Browsing by Author "Bilgin, Cem"

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Akut iskemik uyanma inmesinde mekanik trombektominin etkinliğinin retrospektif olarak değerlendirilmesi
(Bursa Uludağ Üniversitesi, 2020) Bilgin, Cem; Hakyemez, Bahattin; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.
Akut iskemik inmede tedavi yanıtını belirleyen en önemli parametrelerden biri semptomların süresidir. Semptom süresi uzadıkça geri dönüşümsüz nöron hasarı ve hastalarda fonksiyon kaybı meydana gelme ihtimali artar. Bu nedenle, akut inmede, mekanik trombektomi kararının verilmesinde semptom süresi oldukça önemlidir. Ancak akut iskemik uyanma inmelerinde semptom süresi bilinmemektedir. Bu durum akut iskemik uyanma inmeli olgularının yönetimini zorlaştırmaktadır. DAWN ve DEFUSE-3 çalışmalarında ileri görüntüleme yöntemleri ile seçilen hastalarda mekanik trombektominin bu hastalarda 16-24 saate kadar etkili olabileceği gösterilmiştir. Bu sayede semptomlarının başlangıç zamanı bilinmeyen olgularda mekanik trombektomi günlük pratikte daha çok uygulanmaya başlanmıştır. Biz bu tez çalışmasında akut iskemik uyanma inmesi ile başvuran ve büyük damar tıkanıklığı saptanan olgularda mekanik trombektominin etkinliğini değerlendirmeyi amaçladık. Çalışmamızda Ocak 2012- Şubat 2020 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi hastanesinde mekanik trombektomi ile tedavi edilen 22 akut iskemik uyanma inmesi olgusu retrospektif olarak değerlendirildi. Hastaların demografik verileri, komorbid hastalıkları kaydedildi. Mekanik trombektomi sonrası ilgili damarın rekanalizasyonu Thrombolysis in Cerebral Infarction (TICI) skalası ile değerlendirildi. TICI≥2b rekanalizasyon başarılı olarak kabul edildi. Çalışmamızda TICI≥2b rekanalizasyon %86,36 (19/22) oranında sağlandı. Klinik yanıt ise 90. gün modifiye Rankin Skalası (mRS) ile değerlendirildi. Hedeflenen klinik sonuç fonksiyonel bağımsızlık (mRS≤2) olarak belirlendi. Fonksiyonel bağımsızlık ise %36,36 (8/22) oranında sağlandı. İki olguda (%9,09) semptomatik intrakranial hemoraji gözlendi. Tez çalışmamızda elde ettiğimiz sonuçlar doğru hasta seçimi ile akut iskemik uyanma inme olgularında mekanik trombektomi ile yüksek fonksiyonel bağımsızlık oranlarının sağlanabileceğini göstermektedir. Benzer şekilde düşük iv komplikasyon oranları mekanik trombektominin bu hasta grubununda güvenilirliğini desteklemektedir.
Cross-sectional imaging and laparoscopic findings of diaphragmatic mesothelial cysts
(W.B. Saunders, 2019-10-30) Sansar, Serpil; Özçakır, Esra; Kaya, Mete; Kandemirli, Sedat Giray; Parlak, Ayşe; Bilgin, Cem; Gürpınar, Arif Nuri; Yazıcı, Zeynep; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; 0000-0001-7686-2561; AAH-6766-2021; HHS-7433-2022; AAI-2303-2021; A-1409-2017; ITP-4695-2023; 22834938400; 57202853581; 57200617643; 7004350616; 6701668723
AIM: To present cross-sectional imaging, surgical findings, and follow-up results of diaphragmatic mesothelial cysts. MATERIALS AND METHODS: Radiological findings for location, size, shape, and internal structure of cysts were reviewed retrospectively. For patients that underwent surgery, surgical reports and laparoscopy images were reviewed. In conservatively managed patients, changes in size and imaging findings of the cyst were assessed during follow-up visits. RESULTS: A total of 13 paediatric cases with an imaging and/or pathological diagnosis of diaphragmatic mesothelial cyst were identified. In all cases, the cystic lesions were located between the diaphragm and the posterolateral aspect of the right lobe of the liver. Eleven lesions (84.6%) had a bi-lobulate shape. Eight of these cases underwent laparoscopic cyst aspiration/unroofing. The postoperative course was uneventful and there were no cases of recurrence. The remaining five cases were managed conservatively with follow-up available in four cases. In three cases (75%), there was reduction in the size of the cysts with a mean volume reduction of 55%. CONCLUSION: Diaphragmatic mesothelial cysts are congenital cystic lesions that are usually detected incidentally. A common pitfall is incorrect interpretation of the lesion as a hepatic cyst. Conservative management with imaging follow-up can be adopted in asymptomatic cases with typical imaging findings.
Demonstration of cephaloceles in patients with rhinorrhea: Single centre experience of intrathecal gadolinium enhanced MR cisternography
(Briefland, 2020-01-01) Cebeci, Hakan; Bilgin, Cem; Candan, Selman; Yılmazlar, Selçuk; Hakyemez, Bahattin; BİLGİN, CEM; CANDAN, SELMAN; YILMAZLAR, SELÇUK; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; HHS-7433-2022; AAH-5070-2021; AAI-2318-2021; GVS-7682-2022
Background: MR cisternography has the crucial role for diagnosis of cerebrospinal fluid (CSF) leakage in patients with rhinorrhea and otorrhea. Trauma is the major cause of rhinorrhea. Cephalocele is diagnosed in some rhinorrhea patients.Objectives: To evaluate the CSF leakage in patients with rhinorrhea and assess the frequency of cephalocele in the etiology of rhinorrhea.Patients and Methods: Intrathecal gadolinium enhanced MR cisternography and nonenhanced CT of paranasal sinus images of patients with suspected CSF rhinorrhea between October 2012 and September 2018 were evaluated retrospectively. Twenty-one patients with the diagnosis of contrast leakage causing rhinorrhea were included in the study. All patients had intrathecal gadolinium enhanced MR cisternography. Three dimensional (3D)-T1 weighted and 3D-fluid attenuated inversion recovery (FLAIR) head MRI was obtained after administration of 1 ml intrathecal gadoterate meglumine after half, 3, and 8 hours. Locations of contrast leakage and etiologies were analyzed.Results: Patient group consisted of 21 patients with persistent or intermittent rhinorrhea. CT imaging showed bone defect in all patients. Intrathecal gadolinium enhanced MR cisternography revealed CSF leakage (10 ethmoid, 10 sphenoid, and 1 frontal). Cephalocele was detected in 10 of 21 patients.Conclusion: MR cisternography with intrathecal gadolinium enhancement is an effective and safe imaging modality compared to other techniques used for diagnosis of CSF leakage. Accurate localization of CSF fistula and demonstration of herniating content from cranial bone defect is feasible with this technique.
Determining flow stasis zones in the intracranial aneurysms and the relation between these zones and aneurysms' aspect ratios after flow diversions
(Sage Publications Inc, 2023-03-22) Altındağ, Batı; Olcay, Ali Bahadır; Tercanlı, Muhammed Furkan; Bilgin, Cem; Hakyemez, Bahattin; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0003-0995-9173
Background Flow diverter stents (FDSs) are widely used to treat aneurysms in the clinic. However, even the same flow diverter (FD) use on different patients' aneurysm sites can cause unexpected hemodynamics at the aneurysm region yielding low success rates for the overall treatment. Therefore, the present study aims to unfold why FDs do not work as they are supposed to for some patients and propose empirical correlation along with a contingency table analysis to estimate the flow stasis zones in the aneurysm sacs. Methods The present work numerically evaluated the use of FRED4518 FDS on six patients' intracranial aneurysms based on patient-specific aneurysm geometries. Computational fluid dynamics (CFD) simulation results were further processed to identify the time evolution of weightless blood particles for six patients' aneurysms. Results Stagnation zone formation, incoming and outgoing blood flow at the aneurysm neck, and statistical analysis of six patients indicated that FRED4518 showed a large flow stasis zone for an aspect ratio larger than 0.75. However, FRED4518, used for aneurysms with an aspect ratio of less than 0.65, caused small stagnant flow zones based on the number of blood particles that stayed in the aneurysm sac. Conclusion A patient-specific empirical equation is derived considering aneurysms' morphological characteristics to determine the amount of stagnated fluid flow zones and magnitude of the mean aneurysm velocity in the aneurysm sac for FRED4518 based on weightless fluid particle results for the first time in the literature. As a result, numerical simulation results and patient data-driven equation can help perceive stagnated fluid zone amount before FRED4518 placement by shedding light on neuro-interventional surgeons and radiologists.
Diagnostic utility of superb microvascular imaging in depiction of corkscrew collaterals in Buerger's disease
(Wiley, 2020-05-27) Nas, Ömer Fatih; Kandemirli, Sedat Giray; Erdemli Gürsel, Başak; Bilgin, Cem; Korkmaz, Barış; Yolgösteren, Atıf; İnecikli, Mehmet Fatih; NAS, ÖMER FATİH; Kandemirli, Sedat Giray; ERDEMLİ GÜRSEL, BAŞAK; BİLGİN, CEM; KORKMAZ, BARIŞ; YOLGÖSTEREN, ATIF; İNECİKLİ, MEHMET FATİH; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.; 0000-0002-4467-3915; AAG-2372-2021; HHS-7433-2022; AAK-5124-2020; AAG-8561-2021; AAH-6568-2021; A-1409-2017; FHT-9776-2022
Purpose To evaluate the corkscrew collaterals in Buerger's disease by superb microvascular imaging (SMI) and power Doppler ultrasonography (PDU). Methods We evaluated with SMI and PDU 14 patients with Buerger's disease in whom corkscrew collaterals had been identified on digital subtraction angiography (DSA). Corkscrew collaterals were classified on DSA and PDU based on their size and morphology. Results A total of 17 vascular regions of collateral vessel formation were assessed. Based on DSA classification, there were three cases of type I collaterals (arterial diameter of >2 mm with large helical pattern), seven cases of type III collaterals (arterial diameter of 1-1.5 mm with small helical pattern), and seven cases of type IV collaterals (arterial diameter of <1 mm with tiny helical pattern). On PDU, all type I collaterals on DSA appeared as "large snake" images, all type III collaterals on DSA appeared as "small snake" images, and all type IV collaterals on DSA appeared as dots. SMI imaging, both in color and monochrome mode, provided superior demonstration of the continuity of the vessel of large or small "snake" images. In cases appearing as dot pattern on PDU, color SMI was able to show continuity of the flow signal as a helical pattern. Discussion SMI is a promising new Doppler imaging technique that is superior to conventional power Doppler imaging in depiction and identification of corkscrew collaterals in Buerger's disease.
Diffuse large B-cell lymphoma presenting with masses in the pineal and adrenal glands
(Wiley, 2019-03-01) Bilgin, Cem; Korkmaz, Barış; Soylu, Esra; Öztürk, Hulya; Öztürk, Kerem; BİLGİN, CEM; KORKMAZ, BARIŞ; Soylu, Esra; ÖZTÜRK NAZLIOĞLU, HÜLYA; Öztürk, Kerem; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0001-9664-2347; HHS-7433-2022; E-1228-2018; FHT-9776-2022; DSW-1175-2022; IXQ-3375-2023
Key Clinical Message Magnetic resonance imaging (MRI) may offer several potential advantages in the evaluation of lymphoma with the additive value of H-1-MRS for differential diagnosis. Even though lymphoma has unique imaging findings on CT and multiparametric MRI, definite diagnosis must be thoroughly established by histopathological examination.
Direct aspiration thrombectomy experience with the SOFIA 6F catheter in acute ischemic stroke
(Springer, 2021-01-19) Bilgin, Cem; Durmuş, Yavuz; Haki, Cemile; Nas, Ömer Fatih; Hakyemez, Bahattin; NAS, ÖMER FATİH; HAKYEMEZ, BAHATTİN; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; 0000-0002-3425-0740; AAG-8561-2021; AAI-2318-2021
Introduction As the SOFIA (Soft torqueable catheter Optimized For Intracranial Access) 6F catheter has a large luminal diameter, it can be used as an aspiration catheter. Furthermore, it may function as an intermediate catheter when a stent retriever is required. Purpose We aimed to evaluate the usefulness of the SOFIA 6F catheter in mechanical thrombectomy with the direct aspiration first pass technique.Method Patients who had undergone mechanical thrombectomy (September 2017-January 2019) using the SOFIA 6F catheter in two centers were retrospectively analyzed. We used the thrombolysis in cerebral infarction (TICI) scale to evaluate the success of recanalization. National Institutes of Health Stroke Scale scores on admission and discharge were used together with the modified Rankin Scale (mRS) scores at 90 days.Results In 132 (89.1%) of the 148 cases, the thrombus was in the anterior system. The SOFIA 6F catheter reached the thrombus site in 130 (87.8%) cases. The rate of successful recanalization (TICI >= 2b) was 89.1%. The targeted clinical outcome (mRS score <= 2 at 90th days) was achieved in 49.3% of cases. Symptomatic intracranial hemorrhage occurred in 5.4%. The rate of emboli to new vascular territories was 5.4%. Mortality was 14.1%.Conclusion In the majority of our cases, the SOFIA 6F catheter provided effective and rapid recanalization with aspiration thrombectomy.
Evaluating the effect of the number of wire of flow diverter stents on the nonstagnated region formation in an aneurysm sac using lagrangian coherent structure and hyperbolic time analysis
(Elsevier Science, 2020-01) Mutlu, Onur; Olcay, Ali Bahadır; Bilgin, Cem; Hakyemez, Bahattin; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740; HHS-7433-2022; AAI-2318-2021; 57200617643; 6602527239
Background: Giant aneurysms at carotid arteries are typically treated with flow diverter (FD) stents in the clinic. Although the goal of an FD stent is to direct most of the blood flow into the main artery, not much is known regarding the effects of wire number an FD possesses on the hemodynamics inside the aneurysm. Methods: In this study, 48-, 72-, and 96-wire FD stents were separately implanted into the site of aneurysm of a 45-year-old woman to evaluate the effects of the FD's number of wires on fluid flow behavior in the aneurysm sac. Time evolution of both finite-time Lyapunov exponent (FTLE) and hyperbolic time fields in the aneurysm sac were calculated by using computational fluid dynamics along with Lagrangian coherent structure (LCS) methods. Results: The computations reveal that a 48-wire FD stent allows a large amount of blood to enter inside the aneurysm sac revealing scattered nonstagnant flow zones formation. Besides, time-dependent results of LCS analysis show that most of the blood flow is diverted into the main artery when 72- and 96-wire number Surpass brand FD stents are separately implanted into the site of the aneurysm, yielding a small amount of blood flow to penetrate into the aneurysm sac. Conclusions: Furthermore, FTLE and hyperbolic time field plots are in good agreement with the patient's digital subtraction angiography image captured 3.5 minutes after 72-wire Surpass brand FD stent implantation.
Evaluating the effectiveness of 2 different flow diverter stents based on the stagnation region formation in an aneurysm sac using lagrangian coherent structure
(Elsevier Science Inc, 2019-07) Mutlu, Onur; Olcay, Ali Bahadır; Hakyemez, Bahattin; Bilgin, Cem; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740; AAI-2318-2021; HHS-7433-2022; 57200617643; 6602527239
BACKGROUND: Flow diverter stents are often used in the treatment of giant aneurysms at carotid arteries. Although these stents promise to decrease blood flow into the aneurysm sac, little is known about hemodynamics inside the aneurysm once the stent is planted into the aneurysm neck. To further explore this, computational fluid dynamics and Lagrangian coherent structure (LCS) techniques were used to evaluate the time evolution mechanism of stagnation regions inside an aneurysm. The purpose of this work is to provide a quantitative effectiveness comparison of 2 different flow diverter stents placed into the aneurysm neck based on their stagnation zone formations in the sac.METHODS: In numerical modeling, Womersley function, and fluidsolid interaction were defined as the 3 cardiac cycles for blood velocity and the aneurysm wall, respectively. Moreover, blood was accepted as a non-Newtonian fluid, and mean arterial blood pressure of the patient was entered into the computational domain to accurately mimic the hemodynamics inside the aneurysm sac accurately.RESULTS: The numerical analyses revealed that the use of a Fred-type stent in the aneurysm neck causes fluid flow zone formations yielding to sequenced stagnated regions. Time evolution of stagnation regions in an aneurysm sac was shown just after a flow diverter stent was employed at a patient's aneurysm neck. Furthermore, the stagnation field in the Fred stent-fitted aneurysm was nearly 4.8 times the stagnation area of the Surpass brand stent-attached aneurysm.CONCLUSIONS: Finite time Lyapunov exponent fields obtained from the LCS techniques demonstrated a good agreement with the patient's digital subtraction angiography images obtained just after treatment.
Investigation of blood flow behavior in an aneurysm sac using computational fluid dynamics
(IEEE, 2019-01-01) Güçlü, Görkem; Günaydın, Talha; Ünsal, Can; Olcay, Ali Bahadır; Bilgin, Cem; Hakyemez, Bahattin; HAKYEMEZ, BAHATTİN; Bilgin, Cem; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Bölümü; 0000-0003-0995-9173; AAI-2318-2021; HHS-7433-2022
Blood flow behavior inside an aneurysm is a complex three-dimensional fluid mechanics problem and clarity on this subject can improve or enhance the effectiveness of the treatment. In this study, the fluid flow properties such as velocity, viscosity, wall shear, and pressure are examined by using a computational fluid dynamics (CFD) technique. The patient's angiographic images are provided by the Radiology Department of Uludag University Medical School. These images are converted into a three-dimensional solid model; then, this model is used as a fluid domain in CFD. The blood flow is defined as non-Newtonian, laminar and parabolic pulsatile with two different maximum velocities so that the difference in velocity can be evaluated. The findings are presented in charts for each fluid flow parameter (e.g., velocity, viscosity, wall shear, pressure).
Investigation of the effect of anticoagulant usage in the flow diverter stent treatment of the patient-specific cerebral aneurysm using the Lagrangian coherent structures
(Elsevier Sci Ltd, 2021-10-16) Tercanlı, Muhammed Furkan; Olcay, Ali Bahadır; Mutlu, Onur; Bilgin, Cem; Hakyemez, Bahattin; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740 ; AAI-2318-2021
Anticoagulants are prescribed to the flow diverter treated patients to diminish the risk of embolism in the arteries. In the present study, digital subtraction angiography images of a 49-year-old female patient with a left paraophthalmic aneurysm were used to build a numerical model to investigate the effect of an anticoagulant on hemodynamics at the aneurysm site. The Carreau-Yasuda viscosity model was utilized to define blood viscosity, and the coefficients of the viscosity model were updated based on the usage of warfarin. The five-cardiac cycle-long numerical simulations were performed, and Lagrangian coherent structures, hyperbolic time, and fluid particle analyses were also employed in the numerical models. These analyses allowed us to evaluate the formation of stagnated regions, recirculation zones, and the number of jailed particles inside the aneurysm sac following a flow diverter placement. It is realized that anticoagulant use caused blood to be less viscous, yielding a substantial amount of incoming blood flow to enter the aneurysm sac. Only 12% of the nearly 25,000 fluid particles seeded from the artery inlet have stayed inside the sac. Furthermore, the deviation between warfarin added blood and normal blood flow becomes more extensive, with every heartbeat undermining the effectiveness of patient-specific CFD models when the use of anticoagulants is overlooked in the viscosity models. (c) 2021 Elsevier Ltd. All rights reserved.
Neuroimaging of first seizure in the adult emergency patients
(Springer Heidelberg, 2020-08-01) Öztürk, Kerem; Soylu, Esra; Bilgin, Cem; Hakyemez, Bahattin; Parlak, Müfit; Öztürk, Kerem; BİLGİN, CEM; HAKYEMEZ, BAHATTİN; PARLAK, MÜFİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-9664-2347; 0000-0002-3425-0740; HHS-7433-2022; E-1228-2018; AAI-2318-2021; AAG-8521-2021
The aim is to establish the role of head computed tomography (CT) and magnetic resonance imaging (MRI) in adults presenting to the emergency department (ED) with first-time seizure (FS) and to analyze the potential predictor variables for the adverse imaging outcome. We retrospectively reviewed the medical records of all adults who underwent cranial CT or MRI between January 1, 2011, and December 1, 2016, to an academic ED for FS. Patients were excluded if were under 18 years of age, had known recent intracranial pathology, known brain tumor or having a history of trauma. Important predictive variables to indicate pathology in either CT or MR scan in patients with FS were evaluated with logistic regression analysis. A total of 546 FS (293 men and 253 women; range, 18-81 years; mean, 47 years) were identified in patients receiving either cranial CT or MR scan. Of them, abnormal findings were observed in 22/451 (4.8%) patients on CT and 18/95 (18.9%) patients on MRI. Predictor variables of age greater than 50 years, focal neurologic deficit, hypoglycemia, and history of malignancy were identified on CT, whereas a history of malignancy, age greater than 50 years and focal neurological deficit were determined on MRI. Limiting neuroimaging to this population would potentially reduce head CT scans by 67% and would potentially reduce head MRI scans by 47%. Clinical suspicion should be heightened and the neuroimaging should be considered for advanced age, history of malignancy, hypoglycemia or focal neurological deficits in patients with FS.
Numerical study of a simplified cerebral aneurysm using a two different flow diverter stent modeling
(Ieee, 2019-01-01) Tercanlı, Muhammed Furkan; Mutlu, Onur; Olcay, Ali Bahadır; Bilgin, Cem; Hakyemez, Bahattin; BİLGİN, CEM; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3425-0740 ; HHS-7433-2022; AAI-2318-2021
The effectiveness of clinical treatments in-stent modeling have been recently started to be analyzed using Computational Fluid Dynamics (CFD) technique. Particularly, variation of pressure loss with flow velocity is used to evaluate permeability and internal resistance coefficients of the flow diverter stents to describe the stent properties to CFD model. The velocity profile is described as pulsatile parabolic at the inlet, the pressure is described at the outlet to be 93 mmHg as a mean arterial pressure (MAP) in the present study. The results implied that there was no significant difference found between porous media and stent implantation of a flow diverter stent modelings based on the studied cases. However, fluid flow simulations indicated that use of 48 wires stent allows more blood flow passing into the aneurysm sac compared to the 72 and 96 wires stents for the studied geometry. Effect of pressure change in the vessel and shape factor of the artery was neglected.
Post-traumatic occipital intradiploic encephalocele
(Elsevier Science, 2019-05-22) Kandemirli, Sedat Giray; Candan, Selman; Bilgin, Cem; Kandemirli, Sedat Giray; CANDAN, SELMAN; BİLGİN, CEM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-3976-4062; HHS-7433-2022; GVS-7682-2022; A-1409-2017
BACKGROUND: Brain parenchyma herniation through a disrupted inner table into an enlarged diploic cavity with an intact outer table is described as intradiploic encephalocele. Intradiploic encephaloceles share common morphologic characteristics with expanding skull fractures and intradiploic arachnoid cysts. Herein, we describe a case of traumatic occipital intradiploic encephalocele.CASE DESCRIPTION: Cranial computed tomography of an 11-year-old boy revealed erosion of the inner table of the left side of occipital bone and expansion of the cranial diploe by a soft-tissue density with a gyral pattern. His medical history was positive for head trauma at the age of 3 years to the same region. Magnetic resonance imaging showed herniation of left occipital parenchyma with cystic encephalomalacic changes into the diploe.CONCLUSIONS: Intradiploic encephaloceles have different features compared with the classic encephalocele and can be considered as a variant of expanding skull fracture and intradiploic arachnoid cyst.
Predictor variables of abnormal imaging findings of syncope in the emergency department
(Springer London Ltd, 2018-03-12) Soylu, Esra; Öztürk, Kerem; Bilgin, Cem; BİLGİN, CEM; Hakyemez, Bahattin; HAKYEMEZ, BAHATTİN; Parlak, Mufit; PARLAK, MÜFİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-9664-2347; AAI-2318-2021; AAG-8521-2021; E-1228-2018; HHS-7433-2022
Background: This study aimed to describe the pathological findings and to analyze clinical predictors of abnormal imaging findings in patients presenting to the emergency department (ED) with syncope.Methods: The database was retrospectively reviewed for all patients who underwent cranial computed tomography (CT) or magnetic resonance imaging (MRI), having the symptom of syncope. Patients were included only if they were from the emergency department and excluded if were under 18 years of age, had known recent intracranial pathology, known brain tumor, or having a history of trauma. The primary outcome was assumed as abnormal head CT or MRI including intracranial hemorrhage, acute or subacute stroke, and newly diagnosed brain mass. Univariate and multivariate logistic regression analysis was utilized to determine the association between clinical variables and any significant pathology in either CT or MR scan.Results: Total of 1230 syncope (717 men and 513 women; range, 18-92 years; mean, 54.5 years) as presenting symptoms were identified in patients receiving either cranial CT or MR scan in the ED. Abnormal findings related to the syncope were observed in 47 (3.8%) patients. The following predictor variables were found to be significantly correlated with acutely abnormal head CT and MRI: a focal neurologic deficit, history of malignancy, hypertension, and age greater than 60 years.Conclusions: Our data offer that the identification of predictor variables has a potential to decrease the routine use of head CT and MRI in patients admitting to the ED with syncope.
Predictors of antegrade ureteral stenting failure: A single-center experience in patients with malignant and benign ureteral obstruction
(Springer, 2020-11-05) Kandemirli, Sedat Giray; Nas, Ömer F.; Öztepe, Muhammed F.; Bilgin, Cem; Özkaya, Güven; İnecikli, Mehmet F.; Kaygısız, Onur; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Aanabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Üroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-0297-846X; 0000-0002-9796-8223; AAG-8561-2021; DLB-1623-2022; HHS-7433-2022; GBB-7153-2022; 51864050100; 57219990637; 57200617643; 16316866500; 36660852200; 16637252400
Objective To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. Method We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. Results Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39 days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30 days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30 days) were urinary tract infection (n: 1) and stent migration (n: 1). Conclusion This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.
Prognostic value of pretreatment tumor-to-blood Standardized Uptake Ratio (SUR) in rectal cancer
(Springer, 2020-06) Kandemirli, Sedat Giray; Belge, Gökçe; Bilgin, Cem; Özkaya, Güven; Alper, Eray; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Bölümü; Uludağ Üniversitesi/Tıp Fakültesi/Nükleer Tıp Bölümü; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Bölümü; 0000-0003-0297-846X; CFT-6124-2022; A-4421-2016; EJU-2547-2022; 57216409186; 57200617643; 16316866500; 7006827670
Objectives: The prognostic value of SUV on pretreatment F-18 FDG PET/CT imaging in patients with rectal cancer is a matter of debate. SUR is of prognostic value for survival in different cancers. In this study, we aimed to examine the potential prognostic value of SUR and other parameters in pretreatment F-18 FDG PET/CT for non-metastatic rectal cancer. Methods: One hundred four non-metastatic rectal cancer patients who underwent pretreatment PET/CT between March 2012 and January 2018 were included in the study. Firstly, SUVmax, SUVmean, MTV, and TLG were calculated semi-automatically at the workstation. SUR was calculated as the ratio of tumor SUVmax to thoracic aorta blood SUVmean. Univariate Cox regression and Kaplan–Meier analysis were used to evaluate overall survival (OS), progression free survival (PFS), and local recurrence (LR). Then, multivariate Cox regression analysis, which included the parameters that were significant in the univariate analysis, was performed. Results: Multivariate Cox regression analysis revealed that SUR was a prognostic factor for PFS. Age and T stage were prognostic factors for both OS and PFS. MTV was found to be independent risk factors for OS. Conclusions: In our study, SUR was the only F-18 FDG PET/CT parameter found to be significant for PFS. The development of new parameters can increase the prognostic value of F-18 FDG PET/CT.
Right- versus left-sided approach for transhepatic tunneled catheter placement: Is there a difference?
(Springer, 2021-04-08) Nas, Ömer F.; Candan, Selman; Öztepe, Muhammed F.; Kandemirli, Sedat G.; Bilgin, Cem; İnecikli, Mehmet F.; Özkaya, Güven; Gökalp, Gökhan; Öngen, Gökhan; Erdoğan, Cüneyt; NAS, ÖMER FATİH; CANDAN, SELMAN; Öztepe, Muhammed F.; İNECİKLİ, MEHMET FATİH; ÖZKAYA, GÜVEN; GÖKALP, GÖKHAN; ÖNGEN, GÖKHAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Sağlık Bilimleri Enstitüsünde/Biyoistatistik Bilim Dalı.; 0000-0003-0297-846X; 0000-0002-3682-2474; AAK-5124-2020; HHS-7433-2022; GVS-7682-2022; AAG-8561-2021; DLB-1623-2022; IVU-2672-2023; GMO-0473-2022; FQR-8472-2022
Objective We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. Methods We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. Results A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 +/- 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. Conclusions In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.
Spinal cerebrospinal fluid leakage in spontaneous intracranial hypotension: An intrathecal gadolinium enhanced MR-myelography study
(Ubiquity Press, 2019-12-25) Cebeci, Hakan; Bilgin, Cem; Candan, Selman; Demir, Aylin Bican; Hakyemez, Bahattin; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 0000-0001-6739-8605; 0000-0002-3425-0740; HHS-7433-2022; GVS-7682-2022; 57200617643; 57209348454; 18036596400; 6602527239
Objectives: In the present study, the authors presented the intrathecal gadolinium enhanced MR-myelography findings of patients with spontaneous intracranial hypotension. Materials and Methods: Intrathecal gadolinium enhanced MR-myelography (Gd-MR-myelography) examina-tions between October 2012 and September 2018 in patients having clinical and radiological findings of spontaneous intracranial hypotension were evaluated retrospectively. Sites and types of contrast leakages in 20 patients who met inclusion criteria were reviewed. All patients had undergone T1-fat suppressed sagittal images of cervical, thoracic and lumbar region after the off label intrathecal injection of 1 ml gadolinium-based contrast agent. Results: Patients (18 female, 2 male) are aged between 23 and 62 years-old (mean age: 41.1). Cerebrospi-nal fluid (CSF) leakages were cervical in 6 patients, thoracic in 5 patients, lumbar in 5 patients. One patient had leakage in multiple levels on both cervical and thoracic region and another patient on both cervical-thoracic and lumbar regions. No patients had adverse effects related to intrathecal injection of gadolinium. Conclusions: Gd-MR-myelography is effective imaging modality to reveal spinal CSF leakages in patients with spontaneous intracranial hypotension.
Superb microvascular imaging in assessment of synovitis and tenosynovitis in juvenile idiopathic arthritis
(Lippincott Williams & Wilkins, 2021-03-01) Kandemirli, Sedat Giray; Çicek, Fatih; Erdemli Gürsel, Başak; Bilgin, Cem; Kiliç, Sara Sebnem; Yazıcı, Zeynep; Çicek, Fatih; ÇİÇEK, FATİH; Erdemli Gürsel, Başak; ERDEMLİ GÜRSEL, BAŞAK; Bilgin, Cem; BİLGİN, CEM; Kiliç, Sara Sebnem; KILIÇ GÜLTEKİN, SARA ŞEBNEM; Yazıcı, Zeynep; YAZICI, ZEYNEP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-7348-7081; 0000-0001-8571-2581; AAH-1658-2021; HHS-7433-2022; JKI-5906-2023; AAH-6568-2021
The aim of this study is to evaluate the diagnostic utility of superb microvascular imaging (SMI) in assessment of synovitis/tenosynovitis in juvenile idiopathic arthritis in comparison to power Doppler ultrasound. Thirty juvenile idiopathic arthritis cases with active clinical findings and ultrasound features of effusion and/or tenosynovitis were further imaged with power Doppler and SMI. For classification of synovial inflammation, a semiquantitative scale (4 points) adopted by Outcome Measures in Rheumatology was used.A total of 35 knee, 2 hip, 2 ankle, 2 wrist, 2 elbow joints, and 6 flexor hallucis longus/tibialis posterior tenosynovitis were assessed. In knee joint, power Doppler and SMI scales were the same for 23 (65.7%) joints, SMI upgraded scale from 0 to 2 in single joint (2.9%); 1 to 2 (14.3%) in 5 joints; and 2 to 3 (17.1%) in 6 joints. For other joints, power Doppler and SMI scales were the same for 5 (62.5%) joints. Superb microvascular imaging upgraded scale from 1 to 2 (25%) in 2 joints and 1 to 3 (12.5%) in a single joint. For flexor hallucis longus/tibialis posterior tenosynovitis, power Doppler and SMI scales were the same for two cases (33.3%). Superb microvascular imaging upgraded scale from 0 to 2 in two cases (33.3%); and 2 to 3 (33.3%) in 2 cases. There was no case of SMI scale downgraded compared with power Doppler scale.Superb microvascular imaging is a feasible technique in the assessment of synovial inflammation and tenosynovitis in juvenile idiopathic arthritis. Superb microvascular imaging has higher sensitivity compared with power Doppler ultrasound in depiction of increased vascularity.