, parkinson disease, SWI

O-0120

A COMPARATIVE STUDY ON MAGNETIC RESOANCE VENOGRAPHY WITH T2SPACE SEQUENCE MRIKARABEKIR ERCAN, BURAK YAGDIRAN


Abstract

Objective: The relationship between MR venography MRI using TOF (time of flight) sequence and T2Space sequence MRI technique was investigated in this study.


Materials and Methods: 37 patients with the clinical preliminary diagnosis of sinus vein thrombosis who applied to the radiology clinic evaluated 55 intracranial sinus veins. The hypoplasia of the vein, hypoplastic vessel diameters, determine to the thrombotic vessel and thrombosed vessel diameters were investigated by two radiologists. Statistical analysis was performed using SPSS after the data were collected.

Results: There was no significant difference between two tests with McNemar test in vessel hypoplasia study. The hypoplastic vessel diameters were analysed by Student-T test and no statistical differ-ence was found (p=0.519). There was no significant difference in the analysis of dependent groups by the McNemar test in the thrombo-sis detection study (p=0.375). There was no significant difference between the two tests with Wilcoxon test to finding thrombosed veins.There was no significant difference between the T2Space and MR venogram tests in the measurement of thrombosed vessel diam-eters. There was significant correlation between two tests (p=0.001).

Conclusion: There was no significant difference between T2Space sequence and MR venogram obtained with TOF MRI technique in the hypoplastic vein, the detection of the thrombotic vein and thrombotic and non-thrombotic vessel diameters. There was no superiority between two MRI sequences. According to the obtained results, both MRI technique can be used instead of each other.

Keywords: Sinus vein thrombosis, T2space, venography, MRI

O-0128

EVALUATION OF GRAY MATTER HETEROTOPIES WITH MRI IN THE PEDIATRIC AGE GROUPSHUSEYIN ALPER KIZILOGLU, RECEP SADE, MECIT KANTARCI

Atatürk University School of Medicine, Erzurum, Turkey

Abstract

Objective: Gray matter heterotopes are neuronalmigration disorder that describe the abnormal location of cortical neurons. We aimed to determine gray matter heterotopes causing epilepsy, developmental retardation and mental retardation in children by magnetic resonance imaging (MRI) examination, and classification possible additional mal-formations.

Materials and Methods: In our center, brain MRIs of the cochleas evaluated with the pre-diagnosis of epilepsy, mental retardation and developmental retardation between 2013-2017. Conventional MRI images were obtained with a 1.5 T or 3-T MR device (MagnetomAvantoorMagnetomSkyra: Siemens Healtcare, Erlangen, Germany). Patients were studied by obtain-ing spin echo T1AG, T2AG and FLAIR (fluid attenuated inversion recov-ery) AG images on axillary, coronal and sagittal planes with coils suitable for the imaging table. General anesthesia was applied to some age groups for imaging.

Results: A total of 400 cases pre-diagnosed with epilepsy, mental retardation and developmental delay were reviewed. Gray matter heterotopy was detected in 21 cases (5%). 10 of them were male, 11 of them were female. The cases were between 1-18 years of age (mean age 6.5 years). 13 of them were nodular, 3 of them were lami-

nar and 4 of them were band heterotopia group, 1 had both nodular and laminar koponent. There were additional anomalies in 5 of the patients. 2 of them had polymicrogri-pachygly, 2 of them had schizen-cephaly and corpus callosum agenesis and only one had corpus cal-losum agenesis. Six of the heterotopic gray matter foci were located in the periventricular white matter, 11 in the subepandimal wall, and 4 in the subepandimal wall and periventricular white matter. Nine of the cases had both hemispheres and 12 had single hemispheres.

Conclusion: Heterotopes may be clinically asymptomatic; but may cause epilepsy, developmental delay, and mental retardation. These patients need to be recognized by radiologists.

Keywords: Heterotopia, MRI, gray matter

O-0129

PRELIMINARY STUDY: WHAT IS T1 TIME MEASUREMENT IN PATIENTS WITH NORMAL CONVENTIONAL CORONARY ANGIOGRAPHIC EXAMINATION BUT ISCHEMIC SYMPTOMS?SAFIYE SANEM DERELI BULUT1, FUAT NURILI3, BURAK OZTURKERI2, YASAR BUKTE1 1Department of Radiology, University of Health Sciences University Umraniye Research and Training Hospital, İstanbul, Turkey2Department of Cardiology, University of Health Sciences University Umraniye Research and Training Hospital, İstanbul, Turkey3Department of Radiology, Memorial Sloan-Kettering Cancer Center, İstanbul, Turkey

Abstract

Objective: To evaluate the possible changes in myocardium with native T1 mapping method in patients with normal coronary angiog-raphy examination but with chest pain and positive exercise stress tests.

Materials and Methods: Cardiac MR examinations were performed in 1.5 tesla MR machine (OPTIMA MR 450, GE) for 20 patients with isch-emic symptoms but normal conventional coronary angiography between December 2016 and June 2017. Myocardial T1 maps were acquired by SMART T1 (saturation method using adaptive recovery times for cardiac T1 mapping) in short-axis orientations. Native T1 times were evaluated manually. Patients with any additional (amyloidosis, DM, hemochromatosis, cardiomyopathies) disease that may affect myocardial native T1 time of study were excluded. The age range of the patient is between 22-56 years and the average age is 40 years.

Results: On short axis images obtained from the apical, midventricular, and basal levels, it was noted that the T1 time was significantly higher than normal myocardium as a result of manual measurements made to 17 cardiac segments.

Conclusion: Patients with positive exercise stress tests and chest pain but with normal conventional coronary angiography examina-tion shows myocardial tissue T1 time prolongation. In these patients, even if fibrosis with late myocardial enhancement is not observed in myocardium, early treatment and close monitoring should be applied.


O-0130

INVESTIGATION OF EFFECTIVENESS IN DETERMINING HEMORRHAGE, CALCIFICATION AND VASCULAR ANOMALIES IN MRI OF CHILD BRAIN WITH ADDING SUSCEPTIBILITY WEIGHTED IMAGING TO CONVENTIONAL SEQUENCESKEMAL CAGLAR TUNA, FATMA CEREN SARIOGLU, MUHAMMET SALMAN, YASIN ERTUG CEKDEMIR, HANDAN GULERYUZ


Abstract

Objective: To investigate the efficacy of adding SWI sequence to con-ventional sequences in pediatric brain imaging to demonstrate calcific or hemorrhagic focus and abnormal venous structures, the usage areas of SWI in pediatric patients, the characteristics of SWI signals, sequence-specific artifacts and pitfalls.

Materials and Methods: We retrospectively examine the images of pediatric patients who had pathologic signal foci on SWI sequence, with different pre-diagnosis MRI between 31.07.2017 and 22.01.2018. The foci are classified as homogeneous paramagnetic, primer paramagnetic, homogeneous diamagnetic and primer diamagnetic. Classification of lesions as calcification or hemorrhage was made in the context of CT and conventional MR images, medical history and clinical information including laboratory, pathology results. These foci have been investi-gated in conventional sequences. The focus higher than 100 HU on CT were accepted as gold standard for calcification. Descriptive statistical methods were used to classify the data. Chi-square test was used for agreement of conventional sequences and SWI. Chi-square test was used to compare the calcific foci observed on CT with conventional sequences and SWI. In the chi-square test, values below P <0.05 were considered to be statistically significant.

Results: On SWI images 287 hypointense focuses were found. 135 of these foci were classified as diamagnetic or calcification, 149 as para-magnetic or hemorrhagic focus, and 13 as vascular anomaly. There are 6 signal changes on T1 WI, 11 signal on T2 WI and 7 signal on FLAIR the presence of foci that support calcification. Totaly 13 (approx. 9.6%) of the 135 diamagnetic focus were appeared in conventional sequences. There are 19 signal changes on T1 WI, 20 signal on T2 WI and 15 signal on FLAIR the presence of foci that support hemorrhagi. Twenty-five (approx. 16.7%) were selected on conventional sequences from a total of 149 signal changes. Only one of the vascular anomalies observed in thirteen patients on the conventional sequences was showed. There are 143 calcification focus on CT images. On SWI this was 135. Eight calcified foci could not be distinguished on SWI. A Chi-square test was used to compare the efficacy of SAG-added conventional sequences in detecting calcification with the efficacy of conventional sequences only in detecting calcification, and the p value was found to be 0.001. The signal is more heterogeneous proportional to the increasing dimension on phase images.

Conclusion: We observed that on SWI calcification or bleeding products have significant determined, because of the nature of hemorrhagi focus may be heterogeneous, involve some artifacts and have been shown

heterogeneity is associated with the focal dimension of the foci and at the same time the sequence may be an important diagnostic tool in the diagnosis of venous anomalies.

Keywords: Pediatric neuroimaging, susceptibility weighted imaging, para-magnetism, diamagnetism

O-0131

QUANTITATIVE ANALYSIS OF HEALTHY LIVER AND KIDNEY USING A NATIVE T1 MAPPING IN CHILDRENSERCIN OZKOK, AHMET ASLAN, MINE ASLAN, AYSENUR BUZ

Department of Radiology, İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: T1 mapping is a technique to quantify tissue T1 relaxation time for assessing fibrosis of organs. The purpose of this study is to determine native T1 relaxation times of liver and kidney in healthy children with MOLLI T1 magnetic resonance imaging(MRI).

Materials and Methods: Healthy subjects referred for abdominal MRI were examined with MOLLI T1 sequence. Native T1-maps were acquired in a single axial slice through liver and coronal slice through kidneys. Reference values were recorded with region of interest measurements by two radiologists for assessing interob-server reliability.

Results: Mean native T1 values for liver were 709.47±126.54 and 691.43±80.02 msec, for right kidney cortex(RKC) were 1111.33±170.19 and 1178.63±192.71 msec, for right kidney medulla (RKM) were 146786±177.58 and 1441.88±258.64 msec, for left kidney cortex (LKC) were 1174.81±207.18 and 1501.54±254.64 msec, for left kid-ney medulla (LKM) were 1508.57±182.99 and 1166.04±180.14 msec, respectively. Interobserver reliability was good for liver measurements (ICC: 0.512), were moderate for RKC and LKC and LKM (ICC: 0.772, 0.705, and 0.684, respectively), and excellent for LKM (ICC:0.89) with statistically significant differences (p<0.05 for all parameters). There were no significant correlation between age, body mass index (BMI) and T1 relaxation times.

Conclusion: T1 mapping is a reliable method for assessing pediatric liver and kidney parenchyma without using a contrast media and may be used as a diagnostic tool to distinguish between normal variants and pathologi-cal conditions.

Keywords: T1 mapping, children, liver, kidney, pediatric T1 mapping

O-0132

ASSESSMENT OF BRAIN DIFFUSION-WEIGHTED IMAGES AT 3 TESLA MRI IN CHILDREN WITH NEPHROTIC SYNDROME, PRELIMINARY RESULTSDILEK SEN DOKUMACI1, SUNAY SIBEL KARAYOL1, FERIT DOGAN2, KENAN YILMAZ3


1Department of Radiology, Harran University School of Medicine, Şanlıurfa, Turkey2Department of Radiology, Sanlıurfa Children’s Hospital, Şanlıurfa, Turkey3Department of Pediatric Nephrology, Şanlıurfa Children’s Hospital, Şanlıurfa, Turkey

Abstract

Objective: To compare ADC values obtained from different regions of brain parenchyma in normal children with children with nephrotic syn-drome (NOS) via brain diffusion-weighted images.

Materials and Methods: This prospective study was planned from January 2017 to July 2017 with 15 children with a mean age of 10.8±2.3 (7-15) who were diagnosed with nephrotic syndrome at the pediatric nephrol-ogy clinic and 15 healthy children of the same age group that accepted as a control group. We performed non-contrast brain MR and diffusion MR examinations with 3T MRI scanner (Magnetom Skyra, Siemens Healthcare, Erlangen, Germany) in both groups. Brain MRI scans were evaluated for parenchymal lesions. The diffusion images obtained with b0 and b1000s/mm2 were analyzed with 0.25 cm² ROIs for ADC measurements bilaterally from perirolandic white matter, anterior and posterior centrum semiovale, anterior and posterior corona radiata, periatrial white matter, internal cap-sule anterior and posterior limbs, corpus callosum genu and splenium, mes-encephalon, dorsal and ventral pons, caudate nucleus, putamen, thalamus, cerebellar white matter and dentate nuclei. ADC values were compared for differences between the NOS group and the control group.

Results: There was a significant difference between the ADC values measured from right internal capsule, left perirolandic white matter, left thalamus, left cerebellar dentate nuclei (p<0.05 for all). The ADC values in these regions were lower in the patient group.

Conclusion: Nephrotic syndrome, as a primary renal pathology, may also cause diffusion changes in some areas of the brain parenchyma. Further research with more patients is needed to better define this issue.

Keywords: Nephrotic syndrome, 3T MRI, DWI

O-0133

THE UPPER ABDOMEN MR-MR CHOLANGIOGRAPHY AND CT FINDINGS OF THE CHILDREN WHO HAD PANCREATITISAYSEL UNLUSOY AKSU, BETUL EMINE DERINKUYU

Dr. Sami Ulus Children Hospital, Ankara, Turkey

Abstract

Objective: The study aims to evaluate the imaging findings of children with pancreatitis, especially MR cholangiography.

Materials and Methods: The upper abdomen MR-MRCP and CT images of the children who had pancreatitis between 2008-2018 in the pediatric gastroenterology clinic of Dr. Sami Ulus Children’s Hospital were retro-spectively reviewed.

Results: The mean age of the 46 patients who were diagnosed with pancreatitis was 10,5 years (2-17,5) and 52,1% were male. 22.2% of the patients had recurrent episodes of pancreatitis (≥2). The most common etiologies were 39% idiopathic, 13% stone, 10,9% infection, 10,9% con-genital anomaly, 6,5% drug, 6,5% trauma, 6,5% dyslipidemia, 6.5% other were noted. Upper abdominal MR-MR cholangiography was performed in

20 patients (43.5%) and CT images were obtained in 9 patients (19.6%). Along with the findings of MRCP and CT, ERCP were performed under an intention to treat in eleven patients (23.9%). Seventeen patients (36.9%) were followed up with USG and recovered in a short time, and no further imaging was performed. Upper abdomen MR-MRCP and CT images revealed 75.9% pancreatic thickening, 48.3% parenchymal heterogeneity-T2AG signal increase. Additionally images showed peripan-creatic dirty fat tissue in 72.4%, peripancreatic collection in 58.6%, and intraabdominal ascites in 48.2% of the patients. MRCP and CT findings explained the stones in the biliary tract and/or pancreatic duct in 24.1%, dilated biliary ducts in 27,6%, and dilated pancreatic ducts in 34.5% of the patients. Pseudocyst formation occurred in 2 patients (6.9%).

Conclusion: The comprehensive assessment of pancreatitis is based on clinical, laboratory and imaging evaluation. MRI is an excellent noninvasive modality to detect and to stage the severity of inflammatory processes. The development of complications of pancreatitis such as hemorrhage, pseudocysts, abscesses, and venous thrombosis are well-demonstrated by MRI which is an inalienable radiological modality by the clinicians.

Keywords: Pancreatitis, MR cholangiography, children

O-0134

COEXISTENCE OF PERSISTENT FALCINE SINUS AND VARIOUS CLINICORADIOLOGICAL CONDITIONS: MRI FINDINGSMEHMET H. ATALAR1, BULENT YILDIZ1, R NURI SENER2 1Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey2Department of Radiology, Ege University School of Medicine, İzmir, Turkey

Abstract

Falcine sinus is a rare variation of the venous pathway between the dural layers of the falx cerebri, and it is a normal anatomic structure that typically closes before birth. Persistent falcine sinus (PFS) extremely rarely occurs in isolation from sinus thrombosis and congenital anomalies. PFS is associated with absent or hypoplastic straight sinus. PFS has been widely reported in pediatric patients. In the literature, it has been reported that persistent falcine sinus may coexist with various conditions including atretic parietal encephalocele, galen vein malformations, arteriovenous malformations, corpus callosum agenesis, osteogenesis imperfecta, acro-cephalosyndactyly, dysplastic or absent tentorium cerebelli, bilateral giant parietal foramen, and Chiari type II malformation. In this presentation, we aimed to report the MRI findings of 16 patients with various pathological conditions accompanying the rarely encountered PFS. Five patients had atretic parietal encephalocele, 3 had arteriovenous malformation, 1 had total corpus callosum anomaly, 1 had osteogenesis imperfecta, 1 had clo-verleaf skull anomaly, 1 had cerebellar hypoplasia, 1 had Apert syndrome, 1 had focal gray matter heterotopia, and 1 had Chiari type II malformation. One patient had isolated PFS. The patients had an age range of 1 month to 15 years. Nine patients were male and 7 were female. Five patients underwent MR venography examination in addition to conventional MRI. MR imaging, particularly with the help of sagittal images, greatly helps for making the diagnosis of PFS, and it can also detect most of the underlying malformations. It should be remembered that PFS may coexist with many different clinical conditions.

Keywords: Anomalies, brain, magnetic resonance imaging, persistent falcine sinus


O-0138

“PULMONARY VEIN SIGN” IN PATIENTS WITH SUSPECTED PULMONARY EMBOLISM ON MAGNETIC RESONANCE IMAGINGFURKAN UFUK1, FURKAN KAYA2, PINAR CAKMAK1, ERGIN SAĞTAŞ1, AHMET BAKI YAĞCI1 1Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey2Department of Radiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey

Abstract

Objective: In pulmonary embolism (PE), hypodense filling defect in pulmonary veins due to decreased perfusion on computed tomography angiography was defined as “pulmonary vein sign (PVS)“. Herein, we aimed to evaluate PVS for PE diagnosis in magnetic resonance imaging (MRI) sequences.

Materials and Methods: Sixty-four patients who underwent MRI both with unenhanced steady-state free precession (SSFP) and contrast-enhanced 3-dimensional gradient echo (3D-GRE) sequences for sus-pected PE constituted the study population. The PVS was defined as the presence of > 2 cm hypointense filling defect in a pulmonary vein. Two observers who were unaware of the patients clinical findings and final diagnosis (PE +/-) assessed images for the presence of PVS by consensus. Diagnostic performance of PVS was calculated using patients final diag-noses for PE as reference. In addition, presence of pleural effusion and atelectasis-linear bands were investigated.

Results: Forty-one patients (64%) had a final diagnosis of PE. The PVS was detected in one patient (2.4%) on 3D-GRE and 6 patients (14.6%) on SSFP. Sensitivity, specificity, accuracy, positive and negative predictive values of PVS on SSFP were 15%; 95.8%, 45.3%, 85.7%, and 40.3%, respectively. A statistically significant correlation was found between atelectasis-linear bands and presence of PE (p=0.011, r=0.313) .

Conclusion: We suggest that presence of PVS and atelectasis-linear band on MRI may contribute the diagnosis of PE in patients with suspected PE, especially in unenhanced MR images.

Keywords: Pulmonary vein sign, embolism, MRI


Poster Presentations


P - 01

ROLE OF ARFI IN DIFFERENTIAL DIAGNOSIS OF ENDOMETRIUM PATHOLOGIESHALIME CEVIK1, BIRNUR YILMAZ1, TEVFIK BERK BILDACI2, GULDENIZ DESTELI2

1 Okan University School of Medicine Hospital, İstanbul, Turkey2 Başkent University School of Medicine İstanbul Hospital, İstanbul, Turkey

Objective: To show contribution of ARFI in distinguishing endometrium cancer and other pathologies from each other and in detecting myome-trium invasion, in cases with bleeding complaints.

Materials and Methods: Our study was prospectively performed with 45 cases of hysterectomy decision in 41-91 years (mean 58.3 years) age range. Pathology revealed 14 cases of endometrial atrophy, 11 cases of secretory and proliferative phase, 10 cases of polyp, 6 cases of endome-trial hyperplasia and 4 cases of endometrium cancer. Independent sample T test was used for comparison of ARFI values.

Results: Minimum, mean and maximum ARFI values were found to be 2.72 m/s, 3.09 m/s and 3.45 m/s for atrophy, 3.37 m/s, 3.80 m/s and 4.22 m/s for endometrial proliferation, 2.60 m/s 3.02 m/s and 3.43 m/s for polyp, 3.68 m/s, 4.02 m/s, 4.36 m/s for hyperplasia and 2.57 m/s, 2.98 m/s and 3.4,0 m/s for cancer, respectively. There is a statistically significant difference between the mean of the minimum, mean and maximum ARFI values of the two groups with atrophy and proliferation and with hyperplasia and polyp (p<0.05). There is a statistically significant differ-ence between average of the minimum, mean and maximum ARFI values of the two groups in which endometrial hyperplasia and atrophy were detected (p<0.01). There is a statistically significant difference between the average of the minimum and mean ARFI values of the two groups with endometrial polyp and proliferation (p<0.05). There was no statisti-cally significant difference between the average of minimum, mean and maximum ARFI values of dual groups of polyps and atrophy, cancer and atrophy, hyperplasia and proliferative endometrium, cancer and polyp, cancer and hyperplasia in endometrium. No statistically significant differ-ence was detected in the average of minimum, mean and maximum ARFI values of cases with and without endometrial cancer.

Conclusion: As a result, the ARFI contributes to the differential diagnosis of benign pathologies such as hyperplasia, polyps and atrophic endometri-um causing bleeding like cancer in the postmenopausal period. However, it is insufficient in differentiating cancer, atrophy and other pathologies from each other.

Keywords: Endometrial cancer, ARFI, elastography, ultrasonography

P - 02

A RARE CAUSE OF INGUINAL SWELLING; SPERMATIC CORD LIPOMADILAN ECE GEYLAN, NESRIN ERDOGAN, BERRAK BARUTCU, ALI YUSUF ONER


Abstract

Lipoma is the most common soft tissue tumor of body. It is usually located in proximal extremities, trunk, shoulders etc. Paratesticular localisation is very rare, there is only a few cases in the literature. The most common paratesticu-lar mass is hernia and spermatic cord lipoma is usually diagnosed incidentally during hernia operation. In some cases spermatic cord lipoma may be the only finding without accompanying hernia during the surgery. Spermatic cord lipoma can be diagnosed with ultrasound and magnetic resonas imaging (MRI). In ultrasound examination, like most fatty lesions, lipomas are usually hyperechoic which is neither sensitive nor specific. Other benign masses like hernia or malign lesions like sarcoma, can also be echogenic. MR imaging can be helpful in diagnosis, showing high signal intensity similar to subcutaneous fat. Especially in coronal and sagittal views, it has a well demarcated superior wall and there is no connection with the peritoneum. While inguinal hernias containing mesenteric fat extend to ward mesentery medially or laterally to the inferior epigastric vessels without distinct superior wall. Cord lipoma may cause inguianl hernia symptoms and patient may end up with unneces-sary hernia surgery. So MRI has significant role to diagnose spermatic cord lipoma. Lipoma is the most common paratesticular neoplasm and although it can occur other places with in the scrotum, it most often originate from the spermatic cord. We present here a case of spermatic cord lipoma presented as a palpable mass lesion in the scrotum with MRI findings.

Keywords: Inguinal swelling, spermatic cord lipoma, scrotal MRI

P - 03

GIANT UTERINE LEIOMYOMA TORSION AND ASSOCIATED UTERINE TORSION: MRI FINDINGSFURKAN UFUK, HUSEYIN GOKHAN YAVAS

Pamukkale University School of Medicine, Denizli, Turkey

Abstract

Uterine torsion is an unusual cause of acute abdominal pain and it can be seen in pregnancy but torsion of non-pregnant uterus is a very rare condition. It may cause irreversible ischemic changes and life-threatening conditions. To prevent these complications, early and correct diagnosis is of great importance. Computed tomography and magnetic resonance imaging are successful methods for prompt diagnosis in suspected cases. Also, these methods can guide the surgeon. The aim of this study was to evaluate the clinical and imaging findings of a non-pregnant patient diag-nosed with uterine torsion.

Keywords: Myoma, torsion abnormality, uterine neoplasms, magnetic resonance imaging, computed tomography

P - 04

AN UNUSUAL CASE: TRANSDIAPHRAGMATIC RUPTURE OF HEPATIC HYDATID CYSTKEVSER ESMERAY CIFCI, AYTUL HANDE YARDIMCI, CEYDA TURAN BEKTAS, ESMA AKTUFAN



Abstract

We present a rare case of right sided huge hydatic cyst with transdia-phragmatic rupture to the right hemithorax. In this case with huge multipl hepatic hydatid cysts, acute respiratory complaints had developed. Thorax CT and contrast enhanced abdomen MRI showed right athelectasis and consolidation in lung basal segments and right sided extensive pleural effusion and air images in the cyst. The huge cyst at the dome of the liver was transdiaphragmatically ruptured to the right hemitoraks and the small defect on cyst wall and diaphragma was seen. There are few similar examples in the literature. Blunt trauma and large diameters of the cyst are the risk factors for rupture, it can also be spontaneously. Transdiaphragmatic rupture of hydatid cyst can cause anaphilactic shock or ordinary respiratuar complaints. In such cases, percutaneous drainage with oral albendazole is a successful treatment option.

Keywords: Transdiaphragmatic, rupture, hydatid cyst

P - 05

DIFFUSE LARGE B-CELL LYMPHOMA: MASSIVE ABDOMINAL INVOLVEMENTEMIN DEMIREL, ERANIL ASLAN, IBRAHIM SULKU, CIGDEM OZER GOKASLAN

Department of Radiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey

Abstract

Diffuse large B cell lymphoma (DLBCL), a subtype of non-Hodgkin’s lymphoma (NHL)accounting for 30%-40% of adult NHLs, according to the World Health Organization’s (WHO) classification.The patient was a 48-year-old man who had chief complaint weight loss and anorexia. He was admitted to the hospital due to fatigue, night sweating and cough. Imaging findings are bilateral renal medulla involvement, extensive retro-peritoneal lymph nodes, widespread paroaortic involvement that envelop-ing left ureter. The massive involvement consist of perisplenic, periportal, paracaval and bilaterally iliac region.

Keywords: Diffuse large cell B-lymphoma, renal involvement, MRI

P - 06

THE CASE OF HETEROTOPIC PREGNANCY AFTER IN VITRO FERTILIZATIONCEMAL AYDOGAN, SUKRU OGUZ, DILARA ATASOY, DENIZ OZTURK KOCAKGOL, AYSEGUL CANSU

Department of Radiology, Karadeniz Technical University, Trabzon, Turkey

Abstract

Heterotopic pregnancy is a life-threatening complication of pregnancy defined as coexistent intrauterine and ectopic gestation. Its diagnosis is frequently overlooked and delayed. A 28-year-old woman experienced acute abdominal pain in pregnancy achieved by in vitro fertilization. Since all previous checkups indicated a normal course of pregnancy, the ectopic pregnancy was not suspected on admission. However, due to persistent lower quadrant pain and decrease in hemoglobin level, this diagnosis

was also considered. Transvaginal and transabdominal ultrasonography showed heterogeneous formation without flow to color Doppler in left tubal topography with intrauterine live embryo. In addition, hemorrhagic free fluid was observed in the pelvic region. Magnetic resonance imaging revealed a heterogeneous formation in the left adnexal region, a gravid uterus with a live embryo and some internal cystic focal spots. A prompt laparotomy revealed a ruptured left ampullary pregnancy, and salpingec-tomy was performed. Although rare, heterotopic pregnancy should be considered in the differential diagnosis of abdominal pain in pregnancy. Every physician treating women of reproductive age should bear in mind the possibility of heterotopic pregnancy not only in patients with predis-posing risk factors but also in those without them.

Keywords: Heterotopic pregnancy, abdominal pain, intraabdominal hem-orrhage

P - 07

A RARE CASE: ZINNER’S SYNDROMENEVIN KOREMEZLI KESKIN1, HAKAN KELES1, OZER BARAN2

1Department of Radiology, Karabük Training and Research Hospital, Karabük, Turkey2Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey

Abstract

Introduction: Zinner’s syndrome is a rare condition which consist of semi-nal vesicle cysts, ipsilateral renal agenesis and ejaculatory duct obstruction. In this case report, we aimed to present the imaging findings of 40-year-old male with Zinner’s syndrome.

Case Report: A 40-year-old man with nonspecific complaints was referred for routine ultrasonography by the urology clinic. Ultrasonography revealed absence of left kidney and cystic dilatations in left seminal vesicle. Renal agenesis was confirmed with contrast-enhanced magnetic resonance imaging (MRI). MRI showed cystic tortuous dilatations in the region of left seminal vesicle appearing intermediate signal intensity on T1-weighted image and hyperintense on T2-weighted image. Cystic dilata-tions did not show pathologic contrast enhancement. In addition to the findings, a mildly dilated tubular structure, extending from the left main iliac artery to the aortic bifurcation was observed. It was considered as ectopic-atretic ureter. The spermiogram and laboratory test results were normal.

Discussion: Zinners syndrome is distal mesonephric duct and ure-teral bud developmental disorder. Other genitourinary anomalies such as ectopic-atretic ureter or megaureter may be associated. Seminal vesicle cysts may increase in size due to the atresia of the ejaculatory duct, fluid content may become intense over time and become symptomatic, for example, intraabdominal mass, prostatitis, incontinence, hematospermia, infertility, carcinoma. In our case, ectopic-atretic ureter is observed as an additional anomaly.

Conclusion: USG and MRI are important imaging modalities for assessing the urogenital system.The absence of ionizing radiation and good soft tis-sue contrast are the most important advantages of MRI.

Keywords: Zinners syndrome, seminal vesicle cysts, Ipsilateral renal agenesis


P - 08

GASTROINTESTINAL STROMAL TUMOR: CT AND MRI FINDINGSUMMUGULSUM BAYRAKTUTAN, HAYRI OGUL, ALPER KIZILOGLU, RECEP SADE, MECIT KANTARCI, AKIN LEVENT

Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey

Abstract

Objective: Gastrointestinal stromal tumors (GIST) are the most com-mon mesenchymal neoplasms of the gastrointestinal tract. GIST is often seen in the stomach less frequently in the extra duodenal small intes-tines, colon and rectum. It is rarely seen in esophagus and duodenum. We aimed to present multislice computerized tomography (MSCT) and magnetic resonance imaging (MRI) findings of the GIST in a 36-year-old male patient.

Materials and Methods: Abdominal imaging studies were performed in a 36-year-old male patient with abdominal pain and vomiting com-plaint with MDCT (320 detector-row CT, Aquilion ONE Vision; Toshiba Medical Systems Corporation, Otawara, Japan) and 1.5 Tesla MRI device (Magnetom Avanto, Siemens Healthcare).

Results: In our case, there was an intraperitoneal mass with cen-trally cystic-necrotic characteristics, heterogeneous peripheral contrast enhancement and lobulated contour in the right side of the abdomen. It was approximately 12x10 cm in dimensions. Case was histopathologically diagnosed as GIST after biopsy.

Conclusion: GIST is mesenchymal tumors originating from interstitial Kajal cells, which can develop throughout the entire gastrointestinal tract, from the esophagus to the anus, and in areas other than the gastroin-testinal tract, such as the omentum, mesenteric, and retroperitoneum. It usually occurs on average at the age of 60 after the 4th decade. The GISTs located in the stomach and rectum are smaller in size and the colon and small bowel tumors are more advanced sarcomas. The most common metastatic regions are the liver and peritoneum. Imaging techniques that can be used include CT, MRI, FDG PET. GISTs are mostly hypervascular lesions and show intense peripheral contrast fixation after contrast medium administration. It may also include cystic degenerated areas, areas of calcification and haemorrhage. Biopsy and immunohistochemical evalu-ation are necessary for definitive diagnosis. Treatment is surgical resection.

Keywords: Gastrointestinal stromal tumor, MDCT, MRI

P - 09

BLADDER LEIOMYOMA: MRI FINDINGSUMMUGULSUM BAYRAKTUTAN, HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT


Abstract

Objective: Leiomyoma in the urinary bladder is a rare benign disease. However, it is the most common benign bladder tumor. While it is more common in women, men can also be affected. We aimed to present mag-

netic resonance imaging (MRI) findings of a case of bladder leiomyoma in a 69-year-old male patient.

Materials and Methods: A 69-year-old male patient with burning in urine was examined by 1.5 Tesla MRI (Magnetom Avanto, Siemens Healthcare) for abdominal imaging.

Results: We present a hypointense mass lesion on T1 and T2 weighted images with having lobulated contours and homogeneous contrast enhancement on the right anterosuperior wall of the bladder. The case was diagnosed as bladder leiomyoma histopathologically after biopsy.

Conclusion: Bladder leiomyomas typically occur in the fourth and fifth decades. The most common symptoms are urinary problems such as obstruction and irritation. Some small leiomyomas are asymptomatic. Tumor primarily shows an intravesical growth pattern (63%), but both extravesical growth (30%) and intramural growth (7%) are uncommon. Non-degenerative leiomyomas on both T1- and T2-weighted images on magnetic resonance imaging can be seen as low-signal intensity nodules with smooth surface. Submucosal localization with intact mucosa is a characteristic feature of leiomyoma. Conversely, transitional cell carci-noma affects mucosa. Definitive diagnosis requires histopathology by urethro-cystoscopy.

Keywords: Bladder leiomyoma, MDCT, MRI

P - 010

SKROTAL LEIOMYOMA: MRI FINDINGSUMMUGULSUM BAYRAKTUTAN, SERHAT KAYA, HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT


Abstract

Objective: Leiomyomas are benign neoplasms that can develop from any organ and structure, including smooth muscle. Scrotal leiomyomas are very rare tumors. We aimed to present magnetic resonance imag-ing (MRI) findings of a case of scrotal leiomyoma in a 44-year-old male patient.

Materials and Methods: A 44-year-old male patient with painless scro-tal mass was examined by 1.5 Tesla MRI (Magnetom Avanto, Siemens Healthcare) for scrotal imaging.

Results: In our case, there was an extratesticular mass in the left hemis-crotum. It was 21x17 mm in size, hypointense on T1 and T2 weighted images and showing relatively homogeneous contrast enhancement. The case was diagnosed as leiomyoma histopathologically as a result of surgical excision.

Conclusion: In contrast to testicular tumors, most extratesticular solid masses are benign. Paratesticular tumors may arise from epididymis, tunica albuginea, spermatic cord, and scrotal smooth muscle. Skrotal leiomyoma usually occurs between the fourth and sixth decades of life and presents with a clinically painless scrotal mass. On magnetic resonance imaging, both T1- and T2-weighted images show low-signal intensity nodules with smooth surface. A fibrous pseudotumor should also be considered in the differential diagnosis. The treatment is surgical excision.

Keywords: Scrotal leiomyoma, MRI


P - 011

TESTICULAR ABSCESS: MRI FINDINGSUMMUGULSUM BAYRAKTUTAN, ALPER KIZILOGLU, HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT


Abstract

Objective: Intratesticular abscess is a rare clinical entity. We aimed to present magnetic resonance imaging (MRI) findings of a case of testicular abscess that completely covered the right testicular tissue in a 53-year-old male patient.

Materials and Methods: A 53-year-old male patient with a painful scro-tal swelling was examined with 1.5 Tesla MRI scans (Magnetom Avanto, Siemens Healthcare).

Results: In our case, scrotal Doppler ultrasound revealed a complicated hypoechoic area without vascularization in the right testis, and MRI imag-ing was performed. MRI examination showed testicular abscess in the right hemiscrotum, that completely covered the right testicular tissue. Abscess in size of approximately 6x5.5 cm, showed diffusion restric-tion on diffusion-weighted images and septal and peripheral contrast enhancement after contrast injection. Orchiectomy was performed with a diagnosis of abscess.

Conclusion: Intratesticular abscesses are usually E. coli lesions that can spread as hematogenous or urine reflux in association with advanced or untreated epididymoorchitis. Testicular parenchyma spread may occur in 5.5% of untreated epididymo-orchitis. Immunosuppressed and diabetic patients are at risk. Diagnostic scrotal doppler ultrasonography and scrotal MRI can be used. More than 50% of cases result in orchiectomy.

Keywords: Intratesticular abscess, magnetic resonance imaging

P - 012

A RARE BENIGN SPLENIC LESION: SCLEROSING ANGIOMATOID NODULAR TRANSFORMATION (SANT)OGUZ LAFCI, PINAR NERCIS KOSAR


Abstract

Sclerosing angiomatoid nodular transformation (SANT) is a rare, benign, proliferative vascular solid lesion of the spleen which was first described by Martel et al. in 2004 and around a hundred cases have been reported so far. Most benign splenic solid lesions are detected incidentally on cross-sectional imaging. Although it is difficult to make a proper diagnosis only by imaging, some certain characteristics of solid splenic lesions may help to differantiate between them. We present MRI findings of SANT which detected incidentally in a 50 year old male patient who had undergone contrast-enhanced thorax CT examination for his respiratory complaints.

Keywords: SANT, MRI, spleen

P - 013

PRIMARY HEPATIC TERATOMA: A RARE CAUSE OF CYSTIC LIVER MASS IN AN INFANTASLI IRMAK BIRANCI, HILAL SAHIN, YELIZ PEKCEVIK, AYSUN CAKIR, TUGCE HANCIOGLU

University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey

Abstract

Introduction: Teratoma is one subtype of the germ cell tumor group that develops most commonly in ovaries or testicles.Teratoma of the liver is a rare neoplasm accounting for less than 1% of all teratomas. Less than 50 cases of primary hepatic teratomas has been described in the literature.The aim of this case report is to discuss the imaging findings of teratoma of the liver in an infant.

Case Report: A 2 month old girl, whose neonatal ultrasound examination revealed an incidental cystic liver lesion was further investigated with MRI. MRI demonstrated a cystic lesion with thin wall and a few septation which was located in gallbladder site and extended to the liver parenchyma. Fat or amorphous calcification signal was not seen in the lesion. In our case operation was planned due to possible association of the cystic lesion with the bile ducts. During the dissection, the cyst was perforated and the bile was seen as discharging from cyst lumen. Pathological examina-tion revealed that the internal surface of the cyst lumen was lined by primarily biliary epithelium, occasionally lined with respiratory and gastric epithelium. With all these findings, the final diagnosis was primary hepatic cystic teratoma.

Discussion: Teratomas are often incidentally detected and symptoms are usually due to the mass effect on surrounding organs. Although it is typi-cal to see fat or calcification in the teratomas of the liver, it is described in the literature that in some cases there may not be both, as in our case.In conclusion, although primary hepatic teratoma is a rare neoplasm, it should be remembered in the differential diagnosis of cystic liver lesions in the pediatric population.

Keywords: Teratoma, MRI, cystic mass, infant

P - 014

PRIMARY PELVIC MYXOID LIPOSARCOMA MIMICKING AN OVARIAN MASS: MRI FINDINGSHILAL SAHIN1, YELIZ PEKCEVIK1, ASLI IRMAK BIRANCI 1, MUSTAFA BAGCI2, SAMIR ABDULLAZADE3, MUZAFFER SANCI2

1Department of Radiology, Tepecik Training and Research Hospital, İzmir, Turkey2Department of Gynecologic Oncology, Tepecik Training and Research Hospital, İzmir, Turkey3Department of Pathology, Tepecik Training and Research Hospital, İzmir, Turkey

Abstract

Introduction: Myxoid liposarcoma is a malignant neoplasia of fat tis-sue which is usually located at lower extremities, particularly thighs.


Liposarcomas involving the pelvis are uncommon and reported in few case reports in the literature. We present an unusual case of a myxoid pelvic liposarcoma that presented as a mass near right ovary mimicking a primary ovarian tumor.

Case Report: A 25 year-old woman presented with right flank pain. A urinary US revealed right hydronephrosis with right proximal ureter compressed with an adnexial mass. In pelvic MRI, T2-weighted imaging demonstrated a 5 cm hyperintense mass near the right ovary. However, the mass was located outside of the ovary regarding extraovarian origin. In addition, abrupt interruption of right ureter with proximal dilatation was a clue for retroperitoneal location. Fat signal was not demonstrated in the lesion. In postkontrast imaging, intense contrast enhancement was seen in the lesion. Tumor markers and laboratory findings were in normal limits. Operation was planned due to suspicion of malignancy. At laparotomy, a mass was identified near the right external iliac vessels and apart from the right ovary. The mass was separated from the ureter and removed. Histopathological analysis showed that the mass consisted of a myxoid matrix as the predominant component with small amount of fat regarding the diagnosis of myxoid liposarcoma.

Conclusion: In young female population, myxoid liposarcomas may pres-ent as a pelvic mass mimicking an ovarian neoplasm. MRI findings are important to show the origin of those tumors, enable the proper diagno-sis and surgical planning.

Keywords: Myxoid liposarcoma, pelvis, retroperitoneum, magnetic reso-nance imaging

P - 015

COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FINDINGS OF CLEAR CELL CARCINOMA ARISING FROM ENDOMETRIOSIS IN THE ABDOMINAL WALLEMINE MERVE HOROZ, SEBNEM KARASU

Department of Radiology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey

Abstract

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It is usually located in the ovaries and pelvic peritoneum but it can be found in the lung, bowel, ureter and abdominal wall. It affects approximately 15-40% of women of reproductive age. Endometriosis-associated abdominal wall cancer (EAAWC) is a rare condition, with poor prognosis. Few cases have been reported in the literature. Abdominal wall is one of the most common locations of endometriosis outside the peritoneal region. In most of the cases a prior caesarean section or other gynaecological operations cause the seeding of endometrial tissue implants in the abdominal wall.

Here, we report a case of 43-years-old female with clear cell adeno-carcinoma derived from pathologically confirmed endometriosis in the abdominal wall. On computed tomography (CT) there was a well cir-cumscribed, multiloculated, hypodense cystic large mass with solid parts in the left rectus muscle. On magnetic resonance imaging (MRI) the mass had a malignant appearance which was predominantly cystic with

enhancing solid components. The patient underwent laparatomy and histopathologically confirmed the diagnosis of clear cell carcinoma arising from endometriosis.

Keywords: Endometriosis, clear cell carcinoma, abdominal wall, mri

P - 016

OVARIAN MATURE CYSTIC TERATOMA WITH MULTIPLE KERATIN BALLS: THE IMPORTANCE OF DIFFUSION WEIGHTED IMAGING IN DIAGNOSISHILAL SAHIN1, YELIZ PEKCEVIK1, TUGCE HANCIOGLU1, TUGBA KARADENIZ2, ORHAN TEMEL3, MUZAFFER SANCI3

1Department of Radiology, Tepecik Training and Research Hospital, İzmir, Turkey2Department of Pathology, Tepecik Training and Research Hospital, İzmir, Turkey3Department of Gynecologic Oncology, Tepecik Training and Research Hospital, İzmir, Turkey

Abstract

Introduction: Floating keratin balls are uncommon features of ovarian mature cystic teratomas (MCT) which are described in few case reports. Diffusion weighted imaging (DWI) is helpful in demonstrating the keratin content, especially when the teratoma does not contain major fat. We present an unusual case of MCT with multiple floating keratin balls which were diagnosed with DWI.

Case Report: A 57 year-old woman presented with a pelvic mass. A pelvic ultrasonography revealed a 12 cm cystic mass in the pelvis with multiple floating echogenic spherules within it. Magnetic resonance imaging dem-onstrated multiple floating balls with intermediate T2 signal intensity. Major fat signal was not demonstrated in the cystic lesion, however minor fat was seen in the floating balls in T1 DIXON imaging. DWI showed evi-dent diffusion restriction in those balls regarding viscous keratin content. Tumor markers and laboratory findings were in normal limits. Operation was planned with diagnosis of ovarian teratoma. At laparotomy, a cystic mass was identified originating from the right ovary. Smooth globules were felt manually inside the mass. The mass consisted of creamy yellow liquid with compacted round shaped keratin material. Mature cystic tera-toma was diagnosed after histological examination.

Conclusion: Floating balls in mature cystic teratomas shows evident diffu-sion restriction due to viscous keratin material. DWI may help in diagnosis by detecting keratin content, particularly in teratomas without apparent fat.

Keywords: Mature cystic teratoma, floating ball, keratin, diffusion weight-ed imaging

P - 017

IG G4- RELATED AUTOIMMUNE CHOLANGITIS: CT AND MRI FINDINGS


GURCAN ERBAY1, ELIF KARADELI1, BURCAK CAKIR PEKOZ2, KENAN CALISKAN1, FAZILET KAYASELCUK1

1Başkent University Adana Hospital, Adana, Turkey2Adana State Hospital, Adana, Turkey

Abstract

Objective: Immunoglobulin G4-related disease is a new clinical entity that has unique clinical, serological, radiological and pathological features with multiorgan involvement. Autoimmune cholangitis is a part of this clinical picture. We aimed to present computed tomography (CT) and magnetic resonance imaging (MRI) findings of Ig G4-related autoimmune cholangitis (IgG4-RAC), which was diagnosed histopathologically.

Materials and Methods: A forty three year-old male patient was admit-ted to our hospital with complaints of abdominal pain and jaundice for 10 days. There was a history of cholecystectomy. CT and MRI were performed.

Results: CT showed a lesion with soft tissue density at extrahepatic bile ducts. MRI showed hypointense lesion at the junction of right and left intrahepatic bile ducts on T1 and T2 weighted images. There was mild enhancement on late phase. We observed slightly restricted diffusion on diffusion MRI. Serum Ig G4 level was increased. The patient under-went surgery because the findings didn’t exclude cholangiocarcinoma. Histopathologic evaluation showed IgG4-RAC, chronic inflammation and fibrosis.

Conclusion: IgG4-RAC is an autoimmune disease usually involving bile ducts, and is associated with autoimmune pancreatitis by 90%. Diagnosis is very difficult if autoimmune pancreatitis is not accompanied, as our case. It may mimic many diseases such as primary sclerosing cholangitis, pseu-dotumoral lesions, and cholangiocarcinoma. Serum Ig G4 level elevation is an important finding but is not sufficient for diagnosis alone. IgG4-RAC can be diagnosed by clinical, serological, radiological and histopathological findings. Differential diagnosis is important to guide the treatment of the disease.

Keywords: Autoimmune cholangitis, Ig G4, MRI

P - 018

HEPATIC INVOLVEMENT OF NON HODGKIN LYMPHOMA IN A PEDIATRIC PATIENTMIRACE YASEMIN KARADENIZ BILGILI1, NESE ASAL1, SELMIN PERIHAN KOMURCU ERKMEN1, MERYEM ALBAYRAK2, MIKAIL INAL 1

1Department of Radiology, Kırıkkale University School of Medicine, Kırıkkale, Turkey

2Department of Pediatrics, Kırıkkale University School of Medicine, Kırıkkale, Turkey

Abstract

Non-Hodgkin lymphomas are heterogeneous group B or T cell malignan-cies that usually originate from lymphocytes. We present an 8 year old child diagnosed to have invagination with ultrasound complaining abdomi-nal pain. Abdominal CT demonstrated the invaginated segment in right lower quadrant as well as lymphadenopathy and multiple liver masses. MRI, besides the invaginated segment and lymphadenopathies, dem-onstrated bone marrow infiltration as well as the T2 hyperintense and

diffusion restricted multifocal liver masses. Hepatic involvement caused by granulomatous diseases can be particularly challenging to differentiate from lymphoma, since they can also result hepatic and lymp node involve-ment. Presence of necrotic rim-enhancing lymph nodes in tuberculosis and T2-hypointense nodules in sarcoidosis may help the differential diag-nosis. Regarding the involvement of multiple systems; liver, intestine, lymph nodes and bone marrow, lymphoma will be esentially encountered in the differential diagnosis.

Keywords: Non Hodgkin lymphoma, liver, invagination

P - 019

A VASCULAR HERO: SUPERIOR MESENTERIC ARTERY SUPPLYING THE GASTROINTESTINAL SYSTEM, HEPATOBILIARY SYSTEM AND THE SPLEEN ON ITS OWNSERDAR KARAKOSE, HASAN EMIN KAYA, CENGIZ KADIYORAN, ABDULLAH ENES ATAS, MELTEM ORUC

Department of Radiology, Necmettin Erbakan University School of Medicine, Konya, Turkey

Abstract

In patients with celiac axis stenosis the most common and important col-lateral vessels from the SMA are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Severe stenosis of the celiac artery is commonly associated with enlargement of the arteries of the pancreaticoduodenal arcade. Here we present a case with celiac axis and inferior mesenteric artery occlusion which resulted in superior mesenteric artery supplying the whole gastrointestinal system, hepatobiliary system and the spleen on its own.

Keywords: MR angiography, celiac axis occlusion, superior mesenteric artery

P - 020

A BENIGN DIAGNOSIS MIMICKING PERITONEAL CARCINOMATOSIS, CONFUSED WITH OVARIAN CANCER IN IMAGING: MULTICYSTIC PERITONEAL MESOTHELIOMACEYLAN ALTINTAS, ELMIRE DERVISOGLU, ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN

Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey

Abstract

Multicystic peritoneal mesothelioma (MPM) is a benign, rare disease caused by mesothelial cells surrounding serous membranes. Pleural, pericardial, or peritoneal origin may occur and is frequently caused by the pelvic peritoneum. The incidence is 2/1,000,000 per year. According to our knowledge, up to 200 cases have been reported in English language papers. Preoperative diagnosis is difficult because of its rare


occurrence, imaging findings are not specific, and there are no obvious diagnostic clinical manifestations. Patients usually have the preoperative diagnosis of peritonitis carcinomatosa, pseudomyxoma peritonei, appen-dicitis, or ovarian tumors. Ancestral diagnosis is made only by the patho-logical evaluation of surgical specimens. If female patients present with multicystic lesions in the pelvic region in the form of grape clusters, If the patients CEA and CA-125 values are close to normal or normal, and if there is a clinical history of pelvic operation, MPM should be considered in the differential diagnosis. We hereby present the imaging findings of a 45-year-old female patient diagnosed with postoperative multicystic peritoneal mesothelioma and aim to compare them to cases reported in literature.

Keywords: CT, MRI, multicystic peritoneal mesothelioma, peritoneal carcinomatosis

P - 021

ADRENIFORM SHAPE OF NON-ADENOMA ADRENAL LESION: LYMPHOMAFERHAT CUCE, KEMAL NIYAZI ARDA, UGUR BOZLAR

Gülhane Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: Nod Hodgkin lymphoma (NHL) frequently involves adrenal gland and to be usually bilateral. The computed tomography (CT) and magnetic resonance imaging (MRI) is the most important radiological imaging modalities for differentiating other malignant lesions of adrenal gland from lymphoma and prevent unnecessary surgical interventions to adrenal lymphoma.

Case Report: A 37-year-old male patient with a complaint of malaise applied to the internal medicine in February 2017. No significant find-ings were found in the blood tests. As he described a blunt pain in the left upper quadrant on physical examination, abdominal ultrasonography (US) was performed. A hypoechoic lesion was detected adjacent to the upper pole of left kidney. The abdominal CT with intravenous contrast material revealed a huge nonadenom adrenal mass lesion with 51x43x64 mm size. The significant finding was an adreniform shape of the gland was maintained in the lesion. The magnetic resonance imaging (MRI) was also scheduled.

Discussion: Secondary involvement of the adrenal gland with NHL has been reported in as many as 25% of the patients. The adrenal lymphoma should be considered in patients with an adreniform shape of a non adenoma adrenal lesion on CT. The MRI enables differentiation of adrenal adenomas from other adrenal malignancies, but specific diagnosis might not be achieved with this modality. In our previous radiological experience, we couldn’t see any nonadenom lesion of gland-like adreniform shape.

Keywords: Lymphoma, adrenal, adreniform shape

P - 022

CAVERNOUS TRANSFORMATION OF THE PORTAL VEIN MIMICKING TUMOR: A PSEUDOTUMOR

CEYLAN ALTINTAS, ELMIRE DERVISOGLU, ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN


Abstract

Cavernous transformation of the portal vein occurs when the portal vein is thrombosed. Cavernous transformation results from recanalization of the portal venous thrombus as well as dilatation of paracholedochal veins in an effort to bypass the portal venous obstruction. Cavernous trans-formation has been shown to form as early as 6 to 20 days after acute thrombosis of the portal vein. Cavernous transformation may cause wall thickening in the biliary system, stenosis, dilatation in intra-extrahepatic bile ducts, and pseudotumor appearance. Cavernous transformation may cause a mass appearance in the liver and secondary dilatation of the bile duct. For this reason, it is in the differential diagnosis of the masses in the hilus of liver and it should also be made of the distinction of inflamma-tory pseudotumor. Diffusion imaging can be used at this distinction. Our purpose in this presentation is to describe and evaluate MR findings of tumorlike changes in three patients with cavernous transformation of the portal vein.

Keywords: Cavernous transformation, MRI, pseudotumor

P - 023

A RARE ADRENAL TUMOR: ONCOCYTIC ADRENOCORTICAL CARCINOMAELMIRE DERVISOGLU, CEYLAN ALTINTAS, ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN


Abstract

Oncocytic tumors are mostly benign tumors that originates from kidneys, thyroid, parathyroid, salivary and pituitary glands. Oncocytic tumors of adrenal glands are so rare and generally nonfunctional benign tumors. According to Lin-Weiss-Bisceglia criteria, oncocytic neoplasms divided into three groups histologically; benign oncocytoma, oncocytic neoplasm with indeterminate malignant potential and oncocytic carci-noma. Up to now, 36 cases of oncocytic adrenocortical carsinoma have been reported in the literature. Conventional adrenocortical carsino-mas have biphasic age distribution (first and fifth decade) and female dominance but adrenocortical oncocytic carcinomas are only reported in adults and has no gender dominance. Conventional adrenocortical carsinomas are generally presented with findings caused by hormone hypersecretion but adrenocortical oncocytic carcinomas are generally presented with abdominal discomfort and back pain caused by mass effect. There are many studies in the radiology literature about onco-cytic neoplasms of kidney but studies on the imaging findings of adrenal oncocytic tumors are limited. In this case report, our aim is to present magnetic resonance imaging (MRI) findings of oncocytic adrenocortical carcinoma in a 60 year old female patient and to compare with the find-ings in the literature.

Keywords: Adrenal gland, magnetic resonance imaging, oncocytic carci-noma


P - 024

A RARE CASE OF GRANULOMATOUS PROSTATITIS AND PROSTATIC ABSCESS: GRANULOMATOUS POLYANGIITISDUYGU IMRE, GULNAR AGHAYEVA, EMRE UNAL, MUSTAFA NASUH OZMEN


Abstract

Granulomatous polyangiitis is a rare necrotizing vasculitis which causes systemic involvement of paranasal sinus, lung, genitourinary tract etc. Although it is rare, the lack of proper diagnosis and treatment may increases the morbidity and mortality. Genitourinary system involvement is most commonly seen in the kidney, while the urethra, prostate, vagina, and testis are also can be involved. In our patient with Wegener granu-lomatosis, the involvement of the lung, paranasal sinus, ear and prostate gland are biopsy-proved. We discuss 32-year-old male patient refered to our hospital with eksternal otitis symptoms, hearing loss in the right ear, wound in nose and mouth, nose bleeding, hemoptysis and recurrent pneumonia. Then patient had developed diysuria, hematuria and fever not responsive to antibiotics. The CT scan of the chest, showed multiple cavitary and non cavitary nodules. Anti-c ANCA was positive and granu-lomatous polyangiitis was diagnosed. Prostate MRI was performed on the presence of heterogeneity in the prostate gland in abdomen CT.Prostate MRI revealed a horseshoe-shaped abscess cavity in the internal gland of prostate. In biopsy materials obtained from the prostate gland, necrotizing granulomatous inflammation and microabscess formation were detected (8). Prostate gland involvement is a rare finding of microscopic polyangiitis.The possibility of microscopic polyangiitis should be kept in mind, when antibiotic resistant prostatitis occurs in younger patients, with no pre-disposing factor (suspicious sexual intercourse, etc.). If necessary, biopsy should be performed in such cases

Keywords: Vasculitis, Wegener granulomatosis, prostatic abscess

P - 025

MALIGNANT MIMIC: PELIOSIS HEPATISABDULLAH SUKUN, MEHTAP BARC ERGUN, AYSE EDA PARLAK, SINAN ULGEN, EMIN DURMUS

Department of Radiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Peliosis hepatis is a benign vascular disease cystic spaces ranging from 1 mm to several cm rarely seen in hepatic sinusoids.Pathogenesis is not fully explained. The cases of 20-50% are idiopathic. Distortion of sinusoidal borders and dilatation of the vessel at the center of the hepatic lobule are suggested in the etiology. Patients are usually asymptomatic, but in some cases, bleeding may occur and lead to hepatomegaly and liver failure. Additionly, etiology includes toxins, drugs, anabolic steroids, corticoste-roids, immunoglobulin therapy and chronic diseases such as HCC, malig-nancy, tuberculosis. There may be spleen and bone marrow involvement.

It is important to recognize this antiquity, as this appearance may mimic malignancy. We aimed to present the radiological findings compatible with peliosis hepatis in a 71-year-old woman.

Keywords: Peliosis hepatis, hepatic sinusoid cystic dilatation

P - 026

BILATERAL GIANT MATURE CYSTIC TERATOMASINAN ULGEN, MEHTAP BARC ERGUN, AYSE EDA PARLAK, SAMET MUTLU, EMIN DURMUS

University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Dermoid cyst also known as mature cystic teratoma is a germ cell tumour that is stemmed from all three germ layers. Tumor may contain components of different germ layers such as fat, tooth or hair. Although most cases are originated from gonads, it may be found in other locations including anterior mediastinum, gastrointestinal tract, or retroperitoneal space. Although it is a benign entity, it may reach to massive sizes and lead to further complications such as torsion or rupture. Thus, knowledge of imaging properties and accurate diagnosis of mature cystic teratoma is important. US is preferred imaging modality and MRI is useful for difficult cases. We herein report imaging findings of a case with two giant dermoid cysts in pelvic region.

Keywords: Dermoid cyst, mature cystic teratoma, germ cell tumor

P - 027

A RARE COMPLICATION FOLLOWING RADICAL PROSTATECTOMY: INABILITY TO WALKMEHMET SEYFI BURUK, LEYLA KARACA, ZEYNEP OZDEMIR, ISMAIL OKAN YILDIRIM, MEHMET GEZER

İnönü University School of Medicine, Malatya, Turkey

Abstract

Pubic complications after radical prostatectomy are rare. Osteonecrosis and inflammation of pubic rami present with severe pain during adduction and ambulation of the leg which causes diffuculty during walking. A 65-year-old male patient is scheduled for radical prostatectomy and radiotherapy with diagnosis of prostatic adenocarcinoma. Incontinence and walking difficulty occured during postoperative period. Abdominal and pelvic CT scans was negative for acute pathology. Contrast enhanced MRI of pelvis was per-formed. MRI demonstrated pubic osteonecrosis, inflamatory changes at pubis, edematous signal changes in adductor muscles, collection in symphysis pubis connected to prostatic urethra. Fluoroscopy guided percutaneous sampling from collection at symphysis pubis showed urine. Contrast mate-rial injected to joints pace reached to prostatic urethra and bladder. In this case we showed inability to walk is related to urethral fistulation to symphy-sis pubis and secondary inflammatory changes.

Keywords: Radical prostatectomy, fistula to symphysis pubis, inability to walk


P - 028

MAGNETIC RESONANCE FINDINGS OF DUODENAL DUPLICATION CYST: CASE REPORTENSAR TURK, SUAT INCE, CEMIL GOYA, ALPARSLAN YAVUZ

Van Yüzüncü Yıl University School of Medicine, Van, Turkey

Abstract

Objective: We aimed to present magnetic resonance imaging (MRI) find-ings of a case with duodenal duplication cyst which composes the 2-12% of gastrointestinal system duplication cysts.

Materials and Methods: The initial B-mode US examination of a 8-year-old male with the complaints of abdominal pain, nausea and vomiting revealed a cystic lesion adjacent to the head of pancreas. Contrast-enhanced abdominal computed tomography revealed a 4x3 cm thick-walled cystic lesion at the second part of duodenum. MRI and MRCP examinations were planned in order to correlate the cystic content of the lesion that was described in the US and CT, and to evaluate the pos-sible connection of the cystic lesion with pancreatic duct. In the abdomen MR and MRCP of the patient revealed a well-defined, homogeneous, uniformly bounded T2-weighted hyperintense cystic lesion with distinct walls and suspicious connection by the doudenum lumen. The size of the lesion was approximately 45x35 mm and it was located adjacent to the second part of duodenum and segment of the common bile duct by the head of pancreas.

Results: Due to the MRI findings of our patients indicating the diagnosis of duplication cyst, surgical resection of the cyst was decided. The histo-pathologic examination of the lesion was resulted as “duplication cyst”.

Conclusion: Duplication cyst is a rare congenital condition that forms during the embryonic period of alimentary tract development. Cysts are mostly within 2 to 4 cm in size. They occur frequently in the distal ileum. Conversely duodenal duplication cysts are very uncommon and represent only 2 to 12% of all digestive tract duplications. Imaging techniques initially suggested for pre-diagnosis, however histopathologic analysis must be performed for the confirmation. The criteria required for the definitive diagnosis are the presence of alimentary mucosal lining, a smooth muscle coat, and an intimate attachment to the native gastrointestinal tract. Considering the present findings, duodenal duplication cyst should be considered in the differential diagnosis of cystic lesions that are adjacent to the pancreatic head section and second part of the duodenum.

Keywords: Duplication, cyst, duodenum

P - 029

A RARE CAUSE OF ADNEXAL TORSION: OVARIAN DYSGERMINOMAILHAN HEKIMSOY, EZGI GULER, RAHMI AKYOL, MUSTAFA HARMAN, NEVRA ELMAS

Department of Radiology, Ege University School of Medicine, İzmir, Turkey

Abstract

Introduction: Dysgerminoma is a rare ovarian tumor, accounting for 3-5% of all ovarian malignancies and for 30-50% of all ovarian germ cell

tumors. Adnexal torsion is an uncommon but significant cause of acute lower abdominal pain and morbidity. There are few reports of adnexal torsion due to dysgerminoma in the literature. In this case report we want to present radiological findings of ovarian dysgerminoma that cause adnexal torsion.

Case Report: A 30-year-old woman was admitted to the emergency ser-vice with acute abdominal pain in the right iliac fossa. Except weak hCG positivity, her laboratory findings were unremarkable. Due to suspicions of early pregnancy, US and MRI were performed to identify the etiol-ogy. MRI revealed a large (10.5x9x5.5cm), twisted, heterogeneous and predominantly solid pelvic mass on the right adnexal side. Color Doppler US demonstrated intratumoral flow signals. US showed the normal size uterus and the left ovary. After surgery this tumor was diagnosed histo-pathologically as pure dysgerminoma of the right ovary.

Conclusion: Ovarian dysgerminoma may present as an acute abdomen because of adnexal torsion and passive blood congestion. Ovarian dysger-minoma causing adnexal torsion should be considered in the differential diagnosis in a young woman with acute abdomen.

Keywords: Adnexal torsion, dysgerminoma, MRI

P - 030

A RARE CASE: PRIMARY MUCINOUS ADENOCARCINOMA OF VAGINAELMIRE DERVISOGLU, CEYLAN ALTINTAS, ALI KEMAL SIVRIOGLU, BURCU ALPARSLAN


Abstract

Primary vaginal carcinoma is rare, accounting for only 1%-2% of gyneco-logic malignancies. Of these, approximately 90% are squamous cell carci-nomas, with only 10% being adenocarcinoma.Squamous cell carcinoma is more commonly seen in postmenopausal women and tends to occur in the proximal third of the vagina, in the posterior wall.Primary vaginal ade-nocarcinoma typically occur in younger women, mainly in the upper third and anterior wall of the vagina.Most vaginal adenocarcinomas are of clear cell histology. Mucinous adenocarcinomas of the vagina are rare and can be further subtyped into endocervical and intestinal types.Intestinal type can not be distinguished pathologically from colorectal carcinoma metas-tasis, and a full clinicoradiologic workup of the patient is mandated prior to making this rare diagnosis.On MRI, a mucin-producing adenocarcinoma show higher signal components on T2-weighted images than other vaginal carsinomas.Mucinous adenocarcinoma of vaginashould be considered in the differential diagnosis when high signal intensities similar to cyst are seenin a vaginal mass on T2-weighted images.In this case report, we aimed to present MRI findings of primary vaginal mucinous adenocarcinoma in a 46 year old female patient.

Keywords: MRI, mucinous adenocarcinoma, vaginal mass

P - 031

AN ATYPIC PROSTATE ADENOCARCINOMA METASTASIS


HASAN AYDIN1, KEMAL ARDA2, VOLKAN KIZILGOZ3, MEVLUDE ALTINTAS1, SUMEYYE KAYMAK1

1Department of Radiology, Ankara Oncology Training and Research Hospital, Ankara, Turkey2Department of Radiology, Gülhane Training and Research Hospital, Ankara, Turkey3Department of Radiology, Kafkas University School of Medicine, Kars, Turkey

Abstract

A 72 year old men with prostate cancer and radical prostatectomy, was admitted to our MRI unit for Brain MRI to exclude any metastasis referred to this area.To our surprise, There were multipl heavily enhancing metastatic nodules and masses in the right petroz apex, in the Subcortical white matter of right temporal fossa, clivus in the midline, right parasellar region. There were also multipl enhancing diffuse and/or nodular metas-tasis in the dura of right temporo-parietooccipital region and right frontal cortex at vertex.

Keywords: Prostate, adenoca, MRI-metastasis, clivus-dural

P - 032

LEFT RENAL GIANT ANGIOMYOLIPOMA AND MULTIPL IATROGENIC COMPLICATIONS DUE TO REPETITIVE BIOPSY APPLICATIONSHASAN AYDIN, ZEYNEL YOLOGLU, MUAZZEZ BENGI AKYOL, SINEF HUVAJ AKSOY, OZKAN UNALDepartment of Radiology, Ankara Oncology Training and Research Hospital, Ankara, Turkey

Abstract

A 57 years old men with huge renal mass was referred to our CT and MRI units from Urology clinics, a giant left renal mass over 15 cm. diameter was observed, this mass contains minimal solid area but huge amount fatty component and also 1.5 cm stone was seen in the middle pole.Gerota fascia was also obviously thickened mostly at the lower retroperitoneal area.We reported that left renal mass is most likely to be fat rich-Angio-myolipoma and follow up of mass by CT and MRI was advised but unfor-tunately, urologists applied multipl true-cut and/or open surgical biopsies to this huge mass and lots of unwanted complications occured due to these interventions like left diaphragm perforation, multipl lacerations of spleen,plevral and pericardial effusion,perforation of same jejenal seg-ments and etc.He had hospitalized for approximately 3 months and then discharged with almost total cure, Histopathology only stated adipose and fibrous tissue persistence at those unnecessary interventional procedures.

Keywords: Angiomyolipoma-renal-iatrogenic-biopsy-complications.

P - 033

A RARE CASE: CASE REPORT OF HERLYN-WERNER-WUNDERLICH SYNDROME

IBRAHIM ILIK, CEMIL GOYA, SUAT INCE, ENSAR TURK O., ILYAS DUNDAR

Department of Radiology, Van Yüzüncü Yıl University Dursun Odabaş Medical Center, Van, Turkey

Abstract

Objective: We aimed to present the rare Herlyn-Werner-Wunderlich (HWW) syndrome with the context of MR and Ultrasonography (USG) findings.

Materials and Methods: A 15-year-old female patient was admitted to the clinic with complaints of pelvic pain. After the physical examination USG was taken to the patient. On the USG, a cystic lesion with a level of 5 cm was observed in the widest area extending from the left adnexial area to the umbilicus level. And performed contrast enhanced pelvic MRI to the patient.

Results: Images of the MRI shows the uterus didelfis appearance and its right segment is naturally seen. The segment on the left is dilated and hyperintense (hemorrhagic) fluid values are observed in T1-weighted series in the endometrium (hematometry). Dilated tortious tubular appearance is observed in the widest part extending to the lateral level of the superiorly umbilicus associated with the left segment, reaching a diameter of approximately 5 cm. Hyperintense fluid values are monitored in luminal T1-weighted series (Hematosalpinx). The left kidney wasnt observed. Together with these findings, the case was interpreted as HWW syndrome.

Conclusion: HWW syndrome is a rare mullerian duct anomaly char-acterized by obstructive hemivagina and ipsilateral renal agenesis with uterus didelfis. The actual incidence is unknown, but reported between 0.1% and 3.8%. CT and USG are the most common diagnostic methods 4). However, MRI is thought to be more sensitive to imaging soft tissue anatomy and identifying fine details of congenital anomalies. If treatment is delayed, complications such as endometriosis, infections and pelvic adhe-sions may be develop.

Keywords: Herlyn-Werner-Wunderlich Syndrome, Hematosalpinx, mul-lerian duct anomaly

P - 034

IDENTICAL MASS WITH UNEXPECTED PLACEMENT: PRESACRAL & RETRORECTAL EPIDERMOID CYSTVELI SUHA OZTURK1, OZUM TUNCYUREK1, YELDA DAYANIR1, PARS TUNCYUREK2

1Department of Radiology, Adnan Menderes University School of Medicine, Aydın, Turkey2Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey

Abstract

Epidermal cysts are congenital lesions with ectoderm origin. Although common in the brain, retrorectal & presacral region and they are quite rare. In this case report, we wanted to review the imaging findings of the epidermoid cyst, which is one of the rare presacral cystic masses. 42-year-old male was found to have a cystic mass in the pelvic cavity in abdominal


ultrasonography performed at the public hospital due to pain on the lumbar and sacral vertebra, dysuria, constipation and tenesmus symptom. Patient with no additional findings in physical examination; after, multislice computerized tomography (CT) with intravenous contrast administration was performed. On the CT examination, a multiloculated cystic mass was seen in the presacral space, located to the right of the midline, with high density contents (mean 24 HU), and thin wall, minimal ring enhancement and no internal septations. Subsequent Magnetic Resonance Imaging (MRI) showed high protein content with high T1W signal intensity and also very high T2 signal intensity in the cystic component, whereas other areas showed mild hyperintensity on T2W slices in multiloculated cystic mass. There was no change in signal intensity on the T1W fat saturated slices and no internal contrast enhancement except minimal ring enhance-ment in dynamic postcontrast series. In the diffusion MR examination, the most distinctive finding was that the mass showed significant diffu-sion restriction (ADC value: 0,79 ×10-³ mm²/sn). To our knowledge this finding is particularly important in the differential diagnosis of intracranial and intradural epidermoid cysts. In our case, surgery was performed and histopathological analysis confirmed the diagnosis of epidermoid cyst with high protein content. Retrorectal developmental cysts (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) are very rare diseases and the symptoms are not characteristic and sometimes difficult to make the differential diagnosis of these masses with imaging modalities. The differential diagnosis should definitely include anorectal abscesses, complicated fistulas, and pylonidal disease. Significant heterogenecity in T1A and T2A sequences and significant diffuse restriction, which are two important imaging findings, are very helpful in distinguishing presacral epidermoid cysts from other lesions of this region.

Keywords: Epidermoid, cyst, MRI, presacral, retrorectal

P - 035

A RARE CASE: BLADDER INVASIVE APPENDIX ORIGIN MUCINOUS ADENOCARCINOMASUMEYRA DEMIRKOL ALAGOZ1, MESUT OZGOKCE1, IBRAHIM AKBUDAK2, ADEM YOKUS3, HARUN ARSLAN1

1Department of Radiology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey2Batman State Hospital, Batman, Turkey3Van Region Hospital, Van, Turkey

Abstract

Objective: We aimed to present computed tomography (CT) and magnetic resonance imaging (MRI) findings of an appendix appendiceal mucinous adenocarcinoma.

Materials and Methods: A 53-year-old male patient was admitted to our hospital with complaints of abdominal pain, burning while urinating, and intermittent yellowing particles of the urine. We performed patient-contrast computed tomography (CT), which detected a lesion in the posterior wall of the bladder, and abdominal magnetic resonance (MRI) imaging, for detailed examination. Approximately 5x4 cm sized dilate tubular structure extending from the caecum to the posterior wall of the bladder and invading the mesentery was observed. There was no evidence of free fluid in the abdomen, inflammation in the perilesional mesentery, and pseudomycosis peritonei. Surgical right hemicolectomy and partial cystectomy were performed for the mass.

Results: T4b mucinous adenocarcinoma originating from appendix vermi-formis, appendix full-layer invasive and extending to bladder serosa was reported as a pathologic conclusion.

Conclusion: Primary neoplasms of the appendix are very rare and less than 2% of the appendectomy materials are detected. According to WHO 2010 classification, appendiceal mucinous neoplasms are defined in 3 categories: mucinous adenomas, low grade mucinous neoplasms and adenocarcinomas. Pseudomycosis peritonei may occur due to overgrowth of musculus mucosa or peritoneal dissemination of tumor resulting from perforation. We aimed to present this case because of the absence of pseudomyxoma peritoneum and the first case in the literature with blad-der invasion.

Keywords: Appendix, bladder invasive, mucinous adenocarcinoma

P - 036

TORSION OF WANDERING SPLEEN, PELVIC MASS MIMICS, A CASE OF CHILDTULIN HAKAN DEMIRKAN, GULSAH BAYRAM

Dışkapı Pediatrics Hematology and Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Wandering spleen is a term used for hypermobile spleen following abnormal localization. The spleen loses fixation on the abdominal wall in its normal location and changes its position. It is one of the rare causes of acute abdomen. It is usually asymptomatic but may be detected as a painless mass. However, rarely, tinnitus may result in splenic congestion, infarction that may be accompanied by adjacent tissuesIn our case, a 12-year-old girl was a case. Pelvic US; showed torsion of pelvic mass with pelvic pain. However, the ovaries were separately provided. In the MRI, vascularization in the pelvic region was decreased and hypointense pelvic mass was observed.Postoperative spontaneous torsion of the spleen was found in the pelvic region. It was presented with the reason that it was a rare acute cause.

Keywords: Wandering spleen, pelvic mass, torsion

P - 037

A RARE, RADIOLOGICAL AND CLINICAL DILEMMA: INGUINAL HERNIA OR NUCK CANAL CYST?MEHMET KARAGULLE1, SULEYMAN ONCU1, FATMA ZEYNEP ARSLAN2, MEHMET ONCU1, AHMET TAN CIMILLI1

1Bağcılar Training and Research Hospital, İstanbul, Turkey2Konya Training and Research Hospital, Konya, Turkey

Abstract

Nuck canal cyst is a rarely seen pathological condition due to the pres-ence of patent processus vaginalis. Spermatic cord cysts that are detected


in males and nuck canal cysts are equivalent lesions. Typically irreduct-ible, painless cystic mass lesion located at the inguinolabial region is seen. Redness, increase in temperature and pain extending from inguinal region to labium majus can be seen when cystic mass infected. A 36-year-old female patient admited to outpatient policlinic due to painless swelling in the left inguinolabial region. Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) performed with a provisional diagnosis of inguinal hernia. On USG; a cystic mass with intralesional thin septations in the left inguinal canal was detected. There was no Doppler signal noted within lesion during sonograhic examination. In the left inguinofemoral region, non-enhancing cystic mass lesion with a size of 28x14 mm, which is hypointense on T1-weighted series, hyperintense on T2-weighted series demonstrated. After lesion surgically removed, pathologically diagnosed as Nuck canal cyst. Differential diagnosis of Nuck canal cyst also includes inguinal hernia, lymphadenopathy, neoplasia, bartolin cyst. In conclusion; Nuck canal cyst is rare but should be remember in female patients who had a cystic lesion containing pure cystic or septa in the inguinal region. Radiologists should be familiar with these rare lesions and these patients are playing a key role in getting them to be diagnosed faster.Thus; the number of unnecessary MRI examinations could be reduced and unnec-essary surgeries may be prevent by diffrentiating Nuck canal cysts from inguinal hernia accurately.

Keywords: Inguinal hernia, nuck canal cyst and nuck canal hydrocele

P - 038

RENAL AND URETERIC TUBERCULOSIS RADIOLOGIC FINDINGSELA KAPLAN, LEYLA KARACA

İnönü University Turgut Ozal Medical Center, Malatya, Turkey

Abstract

A 53 year old woman who has DM history presented urology poli-clinic with painful urination. She had has this symptoms for five years. Her analysis result of urineare; leucocytes were three pozitive, glucose was three pozitive, erythrocyte was one pozitive. Because of these result MRI Urography was wanted. In MRI Urography; it was calyceal dilatation and peripheral wall thickining with contrast enhancement in left kidney superior zone. Left collecting system’s wall were thickining and irregular. Correspondingly; pelvicalcyceal system was expansion in inferior zone and there was infindibular stenosis. Ureter tract was destroyed and from place to place narrowing and enlarged. Grade I-II hydronephrosis was left pelvicalyceal system. These findings are special for tuberculosis a patient has DM story who has these sypmtoms longstanding. In urine culture was proliferated TBC.

Keywords: Renal tuberculosis, MRI findings

P - 039

WHY SHOULD RADIOLOGISTS BE FAMILIAR WITH RETRORECTAL CYSTIC HAMARTOMA?FATMA ZEYNEP ARSLAN1, SULEYMAN ONCU2, MEHMET KARAGULLE1, ISA DENIZ1

1Department of Radiology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey2Department of Radiology, Bağcılar Training and Research Hospital, İstanbul, Turkey

Abstract

Presacral tailgut cysts, also known as retrorectal cystic hamartomas, are rare congenital lesions most often discovered incidentally in middle-aged women and believed to arise from aberrant remnants of the postanal gut when incomplete involution occurs during embryogenesis. Patients usually asymptomatic, patients may develop symptoms resulting from local mass effect. Patients may suffer from tenesmus, constipation, pain rectal fullness and urinary rate changes. Initial presentation may also be delayed until complications occur, including infection The most important complications of these cysts are infection with secondary fistulization and malignant degeneration. Cystic nature of the lesion can be demon-strated on sonographic examination. CT delineates a well- circumscribed hypodense mass. On MRI; lobulated, multloculated cystic lesion can be seen wich is hypointense on T1 and homogenously hyperintense on T2 sequences. Herein, we reported MRI findings of a patient with Retrorectal Cystic Hamartoma.

Keywords: Retrorectal mass, retrorectal cystic hamartoma, tailgut cyst

P - 040

A RARE CAUSE OF SONOGRAPHIC MURPHY SIGN: LOW GRADE GALLBLADDER CANCER PRESENTING AS A XANTHOGRANULOMATOUS CHOLECYSTITISMEHMET KARAGULLE1, FATMA ZEYNEP ARSLAN2, SULEYMAN ONCU1

1Department of Radiology, Bağcılar Training and Research Hospital, İstanbul, Turkey2Department of Radiology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey

Abstract

Xanthogranulomatous cholecystitis (XGC) is a rare chronic inflam-matory process characterized with multiple intramural nodules due to progressive fibrosis of gallbladder wall. The reported frequency of XGC is ranged from 1.3% to 5.2%. It is usually seen in women between 60 and 80 years of age. Approximately most of the patients has gallbladder calculus. In a small number of cases, cause of XGC and abdominal pain can be a gall bladder malignancy. Therefore; it is important to note that XGC and malignancy can be seen coexistently in a same gall bladder. Severe complications such as perforation, abse formation, adhesion to the intestinal wall and fistula may be seen. Sonographically diffusely or focal wall thickening of the gallbladder, hypoechoic nodule formation in the gallbladder wall, adhesion to liver parenchyma and generally accompanying gallbladder stones can be seen. On computed tomography, heterogeneously enhancing hypodense areas within the wall can be observed corresponding to sonographic appearance. Despite the fact that there is a limited litera-ture data about Magnetic Resonance Imaging findings of XGC; con-tinuous mucosal line, luminal surface enhancement, and gallbladder


stone highly suggest XGC. XGC may be misinterpereted as gall blad-der malignancy due to increased wall thickness and focal adhesions or may be seen with gall bladder malignancy. In conclusion, although it is not a malignant pathology because of the severe complications of XGC and possible coexistence with malignancy, early diagnosis and appropriate surgical treatment are necessary. we presented a case in which sonographic Murphy sign was positive, sonographically wall irregularity observed and intramural collection and contrast enhance-ment seen on magnetic resonance imaging. Herein, we discussed MRI findings of a case pathologically confirmed as XGC and accompanying low grade gall bladder malignancy.

Keywords: Xanthogranulomatous cholecystitis, low grade gallbladder cancer, murphys sign

P - 041

IMAGING FEATURES OF ATYPICAL LOCALIZED LEIOMYOMAONUR BECERIK1, CANAN ALTAY1, TAYFUN BISGIN2, EMINE BURCIN TUNA3, SELMAN SOKMEN2, MUSTAFA SECIL1

1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey2Department of General Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey3Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Introduction: Leiomyomas are benign mesenchymal tumors that originates from smooth muscle. The most common area of occur-rence in the body is the uterus. Rarely, they may develop at any sites where smooth muscle cells are found. Also malignant mesenchymal tumors such as leiomyosarcomas must be considered in the differ-ential diagnosis of soft tissue tumors. Here, we report the computed tomography (CT), and magnetic resonance imaging (MRI) findings of a leiomyoma in the abdominal wall of the inguinal region.

Case Report: A 67-year-old female was referred a history of palpat-ing mass in the right inguinal region. A physical examination showed a large and stiff mass at the anterior portion of right inguinal region. Consequently, CT, and MRI were performed. Contrast-enhanced-CT of the abdomen revealed a heterogeneously hypodense, lobulated mass in the right inguinal region, anteriorly and superior to the muscle pectineus, medial to femoral artery and vein. The lesion extends into the skin-subcutaneous fatty tissue and has irregular border with homo-geneous enhancement. MRI images reveal, hypointense and lobulated mass on T1-weighted images (WIs) and mildly heterogenous hypoin-tense on T2WIs compare to muscle. Fat-suppressed T1-weighted images obtained after administration of a gadolinium-based contrast material showed strong heterogeneous enhancement of the mass. The pathology revealed a leiomyoma of the abdominal wall.

Conclusion: MRI is the best radiologic imaging tools for the diagnosis of the soft tissue tumors. A leiomyoma in the inguinal region present as a well-defined and homogeneous soft tissue lesion on the MRI.

Keywords: Leiomyoma, magnetic resonance imaging

P - 042

METASTATIC POSTERIOR MEDIASTINAL NEUROBLASTOMA MRI FINDINGSUAT INCE, ALPARSLAN YAVUZ, MESUT OZGOKCE


Abstract

Objective: In this case, we aimed to present a case of metastatic neuro-blastoma located in atypical localization in a 10 year old patient.

Materials and Methods: A 10-year-old girl, who was followed up for one week due to pneumonia at the external center, applied to the hospital for further examination.PA chest X-ray showed suspicious opacity in the lower right zone.Pulmonary and upper abdominal MRI examinations were performed for differential diagnoses.

Results: In the MR examination, 78x74 mm mass consisting of heteroge-neous contrasting and cystic degenerated areas was observed in the right lower thoracic paravertebral region. The lesion could not be distinguished from the right adrenal gland. The lesion extends through the foramen on the medial side and narrows the right half of the spinal canal in a crescen-tic manner. In addition, the lesion was extended to the left paravertebral area and under the skin and signal changes compatible with invasion in adjacent ribs were observed. In the anterior of right lobe of the liver, a solid mass measuring 11x10 mm in size compatible with metastasis was observed. The case was diagnosed as neuroblastoma result of histopatho-logic examination.

Conclusion: Neuroblastoma is the second most common tumor encoun-tered during childhood. Approximately 20% of all neuroblastomas originate posterior mediastinum. Neuroblastoma is seen as mixed intense masses in MRI. Neuroblastoma shows different staining patterns with intravenous contrast material. The staining can be diffuse homogeneous, heterogeneous or circumferential thin. When the mass reaches large dimensions, it can be observed that the ribs are displaced, thinned, and separated from each other.

Keywords: Neuroblastoma, posterior, mediastinal, metastatic

P - 043

PANCREATIC ADENOCARCINOMA ORIGINATING FROM HETEROTOPIC PANCREATIC TISSUE OF THE JEJUNUM; MRI FINDINGSAYSEGUL OZ1, BEDRIYE KOYUNCU SOKMEN1, LEVENT ULUSOY1, SADIK SERVER1, SEZGI BARLAS1, NAGIHAN INAN1, ESAT NAMAL2, YAMAN TOKAT3

1Department of Radiology, İstanbul Bilim University Florence Nightingale Hospital, İstanbul, Turkey2Department of Oncology, İstanbul Bilim University Florence Nightingale Hospital, İstanbul, Turkey3Department of General Surgery, İstanbul Bilim University Florence Nightingale Hospital, İstanbul, Turkey


Abstract

Objective: MRI findings of pancreatic adenocarcinoma originating from heterotopic pancreatic tissue of the jejunum. Heterotopic pancreas (HP) can be located in anywhere in the gastrointestinal system from the esophagus to the rectum. It has no vascular or anatomic contact with the pancreas. Spleen, liver, Meckels diverticulum, gallbladder, bile duct, or fallopian tube involvement is reported. It’s a very rare entity (0.6–5.6% of autopsies) and usually incidentally detected. If symptomatic; epigastric pain, ileus, intussusception, bleeding, pancreatitis or very rarely carci-noma can occur. Fifty-one years old male patient consulted to emergency department with vomiting, intestinal obstruction symptoms.

Results: On contrast enhanced MDCT an infiltrative mass with no con-nection to pancreas in the duodenojejunal junction extending to jejunum was detected. On abdominal MRI, lesions enhancement and morpho-logic pattern was identical with pancreatic adenocarcinomas, diffusion was restricted. After excision of the jejunal tumor by laparotomy, biopsy revealed pancreatic adenocarcinoma in the jejunum.

Conclusion: Morphological and radiological findings of asymptomatic HP of the gastrointestinal system are very similar to other submucosal gastrointestinal stromal tumors. HP can show homogenous or hetero-geneous enhancement pattern depending on the predominant histologic composition (acini or cystic ducts) of the heterotopic tissue (Heinrich’s classification). When symptomatic, MRI demonstrates signal character-istics that may vary according to the cellular component of the lesion. Our case demonstrated similar signal, enhancement and morphologic characteristics with pancreatic adenocarcinomas. HP should be kept in mind, when a gastrointestinal pathology –a submucosal mass, an infiltra-tive tumor, inflammation or bleeding- reveals similar imaging patterns to pancreatic tissue.

Keywords: Heterotopic pancreas, MRI, pancreatic adenocarcinoma

P - 044

MRI FEATURES OF PROSTATIC MUCINOUS ADENOCARCINOMA: A CASE REPORTCANAN ALTAY1, UYGAR MUTLU1, OZAN BOZKURT2, OMER DEMIR2, KUTSAL YORUKOGLU3, ARAS EMRE CANDA4, MUSTAFA SECIL1

1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey2Department of Urology, Dokuz Eylül University School of Medicine, İzmir, Turkey3Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey4Department of General Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Introduction: The mucinous subtype of prostate adenocarcinoma, also referred to as colloid adenocarcinoma, is extremely rare as a primary prostate lesion. The mucinous subtype of prostate adenocarcinoma has aggressive clinical behavior Surgical resection is the main therapeutic option. Herein, we describe the clinical and magnetic resonance imaging (MRI) features with histopathological correlation of a patient with pros-tate mucinous adenocarcinoma.

Case Report: A 48-year-old male presented with urinary symptoms, which were described as progressive urinary retention. The prostate-specific anti-gen (PSA) value was 2,55 ng/mL. MRI of the prostate was performed. MR images revealed a tumor extending from the base of prostate to the apex of prostate. The transitional zone of the prostate gland compromise of macrol-obulated heterogenous, hyper-intense mass with hipointense capsule on the T2-weighted images (WI). The prostatic mass has central hyperintense areas within the mass on the T1WIs competible with mucin lakes. After contrast administration, the lesion demonstrated strong heterogeneous enhance-ment. Surgery was performed using a retropubic approach. Histopathological examination confirmed the presence of a prostatic adenocarcinoma with extraluminal mucinous pools involving >50% of the tumor volume. The final Gleason score given was 4+4=8 and the stage pT4.

Discussion and Conclusion: Primary prostatic mucinous adenocarcinoma is a rare and aggressive malignant tumor. The MRI features of mucinous adeno-carcinoma is nonspecific, however, it can be seen hyperintense regions in the prostatic mass on on T1-WI and T2-WI due to presence of mucin pools. MRI is also helpful for detecting the invasion of adjacent tissues and staging.

Keywords: Prostatic mucinous adenocarcinoma, magnetic resonance imaging

P - 045

TYPE 2 LEFT RENAL VEIN VARIATION: MRI FINDINGSALPER DILLI, IDIL GUNES TATAR

Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

We aimed to present the MRI findings of Type 2 left renal vein variation. Lomber MRI examination of a 59-year-old male patient revealed the incidental finding of Type 2 left renal vein variation where left renal vein had a retroaortic course joining inferior vena cava at the level of iliac vein bifurcation at the level fourth lomber vertebra. It results from the oblitera-tion of the ventral pre-aortic limb of the left renal vein and the remaining dorsal limb turns into a retroaortic left renal vein. Variations in the vascular anatomy should be reported when they are detected to aid the surgical or interventional procedures which can potentially take place in the future.

Keywords: Renal vein, retroaortic, variation, MRI

P - 046

RARE PELVIC BASE HERNIA: SUPRAPRIFORM FORAMEN HERNIAHATICE GUL HATIPOGLU1, HAMZA OZER1, ALI DALGIC2, SEMRA DURAN1

1Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey2Department of Neurosurgery, Ankara Numune Training and Research Hospital, Ankara, Turkey

Abstract

Perineal hernias are rare pelvic hernias, occurring through a defect in the pelvic floor musculature. More common in females, with peak


age of presentation between 40 and 60 years. Perineal hernias are classified as anterior or posterior depending on their relationship with the transverse perineal muscle. Anterior hernias are more common than posterior hernias, and occur almost exclusively in females.Large sciatic foramen-based hernias in the posterior group may cause symp-toms such as sciatica, lumbago, and priformis syndrome. Clarification of etiology is very important for definite treatment and comfort of patient. We aimed to share the imaging findings of the patient who had followed as suprapriform syndrome for years and diagnosed as suprapriform herniation which was detected on perianal MRI examina-tion in our clinic.

Keywords: MRI, suprapriform hernia, perineal hernia

P - 047

GIANT CISTERNA CHYLIDENIZ SOZMEN CILIZ, HAMZA OZER, HATICE GUL HATIPOGLU, SEMRA DURAN, BULENT SAKMAN, MEHTAP CAVUSOGLU

Ankara Numune Training and Research Hospital, Ankara, Turkey

Abstract

Cisterna Chyli is a normal anatomic structure in the retrocrural area where lymphatic channels are formed as a saccular dilatation just to the right of the abdominal aorta. Its main funciton is to transport digested fat. The size can be changed by contraction waves. It may also be confused with cystic lesions of the pancreas and retro-cranial lymph nodes due to its location. Differential diagnosis can be made with some criterias; such as, its characteristic location, structure, isointensity with CSF, and no significant change in the dimension within follow-ups. We wanted to share the findings of ultrasonography, computed tomography and magnetic resonance imaging of this rare giant cisterna chyli case.

Keywords: Cisterna chyli, MRI, cystic lesion

P - 048

ANCIENT SCHWANNOMA OF THE ISCHIORECTAL FOSSA-A RARE CASE WITH MRI FINDINGSBEDRIYE KOYUNCU SOKMEN1, AYSEGUL OZ1, SADIK SERVER1, SEZGI BURCIN BARLAS1, ESAT NAMAL2, NAGIHAN INAN1

1Department of Radiology, İstanbul Bilim University Sişli Florence Nightingale Hospital, İstanbul, Turkey 2Department of Medical Oncology, İstanbul Bilim University Sişli Florence Nightingale Hospital, İstanbul, Turkey

Abstract

Ancient schwannomas are rare, encapsulated tumors of long duration and are benign in nature. Ancient schwannoma, a degenerative neuri-lemmoma, is a schwannoma subtype characterized by degeneration and diffuse hypocellular areas. These changes are believed to occur because it takes a long time for schwannomas to develop. Schwannomas with these degenerative changes can be misdiagnosed as sarcomas or as other forms

of soft-tissue neoplasms. However, the radiologic features of Ancient schwannoma occurred in the ischiorectal fossa have been rarely reported. In this case, we describe the MRI findings in a case of a Ancient schwan-noma involving the ischiorectal fossa of a known primary breast cancer 67-year-old woman.

Keywords: Ancient schwannoma, ischiorectal fossa, MRI

P - 049

ACCESSORY PANCREATIC LOBE: CASE REPORTAYSEGUL SAGIR KAHRAMAN1, BAYRAM KAHRAMAN3, SEZAI YILMAZ2

1Department of Radiology, İnönü University School of Medicine, Malatya, Turkey2Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey3Department of Radiology, Malatya Park Hospital, Malatya, Turkey

Abstract

Accessory pancreatic lobe is a rare congenital duplication anomaly. Currently, Magnetic Resonance Imaging (MRI) and MR cholangiopan-creatography (MRCP) is the first choice for investigating and diagnos-ing parenchymal and ductal pancreatic variations noninvasively. We aimed to report a case of a 68-year-old female patient diagnosed with accessory pancreatic lobe who investigated for biliary stone disease. She presented with recurrent episodes of epigastric and right upper quadrant pain since few months. MRI and MRCP investigated minimal biliary and gallbladder dilatation with cholelithiasis. Additionally, the duplicate pancreas detected incidentally that derived from the head of the normal pancreas, looped back to the duedonum, course inferiorly adjacent to the second portion of duedonum and ended adjacent to the right pararenal space. The duct of duplicated pancreas drained into main pancreatic duct at the head of the pancreas. The main pancreatic duct drained into the duedonum separately from the choledoc. The patient was explored for cholesistectomy and surgery confirmed MRI findings. Although these cases usually remain asymptomatic; duplicated pancreas, if undetected, may be the cause of postoperative complica-tions following pancreaticobiliary interventional procedures or surgery. Congenital anomalies of the pancreas cause variable morphological changes of the organ that can be evaluated by means of imaging modalities including MR and MRCP.

Keywords: Pancreas, MRI, MRCP, accessory pancreatic lobe

P - 050

TRIORCHIDISM (CASE REPORT)SENAY BENGIN ERTEM1, GOKCEN YILDIZ2, IBRAHIM KILCI3

1Department of Radiology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey2Department of Radiology, Private Cihan Hospital, Kocaeli, Turkey3Department of Urology, Private Cihan Hospital, Kocaeli, Turkey


Abstract

Introduction: Polyorchidism is a very rare anomaly, which is defined by the presence of more than two testicles. To date about 200 cases have been reported in literature. Triorchidism -three testicles- is the most common form of polyorchidism. Extra testicles are usually found on the left scrotum. The etiology of polyorchidism is thought to be an embryological developmental abnormalty during the forma-tion of testicles. Usually, patients present with an asymptomatic mass. These extra testicles are at increased risk to develop malignancy and torsion. Polyorchidism classified into four types. Polyorchidism is usually diagnosed on the basis of color Doppler US, further sup-ported by MRI.

Case Report: 32 years old man suffering from right testicular pain applied to our hospital. On physical examination there is a painless mass in the left scrotum; than he referred to our department for testis US.

Discussion: In testis US there were two testis in the left scrotum with their own epididymis. Than he was underwent to pelvic MRI. In pelvic MRI, there were two testis in the left scrotum. Both of them had their own epididymis and vas deferens (Type 4 polyorchidism). There were no sign of torsion or malignancy so patient was discharged by recommended to US follow- up per year.

Conclusion: Polyorchidism is a very rare anomaly. Doppler US is the preferred method for diagnosis and follow-up. MRI may use in compli-cated cases. Extra testicles are at increased risk to develop malignancy and torsion. When such risk developed the extra testicle must be excised surgically.

Keywords: Triochidism, color doppler US, MRI

P - 051

MR UROGRAPHY: URETEROVAGINAL FISTULA WITH DUPLICATED URETERSEHNAZ EVRIMLER1, EVRIM ERDEMOGLU2

1Department of Radiology, Süleyman Demirel University School of Medicine, Isparta, Turkey2Department of Gynecologic Oncology, Süleyman Demirel University School of Medicine, Isparta, Turkey

Abstract

Ureterovaginal, vesicovaginal fistulas can occur after pelvic operations and the probability of them increases by the acompaniment of radioth-eraphy. Other ethiologies are pelvic infectious and inflammatory diseases, traumas. Patients present with drainage of urine from vagina. Scopic imaging techniques, computed tomography and magnetic resonance (MR) imaging can be used for diagnosis. We aimed to demonstrate the probable fistula between urinery system and vagina with MR urography in our patient who complained of urine discharge into the vagina after hysterectomy operation. MR Urography images showed bilateral dublex collecting systems. On the left side both of the ureters fused proximally to the ureterovesical junction level and fistulised to vagina. Findings were compatible with ureterovaginal fistula. There was no vesicovaginal fistula detected. MR Urography findings were verified with cystoscopy and ure-terovaginal fistula was repaired with transabdominal approach successfully without complication.

Keywords: Fistula, magnetic resonance imaging, urography, ureter, vagina

P - 052

EXTRAGENITAL ENDOMETRIOSIS MIMICKING CARCINOMA: A REPORT OF TWO CASESBILGESU ARIKAN ERGUN, ANDELIB BABATURK, DIGDEM KURU, G. AYSE ERDEN


Abstract

Introduction: Endometriosis is characterised by the presence of functional endometrial glands outside the uterus. The most common extragenital location of the disease is gastrointestinal tract (GIT). Cases may be misdiagnosed as neoplastic diseases if this relatively rare entity is not evaluated

particularly. Here in this report of two cases, we aimed to present MR imaging findings of rectal and small bowel endometriosis.

Case 1: A 25-year-old woman had history of intermittant abdominal pain and defecation difficulty. Abdominal computed-tomography (CT) revealed a mass lesion that extend along cul-de-sac, invade cervix and posterior wall of uterine corpus. Pelvic magnetic resonance imaging (MRI) showed an

enhancing, diffusion-restricting lesion arising from posterior cervical wall, extending along cul-de-sac, invading rectum wall and radiating into sur-rounding tissue. Sagittal T2-weighted MR images showed “mushroom cap sign”, which is considered as a specific finding of solid invasive endome-triosis. In the direction of these findings an endoscopic ultrasound-guided biopsy was performed, the final pathologic results showed endometriosis with rectum involvement.

Case 2: A 44-year-old woman presented with chronic abdominal pain. Abdominal CT revealed segmental ileal bowel thickening and a soft tissue mass. MRI showed a diffusion restricting, progressive enhancing segmental intraluminal lesion which was thought to be a carcinoid tumor.

Colonoscopy was not diagnostic. Surgery was performed; pathologic results revealed multiple endometriotic lesions.

Conclusion: The most common extragenital location of endometriosis is GIT and it occurs in 3-37% of patients with endometriosis. Diagnosis of extragenital endometriosis can be difficult. Owing to the fact that dif-ferantial diagnosis consists mainly of neoplastic diseases which need radical surgical procedures, it is essential for radiologists to be aware of imaging findings of this entity.

Keywords: Endometriosis, bowel involvement, magnetic resonance imag-ing

P - 053

BLACK KIDNEYS: SIGN OF HEMOLYSIS ASSOCIATED WITH G6PDDSEHNAZ EVRIMLER

Department of Radiology, Süleyman Demirel University School of Medicine, Isparta, Turkey


Abstract

Iron overload results in susceptibility effect especially on gradient-echo sequences of magnetic resonance imaging (MRI). The major ethiologic factor of renal hemosiderosis is intravascular hemolysis which can be caused by paroxysmal nocturnal hemoglobinuria, sickle cell disease, valvu-lar heart disease. Renal cortex is totally involved and seen in hypointense signal on both T1- weighted and T2-weighted images. A 64 year-old female patient who presented with epigastric pain, diarrhea and icteric sclera-skin. Allergy to fava bean and aspirin was detected in her medical history. Anemia, hyperbilirubinemia, and Glucose-6-phosphate dehydro-genase deficiency (G6PDD) was found in laboratory tests.There was no sign for renal failure. Abdomen MRI showed bilateral entire renal cortex hypointensity on T1- weighted in-phase, isointense on T1- weighted out of -phase, and hypointense on T2-weighted images, accompanied with hepatosplenomegaly. Findings were compatible with renal hemosiderosis caused by hemolysis as a result of G6PDD.To the best of our knowledge, there has been no case report presenting renal iron overload MRI char-acteristics on MRI. Acute hemolytic episodes can cause renal injury in G6PDD patients. MRI can be used for evaluating predisposition to renal injury in such patients, which needs to be investigated with further studies.

Keywords: Glucosephosphate dehydrogenase deficiency, hemosiderosis, kidney, magnetic resonance imaging

P - 054

A CASE OF CHOLESTEATOMA RARELY LOCATED IN THE MASTOIDNURSEN TOPRAK, MAHFUZ TURAN

Van Yüzüncü Yıl University Dursun Odabaş Medical Center, Van, Turkey

Abstract

Objective: We aimed to present a 33-year-old male with mastoid congenital cholesteatoma cholesteatoma that manifested as left otor-rhea was presented in the presence of computed tomography (CT), magnetic resonance imaging (MRI) and diffusion-weighted image(DWI)

Materials and Methods: CT, MRI and DWI was used for diagnosis

Results: CT scan revealed a 3.5x2 cm size destructive lesion at left –sided mastoid cellüler. MRI scans revealed a 3.5x2 cm size cholesteatoma at left -sided with characteristic bright signal in T2 weighted imaging and restricted diffusion on DWI. Histopathologic studies revealed left mastoid cholesteatoma.

Conclusion: Congenital cholesteatoma confined to the mastoid process is a rare lesion. Symptoms are often lacking or nonspecific, and although cases have a congenital origin, the diagnosis often is not made until adulthood. CT, MRI and DWI are invaluable in the diagnosis of occult congenital cholesteatomas, especially those originating in the mastoid.

Keywords: Congenital cholesteatoma, CT, MRI, DWI

P - 055

A RARE LESION OF THE NECK: INTRANODAL MUCOEPIDERMOID CANCER

MERIC TUZUN, BAKI HEKIMOGLU


Abstract

Mucoepidermoid cancers of the head and neck are mostly seen in the major salivary glands or in the intraoral minor salivary glands. It is quite rare to see in the neck lymph node without another known primary focus. In this case report, a 28 year old female patient with intranodal mucoepi-dermoid cancer in the neck is presented with magnetic resonance imaging findings.

Keywords: Neck, mucoepidermoid cancer, lymph node, magnetic reso-nance imaging

P - 056

SKIN METASTASIS OF LARYNGEAL SQUAMOUS CELL CARCINOMAMERIC TUZUN, BAKI HEKIMOGLU


Abstract

Skin metastasis is very rare in larynx cancer. It is often regarded as a sign of poor prognosis. The incidence of skin metastasis in head and neck cancers is less than 1%. In this case report, a 62-year-old male patient with skin metastasis of laryngeal squamous cell carcinoma is presented with magnetic resonance imaging findings.

Keywords: Larynx, squamous cell carcinoma, neck, magnetic resonance imaging, skin

P - 057

SINONASAL MYXOFIBROSARCOMA: MAGNETIC RESONANCE IMAGING FINDINGSMERIC TUZUN, BAKI HEKIMOGLU


Abstract

Myxofibrosarcoma is a malignant soft tissue tumor of fibroblast origin. It is more common in the trunk and extremities. It is rarely seen in the head and neck region. It is usually a slowly growing tumor with a high recurrence rate and occasionally distant metastasis. In this case report, a 55-year-old male patient with sinonasal myxofibrosarcoma is presented with magnetic resonance imaging findings.

Keywords: Myxofibrosarcoma, neck, magnetic resonance imaging, para-nasal sinus, neck


P - 058

SECONDARY MIDDLE TURBINATE EXTENDING INTO THE CONCHA BULLOSAMERIC TUZUN, BAKI HEKIMOGLU


Abstract

Secondary middle turbinate is a rare osteomeatal variation. It is a bone structure extending from the lateral nasal wall to the middle meatus and covered with soft tissue. The frequency of appearance varies between 0.8% and 14.3% in different publications. It can be one-sided or two-sided. It can be accompanied with other osteomeatal variations. Secondary middle turbinate extending into concha bullosa is very rare. In this case report, a unilateral secondary middle turbinate extending into the concha bullosa encountered incidentally on magnetic resonance imaging of the brain is presented.

Keywords: Secondary middle turbinate, concha bullosa, middle turbi-nate

P - 060

SINONASAL INVERTED PAPILLOMA WITH THE CHARACTERISTIC SIGN “CONVOLUTED CEREBRIFORM PATTERN”: A CASE REPORTDIBA SAYGILI, OZGE TANISMAN, ELIF AKTAS

Ankara Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Sinonasal inverted papilloma (SIP) is a rare benign neoplasm of sino-nasal cavities. It is locally aggressive and has malignant transformation potential; despite its benign histology. Thus making distinctive diagnosis of SIP from other benign sinonasal cavity lesions and careful surveillance for malignant transformations are essential. In this article, a 63-year-old man is reported who presented with nasal obstruction, headache and recurrent sinusitis. The patient was evaluated with CT and MRI. The preliminary diagnosis of SIP was confirmed histopathologically. With this case report we aimed to draw attention to characteristic imaging find-ings and highlight the risk of malignant transformation of SIP.

Keywords: Sinonasal inverted papilloma, malignant transformation, con-voluted cerebriform pattern

P - 061

THYROID RELATED ORBITOPATHY CASE REPORTIBRAHIM FEYYAZ NALDEMIR, ELIF NISA UNLU, OMER ONBAS

Düzce University School of Medicine, Düzce, Turkey

Abstract

Introduction: Graves’ disease is a common thyroid-related autoimmune disease. Graves’ ophthalmopathy is one of the complications of this disease and which is reduce the quality of patients life and makes visual disturbances. We presented MR images of a patient who had graves ophthalmopathy.

Case Report: 36-year-old female patient with diagnosis of Graves’ dis-ease was admitted to the hospital with the complaints that her eyes had protruded outward and restricted her eye movements. MR examina-tion revealed exophthalmos, hypertrophy in all extraocular muscles and T2 hyperintensities in these muscles which were thought to be due to infiltration of fat tissue, retrocular fat tissue increase, lacrimal gland size increase, and maxillary sinus indentation of orbital floor.

Discussion: Graves disease is a multisystem disease of unknown cause characterized by one or more of the three pathognomonic clinical entities: Hyperthyroidism, infiltrative ophthalmopathy and infiltra-tive dermopathy. In the clinical features of thyroid orbitopathy are exophthalmos, upper and lower eyelid retraction, limitation of eye movements and eyelid edema. CT and MR imaging may show only markedly swollen retrobulbar orbital contents causing bilateral pro-ptosis. Coronal images should be carefully assessed in evaluating the amount of orbital muscles hypertrophy and the optic nerve pressure. Other CT and MR imaging findings are increased orbital fat, edema (fullness) of the eyelids, enlargement (engorgement) of the lacrimal glands, proptosis, anterior displacement of the orbital septum, and stretching of the optic nerve. The increased orbital fatty tissue results in anterior displacement of the orbital septum and occasionally pro-lapse of lacrimal glands.

Keywords: Thyroid orbitopathy, graves disease, graves ophthalmopathy

P - 062

SKULL METASTASIS IN AN INFANT WITH NEUROBLASTOMAHASAN EMIN KAYA1, ALAATTIN NAYMAN2, ULKU KERIMOGLU1, SERDAR KARAKOSE1

1Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey2Department of Radiology, Selçuk University School of Medicine, Konya, Turkey

Abstract

Metastatic involvement of the skull can be seen in up to 25% of patients with neuroblastoma. Typical appearances include bone thickening, “hair-on-end” periosteal reaction, lytic defects, enhancing soft tissue masses, and separation of sutures. Here we present classic CT and MRI findings of skull metastasis of neuroblastoma in a six-month-old girl.

Keywords: Neuroblastoma, metastasis, bone, CT, MRI

P - 063

TAKAYASU ARTERITIS: MR ANGIOGRAPHY FINDINGS


UMMUGULSUM BAYRAKTUTAN, ALPER KIZILOGLU, HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT


Abstract

Objective: Takayasu arteritis is an inflammatory disease that involves the major branches of the aorta, the aorta, and the pulmonary arteries. It affects large vessels and causes damage to the vessel wall. We have tried to present magnetic resonance imaging angiography (MRA) findings in a 30 year-old-female patient.

Materials and Methods: Neck MRA examination was performed in a 30-year-old woman with complaints of dizziness, fatigue and weakness with a 1.5 Tesla MR device (Magnetom Avanto, Siemens Healthcare).

Results: In our case, bilateral common carotid arteries, internal and external carotid arteries, vertebral artery, subclavian arteries and aorta to be more prominent on the right side showed luminal narrowing and increased wall thickness. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels, which are indicators of inflammation as laboratory findings, were also high. Takayasu arteritis was diagnosed due to the present findings and differences in blood pressure values between arms.

Conclusion: Takayasu arteritis is characterized by prominent intimal proliferation in the arterial wall, granulomatous inflammation causing fibrosis development in the media and adventitia. Stenosis, occlusion and occasionally poststenotic dilatation and aneurysm may occur in the vas-culature. ESH, CRP elevation, blood pressure difference between both arms can help to diagnose. Conventional angiography, CT angiography and MRA are used for diagnosis. CT angiography and MRA can clearly show vessel wall changes that are difficult to detect in conventional angiography. Corticosteroids are used in the treatment of the disease, but stenting in partial or fully occluded vessels and surgical by-pass surgeries are also performed.

Keywords: Takayasu arteritis, magnetic resonance imaging angiography

P - 064

EXTENSIVE ABSCESS FORMATION DUE TO MANDIBULAR OSTEOMYELITISOGUZ LAFCI, HASAN YIGIT, PINAR NERCIS KOSAR


Abstract

Osteomyelitis is defined as an infection of medullary cavity which reaches to periosteum via Haversian canals. Although rare, mandibular ostemyeli-tis is more frequent than maxillary osteomyelitis and is usually seen with involvement of adjacent soft tissues. Here we present a case of a 33 year old man with extensive abscess formations involving masseter, pterygoid and temporal muscles secondary to mandibular osteomyelitis.

Keywords: Mandibula, osteomyelitis, MRI

P - 065

A RARE CASE OF PURPURA FULMINANS WITH PRECENSE OF BRAIN INVOLVEMENTSAIM TURKOGLU, ABDUSSAMET BATUR

Department of Radiology, Van Yüzüncü Yıl Uinversity School of Medicine, Van, Turkey

Abstract

Objective: Purpura fulminans (PF) is a rare syndrome with intravascular coagulation and vascular collapse. Multiorgan can lead to insufficiency. MRI holds an important place in the diagnosis. We aimed to use and present MRI patients with PF.

Materials and Methods: An 8-year-old male patient was followed up with ichthyosis, Central Hypothyroidism, Glaucoma and Protein C, S, AT-III, common skin rashes, coagulation parameters in laboratory tests and gen-eral condition further deteriorated. MR images showed T1 hyperintense diffusion restriction area accompanied by left parietotemporal bleeds.T2AG had edema and moderate hattan shift.

Results: MRI is considered as the ideal examination in showing PF brain involvement. Differential diagnosis should be made from the mass lesions showing limited disease diffusion and the etiologies that may cause bleed-ing. Thus, the shape of the treatment can be given direction.

Conclusion: PF is acute onset and aggressive disease that is occured after infectious diseases and coagulation disorders; Intravascular hemorrhage, thrombosis and infarcts result in multisystem involvement resulting in isch-emia, necrosis, loss of integrity in the skin. It can rarely be seen with haem-orrhagic infarct in the brain as well as in our case. Brain involvement of the disease is non-specific and can interfere with many lesions. Although physiopathology is not fully understood, it is thought to play a role in multiple factor damage mechanisms. Extremity involvement is almost always a rule, but we can not reach clear literature information on brain involvement. Diagnosis is made in the clinic and laboratory but sometimes biopsy is needed for diagnosis. In the present case we were diagnosed by clinical biocompatibility as well as biopsy from the skin. In accordance with histopathology, hemorrhagic infarct areas in the brain parenchyma of the patient were also thought to develop due to purpura fulminans.

Keywords: Purpura fulminans, magnetic resonance imaging, brain

P - 066

INVERTED PAPILLOMA OF THE ANTERIOR CLINOID PROCESSAYDAN ARSLAN1, MUSTAFA GUDUK2, ALP DINCER1, NECMETTIN PAMIR2

1Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey2Department of Neurosurgery Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey

Abstract

Inverted papilloma (IP) is a benign tumor that usually occurs the nasal cavity and paranasal sinuses. The clinical presentation of IP is nasal obstruc-tion and headache as other nasal tumors. We aimed to discuss the MRI


features of a 48-year-old male patient who admitted to our clinic due to headache. Magnetic resonance imaging (MRI) of the brain with contrast showed mild expansile heterogeneous bone mass localized in the right anterior clinoid, extending laterally to the sphenoid sinus. The lesion was reported as a possible inverted papilloma. Anterior clinoid IP is the first case report in the English literature to our knowledge.

Keywords: Inverted papilloma, anterior clinoid process, schneiderian pap-illoma, MRI, anterior clinoid inverted papilloma

P - 067 PAROTIS ADENOCARCINOMA AND ITS METASTASIS, REPORT OF TWO CASESHASAN AYDIN, KEMAL ARDA, MUAZZEZ BENGI AKYOL, MEVLUDE ALTINTAS

Department of Radiology, Oncology Research Hospital

Abstract

Two cases with parotis adenocarcinoma were presented here, both masess were located in the left parotid gland, one was in the superficial, the other was in the deep glandular localization. In both cases, lots of noduler pul-monary and plevral metastasis were shown in the lungs. In the superficially located parotid malignancy; multiple thoracic and mediastinal LAP, massive pleural effusion and right pulmonary artery thrombus were present. Left iliac crest and right transverse process of L4 were also seen in this case. In the deep glandular one, Lots of Liver metastasis were shown. Both cases were eveluated by Torax CT-Head and neck MRI-Abdominal MRI.

Keywords: Parotis-Adeno-carcinoma-metastasis-MRI

P - 068

METASTATIC THYROID CARCINOMA, REPORT OF THREE CASESKEMAL ARDA1, HASAN AYDIN2, VOLKAN KIZILGOZ1, SINEF HUVAJ AKSOY2, SUMEYYE KAYMAK2

1Department of Radiology, Gülhane Research Hospital, Ankara, Turkey2Department of Radiology, Oncology Research Hospital

Abstract

Three metastatic papillary thyroid carcinomas were presented here, All three cases were evaluated by CT and MRI. In the first case, multiple pulmonary metastatic nodules and multiple liver masses with iliac bone invasion were shown. In the second case, multiple bone metastasis involv-ing thoracolumbar vertebrae-both acetabulum-symphisis pubis-ischium-bilateral caput femoris etc. were seen. In the third case, multipl LAP in the mediastinum, retroperitoneum, mesentery and anterior-posterior servical chains with occipital bone invasion were revealed

Keywords: Thyroid-metastasis-carcinoma-MRI-CT

P - 069

BILATERAL CERVICAL ECTOPIC THYMUS

SUMEYRA DEMIRKOL ALAGOZ, IBRAHIM ILIK, SUAT INCE, MESUT OZGOKCE, HARUN ARSLAN, ALPASLAN YAVUZ

Department of Radiology, Van Yüzüncü Yıl University, School of Medicine, Van, Turkey

Abstract

Objective: We aimed to present Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) findings of ectopic thymus tissue which is a rare cause of neck masses. The differential diagnosis of neck masses should be considered especially in children.

Materials and Methods: An 8-month-old male patient was admitted to our hospital with complaints of swelling in the neck. In USG review; con-tinuing bilaterally submandibular area to the inferior, hypoechoic accord-ing to thyroid parenchyma, with multiple echogenic linear seals, doppler examination with vascularity, lesions were observed that did not affect the surrounding tissues. Anterior mediastinal lesions were found to be echogenic and similar to thymus tissue. In MRI review the same intense lesions as the thymus tissue at the anterior mediastinum were detected at T1 and T2 weighted series.

Results: Detected lesions were evaluated as bilateral ectopic thymus tissue with USG and MRI findings. Monitoring of the patient was recom-mended.

Conclusion: Ectopic or aberrant thymus tissue can be seen anywhere from angulus mandibular to anterior mediastinum due to thymus descent during embryological development or involution anomaly of the thy-mopharyngeal canal. It may show a solid or cystic character. Congenital lesions, lymphadenopathies, benign and malignant tumors can often be confused with ectopic thymus. USG is considered as the first imaging method. Computed tomography (CT) is rarely used in infants and chil-dren because of ionizing radiation. Magnetic resonance imaging (MRI) is considered to be the most reliable imaging modality for ectopic thymus. It is stated that in cases with characteristic features after being diagnosed with imaging methots, histopathological diagnosis is not necessary and follow-up is sufficient.

Keywords: Cervical ectopic thymus, ultrasonography, magnetic resonance

P - 070

FETAL MAXILLOFACIAL TERATOMA MRI FINDINGSNUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, MUSTAFA KOPLAY, YAHYA PAKSOY


Abstract

Teratomas are germ celled tumors that may consist all of the three germ leaf. Fetal teratomas are very rare and they can be observed in 1/40.000 rate. Facial placed teratomas are very rare and they are approximately in 1-2% rate. Fetal teratomas are generally not providing any findings so that they can be determined as incidental. In general they have solid and cystic component and it must be kept in mind that they can be monitored as contoured mass rarely. Facial teratomas are important due to air way


obstruction and pressure on other structures, high morbidity and mortal-ity rates related with poly-hydra-amnios, hydrops fetalis, preterm birth and rupture. In this proceeding fetal maxillofacial teratomas and magnetic resonance imaging (MRI) findings had been presented

Keywords: Fetal MRI, maxillofacial teratoma

P - 071

INSIDENTALLY FOUNDED ASYMPTOMATIC UNILATERAL SUBMANDIBULAR GLAND AGENESIS (CASE REPORT)SENAY BENGIN ERTEM1, GOKCEN YILDIZ2

1Department of Radiology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey2Department of Radiology, Private Cihan Hospital, Kocaeli, Turkey

Abstract

Introduction: Congenital absence of major salivary glands is a rare condi-tion of unclear etiology. The first case was presented in 1885 by Gruber was a bilateral submandibular gland aplasia. Since then approximitely 41 cases have been reported in medical literature. Congenital salivary gland agenesis is usually bilateral and sometimes assotiated with other devel-opment anomalies of head and neck area. Clinical syndromes, such as lacrimo-auriculo-dento-digital syndrome and mandibulo-fascial-dyostosis (Treacher-collins syndrome) may also be seen. Unilateral submandibular gland agenesis is often asymptomatic and discovered incidentally through imaging. In sypmtomatic cases dry mouth, dental problems or difficulty in chewing and swallowing are seen.

Case Report: 31 years old young woman suffering from chronic neck pain applied to our hospital. Her physical examination was normal and she underwent to cervical MRI.

Discussion: In cervical MRI it was discovered that her left submandibu-lary gland was absent. Than she was underwent to neck US. In US it was observed that left submandibulary gland was absent and the other major salivary glands were normal both in size and echogenity. She had no spe-cific symptoms such as dry mouth, dysphagia, dental problems or difficulty in chewing and swallowing.

Conclusion: Submandibular gland agenesis is a rare condition. Patient has this condition either asymptomatic or suffered dental problems or dif-ficulty in swallowing by dry mounth. Asypmtomatic patient may diagnosed incidentally through imaging. When such a case is encountered, symptoms, findings and other possible additional deformities should be reevaluated and concervative therapy should be given if necessary.

Keywords: Submandibular Gland Agenesis

P - 072

MRI FINDINGS OF CONGENITAL CERVICAL TERATOMA; A CASE REPORT

DENIZ OZTURK KOCAKGOL1, DILARA ATASOY1, MERVE ERKAN1, REZZAN SUMELI2, AYSEGUL CANSU1

1Department of Radiology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey2Department of Pediatric Surgery, Karadeniz Technical University, School of Medicine, Trabzon, Turkey

Abstract

Introduction: We aimed to present a case of congenital cervical tera-toma with prenatal sonographic and postnatal neck MRI findings; that was detected as a cervical mass during prenatal follow-up and had an operation at postnatal period. Congenital teratomas are generally benign malformations. They are extremely rare in head and neck region. Despite the fact that the majority is benign, they require immediate surgical intervention due to the high mortality rate because of com-pressing of the airway. Today, the widespread use of ultrasonography in prenatal follow-up allows early detection of cervical teratomas. Thus, necessary precautions are taken in the perinatal period and it is possible to intervene at birth in elective conditions and early surgical interven-tion in postpartum period with multidisciplinary approach. In addition, preoperative planning for total surgical resection of teratomas is done by imaging methods (MRI-CT).

Case: A 26-years-old first gravida female reported at 36th week with ante-natal ultrasound of the fetus showing right sided fetal neck mass of size 78 x 47 x 95 mm. The mass had predominantly solid character with cystic areas. Congenital cervical teratoma, neuroblastoma and sarcoma were considered in differential diagnosis. After the fetus was born by caesarean section ın the MRI examination; a minimal heterogeneously enhancing mass was observed, of size 90x50x83 mm, which is predominantly solid character with cystic areas. The mass filled right parapharyngeal area and extended exophytic to subcutaneous soft tissue. Oropharyngeal and laryngeal air column were slightly narrowed and vascular structures were deviated to posteromedial. The mass was excited in early neonatal period and teratoma was confirmed on histology.

Conclusion: The diagnosis of congenital cervical teratomas with pre-natal US is important in terms of postnatal morbidity and mortality. MRI examination should be performed to show the relationship of the cervical mass with other neck regions and airway for appropriate surgi-cal planning.

Keywords: Servical mass, teratom, prenatal us

P - 073

GIANT HEMANGIOMA ON THE TONGUE AND LIPSUMEYRA DEMIRKOL ALAGOZ, FATMA DURMAZ, HARUN ARSLAN, MESUT OZGOKCE, ABDUSSAMET BATUR

Department of Radiology, Van Yüzüncü Yıl University School of Medicine, Van, Turkey

Abstract

Objective: Hemangiomas are frequently seen in children with head and neck tumors. We aimed to present magnetic resonance imaging (MRI) findings of giant-sized hemangiomas involving the lips and the tongue.


Materials and Methods: A 9-year-old girl was admitted to our hospital with the complaint of red-purple colored swelling of her tongue and lower-upper lips, which was born. Magnetic resonance imaging (MRI) was performed after clinical examination. In MRI examination; hypointense on T1-weighted images and hyperintense on T2-weighted images, a lobulated contour mass lesion with millimetric signal fields was observed. It was seen that the lesion reached the oropharynx and narrowed the air column.

Results: According to MRI findings, the patient was diagnosed with hemangioma. She received beta blocker therapy and a 1-year follow-up showed minimal reduction in lesion size.

Conclusion: Hemangiomas are considered a benign proliferation of endo-thelial cells. They are frequently found in childhood age groups of head and neck tumors. Hemangioomas are rarely seen in the mouth. We aim to present it with MRI findings because of being a rare localization and being in large size.

Keywords: Giant hemangioma, tongue, lip

P - 074

A RARE CASE, POST-TRAUMATIC ARTERIOVENOUS FISTULA OF THE SCALPSUAT INCE, SUMEYRA DEMIRKOL ALAGOZ, HARUN ARSLAN

Van Yüzüncü Yıl University, School of Medicine, Van, Turkey

Abstract

Objective: In this case, we aim to present a rare case of posttraumatic arteriovenous fistula of the scalp.

Materials and Methods: A 21-year-old male patient admitted to our hospital due to noise on the left side of the head resulting from head trauma 3 months ago. When there was no pathology on the direct graphy, MRI examination was performed on the patients in terms of differential diagnosis.

Results: MRI examination revealed enlargement of the subcutaneous veins and tortious appearance in the left temporo parieto frontal region. Doppler USG examination was performed because clinical and MRI find-ings suggested an arteriovenous fistula.In the Doppler USG examination, fistula flow was observed in the tortuous vascular structures under the skin therefore an arteriovenous fistula was diagnosed.

Conclusion: An arteriovenous fistula (AVF) is an abnormal connection between an adjacent artery and vein. AVF of the scalp is relatively rare disease. The etiology of the AVF of the scalp is still controversial, how-ever, it may be either of congenital or traumatic origin. There are two theories about pathogenesis of the traumatic AVFs. One is a disruption of the arterial wall and its vasa vasorum with endothelial proliferation to adjacent veins. The other is simultaneous lacerations of the artery and the accompanying vein result in a single fistula. An abnormal early signal enhancement in venous structures on MR angiography may help to find the point of arteriovenous fistulae. Time-resolved imaging sequences in MRI (e.g. TRICKS or TWIST) may be helpful.

Keywords: Arteriovenous, fistula, traumatic, scalp

P - 075

NASOLABIAL CYST: A CASE REPORT WITH CT AND MRI FINDINGSSENAY BENGIN ERTEM 1, YUNUS KANTEKIN 2 1Department of Radiology, Çanakkale Onsekiz Mart University, School of Medicine, Çanakkale, Turkey2Department of Ear Nose Throat, Bozok University, School of Medicine, Yozgat, Turkey

Abstract

Introduction: Nasolabial cyst also known as Klestadt’s cyst is relatively rare soft tissue lesion of nasal alar region. It is a benign, slow-growing, non-odontogenic, primarily unilateral (%90), extraosseous soft tis-sue lesion located in the nasal alar region below the nasolabial fold. Common clinical features include slowly growing painless mass which results in obliteration of nasolabial sulcus, nasal vestibule and maxillary labial sulcus. Nasolabial cysts cannot be seen on conventional radiogra-phy if there are no associated bone changes. CT can show a well demar-cated, rounded, homogeneous, low-density soft tissue lesion in the nasolabial region. MRI can show the characteristics of a liquid-containing cyst, with hypointense on the T1-weighted images and hyperintense on the T2-weighted images.

Case Report: 35 years old woman suffering from painless swelling on the right alar region and nasal obstruction applied to our haspital. On physical examination there is painless, fluctuant, mass lesion at the right nasal alar region. Patient was underwent to paranasal sinus CT and maxillofacial MRI.

Discussion: In MRI well shaped, extraosseous located, T1 hypointense T2 hyperintense cystic mass lesion at the right alar region causing par-tially obliteration of nasal vestibule was reported as nazolabial cyst. In paranasal CT there is no bony destruction. Than mass lesion was totally excised by operation. Lesion was reported as nasolabial cyst hystopatho-logically.

Conclusion: Nasolabial cyst should be considered in the differential diagnosis in patient who have a cystic mass in the nasal vestibuler area. Its clinical diagnosis is supported by its typical CT and MRI features.

Keywords: Nasolabial cyst

P - 076

WYBURN-MASON SYNDROME: A CASE REPORTVELI SUHA OZTURK, YUNUS EMRE ORUK, CAN ZAFER KARAMAN

Department of Radiology, Adnan Menderes University School of Medicine, Aydın, Turkey

Abstract

Introduction: Wyburn-Mason syndrome (WMS) is an extremely rare nonhereditary disorder and associated with multiple arteriovenous mal-formations (AVMs) containing the orbit, brain and face.

Case Report: We present the radiological features of a 33-year-old-woman with Wyburn-Mason syndrome, who suffered from decreased


visual acuity, headache and vomiting. In addition, she had a dark purple nodular mass located in medial canthus and upper eyelid. MRI examina-tion demonstrated an arteriovenous malformation from the orbit to the deep gray matter along the optic nerve on the left side. Cavernous sinus was also affected. Large arteriovenous malformations were detected in the thalamus, basal ganglia and hypothalamus. Angiomas and enlarged ves-sels were seen in the skin, especially in the orbital medial part.

Discussion: The cause of Wyburn-Mason syndrome is unknown. AVMs may range from absence of the capillaries to the presence of large masses of widened and twisted blood vessels; mostly extend thru orbit into the midbrain. According to the sporadic brain AVMs, those are seen at a younger age. Orbit is the region that mostly affected. The complete form of WMS was defined as vascular malformations involving all 3 zones, while the partial form of WMS was defined as vascular malformations involving 2 zones only. Decreased visual acuity, proptosis, blepharoptosis, dilated conjunctival vessels and nerve paralysis may occur in some individuals with WMS and retinal racemose hemangioma can be seen with ophthalmic examination. Neurological symptoms associated with Wyburn-Mason syndrome include severe headaches, vomiting, seizures, paralysis of vari-ous cranial nerves and neck stiffness also spontaneous hemorrhaging of these AVMs can lead to the sudden onset of symptoms. In rare cases, the skin may be affected and angiomas may be seen.

Conclusion: In conclusion, WMS is associated with a wide spectrum of multiple vascular malformations involving frequently unilateral orbits, brain and/or face. This congenital malformation could be easily detected by MRI.

Keywords: Arteriovenous malformation, Orbit, Brain, MRI

P - 077

SINONASAL MUCOSAL MELANOMAHAMZA OZER, SEMRA DURAN, HATICE GUL HATIPOGLU, DENIZ SOZMEN CILIZ, BULENT SAKMAN


Abstract

Malignant melanomas are rarely seen in the sinusoidal cavity; accounting for %0.3 of all mucosal malignant melanomas and 4% of head and neck tumors. It is commonly seen in man and women whom in advanced years. CT/RT is performed after surgery. Prognosis is very poor. Prognosis is determined by the size of the tumor, time of diagnosis and surgery. In our case, we presented a sinonasal malign melanoma case in a patient with unilateral nasal obstruction and edema.

Keywords: Malign melanoma, sinonasal, MRI

P - 078

PLASMACYTOMA OF THE PAROTID GLANDDENIZ SOZMEN CILIZ1, HAMZA OZER1, MUGE OZCAN2, SEMRA DURAN1, HATICE GUL HATIPOGLU1, BULENT SAKMAN1, MEHTAP CAVUSOGLU1

1Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey

2Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey

Abstract

Myeloma is a neoplasm of plasma cells that causes painful, bone-destruc-tive lesions. It may present as a solitary lesion (plasmacytoma), or involve multiple sites (multiple myeloma). Extramedullary plasmocytoma is a relatively rare neoplasm. 90% of cases occur in the head and neck region. Soft tissue plasmacytomas of the head and neck tend to involve the nasal cavity or nasopharynx instead of oral cavity. Solitary plasmocytomas in the parotid gland are rarely seen. We aimed to present the imaging findings in this case.

Keywords: Plasmacytoma, parotid, MRI

P - 079

ACCESSORY PAROTID GLANDZEYNEP NILUFER TEKIN

Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey

Abstract

23-year-old female with a known disease of spondiloartropathy presented to the romathology department of hospital with pain around her right ear radiating to her mandibula and neck. There was no other imaging find-ings to explain her pain. Neck magnetic resonance (MR) images showed accessory parotid gland presented on the lateral aspect of the masseter muscle, anterior and adjacent to the main parotid gland. Accessory parotid glands have the same ultrasound echotexture, computed tomography density and MR imaging signal as the main parotid glands. These have a typical appearence so that diferantiate from the other pathologies eas-ily. Accessory parotid glands are a normal variant and represent ectopic salivary tissue separate from, but usually in close proximity to, the main parotid glands. Occasionally the accessory tissue is contiguous with the main glands.

Keywords: Accessory parotid gland, normal variant, magnetic resonance imaging

P - 081

SARCOIDOSIS PRESENTING AS TRIGEMINAL NEVRALGIA: A CASE REPORTELIF AYSE UCAR, MELTEM OZDEMIR, AYNUR TURAN, BAKI HEKIMOGLU

Health Science University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: Sarcoidosis most commonly presents as a systemic dis-order. Infrequently, sarcoidosis can present as central nervous system disorder, with granulomas involving the leptomeninges and presenting with facial nerve weakness. Sarcoid of the trigeminal nerve is exceed-ingly rare.


Case Report: A 43-year-old woman presented with left-sided facial numbness and pain. Magnetic resonance imaging demonstrated thicken-ing of left trigeminal nerve and upon contrast administration, enhance-ment of all its course. There was also abnormal enhancement of the meninges along the Meckels caves. The right trigeminal nerve course showed minimal signal change and mild enhancement. There was also mild enhancement of bilateral fascial nerves. We suspected of neuro-sarcoidosis with this MRI findings and asked the patient about other systemic symptoms. She declared that she has been in the follow up for pulmonary sarcoidosis in another hospital for 14 months.

Discussion: Imaging findings in neurosarcoid include dural thickening or mass, leptomeningeal involvement, enhancing and non-enhancing parenchymal lesions, cranial nerve involvement and spinal or nerve root enhancement. The most common cranial nerve deficit involves the facial and optic nerves. Trigeminal nerve involvement, as in this case, is very rare with only few cases described in literature. Although rare, sarcoid infiltration of the Gasserian ganglion must be considered in the differential diagnosis of contrast-enhancing and T2 hypointense lesions at Meckel’s cave.

Conclusion: The diagnosis of neurosarcoidosis is always a challenge. For this reason definitive diagnosis requires the exclusion of other causes of neuropathy. Recognizing and correctly diagnosing neurosarcoid leads to proper treatment and decreased morbidity in patients.

Keywords: Sarcoidosis, cranial neuropathies, magnetic resonance imag-ing

P - 082

MR FINDINGS OF RETINAL DETACHMENTBAHAR YILMAZ CANKAYA, ADEM KARAMAN

Department of Radiology, Atatürk University Health Research and Application Center, Erzurum, Turkey

Abstract

Objective: Retinal detachment occurs when the neurosensory retinal layer and the retinal pigment epithelium are separated from each other. The liquid accumulates in the potential space created by separation. Retinal detachment may result in decreased visual function or complete loss of vision. In this case, MR images of retinal detachment in a 75 year old male patient were presented.

Materials and Methods: Brain imaging with a 1.5 T MRI device (Magnetom Avento, Siemens Healthcare) was performed to the patient who complained of headache and visual impairment.

Results: In brain MRI, in the right globe, in classical V-shaped T1 SE and T2 TSE-TRIM, where its apex in the optic nerve region, slightly hyperin-tense compared to vitreous fluid, and appearance compatible with retinal detachment was observed.

Conclusion: Retinal detachment occurs when the neurosensory retinal layer and retinal pigment epithelium are separated from each other. There are four major types of retinal detachment, tractional retinal detachment, exudative retinal detachment and combined retinal decol-lement. Exudative retinal decollement is less common than regmatoin retinal decollement and tractional retinal detachment, and is a detach-

ment of the character with subretinal fluid accumulation without traction or tear. The causes of retinal detachment include diabetic retinopathy, trauma, high myopia, congenital cataract, surgery, congenital glaucoma, sickle cell disease, leukemia, systemic lupus erythematosus and metastasis. Retinal detachment may result in complete loss of vision in late diagnosis. MRI is a guiding for a diagnosis.

Keywords: Retinal detachment, MRI

P - 083

TWO CASES OF EPIGLOTTIC LARYNGEAL CYSTS WITH DIAGNOSTIC MR APPEARANCEYESIM KARAGOZ, HANIFE GULDEN DUZKALIR, ZEHRA DONMEZ


Abstract

Epiglottic cysts are rarest laryngeal cysts reported in english literature since 19th century as several case series or separate case reports. They have different histogenetic origins diagnosed incidentally or causing diverse symptoms related to their location and size. Symptoms are generally hoarseness and dysphagia. Adult patients are mostly around sixth decade, though many pediatric cases has been reported. Two middle-aged male patients both with difficulty in swallowing and hoarse-ness were referred to our radiology department at different times . Before imaging , all patients were examined laryngoscopically. On oto-laryngologists note lesions were described as well defined swellings with smooth mucosal surface bearing anterior vallecular wall and lingual face of epiglottis. In all scan series, signal intensities were identical in both patients with slight different location along with sagittal plane (first case in the midline second one from right vallecula extending to midline). Because of hypointensity on T2 weighted images lesions were almost isointense to air column. They had no mural solid component and had homogeneous T1 hyperintensity. No enhancement was apparent after routine iv gadolinium injection. There are several classifications of these cysts representing a mixed group of benign laryngeal lesions that can cause diagnostic and the rapeutic difficulties. Early diagnosis and surgical excision must be planned especially those with large dimensions. There are some case reports of stridor and/or respiratory distress in neonates and young infants due to their small airway.

Keywords: Laryngeal cyst, epiglottic cyst

P - 084

SINONASAL MENINGIOMADENIZ SOZMEN CILIZ, HAMZA OZER, SEMRA DURAN, HATICE GUL HATIPOGLU, BULENT SAKMAN, MEHTAP CAVUSOGLU


Abstract

Meningioma consists of approximately 20% of all intracranial neoplasms and are the second most common tumors of the central nervous system


following the gliomas. Meningiomas rarely (2% of all menengiomas) show extracranial localization, mostly in the head-neck, especially paranasal sinuses. Clinical and radiological features of these tumors are nonspecific and histopathological evaluations are required for diagnosis. We aimed to present the patient with sinonasal meningioma patient including his imag-ing and histopathology findings.

Keywords: Extracranial meningioma, MRI, sinonasal

P - 085

INCIDENTALLY DETERMINED PERIRENAL HEMANGIOMA IN ADULT FEMALE PATIENT: CASE REPORTHATICE KUBRA OZDEMIR, HASAN YIGIT, SONAY AYDIN, ZEYNEP MUNTEHA AKBULUT, PINAR NERCIS KOSAR


Abstract

Hemangiomas are benign, vascular tumors and can be seen anywhere in the body. Renal hemangiomas are rare and most commonly localised in the medulla and renal pelvis. Perirenal hemangiomas that will be mentioned on this poster are much more rare lesions. A 62-year-old woman was examined with urinary ultrasonography due to a slight increase in creatinine values, and a solid lesion in the left kidney, which may be consistent with angiomyolyoma was discovered. MRI confirmed the diagnosis of angiomyolipoma in the left kidney. We also diagnosed a perirenal hemangioma at renal hilus, the size of 16x15 mm, observed as hyperintense at T2WI and hypointense in T1WI. The lesion shows peripheral-globular enhancement in arterial phase, and progressive increase in contrast enhancement in the following phases. Perirenal hemangiomas are rare, benign, mesenchymal vascular tumors. Small hemangiomas rarely have preoperative diagnosis because their findings are nonspecific. MR imaging shows homogeneous hypointense T1AG signals and hyperintense T2AG signals. Signaling loss in the lesion is primarily thought of as phlebolithia, and the existence of phlebolitia makes it easier to diagnose with CT. Contrast-enhanced series show contrast enhancement in the arterial phase and progressive contrast enhancement in the ongoing phases. However, findings are nonspe-cific and may mimic hypervascular tumors, transitional cell carcinoma, and renal cell carcinoma. The diagnosis of perirenal hemangiomas can be confirmed by histopathology or by long-term follow-up and characteristic imaging findings. In our patient, the defined lesion was diagnosed by the presence of classic imaging findings and stability in 6 year follow-up.

Keywords: Hemangiomas, perirenal hemangiomas

P - 086

FETAL MR IMAGING FINDINGSNUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, MUSTAFA KOPLAY, YAHYA PAKSOY

Department of Radiology, Selçuk University, School of Medicine, Konya, Turkey

Abstract

Objective: Fetal imaging is the most commonly used and first choice method due to its low cost of ultrasonography (US). However in some cases US is insufficient. Fetal Magnetic Resonance Imaging (MRI) is applied in order to validate any abnormal condition we determined or we sus-pected and also execute distribution and anatomic relations of complex lesions and to determine additional abnormal conditions. Also in case of conditions like maternal obesity, oligo-anhydramnios or other inappropri-ate fetal positions that limits US causes MRI indication. In this proceeding there had been fetal MRI examinations and monitored pathologies had been submitted.

Materials and Methods: Patients has been taken into this survey between November 2012-February 2018 in which are examined by 1.5 TESLA MR device. There has been coronal, axial and sagittal T2 HASTE, axial and coronal T1 weighted images and axial diffusion weighted images taken.

Results: 89 patients have been evaluated. There was twin pregnancy in 2 patients. There has been intra-cranial examination conducted in 71 patients, spinal examination has been conducted in 6 patients, thorax has been conducted in 3 patients, maxillo-facial examination conducted in 2 patients and abdominal pathologies has been examined in 3 patients. There has been no pathology found in 12 patients. For detected patholo-gies ventriculomegaly (n=10), colpo-cephaly (n=16) had been monitored and corpus callosum agenesis (n=10), corpus callosum disgenesis (n=3) had been accompanied with them. Isolated corpus callosum agenesis (n=1), isolated unilateral lateral ventricular dilatation (n=12), lissence-phalia (n=4), hydrocephalia (n=4) and secondary hydrocephalia has been monitored in 1 patient at MCA infarction. Dandy walker variance (n=5), dandy walker malformation (n=2) has been monitored. Agria (gyrus deficiency) -pachygria (n=4), meningocele (n=3), encephalocoele (1) has been observed. In one each patient maxilo-facial teratoma, lymphangioma in oral cavity, omphalocele, renal agenesia, renal hypoplasia, bronchopul-monary sequestration, cystic adenoid malformation, diaphragmatic hernia, sacral tail-gut cystic, alobar holoprosencephaly has been monitored.

Conclusion: MRI is more functional than US for distinguishing normal tis-sue from pathological tissue and it has higher contrast resolution proper-ties and due to these superior properties it is started to be used widely in common and it must be used in case of requirement.

Keywords: Fetal MRI, ventriculomegaly, agenesis

P - 087

MAGNETIC RESONANCE IMAGING IN SCROTAL DISORDERSFURKAN UFUK

Department of Radiology, Pamukkale University, School of Medicine, Denizli, Turkey

Abstract

Scrotal pain may result from testicular or extra-testicular pathologies. Early diagnosis and treatment of acute scrotal pathologies is important due to risk of infertility. Color Doppler ultrasound (CDU) is a recom-mended initial method to patients affected by scrotal pain. The depen-dence of the observer’s experience and device quality has disadvantages of CDU and in some cases CDUmay be insufficient for diagnosis. Recently, the use of magnetic resonance imaging (MRI) has been increasing in patients with scrotal pathologies, due to more detailed anatomical resolu-


tion. Radiologists should be familiar with MRI findings of common scrotal and testicular disorders for accurate diagnosis. In this report, we aimed to present the MRI findings of patients with scrotal disorders.

Keywords: Scrotal imaging, testicular tumors, testicular torsion, scrotal pseudotumors, trauma, magnetic resonance imaging

P - 088

INFLAMMATORY MYOFIBROBLASTIC TUMOR OF LUNG: CT AND MRI FINDINGSABDULLAH ENES ATAS1, NECDET POYRAZ1, ZEKI ILHAN1, SIDDIKA FINDIK2, TAMER ALTINOK3

1Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey2Department of Medical Pathology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey3Department of Thoracic Surgery, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey

Abstract

Inflammatory myofibroblastic tumor of the lung is a rare primary lung tumor previously called as “inflammatory pseudotumor”. The tumor appears more common in young adult patients. Patients may be asymp-tomatic, or present with nonspesific symptoms like cough, hemoptysis, dyspnea or pleuritic pain. Because of atypical symptoms and signs, those patients initially misdiagnosed as lung cancer and other pulmonary dis-eases. Here we present CT and MRI findings of 18-year-old male patient with pathologically proven inflammatory myofibroblastic tumor.

Keywords: Inflammatory myofibroblastic tumor, inflammatory pseudotu-mor, lung, computed tomography, magnetic resonance imaging

P - 089

MALIGNANT SOLITARY FIBROUS TUMOR OF THE PLEURAMUSTAFA YASIR OZLU, HAKAN CEBECI, EMINE UYSAL, MUSTAFA KOPLAY


Abstract

Objective: Solitary fibrous tumor of the pleura (SFTP) is a very rare neo-plasm arising from the submesothelial mesenchymal layer of the pleura. SFTPs are commonly benign lesions with potential malignant transforma-tion. Most of SFTPs are clinically asymptomatic and diagnosed incidentally in radiological imaging modalities. The clinical symptoms include cough, chest pain, dyspnea, finger clubbing and hypoglycemia. We aimed to pres-ent a case of a SFTP with malignant transformation.

Materials and Methods: A 67-year-old male patient admitted to our clinic with complaints of cough and dyspnea. A round mass lesion with sharp margins was detected posterior to the hearth, in chest X-ray. Computed tomography showed a huge lesion with the size of 10x12x13 cm in pos-terior inferior mediastinum. Possible differential diagnoses were neuro-genic tumors, neoplasms originated from pleura and diaphragm. Magnetic resonance imaging revealed for detailed examination and showed a lesion

heterogenous signal in both T1 and T2 weighted images. The lesion revealed significant enhancement after intravenous contrast material administration. The patient underwent thoracotomy and surgical excision was applied. Histology revealed a fibrous tumor with malignant features originating from the pleura.

Conclusion: SFTPs are commonly benign and rare neoplasms. There is a risk for recurrence and malignant transformation. Magnetic resonance imaging reveals adjunctive details for tumor margins and invasion to adja-cent organs.

Keywords: MRI, pleura, tumor

P - 090

MRI APPEARANCE OF TESTICULAR ADRENAL REST TUMORABDULLAH ENES ATAS1, OMER FARUK YUCE1, OZGU ALCALI1, SULEYMAN BAKDIK1, YUNUS EMRE GOGER2, LEMA TAVLI3, ULKU KERIMOGLU1

1Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey2Department of Urology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey3Department of Pathology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey

Abstract

Testicular adrenal rest tumor (TART) is a rare primary testicular tumor and described as an important complication of congenital adrenal hyper-plasia (CAH). Patients who were diagnosed as CAH should be followed-up for testicular imaging because TART has risk of testicular damage and infertility. TART can mimic other primary testicular tumors like germ cell tumors. Here we present MRI appearance of 23-year-old male patient with TART, formerly diagnosed as CAH.

Keywords: Testicular adrenal rest tumor, testicular, congenital adrenal hyperplasia, magnetic resonance.

P - 091

PILOMATRIXOMA LOCATED ON UPPER EXTREMITY NESE ASAL, UMRAN CANKAYA, MEHMET HAMDI SAHAN

Kırıkkale University, School of Medicine, Kırıkkale, Turkey

Abstract

Pilomatrixoma is a rare, benign, limited, calcifying epithelial neoplasm that arises from the hair pluripotent precursor matrix cells. It is usually seen as an asymptomatic hard mass on the head and neck and on the upper extremity, skin or under the skin. Multiple occurrences often have family history, and are associated with some syndromes. The treatment is simple excision. The definitive diagnosis is performed after histopathological evaluation. In this case report, we aimed to increase the knowledge of the physicians about pilomatrixoma and to consider the differential diagnosis of pilomatrixoma among skin neoplasms.

Keywords: Pilomatrixoma, skin, tumor, cyst


P - 092

A RARE CASE: CASTLEMAN DISEASE PRESENTING IN THE LUNG PARENCHYMAFATMA DURMAZ1, MESUT OZGOKCE1, HARUN ARSLAN1, ADEM YOKUS2, IBRAHIM AKBUDAK3, ALI MAHIR GUNDUZ1

1Department of Radiology, Van Yüzüncü Yıl University, School of Medicine, Van, Turkey2TR Ministry of Health University, Van Training and Resarch Hospital, Van, Turkey3Batman State Hospital, Batman, Turkey

Abstract

Objective: Castleman Disease (CD) is a rare lymphoproliferative disor-der of unknown cause.Mediastinum is the most commonsite of localized CD.Extranodal involvement is rare. Here, we report the case of a patient presenting with the hyalin vascular variant of the disease presenting as a solitary pulmonary mass, with CT and MR finding.

Materials and Methods: 20-year-old woman presented with nonspecifik caugh. CT revealed a solid hyperattenuating, well-circumscribed right lung lower lob. On MRI, the lung mass was homogeneously iso-hyperintense to muscle on T1-T2WI.Postcontrast imaging revealed avid enhancement of the lung mass. After performing open lung excisional biopsy, pathological examination revealed hyalin-vascular type Castleman Disease.

Discussion: CD is one of the more common causes of nonneoplastic lymphadenopathy.CD typically affects mediastinal lymph nodes, it can also affect intra-abdominal lymph nodes, as well as lymph nodes located in the axillary, cervical, pelvis. Extranodal involvement may occur in lung, larynx, parotis, pancreas, meninx and muscles, in only 5% of cases.CD may be classified morphologically as localized and multicentric, histologically Hyalin Vascular-type, Plasma Cell-type and mixedtype. The most common type is localized hyalin-vascular-type (%90). Majority of multicentric-CD is associ-ated with an immunodeficiency state and patients also have an increased risk for development of Kaposi sarcoma and lymphoma. Homogenous high enhancement is typically observed in Hyalin-Vascular-type CD due to the abundance of blood vessels.

Conclusion: Castleman disease can mimic many disease according to the involved region. As in our case, if lung is involved, it can mimic adenocancer.CD should be kept in mind in differantial diagnosis of solitary lung masses, in the case of well circumscribed, especially avid enhaenced lesions.

Keywords: Lung castleman disease, MRI

P - 093

PARASPINAL CYSTIC DEGENERATING MASSES –ATYPICAL PRESENTATION OF EXTRAMEDULLARY HEMATOPOIESISGULNAR AGHAYEVA, DUYGU IMRE, TUNCAY HAZIROLAN

Hacettepe University, School of Medicine, Ankara, Turkey

Abstract

EH (Extramedullary hematopoiesis) is the proliferation of hematopoi-etic precursor cells outside of bone marrow. In adults it is compensatory

mechanism, that is always associated with insufficient blood formation. Among the various atypical presentations paraspinal involvement deserves special attention due to irreversible neurologic damage. Thalassaemia is a hereditary haemolytic anaemia caused by deficiency of globulin chains. In this report, we present 34 year-old patient with Talasemia intermedia and typical MRI findings of paraspinal EH. Bilateral multipl large, lobulated ,smooth-margined paraspinal masses along the thoracic vertebra were demonstrated in obtained MRI. Massescaused widening of the neural foramens and thickening of the adjacent posterior rib heads. There were not any sign of neural compression nor any bone invasion. Lesions were composed of T1 and T2 hypointense homogenous enhanced solid com-ponents and cystic degeneration areas. Also, there were a decrease in the bone marrow intensity, a decrease in the T2 star value due to significant iron accumulation in liver and hepatosplenomegaly. MRI can clearly show anatomical details and extent of the masses within the spinal canal. In differential diagnosis NF1 and other neurologic tumors must be ques-tioned. During atypic soliter presentation biopsy can be done to conform diagnosis. In our case differential diagnosis was easy due to characteristic topography ,history and past MRI series.

Keywords: Extramedullary hematopoiesis, paraspinal mass, thalassaemia intermedia

P - 094

TUBOOVARIAN ABSCESS ARTER DELIVERY: CASE REPORTLEYLA KARACA, FATIH ERBAY, GULEC DOGAN

İnönü University, School of Medicine, Malatya, Turkey

Abstract

A 32-years-old woman presented to the obstetrıc clinic with history of low abdomen pain after just delivery. She had fever and unremarkable abdominal signs on physical examination. She had no complaint during the pregnancy. Pelvic magnetic resonance imaging (MRI) revealed a cystic lesion at the right adnexal region that was hypointense on T1 weighted (T1W) images and hyperintense on T2 weighted (T2W) images. After gadolinium administration, there was peripheral enhancement of the cys-tic lesion. Magnetic resonance imaging also showed multiple tubal ectasia Based on the above findings, the patient was diagnosed with tuboovarian abscess. At the surgery its revealed tuboovarian abscess with massive purulent contamination of the abdominal cavity. Tuboovarian abscess can occur at any during the any time periods. Tuboovarian abscess during pregnancy or immediately after birth are rare but it has been previously reported. According to an early literature, delayed diagnosis and inter-vention may cause maternal death or fetal loss but in our case it’s not complaint during the pregnancy. We report the case of a patient with tuboovarian abscess after just delıvery.

Keywords: Tuboovarian abscess, delivery, pregnancy

P - 095

BRONCHIAL ATRESIA MIMICKING PULMONARY ARTERY ANEURYSMSERKAN GUNEYLI1, EMRAH CAGLAR1, FATMA BUSRA CAYLAR1, MEHMET KORKMAZ2


1Bülent Ecevit University, Zonguldak, Turkey2Dumlupınar University, Kütahya, Turkey

Abstract

Objective: Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus associated with hyperinflation of the distal lung. It is usually asymptomatic and may be found incidentally. On imaging, it commonly presents as a proximal focal tubular shaped opacity radiating from the hilum. In the differential diagno-sis, pulmonary sequestration, bronchogenic cyst, endobronchial carcinoid tumor, pulmonary artery aneurysm, and allergic bronchopulmonary aspergillosis should be considered. We aimed to evaluate the radiological findings of a 56-year-old man with an opacity in the lung.

Materials and Methods: A 56-year-old man was admitted to our instu-tion with weakness, weight loss, and back pain. Contrast-enhanced thorax computed tomography (CT), and magnetic resonance imaging (MRI) were performed.

Results: Our case has a history of hyperlipidemia, hypertension, diabetes mellitus, and coronary artery disease. Twenty years ago, he had an acute ischemic stroke improved completely. Twenty-five years ago, he had a lung disease improved with treatment that was not clearly diagnosed. He has been complaining from weakness, weight loss, and back pain for 2 months. Chest X-ray revealed a tubular opacity in the left upper zone. Pulmonary artery aneurysm, tumor, and bronchial atresia were considered as a pre-liminary diagnosis. On contrast-enhanced CT, a lobulated lesion in the left upper lobe without marked enhancement was demonstrated. MR image showed the non-enhancing tubular lesion with a finger-in-glove appear-ance. The diagnosis of a bronchial atresia was made. In the follow-up, control CT after 1 year revealed the lesion without any change.

Keywords: Bronchial atresia, computed tomography, magnetic resonance imaging, pulmonary artery aneurysm

P - 096

CONGENITAL MUSCULAR DYSTROPHY FETAL MRI FINDINGSNUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, MUSTAFA KOPLAY, YAHYA PAKSOY


Abstract

Congenital muscular dystrophy (CMD), early onset hypotonia, weakness, myopathic findings and muscle in electromyography hereditary disease with frequent dystrophic changes in biopsy muscle disease group. The incidence in the society is estimated to be about 1/100,000. Early diag-nosis is very important for the management of the disease. Fetal MRI examination with pathologic changes in fetal intracranial structures should be performed in US. Brain structures in fetal MRI are examined in more detail, and MRI is superior to US in terms of maternal obesity, oligo-anhy-dramnios, or inappropriate fetal positions, and US in distinguishing normal tissue from pathologic tissue, necessity due to its superior features such as higher contrast resolution. In this proceeding there had been fetal MRI examinations and monitored pathologies had been submitted.

Keywords: Fetal MRI, congenital muscular dystrophy

P - 097

A RARE CASE OF THYMUS GLAND: TYMOLIPOMAOZLEM DEMIRCIOGLU, CANAN CIMSIT, NURI CAGATAY CIMSIT

Marmara University Pendik Training and Research Hospital, İstanbul, Turkey

Abstract

Thymolipomas are rare anterior mediastineal benign tumors that can occur at any age. Tumors are usually asymptomatic which grow slowly causing mass effect to adjacent thoracic structures. These fat containing slow- growing lesions usually give benign appearance which can enlarge in years and present with cough, dyspnea, hemoptysis, chest pain, hoarse-ness or paroxysmal atrial tachycardia. Thymomas can also arise from such lesions so close monitoring is necessary. Thymoma, thymic variation, hyperplasia of mediastinal fat, and neoplasms should be differentiated. Aplastic anemia, Graves, lymphoma and leukemia are described in asso-ciation with thymolipoma. We present the case of 53 year-old man who admitted to the Respiratory Disease Department with upper respiratory tract infection. Computed tomography demonstrated heterogeneous soft tissue mass with areas of extensive fat. Magnetic resonance imaging demonstrated anterior mediastineal mass containing multiple areas of high signal in both T1 and T2 sequences with homogeneous enhance-ment. The patient was referred for surgical treatment and histopathology confirmed the diagnosis of thymolipoma.

Keywords: Tymolipoma, mediastinal mass, magnetic resonance

P - 098

EXTRAMEDULLARY-INTRADURAL HEMANGIOMANIMET AKIN, BANU TOPCU CAKIR, AYHAN HIZ YIGIT, NURDAN CAY, AYSENUR OZCAN, KARABEKIR ERCAN


Abstract

A 48-year-old male patient; contrast-enhanced thoracic MRI images were obtained upon mass lesion detection on the spinal cord in unenhanced thoracic MRI images taken for back pain. Made in review; Mass , which is extramedullary-intradural and 7x1 cm measured, was observed in the posterior of spinal cord.In addition,the lesion is hypointence in T1A images compared with spinal cord and hyper-intence in T2A images compared with spinal cord. Spinal cord level is between T4-T7 spinal level.This mass is recognizable with diffuse contrast material after contrast injection. The lesion was bilaterally located at C5-C6 level and right neural foramene at C6-7 level. It was observed that it was anteriorly marked. In addition, linear enhance-ment was observed, which is showed to be compatible with the superior and inferior dural tail of the lesion. Meningioma was first considered in the differential diagnosis of lesions with present findings. However, other intradural lesions (schwannomas, metastases ...) were not ruled out. Histopathologic examination of the mass after surgery showed that the lesion was compatible with hemangioma.

Keywords: Intradural-extramedullary, hemangioma


P - 099

PRECOCCYGEAL EPIDERMOID CYST PRESENTING AS TENESMUSGOKHAN POLAT, HAYRI OGUL, RECEP SADE, MECIT KANTARCI, SUAT EREN, AKIN LEVENT

Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey

Abstract

A 23-year-old woman was admitted to our department with low back pain, tenesmus and functional constipation for a long time. MRI revealed a well-defined, unilocular, thin-walled cystic lesion in the retrorectal precoccygeal space. The lesion had homogeneous hyperintense signal characteristics on T2-weighted images . The cystic lesion also showed diffusion restriction with corresponding low intensity on apparent diffusion coefficient (ADC) map. Thus, the lesion was considered as epidermoid cyst accompanied by radiological features. The patient underwent surgical excision and the epidermoid cyst was corrected by histopathologically.

Keywords: Precoccygeal epidermoid cyst, tenesmus, MRI

P - 0100

CALVARIAL MASS CONFUSED WITH TRICHILEMMAL CYST: HCC METASTASISGOKHAN POLAT, RECEP SADE, HAYRI OGUL, MECIT KANTARCI, SUAT EREN, AKIN LEVENT


Abstract

Introduction: The hepatocellular cancer (HCC) calvarial metastasis is a rare condition that commonly present cranial swelling. Therefore, calvarial swelling may confuse with frequently lesions of the scalp. Our patient was operated as trichilemmal cyst. But, intracranial extension was seen in operation. Calvarial metastasis of HCC was observed by examination of the patient.

The hepatocellular cancer is the third most frequent tumor among cancer types. In addition, liver metastasis is the most frequent metas-tasis of hepatocellular cancer. The most frequent metastasizes is observed in the liver and lymph nodes among extrahepatic locations. The skeletal system involvement of HCC is limited. The skull metas-tasis of hepatocellular cancer has been described rarely. Our case is demonstrated the calvarial involvement which is rare involvement of HCC. The cranial lesion has been presented such as trichilemmal cyst different from described cases in published data. There is no another case reported with first presentation form like ours and diagnosed with HCC in similar way to our case in published data.

Case Report: 66-year-old male patient was admitted to neurosur-gery clinic with complaint of cranial mass. The complaint of cranial swelling was noted in history of patient. Also patient was admitted to another hospital with these complaints. Thereafter, he was diagnosed

with the trichilemmal cyst in that center and operation decision has taken by clinicians. Clinical operation has been terminated due to intracranial extent of lesions in plastic surgery department. The patient was referred to our hospital. Craniography was performed on patient. The bone defect was presented at the vertex level in graph. Cranial CT and MRI were performed on patient. A bone lesion was observed at vertex level with intracranial and extracranial extension. The lesion was well-circumscribed and destructed the bone. Patient was operated by neurosurgeon. HCC metastasis was diagnosed histopathologically after the operation. In addition, CT was performed on the patient. HCC carcinoma was observed in liver at the CT.

Discussion: Common primary neoplasms of metastatic cranial tumors are lung cancer, breast cancer, melanoma and colorectal cancer. Calvarial metastasis is reported between 0.4% to 1.6% in patients with HCC. HCCs calvarial metastasis has been described rarely in the literature. 3 type pattern of growth were observed in involvement calvarial. The first is intracranial, second is extracranial and the third is both intracranial and extracranial growth pattern. The lesion presentation shows differences according to the growth pattern. It has been described in the literature, especially the masses which represent an intracranial growth pattern confused with hemorrhage. There is the both intracranial and extracranial growth pattern in our case. Extracranial growth pattern may con-fuse with frequently lesions of the scalp. Also, trichilemmal cysts are frequently observed in the scalp. This cyst may be calcification or remain in solitary structure. In this case, it may confuse with all solitary lesions of the head. The treatment of the trichilemmal cyst is surgical removal. Therefore, the imaging is important before interventional procedure in solitary lesions of the head. Imaging detects the actual size and the extensions of the lesion. Also it shows that the lesions originated from skin or bone. Therefore, possible mistakes would be observing in diagnosis without utiliza-tion of the imaging methods. Consequently, the HCC, rare meta-static involvement of head, may be confused with other solitary lesions. Therefore, utilization of the imaging methods is important for accurate diagnosis and therapy.

Keywords: Calvarial mass, trichilemmal cyst, hcc metastasis

P - 0101

RARE AND SERIOUS COMPLICATIONS OF SINUSITIS IN PEDIATRIC PATIENTS: EPIDURAL ABCESSGOKHAN POLAT, RECEP SADE, HAYRI OGUL, BERHAN PIRIMOGLU, MECIT KANTARCI, SUAT EREN, AKIN LEVENT


Abstract

Introduction: Intracranial abscess has serious mortality. Therefore, early diagnosis and treatment is important. Intracranial abscess is rarely seen as a complication of sinusitis. Specially in children it has been reported rarely. Fever and headache can indicate complications in children. Intracranial abscesses are rarely reported in children and emerge due to bacterial


infections. Intracranial abscesses may observe as complication of sinus-itis. In addition, they were associated with high mortality and morbidity. Therefore, recognition of them is important. We have tried to show the rare and serious complication of isolated sinusitis in patient with headache and fever presented to the emergency department.

Case Report: 13-year-old male patient applied to the pediatric clinic with headache and fever. Patients had occasionally complained of head-aches for a long time. Recently, the complaints such as fatigue and fever has emerged and headache became constant in patient. A significant pathology was not observed in patients physical examination. The slightly increased leukocytosis was reported in laboratory results. Patient was scanned cranial computerized tomography. The subdural fluid collection was observed at the right frontal level in cranial CT. The cranial MRI was performed on the patient. There was collection restricted diffusion at MRI in the right frontal. Appearance was evalu-ated as abscess. Moreover, there was sinusitis in the right maxillary sinus and ethmoidal cells. Also the bone defect was not detected at this level. The antibiotherapy was started on patient. The patient was operated for epidural abscess in neurosurgery service. Subdural abscess was drained. The symptoms of the patient were decreased after the treatment.

Discussion: Epidural abscess is an important clinical entity. It may occur with hematogenous spread or direct contact. Direct contact is often observing as a complication of sinusitis. The intracranial transi-tion has occurred with spread on lamina paprecea or direct contact with after posttraumatic fracture. The meningitis, cavernous sinus thrombosis, potts puffy tumor and intracranial abscesses are located between intracranial complications of sinusitis. Patients are generally presented to the clinic with triad of headache, fever and focal deficit for epidural abscess. The fever and headache were observed but focal deficit was undeveloped in our case. Therefore, early diagnosis and treatment are important to protect from focal deficits and complica-tions in these patients. The most frequently isolated pathogens are Streptococcus, Hemophilus influenza and Staphylococcus. Treatment of antibiotic and drainage may also be applied at epidural abscess. The treatment process is long and difficult. The high mortality and morbid-ity are observed in patients with untreated timely. Furthermore, the treatment of sinusitis have an important role in the process. Especially, early diagnosis and treatment of sinusitis protect from complications in patients with headaches.

Conclusion: Epidural abscess is uncommon but serious complication of sinusitis. Therefore, the clinicians sufficiently should pay attention to the presence of complications as much as diagnosis and treatment of sinusitis in patients with headaches.

Keywords: Sinusitis in pediatric patients, epidural abcess

P - 0102

SIGN OF INTRACRANIAL EXTENSION IN SOLITARY PLASMACYTOMAGOKHAN POLAT, RECEP SADE, HAYRI OGUL, MECIT KANTARCI, SUAT EREN, AKIN LEVENT


Abstract

Solitary plasmacytoma usually gives systemic findings. Particularly the involvement of the head without systemic symptoms is uncommon. If cranial involvement occurs, the patient usually comes with a complaint of calvarial swelling. Development of headache complaints in the patient may indicate intracranial extension.

Keywords: Solitary plasmacytoma, intracranial extension, headache

P - 0103

A RARE COMPLICATION OF CRANIOCERVICAL TRAUMA AND THE IMPORTANCE OF THE MAGNETIC RESONANCE IMAGINGGOKHAN POLAT, HAYRI OGUL, MECIT KANTARCI, RECEP SADE, SUAT EREN, AKIN LEVENT


Abstract

Craniocervical injury generally occurs secondary to trauma. Imaging findings are important for diagnosis. Because these patients may be unconscious. Pseudomeningocele appearance is important for diagnosis. Accompanying complications such as epidural hematoma can occur with craniocervical magnetic resonance imaging (MRI). MRI may be guided for guiding therapy and diagnosis.

Keywords: Craniocervical trauma, magnetic resonance imaging, pseudo-meningocele

P - 0104

A RARE COMPLICATION AND PRESENTATION OF THE NEUROFIBROMATOSIS TYPE -1GOKHAN POLAT, HAYRI OGUL, MECIT KANTARCI


Abstract

Neurofibromatosis is a genetic disease. Characteristic features of the neurofibromatosis include Lisch nodules, café au lait spots, and neurofi-bromas. It can also cause musculoskeletal abnormalities. Atlantoaxial dis-location associated with neuro fibromatosis is also very rare. Atlantoaxial dislocation often leads to neurological symptoms. In our case, lesion observed at oropharyngeal area. We reported a unique case in which there was presence of dyspnea and progressive quadriparesis in the set-ting of neurofibromatosis and atlantoaxial dislocation.

Keywords: Neurofibromatosis Type -1, atlantoaxial dislocation, dys-

pnea


P - 0105

HYDATIDOSIS WITH MULTIPLE ORGAN INVOLVEMENT

GOKHAN POLAT, HAYRI OGUL, RECEP SADE, BERHAN PIRIMOGLU, MECIT KANTARCI, AKIN LEVENT, SUAT EREN


Abstract

A 79 year-old woman was admitted to our department with intermittent non-specific pains. MRI revealed a well-defined, unilocular, thin-walled multiple cystic lesion in the spleen, liver and cardiac. The lesions had homogeneous hyperintense signal characteristics with the hypointense rim on T2-weighted images. Some cystic lesions had germinative mem-branes. Thus, the lesions were considered as hydatid cyst accompanied by radiological features. Hydatid cyst was corrected by histopathologi-cally and supported by enzyme-linked immunosorbent assay (ELISA) for echinococcosis. The patient was treated with albendazole at a dose of 15 mg/kg/day.

Keywords: Hydatidosis, ELISA, MRI

P - 0106

GRANULOMATOUS INFECTION OF THE FACET JOINTGOKHAN POLAT, RECEP SADE, HAYRI OGUL, BERHAN PIRIMOGLU, MECIT KANTARCI, SUAT EREN, AKIN LEVENT


Abstract

A 17 year-old male presented to the pediatric clinic with complaints of lumbar pain and high fever. There was no history of trauma and surgery. There was history of tuberculosis. The spinal magnetic resonance (MR) imaging was performed. Magnetic resonance imaging (MRI) showed lum-bar 4/5 vertebrae facet joint heterogeneous hypointense on T1 weighted (T1W), heterogeneous hyperintense T2-weighted (T2W) images and it was heterogeneously enhanced after contrast administration. Laboratory findings showed increased inflammation markers. Lesion was identified as a granulomatous inflammation via pathological examination. According to radiological and laboratory findings, the lesions were evaluated primarily tuberculosis involvement of the facet joint. Septic arthritis is most preva-lently secondary to a bacterial infection with less common, more slowly progressive infections resulting from fungal or mycobacterial causes. Septic arthritis is most prevalently seen in larger peripheral joints, how-ever rarely reported in facet joints.

Keywords: Granulomatous Infection, spinal magnetic resonance, facet joint

P - 0107

A RARE NONOBSTRUCTIVE MASS OF THE URETER: NON-HODGKIN’S LYMPHOMAGOKHAN POLAT, UMMUGULSUM BAYRAKTUTAN, MECIT KANTARCI, HAYRI OGUL, SUAT EREN, AKIN LEVENT


Abstract

A 69-year-old man presented to hematology clinic complaining of fever and abdominal pain. Patient had non-Hodgkins lymphoma history. Abdominal computed tomography (CT) and Magnetic resonance imag-ing (MRI) were performed. MRI imagings revealed a massive increase in the ureteral wall thickness. On the diffusion-weighted imaging, the mass has relatively homogeneous increased signal intensity. The apparent diffusion coefficient (ADC) map reveals decreased ADC. CT imagings showed that the ureter was completely involvement. Non-Hodgkin lymphoma arising primarily from the ureteral wall is exceedingly uncom-mon. Also, obstruction was not observed against the massive involve-ment. The absence of obstruction and restriction of diffusion is typical for lymphoma.

Keywords: Nonobstructive mass of the ureter, non-hodgkins lymphoma, magnetic resonance imaging

P - 0109

A RARE CAUSE OF EPISODIC PARESTHESIA: SPINAL CAVERNOMARECEP SADE, HAYRI OGUL, MECIT KANTARCI, BERHAN PIRIMOGLU, AKIN LEVENT


Abstract

A 57-year-old male patient was admitted to our neurosurgery depart-ment with episodic numbness in both lower extremities during the past 6 months. Neurological examination and cranial magnetic resonance imaging were normal. Spinal magnetic resonance imaging was performed. Magnetic resonance images showed intramedullary cavernous angiomas (CA) at cervical spinal cord. Cavernous angiomas are vascular malforma-tions that occur throughout the central nervous system. Cavernous angio-mas most commonly occur in the cerebral hemispheres, but spinal CA are rare. Spinal CA can be intramedullary, intradural extramedullary, or extradural lesions. Intradural spinal CA are uncommon. Spinal CA occur mostly in the thoracic spine.

The common symptoms of spinal CA include paraesthesia, pain, and weakness. The mechanism of episodic deterioration in these patients is most likely episodic hemorrhage into the spinal cord parenchyma. A complete surgical resection is the goal of the treatment for spinal CA.

Keywords: Episodic paresthesia, spinal cavernoma, MRI finding


P - 0110

A RARE LOCALIZATION: PRIMARY PLEOMORPHIC UNDIFFERENTIATED SARCOMARECEP SADE1, LEYLA KARACA2, HAYRI OGUL1, UMMUGULSUM BARAKTUTAN1, MECIT KANTARCI1, BERHAN PIRIMOGLU1, AKIN LEVENT1

1Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey2Department of Radiology, İnönü University, School of Medicine, Malatya, Turkey

Abstract

A 51-year-old man with a 1 year history of back pain presented to our neurosurgery clinic. Lumber magnetic resonance imaging (MRI) revealed a mass hypointense T1-weighted image and hyperintense T2-weighted image at the L1–T12 vertebrae and paravertebral tissue. The mass was also spread into the retroperitoneal space. After injection of a contrast agent, magnetic resonance imaging showed a heterogeneous enhance-ment in mass. The tumor was incompletely excised. It was diagnosed as undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcomas are very rare but have been reported in the literature.

Keywords: Primary pleomorphic undifferentiated sarcoma, vertebrae, MRI findings

P - 0111

SEVERE TOXIC LEUKOENCEPHALOPATHY ASSOCIATED WITH TACROLIMUS AFTER LIVING DONOR LIVER TRANSPLANTATIONHAYRI OGUL1, LEYLA KARACA2, BERHAN PIRIMOGLU1, BULENT AYDINLI3, MECIT KANTARCI 1

1Department of Radiology, Atatürk University, School of Medicine, Erzurum, urkey2Department of Radiology, İnönü University, School of Medicine, Malatya, Turkey3 Department of General Surgery, Akdeniz University, School of Medicine, Antalya, Turkey

Abstract

A 32-year-old woman underwent living donor liver transplantation from her mother in April 2013 and received tacrolimus therapy. About 8 weeks after starting immunosuppressive therapy, the patient presented to our emergency radiology department with acute onset of aphasia and headache. No other neurological deficits were noted. Magnetic resonance imaging (MRI) during the episode showed significant diffusion restriction, with reduced ADC values in the bilaterally frontal, parietal and occipital white matter, internal capsule, middle cerebellar peduncle, corpus cal-losum. Tacrolimus blood level was within therapeutic range: 16.9 ng/mL (normal values 5–20 ng/mL). The tacrolimus dosage was decreased and stopped; it was replaced by cyclosporine A. After a decrease in tacrolimus dosage, the lesions gradually disappeared. The radiologic findings of the patient were consistent with the tacrolimus neurotoxicity. Clinical recov-ery was complete within 3 months.

Keywords: Tacrolimus, liver transplantation, acute toxic leukoencepha-lopathy

P - 0112

UTERINE ABSCESS AS A COMPLICATION OF ACUTE APPENDICITISOGUZ LAFCI, HASAN YIGIT, PINAR NERCIS KOSAR


Abstract

Acute appendicitis is a common cause of abdominal pain that requires surgical intervention. Main complications of acute appendicitis are perfora-tion, abscess formation, peritonitis, bowel obstruction, septic seeding of mesenteric vessels and gangrenous appendicitis, although in some rare occasions complications like appendico-vesical, appendico-cutaneous or appendico-uterine fistula formations may also occur. Here we present a case of a 83-year-old woman who was found to have uterine abscess due to acute appendicitis.

Keywords: Acute appendicitis, uterus, appendicitis complications

P - 0113

AN ATYPIC MELANOMA METASTASISKEMAL ARDA1, HASAN AYDIN2

1Department of Radiology, Gülhane Research Hospital, Ankara, Turkey2Department of Radiology, Oncology Research Hospital

Abstract

A 64 year old men with previous diagnosis of malignant melanoma, was referred to CT and MRI unit for suspicion of metastasis, in the Torax CT metastatic pulmonary nodules were observed. In Abdominal CT and MRI, Metastatic masses were shown in liver and spleen; Bilobar multiple metas-tasis were visualized in liver, parencymal and subcapsular multiple spleen metastasis were seen. In the Brain MRI, multipl cerebellar and cerebral metastasis were also observed mainly as Hyperintensities in T1W images.

Keywords: Melanoma-metastasis-MRI-ATYPIC

P - 0114

ERDHEIM-CHESTER DISEASE (ECD); PRESENTATION OF A CASE WITH MULTISYSTEMIC INVOLVEMENT USING MULTIMODALITY IMAGINGOSMAN CANCURI, SA TRAN, AJAY ARORA, SHWETA GUPTA

Princess Royal University Hospital, England

Abstract

ECD is a very rare multisystemic non-Langerhans-cell-histiocytosis. The disease has a broad spectrum of organ manifestations. Bones are the most common sites of involvement and scintigraphic appearance is pathognomonic. However nearly every organ may be involved. Cardiac disease commonly presents as right atrial pseudotumor. Retroperitoneal


disease involves the perirenal fat and kidneys. Herein, we present a case with bone, cardiovascular, retroperitoneal and renal involvement. An 81y old male patient was referred to radiology for Cardiac MRI for further investigation of a suspicious mass on echocardiography. MRI showed right atrial pseudomass with mediastinal/atrioventricular groove extension and superior vena cava (SVC) encasement. CT demonstrated additional distal right coronary artery encasement and bilateral perirenal-renal infiltra-tions. Skeletal survey revealed patchy sclerotic appendicular skeleton lesions which showed high tracer uptake on bone scintgraphy. FDG PET/CT revealed moderately increased metabolic activity of the right atrial/mediastinal lesion. Non-Langerhans-cell histiocytosis was diagnosed after CT-guided core biopsy of the retroperitoneal lesion.

Keywords: Erdheim-Chester disease (ECD), multimodality imaging, multi-systemic involvement, Non-Langerhans-cell histiocytosis

P - 0115

PIRIFORMIS SYNDROME MIMICKING LOMBER DISC HERNIAFADIME GUVEN, HAYRI OGUL, MECIT KANTARCI

Atatürk University, School of Medicine, Erzurum, Turkey

Abstract

The piriformis muscle originates from the anterior of sacral 2 and 4 ver-tebrae and from the sacroiliac joint capsule. The PS is a rare entrapment neuropathy in which the sciatic nerve is compromised by an abnormal piriformis muscle. Several variations in the anatomical relationship of the sciatic nerve and the piriformis muscle may be seen. Hypertrophy, inflammation, traumatic injury, anatomical variations of the piriformis muscle and/or the sciatic nerve, and myositis ossificans can cause PS. Approximately 6% of lower back pain and sciatica cases seen in a general practice may be caused by PS. However, this ratio may be higher because it’s similarity with radicüler pain. The rarity, nonspecific clinical symptoms, and absence of definite diagnostic tests may cause the diagnosis of pirifor-mis syndrome to be missed or delayed. MRI can be used to make a cor-rect diagnosis, to specify anatomic relationships for preoperative planning, and to differentiate piriformis syndrome from the more common causes of lower back pain and sciatic. In this case report, the patient presented to us as lumbar disc hernie who has with a complaint of pain spreading from hip to lower back and to left foot was evaluated by MRI. On MRI images it was seen that piriformis syndrome due to inflammation in the left piriformis muscle.

Keywords: Piriformis syndrome, sciatic nerve, magnetic resonance imag-ing

P - 0116

PULMONARY SEQUESTRATION: INTRAUTERIN ULTRASONOGRAPHY AND MRI FINDINGSFADIME GUVEN, EMSAL PINAR TOPDAGI YILMAZ, MECIT KANTARCI


Abstract

Pulmonary sequestration, also called accessory lung, refers to the aber-rant formation of segmental lung tissue that has no connection with the bronchial tree or pulmonary arteries. The estimated incidence is 0,1%. There are two types:intralobar sequestration (ILS) and extralobar seques-tration (ELS). ELS more commonly presents in newborns as respiratory distress, cyanosis, or infection, whereas ILS presents in late childhood or adolescence with recurrent pulmonary infections. Overall, sequestration preferentially affects the lower lobes. 60% of intralobar sequestrations affect the left lower lobe, and 40% the right lower lobe. Extralobar sequestrations almost always affect the left lower lobe, however, ~10% of extralobar sequestrations can be subdiaphragmatic. In this case report, ultrasonography and MRI findings of the pulmonary sequestration in the lower lobe of the left lung during 26 week intrauterine pregnancy exami-nation was emphasized.

Keywords: Pulmonary sequestration, fetal MRI, ultrasonography

P - 0117

PARASITIC LEIOMYOMA IN THE LUNGISMAIL YURTSEVER, RASUL SHARIFOV

Department of Radiology, Bezmialem Vakıf University, School of Medicine, İstanbul, Turkey

Abstract

Thoracic CT of 78-years-old female patient complaining of dyspnea and weight loss revealed well defined multiple enhancing mass lesions together with infected bronchiectasis in the both lung parenchyma. For charac-terization of masses MRI was performed. Leiomyoma was diagnosed on biopsy. Myomectomy and coronary artery by-pass surgery were present on history of the patient. Uterine leiomyomas are one of the most com-mon tumors in women. Parasitic leiomyoma is an uncommon type of uterine leiomyoma. It may present with a wide spectrum of symptoms. A parasitic leiomyoma that had blood supplies from the common iliac ves-sels was diagnosed during the operation. Total abdominal hysterectomy and mass removal were performed without complication. Even though a parasitic leiomyoma is uncommon, it should be included in the differential diagnosis of pelvic and lung mass.

Keywords: Parasitic leiomyoma, lung mass, hysterectomy

P - 0118

A RARE LOCATION OF HYDATID CYSTFADIME GUVEN, RECEP SADE, MECIT KANTARCI


Abstract

Hydatid cyst is an endemic parasitic disease seen in people who are engaged in agriculture and animal husbandry. It is most commonly local-ized in the liver and lungs. In this case report, we aimed to identify MRI findings of a rare localization of cyst hydatid. A 25-year-old woman with a complaint of swelling is seen in the left posterior cervical region with a hydatid cyst located at C2-4 level in the side of the left arch of the vertebra.

Keywords: Hydatid cyst, neck, magnetic resonance imaging


P - 0119

COR TRIATRIATUM SINISTER WITH PRIMUM ATRIAL SEPTAL DEFECTEMIN DEMIREL1, CIGDEM OZER GOKASLAN1, SERKAN GOKASLAN2

1Department of Radiology, Afyon Kocatepe University, Afyonkarahisar, Turkey2Department of Cardiology, Afyon Kocatepe University, Afyonkarahisar, Turkey

Abstract

Cor triatriatum sinister is a comperatively rare congenital malforma-tion in which the left atrium is divided by a fibromuscular membrane into two seperated chambers. The embryologic origin of this congenital defect is still debated. The presentation of patients can be during infancy, childhood, or adulthood, and this is due largely to variation in both the degree of obstruction to pulmonary venous return and the presence of associated lesions. We describe the case of a patient presenting in early adulthood with symptoms associated with cor triatriatum sinister and an primum atrial septal defect.

Keywords: Atrial septal defect, cardiac MRI, cor triatriatum sinistrum

P - 0120

PATTERNS OF MYOCARDIAL LATE ENHANCEMENTFURKAN BULUT, IBRAHIM HALIL OZYAVUZ, YUNUS EMRE AKPINAR, MENDUH DURSUN

Department of Radiology, İstanbul University School of Medicine, İstanbul, Turkey

Abstract

Magnetic resonance imaging (MRI) was initially utilized to distinguish viable myocardium from scar tissue in the evaluation of cardiac pathologies. The use of MRI for this purpose is important for evaluating different cardiac pathologies with a non-invasive examination method. Myocardial late contrast enhancement has an important role in cardiovascular magnetic resonance imaging. In this review, we aimed to describe late contrast enhancement patterns on ischemic and non-ischemic cardiomyopathy cases such as myocarditis, sarcodiosis, amyloidosis, systemic sclerosis, Duchenne muscular distrophy, Becker muscular distrophy, systemic lupus erythematosus, hypertrophic cardiomyopathy, dilated cardiomyopathy, left ventricular non-compaction, arrhythmogenic right ventricular dyspla-sia, pulmonary hypertension and infective endocarditis.

Keywords: Cardiac imaging, ischemic cardiomyopathy, myocarditis, amy-loidosis

P - 0121

CONSTRICTIVE PERICARDITIS MR IMAGING FINDINGSEMEL YERLI, KEMAL BUGRA MEMIS, ELIF PEKER, BASAK GULPINAR, ANIL COLAKLAR, MEMET ILHAN ERDEN


Abstract

Introduction: Constrictive pericarditis; is a rare disease that develops due to chronic inflammation of the pericardium and results in thickening of the pericardium, adhesion between the pericardial leaves and occasionally calcification. Diastolic filling of the heart is typically reduced, resulting in an increase in diastolic pressures. As a result, symptoms of systemic and pulmonary venous congestion occur. A case of constrictive pericarditis is presented with imaging findings.

Case Report: A 62-year-old male patient with chronic liver failure was admitted to our hospital. Dynamic liver computed tomography (CT) examination revealed contour nodularity compatible with chronic liver disease in the liver and hypertrophy of the caudate lobe. Hepatic venules and inferior vena cava were significantly dilated. Pericardial thickening and calcification was observed in the pericardium in the thorax sections included in the study. Contrast-enhanced cardiac MR images, revealed biatrial enlargement. The pericardium was thickened diffusely, especially in the vicinity of the right ventricle. The lateral wall of the right ventricle was compressed. There was mild enhanecement in the pericardium. Paradoxical wall motion was observed in the interventricular septum. The findings were consistent with constrictive pericarditis.

Conclusion: Constructive pericarditis is a rare but important disease that causes high morbidity and mortality. Diagnostic imaging methods can be used and MR imaging provides a significant advantage over other imaging modalities in terms of constrictive pericarditis in many ways.

Keywords: Cardiac MRI, constrictive pericarditis, pericardial thickening

P - 0122

FOUR PATIENTS WITH CARDIAC HYDATID CYST IN UNUSUAL LOCATIONSSAFIYE SANEM DERELI BULUT1, FUAT NURILI2, YASAR BUKTE1

1Department of Radiology, Health Sciences University Umraniye Research and Training Hospital, İstanbul, Turkey2Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA

Abstract

Hydatid disease commonly involves liver but in rare cases, it can involve cardiac structures. Cardiac involvement in hydatid disease is uncommon, constituting only 0.5–2% of all cases of hydatidosis. We report three cases of hydatid cyst in unusual locations of heart. All patients underwent MR examination with a 1.5-T system (OPTIMA MR 450,GE) with ECG triggering. Areas of cardiac involvement in hydatid disease usually include the left ventricle (60% of cases), right ventricle (10%), pericardium (7%), pulmonary artery (6%), and left atrial appendage (6%); involvement of the interventricular septum is rare (4% of cases). One of our patients was 38 years old and the hydatid cyst was located in AV groove. In 13-year-old patient, hydatid cyst was located in the right ventricular free wall with pericardial massive effusion. the other patients cardiac mass was located in the lateral wall of the left ventricle. The diagnosis of hydatid cyst was confirmed by serological tests and operation. Early diagnosis and surgico-medical treatment is the success key of treatment for cardiac hydatid disease. In endemic areas, hydatid cyst should be considered in differential diagnosis of heterogeneous echogenic lesions in ECHO on even if the serologic tests are negative. Physician can use cardiac MRI to earn valuable information about the lesion and its relation to other structures.

Keywords: Hydatid cyst, cardiac MR, unusual involvement


P - 0123

MASS-LIKE HYPERTROPHIC CARDIOMYOPATHY: A DIFFICULT CASE TO DISTINGUISH FROM CARDIAC MASSESMEHMET ERSEN, UGUR BOZLAR, SINAN AKAY, KEMAL NIYAZI ARDA, SALIH HAMCAN, HATICE TUBA SANAL, MUSTAFA TASAR

Department of Radiology, Gülhane Gülhane Military Medicine Academy, Ankara Turkey

Abstract

Objective: Hypertrophic cardiomyopathy (HCM) is a cardiomyopathy which continues with focal or diffuse ventricular wall thickening without any other systemic or cardiological disease. HCM is the most-common primary cardiomyopathy and it has autosomal dominant genetic back-ground. But some HCM types are difficult to diagnose like mass-like HCM. To describe MRI features of a case with mass-like HCM.

Materials and Methods: 49-year-old female patient with complaint of shortness of breath on exertion has been referred to our radiology department for cardiac MRI imaging. Cardiac MRI showed T1 and T2 hypointense focal lesion in the basal-mid cardiac portion of the inter-ventricular septum. Lesion shows contractility on cine-steady state free precession (SSFP) and cine grid-tagged images. There were patch-like late gadolinium enhancement (LGE) areas in the lesion on phase sensitive inversion recovery (PSIR) images.

Conclusion: Mass-like HCM’s are visualized as mass as similar intensity with myocardium and causes lobulation in myocardium contours. These findings lead to interpretation of this HCM subtype as a cardiac mass. Cardiac MRI plays a critical role in distinguishing mass and mass-like HCM at this point. Diffuse or focal myocardial thickening and patch like late gad-olinium enhancement on thickened part are the main diagnostic imaging findings of HCM. But, these findings may not be enough to distinguish the focal/mass-like HCM from the cardiac masses. In such cases, demonstra-tion of myocardial contractility gains importance in differential diagnosis. Myocardial contractility can be assessed in cine-SSFP sequences or more prominently in cine myocardial tagging images.

Keywords: Hypertrophic cardiomyopathy, tagging, mass-like HCM

P - 0124

CALCIFIED AMORPHOUS TUMOR OF HEART: A RARE CASE REPORTUGUR BOZLAR, MEHMET ERSEN, SALIH HAMCAN, HATICE TUBA SANAL, KEMAL NIYAZI ARDA, SINAN AKAY, MUSTAFA TASAR

Department of Radiology, Gülhane Military Medicine Academy, Ankara, Turkey

Abstract

Objective: Calcified Amorphous Tumor (CAT) is a rare, non-neoplastic mass which can mimic malign lesions of heart. It is first described in 1997. Before that time non-neoplastic masses of heart are known as pseudo-

tumor and they were usually used for conditions related with thrombi. To describe cardiac magnetic resonance imaging (CMR) and computed tomography angiography (CTA) features of a case with cardiac calcified amorphous tumor.

Materials and Methods: 62-year-old female patient with mass conform-ing findings near to mitral valve on echocardiography imaging, has been referred to our radiology department for further evaluation. CTA imaging showed a calcified lesion near the posterior leaflet of mitral valve. After that patient evaluated with CMR. CMR showed a mobil, hypointense lesion on T1 and T2-weighted images near the annulus on mitral valve posterior leaflets inferior surface. Late gadolinium enhancement on the around the lesion which associated with fibroinflammatory process was observed.

Conclusion: Cardiac CAT is associated with nodular calcium deposits and with a background of fibrin and amorphous fibrillary material. Cardiac CAT usually seen as calcified or partially calcified mass on CT images. They usually visualized as hypointense lesions on T1 and T2 weighted images on MRI images. They can be seen as mobile mass depending on the attach-ment point. Cardiac CATs usually don’t show enhancement on early or late gadolinium images. But our lesion showed peripheral enhancement related with fibroinflammatory reaction near lesion. Surgical excision in suitable patients can be curative. Valve repair may be necessary to prevent valvular dysfunction.

Keywords: Calcified tumor, pseudotumor of heart, CMR, cardiac MRI

P - 0125

SACCULAR ANEURYSM IN GREAT SAPHENOUS VEIN WHICH IMITATING HERNIABAHAR YILMAZ CANKAYA, HAYRI OGUL

Department of Radiology, Ataturk University Health Research and Application Centeri Erzurum, Turkey

Abstract

Objective: Venous aneurysms are rare lesions and are important for the risk of life-threatening pulmonary embolism. Differential diagnosis should be made with inguinal hernia, femoral hernia or lymphadenopathies with the location of the Great Safen venous aneurysm. In this case report, MRI findings of a 64 year old female patient with a large saccular aneurysm were included.

Matherials and Methods: In the right femoral region, a thigh imaging with a 1.5 T MRI device (Magnetom Avento, Siemens Healthcare) was performed to the patient who complained of increasing swelling and pain for 1 month.

Results: In the MRI taken for the right thigh region, signal changes were observed proximal to the large saphenous vein, which corresponded to a 4.5 cm diameter, broad necked saccular aneurysm and a lumen thrombus.

Conclusion: In primary venous aneurysms, jugular vein, anterior part of the arm, femoral vein and popliteal vein aneurysms are frequently seen, and rarely are large saphen vein aneurysms. Serious problems can be encountered if there is not enough evaluation before the operation or biopsy.

Keywords: Vein, aneurysm, MRI, hernia


P - 0126

SYNOVIAL HEMANGIOMA AND VARICOSE VEINS OF THE KNEE JOINTYASEMIN ALTINTAS

Private Adana Ortadoğu Hospital, Adana, Turkey

Abstract

Introduction: Synovial hemangiomas are rare benign tumors of the knee joint. In childhood and early adulthood, there is confusion with knee pain and non traumatic hemarthrosis. They are often diagnosed late. Magnetic resonance imaging is the best diagnostic method and the best radiological examination in the differential diagnosis of other lesions of the knee joint.

Case Report: A 40-year-old male patient presented to our clinic with complaints of swelling and limitation of movement in the left knee. MRI showed suprapatellar, infrapatellar lobuleted mass containing fibrous septa and common varicose vein around the knee joint.

Conclusions: Synovial hemangiomas should be considered in patients with recurrent pain and swelling of the knee joint. Patients with late diag-nosis develop osteoarthritis at an early age. For this reason, typical MR findings should be evaluated correctly.

Keywords: Synovial hemangioma, knee joint, MRI, varicose veins

P - 0127

FREIBERG DISEASE IMAGING FINDINGS: A COMMON CAUSE OF METATARSALGIA REVISITEDABDULLAH SUKUN, BERNA AK YILDIZ, SINAN ULGEN, BULENT CEKIC, ICLAL ERDEM TOSLAK

Department of Radiology, Health Sciences University Antalya Training and Research Hospital Antalya, Turkey

Abstract

Freiberg disease, osteochondrosis of metatarsal heads, is a common cause of metatarsilgea. It is the only osteochondrosis seen more frequently in women than in men. When first identified, it was so called aseptic or avas-cular necrosis of the metatarsal head, and defined as the inco mpleteness of the metatarsal head. Normally, the current load is distributed to each metatarsal bones. Overloading of one of the metatarsal head in Freibergs disease causes micro fractures in the cortical changes of the long but less mobile metatarsal head. Recurrent microtrauma results in impaired sub-chondral flow, resulting in chondral collapse and necrosis. Wearing high-heel shoes may be a reason especially in adolescents and young women, in which one foot and one metatarsal is usually involved. One in ten of the patients may have both feet involvement. Accompanying reactive synovitis may cause swelling and limitation of motion in the joint. Pain is more pronounced in weight bearing and lean feet walking. MRI is important in the diagnosis at early stage. Surgical rescue osteotomy is performed in the early period of recovery and plays an important role management of the diseases. We aimed to present the radiological features of Freiberg disease including radiographic, CT, and MRI findings.

Keywords: Freiberg disease, metatarsalgy, avascular necrosis of metatarsal head

P - 0128

OSGOOD SCHLATTER DISEASE FOLLOWING SINDING-LARSEN-JOHANSSON SYNDROME: MRI FINDINGS OF TWO OSTEOCHONDROSIS OF KNEE IN SAME PATIENTBUKET YAGCI2, ICLAL ERDEM TOSLAK1, BERNA AK YILDIZ1

1 Antalya Training and Research Hospital, Antalya, Turkey2 Kastamonu State Hospital, Kastamonu, Turkey

Abstract

Introduction: Sinding-Larsen-Johansson (SLJ) syndrome is an osteochon-drosis of the inferior pole of the patella. SLJ affects the proximal end of the patellar tendon as it inserts into the inferior pole of the patella. The SLJ syndrome is caused by increased tension and pressure due to repeti-tive traction by the patellar tendon on the lower pole of the patella. SLJ disease is seen in active adolescents, typically between 10-14 years of age . SLJ syndrome has a pathogenesis similar to that of the Osgood-Schlatter disease and two disorders sometimes occur simultaneously. In this case report, we aimed to present MRI findings in an 11-year-old-boy with a prior diagnosis of SLJ in whom Osgood Schlatter Disease and Clergyman knee developed in a year after SLJ diagnosis.

Case Report: A 11-year-old boy presented to a pediatric outpatient clinic with a 2-month history of knee pain. The pain was exaggerated especially after climbing stairs or walking for long distances. Standard X Rays on AP and lateral projections and right/left knee MRI were performed. A bony fragment at inferior pole of patella was seen on plain radiograph. There was also associated thickening of proximal patellar tendon. On MRI, the inferior pole of the patella, proximal and posterior part of the patellar ligament and surrounding soft tissues were hypointense on T1-weighted MRI sequences and hyperintense on fluid sensitive T2-weighted MRI sequences. A diagnosis of Sinding-Larsen-Johansson syndrome (osteochondrosis of the inferior pole of the patel-la) was made and patient was treated conservatively. At 1-year follow-up examination another series of X ray and knee MRI was performed for the same knee as the patient’s symptoms hadn’t resolved. On X ray, fragmented apophysis at tibial tuberosity and obscuring of infrapatellar fat planes were seen suggesting edema/effusion in this region. On MRI there were soft-tissue swelling anterior to the tibial tuberosity, loss of the sharp inferior angle of the Hoffa’s fat pad, thickening and edema of the inferior patellar tendon and infrapatellar bursitis. Patient was diag-nosed as Osgood Schlatter disease and Clergyman’s knee.

Conclusion: Osteochondrosis of the tibial tuberosity (Osgood Schlatter disease) and osteochondrosis of the inferior patella (SLJ syndrome) occur at tendinous insertions of the patella at the distal and proximal levels, respectively. Infrapatellar bursitis (clergyman knee) occurs with inflam-mation of bursae around the insertion of the distal patellar tendon. Infrapatellar bursitis may be a component of Osgood-Schlatter disease.

Keywords: Sinding-Larsen-Johansson syndrome, Osgood-Schlatter, MRI

P - 0129

GIANT SOLITARY SYNOVIAL OSTEOCHONDROMA OF THE HIP


RAFAIL JOMARDOV, IPEK TAMSEL, MEHMET ARGIN


Abstract

Giant or solitary osteochondroma is part of a rare disorder known as syno-vial osteochondromatosis. Usually arising from the juxta-articular soft tissues without attaching to the bone, these lesions can be large and show clinical and radiological features of a malignant process. It usually present in adult population and is rare in children. The main symptoms are pain, swelling and limitation of movements in the affected joint. This report is about 22 old male patient present with pain and limited range of motion at hip and right leg caused by giant solitary synovial osteochondroma of the hip. In this rare case we demonstrate the X-ray and MRI findings of the giant osteochondroma.

Keywords: Solitary osteochondroma, pain, hip

P - 0130

HUMERAL CHONDRAL DEFECT AND LABRAL TEAR ASSOCIATED WITH PARAGLENOID LABRAL CYST: A CASE REPORTBERHAN PIRIMOGLU, HAYRI OGUL, MECIT KANTARCI


Abstract

Objective: To report an unusual combination of paraglenoid labral cyst and labral tear with chondral defect of the humeral head.

Clinical Presentation: A 34-year-old man presented with right shoul-der pain. Conventional MR imaging showed paraglenoid labral cyst. MR arthrography revealed a humeral chondral defect and labral tear associ-ated with paraglenoid labral cyst, and a defect of the posterior inferior labrum extending to the superior labrum and humeral chondral defect. The patient underwent arthroscopic surgery.

Conclusion: This case showed the importance of MR arthrography in a case that involved an unusual combination of paraglenoid labral cyst and labral tear with chondral defect.

Keywords: Paraglenoid labral cyst, 3D VIBE MR arthrography sequence, labral tear, chondral defect

P - 0131

RIGHT HAND 2ND FINGER A1 PULLEY RUPTUREABDULLAH SUKUN, BERNA AK YILDIZ, EMIN DURMUS, SINAN ULGEN, ICLAL ERDEM TOSLAK

Department of Radiology, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Flanks movements are provided by deep and superficial flexor tendons. The fibrous construct that provides stabilization of the flexor tendons is called

pulley. Pulleys are 2 types including anulus and krusiform. While the annular scales are thicker and stronger than the crusiform scales are thinner and the annular scales prevent tendon dislocation, they also allow optimal joint motion. Krusiform pulley facilitates the movement and contributes to flexibility. Scales sticking to the periosteum and volar plate of phalanges slide along the fibrous canal. Except for the thumb, there are a total of 8 pulleys, 5 of which are ann-lar and 3 of which are crusiform. The pulleys supporting the synovial sheath are separated according to joint levels. There is A1 at the level of the MKP joint, A3 at the PIF joint level, and A5 Pulleyi at the DIF joint level. A2pulley is from the MP joint to the begining of proximal phalanx. A4 pulley is proxi-mal to middle phalanx. In the absence of A2 and A4 pulleys, finger flap loss increases. Thus it must be repaired absolutely. Generally pulley rupture include long fingers. Pulley injuries usually start at A2 and these injuries are called climber’s finger. Isolated A1 pulley injury is rare. We aimed to present A1 rup-ture findings in a 34-year-old man who presented with hand pain complaints.

Keywords: Pulley rupture, A1 pulley injury, climbers finger

P - 0132

MALIGN PERIPHERAL NERVE SHEATH TUMOR: A CASE REPORTABDULLAH SUKUN, SAMET MUTLU, EMIN DURMUS, BERNA AK YILDIZ, ICLAL ERDEM TOSLAK


Abstract

By definition, malignant soft tissue tumors arising from nerve tissue, including neurofibrosarcoma, neurosarcoma and malignant schwannoma, are included. The origin may be the schwann cell as well as the fibroblast and the perineural cell. These are called malignant peripheral nerve sheath tumors (MPSCT) because of the difficulty in distinguishing them. The great nerve involvement in the extremity and body is frequent. It is seen in 2-5% of patients with neurofi-bromatosis. However, half of the patients with MPSCT are NF-1. Involvement in children is rare. The mass does not show any sign until it reaches a certain size, so the mixture comes out as massive masses. Symptoms such as pain, weakness and numbness occurs late. 1/5 of the tumors come to the upper extremity. This constitutes approximately 3% of all malignant tumors of the hand. We aimed to present the radiological features of malignant peripheral nerve sheath tumors in a 79-year-old woman with wrist pain.

Keywords: MPSCT, NF-1, Nerve sheath tumor

P – 0133

CHARCOT SHOULDER: A DIFFERENTIAL DIAGNOSIS TO BE KEPT IN MINDMURAT UCAR, BERRAK BARUTCU, UMUT ASFUROGLU, NIL TOKGOZ

Gazi University School of Medicine, Ankara, Turkey

Abstract

Neuropathic arthropathy, also known as Charcot joint, is a progressive and chronic degenerative disease which causes loss or reduction of sensation


and pain or destruction of the affected joint. One of the most common causes is syringomyelia. Patients with syringomyelia frequently suffer from shoulder involvement. Neuropathic arthropathy may develop early or late in the course of syringomyelia and occurs 25% all cases of syringomyelia. MRI is the most useful imaging modality to diagnose syringomyelia and neuroarthropathy. In the early stage of the disease, joints can be warm and erythematous and it can be difficult to differentiate from septic arthritis. In addition to this, joint effusion, soft-tissue swelling, joint space narrowing, sub-chondral sclerosis and osteophytes are early radiologic findings in common with primary osteoarthrosis in the early stages. It is important to think about differential diagnosis due to varied treatment plans. Herein, we present MRI findings of a patient with neuropathic arthropathy of the shoulder second-ary to Chiari type I malformation associated with syringomyelia.

Keywords: Charcot joint, syringomyelia, neuropathic artropathy

P - 0134

INTRAMUSCULAR EXTRAOSSEOUS PLASMACYTOMA: A CASE REPORTIPEK TAMSEL, MEHMET ARGIN


Abstract

In multiple myeloma, secondary infiltration of muscle structures adjacent to bone lesions is frequently seen. Nevertheless, plasmacytoma, which occurs directly in muscle tissue without bone lesions, is rarely reported.Typically seen in the head and neck. It accounts approximately 3% of all plasma cell neoplasms. MRI examination of a 78-year-old male patient who presented with swelling and pain on the way to our institution revealed a solid mass lesion within the triceps muscle. The result of the biopsy was an extraosseous plasmacytoma. In this case report, we present radiological imaging findings of isolated extraosseous plasmacytoma in the triceps muscle without bone lesion.

Keywords: Multiple myeloma, muscles, neoplasms, plasmacytoma, plasma cell

P - 0135

SYNOVIAL CHONDROMATOSIS MIMICKING SOFT TISSUE CHONDROSARCOMAIPEK TAMSEL, MEHMET ARGIN


Abstract

Synovial chondromatosis, joint, tendon sheath or synovial membrane of the bursa metaplasia is characterized by the formation of multiple chondral or osteochondral nodules within the resultant synovium. It is benign and usually monoarticular. It is most often seen in large joints such as the knees, hips, shoulders and elbows, less frequently in the joints of the foot and ankle. In this case report, we present MRI findings of a 39-year-old female patient with synovial chondromatosis diagnosed as aggressive behavior that mimics soft tissue chondrosarcoma causing erosion in adjacent bone structures in infiltrative form at the level of intertarsal and tarsometatarsal joints.

Keywords: Synovial chondromatosis, joint, soft tissue chondrosarcoma

P - 0136

A RARE ENTITY; OSTEOID OSTEOMA OF TALUSCIGDEM OZER GOKASLAN, CANAN INCEOGLU


Abstract

Osteoid osteoma is a benign, osteoblastic well circumscribed tumor of spongy bone. Osteoid osteoma can be localized in all bones. It is more common in the lower extremities. It is most common in femur and sec-ondly in tibia. Osteoid osteoma is localized approximately % 60 in femur and tibia. In %20 of the cases, it locates in hand and foot bones. It is seen most in proximal phalanx, metacarpal bones and scaphoid. It is seen % 4-5 in talus, %2-3 in calcaneus. Approximately %10 of cases is localized ver-tebrae. High degree of suspicion is needed for early diagnosis and delay in diagnosis can cause significant disability because of osteoid osteoma is a rare entity in the tarsal bones. If the diagnosis is made early, it can be treated without complication. Radiofrequency ablation is safe, minimally invasive method especially to treat juxta-articular and inaccessible lesions.

We present radiological findings of a osteoid osteoma of the talus which was not been suspected over a long time because of its rare location.

Keywords: Osteoid osteom, talus, CT, MRI

P - 0137

KNEE SYNOVYAL SARCOMA: MRI FINDINGSUMMUGULSUM BAYRAKTUTAN, HAYRI OGUL, RECEP SADE, MECIT KANTARCI, AKIN LEVENT


Abstract

Objective: Synovial sarcoma is a malignant soft tissue tumor. It is seen around joints in the young adults. The most common sight after the knee is the foot. We present a magnetic resonance imaging (MRI) scan of a 55-year-old female patient with synovial sarcoma of the left knee.

Materials and Methods: A 55-year-old female patient who presented with swelling and pain in the left knee and had no trauma history was examined by magnetic resonance imaging with a 1.5 Tesla MRI device (Magnetom Avanto, Siemens Healthcare) for knee imaging.

Results: In our case, there was a lobulated, enhancing mass which is seen as heterogeneous hypointense on T1-weighted images, heterogeneous hypo-hyperintense on T2-weighted images in periarticular soft-tissue on the lateral side of the left knee joint. The case was diagnosed as synovial sarcoma histopathologically after surgical resection.

Conclusion: Synovial sarcoma accounts for 5-10% of all soft tissue sarcomas. It is seen often between 3 and 5. decades. 65% of the cases have lower extremity location around the knee is the most common location. The most common finding is a mass with pain and sensitivity. Biphasic type, monophasic fibrous type and poor differentiated type are the histopathological types. The prognosis is poor. Synovial sarcoma often grows slowly. The organ in which soft tissue sarcomas metastasize


in the first place is the lung. For this reason, computerized tomography of thorax and whole body bone scintigraphy should be requested. The tumor site can be best demonstrated by MRI. Standard treatment is surgery and lesion show sensitivity to chemotherapy. In the postopera-tive period, recurrence or pulmonary metastasis should be controlled at intervals.

Keywords: Synovial sarcoma, MRI

P - 0138

A CASE REPORT - MULTIPLE ENCHONDROMATOSIS (OLLIER DISEASE)SUMEYYA DURAN KAYMAK, ZEYNEL YOLOGLU, OZKAN UNAL

Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Olliers disease (OD) is one of the rare disorders which is characterised by non-hereditary multiple enchondromatosis with at least 3 enchon-dromas seen in the metaphyseal regions of appendicular skeleton. The prevalence of the disease is 1 / 100.00.The phalanges and metacarpals are the most commonly effected sites by the disease. It is often mani-fested in first decade of life. A 12-year-old female who was complaining pain on her left hand for 3 months after trauma had gone to X-ray study. An osteolytic lesion was seen on the 3rd phalanx. Hence she was refered to MRI. The findings were regarded as a multiple enchondro-matosis. OD was first described by Ollier in 1899.Spranger classification which is comprehensive for multiple enchondromatosis is used for the definition of the disease. OD is Spranger type 1.The pathogenesis of enchondromatosis is not clearly understood. Recently, some authors believe that the heterozygous mutations of PTHR1, IDH1(most com-mon) and IDH2 genes play some role in pathogenesis of the disease. Approximately 30% of cases with multiple enchondromatosis may transform into chondrosarcomas similar to other echondromas.In addi-tion they are at risk of developing glioma, pancreas tumors and ovarian juvenile granulosa cell tumors. Even if OD is a rare disorder, proper diagnosis and follow-ups are crucial because of the risk of malignant transformation. Our aim present a case repor with Ollier Disease and talk about the epidemiology, diagnosis and radiological findings of ollier disease.

Keywords: Multiple enkondrom, syndrom, malignity

P - 0139

ACCESSORIES MUSCLES AND OSSICLES IN THE MUSCULOSKELETAL SYSTEMIBRAHIM HALIL OZYAVUZ, YUNUS EMRE AKPINAR, FURKAN BULUT, MENDUH DURSUN

Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey

Abstract

Accessory ossicles are secondary ossification centres these are dis-crete from the attached bones. Sesamoids and accessory ossicles are often found on the feet, knees and hands. They are often congenital, although they appear as a result of trauma or local degenerative diseases. The incidence of symptomatic accessory bones is relatively small. Accessory ossicles may be associated with painful syndromes, as well as trauma, infection, inflammation, degenerations.it can be very difficult to differentiate between incidental variants and what is really symptomatic. However, the main clinical importance of accessory bones is their ability to mimic avulsion fractures and lead to compression syndromes. Accessories muscles are anatomical variants characterised by an additional distinct muscle encountered along a normal muscle. Although they are generally asymptomatic, and randomly encountered. Sometimes, these may be symptomatic. Such symptom often mass effect of the supernumerary muscle. The other presenting with either a palpable swelling or secondary compression of near structures such as nerves, vessels, or tendons. Our purpose in this report is to present the radiological features of accessory muscles and bones that causing various clinical symptoms.

Keywords: Accessory bone, accessory muscle, compression syndrome

P - 0140

CARDIAC METASTATIC TUMOURSYUNUS EMRE AKPINAR, FURKAN BULUT, IBRAHIM HALIL OZYAVUZ, MEMDUH DURSUN

İstanbul University İstanbul School of Medicine, İstanbul, Turkey

Abstract

Metastatic cardiac tumors are seen about 30 times more common than primary cardiac masses in adult population. Many patients with cardiac metastatic disease usually have no significant symptoms therefore their diagnosis is usually discovered postmortem. Cardiac metastatic tumours can spread to heart through four alternative pathways:by direct invasion from peripheral adjacent tissues (lung, breast, esophagus), lymphatic extension, hematogenous spread by blood vessels (melanoma, lymphoma, leukemia) or transvenous exten-sion to both atriums (renal cell carcinoma, hepatocellular carcinoma). The most common tumors that metastasize to the heart are lung and breast carcinomas, lymphoma, malignant melanoma. Cardiac magnetic resonance imaging is very sensetive and specific to detect cardiac massses but there is no specific signal characterization of cardiac metastases on magnetic resonance imaging. These masses are usually seen hypointense on T1 weighted series and hyperintense on T2 weighted series except malignant melanoma metastases. Almost all malignant lesions will show detectable signal enhancement on contrast-based sequences. In this report, cardiac metastases from dif-ferent origins that spread to heart through different pathways, such as invasive thymoma, anaplastic thyroid cancer, hepatoselluler carcinoma, leukemia, lymphoma nasopharynx carcinoma, renal cell carsinoma and lung carcinoma were emphasized.

Keywords: Cardiac magnetic resonance, metastatic cardiac masses, spread of metastasis to heart


P - 0141

A RARE CAUSE OF MEDIAN NERVE ENTRAPMENT NEUROPATHY: CARPAL LIPOMANILUFER AYLANC, BURAK KAYMAZ, MUSTAFA RESORLU, CANAN AKGUN TOPRAK

Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey

Abstract

Introduction: Lipomas are common benign soft tissue tumors and may appear in different anatomical regions of the body, are rarely seen in the hand. These lesions, in varying sizes, can cause some complications and clinical symptoms depending on the mass effect on the anatomic region. Especially lesions in the hand, can cause carpal tunnel syndrome (CTS), due to the proximity to the median nerve or to compression effect. In this article, the lipoma causing median nerve entrapment will be discussed, although it is not located just in the carpal tunnel but distally.

Case Report: A 75-year-old female patient presented to the orthopedic clinic with a right hand palmar mass and median nerve entrapment clini-cal symptoms. EMG examination, than radiologic imaging was performed considering CTS as a preliminary diagnosis. EMG results supported CTS. On MRI, in the 3-4. metatarsal levels, a lipomatous mass was found in the dimensions of about 3x3x4 cm, displacing the tendons of the flexor group on the palmar side of the hand. The histopathologic evaluation obtained after surgical intervention was compatible with lipoma.

Conclusion: Lipomas causing carpal tunnel syndrome are very rare lesions and can lead to symptoms of entrapment neuropathy, particu-larly in the carpal tunnel or near it, by compression of median nerve. CTS is the most common entrapment neuropathy of the upper extrem-ity, often seen between the ages of 36-60 years and mostly in female. EMG is quite useful in diagnosis. However, MRI plays a very important role in the differential diagnosis of mass lesions that may cause CTS, and also demonstrate lesion characteristics and the relationship between the mass and the adjacent anatomic structures detailly, thus contributing to the highlightening the symptomatology as well as to the management of the treatment.

Keywords: Carpal tunnel syndrome, lipoma, MRI

P - 0142

AN ANATOMICAL VARIANT OF ACETABULUM: ‘SUPERIOR ACETABULAR NOTCH’DERYA GUCLU, ELIF NISA UNLU

Department of Radiology, Düzce University School of Medicine, Düzce, Turkey

Abstract

Introduction: A superior acetabular notch has been described as an anatomic variant where there is a focal defect within the subchondral bone of the acetabular roof. The purpose of this case is to describe this anatomic variant of acetabulum to distinguish it from pathologic osteo-chondral lesions.

Case Report: A magnetic resonance imaging (MRI) was obtained from a 15-year-old male who presented to the orthopedic outpatient clinic with a complaint of low back pain and hip pain on the left side for six months. On pelvic MRI, an millimetric interruption was observed on the subchon-dral bone and the cartilage of the left acetabulum. A defect was detected on the left pars interarticularis of the L5 vertebra on lumbar MRI and the patient’s complaint was attributed to this lesion.

Conclusion: The radiological interruption of the medial portion of the acetabular roof which is commonly seen in normal subjects is an anatomi-cal notch in the apex of the acetabulum. This has no known function and represents an anatomic variant. Superior acetabular notchs are commonly seen on MR and MR-arthrograms. That a superior acetabular notch is symmetric, that it has well defined borders and an absence of pathologic signal change of the medulla, is important to distinguish a superior acetab-ular notch from an osteochondral defect. The remarkable aspect of our case was that the lesion was unilateral, because this unilaterality might lead to a wrong diagnosis as an osteochondral lesion. Besides this, the typical localization, morphology and absence of pahologic signal changes in the periphery all support the presence of normal variation.

Keywords: MR, normal variant, superior acetabular notch

P - 0143

SPINAL DYSRAPHYSM SPECTRUM REMEMBER WITH CASESMUSTAFA TASAR, SEREF BARBAROS ARIK, SALIH HAMCAN, SINAN AKAY, UGUR BOZLAR, KEMAL NIYAZI ARDA, HATICE TUBA SANAL

Department of Radiology, Gülhane Research and Training Hospital, Ankara, Turkey

Abstract

Introduction: The spine and spinal cord are a complex anatomic struc-ture. That’s why their congenital anomalies tend to be complex and confusing. This complexity make the neuroradiologic diagnosis challenging. Because magnetic resonance imaging plays a crucial role in both diagnosis and postoperative evaluation, we aim to remember useful Tortori-Donati and Rossi classification with understandable short notes and to provide an algorithm for an organized approach.

CASE 1: Syringohydromyelia + cervical diastematomyelia

CASE 2: Closed dysraphism with no mass + complex form (diastemato-myelia + causdal agenesia) + cervical ectasia + dermal sinus

CASE 3: Closed dysraphism with no mass + simple form (tight filum terminale) + filar cyst + ventriculomegaly

CASE 4: Closed dysraphism with no mass + simple form (dermal sinus + tight filum terminale + diastematomyelia + persisten terminal ventricle)

CASE 5: Spinal dysraphism mimicker postoperative changes

CASE 6: Postoperative lumbar dural tear and subcutaneous CSF leak

Conclusion: Congenital malformations of the spine and spinal cord can be complex and confusing. An organized approach to imaging findings allows greater ease in diagnosis.

Keywords: Spinal dysraphysm, algorithm, classification


P - 0144

THE RARE CAUSES OF THE KNEE PAIN AND CHRONIC EFFUSION: LIPOMA ARBORESCENSSUMEYRA DEMIRKOL ALAGOZ, SAIM TURKOGLU, HARUN ARSLAN, MESUT OZGOKCE, ABDUSSAMET BATUR

Department of Radiology, Yüzüncu Yıl University, Van, Turkey

Abstract

Objective: We aimed to present magnetic resonance imaging (MRI) find-ings of lipoma arborescens, a rare cause of long-lasting pain and recurrent effusion attacks in the knee joint.

Materials and Methods: A 53-year-old male patient was received to our hospital with the complaint of a knee pain which continued for a long time and increased with movement. No increase in temperature was observed on physical examination. Patients with no significant laboratory findings knee MR imaging was performed in the radiology clinic. Effusion in supra-patellar bursa and multiple nodular lesions with hyperintensities on T1 and proton density-weighted images in the synovium was detected. The signal intensity of the lesions was coexistent with subcutaneous adipose tissue. Suppression was detected in oil-imprinted sequences. The signal intensity of the lesions was coexistent with subcutaneous adipose tissue. Suppression was detected in oil-imprinted sequences

Results: According to the findings of knee MRI, the patient was diagnosed with lipoma arborescens (LA).

Conclusion: Lipoma arborescens (LA) is a rare intraarticular lesion formed by lipomatous proliferation of synovium. There are slowly increasing, painless swelling in the knee joints of patients for many years and recurrent effusion attacks. Diagnostic magnetic resonance imaging (MRI) is the gold standard. Pathologically, villous proliferation of synovial membrane and hyperplasia of mature fat tissue in subsynovial tissue are present. LA is usually seen in middle-aged men. LA is a disease that should be remembered in patients with long-standing swelling in the knee joint.

Keywords: Lipoma arborescens, magnetic resonance, knee pain

P - 0145

A RARE MASS LESION IN HOFFA: EXTRASKELETAL CHONDROMAHATICE TUBA SANAL, SEREF BARBAROS ARIK, MUSTAFA TASAR, KEMAL NIYAZI ARDA, SALIH HAMCAN, SINAN AKAY, UGUR BOZLAR

Department of Radiology, Gülhane Research and Training Hospital, Ankara, Turkey

Abstract

Objective: Hoffa’s pad is an intracapsular extrasynovial wedge shape adipose tissue that is localized anterior of the knee. Abnormalities related with Hoffa commonly are the consequences of trauma and degeneration, but inflammatory and neoplastic diseases can arise in the fat pad. The purpose of this paper is to describe a rare mass lesion with in Hoffa’s pad and to increase awareness about Hoffa’s pad tumors.

Materials and Methods: 35 years old women who is complaining about chronic pain on the anterior part of her knee is consulted to our radiol-ogy department. On rontgenogram, CT and MR images findings are consistent with edema, inflammation and ossifying mass lesion with in her infrapatellar fat with no bone destruction.

Results and Conclusion: Hoffa’s pad tumors are an uncommon and rarely diagnosed lesions that can be misinterpreted as any knee pathol-ogy. It’s important to diagnose this clinical condition early and to start the appropriate treatment in order to avoid morbidity. Although the majority of tumours are benign, malignant tumours should be considered especially in the paediatric population.

Keywords: Hoffas pad, extraskeletal chondroma, chronic pain

P - 0146

PATELLAR TENDON GANGLION IN PATELLAR TENDON-LATERAL FEMORAL CONDYLE FRICTION SYNDROMEBURCU SAHIN, ELIF AKTAS, NAZAN CILEDAG, HIDIR KAYGUSUZ, OZKAN UNAL

Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Intratendinous ganglia are rare. We report the case of a 55 year old woman with chronic anterolateral pain of the knee and a ganglion of the patellar tendon as indicated on magnetic resonance (MR) examination. There was evidence of patellar tendon-lateral femoral condyle friction syndrome with significantly close contact between the patellar tendon and the lateral facet of the femoral trochlea. To our knowledge, we report the second case of a ganglion of the patellar tendon subsequent to patellar tendon-lateral femoral condyle friction syndrome. We believe that this case is illustrative of mucoid degeneration in connective tissue due to chronic repetitive microtraumas.

Keywords: Patellar tendon, ganglion, friction syndrome

P - 0147

A RARE CASE, PRIMARY PATELLAR ANEURYSMAL BONE CYST MRI FINDINGSSUAT INCE, ENSAR TURK O., HARUN ARSLAN

Yüzüncü Yıl University, Van, Turkey

Abstract

Objective: Aneurysmal bone cyst (ABC), which is seen in 1% of primary bone tumors, is a rare bone lesion and patellar location is very rare. In this case, we aimed to present primary patellar aneurysmal bone cyst.

Materials and Methods: A 15-year-old male patient was admitted to our hospital because of left-sided knee pain which continued for one year, increased activity and decreased at rest. The last 15 days have developed swelling in the area of pain. A direct radiograph was requested from the patient in terms of differential diagnosis.


Results: On a direct X-ray examination, a multiloculated lytic lesion causing enlargement of the patella was detected. In terms of differen-tial diagnoses, MRI examination was requested. On T1-weighted and T2-weighted MR images, a multiloculated cystic lesion filled with the entire patellar lumen with fluid-fluid levels was observed (and 3). Post contrast images showed septal contrast nhancement. The patient was evaluated as primary ABC with radiological and histopathological findings.

Conclusion: ABC is a tumor-like, benign, enlarging bone lesion that occurs in 1% of primary bone tumors. ABC can develop in normal bone, and it can develop in a pre-existing lesion base such as giant cell tumor, chondroblas-toma, chondromyxoid fibroma, osteosarcoma, fibrous dysplasia, eosinophilic granuloma, trauma, and it is called as secondary ABC. Typical radiographic appearance of ABC is eccentrically located, expansile, occasionally osteolytic bone lesion.In computed tomography and magnetic resonance imaging, the lesion resembles honeycomb with internal septa and fluid-fluid levels.

Keywords: Aneurysmal, cyst, patellar, primary

P - 0148

HEREDITARY MULTIPLE EXOSTOSES WITH GIANT PELVIC CHONDROSARCOMA: MR IMAGING FINDINGSHALIL CAYLAK, VILIAM GASANOVI, BULENT YILDIZ, MEHMET H. ATALAR

Department of Radiology, Cumhuriyet University Hospital, Sivas, Turkey

Abstract

Hereditary multiple exostoses (HME), also known as diaphyseal aclasis, is an rare disease with autosomal dominant condition, characterised by the development of multiple osteochondromas. Ostochondomas are cartilage-covered bone tumors that arise from metaphyses of long bones and grow outwards. The diagnosis can be made with radiological and / or clinical findings. Many complications of HME have been described., but the most feared is malignant transformation. The prevalence of chondrosar-coma in the general population is 1 in 250,000-100,000. In patients with HME, the risk is 5%. Axial skeletal elements (pelvis, scapula, rib, vertebrae) are the most common sites of sarcomatous degeneration in osteochon-dromas. We will present MRI findings of a 38-year-old male patient referred to our hospital with a complaint of giant palpable mass in his pel-vis. Pelvic localization of the lesion caused to marked increase in lesion size without any symptoms. Histopathologic examination of the giant pelvic mass was found to be compatible with chondrosarcoma. On the skeletal survey; Madelung deformity and a large number of osteochondromes in the upper and lower extremities and in the ribs were observed.

Keywords: Hereditary multiple exostoses, osteochondroma, chondro-sarcoma

P - 0149

NORMAL DEVELOPMENTAL IRREGULAR OSSIFICATION OF THE LATERAL FEMORAL CONDYLE: IMAGING FINDINGS

ABDULLAH SUKUN, EMIN DURMUS, BERNA AK YILDIZ, BULENT CEKIC, ICLAL ERDEM TOSLAK

Department of Radiology, Health Sciences University Antalya Training And Research Hospital, Antalya, Turkey

Abstract

The process of ossification of long bones during skeletal maturation is a complex and dynamic process. The ossification centers within the cartilage-containing epiphysis centers undergo endochondral ossification. During this process, a nodular and fragmented appearance may occur at the edges during ossification. Irregular ossification centers are com-monly seen at the distal femoral condyle epiphysis, humeral trochlea, and navicular bone. Females are more frequently affected during rapid growth periods. The medial compartment is affected more frequently than the lateral compartment, however irregular ossification areas may be bilateral. This normal variations in developmental period may be confused with osteochondral defects and OCD. The absence of bone marrow edema helps to diagnosis. Both has a similar appearance on plain radiographs. Irregular cortical borders on the radiographs may also mimic fracture lines. Irregular ossification centers are frequently located in the posterior inferior portion of lateral femoral condyle. The cartilage must be intact in irregular ossification. MRI is helpful in differential diagnosis. We aimed to present the radiological findings of irregular ossification at knee joint in a 7 year-old-male.

Keywords: Irregular ossification, lateral femoral condyle

P - 0150

ANEURYSMAL BONE CYSTS CAUSED TO FORAMINAL OBLITERATION AND MONOPARESIAHARUN ARSLAN1, IBRAHIM ILIK1, ABDURRAHMAN AYCAN2, SUMEYRA DEMIRKOL ALAGOZ1, SUAT INCE1

1Department of Radiology, Van Yuzuncu Yıl University Dursun Odabas Medical Center, Van, Turkey 2Department of Neurosurgery, Van Yuzuncu Yıl University Dursun Odabas Medical Center, Van, Turkey

Abstract

Objectives: Aneurysmal bone cysts (ABCs) are rare entities that causes expansile and destruction of bone tissue lesions characterized by response to reactive proliferation of connective tissue.. We aimed to present MR findings of ABC that caused significant foraminal compression and monoparesia in this case.

Materials and Methods: A 16-year-old female patient admitted to clinic with lomber pain, swelling and suffering of being unable to walk which started 3-4 months ago. After the examination, lomber MR planned to the patient in our department.

Results: On the contrast-enhanced spinal MR, showed that neural fora-men obliteration with in the right half of the L1 vertebra approximately 63x46 mm dimension, lytic and expansive, hypointense with septations on T1-weighted images, heterogeneous hyperintense showing fluid-fluid levels in T2-weighted images, peripheric and septal contrast enhancement lesions were observed after intravenous contrast material injection. The lesion, which was interpreted as an ABC, was reported as ABC with postoperative pathologic result.


Conclusion: ABC is a benign, tumor-like, high vascular quality, local aggressive and relatively rare osteolytic lesion. Lesions occur primary in the first two decades of life, with relatively female dominance. The third most common benign bone tumor is aneurysmal bone cyst after osteoid osteoma and osteoblastoma. Primary aneurysmal bone cysts constitute 1.4% of primary bone tumors. They holds vertebral column especially the lumbar-posterior bone elements and forms 3-30% of cases. Differential diagnosis of the ABC are other benign-malignant tumors with fluid-fluid levels (giant cell tumor, chondroblastoma, and telangiectatic osteosar-coma).

Keywords: Aneurysmal bone cysts, MR findings, bone tumours

P - 0151

A RARE CAUSE OF HEEL PAIN: BAXTER NEUROPATHYANDELIB BABATURK, BILGESU ARIKAN ERGUN, ORHAN AVCI, ZEHRA AKKAYA, GULDEN SAHIN

Department of Radiology, Atatürk University Achool of Medicine, Erzurum, Turkey

Abstract

Objective: Entrapment of the primary branch of lateral plantar nerve (Baxter nerve entrapment) is one of the rare causes of heel pain. Clinically it is difficult to diagnose but there are clues for a radiologist who knows what to look for. In this presentation, magnetic resonance imaging (MRI) findings of a case with Baxters neuropathy (BN) are summarized.

Materials and Methods: Forty-one year old female patient with chronic heel pain for 1.5 years, unresponsive to conservative treatments, was referred to our clinic for further investigation. Frontal and lateral view radiographs of the ankle and 3.0 T MRI were performed, which revealed a calcaneal spur and severe, isolated fatty atrophy in the adductor digiti minimi muscle.

Conclusion: Differantial diagnosis of heel pain includes various entities such as plantar fasciitis, fat pad atrophy, calcaneal stress fracture, neoplasia, infections. BN is a rare cause for which treatment of choice is decompres-sion surgery. It presents with medial sided heel pain similar to plantar fasciitis, which itself may be a cause of nerve entrapment. Characteristic MRI findings are atrophic changes in adductor digiti minimi muscle due to denervation, which are best appreciated on T1- weighted images without fat suppression at late stages as in our case. MRI plays a key role both in revealing the undelying pathology as well as ruling out other possible dif-ferential diagnoses such as stress fractures, masses, plantar fasciitis, tendon pathologies.

Keywords: Baxter neuropathy; inferior calcaneal nerve entrapment; lat-eral plantar nerve; magnetic resonance imaging

P - 0152

ISCHIOFEMORAL IMPINGEMENT: HIP PAIN OF INFREQUENT CAUSEICLAL ERDEM TOSLAK1, BUKET YAGCI2

1 Antalya Training and Research Hospital, Antalya, Turkey2 Kastamonu State Hospital, Kastamonu, Turkey

Abstract

Ischiofemoral impingement (IFI) is a recently identified clinical condition characterized by the decreased space between the lesser trochanter and ischial tuberosity leading to compression of quadratus femoris muscle in between (1). IFI usually occurs in middle-aged to elderly women, with a presenting symptom of hip pain. However, it may affect both genders at all ages, ranging from 11 to 77 years. Bilateral hip involvement has been observed in 25-40 % of patients (2). MRI findings include abnormalities quadratus femoris muscle (muscle edema, partial tear, and atrophy). Up to 50 % of patients have also associated hamstring tendon edema and 25% partial tear. We here in aimed to describe MRI findings of IFI syndrome in a 55 year-old-woman with low back pain.

Keywords: Ischiofemoral impingement syndrome, MRI

P - 0153

WRISBERG VARIANT, A RARE SUBTYPE OF DISCOID MENISCUSNESRIN ERDOGAN, MURAT UCAR, NIL TOKGOZ


Abstract

Wrisberg variant is less common form of discoid meniscus that means lack of posterior meniscocapsular attachment to joint capsula and tibia of lateral meniscus and can leads to anteriorly flipped posterior horn of meniscus. Here, we aimed to present 18 years old female patient who have bilateral wrisberg variant discoid meniscus with anterior subluxation.

Keywords: Wrisberg variant, discoid, meniscopathy

P - 0154

DIAGNOSIS OF RARE SKELETAL MUSCLE INVOLVEMENT IN A MALT LYMPHOMA CASE USING DISTINCTIVE IMAGING FINDINGSOSMAN CANCURI, AJAY ARORA, SA TRAN, SHWETA GUPTA

Princess Royal University Hospital, Orpington, UK

Abstract

Involvement of skeletal muscles either primary or secondary is an extremely rare feature of all type of lymphomas. Extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) of skeletal muscles are even more rare. Nevertheless, the imaging findings are distinctive. Regardless of the imaging modality, long segmental and multicompartmantal involvement, intralesional vessels, infiltrative appearance, adjacent subcutaneous stranding and skin thicken-ing are the main features of skeletal muscle lymphomas. They are highly vascular and cellular tumours. Herein, we present a MALT lymphoma case with involvement of skeletal muscles in order to highlight the imag-ing features. An 80y old female patient presented to opthalmology clinic with a lump on her left eyelid and right forearm. After excision of eyelid


lesion she was referred for radiological evaluation of her forearm lump. US revealed a hypervascular mass within the flexor muscle group which had echotexture similar to normal musculature. MRI demonstrated a homogeneous infiltrative lesion showing restricted diffusion. The muscles were enlarged with preserved architecture. Encasement of the neuro-vascular bundle and nodular subcutaneous extension were also noted. MALT lymphoma was diagnosed after US-guided core biopsy. The eyelid lesion demonstrated same histopathology. CT revealed further chest and abdominal wall masses.

Keywords: Extranodal marginal zone lymphoma (EMZL), mucosa associ-ated lymphoid tissue (MALT), skeletal muscle lymphoma, diffusion weight-ed imaging (DWI), magnetic resonance imaging (MRI), ultrasound (US)

P - 0155

MRI FINDINGS OF MYONECROSIS WHICH OCCURS AFTER HIGH VOLTAGE ELECTRICITY BURNSEMRA DURAN, HAMZA OZER, DENIZ SOZMEN CILIZ, HATICE GUL HATIPOGLU, BULENT SAKMAN


Abstract

Myonecrosis is a myopathy which involves the infarction of the skeletal muscle. Although secondary to clostridial infections is the main cause; trauma can be reason for myonecrosis. Differantiating from the intraab-dominal abscess is important to determine the appropriate treatment regime. In this case, we both aimed to present the MRI findings of left arm myonecrosis due to high-voltage.

Keywords: MRI, electrocution, myonecrosis

P - 0156

ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA MIMICKING ABSCESS: CASE REPORTNURDAN CAY1, KARABEKIR ERCAN1, BANU CAKIR1, MAHMUT NEDIM AYTEKIN2

1Department of Radiology, Ankara Yıldırım Beyazıt University School of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey2Department of Orthopedics, Ankara Yıldırım Beyazıt University School of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey

Abstract

Angioimmunoblastic T-cell lymphoma (AITL) is a rare subset of peripheral T-cell lymphoma, which accounts for 1-2% of non-Hodgkins lymphomas. They frequently appear in the 7th decade and present with generalized lymphadenopathy and hepatosplenomegaly. Extranodal involvement such as lung, skin and bone marrow may also be present. In this case report, a 38-year-old male patient with a diagnosis of AITL mimicking abscess in biceps brachii muscle was presented with magnetic resonance imaging findings.

Keywords: Abscess, angioimmunoblastic T-cell lymphoma, extranodal

P – 0157

EXTRAPLEURAL SOLITARY FIBROUS TUMOR OF THE INGUINAL AREA: CASE REPORTNURDAN CAY1, BANU CAKIR1, KARABEKIR ERCAN1, YETKIN AGACKIRAN2

1Department of Radiology, Ankara Yıldırım Beyazıt University School of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey2Department of Medical Pathology, Health Sciences University School of Medicine, Ankara Atatürk Pulmonary Diseases and Chest Surgery Health Implementation and Research Center, Ankara, Turkey

Abstract

Solitary fibrous tumors (SFT) are rare tumors of mesenchymal origin. They form less than 2% of soft tissue tumors. They mostly show intratho-racic placement although their wide anatomical distributions. One third of them show extrathoracic location and may originate from any soft tissue or visceral localization. The differential diagnosis includes benign nerve tumors, smooth muscle tumors and monophasic synovial sarcoma. In this case report, a 43-year-old female patient was presented with magnetic resonance imaging findings of extrapleural SFT in the right inguinal region.

Keywords: Extrapleural, soft tissue tumor, solitary fibrous tumor

P - 0158

TWO CASES OF UNDIFFERENTIATED PLEOMORPHIC SARCOMA OF SHOULDER AND THIGH AS A PAINLESS LARGE MASSNURDAN CAY, SERHAN EREN, GOKHAN YUCE, KARABEKIR ERCAN, MAHMUT NEDIM AYTEKIN

Clinic of Radiology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey

Abstract

Soft tissue sarcomas arises from transformed cells of mesenchymal origin. Soft tissue sarcomas are not common tumors but unfortunately in adults soft tissue malignancies are one of the most common can-cers. The most common types of soft tissue sarcomas are liposarcoma, fibrosarcoma, dermatofibrosarcoma protuberans and malignant fibrous histiocytoma. Sarcoma is classified for their differentiation pattern as low grade, intermediate grade, high grade and undifferentiated respectively. Undifferentiated pleomorphic sarcoma, or named as malignant fibrous histiocytoma previously, is a type of soft tissue cancer which usually origi-nated from arms, legs, and less often in abdominal cavity and retroperito-neum. Undifferentiated pleomorphic sarcoma are rare tumor, accounting for 4th most common soft tissue sarcoma and incidence has been evalu-ated to 1-9 per 100000 per year. Clinically, undifferentiated pleomorphic sarcoma has no specific signs and presents with painless large mass, pathological fractures and rapidly growing mass. We present two cases of undifferentiated pleomorphic sarcoma thigh and shoulder. A 39-year-old man presented with a 25 cm diameter rapidly growing painless mass in the left shoulder for one month and a 71- year- old man presented with a 18 cm diameter rapidly growing mass in the right thigh. In MRI examina-


tion, poorly demarcated solid masses with cystic component were seen. In T1 sequence, both masses have heterogeneity iso-high signal intensity with prominent enhancement of solid components and In T2 sequence, intermediate to high signal intensity were seen.

Keywords: Undifferentiated pleomorphic sarcoma, MRI, shoulder, thigh

P - 0159

PARADOXIC HYPERTROPHY OF THE SCIATIC NERVE AFTER LIMB AMPUTATIONNURDAN CAY, KARABEKIR ERCAN, SERHAN EREN, BANU CAKIR

Clinic of Radiology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey

Abstract

Paradoxic sciatic nerve hypertrophy can occur in following lower limb amputation for malignant and nonmalignant conditions. Sciatic nerve hypertrophy is greatest in transection site and gradually decrease proxi-mally. It is called paradoxic because of nerve atrophy usually occured after limb amputation. The etiology is unclear and dysregulated axonal transport may cause of paradoxical hypertrophy. It cause unnecessary biopsy whether a residual or locally recurrent tumor can occur. In this case we present of paradoxic sciatic nerve hypertrophy after left lower limb amputation. A 34 year-old man bove-knee amputation underwent a surveillance MRI of the lower extremities. It revealed an tubular structure of high signal intensity compared to muscle on coronal STIR, axial fat-sat-urated T1-W and T2-W images along the medial left thigh, representing a hypertrophied sciatic nerve.

Keywords: Paradoxic sciatic nerve hypertrophy, limb amputation

P - 0160

HYPOTENAR HAMMER SYNDROMEONUR KARACIF, AYNUR TURAN

Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: Hypotenar hammer syndrome is seen in some occupational groups or some athletes who use objects that can cause trauma to the superficial palmar region of the ulnar artery. After technological develo-ments MRI is very important to evaluate of wrist pathology as well as angiography. By this case we aim to discuss the imaging findings of hypo-tenar hammer syndrome.

Case Report: 39 years male cobbler with left wrist swelling, pain and 4-5.th distal finger joint pain. Also he hasn’t any chronic disease. Contrast-enhanced MRI was to be compatible that wrist level aneurysmatic dilata-tion of ulnar artery and superficial palmar segments and on these arteries diffuse wall thickening(reaching 4 mm) and contrast enhancement also loss of signal void due to slow flow or thrombosis of the artery lumen. The findings were thought to be compatible with vasculitis and hypote-nar hammer syndrome. The MRI findings were confirmed by left upper

extremity CT angiography examination and compatible with hypotenar hammer syndrome.

Discussion: Ulnar artery provides blood flow to most of the fingers. The superficial palmar arch of the hand is generally formed by the ulnar artery and superficial palmar branch of the radial artery. The arc is superficial and easily damaged. Also there are too many variations on this connection. Because of these variations, the clinical findings of hypotenar hammer syndrome are very different. On pysical examination the Allen test can provide important clues. Radiography and doppler US may be helpful for the diagnose. MRI and MR angiography provides a detailed examination of this region.

Keywords: Hypotenar hammer syndome, hand pain, MRI

P - 0161

A HUGE CUTANEOUS DERMATOFIBROMA: MRI FINDINGSDERYA GUCLU1, NISA UNLU1, EMIN OZLU2, MEHMET GAMSIZKAN3

1Department of Radiology, Düzce University School of Medicine, Düzce, Turkey2Department of Dermatology, Düzce University School of Medicine, Düzce, Turkey3Department of Pathology, Düzce University School of Medicine, Düzce, Turkey

Abstract

Introduction: Subcutaneous dermatofibroma is a benign tumor usually seen on proximal extremities. It was aimed to present MRI findings of a histologically confirmed dermatofibroma case and emphasize its distinc-tive features.

Case Report: A 30-year-old woman applied to the dermatology outpa-tient clinic with a swelling on the superolateral aspect of her thigh that had become more prominent in recent years. Ultrasonography and mag-netic resonance imaging (MRI) was planned for the lesion that appeared on physical examination as a firm, solitary tumoral mass, with a regular surface. Ultrasonography revealed a hypoechoic, lobulated solid lesion showing increased vascularization. On MRI, the lesion appeared as a soft tissue mass located in the skin and subcutaneous tissue with a dimension of 5,5x5x3 cm. It was isointense compared to muscles on T1-weighted sequence, slightly hyperintense compared to muscles, but hypointense compared to fat, with a hypointense rim on T2-weighted sequence. After IV contrast infusion it showed an intense heterogenous contrast enhance-ment with fine aberrant, tortuous vascular structures in the periphery. The lesion was lobulated and well demarcated without any muscle and fascial involvement. Also because the lesion persisted for a long time, the soft tissue mass was considered benign. Punch biopsy was evaluated as a cellular dermatofibroma and excision was suggested.

Conclusion: Dermatofibromas may be mistaken for several benign and malignant masses like especially dermatofibrosarcoma protuberans and also other lesions like malignant fibrous histiocytoma, giant cell tumor, rhabdomyosarcoma and desmoid tumors. Accurate differential diagnosis is made by a immunohistochemical examination while MRI is quite useful in determining the localization and extension to surrounding structures and in discriminating atypical cases.

Keywords: Cutaneous, dermatofibroma, MRI


P - 0162

FIBROLIPOMATOUS HAMARTOMA OF THE MEDIAN NERVEMEHMET GEZER1, ZEYNEP MARAS OZDEMIR1, MEHMET SEYFI BURUK1, MEHMET SAH SAKCI2, KADIR ERTEM2

1Department of Radiology, İnönü University School of Medicine, Malatya, Turkey2 Department of Orthopedics, İnönü University School of Medicine, Malatya, Turkey

Abstract

Fibrolipomatous hamartoma (FLH) of the nerve or neural fibrolipoma is a rare benign fibrofatty tumor of nerves first described in 1953. Median nerve is most commonly affected nerve and usually affected at the wrist level. Affected nerve is enlarged due to fibrous and fatty infiltration around nerve fascicles into epineurium and perineurium. We report a 28 years old male patient diagnosed with fibrolipomatous hamartoma of median nerve presented with carpal tunnel syndrome findings.

Keywords: Fibrolipomatous hamartoma, median nerve, carpal tunnel syndrome

P - 0163

CARPAL BOSS CASE REPORTONUR KARACIF, AYNUR TURAN, BAKI HEKIMOGLU

Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: Carpal boss is a bone prominence at the dorsal aspect of the 2 nd or 3rd carpometacarpal joint, whose incidence is underestimated, which has been linked to various etiologies, including trauma, os styloi-deum, osteophyte formation, and partial osseous coalition. From the clini-cal point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. On this case we purpose highlight the MRI findings of carpal boss impingement and secondary osteoarthritis.

Case Report: 15 years female with pain and swelling on the dorsal aspect of the right wrist for a few months, without a history of trauma. This pain has been recurrent for a few years and exacerbated by activities that require wrist movements. After routin radiographics, MRI was performed for further assessment, which revealed a dorsal bone process at the quadrangular joint representing fused to the base of the 3rd metacarpal. Minimal bone marrow edema was observed at this abnormal joint level. No ganglion cyst, a common finding in dorsal wrist pain and swelling, was evident. The fused osseous synchondrosis with the adjacent trapezoid bone at its dorsal aspect. Degenerative osteophytic spurs developing at the dorsal aspect of the base of the 3 rd metacarpal were observed and, in conjunction with the os trapezoid at the dorsal aspect of the quadrangular joint, constituted the “carpal boss”.

Discussion: Clinical examination and plain radiography will usually reveal the diagnosis. US and CT also may be helpful. MRI may illustrate a vari-able bone morphology and additional bone and soft tissue pathologies. Bone marrow edema shows a significant correlation with a painful carpal

boss. Therefore, MRI may be of additional diagnostic value in patients with persistent pain and preoperatively.

Keywords: Carpal boss, MRI, dorsal hand pain

P - 0164

MEDULLARY LIKE INVASIVE DUCTAL CARCINOMA MIMICKING PHYLLODES TUMORISIL BASARA AKIN1, KEMAL CAGLAR TUNA1, MERIH GURAY DURAK2, SULEYMAN OZKAN AKSOY3, PINAR BALCI1

1Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey2Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey3Department of General Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Medullary carcinoma of breast arises from supporting stromal cells of the breast. Invasive ductal carcinomas with some, but not all, the histologic features of medullary carcinomas are defined as medullary like invasive carcinomas (MLIDC). MLIDCs have similar radiologic features with phyl-lodes tumor (PT) and may be misdiagnosed. Herein we present a patient with MLIDC misdiagnosed as PT. A 32-year-old female patient with pal-pable right breast lesions was evaluated. Ultrasonography, mammography and magnetic resonance imaging (MRI) were applied. MRI revealed that the lesions were hypointense with internal septa in T1 and T2 weighted images. There were intense peripheral and heterogeneous central enhancements with restricted diffusion. Type 3 pharmacokinetic curves were provided. The preliminary diagnosis was PT and she was redirected to surgery. Histopathology was medullary like invasive ductal carcinoma. Histologic appearance of medullary carcinoma can mimic that of poorly differentiated intraductal carcinoma. MLIDC has similar radiologic findings with medullary carcinoma and PT. PTs may have a typical morphology with smooth margins, internal cysts, and septa at MRI. PT shows hetero-geneous enhancement due to solid components. Dynamic enhancement patterns can be changed as the tumor has malignant components. In MRI, MLIDCs are mostly oval or lobular shaped with smooth margin. Additionally, peripheral enhancement is detected. In the present case, MRI examination was not useful in lesion discrimination. MLIDCs are rare and have similar imaging findings with PT. However, it is important to aware of the malignant lesions like medullary breast carcinomas and MLIBC.

Keywords: Magnetic resonance imaging, medullary like invasive carcino-mas, phyllodes tumor

P - 0165

METASTASIS OF OVARIAN PAPILLARY SEROUS CARCINOMA TO THE BREASTAYDAN ARSLAN1, CAN ATALAY1, EYLEM AKAR OZKAN2, ERKIN ARIBAL1

1Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul Turkey2Acıbadem Altunizade Hospital, İstanbul, Turkey


Abstract

Breast metastasis from primary ovarian papillary serous carcinoma is unusual. Clinical history and imaging morphology can help for metastasis vs primary tumor differentiation. Additionally Pax8, is a transcription factor, has high sen-sitivity in distinguishing metastasis from primary. A 47- year- old female with no familial or personal cancer history was admitted to the general surgery department due to the abdominal pain and breast lump. Dynamic contrast-enhanced breast MRI (DCE-MRI) revealed a complex cystic mass which was located at 7:00 oclock in left breast. The lesion had a large cystic component with a mural nodule of 5 mm in size. Contrast enhancement of the solid component (mural nodule) showed persistent contrast enhancement (type 1). Clinical history and immunohistochemical examinations of the lesion were typical over-induced serous papillary adenocarcinoma metastasis.

Keywords: Dynamic contrast-enhanced breast MRI, breast metastasis, serous papillary adenocarcinoma metastasis, PAX8, ovarian metastasis

P - 0166

MRI FINDINGS OF A PATIENT WITH AUTOLOGUS FAT GRAFTING TO THE BREASTISIL BASARA AKIN, PINAR BALCI


Abstract

Autologous fat grafting is a technique that involves using the patient’s own adipose tissue to be applied on a subcutaneous area of the body to increase total fat volume. Autologous fat is a soft-tissue filler that is easy to harvest and does not cause hypersensitivity or foreign-body reactions on implantation. The postoperative complications of autologous fat grafting are similar to other breast augmentation techniques and include fat necro-sis, sclerosis, and calcification and breast disfigurement. These patients, should be considered by breast magnetic resonance imaging (MRI) a first line screening tool or at least used when clinical suspicion or radiographic abnormality is indeterminate. Herein we present breast MRI findings of a patient with autologous fat grafting. A 35-year-old female patient with palpable right breast lesions and pain was evaluated. MRI was applied. MRI revealed that there was a global edema, ill defined, heterogeneous enhancing lesions and granulomas. Right breast findings were similar but less prominent. The findings were diagnosed as fat necrosis due to autolo-gous fat grafting; in second look ultrasonography the diagnosis was veri-fied. Autologous fat grafting in the breast is not a simple procedure and should be performed by highly trained and skilled surgeons. The recipient of autologous fat grafting is at risk of calcification, multiple cyst formation, focal breast indurations, pain, infection, and abscesses, abnormal breast discharge, and reactive lymphadenopathy. MRI has been reported to be more capable than mammography of early detection of fat necrosis and clinically non-detectable masses, nodules and other complications.

Keywords: Autologus fat grafting, breast, magnetic resonance imaging

P - 0167

BREAST IMAGING AFTER AUGMENTATION WITH AQUAFILLING

UMIT AKSOY OZCAN, SILA ULUS, DENIZ MUTLU

Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul Turkey

Abstract

Introduction: Breast augmentation with various injectable materials has been performed for decades. Aquafilling was developed in 2005 as soft tissue filler for facial contouring and recently its use for breast augmentation has started in several countries. Although not approved by FDA the procedure is increasingly applied in Turkey. Thus, familiar-ity with the specific imaging findings and complications of this entity is important. Hereby we present two cases with a history of breast augmentation with aquafilling.

Case 1: The patient presented to the plastic surgery department of our hospital due to progressive swelling of the right breast. The patient has a history of augmentation mammoplasty with Aquafilling (declared compo-sition: % 98 water, % 2 copoliamid) four years ago. The right breast was twice the size of the left breast in the physical examination. The patient was referred to our radiology department for breast sonography (US). An ill-defined complex cystic structure 11x2 cm in size with multiple and mobile hypoechoic inner foci in the retroglandular area of the right breast was noted. In addition, a similar yet smaller complex cystic structure was noted at the retroglandular location of the left breast. Then, the patient was referred for breast magnetic resonance imaging (MRI) for further investigation. Axial T2-weighted (T2-W) turbo spin echo (TSE), 2 dimen-sional (2D) fat saturated (fat sat) time of repetition-independent multislice (TRIM), 3D Flash T1-W, and 2D WS-FS short tau inversion recovery (STIR) sequences were obtained with 1.5T MR (Siemens Espree; Siemens Medical Solutions, Erlangen, Germany). No contrast medium was used. Breast MRI revealed hyperintense and heterogenous loculated areas in the T2-W sequences. The region of injection appeared more spheric in the right breast compared to the left breast. Hyperintense injection material was noted among pectoral muscle fibers in the superior parts of both breasts. In addition, Aquafilling material was seen between the left pectoralis major and minor muscles. Migration of the Aquafilling material into the subcutaneous fat tissue in the bilateral middle-inner quadrants was noted. The patient was referred to her clinician for the excision of the material.

Case 2: A 32-year-old female was referred to our radiology depart-ment for routine breast US. She had no complaints. The patient had a history of breast augmentation with Aquafilling one year ago. An ill-defined and complex cystic structure approximately 3x1.5 cm in size with multiple mobile hypoechoic foci in the retroglandular area of the right breast was noted. Breast MRI was performed for further evalua-tion and it revealed hyperintense and heterogenous loculated areas in the T2-W sequences. Also, migration of the Aquafilling material into the subcutaneous fat tissue in the bilateral middle-inner quadrants was noted. The patient was also referred to her clinician for the excision of the material.

Conclusion: In conclusion, there can be severe complications of bilateral breast augmentation with Aquafilling injection. Knowledge of the radio-logic characteristics of Aquafilling injected breasts as well as of related complications is very useful to make an accurate diagnosis and suggest proper management.

Keywords: Breast augmentation, aquafilling, sonography, magnetic reso-nance imaging


P - 0168

EXTRACAPSULAR INVASION OF LYMPH NODE METASTASIS FROM BREAST CARCINOMA: CAN WE FIND CLUES FROM MRI?LEMAN GUNBEY KARABEKMEZ

Department of Radiology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey

Abstract

Objective: The aim of the study is to find radiological signs for extracapsu-lar invasion in metastatic axillary lymph nodes in breast carcinoma.

Materials and Methods: Patients with breast magnetic resonance imag-ing (MRI) and consequently radical mastectomy and axillary lymph node dissection were searched. Among the 51 patients 5 had extracapsular invasion of metastatic lymph node. Non-fat saturated T1, fat saturated T2 and dynamic images were reviewed.

Results: It is found that the heterogeneous fat tissue around involved lymph nodes, ondulated border and striated fat tissue on non-fat satu-rated T1 images and enhancement of perilymphatic adipose tissue were seen on MRI.

Conclusion: Extra capsular invasion has been blamed for local and distant recurrences in breast carcinoma. Evaluations of lymph nodes are limited on breast MRI. Heterogeneous fat tissue around involved lymph nodes, ondulated border and striated fat tissue on non-fat saturated T1 images and enhancement of perilymphatic adipose tissue are found on patients with extracapsular invasion of metastatic lymph nodes. These findings require further studies on breast MRI in order to have information on extracapsular invasion of metastatic lymph nodes of breast carcinoma.

Keywords: Breast cancer, magnetic resonance imaging, axillary lymph nodes, extracapsular invasion

P - 0169

LISTERIA RHOMBENCEPHALITIS: MRI FINDINGSSONAY AYDIN, ERDEM FATIHOGLU, HASAN YIGIT, PINAR KOSAR


Abstract

Listeria monocytogenes, the main cause of human listeriosis, is a gram-positive facultatively intracellular bacterium. The main way for infecting people is ingestion of contaminated food. Listeriosis usually affects immu-nocompromised patients, the elderly, and pregnant women. The infection of healthy individuals is rare. Two forms of the disease are defined: nonin-vasive gastrointestinal listeriosis (immunocompetent people) and invasive listeriosis (immunocompromised adults). A 40-year-old female, with a 2-week history of headache, vertigo,and nausea, was referred to radiology for MRI scan. On admission to hospital, she was conscious (12 points in GCS). Fever is 39°C. Neck stiffness were stated. Brain CT examination

did not show any pathological finding. Lumbar puncture was performed, CSF had inflammatory features (pleocytosis withwith lymphocyte pre-dominance). On MRI there are nonspecific white matter lesions located at brainstem, at midline and on the left. The lesions do not enhance. One day later from the MRI scan, in blood culture, ampicillin-resistant Listeria monocytogenes was identified. Listerial rhombencephalitis accounts of approximately 9% of CNS listeriosis cases. Immunocompetent patients consist of 42–92% of examined patients with listerial rhombencephalitis. Blood cultures are positive in 61% of cases. MRI is capable of detecting parenchymal lesions and usefull in early diagnosis. Patchy signal hyperin-tensity throughout the medulla and cerebellar peduncles on T2 weighted images, in association with a hypointense dot, and multiple gadolinium-enhanced microabscesses in the rhombencephalon are some imaging characteristics. Listeriosis is a rare cause for rhombencephalitis, and must be kept in mind in the presence of a cerebellar or medullary lesions on MRI.

Keywords: Listeria, rhombencephalitis, MRI

P - 0170

CYSTIC DILATATION OF VENTRICULUS TERMINALIS: CASE REPORTADEM YOKUS

Van Training and Research Hospital, Van, Turkey

Abstract

Objective: Ventriculus terminalis (VT) is a space filled with CSF which is coated by ependymal cells in conus medullaris of medulla spinalis. It is also known as the ependymal cyst or the 5th ventricle. It has been reported in the literature that the dilated VT is seen in 2.6% of pediatric patients under five age, but observed rarely in adults. In this presenta-tion, we aimed to present Magnetic Resonance Imaging (MRI) findings of cystic dilatation of VT in a middle-aged female patient with low back pain complaint.

Materials and Methods: MRI was performed in a 33-year-old female patient with a low back pain complaint.

Results: Thoracolumbar region images were obtained by using routine MRI sequences. On sagittal and axial T2-weighted images, a cystic dilata-tion with dimensions of 11x8mm which is isointense with CSF in all MRI sequences was detected in the centre of medulla spinalis at conus medul-laris (T12-L1) level. Pre-contrast and post-contrast T1-weighted images showed no contrast enhancement in the lesion. The signal intensity of medulla spinalis was observed to be normal, perilesional cord edema was not detected. There was no septation within the detected lesion. There were no additional spinal anomalies such as hydromyelia cavity and verte-bral deformities that could accompany the lesion.

Conclusion: Ventriculus terminalis is a cavity covered with ependymal cells in conus medullaris. The VT was described as a normal developmental phenomenon in newborns and pediatric cases; but it is a rare pathology in adults and few cases have been reported in the literature. Coleman et al. (2) reported that there is no pathology associated with VT and they reported also VT has no pathological prognosis in their study on 418 chil-


drens MR images. In the same study, the incidence of childhood VT was found to be 2.6% in children under the age of five. Suh et al. reported that septation, perilesional cord edema, kyphosis and arteriovenous mal-formation were associated with ventriculus terminalis in a study of 10 adult patients with VT.

In adults, VT is rarely encountered in thoracolomber MR images. Cystic neoplasms located at the same level take place in the differential diagnosis, therefore the image feature and intensity of the lesion must be known. VT cases are usually asymptomatic and the treatment is based on clinical findings. Patients with nonspecific symptoms are followed up by conserva-tive treatment; however, surgical treatment may be required in cases with focal neurological deficits. The cystic dilatation of the VT is seen as an ovoid-shaped, regular wall structure in MR images, with no septation and continuing with canalis centralis. The intensity of fluid within the lesion is hypointense on T1-weighted images, hyperintense on T2-weighted imag-es, and isointense with CSF in all MRI sequences. No contrast enhance-ment is found within the cyst, on the wall or in the surrounding tissues. As a conclusion, MR imaging is very important in the diagnosis and follow-up of ventriculus terminalis.

Keywords: Ventriculus terminalis, cystic dilatation, conus medullaris, mag-netic resonance imaging

P - 0171

BILATERAL FRONTAL POLYMICROGYRIA AND ECTOPIA LENTISYASEMIN KUCUKCILOGLU, MURAT KOCAOGLU, BURCIN SANLIDAG

Near East University, Nicosia, Cyprus

Abstract

Polymicrogyria is a form of cortical displasia in which normal gyral pat-tern is replaced by multiple small gyri, separated by shallow sulci. Focal, diffuse, bilateral and unilateral involvement has been described. Studies to delinate the genetic basis of the finding have become frequent for the past years. Ectopia lentis is defined as displacement or malposition of the lens of the eye. It has been described in genetic syndromes like Marfan or Weill-Marchesani, also isolated forms have been reported. In this report we present a pediatric patient with bilateral frontal polymi-crogyria and unilateral ectopia lentis.

Keywords: Polymicrogyria, bilateral frontal polymicrogyria, ectopia lentis

P - 0172

UNUSUAL MRI FINDINGS IN A GIRL WITH ACUTE HEPATIC ENCEPHALOPATHY: LEPTOMENINGEAL ENHANCEMENT AND CORTICAL LAMINAR NECROSISHAYRI OGUL, BERHAN PIRIMOGLU, MECIT KANTARCI


Abstract

A 3-year-old girl presented with acute signs of hepatic encephalopathy including abdominal pain, nausea, vomiting and impairment of conscious-ness. Physical examination revealed mild confusion and minimal changes in memory, concentration, and coordination. The laboratory findings indicated elevated alanine aminotransferase (ALT), aspartate amino-transferase (AST), total bilirubin levels (AST: 103 IU/L, reference levels: 6–40 IU/L; ALT: 93 IU/L, reference levels: 7–56 IU/L and total bilirubin: 3 mg/dL, reference levels: 0.1–1 mg/dL). After 12 h of acetaminophen overdoses, magnetic resonance imaging (MRI) showed the widespread edema and minimal diffusion restricted to cortical gray matter of both brain hemispheres. MRI obtained two weeks after treatment demon-strated periventricular hyper-intensities, cortical laminar necrosis and markedly diffusion restrictions. Follow-up MRI with gadolinium also showed the contrast-enhanced areas at the bilateral leptomeningeal regions.

Keywords: Acute hepatic encephalopathy, MRI, Leptomeningeal enhance-ment, Cortical laminar necrosis

P - 0173

GUILLAIN BARRE SYNDROME AND MRI FINDINGS: CASE REPORTADEM YOKUS

Van Training and Research Hospital, Van, Turkey

Abstract

Introduction: Guillain-Barre Syndrome (GBS), is an acute and inflamma-tory polyneuropathy, that is usually progressive and ascendant and char-acterized by symmetrical weakness and areflexia. It emerges usually 2-3 weeks after a non-specific infection such as respiratory tract infection or gastroenteritis and is characterized by ascendant progressive weakness and areflexia. Regarding the laboratory findings, an increase of protein level without an increase of the cell count in the cerebrospinal fluid indicates GBS. GBS is most common between the ages of 4 and 9 years in the pediatric population. In this report, our objective was to present a case with Guillain-Barre Syndrome and its imaging findings.

Case Report: An eight-year-old female patient, who had gastroen-teritis approximately for 2 weeks, had pain in legs and could not walk in the last three days, applied to the pediatric outpatient department of our hospital. During the physical examination, bilateral muscle strength was measured as 2-3/5 in the lower extremities and 4/5 in the upper extremities. Deep tendon reflexes were impaired in the upper extremities and could not be examined in the lower extremities. The examination of the cerebrospinal fluid showed an albuminocytologic dissociation. Electromyography showed axonal involvement and acute motor-sensorial polyneuropathy. Clinically GBS was considered and a spinal Magnetic Resonance Imaging (MRI) examination was requested. Spinal MRI revealed thickening in the cauda equina fibers at the level of conus medullaris. Following the administration of the contrast agent, prominent contrast agent uptake was observed in the nerve roots (1a, b, 2a, b). As the findings were consistent with GBS and the patient was hospitalized for follow-up and treatment.


Supplementary treatment was administered for the relief of the symp-toms and intravenous immunoglobulin treatment (400 mg/kg/day) was administered for 5 days. On the 5th day of the treatment, the muscle strength became 3-4/5 in the lower and 4-5/5 in the upper extremities and the patient was able to walk. As the general status of the patient gradually improved and the muscle strength became normal, the patient was discharged on the 16th day of the hospitalization. The patient was referred to the physical therapy and rehabilitation program and included in the outpatient follow-up plan for controls. We observed that the symptoms resolved completely at the end of 2.5 months and the patient was able to walk without aid.

Discussion: GBS is an acute, inflammatory and demyelinating disease of the peripheral nerves and nerve roots. GBS was considered as an autoimmune disease, which is characterized by the production of the antibodies against antigenic proteins of the peripheral nerves follow-ing the T-cell activation (1). GBS is usually diagnosed during the clinical examination. Spinal MR imaging is useful in the diagnosis of the disease and the exclusion of the additional pathological conditions. In patients with severe back pain, sensory deficit at a certain level or sphincter dys-function, spinal MRI examination should be urgently performed in order to exclude the compression of the spinal cord. Intracranial complica-tions such as hydrocephaly, pseudotumor cerebri and papilledema may emerge in very rare cases. Computerized Cranial Tomography, Cranial MRI and Orbital MRI may make important contributions to the diagnosis and follow-up of these complications.

Conclusion: Guillain-Barre Syndrome is principally diagnosed with the clinical and laboratory findings. The imaging methods are mostly used for the exclusion of other conditions such as spinal cord compression and transverse myelitis.

Keywords: Guillain-Barre Syndrome, magnetic resonance imaging, peripheral neuropathy

P - 0174

PETROUS APEX CEPHALOCELE AND EMPTY SELLA COMBINATION: MRI FINDINGSABDULLAH SUKUN, BERNA AK YILDIZ, SAMET MUTLU, BULENT CEKIC, ICLAL ERDEM TOSLAK

Department of Radiology, Health Sciences University School of Medicine, Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Petrous apex cephalocele is an asymptomatic rare form of cephalocele eccentrically located on the posterolateral side of the Meckel cave. It is usually seen bilaterally and detected incidentally. There is a slight female predilection. Pathogenesis is not fully understood. Congenital or acquired CSF pulsations may lead to dehiscence in patients with pneumatized petrous apex. Histology may contain all or only one of the meninges layers. Imaging plays an important role in the diagnosis as well as differentiation of other common non-neoplastic cystic lesions of the petrous apex including cholesterol granuloma, mucocele and congenital cholestatoma., and less commonly from petrous apicitis and Meckels Cave schwannoma. Petrous apex cephalocele may be associated with empty sella and Ushers syndrome. Patients may present with headache, dizziness, sensorineural hearing loss, and trigeminal neuralgia. We herein

present a left-sided petrous apex cephocele with an empty sella asso-ciatiob in a 68-year-old female patient with cerebral MRI, complaining of dizziness.

Keywords: Petrous apex, cephalocele, empty sella

P - 0175

FETAL ATYPICAL TERATOID RHABDOID TUMOUR: A RARE AND FATAL CASEIBRAHIM SULKU, EMIN DEMIREL, CIGDEM OZER GOKASLAN


Abstract

Congenital intracranial tumors are rare and usually fatal. The incidence of congenital brain tumors has been estimated at 0.5–1.9% of all pediatric tumors. Primary central nervous system atypical rhabdoid/teratoid tumour (ATRT) is a rare and highly malignant tumour that tends to occur in infancy and early childhood. The majority of tumours (approximately two-third) arise in the posterior fossa. The optimal treatment for ATRT remains unclear. Fetal ATRT is quite rare and nearly always fatal.

Keywords: Atypical teratoid/rhabdoid tumour, fetal MRI, fetal brain tumours

P - 0176

IMAGING FINDINGS IN PARTIAL FACIAL DUPLICATION (A RARE DIPROSOPUS): A CASE REPORT AND LITERATURE REVIEWIKRAM EDA DUMAN, GAZANFER EKINCI

Marmara University School of Medicine, İstanbul, Turkey

Abstract

The craniofacial duplication or diprosopus (Greek; di-, “two” + prosopon, “face”), which is one of the conjoined twinning types defining the duplica-tion of all the facial structures, is a rarely seen malformation. Partial facial duplication defines the spectrum of congenital anomalies that can be symmetrical or asymmetrical and include nose, maxilla, mandible, palate, and tongue. In the present case, as well as nose, also the cerebral frontal lobes and superior sagittal sinus rostral segment were determined to be duplicated. Three anterior cerebral arteries were observed. Corpus callosum agenesis was detected. Computed tomography (CT), magnetic resonance imaging (MRI), MR angiography-venography, and MR tractog-raphy were utilized for determining the level of cranial duplications and the accompanying cranial malformations. In the present case report, we aimed to present the partial facial duplication case, which is a rare variant of diprosopus, and to review the literature.

Keywords: Diprosopus, partial facial duplication


P - 0177

MULTIPLE SYSTEM ATROPHY: CLINICAL AND MRI FINDINGSERANIL ASLAN, EMIN DEMIREL


Abstract

Multiple system atrophy (MSA) is a sporadic, progressive neurodegenera-tive disorder of unknown etiology, characterized by various combinations of autonomic, cerebellar, pyramidal and extra pyramidal signs. The annual incidence of MSA is 0.6/ 1,00,000. MSA is a distinct clinic-pathologic entity previously known as olivopontocerebellar atrophy, striatonigral degenera-tion and Shy-Dragger syndrome are now all named as MSA.Based on the consensus criteria, patients with MSA are classified as MSA-C and MSA-P. MRI plays critical role in early diagnosis. Characteristic findings are hot crossed bun sign, brain stem and cerebellar atrophy, symmetric cerebral atrophy. In our report we present 62-yo male patient with parkinsonian features predominate (MSA-P).

Keywords: Multiple system atrophy, neuroradiology, MRI, parkinson, hot crossed bun

P - 0178

MILLER DIEKER SYNDROME: A RARE NEURODEVELOPMENTAL DISEASEERANIL ASLAN, EMIN DEMIREL


Abstract

Miller-Dieker syndrome (MDS) is a rare, devastat-ing neurodevelopmen-tal disease of childhood.This gene micro-deletion syndrome results from a mutation on chromosome 17p 13.3 and is char-acterized by craniofacial abnormalities and with clas-sical lissencephaly (lissencephaly type 1). We report a MDS associated with chorea,consegecious paretns, psychomotor retardation in a 6 years old girl. eneralized agyria, a figure-eight appear-ance of the brain, a wide and shallow Sylvianfissure, enlarged subarachnoid space, and ventriculomegaly are the main MRI findings in MDS The poste-rior fossa structures usually look normal.

Keywords: Miller-Dieker syndrome, MRI, brain, lissencephaly type 1

P - 0179

ISOLATED RHOMBENCEPHALOSYNAPSIS WITH MRI AND CLINICAL FINDINGSERANIL ASLAN, EMIN DEMIREL

Department of Radiology, Afyon Kocatepe School of Medicine, Afyonkarahisar, Turkey

Abstract

Rhombencephalosynapsis (RES) is a rare cerebellar malformation of unknown etiology characterized by vermal agenesis or hypogenesis, fusion of hemispheres and the dentate nuclei. Clinical presentation and progno-sis are extremely variable and generally depends one the associated supra-tentorial anomalies. We report RES diagnosed by magnetic resonance imaging (MRI) in a 1year-old girlborn to consanguineous parents. The child had neuromotor development delay.

Keywords: Rhombencephalosynapsis, brain, MRI

P - 0180

MRI FINDINGS OF POSTERIOR SPINAL NERVE ROOT SHEATH CYSTS AT ALL LEVELS: CASE REPORT

SAMET MUTLU, AYSE EDA PARLAK, MEHTAP BARC ERGUN, iCLAL ERDEM TOSLAK, EMiN DURMUS


Abstract

In 1938, Tarlov was first described perineural cysts in sacral spines as an incidental finding at autopsy. Perineural cysts are CSF filled dilatations of the nerve root sheath at the dorsal root ganglion. They can be asymptom-atic or cause progressive neurological symptoms including pain, paraes-thesia and weakness according to the localization. Generally it is incidental findings observed on MRIs or CT scans. We report MRI findings in a case of a 53-year-old female with tarlov cysts at all spinal levels presented with cervical spine and bilateral upper limb pain.

Keywords: Tarlov cyst, spine, perineural cyst

P - 0181

EXTREME WIDENING VIRCHOW-ROBIN SPACE: ASYMPTOMATIC PATIENT

EMIN DEMIREL, IBRAHIM SULKU

Department of Radiology, Afyon Kocatepe University School of Medicine, Afyon, Turkey

Abstract

Virchow-Robin spaces are very well-known radiological entities. They are normally surround the perforating arteries that enter the brain. But, the giant cystic widening of Virchow-Robin spaces is quite rare in asymptom-atic patients. We report a patient presenting with giant cystic widening of Virchow-Robin spaces located in both cerebral hemispheres with mild cerebral atrophy.

Keywords: Perivascular space, virchow-robin space, brain MRI


P - 0182

MRI FINDINGS OF MULTIPLE ANOMALIES OF LUMBAL SPINE: CASE REPORTSAMET MUTLU, AYSE EDA PARLAK, MEHTAP BARC ERGUN, ICLAL ERDEM TOSLAK, ABDULLAH SUKUN


Abstract

Diastematomyelia (split cord malformation) is a rare form of spinal dysra-phism characterized by a sagittal cleft that splitting the spinal cord, conus medullaris, or filum terminale. There may be other associated abnormali-ties including tethered cord, which is an abnormal attachment of the spinal cord to the end lower in the lumbar or sacral spinal canal, lipomyelocele and syringomyelia. Lipomyelocele is also one of the most common type of occult spina bifida generally occurs in the lowermost part of the spine and extends to subcutaneous soft tissues posteriorly through a spina bifida defect from spinal cord. Syringomyelia is a fluid-filled cystic cavity inside the spinal cord. In this case, we report MRI findings of a 42-year-old female with diastematomyelia, tethered cord, lipomyelocele and syrinx cavity.

Keywords: Lipomyelocele, diastematomyelia, tethered cord syndrome, spinal dysraphism, syringomyelia, split cord malformation

P – 0183

REVERSE TIGROID PATTERN DUE TO DIFFUSE ENLARGED VIRCHOW - ROBIN SPACESMERIC TUZUN, BAKI HEKIMOGLU

Department of Radiology, Health Sciences University, Dışkapı Yıldırım Beyazıt Training And Research Hospital, Ankara, Turkey

Abstract

Tigroid pattern is characterized by the radiating linear hypointensities (spared perivascular white matter) within hyperintense demyelinating periventricular white matter areas on T2-weighted images. It is a classical magnetic resonance imaging finding described in diseases such as meta-chromatic leukodystrophy, Pelizaeus-Merzbacher disease. Widespread enlarged Virchow - Robin spaces are seen very rarely. In this report, a case with radiating linear hyperintensities due to diffuse enlarged Virchow-Robin spaces within periventricular white matter on T2-weighted images that we defined as reverse tigroid pattern is presented.

Keywords: Tigroid pattern, reverse tigroid pattern, Virchow - Robin spaces, magnetic resonance imaging

P - 0184

BILATERAL THALAMIC INFARCTION DUE TO OCCLUSION OF ARTERY OF PERCHERON ACCOMPANIED BY POSTERIOR CEREBRAL ARTERY OCCLUSION

IBRAHIM FEYYAZ NALDEMIR, ELIF NISA UNLU, OMER ONBAS

Düzce University School of Medicine, Düzce, Turkey

Abstract

Introduction: Bilateral thalamic infarction is a rare condition. One of the reasons this situation is the occlusion of Artery of Percheron (AOP), which is variational structure that suppiles bilateral paramedian thalami and rostral midbrain. We presented a bilateral thalamic infarction accom-panying the infarction of the posterior cerebral artery supply area.

Case Report: A 49-year-old male patient was brought to the hospital because of seizures. According to the information received from the patients’ relatives, his seizures continued for about 45 minutes. In brain CT, hypodense areas were observed on bilateral thalamus. After, in the diffuse MR examination the signal changes were observed in the bilateral thalami and left posterior cerebral artery (PCA) supply area, consistent with acute diffusion restriction. The patient was diagnosed with left PCA and AOP territory infarction. Because the patient was not suitable, angio-graphic imaging could not performed. A month later control MRI showed chronic stage ischemic changes on this areas.

Conclusion: Bilateral thalamic infarctions are rare condition. The AOP infarc-tion accompanied by the PCA infarct is much less common. AOP occlusion should be considered especially in ischemia where paramedian regions are present. Brain CT, diffusion MRI and if possible angiographic imaging studies should be performed in patients with impaired consciousness. The patients’ story, symptoms, and evaluation of imaging findings facilitate diagnosis.

Keywords: Artery of percheron, bilateral thalamic infarct, paramedian thalami, PCA infarct

P - 0185

MRI FINDINGS OF HEMORRAGHIC BRAINSTEM GLIOMA: CASE REPORTSAMET MUTLU, AYSE EDA PARLAK, MEHTAP BARC ERGUN, ICLAL ERDEM TOSLAK, BERNA AK YILDIZ


Abstract

Brain tumors are second most common childhood tumors after leuke-mia and brainstem gliomas constitues 10 - 20 % of all childhood brain tumors. The incidence in pediatrics is higher than in adults. The most common localization of these tumors is between the aqueduct of Sylvius and the fourth ventricle. Prognosis is usually poor thus accurate diagnosis is important. Brain stem gliomas are classified into four different types: diffuse, focal brainstem glioma, (dorsally) exophytic and cervicomedullary. We here in report MRI findings in a 6-year-old with hemorraghic diffuse brainstem glioma presented with loss of consciousness.

Keywords: Brainstem, glioma, brain tumors, childhood

P - 0186

A CAUSE FOR GRE T2* HYPOINTENSE FOCI ON BRAIN MRI IN CHILDREN: EXTRACORPOREAL MEMBRANE OXYGENATION


OGUZ LAFCI, HASAN YIGIT, PINAR NERCIS KOSAR


Abstract

Gradient echo (GRE)-T2* hypointense foci on brain MRI are expected to be seen in adults with underlying amyloid angiopathy or hyperten-sion and represent microhaemorrhage. In children, same finding may also occur among recievers of extracorporeal membrane oxygenation (ECMO) treatment. ECMO is a life support technique which is also indi-cated in cardiac failure following repair of congenital heart defects. Here we present a case of a 5 year old child with tetralogy of Fallot (TOF) who had undergone cardiac repair surgery and afterwards recieved ECMO treatment.

Keywords: GRE, ECMO, MRI, brain

P - 0187

DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING IN CEREBRAL FAT EMBOLISM SYNDROMEBULENT YILDIZ1, ERTAN UNVER1, KAYHAN KARAKUS1, MEHMET HAYDAR ATALAR1, OZLEM KAYIM YILDIZ2

1Department of Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey2Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey

Abstract

Fat embolism syndrome (FES) is a serious and life-threatening clini-cal picture in which respiratory, hematological, neurological, and skin manifestations of fat particles into to the circulatory system for any reason. It is estimated that after long bone fractures, the incidence of FES development is less than 1% and mortality is about 10-20%. The criteria developed by Gurd-Wilson are widely used in FES. According to these criteria, major findings are triad respiratory failure, neurological symptoms and petechiae. As minor findings including tachycardia, fever, jaundice, oliguria-anuria, retinal changes, anemia-thrombocytopenia, elevated sedimentation rate, fat macroglobulinemia. At least two major or at least one major and four minor criteria are required for diagno-sis. Neurological findings are nonspecific. It extends into a coma from temporary memory loss. Magnetic resonance imaging (MRI) is the most sensitive imaging method for cerebral embolism in cases with FES. In present case, we are presented diffusion weighted imaging (DWI) MRI findings of a patient with fat embolism syndrome after traumatic femur fracture. Previously healthy, 68-year-old male admitted to emergency services after a trauma. The patient underwent operation after the intertrochanteric fracture was detected in the right femur as a result of the examinations. On the third postoperative day following surgery, MRI examination was performed because of no respond to verbal stim-uli and developing tachycardia, tachypnea confusion. DWI was showed multiple hyperintense lesions in sentrum semiovale, and periventricular white matter. The lesions were seen hypointense in ADC map. MRI find-ings were favored by cerebral fat embolism.

Keywords: Fat embolism syndrome, trauma, MRI

P - 0188

CONGENITAL DERMAL SINUS TRACT: A RARE ENTITYMUZEYYEN KALKAN, GAMZE TURK, GULTEKIN SERT

Clinic of Radiology, Health Sciences University Kayseri Training and Research Hospital, Kayseri, Turkey

Abstract

Congenital dermal sinus (CDS) is an epithelium-lined tract extending from the skin to the deep tissues that results from the incomplete sepa-ration of cutaneous and neural ectoderms. The tract may end within the skin layers or adjacent to the neural structures. CDS is most commonly diagnosed during childhood, though adulthood cases have also been reported. A number of pathologies such as tethered cord, bifid lamina, split cord malformation, epidermoid and dermoid cysts, tethered filum terminale, meningomyelocele may accompany CDS. Cervical CDS is the least common type and consist 1% of all dorsal CDS cases. Herein we present MRI findings of an adult CDS patient that presented with dermal ostium at the neck and had incidental stress-induced tremor.

Keywords: Congenital dermal sinus, cervical, magnetic resonance imaging

P - 0189

TRANSIENT SPLENIAL LESION PRESENTING WITH HYPERVENTILATIONNILUFER AYLANC, FATIH BATTAL, OZAN KARATAG, MUSTAFA RESORLU, NEBIL EKER, CANAN AKGUN TOPRAK

Çanakkale University School of Medicine, Çanakkale, Turkey

Abstract

Introduction: Transient splenal lesions of the corpus callosum are revers-ible isolated lesions which may also be associated with mild encephalitis/encephalopathy and are frequently detected during MR imaging (MRI) and may arise due to various etiologies. In this case, a transient splenic lesion arising in association with respiratory alkalosis due to hyperventila-tion and this case is presented because of rhinovirus-related MERS case.

Case Report: 4-year-old female patient presented to pediatric emergency clinic with vomiting, fever,dizziness and respiratory distress symptoms (tachy-pnea, abdominal respiration). Other systemic examination findings were normal. The patients routine blood count and biochemical tests were normal, blood gas pH: 7.60, pCO2:11.2, HCO3:18.3, mmol/L BE:-10.5 mmol/L and compatible with respiratuar alkalosis. Blood serological studies were normal and no pathology was detected in EEG. CSF studies were normal and CSF PCR results were negative. In the nasopharyngeal swab, multiplex PCR revealed rhinovirus was detected positive. On cranial MRI, a focal restricting area on DAG sequence, was detected in the splenium of the corpus callosum. The patient was thought to be compatible with viral encephalitis and acyclo-vir and single dose IVIG treatment were given. On the 7th day of follow-up tachipne was regressed and, also regression of the lesion was seen on the cranial MRI taken on the 10th day of the follow-up.

Conclusion: Transient splenic lesions are not associated with hemispheric disconnection, unlike other splenic lesions of the corpus callosum, and there


are many factors in the etiology including epilepsy and antiepileptic drug interruption, electrolyte imbalance, demyelination, ADEM, PRES, diffuse axonal injury, hypoglycemia and infections. MRI plays an important role in the diagnosis of splenic lesion and in the etiologic diagnosis stage. Prognosis is generally favorable if the lesion is due to epileptic or antiepileptic drug withdrawal, but generally varies depending on the underlying condition.

Keywords: Transient splenial lesion, MRI, encephalitis

P - 0190

TECTAL PLATE CYST MRI FINDINGS

M. YASEMIN KARADENIZ BILGILI, UMRAN CANKAYA

Kırıkkale University School of Medicine Hospital, Kırıkkale, Turkey

Abstract

Tectal plate cysts are very rare benign, tumor-like lesions. Asymptomatic patients can be diagnosed incidentally. Increased size may cause obstruc-tive hydrocephalus and associated symptoms. Patients may present with symptoms such as headache, vomiting, diplopia, cognitive impairment, ataxia and urinary incontinence. It can be confused with pineal region tumors. As the resolution of magnetic resonance imaging (MR) devices increases, it is possible to distinguish between tumors. In this case we presented a tectal plate cyst in the adult patient who presented with headache and did not cause hydrocephalus.

Keywords: Tectal plate, pineal region, cyst, hydrocephalus

P - 0191

A RARE CENTRAL NERVOUS SYSTEM NEOPLASIA: DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMORATILLA HIKMET CILENGIR1, MUSTAFA FAZIL GELAL1, TURKAN ATASEVER REZANKO2, CIHAT UZUNKOPRU3, HASAN KAMIL SUCU4

1Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey2Department of Pathology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey3Department of Neurology İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey4Department of Neurosurgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare central ner-vous system neoplasia. It occurs predominantly in childhood and young-adult ages. Presenting symptoms such as headaches and seizures are related with hydrocephalus due to obstruction of cerebrospinal fluid (CSF) flow. Irregular leptomeningeal thickening and enhancement, small cysts over the parenchyma surface around basal cisterns and subarachnoid spaces without intraparency-mal mass are the characteristic magnetic resonance imaging (MRI) findings. Irregular and enhancing mass can also be seen in the subarachnoid spaces.

Because of the lesion patterns and locations, tuberculous meningitis and lep-tomeningeal carcinomatosis should be considered in differential diagnosis and absence of any abnormality except high protein levels in CSF analysis is helpful to discriminate. Specific immunohistochemical methods must be performed on the pathologic specimen for the diagnosis of DLGNT. Ventriculoperitoneal shunt placement, surgery, chemotherapy and radiotherapy are helpful in treatment. Here, we aimed to present MRI findings and clinical course of a 35-year-old male patient who was diagnosed with DLGNT.

Keywords: Glioneuronal tumor, leptomeninges, hydrocephalus

P - 0192

EXPANSILE AND DESTRUCTIVE SKULL LESION AND SUNBURST SIGN: PRIMARY OSTEOSARCOMAFERHAT CUCE, HATICE TUBA SANAL

Gülhane Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: The primary osteosarcoma of the skull is an extremely rare tumor and the incidence is 1-2% among all skull tumors. The benign and malignant lesions such as eosinophilic granuloma, hemangiopericytoma, metastasis, and other sarcomas should be considered with the primary osteosarcoma in the differential diagnosis of an expansile, destructive skull lesion in a young patient. The sunburst sign as a CT finding may be an important clue to suggest osteosarcoma.

Case Report: A 23-year-old male patient was presented with a rubbery hard swelling of a left temporoparietal region which he first noticed 18 months ago but it has grown rapidly in the last five months. A painless mass fixed to bone approximately 7x5 cm was observed on physical examination. The CT imaging was scheduled for the patient with the normal neurological examination as well routine blood tests.

Discussion: The differential diagnosis of a skull lesion should primarily be made according to the age of the patient. The osteoma is the most com-mon (26%) skull lesion, but eosinophilic granuloma should be considered firstly for an expansile lesion in young patients. In our case, the CT showed numerous, thin, linear calcifications within the skull lesion so-called sun-burst sign which is typical for skull hemangioma and osteosarcoma have mostly seen in the long bone metaphysis.

Keywords: Calcarium, osteosarcoma, sunburst sign

P - 0193

ACUTE HYPERAMMONEMIC ENCEPHALOPATHYSONAY AYDIN, KUBRA OZDEMIR, HASAN YIGIT, PINAR KOSAR


Abstract

Acute hyperammonemic encephalopathy, generally presents with altered mentality, and can even progress to coma state. The most common involving sites are insula, diffuse cerebral cortex, cingulate cortices, and bilateral thalami.


MRI has an important role in diagnosis. A 17-year-old female patient present-ed nausea, vomiting and lethargy. She had the diagnosis of arginase deficiency. Ammonia level is 302 ug/dL. On MRI, edema is present on cerebral and cer-ebellar hemispheres. On DWI, diffusion restriction is present at both caudate and lentiform nucleus. On T1WI, lineer hyperintensities belonging to laminer cortical necrosis are detected at cortical surfaces in bilateral frontotemporo-parietal lobes. She was diagnosed as acute hyperammonemic encephalopathy by laboratory and imaging findings. Sudden onset drowsiness and seizures are some common signs of the disease. Lated diagnosis and treatment can cause permanent brain injury. Bilateral involvement of the insular cortex and cingulate gyrus was a strikingly common feature, restricted diffusion is seen in insula, cingulate cortex and diffuse cerebral cortex. Cortical laminal necrosis is commonly seen. Thalamic involvement (dorsomedial thalami) is told to be more common than cortical involvement. Plasma ammonia levels and MRI findings are correlated. Ammonia levels are told to correlate with clinical out-come, too. MRI features have only moderate correlation with outcome. Acute hyperammonemic encephalopathy is reversible with prompt and proper diagnosis and treatment. Seeing that, knowing the typical MRI findings and correlating them with laboratory findings is crucial for the patient.

Keywords: Hyperammonemic encephalopathy, MRI, DWI

P - 0194

THE LEPTOMENINGEAL “IVY SIGN” ON FLAIR MR IMAGING IN A CASE WITH MOYAMOYA DISEASEDILARA ATASOY, ILKER EYUBOGLU, AHMET SARI, DENIZ OZTURK KOCAKGOL, CEMAL AYDOGAN, MERVE ERKAN

Karadeniz Technical University School of Medicine, Trabzon, Turkey

Abstract

Introduction: We aimed to present the imaging findings of the Moyamoya disease on the basis of a case got the diagnose with ivy sign on the FLAIR image. Moyamoya disease (MMD) is an idiopathic progressive arteriopathy characterized by stenosis of the terminal segment of (supraclinoid) internal carotid arteries (ICAs) and formation of an abnormal vascular network called ‘Moyamoya vessels’ at the base of the brain. These Moyamoya vessels are mul-tiple enlarged telangiectatic lenticulostriate, thalamo-perforating, leptomenin-geal, dural, and pial arteries develop as compensatory circulation. Moyamoya disease’s etiology is unknown some of is seen with some genetic, acquired and environmental factors. When MMD presents in childhood, the initial symp-toms are usually ischemic. However in adults intracranial hemorrhage from rupture of the fragile collateral vessels is more common. With high diagnostic accuracy, magnetic resonance (MR) imaging and MR angiography (MRA) are very useful in assessing moyamoya disease.

Case Repor: An 8-year-old boy was referred to our department after choreiform movement intervals. Magnetic resonance imaging of brain revealed hyperintense cerebral sulcus on FLAIR images and then we decided to examine the case with contrast enhanced T1A and MRA images. Leptomeningeal enhancements were seen on contrast-enhanced T1A images. Moyamoya disease was diagnosed with the MRA examina-tion that revealed markedly narrowed bilateral supraclinoid ICAs and widespread lenticolostriate-thalamoperforated collaterals (Moyamoya vessels) on the base of brain.

Conclusion: Moyamoya disease is an idiopathic progressive cerebrovascu-lar disease characterized by narrowing of the distal (supraclinoid) internal carotid artery. DSA, CTA, and MRA show predominantly marked stenosis of both supraclinoid ICAs (“bottle neck” sign). Prominent deep-seated lenticulostriate and thalamoperforator collaterals are present, forming the “puff of smoke” appearance characteristic of moyamoya. And also an “ivy” sign with sulcal hyperintensity from slow flow in leptomeningeal col-laterals is sometimes seen on FLAIR and contrast enhaced T1 scans often show leptomeningeal enhacement. These are the characteristic imaging findings of Moyamoya disease.

Keywords: Moyamoya disease, ivy sign, puff of smoke

P - 0195

COMMON BENIGN CHOROID PLEXUS TUMORSSEREF BARBAROS ARIK, HATICE TUBA SANAL, KEMAL NIYAZI ARDA, SINAN AKAY, SALIH HAMCAN, UGUR BOZLAR, MUSTAFA TASAR

Department of Radiology, Gülhane Training and Research Hospital, Ankara, Turkey

Abstract

Introduction:Choroid plexus tumors are rare. Choroid plexus papillomas are far more common than carcinomas (ratio of 5:1). In some cases distinction between choroid plexus papillomas and choroid plexus carci-nomas may only be made by histologically. Choroid plexus carcinoma is a highly aggressive malignant tumor (WHO grade-III) that usually presents with CSF obstruction. The differential diagnosis includes choroid plexus papilloma (WHO grade-I), meningioma and metastatic papillary neo-plasms. In this paper, we describe two cases of choroid plexus tumors to discuss and remember the radiological characteristics.

Case Report:

1st Case: Choroid Plexus Papilloma

2nd Case: Intraventricular Menengioma (we assumed it was plexus car-cinoma and frozen examination was malign but final pathology report is atypical menengioma)

Conclusion: Choroid plexus tumors arise from the choroid plexus epi-thelium in ventricles especially derive from lateral ventricles in children and fourth ventricle in adults. Approximately 80% of choroid plexus carcinomas arise in children. In adults choroid plexus carcinomas are rare. There is currently no accepted treatment protocol for choroid plexus carcinoma. The main treatment option is complete resection of the tumor; however, a gross total resection sometimes may not be possible. Chemotherapy and postsurgical radiotherapy may be considered if the patient is an adult.

Keywords: Choroid plexus, carcinoma, menengioma, papilloma

P - 0196

A CASE OF GASTRIC CANCER MANIFESTING AS A SOLITARY CEREBELLAR METASTASIS


SUMEYYA DURAN KAYMAK, BURCU SAVRAN SAHIN, ELIF AKTAS, NAZAN CILEDAG, OZKAN UNAL

Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: Gastric cancer is fourth most common cancer in world-wide. Therewithal gastric cancer is third leading cause of cancer-related mortality. Stomach cancer metastasize most commonly to peritoneum, lymph nodes, liver, lungs and bones. Brain metastasis of gastric cancer is extremely rare with less than 1% frequency. Our aim is to present a rare case of stomach cancer with cerebellum metastasis.

Case Report: A 37-year-old female patient was diagnosed with stomach cancer in 2014 and had an operation. On the follow-up, the patient underwent brain CT due to headache complaint. The brain MR is being taken after the headache of the ongoing patient. CT revealed a decrease in the depth of the cerebellar sulci, an isodense mass lesion in the right cerebellum which is 39x37 mm in length with a peripheral hypodense ring. Then the patient was examined with MRI. MRI showed a mass lesion in right cerebellum which is approxi-mately 38x36 mm in length, heterogenously hyperintense (thought to contain blood-degrading products) in T1-weighted sequences, hetero-geneously hyperintense appearance in T2-weighted sequences, het-erogeneously enhancing after contrast medium injection. The lesion caused no diffusion restriction.

Discussion: Brain metastasis from gastric cancer is rare. Also solitary brain metastases are even rarer compared to multiple metastasis. The differential diagnosis of intracranial solitary hemorrhagic lesion must include metastases if the patient has a primary tumor history; even if the histologic type of the tumor has low incidence of brain metastases.

Keywords: Gastric cancer, brain metastasis, solitary

P - 0197

A RARE CASE; MRI FINDINGS OF AICARDI SYNDROMESUAT INCE, IBRAHIM ILIK, HARUN ARSLAN

Yüzüncü Yıl University, Van, Turkey

Abstract

Objective: In this case, we aimed to present the MRI findings of aicardi syndrome.

Materials and Methods: Infantile spasm type seizure was detected in the EEG examination performed in our 10-month-old girl. Chorioretinal lacunae were observed in the optic disc. Brain MRI examination was per-formed for the diagnosis.

Results: n MRI examination, no corpus callosum was observed, lateral ventricles were wide, contours were curved, and occipitotemporal horns were parallel to each other. The right cerebellar hemispherical anterior was 21x14 mm in size and the left occipital lobe parafalin was 23x17 mm in size, with extraaxial placement and arachnoid cyst compatible lesions. Cystic lesions of 6x5 mm in the right lateral ventricle and 7x5 mm in the fourth ventricle were observed. The retrobulbar area in the right eye had

a 5x5 mm sized cystic lesion compatible with the optic nerve coloboma. In both frontal lobes, heterotopes were observed in periventricular and subcortical areas. The case was diagnosed as Aicardi syndrome with clini-cal and radiological findings.

Conclusion: Three cardinal findings of the disease; corpus callosum agen-esis, infantile spasms, chorioretinal lacunations. In addition, major findings include cortical malformations, periventricular and subcortical heteroto-pia, choroid plexus papillomas, third ventricle or intracranial cysts, optic nerve coloboma. Microphtalmia and other ocular anomalies, vertebral or extremity anomalies, cerebral hemispheric asymmetry, hipsaritmia or burst-suppression in EEG are the supporting findings of the disease. The diagnosis is made by three cardinal findings or two cardinal findings + two major findings or two cardinal findings±major findings+supportive findings.

Keywords: Aicardi sydrome, MRI, chorioretinal lacunae

P - 0198

WERNICKE ENCEPHALOPATHY AFTER SLEEVE GASTRECTOMY: MR IMAGING FINDINGSPINAR DIYDEM YILMAZ1, CENGIZ KADIYORAN2, SULEYMAN KARGIN1, SEHER KAYALI3

1Medicana Konya Hospital, Konya, Turkey2Department of Radiology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey 3 Konya Medova Hospital, Konya, Turkey

Abstract

Introduction: The number of surgical treatment for obesity has risen in recent years. Bariatric surgeries suh as sleeve gastrectomy and gas-tric banding are effective for controlling the body weight but they can cause surgical and metabolic complications. Wernicke encephalopathy can occur due to thiamine defficiency after obesity surgery. This metabolic complication presents with confusion, ophtalmoplegia, nys-tagmus and ataxia. MR imaging is useful in early diagnosis of Wernicke encephalopathy. In this case we present MR imaging of Wernicke encephalopathy, occurs after sleeve gastrectomy and recovery after administration of thiamine.

Case: 19 years old woman who had undergone laparoscopic sleeve gastrectomy surgery 2 months prior to our examination. She was referred for MR imaging because of neurologic symptoms. She had ataxia, disartry, vision problems, difficulty in walking and alter in mental state. On MR imaging symmetrical alterations and diffusion restriction in the basal ganglia are seen. After administration of thiamine her symptoms were disappeared. 2 weeks later MR imaging confirmed again and no definite structural abnormalities or signal changes seen.

Conclusion: Depending on the increase in surgical treatment for obe-sity, metabolic complications such as Wernicke encephalopaty need to be known and early diagnosed. MR imaging is useful in early diagnosis of acute Wernicke encephalopathy.

Keywords: Wernicke, obesity, sleeve gastrectomy


P - 0199

A RARE CASE: SUBAKUT SKELEROUS PANENSEFALITE (SSPE)SUMEYRA DEMIRKOL ALAGOZ, FATMA DURMAZ, HARUN ARSLAN, MESUT OZGOKCE, ABDUSSAMET BATUR

Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, Turkey

Abstract

Objective: Subacute sclerosing panencephalitis (SSPE) is a rare neurode-generative disease caused by measles virus. We aimed to present cranial magnetic resonance (MRI) findings due to its rare nature.

Materials and Methods: A 16-year-old girl was admitted to our hospital with complaints of spasm two years ago. In contrast cranial MRI, several hyperintense foci were detected in T2-weighted and FLAIR-weighted images in bilateral frontal, parietal, and temporal lobe anterior white matter. Contrast and diffusion restriction were not detected. No specific diagnosis could be made for the patient according to MRG findings. A cra-nial MRI examination was performed 6 months after the onset of akinetic mutism. More pronounced in the frontal lobe bilateral frontal, parietal and temporal lobe common white matter, hyperintense on T2 and FLAIR weighted images, hypointense lesions on T1-weighted images and newly developing atrophy in the brain were detected.

Results: Patient who had positive measles antibody in CSF examination and who supported by MRI findings was diagnosed as SSPE. The patient who started myoclonus and drop attacks and whose clinic became worse was unfortunately died 7 months later.

Conclusion: SSPE is a rare late complication of measles infection. It is most commonly seen between 5 and 15 years. Cranial magnetic reso-nance (MR) and CT may be normal or have non-specific findings in the early stages of the disease. However, progressive cortical atrophy, gray matter changes with inflammation in the early stages, hyperintense lesions usually occur in the subcortical white matter. Over time, symmetric peri-ventricular white matter changes become more pronounced

Keywords: Subacute sclerosing panencephalitis (SSPE), magnetic reso-nance

P - 0200

SPORADIC MENINGIOANGIOMATOSIS: CT AND MRI FINDINGSBURCAK CAKIR PEKOZ1, OZLEM ALKAN2, EMRE DURDAG2

1Adana State Hospital, Adana, Turkey

2Başkent University Adana Hospital, Adana, Turkey

Abstract

Objectives: Meningioangiomatosis is a rare benign hamartomatous lesion involving the leptomeninges and the cerebral cortex. Meningioangiomatosis may occur sporadically, or in association with neurofibromatosis type II in up to 50% of patients. We aimed to present a case of sporadic menin-gioangiomatosis.

Materials and Methods: A sixteen year-old girl presented with head-ache and seizure for 3 months. Neurological examination was normal. Electroencephalography recorded epileptiform discharge in left temporal lobe. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed. The diagnosis confirmed by operative and patho-logical findings.

Results: CT showed cortical calcification and hypodensity of the subcorti-cal white matter around the silvian fissure in the left temporal lobe. At the same localization, MRI showed gyriform enhancement with subcortical edema. There was no mass effect. Restricted diffusion was not observed on diffusion MRI as increased perfusion was not detected on perfusion MR. MR spectroscopy showed no choline peak. The patient underwent left temporal craniotomy and the lesion was resected. Histopathology confirmed the diagnosis of meningioangiomatosis.

Conclusion: Meningioangiomatosis is a rare benign tumor that has not malignant potential. These lesions usually cause refracter epilepsy. Resection is the only curative treatment in 85% of meningioangiomatosis cases. The differential diagnosis includes oligodendroglioma, granuloma-tous meningitis, meningioma, parasitic disease, and calcified vascular mal-formation. The radiographic findings of meningioangiomatosis may show a variety of features and recognition of meningioangiomatosis is important for correct treatment.

Keywords: Meningioangiomatosis, MRI, seizure, sporadic

P - 0201

BRAIN MR FINDINGS IN ADULT PATIENT WITH UREMIC ENCEPHALOPATHY: CASE REPORTHATICE KUBRA OZDEMIR, HASAN YIGIT, SONAY AYDIN, BUNYAMIN ECE, PINAR NERCIS KOSAR


Abstract

Uremic encephalopathy (UE) is a toxic metabolic encephalopathy that develops secondary to uremia. Radiological findings of a uremic encepha-lopathy case will be presented.

A 68-year-old male with chronic renal insufficiency was admitted to emer-gency department with deficit in consciousness. Brain CT was performed, and no pathological finding was present. In DWI restricted diffusion was present in bilateral basal ganglia. In addition there is hyperintensity in inter-nal and external capsules, bilateral basal ganglia, excluding the thalamus, and caudate nuclei (lentiform fork sign) on T2WI. Mild contrast enhance-ment is present on T1WI in defined areas.

UE is a severe toxic metabolic encephalitis that develops secondarily to uremia. MRI is more sensitive in diagnosis, but usually no pathological findings are detected. Abnormal findings are usually bilateral, symmetrical, and they tend to regress after dialysis. Laboratory and clinical correlation is important for diagnosis, along with imaging.

CT typically shows hypodensity in bilateral basal ganglia, and thalamus, secondary to cytotoxic edema; MRI shows hyperintensities in basal ganglia, thalamus, and mesial temporal lobes in the T2WI/FLAIR sequences, sec-ondary to edema. Diffusion restriction is not typical for UE. Hyperintesity seen in the white matter surrounding the basal ganglia, internal, and


external capsules, and medullary laminae (lentiform fork sign) is a typical finding for UE, as in our case.

Keywords: Uremic encephalopathy, lentiform fork sign

P - 0202

A RARE CASE, HALLERVORDEN-SPATZ SYNDROMESUAT INCE, ILYAS DUNDAR, HARUN ARSLAN

Yüzüncü Yıl University School of Medicine, Van, Turkey

Abstract

Objective: Hallervorden-Spatz syndrome is a collection of symptoms that inherit autosomal recessive pathogenesis, also known as pantothenate kinase-dependent neurodegeneration, with globus pallidus, substantia nigra and nucleus ruberin pigmentary degeneration. In this case, we presented magnetic resonance imaging (MRI) findings of a patient with Hallervorden-Spatz syndrome.

Materials and Methods: We performed a brain MRI examination of a 25-year-old male patient to explain neurological findings such as dystonia, Parkinsonism and tremors in the hands.

Results: MRI showed hypointensity due to iron deposition in the bilateral globus pallidus, hyperintensity due to central gliosis in T2, T2-FLAIR and SWI sequences. Our patient was classified as classical Hallervorden-Spatz syndrome on the basis of the age of onset, clinical evaluation, and the specific pattern demonstrated on MRI.

Conclusion: Pantothenate kinase-2 associated neurodegeneration (PKAN) or Hallervorden-Spatz syndrome (HSS) is a rare autosomal recessive degenerative disorder. In HSS, neurons of the globus pallidus and substantia nigra are affected due to excessive iron deposition. The characteristic MRI findings of bilateral symmetrical hyperintense signals surrounded by hypoin-tensity on T2W images lead to the “eye-of-the-tiger” sign. The surrounding hypointensity is caused by signal loss (susceptibility) from the iron deposi-tion, while the central hyperintensity is due to axonal swelling, formation of spheroids, gliosis, and neuronal loss and degeneration. MRI is the preferred radiological imaging method in patients with Hallervorden-Spatz syndrome and the imaging findings are very typical for this disease.

Keywords: Hallervorden-Spatz, syndrome, MRI, iron

P - 0203 AIDS ASSOCIATED DEMENTIA: A CASE REPORTSUAT INCE, IBRAHIM ILIK, HARUN ARSLAN

Yüzüncü Yıl University School of Medicine, Van, Turkey

Abstract

Objectives: HIV affects the nervous system producing different clini-cal manifestations,for which neuropsychological disorders are the most common. We aimed to present the MRI findings of a patient diagnosed with AIDS related dementia with clinical and radiological findings in our 31-year-old HIV-positive patient.

Materials and Methods: A 31-year-old HIV-positive patient presented to hospital with forgetfulness, disorganized behavior and complaints of not walking. On neurological examination, the patient was distracted and the patient was partially co-operative. MRI examination was performed to the patient in terms of differential diagnosis.

Results: MRI examination revealed symmetrical widespread signal increas-es in white matter in both cerebral hemispheres. In both cerebral hemi-spheres, atrophy-related enlargement was present in the sulcus. The patient was diagnosed AIDS related dementia with clinical and radiological findings.

Conclusion: AIDS associated dementia complex, is a progressive sub-cortical dementia, attributed to direct infection of the CNS with HIV. According to histopathologic analysis, patients either have HIV encepha-litis, HIV leukoencephalopathy, or both; some authors consider these conditions to be the extremes of a spectrum of HIV-induced disease. On magnetic resonance (MR) images, a diffuse cerebral atrophy with symmetric, patchy or confluent areas of T1 and T2 prolongation are seen within the periventricular and deep white matter. Proton (1H) MR spectroscopy reveals decreased N-acetylaspartate (NAA) and elevated peaks of in choline and myoinositol. HIV encephalopathy does not result in mass effect or enhancement. If either of these findings is present, another diagnosis must be considered.

Keywords: AIDS, dementia, HIV, encephalopathy

P - 0204

HORIZONTAL GAZE PALSY WITH PROGRESSIVE SCOLIOSIS (HGPPS): A CASE REPORTHALIL CAYLAK, VILIAM GASANOVI, BULENT YILDIZ, MEHMET H. ATALAR


Abstract

HGPPS is a rare autosomal recessive congenital anomaly caused by muta-tion of ROBO3 gene on chromosome 11 and chacterized with abnormal horizontal gaze while normal vertical gaze and kyphoscoliosis. Horizontal gaze requires the action of ipsilateral abducent nerve and contralateral oculomotor nerve and mediated by the abducens nucleus. In this condi-tion, there is congenital absence of the abducens nucleus results in abnor-mal horizontal gaze. The ROBO3 protein plays a critical role in ensuring that motor and sensory nerve pathways cross over in the brainstem. The cause of progressive scoliosis in HGPPS is unclear. We report a case of a 6-year-old girl who presented with complaints of defective vision in both eyes. On examination, she had restricted abduction in both eyes and lack of conjugate eye movement. Magnetic resonance imaging of the brain and orbit showed deep midline pontin cleft (split pons sign), and a butterfly confugiration of the medulla oblongata which are the MRI findings seen in this disorder. Her axial postura was normal on physical examination but there was mild scoliosis in thoracalomber vertebra on antero-posterior radiography.

Keywords: Horizontal gaze palsy, progressive scoliosis, ROBO3


P - 0205

ABNORMAL DILATATION OF PERIVASCULER SPACES: A CASE REPORTABDULLAH SUKUN, MEHTAP BARC ERGUN, EMIN DURMUS, MURUVET AKIN, AYSE EDA PARLAK


Abstract

Perivascular spaces are pia-plied and surround the small perforating artery, small arteries and arterioles that penetrate the brain surface. These spac-es are not directly related to the subarachnoid space. These areas, which are normally microscopic, were first described by the German pathologist Rudolf Virchow (1821-1902) and the French anatomist Charles Philippe Robin (1821-1885). T2A axial image are seen as smoothly confined fluid-filled hyperintense cysts less than five mm. It is usually asymptomatic and rarely causes obstructive hydrocephalus due to mass effect. When these spaces reach very large sizes called tumefactive perivascular spaces. Perivascular spaces are located in the lower half of the basal ganglia and around the anterior commissur but cortical areas are generally protected. Three types are defined according to their location. The level of basal gan-glia supplied by from the lenticulostriate arteries is called type 1, the gray matter level supplied by the perforated medullary arteries is called type 2, and the found in the middle brain is type 3. Perivascular spaces may be associated with traumatic brain injury, mucopolysaccharidoses and mus-cular dystrophies. If there is no vascular risk factor in the young patient, it should be considered first. Perivascular spaces may be confused with small vascular disease, demyelinating disease, and postcontrast changes. In this study, we aimed to present the radiological findings of abnormal perivas-cular spaces in a 23-year-old asymptomatic female patient.

Keywords: Perivascular spaces, Virchow-Robin cysts

P - 0206

HEMIMEGALENCEPHALY: A CASE REPORTABDULLAH SUKUN, MEHTAP BARC ERGUN, SAMET MUTLU, EMIN DURMUS, MURUVET AKIN


Abstract

Hemimegaencephaly is a rare hamartomatous malformation that devel-ops during neuronal migration and cellular organization, leading to excessive asymmetry of a cerebral hemisphere. The cause of 0.2% of childhood epilepsy is hemimegaencephaly. Most patients present with focal or generalized infantile spasms. Hemimagalencephaly can lead to developmental retardation and hemiparesis. Ventriculomegaly, abnormal gyrus formation, and colposcopy occur on the affected side. There are three forms: isolated, syndromic or total hemimegalencephaly. Posterior falx midline contralateral displacement, increased signal intensity of white matter, white matter calcifications are additional findings. Early diagnosis is very important, although there is a lot of imaging and pathologic evidence. Misdiagnosis of obstructive hydrocephalus and cerebral neoplasia lead to

unnecessary surgery. Hemispherectomy is recommended early in patients with severe epilepsy. In this case report, we aimed to discuss the radio-logical findings of hemimegalcephaly in 3-year-old girl with epilepsy clinic.

Keywords: Hemimegaencephaly, childhood epilepsy

P - 0207

POST-SHUNTING CALLOSAL CYSTIC DEGENERATION: A CASE REPORTBUSRA HAS, OMER ONBAS, ELIF NISA UNLU

Düzce University School of Medicine Hospital, Düzce, Turkey

Abstract

Introduction: Demonstration of cystic degenerations that may occur in ventriculoperitoneal (V/P) shunt after long-term lateral ventricular dilata-tion and decompression induced corpus callosum.

Case Report: A 40-year-old male patient underwent V/P shunt due to hydrocephalus 5 years ago was admitted to the neurosurgery polyclinic with headache complaint. Cranial magnetic resonance (MR) imaging of the patient revealed hypointense on T1-weighted image (T1WI), hyper-intense on T2-weighted image (T2WI), and cystic formations with no contrast enhancement on post-contrast sections in corpus callosum body section. There were simultaneous intracranial hypotension findings after shunt.

Discussion: Prolonged lateral ventriculomegaly causes stretching and impingement of the corpus callosum against the rigid falx cerebri, resulting in chronic ischemia. Rapid decompression of this long-standing hydro-cephalus results in transcallosal demyelination. MR changes of corpus callosum degeneration after shunting are clinically alleviated although they are striking. The asymptomatic nature of these changes is assumed to be due to the relative sparing of the splenium. Recognizing these imaging findings is important to avoid unnecessary interventions to the patient.

Keywords: Corpus callosum, post-shunting degeneration, cranial magnetic resonance

P - 0208

COMBINATION OF MILD ENCEPHALOPATHY WITH A REVERSIBLE SPLENIAL LESION (MERS) AND ENSEPHALITIS AFTER INFLUENZA-INFECTION - A CASE REPORTNEVIN SAHIN1, ILHAN HEKIMSOY1, CENK ERASLAN1, MEHMET ARDA KIVANC2, SERKAN GUNEYLI3, OMER KITIS1, MEHMET CEM CALLI1

1Department of Radiology, Ege University School of Medicine Hospital, İzmir, Turkey 2Department of Child Health and Diseases, Ege University School of Medicine Hospital, İzmir, Turkey 3Department of Radiology, Bülent Ecevit University Hospital, Zonguldak, Turkey


Abstract

Influenza is a common disease induced by a viral pathogen of the upper respiratory tract. Influenza infaction can result central nervous system (CNS) dysfunction and it has been reported worldwide. In patients with decreased consciousness after influenza infection, we should consider various diagnoses, including viral encephalitis, medicationrelated encepha-lopathy, and MERS. We herein report a case of influenza-associated MERS and encephalitis in a child. An 8-year-old girl was admitted to outer medical center due to a high-grade fever. Antibiotic treatment was started. Three days after the treatment, the patient presented with vomiting, sterotypic movements in the hands, jaw shift, leftward slipping in the eyes and bruising. No specific findings were found in CSF examination and laboratory results, but positive for Influenza A in serology. Brain MRI on admission showed high intensity in the center of the splenium of corpus callosum (SCC) on diffusion imaging. Hypointense lesions were noted on T1WI, hyperinten-sity on T2W/FLAIR imaging. No contrast enhancement was observed in post-contrast images. Follow-up MRI, there was high signal intensty on bilateral hippocampus and medial parts of temporal lobes (limbic system involement). The findings were evaluated in favor of influenza-associated encephalitis. The lesion of SCC was disappeared on follow-up imaging.

Keywords: Influenza, MERS, encephalitis, MRI.

P - 0209

CENTRAL NERVOUS SYSTEM LYMPHOMAABDULLAH SUKUN, MEHTAP BARC ERGUN, SINAN ULGEN, AYSE EDA PARLAK, SAMET MUTLU


Abstract

Primary central nervous system lymphoma is a relatively rare tumor, which covers 2. 5% of all brain tumors and 1% of NHL lymphomas. The incidence is increased immunocompromised patients. Most of them are diffuse large B-cell lymphomas. Terminology is divided into three sub-groups as immunological failure, intravascular lymphoma and dura malt-lymphoma. In epidemiology, it is more frequent at 50 years old and twice as common in men. Masses of different sizes have different clinical presentation. Intracranial pressure increase, focal neurological deficits and seizures may occur. In view, characteristically, T1 is hypointense, T2 iso-hypointense. If there is necrosis, T2A is seen as lesions that cause hyperintense, diffusion restriction in the sequences. Lesions tend to be solitary, and supratentorial white matter, periventricular areas, and corpus callosum involvement are frequent. Vasogenic edema is usually seen. It is important to note that in immunocompromised individuals the appear-ances tend to be more heterogeneous. We aimed to discuss the radio-logical features of the central nervous system lymphoma in a 36-year-old male patient.

Keywords: Primer central nervous system lymphoma

P - 0210

AN UNUSUAL COMPLICATION OF AUDITORY BRAINSTEM IMPLANTATION

EKIM GUMELER, SAFAK PARLAK, KADER KARLI OGUZ


Abstract

Auditory brainstem implantation (ABI) is a treatment method used espe-cially in children with cochlear nerve anomalies. In this case report, we present a complication of auditory brainstem implantation which has not been defined in the literature previously. A 2.5-year-old female patient with bilateral incomplete partition type 1 anomaly, bilateral cochlear hypoplasia-aplasia had ABI. CT images acquired at 1 month after the procedure showed that the electrode was terminated in the 4th ventricle. The patient developed triventricular hydrocephalus after 5 months and A VP shunt catheter was inserted. The patient had follow-up with CT scans intermittently during 8 months. Proggressive edema starting from the periventricular area of the fourth ventricle, extending to the brainstem and cerebellar hemispheres and a cystic lesion in the right cerebellopon-tine angle was detected. On the MRI examination with necessary precau-tions, T2A and FLAIR images showed significant edema around the fourth ventricle extending to both cerebellar hemispheres and brainstem, and on post-contrast (gadoterate meglumine, 10 mL) axial T1W images contrast enhancement around the fourth ventricle, surrounding the electrode was revealed. This appearance suggested a reactive inflammation of the ven-tricle due to migrated electrode, as the patient did not have fever or there is no sign of infection in the patients repeat CSF cultures. In the follow-up CT images of the patient who was under dexamethasone treatment, the edema of the brain stem and cerebellum resolved significantly.

Keywords: Auditory brainstem impantation, MRI

P - 0211

BILATERAL PEDICLE STRESS FRACTURE IN THE LUMBAR SPINEMERVE ERKAN, ILKER EYUPOGLU, DILARA GUNGOR, DENIZ OZTURK KOCAKGOL, AHMET SARI

Department of Radiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey

Abstract

Introduction: We aimed to present bilateral pedicle stres fracture imag-ing findings of the L5 vertebra with chronic backpain without trauma or surgical history. Stress fractures occur in normal or abnormal bone when prolonged and repetitive mechanical load exceeds the biological capac-ity of the bone. Because the pars interarticularis is the weakest part of the neural arch, the stress fractures of the vertebral neural arch usually involve the pars interarticularis. The pedicle is the second weakest part of the vertebrae after the pars interarticularis. However, stres fractures of the pedicle are much less common. These fractures may occur bilateral or unilateral. Bilateral pedicle stress fracture is a rare entity. Few cases have been reported in the literature. Most pedicle stress fractures have been reported in association with previous spine surgery,trauma or stress-related activities such as in athletes.

Case Report: Lumbar spine magnetic resonance imaging (MRI) examina-tion performed to 53-year-old female patient with chronic low back pain. MRI of lumbar spine revealed edema in both pedicles of L5 vertebrae that was seen hypointense on T1W images and hyperintense on STIR sequence. In addition, a hypointense linear line was observed on T1W and STIR images in both pedicles. With suspicion of fracture, lumbar


spine computed tomography (CT) examination was performed. CT examination demonstrated fracture line on both pedicle and the patient was diagnosed as bilateral L5 pedicle stress fracture. Because there are no complications such as spinal stenosis and spondylolisthesis, conservative treatment planned.

Conclusion: The STIR sequence is an important sequence in the lomber vertebra MRI. In the presence of hyperintensity in the pedicle on the STIR sequence stress fracture and accompanying edema should be kept in mind. Similarly, hyperintensity in the pedicle on STIR sequence may be associated with infection, hemangioma, osteoid osteoma, or other bone neoplasms. Untreated stress fractures can lead to nonunion, spondylolisthesis, and spi-nal stenosis. Early detection and treatment are therefore important.

Keywords: Bilateral, pedicle, stress fracture, lomber spine

P - 0212

EWING SARCOMA PLACED ON CEREBELLAR TENTORIUMNUSRET SEHER, EMINE UYSAL, HAKAN CEBECI, MUSTAFA KOPLAY, YAHYA PAKSOY


Abstract

Ewing sarcoma is a small circular cell tumor that creates 6-8% of the primer malign bone tumor appeared mainly on bone and soft tissues and it is mainly observed between 5-25 ages. It can rarely show extra-skeletal placement. Tentorial placement is very rare and it is seen approximately in 0.5%. Extra-skeletal ewing sarcoma is rarely seen and it can be also named as peripheral primitive neuro-acto-dermal tumor (pPNET). Generally it can be placed on posterior fossa as extra-axially and it can elongate to spinal canal. In this proceeding findings of magnetic resonance imaging (MRI) of ewing sarcoma placed on tentorial had been shown.

Keywords: Tentorial ewing sarcoma, MRI, pnet

P - 0213

CORPUS CALLOZUM AGENESIS AND CENTRAL NERVOUS SYSTEM ANOMALIES: HETEROTROPHY, POLYMICROGRYABDULLAH SUKUN, MEHTAP BARC ERGUN, SINAN ULGEN, SAMET MUTLU, AYSE EDA PARLAK


Abstract

Corpus callosum is the widest commissure that joins the cerebral hemi-spheres. The development of the corpus callosum is anterior to posterior, but myelination starts from the splenium part and proceeds anteriorly. They are classified as agenesis, partial agenesis and hypogenesis according to the defects during development. The incidence of corpus callosum agenesis has not been clearly determined since most cases are asymptom-atic. The incidence is approximately 1 in 20,000 patients. In males, the rate

is two times higher than females. Maternal alcohol use during pregnancy is an important risk factor. In cases with corpus callosum agenesis, many central nervous system anomalies are accompanied. Some of these are hydrocephalus, colpocephaly, holoprosencephaly, polymicrogyri, inter-hemispheric cyst, intracranial lipoma, Chiari and Dandy-Walker malforma-tions. it causes hippocampus hypoplasis in the limbic system. We aimed to present the radiological findings of interhemispheric cyst, gray matter heterotropy, polymicrogyri associated with corpus callosum agenesis in 38 years-old-male.

Keywords: Polymicrogri, interhemispheric cyst, intracranial lipoma, corpus callosum agenesis

P - 0214 CEREBRAL ASPERGILLOSIS: NEUROIMAGING FEATURES OF THE DEVELOPMENTAL STAGESDENIZ SOZMEN CILIZ, DINARA MAMEDOVA, AYSEL KOCAGUL CELIKBAS, SIMTEN DAGDASH, DENIZHAN DIVANLIOGLU, BULENT SAKMAN, GULSUM OZET

Ankara Numune Training And Research Hospital, Ankara, Turkey

Abstract

Introduction: Cerebral Aspergillosis is a rare infection observed mainly among immunosuppressed patients. It is associated with poor prognosis and high mortality (88-99%). The spread of Aspergillus species in the central nervous system occurs via hematogenous spread from the lungs or direct invasion via the paranasal sinuses. Most common presentation of cerebral aspergillosis is brain abscess but various presentations have been reported. Blood and tissue cultures have low sensitivity for identifying infection, with as many as 90% of cases not confirmed until postmortem examination. We present neuroimaging features of the developmental stages of cerebral aspergillosis.

Case Report: 37-year-old female patient admitted to hospital due to a head-ache for 2 weeks with nausea, vomit. Soon she developed neutropenic fever and eventually was consulted to hematology department. Blood marrow analyses revealed Acute lymphoblastic leukemia. Serial MR examinations of the brain were made because of confusion and deterioration of symptoms. Detailed MRI findings explained in figures. Findings pointed to Aspergillus abscess. The number of lesions progressed after the following examination. The patient underwent surgery. A well-encapsulated pus pocket was found, and histopathology resulted in the diagnosis of aspergillosis. Despite appropri-ate anti-fungal treatment, the patient eventually died from cardiac arrest.

Conclusion: This case highlights the importance of the high level of vigi-lance in detecting the early imaging findings of cerebral aspergillosis, which can be difficult to diagnose clinically. Neuroimaging features with careful observation and detailed history-taking can help to make a final diagnosis.

Keywords: Aspergillosis, cerebral, MRI

P - 0215

METRONIDAZOLE INDUCED ENCEPHALOPATHYSULEYMAN ONCU1, ISMAIL SERIFOGLU1, MEHMET KARAGULLE1, FATMA ZEYNEP ARSLAN2

1Bağcılar Training and Research Hospital, İstanbul, Turkey 2Konya Training and Research Hospital, Konya, Turkey


Abstract

Metronidazole-induced encephalopathy (MIE) is a rare condition and associated with long-term use of high-dose metronidazole. Clinically, it manifests as convulsive seizures, ataxia, dysarthria and confusion. Radiologically, T2A and FLAIR hyperintense signal changes can be seen symmetrically in bilateral dentate nuclei, brain stem, and corpus cal-losum.

In our case, 38 years old female diagnosed with type 1 DM had suffered from foot trauma 2 months ago and started her treatment due to osteo-myelitis developing in calcaneus. Brain MRI was performed on the devel-opment of dysarthria and confusion during treatment. Brain MRI revealed that bilateral dentate nucleus hyperintensities on T2W-FLAIR images. When the treatment was questioned, it was learned that a total of 75 gr IV metronidazole was used over a period of 45 days. MIE was considered and metronidazole therapy was terminated. 3 weeks after termination, patients’ symptoms were regressed.

Metronidazole is commonly used in the treatment of anaerobic bacteria and protozoan-related infections. Most common side effect on nervous system is peripheral neuropathy, rarely convulsive seizures, ataxia, dysar-thria, confusion, and encephalopathy can be seen. Previous cases shown that side effects are related to long-term, high-dose metronidazole usage. The most common finding on brain MRI is high signal intensity in sym-metrical bilateral dentate nucleus on T2W/FLAIR images.. Its mechanism and frequency aren’t fully known. Canavan disease, MSUD and type 1 glutaric aciduria can cause dentate nucleus hyperintensities but MIE should be regarded in the long-term metronidazole usage.

Keywords: Metronidazole, dentate nucleus, dysarthria

P - 0216

CEREBELLOPONTINE ANGLE EPIDERMOID CARCINOMA: A RARE CASEEMIN DURMUS, AYSE EDA PARLAK, MEHTAP BARC ERGUN, SINAN ULGEN, SAMET MUTLU

Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Objective: Intracranial epidermoid cysts are congenital lesions and con-sist 1% of brain tumors. These lesions grow very slowly. It’s mostly seen between ages is 20 and 40. They are located in cerebellopontine angle 40-50% of cases and typical imaging features are high signaling in diffusion weighted sequences. These lesions may rarely show epidermoid carci-noma degeneration.

Materials and Methods: A 59-year-old female patient with long-standing headache was referred to our clinic for first imaging CT scan. The suspi-cious lesion was diagnosed with advanced contrast-enhanced brain MRI and brain diffusion MR imaging.

Results: Brain MRI revealed a 63×30×40 mm lesion appearing hyper-intense in T2A, mildly suppressed in FLAIR sequences, showing a heterogenous peripheral rim contrast enhancement after intravenous contrast medium administration. This lesion was also including a 23x12 mm solid nodule with a diffuse homogeneous enhancement at left

cerebellopontine angle. Diffusion restriction of the cystic component of the lesion was noted in diffusion-weighted studies. The lesion was apply-ing pressure to fourth ventricle, mesencephalon and pons. The lesion was then surgically removed and pathologically identified as epidermoid carcinoma.

Conclusion: Epidermoid carcinoma is a rare tumor that should be kept in mind in intracranial-extraaxial lesions, especially in the pontocerebel-lar angle; because the treatment is surgical, radiological diagnosis is of great importance.

Keywords: Cerebellopontine angle, epidermoid carcinoma, epidermoid cyst

P - 0217

BALO’S CONCENTRIC SCLEROSIS: A CASE REPORTEMIN DURMUS, MEHTAP BARC ERGUN, AYSE EDA PARLAK, BERNA AK YILDIZ, ABDULLAH SUKUN


Abstract

Objective: Balo’s concentric sclerosis is a demyelinating disease similar to Multiple Sclerosis (MS). Typically demyelinating areas are seen as concentric lesions (circular) on imaging. This is a rare variant of MS and is often as monophasic type in young people.

Material and Methods: A 24-year-old female patient with acute neu-rologic findings in our hospital emergency department had a suspicious hypodense lesion in the left periventricular area in the first brain CT scan. Due to suspicion of CVD, firstly diffusion brain MRI was perfomed. After diffusion brain MRI didn’t show any diffusion restriction. A con-trast enhanced brain MRI was planned.

Results: A lesion of approximately 3 cm in diameter, which appeared as a rounded lesion with alternating layers in the white matter adjacent to body of left lateral ventricle was observed on FLAIR-weighted imaging. In addition, hyperintense signal changes were observed at temporal lobe periventricular white matter and hippocampus in T2-FLAIR sequences. Peripheral rim enhancement was observed at left periventricular area following intravenous contrast matter administration. There was no significant edema in the periphery of the lesion. Balo’s concentric scle-rosis was considered due to age, characteristic periventricular lesions observed and accompanying white matter lesions.

Conclusion: Typical MRI findings of Balo’s Concentric Sclerosis are lesions with concentric rings on T2-weighted images and on contrast enhanced T1-weighted images as target nodules. In some studies these layered-concentric areas are said to represent demyelinating and remyelinating regions. Despite the presence of a single hemispheric lesion, lesions were reported in cerebellum, brain stem, spinal cord, and optic chiasm were reported and clinical findings of these lesions were described. In our case, age, characteristic localization of the lesions observed and accompanying white matter lesions pointed out Balo’s concentric sclerosis and it is shown that disease can diagnosed with radiologic imaging.

Keywords: Balo’s concentric sclerosis, demyelinating disease, multiple sclerosis


P - 0218

CRANIAL MAGNETIC RESONANCE AND MAGNETIC RESONANCE ANGIOGRAPHY IN MOYAMOYAMERAL KAPLAN, OMER ONBAS, ELIF NISA UNLU

Department of Radiology, Düzce University School of Medicine, Düzce, Turkey

Abstract

Objective: To demonstrate cranial magnetic resonance (MR) and MR angiographic findings of collateral vascular structures observed in moy-amoya disease.

Materials and Methods: Cranial MR and MR angiography of an 8-year-old girl who was followed up due to resistant epilepsy revealed marked thinning of the cerebral arteries in the supraclinoid segments in the Wills polygon, fine-tortuous vascular collaterals in the perivascular neighbor-hoods and bilateral basal ganglia.

Conclusion: Moyamoya disease is an arteriopathy that usually results from bilateral, idiopathic and progressive narrowness or occlusion of the branches of distal supraclinoid internal carotid arteries and the main branches of the Wills polygon. Colleteral vascular structures are usually observed in this disease due to its occlusive nature in main supplier arter.

Moyamoya is a Japanese word that refers the collateral vascular structers resembling cigarette smoke. Two thirds of cases are seen in children and most of these individuals are younger than 10 years. Moyamoya disease is progressive and long-term results are usually poor. In children, the clinic usually shows signs of ischemia.

Keywords: Magnetic resonance angiography, magnetic resonance imaging, moyamoya disease

P - 0219

A RARE CAUSE OF CEREBELLAR SYNDROME: LANGERHANS CELL HISTIOCYTOSISILHAN HEKIMSOY, NEVIN SAHIN, CENK ERASLAN, OMER KITIS, SELEN BAYRAKTAROGLU


Abstract

Objective: Langerhans cell histiocytosis (LCH) is a rare multisystemic disease which is characterized by proliferation of myeloid progenitors with altered differentiation program and similar phenotypic features to epidermal dendritic cells termed Langerhans cell. Neurological involve-ment is observed in 5 to 10% of cases. In this case report we want to present radiological findings of neuro-LCH which is a rare cause of cer-ebellar syndrome.

Materials and Methods: A 50-year-old man was admitted to the neurol-ogy service with a history of gait disturbance, imbalance and dysphagia for 1.5 years. On examination, dysarthria with nasal sound were also noted. All his tests were negative including tumor markers and autoantibodies. It was determined as a cerebellar syndrome. Cranial MRI and thora-

coabdominal CT were performed to identify the etiology. Centrilobular nodules and numerous bilateral upper-lobe predominant cysts of varying sizes were detected on chest CT. The costophrenic angles were spared. Hyperintense lesions were depicted in pons, middle cerebellar peduncles and cerebellar white matter on T2W images. Diagnosis of LCH with CNS involvement was made according to imaging findings. Pathological confir-mation of the diagnosis was also made by wedge resection of the lung and immunohistochemical examination was performed.

Conclusion: Radiology plays a large role in the diagnosis of patients with LCH. Familiarity with the rare imaging appearances of LCH is crucial for appropriate patient management.

Keywords: Cerebellar syndrome, langerhans cell histiocytosis, MRI

P - 0220

DYKE DAVIDOFF MASSON SYNDROME IN ADULT PATIENTSINAN ULGEN, AYSE EDA PARLAK, MEHTAP BARC ERGUN, ABDULLAH SUKUN, BERNA AK YILDIZ


Abstract

Dyke davidoff masson syndrome is rare condition. Clinical findings of the syndrome are facial asymmetry, hemiplegia or hemiparesis, mental retardation, sensorineural hearing loss, psychiatric disorders, epilepsy. Radiological findings are cerebral hemiatrophy, unilateral thickening of the skull, extensive widening of paranasal sinuses and increase in air levels. Here we report a case of a 39 years old female patient who has depres-sion and anxiety disorder. Cranial MRI scan shows modarate frontal lobe atrophy in left hemisphere, thickening of the nearby skull and widening of left side of the frontal sinus. All clinical and imaging findings are suggestive for Dyke Davidoff Masson Syndrome.

Keywords: Dyke-Davidoff-Masson sydrome, Neuroradiology, Cerebral hemiatrophy

P - 0221

SYMPTOMATIC HYPERTROPHIC OLIVARY DEGENERATION SECONDARY TO PONTINE CAVERNOMASEBAHAT NACAR DOGAN, ISMAIL SINAN DUMAN, AYLIN HASANEFENDIOGLU BAYRAKGOZ, SELEN BEYZA KAVUNCU

Department of Radiology, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey

Abstract

We report a case of unilateral hypertrophic olivary degeneration second-ary to pontine cavernoma. The patient was 63-year-old man who had hemorrhage of a cavernous malformation in the pons 17 month ago. He complained rest, postural and kinetic tremor of his left upper extremity. On magnetic resonance imaging (MRI), a cavernous malformation was detected on the right side of pons. The ipsilateral olivary nucleus was


markedly enlarged and T2 weighted axial MRI sequence demonstrated increased signal intensity of the right inferior olivary nucleus.

Hypertrophic olivary degeneration (HOD) is a rare condition, a sec-ondary trans-synaptic degeneration of the inferior olivary nucleus. Disruption of triangle of Guillain-Mollaret (dentato-rubro-olivary tract) by hemorrhage, either due to hypertension, trauma, and surgery or, as in our patient, a vascular malformation, ischemia and demyelination can cause HOD. The dentato-rubro-olivary fibers connect the ipsilateral red nucleus and inferior olive with the contralateral dentate nucleus. HOD is matchless because the degenerating olive initially becomes hypertrophic due to cytoplasmic vacuolation of neurons rather than atrophic. HOD may appear in three patterns depending on the involvement of dentato-rubro-olivary tract: ipsilateral olivary hypertrophy, contralateral olivary hypertrophy and bilateral olivary hypertrophy. The palatal myoclonus is classical symptom but as in our case, dentate-rubral tremor is also seen.

We aim to remember the imaging findings of HOD to prevent inaccurate diagnosis of other pathology.

Keywords: Hypertrophic olivary degeneration, cavernoma, pons

P - 0222

MAGNETIC RESONANS IMAGING AND CT FINDING IN A CASE OF METHYLMALONIC ACIDEMIAFATMA DURMAZ1, ABDUSAMET BATUR2, MESUT OZGOKCE1, SUMEYRA DEMIRKOL ALAGOZ1, ILYAS DUNDAR1

1Department of Radiology, Yüzüncü Yıl University School of Medicine, Van, Turkey2Department of Radiology, Selçuk University School of Medicine, Konya, Turkey

Abstract

Objectives: Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism that commonly presents with neurologic deficits. CT and MR imaging of the brain typically reveal atrophy, delay in myelina-tion, and abnormalities in the basal ganglia, predominantly in the globi pallidi. Here, we aimed to present CT-MRI finding of a 3 year-old patient with a diagnosis of MMA, with diffuse parenchymal atrophy, ventricular dilatation, and prominent subdural effusion without involvement of globi pallidi or basal ganglia.

Materials and Methods: The conversion of methylmalonyl acid to suc-cinic acid requires an apoenzyme (methylmalonil-CoA mutase) with coenzyme (adenosylcobalamine). Deficiency of these enzymes results in accumulation of methylmalonic acid in patients with MMA. The pathophysiology of brain injury is attributed to competitive inhibition of succinate dehydrogenase (an enzyme essential for mitochondrial aerobic glucose oxidation) by methylmalonic acid accumulation. The basal ganglia, predominantly globi pallidi, are particularly susceptible to mitochondrial dysfunction and are thus the main target for brain damage. Contrary to what is believed, in our case there wasn’t involvemenet of globi pallidi.

Conclusion: In MMA symmetrical involvement in the brain and progres-sive white matter loss can be detected early on CT and MR imaging. Imaging plays an important role in early diagnosis and follow-up. It should

be kept in mind that, contrary to what is known, methylmalonic acidemia may not cause globus pallidus involvement.

Keywords: Methymalonic asidemia, MRI, inborn

P - 0223

PHACE SYNDROME: A CASE REPORTEGEMEN OZTURK, CELAL CINAR, CENK ERASLAN, ISMAIL ORAN


Abstract

PHACE syndrome is an uncommon disorder of unknown etiology charac-terized by large segmental hemangiomas of the face and various develop-mental defects. PHACE is an acronym that refers to a group of abnormal medical findings. People with PHACE syndrome may have Posterior fossa brain malformations, Hemangioma, Arterial lesions (blood vessel anoma-lies in the head or neck), Cardiac anomalies, and Eye anomalies. Its exact incidence and prevalence are unknown. There are over 300 individual case reports and case series published in the literature. In an analysis of 150 PHACE patients from the PHACE Syndrome International Clinical Registry, the female to male ratio was 4. 2:1. the diagnosis can be made based upon the presence of a facial hemangioma greater than 5 cm in diameter plus one major or two minor criteria. Here we aimed to pres-ent a 3 months old female patient with a diagnosis of PHACE syndrome with a facial hemangioma, Dandy-Walker complex and intracranial arterial dolichoectasia.

Keywords: PHACE syndrome, hemangioma, Dandy-Walker complex

P - 0224

CENTRAL NERVOUS SYSTEM TUBERCULOSIS: PARENCHYMAL TUBERCULOSISERTAN ZENGIN

Department of Radiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey

Abstract

Tuberculosis is a disease caused by Mycobacterium tuberculosis and is thought to cause around 8 million deaths worldwide annually. Central nervous system (CNS) involvement of the tuberculosis is an important and serious extrapulmonary spread. Approximately 10% of all patients with tuberculosis have CNS involvement in immunocompromised patients, this rate increases by up to 15%. CNS involvement is a serious life-threatening condition and may mimic many infectious and nonin-fectious involvements For this reason, familiarity with imaging findings is important for radiologists and infectious disease specialists. Prompt and accurate diagnosis contributes to reducing morbidity and mortality in affected patients. Granulomatous inflammatory reaction can affect meninges, brain parenchyma, cranial nerves, spinal cord, bone struc-tures surrounding brain and spinal cord. Meningitis is the most common manifestation of CNS tuberculosis. Enhancing exudates in basal cisterns are the most common imaging findings and are very specific manifesta-tion of leptomeningeal tuberculosis. The most common lesion in the


parenchymal involvement is tuberculoma and may be solitary, multiple or miliary. Tuberculomas are most commonly seen in the parietal and frontal lobes. Imaging findings depend on whether the tuberculoma is caseating, and if so, whether the center is liquid or solid. We aimed to present the imaging findings of central nervous system involvement of tuberculosis in a patient with myasthenia gravis history and immunosup-pressive drug therapy.

Keywords: Tuberculosis, central nervous system, Mycobacterium Tuberculosis

P - 0225

DRUG ABUSE ASSOCIATED TRANSIENT SPLENIAL LESION OF CORPUS CALLOSUM: CONVENTIONAL AND DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING FINDINGS WITH A CASEEDA BEYKOZ CETIN, MAKSUDE ESRA KADIOGLU, ERTAN ZENGIN, TUGBA ELDES

Department of Radiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey

Abstract

Introduction: Transient lesions of splenium of the corpus callosum are associated with various entities such as drug use, malignancy, infection, metabolic disorders, and other many entities. It is generally agreed that these callosal lesions with reduced diffusion (low apparent diffusion coefficient [ADC] value) are caused by cytotoxic edema. Therefore, the other name of these lesions is Cytotoxic Lesions of the Corpus Callosum (CLOCCs). Diagnosis would be confusing if there is not enough history from such patients. We would like to discuss Magnetic Resonance Imaging (MRI) findings of cytotoxic lesion of the corpus callosum with a drug abuse case.

Case: A 21-year-old woman who had history of drug abuse applied to our hospital and her main complaints were dysarthria and confusion. No abnormal laboratory findings were detected to explain any metabolic diseases. Magnetic resonance imaging was performed to confirm the diag-nosis. On the MRI; there was an abnormal signal area at the splenium of the corpus callosum and this lesion had no mass effect. On the diffusion weighted images there was restricted diffusion at the lesion with low ADC values. On follow-up MRI; the splenium was totally resolved and no abnormalities were detected at diffusion weighted images. We aimed to demonstrate the changes at the lesion of the corpus callosum with follow-up MRI.

Conclusion: Transient focal lesions of splenium of the corpus callosum is a rare condition that may occur in patients with many reasons. In our case the restricted diffusion (low ADC values) representing cytotoxic edema was demonstrated at splenium of the patient’s corpus callosum. Radiologist should be familiar to these lesions to prevent unnecessary invasive treatment protocols.

Keywords: Drug abuse, transient splenial lesions, CLOCCs, magnetic resonance imaging (MRI)

P - 0226

A RARE CASE REPORT OF LISSENCEPHALY TYPE IIFATMA ZEYNEP ARSLAN, SEDA SOGUKPINAR KARAAGAC, SERDAR ARSLAN, MERAL BUYUKTERZI, HASAN ERDOGAN, VEFA ONER

Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey

Abstract

Lissencephaly defines approximately complete absence of normal gyra-tion and sulcation of the cerebral cortex, and is frequently accompanying by microcephaly. Patients may suffer from developmental delay, intellec-tual disability, and medically intractable epilepsy. There is two subgroup of Lissencephaly spectrum. The classical form, named as lissencephaly type I, is a primitive neuronal undermigration, apart from the type II. Lissencephaly type II occurs secondary to overmigration resulting in abnormal settlement of the cortical plate. Thus; an extracortical neuroglial layer leads to agyria with or without irregular, “cobblestone”, surface of the brain and ventriculomegaly. The lissencephaly-pachygyria spectrum may be associated with varying disease such as Walker-Warburg syn-drome, muscle-eye-brain Disease and Fukuyama muscular and cerebral dystrophy.

An 8-year-old female patient’s complainning from intractable seizures admitted to our hospital. On MRI; a few poorly formed gyri and a smooth outer surface of frontoparietal cortex observed.

Morphological changes can be evaluated using antenatal USG, computed tomography or MRI. However; most superior modality is MRI examina-tion. On MRI; few shallow sulci and shallow Sylvian fissures, an hour glass appearance may be seen on axial images. Subcortical band heterotopia and markedly thickened cortex is generally noted. The lissencephaly-pachygyria spectrum is usually diffusely and symmetricly affect cortex but only anterior-posterior involvement is can be seen depending the under-lying mutations. Enlarged ventricles, hypoplastic anterior corpus callosum and cavum septum pellucidum et vergae are additional features of the lissencephaly-pachygyria spectrum.

In conclusion; lissencephaly is a rarely seen abnormaly and may be accom-pany with syndromic disorders.

Keywords: Lissencephaly, epilepsy

P - 0227

PETROUS APEX CEPHALOCELE REPRESENTED WITH RHINORRHEA: REPORT OF TWO CASESSEBAHAT NACAR DOGAN, MERVE SAM OZDEMIR, AYLIN HASANEFENDIOGLU BAYRAKGOZ

Department of Radiology, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey

Abstract

Petrous apex cephalocele is herniation of the posterolateral Meckel’s cave margin and contents into the petrous apex. Petrous apex cephalo-


cele (PAC) is a rare condition that exact etiology is not known. It is either a congenital or acquired. The theory is that chronically increased intracra-nial pressure that is transmitted into the Meckel cave could cause PAC. PACs are usually bilateral, and occur more often in women than in men. They are usually incidental but could be rarely symptomatic. Complaints of patients could be headache and rhinorrhea. Magnetic resonance imag-ing (MRI) depicts a cystic-appearing petrous apex lesion with CSF signal intensity in all MRI sequence and continuous with Meckel’s cave. According to bone remodeling or erosion on computed tomography (CT), PACs are characterized into aggressive or non-aggressive.

We report two unusual cases of PAC that were 31 year old and 42 year old female who had intermittent rhinorrhea and headache. Both of them had no operation, trauma or infection. Their neurologic examination had no abnormality. On MRI, bilateral herniation of Meckel cave into petrous apex was depicted. On CT, bony defect in petrous apex was detected in both of case.

Familiarity to imaging features of PAC, especially aggressive ones, could be very important in symptomatic patients in whom surgical intervention could be necessary.

Keywords: Petrous apex cephalocele, rhinorrhea, magnetic resonance imaging

P - 0228

HEMORRHAGIC COLLOID CYSTCANSU OZTURK, OZLEM GUNGOR, OMER FARUK GULER, SELMA UYSAL RAMADAN

Keçiören Training and Research Hospital, Ankara, Turkey

Abstract

Colloid cysts are benign cystic lesions with thin walls. These lesions are located in the anterior part of the third ventricle and located near the foramen Monroe. They constitute about 0.5% to 1% of all intracranial tumors. They usually asymptomatic but sometimes grow rapidly, and may be symptomatic such as headache, diplopia, and sixth cranial nerve palsy. Acute hemorrhage in colloid cyst is extremely rare and may present with acute symptoms and even sudden death. Although hemorrhagic changes of colloid cysts can give rise to an acute increase of cyst dimension result-ing in an acute and complete obstruction of CSF circulation, the cause of hemorrhage is not known. We report a rare case of a hemorrhagic colloid cyst in a thirty years old male patient with sudden onset headache.

Keywords: Colloid cyst, third ventricule, hemorrhagie

P - 0229

FETAL MRI IN PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM ANOMALIESILHAN HEKIMSOY, CENK ERASLAN, OMER KITIS, CEM CALLI


Abstract

Objective: Fetal MRI is the main supplementary imaging modality of pre-natal ultrasound in diagnosis of central nervous system (CNS) anomalies. With modern fast sequences, motion artefacts are minimized and high resolution of regions like the brain made possible. A combination of pre-natal ultrasound and MRI can be used to detect and characterize many primary and secondary CNS abnormalities in the developing fetus. Our aim is to report the fetal MRI findings of CNS anomalies with the current literature knowledge.

Materials and Methods: We retrospectively reviewed fetal MRI findings from October 2016 to November 2017. Six fetuses of six pregnant women (4 singleton, 2 twin pregnancies) were included in this study on the basis of their fetal MRI findings which depicted CNS lesion or abnormality. Hydrocephalus was identified in 2 fetuses, one fetus had evidence of corpus callosum agenesis, one had intracranial hemorrhage, one had Chiari type II malformation and one had Dandy Walker malformation.

Conclusion: Fetal MRI plays an increasingly important role in the prenatal diagnosis of CNS anomalies. For proper interpretation and diagnosis of fetal CNS anomalies, radiologist should be familiar with the normal devel-oping fetal anatomy and limitations of fetal MRI.

Keywords: Anomalies, congenital, MRI

P - 0230

A RARE CASE REPORT: RHOMBENCEPHALOSYNAPSISFATMA ZEYNEP ARSLAN, HASAN ERDOGAN, SERDAR ARSLAN, SEDA SOGUKPINAR KARAAGAC, MEHMET SEDAT, VEFA ONER

Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey

Abstract

Rhombencephalosynapsis is a cerebellar anomaly characterized by hypo-genesis of cerebellar vermis and fusion of the cerebellar hemispheres, the middle cerebellar peduncles, and the dentate nuclei. The vermian maldevelopment which is generally sporadic can be seen as an absence of the anterior vermis or a deficiency of the posterior vermis.

Overall life expantancy could short compared to unaffected people since Rhombencephalosynapsis patients tend to die in childhood or early adult life. Diagnosed Rhombencephalosynapsis in an adult patients is unusual.

A 48-year-old male patient complaining of headache admitted to our outpatient polyclinic. There was no history of known disease. Hypoplasia in the cerebellar tonsils were noted and cerebellar hemispheres were posteroinferiorly fusioned.

Rhombencephalosynapsis has also can see with Gomez-Lopez-Hernandez syndrome and VACTERAL syndrome or with varying abnormalities such as absent olfactory bulbs, dysgenesis of the corpus callosum, absent sep-tum pellucidum and atypical forms of holoprosencephaly.

Severity of rhombencephalosynapsis classified as mild form which is characterized with the partial absence of nodulus, anterior, and pos-


terior vermis; moderate form described as the absence of posterior vermis with some anterior vermis and nodulus present; severe form in which posterior and anterior vermis is absent with some nodulus present.

Affected patients may have severe congenital hydrocephalus, cerebral palsy and mental retardation or may be asymptomatic.

Rhombencephalosynapsis has a typical Magnetic Resonance Imaging appearance (MRI).

Fusion of the cerebellar hemispheres leads to continuous cerebellar folia, flat-based cerebellum without cerebellar vallecula and diamond-shaped fourth ventricle is observed on MRI.

In conclusion; rhombencephalosynapsis may be associated with intellectual deficits thus and ait is important to be familiar with thise rare appearences.

Keywords: Rhombencephalosynapsis, magnetic resonance imaging, brain

P - 0231

VASCULAR INTRACRANIAL HYPERTENSION WITH CHARACTERISTICS MR RESULTSHANIFE GULDEN DUZKALIR1, YESIM KARAGOZ1, ABDULLAH SOYDAN MAHMUTOGLU1, SERAY KURT GUNEY1, ALI HALUK DUZKALIR2

1İstanbul Training and Research Hospital, İstanbul, Turkey2Kartal Dr Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: Intracranial hypertension is characterized by increased cerebrospinal fluid (CSF) pressure, severe headache, reduction/loss of vision, nausea and vomiting, and many factors play role in etiology. It is divided into two types as vascular and idiopathic. Venous stasis is one of the etiologic factors. Magnetic resonance imaging (MRI) may help identifying the etiology and protecting vision by contributing to early diagnosis.

Materials and Methods: We aimed to present typical findings of vascular intracranial hypertension using brain MRI, CSF flow MRI and brain MRI venography in a 37-year-old woman presenting with paroxysmal head-ache.

RESULTS: Here we report typical MRI findings of intracranial hyperten-sion characterized by an enlarged subarachnoidal space around the optic nerve, optic nerve tortuosity, posterior scleral flattening and papilledema with protrusion of the optic nerve head, enlarged arachnoid cavities (suprasellar cisterna, Meckel cave enlargement), enlargement of CSF space around cavernous sinus lateral wall and oculomotor nerve, thinned venous sinuses, slit ventricles, caudal extension of cerebellar tonsils, increased skin fat thickness in the head and neck. Due to progression of the symptoms of the patient receiving medical treatment for the history of dural sinus thrombosis and intracranial hypertension, lumboperitoneal shunt was performed for detection of 48 cm H2O CSF pressure in lum-bar puncture.

Conclusion: It should be kept in mind that intracranial hypertension may present only with paroxysmal headache as in our case. Secondary

radiological findings that may contribute diagnosis should be evalu-ated carefully. MR imaging may help detection of the etiology, early diagnosis and treatment planning of vascular and idiopathic intracranial hypertension.

Keywords: Intracranial hypertension, optic nerve, headache

P – 0232

VERTEBRAL ARTERY LOOP FORMATION CAUSING RADICULOPATHYFATMA ZEYNEP ARSLAN1, OZGUR ONER1, MEHMET KARAGULLE2, SULEYMAN ONCU2

1Department of Radiology, Health Sciences University Konya Training and Research Hospital, Konya, Turkey2Department of Radiology, Bağcılar Training and Research Hospital, İstanbul, Turkey

Abstract

Cervical radiculopathy is an important health issue characterized with a dysfunction of a nerve root of the cervical spine among population. Most commonly, the cause of cervical radiculopathy is cervical disk herniations and/or osteophyte formationCR secondary to compression from anoma-lous VAs is a rarely seen entity with an incidence of approximately 2. 7% in cadaveric specimens (1). An ectatic VA loop can directly compress the exiting nerve root.

A 45-year-old woman presented with stabbing pain in her neck and upper back above her left shoulder, radiating into both arms. Examination results were normal. Somatosensory evoked potentials showed significantly prolonged latency of the left C4 nerve root. Cervical spine MRI demon-strated tortuous vertebral arteries looping into the C3-C4 neural foram-ina impinging the left C4 nerve roots.

A 35-years-old male admited to our outpatient clinic with cervical pain. Examination results were normal. On MRI; cervical radiculopathy second-ary to direct neural compression from an aberrant loop of the VA at the level of C5-6 is observed.

Symptomatic patients usually present with radicular pain and palsy in the C3 to C6 range.

Vertebral artery loop formation may lead to bony erosions or vertebro-basillar insufficiency. A good initial prognostic sign on MRI is an enlarged neural foramina containing a vascular structure.

In conclusion; this is a very important cause of radiculopathy because of possible negative sequelae if missed on imaging i. e. cervical spine CT. Neurosurgical attempt of discectomy is likely to cause vertebral artery injury.

Keywords: Cervical radiculopathy, vertebral artery, hernia

P - 0233

A RARE CAUSE OF EARLY-ONSET ATAXIA: MRI FINDINGS OF “ARSACS”


BILGESU ARIKAN ERGUN, HAKAN BAS, ELIF PEKER, M. ILHAN ERDEN


Abstract

Introduction: Inherited ataxias include a heterogenous group of neuro-degenerative disorders. Autosomal recessive spastic ataxia of Charlevoix Seguenay (ARSACS) is a complex disorder characterized by spasticity, ataxia, polyneuropathy and amyotrophy of distal muscles. Magnetic reso-nance imaging (MRI) has a vital role in differential diagnosis. We aimed to emphasize that ARSACS is one of the causes that leads childhood ataxia and tigroid pattern at pontine level is specific.

Case Report: 17 year-old female applied to our hospital with complaints of imbalance and walking difficulty. In the physical examination, spastic paraparesis, bilateral Achilles clonus, patellar clonus and bilateral Babinski reflex positivity were observed. Her medical history revealed a tendency to fall. The patient had consanguineous parents. MRI showed atrophic superior vermis, deepened cerebellar folia and bilateral-symmetrical transvers linear hypointensity on T2- and T2-FLAIR weighted images in the pons. EMG showed signs of polineuropathy. ARSACS was suspected; and the genetic testing is still running.

Conclusion: ARSACS have been identified as a rare cause of early-onset ataxia. Most patients show a typical triad of early-onset cerebellar ataxia, limb spasticity and polineuropathy. A specific pontine tigroid pattern has been described in ARSACS. Other common but less specific findings include cerebellar hemisphere atrophy, inferior vermis and superior spinal cord atrophy, thalamic T2 hyperintensities and corpus callosum thinning. These changes could help diagnose ARSACS earlier in young children, in whom the disease is often mistaken for cerebral palsy. Inherited ataxias include a heterogenous group of neurodegenerative disorders and MRI has a vital role in differential diagnosis.

Keywords: ARSACS, childhood ataxia, magnetic resonance imaging, tigroid pattern

P - 0234

DISSEMINATED OLIGODENDROGLIAL-LIKE LEPTOMENINGEAL TUMOR: A RARE CHILDHOOD TUMORKURSAT ERMAN, A. UTKU SENOL

Akdeniz University School of Medicine, Antalya, Turkey

Abstract

Disseminated oligodendroglial-like leptomeningeal tumor is a recently known entity whose radiological characteristics have rarely been dis-cussed before. It should be differentiated clinically and radiographically from granulomatous or infectious conditions such as tuberculous menin-gitis. The key to the diagnosis, even at an early stage, might be the pres-ence of tiny T2 hyperintense lesions on the surface of the brain or spine. When suspected, a meningeal biopsy should be performed to confirm

the diagnostic. A 16-year-old male patient, who was followed-up at the external center with the diagnosis of Neurocysticercosis since 10 years, was referred to our clinic for brain MR imaging because of the newly developed obsessive-compulsive disorder. In this case report, we aimed to present findings of Disseminated oligodendroglial-like leptomeningeal tumor MR imaging.

Keywords: Tumor, leptomeninges, MRI, pediatrics

P - 0235

ACUTE METHANOL INTOXICATION PRESENTED WITH ATYPICAL MRI FINDINGSHANIFE GULDEN DUZKALIR, ABDULLAH SOYDAN MAHMUTOGLU, YESIM KARAGOZ, SERAY KURT GUNEY


Abstract

Objective: Acute methanol intoxication may cause serious neurological sequelae. Severe metabolic acidosis can cause permanent neurological sequelae such as blindness, or even death. Computed tomography (CT) and magnetic resonance imaging (MRI) may show toxic effects in the brain of the methanol. The most important finding is bilateral putaminal necrosis. Other findings such as subcortical and deep white matter lesions, cerebral and cerebellar cortical lesions, midbrain lesions, cerebral and intraventricular haemorrhage may also be observed.

Materials and Methods: We report brain CT and MRI findings in a 33-year-old male who presented with a sudden loss of vision after drink-ing methanol in our emergency department.

Results: There was no pathological finding on CT imaging at the time of the admission. Diffusion MR imaging of the patient with severe metabolic acido-sis and progressive Glasgow Coma Scale (GCS) regression revealed bilateral putaminal FLAIR signal enhancements with diffuse restriction of subcortical and deep white matter. Symmetrical diffusion restriction was also observed in retrobulbar segments of both optic nerves. The patient was admitted to intensive care unit due to respiratory arrest during follow-up.

Conclusion: In cases of severe methanol intoxication, besides bilateral basal ganglia lesions, diffuse subcortical and deep white matter lesions can also be observed in brain MRI. The amount of metabolic acidosis, cumulated formic acid and prognosis depends on the amount of metha-nol taken by the patient. Early diagnosis is important for the prognosis. Detection of optic nerve involvement using brain diffusion MRI in cases presenting with sudden visual impairment may provide early diagnosis and treatment.

Keywords: Methanol intoxication, optic nerve, basal ganglia

P - 0236

CHOROID PLEXUS PAPILLOMA PRESENT WITH HIGH PERFUSION


RAFAIL JOMARDOV, CENK ERASLAN, OMER KITIS, GOKCEN COBAN, CEM CALLI, TANER AKALIN


Abstract

Choroid plexus papillomas benign (WHO grade 1) neuroepithelial intraven-tricular tumour which can occur in both the paediatric and adult population. The frequent locations are the lateral ventricle in infants and children and the fourth ventricle in adults. Choroid plexus papillomas are isointense on T1-waighted images and iso-hyperintense on T2-waighted images to the cortex and enhanced strongly after contrast administration. Advanced MR imaging techniques such as perfusion-weighted imaging could provide addi-tional information on tumor vascularization that may help in the differential diagnosis. Perfusion maps showed hypoperfusion low values of rCBV gener-ally. Studies reported high perfusion values for choroid plexus carcinoma and low perfusion values for choroid plexus papilloma perspectively. In this rare case we demonstrate choroid plexus papilloma with high perfusion values.

Keywords: Choroid plexus papillomas, choroid plexus carcinoma, rCBV, high perfusion

P - 0237

TENTORIUM CEREBELLI HYPOPLASIA WITH CEREBRAL HERNIATIONMERIC TUZUN, BAKI HEKIMOGLU

Department of Radiology, Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

Tentorium cerebelli hypoplasia is an uncommon condition and generally is seen with other central nervous system malformations. The cause of this anomaly is unknown. It may be due to perinatal injury or impaired embryological development. In this report, a case with tentorial hypopla-sia and cerebral herniation without coexisting anomaly is presented with magnetic resonance imaging findings.

Keywords: Tentorium cerebelli, hypoplasia, herniation, magnetic reso-nance imaging

P - 0238

SYMMETRICAL T2 HYPERINTENSE SIGNAL OF THE CENTRAL TEGMENTAL TRACT IN AN ADULT PATIENTNUR HURSOY1, ELIF PEKER1, SINAN GENC2, ILHAN ERDEN1

1Ankara University School of Medicine, Ankara, Turkey 2Dr Behçet Uz Child Diseases Training and Research Hospital, İzmir, Turkey

Abstract

The symmetrical T2 hyperintense signal of the central tegmental tract (CTTH) is a rare finding in the pediatric population. In children, this imag-ing finding can be associated with brain tumors, epilepsy, developmental delay, metabolic disorders and genetic syndromes, hypoxic-ischemic encephalopathy, and epilepsy. Because of this different clinical conditions, some authors also suggest that CTTH might be a physiologic process. To

the best of our knowledge, there is no literature data about CTTH in adults. In this report, we aimed to summarize the clinical data of a twenty-year-old woman with a diagnosis of systemic lupus erythematosus with symmetrical CTTH on magnetic resonance imaging.

Keywords: Central segmental hyperintensity, Systemic lupus erythema-tosus

P - 0239

RADIOLOGICAL SPECTRUM OF IDIOPATHIC INTRACRANIAL HYPERTENSION: A CASE SERIESALI MURAT KOC1, OZGUR ESEN1, GULSEN YUCEL OGUZDOGAN1, NESLIHAN ESKUT2, ZEHRA HILAL ADIBELLI1

1Clinic of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey2Clinic of Neurology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey

Abstract

Seven patients with suspected intracranial hypertension were evaluated with cranial MRI. All patients were referred for cranial MRI scan with symp-tom of headache. One of the patients found to had a history of venous sinüs thrombosis. Four patients had papilledema, two with blurry vision. One of the patients had runny nose and suspected for rhinorrhea. Beta-2 transferrin test was positive, hence diagnosed as CSF leak. All of the patients had elevated CSF opening pressures, which were evaluated after MRI scan. Most common findings were enlarged subarachnoid spaces around optic nerves and partial empty sella, seen in 6 of 7 patients. Other common findings were flattening of posterior sclera and arachnoid pits, seen in 4 patients. Slit-like ventricles, enlarged meckel caves were seen in 3; menin-gocele and optic nerve tortuosity seen in 2; tonsillar ectopy and venous sinüs thrombosis were seen only in one patient. Intracranial hypertension is a clinical syndrome with specific radiological findings. Detection of venous sinüs thrombosis and meningocele with possible CSF leakage are crucial at the time of diagnosis. Radiological signs of intracranial hypertension should be kept in mind in patients with headache.

Keywords: Intracranial hypertension, HRI, headache

P - 0240

PRIMARY CYSTIC CENTRAL NERVOUS SYSTEM LYMPHOMA MIMICKING FUNGAL ABSCESSALi MURAT KOC1, OZGUR ESEN1, BETUL BELKIS TOKLU1, AYSE YAGCI3, ISMAIL AKKOL2, ZEHRA HILAL ADIBELLI1

1Department of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey2Department of Neurosurgery, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey3Department of Pathology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey


Abstract

Central nervous system lymphomas are relatively uncommon pri-mary brain tumors. Due to their hypercellular nature, they are usually solid, enhancing tumors. CT examinations show hyperdense tumors, whereas MRI demonstrates T2-hypointense tumors with little per-ilesional edema. Diffusion imaging is helpful in differential diagnosis where lower ADC values are in favor of lymphoma diagnosis. Here we present a 70-year-old lady admitted to hospital with weakness of left leg started one week ago. MRI examination demonstrated a cystic 2 cm mass in right precentral gyrus with solid T2-hypointense wall and prominent perilesional vasogenic edema. Lesion was peripherally enhancing and diffusion imaging showed low ADC values in thick wall of the cystic lesion. MR spectroscopy showed lactate peak with little elevation in Choline. Radiological differential diagnosis was in favor of fungal abscess or a necrotic metastasis. Intraoperative ultrasonography demonstrated precise location of the right frontal mass with semi-solid sonographic echogenicity. Pathological diagnosis of the mass was surprisingly a central nervous system lymphoma. Although primary CNS lymphomas resembles many other pathologies including tumors and abscesses; it’s even more rare when they appear as cystic lesions.

Keywords: Lymphoma, CNS, cystic

P - 0241

WALLERIAN DEGENERATION OF MIDDLE CEREBELLAR PEDINCULEEMEL YERLI, KEMAL BUGRA MEMIS, ELIF PEKER, MEMET ILHAN ERDEN


Abstract

Introduction: Wallerian degeneration is defined as distal axonal injury and antegrade destruction of the myelin sheath secondary to the injury of proximal axon or cell body. High signal abnormalities in white matter and atrophy may be seen at MRI. The most common cause of wallerian degeneration is infarct, but it can be due to many factors such as hemor-rhage, trauma and neoplasia. We report a case of Wallerian degeneration in the corticospinal tract and both middle cerebellar peduncles due to pons infarction.

Case Report: A 45-year-old male patient was admitted to our hospital with complaints of hypertension and headache who has Buergers dis-ease in the history. On nonenhanced magnetic resonance (MR) imag-ing, encephalomalacia was observed at the pons. Hyperintense signal which crossed the descending pyramidal tract in the inferior bulbus and extended to the lateral corticospinal tract, was observed. In both middle cerebellar peduncles, hyperintense signal in T2 AG and FLAIR sequences were observed.

Conclusion: Wallerian degeneration is most commonly seen on the corticospinal tract. In cerebellar peduncles, wallerian degeneration is relatively rare, but the most common part is middle cerebellar peduncles because they are larger than others and are the main component of the pontocerebellar tract.

Keywords: Wallerian degeneration, cerebellum, middle cerebellar pedin-cule

P - 0242

IMAGING FINDINGS OF WALLENBERG SYNDROMEEMEL YERLI, KEMAL BUGRA MEMIS, ELIF PEKER, MEMET ILHAN ERDEN


Abstract

Wallenberg syndrome is one of the cerebrospinal syndromes that occur due to the infarction of the lateral medulla and cause neurological symp-toms. In this case series Magnetic resonance (MR) imaging findings of three patients with Wallenberg syndrome are presented.

Diffusion wieghted MR imaging of three patients with Wallenberg syn-drome revealed acute ischemia on the right posterolateral of the bulbus, diffusion restriction at the right cerebellar hemisphere and right postero-lateral portion of the bulbus and diffusion restriction at the right half of the bulbus compatible with acute ischemia.

Wallenberg syndrome is one of the brain stem syndromes that occur with the infarction of the lateral medullary.

Keywords: Wallenberg syndrome, bulbus, acute ischaemia, diffusion restriction

P - 0243

A RARE CAUSE OF CAVERNOUS SINUS AND SUPERIOR OPHTALMIC VEIN THROMBOPHLEBITIS: FUNGUS BALL IN SPHENOID SINUSALI MURAT KOC1, ABDULHALIM AYSEL2, FATIH YILMAZ2, UGURTAN ERGUN2, DENIZ TUNA EDIZER2, AYSE YAGCI3, GULSEN YUCEL OGUZDOGAN1

1Clinic of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey2Clinic of Otorhinolaryngology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey3Clinic of Pathology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey

Abstract

Cavernous sinüs thrombophelibitis (CST) is a rare disease but it has high potential of morbidity and mortality. Most common cause of CST is para-nasal sinusitis, followed by odontogenic and/or otogenic infections. Patients with CST commonly have multiple cranial nerve palsies, headache, fever, periorbital edema, chemosis, proptosis and vision loss. Herewe present a 67 year old lady admitted to hospital with headache, redness in right eye, double vision for the last 10 days. Neurological examination showed right orbital proptosis, chemosis, restricted ocular movements in right, supe-rior and inferior directions. Cranial MRI examination showed asymmetic enlargement and enhancement of right cavernous sinus. There was also dural enhacement through the right temporal lobe. Right superior oph-talmic vein was thickened, tortuose with peripheral edema; post-contrast images showed enhancement through walls of the vein and also filling defect favoring thrombosis. MRI together with CT images showed soft tissue obliteration of right side of sphenoid sinus which is hypointense on


T2 images and showed calcified spots inside in CT images. CT also showed sclerosis of sphenoid sinus walls. Imaging findinds were consistent of right cavernous sinus and superior ophtalmic vein thrombosis with a possible etiology of chronic fungal infection in sphenoid sinus. Patient was treated with steroids and operated afterwards. With endoscopic sphenoidotomy of the spheniod sinus at the affected side, fungal ball was diagnosed and infectious material was cleared from the sinus. Follow-up examinations showed complete resolution of findings together with full recovery of clinical symptoms.

Keywords: Cavenous sinus thrombosis, superior ophtalmic vein, mri, fungus ball

P - 0244

SPONTANEOUS VENTRICULOSTOMY DUE TO A THIRD VENTRICULAR ARACHNOID CYST: A CASE REPORTYUSUF KENAN CETINOGLU, ATILLA HIKMET CILENGIR, OZGUR TOSUN, MUSTAFA FAZIL GELAL

Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Arachnoid cysts (AC) are benign, extra-axial space-occupying developmental lesions that filled with cerebrospinal fluid (CSF). Almost 50% of ACs are located in the middle cranial fossa. Rarely, they can occur within the intraven-tricular system. Although intraventricular ACs are usually asymptomatic and discovered incidentally, sometimes patients may present with a non-specific headache, seizures and obstructive hydrocephalus symptoms. Surgical inter-vention is usually needed if hydrocephalus is present. On the other hand, in few cases of chronic obstructive hydrocephalus, spontaneous ventriculostomy may occur. Spontaneous ventriculostomy is a very rare condition that results from spontaneous rupture of ventricular wall connecting the ventricular system to the subarachnoid space mostly seen on the floor of the third ventricle. Herein, we report a case of 49-year-old women who presented with a non-specific headache. Obstructive hydrocephalus which is secondary to third ventricular AC above the superior portion of cerebral aqueduct and also giant multilobulated Virchow-Robin (VR) space causing aqueductal narrowing in the pontomesencephalic region was seen on her MRI. On CSF flow study, there was no aqueductal flow but a CSF flow between the third ventricle and the prepontine cistern was seen. Since she had no history of surgical intervention, it was thought to be a spontaneous ventriculostomy. As far as we know, this is the first reported case of obstructive hydrocephalus due to third ventricular AC and an overlapped midbrain giant VR space which resulting in spontaneous third ventriculostomy.

Keywords: Arachnoid cyst, obstructive hydrocephalus, spontaneous ven-triculostomy, CSF flow study, Virchow Robin space

P - 0245

TRANSMANTLE SIGN: A SPECIFIC FINDING OF FCD TYPE IIALI MURAT KOC, GULSEN YUCEL OGUZDOGAN, BETUL BELKIS TOKLU, ZEHRA HILAL ADIBELLI, OZGUR ESEN

University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey

Abstract

Focal cortical dysplasias (FCDs) are the most common cause of epilepsy in children. There are typical findings in MRI dedicated to FCD: cortical thickening, blurring, cortical signal changes, subcortical signal changes, and “transmantle” sign. The transmantle sign is often presented as a focal finding, typically limited to one or several gyri with well-defined epileptic tissue. MRI shows signal abnormality extending from the cortex to the superolateral wall of the lateral ventricle. Histological findings are cortical disorganization, neuronal cytomegaly, balloon cells, indistinct cortical gray matter-white matter junctions, and variable accompanying astrogliosis. MRI is critical to determine the morphological alterations in cortical dysplasia - the placement and full content of the lesion and the correlation of the lesion to the eloquent areas of the brain. Here we present MRI findings of FCD II by reporting 3 patients who shows symptoms of epilepsy or fixed neurologic deficits. One patient has (right parietooccipital), two patients have (left frontal) lobe FCD with gray/white matter blurring on T2 images. Cortical thicknening is well demonstrated with T1-IR images through its high contrast ratio between gray and white matter. Transmantle sign is nicely presented on T2 and T1-IR images.There was no contrast enhance-ment in the lesions but one of them was observed with DNET. Its crucial to define the exact location of FCD because in many patients, surgical resection of the epileptogenic focus can control the seizures when the location of the lesion is precisely evaluated preoperatively.

Keywords: Focal cortical dysplasias, MRI, Transmantle sign

P - 0246

CEREBELLAR CLEFTOZLEM GUNGOR, ALPER BATAK, CANSU OZTURK, SELMA UYSAL RAMADAN


Abstract

Cerebellar cleft (CC), one of the cerebellar disruptions, had have little pay attention in the literature. There are not consensus of causes and clinical consequences of CC in the literature. Some exogenous (i.e. infections) or intrinsic (i.e. coagulopathies) causes or a complication of extreme pre-maturity accused on the pathogenesis of cerebellar disruptions. Although the pathogenesis of CC is not clear, some malorientation of cerebellar foliation and irregular gray/white matter junction can be seen on CC and cerebellar hemispheres are asymmetric volumes due to the fact that the affected hemisphere is smaller than contralateral side. Clinical symptoms are highly variable such as truncal ataxia, dysarthria, ocular motor apraxia, intellectual disability, speech impairment, and behavioral changes. CC is diagnosed usually during childhood ages in the literature.

In this present study, we presented a 32-year-old man with speech impair-ment since his childhood. His right cerebellar hemisphere was smaller than contralateral side and it had linear defect filling with CSF extending from the surface of cerebellar hemisphere to fourth ventricle on MRI. There was not additional supratentorial and contralateral cerebellar hemisphere abnormality. According to this MRI findings CC was diagnosed in this patient.

The cases of CC were generally diagnosed during childhood ages in the literature. However, we presented a case with CC who was diagnosed on


adult age. This shows that CC can be under-recognized until adult age. Because of that, a special care must be given during evaluation of cerebel-lum on cranial MRI.

Keywords: Cerebellar cleft, adult age,cerebellar disruptions

P - 0247

CEREBRAL AND CEREBELLAR METASTASES OF SMALL-CELL LUNG CANCER MIMICKING MULTIPLE ISCHAEMIC LESIONSSUAT INCE, IBRAHIM ILIK, FATMA DURMAZ, HARUN ARSLAN


Abstract

Objective: Restricted diffusion that is found on typically indicates acute ischaemic stroke. However, restricted diffusion can also occur in other diseases, like metastatic brain tumours, which we describe in this case report.

Materials and Methods: 55-year-old patient who was followed up for small-cell lung cancer was referred to the emergency department due to severe headache and dizziness. Non-contrast brain CT and magnetic resonance diffusion-weighted imaging (DWI) were performed on the patients in terms of differential diagnosis.

Results: Non-contrast brain CT revealed multiple hyperdense lesions in both basal ganglion and cerebral-cerebellar hemispheres. Lesions dis-played restricted diffusion on DWI and mimic acute ischemia. Clinical-radiological findings and following the patient, the described lesions were evaluated as hypercellular metastatic focus due to small-cell lung cancer.

Conclusion: Restricted diffusion on DWI is observed primarily in acute or hyperacute ischaemic infarcts, abscesses, and in certain hypercellular brain tumours. Restriction of diffusion that is observed in cerebral metastases could result from a high nuclear-cytoplasmic ratio with rela-tive hypercellularity of cancer cells, liquefactive necrosis, and haemor-rhage. A potential relationship between primary tumour cell type and presence of cerebral metastases that are characterised by restricted diffusion has been studied by some authors. Those authors noted that cerebral metastases with restricted diffusion were observed primarily in patients with lung cancer (small-cell and non-small-cell carcinoma) or breast cancer. Moreover, 15 patients with colon cancer and prostate cancer also presented with cerebral metastases that displayed restricted diffusion.

Keywords: Metastases, restricted diffusion, cancer, ischaemic

P - 0248

PERSISTENT TRIGEMINAL ARTERY WITH ANEURYSM

GULSEN YUCEL OGUZDOGAN, ALI MURAT KOC, BETUL BELKIS TOKLU, OZGUR ESEN, ZEHRA HILAL ADIBELLI


Abstract

Primitive trigeminal artery (PTA) is the most common anomaly of primitive carotid-basilar anastomosis with an incidence between 0.1% and 0.3% and is related with cerebrovascular anomalies, such as aneurysm. Approximately 14% of patients with a persistent trigeminal artery also have an intracranial aneurysm. In 1950, Sutton was the first to show PTA angiographically.

Giant or large cavernous aneurysms associated with PTA are rare, and treatment strategies differ when compared to large or giant aneurysms without PTA. Therefore; determining the PTA is important.

There are 2 different types (Saltzman type I, Saltzman type II) of PTA. In first type, distal vertebro-basilary arteries are supplied by PTA. The PCOM is absent and the caudal BA is absent or hypoplastic with hypo-plastic distal vertebral arteries. In the second type, PTA provides superior cerebellar arteries with the PCAs supplied by the PCOM.

Here we present a 61-year-old woman who has been suffering from thun-derclap headache recently. Magnetic resonance imaging (MRI) revealed a tubular signal void lesion near the left cavernous segment of ICA. MR angiography demonstrated a vascular structure extending from the cav-ernous segment of the left internal carotid artery to basillary artery, which is consistent with persistent trigeminal artery. Furthermore, a tortuosity and dilatation were noted, indicating an aneurysmal filling in PTA. Hence the PCOM was also absent, the findings were compatible with Saltzman type 1.

The presence of PTA should be suspected in cases where Neptune’s tri-dent sign or Tau sign is observed in sagittal angiographic images.

Keywords: Persistent trigeminal artery, aneurysm, MRI

P - 0249

CEREBRAL CORTICAL VENOUS THROMBOSISALI MURAT KOC, GULSEN YUCEL OGUZDOGAN, BETUL BELKIS TOKLU, TURKER ACAR, ZEHRA HILAL ADIBELLI


Abstract

Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involv-ing the cerebral veins and dural sinuses. CVT mainly affects adults younger than 50 years and children. People older than 65 years represents only %10 of the patients. %75 of the cases are seen in women. Although presenting symptoms are variable, headache is usually the first symptom, often in combination with focal neurologic deficits and epileptic seizures.

Mortal rate in the acute phase is %5 up to 10, mostly caused by trans-tentorial herniation due to large parenchymal lesions or by generalized cerebral edema. Patients who survive the acute phase, %70 to 80 recover without functional disability, but chronic symptoms such as headache and fatigue can be seen often.


2 patients who have CVT are presented:

First patient is 40 years old man with MS disease. Intracranial hypotension and headache developed after lumbar puncture. Following this, MRI and MR venography examination demonstrated thrombosis in the Superior Sagital Sinus and cortical veins.

Second patient is 25 years old woman. She admitted with a seizure story starting from the right upper extremity continue as generalized seizure. MR-MR venography was performed upon the suspicious hyperdense appearance revealed at left frontal lobe in CT imaging. At the vertex level, no flow signal was detected in a cortical vein draining in to the superior sagittal sinus (Trollard vein) and thrombus-mediated hypointense signal changes were noted. Edema-related signal increase and microhemorrhage was also noted in the same gyrus in the left frontal region.

Keywords: Trolard vein, lumbar punction, cortical vein trombosis

P - 0250

MULTISYSTEM ATROPHY WITH MSA-P AND MSA-C SUBTYPES: MRI FINDINGS OF TWO CASESAYTEKIN TAMER1, YUSUF KENAN CETINOGLU1, FATMA UNCU CETIN2, YESIM SECIL2, MUSTAFA FAZIL GELAL1

1Deparment of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey2Deparment of Neurology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Multisystem Atrophy (MSA) is a relatively rare, sporadic, an adult-onset progressive neurodegenerative disease characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction clinically. The disease is in the spectrum of synucleinopathies among with Parkinson disease and Lewy body disease. On the basis of symptoms at onset, MSA has been divided into two subtypes: MSA-C (olivopontocerebellar atrophy) with predominance of cerebellar symptoms, MSA-P (striatonigral degenera-tion) with predominance of Parkinsonism. In both subtypes, autonomic symptoms can be seen. Because of a lack of reliable diagnostic biomark-ers, MRI should be performed in patients with suspected MSA. Here, we aimed to present two rare cases of MSA. Our first patient, a 66-year-old woman, presented with imbalance, falling episodes for 5 years progressed within the last 2 years. Additionally, she had amnesia and hypotension for 4 months. MRI showed excessive parenchymal, middle cerebellar pedun-cular, brainstem, and olivary nucleus atrophy. On T2-weighted images, “hot cross bun sign” defined as cross-like T2 hyperintensity in pons was seen. Clinically, this patient was diagnosed with MSA-C and radiologic find-ings were supportive. Our second patient was an 82-year-old man who was diagnosed with Parkinson disease two years ago in an outer clinic. He presented with bradykinesia, dysarthria, flexion rigidity, urgency, and incontinence. MRI showed putaminal volume loss, decreased T2 signal within the putamen relative to the globus pallidus. Abnormal bilateral T2 linear rim surrounding the putamen called “putaminal rim sign” was also noted. Clinical and radiological findings of this patient supported the diagnosis of MSA-P.

Keywords: Multisystem atrophy, olivopontocerebellar atrophy, striatoni-gral degeneration, synucleinopathies, MRI

P - 0251

PARTIAL SPINAL CORD AGENESIS MR IMAGING FINDINGSSAIM TURKOGLU, ABDUSSAMET BATUR, SUMEYRA DEMIRKOL ALAGOZ, FATMA DURMAZ

Departman of Radiology, Van Yüzüncü Yıl Universty School of Medicine, Van, Turkey

Abstract

Objective: Caudal regression syndrome is a rare neural tube defect that involves spinal and visceral abnormalities ranging from coccygeal agenesis to thoracic vertebral levels. Caudal agenesis is divided into two types. In type 1, the medullar is in a high position and ends suddenly. Although type 2 conus medullaris are observed in a low position. We aimed to present the MRI findings of the spinal cord partial agenesis with caudal regression syndrome.

Materials and Methods: 2.5 year old female patient was suspected of der-mal sinus tract and suspected of possible neural tube defects. Spinal cord fibers were not detected from the upper thoracal cavity within the spinal canal at the ultrasound. Spinal cord was observed up to T2-3 vertebra level and no significant spinal cord structure was observed from the distal end of this level. Irregular heterogeneous signal changes in the spinal canal leading to expansions and cystic areas of 8mm in diameter sprouting in the spinal canal were observed at the lumbar region. Results were consistent with Type 1 partial agenesis of spinal cord variant.

Discussion: Caudal regression syndrome is rare. Radiological findings include a sharp ending spinal cord, sacral hypoplasia or aplasia, lumbosacral vertebral dysgenesis or hypogenesis. Often accompanied by spinal anoma-lies such as vertebral anomalies, congenital cardiovascular anomalies, pul-monary hypoplasia can be accompanied by cases. In our case, there was isolated partial spinal cord agenesis without any of them.

Conclusion: MRI is the gold standard for imaging and surgical planning of spinal cord abnormalities.

Keywords: Spinal cord, spinal cord agenesis, mri

P - 0252

HYDATID CYSTS OF THE HEART AND BRAIN: A CASE REPORT WITH A COMPLICATIONGOKAY KARACA, ATILLA HIKMET CILENGIR, SEDAT ALTAY, EMINE MERVE HOROZ, OZGUR TOSUN, MUSTAFA FAZIL GELAL

Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey

Abstract

Hydatid cyst is a parasitic disease which is endemic in many parts of the world. It can develop in many organs of the human body and liver is the primary affected organ. Other most common locations are lung, spleen, kidney, bones, brain and heart. After opening of the eggs in the gastro-intestinal tract, the larvae migrate to the liver, then they spread to other organs with systemic circulation. Although cardiac involvement is not a very common clinical condition, it may cause life threatening complica-tions such as rupture, tamponade, embolism, anaphylactic shock, infec-


tion, rhythm disorders, acute coronary syndrome and valve dysfunction. The most common locations in the heart are the left ventricular wall, right ventricular wall and interventricular septum, in decreasing order of frequency. In the brain, which is another rarely effected organ, cycts are located in the vascular territory of the middle cerebral artery. Isolated cerebral hydatid cyst is quite rare, it generally coexists with other visceral involvement. Cystic lesions are usually single, round and unilocular. When it reaches large dimensions neurological symptoms due to increased intra-cranial pressure can be seen.

We present a 26-year-old male patient who had cerebral and cardiac hydatic cyst. Since he did not have neurological symptoms, first cardiac surgery was performed. After cardiac surgery the patient presented with seizure and numbness in the left arm. CT scan showed that hydatid cyst in the right frontal lobe had ruptured. The patient was taken to surgery immediately. Herein we aimed to present a rare case with simultaneous cerebral and cardiac involvement, complicated with cerebral cyst rupture after cardiac surgery.

Keywords: Hydatid cyst, cardiac, interventricular septum, brain, rupture

P - 0253

A RARE DEVELOPMENTAL VENOUS ANOMALY WITH THREE LARGE COLLECTOR VEINS: CASE PRESENTATION, BRAIN MRI, SWI, MRA, DSA FINDINGS WITH DIFFERENTIAL DIAGNOSISRAHIME SEZER, MUHTESEM AGILDERE

Başkent University School of Medicine, Ankara, Turkey

Abstract

By definition developmental venous anomalies have one main collector vein but in presented case there are three large collector veins draining into straight sinus, hypoplastic left transverse sinus and vein of Galen, interestingly with a large mass effect. In this presentation by the findings of this rare case of DVA with three collector veins, other vascular anomalies including pial arteriovenous malformation (AVM), dural AVM, cavernoma and capillary telengiectasia will be discussed as differential diagnosis on the basis of crucial imaging findings.

A 19 years old man with a history of blind head trauma will be discussed with his brain CT, MRI, MR Venography (MRV) and Digital Substruction Angiography (DSA) imaging findings.

The lesion had 3 large collector veins which drains into the straight sinus through the ambient cistern, vein of Galen through the left lateral ventricle and left hypoplastic transvers sinus with a transcortical course. On susceptibility Weighted Images (SWI) medullary veins of the DVA had high signal areas and collector veins had low signal areas due to dif-ference of the blood flow. In phase and out of phase images showed no haemorrhage.

The number and size of collector veins may vary due to size of the lesion.

Surgical treatment or other interventions should be avoided. The associa-tion of cavernoma with DVA is not rare and if its symptomatic look for a cavernoma and if ıts needed the treatment should be for cavernoma.

Keywords: DVA, developmental venous anomaly, AVM, cavernoma, capil-lary telangiectasias, MRI

P - 0254

PEDIATRIC ACUTE ENCEPHALOMYELITISZEYNEP NILUFER TEKIN1, ATILLA DAMLACIK2, OZLEM SAYGILI3

1Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey2Acıbadem Kadıköy Hospital, İstanbul, Turkey3Acıbadem University, İstanbul, Turkey

Abstract

A 4-year-old female child patient who had a history of a recent acute otitis media treatment presented with high fever, weakness, quadripare-sis and rapidly progressive gait disturbance. Ataxic gait and drop, neck stiffness and drowsiness were observed on her physical examination.Contrast-enhanced cranial and whole spinal magnetic resonance imag-ing (MRI) were performed to demonstrate the pathology. Cranial MRI showed bilateral otomastoiditis and increased signal intensity in basal ganglia, pons and right thalamus without any pathological contrast enhancement. Whole spinal MRI demonstrated partly well-defined, multifocal, integrative, minimally expansile plaque-like lesions within all segments of spinal cord. The lesions showed no contrast enhancement. When all these imaging findings and clinical conditions were taken into consideration; the definitive diagnosis was made as acute encepha-lomyelitis developed after bilateral severe viral acute otomastoiditis. The patient was admitted to intensive care unit in order to be given antivirals, intravenosus immunoglobulin (IVIG), steroids as an efficient and wide-spectrum treatment. The patient’s symptoms were resolved progressively during a period of twenty days. The lesions in the spinal cord showed nearly total regression in all segments on her control MRI.This case emphasizes that clinicians must be aware of the possibility of acute encephalomyelitis associated with viral infections, because early and aggressive treatment (antivirals, IVIG, steroids, plasmapheresis) improve the overall clinical outcome in these cases.

Keywords: Acute encephalomyelitis, pediatric, magnetic resonance imag-ing

P - 0255

A USEFUL SIGN IN DIAGNOSTIC NEURORADIOLOGY: ‘HOT CROSS BUN SIGN’ IN A PATIENT WITH CEREBELLAR TYPE OF MULTIPLE SYSTEM ATROPHY (MSA-C)SHWETA GUPTA, JOERG EDERLE, OSMAN CANCURI

Princess Royal University Hospital, Locksbottom, England

Abstract

Multiple system atrophy (MSA) is a sporadic, progressive neurode-generative disorder characterized clinically by autonomic dysfunction,


Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any combina-tion. The Hot Cross Bun sign (HCB) describes cruciform hyperintensity of the pons on the transverse T2 weighted MR images. The HCB sign has mostly been described in patients with multiple system atrophy of the cerebellar type (MSA-C). Although this sign is not pathognomonic for MSA-C, it has high diagnostic value. Herein, we present a case of MSA-C to emphasize the value of the HCB sign. A 53y female patient presented to neurology clinic with long standing complaints of walking difficulty, slurring, speech and handwriting problems, mild urinary symp-toms. On physical examination she had mild limb and gait ataxia. MRI revealed HCB sign associated with pontine atrophy, bilateral symmetrical T2 hyperintensity and atrophy of the middle cerebellar peduncles. CSF study was unremarkable. The genetic testing for ataxia syndromes was negative. MSA-C was finally diagnosed based on appropriate neuroimag-ing and clinical findings.

Keywords: Multiple System Atrophy (MSA), the Hot-Cross-Bun (HCB) sign, Neurodegenerative Disease

P - 0256

A CASE OF CHILD WITH REVERSIBL EXTRALIMBIC PARANEOPLASTIC ENCEPHALOPATIESTULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, OZLEM BALIK2, HAVVA AKMAZ UNLU1, MESUT SIVRI1, MEHMET TIFTIK1

1Dışkapı Children Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey2Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey

Abstract

Autoimmune encephalitis has begun to be defined in the medical litera-ture with an entity to characterize with a change in the initial onset of mental status. Although increasingly defined, it is often diagnosed in large tertiary centers. Autoimmune encephalitis is a group of closely related disease processes that overlap with each other and share neuroimaging findings. However, different underlying SSS constructs differ from the specific antibody types that vary according to the underlying system. Antibody attack made by neuronal construction causes localized inflam-matory changes. Clinical and imaging findings are specific to the variability of the underlying immune response in the nervous system. Autoimmune encephalitis is the most frequent involvement of the limbic system, depending on the profile of the original antibody, the degree of involve-ment may vary from neocortex, striatum, posterior fossa, medulla spinalis and peripheral nerves.

Paraneoplastic disorders may present with limbic encephalitis, cerebellar degeneration, and brain stem encephalitis. While most of the cases show classic presentation, in some cases, paraneoplastic neurological findings may involve focal or multifocal cerebral or cerebellar hemispheres other than the limbic system.

Our case was a 2 year old girl who was being treated with the cause of embryonal rhabdomyosarcoma. On the other hand, in the MR examination performed changes, unilateral spreading on the right cortical side and diffu-sion restriction on the basal ganglions were observed while cortical diffusion restrictions were observed in the left cortical pattern while regression was observed in the follow-up control examinations. At this time, the withdraw-

ing MRA examination was within normal limits. The imaging findings were evaluated in terms of autoimmune paraneoplastic extralimbic encephalitis, as the findings of the patient were atypical and incompatible with other encephalitis findings. After this treatment regression was observed in the findings of the patient. It was presented for the rare occurence.

Keywords: Paraneoplastic ensefalitis, autouimmune encephalitis, limbic ensephalitis

P - 0257

MAGNETIC RESONANCE FINDINGS OF ZELLWEGER SYNDROMEERGIN SAGTAS1, HAKAN ABDULLAH OZGUL2

1Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey2Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Zellweger syndrome (ZS) as also known cerebrohepatorenal syndrome is the most severe peroxisomal metabolic disease, inherited autosomally recessive. In the case of Zellweger syndrome, especially the central ner-vous system, the liver and kidneys, and the musculoskeletal systems are affected. In this syndrome, which is very rare, patients are usually diagnosed in the prenatal period and they generally die within the first year of life. Radiological imaging methods have an important role in the clinical diag-nosis of ZS but the most valuable imaging method in diagnosis is Magnetic Resonance Imaging (MRI). Herein we present MRI findings of ZS.

A 35-week-old fetus applied to our hospital because of hydrocephalus detected during ultrasonography in the prenatal period. Patient with APGAR score 3 at birth, admitted to a neonatal intensive care unit. Brain MRI was applied due to hydrocephalus. Brain MRI revealed lateral ventricular diameter of 12 mm and third ventricular diameter of 6 mm. Patient with cavum septum pellucidum et vergae variation, MRI showed diffuse intensity increase in white matter in T2W. In addition pachygyria and polymicrogyria patterns was detected. Patient had other components of ZS such as hepatomegaly, hyperechoic kidneys, and the presence of a typical facial appearance. With these findings samples were sent for genetic studies. Radiologic examinations, especially MRI in the diagnosis of ZS have a high importance. ZS should be considered in the differential diagnosis of hydrocephalus.

Key Words: Zellweger syndrome, magnetic resonance imaging, hyrdro-cephalus

P - 0258

A RARE CASE: BRAIN INVOLVEMENT OF LIPOID PROTEINOSIS, MRI FINDINGSSINAN AKAY, ALAKBAR IMANLI, UGUR BOZLAR, MUSTAFA TASAR, KEMAL NIYAZI ARDA, SALIH HAMCAN, HATICE TUBA SANAL

Department of Radiology, Gülhane Training and Research Hospital, İstanbul, Turkey


Abstract

Introduction: Lipoid proteinosis (Urbach-Wiethe disease), is a rare, autosomal-recessive, genetic disorder characterized by intracellular depo-sition of amorphous hyaline material and multisystem involvement. Skin, mucosa, and central nervous system are commonly affected. In this report, we aimed to present cranial MRI findings of characteristic brain involvement in lipoid proteinosis.

Case report: 25-year-old female patient previously diagnosed with lipoid proteinosis was admitted to our hospital due to new lesions on her face. On physical examination, besides hoarseness, she had small papules and atrophic plaques on her face region, elbows and fingers. Contrast enhanced Brain MRI was obtained for possible brain involvement. MRI revealed that, bilateral symmetric markedly T2 hypointense lesions in amigdala. There wasn’t any diffusion restriction or contrast enhancement. With these findings lesion sustained as calcification.

Conclusion: Lipoid proteininosis is a multisystemic disease due to ECM1 gene mutation. Central nervous system involvement is seen in 50-75% of cases. The hallmark findings are calcifications, mostly occurring in the amygdala, hippocampus, parahippocampal gyrus, or even the striatum.

Keywords: Lipoid proteinosis, MRI, amigdala, calcification

P - 0259

MRI FINDINGS IN RHOMBENCEPHALOSYNAPSIS, REPORT OF THREE CASESNUR HURSOY, ELIF PEKER, ILHAN ERDEN


Abstract

We presented the imaging findings of three adult cases (a 48-year-old female, 25-year-old, and 39-year-old male patients) and two of them have partial rhombencephalosynapsis. Rhombencephalosynapsis is a rare posterior fossa anomaly which characterized by fusion of the cerebellar hemispheres and the vermian agenesis/hypogenesis. There could be associated supratentorial anomalies. Obersteiner first described the post-mortem findings at 1914 and at 1991, MR imaging findings of three cases have been published. The main pathology is the fusion of cerebellar hemispheres (single-lobed cerebellum) with no cyst or cleft between them. In magnetic resonance imaging, the find-ings include a narrow fourth ventricle and transversely oriented cerebellar folia. The clinical presentation depends on vermian agenesis/hypogenesis and the degree of cerebellar dysfunction. Since the imaging findings are unique and pathognomonic, the radiologist should be aware of this clinical entity thus may guide clinicians to the appropriate diagnosis.

Keywords: Complete rhombencephalosynapsis, partial rhombencepha-losynapsis

P - 0260

INTRACRANIAL SUPRATENTORIAL CHONDROSARCOMA MIMICKING CALCIFIED BRAIN TUMOR: A RARE CASE REPORT

DINARA MAMEDOVA, DENIZ SOZMEN CILIZ, MEHTAP CAVUSOGLU, HATICE GUL HATIPOGLU CETIN, BULENT SAKMAN


Abstract

Introduction: Intracranial chondrosarcomas are very rare (0.15%) tumors mostly occurring in the skull base. Primary location supratentorialy has a very low occurrence rate. In our case report, we present Intracranial Supratentorial Chondrosarcoma mimicking calcified brain tumor.

Case Report: A 48-year-old man presented to the emergency depart-ment (ED) after a fall and a head trauma. The patient was suffering from a severe headache. Initial Computed tomography (CT) of the head showed 8x4.5x6 cm well-defined lobulated, calcified tumor located in a left frontoparietal region with no extension to the calvarium. The tumor had ring and arc calcifications. The scan also revealed intra end extra axial hemorrhages due to trauma (not shown). Also left to right shift. MRI examination of the patient was performed. The tumor had no diffusion restriction and had peritumoral edema. The patient underwent surgery, histopathology result showed grade 1 Chondrosarcoma. The patient underwent follow-up, MRI spectroscopy, which revealed residual tumor. The patient received adjuvant radiotherapy and the tumor disappeared.

Conclusion: Intracranial chondrosarcomas are rare but should be consid-ered as a differential diagnosis of intracranial tumors.

Keywords: Intracranial, supratentorial, Chondrosarcoma

P - 0261

TUBER CINEREUM HAMARTOMA: MRI FINDINGSALPER DILLI1, IDIL GUNES TATAR1, SELDA TEZEL1, NURSU ERDOGAN2

1Department of Radiology, University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey2Department of Neurology, University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

The aim of this case was to demonstrate the MRI findings of tuber cinereum hamartomas which are benign non-neoplastic gray matter het-erotopias. A ten-year-old boy with gelastic seizures was referred to the radiology department for MRI. His cranial MRI examination revealed a solid parasellar lesion of 31x20x20 mm located between the optic chiasm and mammillary bodies. The lesion was diagnosed as tuber cinereum hamartoma since it was isointense to the gray matter and did not show contrast enhancement.

Tuber cinereum hamartomas are benign non-neoplastic gray matter het-erotopias which originate between optic chiasm and mammillary bodies. Radiologically they can be sessile or pedinculated. When increased in size they can exert pressure to the third ventricule or optic chiasm. Since they are gray matter heterotopias they are isointense to gray matter on MRI sequences. However they can show high T2 signal due to the increase of the glial cell content. Clinically central puberty precox, gelastic seizures and visual field problems can occur.

Keywords: Tuber cinereum, hamartoma, MRI


P - 0262

A CHILD CASE WITH HEMAFAGOCYTIC LYMPHOHISTYOSIS CNS INVOLVMENTTULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, AYSEGUL ALIMLI1, OZLEM OZGOKHAN BALIK2, HAVVA AKMAZ UNLU1, MESUT SIVRI1, MEHMET TIFTIK1


Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a multisystemic disease characterized by diffuse infiltration of multiple organs by histiocytes. These include FAQs. It can be seen in adults as well as being more fre-quently identified in children.

It is a life-threatening condition that occurs as a result of uncontrolled development of hemophagocytic lymphohistiocytosis patients. It is a life threatening condition resulting from response to clinical, histopathological and laboratory studies. Lung fever, hepatosplenomegaly, hematopoiocyto-sis in various organs (blood cells are swallowed by active macrophages), cytopenia, hypofibrinogen, ferritin, soluble in triglycerides CD25 sCD25, sIL2RA) and an increase in liver enzymes.

HLH can be divided into primer and secondary.

In pediatric HLH patients, the cranial findings may vary widely. Lymphocytosis is seen in the CSF lining as a result of extensive lepto-meningeal involvement of lymphocytes and histiocytes in extensive cNS involvement. If parenchymal involvement occurs, perivascular infiltration is observed. In many cases demyelination and tissue necrosis, especially in white matter, can be observed.

We present a 2-year-old male patient with bilateral involvement of white matter, especially temporal lobes, as a result of CNS involvement. In addition, an acute focal parenchymal infarct area was observed in the left upper lateral ventricle.

It was presented for the rare occurence.

Keywords: Hemophagocytic lymphohistiocytosis (HLH), HLH CNS involvement

P - 0263

PANTOTHENATE KINASE-ASSOCIATED NEURODEGENERATION: MRI FINDINGSIDIL GUNES TATAR, ALPER DILLI

Department of Radiology, University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

A 19-year-old boy was referred to MRI with mental retardation and sensorial type polyneuropathy. MRI revealed the deposition of iron in red nuclei, substantia nigra and globi pallidi as hypointense signal changes in T2 weighted images. The findings were interpreted as pantothenate kinase-associated neurodegeneration, previously named as Hallervorden-Spatz

Syndrome which is an autosomal recessively inherited degeneration with iron deposition in the brain. The eye of the tiger sign demonstrates the central T2 hyperintense spot within the hypointense globi pallidi due to vacualisation and gliosis. Clinically it is presented with spasticity, rigidity, tremors, progressive dementia and cognitive impairment.

Keywords: Pantothenate kinase-associated,neurodegeneration, eye of the tiger, MRI

P - 0264

MOYAMOYA DISEASE: MRI FINDINGS OF A RARE DISORDERIDIL GUNES TATAR, ALPER DILLI

Department of Radiology, University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

A 29-year-old male patient was referred to the radiology department with follow up of previous watershed infarcts. MRI and MRA revealed multi-segmental luminal narrowings in both internal carotid artery and middle cerebral artery with collateral vessels suggestive of Moyamoya disease. Moyamoya disease is a rare idiopathic progressive cerebrovascular disease due to occlusion of the arteries involving the circle of Willis, most com-monly the supraclinoid internal carotid arteries. The disease was initially described in Japanese patients as the name refers to ‘’puff of smoke’’ appearance on angiography.

Keywords: Vasoocclusive disease, Moyamoya, MRA

P - 0265

SPONTANEOUS LUMBAR EPIDURAL HEMORRHAGE MIMICKING EPIDERMOID CYST: CT AND MRI FINDINGSSALIH HAMCAN, UGURCAN BALYEMEZ, MUSTAFA TASAR, UGUR BOZLAR, HATICE TUBA SANAL, SINAN AKAY, KEMAL NIYAZI ARDA

Department of Radiology, University of Health Sciences, Gülhane Institute of Health Sciences, Ankara, Turkey

Abstract

Objective: Spontaneous spinal epidural hematomas (SSEH) have very rare occurrence. They have an estimated incidence of 0.1 in 100,000 per year. Without any trauma or iatrogenic history the diagnosis can be challenging and called as spontaneous spinal epidural hematoma (SSEH). We aimed to present CT and MRI findings of a lumbar SSEH case, which mimics lumbar epidermoid cyst.

Materials and Methods: 63-year-old female patient admitted to emergen-cy department with new onset lower extremity weakness. Neurological examination confirmed the weakness and patient evaluated with CT and MRI scans.

Result: CT scan revealed that there is mildly hyperdense space occupy-ing lesion in spinal canal between twelfth thoracal and second lumbar


vertebral level. The density of the lesion was not pathognomonic for hematoma and MRI scan was applied. On MRI, there was a T1 hypo-, T2 hyperintense, non enhancing, diffusion restricting space occupying lesion. The diffusion restriction was confounding finding and there wasn’t any hemosiderin referring T2 signal void area. The diagnosis discussed between epidural hematoma and epidermoid cyst. After surgery, patho-logical diagnosis confirmed the epidural hematoma.

Conclusion: Spontaneous spinal epidural hematomas are challenging lesions of spinal imaging especially in acute periods. In our patient surgical prepara-tion tests shows an important finding, which the INR value of the patient, was 4.3. In patients with new onset spinal cord or spinal nerve compression symptoms, and oral anticoagulant usage history, spontaneous spinal epidural hematoma diagnosis should be considered in differential diagnosis.

Keywords: Lumbar epidural hematoma, spine, MRI

P - 0266

A RARE CASE REPORT: PEDIATRIC MULTIFOCAL CEREBRAL GLIOBLASTOMA WITH SPINAL CORD METASTASISUGURCAN BALYEMEZ, MEHMET SERINDERE, KEMAL NIYAZI ARDA, HATICE TUBA SANAL, SINAN AKAY, SALIH HAMCAN, UGUR BOZLAR, MUSTAFA TASAR

Department of Radiology, University of Health Sciences, Gülhane Institute of Health Sciences, Ankara, Turkey

Abstract

Objective: Glioblastoma is a World Health Organisition’s (WHO) Grade IV tumor which is most common adult primary intracranial neoplasm. The incidence of glioblastoma in pediatric age group is very rare and its considered together with the other paediatric high-grade gliomas in the literature due to this lower incidence. We aimed to present a pediatric case with multifocal cerebral glioblastomas, spinal cord and leptomenin-geal involvement.

Materials and Methods: 10 years-old male child presented with headache, paraperasis and weakness on his right arm for two weeks. CT and MRI scan revealed heterogen and moderate enhancing mass lesion which infiltrate left talamus, lentiform nucleus and posterior aspect of insular cortex. After surgery, lesion was defined as glioblastoma. On follow up cranial and spinal MRI scans, cerebral and spinal multifocal new lesions and leptomeningeal involvement were detected.

Result: Multifocal glioblastoma can occur with three ways including cere-brospinal fluid dissemination, spread through the white matter tracks or local metastasis. Multifocal glioblastoma has been shown to have a poorer prognosis than solitary tumors. Multifocal glioblastoma in pediatric age group is rarely reported and management or outcome of these tumors has not studied yet.

Conclusion: Pediatric glioblastoma is very rare primary cranial pediatric tumor. These tumors can be presented with multifocality or spinal metas-tasis. Full neuroaxis MRI is helpful for detecting the spinal cord involve-ment and shoud be performed suspected patients which neurological symptoms can not explained by the primary lesion.

Keywords: Multifocal GBM, spine, MRI

P - 0267

PRIMARY UVEAL MALIGNANT MELANOM METASTASIS MRI FINDINGSMELTEM YILDIRIM EROL, BANU TOPCU CAKIR, AYHAN HIZ YIGIT, NURDAN CAY, AYSENUR OZCAN, KARABEKIR ERCAN

Yıldırım Beyazıt University School of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey

Abstract

Uveal malignant melanoma is the most common primary intraocular malig-nancy. Tumor incidence increases with age. Less than 1% of patients develop metastatic at the onset but most of the time. Bone metastasis is very rare and is usually seen in advanced disease. Typically, it is lytic metastasis. We aimed to present spinal metastasis findings of rare ocular melanoma in this case. An 86-year-old male patient underwent MRI examination of the cervical vertebrae when he presented with neck pain. In this examina-tion, a mass lesion with destructive, T1A hyperintense, T2A hypointense, heterogeneous contrast material enhancement located on the C1 and C2 vertebra corpus anterior were detected. It was thought that the lesion was compatible with malignant melanoma metastasis because of the hyperin-tense lesion of T1A and the patient was diagnosed with eye evisceration 6 years ago and was diagnosed with malignant melanoma.

Keywords: Malignant melanoma, metastasis, MRI

P - 0268

CONGENITAL BILATERAL PERISYLVIAN SYNDROME WITH CHILD CASESTULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, MESUT SIVRI1, HAVVA AKMAZ UNLU1, OZLEM OZGOKHAN BALIK2, MEHMET TIFTIK1, AYSEGUL ALIMLI1


Abstract

Congenital perisylvian syndrome is a rare anomaly that can be diagnosed at birth, during infancy or during late childhood. It is characterized by paralysis (diplegia), tongue, tooth and throat (pseudobulbar paralysis), difficulty speaking, dentition, dysphagia, epilepsy in bilateral muscles of the face.

Polymicrogia is the most common anomaly of cortical development. Small cortical folyls are observed, often accompanied by deterioration in corti-cal lamination as well as joints. Polymicrogia is most frequently observed in perisilvian areas, although it is present in many localizations.

We present a 16 - year - old male patient who underwent bilateral poly-microgia on MR examination with epilepsy. Congenital muscular dystro-phy of the patient was noted but no other CNS findings were observed.

It was presented for the rare occasion.

Keywords: Congenital polymicrogyria, perısylvıan syndrome, bilateral


P - 0269

COGNARD TYPE 4 DURAL AVF: A CASE REPORT WITH CROSS SECTIONAL IMAGING FINDINGS AND DSA CORRELATIONALI MURAT KOC, OZGUR ESEN, BETUL BELKIS TOKLU

Clinic of Radiology, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey

Abstract

Dural arteriovenous fistulas (dAVF) is an arteriovenous shunts between arterial branches of internal, external carotis or vertebral arteries and dural vessels. They are mostly acquired and most commonly seen in trans-verse, sigmoid sinuses followed by cavernous sinüs, superior sagittal sinüs, straight sinüs etc. They can present with tinnitus, cranial neuropathies and hemorrhage. Gold standart diagnostic method is Digital Substraction Angiography (DSA). Diagnosis with cross sectional methods is challenging in cases without any sign of hemorrhage.

Here we present a case of 57 year old man admitting to ED with con-ciousness. Neurological examination showed left sided weakness. CT showed right temporo-parietal 6 cm hematoma with surrounding edema. MRI also showed hematoma with a 6 mm vascular dilatation in contiunity with dilated cortical veins draning into superior sagittal sinüs on T2 and SWI images. CT-angiography also confirmed the dilated cortical drainage veins with ectasy at the periphery of hematoma. Neither nidus nor fed-ing arteries could have been defined on CT and MR angiography images. Patient was referred to DSA with initial diagnosis of Dural AVF with venous ectasia. DSA demostrated dAVF suppllied with branches of right ICA with venous ectasia and cortical venous drainage hence the diagnosis was a Cognard Type IV dAVF.

Cross sectional imaging is essential in patients presenting with acute hematoma. Venous ectasia, nidus, dilated feeder and drainage vessels are important in diagnosis of possible AVF or AVM in patients with intracranial hematoma in locations unusual for hypertensive etiologies.

Keywords: Dural arteriovenous fistula, cognard, MRI, CT angiography

P - 0270

VON HIPPEL-LINDAU DISEASE WITH ENDOLYHPMHATIC SAC TUMOR AND CEREBELLAR HEMANGIOBLASTOMAHUSEYIN COSKUN, AYNUR TURAN, ONUR KARACIF, ELIF AYSE UCAR, AZAD HEKIMOGLU

University of Health Sciences, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Abstract

Von Hippel Lindau is an autosomal dominant syndrome with a prevalence of 1/39000 which includes renal cysts and renal cell carcinoma, pheochro-mocytoma, pancreatic cysts, neuroendocrine tumors, cystadenomas of genital and adnexal organs, retinal angiomas and cerebellar hemangioblas-tomas. Endolymphatic sac tumors are local invasive epithelial neoplasms arising from the endolymphatic sac located in the temporal bone and

can cause hearing loss, ear tinnitus, vertigo, facial nerve dysfunction. The extremely rare endolymphatic sac tumors were associated with von Hippel Lindau syndrome at the end of 1990s. Here, we present endolym-phatic sac tumor MR imaging findings in which endolymphatic sac tumor and cerebellar hemangioblastoma were detected in the MR imaging and later renal cell carcinoma was detected and von Hippel Lindau syndrome was diagnosed.

Keywords: Endolymphatic sac, cerebellar hemangioblastomas, Von hippel Lindau disase

P - 0271

NEUROMYELITIS OPTICA: TWO CASE REPORTHATICE GUL HATIPOGLU, HAMZA OZER, SEMRA DURAN, DENIZ SOZMEN CILIZ, BULENT SAKMAN


Abstract

Neuromyelitis optica (NMO) is a rare and serious primary demyelinating disease. It is presented with the demyelination of both optic nerves and spinal cord in acute or recurrent fashion. Distinguishing patients with NMO from neoplasia and other central infectious pathologies is very important in terms of management and early immunosuppressive treatment plan of that disease. Because of the immunosuppressive treatment initiated by early diagnosis, the progressive progression of NMO may stop. Unlike ADEM; demyelinating changes do not return and persist as sequelae in patients with NMO. For this reason, early diagnosis of NMO is very important for the management of the disease. The role of radiological evaluation in diagnose of early stage is high. We also aimed to present both clinical and imaging findings of two patients diagnosed with NMO in our clinic.

Keywords: Neuromyelitis optica, MRI, demyelinating disease

P - 0272

TUMEFACTIVE PERIVASCULAR SPACEOZLEM GUNGOR, CANSU OZTURK, ALPER BATAK, SELMA UYSAL RAMADAN


Abstract

Perivascular spaces are small cystic structures in the brain. They are about 1-2 mm in size. When enlarged termed as giant tumefactive perivascular space (GTPVS), which can cause mass effect upon the surrounding struc-tures. Depend on location they can cause specific clinical manifestations. The most common symptom is headache, and other symptoms include dizziness, dementia, visual changes, syncope, seizure, stroke, poor balance, memory problems, and poor concentration.

They can be mistaken such as cystic neoplasms, nonneoplastic neuroepi-thelial cysts, ventricular diverticula, cystic infarction parasitic infections, or mucopolysaccharidosis.

We report a woman, 46 years old; which were initialy mistaken for cystic neoplasm. Brain MRI showed clustered cystic areas in right mesencepha-lothalamic region that doesn’t cause hydrocephalus.


GTPVS can be misinterpreted as other pathologic processes, most often a cystic neoplasm. GTPVS must be considered when a lesion is round or oval, single or multilocular lesions that are isointense relative to CSF regardless of imaging sequences and do not enhance.

Keywords: Giant tumefactive perivascular space, cystic neoplasm

P - 0273

CONGENITAL MUSCULAR DYSTROPHYHAVVA AKMAZ UNLU, MEHMET TIFTIK, MESUT SIVRI, TULIN HAKAN DEMIRKAN, NAZLI GULSUM AKYEL

Ankara Children Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Congenital muscular dystrophies (CMD) are heterogenous group of autoso-mal recessive myopathies presenting at birth with hypotonia, delayed motor development and early onset of progressive muscle weakness, confirmed with a dystrophic pattern on muscle biopsy. Best diagnostic clue is Cobblestone brain and Z shaped brainstem in hypotonic infant. Myelination defects, hypo-plastic vermis, ventriculomegaly and dysgenesis of the corpus callosum may be seen. We aimed to demonstrate kranial MRI findings in our patient.

Keywords: Congenital muscular dystrophy, myelination defects, hypotonic infant

P - 0274

MULTINODULAR VACUOLATING NEURONAL TUMOR (MVNT): A CASE REPORTEMEL EMIR YETIM, KAMIL KARAALI


Abstract

Multinodular vacuolating neuronal tumor (MVNT) was first described in 2013 as a seizure-related benign lesion with characteristic histopathological features.

Until the revision of WHOs most recent revision in central nervous system tumors (2016), it remains unclear whether a true neoplastic process or mal-formative lesion or dysplastic hamartomatous lesion. MVNT was defined as a specific cytologic pattern of gangliocytoma in the revision classification.

The epidemiology of this newly identified tumor group is unclear. Many of them are asymptomatic and are seen incidentally. For these reasons, this tumor is usually underdiagnosed. In the reported cases, the lesions are mostly located in the temporal lobe, which are usually present in young-middle aged patients with epilepsy.

MRI findings are lesions which are clusters of well circumscribed high T2 signal bubbles located predominantly in the subcortical white matter. They are hyperintense on T2 and T2-FLAIR images and lesions contrast enhancement or mass effect are almost never present.

MVNT is considered a “leave me alone” lesion; it must be managed properly in order to avoid unnecessary biopsy or surgery, taking into consideration the stability of the case especially if it is found incidentally.

The differential diagnosis of MVNT are dysembryonic neuroepithe-lial tumor, focal cortical dysplasia (type II), Virchow-Robin perivascular spaces.

In this case report, we aimed to present MRI findings of MVNT.

Keywords: MVNT, DNET, temporal lobe lesions, epilepsy

P - 0275

ATRETIC CEPHALOCELE: MRI FINDINGS OF TWO CASESEMEL EMIR YETIM, KAMIL KARAALI


Abstract

Atretic cephaloceles are congenital, benign malformative lesions which are skin-covered midline subscalp lesions at parietal region. They consist meningeal structures or neuronal and glial remnants.

Atretic cephalocele is considered as benign and curable neural tube clo-sure defect and is important because of accompanying central nervous system (CNS) anomalies.

The prognosis is determined by the accompanying CNS anomalies such as cortical developmental anomalies, cortical heterotopy, holoprosencephaly, Dandy-Walker malformation, corpus callosum hypogenesis, ventriculo-megaly. If one of these anomalies are present, prognosis is much worse.

Although radiographs, CT and US imaging can be used for the diagnosis, MRI is the best imaging method because it reveals key findings, helps to exclude differential diagnoses, and doesnt contain ionizing radiation.

Findings evaluated in MRI are; a subgaleal cystic mass with herniation of intracranial structures from a sharp limited calvarial defect, a vertically oriented primitive falciparum vein terminating in the cystic mass and the accompanying linear CSF tract,, cephalocele associated fibrous stalk, superior displacement of the posterior tentorium and tentorial insisor, superficial sagittal sinus fenestration at the level of atretic cephalocele and prominence of the superior cerebellar cistern and suprapineal recess.

Differential diagnoses primarily include sinus pericrania and dermoid / epidermoid cysts. Also encephalocele,hematoma, vascular lesions such as hemangioma, tumors such as langerhans cell histiocytosis, rhabdomyosar-coma and bone marrow or soft tissue infections should be kept in mind.

In this presentation, we aimed to present MRI findings of two patients with atretic cephalocele. As well, relevant literature is reviewed along with the findings.

Keywords: Atretic cephalocele, cystic scalp lesion

P - 0276

RADIOLOGIC STAGING IN NEUROBLASTOMA: CT OR MRI?FATMA CEREN SARIOGLU1, MUHAMMET SALMAN1, YASIN ERTUG CEKDEMIR1, HATICE NUR OLGUN2, DILEK INCE2, EMRE CECEN2, DENIZ KIZMAZOGLU2, MELEK OZDENER2, HANDAN GULERYUZ1


1Department of Radiology, Dokuz Eyül University School of Medicine, İzmir, Turkey2Department of Pediatric Oncology Dokuz Eylül University School of Medicine, İzmir, Turkey

Abstract

Objective: Neuroblastomas are the most common extracranial solid tumors in pediatric age group. “International Neuroblastoma Staging System (INSS)” which is described based on the postoperative findings is used for staging of neuroblastoma. The “International Neuroblastoma Risk Group Staging System (INRGSS)” is designed for pre-treatment tumor staging. According to the INSS; neuroblastomas are categorized as localized-resectable (Stage 1-2), unresectable (Stage 3), and meta-static (Stage 4-4S). According to the INRGSS; they are classified as local-ized (L1-2) and metastatic (M, MS) disease. The aim of this study is to compare the effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) in the staging of neuroblastomas according to the INRGSS.

Materials and Methods: We evaluated 20 patients with neuroblastoma, who had both CT scan and MRI, and were staged based on the INSS between 2005 and 2018. The INRGSS stages corresponding to the INSS stages of the tumors were determined. The image-defined risk factors of tumors (vascular encasement, intraspinal extension, airway compression, visceral organ infiltration, and involvement of multiple body compartments) were evaluated by CT scan and MRI. Then, stages of tumors were described according to the INRGSS for CT and MRI, separately. Kappa test was used to evaluate the compatibility between expected tumors’ stages and tumors’ stages which were considered by using CT scan and MRI.

Results: The mean age of 20 patients was 22.9±28months. The distri-bution of tumors’ stages according to the INSS was stage 1 2/20; stage 2 2/20; stage 3 6/20; stage 4 7/20; stage 4S 3/20. The distribution of expected tumors’ stages was L1 2/20; L2 8/20; M 7/20, MS 3/20. The level of agreement between expected tumors’ stages and tumors’ stages which were considered by using CT was found as good (k=0.77), by using MRI was excellent (k=0.86). MRI was also superior to CT for determination of metastatic disease and bone marrow infiltration. CT was more useful to consider the relationship between tumors and vas-cular structures.

Conclusion: MRI and CT have high diagnostic accuracy rates in the stag-ing of pre-treatment neuroblastomas. MRI is important in pre-treatment evaluation of neuroblastomas because of the higher detection of metas-tases as well as the lack of ionizing radiation.

Keywords: Neuroblastoma, MRI, CT, staging

P - 0277

THE EFFICACY OF DIFFUSION-WEIGHTED IMAGING IN HYPOXIC ISCHEMIC ENCEPHALOPATHIES OF NEWBORNSADEM AGYAR1, MESUT CETIN1, HUSEYIN GUMUS2, OSMAN DERE1, HALIL ASLAN2, ABDURRAHIM DUSAK1

1Department of Radiology, Harran University School of Medicine, Şanlıurfa, Turkey

2Department of Children Health and Diseases, Harran University School of Medicine, Şanlıurfa, Turkey

Abstract

Objective: Hypoxic ischemic encephalopathy is the most important cause of neurological morbidity and mortality in preterm and term newborns. 15-20% of cases with HIE die during neonatal period and 30% of sur-vivors have neurodevelopmental disorders such as cerebral palsy and mental retardation. In our study, the efficacy of DAG in determining the diagnosis and prognosis of the HIE of the newborn was investigated.

Materials and Methods: We evaluated the images of eleven patients and six control cases who were diagnosed with HIE in the last 6 months in our hospitals newborn unit. Diffuse MRI images were evaluated in frontal and parietal white matter, basal ganglia, thalamus, splenium and cerbellar white matter. ADC values of patient and control group were compared with student T test.

Results: There were 5 female 6 male patients in the patient group and 1 female 5 male in the control group. Significant differences were detected between the findings of the corpus callosum splenium component in correlation with the ADC values obtained from ROIs placed in different regions in the patient and control group, Student T test (p<0.05). There was no significant difference in measurements made from other regions (p>0.05). There was no significant relationship between gender in the patient and control group (p>0.05).

Conclusion: Early detection of neurological damage in HIE babies is the most important step in determining appropriate preventive treatment approaches. The radiological method that shows the ischemic changes of the brain at the earliest is DAG. In our study, the efficacy of determin-ing the prognosis and the diagnosis of HIE of newborn of newborn was investigated.

Keywords: HIE, newborn, DWI

P - 0278

A BOY WITH SEVERE EPIGASTRIC PAIN: ACUTE NECROTIZING PANCREATITISBERHAN PIRIMOGLU, RECEP SADE, GOKHAN POLAT, MECIT KANTARCI, AKIN LEVENT


Abstract

A 9-year-old male child was admitted with severe vomiting and epigastric abdominal pain for one week. There was no known medical history of our patient. The plain X-Ray of the abdomen was unremarkable. The axial transvers abdominal ultrasonography revealed the cystic hypoechoic (white asterisk), necrotic and inflammatory (black asterisk) hyperechoic changes at the level of the pancreatic corpus and tail. T2-weighted axial magnetic resonance image showed the signal characteristics referring the cystic-necrotizing pancreatitis at the level of the pancreatic corpus and tail. The serum amylase level was 288 U per L; normal range: zero to 88 U per L. Acute necrotizing pancreatitis was diagnosed by imaging and labora-tory findings. Thus, our patient underwent therapy including intravenous hydration, pain control and bowel rest.


Acute necrotizing pancreatitis is a serious condition associated with high morbidity and mortality. Necrotizing pancreatitis is well described in adults; but the pediatric literature is very limited. The imaging features of acute pancreatitis in pediatric patients are similar to those seen in adults include pancreatic collection, edema, hemor-rhage or necrosis of the pancreatic parenchyma, peripancreatic fat. Acute pancreatic pseudocysts smaller than 5 cm in diameter are managed with observation for 4-6 weeks. Pancreatic pseudocysts larger than 5 cm in diameter may require surgical intervention.

Keywords: Epigastric pain, pediatric, MRI, pancreatitis

P - 0279

AN UNUSUAL CAUSE OF HYDRONEPHROSIS IN A 9-YEAR-OLD CHILD: RENAL HYDATID CYSTBERHAN PIRIMOGLU, GOKHAN POLAT, RECEP SADE, MECIT KANTARCI


Abstract

A 9-year-old girl presented with right flank pain for three months. Physical examination revealed right costovertebral angle tender-ness. The laboratory findings, including renal function tests revealed elevated creatinine levels (3.1 milligrams per deciliter; normal levels: 0.84-1.21 milligrams per deciliter) and urine tests were within normal limits. Ultrasonography (US) imaging of abdomen presented mild hydronephrosis and a well-defined, hypoechoic, thin walled cystic lesion in the lower pole of the right kidney. The US imaging study also showed a well-defined, hypoechoic, thin walled cystic lesion in the left lobe of the liver. Then, abdominal MR imaging studies were performed. It revealed a well-defined, 65x55 mm cystic lesion in the lower pole of the right kidney. This cystic lesion was hypointense on T1-weighted and hyperintense on T2-weighted MR images. The cyst wall was hypointense on T2-weighted MR images, isointense on T1-weighted images. It had not any solid component and septa. There were no contrast enhancement patterns in this cystic lesion on the contrast enhanced T1-weighted images. The MR images also showed grade II pelvicalyceal dilatation of the right kidney secondary compres-sion of the ureter. In addition, it revealed a well-defined, 35x41 mm cystic lesion in the left lobe of the liver. MR signal characteristics of this cystic lesion were similar to the cystic lesion in kidney. Immunological findings also revealed elevated Echinococcosis antibody titers (IgG levels:2.95; positive values >1.1). Abdominal surgical exploration showed the renal and hepatic hydatid cyst and open cystectomy was performed for both cysts.

Keywords: Renal, hydatid cyst, hydronephrosis, MRI

P - 0280

HYPOPHYSEAL INVOLVEMENT OF T-CELL LYMPHOBLASTIC LYMPHOMA MIMICKING PITUITARY ADENOMA

BERHAN PIRIMOGLU1, HAYRI OGUL1, DUYGU OZKORUCU YILDIRGAN2, RECEP SADE1, MECIT KANTARCI1

1Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey2Clinic of Hematology and Oncology, Erzurum State Training and Research Hospital, Erzurum, Turkey

Abstract

We present an unusual case of hypophyseal involvement in a girl with T-cell lymphoblastic lymphoma via magnetic resonance (MR) imaging findings. In our case, the T-cell lymphoblastic lymphoma of the pitu-itary gland was accurately distinguished from a pituitary adenoma by contrast-enhanced dynamic hypophysis MR imaging studies.

A 14-year-old boy was referred to our radiology department to perform the contrast-enhanced brain magnetic resonance (MR) imag-ing. There was known history of T-cell lymphoblastic lymphoma and course of chemotherapy for three years in his medical background. During follow-up in remission, the patient had visual disturbance in bilateral eyes and severe headache for one week. We detected a large, homogeneously enhancing intrasellar/suprasellar lesion on post-contrast fat suppressed T1-weighted brain MR images. We did not decide whether it was hypophyseal involvement of T-cell lym-phoblastic lymphoma or pituitary adenoma. To make a differential diagnosis, contrast-enhanced dynamic hypophysis MR imaging pro-cedure was performed to the patient. This lesion displaced the optic chiasm and extending into the hypophyseal stalk. It had homogeneous hyperintense contrast enhancement pattern on dynamic post-contrast fat suppressed T1-weighted hypophysis MR images. Since pituitary adenoma has usually hypointense signal characteristics on dynamic post-contrast fat suppressed T1-weighted hypophysis MR images; radiologically, these findings were thought to represent a hypophyseal involvement of T-cell lymphoblastic lymphoma in our patient. Thus, the patient underwent chemotherapy and hypophyseal hormone replacement treatments. After three months of follow-up, control dynamic post-contrast fat suppressed T1-weighted hypophysis MR images showed apparent regression of hypophyseal involvement. The T-cell lymphoblastic lymphoma of the pituitary gland was accurately distinguished from a pituitary adenoma by contrast-enhanced dynamic hypophysis MR imaging technique in our patient.

Keywords: Hypophysis, lymphoma, MRI

P - 0281

A RARE LOCATION: ISOLATED MULTIPLE PSAMMOMATOUS MENINGIOMASRECEP SADE1, LEYLA KARACA2, HAYRI OGUL1, UMMUGULSUM BAYRAKTUTAN1, MECIT KANTARCI1, AKIN LEVENT1

1Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey2Department of Radiology, İnönü University School of Medicine, Malatya, Turkey


Abstract

A 13-year-old girl presented to the neurosurgery clinic with progres-sive motor weakness and sensation disturbance. Magnetic resonance imaging revealed multiple intradural extramedullary mass at the cervi-cothoracal region causing cord compression. The lesions were hyper-intense on T2-weighted (T2W) and hypointense on T1-weighted (T1W) images. After injection of contrast agent, magnetic resonance imaging showed a homogenous enhancement in masses. Pathologic specimens obtained at surgery showed psammomatous meningiomas. Isolated multiple spinal meningiomas are very rare but have been reported.

Keywords: Isolated multiple psammomatous meningiomas, spine, MRI findings

P - 0282

A DIAGNOSTIC CHALLENGE: FOCAL FATTY LIVER OR METASTASIS?BERHAN PIRIMOGLU, RECEP SADE, MECIT KANTARCI


Abstract

A 12-year-old girl was referred to our radiology department to perform imaging of the contrast-enhanced thorax and abdomen via computed tomography. There was history of T-cell lymphoma man-aged with chemotherapy for 3 years. We detected a hypodense well-circumscribed lesion located at the perivascular region adjacent to the right portal vein. This hypodense lesion was not seen on the previous abdominal computed tomography examination. To differentiate the lesion, a magnetic resonance (MR) imaging procedure was performed. This lesion had hyperintense signal characteristic on in-phase MR images but was hypointense on out-of-phase MR images. There was no contrast enhancement pattern on postcontrast T1-weighted MR images. The focal fatty liver was accurately distinguished from a meta-static liver lesion by inand out-of-phase sequences of abdomen MR imaging procedure.

Keywords: Fatty liver, metastasis, MRI, pediatric

P - 0283

BRAIN MRI FINDINGS IN PRIMARY CARNITINE DEFICIENCY: A CASE REPORTMUSTAFA YILDIRIM, AHMET KURSAD POYRAZ

Fırat University School of Medicine, Elazığ, Turkey

Abstract

We presented MRI and DWI findings of a 16-year-old boy manifested with hypoglycemic hypoketotic encephalopathy.

In our case, T2 hyperintensity and diffusion restriction were noted bilater-ally in the centrum semiovale, cerebral white matter, deep white matter

of cerebellum, corticospinal and corticobulbar tracts of brainstem.These MRI findings were consistent with hypoglycemic hypoketotic encepha-lopathy secondary to primary carnitine deficiency. MRI is helpful in the diagnosis, therapy planning, and follow-up of encephalopathic cases with carnitine deficiency.

Keywords: MRI, primary carnitine deficiency, encephalopathy

P - 0284

PATHOLOGICAL CONDITIONS CAUSING ABNORMAL SHAPE AND DEFORMATION OF THE FOURTH VENTRICLE: MRI FINDINGSMEHMET H. ATALAR, BULENT YILDIZ, KAYHAN KARAKUS


Abstract

The fourth ventricle is at the center of the posterior fossa. It is sur-rounded by critical nuclear structures and important foraminal structures. A wide array of pathological conditions may affect the fourth ventricle, ranging from congenital anomalies to mass lesions. A thorough under-standing of the anatomic relationships in the posterior fossa and the effect of various pathological conditions on the ventricle’s shape play a key role in the assessment of imaging findings and making differential diagnosis. Some pathologies involving the fourth ventricle may cause alterations of its shape, creating some characteristic shapes such as “tent”, “bat wing”, “key holes”, and “butterflies”. Some of these deformities helps make a “aunt ayşe” diagnosis known to a radiologist in daily practice. In many cases, an asymmetric appearance or shift in the shape, volume, and local-ization of the fourth ventricle may be the only sign of a pathological lesion. Thus, a more comprehensive scan is needed in radiological evaluation. In this report, various pathological conditions causing dysmorphism and deformation of the fourth ventricle were reported with a large number of cases and MRI findings.

Keywords: Anomalies, fourth ventricle, magnetic resonance imaging, posterior fossa

P - 0285

BONE MARROW TRANSPLANTATION COMPLICATION: “PRES”S THE MINDKEMAL NIYAZI ARDA, SEREF BARBAROS ARIK, HATICE TUBA SANAL, MUSTAFA TASAR, SINAN AKAY, SALIH HAMCAN, UGUR BOZLAR

Department of Radiology, Gülhane Training and Research Hospital, Ankara, Turkey

Abstract

Objective; Posterior reversible encephalopathy syndrome (PRES) is a complex but well understood radiological entity. However the patho-genesis is not completely understood. It is believed that damaged auto


regulation and endothelial dysfunction is responsible from vasogenic sub cortical edema without infarction.

Patients who undergo bone marrow transplantation are at risk for devel-oping graft versus host disease (GVHD). Calcineurin inhibitors, such as tacrolimus or cyclosporine, are agents commonly used to prevent the development of GVHD. One rare but significant side effect of these drugs is PRES. The incidence of PRES secondary to tacrolimus is not well known.

In this poster we aim to remember radiologic features of PRES by giving an example of magnetic resonance images (MRI) of a pediatric hematology patient.

Materials and Methods: 10 years old boy who has a seizure after bone mar-row transplantation is consulted to our radiology department to perform MRI scan. Seizure was explained with no other reasons. On his MR images frontoparietal patchy hyperintensities without diffusion restriction are seen.

Conclusion: The seizures are frequent manifestations of neurological complications after pediatric hematopoietic stem cell transplantation. In most cases seizures are the first manifestation of effected brain. Also they were often repeated and/or long lasting requiring treatment.

In pediatric patient in some cases neuroimaging is essential to diagnose and treat correctly. Because in these cases it is required to be ensured acute antiepileptic treatment, but a long lasting prophylactic therapy with benzodiazepines and/or phenytoin is not usually necessary. That’s why PRES has to be kept in mind in differential diagnosis.

Keywords: PRES, pediatric petient, bone marrow transplantation

P - 0286

PRENATAL DIAGNOSIS OF RHOMBENCEPHALOSYNAPSISESRA OZKAVUKCU, EMEL YERLI, NURAY HALILOGLU


Abstract

Rhombencephalosynapsis (RC) is a rare cerebellar malformation with unknown etiology. It is usually sporadic, and clinical presentation can be variable. RC refers to the absence of cerebellar vermis, cerebellar fusion and apposition or fusion of the dentate nuclei. RC is frequently associ-ated with other cerebral and extracerebral malformations. RC is known to co-exist with congenital ventriculomegaly in 45-65% of the cases. Ventriculomegaly can be a result of aqueductal stenosis, or abnormal orientation of the 4th ventricle.

Herein, we present the fetal US and MRI findings of a rare case of RC at 20 weeks of gestation. Second trimester fetal US revealed dichorionic diamniotic twin pregnancy. Twin A appeared normal on US. Twin B had hypoplastic and fused cerebellar hemispheres, as well as agenetic cerebel-lar vermis. In addition to these findings, twin B also showed triventricular hydrocephaly (atrial width: 21 mm), with the 4th ventricle being normal. No additional fetal anomalies were detected on US. Fetal MRI confirmed the US findings, with better delineation of the cranial anatomy. Final diag-nosis was RC with aqueductal stenosis.

In conclusion, RC is a rare abnormality that can be identified in the prena-tal period by US and fetal MRI.

Keywords: Rhombencephalosynapsis, fetal MRI, fetal ultrasound, prenatal diagnosis

P - 0287

ATROPHY OF THE LEFT FACE AND SHORTNESS OF THE LEFT EXTREMITIES: MIDBRAIN CAVERNOMA IN A PEDIATRIC PATIENTAYSE GUL ALIMLI 1, MESUT SIVRI 2, NAZLI GULSUM AKYEL 2, HAVVA AKMAZ UNLU 2

1Department of Pediatric Radiology, Health Sciences University, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey2Department of Radiology, Health Sciences University, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Cavernous hemangiomas (cavernoma) are 9% of cerebral vascular malfor-mations.Cerebral cavernomas tend to be cerebral hemispheres. Thalamic and midbrain cavernomas are relatively rare. These lesions frequently symptomatic because of their significant location. We aimed to present 10 years old female patient who admitted to hospital complaint of atrophy of the left face and shortness of the left extremities with hemiparesis. Magnetic resonance imaging, susceptibility weighted imaging and diffusion weighted imaging findings are discussed.

Keywords: Midbrain cavernoma, face atrophy, magnetic resonance imag-ing, susceptibility weighted imaging

P - 0288

SYDENHAM CHOREA: THREE PEDIATRIC PATIENTSNAZLI GULSUM AKYEL, HAVVA AKMAZ UNLU, MESUT SIVRI, AYSE GUL ALIMLI

Department of Radiology, Health Sciences University, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Sydenhams chorea is a late manifestation of acute rheumatic fever and thought to be an autoimmune disorder. The neuroimaging findings of this entity rarely reported. In this report we aimed to present Magnetic Resonance Imaging (MRI) findings of three patients with Sydenhams chorea.

Keywords: Sydenhams chorea, chorea, Magnetic Resonance Imaging

P - 0289

TAYLOR DYSPLASIA (TYPE II FOCAL CORTICAL DYSPLASIA) IN CHILDREN: CASE SERIESNAZLI GULSUM AKYEL, MESUT SIVRI, AYSE GUL ALIMLI, HAVVA AKMAZ UNLU


Department of Radiology, University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Type II focal cortical dysplasia (FCD) is most common cause of drug resistant epilepsy in pediatric population and curable by surgery. It is highly epileptogen-ic lesion that missed by magnetic resonance imaging (MRI) in about one third of cases. The most common findings on MRI include focal cortical thickening or thining, increased signal on T2 weighted and FLAIR sequences in the gray and subcortical white matter, blurring of the gray-white matter junction. We present radiological findings of Taylor dysplasia in seven children with epilepsy.

Keywords: Focal cortical dysplasia, taylor dysplasia, magnetic resonance imaging, epilepsy

P - 0290

CHILD WITH HERLYN-WERNER-WUNDERLICH (HWW) SYNDROMETULIN HAKAN DEMIRKAN1, GULSAH BAYRAM1, NAZLI GULSUM AKYEL1, OZLEM OZGOKHAN BALIK2, MEHMET TIFTIK1, MESUT SIVRI11Dışkapı Children Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey2Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey

Abstract

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare anomaly of the mullerian duct. The uterus is involved with the didelphys, the hemivagina is obstructed, and the unilateral is renal agenesis.

The most common finding is hematocolposa secondary to abdominal and pelvic pain, dysmenorrhea.

This syndrome was first described in 1922 with regular menstruation, with increasing pelvic pain and a pelvic mass beginning with menarche.

Our case was a 15-year-old girl with agenesis in the left kidney, a corpus in the left uterus with uterus didelphys, which was normal, and heteroge-neous in the cervix filling hemorrhage.

Once the cervix was emptied, the lesion recurred. For the second time, the cervix was drained.

It was presented for the rare occurence.

Keywords: Herlyn-Werner-Wunderlich (HWW) syndrome, uterus didel-phis, mullerian duct anomaly, hematocolpos

P - 0291

PEDIATRIC CARDIAC MAGNETIC RESONANCE IMAGING: COMPARISION OF MRI MEASUREMENT OF LEFT VENTRICULAR EJECTION FRACTION TO ECHOCARDIOGRAPHY, EVALUATION OF BIVENTRICULAR VOLUMES AND FLOW DYNAMICS IN PATIENTS WITH REPAIRED TETRALOGY OF FALLOT

DERYA BAKO KESKIN, SUAT FITOZ

Department of Pediatric Radiology, Ankara University School of Medicine, Ankara, Turkey

Abstract

Objective: Our main purposes were to compare agreement between M Mode echocardiography and MRI for left ventricular ejection fraction (LVEF) measurements; to evaluate biventricular volumes and pulmonary valve dynamics in patients with repaired Tetralogy of Fallot (TOF) and to compare agreement of tomographic and VEC-PC methods for pulmo-nary regurgitation quantification.

Materials and Methods: 25 patients were studied. Left ventricle volumes of all patients were measured from short axis images. Intraclass correla-tion coefficient (ICC) was used to compare MRI and echocardiography measurements for LVEF. Biventricular volumes and functions were evalu-ated and compared to control group in repaired TOF patients. Also pul-monary valve flow was assessed by VEC-PC and tomographic methods and agreement evaluated.

Results: Measurements of left ventricle EF correlated mildly between MRI and echocardiography (ICC 0.54). MRI comparison of biventricular metrics of patients with repaired TOF with normal controls confirmed an increase in RVEDVI, RVESVI, RVSVI and LVEF (p<0.05). LVSVI was higher in control group (p<0.05). High agreement (r=0.81, p 0.026) between VEC-PC and tomographic methods for pulmonary regurgitant flow mea-surement was noted.

Conclusion: Cardiac MRI has many advantages over echocardiography in diagnosis, follow up and evaluation of postoperative complications and valvular pathologies of patients with congenital heart disease. Echocardiography cannot be used as an alternative of MRI in quantifica-tion of left ventricular EF, because of the very wide variances and mild correlation between two techniques. Biventricular evaluation is essential in patients with repaired TOF for detection of left ventricular dysfunction. Increase in LVEF might be the first finding of early dysfunction.

Keywords: Cardiac, pediatric, TOF

P - 0292

ECTOPIC PARTIAL INTRAHEPATIC GALLBLADDER: RADIOLOGICAL FINDINGS OF AN UNUSUAL ANATOMICAL VARIANTOZKAN OZEN1, MANI HABIBI2

1Department of Radiology, Alanya Alaaddin Keykubat University School of Medicine, Antalya, Turkey2Department of General Surgery, Alanya Alaaddin Keykubat University, Alanya Training and Research Hospital, Antalya, Turkey

Abstract

Objective: Ectopic gallbladder is very rare and can be found in intra-hepatic, suprahepatic, retrohepatic, retroperitoneal, falciform ligament, abdominal wall, left quadrant of abdomen and intrathoracic localizations. In this study we aimed to present an ectopic partial intrahepatic gallblad-der anomaly by radiological methods, which was only able to be revealed in surgery and cadaver studies so far.


Materials and Methods: Ultrasonography of a 43-year-old male patient with right upper quadrant pain in the abdomen revealed a lobulated cystic lesion associated with gallbaldder in the liver. In CT, a lobulated, non-contrasting cystic structure associated with gall bladder at segment 8 of the liver observed. The patients laboratory values were normal.

Magnetic Resonance Cholangiopancreatography (MRCP), dynamic mag-netic resonance (MR) after IV Gadoxetate disodium (commercial names Primovist and Eovist) injections and MRCP at the 30th and 60th minutes after and drug injection was performed for the diagnosis.

Unenhanced MRCP was also found that gallbladder associated with the lesion. MR showed that the cystic structure was connected to the gallblad-der and based on MRCP findings at 60th minutes after the contrast injec-tion; it revealed that the lesion was homogeneously filled with the contrast

Conclusion: It is important to recognize ectopic intrahepatic gallbladder before surgery. Cholecystectomy in intrahepatic gallbaldder variations is more difficult and dangerous. If these cases are accompanied by cholecys-titis, it is even more difficult to recognize it radiologically. For this reason, it is important to diagnose this anomaly with preoperative imaging methods. Contrast-enhanced MRCP may contribute to diagnosis.

Keywords: Gallbladder, magnetic resonance cholangiography, varvation

P - 0293

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN PEDIATRIC PATIENTS: FALL IN LOVE WITH CEREBELLUM, FRONTAL LOBE AND TEMPORAL LOBE?AYSE GUL ALIMLI1, HAVVA AKMAZ UNLU2, NAZLI GULSUM AKYEL2, MESUT SIVRI2

1Department of Pediatric Radiology, Health Sciences University, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey2Department of Radiology, Health Sciences University, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Objective: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological disease with characteristic magnetic resonance imaging (MRI) findings. MRI shows subcortical/cortical hyperintensity in T2-weighted sequences, typically in posterior circulation distribution. Although parieto-occipital regions involvement is most common; atypi-cally, involvement of the cerebellum, frontal lobe and temporal lobe in pediatric patients are often detected. We aimed to present clinical and radiologic findings of PRES with atypical MRI findings in pediatric patients.

Materials and Methods: We retrospectively evaluated the MRI findings of 9 cases of pediatric PRES.

Results: Three of the patients were girls, six were boys. The patients’ age ranged from 5 to 16 years (mean age, 9.4 years). All lesions had subcortical/cortical hyperintensity in T2-weighted sequences. All patients had parieto-occipital regions involvement, eight patients had frontal lobe, seven patients had cerebellar and temporal lobe and one patient had splenic involvement. In two patients cortical diffusion restriction, in two

patients hemorrhage was an associated feature. In one patient exhibited intense enhancement after intravenous contrast injection.

Conclusion: Atypical MRI findings of PRES are seen quite often in pedi-atric patients; especially involvement of the cerebellum, frontal lobe and temporal lobe. In addition diffusion restriction, contrast enhancement and hemorrhage can also be seen.

Keywords: Atypical findings, MRI, cerebellum, PRES

P - 0294

THE BENEFIT OF ENDORECTAL COIL USAGE IN DIAGNOSING BIOCHEMICAL RECURRENCE: CASE REPORTMEHMET COSKUN, MERVE HOROZ, KAMIL YUCEL, MUHSIN ENGIN ULUC

Department of Radiology, İzmir Katip Çelebi University Atatürk Training And Research Hospital, İzmir, Turkey

Abstract

Introduction: After radical prostatectomy(RP),a significant drop expect-ed in prostate specific antigen (PSA) level to 0.01ng/mL. Post-RP level of PSA above 0.2ng/mL is defined as biochemical recurrence( BCR). It is dif-ficult to detect BCR with MRI after RP when PSA is below 1ng/ml. In this case report, early diagnosis of BCR and incidental small polipoid bladder carcinoma was demonstrated with use of endorectal coil(ERC).

Case Report: Twelve-quadrant systemic tru-cut biopsy were performed to the 78 years old patient with PSA=8.24ng/mL and diagnosed Gleason 3+3 at 5 cores with maximum 80% involvement. Thoracoabdominal computerized tomography, whole body scintigraphy were negative for metastasis. Gleason 3+4 tumour with 5% involvement determined by RP specimen(upgrade after RP) and the surgical margin was tumor posi-tive on the right. Multiparametric prostate MRI (mpMRI) was performed with 1.5 Tesla (T) (Avanto, Siemens, Germany) due to high post-op PSA (0.59ng/mL). ERC was used to increase diagnostic accuracy. In this MRI, a 2.4mm nodular lesion was detected on right side of bladder neck anas-tomosis. This lesion had low signal on T2W, slightly restricted diffusion, nodular enhancement and was reported as residue which was supported with laboratory findings and proven pathologically. 4.5mm bladder tumor was coincidentally noticed and confirmed by cystoscopy.

Conclusion: The standard use of ERC is controversial, but it is recom-mended for 1.5T devices in prostate imaging reporting and data system version 2 (PIRADSv2). ERC can increase signal-to-noise ratio by 4-9 folds. Sensitivity of mpMRI without ERC is relatively low in treated cases. The usage of ERC seems to be beneficial in treated patients with prostate carcinoma.

Keywords: Prostate carcinoma, biochemical recurrence, endorectal coil, MRI, PIRADSv2

P - 0295

FRONTOORBITAL ANEURYSMAL BONE CYST: A RARE CASE REPORT WITH LITERATURE REVIEW


MESUT SIVRI

Department of Radiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Aneurysmal bone cysts are uncommon, benign, vascular, multicystic lesions destructing the cortical bone by the expansion of the vascular channel in the diploic space. That occur most frequently in long bones, vertebrae, and the pelvis. It has been reported incidence with 0.14 cases for every 1,000,000 people. Fronto orbital involvement is very rare and less than 100 patients has been reported in the literature to our knowl-edge. We present X-ray, CT and MR imaging findings and literature review of an aneurysmal bone cyst of the fronto orbital region with intracranial extension in a 4-year-old female confirmed histopathologically.

Keywords: Aneurysmal bone cyst, CT, frontal, MRI, orbita,

P - 0296

IDIOPATHIC ORBITAL INFLAMMATORY SYNDROMEBERNA AK YILDIZ, ABDULLAH SUKUN, ICLAL ERDEM TOSLAK, SINAN ULGEN, BULENT CEKIC

Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Idiopathic orbital inflammatory syndrome, also known as orbital pseudo-tumor, is a nonspecific, non-neoplastic inflammatory process of the orbit, and 3rd most common ophthalmologic disease of the orbit, following Graves disease and lymphoproliferative disorders. Pathologically, orbital pseudotumors show a nonspecific infiltration of inflammatory cells com-posed of lymphocytes, plasma cells, neutrophils, and macrophages. It may involve any part of the orbit including muscles, tendons, fat, optic nerve, nerve sheet, lacrimal gland. The symptoms of idiopathic pseudotumors reflect the degree of the inflammatory response (acute, subacute, or chronic) and location of the inflammatory tissue. The radiological findings of pseudotumor are characterized by inflammatory changes and in the various intraorbital structures. MRI is gold standard particularly useful in assessing muscular involvement, extraorbital extent, such as cavernous sinus and to determine the tendinous involvement in addition to extra-ocular muscles which suggests pseduotumor orbita and is a key finding in distinguishing pseudotumor orbita from thyroid eye disease. MRI find-ings include T2-weighted hypointensity (possibly reflecting the fibrotic changes), rarely hipo-izointensity and marked gadolinium enhancement. The disease respondes well to steroid therapy. We herein present the MRI findings of a case with idiopathic orbital inflammatory syndrome that was treated with medical therapy and both symptoms and follow-up MRI scans were improved dramatically.

Keywords: Idiopathic orbital inflammatory syndrome, orbital pseudotu-mor

P - 0297

A CASE OF OLFACTORY NEUROBLASTOMA

NAMIK KEMAL ALTINBAS


Abstract

Olfactory neuroblastomas (esthesioneuroblastoma) are neuroectodermal tumors arising from nasal cavity olfactory recess. In this case report, a nineteen year-old male patient with nasal stuffiness was presented via computed tomography (CT) and magnetic resonance imaging (MRI) findings. CT findings were useful for the detection of bony destruction. CT images were revealed that right medial wall of the orbit and maxil-lary sinus resorbing with soft tissue extension. The lesion demonstrated intermediate signal intensity on T1 and T2 weighted images. Also, contrast enhancement was marked in MRI study. This patient with extension to the orbit staged as group C.

Keywords: Esthesioneuroblastoma, olfactory, CT, MRI

P - 0298

TWO RARE CASES OF BILATERAL OPTIC NERVE SHEATH MENINGIOMASIBEL CAGLAR ATACAN1, AJDA AGIRBAS1, NACIYE AKAN2 1Department of Radiology, Forensic Medicine Institute, İstanbul, Turkey2Forensic Medicine Institute, İstanbul, Turkey

Abstract

We describe two cases of bilateral optic nerve sheath meningioma in which the diagnosis was missed for more than 3 years after the onset of symptoms. Clinical features led to a misdiagnosis of optic neuritis in all cases. Radiologically, these tumors can easily be overlooked on routine imaging protocols. Radiologists must be aware for the early diagnosis of optic nerve sheath meningioma in patients with progressive visual loss.

Keywords: Optic nerve sheath meningioma, MRI, radiologic malpractice

P - 0299

FOLLOW-UP IMAGING OF A NON-FAMILIAL CHERUBISM CASE WITH MAXILLARY AND MANDIBULAR INVOLVEMENTSEHNAZ EVRIMLER, DUYGU KOC KELES, HUSEYIN AYDIN


Abstract

Introduction: The aim of this case report is to inform clinicians and radiologists about Cherubism, a rare pediatric maxillofacial disease which spontaneously resolves after puberty and doesn’t require any operation or medication unless a complication or severe symptom occurs.

Case Report: We present a case with seven years follow-up, who has late onset of the Cherubism disease. Firstly, our seven-years old, male patient presented with swelling of bilateral jaws in 2010. Maxillofacial Computed Tomography (CT) showed multiple, hypodense, multilocular cystic lesions in bilateral maxilla and mandible. Histopathological findings of the lesions


were osteoclast type multinucleated giant cells. According to clinical, radiological and histopathological findings, the patient with no disease or family history was diagnosed with Cherubism. He did not have any severe symptoms or complication during his clinical follow up within routine peri-ods. Seven years after the first diagnosis, bilateral exophtalmus occured in his adolescence. Orbital Magnetic Resonance Imaging (MRI), Maxillofacial CT were performed in order to evaluate for orbital wall infiltration which showed resolvement of the cystic lesions. Mandibular condyle involve-ment, a rare presentation of Cherubism disease and proptosis in despite of the regression of the lesions was observed.

Conclusion: Clinicians and radiologists should keep in mind Cherubism, which spontaneously resolves after puberty, for differential diagnosis of children with jaw swelling and tooth maloclusion in order to avoid unnec-essary interventions.

Keywords: Cherubism, mandible, maxilla, computed tomography, mag-netic resonance imaging

P - 0300

COSTAL CHONDROBLASTOMA MIMICKING BREAST CANCER IN AN ELDERLY MALE: A CASE REPORTTURKAN IKIZCELI

Health Sciences University Haseki Training and Research Hospital, İstanbul, Turkey

Abstract

Although chondrosarcoma is common among the bone tumors, costal chondrosarcoma is a very rare malignant tumor of the bone. They are most commonly found in elderly patients within the long bones especially upper and lower extremities. In rare instances, the chest wall can be involved, with chondrosarcomas occurring in the ribs, sternum, anterior and posterior costosternal junction. Some types of chondrosarcomas grow slowly and, provided they are removed completely, have a low risk of spreading to other organs. Others grow rapidly and have a high risk of metastasis. Most patients present with an enlarging painful anterior chest wall tumor. Primary chondrosarcoma of the breast is extremely rare in the literature.

Here, a case of costal chondrosarcoma mimicking breast cancer in 76-years old male with a tumor size of 14×10 cm on the right breast involving the chest wall and 8th rib was presented with Magnetic Resonance Imaging (MRI) findings.

Keywords: Chondrosarcoma, costa, male breast cancer

P - 0301

CEREBRAL AND SPINAL CORD ISCHEMIA DEVELOPING SECONDARY TO SHORT SEGMENT AORTIC DISSECTIONFATMA AKTAS

Department of Radiology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey

Abstract

Objective: In this study, it is aimed to discuss the patient presented to emergency services due to sudden chest pain, dyspnea, and weakness in the lower extremities with suspected of having aortic dissection and in whom cerebral and spinal cord ischemia developed during the follow-up along with literature.

Material and Methods: 76 years male patient consulted to emergency service due to the sudden chest pain, dyspnea and weakness in lower extremities. According to these findings thorax CT, cranial diffusion magnetic resonance imaging (MRI) and thoracolumbar MRI imaging was performed.

Results: In cranial diffusion MRI there were acute ischemia areas in left occipital and right parahippocampal gyrus. According to the thoracolumbar MRI, hypointense signal changes in T1W series and hyperintense signal changes in T2W series causing expansion were detected in the spinal cord. It was diagnosed as spinal cord ischemia In thorax CT dissection of descend-ing aorta in 2 cm segment at distal thoracal level was confirmed. Pleural fluid reaching 10 cm of thickness was seen at left hemithorax. Laboratory examination result of the fluid was consistent with hemothorax

Conclusion: The patient was diagnosed with only 2 cm segment aortic dissection and rupture based on the Thorax CT findings. The patient was diagnosed with spinal cord and cerebral ischemia due to malperfusion. Sudden chest pain is generally the first symptom of aortic dissection, but aortic dissection patients can also consult with atypical symptoms like paraplegia and syncope without pain.

Keywords: Aortic dissection, ischemia, MRI, thorax CT

P - 0302

MRI FINDINGS OF SUBACUTE SCLEROSING PANENCEPHALITIS: A CASE REPORT WITH REVIEW OF THE LITERATUREMEHMET FATIH ERBAY, LEYLA KARACA

Department of Radiology, İnönü University Turgut Özal Medical Center, Malatya, Turkey

Abstract

Subacute sclerosing panencephalitis (SSPE) is a rare, chronic, demyelinating and progressive encephalitis of central nerve system (CNS) affecting primar-ily children and young adults that is caused by persistent infection of measles virus. The disease typically involves periventricular and subcortical white matter but grey matter may also be affected. Corpus callosum, basal ganglia and brainstem are rarely involved structures. In this case report, findings of conventional mri and proton mr spectroscopy of a 20 years old male who was diagnosed with SSPE are presented with the review of the literature.

Keywords: SSPE, conventional mri, proton mr spectroscopy

P - 0303

A RARE CAUSE OF TEMPORAL LOBE EPILEPSY: INCOMPLETE HIPPOCAMPAL INVERSION


BERNA AK YILDIZ, MEHTAP BARC ERGUN, AYSE EDA PARLAK, SAMET MUTLU, EMIN DURMUS

Antalya Training and Research Hospital, Antalya, Turkey

Abstract

Hippocampal development is completed between 8-21 gestational weeks. During this period, folding of dentate gyrus and cornu ammonis around the hippocampal sulcus, so called hippocampal inversion, takes place. If this process is not completed, incomplete hippocampal inversion (IHI) occurs. IHI is a rare cause of in temporal lobe epilepsies. The hippocampus becomes more rounded, and positioned more vertically and medially than it should be. Hippocampal signal intensity and size is usually normal, while internal structure may be blurred. We herein present the MRI findings of incomplete hippocampal inversion as epileptogenic foci in two cases with epilepsy.

Keywords: Incomplete hippocampal inversion, temporal lobe epilepsy

P - 0304

FAT DROPLETS IN SUBARACHNOID SPACE DUE TO RUPTURED DERMOID CYST: A RARE ENTITYILKER OZGUR KOSKA


Abstract

Intracranial dermoid cysts are extremely rare, slow-growing, congenital inclusion cysts, originating from an ectodermal inclusion during develop-ment of the neural tube.So, they preferentially occur in the posterior skull base and the supra- and parasellar region. The secretion and accumulation of epithelium, or fat lead to slow growth of the cyst. Symptomatic compli-cations usually occur in the 2nd to 3rd decade of life, due to space-occu-pying effect, or rupture. Headache, nause, vomitting, epilepsy or chemical menigitis may be the presenting symptoms. We presented 26 years old male admitted to hospital because of severe headache. MRI examination revealed 4x2.5 cm T1 and T2 hyperintense fat containing extraaxial mass adjacent to sphenoidal bone and fat droplets in subarachnoid space patho-gnomic for ruptured dermoid cyst.

Keywords: Ruptured dermoid cyst, fat droplets

P - 0305

RADIOLOGICAL IMAGING FINDINGS OF JOUBERT SYNDROME WHICH IS RAREVEYSEL ATILLA AYYILDIZ, AYSE SAY, ABDULKERIM SALKACI


Abstract

Introduction: Joubert syndrome is a rare autosomal recessive disease characterized by neonatal respiratory disregulation, developmental retar-dation, hypotonia, ataxia, nystagmus and facial dysmorphism. It is charac-terized by varying degrees of vermian hypoplasia and horizontal course of the superior cerebellar peduncle as a result of thickening between brain

stem and cerebellum. Incidence varies between 1/80.0000 -1/100.000. We aimed to present CT and MRI findings of this rare syndrome in a 2-month-old girl.

Case Report: A 2-month-old girl was referred to pediatric neurology clin-ic with complaint of developmental retardation and seizure. Noncontrast brain CT and MRI for seizure etiology revealed vermian hypoplasia and dilate bat wing-like 4. ventricle. It was observed that thickening, elongation of the superior cerebellar peduncle and not connected peduncles of mid-line. In MRI, splenium of corpus callosum was not observed in compatible with corpus callosum dysgenesis, lateral ventricles were large and parallel to each other. Findings were interpreted radiologically with Joubert syn-drome. Ultrasonography of the abdomen showed no organ anomalies.

Discussion: Joubert syndrome is a rare autosomal recessive disorder; it is characterized by congenital ataxia, hypotonia, neonatal respiratory distur-bances, developmental retardation, abnormal eye movements. The delay in diagnosing this disease is usually due to the different and nonspecific presentation of the disease. Multidisciplinary approach is needed for man-agement of the disease. The prognosis depends on the prevalence of the disease, the severity of the respiratory problems and systemic anomalies. Awareness of the characteristic clinical and radiological findings of this disease will help early diagnosis and provide appropriate rehabilitation.

Keywords: Joubert, molar tooth, respiratory disregulation

P - 0306

PSEUDOMENINGOSEL AFTER TYPE 1 CHIARIAN DECOMPRESSIONVEYSEL ATILLA AYYILDIZ, AYSE SAY, ABDULKERIM SALKACI


Abstract

Introduction: Type I Chiari malformation is inferior cerebellar tonsiller herniation from foramen magnum. Cervical syringomyelia is frequently accompanied. Posterior fossa decompression is applied in the treatment. It has been reported that the frequency of pseudomeningocele, which is the most common postoperative complication in literature, varies between 3% and 40%. In this case, we aimed to reveal the magnetic resonance imaging (MRI) findings of a patient who was operated due to type 1 Chiari malformation.

Case Report: A 31-year-old female was admitted for 1 year back pain and numbness on both arms. On cervical MRI cerebellar tonsils were about 7 mm inferior from foramen magnum. At C7-Th1 level were observed syrinx cavity. Posterior fossa decompression was performed. Six days after the operation, patient applied with swelling and discharge in operation.area to emergency department. Patient was admitted to the neurosurgical service with pre-diagnosis of CSF flow. On cervical MR examination, the collecting area which does not contrast, same density with the CSF and dura defect at this level was noticed. Radiological findings were evaluated in favor of postoperative pseudomeningocele.

Conclusion: Surgical management of Type 1 Chiari malformation allows the patient to improve relieve pain, disability of mobility and quality of life in a prominent and sustainable way. Large-size C1 laminectomy without duraplasty facilitates the formation of pseudomeningocele and eventually cord herniation into this cavity. Pseudomeningocele development should


be considered in patients who have undergone posterior fossa surgery and who present with complaints of swelling and discharge.

Keywords: Chiari malformation, posterior fossa, pseudomeningosel

P - 0307

REVERSIBLE CRANIAL MRI FINDINGS IN AN ANTI-RI POSITIVE PARANEOPLASTIC SYNDROME CASESABRIYE SENNUR BILGIN 1, NESRIN HELVACI YILMAZ 2 1Department of Radiology, Medipol University School of Medicine, İstanbul, Turkey2Department of Neurology, Medipol University School of Medicine, İstanbul, Turkey

Abstract

Case Report: 46-year old female came in our neurology clinic with com-plaints of diplopia one year ago. Neurologic examination revealed bilateral horizontal and vertical sight impairment, prominent truncal ataxia and trismus. The patient exhibited a 4th cranial nerve paralysis. On examination the patient also had difficulty swallowing, hoarseness and imbalance. T2 weighted cranial magnetic resonance imaging (MRI) scan showed sym-metric hyperintensities on the parapontine reticular formation and medial longitudinal fasciculus. Having paraneoplastic syndrome in mind, lung x-ray, breast ultrasound and mammography was performed. Breast ultrasound revealed a solid lesion; and mammography clustered microcalcifications on the right breast. FDG-PET-CT scan demonstrated hypermetabolic right breast tail and axillary lymph node (SUV-max 6.4) Breast biopsy was interpreted as invasive ductal carcinoma. Cerebrospinal fluid showed a glucose level of 50mg/dL, protein level of 42mg/dL, cell count of 30 with monocyte cell dominance and no atypical cells. On the paraneoplastic cell panel anti-Ri antibodies were tested positive. After mastectomy che-motherapy was started with the diagnosis of invasive ductal carcinoma. Also, methylprednisolon and intravenous immunoglobulin (IVIG) therapy was added to the treatment. 4 months later control MRI scan revealed prominent regression of prior intensity changes of the pons, 9 months later MRI findings disappeared.

Discussion: Anti-Ri antibody positivity is a rare form of paraneoplastic syndrome. Often it has been linked to ovarian, breast and small cell lung cancer. Here, primary objective is the diagnosis of underlying tumor and its treatment and occult malignancy screening should be performed for at least 5 years. Next to tumor resection and chemotherapy, there are also immunosuppressive and immunomodulatory treatment protocols. In our patient, with prednisolone and IVIG treatment clinical symptoms decreased and MRI findings disappeared.

Keywords: Anti-Ri positive, paraneoplastic sydrome, MRI

P - 0308

NECROTIC LEUKOENCEPHALOPATHY DUE TO COMPLEX TYPE 1 RESPIRATORY CHAIN DEFICIENCYERKAN GOKCE1, MURAT BEYHAN2

1Department of Radiology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey2Department of Radiology, Tokat State Hospital, Tokat, Turkey

Abstract

Complex type 1 respiratory chain deficiency is one of the most common observed defect in childhood-onset mitochondrial diseases. Defects in complex I are genetically heterogeneous and clinically associated with a wide range of presentations, including marked and often fatal lactic aci-dosis with cardiomyopathy, Leigh syndrome, myopathy, hepatopathy, renal tubular dysfunction, stroke-like episodes (MELAS), and leukodystrophy. The majority of affected individuals present during the first year of life and have a rapidly progressive leukoencephalopathy and fatal course. Here, we aimed to present the findings of necrotic leukoencephalopathy due to complex type 1 respiratory chain deficiency in a 5-year-old male patient who underwent contrast-enhanced magnetik resonance imaging (MRI), diffusion MRI and MR spectroscopy.

Keywords: Complex type 1 respiratory chain deficiency, leukoencepha-lopathy, magnetic resonance imaging, magnetic resonance spectroscopy

P - 0309

TRANSECTION OF THE INFUNDIBULAR STALK AFTER THE BOMBING IN A SYRIAN REFUGEE CAUSING CENTRAL DIABETES INSIPIDUSMESUT SIVRI, NAZLI GULSUM AKYEL, AYSE GUL ALIMLI

Department of Radiology, Health Sciences University Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Diabetes insipidus (DI) is a clinical syndrome characterized by excessive urination, excessive thirst and excessive drinking of water. It is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (<300 mOsm/kg). There are two major forms of DI; central (neurogenic, pituitary, or neurohypophyseal) and nephrogenic. In the central form, secretion of antidiuretic hormone decreases secondary to neoplastic and infectious or inflammatory causes. It may rarely be secondary to trauma, in particular by motor vehicle accidents. We present MR imaging findings of transec-tion of the infundibular stalk causing central DI in a 13-year-old male Syrian refugee after the bombing.

Keywords: Bomb, diabetes insipidus, infundibular stalk, transection

P - 0310

MESIAL TEMPORAL SCLEROSIS IN PEDIATRIC AGESNAMIK KEMAL ALTINBAS


Abstract

Mesial temporal sclerosis (hippocampal sclerosis) is relatively less com-


mon in children than adults and associated with refractory temporal lobe epilepsy. In this case report, two pediatric patients were presented. A male case sample with left mesial temporal sclerosis was 16 years old and suffering from intractable focal epilepsy. There was reduced volume and increased T2 signal of left hippocampus compared to the right on magnetic resonance (MR) images. A female patient with left hippocampal sclerosis was 14 years old and suffering from intractable complex partial temporal lobe epilepsy. There were similar changes on MR images.

P - 0311

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN PEDIATRIC PATIENTS: FALL IN LOVE WITH CEREBELLUM, FRONTAL LOBE AND TEMPORAL LOBE?AYSE GUL ALIMLI1, HAVVA AKMAZ UNLU2, NAZLI GULSUM AKYEL2, MESUT SIVRI2 1Department of Pediatric Radiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey2Department of Radiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey

Abstract

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological disease with characteristic magnetic resonance imaging (MRI) findings. MRI shows subcortical/cortical hyperintensity in T2-weighted sequences, typically in posterior circulation distribution . Although parieto-occipital regions involvement is most common; atypi-cally , involvement of the cerebellum, frontal lobe and temporal lobe in pediatric patients are often detected. We aimed to present clinical and radiologic findings of PRES with atypical MRI findings in pediatric patients.

Materials and Methods: We retrospectively evaluated the MRI findings of 9 cases of pediatric PRES.

Results: Three of the patients were girls, six were boys. The patients’ age ranged from 5 to 16 years (mean age, 9,4 years). All lesions had subcortical/cortical hyperintensity in T2-weighted sequences. All patients hadparieto-occipital regions involvement, eight patients had frontal lobe, seven patients had cerebellar and temporal lobe and one patient had splenic involvement. In two patients cortical diffusion restriction, in two patients hemorrhage was an associated feature.In one patient exhibited intense enhancement after intravenous contrast injection.

Conclusion: Atypical MRI findings of PRES are seen quite often in pedi-atric patients; especially involvement of the cerebellum, frontal lobe and temporal lobe. In addition diffusion restriction, contrast enhancement and hemorrhage can also be seen.

Keywords: Atypical findings, MRI, cerebellum, PRESXeremperiam ra non-senis quide endae simaxim as dunt.

TÜRK MANYETİK REZONANS DERNEĞİULUSLARARASI KATILIMLI

23. YILLIK BİLİMSELTOPLANTISI

10-12 MAYIS 2018, ANKARASHERATON OTEL

KONGRE ÖZET KİTAPÇIĞI

Sözlü Bildiriler

S2 • Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı

S - 01

TRANSFÜZYON BAĞIMLI BETA TALASEMİ MAJOR HASTALARINDA SPLENİK DEMİR BİRİKİMİNİN SHEAR WAVE ELASTOGRAFİ VE MANYETİK REZONANS T2* GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİMEHMET FATİH ÖZKILIÇ, BÜLENT ÇEKİÇ, ERDAL KURTOĞLU

Sağlık Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi, Antalya, Türkiye

Özet

Amaç: Bu çalışmada, uzun dönem transfüzyon tedavisi gören Beta Talasemi Major hastalarında splenik demir birikiminin GRE T2* (star) görüntüleme ve shear wave elastografi ile değerlendirilmesi ve normal populasyon ile karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: 21-45 yaş arası 30 sağlıklı gönüllü ve uzun dönem transfüzyon tedavisi almakta olan 15-40 yaş arası 30 Beta Talasemi Major hasta-sında dalağa yönelik MRG (multi TE GRE sekansı) ve shear wave elastografi incelemeleri yapıldı.Hasta grubunda serum ferritin değerleri kaydedildi. Her olguda MRG ile karaciğer ve dalak T2* (star) değeri ölçüldü. Shear wave elastografi ile dalak shear wave stiffness ve hız değerleri saptandı.

Bulgular: Talasemi grubunda dalak T2* değerleri kontrol grubuna oranla anlamlı düşük saptandı (p<0,05). Talasemi grubunda dalak shear wave stiffness ve hız değerleri kontrol grubuna oranla anlamlı yüksek saptandı (p<0,05).Dalak T2* değerleri ile serum ferritin değerleri arasında anlamlı negatif korelasyon saptandı (p<0,05). Shear wave elastografi parametreleri ile dalak T2* veya serum ferritin değerleri arasında anlamlı korelasyon saptanmadı (p>0,05).

Sonuç: Talasemi Major hasta grubunda dalak T2* değerleri demir birikimine bağlı olarak azalma göstermektedir. Splenik biyopsinin dahil edileceği çalış-malarla demir yükü tayininde dalak için eşik T2* değerleri belirlenebilir. Shear wave elastografi parametreleri dalak T2* ve serum ferritin değerleri ile korelasyon göstermediğinden dalak demir yükü saptanmasında kullanımı pratik değildir.

S - 02

GASTROİNTESTİNAL SİSTEM MALİGNİTESİ BULUNAN HASTALARIN KARACİĞER METASTAZLARININ MRG İLE GÖRÜNTÜLENMESİNDE GADOKSETİK ASİT VE GADOPENTATE DİMEGLUMİNİN ETKİNLİĞİNİN KARŞILAŞTIRILARAK DEĞERLENDİRİLMESİCENGİZ KADIYORAN

Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye

Özet

Amaç: Bu çalışmanın amacı gastrointestinal sistem malignitesi bulunan hastaların karaciğer metastazlarının MRG ile görüntülenmesinde gadoksetik asit ve gadopentate dimegluminin etkinliğinin karşılaştırılarak değerlendirilmesidir.

Gereç ve Yöntemler: Histopatolojik olarak gastrointestinal sistem malignite tanısı kesinleşmiş hastaların daha önceden çekilmiş olan BT ve MRG tetkikleri retrospektif olarak değerlendirilmiştir. Bu hasta grubunda karaciğer metastazı bulunan 50 hasta seçilerek çalışmaya dahil edil-miştir. Çalışmaya dahil edilen hastalar yapılacak işlem konusunda bilgilendirilmiş ve yazılı onayları alınmıştır. Her iki kontrast madde grubu ile prekontrast standart serileri takiben arteryel, portal ve 5. dakikada geç faz seriler elde olunmuştur. Gadoksetik asite özel 20. dakikada seriler elde edilmiştir. Her iki kontrast madde grubunda da arteryel, portal ve geç fazda da karaciğer parankiminden komşuluğunda vasküler yapı ve metastatik lezyonun izlenmediği parankim alanından intensite ölçümü yapılmıştır. Ayrıca her üç fazda da nekrotik alan içermeyen bir metastatik lezyondan intensite ölçümü yapılarak elde edilen değerler kaydedilmiştir. Gadoksetik asit verilen hasta grubunda alınan 20. dakika serilerde de benzer şekilde ROI yardımı ile karaciğer parankim ve metastatik lezyon intensite ölçümü yapılarak değerler kaydedilmiştir. Hem gadoksetik asit hem de gadopentate dimeglumine uygulanan hastalarda arteryel, portal ve geç faz elde edilen karaciğer parankim intensite ve metastatik lezyon intensite değerleri karşılaştırılmıştır. Gadoksetik asit uygulaması sonrasında 20. dakikadaki seriler ile gadopentate dimeglumine uygulanan hasta-lardaki geç fazda elde edilen seriler karaciğer parankim ve metastatik lezyon intensiteleri açısından karşılaştırılmıştır. Daha sonra gadoksetik asit grubunda hem karaciğer parankiminin hem de metastatik lezyonun sekanslar ilerledikçe gösterdiği intensite değişikliğini değerlendirmek amacı ile arteryel, portal, geç faz ve 20. dakikadaki serilerde daha önceden ölçmüş olduğumuz intensite değerleri karşılaştırılmıştır. Elde edilen intesite değerleri tabloda özetlenmiştir. Gadoksetik asit ile edilen serilerde 20.dakika serilerin yeni metastaz tespitine olan katkısını değerlendirebilmek amacı ile portal fazda izlenen metastatik lezyonlar, 20. dakikadaki serilerde ki metastatik lezyonlar ile karşılaştırılmış, yeni tespit edilen lezyon varsa not edilmiştir.

Bulgular: Gadoksetik asit ile elde edilen 20. dakikadaki serilerin gadopentate dimeglumine ile elde edilen 5. dakikadaki seriler ile karaciğer parankimi ve metastatik lezyon intensiteleri açısından karşılaştırılmasında gadoksetik asit lehine istatistiksel anlamlı fark bulunmuştur. Arteryel, portal ve geç fazda her 2 kontrast madde arasında intensite değerleri açısından anlamlı fark saptanmamıştır. Gadoksetik asit uygulmasını takiben arteryel fazda artmaya başlayan karaciğer intensitesi, portal ve geç faz karşılaştırıldığında anlamlı artış göstermemektedir. Ancak 20. dakika elde olunan serilerde karaciğer parankim intensitesi portal faza göre anlamlı artış göstermiştir. Bu sırada matastatik lezyon intensitesi fazlar arası anlamlı farklılık göstermemiştir. Gadoksetik asit

Türk Manyetik Rezonans Derneği Uluslararası Katılımlı 23. Yıllık Bilimsel Toplantısı • S3

uygulanan hastalarda portal faz ve 20. dakikada elde edilen serilerde tüm hastalardaki metastazlar sayılarak karşılaştırıldığında metastatik lezyon sayısında bu iki faz arasında anlamlı farklılık izlenmemiştir.

Sonuç: Gadoksetik asit hepatoselüler bir kontrast madde olup gastrointestinal sistem maligniteli hastaların karaciğer metastazlarının manyetik rezonans ile değerlendirilmesinde 20. dakikada elde edilen serilerde önemli tanısal katkılar sağlar. Karaciğer kontrastı artarken metastatik lezyonlardaki kontrastlan-manın artmıyor olması karaciğerdeki metastatik lezyon ve normal karaciğer parankimi arasında belirgin kontrast farkına yol açmaktadır. Böylece zamanla gittikçe artan karaciğer kontrastlanmasını takiben fazlar süresince anlamlı artış göstermeyen metastatik lezyon intensitene de bağlı olarak lezyonların tespiti kolaylaşmaktadır.

S - 03

KLİNİK OLARAK VAS DEFERENS AGENEZİ TANISI OLAN HASTALARDA VAS DEFERENS VE SEMİNAL VEZİKÜLÜN MAGNETİK REZONANS GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİHAKAN İMAMOĞLU

Erciyes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Kayseri, Türkiye

Özet

Amaç: Erkek infertilitesinde kesin tanı ve uygun tedavi için Magnetik Rezonans (MR) görüntüleme kullanılabilir. MR görüntüleme, vas deferensin intraab-dominal parçasını da gösterebildiğinden vas deferensi değerlendirmede ultrasonografiye kıyasla üstünlük gösterir. Bu çalışmanın amacı klinik olarak vazal agenezi (VA) tanısı olan hastalarda vas deferens ve seminal vezikülün MR görüntüleme ile değerlendirilmesidir.

Gereç ve Yöntemler: Klinik olarak unilateral veya bilateral VA olan 17 hastanın MR görüntüleri aksial, koronal ve sagittal düzlemlerde 1.5 Tesla cihaz ile endorektal koil kullanılmadan elde olundu. Görüntülerde unilateral veya bilateral VA; seminal vezikül (SV) defekti (hipoplazi veya atrofi); SV agenezisi, SV kisti ve vas deferensin ampulla dışındaki pelvik (intraabdominal) parçası araştırıldı. Unilateral ve bilateral VA olan hastaların MR görüntüleme bulguları arasındaki fark ki-kare testi ile değerlendirildi.

Bulgular: Klinik olarak 9 hastada bilateral, sekiz hastada ise unilateral VA vardı. Vas deferensin intraabdominal parçası bilateral VA’si olan hastaların dördünde, unilateral VA’si olan hastaların ise birinde mevcuttu. Bilateral VA’si olan hastalarda intraabdominal parça saptanma oranı unilateral VA’si olan hastalardan yüksek olsada her iki grup arasındaki fark istatistiksel olarak anlamlı değildi (p>0,05). Ek olarak, unilateral ve/veya bilateral VA’si olan hastaların %94’ünde eşlik eden SV defekti ve/veya agenezisi saptandı.

Sonuç: Klinik olarak unilateral veya bilateral VA tanısı alan hastalarda vas deferensin intraabdominal parçasının MR görüntüleme ile araştırılması önerilir. Bu yaklaşım VA’nin etiyolojisini aydınlatmaya katkıda bulunabilir.

S - 04

PERİTONEAL İMPLANTLARDA ADC VE ULTRASON ELASTOGRAFİNİN TANIDAKİ YERİMESUT ÇETİN 1, ADEM AĞYAR 1, OSMAN DERE 1, ABDURRAHİM DUSAK 1, HAKAN BÜYÜKHATİPOĞLU 2 1Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye2Harran Üniversitesi Tıp Fakültesi, Tibbi Onkoloji Bilim Dalı, Şanlıurfa, Türkiye

Özet

Amaç: Ovaryan ve GİS malignitesi olan hastalarda periteonal implantların share –wave elastografi hız değerleri ile difüzyon MR da ADC değerleri ara-sında ilişkinin araştırılması.

Gereç ve Yöntemler: Ekim 2017 ve mart 2018 tarihleri arasında Kadın hastalıkları ve onkoloji kliniklerinden bilinen over malignitesi olan veya şüphesi bulunan hastaların 3 Tesla Mr da çekilen abdomen Mr ları aynı gün değerlendirildi. Peritonal implantı olan hastalar eş zamanlı Shear-wave elastografi tek-niğiyle hız ölçümleri yapıldı. Overyan ve GİS malignitesi olan 28 hastanın abdomen mr incelemesinde 9 hastada peritonal implant saptandı. Bu hastalarda implantı olan hastalarda boyutu en büyük olan ve cilde yakın olan seçildi. ADC haritalamada 3 adet 4 mm² ROİ değerleri alındı. Shear-wave elastografide ADC değeri alınan implanttan 3 adet 1,5 mm² ROİ kullanılarak hız değerleri ölçüldü. Elde edilen ortalama değerler Spearman’s korelasyon testi kullanıldı. P≤0,05 değeri istastiksel olarak anlamlı kabul edildi.

Bulgular: Hasta sayımız 9 olup ortalama yaş 52,5 olarak saptandı. Ortalama ADC değeri 1,02 (min:0,87, max:1,8) bulundu. Share-wave hız değeri ortalama 2,1 m/sec (min:1,8, max:2,8) olarak hesaplandı. Peritonal implantlardan elde edilen ADC değeri ve ortalama hız değerleri arasında ters orantı saptandı.

Sonuç: Bu çalışmamızdaki veriler ile shear -wave elastografinin peritonal implantların saptanmasında Difüzyon mr kadar değerli olduğunu düşünmekteyiz.


S - 05

PERİANAL FİSTÜL GÖRÜNTÜLEMESİNDE VÜCUT KOİLİ İLE YÜZEYEL FLEX KOİLİN ETKİNLİĞİNİN KARŞILAŞTIRILMASINAZLI GÜLSÜM AKYEL 1, KAYIHAN AKIN 2, DİLEK KÖSEHAN 3, ASLI KÖKTENER 2 1Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye2Ankara Umut Hastanesi, Ankara, Türkiye3Memorial Ankara Hastanesi, Ankara, Türkiye

Özet

Amaç: Manyetik rezonans görüntüleme (MRG) ile anal fistül değerlendirilmesinde vücut koili ile yüzeyel Flex-M koilin tanıya yararının karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Anal fistül klinik tanısı ile MRG yapılan 19u erkek, 10u kadın 29 hasta çalışmaya dahil edildi. Toplam 31 fistül değerlendirildi. İncelemeler 1.5 Tesla MR cihazında (Achieva; Philips Medical Systems; Best, Netherlands) 8 kanallı faz dizilimli body koil kullanılarak gerçekleştirildi. Rutin protokole ek olarak Flex-M koil ile aksiyel planda yağ baskılı T2 ağırlıklı sekans tekrarlandı. İki uzman radyolog birbirinden bağımsız olarak ve ayrı zamanlarda body koil ve Flex koil ile alınan görüntüleri inceledi. İç ağız, dış ağız, abse ve sekonder trakt görüntülenebilirliği değerlendirildi. Olgular Parks ve St. James Üniversitesi Sınıflamalarına göre sınıflandırıldı.

Bulgular: Birinci radyolog; dış ağızların body koil ile 27, Flex koil ile 29unu, iç ağızların body koil ile 19, Flex koil ile 30unu, sekonder traktların body koil ile 6, Flex koil ile 8ini görebildi. İkinci radyolog; dış ağızların body koil ile 25, Flex koil ile 27sini, iç ağızların body koil ile 18, Flex koil ile 28ini, sekonder traktların body koil ile 6, Flex koil ile 8ini görebildi. Hastalardaki 6 absenin tamamını iki radyolog da her iki koille görebildi. İki hastada ikişer fistül vardı ve radyologların ikisi de ikinci fistülü body koil ile göremedi. Flex koil ile birinci radyolog fistüllerin her ikisini de, ikinci radyolog birini görebildi. Gözlemciler arası değişkenlik istatistiksel olarak anlamlı değildi ve kappa değerleri uyumluydu.

Sonuç: Bu çalışmada yüzeyel koil ile çözünürlüğün daha iyi olduğunu ve özellikle iç ağız görüntülemesi olmak üzere tanıya katkı sağladığını ortaya koyduk.

S - 06

KARACİĞER PARANKİMİNDE FARKLI KONTRAST MADDELERİN KONTRASTLANMA PATERNLERİNİN KARŞILAŞTIRILMASIMEHMET MERT GERES, UMUT ERDEM, BADE KELEŞ, ŞÜKRÜ MEHMET ERTÜRK

Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Amaç: Gadoterate meglumine, gadoversetamide, gadobutrol, gadodiamide ve gadoxetate sodyum adlı gadolinyum içeren manyetik rezonans (MR) kontrast ajanlarının intravenöz enjeksiyonu sonrasında gerçekleştirilen dinamik batın MR incelemelerinde, arteryel fazda aorta ve karaciğer parankiminin, portal venöz ve denge fazlarda karaciğer parankiminin sinyal intensitelerinin karşılaştırılması.

Gereç ve Yöntemler: Retrospektif çalışmaya gadoxetate sodyum için 0,05 mmol/kg, diğer her bir kontrast madde için 0,1 mmol/kg intravenöz yolla gadolinyum enjekte edilmiş, 25’er adet dinamik kontrastlı abdominal MR çalışması dahil edildi. Arteryel fazda, aortadan ve karaciğer parenkiminden, portal venöz ve denge fazlarında ise yalnızca karaciğer parankiminden sinyal intensite ölçümleri yapıldı. Hepatosit spesifik fazda elde edilen görüntüler gadoxetate sodyum’a özgü oduklarından farklı kontrast madde kullanılmış gruplar arasında sinyal intensite farkları ANOVA testi kullanılarak araştırıldı. ANOVA testi ile istatistiki anlamlı fark ortaya çıkan durumlarda gruplar arası karşılaştırmalar ad hoc Tukey testi kullanılarak gerçekleştirildi.

Bulgular: Arteryel faz esnasında aortadan yapılan ölçümler arasında anlamlı fark yoktu. Arteryel fazda karaciğer parankiminden yapılan ölçümler göz önüne alındı-ğında gadoxetate sodyum grubunda sinyal intensitesi (555,1±122,3) gadobutrol grubunun sinyal intensitesinden (474,1±170,8) anlamlı derece yüksekti (p<0,05). Portal venöz fazda karaciğer parankiminden yapılan ölçümlerde, gadoxetate sodyum grubunda sinyal intensitesi (339,0±71,1) gadoversetamide (255,4±86,9) ve gadobutrol (255,5±83,6) grubundan anlamlı derece yüksekti (p<0.05). Denge fazında karaciğer parankiminden yapılan ölçümlerde gadoxetate sodyum grubunda sinyal intensitesi (368,6±74,2) gadoversetamide (280,0±96,7) ve gadobutrol (279,0±93,4) grubundan anlamlı derece yüksekti.

Sonuç: Gadoxetate sodyum, daha az gadolinyum içermesine rağmen, arteryel, portal venöz ve denge fazlarında karaciğerde diğer gadolinyum içeren kontrast maddelere göre aynı miktarda ya da daha fazla sinyal artışı sağlamaktadır. Gadoxetate sodyuma özgü hepatosit spesifik faz, diğer ajanlar ile bu fazda görüntü elde edilmesi mümkün olmadığından çalışma kapsamına alınmamıştır.

S - 07

SAFRA KESESİ VE SAFRA YOLLARI TAŞ OLUŞUMUNDA MRKP İLE BELİRLENEN MORFOLOJİK PARAMETRELERİN DEĞERİÖZGÜR KARABIYIK, ALİ KOÇ, TURGUT TURSEM TOKMAK, GAMZE TÜRK, MUSTAFA BİLGİLİ

Sağlık Bilimleri Üniversitesi Kayseri Eğitim ve Araştırma Hastanesi, Kayseri, Türkiye


Özet

Amaç: Safra kesesi, intra ve ekstrahepatik taş oluşumunda birçok etyolojik faktör bulunmaktadır. Ancak ekstra ve intrahepatik safra yollarının morfolojik özellikleri ve taş oluşumu ile ilgili günümüze kadar yapılan yeterli çalışma yoktur. Bu çalışmadaki amacımız safra yolları ve safra kesesi taşlarında sağ ve sol intrahepatik safra kanalı arasındaki açı (SSHKA), sistik kanal-ana hepatik kanal birleşim açısı (SHA), hepatikokoledokal açı (HKA) ilişkisini saptamak ve ayrıca sistik kanal uzunluğu ve çapının taş oluşumuna katkısı olup olmadığını literatürle karşılaştırmaktır.

Gereç ve Yöntemler: 63 olguya ait MRKP (manyetik rezonans pankreatikokolanjiyografi) tetkikleri retrospektif olarak incelendi. Olguların safra kesesi açısı (SKA), SHA, sistik kanal uzunluğu (SKU), sistik kanal çapı (SKÇ), SSHKA, HKA, intra-ekstrahepatik kanallarda taş olup olmaması, sistik kanal tipi not edildi. Görüntülerin incelenmesinde PACS ortamında MIP ve diğer kesitsel imajlar birlikte kullanıldı. SPSS programı ile İstatistiki olarak olgulara ait tanımlayıcı analiz ve korelasyon testleri uygulandı.

Bulgular: Olguların %46’sı erkek, %56’sı bayan idi. Olguların yaş ortalaması 59 idi. Olguların 46 sında (%73) safra kesesinde taş vardı. Olguların 27 sinde (%43) koledokta, 5 tanesinde (%8) ana hepatik kanalda, 4 tanesinde (%6) intrahepatik safra yollarında taş tespit edildi. SKA, ortalama 62 derece; SHA, 24 derece, SKU, ortalama 43 mm; SKÇ, ortalama 5,4 mm; SSHKA, ortalama 63 derece; HKA, ortalama 132 derece ölçüldü. Yaş arttıkça SHA,SSHKA ve HKA açıları azalıyordu. Ancak istatistiksel olarak anlamlı değildi (p>0,05). Bayanlarda SHA ve HKA açısı erkeklere göre artarken, SSHKA açısı azalıyordu (p>0,05). Safra kesesinde taş olanlarda SHA ve SSHKA açıları azalırken (p>0,05), HKA artıyordu (p=0,05). Koledokta taşı olanlarda SHA, SSHKA ve HKA açılarının hepsinde artış vardı (p>0,05). Ana hepatik kanalda taşı olanlarda SHA ve HKA azalırken, SSHKA açısı artıyordu (p>0,05).

Sonuç: Safra kesesi ve yollarının morfolojik yapısı da taş oluşumu etyoljisi açısından dikkatlice değerlendirilmelidir.

S - 08

BÖLGEMİZDE KARACİĞER TRANSPLANTASYON ÖNCESİ DONÖRLERDE SAFRA YOLLARI VARYASYONLARININ İNSİDANSININ MRCP İLE ARAŞTIRILMASIMUSTAFA KOÇ

Fırat Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Elazığ, Türkiye

Özet

Amaç: Bu çalışmanın amacı; bölgemizde, karaciğer donörlerinde safra yolları varyasyonlarının manyetik rezonans kolanjiyopankreatografi (MRKP) yön-temi ile insidansını değerlendirmektir.

Gereç ve Yöntemler: Ocak 2016-Şubat 2018 tarihleri arasında, kliniğimizde 1.5 T MRG ile MRKP uygulanan karaciğer donörü hasta dosyalarına ait kayıtlar, retrospektif olarak incelendi. Çalışmaya 32 olgu dâhil edildi. Olguların 19 u erkek (%59), 13 ü kadın (%41) idi. Yaşları 22 ile 65 arasında değiş-mekte olup, ortalama yaş 47±10.3 bulundu. Safra yollarının anatomisi incelendi. Safra yolları varyasyonları Huang sınıflamasına (Tip A1-A5) göre yapıldı. Varyasyonların varlığı ve tipi kaydedildi.

Bulgular: 21 olgunun (%66) safra yolları normal anatomik görünümde olup varyasyon tespit edilmedi (Tip A1). Kalan 11 olguda (%34) çeşitli varyasyonlar mev-cuttu. 6 olguda (%19) Tip A2, 3 olguda (%9) Tip A3, 1 olguda Tip A4 (%3) ve 1 olguda (%3) Tip A5 varyasyonu mevcuttu. Tip A1 ve Tip A2 olguları (%85) safra yolları açısından transplantasyon için uygun değerlendirilmiş, Tip A3-A4 ve A5 varyasyonlu olgular (%15) ise transplantasyona uygun bulunmamıştı.

Sonuç: Karaciğer transplantasyonu işleminde, preoperatif görüntülemede, hepatik arteriyel ve venöz yapıların, safra yollarının normal anatomisinin ve varyasyonlarının değerlendirilmesi, operasyon esnasında veya postoperatif takiplerde oluşacak komplikasyonlar açısından büyük önem taşımaktadır. Biliyer varyasyonlar sık gözükmekte olup, morbiditenin büyük kısmı biliyer anastomozlarla ilgili komplikasyonlara bağlıdır. Komplikasyonların önüne geç-mek için, preoperatif verici adaylarının biliyer sistemlerinin, noninvazif radyolojik yöntemler kullanılarak, dikkatlice değerlendirilmesi gerekmektedir. Biliyer anatominin ve varyasyonların değerlendirilmesinde MRKP ilk tercih edilecek non invazif radyolojik modalitedir.

S - 010

BENİGN VE MALİGN TİROİD NODÜLLERİNİ AYIRMADA DİNAMİK KONTRASTLI PERFÜZYON MANYETİK REZONANS GÖRÜNTÜLEMENİN KULLANIMIMURAT BEYHAN 1, RECEP SADE 2 1Devlet Hastanesi, Radyoloji Kliniği, Tokat, Türkiye2Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye

Özet

Amaç: Tiroid nodülleri sıklıkla görülür ve genel popülasyonun%60ında gözlenir. Ancak bu nodüllerin sadece %3-7si maligndir. Malign tiroid nodüllerini benign nodüllerden ayırma tiroid lezyonlarında gereksiz cerrahinin ve zaman kaybının önlenmesi açısından oldukça önemlidir. Çalışmamızda amaç tiroid nodüllerinde benign-malign ayrımında perfüzyon manyetik rezonans görüntülemenin (MRG) etkinliğini araştırmaktır.

Gereç ve Yöntemler: Aralık 2016-Aralık 2017 arasında tiroid bezinde kitlesi olan 18 yaş ve üzeri 24 hastanın görüntüleri 3-T MRde dinamik kontrastlı MRG kullanılarak elde edildi. Bu görüntüler software üzerinde seçilmiş regions of interest (ROI) ile post-processing işleminden geçirilerek ROI içindeki


her voksel için kantitatif veriler elde edildi. Ktrans, Ve, Kep, iAUC ve chi2 otomatik olarak hesaplandı. Daha sonra benign ve malign lezyonların dinamik kontrastlı MRG değerleri karşılaştırıldı.

Bulgular: Hastaların 15’i kadın 9’u erkekti. Yaş ortalaması 36,2 idi. Hastaların 14’ünde benign lezyon 10unda malign tümör mevcuttu. Malign lezyonlarda ortalama Ktrans, Kep, Ve, iAUC ve chi2 değerleri sırasıyla 0.265, 1.046, 0.419, 20.579 ve 0.442; benign lezyonlarda 0,531, 1.498, 0.438, 29.64 ve 0.434; normal parankimde ise 0.859, 1.63, 0.461, 35.85 ve 0.39 idi. Malign lezyonlardaki ortalama Ktrans ve iAUC değerleri benign lezyonlardan anlamlı olarak daha düşüktü (0.028 ve 0.049). Malign lezyonlarda Ktrans, Kep ve iAUC değerleri normal parankim değerlerinden istatistiksel olarak anlamlı derecede düşüktü (sırasıyla p 0.001, 0.002 ve 0.001).

Sonuç: Diğer dokuların aksine, tiroid kitlelerinde perfüzyon MRG değerleri maligniteye doğru gidildikçe Ktrans ve iAUC değerlerinde bir azalma sergiler. Perfüzyon MRG’nin kullanımı benign ve malign tiroid nodüllerini ayırmada daha büyük çalışmaların sonucu olarak bir cut-off değeri oluşturulduktan sonra yararlı olabilir.

S - 013

ULTRASON REHBERLİĞİNDE MR ARTROGRAFİK İNTRAARTİKÜLER ENJEKSİYON TEKNİKLERİGÖKHAN POLAT, SERHAT KAYA, HAYRİ OĞUL, BERHAN PİRİMOĞLU, MECİT KANTARCI, AKIN LEVENT

Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye

Özet

Amaç: Biz çalışmamızda tanı ve tedavi açısından önemli olan intraartiküler enjeksiyon yöntemlerinin ultrason kılavuzluğunda uygulanış yöntemlerini tanıtmayı amaçladık.

Gereç ve Yöntemler: 100 cc serum fizyolojik, MR kontrast madde,BT kontrast madde,İnsülin enjektörü,20cc enjektör, Gazlı bez /batikon, Steril eldiven,Steril prob kılıfı, Damar yolu

Kontrast maddenin hazırlanması;

1) MR artrografi için;

• 100cc serum fizyolojik içerisine 0,5 cc MR kontrast madde verilir.• 20cc steril enjektör içerisine hazırladığımız karışım alınır.

2) MR artrografi+CT artrografi için;

• 100 cc serum fizyolojik içerisine 0,75cc MR kontrast madde verilir.• 20 cc enjektör içerisine 5 cc CT kontrast maddeden 15 cc dilüe ettiğimiz MR kontrast maddeden alınır.

İşlem Öncesi Hazırlık;

• Enjeksiyon yapılacak eklem antiseptik solüsyon ile steril edilir.• Lineer transducere steril ultrason prob kılıfı geçirilir.• Girişimsel işlemi yapacak doktorumuz steril giyinmesi gerekiyor.• Ultrasonda lineer prob (5-12 MHz) ve MSK modu seçilir.

Bulgular:

Posterior Yaklaşımda Omuz eklemi İçin;

• Hasta dik oturur pozisyonda yerleştirilir.• Linear prob infraspinatus kasına paralel yerleştirilir.• Humerus başı ve glenoid kemik arasında eklem boşluğu görülür.• İğnemiz probumuzun yaklaşık 1cm uzağından, yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir.• Posterior yaklaşımda hedef iğnemizin humerus başı ile glenoid kemik arasına yerleştirilmesidir.• Yaklaşık 10-15 cc (12 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir.

2) Tibiotalar Eklem İçin;

• Hasta sedye uzerinde oturur pozisyonda durur ve işlem yapılacak ayak için ayak tabanı sedyeye paralel yerleştirilir.• Lineer prob tibia diafizine paralel olacak şekilde eklem üzerine yerleştirilir.• Tibia epifizi ve talus domu arasından eklem boşluğu görülür.• İğnemiz probumuzun yaklaşık 1cm uzağından,yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir.• Hedef iğnemizin tabiotalar eklem boşluğuna yerleştirilmesidir.• Yaklaşık 3-5 cc (4 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir.

3) Lateral Yaklaşımda Radiohumeral Eklem İçin;

• Hasta sedye yanında sedyeye vücudunun yan tarafı gelecek şekilde oturtulur.• Humerus sedye üzerine paralel şekilde yerleştirilir.


• Ön kol 90 derece fleksiyonda ve baş parmak yukarıda olacak şekilde yerleştirilir.• Lineer prob radius diafizine paralel olacak şekilde radius başında eklem üzerine yerleştirilir.• Radius başı ile kapitellum arasından eklem boşluğu görülür.• İğnemiz probumuzun yaklaşık 0,5 cm uzağından,yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir.• Lateral Yaklaşımda hedef radiokapitellar eklem boşluğunda iğnemizin radius başına uzanmasıdır.• Yaklaşık 3-5cc (4 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir.

4) El Bileği İçin;

• Hasta sedye yanında yüzü sedyeye dönük yerleştirilir.• El bileği altına mümkünse bileğin hafif fleksiyonda durmasına yardımcı olacak aparat yerleştirilir.• El bileği hafif ulnar deviasyona getirilir.• Lineer prob radius diafizine paralel olacak şekilde distal radius epifizi üzerine yerleştirilir.• Radiokarpal eklem mesafesi görülür.• İğnemiz probumuzun yaklaşık 0,5 cm uzağından,yaklaşık 45 derecelik açı ile ve probun uzun aksına paralel olacak şekilde ilerletilir.• Hedef iğnemizin radiokarpal eklem boşluğunda radius distal epifizine ulaşmasıdır.• Yaklaşık 2-4cc (3 cc) arasında hazırladığımız dilüe kontrast madde enjekte edilir.

Sonuç: Ultrason gerçek zamanlı bir tetkik olduğu için işlem sırasında iğne trasesi daha iyi değerlendirilebilir. Özellikle pediatrik hasta grubunda radyas-yondan korunmak ve daha efektif bir enjeksiyon için tercih edilir.

S - 014

DİNAMİK KONTRASTLI MRG DE WASH-IN, WASH-OUT VE MAKSİMUM KONTRASTLANMA SKORU: PROSTAT KANSERİ SAPTAMA VE LOKALİZE ETMEDEKİ YERİFEYZA YILMAZ

Gaziantep Üniversitesi Tıp Fakültesi, Gaziantep, Türkiye

Özet

Amaç: Çalışmamızda dinamik Magnetik Rezonans (MR) görüntüleme ile normal ve anormal prostatik dokuların karakteristik kontrastlanma özelliklerini saptayarak; histolojik derece (Gleason skoru) ve tümör belirteçleri ile ilişkilerini değerlendirdik.

Gereç ve Yöntemler: Prostat kanseri olan 27 hastada gadopentetat dimegluminin bolus enjeksiyonunu takiben dinamik MR görüntüleri elde edildi. Aynı anatomik pozisyonda T2 ağırlıklı ve diffüzyon görüntülerinde yeri belirlenen 27 tümör dokusu, 21 normal periferal zon, 13 normal santral zondan ve 8 benign prostat hiperplaziden zaman-sinyal yoğunluğu parametreleri olan; kontrastlanma başlangıç zamanı, maksimum kontrastlanma zamanı, kont-rastlanma bitiş zamanı, başlangıç sinyal değeri, maksimum kontrastlanma sinyal değeri, bitiş kontrastlanma sinyal değeri kullanılarak wash-in, wash-out ve maksimum kontrastlanma skoru elde edilerek; normal doku ve benign patolojilerle, kanser dokusu karşılaştırıldı. Ayrıca tümörün histolojik derece (Gleason skoru) ve serum prostatik spesifik antijen (PSA) seviyeleri ile korele edildi.

Bulgular: Periferik zon ve tümör arasında başlama zamanı hariç sinyal yoğunluğu parametreleri ile anlamlı fark bulundu. Santral gland ve tümör kont-rastlanma parametreleri değerleri arasında maksimum kontrastlanma zamanı ve wash in skoru hariç fark izlenmedi. BPH ve tümör kontrastlanma parametreleri değerleri arasında maksimum kontrastlanma zamanı hariç fark izlenmedi. Bununla birlikte, Gleason skoru veya PSA seviyeleri ile önemli bir korelasyon görülmedi.

Sonuç: MR kontrastlanma özelliklerinin değerlendirilmesi özellikle periferal zonda normal doku- tümör ayrımı yapılmasına olanak tanıdığı bilinmekle birlikte maksimum kontrastlanma zamanı BPH ve tümör ayrımında faydalı olabilir.

S - 016

PERİFERAL ZON YERLEŞİMLİ PROSTAT ADENOKARSİNOM VAKALARINDA DİFÜZYON AĞIRLIKLI GÖRÜNTÜLERİN OBJEKTİF VE SUBJEKTİF DEĞERLENDİRİLMESİGÖKHAN TONKAZ, GÖKHAN POLAT, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Amaç: Multiparametrik prostat MR (mpMRG) çekilen ve sonrasında yapılan biyopsi sonucu prostatik adenokersinom gelen hastalarda lezyonlarının subjektif ve objektif difüzyon karakterlerinin incelenmesi.


Gereç ve Yöntemler: Ocak 2016 – Ocak 2018 tarihleri arasında bölümümüzde mpMRG çekilen ve sonrasında biyopsi yapılan hastalar retrospektif olarak değerlendirildi. Biyopsi sonucu prostatik adenokersinom gelen 26 tane hasta tespit edildi. Mevcut 26 hastadaki lezyonların tamamına ait difüzyon ağırlıklı görünütüler 5 yıllık tecrübeye sahip abdominal radyolog ve 2 yıllık tecrübeye sahip radyoloji uzmanlık öğrencisi tarafından incelendi. Lezyonların b50, b1000, b1500 deki sinyal intensiteleri subjektif olarak (4 puanlık skala) ile belirgin sinyal artışı göstermeyen (0 puan), hafif derecede (1 puan), orta derecede (2 puan) ve ileri derecede hiperintens diye sınıflandırıldı. Lezyonların difüzyon karakterleri objektif olarak ADC değerleri ölçüldü. b50, b1000, b1500 deki sinyal intensitelerinin subjectif değerlendirilmesi ve ADC haritasındaki veriler iki radyolog arasındaki interobserver agreement (kappa) değerleri ile incelendi.

Bulgular: Mevcut 26 hastadaki 26 adet periferik zon yerleşimli prostatik adenokanser lezyonun ortalama ADC değeri 626.3±70.2 mm2/s olarak gözlendi. İki radyolog arasında ADC ölçümleri için kappa değeri 0,88 ile yüksek uyumluluk göstermektedir. İki radyolog arasında b50’deki sinyal intensiteleri ara-sındaki subjectif uyum için elde olunan kappa değeri 0.51 (zayıf), b1000’deki sinyal intensiteleri arasındaki subjectif uyum için elde olunan kappa değeri 0.63 (orta) ve b1500’deki sinyal intensiteleri arasındaki subjectif uyum için elde olunan kappa değeri ise 0.65 (orta) olarak gözlendi. Lezyonların büyük çoğunluğunun b1500 ve b1000 görüntülerde yüksek sinyal intensitesine sahip olduğu gözlendi.

Sonuç: Çalışmamızda gözlendiği gibi farklı b değerleri arasında interobserver agreement değerleri düşük olduğu için ADCnin sayısal olarak ölçülmesi, radyologların objektif verilerinin rapora yansıtılmasını sağlayarak, MR sonuçlarını iyileştirilmesini ve prostat kanserinin daha iyi tespit edilmesine olanak tanır. Daha düşük ADC değerleri ile difüzyon kısıtlaması, biyopsi öncesinde multiparametrik MRGda kanseri öngörmek için iyi bir parametredir.

S - 017

OSTEOİD OSTEOMA TANISINDA YÜKSEK REZOLÜSYONLU MR GÖRÜNTÜLEMENİN ÖNEMİGÖKHAN POLAT 1, AYSEL ÖNEM AYDIN 1, HAYRİ OĞUL 1, SERHAT KAYA 1, MECİT KANTARCI 1, KUTSİ TUNCER 2 1Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye2Atatürk Üniversitesi Araştırma Hastanesi Ortopedi ve Travmatoloji Anabilim Dalı, Erzurum, Türkiye

Özet

Amaç: Çalışmamızda MRG de ince kesit 3D volumetric interpolated breathhold examination (VIBE) sekansının osteoid osteomayı değerlendirmede ince kesit BT’ye göre etkinliğini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Kas iskelet sistemi ile ilgili raporlama deneyimi olan 3 radyologun rutin muayenesinde 25 hasta kör olarak değerlendirildi. Değerlendirme için BT, kontrastsız VIBE ve kontrastlı VIBEden sadece biri radyologa randomize teslim edildi. Daha sonra radyologların radyolojik tanısı değerlendirildi. Daha sonra radyologlardan VIBE, kontrastlı VIBE ve BT görüntüleri ile birlikte osteoid osteomalı hastaları değerlendirmeleri istendi. Bu ikinci görüşte OO bileşenlerinin değerlendirilmesi talep edildi. Görüntülerde sklerotik marjın varlığı, nidus ve nidus kalsifikasyonun değerlendirilmesi istendi. Resimlerde görülen her özellik için 0 ile 2 arasında bir skala yapıldı (0=izlenmedi, 1=kısmen izlendi, 2=mükemmel izlendi).

Bulgular: BT, VIBE ve kontrastlı VIBE tanıları patolojik tanı ile karşılaştırıldığında anlamlı fark saptanmadı (p = 1). Nidus ve nidus kalsifikasyonun değer-lendirilmesinde görüntüleme yöntemleri arasında anlamlı bir fark yoktu (sırasıyla p = 0.385, p = 1). Sklerotik marjinin değerlendirilmesinde BT, VIBE ve kontrastlı VIBE arasında BT anlamlı derecede daha etkin bulundu (sırasıyla p = 0,0002, p = 0,0031).

Sonuç: Çalışmamız VIBE ve kontrastlı VIBE sekanslarının osteoid osteoma tanısında altın standart olarak kabul edilen ince kesit BT kadar etkin bir yöntem olduğunu göstermiştir. Böylece osteoid osteoma tanısında hastaların maruz kaldığı radyasyon miktarı azaltılabilir.

S - 018

İNTRAKRANİAL ANEVRİZMALARIN DSC PA-MRG İLE DEĞERLENDİRİLMESİGÖKHAN POLAT, EMİNE İZGİ, SUAT EREN, AKIN LEVENT, HAYRİ OĞUL, MECİT KANTARCI


Özet

Amaç: Çalışmamız, anevrizma tedavisinin beyin perfüzyonunu nasıl etkilediğini belirlemeyi amaçlamaktadır.

Gereç ve Yöntemler: Endovasküler anevrizma tedavisi olmuş 42 hasta incelendi. Sekiz hasta dahil edilme kriterlerini karşılamadığı için çalışmaya alınmadı. Çalışmada 34 hasta ile ilgili veriler değerlendirildi. Beyin perfüzyon parametreleri, işlem öncesi, işlemden 3 gün sonra ve işlemden 1 ay sonra ölçülmüş-tür. Ayrıca, rCBV, rCBF, MTT ve TTP parametreleri posterior dolaşım ile karşılaştırıldı ve perfüzyon parametrelerindeki değişiklikler istatistiksel olarak değerlendirildi.

Bulgular: Anevrizmaların boyutu hastalarımızda ≤10 mm olarak ölçüldü. Böylece bu hastalar küçük anevrizma sınıfında değerlendirildi. Perfüzyon para-metreleri karşılaştırıldığında, rCBV, rCBF ve MTT açısından preoperatif ve postoperatif değerler arasında anlamlı fark yoktu. Elde edilen p değerleri: rCBV için p=0.652; rCBF için p=0.563; ve MTT için; p=0.865. TTP haritasından elde edilen değerler arasında ise anlamlı fark vardı (p=0.025). TTP değerlerinde operasyondan önce alınan ölçümlere göre, operasyondan sonraki üçüncü günde uzama gözlendi ve işlem sonrası birinci ayda azalma oldu.


Sonuç: Beyin perfüzyonu sırasında küçük çaplı anevrizmalar (<10 mm) rCBV ve rCBFyi etkilemediğinden, anevrizmaların tedavisi sırasında görülebilen perfüzyonla ilgili komplikasyonlar (hiperperfüzyon sendromu) beklenmemektedir. TTP’nin üçüncü gününde uzaması ve ilk ayında kısalması, prosedür sırasında veya sonrasında gelişebilecek beyin ödemi ve vasospazm gibi komplikasyonların göstergesi olabilir.

S - 019

SEZARYEN SKAR GEBELİĞİNDE MANYETİK REZONANS GÖRÜNTÜLEME: OLGULARLA DEĞERLENDİRMEÖMER ERKAN YAPÇA, EMSAL PINAR TOPDAĞI YILMAZ, GÖKHAN POLAT

Atatürk Üniversitesi Araştırma Hastanesi, Erzurum, Türkiye

Özet

Amaç: Sezaryen skar gebeliği, her ne kadar en nadir ektopik gebelik formlarından birisi olsa da insidansı, hızla artmakta olan sezaryen doğum oranları nedeniyle yükselmektedir. Nadir görülüyor olmasına karşın obstetrik kliniğinin yaşamı en tehdit edici acillerindendir. Acil servislerde akut batın ve vajinal kanama durumlarında b-HCG değerinin yüksek olmasına sekonder abdominal ultrasonografi sonrası olası başka patolojilerin ekartasyonu için pelvik MRG çekimleri yapılabilmektedir. Bu akut durumlar içerisinde nadiren insizyonel gebelikler görülebilmekte ve bunlar yaşamı tehdit edici sonuçlarından dolayı erken tanınması gerekmektedir.

Gereç ve Yöntemler: Hastanemize 2012-2018 tarihleri arasında akut batın ve vajinal kanama şikayeti ile başvuran ve gebelik şüphesi nedeniyle manyetik rezonans görüntüleme yapılan 40 hasta incelendi. Bu hastalardan 4 tanesinde insizyonel gebelik,12 tanesinde akut appendisit, 5 tanesinde uterus dışı ektopik gebelik, 3 tanesinde over torsiyonu, 6 tanesinde over kist rüptürü, 10 tanesinde ürolojik sebepler bulundu. İnsizyonel gebelik nihai tanısı alan 4 hastanın manyetik rezonans görüntüleri değerlendirildi ve görüntüleme bulguları çalışmamızda değerlendirildi.

Vaka 1: 40 yaşında hasta acile karın ağrısı ve vajinal kanama şikayeti ile başvurdu. Hastanın gravida 3, parite 2 gebelik öyküsü mevcut. B-Hcg değeri 132000 ölçülmüş olup 8 hafta gebelik öyküsü mevcuttu (FKA -). Gebeliğin insizyon skar düzeyine yerleştiği görüldü. Hastaya ardısık mtx verildi ve hastaya full küretaj yapıldı.

Vaka 2: 36 yaşında hasta acile karın ağrısı ve vajinal kanama şikayeti ile başvurdu. Hastanın gravida 3, parite 2 gebelik öyküsü mevcut. B-Hcg değeri 47 ölçülmüş olup gebeliğin insizyon skar düzeyine yerleştiği görüldü (FKA +). Hastaya ardısık mtx verildi ve hastaya full küretaj yapıldı.

Vaka 3: 38 yaşında hasta acile vajinal kanama şikayeti ile başvurdu. Hastanın gravida 2, parite 1 gebelik öyküsü mevcut. B-Hcg değeri 156 ölçülmüş olup gebeliğin insizyon skar düzeyine yerleştiği görüldü. Hastaya bilateral hipogastrik arterlere balon anjiyoplasti sonrası full küretaj yapıldı (FKA +).

Vaka 4: 32 yaşında hasta acile vajinal kanama şikayeti ile başvurdu. Hastanın gravida 2, parite 1 gebelik öyküsü mevcut. B-Hcg değeri 156000 ölçülmüş olup gebeliğin insizyon skar düzeyine yerleştiği görüldü (FKA -). Hastaya ardısık mtx verildi ve hastaya full küretaj yapıldı.

Sonuç: Sezaryen skar gebeliğinin tanısının konmasında gecikme olması yaşamı tehdit edici sonuçlara neden olabileceği gibi yanlış tanı konması halinde ise gereksiz ve komplikasyonlara neden olabilecek tıbbi girişimler ile sonuçlanabilir. Acil servise akut batın ve vajinal kanama ile başvuran hastalarda insizyonel gebelik tanısı akılda tutulmalıdır. Manyetik rezonans görüntüleri gebelik haftası ve FKA (+)’liğine göre farklılıklar gösterebilmektedir. Erken haftalarda basit bir kist görünümündeyken ileri haftalarda ve FKA negatifliğine göre heterojen-komplike kistik görünümlerede neden olabilmektedir. Bu nedenle hastanın öyküsü ve klinik verileri iyi analiz edilmeli ve insizyonel gebelik şüphesi akılda tutulmalıdır.

S - 023

MEDİAL MENİSKÜS PROTRÜZYONU MEDİAL STABİLİZATÖRLERİN HASARINI GÖSTEREBİLİR Mİ?HASAN ALİ EKŞİLİ 2, UĞUR TOPRAK 1 1Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Eskişehir, Türkiye2Süleyman Demirel Üniversitesi Tıp Fakültesi, Isparta, Türkiye

Özet

Amaç: Medial menisküs protrüzyonu ile meniskokollateral ligament ve diğer posteromedial köşe stabilizatörlerinin hasarı ve osteoartrit arasındaki ilişkinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Retrospektif olarak medial menisküste protrüzyonu olan 214 diz MR olgusu ile çalışıldı. Anterior ve medial protrüzyon miktarları ölçüldü. Meniskotibial (MTL) ve meniskofemoral (MFL) bağlar, gastroknemius ve semimembranozus tendonlarının varsa hasar tipleri kaydedildi. Medial menisküs ve çapraz bağların anormallikleri, eklem effüzyonu, kemik ve kıkırdak yapıların hasar durumu değerlendirildi.

Bulgular: Medial menisküste 172 olguda (%80) anteriora, 209 olguda (%97) mediale protrüzyon mevcuttur. Hem MTF ve MFL bağ hasarında medial protrüzyon daha fazladır (p<0.001). MTL bağ hasarı olan hastalarda MFL bağ hasarı daha fazla bulunmuştur (p<0.001). Anterior protrüzyon, MTL veya MFL bağ hasarı olanlarda farklı değildir (p>0.05). Menisküsü normal olanlarda her iki bağda da hasar görülme yüzdesi hem meniskal dejenerasyon hem


de yırtık olanlara oranla anlamlı düzeyde düşük bulunmuştur (sırasıyla p<0.001, p<0.01). Menisküs dejenerasyonu olanların medial protrüzyon değerleri, hem meniskal yırtık hastalarindan (p=0.01) hem de menisküsü normal (p<0.001) olan gruptan fazladır. Meniskal hasarı olan hastalarda semimembrano-zus tendonunda yaralanma anlamlı oranda yüksek bulunmuştur (p=0.009). Tibial kondromalazide her iki bağ hasarı ve menisküsün anteriora ve mediale protrüzyonu daha yüksektir (p<0.05). Femural kondromalazide meniskotibial bağ hasarı daha sık saptandı (p=0.021). Eklem içi effüzyonu olan hastalarda menisküsün protrüzyonu daha sık görülmüştür (p<0.01). Yaş ile meniskal hasar (p=0.002), bağ hasarları (p<0.01) artmaktadır. Medial protrüzyon yaş (p<0.001) ve vücut ağırlığı (p = 0.027) ile artmaktadır.

Sonuç: Medial menisküsün özellikle mediale protrüzyonu diz posteromedial köşe yapılarının hasarı ile yakından ilişkilidir. Protrüzyonun meniskokollateral ligamanların hasarını da işaret ettiği bilinmeli ve bu yapılar dikkatlice gözden geçirilmelidir.

S - 024

TİBİAL TÜBERKÜL-TROKLEAR OLUK MESAFESİNİN NORMAL POPULASYONDA MANYETİK REZONANS GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİHATİCE KAPLANOĞLU

Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye

Özet

Amaç: Patellar instabilite, yüksek nüks oranı olan, multifaktöryel yaygın bir diz patolojisi olup, semptomlar devam eder ve hastayı kondromalaziye ve osteoartrite yatkın hale getirir. Patellofemoral eklem instabilitesinin değerlendirilmesinde tibial tüberosit-troklear oluk mesafesi (TT-TO) çok önemlidir. Bu çalışmanın amacı, farklı yaş gruplarında erkeklerde ve kadınlarda TT-TO mesafesi’nin normal değerini bildirmek ve TT-TO mesafesi ölçümünde man-yetik resonans görüntülemenin (MRG) güvenilirliğini değerlendirmektir.

Gereç ve Yöntemler: Bu çalışma Ocak 2017-Aralık 2017 tarihleri arasında, 18 yaşın üzerinde, diz ağrısı olan ancak diz muayenesi, diz MRG’si normal olan 99 hasta üzerinde yapılmıştır. Diz MRG’ sinde veya diz muayenesinde anormal bulgusu olan hastalar çalışmadan dışlandı. MR görüntüleri, 1.5 Tesla MR tarayıcısında TR 2560, TE 30, and 4 mm kesit kalınlığı kullanılarak elde edildi. Görüntüler, diz full ekstansiyon ve quadriseps gevşemiş şekildeyken elde edildi.

Bulgular: Araştırma kapsamında toplam 99 hasta incelendi. İncelenen hastaların yaş ortalaması 41.1±11.0 yıl, ortancası 40 (18-68) yıldır. Hastaların %54.5’i (n=54) kadın, %45.5’i (n=45) erkekti. Toplam populasyonda ortalama TT-TO mesafesi 9.3±3.3 mm dir. Ortalama TT-TO mesafesi erkeklerde 9.9±3.6 mm; kadınlarda 8.8±3.0 mm; ≤30 yaş altında 10.2±3.9mm; 31-50 yaş arasında 9.2±3.2 mm; ≥51 yaş üzerinde 8.9±3.1 ölçülmüştür. Hastaların yaş grupları ve cinsiyetleri arasında TT-TO mesaafesi açısından fark saptanmadı (sırasıyla; p=0.618; p=0.131). TT-TO mesafesi ölçümünde erkek ve kadın hastalar ile; ayrı ayrı yaş grupları arasında fark saptanmadı (sırasıyla; p=0.646; p=0.570).

Sonuç: Bu çalışmanın sonucunda, TT-TO mesafesi ölçümünde, farklı yaş gruplarında erkeklerde ve kadınlar arasında anlamlı bir farklılık saptanmadı. TT-TO mesafesinin normal değerini 9.3±3.3 mm olarak tespit etti. Bu çalışma MRG’nin TT-TO mesafesinin değerlendirilmesinde güvenilir bir yöntem olduğunu göstermiştir.

S - 025

PATELLAR VOLÜM VE KARTİLAJ KALINLIĞI İLE KONDROMALAZİ ARASINDAKİ İLİŞKİNİN DEĞERLENDİRİLMESİMEHMET ŞİRİK

Adıyaman Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Adıyaman, Türkiye

Özet

Amaç: Bu çalışmada patella volümü ve patellar kartilaj kalınlığı ile kondromalazi gelişimi arasındaki ilişkiyi değerlendirdik.

Gereç ve Yöntemler: Çalışmaya 01.01.2017 ile 31.05.2017 tarihleri arasında kliniğimizde diz ağrısı nedeniyle diz manyetik rezonans (MR) çekimi yapılan ve inceleme sonucu kondromalazi saptanan 111 olgu ile diz MR incelemesi normal olan 51 olgu dahil edildi. Tüm olguların patella volümleri iş istasyo-nunda yarı otomatik yazılım kullanarak analiz edildi. Kondromalazi saptanan olgularda evreleme Outerbridge kalsifikasyonuna göre evre 1-4 arasında gruplandırıldı. Patella volümü ile kondromalazi varlığı ve derecesi, kartilaj kalınlığı, yaş ve cinsiyet arasındaki ilişki istatistiksel olarak analiz edildi.

Bulgular: Çalışmaya dahil 162 olgunun 67’si (%41,4) erkek, 95’i (%58,6) kadındı. Patellar kondromalazi saptanan olguların 23’ünde (%20,7) grade I, 52’sinde (%46,8) grade II, 32’sinde (%28,8) grade III, 4’ünde (%3,6) ise grade 4 kondromalazi mevcuttu. Çalışmaya dahil edilen olguların ortanca yaşı 44’tü. Patella volümü minimum 12,24, maksimum 39,44, ortanca patella volümü ise 21,4 cm3’tü. Patellar kondromalazi bulunan olgularda yaş bulunmayan olgulara göre daha yüksek bulunmuş olup sonuç istatistiksel olarak anlamlıydı (p=<0,0001). Patellar kondromalazi bulunan olgularda patella volümü daha yüksekti (p=0,026). Ayrıca patellar kondromalazi bulunan olgularda medial fasetteki kıkırdak kalınlığı istatistiksel olarak daha düşüktü. Patellar kondroma-lazi bulunan olgularda kondromalazi evresi ile patella volümü arasında istatistiksel olarak anlamlı, zayıf, pozitif korelasyon mevcuttu (p=0,446; r=-0,073 ve p=0,444; r=-0,073).


Sonuç: Çalışmamızda kronik ön taraf diz ağrısının önemli nedenleri arasında yer alan patellar kondromalazi ile patella volümü arasındaki anlamlı ilişki ve patella medial yüz kartilaj kalınlığının kondromalazili olgularda lateral yüze göre daha ince olduğu gösterilmiştir. Kondromalazi gelişimi yaş ile pozitif korelasyon göstermekle beraber kadın ve erkek arasında anlamlı bir fark gözlenmemiştir.

S - 026

OS AKROMİYALE OLGULARINDA; ROTATOR MANŞET YIRTIK TİPLERİNİN, BİSEPS TENDONU, BURSA VE GLENOİD LABRUM ANORMALLİKLERİNİN MRG İLE DEĞERLENDİRİLMESİALİ KOÇ, TURGUT TURSEM TOKMAK, ÖZGÜR KARABIYIK

Kayseri Eğitim ve Araştırma Hastanesi, Kayseri, Türkiye

Özet

Amaç: Literatürde, os akromiyale ile rotator manşet patolojisi arasındaki ilişki; yayınlanmış birçok çalışmadaki yetersiz metodlara bağlı henüz tanımlan-mamıştır. Bu çalışmanın amacı; MR inceleme ile os kromiyale olgularında, rotator manşet, biseps tendonu, bursalar ve glenoid labrum ile ilgili patolojileri değerlendirmektir.

Gereç ve Yöntemler: PACS’ta kayıtlı, omuz ağrısı şikayeti ile başvuran ve omuz MR incelemesi yapılan 1642 hastadan os akromiyalesi olan, yaşı 24 ve üzerinde toplam 43 olgu çalışmaya dahil edildi. MR incelemeleri; rotator manşet tendon yırtık tipleri, biseps tendonu, bursalar ve glenoid labrum pato-lojileri yönünden değerlendirildi.

Bulgular: Os akromiyale sıklığı %2.6 bulundu. Olguların %81.4’ünü bayanlar oluşturdu. Rotator manşet yırtığı 38 (%88.3) hastada tanımlandı. Supraspinatus tendonunun parsiyel kat yırtığı 31 (%72) hastada mevcuttu. Parsiyel kat yırtıklar, 22 (%70) hastada rim-rent şeklinde idi. Supraspinatus tendonunun tam kat yırtığı sadece yedi (%16) hastada mevcuttu. Subakromiyal ve subkorakoid bursit, sırasıyla 31 (%72) ve 14 (%32) hastada tanımlandı. Biseps tendon patolojisi üç (%7) hastada, labral patoloji ise sadece bir (%2) hastada izlendi.

Sonuç: Os akromiyale olgularında, rotator manşet yırtıklarının görülme oranı artmıştır. Çoğu rotator manşet yırtığı supraspinatus tendonu ile ilişkili bulunmuştur ve en sık yırtık tipi parsiyel kat şeklindedir. Biseps tendonu ve glenoid labrum ile ilişkili patolojilerin görülme oranında artış saptanmamıştır.

S - 027

ANKİLOZAN SPONDİLİTLİ HASTALARDA AŞİL TENDONUNUN KANTİTATİF T2* (T2 STAR) İLE DEĞERLENDİRİLMESİ; ÖN ÇALIŞMA SONUÇLARIMEHMET BEYAZAL1, MÜNEVVER SERDAROĞLU BEYAZAL2 1Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Rize, Türkiye2Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Fiziksel Tip Ve Rehabilitasyon Anabilim Dalı, Rize, Türkiye

Özet

Amaç: Bu çalışmanın amacı ankilozan spondilitte (AS) aşil tendonunun kantitatif T2* (T2 star) bulgularını değerlendirmek ve bu bulguların hastalıkla ilgili parametrelerle ilişkisini incelemektir.

Gereç ve Yöntemler: Çalışmaya AS tanılı 30 hasta (19 erkek, 11 kadın; ortalama yaş, 42,3 yıl; aralık 23-60 yıl), yaş ve cinsiyeti eşleştirilmiş 15 sağlıklı kontrol alındı. Hastalık aktivitesi, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) kullanılarak değerlendirilirken, fonksiyonel durum, Bath Ankylosing Spondylitis Functional Index (BASFI) kullanılarak değerlendirildi. Eritrosit sedimentasyon hızı ve C-reaktif protein (CRP) kaydedildi.

Bulgular: Ankilozan spondilitli hastalarda kontrol grubuna göre sağ ve sol aşil T2* değerlerinde belirgin azalma saptandı (140,2±13.9 vs 151.9±9.4, p=0.005; 137.8±14.1 vs 149.8±10.9, p=0.006, respectively). Sol aşil T2* değeri hastalık aktivitesi ve fonksiyonel durum arasında anlamlı bir korelasyon göstermedi. Sağ aşil T2* değeri CRP ile anlamlı negatif korelasyon göstermesine rağmen (p=0,019, r=-0,427) diğer hastalıkla ilişkili parametreler ile arasında anlamlı bir ilişki bulunmadı.

Sonuç: T2* değeri ASli hastalarda aşil entezitinin değerlendirilmesinde yardımcı olabilir.

S - 028

SIKIŞMA SENDROMUNUN NADİR BİR NEDENİ: OS AKROMİALEAYŞEGÜL ALTUNKAŞ

Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye


Özet

Amaç: Os akromiale akromial apofizin 4 osifikasyon merkezinden herhangi birinde olan birleşme kusuru nedeniyle ortaya çıkan kemikçiktir. Bu anatomik oluşum birkaç çalışmada omuz impingement sendromu ile ilişkilendirilmiştir. Biz bu çalışmamızda toplumumuzda os akromiale sıklığı ile birlikte os akro-miale bulunan semptomatik hastaların radyolojik bulgularını literatür bilgileri eşliğinde sunmayı amaçladık.

Gereç ve Yöntemler: Çalışmaya 2014 Ocak-2018 Ocak tarihleri arasında çekilen omuz MR tetkikleri dahil edildi. Toplamda 864 omuz MR tetkiki değerlendirildi. Os akromiale tespit edilen hastaların fibröz-sinkondroz eklem ilişkileri, dejeneratif değişiklikleri ve aynı zamanda supraspinatus tendon bütünlüğü ve sinyal intensitesi değerlendirildi.

Bulgular: 58 hastada (%6,7) os akromiale tespit edildi. 39 hastada os akromiale sinkondrozis ekleminde hipertrofik, dejeneratif değişiklikler ve komşu subakromial bursada fokal efüzyon mevcuttu. Bu hastalarda aynı zamanda akromiohumeral mesafeye uzanan osteofit dikkati çekti. 36 hastada supraspi-natus tendonunda yırtık mevcuttu 6 hastada ise tendinozis saptandı.

Sonuç: Os akromiale genellikle radyolojik incelemelerde raslantısal olarak saptanır. Semptomatik olguların sıklığı ise bilinmemektedir. Literatürde os akromialenin değişik yolarla omuz impingement sendromuna neden olabileceği ileri sürülmüştür. Özellikle MR tetkikinde eklemde oluşan dejeneratif değişiklikler kolaylıkla değerlendirilebilmektedir. İmpingement ön tanısı ile çekilen MR tetkikinde izlenen os akromiale izlenen hastada başka radyolojik bulunmasa bile os akromiale etyolojide akılda tutulmalıdır.

S - 029

SAKROİLİAK EKLEMLERİN MR GÖRÜNTÜLEMESİNDE KONTRAST MADDE KULLANIMI GEREKLİ Mİ? KONTRASTLI ÇEKİMLERİN SAKROİLEİT TANISINDA ANLAMLI KATKISI VAR MI?MEHMET SEDAT DURMAZ1, HAKAN CEBECİ2, MEHMET ÖZTÜRK2 1Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Birimi, Konya, Türkiye2Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye

Özet

Amaç: Sakroileit ön tanısı ile MRG çekilenlerde kontrast madde kullanımının gerekliliğinin tartışılması amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2017-Ocak 2018 arasında, Konya ilinde iki üniversite hastanesi radyoloji bölümünde sakroileit ön tanısı ile çekilen toplam 1144 sakroiliak MRG tetkiki içerisinden seçkisiz (sistematik) örnekleme yöntemiyle seçilen 106 hastanın sakroiliak eklem MR görüntüleri retrospektif olarak değerlendirildi. Tüm MRG çekimleri 1,5 Tesla MR ünitesinde gerçekleştirilmişti. Sakroiliak eklem MRG sekanslarından STIR ve kontrastlı görüntüler kemik iliği ödemi-osteitis açısından 5 ve 8 yıllık deneyimli 2 ayrı radyolog tarafından, bağımsız olarak ve sonrasında birlikte değerlendirildi. 106 hasta-da toplamda 212 sakroiliak eklem değerlendirildi. Sağ ve sol sakroiliak eklemlerde sakroiliet ile uyumlu bulgular 0-4 puanlı skala üzerinden skorlandı. Sekanslar arasındaki uyum ve gözlemciler arası değişkenlik değerlendirildi. Sakroileit tanısında kontrastlı yağ baskılı incelemenin STIR sekansına ek katkısı olup olmadığı araştırıldı.

Bulgular: İki radyolog arasında STIR sekansında sakroiliak eklem bulguları açısından gözlemciler arasındaki uyum sağ sakroiliak eklemde %93 (K=0,519, p<0,001), sol sakroiliak eklemde %93,9 (K=0,511, p<0,001) olarak saptandı. Ortak konsensus ile sakroileit bulguları STIR sekansında 16 sağ, 15 sol sakroiliak eklemde, kontrastlı incelemede ise sakroileiti destekleyen bulgular 17 sağ, 17 sol sakroiliak eklemde izlendi. Değerlendirilen 212 sakroiliak eklemin 34 ünde (%16,03) sakroileit ile uyumlu bulgular mevcuttu. Sakroileit tanısında kontrast madde sonrası ek olarak sadece 3 sakroiliak eklemde sakroileit tanısı kondu.

Sonuç: Kontrastlı görüntüler sakroileit tanısında ek bilgiler verebilir ancak sakroileit tanısında STIR sekansına anlamlı üstünlüğü yoktur. Özellikle kontrast maddelerin yan etkileri, maliyet, tetkik süresi gözönüne alındığında sakroileit ön tanısı ile MRG çekilen hastalarda kontrast madde kullanımına gerek yoktur, sınırlı sayıda hasta grubunda, gerekli görüldüğünde ek çekim olarak kontrastlı inceleme yapılabilir.

S - 030

ÖN ÇAPRAZ BAĞ YARALANMALARINDA POSTERİOR TİBİAL EĞİM AÇISININ MANYETİK REZONANS GÖRÜNTÜLEME İLE BİRLİKTE DEĞERLENDİRİLMESİEMRAH SAYIT1, ASLI TANRIVERMİŞ SAYIT2 1Samsun Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Samsun, Türkiye2Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Radyoloji Ana Bilim Dalı, Samsun, Türkiye

Özet

Amaç: Bu çalışmanın amacı posterior tibial eğim (PTE) açısının komplet ön çapraz bağ (ÖÇB) rüptürü ile arasındaki ilişkiyi manyetik rezonans görüntüleri (MRG) ile birlikte araştırmaktır.


Gereç ve Yöntemler: ÖÇBde yırtık bulunan 60 hasta ile yaşı ve cinsiyeti uyumlu 60 sağlıklı bireyin diz MRG’si geriye dönük olarak değerlendirildi. Travma öyküsü, parsiyel ÖÇB yırtığı, implant, geçirilmiş diz cerrahisi öyküsü ve kemik tümörü olan hastalar çalışmaya alınmadı. Her iki grup için PTE açısı sagittal T1 ağırlıklı imajlardan ölçüldü. Tibianın uzun aksına dik çizilen hatla medial tibia platosuna parelel çizilen hat arasında kalan açı medial PTE açısı, lateral tibia platosuna paralel çizilen hat ile arasında kalan açı ise lateral PTE açısı olup ÖÇB’de yırtık olan hastalar ve kontrol grubunda ayrı ayrı ölçüldü. Medial ve lateral PTE açılarının medyan değerleri hesaplandı ve her iki grup arasında istatistiksel olarak anlamlı farklılık olup olmadığı araştırıldı.

Bulgular: Komplet ÖÇB yırtığı olan 60 hastanın 25’i kadın, 35’i erkek olup median yaşı 39’dur. Kontrol grubunun 27’si kadın, 33’ü erkek olup median yaşı 37’dir. Medial PTE açısı, komplet ÖÇB yırtığı olan hastalarda 3.2°, kontrol grubunda 3.1° ölçülmüş olup istatistiksel olarak aralarında anlamlı farklılık saptanmadı (p=0,4). Lateral PTE açısı, komplet ÖÇB yırtığı olan hastalarda 4,5°, kontrol grubunda 3.8° olup anlamlı olarak daha geniş saptandı (p<0,01).

Sonuç: Çalışmamızda lateral PTE açısında, komplet ÖÇB yırtığı olan grup ile kontrol grubu arasında anlamlı farklılık saptandı. Lateral PTE açısındaki (≥4,5°) artışın ÖÇB yırtığı için anatomik bir risk faktörü olabileceği düşünüldü

S - 031

MEME LEZYONLARINDA SHEAR WAVE VE ADC DEĞERLERİNİN KARŞILAŞTIRILMASITEVFİK GÜZELBEY1, NAİL UZUNLULU2, EZGİ KARTAL2, ARDA KAYHAN2 1İstanbul Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye2İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Amaç: Bu çalışmada meme lezyonlarında shear wave elastografi (SWE) değerleri ile manyetik rezonans görüntüleme ADC değerlerinin karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Ele gelen meme lezyonu olan 22 kadın hastada (ortalama yaş 48,69±12,49) 24 lezyon SWE ve MRG ile değerlendirildi. SWE ve ultrason eşliğinde biyopsi aynı seansta gerçekleştirildi. SWE lezyonun en sert yerinden ölçüldü. ADC ölçümleri lezyonun tümünden ve ADC haritasında en koyu alandan yapıldı.

Bulgular: Biyopsi sonuçlarına göre 9 fibroadenom, 9 invaziv duktal karsinom, 2 intraduktal papillom, birer tane invaziv lobular karsinom, atipik duktal hiperplazi, sklerozan adenozis ve duktal karsinoma in situ saptandı. SWE ile lezyonun tümünden ölçülen ADC değerleri (p=0,009, korelasyon katsayısı -0,520) ve en koyu yerden ölçülen ADC değerleri (p=0,002, korelasyon katsayısı -0,620) arasında orta derecede negatif korelasyon saptandı.

Sonuç: Çalışmamızda meme lezyonlarında dokunun sertliğini ölçen SWE değerleri ile suyun hareketini ölçen ADC değerleri arasında anlamlı korelasyon saptanmıştır.

S - 032

MEME ARKA PLAN KONTRASTLANMASININ MEMENİN MORFOFİZYOLOJİK PARAMETRELERİ VE MEME LEZYONLARI İLE KORELASYONULEYLA İSAYEVA1, ZEHRA HİLAL ADIBELLİ2, ALİ MURAT KOÇ2 1Medilife Beylikdüzü Hastanesi, İstanbul, Türkiye2İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İzmir, Türkiye

Özet

Amaç: Dinamik kontrastlı manyetik rezonans inceleme hormona duyarlı glandüler doku ile fibröz bağ dokuları arasındaki farkı gösterir. Arka plan kontrastlanması fibroglanduler dokunun kontrast enjeksiyonu sonrası normal boyanmasıdır. Normal arka plan kontrastlanması minimal (tip1; glanduler doku kontrastlanması %25’in altı), ılımlı (tip 2; glanduler doku kontrastlanması %25- %50 arası), belirgin (tip 3; glanduler doku kontrastlanması %50-%75 arası) ve şiddetli (tip 4; glanduler doku kontrastlanması %75’in üstü) olarak sınıflandırılmıştır. Bizim bu çalışmadaki amacımız; meme APK nı tiplendirerek, meme yoğunluğu ile karşılaştırmak, benign lezyonlarla, malign lezyonların subtipleri ile, hasta yaşı ve meme hacmi ile ilişkisinin olup olmadığını göstermekti

Gereç ve Yöntemler: Bu çalışma İzmir Bozyaka Eğitim ve Araştırma Hastanesi Radyoloji bölümünde Mayıs 2015 ile Şubat 2016 tarihleri arasında meme MR tetkiki yapılmış hastalarda etik kurul onayı alınarak gerçekleştirildi. Çalışmamızda 1210 hasta dinamik meme MRG ile değerlendirildi. Hastanemizde premenapozal dönemdeki olgularda menstrüel siklusun APK üzerinde olumsuz etkilerinden kaçınmak amacı ile meme MRG tetkiki siklusun 7-14. günleri arasında uygulanmaktadır. APK şiddetinin düzgün değerlendirilmesi için neoadjuvan kemoterapi, hormon terapi, mastektomili hastalar ve erkek hastalar çalışma dışı bırakıldı. Ayrıca meme MR bulgularına göre BIRADS 1 olarak raporlanan hastalar arasında diğer meme görüntülemelerinde her hangi lezyon tespit edilen hastalar da çalışma dışı bırakıldı.Bu kriterlere uyan toplam 899 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen hastalara ait görüntüler iki radyolog tarafından, birbirlerinden ayrı ve bağımsız olarak değerlendirildi, farklı sonuç olduğunda konsensus ile tek bir sonuç belirlendi.


Bulgular: Çalışmamıza dahil edilen 899 kadın hastada ortalama yaş 47,10±11,90 olarak hesaplandı. 246 (%27,4) hastada tip 1,286 (%31,8) hastada tip 2, 237 (%26,4) hastada tip 3, 130 (%14,5) hastada tip 4 arka plan kontrastlanması izlendi. 110 hasta BIRADS 1, 175 hasta BIRADS 2, 380 hasta BIRADS 3, 126 hasta BIRADS 4, 108 hasta BIRADS 5 kategoride değerlendirildi. Toplam 246 hastanın patolojik sonucu olup bu hastaların 140’ı malign,116’ı benign grupta değerlendirildi. Toplam hastalarda, premenapozal, perimenapozal ve postmenapozal dönemdeki hastalarda yağlı memede arka plan kontrastlanması dens memelere göre anlamlı düşüktür (sırasıyla p;<0,001; 0,013;<0,001; 0,001). BIRADS 1, benign ve malign lezyon görülen hastalarda menopoz durumları açısından gruplar arasında istatistiki açıdan anlamlı fark saptandı (p<0,001). Tüm lezyonların en sık perimenapozal dönemde görüldüğü belirlendi. Toplam hastalarda, BIRADS 1, benign ve malign hastalarda yağlı memede arka plan kontrastlanması dens memelere göre anlamlı düşük bulundu.

Sonuç: Sonuç olarak yaptığımız analizler meme APK sının aslında meme parankim yoğunluğuyla ilişkisi olduğunu göstermiş olup, özellikle malign lezyon-larla ve moleküler subtipleri ile ilişkili olmadığını göstermiştir. Çalışmamızda benign hastalarda meme parankim yoğunluğu ve dolayısıyla APK yüksektir, ancak benign subgruplar arasında ilişki gösterilememiştir. Aynı şekilde meme parankim yoğunluğu ve APK’sı malign hastalarda düşüktür. Çalışmamıza göre yüksek APK, dens meme parankim yoğunluğu meme malignitesi gelişimi için bir risk faktörü değildir.

S - 033

MEME KANSERLİ HASTALARDA, TÜMÖRÜN MOLEKÜLER ALT TİPLERİNE GÖRE MR BULGULARIBİRNUR YILMAZ

Okan Üniversitesi Tıp Fakültesi Hastanesi, İstanbul, Türkiye

Özet

Amaç: Son 11 yılda, meme karsinomunun moleküler subtipleri karakterize edilmiştir. Bilgilerin büyük kısmı, son yıllarda öğrenilmiş olup, moleküler tak-sonomi hala gelişmekte ve önümüzdeki yıllarda daha da gelişecek gibi görünmektedir. Bu çalışmada; meme kanserli hastalarda MR bulguları ile tümörün moleküler alt tiplerinin ilişkisinin olup, olmadığı değerlendirildi.

Gereç ve Yöntemler: Ekim 2016- Şubat 2018 arasında hastanemizde, meme kanseri tanısı almış ve pre-operatif meme MRI çekilmiş hastaların MR bulguları, retrospektif olarak değerlendirildi ve kaydedildi. Bulgular BI-RADS MR sınıflamasına uygun olarak sınıflandırıldı. Kitlesel olmayan ve boyanma gösteren meme lezyonları çalışma dışında tutuldu. Patoloji sonuçlarına göre tümörün moleküler alt tipleri belirlendi ve kaydedildi. Tümörün alt tipleri ile MR bulgularının ilişkisinin olup olmadığı, istatiksel olarak değerlendirildi.

Bulgular: Toplam 98 tru-cut biyopsi yapılan ve meme kanseri tanısı almış olgularda patolojik tanı; 34’ü Luminal A, 32’si Luminal B, 18’i HER2 pozitif ve 14’ü triple negatif tümör olarak geldi. Kitle lezyonlarında düzgün ve lobüle kenar, halkasal boyanma ve tümör nekroz varlığı ile, üçlü negatif tümör alt tipi arasında anlamlı ilişki bulundu. Tümörün moleküler alt tiplerine göre kitle lezyonlarında; MR bulgularının dağılımı Tablo 1’de gösterildi.

Sonuç: Meme kanserinde tedaviyi ve prognozu belirleyen, en önemli faktörlerden biri tümörün patolojik moleküler alt tipidir. Meme kanserinin pre-operatif evreleme ve izleminde MR, görüntülemeye önemli katkı sağlayan bir yöntemdir. Meme MR ile saptanan düzgün ve lobüle kenar özellikleri, halkasal kitle boyanması ve tümör nekrozu, üçlü negatif tümörlerde de sık görülen bulgulardır. Meme MR’ında; benign lezyonlarda da görülebilen bu bulguların, tümörlerde de görülebileceğinin bilinmesi önemlidir. Biyopsi kararı verilirken, bu olasılığında olduğu akılda bulun-durulmalıdır.

S - 034

MEME KANSERİNDE DİNAMİK EĞRİ TİPLERİ İLE PROGNOSTİK FAKTÖRLER ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASIIŞIL ESEN BOSTANCI, HALE AYDIN, BAHAR GÜNER

Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye

Özet

Amaç: Meme kanserinde kinetik MRG bulguları ve patolojik prognostik faktörler ile dinamik eğri tipleri arasındaki ilişkiyi saptamak amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2016-Aralık 2016 tarihleri arasında bölümümüzde çekilen meme MRG tetkikinde BI-RADS4 ve BI-RADS5 olarak rapor edilen ve patolojisi İnvaziv duktal karsinom olarak gelen 98 olgu değerlendirildi. Bunlardan 4 olgu prognostik faktörlerin değerlendirimi için yetersiz doku örneği olması,3 olgu patoji sonucunun duktal karsinoma in-situ gelmesi,10 olgu da benign patolojik sonuç gelmesi nedeni ile çalışmadan çıkarıldı. Meme MRG’de dinamik eğri tipleri incelenerek patolojik prognostik faktör sonuçları ile karşılaştırıldı.

Bulgular: Çalışmaya 81 hasta dahil edildi. Ortalama yaş 47,27+12,13 idi. 63 (%77,8) olgu invaziv duktal karsinom iken 9 (%11,1) olgu invaziv lobüler karsinom tanısı almıştı. Tümör derecelendirmesinde 11 (%14,9) olgu grade 1, 29 (%29,2) olgu grade 2 ve 34 (%45,9) olgu grade 3 idi.


7 olgunun derecendirmesi yapılmamıştı. 45 (%55,6) olgunun duktal karsinoma in-situ komponenti, 10 (12,3) olgunun lobuler karsinoma in-situ komponenti vardı. Ki 67 oranı grade 3 tümörlerde belirgin derecede yüksekti (p<0,001). C-erb B2 pozitif olan 15 (%73,3) olgunun 11’ide grade 3 idi (p=0,011).Olgular başlangıç kontrastlanmalarına göre üç gruba ayrıldı. Prognostik faktörlerle anlamlı ilşki saptanmadı. Olgular dinamik eğrilere göre ikiye ayrıldı; tip 3 eğrili ve tip 1-2 eğrili. Prognostik faktörler ile dinamik eğriler arasında ilişki değerlendirildi.

Sonuç: Meme kanserinde dinamik MRG eğri tipleri ile patolojik prognostik faktörler arasında anlamlı ilişki saptanmamıştır.

S - 035

MEME LEZYONLARININ DEĞERLENDİRİLMESİNDE MRG İLE SHEAR WAVE ELASTOGRAFİ KARŞILAŞTIRMASINURŞEN TOPRAK, ALİ MAHİR GÜNDÜZ

Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Van, Türkiye

Özet

Amaç: Bu çalışmanın amacı, ultrasonografide meme lezyonlarının sertlik düzeyini akustik radyasyon kuvvet impulse elastografi (ARFI UE) ile değerlendi-rerek benign ve malign ayrımını yapmada manyetik rezonans görüntüleme (MRG) ile karşılaştırmaktır.

Gereç ve Yöntemler: Bu çalışma Van YYÜ Tıp Fakültesi Radyodiagnostik AD.de meme ünitesine başvuran memesinde Birads 3-5 kitlesi olan 16 hasta üzerinde yapıldı. Tüm hastalar ARFI UE ve MRG ile değerlendirildi. Tüm hastalardan trucut biyopsi ile histopatolojik veriler elde edildi

Bulgular: ARFI UE ortalama kayma dalgası hızı (SWV) malign lezyonlarda 8,38±1,74 m/sn, bening lezyonlarda 4,30±1,94 m/sn idi. Malign lezyonların SWV değerleri literatür ile uyumlu iken bening lezyonların SWV değerleri literatür verilerinin üzerinde idi. MRG de kontrast zaman eğrisi oranları 8 (%50) hastada tip 1, 5 (%31,2) hastada tip 2, 3 (%18,8) hastada tip 3 idi. Histopatoloji 5 (%31,2) İDC, 3 (18,8) skar dokusu, 5 (%31,2) fibroadenom 2 (%12,5) mastit, 1 (%6,2) yağ nekrozu idi. 5 (%31,2) hasta malign, 11 (%68,8) hasta bening idi. ARFI UE ile SWV 3m/sn üzerinde elastisite gösteren skar dokusu, yağ nekrozu ve mastit olguları MRG’de tip 1 kontrast zaman eğrisi göstermiştir.

Sonuç: ARFI UE malign meme lezyonlarını artmış SWV ye dayanarak mükemmel bir şekilde karakterize eder, ancak bizim çalışmamızda olduğu gibi doku sertliği gösteren yağ nekrozu mastit ve skar dokusu gibi lezyonlarda yalancı pozitiflik gösterip gereksiz biyopsiye neden olabilir. MRG ve UE beraber kullanımı biyopsi kararı vermede daha etkilidir. Bizim çalışmamız sınırlı hasta grubunda yapılmış olup bu bulguları doğrulamak için daha ileri çalışmalara ihtiyaç vardır.

S - 036

3 TESLA MR’DA MALİGN MEME LEZYONLARININ T1 HARİTALAMA İLE GÖRÜNTÜLENMESİ VE B1 DÜZELTMENİN KANTİTATİF DİNAMİK KONTRASTLI MR GÖRÜNTÜLEMESİ ÜZERİNE ETKİSİNİN DEĞERLENDİRİLMESİÖZLEM ÜNAL

Yıldırım Beyazıt Üniversitesi Ankara Atatürk Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Ankara, Türkiye

Özet

Amaç: 3 T manyetik rezonans (MR) görüntülemede B1+ düzeltmesinin, kontrast madde enjeksiyon öncesi ve sonrasında, meme dokusu ve malign lezyonlardaki T1 haritalama üzerine etkisini ölçmek ve değerlendirmek.

Gereç ve Yöntemler: Şubat 2017-Şubat 2018 tarihleri arasında 25 invaziv duktal karsinomu olan kadın (ortalama 52 yaşında; 66-44 yaş ara-lığında) hasta değerlendirilerek ameliyat öncesi 3T MR ile dinamik kontrastlı manyetik rezonans görüntülemeleri elde edildi. Her iki memede fibroglandüler doku ve malign lezyonlarda, T1 haritalama (mapping) üzerindeki etkisini değerlendirmek için enjeksiyon öncesi ve sonrası B1+ düzeltmesi (correction) yapıldı. Düzeltme yapıldıktan sonra 7 yıllık deneyimli radyolog tarafından ölçüm yapılarak parametreler hesaplandı. Sonuçlar histolojik derece ile korele edildi.

Bulgular: Ölçümlerde malign lezyonlar ile fibroglandüler doku arasında ve malign lezyonlarda ilaç öncesi-sonrası ölçümleri arasında anlamlı bir farklılığın bulunduğu, ilaç sonrası ölçüm değerlerinin ilaç öncesi ölçüm değerlerine göre azaldığı görülmüştür.

Sonuç: Bu çalışmada, 3T MR görüntülemede B1+ düzeltmesinin kontrast madde enjeksiyonu öncesi ve sonrası alınan T1 haritalama üzerinde, malign lezyonları ayırt etmede dinamik serilere anlamlı katkısı olduğu sonucuna ulaşılmıştır.


S - 037

MEME DIŞI KANSERLERİN MEMEYE METASTAZLARININ DEĞERLENDİRİLMESİNDE MR İNCELEME VE MULTİMODALİTER YAKLAŞIMMEHMET ALİ NAZLI, İLHAN NAHİT MUTLU, AYTÜL HANDE YARDIMCI, FADİME DİDEM CAN TRABULUS, ŞEFİKA AKSOY, ESRA CANAN KELTEN

Sağlık Bilimleri Üniversitesi İstanbul Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Amaç: Meme dışı alanlardan memeye metastaz literatürde oldukça ender görülmekte olup görülse de memede saptanan malign özellikli kitlelerin ayırıcı tanısında metastaz olabileceği dikkate alınmalıdır, çünkü bu hastaların tedavi ve prognozu belirgin farklılıklar göstermektedir. Bu nedenle hastaların tedavi ve yönetiminde primer hastalıktan ayırımı çok önemlidir. Biz bu çalışmada kliniğimizde memede metastaz şeklinde bulgu veren olgularımızın radyolojik ve özellikle MR inceleme bulgularını sunmayı, histopatolojik ve immunohistokimyasal moleküler tanı kriterlerini gözden geçirmeyi amaçladık.

Gereç ve Yöntemler: (SBU IEAH) Radyoloji kliniğimizde 2013-2018 yılları arasında meme kanseri nedeni ile incelenen olgulardan memeye metastaz tanısı almış 18-77 yaş aralığında (ort=49,4) 13 olgunun radyolojik tüm inceleme bulguları, MR inceleme özellikleri retrospektif olarak yeniden gözden geçirildi. Histopatolojik ve immunohistokimyasal olarak metastaz kaynağını gösterebilecek moleküler parameterler incelendi, tanı koyma kritlerleri irdelendi.

Bulgular: Radyoloji kliniğimiz meme görüntüleme biriminde biopsileri yapılan ve histopatolojik tanısı bulunan 1350 meme kanser hastasından 13 (%0.96) tanesin-de, toplamda 15 memede meme dışı diğer organ ve sistemlerinden metastaz tespit edildi (n=15). Bunlar sırasıyla 4 olgu akciğer kanseri (%30), iki olgu lenfoma (%15) ve diğer olgular lösemik infiltrasyon, kolon, böbrek, over, mesane, multiple myeloma, bir olguda ise Ewing sarkomu göğüs ön duvardan memeye direk lokal invazyonu şeklinde idi. Mesane tümörü ve Multiple myelomada her iki memeye metastaz vardı (%15). Memede tespit edilen tümör morfolojisi büyük çoğunlukta (%80) iyi sınırlı, oval veya sferik formlu idi. Parankimal distorsiyon, kalsifikasyon veya DCIS komponenti yoktu. Lösemik infiltrasyon, lenfoma tutulumu ve mesane tutulumu gösteren bir memede yaygın infiltran tutulum görüldü, özellikle lenfomada lokal cilt eksülserasyon ve memede yaygın deformasyon vardı.

Sonuç: Meme dışı organlardan kaynaklı memeye metastazlar genellikle memenin primer kanserlerine göre benign morfolojide ve iyi sınırlı kitleler şeklinde radyolojik görüntü vermekte, ayrıca in-situ komponent ve mikrokalsifikasyonlar gibi ek bulgular genellikle eşlik etmemektedir. Ayrıca bizim iki olgumuzda olduğu gibi ebklenmedik şekilde yaygın infiltran tutulum görülebilmektedir. Memenin metastatik tutulumu çok nadiren de olsa görülebilmek-te, tedavi yaklaşımları birincil meme kanserinden farklı olup teşhis edilmesi önem arzetmektedir.

S - 040

SOLİTER BEYİN METASTAZI VE GLİOBLASTOMA AYIRICI TANISINDA PERİTÜMÖRAL ADC DEĞERLERİNİN YERİMURAT TEPE1, SUZAN SAYLISOY2, UĞUR TOPRAK2, İBRAHİM İNAN3, ZÜHTÜ ÖZBEK4, EMRE ÖZKARA4, ALİ ARSLANTAŞ4 1Midyat Devlet Hastanesi, Radyoloji Bölümü, Mardin, Türkiye2Eskisehir Osmangazi Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Eskişehir, Türkiye3Adıyaman Üniversitesi Eğitim Araştırma Hastanesi, Radyoloji Bölümü, Adıyaman, Türkiye4Eskisehir Osmangazi Üniversitesi Tıp Fakültesi, Beyin Cerrahisi Anabilim Dalı, Eskişehir, Türkiye

Özet

Amaç: Glioblastom (GBM) ve soliter metastazı birbirinden ayırmak konvansiyonel manyetik rezonans görüntüleme (MRG) yöntemleri ile her zaman mümkün değildir. Bu çalışmada peritümöral alandan ölçülen ADC oranlarının, ADC gradientlerinin ve minimum ADC değerlerinin bu iki lezyonu ayır-mada yararlı olup olmadığı araştırılmıştır.

Gereç ve Yöntemler: Bu retrospektif araştırma üniversite etik kurul onayı alındıktan sonra gerçekleştirilmiş olup hastalardan onam formu alınması çalışmanın retrospektif doğası gereği etik kurul tarafından gerekli görülmemiştir. Medikal ve cerrahi tedavi öncesinde 43 hastanın (12 GBM ve 31 soliter metastaz tanılı) konvansiyonel Beyin ve Difüzyon MRG (b=0, b=1000) görüntüleri elde olundu. Peritümöral ödem dokusu içinden tümöre en yakin, orta uzaklıkta ve en uzak kesimden kantitatif ADC ölçümleri yapılıp sırasıyla ADC1, ADC2, ADC3 olarak kodlandı. Bu üç değer birbirine oranlanarak peritümöral ADC oranları, birbirinden çıkartılarak peritümöral ADC gradientleri hesaplandı. Bunların dışında tümöral ve peritümöral dokudan minimum ADC değerleri, ipsilateral normal görünümlü beyaz cevherden ve kontralateral normal beyaz cevherden ADC değerleri ölçülerek sırasıyla ADCTMIN, ADCPMIN, ADCI, ADCC olarak kodlandı.

Bulgular: GBM ve soliter metastaz ayrımında ADC3/ADC1 değeri en güçlü parametre olarak bulunmuş olup kestirim değeri 1.105 olarak alındığında duyarlılık %91,7, özgüllük %87,1 olarak hesaplandı (p<0,001). ADC3/ADC2 parametresi için kestirim değeri 1.025 olarak alındığında duyarlılık %91,7 ve özgüllük %74,2 olarak hesaplandı (p<0,001). ADC2/ADC1 için ise kestirim değeri 1.055 olduğunda duyarlılık %83,3, özgüllük %67,7 olarak hesaplandı (p=0,002). ADC3–ADC1 için kestirim değeri 150 olarak alındığında duyarlılık %91,7, özgüllük %83,9 olarak hesaplandı (p<0,001). ADC3–ADC2 para-metresi için kestirim değeri 55 olarak alındığında duyarlılık %91,7, özgüllük %77,4 olarak hesaplandı (p=0,001). ADC2–ADC1 için kestirim değeri 75 olarak alındığında duyarlılık %91,7, özgüllük %61,3 olarak hesaplandı (p=0,003).

Sonuç: Difüzyon MRG tekniği, MR Spektroskopi, MR Perfüzyon, Difüzyon Tensör Görüntüleme gibi ileri MRG tekniklerinden biri olup konvansiyonel MRG ile birlikte değerlendirildiğinde peritümoral ADC oran ve gradient ölçümleri GBM ve soliter metastaz ayrımı konusunda önemli katkılar sağlayabilir.


S - 041

STROK GEÇİRMİŞ HASTALARDA KRANİAL MRG’DE OLFAKTOR BULBUS VOLÜMÜ VE OLFAKTOR SULKUS DERİNLİĞİNİN DEGERLENDİRİLMESİADİL DOĞAN1, VEYSEL BURULDAY2, MURAT ALPUA3 1Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi, Radyoloji Bölümü, Kahramanmaraş, Türkiye2Kırıkkale Üniversitesi Tıp Fakültesi, Radyoloji Bölümü, Kırıkkale, Türkiye3Kırıkkale Üniversitesi Tıp Fakültesi, Nöroloji Bölümü, Kırıkkale, Türkiye

Özet

Amaç: Strok geçirmiş hastalar ile sağlıklı kontrol grubunun kranial MRG’de olfaktor bulbus volümü ve olfaktor sulkus derinliğinin karşılaştırılması.

Gereç ve Yöntemler: Hasta grubunu strok geçirmiş nörodejeneratif hastalığı olmayan hastalar oluşturdu.Sağlıklı bireylerden uygun yaş ve cinsiyete göre kontrol grubu oluşturuldu.Olfaktör bulbus volümü ve olfaktör sulkus derinliğinin ölçümü 1.5 Tesla MRI cihazında coronal T2 agırlıklı görüntülerden elde edildi.Görüntüler iki radyolog tarafından değerlendirildi.

Bulgular: Hasta grubunu 45 strok geçirmiş (21 erkek-24 kadın) yaş ortalaması 47,7±10,7 ve kontrol grubunu 45 sağlıklı (19 erkek-26 kadın) oluşturmakta olup yaş ortalaması 44,5±8,7 (p>0,05).Hasta grubunun sağ-sol olfaktör bulbus volümleri kontrol grubu ile karşılaştırıldığında hasta grubunun olfaktör bulbus volümlerinin azaldığı tespit edildi (p<0,001). Hasta grubunun sağ-sol olfaktör sulkus derinliği kontrol grubu ile karşılaştırıldığında anlamlı fark saptanmadı (p>0,05).

Sonuç: Strok geçirmiş hastalarda olfaktör bulbus hacminde azalma olduğu tespit edildi.Olfaktör bulbus hacim azalmasına bağlı geliştiği düşünülen koku disfonksiyonu hastaların yaşam kalitesini, yiyecek seçimlerini ve duman, doğal gaz veya diğer toksinleri çevre içinde bulgulama kabiliyetini etkileyebilir.

S - 042

GAMMA KNİFE İLE TEDAVİ GÖREN KAVERNÖZ MENENJİOMALI HASTALARDA GÖRME YOLAKLARININ DTG ÖZELLİKLERİNİN DEĞERLENDİRİLMESİHAFİZE OTCU TEMUR1, MUSTAFA AZİZ HATİBOĞLU2, ALPAY ALKAN1, İSMAİL YURTSEVER1, KERİME AKDUR2, MEHMET HAKAN SEYİTHANOĞLU2 1Bezmialem Vakıf Üniversitesi Tıp Fakültesi Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye2Bezmialem Vakıf Üniversitesi Tıp Fakültesi Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, İstanbul, Türkiye

Amaç: Gamma Knife Radyocerrahisi (GKR) kavernöz sinus menenjiomalı hastaların tedavisinde etkin bir yöntemdir. Bununla birlikte optik sinir radyas-yon toksitesi riski altındadır. Çalışmamızda GKR tedavisi sonrasında görme yolaklarındaki (Difüzyon Tensör Görüntüleme) DTG değişikliklerini ve DTG değişiklikleri ile radyocerrahi tedavi değişkenleri arasındaki ilişkiyi değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Çalışmamız 13 kavernöz sinus menenjiomalı hasta ve 15 sağlıklı kontrol içermektedir. DTG ile görme yolaklarından apparent diffusion coefficient (ADC), fractional anisotropy (FA), mean diffusivity (MD) ve radial diffusivity (RD) değerleri ölçülmüştür. Kontrol grubu ile hasta grubunda GKR öncesi ve sonrasında görme yolaklarından elde edilen DTG değerleri karşılaştırılmıştır. Ayrıca DTG değerleri ile radyocerrahi tedavi değişkenleri arasındaki ilişki araştırılmıştır. DTG, GKR tedavisinden önce ve 12 ay sonra yapılmıştır.

Bulgular: Sağlıklı kontrol grubu ile hasta grubundan GKR öncesinde ve sonrasında görme yolaklarından elde edilen ADC, FA, MD ve RD değerleri arasın-da istatistiksel olarak anlamlı farklılık izlenmemiştir. Optik kiazmadan elde edilen FA ile prekiazmatik optik sinirin aldığı maksimum ve ortalama radyasyon dozu arasında negatif korelasyon mevcuttur. Oksipital lobdan elde edilen FA ile optik aparatusun aldığı maksimum ve ortalama radyasyon dozu arasında negatif korelasyon mevcuttur. Optik kiazmadan elde edilen RD ile optik aparatusa verilen maksimum radyasyon dozu arasında pozitif korelasyon mev-cuttur. Oksipital lobdan elde edilen ADC, MD, RD değerleri ile optik aparatusa verilen ortalama radyasyon dozu arasında pozitif korelasyon mevcuttur.

Sonuç: GKR tedavisi sonrasında görme yolaklarında oluşan radyasyon ile ilişkili mikroyapısal değişikliklerin saptanması, uygun ve güvenilir bir tedavi yaklaşı-mının belirlenmesi açısından yararlı bilgiler sağlayabilir. DTI kavernöz sinus menenjiomalı hastalarda GKR tedavisi ile görme yolaklarında oluşan radyasyona bağlı değişiklikleri karakterize etmede faydalı bilgiler sağlayabilir.

S - 043

DİSK HERNİLİ HASTALARDA LOMBER AÇININ DEĞERLENDİRMESİNDE DİREK GRAFİNİN MRG’YE ÜSTÜNLÜĞÜEMİNE DAĞISTAN

Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Bolu, Türkiye

Özet

Amaç: Bel ağrısı nüfüsün yaklaşık %80’inde yaşamının herhangi bir döneminde görülen yaygın bir problemdir. Dejeneratif disk hastalığı önemli bir aktivite


ve iş kaybı sebebi olan bel ağrısının en sık nedenidir. Lomber lordozda azalma disk hastalığının önemli bulgularından biri olup dejeneratif sürecin sonucu olarak ortaya çıkmaktadır. Bu retrospektif çalışmada, disk hernisi olan hastalarda Manyetik Rezonans Görüntüleme (MRG) ve direk grafilerle lordoz açılarının ölçülmesi ve normal popülasyonla karşılaştırılması amaçlandı.

Gereç ve Yöntemler: 2014 ve 2017 yılları arasında bel ağrısı ve siyatalji şikayeti olan ve hastanemiz polikliniğimize başvuran hastalar çalışmaya dahil edildi. Hastalar üç gruba ayrıldı: Grup 1 (kontrol) herhangi bir yapısal bozukluğu olmayan ancak bel ağrısı olan hastalar; Grup 2; L4-5 düzeyinde disk hernisi olan hastalar; Grup 3; L5-S1 düzeyinde disk hernisi olan hastalar. Tüm olguların hem MRG hem lomber direk grafi incelemeleri mevcuttu. Lomber lordoz açısı MRG ve direk grafilerde ölçüldü.

Bulgular: L5-S1 disk hernisi olan 27 olgu, L4-5 disk hernisi olan 56 olgu ve kontrol grubunda 27 olmak üzere toplam 110 olgu değerlendirildi. Çalışma popülasyonunda 63 erkek ve 46 kadın vardı. Cobb açısı ile ilgili erkek ve kadınlar arasında anlamlı fark yoktu. MRG de yapılan ölçümlerde gruplar arasında anlamlı farklılık yoktu (p=0,12). Düz grafide yapılan ölçümlerde ise gruplar arasında anlamlı farklılık görüldü (p<0,001) Direk grafi ve MRG görüntülerinin karşılaştırılması. 62 yaşındaki bayan hastanın aynı gün çekilen lateral lumbosakral direk radyogram (1a) ve MRG (1b) görüntüsü. Lomber lordoz açısının MRG de azaldığı görülmektedir).

Sonuç: Lordoz açısının değerlendirmesinde MRG ile Direk grafi ölçümlerinin karşılaştırlması literatürde bizim bilgimize göre ilktir. Bu çalışmanın çarpıcı sonucu, disk herniasyonlu hastalarda düz radyografi ile belirlenen lomber lordoz açılarının sağlıklı kontrollere göre anlamlı olarak azaldığı ve MRG ölçüm-leri ile karşılaştırıldığında direk grafi ile ölçümün daha anlamlı olduğu görülmektedir.

S - 044

KAROTİS İNTİMA MEDİA KALINLIĞI İLE MRG’DE İSKEMİK / GLİOTİK ODAK YAYGINLIĞI ARASINDAKİ İLİŞKİSİNİN ARAŞTIRILMASIÖMER KAYA

Ceyhan Devlet Hastanesi, Radyoloji Bölümü, Adana, Türkiye

Özet

Amaç: Çalışmamızda arteryel sistemdeki erken dönem aterosklerotik değişikliklerin önemli göstergesi olan karotis intima media kalınlığı artışı ve ileri yaşta çoğunlukla küçük damar hastalığının sonucu olabilen MRGde iskemik/gliotik beyaz cevher hiperintensiteleri arasındaki ilişki araştırıldı.

Gereç ve Yöntemler: 50 yaş üzeri 138 hastanın serebral MR görüntülemesi yapılmış ve beyaz cevher hiperintensiteleri Fazekas skorlamasına göre değerlendirilmiştir. Hastalara eksternal karotid sisteme yönelik Doppler Ultrasonografi ile internal karotid arter proksimalinden intima media kalınlıkları ölçülmüştür. Aralarındaki korelasyon değerlendirilmesi istatistiksel olarak yapılmıştır. Değerlendirmede 0,05’ten küçük değerler anlamlı kabul edilmiştir. İntima media kalınlığı için sınır değer 0,9 mm kabul edilmiştir.

Bulgular: Değerlendirilen 138 hastada Fazekas skorlamasına göre beyaz cevher T2A hiperintensitelerinde evre arttıkça intima media kalınlıklarında istatistiksel olarak anlamlı artış saptanmıştır.

Sonuç: Sonuç olarak serebral beyaz cevherde iskemik/gliotik değişiklikleri temsil eden T2A hiperintensitelerinin olası varlığı ve MR görüntüleme gerekliliği için internal karotid arter intima media kalınlığının ölçümü anlamlı ve pratik bir öngörüsel yöntem olarak düşünülmektedir.

S - 045

KARACİĞER VEYA BÖBREK NAKLİ UYGULANMIŞ PEDİATRİK HASTALARIN BEYİN MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMERT BAYRAMOĞLU, FERİDE KURAL RAHATLI, FULDEM YILDIRIM DÖNMEZ, TÜLİN YILDIRIM, AHMET MUHTEŞEM AĞILDERE

Başkent Üniversitesi Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye

Amaç: Karaciğer veya böbrek nakli uygulanmış pediatrik hastaların beyin manyetik rezonans görüntüleme (MRG) bulgularını retrospektif olarak analiz etmektir.

Gereç ve Yöntemler: 2004-2018 yılları arasında Başkent Üniversitesi Tıp Fakültesi Hastanesinde 235 karaciğer, 155 böbrek nakli uygulanmış toplam 390 pediatrik hastanın 64 tanesine (39 karaciğer nakli, 25 böbrek nakli) değişik sebeplerle yapılan beyin MRG tetkikleri retrospektif olarak değerlendirilmiştir. Bulgular 3 grupta sınıflanmıştır. Grup 1’de nakil ile ilişkili bulgular, grup 2 de kronik hastalık ile ilişkili bulgular, grup 3 de ise nakil yada kronik hastalık ile ilişkili olmayan bulgular kaydedilmiştir.

Bulgular: En sık transplantasyon nedeni karaciğer hastaları için fulminan hepatit iken (%12,8) iken, böbrek hastaları için glomerülonefritlerdir (%24). Nöbet öyküsü hem karaciğer (%46), hem de böbrek (%40) hastaları için en sık görüntüleme istem nedenidir.

Karaciğer nakli uygulanmış 13 (%20,3), böbrek nakli uygulanmış 14 (%21,8) hastanın görüntülemesinde herhangi bir patolojiye rastlanmamıştır. Geri kalan 37 (%57,8) hastadan bazılarının birden fazla bulgusu bulunduğundan istatistik hesaplanırken toplam sayı yerine grup içerisindeki sayı


göz önüne alınmıştır. Karaciğer hastalarında grup 1 de 14, grup 2 de 14 kişi, böbrek hastalarında grup 1 de 6,grup 2 de 3 kişi bulunmaktadır. Grup 3 de toplam 14 kişi bulunmaktadır. Hem karaciğer (%64,2), hem böbrek (%50) hastalarında grup 1 de en sık bulgu posterior reversibl ensefalopati sendromu olmuştur. Hem karaciğer (%50), hem böbrek (%100) hastalarında grup 2 de en sık bulgu serebral atrofi olmuştur. Grup 3 de en sık bulgu konjenital anomalilerdir (%50).

Sonuç: Karaciğer ve böbrek nakli öncesinde ve sonrasında nörolojik komplikasyonlar görülebilir. Komplikasyonların acil tanısında ve takibinde beyin MRG çok önemlidir.

S - 048

NADİR GÖRÜLEN NÖROMETABOLİK HASTALIKLARDA BEYİN MRG VE SPEKTROSKOPİ BULGULARIMEHMET SEDAT DURMAZ1, FAYSAL EKİCİ2, SERDAR ARSLAN1 1Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Birimi, Konya, Türkiye2Dicle Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Diyarbakır, Türkiye

Özet

Amaç: Çocukluk çağı nörometabolik hastalıkları biyokimyasal maddelerin sentezlenememesi, anormal birikimi sonucu beyin dokusunun hasar görmesi ile karakterizedir. Klinik belirtilerin başlama yaşı, ortaya çıkış şekli ve seyri, görüntüleme bulguları tanı konulmasında önemlidir. Bu sunumda nadir görülen 9 metabolik hastalığın tanısal beyin MRG ve MR spekstroskopi bulguları ve ayırıcı tanılarının, ayırıcı tanıya yönelik ipuçlarının mevcut literatür bilgileri eşliğinde tartışılması amaçlanmıştır.

Gereç ve Yöntemler: 2014-2018 yılları arasında nörometaolik hastalık ön tanısıyla çekilen beyin MR görüntüleri retrospektif olarak tarandı. Tanı alan nadir görülen nörometabolik hastalıkların tanısal beyin MRG bulguları ve MR spekstroskopi bulguları, labaratuar bulguları değer-lendirildi.

Bulgular: Kardeş iki olguda ardıç ağacı kokulu idrar hastalığı, bir olguda kreatinin eksikliği, bir olguda molibden kofaktör eksikliği, iki olguda Kanavan hasta-lığı, iki olguda vander nap hastalığı, bir olguda Leigh hastalığı (subakut nekrotizan ensefalopati), bir olguda L2 hidroksi glutarik asidüri, bir olguda glutarik asidüri tip 1, bir olguda Dars 2 gen mutasyonuna sekonder gelişen beyin sapı ve spinal kord tutulumunun eşlik ettiği lökoensefalopati ile uyumlu beyin MRG ve-veya MR spektroskopi bulguları izlenen olan toplam 12 hasta mevcuttu.

Sonuç: Çocukluk çağı nörometabolik hastalıklarında tanı, spesifik MRG veya MR spektroskopi bulgularının varlığıyla konulabilir.

S - 049

PEDİATRİK DİRENÇLİ EPİLEPSİ OLGULARINDA 3T MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMIZ BERHAN PİRİMOĞLU

Atatürk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Pediatrik Radyoloji Bilim Dalı, Erzurum, Türkiye

Özet

Amaç: Çalışmamızda pediatrik radyoloji bölümümüze medikal tedaviye dirençli epilepsi ön tanısı ile beyin manyetik rezonans görüntüleme (MRG) için başvuran pediatrik yaş grubu hastalarda tespit ettiğimiz dirençli epilepsi nedenlerini ve 3T beyin MRG bulgularını sunmayı amaçladık.

Gereç ve Yöntemler: Çalışmamıza Ocak 2015 – Ocak 2018 tarihleri arasında bölümümüze başvuran medikal tedaviye dirençli epilepsi tanılı 52 hasta dahil edildi. 52 hastada dirençli epilepsi nedeni olan organik beyin lezyonları 3T MRG bulguları 3 yıllık tecrübeye sahip pediatrik radyolog ve 1 yıllık tecrübeye sahip pediatrik radyoloji yandal uzmanlık öğrencisi tarafından ortak konsensus ile değerlendirildi. Lezyonların natür, lokalizasyon ve 3T MRG sinyal özellikleri kaydedildi. Tanımlayıcı istatistiksel analiz yapıldı.

Bulgular: Hasta yaş aralığı 6 ay-17 yaş (ortalama 9,1±2,3 yaş) olarak gözlendi. Mevcut 52 hastadan 21`sinde (%38,1) sulkasyon-migrasyon ano-malileri (heterotopi (n=11 hasta), şizensefali (n=3 hasta), lizensefali (n=3 hasta), hemimegalensefali (n=2 hasta), polimikrogri ve agiri-pakigri (n=2 hasta)), 8ìnde (%14,5) nörokutanöz sendrom (tuberozskleroz (n=6 hasta), sturge-weber sendromu (n=2 hasta)), 7`sinde (%12,8) fokal kortikal displazi, 6`sında (%10,9) tümöral lezyonlar (DNET (n=3 hasta), astrositom (n=2 hasta), PNET (n=1 hasta)), 5ìnde sekel değişiklikler (%9,1) (travma (n=3 hasta), iskemi (n=1 hasta) ve hipoksiye (n=1 hasta) sekonder), 2`sinde (%3,6) kavernöz malformasyon (kavernom), 1ìnde (%1,86) Rasmussen ensefaliti, 1ìnde (%1,86) Van der Knaap hastalığı, 1ìnde ise (%1,86) mezial temporal skleroz gözlendi. 3 hastada (%5,42) belirgin intrakranial patoloji izlenemedi.

Sonuç: Medikal tedaviye dirençli epilepsiler özellikle pediatrik yaş grubunda çok önemli bir problem olup, 3T MRG çalışmalar oldukça tanısal özellikler göstermekle birlikte iyonizan radyasyon içermemesiyle pediatrik çağda önemli avantaj sağlamaktadır.


S - 050

SUSEPTİBİLİTE AĞIRLIKLI GÖRÜNTÜLEMENİN, ÇOCUK BEYİN MR İNCELEMELERİNDE, KONVANSİYONEL SEKANSLARA EKLENMESİNİN HEMORAJİ, KALSİFİKASYON VE VASKÜLER ANOMALİLERİ TANIMLAMADA ETKİNLİĞİNİN ARAŞTIRILMASIKEMAL ÇAĞLAR TUNA, FATMA CEREN SARIOĞLU, MUHAMMET SALMAN, YASİN ERTUĞ ÇEKDEMİR, HANDAN GÜLERYÜZ

Dokuz Eylül Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İzmir, Türkiye

Özet

Amaç: Çalışmamızda pediatrik beyin görüntülemede SAG sekansının konvansiyonel sekanslara eklenmesinin kalsifikasyon, kanama ürünleri içeren odak ve anormal venöz yapıların gösterilmesindeki etkinliğini, SAG’ın çocuk hastalarda kullanım alanlarını, SAG’deki sinyallerin özelliklerini, sekansa özgü arte-faktları ve yanılgıları araştırmayı amaçladık.

Gereç ve Yöntemler: Çalışmada farklı ön tanılarla MR incelemeleri olan ve SAG sekansında patolojik sinyal odakları saptanan, çocuk hastaların görün-tüleri retrospektif olarak incelenmiştir. Odaklar homojen paramanyetik, primer paramanyetik, homojen diyamanyetik ve primer diyamanyetik olarak sınıflandırılmıştır. Lezyonların kalsifikasyon veya kanama olarak sınıflandırılması ise BT ve konvansiyonel MR görüntüleri, tıbbi geçmişi ve laboratuvar, patoloji sonuçlarını içeren klinik bilgiler dâhilinde yapılmıştır. Bu odakların konvansiyonel sekanslarda karşılıkları araştırılmıştır. Kalsifik odakların gold stan-dartı olarak BT’de 100 HU’dan yüksek dansite ölçüt olarak kabul edilmiştir. Verilerin sınıflandırılmasında deskriptif istatistiksel yöntemleri kullanılmıştır. Konvansiyonel sekans ve SAG’nin uyumu yönünden ki-kare ve BT’de izlenen kalsifik odakların konvansiyonel sekanslar ve SAG ile karşılaştırılması için ki-kare testi kulanılmıştır.

Bulgular: SAG imajlarda 287 hipointens odak saptanmıştır. Bu odakların 135’i diyamanyetik yani kalsifikasyon, 149’u paramanyetik yani hemorajik odak, 13’ü ise vasküler anomali olarak sınıflandırılmıştır. Konvansiyonel sekanslarda kalsifik odakların karşılığında T1 AG’de 6, T2’de AG’de 11 ve FLAIR’de sekan-sında ise 7 kalsifikasyonu destekler sinyal değişiklikleri vardır. Toplamda 135 diyamenyetik odaktan 13 tanesi (yaklaşık %9,6) konvansiyonel sekanslarda seçilebilmiştir. Hemorajik odakların karşılığında T1 AG’de 19, T2 AG’de 20 ve FLAIR’de sekansında ise 15 kanama ürünlerinin varlığını destekler bulgu vardır. Toplamda 149 odaktan 25 tanesi (yaklaşık %16,7) konvansiyonel sekanslarda seçilebilmiştir. On üç hastada izlenen vasküler anomalilerden sadece bir tanesi konvansiyonel sekanslarda seçilebilmektedir. BT görüntülerinde 143 kalsifikasyon odağı mevcuttur. SAG’de bu sayı 135’tir. Sekiz kalsifik odak SAG’de ayırt edilememiştir. SAG eklenmiş konvansiyonel sekansların kalsifikasyon saptamadaki etkinliği ile sadece konvansiyonel sekansların kalsifikasyon saptamadaki etkinliğinin karşılaştırılması için Ki-kare testi kullanılmış ve p değeri 0,001 olarak bulunmuştur. Hemorojik odaların artan çapla orantılı faz imajlarda heterojen sinyalde olma ihtimali artmaktadır.

Sonuç: SAG sekansı ile kalsifik ve kanama ürünleri içeren odakların odakların anlamlı oranda saptanılabilirliği, kanama odaklarının doğası gereği heterojen olabileceği ve bazı artektlar içerebeleceği saptanmış bunların odak boyutu ile ilişkisi gösterilmiş ve aynı zamanda venöz anomalilerin teşhisinde sekansın önemli bir tanı aracı olabileceği gösterilmiştir.

S - 051

OBSTETRİK BRAKİAL PLEKSUS PARALİZİLİ ÇOCUKLARDA OMUZ ULTRASONOGRAFİSİNİN KLİNİK VE MRG BULGULARI İLE KORELASYONUALTAN GÜNEŞ1, ADALET ELÇİN YILDIZ1, AKIN ÜZÜMCÜGİL2 1Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye2Hacettepe Üniversitesi Tıp Fakültesi, Ortopedi Ve Travmatoloji Anabilim Dalı, Ankara, Türkiye

Özet

Amaç: Obstetrik brakial pleksus paralizili (OBPP) çocuklarda, glenohumeral displazi ve omuz dislokasyonu,klinik olarak hareket kısıtlılığına neden olmadan da gelişebilen, OBPP’nin komplikasyonlarındandır.Çalışmadaki amacımız, OBPP ile takip edilen hastalarda, omuz ultrasonografisi ile MRG ve klinik bulgular arasındaki korelasyonu değerlendirmektir.

Gereç ve Yöntemler: Çalışmamız, ebeveynlerin ve etik kurul onayı alınarak prospektif yapıldı (onay no:16969557–627). Mayıs 2014 ile Mart 2018 tarihleri arasında, Ortopedi ve Travmatoloji Anabilim dalında, klinik olarak Modifiye Mallet sistemiyle, aynı ortopedist tarafından 1-3 aylık süreler ile takip edilen OBPP’li 72 hastaya (32 erkek, 40 kız, sağ [59], sol [13]), aynı pediatrik radyolog tarafından, ön hazırlık yapılmadan, seri omuz ultrasonu yapıldı.

Bulgular: Ortalama yaşı (3,2±2,1 ay) 72 hastaya toplamda 168 ultrason incelemesi yapıldı. Hastaların 19’unda (yaşları 3,5-8 ay), klinik olarak da doğru-lanan dislokasyon saptandı. Ultrason ile MRG arasında

Sonuç: OBPP’li çocukların, klinik ve MRG ile de uyumlu bulunan omuz ultrasonografisi ile takip edilmeleri, klinik olarak saptanmadan önce de dislokasyon tanısının konularak erken tedavi başlanmasına olanak sağlar.


S - 052

PEDİATRİK TORAKS PATOLOJİLERİNDE DİFÜZYON MANYETİK REZONANS GÖRÜNTÜLEMENİN ÖNEMİ: OLGULARLA DEĞERLENDİRMEGÖKHAN POLAT


Özet

Giriş: Difüzyon ağırlıklı manyetik rezonans görüntüleme (MRG)`nin pediatrik yaş grubu hastalarda toraks patolojilerinde önemi olgular ile sunulmuştur.

Olgu 1: 15 yaşında bir erkek olguda toraks BT incelemede anterior mediasten bölgesinde tespit edilen yumuşak doku dansitesinde lezyon için yapılan MRG incelemede T2 ağırlıklı serilerde ara intensitede difüzyon ağırlıklı serilerde hafif derecede difüzyon kısıtlayan kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 1,42±0,23x10-3 mm2/sn olarak izlendi.

Olgu 2: 6 yaşında bir kız olguda anterior mediasten yerleşimli T2 ağırlıklı serilerde belirgin hiperintens, difüzyon ağırlıklı serilerde anlamlı difüzyon kısıtlılığı göstermeyen kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 2,89±0,38x10-3 mm2/sn olarak izlendi.

Olgu 3: 4 yaşında bir kız olguda posterior mediasten-paravertebral mesafe düzeyinde lokalize olan difüzyon ağırlıklı serilerde anlamlı difüzyon kısıtlayan ve T2 ağırlıklı serilerde belirgin hiperintens kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 0,71±0,23x10-3 mm2/sn olarak izlendi.

Olgu 4: 10 aylık bir kız olguda anterior mediasteni tama yakın dolduran difüzyon ağırlıklı serilerde sağ lateral kesiminde hafif derecede difüzyon kısıtlayan, T2 ağırlıklı serilerde ara intensitede kitle lezyon imajı izlenmektedir. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 0,58±0,11x10-3 mm2/sn olarak izlendi.

Olgu 5: 17 yaşında bir kız olguda akciğer alt lob düzeyinde difüzyon kısıtlılığı göstermeyen T2 ağırlıklı görüntülerde germinatif memban içeren heterojen hipointens lezyon izlendi. Lezyonun ADC serilerde ortalama ROI değeri yaklaşık 1,80±0,86 53x10-3 mm2/sn olarak izlendi.

Tartışma: Birinci olguda histopatolojik olarak karsinoid tümör tanısı konuldu. İkinci olguda ise yapılan yüzeyel ultrasonografi, MRG ve histopatolojik veriler ile kavernöz hemanjiom tanısı konuldu Üçüncü olguda ise belirgin difüzyon kısıtlaması var olup, histopatolojik olarak nöroblastom metastazı tanısı konuldu. Dördüncü olguda ise tru-cut biyopsi ile timoma tanısı konuldu. Beşinci olguda germinatif membranlar izlenmiş olup laboratuar verileride hidatik kist tanısını doğrulamıştır. Malign lezyonlarda ADC değeri, benign ve kistik natürdeki lezyonlara göre belirgin olarak daha düşük olmaktadır. Diğer konvansiyonel MRG bulguları ile birlikte değerlendirildiğinde difüzyon görüntüleme toraks lezyonlarında ayırıcı tanıya katkı sağlamaktadır. ROI ölçümüne imkan tanıyıp aynı zamanda kantitatif değerlendir-meye olanak sağlamakta olup benign-malign lezyon ayrımında katkı sağlamaktadır. Hem 1,5 hem 3 Tesla cihazlarda pediatrik vakalarda difüzyon ağırlıklı görüntüleme toraks MRG incelemelerine kolaylıkla eklenebilmektedir.

Sonuç: Difüzyon MRG kısa sürede elde edilebilen bir tetkik olup, pediatrik toraks patolojilerinde rutin görüntülemeye mutlaka eklenmesi gereken bir inceleme yöntemidir.

S - 053

GLUTARİK ASİDÜRİ TİP 1 HASTALARİN TANISINDA KRANİAL MRGMESUT ÇETİN1, ADEM AĞYAR1, OSMAN ÖZDERE1, SİBEL KARAYOL1, MERYEM KARACA2

1Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye 2Harran Üniversitesi Tıp Fakültesi, Çocuk Metabolizma Anabilim Dalı, Şanlıurfa, Türkiye

Özet

Giriş: Glutarik asit tip 1 (GA tip 1) glutaril-CoA dehidrogenaz enziminin eksikliği sonucu gelişen, otozomal resesif geçişli nadir bir metabolik hastalıktır. Lizin, hidroksilizin, triptofan amino asitlerin bir metaboliti olan glutarik asitin dekarboksilasyonu ve dehidrojenasyonunda glutaril-CoA görev alır. Hastalık makrosefali, diskinezi, nöbet, ensefalopati, nöromotor gelişimde gerilik olarak kendini gösterir. Erken safhada klinikten çok kranial MRG bulguları erken tanıda yardımcı olur. Erken tanı ve tedavinin nörolojik sekellerin önlenmesinde başarılı olduğu gösterilmiştir. Çocuk metabolizma polikliğine başvurmuş veya takibinde GA tip 1 li 10 vakanın kranial MRG bulgularını sunmayı amaçladık.

Olgu: Son bir yıl içerisinde çocuk metabolizma ve radyoloji departmanları tarafından tanı ve takibinde yer alınan 10 GA tip 1 hastasının beyin MRG leri ele alındı. Hastaların 7’i erkek 3 si kızdı. Hastaların tanı alma yaşı ortalama 9-10 ay olup yaş ortalamaları 30 ay olarak hesaplandı. Kranial MRG bulguları genişlemiş silvian fissür (n=10), frontotemporal atrofi (n=10),), bazal ganglion tutulumu (n=7,özellikle globus pallidus), beyaz cevher tutulumu (n=9), genişlemiş mezensefalik sistern (n=6), makrosefali (n=8) medial leminiskus (n=6) ve dentate nukleus tutulumu (n=4), difüzyon kısıtlılığı (n=4), subdural koleksiyon (n=2) olarak bulundu.

Sonuç: GA tip 1 kranial MRG bulguları çeşitlilik göstermektedir. Çoğu vakada makrosefali, frontotemporal atrofi, silvian fissür genişlemesi en sık bulgu-lar olarak karşımıza çıkmaktadır. Bazal ganglion tutulumu ve beyaz cevher tutulumunun eşlik etmesi GA tip 1 tanısını güçlendirir. Hastalığın hayatın ilk yıllarında bulgu vermemesi ve serebral palsi ile karıştırılması nedeniyle klinik olarak şüpheli vakalarda beyin MRG bulguları tanıya yardımcı olmaktadır.

Poster Bildiriler


P - 01

KÖTÜ KONTROLLÜ TİP1 DİABETES MELLİTUSTA GLİKOJENİK HEPATOPATİNİN RADYOLOJİK TANISIHÜSEYİN AYDIN1, MÜGE ATAR2 1Süleyman Demirel Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı, Isparta, Türkiye2Süleyman Demirel Üniversitesi Tıp Fakültesi Pediatri Anabilim Dalı, Isparta, Türkiye

Özet

Jinekolojik hepatopati kontrol edilmemiş diyabetin bir sonucu olarak görülen nadir bir durumdur. Hiperglisemi ve hiperinsülinemi hepatositlerde glukoz birikimine ve hepatomegaliye neden olur. 17 yaşında kadın hasta diyabetik ketoasidoz tanısı ile birçok kere hastanede yatarak tedavi edilmiştir. Laboratuvar ve görüntüleme bulguları ile birlikte glikojenik hepatopi tanısı konmuştur. Hepatomegalisi ve karaciğer enzimlerindeki artış sıkı bir kan şekeri kontrolü ile düzelmiştir. Diyabeti kontrol altında olmayan hepatomegali ve karaciğer enzimlerinde artış tespit edilen hastalarda glikojenik hepatopi tanısı akılda tutulmalıdır. Tanı için biyopsiden önce radyolojik görüntüleme yapılmalıdır.

P - 02

AKUT PANKREATİTİN NADİR BİR KOMPLİKASYONU: MEDİASTİNAL PSÖDOKİSTERTAN HAZAR, EZGİ GÜLER

Ege Üniversitesi Radyoloji Anabilim Dalı, İzmir, Türkiye

Özet

Giriş: Akut pankreatit pankreasın steril inflamasyonudur. Çoklu organ yetmezliğine ve ölüme neden olabilir. Atlanta klasifikasyonuna göre major olarak iki tipe ayrılır; İnterstisyel ödematöz pankreatit ve nekrotizan pankreatit. Etiyolojide safra taşları, alkol, otoimmün, metabolik, herediter, iyatrojenik nedenler yer alır.

Olgu Sunumu: 46 yaş erkek olgu. Akut pankreatit nedeni ile takipte olan hasta, karın ağrısı, dispne ve yutma güçlüğü nedeni ile tetkik ediliyor. BT de pankreas gövde ve kuyruk komşuluğunda izlenen psodokistin yanı sıra, pankreas baş kesiminden posterior mediastende hiatusa doğru uzanan multiloküle psödokist izlendi. Ayrıca peritonit bulguları ve asit sıvısı mevcuttu. MRGde BT ile benzer şekilde posterior mediastene uza-nım gösteren T1A hipointens, T2A hiperintens, postkontrast imajlarda periferal kontrastlanma gösteren hafif kalın duvarlara sahip multiloküle psödokist izlendi. Pankreas parankiminde nekroz bulgusu saptanmadı.

Tartışma: Atlanta kriterlerine göre nekroz varlığı veya yokluğuna göre ve 4 haftalık zaman intervali dikkate alınarak peripankreatik sıvıya bazı tanımalamar getirilmiştir. Nekrotizan pankreatit diyebilmek için akut pankreatit atağı üzerinden 72 saat geçmesi gerekmektedir. Nekroz var ise <%30, %30-50, >%50 şeklinde yüzde belirtmek gerekir. Pankreatik nekroz en sağlıklı geç arteryel (yaklaşık 35-40. sn) fazda ayırt edilir. Komplikasyon olarak; nekroz, enfeksiyon, apse, psödokist, hemorajik veya amfizematöz pankreatit, vaskuler yapılarda tromboz veya psödoanev-rizma gelişebilir. Ayırıcı tanıda pankreatik lenfoma, peptik ülser, maligniteler düşünülebilir. Mediastinal psödokist: Akut pankreatit sonrasında olu-şan pankreatik psödokistin diyafragmatik hiatus aracılığı ile posterior mediastene uzanımı ile oluşur. Nadir bir komplikasyondur. Psödokistlerin yaklaşık %20 si ekstrapankreatik görülmektedir. Bası bulgusu nedeniyle dispne, disfaji gelişebilir. Psödokist enfekte olabilir, hemoraji ile komplike olabilir. BT, MRG de kistik, duvarda kontrastlanma gösteren yapılar şeklinde izlenir. MRCP ile safra ve pankreatik kanal ilişkileri daha net ortaya konabilir. Serolojik olarak amilaz yüksekliği kuşku uyandırmalıdır. Tedavide medikal ve cerrahi seçenekler mevcuttur.

Sonuç: Akut pankreatit fatal olabilen bir hastalıktır. Akut pankreatite eşlik eden dispne veya yutma güçlüğü akla mediastinal psödokisti getirme-lidir. Pankreatite eşlik eden komplikasyon varlığı mutlaka raporda belirtilmelidir. Olgumuzda da izlendiği gibi psödokistlerin uzandığı kompart-manlar net olarak belirtilmelidir. Enfeksiyon süreçlerinin tabloya eklenebileceği unutulmamalıdır.

P - 03

CAROLİ HASTALIĞI ZEMİNİNDE GELİŞEN KOLANJİYOSELLÜLER KANSER OLGUSUERTAN HAZAR, EZGİ GÜLER



Özet

Giriş: Caroli hastalığı intrahepatik safra yollarının sakküler kistik dilatasyonu ile ilişkili konjenital bir hastalıktır. Hastalık otozomal resesif geçiş göstermektedir. Genellikle çocuk ve genç erişkin dönemde bulgu verir. Todani sınıflamasında Tıp 5 koledok kisti kategorisine girmektedir. Kolanjiyosellüler kanser riskini ciddi oranda artırmaktadır.

Olgu Sunumu: 50 yaşında kadın olgu. Caroli hastalığı nedeniyle uzun süredir takipte olan hasta10 yıl önce kolanjiyosellüler kanser nedeni ile opere olmuş. Sırta vuran sağ üst kadran ağrısı nedeniyle kliniğe başvurmuş. BTde intrahepatik safra yollarında yaygın sakküler genişlemeler, dilate safra yolları içerisinde taş ve çamura ait dansiteler, segment 8 düzeyinde infiltran karakterde çevre parankimde çekinti yapmış malign morfolo-jide kitle izlendi. Koledok çapı yaklaşık 8 mm idi. Portal hilusta ve peripankreatik metastatik lenf bezleri mevcuttu. MRG de T2A görüntülerde yaygın intrahepatik kistik safra yolları içerisinde çok sayıda taşa ait sinyalsiz oluşum izlendi. MRCP de sakküler genişlemelerin safra ağacı ile ilişkisi ortaya konuldu. Portal hilus düzeyinde metastatik lenf bezlerinde ve kitlede kısıtlanmış difüzyon bulguları gözlenmiştir. PET BT de karaciğerde infiltran karakterde kolanjiyoselüler kanserde artmış FDG tutulumu mevcuttu. Ayrıca portal ven çapı intrahepatik konfluens düzeyinde eksternal bası nedeni ile preokluziv darlık derecesinde azalmıştı.

Tartışma: Caroli hastalığı sarılık, sağ üst kadran ağrısı, kolanjit, portal hipertansiyon, özefagus varisleri, kolanjiyosellüler kanser gibi bulgularla ortaya çıkabilir. Genetik temelde Caroli hastalığı PKHD1 geni aracılığı ile polikistik böbrek hastalığı veya medüller sünger böbrek hastalığı ile ilişkili olabilir. Karaciğer tutulumu segmental, lober veya diffüz olabilir. Basit tip ve periportal tip şeklinde iki alt gruba ayrılır. Basit tip geniş santral safra yollarından, periportal tip ise geniş ve periferal küçük safra yollarından kaynaklanmaktadır.

Sonuç: Dilate safra kanalı içinde portal veni temsil eden santral nokta işareti tipiktir. MRCP de kistik genişlemelerin safra ağacı ile ilişkisi gös-terilmelidir. Hastalığın ayırıcı tanısında polikistik karaciğer hastalığı, biliyer hamartom (Von Meyenburg kompleksi), primer sklerozan kolanjit, piyojenik apseler yer alır. Tedavide segmental veya lober tutulumda cerrahi seçeneği var iken diffüz tutulumda karaciğer nakli veya konservatif tedavi uygulanmaktadır.

P - 04

SKROTAL KİTLE AYIRICI TANISINDA ÜRETRAL DİVERTİKÜL KALKÜLÜFATMA UYSAL, MUSTAFA REŞORLU

Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi, Çanakkale, Türkiye

Özet

Giriş: Üretranın konjenital divertikülü nadir görülen bir anomalidir. Üretra ile divertikülün bağlantılı kısmın genişliğine bağlı olarak akut enfektif epizotlar meydana gelir veya üretraya drenaj yeterli ise zamanla içerisinde kalkül gelişebilir. Bu olgu sunumunda skrotal kitle nedeniyle başvuran penil üretral divertikül içerisinde yerleşen kakül saptanan olguya ait ultrasonografi (US) ve manyetik rezonans görüntüleme(MRG) bulgularını sunduk. Skrotumu da içeren alt batın MRG ve yüzeyel US tetkiki değerlendirilmiştir.

Olgu Sunumu: Skrotumda ele gelen kitle ve idrar yaparken zorlanma şikayeti ile başvuran 63 yaşındaki erkek hastanın skrotumu içeren alt batın MR tetkikinde skrotum sol paramedian alanda ekstratestiküler yerleşimli 28x38 mm boyutta, T1 aksiyal- T2 aksiyal-sagittal ağırlıklı serilerde homojen hipointens iç yapıda, postkontrast serilerde kontrast tutulumu göstermeyen düzgün, keskin konturlu kitlesel lezyon izlendi. T1 ve T2 ağrlıklı serilerde hipointens olması nedeniyle pür kalsifik kitle, paratestiküler fibröz psödotümör, egzofirik divertikül içerisinde kalkül düşünül-dü. MR tetkiki sınırlarında lezyonun üretra ile bağlantısı görülmemekteydi. Yapılan US incelemede posteriorundaki belirgin akustik gölgelenme nedeniyle içeriği değerlendirilemeyen kitlesel lezyon saptandı. Operasyonda penil kök düzeyinde üretral divertikül içerisinde yer alan kalkül görülerek eksize edildi.

Tartışma: Üretral divertikül konjenital, periüretral abse, travma ya da striktüre sekonder edinsel olabilir. Üretral divertikül daha çok stres inkontinası olan kadınlarda görülür. Görülme sıklığı yaklaşık %1-6 dır. Genelde 3-5. dekatlar arasında bulgu verir. Enfekte boş divertikülün tanısı üretrogram ile konur. Eğer kalkül mevcutsa palpe edilebilir ve radyolojik tanı üretroskopi ile doğrulanabilir. Tedavisi divertikül ve kal-külün eksizyonudur. Disüri, dispareunia, tekrarlayan üriner enfeksiyon, hematüri, stres inkontinansı gibi semptomlara neden olabilir. Üretral divertikül olgularının %10 unda kalkül gelişebilir. Tekrarlayan enfeksiyon, ve irritasyon üroepiteliumda malign transformasyon açısından predispozandır.

Sonuç: Skrotal kitle ile başvuran olguda ayırıcı tanıda nadir de görülse üretral düvertikül ve içerisinde yerleşen kalkül akılda bulundurulmalıdır.

P - 05

İNSİDENTAL OLARAK TANI ALAN ZİNNER SENDROMU OLGUSUADEM AĞYAR, MESUT ÇETİN, OSMAN DERE, ATAKAN KIRTEKE, ABDURRAHİM DUSAK

Harran Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Şanlıurfa, Türkiye


Özet

Giriş: Konjenital seminal vezikül kistleri (SVK) nadir ve çoğunlukla aynı taraftaki böbrek yokluğu ile birliktelik gösterir. Eğer beraberinde eja-külatör kanal obstrüksiyonu varsa “Zinner Sendromu” olarak bilinir. SVK çoğunlukla semptom vermez veya nonspesifik semptom verdiğinden dolayı tanı gecikebilir. Görüntüleme yöntemlerinin sık kullanıldığı günümüzde başka nedenlerle yapılan tetkikler sonucu rastlantısal olarak tanı konulmaktadır. Bu çalışmamızda skrotal kitle nedeniyle görüntüleme yapılan 34 yaşındaki olguyu sunuyoruz.

Olgu Sunumu: 34 yaşında erkek hasta, 3 çocuk sahibi, sağ skrotumda şişlik şikayeti ile başvuran hastanın fizik muayenesinde sağ hemiskrotum proksimal kesimde ele gelen kitlesi var. Karın ultrasonografisinde (USG) mesane posteriorunda solda 30x20 mm boyutunda kalın duvarlı iç yapısında yoğun sıvı olduğu düşünülen görünüm ve sol böbrek yokluğu tesbit edildi. Manyetik rezonans görüntülme(MRG)de sol böbrek izlen-memiştir. Sol vezikula seminalis ile ilişkili olması muhtemel T2AG hiperintens T1AG iso-hiperintens, iyi sınırlı lobule konturlu kistik lezyon sap-tandı. Seminal vezikül kisti olarak değerlendirilen olguda ipsilateral böbrek yokluğu ve ejakulatör kanal obstrüksiyonu olması nedeniyle Zinner Sendromu tanısı konuldu. Hastada ek olarak sağ hemiskrotumda 62x37 mm boyutlarında ölçülen teratom saptandı.

Sonuç: Konjenital seminal vezikül kistleri mezonefrik kanaldan kaynaklanmaları nedeniyle çoğunlukla ipsilateral üriner anomaliler ile ilişkilidir. Çoğu olgu asemptomatik olup infertilite nedeniyle incelenirken tanı alır. Olgularda dizüri, ağrılı ejakulasyon, pelvik ağrı gibi yakınmalar olabilir. Zinner Sendromu kadınlarda görülen Mayer-Rokitansky-Kustner-Hauser sendromunun erkek versiyonu olup renal agenezi, ipsilateral seminal vezikül kisti ve ejakulator duktus tıkanıklığı triadından oluşan nadir görülen bir infertilite nedenidir. Ayırıcı tanıda prostat kistleri, ejakulator duk-tus kistleri, mesane divertikülü, üreterosel gibi diğer pelvik kistler düşünülmelidir. Tanıda İVP, ultrason ve kesitsel görüntüleme yöntemleri rol alır.

P - 06

ÖZEFAGUS LEİOMYOMU: MRG BULGULARIHASAN ERDOĞAN, FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, GÜL ESER

Sağlik Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye

Özet

Özefagus leiomyomu, özefagusun muskularis propria tabakasından köken alan, düz kas hücrelerinin benign tümörüdür. Genellikle tek, düzgün sınırlı submukozal kitle şeklinde ortaya çıkar. Bütün gastrointestinal leiomyomların %10’u özefagusta görülür. Leiomyomlar genellikle özefagusun orta ve alt 1/3’lük kısmında yerleşirler. Disfaji, nonspesifik retrosternal ağrı, kilo kaybı gibi septomlara yol açabilirler. Bu sunumda özefagusta leiomyom histopatolojik tanısı olan 59 yaşındaki erkek olgunun manyetik rezonans görüntüleme bulguları sunulmuştur.

P - 07

PANKREASIN SERÖZ KİSTADENOKARSİNOMUNU TAKLİT EDEN JUKSTAPAPİLLER DUODENUM DİVERTİKÜLÜSEMİH ASOĞLU, MUSTAFA ALPER BOZKURT, EMİNE UYSAL, MUSTAFA KOPLAY

Selçuk Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye

Özet

Giriş: Divertikül hastalığının kolondan sonra ikinci en sık yerleşim yeri duodenumdur. Dudenum divertikülünün insidansı %2-5 olup, en sık duoedenum ikinci veya üçüncü kıtada yerleşirler. Duodenum divertikülü genellikle asemptomatik olup semptomatik hastalarda perforasyon, ağrı, kanama, divertikülit, kolanjit ve pankratit bulguları izlenebilir. Duodenal divertiküller içlerinin tamamen hava ile dolmasıyla veya sıvı-gaz kombinasyonlarıyla bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) ile tanınabilirler. Divertikülün içi tamamen sıvı ile doluysa pankrasın kistik tümörlerini taklit edebilir.

Olgu Sunumu: 61 yaşındaki kadın hastanın karın ağrısı sebebiyle yapılan ultrasonografi incelemesinde karaciğerde lobüle konturlu, içerisinde septasyonların bulunduğu kistik lezyon görüldü. Hastaya daha sonra yapılan MRG incelemesinde pankreas başı düzeyinde 20x12 mm ebatlı, ince septasyon içeren, kistik lezyon görüldü. Ayırıcı tanılar arasında pankreas seröz kistadenomu ve duodenum divertikülü düşünüldü. Hastanın takip-lerinde şiddetli karın ağrısı olması sebebiyle çekilen IV-oral kontrastlı abdomen BT’sinde duodenum 2. segmentten periampüller alana doğru uzanım gösteren yaklaşık 3 cm uzunluğunda 1 cm çapında, içerisinde hava dansiteleri ve kontrast içeren lezyon alanının duodenum divertikülü olduğu anlaşıldı.

Sonuç: Duodonal divertiküller primer veya sekonder olabilir. Primer divertiküller gerçek divertiküller olup bağırsağın tüm katmanlarını içerir. Sekonder divertiküller ise kronik duodenal ülserin bir sonucu olarak ortaya çıkabilir. Duoedenum divertikülleri sıklıkla periampuller bölgede lokalizedir. Duodenum divertiküllerinin görülme sıklığı yaşla artar ve en sık 50-60 yaş aralığında görülür. Duodenal divertiküllerin pankreas başına olan komşulukları, görüntüleme yöntemlerinde pankreasın kistik neoplazmları ile karışmalarına neden olmaktadır. Görüntüleme yön-temlerinde pankreas başı kistik neoplazmları düşünülen hastalarda duodenal divertiküller ayırıcı tanıda akla gelmeli ve hastalar bu yönden ek inceleme ile tetkik edilmelidir.


P - 08

BÖBREK LENFOMA TUTULUMU MANYETİK REZONANS GÖRÜNTÜLEME BULGULARISEMİH ASOĞLU, MUSTAFA KOPLAY, MUSTAFA ALPER BOZKURT, YAHYA PAKSOY


Özet

Giriş: Böbrek lenfoması genellikle multisistemik lenfoma spektrumunun bir parçası olarak görülür. Böbrekler lenfomanın en yaygın ekstranodal bölgeleridir. Böbrek lenfoması yaygın olarak non-Hodgkin lenfoma ile ortaya çıkmakla birlikte çoğunluğu B hücreli lenfoma alt tipidir. Biz bu sunumda her iki böbreği tutan B hücreli lenfomanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık.

Olgu Sunumu: 73 yaşında KOAH tanılı hasta karın ağrısı ve nefes darlığı şikayetiyle acile başvurdu. Pulmoner bilgisayarlı tomografi (BT) anji-ografisinde emboli izlenmedi ancak paratrakeal alanda ve anterior mediastende en büyüğü 2 cm çapa ulaşan multipl sayıda lenfadenopatiler izlendi. Kesit alanına giren üst abdomen bölgesinde diyafragma komşuluğunda, parakardiyak yağ yastıkçığı içerisinde lenf nodları izlendi. Ayrıca batın içerisinde ve böbrek superiorunda multipl sayıda lenf nodları ve omental kirlenmeler mevcuttu. MRG incelemede paraaortik, parakaval alanlarda büyüğü sol paraaortik alanda 5x3. 5 cm ebatlı olmak üzere paraaortik, parakaval yerleşimli konglomerasyon oluşturan multiple lenfa-denopatiler izlendi. Gerota fasiyasında ve pararenal yağlı dokuda belirgin kalınlaşma yanısıra retroperitonael yerleşimli lenfadenopatilerin belirgin invazyonu mevcuttu. Her iki pararenal alanda ve böbrek parankiminde diffüzyon kısıtlanmaları da izlendi. Bulgular sekonder böbrek lenfoması olarak değerlendirildi.

Sonuç: Renal lenfomalar unilateral veya bilateral olarak izlenebilir. Bazen de karşımıza fokal kitleler (tekli veya çoklu) veya fokal kitle olmadan diffüz böbrek tutulumu yaparak böbreklerde büyümeye sebep olabilir. Yapılan çalışmalar renal ve perirenal lenfoma tutulumunu göstermede MRG’ ‘nin de kontrastlı BT kadar doğru sonuç verdiğini göstermiştir. Lenfomalar genel olarak böbrekte büyüme, kontrastlanmayan alanlar, parankimal nodüler lezyonlar şeklinde izlenmekle birlikte daha nadir görülen pararenal tutulum, kortikal invazyon şeklinde tutulumda izlenebilir.

P - 09

OVER HİPERSTİMÜLASYON SENDROMU OLAN BİR OLGUDA OVER TORSİYONU: KONVANSİYONEL VE DİFÜZYON MRG BULGULARIAHMET BAYTOK, EMİNE UYSAL, SEMİH ASOĞLU, MUSTAFA KOPLAY


Özet

Giriş: Over hiperstimülasyon sendromu (OHSS), invitro fertilizasyon (İVF) uygulanan kadınlarda karşılaşılan en önemli komplikasyondur. Ovulasyon indüksiyonu ile büyüyen overler belirgin torsiyon riski taşır. Tanıda renkli doppler ultrasonografi (RDUS) ilk sırada kullanılmakla birlikte manyetik rezonans görüntüleme (MRG) ileri incelemede önemli bir yere sahiptir. Burada IVF tedavisi sonrası OHSS ve over torsiyonu tanısı alan bir olguda konvansiyonel ve özellikle difüzyon MRG bulgularını sunmayı amaçladık.

Olgu Sunumu: 23 yaşında kadın hasta ani başlayan sağ adneksiyel ağrıyla başvurdu. Bir hafta önce İVF hikayesi olan hastaya yapılan RDUS ince-lemede her iki overde multiple kistler ve pelviste serbest sıvı izlendi. RDUS incelemede sağ overde belirgin kanlanma saptanmadı. Yapılan MRG incelemede her iki over boyutlarında artış, homojen yapıda büyüğü 4,5 cm çaplı basit kistler ve bir adet hemorajik kist izlendi. Ayrıca stromal ödeme bağlı intensite artımı ve difüzyon MRG de sağ over periferinde daha belirgin olan anlamlı difüzyon kısıtlanması izlendi ve görünüm OHSS’ye sekonder over torsiyonu açısından anlamlı bulundu.

Sonuç: Over torsiyonu; overyan vasküler pedikülün kısmi veya tam rotasyonu olup arteriyel ve/veya venöz dolaşımın durması sebebiyle OHSS’nin jinekolojik acil oluşturan komplikasyonlarındandır. Tanıda primer görüntüleme yöntemi RDUS olup over kanlanmasının net değerlen-dirilemediği durumlarda MRG önemli ipuçları vermektedir. Torsiyone overdeki asimetrik büyüme, periferik foliküller, stromal ödem, hemoraji, over pedikülündeki dönme (girdap işareti), ipsilateral fallop tüpünde duvar kalınlaşması, pelvik serbest sıvı ve uterusta torsiyon tarafına devias-yon izlenebilir. DAG’lerde düşük apparent diffusion coefficient (ADC) değerleri hemorajik enfarkt açısından yüksek sensitiviteye sahiptir. Sonuç olarak, difüzyon MRG torsiyonu ve buna bağlı gelişen enfarktı tespit edip ayırıcı tanıda önemli role sahiptir.

P - 010

OKSİPİTAL MENİNGOSEL: FETAL MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIAHMET BAYTOK, MUSTAFA KOPLAY, EMİNE UYSAL, YAHYA PAKSOY



Özet

Giriş: Meningosel; embriyolojik yaşamın erken dönemlerinde ektodermal yaprağın nöroektoderme dönüşememesine bağlı kemik yapıda defekt oluşması ve bu defektten meninkslerin fıtıklaşması olarak tanımlanmaktadır. Sıklıkla torakolomber bölgede görülmekle birlikte oksipital yerle-şim nadirdir (%1-8). Bu olguda nadir görülen oksipital meningosel olgusunun fetal manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık.

Olgu Sunumu: 33 yaşında kadın hastanın 27 gebelik haftasında yapılan ultrasonografide oksipital defekt görülmesi üzerine fetal MRG yapıldı. MRG’de her iki lateral ventrikül posterior hornlarında kolposefalik genişleme ve orta hatta oksipital kemikteki küçük bir defektten posteriora uzanım gösteren 15 mm çaplı kese izlendi. Kese içerinde nöral parankime ait görünüm saptanmadı ve oksipital meningosel tanısı konuldu.

Sonuç: Spinal kord gelişiminde sırasıyla gastrulasyon, nörülasyon ve differensiasyon aşamaları olurken erken embriyonik dönemdeki defektler spinal disrafizmlere neden olmaktadır. Spinal disrafizmler açık ve kapalı olmak üzere klinik olarak iki alt gruba ayrılırken meningosel kapalı disrafizm grubunda yer almaktadır. Meningoselde herniye kese içerinde meninksler ve beyin omurilik sıvısı bulurken nöral parankim izlenmez. Oksipital yerleşim meningosel için nadir olmakla birlikte ayırıcı tanıda kistik higroma da düşünülmelidir. Fetal MRG primer görüntüleme yöntemi olmayıp USG’yi tamamlayıcı görüntüleme yöntemi olarak kullanılmaktadır. MRG; özellikle meningoselin içeriğinin saptanması, medulla spinalis ile olan ilişkilerin ortaya konması ve eşlik eden lezyonların detaylandırılmasında önemli yere sahip olup olası cerrahi planlanmasına da klavuzluk etmektedir.

P - 011

FETAL BRONKOPULMONER SEKESTRASYON: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMUSTAFA ALPER BOZKURT, SEMİH ASOĞLU, YAHYA PAKSOY, MUSTAFA KOPLAY


Özet

Giriş: Pulmoner sekestrasyon, trakeobronşiyal ağaca bağlanmayan ve sistemik bir arter tarafından dolaşımı sağlanan anormal bir akciğer dokusu içeren konjenital anomalidir. Antenatal izlemde ultrasonografinin (USG) rutin hale gelmesi ile birlikte akciğer ve toraksa ait birçok konjenital anomalinin prenatal erken tanısı konulabilmektedir. Ancak ayırıcı tanıya gidilemediği veya anatomideki değişikliklerin detaylı olarak anlaşılamadığı durumlarda manyetik rezonans görüntüleme (MRG) kullanılabilir. Bu sunumda pulmoner sekestrasyonda MRG bulguları sunulmuştur.

Olgu Sunumu: 23 yaşında, primigravid, G1P0, 23. gebelik haftasında olan hasta, rutin izlemler sırasında toraksta kitle ön tanısı ile merkezimize refere edildi. Hastanın tıbbi özgeçmişinde özelliği yoktu. Yapılan USG de sol akciğerde ekojen bir odak izlendi. Ancak vasküler yapısı net olarak değerlendirilemedi. Hastaya ayırıcı tanı amacıyla yapılan Fetal MRG de, sol akciğer inferiorunda ekstralober yerleşimli yaklaşık 2. 5x1. 5 cm ebatlı, triangüler şekilli intensite artışları dikkati çekmekte olup, aortadan bu intensite artışı gösteren alana doğru hipointens lineer uzanım gösteren vasküler yapı izlendi. Bu bulgular bronkopulmoner sekestrasyon ile uyumlu bulundu ve postnatal dönemde doğrulandı.

Sonuç: Antenatal izlemde USG nin daha sistematik ve etkin kullanılması toraksta yer işgal eden lezyonların daha erken tanı almasına olanak sağla-mıştır. Ancak bazı bronkopulmoner sekestrasyon olgularında USG ile vasküler yapı gösterilememektedir. Bu gibi durumlarda kistik adenomatoid malformasyondan ayrımı, ek patolojilerin varlığı, akciğer hacminin ölçülebilmesi avantajlarını sağladığı için MRG kullanılabilir.

P - 012

SİSTİK KANAL YARALANMASINDA GADOKSETAT DİSODYUM İLE MANYETİK REZONANS KOLANJİYOPANKREATOGRAFİ BULGULARIMUSTAFA ALPER BOZKURT, SEMİH ASOĞLU, ABDÜSSAMET BATUR, MUSTAFA KOPLAY


Özet:

Giriş: Safra kaçağı travmatik veya iatrojenik safra yolları yaralanması sonucu gelişebilir. Laparoskopik kolesistektomide safra yolu yaralanma-ları açık kolesistektomiye oranla daha sık görülmektedir. Postoperatif dönemde komplikasyon şüphesinde ultrasonografi (US) ve bilgisayarlı tomografi (BT) sık kullanılan görüntüleme yöntemleridir. Ancak bu yöntemlerde safra ile diğer postoperatif sıvı koleksiyonları güvenilir şekilde ayırt edilemeyebilir. Manyetik rezonans görüntüleme (MRG) ve hepatosit spesifik kontrast madde kullanılarak yapılan manyetik rezonans kolan-jiyopankreatografi (MRKP) tetkiklerinde anatomik ve fonksiyonel bilgi daha net ayırt edilir ve tanıya daha kısa sürede ulaşılabilir. Bu sunumda kolesistektomi sonrası safra kaçağı gelişen olguda gadoksetat disodyum ile çekilen MRKP bulguları sunulmuştur.

Olgu Sunumu: 56 yaşında erkek hasta laparoskopik kolesistektomi sonrası gelişen karın ağrısı ve bulantı - kusma şikayetleriye tetkik ediliyor. US ve kontrastlı BT incelemesinde karaciğerde apse ile uyumlu sıvı lokülasyonu izlendi. Safra yolları ile ilişkili olabileceği şüphesi üzerine hastaya gadoksetat


disodyum içeren kontrast madde kullanılarak uygulanan üst abdomen MRG ve MRKP tetkikinde perihepatik alanda apse ile uyumlu görünüm izlendi. 30. ve 60. dakikalarda alınan görüntülerde apse içerisinde kontrast madde izlenmiş olup safra kaçağı ve sistik kanal seviyesinden rüptür olduğu görüldü.

Sonuç: Hepatobiliyer ameliyatların artması beraberinde safra kaçağı gibi komplikasyonların da artmasına neden olmuştur. Komplikasyonların değerlendirilmesinde görüntüleme yöntemleri büyük önem arz etmektedir. Safra kaçağı gibi durumları göstermede US ve BT yetersiz kalabilir. Hepatosit spesifik kontrast madde kullanılarak uygulanan MRG ve MRKP tetkiki safra kaçağını saptayabilen ve diğer postoperatif komplikasyon-lardan ayıran faydalı bir görüntüleme yöntemidir. Non-invaziv bir yaklaşım olduğu için endoskopik retrograd kolanjiyopankreatografi ve perkütan transhepatik kolanjiyografi yerine tanıda ön planda düşünülmelidir.

P - 013

NADİR BİR OLGU SUNUMU: RADYOTERAPİYE BAĞLI GELİŞEN PERİANAL FİBROSİS VE KOLON OBSTRÜKSİYONUMERAL BÜYÜKTERZİ, ÖZGÜR ÖNER, MEHMET SEDAT DURMAZ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, İSMET TOLU

Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye

Özet

Giriş: Radyoterapiye bağlı gelişen komplikasyonlar tipik olmayan semptomları nedeni ile tanı konulması zor patolojilerdir. Pelvik bölgeye uygu-lanan radyoterapi barsak segmentlerinde, genitoüriner sistemde, kemiklerde veya deride çeşitli hastalıklara yol açabilir. Bu olgu sunumunda prostat karsinomu nedeni ile radyoterapi tedavisi almış bir hastanın radyoterapiye bağlı gelişen perianal fibrozis bulgularının manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık.

Olgu Sunumu: 68 yaşında erkek hasta hastanemizin acil servis bölümüne gaz-gayta çıkaramama ve yaygın karın ağrısı şikayetleri nedeni ile baş-vurdu. Hastanın prostat karsinomu nedeni ile bir yıl önce opere olduğu ve radyoterapi ve kemoterapi tedavisi aldığı öğrenildi. Hastaya uygulanan ayakta direkt batın grafisinde barsak anslarında yaygın dilatasyon ve hava sıvı seviyelenmeleri saptandı. Bilgisayarlı tomografi tetkikinde kolon segmentlerinde belirgin dilatasyon ve hava-sıvı seviyelenmeleri saptandı. Ayrıca rektum distal kesiminde anal girim düzeyinde diffüz duvar kalın-laşması izlendi. Hastaya uygulanan MRG tetkikinde ise rektum distal kesiminde rektum mukozasında diffüz kalınlaşma izlendi. Bu düzeyde sınır veren kitle lezyonu saptanmadı. Opere edilen hastanın patolojik tanısı fibrozis ile uyumlu olarak sonuçlandı.

Sonuç: Pelvik radyoterapi tedavisi uygulanan hastalarda anal ülserasyon, kanama, şişkinlik ve kabızlık, hemoroid, uykusuzluk, mukozal akıntı gibi çok çeşitli semptomlar ortaya çıkabilir. Bu semptomlardan bazıları radyoterapi dozuna bağlı olduğu gibi bir kısmı dozdan bağımsızdır. Barsak obstrüksiyonları, fistül ve sekonder karsinomlar radyoterapiye bağlı daha geç dönemde ortaya çıkabilen gastrointestinal semptomlardır.

P - 014

NADİR BİR OLGU: KAUDAL DUPLİKASYON SENDROMUERTAN HAZAR, EZGİ GÜLER, MUSTAFA HARMAN, NEVRA ELMAS


Özet

Giriş: Kaudal duplikasyon sendromu insidansı 1/100000’den az olan nadir bir hastalıktır. Hastalık kloaka ve nöral tüpten gelişen distal gastroin-testinal, genitoüriner sistemde parsiyel veya komplet organ duplikasyonu ve nöral tüp defektlerine neden olmaktadır. Etiyoloji net olmamakla birlikte bazı teoriler ortaya atılmıştır. Bu teorilerden en kabul göreni monozigot ikizlerin inkomplet ayrışmasıdır. Asemptomatik olabileceği gibi inferitilite, anorektal ve genitoüriner şikayetlere neden olabilir. Kızlarda 2 kat fazla görülmektedir.

Olgu Sunumu: 27 yaşında kadın olgu. İnfertilite nedeni ile araştırılmakta olan hastaya yapılan pelvik mrg de ortadan fibröz bir septumla tamamen ayrılmış iki mesane, uterus didelfis anomalisi, rektum, sigmoid kolon ve inen kolonda duplikasyon izlendi. İki ayrı serviks uteri kavitesi tek vajen aracılığı ile perineye açılmaktaydı. Gastrointestinal olarak tek bir anal kanal ve anal açıklık mevcuttu. Apendiks tek olarak lojunda yer almaktaydı. Üretra ve eksternal genitalyada duplikasyon gözlenmedi. Her iki over normal lorunda yer almakta olup bilateral fizyolojik boyutlarda folikül kistleri barındırmaktaydı. Ayrıca T11 vertebrada kelebek vertebra anomalisi ve lumbosakral düzeyde skolyoz dikkat çekmiştir. Eşlik edebilecek toplayıcı sistem değerlendirmesi için yapılan BT ürografide her iki böbrek normal lojunda yer almaktydı. Üreter duplikasyonu veya ek üreter malformasyonu izlenmedi. Her üreter kendi tarafındaki mesaneye drene olmaktaydı. Fistüloz bir ilişki seçilmedi.

Tartışma: Kaudal duplikasyon sendromu embriyolojik olrak kloaka ve nöral tüpten gelişen yapıların parsiyel veya komplet duplikasyonu olarak değerlendirilir. Genitoüriner sistemde ektopik böbrek, üreter, üretra, eksternal genitalya, mesane duplikasyonu veya üreteral ektopi görülebilir. Gastrointestinal sistemde bağırsak anslarında ve apendikste duplikasyon, anorektal malformasyonlar, batın ön duvarı defektleri, intestinal mal-rotasyon, duodenal agenez, vertebrada kelebek vertebra, hemivertebra, diyastometamiyeli, spina bifida, sakral agenez, myelomeningosel gibi anomaliler eşlik edebilir.


Sonuç: Hastalığın prognozu tutulan organ ve sistemlere göre farklılık göstermektedir. Bizim olgumuzda bulgular infertilite etiyolojisi araştırması sırasında insidental olarak izlenmiştir. Tedavide duplikasyon gösteren organ sisteminde cerrahi onarım yer almaktadır. Özellikle üretra ve eks-ternal genitalya duplikasyonunda cerrahi sonrası başarılı kozmetik sonuçlar elde edilmektedir.

P - 015

NADİR BİR OLGU: XP11 TRANSLOKASYON HÜCRELİ KARSİNOMUN MR BULGULARIÖNER ÖZBEY, EZGİ GÜLER, MUSTAFA HARMAN, NEVRA ZEHRA ELMAS


Özet

Xp11 translokasyon hücreli karsinomu genç yaşta ve kadınlarda daha sık görülen; kistik değişiklikler, lenf nodu metastazı ve uzak metastaz eğiliminin diğer subtiplere göre daha yüksek olduğu, genetik olarak tamamında Xp11. 2 kesiminin tutulduğu nadir bir renal hüreli tümör sub-tipidir. Biz bu posterde karın ağrısı nedeniyle yapılan USGde renal kitle saptanması üzerine MRG ile T2A görüntülerde düşük sinyalli, belirgin kontrastlanma etkileşimi göstermeyen, paraaortik metastatik lenfadenopatilerin eşlik ettiği gözlenen; histopatolojik olarak translokasyon hücreli karsinom tanısı alan ve post-op 2. yıl kontrolünde akciğer metastazı gelişen 21 yaşında kadın olgunun görüntüleme bulgularını sunmayı amaçladık.

P - 016

NADİR BİR OLGU: SÜPERİOR MEZENTERİK ARTER ORJİNLİ ANA HEPATİK ARTERİN VARYASYONUSEDA SOĞUKPINAR KARAAĞAÇ, HASAN ERDOĞAN, ZEYNEP ARSLAN, MEHMET SEDAT DURMAZ, SERDAR ARSLAN

Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye

Özet

Mezenterik arteriyel varyasyonlar toplumda oldukça sıktır. Bu varyasyonlar, giderek artan girişimsel radyolojik işlemler, transplantasyon ve vas-küler cerrahi işlemler nedeniyle daha fazla önem kazanmaktadır. Hepatik arter varyasyonları bunlar içinde %40 gibi bir oranla en sık görülen mezenterik arter varyasyonlarıdır. Normalde çölyak trunkusun üç dalından biri olan ana hepatik arter, duedonum’un birinci kısmının üst yüzün-de arteria hepatica propria ve arteria gastroduedonalis dallarını verir. Biz de % 2 oranında görülen ana hepatik arterin süperior mezenterik arterden orjin alan varyantının MRG görüntülerini sunmayı amaçladık. 44 yaşında buerger tanısıyla takipli erkek hastanın çekilen abdominal MRG anjiografisinde ana hepatik arterin süperior mezenterik arterden orjin aldığı izlenmiştir. Vasküler görüntülemede altın standart olarak kabul edilen konvansiyonel kateter anjiyografinin invaziv doğasından dolayı, kesitsel tanı yöntemleri önem taşımaktadır. Bu nedenlerle, hem tanısal hem de girişimsel radyologların, başta çölyak arter ve hepatik arter olmak üzere mezenterik arteriyel varyasyonların kesitsel ve üç boyutlu anatomisine hakim olması, cerrahların da olası vasküler varyasyonların varlığı konusunda bilgili olması gerekmektedir.

P - 017

ATİPİK MAYER-ROKİTANSKY-KÜSTER-HAUSER SENDROMU: OLGU SUNUMUFATMA ZEYNEP ARSLAN 1, VEFA ÖNER 1, MEHMET KARAGÜLLE 2, SÜLEYMAN ÖNCÜ 2, İSA DENİZ 1 1Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye2Bağcılar Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye

Özet

Mayer-Rokitansky-Kuster-Hauser (MRKH) sendromu, uterus aplazisi ve vajen hipoplazisi ile seyreden nadir olarak görülen konjenital bir has-talıktır. 5000 canlı doğumda bir görülür ve hastalarda normal karyotip izlenir. Tipik formlu MRKH’de; uterus ve vajen üst 2/3 ü izlenmez iken overler normaldır. Atipik formunda ise ovarian, tubal ve genitüriner sistem anomalileri de izlenir. 18 yaşındaki kadın hasta primer amenore yakınması ile hastanemize başvurmuştur. Labaratuar tahlilleri ve fizik muayenenormal olarak izlenmiştir. Çekilen pelvik ultrasonografide; uterus ve vajen net olarak izlenemedi ve sağ böbreğin pelvik yerleşimli olduğu görüldü. Çekilen pelvik MRG tetkikinde; uterus ve vajen kafı süperior kesimi rüdimente görünümde idi. Vajen kafı düzeyinden sol inguinal kanala doğru uzanan 12 mm kalınlıkta yaklaşık 45 mm uzunlukta Müllerien kanal displazisi ile uyumlu tübüler yumuşak doku intensitesi izlenmekteydi. Ayrıca pelvik yerleşimli sol böbrek izlendi. Hastalarda en önemli klinik semptom primer amoneredir. Tanıda pelvik MRG en önemli radyolojik tetkiktir. MRG’de; uterus ve vajen üst 2/3 ü hipoplaziktir. Ayrıca bu hastalarda vertebral anomaliler, eşlik eden başka ürogenital anomaliler sıklıkla izlenmektedir. Sonuç olarak; MRKH nadir bir hastalıktır ve radyologların bu nadir görünümlere aşina olup eşlik eden olası ek anomalilere karşı dikkatli olmaları önemlidir.


P - 018

TAİLGUT KİSTİ: MRG BULGULARIMERAL ÇETİNKAYA, MEHMET ŞEKER, AFAK DURUR KARAKAYA

Medipol Üniversitesi Radyoloji Bölümü, İstanbul, Türkiye

Özet

Amaç: Tailgut hintgutun kaudal parçası olup embriyonik hayatın 8. haftasında involüsyona uğrar. Tailgut kisti involüsyona uğramayan kalıntılardan köken alır. Nadir karşılaşılan tailgut kisti orta yaş grup kadınlarda daha sık izlenen benign gelişimsel lezyonlardır. Konstipasyon ve kronik pelvik ağrı gibi şikayetlere yol açabileceği gibi insidental olarak da bulunabilir. Burada tailgut kistinin MR bulgularını sunmayı amaçladık.

Gereç ve Yöntemler: Konstipasyon ve kronik pelvik ağrı şikayeti ile gelen 27 yaşındaki bayan hastada kontrastlı alt batın MR görüntüleri elde edilmiştir.

Bulgular: Alt batın MR’ de, retrorektal yerleşimli, T1A kesitlerde hipointens, T2A kesitlerde hiperintens, internal septumlarda içeren, posterior-da müsinöz içerik, yüksek protein ya da hemoraji içerik ile uyumlu milimetrik boyutlarda T1A kesitlerde hiperintens, T2A kesitlerde hipointens komponenti de bulunan kontrast madde tutulumu izlenmeyen iyi sınırlı, multiloküle, rektumu anteriora deplase eden kistik kitle izlendi.

Sonuç: Tailgut kistleri, MR görüntülemede tipik olarak retrorektal yerleşimli, genellikle multiloküle, daha ender uniloküle T1A imajlarda hipoin-tens, T2A imajlarda hiperinten izlenir. T2A imajlarda internal septa varlığı özgün bir bulgudur. Presakral kistik kitleler arasında epidermoid kist, dermoid kist, rektal duplikasyon kistleri ve anterior meningosel genellikle unilokuler, tailgut kistleri ve kistik lenfanjiomlar genellikle multikistik-lerdir. Fokal irregüler duvar kalınlaşması, polipoid kitle varlığında malign transformasyondan şüphelenilmelidir. Adenokarsinom, nöroendokrin karsinom ve sarkom gelişebilmesi riski nedeniyle, preoperatif rektum ve kemik yapılar ile ilişkisinin ortaya konmasında, yumuşak doku rezolüs-yonun iyi olması ve cerrahiye yardımcı olacak multiplanar görüntüleme kapasitesi nedeniyle tailgut kistlerinde seçilecek en uygun görüntüleme yöntemi MR olmuştur.

P - 019

FARKLI KLİNİK TABLOLAR OLUŞTURAN İNTRAPERİTONEAL KİST HİDATİK OLGUSUÇİLEM KOLCA, MEHMET KARAGÜLLE, ESRA BİLGİ, CANDAN VARLIK, TUĞBA POLAT ADMIŞ

Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Hidatik kist, ekinokokkus granülosusun yaptığı paraziter bir hastalık olup bir çok organ tutulumu bulunmaktadır. Ülkemizde endemik olarak görülen bir halk sağlığı sorunudur. Tutulan organlara göre farklı klinik tablolar oluşturmaktadır. Bizim olgumuzda 32 yaşında erkek hasta uzun zamandır karında şişkinlik, dispeptik şikayetler, sık idrara çıkma, sol yan ağrısı ve tenezm hissi gibi nonspesifik semptomlarla genel cerrahi polik-liniğine başvurdu. Fizik muayenesinde sağ üst kadran, epigastrik bölge ve batın alt kadranda ele gelen kitle ve hassasiyet tespit edildi. Bunun üzerine çekilen batın USG de ve sonrasında yapılan MR incelemede karaciğerde, subhepatik alanda, lesser sacta WHO evre 1 hidatik kistler ile karaciğer ve majör pelviste WHO evre 2a hidatik kistler izlendi. Majör pelviste yerleşen hidatik kistin mesane, sol üreter ve rektuma basısı görülmektedir. Kist hidatik en sık karaciğer ve akciğer olmak üzere tüm dokularda görülebilir. MRda genellikle evresine göre değişmekle beraber T1A hipointens T2A hiperintens kalın cidarlı periferik kontastlanan basit veya kompleks kistik lezyonlar şeklinde görülmektedir. Karaciğerde yer-leşenlerin ayırıcı tanısında basit karaciğer kisti ve kistik neoplaziler bulunmaktadır. İntraabdominal yerleşimli olanların ayırıcı tanısında pankreas psödokisti, pankreasın kistik neoplazileri, konjenital mezenterik kistler ve retroperitoneal mezenkimal tümörler düşünülmelidir. İntraabdominal büyük boyutlu kistik lezyonların ayırıcı tanısında kist hidatik hastalığı akılda tutulmalıdır.

P - 020

UTERİN MİYOM EMBOLİZASYONU UYGULANMIŞ OLGUDA TEDAVİ ETKİNLİĞİNİN MR VERİLERİ İLE DEĞERLENDİRİLMESİMEHMET FATİH İNECİKLİ, MEHMET BEYAZAL, ARZU TURAN, MAKSUDE ESRA KADIOĞLU, FATMA BEYAZAL ÇELİKER

Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye

Özet

Amaç: Miyomlar, kadınlarda en sık izlenen benign tümörlerdir. Menoraji, pelvik ağrı, dismenore, fertilitede azalma, spontan abotrusta artış, üriner retansiyon ve konstipasyona neden olabilirler. Uterin arter embolizasyonu (UAE), miyom tedavisinde endovasküler olarak uygulanan bir


yöntemdir. UAE’da amaç, her iki uterin arterin selektif embolizasyonu ile hipervasküler miyom beslenmesini bozarak miyomda enfarkt oluş-turmak, endometrial ve myometrial kanlanmanın devamını sağlamaktır. Embolize olan miyomlar, zamanla küçülmekte ve semptomları büyük oranda kaybolmaktadır. Bu bildiriyi sunmamızdaki amaç, endovasküler miyom embolizasyonu uygulanmış olguda tedavi etkinliğini, işlem öncesi ve sonrası MR verileri ile ortaya koymaktır.

Gereç ve Yöntemler: 42 yaşında bayan hasta. Dismenore, menometroraji ve pelvik ağrı şikayetleri ile başvurdu. Ultrasonografide uterus myo-metriumu içinde multiple myom saptandı. Yapılan pelvik MR tetkikinde 8 adet intrauterin miyom saptandı. Olguya Girişimsel Radyolojide miyom embolizasyonu uygulanmasına karar verildi. Sağ common femoral arter yoluyla her iki uterin artere mikrokateter ile ulaşıldı. 500-700 mikron şekilli PVA partikülleri ile embolizasyon uygulandı. 6 ay sonraki pelvik MR tetkikinde miyom sayı ve boyutlarında regresyon sağlandı. Miyomların vaskülarizasyonunda tama yakın azalma saptandı.

Sonuç: UAE, miyoma uteri tedavisinde etkin bir yöntemdir. Jinekolojik problemlerin ve pelvik ağrının azalmasını sağlar. Tedavi etkinliği kontrastlı Pelvik MR tetkiki ile kolaylıkla değerlendirilir. UAE sonrası, özellikle T1A kontrastlı imajlarda miyom vaskülaritesini azalması, miyomlardaki yüksek T2A sinyal intensitesinin, UAE sonrası, işlem öncesine göre belirgin derecede azalması önemli bir bulgulardır.

P - 021

ABONDAN VAJİNAL KANAMALARDA AKILDA TUTULMASI GEREKEN BİR PATOLOJİ: UTERİN AVMÇİLEM KOLCA, MEHMET KARAGÜLLE, ESRA BİLGİ, AHMET TAN CİMİLLİ

Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Uterin AVM nadir görülen sıklıkla 18-64 yaş grubunu etkileyen konjenital veya akkiz olabilen ve hayatı tehdit edebilen bir lezyondur. Akkiz uterin AVM sebeplerinden en sık görüleni geçirilmiş uterin cerrahidir. En yaygın semptom, aralıklarla olan menoraji veya menometroraji olup olgularn %30’unda kan transfüzyonu gerekmektedir. Adet düzensizliğİ nedeniyle hastanemize başvuran 49 yaşındaki iki sezaryen doğum öyküsü olan kadın hastada USGde uterus korpusunda insizyon hattı altında tortüyöz vasküler görünümde kitle lezyon izlendi. Tümör markerları negatif sap-tanan hastanın sonografide kitle lezyon olarak tariflenen alanın MRGde keskin sınırlı T2 heterojen hiperintens, T1 hipointens, periferinde hemo-rajik odakların izlendiği, kontrastlı hetreojen tutulumunun izlendiği ve diffüzyon kısıtlamayan lezyon olduğu görüldü. Solda parauterin vasküler yapılarda belirginleşmiştir ve sol ovarian ven dilatedir. Komşu yapılardaki dilatasyon ve yerleşim yerinin insizyon hattında olması Uterin AVM tanısını koydurmuştur. Tedaviye yanıtsız anormal uterin kanaması olan ve özgeçmişte cerrahi işlem varsa uterin arteriovenöz malformasyonlar akılda tutulmalıdır. Ultrasonografide anekoik, tortuöz görünümlü alan AVM’nin damar paketini temsil etmektedir. USG ile tanı konulamayan veya şüphede kalınan durumlarda noninvaziv ve radyasyon içermeyen bir tetkik MRI tanıda iyi bir yol göstericidir.

P - 022

MEME KANSERİ OLGUSUNDA HEPATOPORTAL SKLEROZ: MRG BULGULARELİF KARADELİ 1, GÜRCAN ERBAY 1, BURÇAK ÇAKIR PEKÖZ 2, FAZİLET KAYASELÇUK 1 1Başkent Üniversitesi Adana Hastanesi, Adana, Türkiye2Adana Şehir Hastanesi, Adana, Türkiye

Özet

Amaç: Hepatoportal skleroz nadir bir hastalık olup nonsirotik portal hipertansiyonun nedeni olarak bilinmektedir. Etyolojisi henüz anlaşılama-makla birlikte, altta yatan protrombotik durumlar, antiviral tedaviler ve HIV suçlanmaktadır. Tanı karaciğer biyopsisi ile konur. Histopatolojik incelemede fibrozisin sadece portal traktlar çevresinde olması sirozdan ayrımını sağlar. Bu sunumda portal hipertansiyon bulgularının eşlik etmediği ve tanısı histopatolojik olarak desteklenmiş olan hepatoportal skleroz olgusunun MRG bulgularını sunmayı amaçladık.

Gereç ve Yöntemler: Kırk yaşında kadın hasta meme kanseri nedeni ile üç yıldır hastanemizde takip edilmekte idi. Kontrol abdomen ultraso-nografi incelemesinde karaciğerde fokal lezyon saptanmdı. Metastazı ekarte etmek amacıyla MRG ile tetkik edildi. Sağ lobda T2 ağırlıklı seriler-de hiperintens, T1 ağırlıklı seride hipointens, intravenöz kontrast madde verilmesini takiben homojen kontrastlanma gösteren lezyon izlendi. Difüzyon MRG’de hafif derecede difüzyon kısıtlaması eşlik etmekteydi. Primer meme kanseri nedeni ile metastaz ekarte edilemedi ve lezyondan biyopsi alındı. Histopatolojisi hepatoportal skleroz ile uyumlu bulundu.

Sonuç: Hepatoportal skleroz etiyolojisi bilinmeyen nadir bir hastalık olup nonsirotik portal hipertansiyonun nedeni olarak bilinmektedir. Literatürdeki hepatoportal skleroz olgularının çoğunda kaudat lob hipertrofisi, sağ hepatik lob atrofisi ve splenomegali izlenmiş olup genellikle karaciğer konturlarında nodülarite eşlik etmemektedir. Bu olguların çok azında karaciğerde T2 hiperintens ve kontrastlı serilerde homojen kontrastlanma gösteren fokal lezyonlar bildirilmiştir. Primer meme kanseri nedeni ile tedavi edilen olgumuzda karaciğerde izlenen fokal lezyonun özellikleri literatürde belirtilene uymaktaydı. Olgumuzda portal hipertansiyon bulguları eşlik etmemekteydi. Doxorubicin, endoxan, tamoxifen kullanım öyküsü olan olguda bu ilaçların özellikle de doxorubicinin karaciğerde hasar, skleroz yapabildiği bilinmektedir. Olgumuzdaki bulgunun da öncelikle kemoterapi ilaçlarının yan etkisi olduğunu düşündük.


P - 023

BAŞ BOYUN BÖLGESİ LENFOMALARINDA DİFÜZYON AĞIRLIKLI MR SEKANSLARININ TANIYA KATKISIMEHMET FATİH İNECİKLİ1, FATMA BEYAZAL ÇELİKER1, METİN ÇELİKER1, SİBEL GÖK İNECİKLİ2, ARZU TURAN1 1Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye2Rize İl Sağlık Müdürlüğü, Rize, Türkiye

Özet

Amaç: Baş-boyun kitlelerinde, özellikle erişkinlerde, neoplazik hastalıklar ön plandadır. Baş-boyun kitlelerinde malign-benign ayrımının yapıl-masında görüntüleme yöntemlerinin katkısı yüksektir. Çeşitli Manyetik Rezonans (MR) sekansları ile benign kitleler malign kitlelerden ayırt edilebilmektedir. MR görüntüleme yöntemlerinden biri olan difüzyon ağırlıklı görüntüleme (DAG), su moleküllerinin dokulardaki rastgele hare-ketlerini, mikroskopik difüzyonunu inceleyen fonksiyonel bir yöntemdir. İnsan vücudunda moleküllerin iletilen difüzyonunun ölçülen büyüklüğü ADC (Apparent Diffusion Coefficient – Görünüşteki Difüzyon Katsayısı) olarak bilinir. ADC değeri difüzyonel hareketin hızını ifade eder ve bir dizi difüzyon ağırlıklı MRG görüntüsünde sinyal intensitesi ölçülerek ve hesaplanarak elde edilir. ADC değerinin lezyonun sellüler yoğunluğuna, dokuların mikroyapılarına ve patofizyolojik durumlarına göre değişmesi beklenir. Malign lezyonlar düşük ADC değerleri gösterirken, benign lezyonlarda yüksek ADC değerleri izlenmektedir. Bildiriyi sunmamızdaki amaç, baş boyun bölgelerindeki kitlelerin benign malign ayrımında DAG ve ADC değerlerinin tanıya yaptığı katkıyı ortaya koymaktır.

Gereç ve Yöntemler: Boyunda şişlik nedeni ile başvuran 21 yaşında bayan hasta. Boyun sağ level 2de 3x3 cm boyutunda sert fikse kitlesel lezyon mevcut. Boyun ultrasonografisinde korteksi kalınlaşmış, yağlı hilusu silinmiş lenf nodu olarak tarif edilmiş. Dış merkezde 2 kez ince iğne aspirasyon biyopsisi yapılmış ve süpüratif lenfadenit teşhisi konulmuş. Antibiyotik kullanmasına rağmen şişliği artan hastaya kontrastlı boyun MR tetkiki yapılmış. Sağ servikal zincirde seviye 2de 32x23 mm boyutunda periferal kontrastlanma ve difüzyon kısıtlanması gösteren lenfadenopati izlendi (süpüratif lap?) olarak raporlanmış. Tekrar yapılan ince iğne aspirasyon biyopsisinde Reaktif lenfoid hiperplazi olarak patoloji tarafından rapor edilmiş. Hastaya merkezimizde kontrastlı boyun MR ve difüzyon MR tetkiki yapıldı. DAG’lerde b: 0sn/mm2, b: 1000sn/mm2, b: 2000 sn/mm2 ve b: 3000 sn/mm2değerleri kullanıldı. Sağ zon 2A’da lobule konturlu, T1A’da hipointens, T2A’da hiperintens, intravenöz kontrast kullanımı sonrası periferal kontrastlanma gösteren, DAG’lerde b: 1000sn/mm2 imajlarda hiperintens izlenen lezyon, b: 2000 sn/mm2 ve b: 3000 sn/mm2 değerlerinde de hiperintens izlenmekteydi. ADC değerleri 0,433 x10-3 mm2/sn gibi çok düşük ölçüldü. Difüzyon kısıtlanması çok belirgindi. İlgili klinisyene, MR verilerine göre kitlenin yüksek olasılıkla lenfoma gibi malign neoplastik bir lezyon olduğu, multiple odak kesici iğne biyopsi ya da eksizyonel biyopsi yapılması gerektiği ifade edildi. Kitle total eksize edildi. Tanı “Yüksek dereceli atipik lenfoid proliferasyon, Burkitt Lenfoma” olarak geldi. Hastaya uygun tedavi yapıldı.

Sonuç: Tümör dokusu gibi yüksek hücre yoğunluğuna sahip dokularda su moleküllerinin hareketi daha çok kısıtlanmıştır. Genellikle büyük nük-leuslu ve hipersellüler malign tümörlerde su moleküllerinin difüzyonu zorlaşır ve bu lezyonlar daha düşük ADC değerleri gösterir. Baş-boyun bölgesindeki malign lenfomaların ortalama ADC değerlerinin karsinomlara göre belirgin düşüktür. Boyun kitlelerinde ADC değerleri tanıda yardımcı olabilir. Baş-boyun lezyonlarının görüntülemesinde rutin protokollere difüzyon görüntülemenin eklenmesi, lezyonların değerlendiril-mesinde ve ayırıcı tanısında katkı sağlar.

P - 024

YÜZDE AV-MALFORMASYONHÜSEYİN ALPER KIZILOĞLU, HASAN OGÜN ÖZDEMİR, HAYRİ OĞUL


Özet

Giriş: Vasküler anomaliler konusunda günümüze kadar değişik açılardan sınıflamalar yapılmıştır. Bunlar arasında anatomopatolojik veya embir-yolojik sınıflamalar yapılmış. Anomalilerin mikroskop altında kanal yapıları incelenerek anatomopatolojik sınıflama yapılmıştır. Eskiden bütün vas-küler anomaliler hemanjiom olarak değerlendirip sınıflandırılırdı. Günümüzde; hemanjiom ve valküler malformasyon olarak genel sınıflandırma yapılmaktadır. Radyolojik olarak farkları hemanjiom lobüle yapıdadır genelde, vasküler malformasyonlar çeşitli anjiografik bulgular sergilemek-tedir. Vasküler malformasyonlar, embiryonik devrenin 4-10. haftalarında oluşan morfojenik proçesler sırasındaki hatalar sonucu oluşan yapısal anormalliklerdir. Bu anormallikler, nadir olup, genellikle nonfamilyaldir. Çoğunluğu doğum sırasında belirgin olmayıp, yıllar sonra ortaya çıkar. Arteriovenöz malformasyonlar yüksek akımlı vasküler malformasyonlar başlığı altında incelenir ve en sık bizim olgumuzda olduğu gibi baş-boyun bölgesinde izlendir. Biz de olgumuzda baş-boyun bölgesine yerleşimli demonstratif MRA görüntüsünü sunmayı amaçladık.

Olgu Sunumu: 20 yaşında bayan hasta yüzde şişlik ön tanısıyla sonografik muayene sonrası vasküler malformasyon ön tanısıyla karotis-vertebral arter MRA çalışması yapılıyor. USG de tübüler anekoik yapılar ve renkli doppler incelemede yapıların vasküler komponente ait olduğu; ancak vasküler yapıların orjinleri saptanamıyor. Şekilde izlenen bukkal bölge üzerinde kontrastlanan vasküler yapılar sol a. carotis internadan perfüze olduğu ve drenajının v. jugularis eksternaya ait olduğu izleniyor. Sağ tarafta eksternal juguler vende kontrast izlenmezken solda erken venöz drenajı yansıtır kontrastlanma izlenmektedir. Tariflenen MRA bulguları yüzde AVM için yüksek spesifitededir.


Sonuç: En sık görülen vasküler lezyonlar hemanjiomlardır. Tüm olgular göz önüne alındığında vakaların %32’si yüzeyel hemanjiom, %14’ü derin hemanjiom, %14’ü mikst hemanjiom idi. Hemanjiomlarda Kadın/Erkek oranı 2,33 iken, vasküler malformasyonlarda 1,22 idi. Vasküler anomali terimi, normal kutanöz vaskülarizasyonun dışında kalan anormal vasküler yapılanmalar için kullanılmaktadır. Bunlar konjenital yada akkiz olabilir. Geçmişte hemanjiom terimi tüm konjenital yada edinsel vasküler lezyonların tanımlanmasında kullanılmış, ancak bu yanlış alışkanlık tedavide de yanlışlıklara neden olmuştur. Vasküler malformasyonlar, vasküler morfogenezdeki hatalar sonucu oluşur. Hücresel hiperplazi yoktur. Damarlarda progresif ektazi gö rülür. Hemanjiom - vasküler malformasyon ve vasküler malformasyonları subtiplerine ayırmada radyoloji önemli yer tutmak-tadır, Preauriküler alan veya servikal bölge gibi yerlerde derin hemanjiomla lenfatik veya venöz malformasyonun ayrılması zor olabilir. Kontrastlı bilgisayarlı tomografi ile proliferatif fazdaki hemanjiom iyi sınırlı homojen dansiteler şeklinde görülürken involüsyon fazında yoğun dansite ve lobüler yapıda görülür. Venöz anomalilerde genellikle kalsifikasyonlar bulunur. Pür lenfatik anomaliler septalarla bölünmüş multiloküler kistler şeklinde görülür. İskelet deformiteleri hemanjiomlarda nadiren görülür. Kemik hipertrofisi ve distorsiyonlar lenfatik ve venöz malformasyonlar için daha tipiktir.

P - 025

BAŞ BOYUN DERİSİNDEKİ SKUAMÖZ HÜCRELİ KANSERİN PAROTİS BEZİNE DİREK İNVAZYONUMERİÇ TÜZÜN, BAKİ HEKİMOĞLU

Sağlık Bilimleri Üniversitesi Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye

Özet

Baş boyun deri skuamöz hücreli kanserlerinin parotis bezine metastazı genellikle lenf nodları şeklinde olur. Parotis bezine direkt invazyonu ise çok nadir görülür. Bu olgu sunumunda, 64 yaşındaki bir erkek hastada, cilt ve cilt altı dokuyu tutan, komşuluğundaki parotis bezine infiltrasyon gösteren bir skuamöz hücreli kanser olgusu manyetik rezonans görüntüleme bulguları ile sunulmaktadır. Anahtar kelimeler: Skuamöz hücreli kanser, parotis bezi, deri, manyetik rezonans görüntüleme

P - 026

GLOMUS KAROTİKUM MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI: NADİR SPORADİK BİLATERAL GLOMUS KAROTİKUM OLGUSUMÜCAHİT DOĞRU, GİZEM ABACI, TUĞBA İLKEM KURTOĞLU ÖZÇAĞLAYAN, ÖMER ÖZÇAĞLAYAN

Namık Kemal Üniversitesi, Tekirdağ, Türkiye

Özet

Giriş: Glomus karotikum karotid bifurkasyonunda yerleşim gösteren nöroektodermal hücrelerden kaynaklanan nadir bir baş boyun tümörüdür. Sporadik formda glomus karotikum tümörlerinde bilateral izlenme oranı düşüktür. Radyolojik tanısı sıklıkla ultrasonografi, kontrastlı boyun bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) görüntüleme ile konulmaktadır.

Olgu Sunumu: Olgumuzda 72 yaşında kadın hasta, üç senedir süren tek taraflı boyunda şişlik şikayeti ile tarafımıza sonografi tetkiki için başvur-du. Hastanın yapılan ultrasonografisinde her iki karotid bifurkasyonunda internal ve eksternal karotis arterlerinde ayrışmaya neden olan kitle lezyon görünümleri izlendi. Hastanın kontrastlı boyun MR incelemesinde karotid bifurkasyon düzeyinde sağda 35x25 mm ve solda 10x8 mmlik yoğun kontrastlanma gösteren radyolojik olarak glomus karotikum ile uyumlu kitle lezyon görünümleri izlendi. Hasta kulak burun boğaz kliniği tarafından opere edildi ve patolojik tanısı paraganglioma ile uyumlu olarak raporlandı.

Sonuç: Sporadik formdaki glomus karotikum vakalarının %5’inden azında bilateral tümör izlenirken, ailesel formda bilateral tümör oranı yaklaşık %35 oranındadır. Sonuç olarak sporadik vakalarda nadir de olsa bilateral olabileceği akılda bulundurulmalıdır. Ayrıca literatürde bilateral vaka-larda sonografi ve kontrastlı BT görüntüleri sık olmasına rağmen MR görüntüleme bulgularına daha az sıklıkta rastlanmaktadır. Bizim vakamızda literatür eşliğinde MR görüntüleme bulguları üzerinde durulmuştur.

P - 027

NADİR BİR OLGU: EKSTERNAL JUGULAR VEN İLE İLİŞKİLİ VENÖZ MALFORMASYONAYSUN ÇAKIR, YELİZ PEKÇEVİK, HİLAL ŞAHİN, ASLI IRMAK BİRANCI, TUĞÇE HANCIOĞLU

Sağlık Bilimleri Üniversitesi, İzmir Tepecik Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İzmir Türkiye


Özet

Amaç: Vasküler malformasyonlar yavaş akımlı ve hızlı akımlı malformasyonlar olarak 2 grupta toplanır. Yavaş akımlı vasküler malformasyonlar; kapiller, venöz, lenfatik, mikst tip iken hızlı akımlı malformasyonlar; arteriyovenöz fistül, arteriyovenöz malformasyondur. Venöz malformasyonlar en sık görülen vasküler malformasyonlardır ve %40 baş-boyun bölgesinde, %40 ekstremitelerde görülür. Bu lezyonlar genelde asemptomatik-ken, ağrı, şişlik, kozmetik problemlere sebep olabilir. Eksternal juguler ven (EJV) kaynaklı venöz malformasyon oldukça nadirdir. Bu bildiride EJV kaynaklı venöz malformasyon tanısı alan olgunun görüntüleme özellikleri tartışılmıştır.

Bulgular: Boyun sağ yarısında lokalize şişlik sebebiyle başvuran 21 yaşındaki kadın hastaya yapılan doppler ultrasonografik incelemede boyun sağ seviye 5Bde cilt altında EJVe yakın komşuluk gösteren içinde vasküler akımın izlendiği komprese olabilen 16x10x18 mm boyutlarında kitlesel oluşum izlenmiştir. Yapılan kontrastlı boyun MRG tetkikinde aynı lokalizasyonda T2Ada belirgin hiperintens, postkontrastlı T1A görüntülerde belirgin kontrastlanan venöz malformasyonla uyumlu lezyon izlenmiştir. Lezyon EJVe bitişik olup EJV ile ilişkili venöz malformasyon lehine değer-lendirilmiştir.

Sonuç: EJV ile ilişkili venöz malformasyonlar çok nadir olmakla birlikte EJVe bitişik komprese olabilen vasküler lezyon varlığında ayırıcı tanıda düşünülmelidir.

P - 028

NADİR BİR OLGU SUNUMU: DERİN VEN OKLÜZYONUNA BAĞLI GELİŞEN TALAMİK ENFARKTMERAL BÜYÜKTERZİ, VEFA ÖNER, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN

Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye

Özet

Giriş: Serebral venöz tromboz daha sıklıkla transvers sinüs, sigmoid sinüs ve süperior sagittal sinüslerde görülmektedir. Derin venöz sistem trombozları çok daha nadir olarak saptanmakta ve prognozu daha kötü seyretmektedir. Bu nedenle derin venöz trombozunun erken tanısı ve tedavisi çok önemlidir. Bu olgu sunumunda derin venöz tromboz nedeni ile takip edilen bir hastanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık.

Olgu: 15 yaşında erkek hasta akut gastroenterit ve buna bağlı gelişen dehidratasyon nedeni ile hastanemizin pediatri bölümüne başvurdu. Pediatri servisinde takip edilen hastada ani gelişen baş ağrısı nedeni ile hastaya beyin MRG ve MR venografi tetkikleri uygulandı. MR venografi tetkikinde inferior sagittal sinüs, gelen veni, straight sinüs, sol transvers ve sol sigmoid sinüste akut tromboz ile uyumlu sinyal kaybı izlendi. Difüzyon ağırlıklı MRG tetkinde sağ talamusta ve beyaz cevher içerisinde milimetrik çaplı akut enfarkt ile uyumlu diffüzyon kısıtlaması gösteren alanlar saptandı.

Tartışma: Derin venöz trombozun etyolojisinde hiperkoagülasyon bozuklukları, oral kontraseptif kullanımı, gebelik, malignensi, dehidratasyon ve enfeksiyon gibi birçok faktör rol oynamaktadır. Derin venöz venler derin beyaz cevher, talamus ve bazal ganglionların drenajında rol oyna-maktadır. Bu nedenle derin venöz tromboz gelişen hastalarda bu alanlarda venöz enfarkt bulguları daha çok ortaya çıkar. MRG ve MR venografi bu hastaların erken tanısında en önemli görüntüleme yöntemleridir.

P - 029

NADİR BİR OLGU SUNUMU: HİPOTALAMİK HAMARTOM MANYETİK REZONANS GÖRÜNTÜLEME BULGULARISERDAR ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MERAL BÜYÜKTERZİ, HASAN ERDOĞAN, MEHMET SEDAT DURMAZ, İSMET TOLU


Özet

Giriş: Hipotalamik hamartomlar veya diğer adıyla tuber sinerum hamartomları ventral hipotalamusun nadir görülen konjenital malformas-yonlarıdır. Radyolojik olarak sesil veya pedinküllü olarak iki şekilde görülebilmektedir. Sesil olan tipleri mamiller bölge ile ilişkilidir ve forniks anterolaterale yer değiştirebilir. Pedinküllü olan tip ise tuber sinerum ile ilişkilidir ve suprasellar sisterne uzanım gösterir. Bu olgu sunumunda hipotalamik hamartom nedeni ile takip edilen bir hastanın manyetik rezonans görüntüleme (MRG) bulgularını sunmayı amaçladık.

Olgu: 10 yaşında kadın hasta hastanemizin pediatri bölümüne erken telarş ve pubik ve aksiller tüylenme şikayetleri ile başvurdu. Puberte pre-koks ön tanısı ile hastaya uygulanan beyin ve hipofiz MRG tetkiklerinde infindubulum proksimalinde, sol lateral yerleşimli T1 ve T2 ağırlıklı seri-lerde serebral korteks ile izointens, düzgün konturlu, kontrast madde tutulumu göstermeyen hipotalamik hamartom ile uyumlu lezyon saptandı.

Tartışma: Hipotalamik hamartomlar epilepsi, görme problemleri, puberte prekoks ve davranış bozuklukları gibi klinik problemlere yol açabi-lirler. Bu hastalarda puberte prekoks çok sıklıkla görülmekte olup Gonadotropin-releasing hormone (GnRH) hormonun aşırı salınımına bağlı


oluşur. Hipotalamik hamartomlar diğer hipotalamo-hipofizer bölge tümörleri ile karışabilmektedir. Radyolojik olarak T1 ve T2 ağırlıklı serilerde serebral korteks ile izonintens olması ve kontrast madde tutulumu göstermemesi diğer lezyonlardan ayırımında önemlidir. MR spektroskopide NAA/Cr oranında azalma ve mI pikinde artış saptanabilir.

P - 030

GLOMUS KAROTİKUM: MRG BULGULARIHASAN ERDOĞAN, FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN, İSMET TOLU


Özet

Paraganglioma olarak da bilinen glomus tümörleri, nöral krest kaynaklı yavaş büyüyen, oldukça vasküler, nadir görülen tümörlerdir. Baş-boyun tümörlerinin %0,6sını oluşturan bu tümörlerden en sık görüleni glomus karotikumdur. Glomus karotikum, karotid bifurkasyoda yerleşim göste-rir. Bu tümörleri göstermede kontrastlı manyetik rezonans görüntüleme (MRG)nin duyarlılık ve özgüllüğü oldukça yüksektir. Bu sunumda glomus karotikum tümörü olan 81 yaşındaki kadın olgunun MRG bulguları sunulmuştur.

P - 031

SUPRASTERNAL YERLEŞİMLİ NADİR BİR KUTANÖZ BRONKOJENİK KİST OLGUSUSEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, HASAN ERDOĞAN, ZEYNEP ARSLAN, MERAL BÜYÜKTERZİ


Özet

Bronkojenik kistler embriyonik dönemde trakea divertikülünün anormal tomurcuklanmasıyla oluşan trakeobronşiyal sistemin gelişimsel bir malformasyonudur. Sıklıkla akciğer parankimi veya mediastende yerleşirler. Kütanöz veya subkütanöz bronkojenik kistler daha çok çocukluk döneminde görülen nadir bronkojenik kist tipidir. Kutanöz bronkojenik kistler için en sık yerleşim yerleri olarak suprasternal ve presternal bölgeler bilinmektedir. Genellikle asemptomatik eleve papüller şeklindedir. Biz de sol suprasternal yerleşimli nadir kutanöz bronkojenik kist vakasını sunmayı amaçladık. 8 yaşında boyun sol yarısında ağrısız şişlik ile gelen hastaya yapılan US incelemede tiroid bezi sol lob anteriorunda yerleşimli, retrosternal uzanımı bulunan, superiorda SCM kası ile yakın komşuluğu bulunan 2,5 cm çapında lobüle konturlu yoğun içerikli kistik lezyon izlendi. Çekilen boyun MRG incelemde sol sternoklavikular eklem superiorunda, tiroid sol lobu anteroinferior kesimi lateralinde, sup-raklavikular alana uzanımı izlenen juguler ven hemen anteriorunda, komşu kas yapıları posteriora yaylandıran, cilt altında yerleşimli kontrast-lanma ve difüzyon kısıtlaması göstermeyen, 2x2,5 cm boyutunda kistik lezyon saptandı. Hastanın yaşı ve kistik lezyonun yerleşimi göz önünde bulundurulduğunda ayırıcı tanıda öncelikle 3 veya 4. brankial kist düşünüldü, ancak görüntüleme yöntemleri ile fistül traktı saptanamadı. Hastaya tanı ve tedavi amaçlı cerrahi işlem uygulandı. Kisint total eksizyonu sonrası hasta şifa ile taburcu edildi. Patolojik incelemesi bronkojenik kist ile uyumlu geldi. Hastaya ek bir tedavi önerilmedi. Bronkojenik kistler çoğunlukla mediastinal ve akciğer parankiminde yerleşim göstermekte olup kutanöz ve boyun bölgesinde nadir de olsa saptanabilmektedir. Yaş grubu ile birlikte değerlendirildiğinde boyun bölgesinde konjenital lezyonlar açısından başta brankial yarık kisti, timik kist, tiroid kisti, tiroglossal kanal kisti, epidermal inklüzyon kisti ve kistik higroma gibi diğer lezyonlar ayırıcı tanıda düşünülmelidir.

P - 032

DİSFAJİNİN NADİR BİR SEBEBİ OLARAK DİFFUSE IDİOPATHİC SKELETAL HYPEROSTEOSİS; OLGU SUNUMUMEHMET SEDAT DURMAZ, SEDA SOĞUKPINAR KARAAĞAÇ, ZEYNEP ARSLAN, HASAN ERDOĞAN, SERDAR ARSLAN, İSMET TOLU

Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Birimi, Konya, Türkiye

Özet

Diffüz idiopatik iskelet hiperostozu (DISH) ligamanlar ve entezis gibi yumuşak dokuların kalsifikasyonu ve ossifikasyonu ile karakterize bir hastalıktır. 50 yaş üstü ve erkeklerde daha sık görülen, etyolojisi bilinmeyen, özellikle torakal vertebralarda intervertebral disk yüksekliğinin


korunarak vertebraların anterior ve sağ lateral kesimlerindeki kaba ve ardışık tarzdaki ossifikasyonları ile karakterize bir hastalıktır. DISH’te en sık karşılaşılan semptomlar omurgada ağrı ve sertlik, hareket kısıtlılığı ve nadiren özofagus kompresyonuna bağlı yutma zorluğudur. Bu sunumda yutma zorluğuna neden olan DISH’in servikal MRG bulgularını sunmayı amaçladık.

Boyun ağrısı ve yutma zorluğu semptomları gelen 61 yaşındaki erkek hastaya direkt iki yönlü servikal grafi ve servikal MRG çekildi. Hastanın bilinen romatolojik hastalığı ve travma öyküsü yoktu. Boyun hareketlerinde kısıtlılık mevcuttu. Çekilen iki yönlü servikal direkt grafide servikal eklem aralıklarında daralma, eklem yüzlerinde subkondral skleroz anteriorda daha belirgin olmak üzere eklem köşelerinde dejeneratif osteofitik sivrileşmeler mevcuttu. MRG incelemede servikal vertebraların korpus anterior köşelerinde izlenen osteofitlerde köprüleşme, ardışık ligamen-töz kalsifikasyonlar mevcut olup özefagusa belirgin bası izlendi.

Sonuç olarak, DISH’te alt torasik vertebra tutulumu tipiktir ancak servikal tutulum da olabilir. Tutukluk, hareket kısıtlılığı, ağrısı, gibi semptomların yanı sıra servikal tutulum olan olgular yutma güçlüğü şikayeti ile de başvurabilir. Yutma zorluğu ile gelen olgularda ayırıcı tanılar arasında düşünülmelidir. Tanıda iki yönlü vertebra grafisi genellikle yeterlidir ancak MRG ile vertebra anterior komşuluklukları-na uzanım, bası daha net bir şekilde değerlendirilebilir. Bu hastalarda direkt grafi sonrasında ilk tercih edilmesi gereken görüntüleme yöntemi MRG olmalıdır.

P - 033

BİLATERAL, DERİN VE YÜZEYEL SERVİKAL BÖLGE YERLEŞİMLİ MULTİPLE HEMANJİOMLAROKAN DİLEK, SEVGİ MUTLU, KERİM ÇALAR

Sağlık Bilimleri Üniversitesi, Gaziantep Dr. Ersin Aslan Eğitim ve Araştirma Hastanesi, Gaziantep, Türkiye

Özet

Yumuşak doku hemanjiyomları benign histolojik kökenli yaygın neoplazmlardır. Anjiyomatöz lezyonların en sık görülenleridir ve genel popülas-yondaki tüm yumuşak yumuşak doku tümörlerinin% 7sine kadarını temsil ederler. Kadınlar erkeklerden daha sık etkilenir. Yerleşim yerlerine göre yüzde 50-60 ı baş boyun, yüzde 25’ i gövde ve yüzde 15 i ekstremite yerleşimlidir.Bizim olgumuzda 29 yaşında kadın hastada yüzeyel ve derin servikal yerleşimli, bilateral, multiple hemanjiomlar izlendi. Nadir görülen bu vaka literatür bilgiler eşliğinde tartışılacaktır.

P - 034

SİNONASAL NÖROENDOKRİN KARSİNOM OLGUSUNDA MRG, DİFÜZYON MRG VE BT BULGULARIMERT BAYRAMOĞLU1, TÜLİN YILDIRIM1, FULDEM YILDIRIM DÖNMEZ1, FERİDE KURAL1, IŞILAY ÖZ2, SELİM SERMED ERBEK2

1Başkent Üniversitesi Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye2Başkent Üniversitesi Hastanesi, Kulak Burun Boğaz Anabilim Dalı, Ankara, Türkiye

Özet

Sinonazal trakt kaynaklı nöroendokrin tümörler nadir görülen tümörlerdir. Tüm sinonazal malign tümörlerin %5’ini oluştururlar. Lokal agresif ve rekürren seyir gösterirler. Kötü prognozlu bu tümörlerin tedavisinde cerrahi tedavi sonrası kemoterapi ve radyoterapi uygulanır. Bu sunumda etmoid sinüsden kaynaklanan; paranazal sinüslere, orbitaya ve anterior kranial fossaya uzanım gösteren sinonazal nöroendokrin tümörün MRG, difüzyon MRG ve BT bulguları tartışılmıştır.

P - 036

NADİR BİR OLGU, AKCİĞER PARANKİMAL CASTLEMAN HASTALIĞIFATMA DURMAZ 1, MESUT ÖZGÖKÇE 1, HARUN ARSLAN 1, ADEM YOKUŞ 2, İBRAHİM AKBUDAK 3, ALİ MAHİR GÜNDÜZ 1

1Van Yüzüncüyıl Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Van, Türkiye2Sağlık Bakanlığı Üniversitesi,Van Eğitim ve Araştırma Hastanesi, Van, Türkiye3Batman Bölge Devlet Hastanesi, Batman, Türkiye


Özet

Amaç: Castleman hastalığı (CH), anjiyofolliküler lenf nodu hiperplazisi ya da dev lenf nodu hiperplazisi olarak da bilinen nadir görülen etiyolojisi bilinmeyen bir lenf nodu hastalığıdır. Hastalığın hiyalin vasküler, plazma hücreli ve mikst olmak üzere üç histolojik tipi vardır.En sık mediastende yerleşir.Ekstranodal tutulum nadirdir. Bu çalışmamızda nadir yerleşim yeri olarak akciğeri tutan Castleman Hastalığı olan bir olgunun BT ve MRG bulgularını sunmayı amaçladık.

Gereç ve Yöntemler: 20 yaşında bayan hasta, öksürük şikayeti nedeniyle çekilen PA akciğer grafisinde sağ parahiler opasite saptandı. Kliniğimizde yapılan kontrastlı Torax BT ve MR incelemesinde sağ akciğer alt lob anteriorda parahiler alanda düzgün sınırlı, MR’da T1 ve T2’de kasa göre izo-hiperintens, IVKM sonrası yoğun homojen kontrastlanan kitle lezyon izlendi. Mediastinal LAP yada ek bulgu saptanmadı.Eksizyonel biyopsi sonucu hyalin-vasküler tip CH olarak raporlandı.

Tartışma: CH nadir görülen etyolojojisi bilinmeyen lenfoproliferatif bir hastalıktır.Non-neoplastik lenfadenopatinin sık nedenlerinden biridir.Çoğunlukla insidental olarak saptanır.Tipik olarak mediastinal lenf nodlarını etkilemekle beraber intraabdominal,pelvik,aksiller, boyun lenf nodları da tutulabilir.Ekstranodal olarak akciğer,larinks,parotis,pankreas,meninksler ve kaslarda görülebilir ve olguların sadece %5’ini oluşturur.Morfolojik olarak lokalize ve multisentrik, histolojik olarak hyalin-vasküler, plazma hücreli ve miks tip olarak sınıflandırılır.En sık görülen (%90) lokalize hyalin vasküler tiptir.Multisentrik olguların çoğu HIV ve HHV-8 ilişkili olup kaposi sarkomu ve lenfoma gelişimi açısından yüksek risk taşırlar. Görüntülemede kontrast sonrası hyalin vasküler tipte vasküler yapı yoğunluğu nedeniyle yoğun kontrastlanma izlenir.

Sonuç: Castleman hastalığı tuttuğu bölgeye göre birçok hastalığı taklit edebilir.Bizim olgumuzda olduğu gibi akciğeri tutmuşsa adenokanser ile karışabilir.Akciğerde solid lezyonların ayırıcı tanısında düzgün sınırlı, özellikle de belirgin kontrast tutan kitlelerde castleman hastalığı akılda tutulmalıdır.

P - 037

İNTRAAKSİYEL VEYA EKSTRAAKSİYEL LEZYONLARIN ORJİNİNİN BELİRLENMESİNDE MR TRAKTOGRAFİGÖKHAN POLAT, HAYRİ OĞUL, RECEP SADE, SUAT EREN, AKIN LEVENT, MECİT KANTARCI

Atatürk Üniversitesi Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye

Amaç: Biz çalışmamızda intrakranial kitlelerin intraaksiyel veya ekstraaksiyel yerleşiminin belirlenmesinde MR traktografi etkinliğini değerlen-dirmeyi amaçladık.

Gereç ve Yöntemler: Hastanemizde haziran 2014- mart 2015 tarihleri arasında intrakranial kitle tanısıyla opere edilecek hastalar seçilmiştir. Hastaların lezyonlarının intraaksiyel veya ekstraaksiyel orjin açısından şüpheli bulunan ve konvansiyonel MR yöntemleri ile net ayrımı yapılamayan hastalar çalışmaya dahil edilmiştir. Hastalara operasyon öncesi 3 Tesla MR (Siemens Magnetom Skyra Erlangen/Germany) cihazı ile MR traktog-rafi çekimi yapılmıştır. MR traktografi tetkikleri 2 radyolog tarafından değerlendirilmiştir.

Bulgular: MR Traktografi beyin parankiminde seyir gösteren yolakların gösterilmesinde kullanılan bir yöntemdir.Çalışmamızda intraaksiyel yerle-şimli lezyonların içine doğru bu yolakların devam ettiği görülürken ekstraaksiyel yerleşimli lezyonların bu yolakları ittiği izlenmiştir.

Sonuç: İntraaksiyel ve ekstraaksiyel lezyonların yerleşim yerinin belirlenmesinde MR Traktografi özellikle şüpheli lezyonlarda operasyon öncesi faydalıdır. Kitle ayırıcı tanıları ve operasyon planlaması için oldukça faydalıdır.

P - 038

PRİMER SANTRAL SİNİR SİSTEMİ LENFOMASIGÖKHAN POLAT, HAYRİ OĞUL, RECEP SADE


Özet

Giriş: Primer santral sinir sistemi lenfoması ekstrakraniyal bir hastalık olmaksızın nöral parankimde lenfoma gelişmesi demektir ve tanı konması daha zordur. Primer SSS lenfomaları daha çok immün sistemin bozuk olduğu durumlarda gelişirken sporadik olarak da görülebilir. Primer SSS lenfoması nonglial primer beyin tümörleri içinde ‘’hemopoietik’ ’ tümörler grubunda yer alan nadir bir tümördür. Tüm SSS tümörlerinin yaklaşık %1’ini oluşturur .Bu tümörler B lenfosit kökenli Non-Hodgkin lenfoma grubunda yer alır.

Olgu: 67 yaşında erkek hastanın departmanımızda yapılan beyin MRG ve BT tetkikinde her iki hemisfere uzanan yer kaplayıcı kitle lezyon izlen-mektedir.Hastaya çekilen PET CT de primer SSS lenfoma tanısının doğrulanması için başka odak izlenmediği görüldü.

Tartışma: Primer SSS lenfoması nadir görülen beyin tümörleridir. Hastaların yarısında fokal nörolojik defisitler ortaya çıkmaktadır. Primer SSS lenfomasında beyin en çok tutulan yerdir.Bazende göz, meninksler ve omurilik tutulabilir. Beyinde multipl tutulum sıktır fakat immün sistemin durumuna göre tek lezyonda izlenebilir. Primer SSS lenfomasında kontrastlı kraniyal MR inceleme tanıda en önemli tetkiktir.Beyinde en çok


bazal ganglionlar, periventriküler bölge ve korpus kallozum tutulması tipiktir.MRS kolin/kreatinin ve kolin/NAA oranında belirgin artış izlenir.Kranial BT de de hiperdens kitlenin görülmesi tanıyı destekler. MRG ve BT bulguları ile nadirde olsa primer SSS lenfoması beyin kitlelerinde ayırıcı tanıda düşünülmelidir.

P - 039

SİSTEMİK LUPUS ERİTAMATOZUS ABDOMİNAL DUVAR TUTULUMUFAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI

Atatürk Üniversitesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye

Özet

Giriş: Sistemik lupus eritomatozis etiyolojisi bilinmeyen multipl organ ve sistem tutulumu yapabilen kronik otoimmün bir hastalıktır. Kadınlarda erkeklere oranla 8-10 kat daha sık görülmektedir. Malar raş, diskoid döküntü, fotosensitivite, alopesi, polartrit, sitopeni, proteinüri gibi bulgular hastalığın klasik bulguları arasındadır.

Olgu: 21 yaşında kadın hasta karın ağrısı şikayeti ile romatoloji kliniğine başvurdu. Sistemiklupuseritamatozus tanısı ile takipli olan hastanın MR incelemesinde abdominal duvarda ödematoz sinyal değişiklikleri izlendi.

Tartışma: SLE intestinal, üriner, kardiyovasküler, respiratuar, hematolojik sistem gibi farklı sistemleri tutabilir. Trombositopeni, anemi, artrit gibi bulguların yanında peritonit gibi serözit tablosu ile kendini gösterebilir. MR inceleme de özellikle T2 gibi sıvı duyarlı sekanslarda sinyal artışları serözit gibi inflamatuar hadiseleri saptamada duyarlıdır. Bizim vakamızda da daha az sıklıkla görülen abdominal ön duvar tutulumu MR incelemede izlenmektedir.

P - 040

MULTİPL ORGAN TUTULUMU GÖSTEREN OD POLİKİSTİK BÖBREK HASTALIĞIFAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Polikistik böbrek hastalığı son evre böbrek yetmezliğine ilerleyen sık görülen herediter bir hastalıktır.Hastalık sadece böbrekleri etkileme-mekte ve bir çok organda veya vücudun herhangi yerinde multipl kistlere neden olabilmektedir. Polikistik böbrek hastalığı otozomal dominant veya resesif polikistik böbrek hastalığı, multikistik displastik böbrek ya da sistemik bir hastalığın parçası olarak farklı tablolar ile ilişkili olabil-mektedir. Polikistik böbrek hastalığı yüksek kan basıncı, sırt ağrısı, hematüri gibi klinik tablolarla sıklıkla ilişkili olabileceği gibi uzun süre boyunca asemptomatik de seyredebilir.

Olgu: 68 yaşında bilinen kronik böbrek hastalığı nedeni takip edilen hasta karın ağrısı yüksek ateş gibi şikayetlerle hastanemize başvuruyor. Hastanın elde olunan MR incelemelerinde batında yaygın kistlerin olduğu izlenmektedir.

Tartışma: Polikistik böbrek hastalığı kadın ve erkekte eşit sıklıkta görülen ve milyonlarca kişiyi etkileyen bir hastalıktır. Hastalar ortalama 55 yaşında son dönem böbrek hastalığına ilerlemektedir. Erken yaşta ortaya çıkan hipertansiyon, hematüri veya proteinüri gelişimi, böbreklerde genişleme ve erkek cinsiyet gibi etkenler hastalığın son dönem böbrek hastalığına ilerlemesi açısından predispozan nedenlerdir. Vakamızda elde olunan MR görüntülerinde batın içinde yaygın farklı sayı ve ebatlarda kistler oldukça demonstratif şekilde izlenmektedir.

P - 041

OLDUKÇA NADİR BİR VAKA: İNVERTED İNTERKOSTAL HERNİFAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Giriş: İnterkostal herniler oldukça nadir görülen hernilerdir. Etiyolojisinde büyük oranda travma ve geçirilmiş torakal cerrahiler bulunmaktadır. İnverted interkostal herni genellikle dispne, göğüs ağrısı gibi nonspesifik bulgulara neden olmakla birlikte asemptomatik de seyredebilir.

Olgu: 81 yaşında erkek hasta nefes darlığı ve şuur bozukluğu şikayeti ile başvuruyor. Kliniğimizde çekilen toraks BT incelemelerinde toraks sağ lateral duvardan cilt altı dokuların intratorasik alana herniasyonu izlendi.


Tartışma: İnterkostal herniler konjenital veya edinsel (postoperatif-travmatik) gelişebilir. Genellikle postoperatif dönemde torakal duvarın tam kapanmaması sonucu gelişir.Büyük oranda akciğerin interkostal aralıktan toraks dışına herniasyonu görülmektedir. Yumuşak dokuların interkostal aralıktan intratortasik alana herniasyonu ise oldukça nadir görülmektedir. Radyolojik olarak BT ve MR da yumuşak dokuların interkostal aralıktan herniasyonu izlenmektedir.

P - 042

KC TRANSPLANTASYONU SONRASI BİLİER STRİKTÜR VE SAFRA KAÇAĞIMUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, GÖKHAN POLAT, ALPER KIZILOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI

Atatürk Üniversitesi, Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye

Özet

Giriş: KC nakli sonrası bilier komplikasyonlar %6-38 sıklığında bildirilmektedir.Bu olgularda en sık bilier stenoz veya kaçaklar gelişmekte olup bu durum canlıdan yapılan nakil olgularında daha sıktır. Biliyer anastomozlar iskemik hasara çok duyarlıdır. Major safra kanallarına kan desteği hepatik arterin dalları ile sağlandığından hepatik arter trombozu olan bir çok hastada biliyer anastomozun açılması veya iskemik darlıklar nede-niyle biliyer kaçak gelişmektedir. Striktürlerin %20 den fazlasında darlığın hepatik arter trombozu ile ilişkili olduğu, hepatik arter trombozu olan hastaların darlıklar ve retransplantasyon için yüksek risk grubunda olduğu bildirilmiştir. Çoğu biliyer komplikasyonlar; ateş, kolanjit, karın ağrısı gibi enfeksiyöz semptomlarla klinik verirler ve çoğu durumlarda problemi tanımlamak açısından abdominal USG ve diğer noninvaziv görüntü-leme yöntemleri gereklidir.

Olgu: 47 yaşında KC transplantlı erkek hasta ateş ve sağ üst kadran ağrısı ile acil servise başvurdu. Hastaya departmanımızda MRCP planlandı MRCP de anastomoz hattında obstrüksiyon görüldü. Obstruksiyona rağmen intrahepatik safra yollarının belirgin dilate olmaması safra kaçağı şüphesini akıllara getirdi Geç faz abdominal MR görüntülemede hepatosit spesifik kontrast ajan ile safra kaçağı gösterildi.

Tartışma: Noninvaziv görüntüleme yöntemleri (USG, BT, MR ve MRCP) safra yollarında dilatasyon ve intraabdominal mayi koleksiyonu hakkın-da bilgi verir. İntraabominal gaz varlığında veya abdominal ağrı nedeniyle USG’nin sınırlandığı hastalarda abdominal CT veya MR biliyer sistem problemleri hakkında daha fazla bilgi sağlayacaktır. Posttransplant biliyer anatominin MR kolanjiografi ve perkütan transhepatik kolanjiografi ile değerlendirilmesi uygundur. Nakil sonrası geç fazda viral enfeksiyon veya akut selüler rejeksiyonla açıklanamayan biyokimyasal anomalisi olan asemptomatik hastalarda; MRCP nakil sonrası geç biliyer komplikasyonları safra yollarını mükemmel şekilde değerlendirmek suretiyle meydana çıkarır. Noninvaziv yaklaşım bu hastalarda kanama, akut pankreatit ve asendan kolanjit riskini azaltır.

P - 043

KC TRANSPLANTASYONLU HASTADA ALVEOLAR EKİNOKOKUN SEREBRAL METASTAZININ İLERİ NÖROGÖRÜNTÜLEMESİMUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI

Atatürk Üniversitesi Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Erzurum, Türkiye

Özet

Giriş: Echinococcus multilocularis tenyanın larva aşamasından kaynaklanır. Echinococcus multilocularis ve E. granulosus, Türkiyede endemiktir. İnsanlar, ara konakçı olarak hizmet ederler. Yetişkin tenya normalde tilki, çakal ve köpeklerde bulunur Hastalık parazit yumurtalarının ağız yoluyla alınmasıyla elde edilir. Karaciğer hastalığın birincil odak noktasıdır ve serebral lokalizasyon nadirdir (yaklaşık %1) ve genelde ölümcül seyreder. Ekinokokkoz tanısı, görüntüleme teknikleriyle belirlenen lezyon morfolojisine, immünodiagnostik ve diğer laboratuvar testleri ile klinik bulgulara dayanmaktadır. Serebral parazitozlar radyolojik olarak spesifik lezyonlar olarak görülüyor.

Olgu: 1 yıl önce alveolar KC kisti nedeniyle transplant olan 30 yaşında erkek hasta baş ağrısı, ateş ve halsizlik şikayeti ile hastanemize tekrar başvuruyor. Departmanımızda hastaya yapılan ileri nörogörüntüleme yöntemleri sonucunda alveolar kist metastazıyla uyumlu görünümler saptanmıştır.

Tartışma: Serebral lezyonlar soliter ve multifokal olabilir. Genel olarak supratentorial ve orta serebral arter sulama sahasına dağılır. Kranial BT ve MR da solid, semisolid ve multilokuler kist şeklinde görülebilirler. Kalsifikasyon ve perifokal ödem yaygındır. Lezyonların ring-like, heterojen, nodüler ve karnıbahar benzeri kontrastlanma paternleri bildirilmiştir. Kontrastlanma paterni alveolar ekinokoku serebral malignitelerden ve tüberküloz, bakteriyel apseler, mantar enfeksiyonu, toksoplazmoz, sistiserkoz ve kistik ekinokokkoz gibi diğer enfektif serebral hastalıklardan ayırt etmek açısından önemlidir.


P - 044

TORSİYONE MYOMA UTERİEMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Myomlar, düz kastan köken alan kadın genital sistemin en sık rastlanan tümörleridir. Nadiren pedinküllü myomlarda görülen önemli komplikasyonlardan biri torsiyon gelişimidir. Biz 46 yaşında bayan hastada nadir görülen bir torsiyone myom vakasını prezente etmeyi amaçladık

Olgu: 46 yaşında bayan hasta acil servise ani başlayan şiddetli karın ağrısı ile başvurdu. Hastanın BT görüntülerinde pelvik bölgede multiple hipoekoik myoma uturi ve uterus korpusundan bir sap ile ayrılan umblikus superioruna kadar uzanan heterojen hipodens kitle lezyon izlendi. Kitle çevresinde ve pelvik bölgede kirlenme ve mayi mevcuttu. Hastanın eski MR ve BT görüntüleri ile komfirme edildiğinde uterus korpus anteriorundan kaynaklanan MR görüntülerinde T2 AG heterojen, myometriuma yakın intensitede, BT görüntülerinde heterojen hipodens myom ile uyumlu olabilecek lezyonun güncel incelemede boyut artışı gösterip umblikus superioruna yer değiştirdiği tespit edildi. Görünüm torsiyone myom olarak değerlendirildi. Ameliyata alınan hastanın histopatolojisi lezyonu myom olarak doğruladı.

Tartışma: Uterin leiomyomlar, düz kastan köken alan kadın genital sistemin en sık rastlanan tümörleridir. Sıklığı reproduktif dönemde artar, menapozdan sonra ise azalır. Lokalizasyonlarına göre submukozal, intramural ve subseröz olarak sınflandırılırlar. Myomlarda, kan akımındaki değişiklikler, hızlı büyüme, mekanik olaylar ve postmenopozal atrofi sonucu çeşitli dejeneratif değişiklikler ortaya çıkabilir. Çoğunlukla asempto-matiktirler. En sık görülen semptom anormal uterin kanamadır. Kronik pelvik ağrı, dismenore ve disparoni gibi semptomlara sebep olabilecekleri gibi mesane, rektum ve üreter basısına bağlı olarak pollaküri, konstipasyon, tenesmus, hidroüreter ve hidronefroz gelişebilir. Bazen abdominal kaviteyi tamamen doldurarak dev boyutlara ulaşabilirler. Özellikle pedinküllü myomlarda oldukça nadir görülen önemli komplikasyonlardan biri de torsiyon gelişimidir. Ayırıcı tanıda adenomyozis, hematometra, uterin sarkomlar ve overyan kitleler düşünülmelidir.

P - 045

HEPATOSPLENİK CANDİDİAZİSEMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Hepatosplenik Candidiazis oldukça nadir karşılaşılan özellikle immunsuprese hastalarda görülen kandida etkeninin dissemine tutulumudur. Bu olgu sunumu ile amacımız, nadir görülen bu vakayı MR görüntüleriyle tanıtmaktır.

Olgu: KT almakta olan B cell ALL tanılı 24 yaşında erkek hasta bir haftadır devam eden bulantı kusma, subfebril ateş şikayetleriyle dahiliye klini-ğine başvurdu.Labaratuvarında nötropeni ve sedim, CRP yüksekliği mevcuttu. Hastanın USG ve kontrastsız alınan BT görüntülerinde anlamlı bir bulgu saptanmadı. Hastanın ileri inceleme amaçlı alınan MR görüntülerinde karaciğer ve dalakta T2 AGlerde demir birikimine sekonder diffüz intensite azalması ve milimetrik ebatlı multiple sayıda T2 AG serilerde hafif hiperintens, diffüzyon kısıtlılığı gösteren anlamlı kontrast tutmayan nodüler lezyon alanları izlendi. Görünümler Hepatosplenik Candidiazis olarak düşünülmüştür.

Tartışma: İmmunsuprese hastalarda fungal infeksiyonların en sık patojeni Candidadır. Candida’nın hematojen yayılımı sırasında en sık etkilenen organlar, böbrekler, beyin, kalp, akciğerler, karaciğer, dalak, deri, gözler, kaslar, kemik ve eklemlerdir. Etkilenen organda multipl küçük mikro veya makro apseler gelişir. Bununla birlikte bu apseler ölmeden önce nadiren ultrasonografi ile belirlenebilecek büyüklüğe ulaşırlar; ancak karaciğer, dalak ve böbreklerde abdominal kontrastlı BT yada MRG ile belirlenebilir. Sağ üst kadranda ağrı, duyarlılık, transaminazlarda hafif, alkalen fosfa-tazda daha belirgin yükselme eşlik edebilen diğer bulgulardır. CRP belirgin yüksektir.

P - 046

WARTHİN TÜMÖRÜEMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Warthin tümörü en sık parotiste görülen benign tükürük bezi tümörlerindendir. Tüm tükürük bezi tümörlerinin yaklaşık % 6- 10’unu oluşturur. Biz 58 yaşında erkek hastada nadir görülen bu lezyonu prezente etmeyi amaçladık.


Olgu: 58 yaşında erkek hasta Kulak Burun Boğaz kliniğine sağ parotis lojunda şişlikle başvurdu. Hastanın US görüntülerinde sağ parotis bezinde yaklaşık olarak 28x34 mm ebatlı içerisinde kistik komponenti izlenen RDUS de internal renk kodlanması alınan heterojen hipoekoik lezyon izlendi. Hastanın MR’ında ise sağ parotis bezi içerisinde yaklaşık 45x37 mm ebatlarında,T1 AG lerde heterojen hipo-hiperintens,T2 AG lerde heterojen intensitede izlenen, difüzyon kısıtlılığı oluşturan, postkontrast kesitlerde kontrast tutulumu gösteren, ortasında nekrotik-hemorajik komponenti olan lezyon alanı izlendi. Görünüm tarafımızca Warthin tümörü olarak düşünüldü ve opere edilen hastanın histopatolojisi de bu yönde geldi.

Tartışma: Warthin tümörü tükürük bezlerinde pleomorfik adenomdan sonra ikinci en sık karşılaşılan neoplazidir. Tüm tükürük bezi tümörlerinin yaklaşık % 6- 10’unu oluşturur. Daha çok parotis bezinden kaynaklanan bu benign tümör, genellikle parotis kuyruğunda yerleşir, kistik ve solid komponentler içeren, düzgün sınırlı kapsülle çevrili bir lezyon olarak karşımıza çıkar. Hastaların %12-20’sinde çok odaklı ve %5-14’ünde bilateral görülebilir. Sıklıkla 4.dekattan sonra karşılaşılır ve daha çok erkeklerde (10/1) görülür. Parotis bezi dışında görülme olasılığı çok düşüktür; nadiren submandibüler bezde, servikal lenf nodlarında ya da minör tükürük bezlerinde rastlanabilir.

P - 047

PARAVERTEBRAL GANGLİONÖROMAEMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Ganglionöroma nadir görülen, benign nöronal bir tümördür. Çoğunlukla asemptomatiktir ve insidental olarak tanı konur. Feokromasitoma, nöroblastoma, lenfadenopati gibi benign yada malign durumlarla karışabilir. Biz 55 yaşında bayan hastada nadir görülen bu lezyonu prezente etmeyi amaçladık.

Olgu: 55 yaşında bayan hasta karın ağrısı ile genel cerrahi polikliniğine başvurmuştur. Hastadan USG istenmiştir ve USG de paravertebral alanda konglomere yumuşak doku ekojeniteleri lenfadenopati olarak yorumlanmıştır. İleri inceleme amaçlı hastadan BT ve kontraslı MR istenmiştir. BT sinde paravertebral alanlarda solda daha belirgin multiple sayıda konglomere yumuşak doku dansitesinde lezyonlar mevcuttur. MR görüntüle-rinde ise paravertebral alanlarda büyüğü yaklaşık 49x27 mm ebatlı, birkaç adet, yer yer konglomere özellik gösteren, difüzyon ağırlıklı görüntü-lerde difüzyon artışı gösteren,T2 AG lerde heterojen hiperintens,T1 AG lerde heterojen hipointens, poskontrast kesitlerde minimal heterojen kontrast tutulumu izlenen lezyon alanları mevcuttur. Kesitsel incelemelerin ardından söz konusu lezyonlar için ganglionöroma ayırıcı tanıda ise lenfadenopati düşünülmüştür.Hastanın histopatolojisi ganglionöroma olarak gelmiştir.

Tartışma: Ganglionöroma nadir görülen, nöroblastomun matürasyonu şeklinde veya “de novo” gelişebilen benign nöronal bir tümördür. Mediasten ve retroperiton en sık yerleşim yeri olup, sıklıkla 3-20 yaş aralığında görülür. Bu kitleler sıklıkla asemptomatik ve hormonal olarak sesiz seyreden kitlelerdir. Nadiren salgıladığı vazoaktif polipeptide bağlı olarak diyare, hipotansiyon, hipokalemi veya maskulinizasyon görülebilir. Sıklıkla asemptomatik kitleler olduğundan büyük boyutlara ulaşmadan nadiren tespit edilirler. Günümüz tanı yöntemleriyle, histopatlojik incele-me olmadan feokromasitoma ve nöroblastoma gibi malign nöroendokrin kitlelerden ayırt etmek mümkün değildir. Çoğunlukla ilişkili olmayan bir sebeple yapılan taramalar esnasında insidental olarak rastlanır.

P - 048

AKUT ALT EKSTREMİTE DERİN VEN TROMBOZUNDA DİFÜZYON -AĞIRLIKLI MANYETİK REZONANS GÖRÜNTÜLEMEZEYNEP NİLÜFER TEKİN 1, ALİ TÜRK 2, ÖZLEM SAYGILI 3 1Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye 2Acıbadem Bakırköy Hastanesi, İstanbul, Türkiye 3Acıbadem Üniversitesi, İstanbul, Türkiye

Amaç: Bu çalışmanın amacı difüzyon-ağırlıklı görüntüleme (DAG) ve apparent diffusion coefficient (ADC) değerinin akut derin ven trombozu (DVT) tanısına katkısını incelemektir.

Gereç ve Yöntemler: Bu çalışmaya iki yıl zaman aralığında, tipik klinik bulgular ile akut başlangıçlı DVT tanısı olan 34 hasta dahil edildi. Hastalar, tecrübeli bir radyolog tarafından Doppler Ultrason ile değerlendirildi. Hastalara aynı gün, aksiyel T1, T2 ağırlıklı, gradient eko, difüzyon ve ADC sekanslarından oluşan protokol ile manyetik rezonans görüntüleme (MRG) gerçekleştirildi. ADC değeri iki radyolog tarafından bağımsız şekilde, diğer sekanslar ise ortak olarak fikir birliği ile değerlendirildi.

Bulgular: Doppler bulguları; 15 (44.1%) hastada pozitif, 18 (52.9%) hastada negatif, 1 (2.9%) hastada şüpheli bulundu. Ortalama ADC değeri trombüslü hastalarda 1.1x10-3mm2/s bulunurken, akut trombüsü olmayan hastalarda 2.7x10-3mm2/s olarak hesaplandı.


Sonuç: Çalışmamızda DAG’nin ADC haritalama ile birlikte akut DVT’yi saptayabildiği gözlenmiştir. Alt ekstremite difüzyon MRG incele-me, derin venöz sistemin sonografik olarak optimal değerlendirilemediği ekstremiteleri kalın ve ödemli hastalarda DVT tanısına katkıda bulunabilir.

P - 049

İNEN AORTADA YÜZEN TROMBÜS OLGUSUCENK HOŞGEÇİN, HAKAN İMAMOĞLU


Özet

Amaç: Aortada yüzen trombüs büyük oranda emboliye neden olabilen ve nadir görülen serbest trombüs örneğidir. Bu olgumuzda inen aortada yüzen trombüsün Bilgisayarlı Tomografi (BT) ve Magnetik Rezonans Görüntüleme (MRG) bulgularını sunmaya amaçladık.

Gereç ve Yöntemler: Göğüs ağrısı nedeniyle hastanemize başvuran 76 yaşındaki kadın hastada ekokardiyografide asendan aortada geniş-leme saptanması nedeniyle BT Anjiografi ve olası tümöral oluşumun dışlanması için kontrastlı MRG Anjiografi tetkikleri yapıldı. Bulgular BT Anjiyografide; inen aorta lümeninde, pedinküle görünümde, 6,5 cm uzunluğunda ve 1,5x1 cm boyutunda hipodens lezyon izlendi. Lezyon akım yönüne doğru seyir göstermekteydi ve lezyonun serbest ucu çölyak trunkus orijininde sonlanmaktaydı. Ayrıca dalakta kapsüler tabanlı, kamasal hipodens alanlar izlendi. Sonrasında istenen kontrastlı MRG görüntülerde lezyonda kontrastlanma saptanmadı.

Tartışma: Yüzen trombüs serbest trombüs örneğidir. Trombüsün bir ucu damar duvarına tutunurken, diğer ucu damar lümeninde akım yönüne doğru serbestçe yüzmektedir. Arteriyel serbest trombüsün beraberinde getirdiği %73 oranındaki embolik olay insidansı klinik açıdan önemlidir. Bu olguda inen aorta kaynaklı yüzen trombüsün serbest ucu çölyak trunkus orijinine doğru uzanmaktaydı ve dalakta akut enfarktı düşündüren kamasal hipodens alanlar izlenmekteydi. Trombüsün medikal tedavisi süresince embolik risklerin artarak devam etmesi nedeniyle cerrahi olarak çıkarılmasını öneren çalışmalar da bulunmaktadır. Yüzen trombüsler venöz damarlarda nispeten sık izlenirken, arteriyel damarlarda nadir olarak karşımıza gelir. Bu sebeple, pedinküle şeklide izlenebilecek olan arteriyel tümörlerden ayırıcı tanısının yapılması gerekir. Bu olguda olduğu gibi, çekilen kontrastlı MRG incelemesinde kontrastlanmanın olmaması trombüs tanısını destekler.

Sonuç: Aortada pedinküle lezyon ile karşılaşıldığında; akım yönüne doğru seyri, beraberinde embolik olayların görülmesi ve kontrastlı MRG incelemesinde kontrastlanmanın bulunmayışı nadir olarak görülen yüzen trombüs tanısını koydurur.

P - 050

ATRİYAL KİTLE İLE KARIŞAN BELİRGİN KRİSTA TERMİNALİS OLGUSUHAKAN İMAMOĞLU, CENK HOŞGEÇİN, SERAP DOĞAN, GÜVEN KAHRİMAN


Özet

Amaç: Krista terminalis sinus venosus ve primitif sağ atriyum bileşkesinde uzanan, iyi sınırlı fibromusküler katlantıdır. Sağ atriyum posterolateral duvarı boyunca uzanmaktadır. Bu anatomik yapı bazen belirgin olarak izlenmekte ve sağ atriyum kitlesi ile karıştırılmaktadır. Bu olgumuzda atriyal kitle ile karışan belirgin krista terminalisin Magnetik Rezonans Görüntüleme (MRG) bulgularını sunmaya amaçladık.

Gereç ve Yöntemler: Kırk dokuz yaşındaki bayan hastada sistemik sklerozun kardiyak tutulumu şüphesiyle yapılan transözofageal ekokardi-yografide (TÖE) sağ atriyum duvarında, lümene doğru protrüde, iyi sınırlı kitle görünümü izlenmesi üzerine hastaya kontrastlı kardiyak (MRG) incelemesi yapıldı. Bulgular Kardiyak MRG’ de sağ atriyum posterolateral duvarı boyunca kraniyokaudal seyir gösteren, iyi sınırlı, 6 mm kalınlı-ğında lezyon izlendi. Lezyon tüm sekanslarda atriyal kas tabakasıyla benzer sinyal özellikleri taşımakta olup, patolojik kontrastlanma göstermedi. Bu özellikleri nedeniyle belirgin krista terminalis lehine tanı aldı.

Tartışma: Krista terminalis kalınlığı erişkin dönemde 3-6 mm arasında değişmektedir. Belirgin krista terminalisin tanı kriteri veya prevalansı ile ilgili yeterli veri bulunmamaktadır. Atriyal aritmilere neden olabileceğini belirten çalışmalar bulunmaktadır. Sağ atriyumun posterolateral duvarı boyunca, inferior vena kava ve süperior vena kava komşuluğuna doğru olan uzanımını göstermek tanıda yönlendiricidir. TÖE’de bikaval planda bu uzanım bir hat şeklinde gösterilebilir. Sıklıkla süperior vena kavaya yakın kesimler görüntülenememektedir. Bu sebeple trombüs, tümör ya da vejatasyon gibi atriyal kitleler ile karıştırılmaktadır. Kardiyak MRG’de lokalizasyon daha kolay ortaya koyulmakta ve ek sekanslar, kontrastlı görüntüler ile tanı desteklenir.

Sonuç: Belirgin krista terminalis kalbin sağ atriyal kitleleri ile karışabilir. Anatomik yerleşimi ve kitlesel morfolojinin bulunmayışı radyolojik olarak doğru tanıya yönlendirir.


P - 051

YETİŞKİN DÖNEMDE KARDİYAK TEK VENTRİKÜL TANISI ALAN 2 OLGUHAKAN İMAMOĞLU, CENK HOŞGEÇİN, SERAP DOĞAN, GÜVEN KAHRİMAN


Özet

Amaç: Tek ventrikül olguları sıklıkla yenidoğan döneminde tanı almaktadır ve çoğu süt çocukluğu döneminde kaybedilmektedir. Erişkin dönemde nadiren görülür. Bu 2 olguda yetişkin dönemde tanı alan tek ventrikülün Magnetik Rezonans Görüntüleme (MRG) bulgularını sunmaya amaçladık.

Yöntem: Nonspesifik kardiyopulmoner şikayetler ile başvuran, 32 ve 40 yaşlarındaki iki erkek hastada ekokardiyografide tek ventrikül görülmesi üzerine kardiyak MRG incelemesi yapıldı.

Bulgular: Olguların ikisinde de sağ ventriküler morfolojinin izlendiği ve büyük arterlerin transpozisyonun (L-form) eşlik ettiği fonksiyonel tek ventrikül saptandı. Sol ventrikül rudimenter olarak izlendi. İki olguda da çift atriyoventriküler (AV) kapak mevcuttu. Her iki olguda da kalp normalden genişti. Tartışma Tek ventrikül, her iki atriyumun tek ventriküle açıldığı, 6500 canlı doğumdan birinde görülen, nadir konjenital kalp hastalığıdır. Tek ventrikül ile doğan hastalara ait ölümlerin %74’ü ilk 6 ay içinde olmaktadır. Olgularda sıklıkla iki ventriküler odacık da bulun-makta olup, biri (sıklıkla sağ ventrikül) rudimenter olarak izlenir ve diğer ventrikül fonksiyonel olarak iş görür. AV bağlantı ise mitral ve triküspit kapak halinde iki kapakçık veya ortak kapak şeklinde görülebilir. Bazen AV kapaklardan biri atreziktir. Büyük arterlerin transpozisyonu (genellikle L-form) anomaliye sıklıkla eşlik etmektedir. Uzun dönem prognozunun çift AV kapak, tek veya sol ventriküler morfoloji, L-transpozisyon, siste-mik çıkış darlığı bulunmaması, ılımlı pulmoner çıkış darlığı bulunması durumlarında daha iyi olduğu düşünülmektedir.

Sonuç: Tek ventrikül gibi konjenital kalp hastalıkları erişkin dönemde de tanı alabilmektedir. Tek ventrikül anomalisinin komponentleri, eşlik eden diğer kardiyak anomalilerin ve kapak hastalıklarının varlığı prognozu ve operasyon kararını etkileyeceğinden kardiyak MRG ile aydınlatılması gereklidir.

P - 052

NADİR BİR TORASİK LEZYON: PLEVRANIN SOLİTER FİBRÖZ TÜMÖRÜMUSTAFA KOÇ


Özet

Amaç: Plevranın soliter fibröz tümörü nadir görülen, submezotelyal bağ doku orjinli bir benign tümördür. Görülme sıklığı 2.8/100.000 olarak bildirilmektedir. Literatürde, lokalize fibröz mezotelyoma, benign mezotelyoma, plevral fibroma, submezotelyal fibroma veya subserosal fibroma olarak ta isimlendirilmektedir. Bu çalışmada sağ akciğerde soliter fibröz tümör tanısı konulan olgu sunuldu.

Gereç ve Yöntemler: 4-5 aydır geçmeyen öksürük ve balgam şikayeti ile polikliniğe başvuran, 43 yaşındaki erkek hastaya, radyolojik olarak PA akciğer grafisi ve kontrastlı toraks bilgisayarlı tomografi (BT) incelemesi yapıldı.

Bulgular: Olgunun PA akciğer grafisinde, sağ akciğerde, alt zonda, parakardiyak alanda, büyük boyutlu, düzgün konturlu, nodüler radyopasite izlendi. Yapılan İ.V. kontrastlı toraks BT incelemede, sağ akciğer alt lob süperiorda, paravertebral alan komşuluğunda, plevral tabanlı, yaklaşık 13x10 cm boyutta, hipodens, düşük atenuasyon değerleri veren, belirgin kontrastlanmayan, düzgün konturlu kitlesel lezyon görüldü. Olgu cer-rahi olarak tedavi edildi. Tanımlanan lezyonun histopatolojik tanısı, plevranın soliter fibröz tümörü olarak rapor edildi.

Sonuç: Plevranın soliter fibröz tümörü, tüm yaş gruplarında görülmekle birlikte, altıncı ve yedinci dekatta pik yapar. Nadir olarak akciğer paran-kiminde, perikartta, mediastende, üst hava yolunda, peritonda, böbreklerde, memede ve karaciğerde görülebilir. Hastalar asemptomatik olabi-leceği gibi, kitlenin boyutuna ve lokalizasyonuna bağlı olarak öksürük, nefes darlığı, göğüs ağrısı gibi semptomlarla da başvurabilirler. Radyolojik olarak; soliter, sınırları belirgin, yumuşak doku yoğunluğunda, plevral tabanlı, göğüs duvarı invazyonu göstermeyen kitle varlığında, ayırıcı tanıda soliter fibröz tümör de düşünülmelidir.

P - 053

MR GÖRÜNÜMÜ İLE SOLİTER KEMİK KİSTİNE BENZEYEN KLAVİKULA YERLEŞİMLİ ANEVRİZMAL KEMİK KİSTİORHAN OYAR 1, ALİ MURAT DÜLGEROĞLU 2, EMİNE MERVE HOROZ 1, TÜRKAN ATASEVER REZANKO 3, ÖZGÜR TOSUN 1, ENGİN ULUÇ 1 1 İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, Atatürk Eğitim ve Araştirma Hastanesi Radyoloji Anabilim Dalı, İzmir, Türkiye2 İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, Atatürk Eğitim ve Araştirma Hastanesi Ortopedi Anabilim Dalı, İzmir, Türkiye3 İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, Atatürk Eğitim ve Araştirma Hastanesi Patoloji Kliniği, İzmir, Türkiye


Özet

Giriş: Anevrizmal kemik kisti (AKK) ilk olarak 1942’de adlandırılmış, intramedüller alana yerleşen, ekspansil-litik özellikte, benign natürde bir kemik tümörüdür. Tüm kemik tümörlerinin %1’ni oluşturur. En sık çocuk ve genç erişkinlerde görülür. Hemen hemen tüm kemikler tutulabilirse de uzun kemik metafizleri ve vertebralar en sık tutulum yerleridir. Tüm yassı kemikler içinde klavikula tümör veya tümör benzeri lezyonların nadir görüldüğü yerlerden biri olup AKK açısındanda da çok nadir yerleşim yerlerinden biridir. Bu çalışmada, nadir yerleşimi yanında MR görün-tüsü ile soliter kemik kisti iç yapı özelliklerini düşündüren sağ klavikula yerleşimli AKK saptanmış ve cerrahi olarak tedavi edilmiş 8 yaşında bir olgu sunulmaktadır.

Olgu Sunumu: Sağ klavikulası üzerinde ağrısız şişliği olan 8 yaşındaki kız çocuğunun fizik muayenesinde sağ klavikula dış kesimine doğru lokalize, 2 x 2 cm’lik ağrısız, fikse, ciltte bozukluk ve renk değişikliği oluşturmamış şişlik sa ptanmıştır. Olgunun biyokimyasal incelemeleri, PTCsinde ve erit-rosit sayısında hafif artış, MHCsinde ise hafif azalım dışında normal sınırlardaydı. Klavikulaya yönelik röntgende ekzantrik yerleşimli, septasyonlu, ekspansil radyolüsent lezyon izlenmiştir. BT incelemede; sağ klavikulada 40 x 20 mm boyutlarda ekspansil, heterojen dansitede, korteksi yer yer inceltmiş kemik lezyonu saptanmıştır. Olgunun MR incelemesinde ise sağ klavikulada yaklaşık 40 x 20 mm boyutlarda, T2 ağırlıklı görüntülerde homojen iç yapıda, santralinde ince bir septasyonla ayrılmış bilobule yüksek sinyalli kitlesel lezyon izlenmştir. Kontrastlı incelemede lezyonun periferik tarzda kontrastlanma gösterdiği ancak belirgin bir sıvı-sıvı seviyelenmesi içermediği tespit edilmiştir. BT ve MR’da lezyon iç yapısının oldukça homojen oluşu ve sıvı-sıvı seviyelenmeleri göstermemesi soliter kemik kisti açısından kuşku çekmiş, lezyon içersinde fokal, biraz da kontrastlanan sahalar görülmesi telenjiektatik osteosarkom ayırıcı tanısını da düşündürmüştür. Sağ klavikuladaki şişlikten yapılan biyopsiden alınan materyalin çok küçük bir alanında anevrizmal kemik kistine uyabilecek bulgulara rastlanmıştır. Enfeksiyon izlenmemiştir. Olgu daha opere edilmiş, sağ klavikuladan frozen çalışması ile alınan küretaj materyalinden yapılmış seri kesitlerde tanı anevrizmal kemik kisti olarak gelmiştir. Materyalde malignite ve atipi bulunmamıştır. Ameliyatla lezyon kürete edilmiş, klavikuladaki boşluk kemik greft ile doldurulmuştur. Olgu takip edilmek üzere yönlendirilmiştir.

Tartışma: Klavikula, kemik tümörleinin nadir yerleşim yerlerinden biridir. Bu kemiğin primer benign lezyonları malign lezyonlardan daha nadirdir. AKK her ne kadar benign karakterli düşünülse de solid tipi özellikle radyolojik olarak tanısal güçlüklere neden olabilir ve yüksek mitotik ve hücresel aktivitesi nedeniyle telanjektatik osteosarkomla karışabilir. Bu nedenle radyolojik olarak benign özellik taşıyan lezyonlarının bile malign histopatolojik natürde olabileceği unutulmamalıdır. Bu lokalizasyonda ayırıcı tanıda kondroblastom, kondromiksoid tümör, fibröz displazi, nonos-sifiye fibrom gibi fibröz lezyonlar ile dev hücreli tümör, hemanjioperisitoma, tümör metastazları, osteosarkomlar düşünülmelidir.

AKK, radyolografik olarak kortekste incelmeye neden olan ekspansil, osteolitik lezyon şeklinde görülür. Olgularda korteks bütünlüğü korunur, normal kemik-lezyon arasında geçiş zonu dardır ve yumuşak doku komponenti izlenmez. Ancak kortikal kemik kenarlarında düzensizlik ile birlik-te geniş geçiş zonu şeklinde de izlenebildiği gibi, tamamen destrüktif, osteolitik görünen ve yumuşak doku komponenti içeren, agresif malign bir lezyonu düşündüren görünüm de sergileyebilir. Nadiren incelmiş korteksle birlikte lezyon içerisinde sabun köpüğü görünümü saptanır. Lezyon kenarlarında izlenen periosteal yeni kemik oluşumu kelebek görünümüne neden olur ve bu özellik soliter kemik kistinden ayırımını kolaylaştır-maktadır. BTde yer yer seviyelenme veren sıvı dansitesinde alanlar bulunur. MRG incelemede T1A görüntülerde düşük sinyalli görünüm, kist içi akut kanama var ise seviyelenme gösteren veya göstermeyen yüksek sinyalli alanlar izlenir. T2 ağırlıklı kesitlerde düşük veya orta derecede sinyal özelliği, kist içeriğine bağlı olarak heterojen yüksek sinyalli alanlar izlenebilir. İnternal septasyonlarla birlikte düşük sinyalli bir rim multiloküle kistik görünümü oluşturur.

Sonuç: Bu olgu sunumunda röntgen incelemesi ile AKK ön planda düşünülen ancak BT ve MR görünümleri ile daha ziyade solid, ince septalı, sıvı-sıvı seviyelenmesi göstermemesi, kontrastlanma özellikleri ile daha çok soliter kemik kisti veya telenjiektatik osteosarkoma benzeyen sağ klavikuler AKK olgusu sunulmuş, ayırıcı tanı kriterleri gözden geçirilmiştir. Klavikulada ekspansil lezyon saptandığında ayırıcı tanıda AKK akla gelmelidir. AKK çoğunlukla primer görülmesine karşın sekonder de görülebileceği hatırlanmalı ve AKK olarak saptanan olgularda ikincil lezyon veya ikincil tümör olasılığı araştırılmalıdır.

P – 054

NADİR YERLEŞİMLİ ASETABULER ANEVRİZMAL KEMİK KİSTİ OLGUSU VE MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMÜCAHİT DOĞRU 1, GİZEM ABACI 1, TUĞBA İLKEM KURTOĞLU ÖZÇAĞLAYAN 1, RÜMEYSA DOĞRU 2, ÖMER ÖZÇAĞLAYAN 1 1 Namik Kemal Üniversitesi Tp Fakültesi, Tekirdağ, Türkiye2 Malkara Devlet Hastanesi, Tekirdağ, Türkiye

Özet

Giriş: Anevrizmal kemik kisti ağrı, şişlikle karakterize ve kemikte ekspansiyona neden olan benign natürde kemik psödotümörüdür. Etyolojisi aydınlatılamamış olup büyük oranda hemorajik ve hiperplastik natürdedir. Daha çok kadın hastalarda ve 10-20 yaş aralığında görülür. En sık üst-alt ekstremite uzun kemiklerinde ve vertebral kolonda izlenmekle birlikte vücudun tüm kemiklerinde bu lezyona rastlanabilir. Primer olabileceği gibi başka bir kemik lezyonunun hemorajik transformasyonuna sekonder de gelişebilmektedir. Tedavisinde cerrahi, radyoterapi ve kanamalı olgularda selektif arteryel embolizasyon gibi girişimsel radyolojik prosedürler tercih edilebilir.

Olgu Sunumu: 12 yaşında kız hasta son altı aydır sol kalçada yaygın ağrı ve yürümede güçlük şikayeti ile hastanemiz ortopedi kliniğine başvurdu. Plan radyografi tetkiki için Radyoloji kliniğimize refere edilen hastanın grafisinde sol asetabulumda hipodens litik karakterde ekspansil kitle lezyon


görünümü dikkati çekti. Bunun üzerine yapılan ileri manyetik rezonans (MR) görüntülemesinde sol pubik ramus proksimalinden başlayarak sol asetabulumu dolduran ve iliak kanat proksimaline uzanım gösteren yaklaşık 77x58x75 mm boyutlarında internal kanamaya sekonder sıvı-sıvı seviyelenmeleri bulunan T1A sekansta hipointens, T2A sekansta büyük oranda hiperintens karakterde anevrizmal kemik kisti ile uyumlu yer kaplayıcı lezyon izlendi.

Tartışma: Anevrizmal kemik kisti sıklıkla üst yada alt ekstremite uzun kemiklerinin metafizinde ve vertebra korpuslarında yerleşim göstermekte olup pelvik yerleşimli olanlar tüm vakaların yaklaşık %8-12 si civarındadır. Asetabuler yerleşim ise oldukça nadirdir. Vakamızda nadir bir lokali-zasyon olan asetabuler yerleşimli anevrizmal kemik kistinin radyografi ve MR görüntüleme bulgularından literatür eşiliğinde bahsettik.

P - 055

DERİN YERLEŞİMLİ DERMATOFİBROMMEHTAP BALABAN, BURAK YAĞDIRAN, MESUT AY, ALİ İPEK, FURKAN NALBANT

Ankara Atatürk Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Türkiye

Özet

Amaç: İnterskapular yerleşimli ağrısız sert kitlenin sonografik görüntüleme bulguları eşliğinde tanımlanması ve histopatolojik korelasyonu.

Gereç ve Yöntemler: Sırt bölgesinde ele gelen şişlik şikayeti olan 32 yaşındaki bayan hasta ortopedi poliklinik muayenesi sonrasında kitle karak-terizasyonu için bölümümüz ultrasonografi (US) departmanına yönlendirildi.

Bulgular: İnterskapular lokalizasyonda şişlik tariflenen alana 14 Mhz’lik lineer prob ile yapılan yüzeyel US incelemede cilt-cilt altı yağ doku içeri-sinde 31X8 MM boyutlarda anteriorda cilt ile ara planları kısmen net seçilemeyen, bu lokalizasyonda ciltte belirgin incelmeye neden olan, renkli Doppler US (RDUS)’de belirgin vaskülarizasyonu izlenen heterojen hipo-zayıf hiperekoik solid lezyon dikkati çekti. Lezyona yönelik yapılan eş zamanlı kompresyon sonoelastografi (SEL) incelemede lezyonun renk skalasına göre mavi ağırlıklı sert kodlandığı izlendi. Sonografik bulgular eşliğinde dermatofibrosarkomprotuberans (DFSP) radyolojik ön tanısıyla histopatolojik korelasyon önerildi. Tanı ve tedavi amaçlı total eksizyon yapılan lezyon dermatofibrom olarak rapor edildi.

Sonuç: Dermatofibrom fibroblastik ve histiyositik hücrelerden kaynaklanan ve sık görülen benign tümörlerdir. Sıklıkla dermis yerleşimli olup subkutan doku yerleşimli olgular nadir görülür. Terminolojide benign fibröz histiyositom olarak da isimlendirilir. Etyolojide travma önemli rol oynar. Subkutan doku ve kas doku yerleşimli olgular derin yerleşimli penetre dermatofibrom olarak anılmakta olup tüm dermatofibrom olguları-nın %1-2’sinden azıdır. 25 yaş üstü ve erkeklerde insidansı fazladır. Ekstremitelerin proksimal kısımları ve baş-boyun bölgesinde görülen lezyonlar olup benign ve malign subkutan tümörlerle ayırıcı tanısı önemlidir. En önemli ayırıcı tanı DFSP ile yapılmalıdır. DFSP subkutan bölgede daha sık yerleşmekte olup konturları daha infiltratiftir. Sonografik ve SEL bulguları benzer olup kesin ayırıcı tanı immünohistokimyasal olarak yapılır. Yeterli cerrahi sınır gözetilerek yapılan total eksizyon küratif ve tanısaldır.

P - 056

İKİ OLGU: TENDON KILIFININ DEV HÜCRELİ TÜMÖRÜ; US, RDUS,SEL VE HİSTOPATOLOJİMEHTAP BALABAN, MESUT AY, BURAK YAĞDIRAN, ALİ İPEK


Özet

Amaç: İki ayrı olguda el yerleşimli tendon kılıfının dev hücreli tümör kitlelerinin sonografik, sonoelastografik (SEL) bulgularının tanımlanması ve eksizyonel biyopsi ile histopatolojik verifikasyonu.

Gereç ve Yöntemler: 41 yaşında erkek olgu sağ el 2. parmak orta falanks ve 42 yaşında kadın olgu sağ el 4. parmak metakarpofalangial (MKF) eklem komşuluğunda tarifledikleri hafif ağrılı şişlikler için departmanımız ultrasonografi(US) ünitesine yönlendirildi.

Bulgular: Her iki olguda elde tanımlanan kitlelere yönelik yüzeyel ultrasonografi (US), renkli Doppler US(RDUS), SEL inceleme yapıldı. Erkek olguda sağ el 2. parmak orta falanks süperficialdijitaltendon anterioru yakın komşuluğunda 18,5x12,5 mm boyutlarda düzgün konturlu, RDUS’de belirgin vaskülarizasyonu izlenmeyen heterojen hipoekoik solid lezyon rapor edildi. Kadın olguda sağ el palmar bölge 4. parmak MKF eklem komşuluğundaki fleksördijitaltendonu kompresyon etkisi izlenmeden çevreleyen 11,3x8,9 mm boyutlarda lobüle düzgün konturlu, RDUS’de vaskülarizasyonu izlenen heterojen hipoekoik solid lezyon rapor edildi. Tanımlanan lezyonlara yönelik eş zamanlı yapılan kompresyon SEL ince-lemede her iki lezyonun da renk skalasına göre mavi renkte sert kodlandığı dikkati çekti. Sonografik bulgularla öncelikle her iki olguda tendon kılıfının dev hücreli tümörü (TKDHT) düşünülen kitlelerin eksizyonel biyopsi sonucu TKDHT olarak rapor edildi.

Sonuç: Tendon kılıfından köken alan dev hücreli tümör etyolojisi net bilinmeyen benign yumuşak doku tümörüdür. Rekürren yumuşak doku travmalarına sekonder gelişen inflamatuar yanıt sonucu meydana gelebileceği iddia edilmektedir.En sık el bölgesinde yerleşim göstermekte olup el ve el bileğinin en sık görülen ikinci benign tümörüdür. Yavaş büyüyen, sert, ağrısız, immobil, soliter kitle lezyonlarıdır. Kadınlarda ve sıklıkla


30-40 yaş aralığında görülmektedirler. Ayırıcı tanıda gangliyon kistleri, lipom, hemanjiom, yabancı cisim ve sinoviyal karsinom düşünülmelidir. Tedavi ve tanı amaçlı total ekzisyon önerilmekle birlikte cerrahi sonrası ilk iki yıl içindeki lokal nüks oranı yaklaşık % 27 olarak rapor edilmiştir.Nadiren de olsa lezyonların malign transformasyon riski göz önünde bulundurulmalıdır. Ve bu durum özellikle nüks görülen vakalarda akılda tutulmalıdır. TKDHT’leri nadir görülen kitleler olsalar da lezyonların sonografik ve SEL bulgularının bilinmesi ayırıcı tanıda yardımcı olacaktır.

P - 057

SFENOİD KEMİKTE TELEANJİEKTATİK OSTEOSARKOM RADYOLOJİK AYIRICI TANI ÖZELLİKLERİLEYLA İSAYEVA 1, ÖZGÜR ASLAN 1, ALİ MURAT KOÇ 2 1 İstanbul Medilife Beylikdüzü Hastanesi, İstanbul, Türkiye2 İzmir Bozyaka Eğitim ve Araştırma Hastanesi, İzmir, Türkiye

Özet

Amaç: Telenjiektatik osteosarkom, bütün osteosarkomların %5-lik kısmını oluşturur. Görüntüleme bulguları klasik osteosarkomdan farklıdır.Dekstrüktif, kötü sınırlı, geniş osteolitik lezyon ve küçük bir alanda osteoid matriks ile daha çok AKK’ne benzer bulgular içermektedir. Lezyona agresif periost reaksiyonu, yumuşak doku kitlesi ve patolojik kırık eşlik eder. MRG’de AKK-de olduğu gibi kan ile dolu kistik kavitelerle sıvı-sıvı seviyeleri ve arada solid nodüler komponentler mevcuttur. Kontrast madde sonrası kalın septal ve nodüler parlaklaşmalar AKK’den ayırıcı tanıda önemlidir. Ayrıca yumuşak doku kitlesinin genişliği, kortikaldestruksiyon ve BT’ de matriks mineralizasyonu AKK’den ayırımda önemlidir.Amacımız özellikle kalvaryal kemikte oldukça nadir gözlenen bu tümörün görüntüleme bulgularını, ayırıcı tanı özelliklerini sunmak ve literatür eşliğinde tartışmaktır.

Gereç ve Yöntemler: Hastanemiz nöroloji kliniğine 1 haftadır sol gözde bulanık görme ve başağrısı şikayetiyle başvuran 38 yaşlı bayan hastaya etiyoloji araştırılması için kraniyal manyetik rezonans görüntüleme (MRG) ve bilgisayarlı tomografi (BT) tetkikleri yapılmıştır. Kraniyal mrg tetkiki 1.5 tesla Siemens symphony, BT tetkiki 64 kesitli Toshiba cihazlarıyla gerçekleştirilmiştir.

Bulgular: Yapılan tetkiklerde sol temporal fossada sfenoid kemik büyük kanadını destrukte eden içerisinde kan ve sıvı seviyelerinin izlendiği kontrastlı serilerde yoğun noduler septal kontrastlanmasının izlendiği diffüzyon serilerde kısıtlanmış diffüzyon alanları da içeren litik lezyon sap-tandı.ek olarak elde edilen BT görüntülerde lezyonun destruktif uzanımı daha ayrıntılı değerlendirildi.Hastanın 9 ay önce yapılan kontrastsız mrg tetkiki tamamen normaldi.Lezyonun agressiv davranışı,yeni oluşması,kemik destruksiyonun olması ve içerisinde kan sıvı seviyelerinin izlenmesi nedeniyle teleanjiektatic osteosarkom ön planda düşünüldü.Ayırıcı tanıda yer alan anevrizmal kemik kisti ve venolenfatik malformasyon eski tetkikte olmaması nedeniyle ekarte edildi.

Sonuç: Baş boyun yerleşimli osteosarkomlar çok nadir ve oldukça aggresivdirler.Osteosarkomalar bütün baş boyun malignitelerinin %1-ni oluş-turur.baş boyun bölgesi osteosarkomları genellikle III ve IV dekadlarda ekstremite osteosarkomları ise daha genç yaşlarda ve çocuklarda görülür.Teleanjiektatik osteosarkomlar anevrizmal kemik kisti ile oldukça yakın radyolojik ve histopatolojik özellikler içermektedir. Kalvaryal kemik yerleşimli teleanjiektatik osteosarkom oldukça nadirdir.Anevrizmal kemik kisti ile histopatolojik olarak bile oldukça benzer olması nedeniyle radyolojik tanı çok değerlidir. Erken tanı ve erken agressiv cerrahi prognozu etkilemektedir.

P - 058

DİSTAL BİSİPİTAL TENDİNİT MANYETİK REZONANS GÖRÜNTÜLEME BULGULARISERDAR ARSLAN, FATMA ZEYNEP ARSLAN, MERAL BÜYÜKTERZİ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, İSMET TOLU

Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye

Özet

Giriş: Distal bisipital tendinopati, dominant kolda biseps travmalarının %3-10 ’unu oluşturmaktadır. Özellikle ağır antreman yapan atletlerde bu oran daha da artış göstermektedir. Manyetik rezonans görüntüleme (MRG) bu hastalarda distal biseps tendonunda rüptür veya diğer ten-dinopatilerin değerlendirilmesinde önemli bir görüntüleme yöntemidir. Bu olgu sunumunda distal bisipital tendinit tanısı alan bir hastanın MRG bulgularını sunmayı amaçladık.

Olgu Sunumu: 35 yaşında erkek hasta dominant kolunda ağır yük kaldırarak zorlama nedeni ile 1 haftadır geçmeyen sağ ön kol ağrısı nedeni ile hastanemize başvurdu. Hastaya uygulanan MRG tetkikinde distal biseps tendonu radial tuberositas yapışma yeri düzeyinde yağ baskılı T2 ağır-lıklı sekanslarda intensitesinde ve tendon kalınlığında artış saptandı. Radial tuberositas düzeyinde yaygın kemik iliği ödem alanları izlendi. Ayrıca tendon etrafında artmış effüzyona ait görünüm izlendi. Rüptür veya retraksiyona ait olabilecek MRG bulgusu saptanmadı. Bu bulgular üzerine hastaya distal bisipital tendinit tanısı konuldu.


Tartışma: Distal bisipital tendinit aşırı ezersiz yapanlarda veya ani kontraksiyonlar sonucu meydana gelmektedir. Distal biseps tendonu genellikle iki ana tendon lifinden oluşur. MRG ile tendinozis, parsiyel veya komplet rüptür gibi tendinopatiler bu liflerden ayrı ayrı veya komplet olup olmadığını ayırmada önemli bir görüntüleme yöntemdir. Tendinozisde artmış sinyal intensitesi, kalınlaşma ve tendon etrafında sıvı saptanabilir. Bununla birlikte parsiyel ve komplet rüptür gelişen hastalarda distal bisipital tendon yapışma yeri düzeyinde tendon bütünlüğünde bozulma, ayrılma ve retraksiyon saptanabilir. Ayrıca bu düzeyde tendon etrafında sıvı, tendonda intensite artışları izlenebilmektedir.

P - 059

NADİR BİR OLGU: DİZ EKLEMİNDE PRİMER SİNOVİAL KONDROMATOZİS MANYETİK REZONANS GÖRÜNTÜLEME BULGULARISERDAR ARSLAN, FATMA ZEYNEP ARSLAN, HASAN ERDOĞAN, MERAL BÜYÜKTERZİ, SEDA SOĞUKPINAR KARAAĞAÇ, İSMET TOLU

Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye

Özet

Giriş: Primer sinovial kondromatozis diğer adıyla Reihel sendromu, etyolojisi bilinmeyen sinovial metaplazi ve proliferasyon sonucu multipl intraartiküler osteokondral lezyonlarla karakterize bir eklem hastalığıdır. En sık diz eklem mesafesinde görülmekle birlikte daha az sıklıkla kalça, dirsek ve omuz ekleminde de görülebilmektedir. Bu olgu sunumunda dizde primer sinovial kondromatozis gelişen bir hastanın manyetik rezo-nans görüntüleme (MRG) bulgularını sunmayı amaçladık.

Olgu Sunumu: 23 yaşında erkek hasta hastanemizin ortopedi bölümüne sağ dizde ağrı ve şişlik şikayetleri ile başvurdu. Hastaya uygulanan MRG tetkikinde sağ diz eklem mesafesinde ve suprapatellar bursada artmış effüzyon izlendi. Ayrıca sinoviumda yer yer hipertrofik görünümler ve T2 ağırlıklı serilerde santrali hiperintens periferi hipointens, T1 ağırlıklı serilerde hipointens multiple serbest osteokondral cisimler izlendi.

Tartışma: Primer sinovial kondromatozis kendini sınırlayan benign neoplastik bir süreçtir. Sinoviumda proliferatif kondroid nodüller ile karakterizedir. Radyografik incelemelerde kondroid nodüllerin ossifkasyon derecesine bağlı olarak görünür hale gelebilir. %25-30 hastada radyografik incelemeler nor-mal olabilir. MRG ile kondroid lezyonların sinyal intensitesi ossifikasyon derecesine göre farklılık göstermekte olup duyarlılığı radyografik incelemelerden daha yüksektir. Bu lezyonların ayrıcı tanısında pigmente villonodüler sinovit, lipoma arboresans, sinovial kondrosarkom akılda tutulmalıdır.

P - 060

CAMPTOCORMİA SENDROMUMEHMET KARAGÜLLE 2, FATMA ZEYNEP ARSLAN 1, MERAL BÜYÜKTERZİ 1 1 Konya Eğitim Araştırma Hastanesi, Konya, Türkiye2 Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Camptocormia diğer adıyla bent spine sendromu (BSS); ayaktayken ortaya çıkan, yatar pozisyonda düzelen, gövdenin anormal fleksiyon duru-mudur. BSS; psikiyatrik, kas-iskelet ve nörolojik hastalıklarla birlikte görülebilmektedir. Müsküler kökenli BSS genelde yaşlı hastalarda progresif ortaya çıkan geç başlangıçlı primer idiyopatik aksiyel myopati ile ilişkilidir fakat bu tanıyı düşünmeden önce BSS’ ye neden olabilecek sekonder nedenler dikkatlice değerlendirilmelidir.Bunlar arasında inflamatuar myopatiler, geç başlangıçlı müsküler distrofiler, endokrin ve metabolik myo-patiler ve Parkinson hastalığı başta olmak üzere bazı nörolojik hastalıklar yer almaktadır.

Bizim olgumuzda 82 yaşında parkinson nedeniyle takip edilen erkek hastada klinik şüphe üzerine çekilen MR incelemesinde paravertebral kas-larda T1A ve T2A incelemelerde yağlı dejenerasyon lehine sinyal değişiklikleri izlendi.

BSS, patolojik olarak düzensiz dejenere lifler, endomisyal fibröz doku ve yağ dokusu içeren görünüme sahiptir. BSS, nadir görülmesinden dolayı çok bilinmeyen bir hastalık tablosu olup klinik bulgular ve MR incelemede, paravertebral kaslarda atrofik değişiklikler ve yağlı dejenerasyon izlenmesi ile tanısı konur.

P - 061

LATERAL PATELLAR DİSLOKASYON MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIİLYAS DÜNDAR 1, MESUT ÖZGÖKÇE 1, HARUN ARSLAN 1, İBRAHİM AKBUDAK 2 1 Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Van, Türkiye2 Batman Bölge Devlet Hastanesi, Batman, Türkiye


Özet

Amaç: Lateral Patellar Dislokasyon medial patellar retinakulumun yıkıcı hasarı sonucunda patellanın laterale doğru yer değiştirmesini ifade eder. Bu olguda klinik tanısı zor olan ve bilinmediği zaman tanı almayan Lateral Patellar Dislokasyon’nun Manyetik Rezonans Görüntüleme bulgularını sunmayı ve farkındalık oluşturmayı amaçladık.

Gereç ve Yöntemler: 17 yaşında erkek hasta yaklaşık 10 gün önce düşme sonrası gelişen sol dizde ağrı ve şişlik şikayeti ile ortopedi kliniğine başvurdu. Hasta diz Manyetik Rezonans Görüntüleme çekilmek üzere tarafımıza yönlendirildi.

Bulgular: Çekilen sol diz Manyetik Rezonans Görüntüleme’de aksiyel yağ baskılı proton dansite ve sagittal T1 ağırlıklı görüntülerde patella medial faset ve femur lateral kondilde kontüzyona bağlı ödematöz sinyal değişiklikleri görüldü. Aksiyel yağ baskılı proton dansite görüntülerde patella medial faset düzeyinde kortikal devamsızlık, kartilaj defektleri (siyah ok) ve medial retinakulumda zorlamaya bağlı sinyal artışları-düzensizlikler (beyaz ok) izlendi. Ayrıca sagittal yağ baskılı proton dansite görüntülerde eklem aralığında belirgin sıvı artışı (siyah oklar) ve eklem çevresinde yumuşak doku planlarında yaygın ödem (beyaz ok) izlendi. Bulgular eşliğinde Lateral Patellar Dislokasyon tanısı konuldu.

Sonuç: Lateral Patellar Dislokasyon genelde sporcularda rotasyonel travmalarda gelişir. Patella medial fasette ve lateral femoral kondil ante-rolateralinde impaksiyon sonucu kontüzyon veya osteokondral kırık ortaya çıkabilir. Transient natürü nedeniyle klinik tanısı zordur. Kemik ve yumuşak doku lezyonlarının ayrıntılı olarak tanımlanabilmesi için Manyetik Rezonans Görüntüleme en iyi görüntüleme yöntemi olarak öne çıkmaktadır.

P - 062

PEDİATRİK ÇAĞDA METAKARP VE TİBİA TUTULUMU YAPAN LANGERHANS HÜCRELİ HİSTİOSİTOZİS OLGUSULEVENT KARAKAŞ 1, AYŞEGÜL AĞIRMAN 2, MERT GENÇTÜRK 2, NİL ÇOMUNOĞLU ÜSTÜNDAĞ 3 1 Tekirdağ Çerkezköy Devlet Hastanesi, Radyoloji Bölümü, Tekirdağ, Türkiye2 Yedikule Surp Pirgiç Ermeni Hastanesi, Radyoloji Bölümü, İstanbul, Türkiye3 İstanbul Üniversitesi Cerrahapaşa Tıp Fakültesi, Patoloji Anabilim Dalı, İstanbul, Türkiye

Özet

Amaç: Metakarp ve tibia tutulumu yapmış Langerhans Hücreli Histiositoz (LHH) olgusunun radyolojik bulgularını sunmak.

Gereç ve Yöntemler: 13 yaşındaki bayan olgu,sol elde ve sol dizde ağrı ön tanısı başvuran olguda sol ele yönelik yapılan direkt grafi inceleme-sinde 3.metakarpta periostta kalınlaşma ve periost reaksiyonu bulguları mevcuttur.16 dedektörlü bilgisayarlı tomografi(BT) cihazında 1 mm aksiyel kesitler ile bu kesitler üzerinden yapılmış koronal ve sagital reformat imajlar incelendiğinde metakarpta ekspansiyon,periostta kalınlaşma ve kesintili tarzda periost reaksiyonu izlenmiştir.1,5T Magnetik Rezonans(MR) cihazında sol ele yönelik T1A TSE, PD TSE ve yağ baskılı(YB) T1A TSE pre ve postkontrastlı aksiyel, koronal ve sagital planlarda inceleme yapılmıştır.Ayrıca sol dize yönelik standart incelemeye ek olarak kontrastlı T1A YB kontrastlı imajlar eklenmiştir.Metakarpta diafizde ekspansiyon periostta kalınlaşma ve çevre yumuşak dokularda ödem,ayrıca diafizde ve çevre dokularda kontrastlanma izlenmiştir.Tibia proksimalinde anteriorda metafiz ve diafizde ödem,periost kalınlaşması subperios-teal rezorbsiyon ve kontrastlanma mevcuttur.3.metakarptan yapılan biyopsi sonucu LHH tanısı bildirilmiştir.

Bulgular: LHH, kemik iliği kökenli Langerhans hücresinin anormal çoğalmasıyla karakterize,nedeni bilinmeyen bir hastalıktır.Milyonda 1-2 oranın-da görülmektedir.Bu yelpazedeki eozinofilik granülomada(EG) sadece kemik tutulumu görülür.Hastalığın monofokal veya monostatik tipi olgu-ların %65’ini oluşturur. Olguların %35’i ise multifokaldir.En fazla etkilenen aksiyel iskelettir.Bu hastalık grubunda uzun kemiklerde en sık tutulan yer diafizdir.Çocuklarda diafiz %60,metafiz %36,epifiz bölgesi %4 oranında etkilenir.Erişkinlerde ise,epifiz bölgesi hemen hemen hiç etkilenmez.Epifiz tutulduğunda,kondroblastom ve subakut osteomiyelitten ayrımlanması güçtür.Diafizde lokalize olan bazı lezyonlar,Ewing sarkom ve oste-omiyelit ile radyolojik olarak karışabilir.Bizim olgumuzun tibiasında olduğu gibi nadiren epifizyometafizyel geçiş gösterebilir.

Sonuç: Pediatrik yaş grubunda özellikle uzun kemikleri tutan, periost reaksiyonu ile atipik paternde kitle imajı olmaksızın görülen ve yumuşak doku tutulumuyla kontrastlanmanın eşlik ettiği durumlarda LHH ayrıcı tanıda düşünülmelidir.

P - 063

PROLİFERATİF MİYOZİT: ÜST EKSTREMİTENİN NADİR PSÖDOSARKOMATÖZ LEZYONUESRA KAHVECİ 1, ZEYNEP MARAŞ ÖZDEMİR 1, LEYLA KARACA 1, AYŞEGÜL SAĞIR KAHRAMAN 1, NUSRET AKPOLAT 2, RESİT SEVİMLİ 3 1 İnönü Üniversitesi Tip Fakültesi Hastanesi, Radyoloji Anabilim Dali, Malatya, Türkiye2 İnönü Üniversitesi Tip Fakültesi Hastanesi, Patoloji Anabilim Dali, Malatya, Türkiye3 İnönü Üniversitesi Tip Fakültesi Hastanesi, Ortopedi Anabilim Dali, Malatya, Türkiye


Özet

Proliferatif miyozit, ani başlangıçlı ve hızlı büyümesiyle sarkomu taklit eden nadir, iyi huylu bir tümördür. Hastalar tipik olarak ortalama 50 yaşında, sıklıkla proksimal ekstremitelerde veya omuzda bulunan bir soliter kitle ile başvururlar. Bu sunumda sol kolda ani büyüyen şişlik şikayeti ile gelen 62 yaşında tru-cut biyopsi ile histopatolojik tanısı bulunan kadın olgu üzerinden manyetik rezonans görüntüleme ve ultrasonografinin proliferatif miyozit ön tanısındaki önemi sunulmuştur.

P - 064

NADİR BİR OLGU: PRİMER MEME ANJİOSARKOMUGÜL ÇOLAKOĞLU 1, AYSUN ÇAKIR 1, ÖZLEM SEZGİN OKÇU 2, AYŞENUR OKTAY 2 1 Sağlık Bilimleri Üniversitesi İzmir Tepecik Eğitim ve Araştirma Hastanesi, Radyoloji Kliniği, İzmir, Türkiye2 Ege Üniversitesi Tip Fakültesi, Radyoloji Anabilim Dalı, İzmir, Türkiye

Özet

Giriş: Anjiosarkomlar damar duvarındaki endotelyal hücrelerden köken alan nadir görülen malign tümörlerdir. En sık meme olmak üzere kalp, karaciğer, deri, kemik ve yumuşak dokularda gelişebilir. Memenin anjiosarkomları primer olabileceği gibi radyoterapiye sekonder de gelişebilir. Primer meme anjiosarkomu tüm malign meme tümörlerinin %0.04ünü oluşturur ve 3-4. dekattaki genç kadınlarda görülür. Hızlı büyüyen, ciltte hiperemi yapan, ele gelen ağrısız kitlelerdir. Bu bildiride primer meme anjiosarkomunun tanısı alan olgunun görüntüleme özellikleri tartışılmıştır.

Olgu Sunumu: Sağ memede sertlik sebebiyle başvuran 36 yaşındaki kadın hastaya yapılan meme ultrasonografisinde meme dokusunda sınır-lanabilen kitlesel lezyon izlenmemiştir. Mamografisinde tip D meme paterni mevcut olup grup oluşturan kuşkulu kalsifikasyon odakları kitlesel oluşum saptanmamıştır. Meme MRG incelemesinde sağ meme alt orta kadranda fibroglandüler dokudan sınırları net ayrılamayan yaklaşık 4x5 cm lik T1de hipointens T2de fibroglandüler dokuya oranla hafif hiperintens alan dinamik serilerde erken dönemde yoğun kontrastlanma göster-mekte olup malignite açısından yüksek kuşkulu olarak değerlendirilmiştir. Tru-cut biyopsi sonrası olgunun patolojik tanısı anjiosarkom ile uyumlu olarak değerlendirilmiştir. Radyoterapi öyküsü olmayan olguda tanı primer meme anjiosarkomu olarak kabul edilmiştir.

Tartışma: Primer ve sekonder meme anjiosarkomu nadirdir. Genç hastalarda ultrasonografide kitle formasyonu oluşturmayan meme dokusunun yapısını bozan, mammografi bulguları nonspesifik olan, MRI da T1A hipointens, T2A hiperintens belirsiz sınırlı hızlı kontrastlanan hemorajik içeriği bulunan kitlelerde ayrıcı tanıda anjiosarkom düşünülmelidir.

P - 065

PERİKALLOZAL LİPOMADEM YOKUŞ

Van Eğitim ve Araştırma Hastanesi, Van, Türkiye

Özet

Giriş: İntrakranial lipomlar nadir görülür ve genellikle asemptomatiktir. Bununla beraber lokalizasyonuna göre klinik belirti verebilirler. Bu sunumda baş ağrısı şikayeti ile başvuran ve perikallozal lipom tanısı konan olgunun Manyetik Rezonans Görüntüleme (MRG) bulgularını sunmayı amaçladık.

Gereç ve Yöntemler: Baş ağrısı şikayeti olan 14 yaşındaki kadın olguya MRG tetkiki yapıldı.

Bulgular: Hastanın yapılan MRG tetkikinde perikallozal alanda yaklaşık 45 mm uzunluğunda, en kalın yerinde 6 mm çapında ölçülen T1 ve T2 ağırliklı görüntülerde hiperintens lipom ile uyumlu lezyon izlendi. Ayrıca korpus kallozum hafif hipoplastik görünümdeydi.

Sonuç: İntrakranyal lipomlar oldukça nadir görülen ve genellikle insidental olarak saptanan benign kitlelerdir. Genel olarak semptom vermezler. Semptomatik olduklarında yerleşim yerine göre değişmekle birlikte baş ağrısı, baş dönmesi, nöbet, ataksi, işitme azlığı veya kaybı gibi belirtiler görülebilir. İntrakranial lipomların beyinde en sık görüldüğü bölge perikallozal alandır. Diğer sık görüldüğü lokasyonlar sırasıyla kuadrigeminal sisterna, suprasellar sisterna ve serebellopontin köşelerdir. İntrakranyal lipomlar en sık korpus kallozum disgenezisi olmak üzere septum pellusidum agenezisi, kranyum bifidum, spina bifida, ensefalosel, myelomeningosel, hipoplastik vermis ve kortikal malformasyonlar gibi santral sinir sistemi anomalileri eşlik edebilir. Kranyal BT ve MRG bulguları karakteristik ve patognomiktir. BT’de lipomlar homojen yapıda, düzgün sınırlı, kontrast tutmayan, hipodens kitle olarak görülürler. MRG’de ise T1 ağırlıklı sekanslarda belirgin hiperintens, T2 ağırlıklı sekanslarda hiperintens, kontrast tutmayan, homojen yapıda kitlelerdir. Yağ baskılı sekanslarda sinyal kaybı gözlenir, ancak FLAIR sekanlarda sinyal kaybı görülmez. Ayrıca intrakranyal lipomlar dermoid kistler ve teratomlar ile karışabilir. Dermoid kistler ve teratomlar MR incelemelerinde sinyal yoğunluğu lipomların tersine sıklıkla heterojen olarak görülür. Perikallozal lipomlar iki alt gruba ayrılırlar. Tubulonodüler tip; daha sık görülen bu tip 2 cm’den küçük nodüler lezyonlarla karakterizedir, posterior veya sıklıkla anterior lokalizasyonda bulunur. Anterior yerleşimli olan tipinde; lipomun kendisinden ziyade eşlik eden frontofasiyal anomaliler semptomlardan sorumludur ve nispeten daha kötü olan formu budur. Eğrisel (curvilinear) tip lipomlar ise; daha nadir görülür, genellikle posteriorda yerleşen, 1 cm’den ince, ekstansif uzanan, asemptomatik kitlelerdir. Bu


tip lipomlarda korpus kallozum hipoplazik olabilmektedir. Bizim olgumuz eğrisel tip lipom ile uyumlu olup korpus kallozum dizgenezisi eşlik etmektedir.

Genellikle tedavi gerektirmemekte ya da semptomatik tedavi ile hastalar takip edilmektedir. İlerleyen semptomatik olgularda; kitlenin büyümesi, intrakraniyal basınç artışı ve hidrosefali gelişmesi halinde cerrahi düşünülmelidir.

P - 066

UVEAL MELANOMA: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIGÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, MUSTAFA YEŞİLYURT, GÖKHAN POLAT, MECİT KANTARCI, AKIN LEVENT


Özet

Giriş: Uvea melanomu erişkinlerde en sık görülen birincil göz içi kanser türüdür. Uveal melanoma açık tenli ve açık renkli gözlü birey-lerde daha sık görülür.Görülme sıklığı USA de milyonda 7 ‘dir. Etyolojide genetik predispozisyon, okulomelanositik lezyonlar, açık renkli iris, sigara suçlanmaktadır.Sıklıkla altıncı dekantta ortaya çıkar. Çoğunlukla tesadüfen yakalanır, genellikle asemptomatik olup mevcut semptomlar; görme keskinliğinde azalma, görme alanında kayıp, retina dekolmanına bağlıdır. Tüm uveal melanomların yaklaşık% 90ı koroidi tutar, geri kalanı siliyer cisim veya irisde ortaya çıkar. Zamanında tedavi edilmediğinde, hastalarda total görme kaybı gelişebilir. Tümör genişleyip bruch membranını rüptüre edince mantar benzeri bir kitle görünümü ortaya çıkar ve sekonder eksudatif retina dekolmanı sık eşlik etmektedir. Oküler tümörün başarılı bir şekilde ortadan kaldırılmasına rağmen, hastaların% 50sine kadar metastatik hastalık gelişir, bu metastatik hastalık genellikle karaciğer içerir. Metastazları hedefleyen etkili bir terapinin henüz mevcut olmadığı için semptomların başlamasından 1 yıl içinde ölümcüldür.

Bulgular: 65 yaşında erkek hasta; sağ gözünde 2 günden beri yabancı cisim hissi, baş ağrısı, bir aydan beri farkettiği görme azalması yakınmalarıyla göz polikliniğne basvurdu. Çekilen orbita MRG’de; sağ glob süperomedial konturunda T1A kesitlerde hiperintens,T2A ve FIR sekansta hipoin-tens, kontrastlı kesitlerde belirgin kontrast tutulumu gösteren yklaşık 11x8 mm boyutlarında nodüler tarzda glob içine uzanan sklera invazyonu olmayan kitle tespit edildi. Uveal melanom olduğu düşünüldü.

Tartışma: Uveal melanom düşünülen hastalarda ayırıcı tanıda; geniş koroidal nevus, lokalize koroidal hemanjiom, metastatik tümör, retina dekolmanı, posterior sklerit düflünülmesi gereken patolojilerdir. Tanıda US çok önemli yer tutar basit, ucuz olması açısından ilk başvurulan tetkiktir. Kitlenin büyüklüğünü, lokalizasyonunu verir. BT ve MRG kitle büyüklüğü lokalizasyonu yanısıra; sklera invazyonu, periokuler yayılımını daha ayrıntılı değerlendirir. Uveal melanom en sık karaciğer olmak üzere, akciğer, kemik, optik sinir ve meninksine metastaz yapmaktadır. Uveal melanom tanısı alan hastalarda özellikle bu organlara yönelik metastaz taraması yapılmalıdır.

P - 067

OLGU SUNUMU: FATAL DEV KRANİOFARİNGİOMAİBRAHİM SÜLKÜ, ÇİĞDEM ÖZER GÖKASLAN, EMİN DEMİREL

Afyon Kocatepe Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Afyonkarahisar, Türkiye

Özet

Kraniofaringiomalar, Rathke kesesi artıklarındaki skuamöz epitelden gelişen, genellikle sellar/suprasellar bölgeye yerleşen benign tümörlerdir. Yerleşim yerleri itibari ile genellikle endokrin disfonksiyonlar ve görme bozuklukları ile prezente olurlar. Önemli nörovasküler yapılara kom-şulukları gösterirler. Bizim olgumuzda hasta, başta görme bozuklukları olmak üzere eşlik eden hormonal disfonksiyon bulguları ile başvurdu. Yapılan MR tetkikinde sellar ve suprasellar bölgeyi tamamen dolduran, sol orbital apekse ve interhemisferik fissüre uzanan, mesencephalon ve ponsu ekspanse eden, komşuluğunda yer alan bilateral internal karotid arterlerin kavernöz ve supraklinoid segmentlerini saran yaklaşık 7x6x6 cm boyutlarda, içerisinde kalsifikasyon odakları bulunan, heterojen kontrastlanan dev boyutlu kitle saptandı.

P - 068

OLGU SUNUMU: KARSİNOMA EX PLEOMORFİK ADENOM TANILI HASTADA PERİNÖRAL KAFA TABANI YAYILIMIİBRAHİM SÜLKÜ, ÇİĞDEM ÖZER GÖKASLAN, EMİN DEMİREL

Afyon Kocatepe Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Afyonkarahisar, Türkiye


Özet

Pleomorfik adenom, tükürük bezi tümörleri arasında en sık rastlanılandır. Pleoformik adenom vakalarında cerrahi tedaviden sonra nüks rastlanmakta ve 1-45 yıl arasında nüks ortaya çıkabilmektedir. Bu tümörlerde malign transformasyon nadir bir durum olup olguların yaklaşık %2.5-3’ünde görülmektedir. Karsinoma ex-pleomorfik adenom olarak adlandırılan malign tip sıklıkla uzun süreli veya nüks durumlarında görü-lebilmektedir. Bizim olgumuzda pleomorfik adenom cerrahisi sonrası 3.yılda operasyon bölgesinde karsinoma ex pleomorfik adenom saptandı. Yapılan takiplerde sellar ve suprasellar bölgeyi dolduran, bilateral internal karotid arterlerin kavernöz segmentlerini tamamen saran, sol orbital apekse uzanan ve sol superior oftalmik veni basılayan perinöral yayılımlı metastatik kitle saptandı.

P - 069

NADİR BİR OLGU: İNTERHEMİSFERİK FİSSÜR EPİDERMOİD KİSTİFATMA DURMAZ, HARUN ARSLAN, SÜMEYRA DEMİRKOL ALAGÖZ, MESUT ÖZGÖKÇE

Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Van, Türkiye

Özet

Amaç: İntrakranial epidermoid kistler benign, yavaş büyüyen konjenital inklüzyon kistleridir. Primer intrakranial tümörlerin %0.2-1.8’ini oluştu-rur ve en sık serebellopontin köşe sisterninde yerleşir. İnterhemisferik fissürden kaynaklanana epidermoid kist nadirdir. Frontal bölgede inter-hemisferik yerleşimli epidermoid kist olgusunu Beyin MR bulguları ile beraber sunmayı amaçladık.

Gereç ve Yöntemler: 28 yaşında erkek hasta uzun süredir olan baş ağrısı şikayetiyle başvurdu. Nörolojik muayene ve laboratuar bulgularında özellik izlenmedi. Kliniğimizde yapılan kontrastlı beyin MRG’de frontal bölgede interhemisferik alanda, solda parankime ve korpus kallozum korpusuna bası yapan, hafif heterojen, T1AG’de BOS ile izo-hiperintens, T2AG’de BOS ile izointens, FLAIR’de tam baskılanmayan, IVKM sonrası kontrast tutmayan, Difüzyon ağırlıklı görüntülerde kısıtlanma gösterenkistik lezyon izlendi.Mevcut bulgularla Epidermoid Kist tanısı kondu.

Bulgular: İntrakranial epidermoid kistler benign,yavaş büyüyen konjenital inklüzyon kistleridir.Primer intrakranial tümörlerin %0.2-1.8’ini oluş-turur.En sık serebellopontin köşe sisterninde yerleşir (%40-50), buranın schwannom ve menegiomdan sonra en sık üçüncü kitlesidir.Ardından suprasellar sisterna, silviyan sisterna ve pineal bölge gelir.İnterhemisferik fissürden kaynaklanan epidermoid kist nadir olup, tüm intrakranial lokasyonların yaklaşık %4’ünü oluşturur.Klinik bulgular lezyonun kitle etkisine ve lokalizasyonuna bağlıdır.Sıklıkla asemptomatiktir, semptomatik olgularda işitme kaybı ve baş ağrısı görülür.Supratentoryal lezyonlarda nöbet sıklığı artmıştır.MR hastalığın tanısı, tedavi planı ve takibi açısından seçilmesi gereken görüntüleme yöntemidir.Epidermoid kistlerin çoğunlu T1 ve T2’de BOS’a göre izointens yada hafif hiperintenstir.FLAIR’de tam olarak baskılanmaz ve düfüzyon ağırlıklı görüntülerde kısıtlanır.Çoğunlukla kontrastlanma izlenmez, yaklaşık %25 vakada minimal rim tarzında kontrastlanma izlenebilir.

Sonuç: Epidermoid kistlerin tanısında, özellikle bazı sekanslarda araknoid kist ile karışması nedeniyle, MR seçilmesi gereken görüntüleme yönte-midir.Özellikle difüzyon ağırlıklı görüntüler ayırıcı tanı yapmada faydalıdır.İnterhemisferik yerleşimli kistik lezyonların ayırıcı tanısında epidermoid kist akılda tutulmalıdır.

P - 070

ABDOMİNAL AORT STENOZUNA SEKONDER GELİŞEN HİPERTANSİF HASTADA PRES SENDROMUMEHMET KARAGÜLLE 1, SAMET ŞİMŞEK 1, SÜLEYMAN ÖNCÜ 1, FATMA ZEYNEP ARSLAN 2, İSMAİL ŞERİFOĞLU 1 1 Bağcılar Eğitim Araştirma Hastanesi, İstanbul, Türkiye2 Konya Eğitim Araştırma Hastanesi, Konya, Türkiye

Özet

Giriş: Posterior reversible ensefalopati sendromu (PRES); nöbet, baş ağrısı, görme bozuklukları ve konfüzyon gibi bulgular ile karakterize bir antite olup tanısı klinik ve radyolojik bulguların bir araya getirilmesi ile konulur. Bilinen en sık nedenleri; hipertansiyon, sitotoksik ilaçlar, preek-lampsi, eklampsi, böbrek yetmezliği ve bazı sistemik hastalıklardır.

Olgu Sunumu: Bizim olgumuzda 14 yaşında erkek hasta 2 aydır aralıklı baş ağrıları nedeniyle hastanemize başvurdu. Hipertansiyon saptanan hastada antihipertansif tedavi başlandı. Tedaviye rağmen tansiyon kontrolü sağlanamaması üzerine renal arter stenozu açısından renal renkli dopler inceleme istendi. RDUS incelemede renal arter stenozu saptanmadı ancak infrarenal düzeyde abdominal aortta anlamlı darlık saptandı. Sonrasında çekilen BTA incelemede infrarenal düzeyde aortta belirgin darlık izlendi. Hastanın yatışı esnasında nöbet geçirmesi üzerine çekilen kranial BT’de her iki paryetooksipi-tal lobda kortikosubkortikal alanlarda hipodansite ve sonrasında kranial MR’da solda belirgin olmak üzere her iki paryetooksipital lobda kortikosubkortikal alanlarda ve korona radiyatada T2A/FLAİR incelemede sinyal artışı izlendi.Bunun üzerine PRES tanısı konuldu.

Sonuç: PRES’in patofizyolojisi tam bilinmemekle beraber hipertansiyon sonucu değişik mekanizmalarla gelişen vazojenik veya sitotoksik ödem-den kaynaklandığı düşünülmektedir. PRES’te en iyi görüntüleme yöntemi FLAİR sekansı ve difüzyon ağırlıklı görüntülemedir(DAG). FLAİR


sekanslarda paryetal ve oksipital bölgede kortikal subkortikal alanlarda, bilateral bazal gangliyonlar,pons ve serebellar bölgelerde sinyal artışı izlenmektedir. DAG ile sitotoksik ve vazojenik ödem ayrımı yapılabilir. Ayrıca DAG iskemi ile komplike olan PRES olgularını ayırt etmemizi sağlar. PRES, tanı ve tedavide gecikme sonrası iskemi ve kalıcı nörolojik defisitlere yol açabilmesi nedeniyle etyolojik faktörleri ve klinik şüphesi bulunan hastada kranial MR çekilerek erken tanı alması önem arzetmektedir.

P - 071

İZOLE TROKLEAR SİNİR PARALİZİSİ: MR BULGUSUFATMA UYSAL, MUSTAFA REŞORLU

Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi, Çanakkale, Türkiye

Özet

Amaç: Troklear sinir paralizisi okuler hareketleri etkileyen en sık izole kranial nöropatidir. Hastalarda aşağı bakış sırasında, özellikle de merdiven inerken veya eğilirken çift görme şikayeti mevcuttur. Troklear sinir paralizisinin %5’i izoledir. En sık neden konjenital olup, edinsel nedenler arasında sıklıkla travma olmak üzere hemoraji, tümör, vasküler malformasyon, enfeksiyon ve demiyelinizan hastalık gibi bir çok nedeni olup iske-mik nedenlere bağlı olgular nadirdir. Bu olgu sunumunda beyin sapı iskemisine bağlı gelişen izole troklear sinir paralizisine ait MR görüntülerini sunduk.

Olgu Sunumu: 53 yaşında erkek hasta yaklaşık 2-3 haftadır merdiven inip çıkarken çift görme şikayeti nedeniyle başvurdu. Göz polikliniğindeki kranial sinir muayenesinde sol gözde aşağı bakışta hafif kıstlılık mevcutken hasta bu esnada çift görme şikayeti olduğunu belirtti. Diğer kranial sinirlerin muayenesi olağandı. İzole troklear sinir paralizisi saptanan olguya orbita MR istendi. Özgeçmişinde hipertansiyon, koroner arter has-talığı mevcuttu. Orbita MRG’de pons sol parasantral alanda T1 ağırlıklı aksiyal görüntülerde belirgin hipointens ve T2 ağırlıklı aksiyal-sagittal görüntülerde hiperintens görünüm ile karakterize kronik laküner infarkt alanı izlendi. Hastada pons iskemisine sekonder troklear liflerin tutu-lumuna bağlı ipsilateral 4. kranial sinir paralizisi düşünüldü.

Tartışma: Obliquus süperior kasının motor siniri olan troklear sinirin motor çekirdeği mezensefalonda bulunur ve nükleusu karşı taraf gözü aşağı-dışa baktırır. Troklear nükleus inferior kollikulus seviyesinde mezensefalon tegmentum düzeyinde bulunur ve lifleri aquaduk kanalı çevresin-de posterolaterale ilerleyerek superior medullar velum düzeyinde çaprazlaşır ve kontralateral superior oblik kasını innerve eder. Troklear sinir paralizisi okuler hareketleri etkileyen en sık izole kranial nöropatidir. Troklear sinir paralizisinde göz aşağı-dışa bakamaz, bu hareket esnasında hastanın gözü içe kayar ve vertikal diplopi meydana gelir. Hastalar sıklıkla merdiven inip çıkarken yada kitap okurken çift görmeden şikayet ederler.

Sonuç: Pozisyonel vertikal çift görme şikayeti olan hastalarda troklear sinir felci ve nadir bir nedeni olan beyin sapı iskemi de düşü-nülmelidir.

P - 072

ERİŞKİN HASTADA DYKE DAVİDOFF MASSON SENDROMUSİNAN ÜLGEN, AYŞE EDA PARLAK, MEHTAP BARÇ ERGÜN, ABDULLAH ŞÜKÜN, BERNA AK YILDIZ

Sağlik Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi, Antalya, Türkiye

Özet

Dyke Davidoff Masson sendromu nadir görülen bir durumdur. Sendrom klinik olarak yüzde asimetri, hemipleji yada hemiparezi, mental retar-dasyon, sensorinöral işitme kaybı, psikiyatrik bozukluklar yada epilepsi ile karakterizedir. Radyolojik olarak serebral hemiatrofi, tek taraflı kranial kemiklerde kalınlaşma, paranasal sinüslerde genişleme ve artmış havalanma görülür. Depresyon ve anksiyete bozukluğu bulunan 39 yaşında bir kadın hastada MRI görüntülerinde sol frontal bölgede ılımlı atrofi, komşu kranial kemikte kalınlaşma ve frontal sinüs sol tarafında genişleme mevcut olup hastanın klinik ve radyolojik bulguları dyke davidoff masson sendromunu desteklemektedir.

P - 073

BETA-TALASEMİ MAJÖR TANILI HASTADA HİPOFİZDE DEMİR BİRİKİMİ: MRG BULGULARIHASAN ERDOĞAN, MEHMET SEDAT DURMAZ, FATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, SERDAR ARSLAN



Özet

Beta-talasemi majör, hemoglobinin yapısındaki ß-zincirinde kalıtsal bozukluk ve bunun bağlı inefektik eritropoez ile karakterize hemolitik bir anemi türüdür. Beta-talasemi majörün konvansiyonel tedavisi düzenli kan tranfüzyonudur. Fakat bu durum çeşitli organlarda demir birikimine yol açmaktadır. Anterior hipofizde demir birikimi, bu hastalarda görülen en sık endokrin komplikasyon olup, gecikmiş puberteye ve hipogonadot-ropik hipogonadizme neden olur. Manyetik rezonans görüntüleme (MRG) demirin paramanyetik etkisi sayesinde organlardaki demir birikimini göstermede etkilidir. Bu sunumda beta-talasemi majör tanısı olan 22 yaşındaki erkek olgunun hipofiz MRG bulguları sunulmuştur.

P - 074

TERM YENİDOĞANDA HİPOKSİK İSKEMİK ENSEFALOPATİ: MRG BULGULARIHASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, FATMA ZEYNEP ARSLAN, MEHMET SEDAT DURMAZ, MERAL BÜYÜKTERZİ


Özet

Hipoksik iskemik ensefalopati (HİE), intrapartum serebral hipoksi veya geç antepartum serebral hipoksi ve iskeminin neden olduğu, akut, iler-leyici ensefalopati tablosudur. HİEyi en erken gösteren radyolojik görüntüleme yöntemi difüzyon manyetik rezonans görüntüleme (MRG)dir. Bu sunumda uzamış doğum eylemi öyküsü olan ve HİE saptanan 7 günlük term bebekte beyin MRG bulguları sunulmuştur.

P - 075

HİPOKAMPÜS YERLEŞİMLİ DNET OLGUSU: MRG BULGULARIHASAN ERDOĞAN, FATMA ZEYNEP ARSLAN, SERDAR ARSLAN, MEHMET SEDAT DURMAZ, SEDA SOĞUKPINAR KARAAĞAÇ


Özet

Disembriyoplastik nöroepitelyal tümör (DNET), çocuk ve genç erişkinlerde görülen, nadir, genellikle benign, glial-nöral kortikal bir neoplazmdır. Tipik olarak dirençli nöbetlere sebep olurlar. DNET, supratentorial korteksin herhangi bir bölgesinde olabilir, fakat temporal lobda daha sık görülür. DNETli hastalarda total rezeksiyon etkili bir tedavi yöntemidir. Bu sunumda 38 yaşında dirençli nöbetleri olan erkek olguda, hipokampal yerleşimli DNETin manyetik rezonans görüntüleme (MRG) bulguları sunulmuştur.

P - 076

İSKEMİK STROKE SONRASI SANTRAL DİABETUS İNSİPUTUS VAKA TAKDİMİFATMA ZEYNEP ARSLAN, SERDAR ARSLAN, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, VEFA ÖNER


Özet

Beyin iskemik enfarktüsünü takiben santral diyabet insipidus nadir görülen bir durum olarak tanımlanmıştır. Posterior hipofizier alanı etkileyen iskemi de idiyopatik santral diabetes insipidusun olası bir nedeni olarak kabul edilmiştir. Biz MRG incelemede Sağ ICA kavernozal segmentte ve inceleme alanına giren petrozal segmentlerde sinyal- void kaybı ve total oklüzyona bağlı yaygın iskemik enfarkt saptanan, Desmopressin tedavisi gerektiren santral diabetes insipidusa bağlı geçici poliüri gelişen hastamızın bulgularınız sunduk.

P - 077

NADİR BİR OLGU: HİPERGLİSEMİYE BAĞLI HEMİKORE MANYETİK REZONANS GÖRÜNTÜLEME BULGULARISEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN, HASAN ERDOĞAN, ZEYNEP ARSLAN



Özet

Hiperglisemiye bağlı hemikore genelde uzun süre iyi kontrol edilemeyen, sıklıkla diyabetli ileri yaşta kadın hastalarda görülen, MRG T1 ağırlıklı görüntülerde bazal ganglia parlamalarının nadir sebeplerinden biridir. Kliniğinde koreiform hareketlerle giden non-ketotik hiperg-lisemiye bağlı hemikore ve hemiballizmin nasıl geliştiği tam olarak bilinmemektedir. Bununla ilgili bazı hipotezler ortaya atılmıştır. Bunların arasında bazal gangliyonlarda GABA’nın azalması, hiperglisemiye bağlı striatumda dopaminerjik aktivitenin artması, hipervisköziteye bağlı kan-beyin bariyerinin hasarlanması ve striatumda oluşabilecek peteşiyal kanamalar ya da enfarktlar vardır. Kan şekerinin regülasyonu sonrasında önce klinik daha sonraki takiplerinde görüntüleme bulgularında düzelme izlenebilmektedir. Biz de benzer bir vakayı sunmayı amaçladık. 15 yıldır tip 2 diyabetes mellitus tanısıyla insülin tedavisi alan 65 yaşındaki erkek hasta kliniğe bilinç bulanıklığı, denge kaybı ile başvuruyor. Yapılan laboratuar tetkiklerinde kan şekeri 500 mg/dl, HbA1c %17 saptandı. Çekilen beyin MRG incelemede bilateral puta-mende T1 ağırlıklı görüntülerde sinyal intensite artışları saptandı. T2 ağırlıkı görüntülerde bu bölgeler kısmen hipointens izlendi. Hastanın hikayesinden diyabetinin kontrolsüz olduğu öğrenildi. Anamnezinde bilinen başka bir hastalığının olmadığı ve toksik hasara maruz kalmadı-ğı öğrenildi. Bu bulgular eşliğinde hastada non ketotik hiperglisemiye bağlı nörolojik bulguların geliştiği düşünüldü. Kan şekeri regülasyonu sonrasında hastanın klinik bulgularında hızla düzelme saptandı. Non-ketotik hiperglisemiye bağlı hemikore genelde uzun süre iyi kontrol edilemeyen diyabetli hastalarda görülür. Radyolojik incelemede ise T1 ağırlıklı görüntülerde striatumda hiperintensite görülmesi tipiktir. Ayırıcı tanıda bazal ganglia düzeylerine hasar veren ve toksik etki yapan metabolizmalar düşünülmelidir. Hastanın anamnezi ile maruzi-yetleri ve bilinen hastalıkları değerlendirilerek ayırıcı tanı yapılmalı ve takip edilmelidir.

P - 078

SEPTO-OPTİK DİSPLAZİ: VAKA TAKDİMİFATMA ZEYNEP ARSLAN, SEDA SOĞUKPINAR KARAAĞAÇ, MEHMET SEDAT DURMAZ, SERDAR ARSLAN, HASAN ERDOĞAN, HATİCE KIVRAK


Özet

Giriş: Septo-optik displazi (SOD), Morsier sendromu olarak da adlandırılan nadir olarak karşılaşılan bir hastalıktır. Optik sinirde hipoplazik görünüm, septum pellusidumun MRG incelemede izlenememesi ve hipotalamo-hipofizier disfonksiyon ile karakterizedir. Kadın ve erkekler eşit olarak etkilenmektedir. Etkilenen hastalarda şizensefali birlikteliği sıklıkla karşımıza çıkmatadır. Klinik olarak hipotalamo-hipofizier yetmezlik, neonatal hipoglisemi eşlik eden kortikal displazilere bağlı olarak bilişsel fonksiyonlarda zayıflık izlenebilir.

Olgu Sunumu: 1 yaşındaki kadın olgu erkek hasta sağ gözde görme kaybı, sol gözde bulanık görme şikayeti ile kliniğimize başvurdu. Hastamıza çekilen beyin MRG incelemede; bilateral optik sinir özellikle süperior orbital fissür düzeyinde ve kiazma seviyesine kadar normalden ince izlendi. Optik kiezma izlenmedi ve nörohipofiz bezine ait T1Ada sinyal artışı net olarak ayırt edilemedi. Ayrıca hastamızda hipofiz infindibulumu normal-den ince izlenmekteydi. Bilgisayarlı tomografide (BT); genişlemeiş lateral ventriküller, septum pellusidumun izlenmemesi, eşlik eden şizensefaliye ait görünüm ve sığ optik foraminaya ait görünüm izlenebilir. Tanı için en etkili tetkik beyin MRG’dir. BT’de izlenilen bulgulara ek olarak MRG’de; nörohipofiz bezine ait sinyalin net olarak seçilememesi, eşlik eden kortikal displazilere ait korteks görünümü, hipoplastik optik kiazma izlenebilir.

Sonuç: Sonuç olarak (SOD); nadir olarak izlenilen, radyologların çok aşina olmadığı önemli bir antitedir.

P - 079

KAPİLLER TELENJEKTAZİ TANISINDA SWI SEKANSININ ÖNEMİ: OLGU SUNUMUMEHMET SEDAT DURMAZ, SERDAR ARSLAN, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, ZEYNEP ARSLAN, İSMET TOLU


Özet

Kapiller telenjektazi (KT) küçük, dilate, normal beyin parankimi içerisinde ince duvarlı dilate kapiller topluluğu tarafından oluşturulan vasküler malformasyonlardır. En sık pons, serebellum ve spinal kord yerleşimi gösterirler. Kanama beklenen bir komplikasyon olmamakla birlikte kaver-nomalara eşlik edebilirler. Kanama olmadığı sürece ödem ve kitle etkisi saptanmaz. BT incelemede özellikle kontrast madde uygulanmazsa genellikle seçilemezler, zayıf hipodens olarak izlenebilirler. MRG’de T2A ve FLAIR sekanslarda bazen hiperintens odaklar şekilde görülebilirler. Kontrastlı MRG serilerinde silik kontrastlanır. Santralinde kontrast tutan lineer drenaj veni görülebilir. T2* GRE ve SWI sekanslarda belirgin hipointens karakterde olmakla birlikte özellikle eşlik eden kavernöz malformasyonları tanımlamada faydalı sekanslardır. KT ayırımın zor olduğu durumlarda SWI ve T2* GRE gibi MR sekansları yararlıdır. Serebral hemisferde yerleşim gösteren KT ile uyumlu lezyonun MRG, MR spektros-kopi, perfüzyon ve SWI görüntüleme bulgularını sunmayı amaçladık.


Başağrısı şikayeti ile başvuran 24 yaşındaki erkek hastaya beyin MRG tetkiki yapıldı. Solda bazal ganglionlar komşuluğundan periventriküler alana uzanım gösteren T1 sekanslarda hipointens, T2 ve FLAIR sekanslarda zayıf hiperintens lezyonda kontrast tutulumu mevcuttu, ancak lezyon düzgün sınırlı olup perilezyonel ödem izlenmedi. MR spektroskopi ve perfüzyon MRG tetkikleri istendi. Lezyonda artmış perfüzyon mevcuttu. Lezyon büyük büyütmede incelendiğinde T2 sekanslarda noktasal sinyal alanları ve kontrastlı incelemede bu alanlarda daha fazla kontrastlanma dikkat çekti. Çekilen SWI sekansında lezyonun belirgin hipointens izlenmesi üzerine KT tanısı kondu.

T2 ve FLAIR sekanslarda hiperintens odaklar izlenmesi, lezyon çevresinde ödem izlenmemesi KT’yi düşündürmelidir. MR spektroskopi ve perfüzyon incelemeleri gereksiz olup kafa karışıklığına neden olur. SWI sekansında belirgin hipointens karakterde olması tanı koydurucudur.

P - 080

LİPOMYELOMENİNGOSEL MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMEHMET SEDAT DURMAZ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, SERDAR ARSLAN, ZEYNEP ARSLAN, İSMET TOLU

Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Konya, Türkiye

Özet

Lipomyelomeningosel görülme sıklığı yaklaşık 1/4000 doğum olup, kız çocuklarında daha sık izlenir. Lipomyelomeningosel, gerçek bir myelo-meningosel veya açık spinal disrafizm değildir. Okült spinal dısrafizmler grubunda incelenen kompleks nöral tüp gelişim kusurudur. Anomali, omurilik üzerine yaptığı kitle etkisi ve omuriliği germesine bağlı klinik tablolar yaratır. Morfolojik olarak, konus medullaris ve kauda ekuina lifleri ile olan anatomik ilişkisine göre lipomyelomeningoselin dorsal, kaudal ve tranzisyonel olarak üç farklı tipi tanımlanmıştır. Bu sunumda kaudal tip lipomyelomeningoselin MRG bulgularını mevcut literatür bilgileri eşliğinde sunmayı amaçladık.

Yürüyememe şikayeti ile gelen 19 yaşındaki erkek hastaya çekilen lumbosakral MRG’de, lumbosakral bölgede orta hatta olan, T1 ve T2 sekans-larda hiperintens olarak izlenen lipom kitlesinin spina bifida kemik defektinden geçerek durayı katettiği ve omuriliğin distal bölümü olan konus medüllaris ile devamlılık gösterdiği izlendi. Konus medullaris aşağı yerleşimli olup posteriorda gergindi. Lipom devamlılığında kauda equina liflerinin devamlılığı izlenmemiş olup lipomyelomeningosel içinde sonlanmaktaydı. Lumbosakral vertebralarda posteriorda füzyon defekti (spina bifida) mevcuttu. Lipom posteriorda cilattına doğru uzanım göstermekte olup omuriliğin distali olan konus, filum terminale ve kauda ekuina liflerini etkilemekteydi. MRG bulguları ile kaudal tip lipomyelomeningosel tanısı kondu.

MRG tüm kapalı spinal disrafizm bozukluklarında olduğu gibi lipomyelomeningosel tanısında da en sık kullanılan ve en geçerli yöntemdir. MRG incelemesinin aksiyal, koronal ve sagittal planlarda görüntüleri lipomyelomeningoselin omurilik ile olan ilişkisini her üç planda ortaya koyabilmesi açısından önemlidir. MRG’de aşağı yerleşimli konus, dorsale doğru lipoma uzanan kauda equina lifleri, sinir köklerinin lipom içinde ve dışında seyri, lipomun dorsalde ekstradural alana geçişi, vertebra posterior elemanlarında füzyon defekti gösterilebilir.

P - 081

QUADRİGEMİNAL SİSTERN YERLEŞİMLİ LİPOM: OLGU SUNUMUMEHMET SEDAT DURMAZ, HASAN ERDOĞAN, SEDA SOĞUKPINAR KARAAĞAÇ, SERDAR ARSLAN, ZEYNEP ARSLAN, İSMET TOLU

Sağlık Bilimleri Üniversitesi Konya Eğitim ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Konya, Türkiye

Özet

Lipomlar en sık görülen iyi huylu tümörlerdendir ve vücudun birçok yerinde izlenebilir. Ancak, beyin lipomları oldukça nadirdir. Tüm beyin tümörlerinin %0,46-%1’ini teşkil eder. Görülme sıklığı otopsi serilerinde %0,08-%0,2 arasında değişir. Beyin lipomları geçmişte iyi huylu tümör olarak tanımlanmıştır ancak günümüzde doğumsal malformasyon olarak kabul edilmektedir. Genellikle radyolojik incelemelerde rastlantısal ola-rak saptanır, büyük kısmı orta hatta yakın beyin yapılarında yerleşir ve bazen eşlik eden anomaliler izlenebilir. Beyin lipomlarının yaklaşık %50’si perikallozal sisternada yerleşir. Diğer yerleşim yerleri sıklık sırasıyla ambient ve quadrigeminal sistern (%25), suprasellar-interpedinküler sistern (%15), serebellopontin açı sisternası (%10), süperior serebellar ve silvian sistern (%5)’dir. Nadir olarak serebral hemisferlerin yüzeyinde de bulunabilir. Bu sunumda quadrigeminal sistern yerleşimli kalsifiye lipomun bilgisayarlı tomografi (BT), kontrastlı manyetik rezonans görüntüleme (MRG), MR spektroskopi ve perfüzyon MRG bulgularını sunmayı amaçladık.

Başağrısı şikayeti ile başvuran hastaya çekilen beyin BT’de quadrigeminal sistern yerleşimli kalsifik komponenti de olan kitle izlendi. Bu aşamada lipom tanısı için yeterli bulgular mevcut olduğu halde, (kitlenin dansite değerleri lipom ile uyumlu olarak -40 ile -100 HU arasındaydı) kalsifiye kitle tanısıyla kontrastlı MRG tetkiki sonra-sında MR spektroskopi ve perfüzyon MRG tetkikleri, lipom tanısı akla gelmediği için gereksiz bir şekilde önerilmiştir. MRG’de kitlede kontrast tutulumu, perfüzyon MRG’de perfüzyon artışı izlenmedi. Spektroskopi incelemesinde kitlede lipid-laktat piki mevcuttu, diğer metabolitler izlenmedi.

Beyin lipomları genellikle asemptomatiktir ve farklı nedenlerle yapılan beyin görüntülemesi sırasında tesadüfen bulunur. Beyin lipomlarının BT bulguları tanı koydurucudur. BT’de tanısal bulgular saptanırsa ileri incelemeye (MRG, MR spektroskopi, perfüzyon MRG gibi) gerek yoktur.


P - 082

AKCİĞER KANSERİNDE KAUDA EKUİNA METASTAZLARI, MRG BULGULARIMEHMET FATİH İNECİKLİ, MEHMET BEYAZAL, FATMA BEYAZAL ÇELİKER

Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye

Özet

Amaç: Akciğer kanserleri metastazları yüksek olasılıkla görülmektedir. Sıklıkla sürrenal gland, karaciğer, beyin ve kemiklere metastaz olmaktadır. Spinal kanalda ve özellikle kauda equina liflerine metastaz oldukça nadirdir. Bu bildiriyi sunmamızdaki amaç, akciğer kanserlerinde spinal kanal ve kauda equina liflerine metastazın gerçekleşebileceğine dikkat çekmektir.

Gereç ve Yöntemler: 52 yaşında erkek hasta. Akciğer karsinomu (Ca) tanılı olgu. Bilateral alt extremitede önce uyuşma, sonrasında kas gücü kaybı gelişmiş. Daha ilerleyen zamanlarda yürüyememe durumu oluşmuş. Yapılan klinik muayenede belirgin kas gücü kaybı saptanıyor. Elde olu-nan kontrastlı Lumbal MR tetkikinde, intradural alanda cauda equina liflerinde multiple sayıda metastatik implant odakları saptanıyor.

Sonuç: Akciğer kanserlerinde kauda equina liflerine metastazlar, görülme sıklığı az olmakla birlikte mümkündür. İmplant odaklarının etkilediği liflerin innerve ettiği odaklarda bulgular ortaya çıkar. Akciğer Ca tanılı olgularda, özellikle alt extremite ve pelvik bölgede patolojik bulgular varsa, spinal bölgede intradural cauda equina metastazları akılda tutulmalıdır.

P - 083

OLDUKÇA BÜYÜK BOYUTLARDA VE YAYGIN SEREBRAL ARTERİOVENÖZ MALFORMASYON OLGUSULEVENT KARAKAŞ1, EVREN ALDEMİR2, ZİVER AYATA3 1 Tekirdağ Çerkezköy Devlet Hastanesi, Tekirdağ, Türkiye2 Özel Egepol Hastanesi, İzmir, Türkiye3 Özel Ege Yaşam Hastanesi, İzmir, Türkiye

Özet

Amaç: Sol serebral hemisferin büyük kısmını dolduran arteriovenöz malformasyon(AVM), eşlik eden diğer parankimal ve ekstraksiyel kompo-nentleriyle radyolojik olarak sunulmuştur. Sol orta kranial fossada 12 mm çapa ulaşan anevrizmatik dilatasyon göstermiştir. Sol serebral hemis-ferde Galen Veni’ne drene olduğu yerde en geniş yeri 10 mm çapa ulaşan dilatasyon göstermiştir. Süperiorda daha belirgin olmak üzere oftalmik venlerin de olaya katılması ve sol orta kranial fossada anevrizmatik dilatasyon görülmesi olguyu daha da atipik kılmaktadır. Olgumuz öncelikle Bilgisayarlı Tomografiyle görüntülenmiş olup AMV’nin yaygın yerleşimi nedeniyle subaraknoid kanama ayırıcı tanıda düşünülmüştür. Amacımız, oldukça büyük boyutlardaki ve yaygın yerleşimli serebral AVM olgusunun radyolojik bulgularını sunmaktır.

Gereç ve Yöntemler: Şiddetli başağrısı ve progresif sağ hemipeji ile afazi ayrıca görme bulanıklığı bulgularıyla başvuran 48 yaşındaki erkek olgu. Laboratuvar bulguları normaldir. Görüntülemede, 16 dedektörlü bilgisayarlı tomografi (BT) cihazında 1 mm aksiyel kesitler ile bu kesitler üze-rinden yapılmış koronal ve sagital reformat imajlar incelenmiştir. 1,5 T Magnetik Rezonans (MR) cihazında 3, 5mm kesit kalınlığındaki, aksiyel T1, T2, FLAIR, SWI, koronal T2 ve sagital T1 imajlar incelenmiştir.

Bulgular: Serebral AVM’ler, insidental olabileceği gibi intraserebral kanama, epilepsi ve başağrısı gibi nörolojik bulgular oluşturan patolojiler ola-rak, nöroradyoloji pratiğinde önemli yer tutarlar. Kapiller Telenjiektazi’den, atipik lokalizasyonlarda intraserebral hematom oluşturan intraksiyel ve kortekse bası oluşturan ekstraksiyel dev vasküler malformasyonlara uzanan oldukça geniş bir yelpazede görülebilirler. Anatomik yapılarla ilişkinin doğru saptanması, tedavi seçimi ve takip peryodunu belirlemede oldukça ödemlidir.

Sonuç: Serebral arteriovenöz malformasyonlar sıklıkla insidental olarak saptanmakla birlikte bizim olgumuzda da olduğu gibi bazı durumlarda kronik semptomlarla progresif klinik seyir göstermekte ve oldukça büyük boyutlarda karşımıza çıkabilmektedir. Radyolojik parametrelerin doğru yorumlanması için genel nöroradyolojik görüntüleme algoritmasına uyulmalı ve girişim planı açısından raporda vasküler yapılar ayrıntılı tanımlan-malı ayrıca varsa ek radyolojik bulgular da belirtilmelidir.

P - 084

BİR OLGU EŞLİĞİNDE AKUT İSKEMİK İNME NEDENİ OLARAK İNTERNAL KAROTİD ARTER DİSEKSİYON GÖRÜNTÜLEME BULGULARIS. ŞENNUR BİLGİN

Medipol Üniversitesi Tıp Fakültesi Hastanesi, İstanbul, Türkiye


Özet

Amaç: Karotid arter diseksiyonu iskemik inme gelişiminde önemli rol oynar. Sıklıkla sağlıklı bireylerde spontan, şiropraktik manevralar ya da boyun manipülasyonları gibi travmalarla veya yatrojenik olarak ortaya çıkabilir. (1, 2) Biz bu posterde akut iskemik inme ile başvuran hastada iskemik inme nedeni olarak saptanan karotid arter diseksiyonu manyetik rezonans görüntüleme (MRG) ve manyetik rezonans anjiografi(MRA) görüntülerini sunmayı amaçladık.

Gereç ve Yöntemler: 59 yaşında erkek hasta, konuşma bozukluğu bulgusuyla başvurduğu nöroloji polikliniğinden akut iskemi ön tanısı ile öncelikle diffüzyon MR görüntüleme için bölümümüze yönlendirilmiştir. Diffüzyon ağırlıklı görüntülerde sol frontal lobda medial serebral arter sulama alanında akut parsiyel enfarkt saptandı. Alınan T2 ağırlıklı aksiyal görüntülerde internal karotid arter ekstrakranyal segment distalinde duvar hematomu görülmesi üzerine optimal değerlendirilmesi için hastaya kranyal MRG ve servikal T2 A ve yağ baskılı T1 A ağırlıklı aksiyal sekanslar ile birlikte kranyal ve servikal MRA incelemeleri gerçekleştirilmiştir.

Travma anamnezi olmayan hastada yapılan manyetik rezonans anjiografi ve boyuna yönelik alınan T2 ve yağ baskılı T1 ağırlıklı aksiyal görüntü-lerde sağ internal karotid arter ekstrakranyal segment distalinde duvar hematomunun eşlik ettiği %90-95 luminal daralma ile karakterize kısa segment diseksiyon tespit edildi.

Sonuç: Diseksiyon her yaşta ortaya çıkabilir ancak genç hastalarda en sık inme nedenidir (45 yaş altı inmelerde % 20-25 arasında). Akut iskemik inmede neden olarak diseksiyon saptanması tedavi planlaması açısından çok önemlidir MRG, ekstrakranyal diseksiyonu tanımlamada daha yararlıdır. MRG mural hematomu göstererek diseksiyonu kanıtlar. MRA da noninvaziv bir yöntem olarak vasküler patolojilerin saptanmasında oldukça önemlidir (5). Yapılan bu incelemeler akut iskemik inme etyolojisini belirlemede, tedavi planlamasında ve komplikasyonların önlenmesinde oldukça önemlidir.

P - 085

TRAVMATİK LENS DİSLOKASYONUGİZEM TİMOÇİN, LÜTFULLAH SARI, ALPAY ALKAN

Bezmialem Vakıf Üniversitesi Hastanesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye

Özet

Göz küresi yaralanmaları ile acil servise başvuru tüm travmaların yaklaşık %3’üdür. Travma sonucunda kanama, retina veya koroid dekolmanı, göz küresi rüptürü ve lens dislokasyonu gözlenebilmektedir. Dislokasyon lensin zonüler liflerinde yırtılma sonucunda meydana gelir. Yine homosistinüri, Marfan, Ehlers Danlos ve Weil Marchesani sendromu gibi herediter hastalıklarda da dislokasyon görülebilir. Bu olgu sunumunda MRG (magnetik rezonans görün-tüleme) ve BT (bilgisayarlı tomografi) ile travma sonucunda vitreus posterioruna lens dislokasyonu saptanan bir olgu sunulmuştur.

P - 086

SLE’Lİ HASTADA SSS TUTULUMUNUN KRANYAL MRG BULGULARIMÜZEYYEN KALKAN, VASFİYE BÜRCEK, ALİ KOÇ, YASEMİN OKATAN

Kayseri Eğitim ve Araştırma Hastanesi, Kayseri, Türkiye

Özet

Santral sinir sistemi lupusu, genellikle anjiyopatik orijinli olarak kabul edilir. Bunun dışında, doğrudan nöral otoimmun hasar, demyelinasyon ve tromboembolizm; SSS hastalığına neden olan diğer mekanizmalardır. Serebral iskemi ve enfarkt; antifosfolipid antikor sendromuna sekonder koagülopati, steroidlere bağlı akselere ateroskleroz, vaskülit veya Libman-Sacks hastalığının sebep olduğu kardiyojenik tromboemboliye bağlı gelişebilir. Nöroloji kliniğinde serebrovasküler hastalık tanısıyla takip edilen, 48 yaşında SLE’li bayan hastaya beyin MRG incelemesi yapıldı. Beyin MRG’de sağ frontotemporal bileşke, sağ temporal lob insular kesimde ve sol oksipital lob perikalkarin alanda kortikal-subkortikal beyaz cevheri içine alan, T1A heterojen hipo, T2A heterojen hiperintens, erken ve geç subakut enfarkt ile uyumlu lezyon alanları izlendi. Ayrıca splenium sol lateral kesimi ve perisplenial beyaz cevherde korpus kallozuma vertikal oryante hiperintens plak görünümleri mevcuttu.

P - 087

İZOLE BULBUS TUTULUMLU POSTERİOR REVERSİBL ENSEFALOPATİ SENDROMU: OLGU SUNUMU

YUNUS EMRE ORUK 1, VELİ SÜHA ÖZTÜRK 1, EMİR HÜSEYİN NEVAİ 2, YELDA ÖZSUNAR DAYANIR 1 1Adnan Menderes Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Aydın, Türkiye2Ağrı Patnos Devlet Hastanesi, Radyoloji Kliniği, Ağrı, Türkiye


Özet

Giriş: Posterior reversible ensefalopati sendromu (PRES) baş ağrısı, konfüzyon, görme bozuklukları ve nöbetler ile karakterize, birçok etyolojik nedeni bulunan, sıklıkla geri dönüşümlü bir klinik durumdur. En yaygın sebep hipertansiyondur ve sıklıkla pariyeto-oksipital bölgelerde simetrik tutuluma neden olur. PRES’ in sadece bulbusa izole olması ise çok atipiktir.

Olgu Sunumu: Preeklampsi tanısı bulunan 35 yaşındaki 27 hafta 4 günlük gebe olgumuz, görme bulanıklığı, baş ağrısı ve tansiyon yüksekliği şikâyetleri ile kurumumuza başvurdu. Özgeçmişinde hipertansiyon ve diyabeti bulunan olgunun kan basıncının normal değerlere düşürüleme-mesi üzerine sezaryen (C/S) planlandı. C/S sonrası sağ gözde midriazis gelişen olgunun elde olunan Beyin MRG tetkikinde, bulbus anterior kesiminde 2,5 cm uzunluğunda bir segmentte T2A ve FLAİR sekanslarda vazojenik ödem ile uyumlu sinyal artışı ve T1A sekansta sinyal kaybı izlendi. Difüzyon ağırlıklı görüntülerde difüzyon kısıtlılığı izlenmemekle birlikte, ADC görüntülerde bu alanda sinyal artışı mevcuttu. Postoperatif dönemde kan basıncı değerleri kontrol altınan ve 6. günde şikâyetleri büyük oranda gerileyen hastamızın bu dönemde çekilen Beyin MRG tetkiki önceki tetkiki ile karşılaştırıldığında bulbusda izlenen ödem bulgularının gerilediği saptandı.

Tartışma: PRES, hipertansif ensefalopati, eklampsi, trombotik trombositopenik purpura ve immünsupresif ilaçlar ile tetiklenebilir. Ayırıcı tanıda iskemik inme, serebral venöz tromboz, vaskülit, reversibl postiktal ödem, mitokondriyal ensefalopatiler, ADEM, ensefalit, progresif multifokal lökoensefalopati ve prion hastalıkları göz önünde bulundurulmalıdır. Vertebrobaziler sistem nispeten adrenerjik sempatik innervasyondan yok-sundur ve posterior beyin bölgeleri, akut kan basıncının yükselmesi ile otoregülasyon mekanizmasına daha duyarlı hale gelir. Bizim olgumuzda bulbusta izlenen ödem bulguları ve MRG görüntülemede bulguların hızla gerilemesi PRES tanısını desteklemektedir.

Sonuç: PRES in çeşitli radyolojik ve klinik bulguları olabilmektedir. Hipertansiyon ve eklampsi gibi tansiyon yüksekliği ile seyreden hastalığı bulu-nan olgularda, atipik MRG bulgularında dahi posterior reversible ensefalopati sendromu akılda bulundurulmalıdır. Diğer ön tanılar ile ayırıcı tanı yapılabilmesi noktasında klinik ve radyolojik takip oldukça yol gösterici olabilir.

P - 088

ERİŞKİNDE TETHEDERED KORD: 2 FARKLI OLGU

MEHMET KARAGÜLLE 1, FATMA ZEYNEP ARSLAN 2, VEFA ÖNER 2, ZEYNEP KESKİN 2, DENİZ EKİNCİ 1, ÖZNUR FUNDA GELENGEÇ 1 1Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye2Konya Eğitim ve Araştırma Hastanesi, Konya, Türkiye

Özet

Tethered kord sendromu (TKS), servikal ve torasik tutulum nadir olarak görülse de genellikle konus medullaris ve kauda ekinanın traksiyonu sonucu ortaya çıkan, progresif nörolojik defisitlerle karakterize klinik tablodur. TKS, kısa ve kalın filum terminale, diastometamyeli, meningom-yelosel, lipomyelomeningosel, spinal lipom ve dermal sinüs ile görülebildiği gibi tümör, araknoidit, travma ve spinal kanala yapılan cerrahi işlemler sonrası görülen yapışıklıklar nedeniyle de görülebilir. Kadınlarda erkeklere oranla daha sıktır. Genellikle çocukluk çağında görülmekle beraber yetişkinlerde de ortaya çıkabilir. TKS, yetişkinlerde asemptomatik olabilir ancak spinal travma, aşırı egzersiz ve tekrarlayan fleksiyon ekstansiyon hareketleri gibi durumlar semptomatik hale gelmesine yol açabilir. Klinik olarak belde, anorektal bölgede ve bacaklarda ağrı, güçsüzlük ve duyu kaybı, üriner ve fekal inkontinans, cilt lezyonları, skolyoz ve ayak bileği deformiteleri görülebilir.

Bizim ilk olgumuz üriner inkontinans şikayetiyle gelen 49 yaşında kadın hastaydı. Çekilen spinal MR incelemesinde; lomber düzeyde skolyoz, T10 verteb-rada kelebek vertebra görünümü, torakal vertebra düzeyinden L2 vertebraya kadar uzanan diastometamyeli ve Spinal kordun L5 vertebra seviyesinde sonlandığı görülmekteydi. İkinci olgumuz üriner inkontinans şikayetiyle başvuran 57 yaşında erkek hastaydı. Spinal MR incelemesinde L2-L3 intervertebral disk düzeyinde 1 cm uzunluğunda syringomyeli, L5-S1 düzeyinde spondilolistezis ve spinal kordun S1 vertebra düzeyinde sonlandığı izlendi.

TKS, normalde L2 vertebra düzeyinde sonlanan conus medullarisin L2 vertebra seviyesinin altında kalması ile kordun gerilmesi ve hareketinde azalma sonucunda nöronal fonksiyonlarda bozulma ve omurilikte ilerleyici iskemi oluşturmasıyla karakterize bir hastalıktır. Nörolojik defisitin ilerleyici olması ve nörojenik mesane tablosunun irreversible olması nedeniyle USG, MR gibi görüntüleme yöntemleri ve klinik bulgularla erken teşhis konulması hastalarda tedavi ve rehabilitasyon açısından oldukça önemlidir.

P - 089

SEREBRAL KAVERNÖZ MALFORMASYONUN MR BULGULARI İLE DEĞERLENDİRİLMESİ. OLGU ÖRNEĞİMEHMET FATİH İNECİKLİ 1, FATMA BEYAZAL ÇELİKER 1, MAKSUDE ESRA KADIOĞLU 1, SİBEL GÖK İNECİKLİ 2, MEHMET BEYAZAL 1 1 Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, Türkiye2 Rize İl Sağlık Müdürlüğü, Rize, Türkiye


Özet

Amaç: Serebral kavernöz malformasyonlar (kavernöz anjiom, kavernom), vasküler yapıların nadir görülen hamartomudur. Serebral kavernöz malformasyonlar (SKM), tamamen kollajenden ibaret olan glial veya nöral doku içermeyen tek tabaka endotelyal hücrelerle örtülü sinüzoidal hücrelere benzer yapılardan oluşmaktadır. Eşlik eden besleyici arter ve drene edici ven yoktur. SKM, intrakranial vasküler malformasyonların %5-16’sını oluştururlar. Klinikte hemoraji, baş ağrısı, epilepsi, ilerleyici nörolojik defisit görülebilir. Serebral hemisferde yerleşimli olanlar genellik-le asemptomatik lezyonlar olup genellikle başka bir nedenle yapılan kranial MR görüntülemelerinde rastlantısal olarak saptanırlar. Asemptomatik olguların MR ile izlenmeleri önerilirken, semptomatik olanlar cerrahi olarak çıkarılmalıdır. Bu bildiride, SKM’lerin MR bulgularını ve özelliklerini sunmayı amaçladık.

Gereç ve Yöntemler: 55 yaşında erkek hasta. Bayılma, kasılma, bilinç kaybı ve senkop tanıları ile başvurdu. Sağ oksipital lobda kalkarin fissüre yakın lokalizasyon 11x12 mm boyutlarında T1A majlarda santrali beyaz cevher ile izointens, periferi hipointens, düzensiz konturlu, T2A ve FLAIR ağırlıklı imajlarda santrali beyaz cevhere göre izo-hipointens, periferal hipointens rimi bulunan patlamış mısır topu görünümünde lezyon saptandı. SWI sekansında belirgin hipointens izlendi. DWI sekanslarında b:1000 değerlerinde kısıtlanma saptanmadı, DWI sekanslarında da hipointens sinyali mevcuttu. Kontrastlı imajlarda santralinde punktat tarzda minimal kontrastlanma dikkati çekmekteydi. MR Perfüzyon sekanslarında düşük değerler mevcuttu. MR Spektroskopi tetkikinde NAA, Cre ve Cho düzeylerinde düşüş saptandı. Cho/Cre, Cho/NAA oranları 2nin altında idi. MR spektroskopi bulguları malign lezyonlar için spesifik değildi.

Sonuç: SKM, T1 ve T2 ağırlıklı MRG’de karakteristik olarak merkezde methemoglobine bağlı yüksek sinyalli bir alan ve çevresinde kalsifikasyon ve fibrozise bağlı düşük sinyalli alanlar gösterirler. T2A kesitlerde tipik olarak çevresinde halka tarzında düşük yoğunluk alanı bulunmakta olup lezyona komşu dokuda ortaya çıkan hemosiderin birikimidir. SWI sekanslarında hipointens izlenmesi, hemorajik alanları temsil edebilir. Belirgin besleyici ater ve drenaj venleri olmayışı nedeniyle perfüzyon değerleri düşüktür. Belirgin nöronal dokuları içermemeleri nedeniyle MR spekt-roskopi verileri spesifik bir özellik göstermemektedir. Ancak özellikle kanama ya da enfarkt oluşumu, klinik bulguları beirginleştirir. Her ne kadar genellikle rastlantısal olarak izlense de klinik veriler doğrultusunda ayrıcı tanıda göz önünde bulundurulmalıdır.

P - 090

GÖZ TUTULUMU İLE PREZENTE ERDHEIM-CHESTER HASTALIĞIÖMER KAYA 1, GÖKHAN SÖKER 2, İLKER BOĞA 3, ORKUN AKMAN 4 1 Ceyhan Devlet Hastanesi, Radyoloji Bölümü, Adana, Türkiye2 Sağlık Bilimleri Üniversitesi Adana Şehir Eğitim ve Araştırma Hastanesi, Adana, Türkiye3 Hacettepe Üniversitesi Tıp Fakültesi, Dahiliye Anabilim Dalı, Ankara, Türkiye4 Hacettepe Üniversitesi Tıp Fakültesi, Patoloji Anabilim Dalı, Ankara, Türkiye

Özet

Erdheim-Chester hastalığı nadir bir ksantogranülamatöz hastalık olup histiosit ve lipid yüklü makrofajların kemik, kalp, akciğer, böbrekler ve retroperiton gibi birçok alanı infiltrasyonu ile karakterizedir. Orbita tutulumu vakaların yaklaşık %25’inde görülmekte olup daha nadirdir.

Orbita tutulumunda ayırıcı tanıda Langerhans hücreli histiyositoz, psödotümör orbita gibi klinik durumlar girmekte olup radyolojik görün-tülemede sıklıkla intrakonal kitle görünümü mevcuttur. Genellikle retroorbital yağ doku, optik sinir, ekstraoküler kasların tutulumu görülür. Radyolojik görüntüleme tanıya yardımcı olmakla birlikte çoğunlukla tanısı için patolojik değerlendirme gerekmektedir.

Bu çalışmada, orbita tutulumu ile prezente olmuş ve ek olarak bir kaç başka sistemik tutulum da gösteren Erdheim-Chester hastalığı olgusu tartışılacak ve radyolojik, patolojik, klinik özellikleri tartışılacaktır.

P - 091

9. KRANİYAL SİNİR FELCİ İLE SEYREDEN SPONTAN UNİLATERAL İNTERNAL KAROTİD ARTER DİSEKSİYONUGÖKHAN KAHRAMAN, MERT BAYRAMOĞLU, FERİDE KURAL RAHATLI, TÜLİN YILDIRIM, AHMET MUHTEŞEM AĞILDERE

Başkent Üniversitesi Tıp Fakültesi, Ankara Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye

Özet

Giriş: Spontan internal karotid arter diseksiyonunun klinik prezentasyonu oldukça değişkendir. ICA diseksiyonu ile birlikte periferik kraniyal sinir felci nadir görülmektedir. Bu olgu bildirisinde 9. kraniyal sinir felci ile birlikte seyreden spontan internal karotid arter (ICA) diseksiyonu olgusunun boyun MR Anjiografi bulgularını sunmaktayız.

Olgu Sunumu: 41 yaşında erkek hasta ani gelişen yüz sağ tarafında ağrı, dil sağ yarısında uyuşma, yutma güçlüğü sebebiyle hastanemize başvurdu. Beyin MRG, difüzyon MRG, boyun MRA tetkikleri yapıldı. Difüzyon MRGde akut enfarkt saptanmadı. Boyun MRA’da sağ ICA’de orijin düzeyinden


1,5 cm distalde kalem ucu tarzında sonlanan total oklüzyon, ICA içerisinde T1ve T2 ağırlıklı imajlarda hiperintens olarak izlenen geç subakut dönemde trombüse ait görünüm, ICA lateral kesiminde T1 ve T2 ağırlıklı serilerde hipointens izlenen kresent sign görünümü saptandı. Sağ orta ve anterior serebral arterlerde kollateral doluşa sekonder patensi izlendi. Hastaya antikoagulan tedavisi başlandı. 5 ay sonra çekilen kontrol boyun MRA tetkikinde sağ internal karotid arter patent olarak izlendi. Hastanın dilde uyuşma, yutma güçlüğü şikâyetlerinin kaybolduğu öğrenildi.

Sonuç: Ani gelişen tek taraflı baş-boyun ağrısı, horner sendromu gibi semptomları bulunan hastalarda intenal karotid arter diseksiyonu akla gelmelidir. Difüzyon MRG serebrovasküler olay ekartasyonunda faydalı iken beyin MRG ve boyun MRA diseksiyon tanısını koymakta eşlik eden tortiozite, anevrizma gibi olası patolojileri saptamakta faydalıdır.

P - 092

IGG4 İLE İLİŞKİLİ HİPOFİZİT VE ORBİTAL TUTULUM: İKİ OLGU SUNUMUGÖKHAN KAHRAMAN, MERT BAYRAMOĞLU, FERİDE KURAL RAHATLI, TÜLİN YILDIRIM, AHMET MUHTEŞEM AĞILDERE

Başkent Üniversitesi Tıp Fakültesi, Ankara Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye

Özet

IgG4 ile ilişkili hipofizit ve orbital tutulum oldukça nadir görülmektedir. IgG4 ile ilişkili hipofizit ve orbital tutulumu olan bir erişkin ve bir pediatrik vaka sunmayı amaçlamaktayız. IgG4 ile ilişkili hipofizit nadir görülen inflamatuar bir durumdur ve hipofiz tümörlerini taklit edebilir. Hipofiz bezin-de kalınlık artışı, superior konturunda bulging, infindibulumda nodülerite ile karaterizedir. IgG4 ile ilişkili orbital inflamasyonda bilateral lakrimal glandlarda inflamasyon ve sıklıkla inferior rektus kasında olmak üzere ekstraoküler kaslarda kalınlık artış izlenebilir. Tiroid oftalmopatisinden ayrı-mında tiroid fonksiyon testlerinim normal olması önemli olmakla beraber tanıda serum IgG4 düzeylerinin yüksek olması yardımcıdır. Radyolojik olarak tanısının koyulması uygun ve etkin tedavide değerlidir. 45 yaşında kadın hastanın hipofiz MRG’sinde hipofiz bez yüksekliğinde artış, hipofiz süperior konturunda suprasellar sisterne doğru bulging, infundibulumda kalınlaşma ve nodüler görünüm izlenmiştir. Orbital MRG’sinde sağda propotozis, sağ inferior, medial, lateral, süperior rektus kaslarında kalınlaşma, sol lateral ve süperior rektus kaslarında minimal kalınlaşma sap-tanmıştır. 13 yaşında erkek çocuk hastanın orbita MRG’sinde sol süperior rektus kasında belirgin kalınlaşma, kontrastlanma, ödem, inflamasyon, komşuluğundaki lakrimal bez boyutlarında artış, retroorbital yağ dokusunda inflamasyon bulguları izlenmiş olup hipofiz tutulumu saptanmamıştır.

P - 093

KAPİTELLAR OSTEOKONDRİTİSHÜSEYİN ALPER KIZILOĞLU, RECEP SADE, RÜSTEM BERHAN PİRİMOĞLU


Özet

Giriş: Osteokondral defektler eklem yüzeyinde kartilaj ve kartilaja komşu subkondral kemik dokusunun fokal hasarını tanımlar. Osteokondral defektler bir grup hastalığı tanımlar ve bu grupta osteokondritis dissekans, osteokondral fraktür ve panner hastalığını kapsar. Dirsekte oste-okondral lezyonlar sıklıkla aşırı kullanım öyküsü olan adölesanlarda karşımıza çıkan idiyopatik bir eklem patolojisidir. Dirsek ekleminde en sık kapitellum etkilenir. Patogenezi tam olarak bilinmemekle birlikte, radyokapitellar ekleme uygulanan tekrarlayıcı mikrotravmalar ile kapitellumun kanlanmasındaki zayıflığın kombinasyonu sonucu geliştiği öngörülmektedir. Sıklıkla 11-15 yaş arası çocuklarda karşılaşılır. Klinik olarak dirsek eklemi lateralinde ağrı, şişlik hassasiyet şeklinde bulgu verir. MRG inceleme dirsekte osteokondral lezyonları değerlendirmede oldukça kullanışlı bir yöntemdir. MRG inceleme kapitellum lezyonlarını radyografi normalken veya minimal bulgu gösteriyorken ortaya koyabilmektedir. MRG bize lezyon boyutu, lokalizasyonu ve stabilizyonu açısından oldukça kullanışlı bilgiler vermektedir. Biz olgumuzda adölesan erkek hastada grafi bulguları oluşmuşken meydana gelen kapitellar osteokondral lezyonun MRG ile değerlendirilmesini sunmayı amaçladık.

Olgu Sunumu: 17 yaşında vücüt geliştirme sporuyla ilgilenen ve sağ dirseğinde ağrı, hassasiyet şikayetleriyle FTR kliniğine başvuran hastaya gerekli muayenede şişlik ve dirsek lateroposterior kesminde hassasiyet bulgularıyla bursit ve osteokondral defekt ön tanısıyla önce direk radyog-rafi çalışılmıştır. Radyolografide distal humerusta kapitellar eklem yüzeyinde coğrafik sınırlı radyolusent görünüm izlenmiştir. Daha sonra hastaya kapitellar osteokondrit ön tanısıyla ve benzer lezyonların ayırıcı tanısı açısından kontrastsız dirsek MRG incelemesi yapılmıştır. MRG incelemede distal humerus kapitellumunde kortikal devamlılık gösteren sınırları T1 AG serilerde daha net ayırt edilebilen subkortikal alana uzanım gösteren eklem yüzeyinde düzensizliğe neden olan T1AG serilerde düşük sinyalli, proton dansite serilerde yüksek sinyalli heterojen çoğrafik sınırlı alanlar izlenmiştir. Hastaya kapitellar osteokondritis tanısı doğrulandı ve stabil lezyon kararı verilerek konservatif tedavi ile takip edilmiştir.

Tartışma: Kapitellar osteokondritis adölesan ve genç yetişkinlerde lateral dirsek ağrısının nadir nedenlerinden birisidir. Konservatif tedavide aktivite modifikasyonu ve kas güçlendirici egzersizlerden oluşur, bu şekilde yaklaşık olarak %50 oranında nonoperatif osteokondral defekt stabilizasyonu sağlanır. Cerrahi girişimler unstabil osteokondral defektlere ve konservatif tedaviye yanıt vermeyen stabil defektlere uygulanır. MRG inceleme dirsek ve diğer bölgelerde osteokondral defektleri tanımlayabilir, stabil ve unstabil şeklinde klasifiye edebilir varsa ek bulguları gösterebilir. Genel sinyal intensite değişikliği T1AG serilerde subkondral alana uzanım gösteren düşük sinyalli alanlar şeklinde T2AG serilerde yüksek sinyalli olarak izlenir. T2 AG görüntülerde unstabil osteokondral defektlerin tanımlanmış dört bulgusu bulunmaktadır : Lezyon ile alttaki


kemik dokuda yüksek sinyalli ince bir hat bulunması, lezyon altında hiperintens ayrı bir alan(kist) varlığı, osteokondral lezyon içerisinden devam eden yüksek sinyalli kartilaj-defekt altındaki kemiğe uzanan transvers seyirli çizgi varlığı ve osteokondral lezyon seviyesinde artiküler yüzeyde fokal defekt varlığı. Bazı osteokondral lezyonlar T1AG görüntülerde düşük sinyalli izlenirken, T2AG gradient eko görüntülerde sinyal değişikliği göstermemektedir, bu grup lezyonlar MRG özeliklerine göre stabil olarak yorumlanır ve konservatif tedavi ile spontan iyileşir. Osteokondral lezyonlar artroskopik ve radyolojik olarak stabil-unstabil ayrımı açısından çeşitli tiplemelere ayrılmaktadır.

Sonuç: biz bu olgumuzda dirsek ayrısının nadir nedenlerinden biri olan kapitellar osteokondritisin tanımlanması tedavisini şekillendirmesi açısın-dan stabilizasyonun değerlendirilmesini vurgulamayı amaçladık.

P - 094

YENİDOĞAN VE İNFANT DÖNEMİ ABDOMİNAL KİTLELERİN TANISINDA MANYETİK REZONANS GÖRÜNTÜLEMENİN YERİKAYHAN KARAKUŞ

Cumhuriyet Üniversitesi, Çocuk Radyolojisi Bilim Dalı, Sivas, Türkiye

Amaç: Bu çalışmada yenidoğan ve infant döneminde abdominal MRG ile saptanan intraabdominal lezyonların MRG bulguları, önemli tanısal ipuçları ve tanısal tuzakları sunulmaktadır.

Gereç ve Yöntemler: Haziran 2012-Ocak 2018 tarihleri arasında farklı ön tanılar ile abdomen MRG yapılmış olan yenidoğan ve infant yaş gru-bundaki yirmi altı olgunun PACS sisteminden görüntüleme bulguları, hasta dosyaları arşivinden klinik ve laboratuar bulguları geriye dönük olarak tarandı. Onyedi olguya abdominal MRG öncesi US inceleme yapıldı. Sekiz olguda MRG’de kontrast madde kullanıldı. Onbeş olguda konvansiyonel MRG’ye difüzyon ağırlıklı görüntüleme ilave edildi.

Bulgular: Yaş ortalaması 82.73±92.72 gün (en küçük 1 gün, en büyük 300 gün) olan 13 kız, 13 erkek toplam 26 olgu incelendi. Olgularda saptanan patolojiler over kisti (n=5), enterik duplikasyon kisti (n=3), megasistis (n=1), mezenterik kist (n=1), diafragmatik mezotelyal kist (n=1), tailgut kisti (n=1), intraabdominal abse (n=1), vulvar kist (n=1), abdominoskrotal hidrosel (n=1), periumblikal kist (n=1), inmemiş testis(n=2), inguinal herni (n=1), konjenital mezoblastik nefroma (n=1), posterior üretral valv (n=1), adrenal hemoraji (n=3), tip 1 sakrokoksigeal teratom (n=1) ve tip 3 sakrokoksigeal teratom (n=1) olarak belirlendi. MRG öncesi US inceleme yapılan onyedi olgunun dördünde US’nin tanıya katkısı olmadı.

Sonuç: Yenidoğan ve infant döneminde farklı lokalizasyonlarda yerleşebilen, orijini, klinik ve radyolojik bulguları farklı çok sayıda abdominal kitle nedeni vardır. Radyolojik tanıda US kolay ulaşılması, iyonizan radyasyon içermemesi nedeniyle ilk tercih edilen inceleme yöntemi olmakla bera-ber US’nin tanıda yetersiz kaldığı durumlarda problem çözücü olarak yumuşak doku rezolüsyonu yüksek olan ve iyonizan radyasyon içermeyen MRG güvenle kullanılmaktadır. İntraabdominal lezyonların görüntüleme bulgularının ve ayırıcı tanılarının bilinmesi, günlük rutinde doğru tanı ve tedavi için radyolog ve klinisyenlere yardımcıdır.

P - 095

NADİR TUTULUM YERİ OLAN HUMERUSDA EOZİNOFİLİK GRANULOMSERHAT KAYA, RÜSTEM BERHAN PİRİMOĞLU, GÖKHAN TONKAZ, GÖKHAN POLAT, RECEP SADE, AKIN LEVENT


Özet

Amaç: Langerhans hücreli histiositoz kemik iliğindeki histosit hücrelerin anormal proliferasyonu sounucu ortaya çıkan nadir bir hastalıktır. Eozinofilik granulom bu hastalığın bir alt tipi olup genellikle tek veya birden fazla kemikte tutuluma neden olan benign bir hastalıktır. Kafatası, vertebra, femur en sık tutulan kemiklerdendir. Biz pediatrik bir vakada nadir tutulum yeri olan humerusda eozinofilik granulom tanısını sunmayı amaçladık.

Gereç ve Yöntemler: 9 yaşında kol ağrısı olan hastaya 1,5 Tesla MRG cihazı ile(Magnetom Avanto, Siemens Healtcare) ile çekim yapıldı. 9 yaşında sağ kolda ağrı ve ele gelen şişlik nedeniyle ortopedi polikliniğine başvurdu. Yapılan muayanede hasta direkt grafi çekildi. Direkt grafisinde sağ humerus orta kesimde kemikte periost reaksiyonuna neden olan litik lezyon izlendi. Hastaya MRI çekildi. Çekilen MRI da sağ humerusda orta diafizer kesimde yaklaşık 23x10x10 mm ebatlı boyutlu korteksde belirgin ekspansiyona ve periost reaksiyonuna neden olan T1 AG serilerde hipointens T2 AG serilerde hiperin-tens postkontrast serilerde kontrast tutmayan kemikte belirgin destrüksiyona neden olmayan kitle lezyon izlendi.

Bulgular: Hastada öncelikli olarak eoznifolik granulom düşünüldü. Hastaya ortopedi tarafından biyopsi yapılıp patoloji sonucu langerhans hücreli histiositoz olarak doğrulandı.

Sonuç: Eozinofilik granülom nadir görülen bir hastalıktır. Genellikle kafatası ve uzun kemikleri tutar. Geçiş zonu dar olup nonagresif özellikler sergiler. En yaygın belirti lezyonun bulunduğu yerde ağrıdır. Bulunduğu kemiklerde patolojik kırıklara neden olabilir. Benign kemik tümörlerinde akılda tutulması gereken hastalıklardan biridir.


P - 096

HİPOTONİK SEREBRAL PALSİYİ TAKLİT EDEN JOUBERT SENDROMUGÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, GÖKHAN POLAT, FAHRİ AYDIN, RECEP SADE, AKIN LEVENT


Özet

Giriş: Joubert sendromu serebellar vermis hipoplazisi veya aplasia ile karakterize otozomal resesif geçişli bir konjenital hastalıktır. Hastalığın insidansının 1/80.000 ila 1/100.000 arasında olduğu tahmin edilmektedir . Joubert sendromunun üç klasik karakteristik özelliği hipotoni, gelişme geriliği ve serebellar malformasyondur. Polidaktili, oküler koloboma, retinal distrofi, kistik displazi veya nefronofitizis gibi renal hastalıklar ve hepatik fibrosiz Joubert sendromunda izlenen diğer bulgulardır. Bazılarının doğumda belirgin olmadığının bilinmesi tarama açısından önemlidir. Hastalar kas tonusunda düzensizlik, anormal göz hareketi ve trunkal ataksiden muzdariptir. Pons ve medullanın çeşitli malformasyonları solunum bozukluklarından sorumludur. Purkinje benzeri nöron heterotopileri semptomları açıklayabilir.

Gereç ve Yöntemler: Biz serebral palsi nedeniyle takipli 10 yaşındaki bir kız hastayı sunuyoruz. Gelişme geriliği, mental retardasyon, hipotoni, ataksi gibi klinik bulguları olan hastadan beyin MRG istendi. MRG de; her iki süperior serebellar pedinkülde kalınlık artışı, belirgin uzamış görünüm ve molar diş görünümü izlendi. 4. ventrikülde yarasa kanadı görünümünün varlığı dikkati çekmektedir. Her iki serebellar hemisfer arasında da vermiyen ageneziyi düşündüren patomorfolojik değişikler izlendi. Mevcut patomorfolojik değişikliklerin varlığı MRG de öncelikle joubert sendromunu düşündürdü.

Bulgular: Joubert sendromunda temel radyolojik bulgular; vermisin tam veya parsiyel yokluğu, hipoplastik serebeller pediküller ve buna bağlı 4. ventrikül deformitesidir. Joubert sendromunda pons ve inferior kollikulus arasındaki beyin sapı bölgesinde disgenezise bağlı ponto-mezansefalik birleşkede uzama, incelme ve interpediküler fossada derinleşme izlenir. Ayrıca süperior serebeller pediküllerde kalınlaşma ile 4. ventrikülde lobulasyon ve genişlemeye neden olan vermis hipoplazisi görülür. Bu üç bulgu aksiyal MR görüntülerde ‘molar diş’ ve ‘yarası kanadı’ görünümüne neden olur.

Sonuç: Joubert sendromunun klinik bulguları serebral palsiye benzerliği gecikmiş veya yanlış tanıya neden olabilir. Joubert sendromu nadir olsa da hipotonik CPnin ayırıcı tanısında dikkate alınmalıdır. Ataksi, nistagmus, hipotoni ve gelişime geriliği olan herhangi bir hasta için nöroradyolojik bulguları değerlendirmek için görüntüleme yapılmalıdır. Joubert sendromu tanısı konulan hastalarda ise ilişkili anomalilerin değerlendirilmesi için tarama faydalıdır.

P - 097

TUBEROZSKLEROZLU HASTADA UNUTULMAMASI GEREKEN LEZYON: RENAL ANJİOMYOLİPOMGÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, MUSTAFA YEŞİLYURT, GÖKHAN POLAT, RECEP SADE, MECİT KANTARCI


Özet

Giriş: Anjiyomyolipomlar(AML) matür yağ dokusu, düz kas hücre demetleri ve kalın duvarlı kan damarlarının değişen oranda karışımlarından oluşan nadir görülen benign mezenkimal tümörlerdir. En yaygın olarak böbreklerde görülür. Bu tümörler genellikle hamartom olarak kabul edilmektedir. Histogenezleri tartışmalı olan bu tümörlerin düz kas ve yağ hücrelerine diferansiye olan puliripotent hücrelerden geliştiğine inanılmaktadır.

Olgu Sunumu: 15 yaşında gelişim geriliği ve tüberoz skleroz nedeniyle takip edilen erkek hasta karın ağrısı olması üzerine çekilen MRG de AML tanısı konulmuş. Biz bu sunumda AML’nin abdomen MRG bulgularını vurgulamayı amaçladık. MRG de sol böbrek üst polde yaklaşık olarak 1 cm ebatlı T1 AG lerde seçilebilen T2 yağ baskılı görüntülerde ise hafif derecede yağ baskılama özelliği gösteren IV kontrast madde enjeksiyonu sonrası alınan görüntülerde kısmı kontrastlanma paterni gösteren öncelikle yağdan fakir anjiomyolipom lehine değerlendirilen lezyon izlendi.

Tartışma: AML ortalama görülme yaşı 41 olmakla birlikte literatürde 6-80 yaşları arasında görüldüğü bildirilmektedir. Kadınlarda erkelerden daha fazla görülmektedir. Renal AML olgularının yaklaşık yarısı izole olarak bulunurken diğer yarısı tüberoz sklerozun deri ya da beyin bulguları ile birlikte bulunur.

Sonuç: Tüberoz skleroz tanısı olan hastalarda AML açısından araştırma yapılmalıdır.

P - 098

NADİR BİR TİROİD MALİGNİTESİ: DİFFÜZ BÜYÜK B HÜCRELİ NONHODGKİN LENFOMAGÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, FAHRİ AYDIN, GÖKHAN POLAT, MECİT KANTARCI, AKIN LEVENT



Özet

Giriş: Primer tiroid lenfoma (PTL), tiroid bezinin seyrek görülen malignitesidir. Erken teşhis, diğer tiroid malignitelerden farklı olarak cerrahi müdahaleye gerek kalmadan başarılı tedavi oranlarının artmasını sağlar. Mevcut etkin tedavinin temel taşı, sistemik kemoterapi ve bölgesel rad-yoterapi kombinasyonudur.

Olgu Sunumu: 15 yaşında kız hasta son bir ay içerisinde hızlı büyüme gösteren, nefes darlığına yol açan, boyun orta hatta ağrısız kitle ile çocuk polikliniğe başvurdu. Çekilen boyun ultrasonografisinde, bilateral tiroid loblarında ve istmus normalden büyük heterojen parankim yapısında izlendi. Parankime yönelik yapılan doppler incelemede parankimal kanlanmada heterojen artış dikkati çekti. Görünümler öncelikle tiroid mali-nitesi lehine değerlendiridi. Kitlenin fikse olması ve büyüklüğü göz önünde bulundurularak boyun Manyetik Rezonans görüntülemede (MRG) yapıldı. MRG de her iki tiroid lobu ve isthmus normalden büyük olup T1 ve T2 AG lerde diffüz heterojen sinyal intensiteleri gösterdi. Her iki tiroid lobu ve isthmus global olarak büyümüş olup trakeayı çepeçevre sarmakta ve heterojenitenin retrosternal uzanımı izlendi. Tiroid glandı T1 AG lerde izo - hipointens, T2 AG lerde hiperintens sinyal karakteristlikleri sergiledi. Postkontrast serilerde her iki tiroid lobu ve isthmus belirgin yoğun ve heterojen kontrastlanma paterni gösterdi. Nefes darlığı ilerleyen hastaya trekastomi takılması planlandı. İşlem sırasında kitleden biyopsi alındı. Biyopsi sonucu Diffüz Büyük B hücreli Lenfoma geldi. Hastaya kemoterapi planlandı.

Tartışma: PTL, tiroid malignitelerinin % 5inden azından ve tüm lenfomaların % 2. 5inden sorumludur. Çoğu PTL, non-Hodgkin lenfomalarıdır. Bu olgu sunumuna benzer şekilde, PTLnin% 50-80i Diffüz büyük B hücreli lenfomalardır ve % 20- 30u, ekstranodal marjinal tipten çoğunun mukoza ilişkili lenfoid doku (MALT) lenfomalarıdır. Diğer nadir alt tipler arasında foliküler lenfoma (% 12), Hodgkin hastalığı (% 7), küçük len-fositik lenfoma (% 4) ve Burkitt lenfoma (% 4).

Otoimmün kronik lenfositik tiroiditi (Hashimoto tiroiditi) varlığı, iyi bilinen bir risk faktörüdür ve genel popülasyona kıyasla PTLyi geliştirme riski 40-80 kat artmıştır. Kadın hastalarda PTL daha sıktır ve yaşamın yedinci dekasında hızlı ve ağrısız bir servikal kitle olarak daha sık rastlanmaktadır.

PTL, vakaların% 80inde (genellikle bir ila üç ay içinde) tiroid nodülünün hızlı bir şekilde büyümesiyle kendini gösterir ve sıkıştırıcı belirtiler (dispne, disfaji, stridor, öksürük, ses kısıklığı ve nadiren Horner sendromu veya Superior Vena Kava sendromu) eşlik edebilir.

PTLde terapötik yaklaşım tartışmalıdır, çünkü nadir bir hastalıktır ve bu nedenle ileriye dönük büyük ölçekli bir çalışma yoktur. Günümüzde çoğu yazar multidisipliner bir yaklaşım önermektedir. Hastalığın lokal kontrolü, radyoterapi, cerrahi veya her ikisi ile sağlanabilir. Kemoterapi, gizli veya yaygın hastalığın kontrolünde, uzun vadeli sonucu iyileştirmek için kullanılır. Cerrahi, bu hastalık için ilk tedavi seçeneği değildir ve seçilen vakalar için ayrılmalıdır. Her bir vaka, kabul edilmiş bir terapötik yaklaşım olmadığından ayrı ayrı değerlendirilmeli ve ele alınmalıdır.

Sonuç: Özellikle hızlı büyüyen tiroid kitlelerinde primer tiroid lenfoması nadir görülüyor olsa da akla getirilmesi gereken bir tanıdır.

P - 099

JOUBERT SENDROMU: OLGU SUNUMUMESUT ÇETİN, ADEM AĞYAR


Özet

Jobert sendromu ( JS) hipotoni, ataksi, serebellum ve beyin sapının nöropatolojik anomalileri ile birlikte nadir görülen otozomal resesif bir send-romdur. 17 aylık kız hasta başını dik tutamama ve başının büyük olması şikayetleri ile hastanemiz çocuk sağlığı ve hastalıkları kliniğine getirildi. Hastadan beyin ve difüzyon MRG istendi. Çekilen MRG de karakteristik görüntüleme bulgusu olan serebellar vermis hipoplazisi ve beyin sapında ‘’molar diş’ ’ bulgusu izlendi. Ayırıcı tanıda Dandy-Walker malformasyonu ve Down sendromu önemli yer teşkil etmektedir. Joubert sendro-munun klinik bulguları oldukça heterojendir. Serebellar vermis hipogenetiktir. Vermiste izlenen minimal doku nedeniyle serebellar hemisferler orta hatta karşı karşıya gelmektedir. Her iki süperior serebellar pedünkül dorsal orta beyinde çaprazlaşmazlar ve orta beyinden serebelluma horizontal bir şekilde uzanırlar. Tüm bu bulgular aksiyal kesitte molar diş görünümüne neden olmaktadır. Geniş spektrumlu heterojenik bul-gularından dolayı, gerçekte var olduğundan daha az oranda JS tanısı konulmaktadır. Bu nedenle klinik olarak JS düşünülen hastaların radyolojik bulguları dikkatle değerlendirilmelidir.

P - 0100

HERLYN WERNER WUNDERLİCH SENDROMUFAHRİ AYDIN, BERHAN PİRİMOĞLU, GÖKHAN POLAT, RECEP SADE, MECİT KANTARCI


Özet

Giriş: Uterus didelfis, hemivajina obstrüksiyonu ve renal agenezi birlikteliği Herlyn Werner Wunderlich(HWW) Sendromu olarak bilinmek-tedir. HWW obstrükte tarafta hematometrokolpos ve buna bağlı gelişen abdominal ağrı ile klinik olarak kendini göstermektedir. Genellikle postpubertal-pubertal dönemdeki adelosanlarda kendini göstermekle birlikte nadiren prepubertal dönemde de bulgu verebilir.


Olgu Sunumu: 13 yaşında kız hasta hastanemize şiddetli sağ alt kadran ağrısı şikayeti ile başvuruyor. Hastanın bölümümüzde çekilen MRG görü-nütülerinde sağda renal agenezi ve sağ tarafta hematokolpos gelişmiş uterus didelfis ile uyumlu görünümler mevcuttu.

Tartışma: HWW nadir görülen ürogenital trakt anomalisidir. Klasik triadı uterus didelfis, hemivajina obstrüksiyonu ve renal agenezidir. Müllerian kanalların orta hatta göçü ve füzyonu yaklaşık intrauterin 8. haftada meydana gelir. Müllerian kanal anomalileri aynı üreterik tomurcuktan köken almaları nedeni ile böbrekler, overler, uterus, serviks ve proksimal vajeni birlikte etkileyebilir.

Sonuç: Akut başlangıçlı şiddetli karın ağrısı ile başvuran pubertal-postpubertal bayanlarda pelvik bölgede hematokolpos yönünden şüphe uyan-dıracak komplike içerikli kistik lezyon tesbitinde, uterus ve böbrekler değerlendirilmeli ve nadir de olsa Herlyn Werner Wunderlich Senromu akla gelmelidir.

P - 0101

NADİR BİR VARYANT : MEDİAN SAKRAL ARTER ORJİNLİ BİLATERAL AKSESUAR RENAL ARTERAYŞE GÜL ALIMLI1, MESUT SİVRİ2, NAZLI GÜLSÜM AKYEL2, MEHMET TİFTİK2, TÜLİN HAKAN DEMİRKAN2 1Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları, Hematoloji, Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji Bilim Dalı, Ankara2Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları, Hematoloji, Onkoloji Eğitim Ve Araştırma Hastanesi Radyoloji Anabilim Dalı, Ankara, Türkiye

Özet

Aksesuar renal arter populasyonda yaklaşık %25 sıklıkla izlenen yaygın bir varyasyondur. Sıklıkla abdominal aorta (%70) orjinlidir. Nadiren çölyak trunkus, süperior mezenterik arter, inferior mezenterik arter, ilyak arterden de köken alabilir. Ancak median sakral arter orjinli aksesuar renal arter oldukça nadirdir. Bu bildiride hipertansiyon nedeni ile manyetik rezonans anjiografi tetkiki elde olunan aorta orjinli aksesuar renal arterleri yanı sıra median sakral arter orjinli sağ böbrek ve sol böbrek alt polü besleyen aksesuar renal arterleri tespit edilen 17 yaşındaki erkek hasta tartışılmıştır.

P - 0102

KAYBOLAN HERNİFAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Disk hernilerinde etiyoloji genellikle mekanik nedenlidir. Anulus fibrosus liflerinde parsiyel ya da tam kat yırtık söz konusudur. Disk her-nileri patolojik olarak prolapsus, ekstrüde disk ve sekestrasyon olarak üç gruba ayrılır.

Olgu Sunumu: 15 yaşında kız hasta bel ağrısı ile hastanemize başvuruyor. Departmanımızda çekilen lomber MR incelemesinde T12 ver-tabra posterior komşuluğunda disk intensitesinde lezyon saptadı. Radyolojik bulgular lezyonun disk herniasyonuna sekonder geliştiğini gös-termekteydi. Hastanın 2 ay sonra çekilen kontrol MR incelemesinde lezyonun tamamen regrese olduğu ve kontrol tetkikinde izlenmediği görülmüştür.

Tartışma: Disk hernisi farklı radyolojik tablolarda ortaya çıkabilmektedir. Protrüzyon, sekestrasyon ve lateral disk temel radyolojik bulgulardır. Protrüzyon diskte gelişen kabarıklıklıktır. Sekestrasyonda esktrude disk ana diskten koparak ekstradural alana serbest bir parça olarak ayrılır. Lateral disk ise diskin laterala doğru yer değiştirip tekal aralığı terk eden sinir köküne bası yapmasıdır.

Sonuç: Bizim vakamızda bulunan “kaybolan herni” literatürde oldukça nadir bahsedilen operasyon edilmeden spontan olarak gerileyen herniyi temsil etmektedir. Spontan disk regresyonunun makrofajlar tarafından meydana gelen fagositik bir inflamatuar süreç olduğu bildirilmektedir.

P - 0103

MYOZİTİS OSSİFİKANSA BENZEYEN SESSİL OSTEOKONDROMFAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, MUSTAFA YEŞİLYURT, GÖKHAN TONKAZ, BERHAN PİRİMOGLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI



Özet

Giriş: Osteokondromlar kemiğin en sık görülen bening tümörleridir. Erkeklerde biraz daha sıktır. Klasik olarak diz çevresinde tibia distali, femur proksimalinde ve omuzda humerus proksimalinde yerleşim gösterirler. Osteokondromun karakteristik bulgusu lezyon seviyesinde kemik korteks ve medullanın devamlılık göstermesi ve hyalin kartilaj kep bulundurmasıdır. Genellikle asemptomatik mobil kitle şeklinde kendini gösterirler.

Olgu Sunumu: 15 yaşında kız hasta sağ kalçada ağrı ve şişlik şikayeti ile hastanemize başvurmuştur. Hastanın travma öyküsü bulunmamaktadır. Departmanımızda çekilen MRG incelemesinde hastanın sağ femur proksimal seviyesinde ince kontrastlanan kıkırdak kep bulunduran pedinküle kitle lezyon izlendi. Hastanın direk grafisinde bu düzeyde kalsifikasyon barındıran opasite alanı izlenmştir.

Tartışma: Osteokondromlar özellikle ilk iki dekatta ortaya çıkan epifizyal büyüme kıkırdağından gelişen tümörlerdir. Sıklıkla diz çevresine yerleşir. Lezyonlar kemik korteksi ile devamlılık gösterirler. Çok nadir olmakla birlikte malign transformasyon gösterebilmektedirler. Malign transformas-yon daha çok herediter multiple egzositoz ilişkili osteokondrom vakalarında bildirilmiştir.

Sonuç: Osteokondromlar farklı varyantlarda ortaya çıkabilmektedir. Bizim vakamızda olduğu gibi nadiren görülen sessile osteokondromlar direkt grafide myozitis ossifikasyon ile karışabilmektedir.

P - 0104

JUVENİL REKÜRREN PAROTİTİSMUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, GÖKHAN POLAT, SERHAT KAYA, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI


Özet

Giriş: JRP, puberte öncesi en az iki defa tekrarlayan tek taraflı veya bilateral parotis bezi şişmesi ile karakterize, non-obstrüktif, non-supuratif inflamatuar hastalık olarak tanımlanır. Hastalığın insidansı bilinmemekle birlikte, tükrük bezlerinin kabakulak sonrası ikinci sırada görülebilen hastalığıdır. İlk atak genellikle 3-6 yaş arasındadır(6 ay-16 yaş) ve erkeklerde daha sık görülür. JRPnin tanısı genellikle tekrarlayan tek taraflı veya bilateral parotid şişme ve sialektazinin gösterilmesine dayanır. JRP tanısında araştırmacı araç olarak konvansiyonel siyalografi, dijital siyalografi, US, MR ve sialendoskopiyi kullanır.

Olgu Sunumu: 16 yaşında kadında hasta hastanemize her iki kulağının altında parotis lojunda ağrılı şişlik şikayeti ile başvurdu. Anamnezinde önceden de bu şekilde ataklar geçirdiğini belirtmiştir. Departmanımızda hastaya çekilen boyun MRG’de her iki parotis bezinde boyut artışı ve fokal sinyal artışları görüldü.

Tartışma: Renkli Doppler US, manyetik rezonans siyalografi ve sialoendoskopi gibi modern, minimal invaziv tanı araçlarının kullanımı, JRP tanı ve tedavisinde yeni bir bakış açısı oluşturmaktadır. JRP, çocuklarda non-obstrüktif, inflamatuar bir parotis hastalığıdır ve MR sialografi ana kanalı ve intraglandüler dalları iyi gösterir. Klasik klinik bulguları olan çocuklarda US tek başına tanısaldır ve MR siyalografi gerekli değildir. Bununla birlikte, MR bulguları, atipik olgularda ve tek taraflı olgularda yararlı olabilir.

Sonuç: MR ve MR sialografi tanı noktasında US nin yerine geçmese ve hasta yönetimini değiştirmese de, hastalığın fazına bağlı olarak parotis bezinde sialektazi ve sinyal yoğunluğu değişiklikleri gibi bulguları doğru bir şekilde gösterebilirler(akut evre ve kronik evre açısından). MR ve MR sialografi artık inflamatuar tükürük bezi hastalığının görüntülemesinde yaygın olarak kullanıldığından, radyologlar JRPnin MR görüntüsüne aşina olmalıdır.

P - 0105

NADİR BAŞ AĞRISI NEDENİ;NÖROBLASTOMUN KALVARİAL METASTAZIMUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI


Özet

Giriş: Nöroblastom erken çocukluk çağı tümörleri içerisinde en sık görülenidir. Adrenal medulla veya sempatik gangliyonlardan kaynaklanırlar. Disemine nöroblastomlarda beyin parankimi ve leptomeningeal tutuluma ait intraaksiyel ve ekstraaksiyel metastazlar görülebilir.

Nöroblastomun kranial metastazlarında BT ve düz röntgenogramlarda kemik yapıda fokal litîk ve blastik lezyonların kalvaryumun hem iç hem de dış tabulasını tuttuğu gözlenir. Bu lezyonlar sıklıkla iyi sınırlı ve sklerotik kenarlıdır. Sütürlerde açılmaya neden olmaları tipiktir.

Olgu Sunumu: 14 yaşında erkek hasta uzun süredir devam eden fakat son birkaç saattir artan baş ağrısı şikayeti ile acil servise başvurdu. Öz geçmişinde nöroblastom nedeniyle opere olduğu öğrenildi. FM de baş çevresinin büyük olduğu gözlenen hastaya kranial BT ve MR görüntüleme planlandı.


Tartışma: Nöroblastomlarda serebral metastaz en sık epîdural aralığa olmaktadır. BT ve MRGde karakteristik olarak bikonveks, beyin parankîmini iç tabuladan uzaklaştıran kitle görünümü İle tanınırlar. Nöroblastomlarm kranyal metastazları en sık epidural mesafeye, daha nadir olarak dura veya leptomeningeal yapılara olmaktadır.

Sonuç: Leptomeningeal metastazlar BT ve MR görüntülemede sulkal-sisternal, epandimal-subepandimal ve tentoryal diffüz kontrast tutulumu şeklinde izlenirken, dural metastazlar kalvaryum İle durayı birbirinden ayıran, epidural mesafeyi dolduran, venöz sinüslere İnvazyon gösterebilen kitleler şeklinde karşımıza çıkmaktadır. Ancak daha nadir olmakla birlikte direkt olarak serebral parankime metastaz yapmış olgular bildirilmiştir.

P - 0106

KUADRİPLEJİYE NEDEN OLAN METASTATİK EMBRİONAL TÜMÖRMUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, ALPER KIZILOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Embrional tümürler 3 yaş altı pediatrik hastalarda en sık beyin tümörleridir. Histolojik olarak undiferansiye küçük yuvarlak hücreli tümör-ler olarak tanımlanırlar. En sık görüleni medulloblastomdur. Primer nöroektodermal tümör(PNET), Atipikal teratoid/rabdoid tümör(ATRT), medulloependimom, epandimoblastomi medullomyoblastom ve melanotik medulloblastom da embrional tümörlerdir. Hepsi agresif seyretmek-te ve santral sinir sistemi dışına yayılma eğilimi göstermektedirler. Embrional tümörler genellikle supretentorial yerleşimli olup daha az oranda infratentorial ve nadiren spinal tutulum gösterirler. Kitle etkisiyle; intrakranial basınç artışı, hemiparazi, serebellar bulgular ve kranial sinir felçleri gibi bulgular oluşabilmektedir.

Olgu Sunumu: 15 yaş erkek hasta tüm ekstremitelerde güçsüzlük ve ağrı, servikal ağrı şikayetleriyle beyin cerrahi kliniğine başvurdu. Çekilen MRG’de kranioservikal bileşkede ekstrameduller yerleşimli T1AG’lerde heterojen izointens, T2 AG’lerde heterojen hiperintens lezyon imajı izlenmiş olup postkontrast serilerde heterojen kontrastlanma göstermektedir. Ayrıca kitlenin spinal kord ve medulla oblongataya bası oluştur-duğu, nöral foramene uzanım gösterdiği izlenmektedir.

Tartışma: Medulloblastomlar 4. ventrikül tepesinden kaynaklanan ve öne ventrikül içine doğru büyüyen düzgün sınırlı, T1 AG’lerde hipointens ve T2 AG’lerde orta derece intensite özellikleri gösterir. FLAIR kesitlerde gri cevher ile izointens izlenmekte difüzyon AG’lerde lezyonlar hipe-rintens izlenmektedir. Supratentorial PNET’ler genellikle fronto parietal bölge kaynaklı, hemoraji, kalsifikasyon ve geniş kistik komponentler içeren büyük iyi sınırlı kitleler olarak izlenmektedir.

Sonuç: Atipik teratoid rabdoid tümörler %50 oranında posterior fossadan, %40 oranında supratentorial alandan kaynaklanan kistik, nekrotik, kalsifik ve hemorajik odaklar içeren medulloblastom ve PNET’lerden net ayrımı yapılamayan lezyonlardır. Tanı anında 1/3 oranında leptomenin-geal yayılım mevcuttur. Kontrastlı tetkiklerde lezyonlar heterojen kontrastlanma göstemektedir. MR Spektroskopide kolin piki ve artmış kolin/aspartat oranı hiperselülariteyi düşündürmektedir.

P - 0107

NÖROBEHÇETİN NADİR YERLEŞİMİ; SERVİKAL TUTULUMMUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, ALPER KIZILOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Nöro Behçet hastalığı, Behçet hastalığının santral sinir sistemi tutulumuna verilen isimdir. Tüm Behçet hastalığı vakalarının %4-49’unda santral sinir sistemi tutulumu mevcuttur. Baş ağrısı, kişilik değişiklikleri, duysal bozukluklar, dizartri ve serebellar bulgular ile prezente olabilir. Vakaların %3’ünde tanı anında santral sinir sistemi bulguları mevcuttur. Fokal ve multifokal tutulumlar nöro-Behçet’in sık görülen SSS tutulum şeklidir, meningoensefalit ve sinüs ven trombozu daha nadirdir. Beyin sapı fokal lezyonların en sık görüldüğü alandır. Bazal ganglionlar 1/3 ora-nında bilateral tutulur. Serebral beyaz cevher tutulumu ve servikotorakal spinal kord tutulumu nadirdir.

Olgu Sunumu: 5 yıldır Behçet hastalığı olduğu bilinen 17 yaşında erkek hasta kol ve bacaklarda güçsüzlük şikayetiyle başvurdu. Kliniğimizde çekilen MRG’de servikal alanda intrameduller patolojik heterojen intensiteler izlendi. Radyolojik bulgular eşliğinde lezyon primer nöro-Behçet hastalığı olarak değerlendirildi.

Tartışma: Nöro Behçet lezyonları tipik olarak T1 AG’lerde hipointens, T2 AG’lerde ve FLAIR kesitlerde hiperintenstir. Lezyonlar tipik olarak orta derece yamalı kontrast tutulumu ve hafif difüzyon kısıtlılığı gösterebilirler. Lezyonlara akut evrede genellikle vazojenik ödem eşlik eder ve olduğundan büyük görünebilir. Akut fazda lezyonlar kitle etkisi oluşturmaktadır. İleri dönemlerde lezyonlar küçülüp akut fazdaki kontrastlanma özelliklerini kaybeder ve bazı lezyonlar hemosiderin birikimine bağlı mikrohemoraji gibi görünebilmektedir. Ayırıcı tanıda multipl skleroz, nöro-sarkoidoz, primer santral sinir sistemi lenfoması akla gelmesi gereken patolojilerdir.


P - 0108

HAYATİ TEHDİT OLUŞTURAN BİR VAKA; PEDİATRİK HASTADA NEKROTİZAN PANKREATİTMUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, BERHAN PİRİMOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Akut pankreatitlerin ödematöz ve nekrotizan olmak üzere iki tür akut pankreatit vardır. Vakaların %90 gibi büyük bir kısmı ödematöz pankreatitdir. Nekrotizan pankreatit akut pankreatitin hayatı tehdit eden ağır formudur. Safra taşları, akut pankreatitlerin en sık sebebini oluşturmaktadır. Görüntüleme yöntemleri komplikasyonların tespiti ve tedavinin yönlendirilmesinde önemli rol oynar. Mortalite oranları steril nekrotizan pankreatitlerde %14 iken enfekte olması halinde %20-30’lara ulaşmaktadır. Enfekte bir nekrotizan pankreatit eğer direne edilmezse %100 ölümcüldür.

Olgu Sunumu: 9 yaş erkek hasta bir haftadır devam eden şiddetli karın ağrısı ve kusma ile başvurdu. Yapılan ultrasonunda pankreas gövde ve kuyruk kesimlerinde kistik ve nekrotik değişiklikler izlendi.

Tartışma: Akut pankreatit ve komplikasyonlarının tanısında tercih edilen görüntüleme yöntemi bilgisayarlı tomografidir. Erken aşamalarda SIRS ve multi organ yetmezliği bulguları pankreatitin ağırlığını değerlendirmede önemlidir, görüntüleme yöntemleri erken aşamada henüz morfolojik bozuklukları yansıtamayacağı için yetersiz kalmaktadır. BT’de nekrotik komponentler, kontrast tutmayan hipodens alanlar olarak izlenmektedir. Nekrotizan pankreatitler; parankimal, peripankreatik ve kombine olmak üzere alt gruplara ayrılır. Nekrotizan pankreatitte iki tür kolleksiyon vardır ilk 4 hafta akut nekrotizan kolleksiyon (ANC), 4 haftadan sonra duvarla çevrili kolleksiyon (WON) alarak adlandırılır. WON duvarı kontrast tutar.

P - 0109

BİLATERAL İLERİ DERECEDE KORTİKAL ATROFİ İZLENEN STURGE WEBER VAKASIMUTLU AY, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, MEHMET ALPEREN TEZCAN, GÖKHAN POLAT, BERHAN PİRİMOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Sturge Weber Sendromu (SWS), 50.000 doğumda bir görülür. Ensefalotrigeminal anjiomatozis olarak da adlandırılır. Yüzde porto şarabı lekesi ve pial anjiomlarla karakterize bir fokomatozdur. Diğer fokomatozlardan farklı olarak SWS sporadiktir ve kesin bir gen bulunamamıştır. Kliniğe konvülsiyon, intrakraniyal kalsifikasyonlar, kontralateral hemiparezi ve ipsilateral vasküler anomaliler eşlik eder. Fasiyal hemanjiomlar genellikle tek taraflı ve intrakranial patoloji ile ipsilateral olmakla birlikte bilateral de olabilmektedir.

Olgu Sunumu: 3 yaş kız hasta, 2 yıldır epilepsi nedeniyle takip edilmekte olup atak ile acile başvurdu. Çekilen tomografisinde ileri derecede kortikal atrofi bulguları ve giruslarda kalsifikasyonlar izlendi. MR görüntülemede koroid pleksuslarda asimetrik hipertrofi ve leptomeningeal pial anjiomlar izlendi. Görüntüleme bulguları eşliğinde hastaya Sturge Weber tanısı konuldu.

Tartışma: SWS’nin BT bulguları arasında; kortikal atrofi kalsifikasyon ve ipsilateral koroid pleksus hipertrofisi bulunmaktadır. BT’de kortikal ve subkortikal kalsifikasyonlar tren rayı görünümü oluşturabilir. MR bulguları T1 AG’lerde etkilenen alanlar izointens izlenmektedir. Kortikal atrofi izlenir. Kontrastlı T1 AG’lerde ipsilateral koroid pleksus hipertrofisi ve leptomeningeal kontrast tutulumu izlenmektedir. T2 AG’lerde anjiomlara bağlı beyaz cevherde hipointens alanlar izlenmektedir, anormal venöz kollateraller sinyal kaybı olarak izlenmektedir.

P - 0110

PEDİATRİK OLGUDA ANEVRİZMAL KEMİK KİSTİMUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY, GÖKHAN POLAT, ALPER KIZILOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI


Özet

Giriş: Anevrizmal kemik kistleri iskelet sisteminin benign ve nadir karşılaşılan lezyonlarıdır; tüm kemik tümörlerinin yaklaşık olarak %1ni oluştu-rurlar. Anevrizmal kemik kisti, kemiği ekspanse, hatta bazen tamamen harap eden kistik, vasküler tümör benzeri bir oluşumdur. Klinik karakteri,


sessiz bir lezyondan bir sarkomu taklit eden agresif davranışa kadar değişik bir spektrum gösterir. Anevrizmal kemik kistinin patogenezi tam olarak bilinmemekle beraber genel düşünce travma veya prekürsör bir lezyon ile başlayan bir vasküler anomali olduğu yolundadır.

Olgu Sunumu: 10 yaşındaki erkek hasta 1 aydır sol omzunda şişlik ve ağrı yakınması ile başvurdu FM de sol humerus proksimal ucunda yerleşen yaklaşık 7x4 cm çapında kitle izlendi Palpasyonda ısı artışı, duyarlılık yada kızarıklık saptanmadı Humerusu görüntülemeye yönelik yapılan röntgen incelemesinde, sol humerus başında, yaklaşık 10x4 cm boyutlarında kitle izlendi.

Tartışma: Anevrizmal kemik kisti, tüm iskelette görülebilmesine karşın, sıklıkla uzun kemiklerde (%65) gözlenir. Kadınlarda (% 58) erkeklere nazaran daha sık görülür. Olguların %80 i yirmi yaşından önce görülmektedir ve otuz yaşından sonra görülmesi nadirdir. Anevrizmal kemik kis-tini tanımak için kullanılan görüntüleme yöntemleri X-ray, bigisayarlı tomografi (BT), magnetik rezonans görüntüleme (MRG) ve arteriografidir. MRG ile lezyondaki internal septalar bal peteği (‘honeycomp) görünümünde izlenir ve sıvı-sıvı seviyesi mevcuttur. Septaların görüntülenmesi olguyu diğer kistik içi sıvı dolu olgulardan ayırmakta yardımcı olur.

P - 0111

SUPRATENTORİAL VE İNFRATENTORİAL MRG BULGULARINI BİRARADA BULUNDURAN JOUBERT SENDROMUMUSTAFA YEŞİLYURT, RECEP SADE, BERHAN PİRİMOĞLU, GÖKHAN POLAT, MECİT KANTARCI, MUTLU AY, GÖKHAN TONKAZ, SERHAT KAYA


Özet

Giriş: Kalıtım olarak otozomal resesif geçiş gösterir. JS asıl olarak vermian ageneziye eşlik eden epizodik hiperpne,okulomotor apraksi, atak-si ve kognitif bozuklukları gibi klinik bulgular ile tanımlanır: Eşlik edebilecek diğer klinik durumlar oküler anomaliler, multikistik displastik böbrek,hepatik fibrozis, polidaktili ve nefronofitizistir. JS’unda beyin sapının orta hat yapıları, hem yapısal hem de fonksiyonel defektlere sahiptir. Nöropatolojik çalışmalar serebellar vermis agenezisini, birçok beyin sapı nükleuslarının hipoplazisi veya fragmentasyonunu ve pontomezensefalik bileşkedeki yapıların displazik olduğunu göstermiştir.

Olgu Sunumu: 9 yaşında kız hasta nöromotor gelişme geriliği ile hastanemiz çocuk servisine yatırılmıştır Departmanımızda hastaya çekilen beyin MRG’de vermian agenezi ve korpus kallosum agenezisi görülmüştür.

Tartışma: Klinik olarak Joubert Sendromu düşünülen olgularda tanı görüntüleme bulguları ile konur. Görüntüleme yöntemi olarak ise kranial MR kullanılır. Yine tanıya yardımcı olması açısından batın USG de multikistik displastik böbrek görülebilir. Kranial MRG de; Vermian Agenezi/Hipoplazi, ventrikül genişlemesi, Superior serebellar pedinkülde morfolojik değişiklik (kalınlaşması/uzaması/incelmesi) ve bunlara sekonder molar diş görünümü ve yarasa kanadı görünümü aranmalıdır. Eşlik edebilen diğer bulgular; Corpus Callosum disgenezi/agenezi, Septum pellu-sidum agenezisi, KIBA ya neden olmayacak düzeyde lateral ventrikülde genişleme Tanıyı Joubert Sendromu lehine düşündükten sonra orta hat defektlerinin eşlik edip etmediğine bakılmalıdır. Nörogörüntüleme açısından ayırıcı tanıda; Dandy-Walker Send/Variantı, Septo-optik Displazi, Rhombensefalosinapsis düşünülmelidir.

P - 0112

STURGE-WEBER SENDROMLU PEDİATRİK OLGUNUN İNTRAKRANİAL GÖRÜNTÜLEME BULGULARININ YAŞLA DEĞİŞİMİMUSTAFA YEŞİLYURT, RECEP SADE, BERHAN PİRİMOĞLU, GÖKHAN POLAT, MECİT KANTARCI, EMİNE İZGİ, FAHRİ AYDIN, SERHAT KAYA


Özet

Giriş: Herediter geçişi belirsiz, malignite riski olmayan, lokal morbiditeye yol açan multisistemik vaskuler hamartomdur. 1/20000-50000 insi-dansa sahiptir. Tanı genelde fasyal anjıom (porto şarabı lekesi-nevus flammeus) nedeniyle belirgindir. Nörolojik semptom fasyal anjıomla aynı tarafta yer alan ve genelde parietooksipital bölgeyi tutan leptomeningeal hemanjiom ile ilgilidir. En sık görülen klinik tablo çocuklukta nöbetler olup, vakaların% 71-89unda görülür ve genellikle tıbbi tedaviye dirençlidir.

Olgu Sunumu: 25 yaşındaki annenin 1.gebeliğinde 1.yaşayan olarak normal yoldan doğan erkek bebeğin yüzünde porto-şarabı lekesi olması nedeniyle ileri tetkikine ve takibine karar verildi 1 yaşındayken sol ağız ve sol kolda atma ve titreme tarzında nöbeti olunca tekrar hastaneye başvurmuşlar.Doğum sonrası çekilen BT de çok anlamlı bulgu olmamasına rağmen 1 yaşında çekilen beyin BT de kortikal atrofi ve kalsifikasyon-ların görülmesiyle sturge –weber sendromu tanısı almış ve takibe girmiştir.


Tartışma: 1/20000-50000 insidans ile nisbeten sık görülen bir sendrom. İlerleyen dönemlerde nöbet şeklinde kendini göstermektedir. Doğumda fasyal anjiom bulgusu olan bebeklerde tanı kranial görüntüleme bulguları ile konulmaktadır. Görüntüleme açısından ayırıcı tanıya intraserebral AV malformasyonlar, TORCH enfeksiyonları ve Gobbi sendromu girer. BT de kortikal-subkortikal kalsifikasyon, koroid pleksusta genişleme ve parankimal volum kaybı görülürken MRG de bunlara ek olarak leptomeningeal kontrastlanma görülür.

P - 0113

PEDİATRİK OLGUDA TİP 1 KİST HİDATİĞİN DİFFÜZYON MR GÖRÜNTÜSÜMUSTAFA YEŞİLYURT, RECEP SADE, BERHAN PİRİMOĞLU, GÖKHAN POLAT, MECİT KANTARCI, GÖKHAN TONKAZ, EMİNE İZGİ, MUTLU AY*, FAHRİ AYDIN


Özet

Giriş: Karaciğer kistleri genel popülasyonda% 5lik bir prevalansla ortaya çıkmaktadır. Hidatik kist hastalığının tanısı epidemiyolojik ve klinik bul-gulara ve radyolojik çalışmalara ve immünolojik testlere dayanır. İnsan kist hidatikleri, olası anafilaktik şok, yeni kistlerin yayılması ve bakteriyel enfeksiyon ile kist rüptürü gibi hayatı tehdit eden komplikasyonlara neden olabilir. Bununla birlikte, enfeksiyon gibi komplikasyon olmadıkça basit kistler asemptomatiktir. Bu nedenle, basit kistleri hidatik kistlerden ayırt etmek çok önemlidir. Kist tipine bağlı olarak çok çeşitli tedavi seçenekleri vardır; Bu nedenle, benign kistin ekinokokkoz, kistadenom ve kistadenokarsinom gibi zararlı kistlerden ayırt edilmesi önemlidir.

Olgu Sunumu: 11 yaşında kadın hasta hastanemize karın ağrısı şikayeti ile başvurdu. Departmanımızda hastaya çekilen difüzyon ve batın MRG de tip 1 kist hidatik ile uyumlu görünümler izlenmiş ve laboratuar olarak kist hidatik olduğu kanıtlanmıştır.

Tartışma: Manyetik rezonans görüntüleme, kliniğimizde MRun kontrast rezolüsyonu ve noniyonize olmasından dolayı kistik lezyonların karakte-rizasyonu için tercih edilen bir yöntemdir. Bununla birlikte, tip 1 hidatik kistleri basit kistlerden ve tip IV hidatik kistlerden karaciğerindeki diğer katı lezyonlardan ayırmak imkansızdır. Bu koşullarda, karaciğerdeki kistik lezyonları ayırt etmek için BT veya MRG yapılabilir. Difüzyon ağırlıklı görüntüleme, konvansiyonel MR görüntüleme tekniklerinden farklıdır; difüzyon veya Brownian su hareketi olarak bilinen randomize moleküler hareketi hassas bir şekilde algılayabilir.

P - 0114

PERİANAL RABDOMYOSARKOMEMİNE İZGİ, ALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, GÖKHAN POLAT, BERHAN PİRİMOĞLU, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: Rabdomyosarkom iskelet kasına farklılaşan mezenkimal hücrelerden kaynaklanan oldukça agresif nadir görülen malign bir tümördür. Bu olgu sunumu ile amacımız, anal bölge kitlelerin ayırıcı tanısında, ender rastlanması ve oldukça kötü seyir göstermesi nedeniyle, perianal rabdom-yosarkom tanısının gözden kaçırılmaması gerekliliğini vurgulamaktır.

Olgu Sunumu: 3 yaşındaki erkek hasta perianal bölgede kitle şikayeti ile pediatri kliniğine başvurdu. Hastanın muayenesinde 8x9 cm ebatlı pal-pasyonla sert kıvamda kitle mevcuttu. Yapılan US de ; skrotum inferioru ile anal kanal arasında yaklaşık 8x7x6 cm ölçülen heterojen ekojenitede, doppler US de belirgin vaskülerite gözlenen yer yer milimetrik kistik alanlar içeren kitlesel görünüm dikkati çekmiştir. Hastanın BT sinde bu böl-gede testis ile ilişkisi saptanmayan yumuşak doku dansitesinde kitle lezyon izlendi. Hastanın MR ında T1 AG hetereojen hipointens T2 AG hete-rojen hiperintens olan lezyon kontrastlı görüntülerde belirgin kontrast tutmakta idi. Lezyonun histopatolojisi rabdomyosarkom olarak gelmiştir.

Tartışma: Çocukluk çağında en sık görülen malign yumuşak doku tümörü olan rabdomyosarkom, bu yaş grubundaki tüm solid tümörlerin %5-8ini oluşturmaktadır. Erişkinlerde ise bu oran %1 dir. Çocukluk çağında perianal bölge lokalizasyonlu rabdomyosarkom oldukça nadir olup, tüm rabdomyosarkomların %2sini oluşturmaktadır. En sık baş ve boyunda (%40), genitoüriner sistemde (%20), ekstemitelerde (%20) ve gövdede (%10) bulunurlar. Retroperitoneal bölge (karın arka duvarı) ve diğer bölgeler (%10)’unu oluşturur. Ekstremite lezyonları ileri yaş çocuklarda daha sıktır ve alveolar histolojik yapıya sahiptirler. Embriyonal en sık görülen tip (% 60) olup baş-boyun ve paratestiküler bölgelerde ortaya çıkarken, botryoid tip sıklıkla genitoüriner sistemin mukozal yüzeylerini tutar. Pleomorfik rabdomyosarkom ise daha çok erişkinlerde, ekstremitelerin büyük kaslarında görülür.

P - 0115

İKİNCİ BRANKİAL KLEFT KİSTİ: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI


GÖKHAN TONKAZ, SERHAT KAYA, BERHAN PİRİMOĞLU, MUTLU AY*, FAHRİ AYDIN, SUAT EREN, MECİT KANTARCI


Özet

Giriş: Brankial arkların embriyonik dönemde anormal gelişmesi sonucunda kist, sinüs veya fistül şeklinde brankial anomaliler gelişir. Brankial anomaliler köken aldığı yere göre isimlendirilir. En sık rastlanan anomali ikinci brankial yarık kistleridir ve tüm brankial yarık anomalilerinin % 95ini oluşturur. Brankial kleft kistleri (BKK) genellikle boyun lateralinde, sternokleidomastoid kasının anteriorunda görülmektedir. Konjenital bir anormallik olmasına rağmen, genellikle küçük travma veya enfeksiyondan sonra erken yetişkinlikte (ikinci ve üçüncü dekatda) farkedilirler. Cinsiyet tercihi yoktur. Klinik olarak ağrısız sternokleidomastoid kasın anterior sınırında şişlik olabilir. Üst solunum yolu enfeksiyonu sırasında ikincil enfeksiyonlar veya inflamasyon sonucu akut boyut artışı oluşabilir. Radyolojik görüntülemede, BKK tipik olarak, ince belirgin kontrastlanan kapsül ve homojen sıvı içeriğine sahip yuvarlak veya oval kitleler halinde bulunurlar. İkinci BKK için tedavi cerrahi eksizyondur.

Olgu Sunumu: 17 yaşında kız hasta boyun sağ tarafında bir aydır şişlik şikayetiyle Kulak Burun Boğaz polikliniğine başvurdu. Fizik muayenesinde boyun sağ üst juguler bölgesine uyan lokalizasyonda palpasyonla hafif ağrılı, mobil düzgün sınırlı kitle izlendi.MRGde sağ sevikal jugulodigastrik zincire yakın yerleşimli T2 AG lerde hiperintens, T1 AG lerde izo - yer yer hipointens diffüzyon kısıtlılığı göstermeyen, postkontrast serilerde kısmen periferik halkasal kontrastlanma gösteren yaklaşık 25x20 mm ebatlı kistik lezyon saptandı. Kitle rezeke edildi. Histolojik incelemede BKK ile uyumlu geldi.

Tartışma: Genç erişkin dönemde (16-40 yaş) boyunda kitle etiyolojilerini sıklık oranına göre sıraladığımızda infeksiyöz, doğumsal ve neoplastik şeklindedir. BKK embriyolojik gelişim sırasında brankial yarıkların tam kapanmaması nedeniyle oluşan konjenital boyun lezyonlarıdır ve genellikle genç erişkinlerde tanı alır. Hastaların birçoğu ağrısız kitlenin büyüyüp belirginleşmesi ile hastaneye başvurur. Kitlede bu ani değişikliğin nedeni sıklıkla faranjit, otitis media veya diş enfeksiyonu gibi akut bir üst solunum yolu enfeksiyonudur. Büyüme sonucu oluşan kitle etkisiyle damar sinir paketi gibi vital yapılara bası yapabilir.Ayırıcı tanı metastatik skuamöz hücreli karsinom, lenfadenit, lenfoma, servikal dermoid kist, kistik higroma ve parotis patolojisini içerir. BKK’nin en sık tedavi seçeneği cerrahi eksizyondur ve komplikasyon oranı düşüktür.Cerrahinin en önemli nedeni nadir de olsa BKK’nın malignleşme potansiyelidir. Sonuç olarak, genç erişkin yaş grubunda boyun kitlelerinde benign etiyolojiler ön planda düşü-nülmelidir ve MRG lezyonun natür tayininde yardımcı bir araçtır.

P - 0116

MRG BULGULARI İLE ADRENOLÖKODİSTROFİ OLGUSUERTAN HAZAR 1, CENK ERASLAN 1, ÖMER KİTİŞ 1, CEM ÇALLI 1, EBRU CANDA 2 1 Ege Üniversitesi, Radyoloji Anabilim Dalı, İzmir, Türkiye2 Ege Üniversitesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Metabolizma Bölümü, İzmir, Türkiye

Özet

Giriş: Adrenolökodistrofi X kromozomu geçişli genetik bir hastalıktır.Patogenezde uzun zincirli yağ asitlerinin peroksizomlarda yıkılamaması sorumludur.Hastalık santral sinir sisteminde demiyelinizasyon ile birlikte adrenal bez ve testis disfonksiyonu yapabilir.Neonatal,çocukluk,adölesan ve erişkin dönemde görülebilir.Neonatal ve çocukluk çağı ALD si oldukça kötü prognozludur.X kromozom geçişi nedeni ile erkekler hasta,kadınlar taşıyıcı konumdadır.İnsidans yaklaşık 1/50.000 dir.

Gereç ve Yöntemler: 5 yaşında erkek olgu. Konuşma bozukluğu,gözde kayma,denge kaybı gibi nörolojik şikayetler üzerine çocuk kliniğine baş-vurmuş. MRG de bilateral paryetal ve oksipital bölgede periventriküler beyaz cevherden subkortikal beyaz cevhere uzanan T1A hipointens,T2A da konfluens gösteren hiperintens alanlar ve bu alanlar içerisinde rim tarzında çizgisel demarkasyon gösteren kontrastlanmalar izlendi. Kontrastlanan alanlar posterior talamik ve internal kapsüle,kaudalde piramidal traktusa uzanım göstermekteydi. Subkortikal u lifleri korunmuştu. DAG de belirgin bir difüzyon kısıtlılığı izlenmedi.ADC de vazojenik ödem alanı hafif hiperintens alanlar olarak izlendi. MR Spektroskopide de NAA de azalma, yer yer laktat piklerinde artış izlendi.

Bulgular: Peroksizomal bir lökodistrofi olan bu hastalıkta uzun zincirli yıkılamayan yağ asit birikimlerine bağlı etkilenen alanda demiyelini-zasyon, akson kaybı, gliozis ve skar gelişmektedir. Histopatolojik olarak tutulan alan 3 zon olarak sınıflandırılmıştır. Santral zon gliozis ve skarı,İntermediate zon perivaskuler aktif enflamasyonu,dış zon ise aktif demiyelinizasyon alanını temsil eder. ALD için tipik kontrastlanma paterninden intermediate zon sorumludur. Subkortikal U lifler genellikle korunur. Santral zon T1A da hipointens, T2A da hiperintens izlenir. İntermediate ve periferal zon T2A da genellikle düşük sinyalli izlenir.MRS de nöron markırı NAA de azalma,laktat pikinde artış beklenir. BT de ise periatrial bilateral beyaz cevherde hipodens alanlar ve postkontrast çizgisel kontrastlanma olarak görülür. Hastalığın tanısında görüntülemeye ek olarak uzun zincirli yağ asit ölçümleri, adrenal veya testis disfonksiyonu olan hastada ACTH ve diğer hormon ölçümleri ve moleküler genetik testler kullanılır.

Sonuç: X kromozomu ile kalıtılan genetik temelli ALD özellikle neonatal ve çocukluk çağında prognozu oldukça kötüdür. Klinik tabloda nöro-lojik yıkım, bu duruma eşlik edebilecek adrenal ve testiküler yetmezlik tablosu akıla ALD yi getirmelidir. MRG de paryetal ve oksipital rim tarzı kontrastlanma tipiktir. Ayırıcı tanıda radyolojik olarak asetil coA oksidaz eksikliği, klinik olarak ise krabbe, zellweger, mitekondrial hastalıklar yer almaktadır.


P - 0117

PREPUBERTAL OLGUDA BİLATERAL TESTİKÜLER ADRENAL REST TÜMÖRÜ: USG VE MRG BULGULARIBERHAN PİRİMOĞLU, GÖKHAN TONKAZ, RECEP SADE, SERHAT KAYA, MUTLU AY*, GÖKHAN POLAT, MECİT KANTARCI


Özet

Giriş: Testiküler adrenal rest tümör (TART), konjenital adrenal hiperplazili (KAH) erkek hastalarda yüksek ACTH düzeylerine bağlı olarak, testislerde gelişebilen benign tümörlerdir. Embriyogenez sürecinde, skrotuma testisin inişi sırasında testise yerleşen kalıntı adrenal hücrelerinden ya da testisdeki puripotent kök hücrelerinden geliştiğini ileri süren iki farklı hipotez vardır. Konjenital adrenal hiperplazi (KAH) steroid sentez yolundaki enzimlerden birinin eksikliği sonucu ortaya çıkan, bir grup adrenal steroid sentez bozukluğu hastalığıdır.Olguların % 90’ından fazla-sında 21-hidroksilaz enzim eksikliği vardır. TART sıklıkla bilateral yerleşimlidir (%83) ve çoğunluğu (%76) erişkin yaşta tanı almaktadır. KAH’li hastalarda, yüksek seyreden adrenal androjen düzeyleri nedeniyle hipofizyal-gonadal aksın baskılanması, küçük testis boyutlarına ve infertiliteye sebep olur. Yine TART, obstrüktif azospermi ve oligospermiye yol açarak infertiliteye sebep olur. KAH’lı erkek hastaların yaşam boyunca %8,2’ sinde testiküler kitle gelişebildiği saptanmıştır .Tedavi almayan hastalarda ve sıklıkla genç erişkin dönemde görülür.

Olgu Sunumu: 2 aylıktan beri KAH tanısı olan ve son 6 aydır testiste ağrı şikayeti ile hastanemize başvuran 6 yaşındaki erkek hasta ultraso-nografi (US) ve manyetik rezonans görüntüleme (MRG) bulguları ile birlikte değerlendirildi.USG’de her iki testiste hilustan parankime uzanan, multifokal, yer yer akustik gölgelenme gösteren hipoekoik lezyonlar izlendi. MRG’de ise yine hilustan parankime uzanan, T1 ağırlıklı görüntüde izointens-hiperintens, T2 ağırlıklı görüntüde hipointens bilateral özellikte solid kitle lezyonlar izlendi. Tipik görünümleri, bilateral olmaları, testis tümör markerlarının negatif olması ve KAH öyküsü olması nedeniyle lezyonlar TART olarak düşünüldü. Steroid tedavisi sonrası 6 ay sonraki kontrollerinde USG’de lezyonların boyut ve sayısında azalma azalma izlendi.

Tartışma: Lezyonlar genellikle rete testiste yerleşimlidir ve parankime doğru uzanım gösterirler. Ayırıcı tanıda;testis kanseri, testis apsesi, Leydig hücre hiperplazisi yer alır. Ancak TART tanısı tipik öykü, bilateral olma ve karakteristik US ve MRG bulguları ile konulabilir. Bununla birlikte tüm bu US ve MRG bulguları uygun klinik ve endokrin profil eşlik etmeden diğer testis malignitelerinden ayrımı kesin olarak sağla-yamaz.

P - 0118

GUILLAIN-BARRE SENDROMU SEMPTOMLARIYLA BAŞVURAN PEDİATRİK SPİNAL LENFOMA OLGUSUALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI


Özet

Giriş: Spinal lenfoma lenfomalar içerisinde nadir görülmekle beraber sıklıkla vertebra korpusunu ve epidural kompartmanı tutar. İntramedüller tutulum çok daha nadir görülür.

Olgu Sunumu: Hastanemize 10 gün önce başlayan alt ekstremitelerde ilerleyici güçsüzlükle başvuran 14 yaşındaki erkek hastanın muayene-sinde duyu kaybı yoktu. Elektrofizyolojik incelemelerde akut jeneralize polinöropati olarak değerlendirilen hastada Guillain-Barre Sendromu tanısı kondu. 1 haftalık intravenöz immunglobulin tedavisine rağmen semptomları gerilemeyen hastaya manyetik rezonans görüntüleme (MRG) yapılmasına karar verildi. MRG’de T1 ağırlıklı görüntülerde izointens, T2 ağırlıklı görüntülerde hipointens, homojen kontrastlanan, spinal kanala uzanım gösteren intramedüller kitle saptandı. Ayrıca eşlik eden servikotorakal siringohidromyeli kavitesi gözlendi. Operasyon sonrası patoloji sonucu lenfoblastik lenfoma gelen hastaya kemoterapi ve radyoterapi tedavisi başlandı.

Sonuç: Guillain-Barre Sendromu benzeri bulgular, ağrı, güçsüzlük ve duyusal şikayetler ile başvuran hastalarda olası spinal kitleler akılda tutul-malıdır ve tanıda spinal MRG standarttır.

P - 0119

ÇOCUKLARDA İNMENİN NADİR NEDENİ: SEREBRAL VENÖZ TROMBOZALPEREN TEZCAN, RECEP SADE, MECİT KANTARCI, BERHAN PİRİMOĞLU, GÖKHAN POLAT



Özet

Giriş: Serebral venlerin ve sinüslerin trombozu nadir; ancak tanısı atlanan veya geç konan önemli bir serebrovasküler hastalıktır. Her yaş grubunda görülmekle birlikte, daha çok genç ve orta yaşlardaki bireyleri ve çoğunlukla da kadınları etkiler. Klinik prezentasyonları değişken ve sıklıkla dramatiktir. Genellikle intrakranial hipertansiyona bağlı baş ağrıları, fokal defisit, nöbetler veya konfüzyonel durum tablolarının birisiyle akut olarak başlamaktadırlar. Tanıda manyetik rezonans (MR) venografi standarttır.

Olgu Sunumu: Çocuk acil polikliniğine daha önceden derin ven trombozu nedeniyle takip edilen, anlamsız bakış ve kusma şikayeti ile başvuran, bilinci uykuya meyilli, her iki pupil dilate olan 16 yaşında kadın hastanın beyin bilgisayarlı tomografisinde (BT) sol temporoparietal lob yerleşimli intraparankimal hematom alanı ve çevresinde ödem etkisi izlendi. Ayrıca sol transvers sinüs trasesinde dansite artımı mevcut olması üzerine çekilen kontrastlı MR venografide sol transvers sinüs, sigmoid sinüs ve internal juguler ven proksimalinde trombüse bağlı dolum defekti ve buna sekonder gelişmiş hemorajik venöz enfarkt saptandı. Bunun üzerine hastaya uygun antikoagülan ve destek tedavisi başlandı.

Sonuç: Akut serebrovasküler olayların nadir rastlanan bir sebebi olsa da bu olguda olduğu gibi, venöz tromboz ciddi bir mortalite ve morbidite nedeni olabileceğinden hiperkoagülabilite durumlarında mutlaka serebral venöz tromboz da ayırıcı tanıda akla gelmelidir. Tanıda kontrastlı MR venografi esastır.

P - 0120

PEDİATRİK KALÇA AĞRISI: SİNOVYAL OSTEOKONDROMATOZİSLİ İKİ OLGUAYŞE GÜL ALIMLI 1, NAZLI GÜLSÜM AKYEL 2, MESUT SİVRİ 2, TÜLİN HAKAN DEMİRKAN 2

1 Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji, Ankara, Türkiye2 Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Radyoloji, Ankara, Türkiye

Özet

Sinovyal osteokondromatozis (SO) sinovyal dokuda metaplazi sonucu gelişen eklem mesafesinde genellikle benzer boyutlu kalsifiye kartilajinöz oluşumlarla karakterize bir hastalıktır. Sıklıkla diz, kalça ve el bileği olmak üzere tek eklem tutulumu yapar. Erişkin hastalığı olup genelde 3-4. dekadda tanı alır. Bu bildiride kalça ağrısı ile başvuran ve SO tanısı konulan iki pediatrik olgu Manyetik Rezonans Görüntüleme (MRG) ve direk grafi bulguları eşliğinde tartışılmıştır.

P - 0121

UNUTULMAMASI GEREKEN BİR PEDİATRİK RENAL PATOLOJİ: MULTİKİSTİK DİSPLASTİK BÖBREK VE MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIGÖKHAN TONKAZ, BERHAN PİRİMOĞLU, SERHAT KAYA, RECEP SADE, MUSTAFA YEŞİLYURT, MUTLU AY*, FAHRİ AYDIN, SUAT EREN, MECİT KANTARCI


Özet

Giriş: Multikistik displastik böbrek (MKDB), böbreğin kalıtsal olmayan gelişimsel anomalisidir ve çocuklarda kistik hastalıkların en sık nedenidir. MKDB’de, bir biriyle bağlantılı olmayan, çok sayıda ve değişik büyüklüklerde kistler vardır, böbrek parankimi yoktur. İnsidans 4300 canlı doğum-da 1dir ve prenatal ultrasonda en sık saptanan anomalilerden biridir. En çok sol tarafı etkiler ve erkeklerde daha sık görülür. MCDK nispeten asemptomatiktir ve genellikle antenatal görüntülemede tespit edilir. MCDKnın postnatal tespiti daha az yaygındır (%20). Postnatal dönemde tanımlanamayabilir ve çocukluk çağında tam involusyonu takiben renal agenezinin bir nedeni olabilir. MCDKnin en önemli klinik özelliği fonksi-yonel olarak soliter kontralateral böbreğin bulunmasıdır, bu nedenle eşzamanlı anomalilerin saptanması ve yönetimi değerlendirmenin temeli haline gelmiştir. Multikistik displastik böbrek tedavisinde seçenekler böbreği çıkarmak, takip veya görmezden gelme seçenekleri mevcuttur.

Olgu Sunumu: 2 yaşında kız hasta karın ağrısı şikayetiyle hastanemize başvuruyor. USG ve MRG’ de sağ böbrek parankimi seçilemedi. Böbrek lojunda bir biriyle ilişkisiz multıple sayı ve ebatta kistler izlendi. MKDB tanısı konulan hastaya konservatif takip planlandı.

Tartışma: MKDB’li klasik klinik prezentasyonunda hastaların; 1/3’ü yenidoğan döneminde asemptomatik palpabl kitle, 1/3’ünde kusma veya anoreksik çocuk tablosu ve geri kalan 1/3’ü ise idrar yolu enfeksiyonları yada otopsi araştırmalarında tesadüfi olarak saptanırken, adölesan veya erişkinlerde ise MKDB daha çok karın ağrısı, karında kitle, hematüri ve hipertansiyon ile ilişkili olmuştur. Kontralateral böbreğin anormalileri hastaların yaklaşık %40’a varan oranda bulunur. Bunlar vezikoüreteral reflü, üreteropelvik bileşke darlığı, üreterovezikal bileşke darlığı, ektopik üreter ve üreterosel şeklindedir.Özellikle dikkat edilmesi gereken diğer bir husus ise MKDB’li hastalarda az görülmesine rağmen hipertansiyon açısından periodik olarak kan basıncı izlenmelidir.Hastaların tanı ve takibi genellikle US ile yapılır. Ultrasonografide değişik boyutlarda ve toplayıcı


sistemle ilişkisiz kistler, renal parankimin gösterilememesi MKDB tanısını düşündürmektedir. Kesin tanı, perfüzyon ve fonksiyon yokluğunu teyit eden sintigrafi ile yapılır. Bir çok MKDB zamanla küçülmekte veya kaybolmaktadır. Asemptomatik olan hastalar konservatif takip edilebilirler. Semptomatik olanlarda ise klinik, laboratuvar ve radyolojik bulgulara göre takip yapılmasının uygundur.

Sonuç: Sonuç olarak USG’nin yanında iyonize olmayan radyasyon görüntüleme modalitesi olan MRG pediatrik popülasyonda önemli bir husus-tur. MKDB kistleri T2 AG de açıkça gösterilmektedir. Uygun vaka seçimlerinde MRG, tanıda operatör bağımlı USG’nin toplayıcı sistemle ilişkisiz kistleri göstermede yetersiz olduğu durumlarda kullanılabilir. USG ve MRG tek taraflı MKDB ile karşı taraf böbrek ve üriner sistem malfromas-yonlarını tanımlamada güvenli bir şekilde kullanılabilir.

P - 0122

FASET EKLEMİN NADİR GRANÜLOMATÖZ ENFEKSİYONU: POTT HASTALIĞIALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI


Özet

Giriş: Pott hastalığı, tüberküloza bağlı kas ve iskelet sistemi tutulumu saptanan olguların yaklaşık üçte birini oluşturur. Pott hastalığı hematojen olarak veya plevral hastalığın lenfatik yolla yayılımı sonucunda gelişebilir. Çocukluk çağında torakal vertebra, erişkinlerde ise lomber vertebra tutulumu daha sıktır.

Olgu Sunumu: Pediatri kliniğimize daha önceden tüberküloz öyküsü olan bel ağrısı ve yüksek ateş ile başvuran 17 yaşındaki erkek hastanın yapılan manyetik rezonans görüntülemesinde lomber 4/5 vertebra faset ekleminde T1’de heterojen hipointens, T2’de heterojen hiperintens, post-kontrast kesitlerde heterojen kontrast tutulumu bulunan lezyon izlendi. Akut faz reaktanları yükselmiş olan hastanın patolojisi granüloma-töz enflamasyon olarak tanımlandı. Radyolojik ve laboratuar sonuçlarına göre lezyon faset eklemin tüberkülozu olarak değerlendirildi.

Sonuç: Basil ile önceden enfekte olduğu bilinen bir çocukta, eklem lezyonlarının gelişmesi ya da inatçı, açıklanamayan eklem lezyonlarının varlı-ğında tüberküloz akla gelmelidir. Lezyonun gösterilmesinde MRG yol gösterici olabilir.

P - 0123

ULNAR ARTER ANEVRİZMASIALPEREN TEZCAN, MUTLU AY*, MUSTAFA YEŞİLYURT, FAHRİ AYDIN, EMİNE İZGİ, GÖKHAN POLAT, BERHAN PİRİMOĞLU, RECEP SADE, HAYRİ OĞUL, MECİT KANTARCI


Özet

Giriş: Ulnar arter anevrizması nadir olarak görülen bir anevrizmadır, genellikle arterin distaline yerleşim gösterir. Travmatik, aterosklerotik ve enfeksiyöz nedenlerle gelişebilir, parmak iskemisine neden olabildiği için tanı ve tedavisi önemlidir.

Olgu Sunumu: 12 yaşında erkek hasta, üç aydır sağ el bileğinde giderek büyüyen ağrılı şişlik şikayeti ile hastanemize başvurdu. Fizik muayenede sağ el bileğinin 3 cm distalinde, 1,5x1 cm boyutunda pulsatil kitle tespit edildi. . Anamnezinde ek hastalık, anevrizma bölgesinde tıbbi girişim, travma ya da delici-kesici alet yaralanması öyküsü yoktu. Hastaya anevrizma ön tanısıyla manyetik rezonans anjiografi (MRA) çekildi ve MRA’da sağ el bileği seviyesinde ulnar arter trasesi boyunca lokalize yaklaşık 10x12 mm ebatlı sakküler anevrizmaya ait görünüm izlendi. İzole ulnar arter anevrizması tanısıyla cerrahi girişim yapıldı ve anevrizma dokusunun histopatolojik incelemesinde gerçek anevrizma olduğu saptandı.

Sonuç: Üst ekstremite arter anevrizmalarının tutulan arterlerin sıklık sırasına göre dağılımı subklavian, aksiller, brakial ve daha az sıklıkla da radial ve ulnar arterlerdir. Anevrizma gelişiminde sıklıkla travma (künt ya da kesici), iatrojenik (arteriyel monitorizasyon ya da kateterizasyon) daha az olarak enfeksiyon (staphylococcus aureus), poliarteritis nodosa, Marfan sendromu, konjenital arteriyel patolojiler rol oynar. Pulsatil kitle tespit edilmesi ile tanı klinik olarak da konabilir. Arteriyel doppler ultrasonografi, manyetik rezonans anjiografi (MRA) ya da selektif üst ektstremite anjiografi ile tanısı kesinleştirilir. MRA operatör bağımlı ve invaziv olmaması nedeniyle daha çok tercih edilmektedir.

P - 0124

AKUT BATIN TABLOSU İLE GELEN İMPERFORE HYMEN OLGUSUMEHMET KARAGÜLLE1, FATMA ZEYNEP ARSLAN2, SÜLEYMAN ÖNCÜ1, CANAN KOCAOĞLU2, GÜL ESER2, SAMET ŞİMŞEK1 1 Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye2 Konya Eğitim ve Araştırma Hastanesi, Konya, Türkiye


Özet

İmperfore hymen, vajinal çıkışta bulunan hymen zarının normal santral açıklığının bulunmadığı konjenital bir durumdur. Tahmin edilen insidansı her 1000 kadında 1 olarak raporlanmıştır.biz olgumuzda imperfore hymenin MR görüntülerini sunmayı amaçladık. 12 yaşında kadın hasta akut batın tablosu düşündüren şiddetli karın ağrısı ile gece acil servise başvurdu. Anamnezinde primer amenore öyküsü mevcuttu. Hastaya yapılan USG’de mesane posteriorunda, pelvisi dolduran homojen yapıda yoğun koleksiyon alanı izlendi. Pelvik MR incelemesinde uterus ve vajende T1AG hiperintese, T2AG hipointense sinyal özelliğinde, postkontrast serilerde kontrast tutmayan hemorajik mayi lehine koleksiyon izlenmiş olup imperfore hymen lehine değerlendirildi. Cerrahi sonrası tanı imperfore hymen olarak doğrulandı. İmperfore hymen nadir görülmesine karşın vajinal çıkış anomalileri arasında en sık görülenidir. Genelde izole olmakla birlikte bazı konjenital ürogenital sistem anomalileri ile bir-likte görülebilmektedir. Büyük oranda sporadik saptanmasına karşın litaretüre bakıldığında çok az sayıda genetik geçişli olgularda bildirilmiştir. İmperfore hymen puberte dönemine kadar bulgu vermese de nadiren biriken uterovajinal sekresyonlara bağlı prepubertal tanı konulabilir.Genelde hastalar adölesan dönemde amenore, siklik karın ağrısı, kitle ve kitle basısına sekonder idrar yapamama semptomları ile gelmektedir. Tanı USG ve klinik bulgular ile konulmakla birlikte ayırıcı tanısı, cerrahi öncesi anatominin değerlendirilmesi ve eşlik eden anomaliler ve komp-likasyonlar açısından MRG çok faydalı bilgiler vermektedir. İmperfore hymen ayırıcı tanısında; transvers vajinal septum, distal vajinal atrezi ve labial adezyon akılda tutulmalıdır.

P - 0125

HİPOKSİ SONRASI GEÇ DÖNEM LÖKOENSEFALOPATİ : ÇOCUK OLGUNAZLI GÜLSÜM AKYEL, TÜLİN HAKAN DEMİRKAN, MESUT SİVRİ, AYŞE GÜL ALIMLI

Sağlık Bilimleri Üniversitesi, Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Ankara, Türkiye

Özet

Hipoksi sonrası geç dönem lökoensefalopati (HSGL) nadir görülen, serebral hipoksik hasar sonrasında gelişen beyaz cevher hasarıdır. Yüzde 60 alev, grade I inhalasyon yanığı ve duman zehirlenmesi ile hastanemize kabul edilen 4 yaşında erkek hastanın manyetik rezonans görüntülemesin-de (MRG) derin asfiksi lehine değerlendirilen bilateral diffüz kortikal difüzyon kısıtlanması, simetrik kaudat nükleus ve globus pallidus sinyalleri mevcut idi. Takibinde yaklaşık 2 ay sonra yapılan MRGde yaygın lökoensefalopati ve parankimal hematomlar gelişti. Bilgimiz dahilinde literatürde HSGL tanımlanan çocuk olgu bulunmamaktadır.

P - 0126

GİANT SAFRAKESELİ ÇOCUK OLGUTÜLİN HAKAN DEMİRKAN, GÜLŞAH BAYRAM, NAZLI GÜLSÜM AKYEL, AYŞEGÜL ALIMLI, HAVVA AKMAZ ÜNLÜ, MEHMET TİFTİK

Dışkapı Çocuk Sağlığı ve Hastalıkları Hematoloji ve Onkoloji Eğitim Araştırma Hastanesi, Ankara, Türkiye

Özet

Normal safra kesesi boyutu 7.5-10 cm arasındadır. Büyük safra kesesi sık raslanılan bir durumdur. Ancak giant safra kesesi nadiren rapor edilmiş-tir. Genellikle nedeni altta yatan bir obstruksiyona baglı olarak (tümör veya safra kessi taşına) gelişmektedir. Ancak nadiren bir taş veya tümör olmadan da izlenebilmektedir. Bizim olgumuzda 6 yaşında erkek hasta olup, multilobüle kontrlu, batın sağ kesimini büyük oranda dolduran giant kese izlenmekteydi. Hastanın operasyon sonrasıda bu bulgular teyit edildi. Nadir olması nedeniyle sunuldu.

P – 0127

MİLD ENCEPHALİTİS WİTH A REVERSİBLE SPLENİAL LESİON: OLGU SUNUMUATAKAN KIRTEKE, MESUT ÇETİN, ADEM AĞYAR


Özet

MERS baş ağrısı,bilinç bozukluğu nöbetler ile gidebilen hafif dereceli bir santral sinir sistemi bozukluğu olmakla birlikte çeşitli enfeksiyonlar(H.influenza,rotavirüs,kızamık virüsü,mikoplazma pnömonisi,legionella pnömonisi gibi), yüksek irtifa sonucu meydana gelen serebral ödem(high altitude cerebral edema), hiponatremi ve hipoglisemi gibi metabolik bozukluklar ve antiepileptik ilaç tedavisi gibi nedenlerle meydana geldiği bildirilmiştir. MRG’de tipik özellikleri T2 ağırlıklı görüntülerde ve FLAİR görüntülerde hiperintens,T1 ağırlıklı görüntülerde ise hiper-izointens görünmeleridir. Ayrıca postkontrast T1 ağırlılı görüntülerde kontrast tutulumu görülmezken; DAG’de kısıtlanma izlenir. MERS lezyonun yerleşim yerine göre 2 gruba ayrılır. Tip 1 Korpus Kallosumun Splenium kesimini tutarken;Tip 2 serebral beyaz cevherde simerik tutulum veya korpus


kallosumun anterior kesimini tutar. Hastanemiz çocuk acil servisine nöbet geçirme şikayetiyle başvuran 14 yaşındaki erkek hastaya Radyoloji kliniğine Beyin MRG çekimi için gönderilmiştir.Çekilen Beyin MRG tetkikinde Korpus Kallosum Splenium kesiminde T2 ağırlıklı görüntülerde izo-hiperintens,T1 ağırlıklı görüntülerde izo-hipointens, DAGde kısıtlanma gösteren lezyon izlenmiştir.Klinik muayene verileriyle beraber hastaya MERS tanısı konulmuştur. Kendine özgü radyolojik bulguların doğru ve hızlı bir şekilde tanınması, MERS tanı ve prognozun katkı sağlayacaktır.

P - 0128

NADİR BİR AKSİLLER LENFADENOPATİ NEDENİ: PULMONER NODÜLLERİN EŞLİK ETTİĞİ LHH OLGUSUAYŞE GÜL ALIMLI

Sağlik Bilimleri Üniversitesi, Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji, Ankara, Türkiye

Özet

Langerhans hücreli histiositozis (LHH) en sık infant ve çocuklarda görülen nadir bir histiositik hastalıktır. Genellikle osteolitik kemik lezyonu ile karakterizedir. Cilt, lenf nodları, karaciğer, dalak, oral mukoza, akciğer, merkezi sinir sistemi de tutulabilir. Bu bildirinin amacı aksiller kitle ile başvuran, pulmoner nodüllerin de eşlik ettiği LHH tanısı alan 4 aylık erkek hastayı manyetik rezonans görüntüleme, B mod ultrason ve shear wave elastografi bulguları ile birlikte tartışmaktır.

P - 0129

BİR AKUT RENAL YETMEZLİK KOMPLİKASYONU: PRESSGÖKHAN POLAT, HAYRİ OĞUL, RECEP SADE, SUAT EREN, AKIN LEVENT, MECİT KANTARCI


Özet

Giriş: PRES (posterior reversibl ensefalopati sendromu) akut ya da subakut nörolojik semptomlara neden olan reversibl bir durumdur. PRES’e en çok sebep olan durumlar hipertansif ensefalopati, eklampsi, siklosporin-A nörotoksisitesi epilepsi sonrası postiktal durumlardır. Başağrısı, konfüzyon, bulantı, kusma ve görme bozuklukları semptomları arasındadır ve nöbet gibi ciddi durumlarada neden olabilir. Akut renal yetmezlik sonucu gelişen hipertansif durumlar ve elektrolit değişimleri PRES sebebi olabilirler.

Olgu Sunumu: 9 yaşında erkek hasta hastanemize kusma,öksürük ve ayaklarında başlayan ödem şikayetiyle başvurmuştur.Hastanın yapılan labo-ratuar tetkikleri sonucunda akut böbrek yetmezliği tanısı konmuştur.Takibinde fokal konvülziyonu olan hastaya çekilen beyin MRG sonucunda PRES tanısı konmuştur.

Tartışma: PRES etyolojisindeki sebepler serebrovasküler endotelial disfonksiyon, kan-beyin bariyerinin geçirgenliğinde artış, vazojenik ödem ve mikrohemorajiye neden olarak PRES tablosunun oluşmasına neden olurlar. PRES tanısında anamnez ve radyolojik inceleme çok önemlidir.Erken ve doğru tanı koymak tedavi ile klinik seyirin düzeltilmesinde elzemdir. Radyolojik olarak bilgisayarlı tomografi (BT) ve manyetik rezo-nans görüntüleme (MRG)’de genellikle oksipital ve pariyetal loblarda özellikle subkortikal beyaz cevherde, bazen de kortekste büyük oranda simetrik yerleşimli ödem olarak izlenir.Daha ciddi olgularda bu bulgular ilerleyerek frontal ve temporal loblarda, derin beyaz cevherde, pons-ta, serebellumda ve diğer bölgelerde görülebilir. PRES radyolojik ve klinik olarak geri dönüşümlü bir tanı olup beyin perfüzyonunu koruyacak tedaviyöntemleri ile hastalarda belirgin düzelme izlenebilir.Bu nedenle erken tanı ve tedavi önem arzetmektedir.

P – 0130

VAN DER KNAAP HASTALIĞI: OLGU SUNUMUMESUT ÇETİN, ADEM AĞYAR


Özet

Van der Knaap hastalığı, çok ender görülen bir megalensefalik lökoensefalopati hastalığıdır. Makrosefali doğumda olabileceği gibi yaşamın iler-leyen safhalarında belirginleşmektedir. Beyin MRG görüntülemelerindeki bariz bulgulara rağmen, klinik bulgulardaki yavaş ilerleyici seyir dikkat çekicidir.9 yaşında erkek hasta dirençli nöbet şikayeti sebebiyle çocuk nöroloji polikliğine başvuruyor.Hastadan beyin ve difüzyon MRG tetkiki istendi.Çekilen beyin MRG de her iki serebral hemisferde diffüz, bilateral simetrik periventriküler ve subkortikal derin beyaz cevherde T2A ve FLAİR görüntülerde sinyal artımları, bilateral anterior temporal ve frontoparyetal bölgelerde BOS intensitesinde subkortikal kistler izlendi.Makrosefali, psikomotor gerilik ve beyin MRG’de beyaz cevher tutulumu saptandığı durumlarda ayırıcı tanıda, Canavan hastalığı, Alexander hastalığı, glutarik asidüri, GM1 ve GM2 gangliozidoz kesinlikle düşünülmelidir.


P - 0131

PAROTİS BEZİ LİPOMU: SONOGRAFİK VE SONOELASTOGRAFİK BULGULAR VE HİSTOPATOLOJİK KORELASYONMEHTAP BALABAN, BURAK YAĞDIRAN, MESUT AY, FURKAN NALBANT, ALİ İPEK


Özet

Amaç: Tükrük bezinin nadir görülen non-epitelial tümörü olan intraglandüler lipom olgusunun ultrasonografi (US), renkli Doppler US (RDUS) ve sonoelastografi (SEL) bulgularının tanımlanması ve histopatolojik korelasyonu.

Gereç ve Yöntemler: Son bir yıldır sol yanağında ağrısız şişlik şikayeti ile Kulak-Burun-Boğaz polikliniğine muayene olan 37 yaşındaki bayan olgu sonografik değerlendirme için departmanımız ultrasonografi (US) ünitesine yönlendirildi.

Bulgular: Lineer prob ile yapılan yüzeyel US incelemede sol parotis bezi süperfisiyal lobu içerisinde 31,5x15 mm boyutlarda, RDUS’de vasküla-rizasyonu izlenmeyen, düzgün konturlu, kompresibl, hipoekoik solid lezyon tanımlandı. Lezyona eş zamanlı yapılan kompresyon SEL incelemede lezyonun ekstraglandüler yağ doku ile benzer özellikte diffüz kırmızı renkte belirgin yumuşak kodlandığı izlendi. Tüm bu bulgular eşliğinde intraglandüler lipom olarak raporlanan lezyonun total eksizyonel biyopsi sonucu adipöz doku ile uyumlu geldi.

Sonuç: Lipomlar matür yağ hücrelerinden köken alan ve en sık görülen mezenkimal kaynaklı tümörlerdir. %13 oranında baş ve boyun bölgesinde görülmekle birlikte vücudun her yerinde görülebilmektedir. Tüm tükrük bezi tümörlerinin %1-4’ünü oluşturmaktadır. Ancak parotis bezinde nadir görülmektedir. Yapılan 6 yıllık bir çalışmada 212 tanesi parotis bezinden olmak üzere toplam 341 adet kitlenin sadece 5 tanesi histopato-lojik olarak lipom tanısı almıştır. Erkeklerde 5-10 kat daha sık olup ortalama görülme yaşı 5.-6. dekaddır. Ayırıcı tanıda mikst tümör, anjiolipom, liposarkom, fokal yağlı infiltrasyon ve siyalolipom gibi diğer yağ içeren lezyonlar vardır. Etyolojide obezite, diyabet, ailesel yatkınlık, steroid ve insülin tedavisi, travma ve endokrin hastalıklar düşünülebilir. Cerrahinin planlanması açısından kitle karakterizasyonu önemli olup nadir görül-melerine rağmen ayırıcı tanıda akılda tutulması gereken benign lezyonlardır.

P - 0132

MICHEL VE MONDINI ARACILIĞIYLA İÇ KULAK ANOMALİLERİHALİME ÇEVİK, PELİN KOÇDOR

Okan Üniversitesi Tıp Fakültesi Hastanesi, İstanbul, Türkiye

Özet

Konjenital senserinöral işitme kaybı olguların %20’sinin nedeni kemik labirent gelişim bozukluklarıdır. Bu olguların %7-31’inde iç kulak anomali-leri görülür. Michel aplazisi ve Mondini deformitesi olan iki olgunun görüntüleme bulguları aracığıyla ile iç kulak anomalilerini gözden geçirmeyi amaçladık. İlk olgumuzda temporal kemik MR incelemede unilateral koklea, vestibul, semisirkuler kanallar yoktu. 8.kranial sinir izlenmedi. Michel aplazisi lehine değerlendirildi. İkinci olgumuzun Temporal kemik BT ve MR incelemesinde bilateral kistik koklea ve vestibül tek boşluk olarak görüldü. Superior semisirküler kanallar hipoplazik olup lateral ve posterior semisirküler kanal izlenmedi. Mondini tip 1 malformasyon olarak değerlendirildi. İç kulak embriyogenezinin farklı aşamalarındaki duraklamalar sonucunda anomaliler oluşmakta ve sınıflamalar da genel-likle buna göre yapılmaktadır. Üçüncü haftada otik plakod oluşumundaki duraklama Michel aplazisine neden olmaktadır. Membranöz ve kemik labirent anomalilerinin en ağırıdır. Herhangi bir iç kulak yapısının oluşmaması ile karakterizedir. Yedinci haftada 1-1,5 dönüsünü tamamlayan kokleanın gelişimi bu aşamada durakladığında Mondini deformitesine neden olabilir. Mondini deformitesi duraklama haftasına bağlı olarak tip 1 ve tip 2 olmak üzere iki tiptir. Tip 1 deformite kistik kokleavestibüler malformasyon olarak bilinir. Klasik form olan Tip 2 de ise kokleadaki kistik apekse ek olarak vestibulde dilatasyon ve geniş vestibuler akuadukt da yer almaktadır. Mondini deformiteli ve ortak kavite gibi konje-nital iç kulak anomalilerinde koklear implantasyon uygulamaları ile başarılı sonuçlar elde edilebilmektedir. SNİK ön tanılı olgularda iç kulak anomalilerinin tanısı ve koklear implant açısından değerlendirilmelerinde apılan temporal kemik BT ve MR ile yüksek çözürlüklü görüntüler katkı sağlamaktadır.

S - 133

MİYOKARD İSKEMİSİNİ TAKLİD EDEN BİR KARDİYAK KİST HİDATİK OLGUSUFATMA ZEYNEP ARSLAN 1, MEHMET KARAGÜLLE 2, SÜLEYMAN ÖNCÜ 2, TUĞBA POLAT 2, CANDAN VARLIK 2 1Sağlık Bilimleri Üniversitesi, Konya Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Konya, Türkiye2Bağcılar Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İstanbul, Türkiye


Özet

Hidatik kistler Echinococcusun neden olduğu enfeksiyondan kaynaklanır ve vücudun herhangi bir yerinde kist oluşumu ile sonuçlanabilir. Kist hidatik hayvancılığın yaygın olduğu bölgelerde ve ülkemizde endemik olarak sıklıkla görülmektedir. En çok tutulumun izlendiği organ karaciğerdir; akciğerler,böbrek, santral sinir sistemi ve dalak yine etkilenen organ ve yapılardır.

Kist hidatik hastalığında kalp tutulumu çok nadirdir ve tüm kist hidatik olgularının neredeyse %1,5undan azında görülür. Kalp tutulumu olunca kist genellikle intramyokardiyal sol ventrikül serbest duvarı, interventrikiUer septum, bazen de sağ ventrikül ve sağ atriyumda yerleşir. Kardiyak kist hidatik yüksek sıklıkta intrakardiyak rüptür ve yaşamı tehdit edici ani komplikasyonlarla karakterizedir. Miyokard Iskemisini Taklid Eden anginal karakterde göğüs ağrısı ve EKGsinde miyokard iskemisi bulguları nedeniyle incelenen 37 yaşındaki erkek hastaya iki-boyutlu ekokardiyografi, torakal MRG tetkikinde kardiyak kist hidatik tanısı koyulan hastamızı sunmayı amaçladık.

P - 0134

ADÖLESAN HASTADA DEV MEME KİTLESİ: GİANT JUVENİL FİBROADENOMMEHMET KARAGÜLLE1, ÖZNUR FUNDA GELENGEÇ1, ESRA BİLGİ1, DENİZ EKİNCİ1, FATMA ZEYNEP ARSLAN2, GÜL GİZEM KAYA1 1Bağcılar Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye2Konya Eğitim ve Araştırma Hastanesi, Konya, Türkiye

Özet

Jüvenil fibroadenom, fibroadenomların bir varyantı olup genelde 10-18 yaş arasında görülür. İnsidansı tüm fibroadenomların %0.5-2’sidir. Biz bu olguda patolojik olarak jüvenil fibroadenom tanısı almış vakanın görüntüleme özelliklerini sunmayı amaçladık.

13 yaşında kadın hasta sol memede şişlik nedeniyle başvurdu. Fizik muayenesinde sol memede palpasyonla ağrısız, büyük boyutlarda ele gelen kitle ve yüzeyel vasküler yapılarda belirginleşme tespit edildi. Yapılan meme USG incelemesinde sol memede 71x54 mm boyutlu, içerisinde kistik açıklıklar bulunan, heterojen, hipoekoik solid kitle izlendi. Sonrasında çekilen MR incelemede T1A hipointense, T2A ara sinyal intensitesinde, içerisinde kistik açıklıkları bulunan, İVKM sonrası giderek artan tarzda (tip 1 patern) kontrast tutan 124x78 mm boyutunda solid kitle izlendi. Tru-cut biyopsi sonrası histokimyasal olarak jüvenil fibroadenom tanısı konuldu.

Fibroadenom, bağ dokusunun aşırı proliferasyonundan kaynaklanan, karakteristik olarak stromal ve epitelyal hücreler içeren memenin en sık görülen beningn lezyonudur. Çocuk ve ergenlerde görülen firoadenomlara jüvenil fibroadenomlar denir. Eğer bu kitleler 5 cm’den büyükse veya 500 gr’dan ağır ise dev jüvenil fibroadenom denilmektedir. İnsidansı tüm fibroadenomların %0.5-2’si kadardır. Lezyonlar genellikle tek taraflı, ağrısız ve hızlı büyüyen kitle şeklindedir. Hızlı büyümeleri meme dokusunun gelişimini engellemekte, deride konjesyon ve ülsere neden olabil-mektedir.MR incelemesinde hızlı büyümesi nedeniyle santralinde kistik açıklıklar görülebilen, T1A hipointense, T2A ara sinyal intensitesinde İVKM sonrası diffüz homojen kontrastlanan dev boyutlarda solid kitle izlenmektedir. Ayırıcı tanısında fizyolojik hipertrofi, abse gibi inflamatuar süreçler ve filloides tümör akılda tutulmalıdır. Hastalarda duygusal ve psikolojik sorunlara yol açması nedeniyle erken tanı ve tedavisi önemlidir.

P - 0135

AKSİLLER PREZENTASYONLU OKKULT NÖROENDOKRİN MEME KARSİNOMUMEHMET ALİ NAZLI, YEŞİM KARAGÖZ, CEYDA TURAN BEKTAŞ, FADİME DİDEM CAN TRABULUS, ESRA CANAN KELTEN, ŞEFİKA AKSOY

Sağlık Bilimleri Üniversitesi İstanbul Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

Özet

Memenin okkült karsinomları çok nadir görülmekte olup literatürde %0.3-1.0 oranları verilmekte, radyolojik görüntülemelerin gelişmesi ve özellikle dinamik meme MR incelemelerden sonra görüleme sıklığı daha da azalmıştır. Memenin primer nöroendokrin karsinomları çok nadir görülmekte olup sıklığı %0.1 altındadır. Biz bu sunumda aksiller tutulum şeklinde prezentasyon gösteren okkült nöroendokrin karsinom tanılı hastamızın radyolojik inceleme bulguları ve patolojik tanı kriterleri ışığında okkült meme karsinomlarına radyolojik yaklaşımı sunmayı amaçladık.

P - 0136

KRANİYUMUN SOLİTER PLAZMOSİTOMU: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARIMUSTAFA KOÇ



Özet

Amaç: Kraniyumun soliter plazmositomu oldukça nadir bir görülmektedir. Geniş bir patolojik spektruma sahip olup benign ve malign (multipl myeloma) formları bulunabilir. Klinik özellikleri karışıktır. Doğru tanı için radyolojik inceleme, immünoglobülin, biyokimya, idrar Bence Jones proteini testi ve kemik iliği değerlendirmesi içeren, kapsamlı bir inceleme ve analiz gereklidir. Bu yazıda kraniyumun soliter plazmositomunun manyetik rezonans görüntüleme (MRG) bulguları sunuldu.

Gereç ve Yöntemler: Frontal bölgede ele gelen şişlik şikâyeti ile kliniğe başvuran 48 yaşında kadın hastada, klinik olarak belirgin bir nörolojik disfonksiyon saptanmadı. Olgunun mevcut patolojisini değerlendirmek için, radyolojik olarak İ.V. kontrastlı kraniyal MRG incelemesi yapıldı.

Bulgular: Kraniyal MRG incelemede, frontal bölgede intra ve ekstradural alana ve cilt altına uzanan, kemik yapıda destrüksiyona neden olan, T1 ve Flair sekanslarda nispeten izointens, kontrast madde sonrası yoğun kontrastlanan, yaklaşık 8x6 cm boyutta kitlesel lezyon izlendi. Cerrahi olarak tedavi edilen olguda, histopatolojik bulgular kraniyumun soliter plazmositomu ile uyumlu değerlendirildi.

Sonuç: Miyelom kemik iliği retikülositlerinden köken alan malign bir tümördür. Tümör hücreleri gittikçe artan bir plazmosit karakteristiğine sahip olduğundan, hastalık plazma hücresi miyelomu olarak bilinir. Çoğunlukla 40 yaşın üzerinde görülür. Vücudun herhangi bir bölgesinde kemik destrüksiyonu oluşturabilir. İzole kraniyumda meydana gelen tümörler kraniyal plazma hücreli tümörler olarak bilinirler. Klinik özelliklerinin karmaşık olması ve kolayca tespit edilememesi, yanlış tanı oranının yüksek olmasına neden olmaktadır. Doğru tanı için kapsamlı bir inceleme ve analiz gereklidir. Bilgisayarlı tomografi ve özellikle MRG bulguları doğru tanıya katkı sunmaktadır.

P - 0137

POEMS SENDROMLU OLGUDA BEYİN MR BULGULARIFATMA AKTAŞ, ERKAN GÖKÇE

Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, İstanbul, Türkiye

Özet

Amaç: Polinöropati, organomegali, endokrinopati, monoklonal gamopati, cilt değişiklikleri ile karakterize olan POEMS sendromu nadir görülen sistemik bir hastalıktır. Klinik bulguları mikroanjiopati, neovaskülarizasyon ve artan vazopermalbilite ile ilişkilidir. Bu çalışmanın amacı POEMS sendromlu bir hastanın kranyal MR bulgularını tartışmaktır.

Gereç ve Yöntemler: POEMS tanısı ile takip edilen 58 yaşında erkek hastada sol gözde görme bulanıklığı gelişti.Fizik muayenesinde şüpheli papilödem olması nedeniyle Kontrastlı kranyal MR incelemesi yapıldı.

Bulgular: Kranyal MR incelemesinde bilateral optik sinir çevresi BOS mesafesinde artış ve optik sinirin globa girdiği lokalizasyonda papilödemle uyumlu kabarıklaşma mevcuttu. T2A ve FLAİR serilerde sol transvers sinüste hiperintensite izlendi. Ayrıca gliotik beyaz cevher lezyonları ve kortikal kronik enfarkt mevcuttu. Kontrastlı serilerde sol transvers sinüste trombüs ile uyumlu dolum defekti ve difüz pakimeningeal kalınlaşma ve kontrastlanma dikkati çekti.

Sonuç: POEM sendromu arteriyal ya da venöz trombüse bağlı oluşan serebral enfarklara eşlik edebilir. Bu bulgular vasküler endotelyal büyüme faktörünün (VEGF) artmış konsantrasyonuna bağlıdır. Pakimeningeal tutulumunda POEM sendromuna eşlik edebilir. Bunun nedeni olarak da enflamasyon olmaksızın meningoendotelyal hücrelerde hiperplazi, neovaskülarizasyon ve tıkanıklığa bağlı damar yapılanması sorumlu tutulmak-tadır.

P - 0138

NADİR BİR AKSİLLER LENFADENOPATİ NEDENİ: PULMONER NODÜLLERİN EŞLİK ETTİĞİ LHH OLGUSUAYŞE GÜL ALIMLI

Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi, Pediatrik Radyoloji Kliniği, Ankara, Türkiye

Özet

Langerhans hücreli histiositozis (LHH) en sık infant ve çocuklarda görülen nadir bir histiositik hastalıktır. Genellikle osteolitik kemik lezyonu ile karakterizedir. Cilt, lenf nodları, karaciğer, dalak, oral mukoza, akciğer, merkezi sinir sistemi de tutulabilir. Bu bildirinin amacı aksiller kitle ile başvuran, pulmoner nodüllerin de eşlik ettiği LHH tanısı alan 4 aylık erkek hastayı manyetik rezonans görüntüleme, B mod ultrason ve shear wave elastografi bulguları ile birlikte tartışmaktır.

Oral Presentations - The Eurasian Journal of Medicine

Documents

Transcript of Oral Presentations - The Eurasian Journal of Medicine