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Öğe Comparison of apparent diffusion coefficient values among different MRI platforms: a multicenter phantom study(AVES, 2013) Kivrak, Ali Sami; Paksoy, Yahya; Erol, Cengiz; Koplay, Mustafa; Ozbek, Seda; Kara, FatihPURPOSE We aimed to compare apparent diffusion coefficient (ADC) values among magnetic resonance imaging (MRI) scanners from different vendors. MATERIALS AND METHODS We used a custom-made phantom solution consisting of distilled water, 0.9% NaCl, 25% NaCl, and shampoo for diffusion-weighted MRI (DW-MRI) examinations. DW-MRI was performed with similar sequence parameters using six different 1.5 Tesla MR scanners (scanners A F). ADC maps were automatically constructed for all DW-MR images (b factors of 0 and 1000 s/mm(2)). ADC measurements were performed using regions of interest and seven different software programs, including four different postprocessing workstations, two different picture archiving and communication systems, and operator console software for each MR scanner. RESULTS The ADC values generated by scanners A and F were higher and those of scanner B were lower than those generated by the other scanners (P = 0.002). The intravendor difference in the ADC values averaged from scanners D, E, and F was statistically significant (P < 0.001). The difference between the ADC values obtained by scanners C and E was not statistically different (P = 0.15). CONCLUSION ADC values may differ among different MRI systems used for DW-MRI. Thus, the MRI vendor should be considered when using DW-MRI in a clinical setting.Öğe Computed tomography findings of polysplenia syndrome with multiple anomalies(UNIV CATHOLIQUE LOUVAIN-UCL, 2016) Guler, Ibrahim; Koplay, Mustafa; Ozbek, Seda; Temizoz, Osman; Cebeci, HakanA 54-year-old patient presented to our hospital with the symptoms of stomach ache, weakness, loss of appetite and weight loss. The patient had mild abdominal sensitivity during physical examination; the results of other systemic examinations were normal. Laboratory findings showed anemia. Since the patient's symptoms were accompanied by weight loss, abdominal CT examination was performed to rule out any malignancies. The abdominal CT examination showed a picture consistent with partial situs inversus. The liver was located on the left, the spleen on the right and the heart was in its normal position. The cecum was observed in the lower left quadrant. Multiple spleens located in the upper right quadrant were observed (Fig. 1). Pancreas was ectopically located in the upper left quadrant and surrounded the second part of the duodenum. A diverticular formation was detected in the second part of the duodenum.Öğe Congenital left ventricular wall abnormalities in adults detected by gated cardiac multidetector computed tomography: Clefts, aneurysms, diverticula and terminology problems(ELSEVIER IRELAND LTD, 2012) Erol, Cengiz; Koplay, Mustafa; Olcay, Ayhan; Kivrak, Ali Sami; Ozbek, Seda; Seker, Mehmet; Paksoy, YahyaObjectives: Our aim was to evaluate congenital left ventricular wall abnormalities (clefts, aneurysms and diverticula), describe and illustrate imaging features, discuss terminology problems and determine their prevalence detected by cardiac CT in a single center. Materials and methods: Coronary CT angiography images of 2093 adult patients were evaluated retrospectively in order to determine congenital left ventricular wall abnormalities. Results: The incidence of left ventricular clefts (LVC) was 6.7% (141 patients) and statistically significant difference was not detected between the sexes regarding LVC (P = 0.5). LVCs were single in 65.2% and multiple in 34.8% of patients. They were located at the basal to mid inferoseptal segment of the left ventricle in 55.4%, the basal to mid anteroseptal segment in 24.1%, basal to mid inferior segment in 17% and septal-apical septal segment in 3.5% of cases. The cleft length ranged from 5 to 22 mm (mean 10.5 mm) and they had a narrow connection with the left ventricle (mean 2.5 mm). They were contractile with the left ventricle and obliterated during systole. Congenital left ventricular septal aneurysm that was located just under the aortic valve was detected in two patients (0.1%). No case of congenital left ventricular diverticulum was detected. Conclusion: Cardiac CT allows us to recognize congenital left ventricular wall abnormalities which have been previously overlooked in adults. LVC is a congenital structural variant of the myocardium, is seen more frequently than previously reported and should be differentiated from aneurysm and diverticulum for possible catastrophic complications of the latter two. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Öğe Cortical and cerebellar atrophy, but no lesion in a patient with neuro-Behcet's disease(SPRINGER WIEN, 2013) Varoglu, Asuman Orhan; Aksoy, Asude; Kocaturk, Idris; Ertekin, Ayfer; Koplay, Mustafa; Odabas, Faruk Omer; Ozbek, SedaNeuro-Beh double dagger et's disease (NBD) is a rare clinical entity. There are no reports about cortical atrophy in NBD. We report a patient with NBD exhibiting only cortical and cerebellar atrophy without any lesions. A 38-year-old male was hospitalized due to gait disorder. He had experienced forgetfulness, irritability, sexual and behavioral dyscontrol, and incontinence for 5 years. Magnetic resonance imaging (MRI) showed cortical and cerebellar atrophy, but there were no lesions. In the differential diagnosis of NBD, physicians should take into account the presence of both brainstem and cerebellar and cortical atrophy even in the absence of typical lesions for NBD, particularly in the presence of cognitive dysfunctions.Öğe An investigation of the anatomical variations of left atrial appendage by multidetector computed tomographic coronary angiography(ELSEVIER IRELAND LTD, 2012) Koplay, Mustafa; Erol, Cengiz; Paksoy, Yahya; Kivrak, Ali Sami; Ozbek, SedaPurpose: The left atrial appendage (LAA) is usually known as a long, tubular, hooked structure derived from the left atrium. However, it varies widely in terms of anatomical shape. In this study, anatomical shape variations of the LAA were investigated and classified in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. Materials and Methods: The study included 320 consecutive patients (223 men and 97 women, with a mean age of 58 years) who underwent MDCT coronary angiography. MDCT was performed with a 64-detector-row computed tomographic scanner. LAA anatomical variations were classified as five main types and further divided into subtypes. In addition, we gave the classifications descriptive names according to the anatomical external appearance of the LAA: horseshoe (type 1), hand-finger (type 2a), fan (type 2b), wing (type 2c), hook (type 3), wedge (type 4) and swan (type 5) shapes. The types and subtypes of the LAA variations and the presence of thrombus were recorded. Results: In our study, the LAA tip orientation was used and the LAA was divided into type 1, type 2a, 2b, 2c, type 3, type 4 and type 5 in 44 (13.8%), 65 (20.3%), 155 (48.4%), 8 (2.5%), 27 (8.4%), 6 (1.9%) and 15 (4.7%) patients, respectively. LAA thrombus was detected in four patients (1.25%), who had classified LAA shapes of type 2a and type 2b. Conclusions: The LAA has multiple anatomical shape variations. We demonstrated previously undefined new shape types of LAA. Knowledge of LAA variations is important in order to avoid procedure-related complications when ablative treatment is to be performed or if surgical procedures are indicated in this region. MDCT coronary angiography provides important and detailed information about determining and evaluating these variations before undertaking a planned procedure in this region. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe Left femoral vein is a better choice for cannulation in children: a computed tomography study(WILEY-BLACKWELL, 2013) Ozbek, Seda; Aydin, Bahattin K.; Apiliogullari, Seza; Kara, Inci; Erol, Cengiz; Ciftci, Ilhan; Duman, AtesBackground Central venous catheters are often required in emergency rooms and intensive care and/or those undergoing major surgical procedures. In this study, we aimed to gain a better understanding of the anatomy of the femoral vessel in relation to central venous cannulation. Methods The right and left (total of 180) femoral veins (FVs) of 90 consecutive pediatric patients were retrospectively evaluated using computed tomography images. Patients were divided into two groups according to their age: group 1, patients up to 9years of age; and group 2, patients between 9 and 16years of age. Results The position and overlap of femoral artery (FA) to FV are significantly different between the left and right sides in both groups (P=0.001). The left FV was most commonly located medial to the FA. However, the right FV was most commonly located posterior-medial to the FA. The incidence of overlap of the FA over the FV was significantly lower at the left side in both groups. Conclusion The incidence of overlap of the FA over the FV was significantly lower at the left side in pediatric patients. This finding was similar between the patients aged 28years and those aged 916years and may have significant clinical implications. Guiding clinicians to select the left FV of children for cannulation may result in lower arterial puncture rates while accessing the central vein.Öğe Optimal Angle of Needle Entry for Internal Jugular Vein Catheterization with a Neutral Head Position: A CT Study(INFORMA HEALTHCARE, 2013) Ozbek, Seda; Apiliogullari, Seza; Erol, Cengiz; Kivrak, Ali Sami; Kara, Inci; Uysal, Emine; Koplay, MustafaPurpose: The aim of this study is to determine the optimal angle of needle entry in the sagittal plane for internal jugular vein (IJV) catheterization with the central approach while the head is in the neutral position. Methods: The contrast-enhanced carotid artery computed tomography angiographies of 123 consecutive patients were retrospectively reviewed. The point of merger between the sternal and clavicular heads of the sternocleidomastoid muscle was assumed as a clinical entry (CE) point. The angle between CE point and the center of the IJV, the depth, diameter of the vessels and the degree of overlap between the IJV and carotid artery (CA) were measured. Results: The angles between the CE point and the center of the IJVs were similar, 7 degrees +/- 13 degrees medial and 8 degrees +/- 12 degrees medial on the right and the left side, respectively. The center of IJVs from the CE point was between 0 degrees and 16 degrees toward the medial in 79.8% on the right side and 89.9% on the left side of patients. The diameters of the right IJVs were greater than the left IJVs (p = 0.001). The depth from the skin and overlap between IJV and CA did not vary between the two sides. Conclusions: When a central approach is used for right internal jugular vein (RIJV) cannulation with a neutral head position, the orientation of the angle of needle entry (i.e., 16 degrees) medially in the sagittal plane may quadruple the success rate of RIJV catheterization compared to the success rate of a laterally oriented angle of entry as recommended by the classic method.Öğe Phenotyping of chronic obstructive pulmonary disease using the modified Bhalla scoring system for high-resolution computed tomography(HINDAWI LTD, 2013) Tulek, Baykal; Kivrak, Ali Sami; Ozbek, Seda; Kanat, Fikret; Suerdem, MecitBACKGROUND: Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease. OBJECTIVE: To characterize the phenotypes of COPD according to high-resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation. METHODS: The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system. RESULTS: Fifty-four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)/peribronchial thickening (PBT) or B/PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, C-reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B/PBT groups showed significantly lower FVC, FEV1 and FEV1/FVC values, and higher CRP levels and number of exacerbations compared with the B/PBT group. No significant differences were found between the E+B/PBT and the B/PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1 and FEV1/FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations. CONCLUSION: The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.Öğe Predictors of Kidney Dimensions Measured by Multi-detector Computed Tomography (MDCT) in 930 Middle-Aged and Elderly Patients(INFORMA HEALTHCARE, 2012) Ozbek, Orhan; Solak, Yalcin; Guler, Ibrahim; Ozbiner, Huseyin; Ozbek, Seda; Turkmen, Kultigin; Nayman, AlaaddinPurpose: A few studies investigated renal size using computed tomography (CT) in middle-aged and elderly patients while taking renal function into account. Thus, we aimed to assess kidney dimensions and their predictors in patients without known renal disease by multi-detector computed tomography (MDCT). Methods: This is a 6-month-long prospective observational study. Estimated glomerular filtration rate (eGFR) was calculated with Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) formulas. Pole-to-pole kidney length (R1) was determined from coronal and sagittal oblique images. Kidney length (R2), width (R3), and parenchymal thickness were measured in axial slices. Results: The data of the 930 patients were included in this study. CG-eGFR was more closely correlated with R1, R2, and R3 than MDRD-eGFR. CG-eGFR, female gender, and presence of diabetes mellitus were independent predictors of R1 size in logistic regression analyses. Conclusion: Kidney sizes diminish with advancing age. CG-eGFR shows a better correlation with kidney dimensions compared with MDRD. Overall, age was a stronger determinant of eGFR than renal dimensions.Öğe Priapism as Presenting Manifestation of Germ Cell Tumor in a Child(AKAD DOKTORLAR YAYINEVI, 2011) Ozbek, Orhan; Koksal, Yavuz; Koc, Osman; Karagol, Cuneyt; Ozbek, Seda; Kilic, MehmetPriapism, defined as prolonged and persistent erection of the penis without sexual stimulation, is rarely seen in children. We report a 2-year-old boy who was admitted with priapism with a history of the perineal trauma. Doppler ultrasonography revealed signs of high-flow priapism. Magnetic resonance imaging revealed an intrapelvic mass beside the root of the penis. The serum alpha-fetoProtein level was 54.600 ng/ml (Normal range: 0-9 ng/ml). Tru-cut biopsy was performed and endo-dermal sinus tumor was diagnosed. At the fourth day of chemotherapy, the penis became progressively less turgid and soft. After the first cycle chemotherapy, priapism had completely resolved.Öğe THE QUEST FOR THE PERFECT INTERNAL JUGULAR VEIN CANNULATION CONTINUES(ELSEVIER SCIENCE INC, 2014) Apiliogullari, Burhan; Ozbek, Seda; Esme, Hidir[Abstract not Available]Öğe Radiofrequency ablation of phalangeal osteoid osteoma: technical challenges encountered in small bones(TURKISH JOINT DISEASES FOUNDATION, 2011) Ozbek, Orhan; Nayman, Alaaddin; Koc, Osman; Kucukapan, Ahmet; Ozbek, Seda; Kerimoglu, UlkuOsteoid osteoma, a benign bone tumor, is characterized by a generally less than 1 cm nidus surrounded by a zone of reactive sclerosis. It is frequently located in the femur and tibia; on the other hand in up to 5% of cases it may be presented in upper extremities. In previous years, its treatment was usually open surgery with en-bloc resection or curettage of the tumor. Various minimal invasive percutaneous treatments including radiofrequency ablation became popular in last years. In this report, the difficulties encountered during radiofrequency ablation treatment in small bones is described in a 19-year-old female case of osteoid osteoma.Öğe Radiologic findings of a traumatic urethral diverticulum with stones in an infertile male patient(TURKISH SOC RADIOLOGY, 2011) Ozbek, Orhan; Piskin, Mesut; Koc, Osman; Kadiyoran, Cengiz; Ozbek, Seda; Odev, KemalUrethral diverticulum is rarely encountered in male patients. Although postmicturition dribble, pain and infection are usually present, infertility is rarely reported in urethral diverticulum. We present a case with urethral diverticulum associated with infertility, which was diagnosed radiologically.Öğe Redundant nerve root syndrome of the cauda equina: the benefits of 3D CISS MRI sequence(ELSEVIER SCIENCE INC, 2015) Nayman, Alaaddin; Ozbek, Seda[Abstract not Available]Öğe Relationship between color M-mode echocardiography flow propagation and cardiac iron load on MRI in patients with thalassemia major(TURKISH SOC RADIOLOGY, 2012) Ozbek, Orhan; Acar, Kadir; Kayrak, Mehmet; Ozbek, Seda; Gul, Enes Elvin; Ucar, Ramazan; Paksoy, YahyaPURPOSE Myocardial iron overload remains an important problem and results in cardiac dysfunction in patients with thalassemia major (TM). The ratio of color M-mode flow propagation velocity to early diastolic transmitral flow velocity (E/Vp) in echocardiography is a marker of increased left ventricular filling pressure, which is independent of preload, afterload, and heart rate. We examined the relationship between E/Vp and iron loading in patients with TM using cardiac magnetic resonance imaging (MRI). MATERIALS AND METHODS Twenty-one TM patients and 21 age-matched healthy controls were enrolled in the study. Transmitral flow, pulmonary vein velocities, and Vp were obtained by two blinded echocardiographers. Left ventricular isovolumetric relaxation time (IVRT) was measured in the apical long axis by echocardiography. All patients also underwent MRI for cardiac T2* evaluation of iron overload. An increased E/Vp was defined as >1.5. RESULTS The E/Vp ratio was increased in TM patients compared with control subjects (1.7+/-0.4 and 1.2+/-0.2, P < 0.01, respectively). There was no correlation between E/Vp and cardiac T2* value. E/Vp was significantly correlated with IVRT (r=0.51, P = 0.02). In addition, the cardiac T2* value was comparable in patients with an E/Vp >1.5 and E/Vp <= 1.5 (21.1+/-9.8 ms vs. 22.3+/-8.0 ms, P = 0.80, respectively). CONCLUSION E/Vp may be a marker of diastolic abnormality that is independent from myocardial iron load in TM patients with preserved left ventricular function.Öğe Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation(TAYLOR & FRANCIS LTD, 2013) Ozbek, Seda; Apiliogullari, Seza; Kivrak, Ali Sami; Kara, Inci; Saltali, Ali OzgulUltrasound-guided right internal jugular vein catheterization (RIJV) should be the first choice to decrease the catheter-related complications in high-risk hemodialysis patients. For this procedure, clinicians should identify the optimum positions of the RIJV, including its lower overlap with the carotid artery (CA) and high cross-sectional area of the vein. The aim of this prospective randomized study to evaluate the effects of mild ipsilateral head rotation combined with Trendelenburg position on RIJV cross-sectional area and its relation to the CA in adult patients. Forty ASA I-II patients who were undergoing elective surgery were enrolled for this study. The subjects were asked to remain supine in the 15-20 degrees Trendelenburg position. Two-dimensional ultrasound was then used to measure the degree of overlap between the RIJV and CA, the cross-sectional area of the RIJV. These measurements were compared between head rotation to the >30 degrees left, <30 degrees left, neutral, and <30 degrees right positions. When the head was in the >30 degrees left position, overlap was seen in 38 of 40 patients (95%). As the head was rotated from >30 degrees left to <30 degrees right, the CA-RIJV overlap (from 95% to 57.5%), and the cross-sectional area (from 14.2 mm to 8.7 mm) significantly decreased. In conclusion, when the head was turned to <30 degrees right, the CA-RIJV overlap significantly decreased, and the cross-sectional area also decreased. When clinicians determine the optimal head position before RIJV cannulation, it is important to consider the advantages and disadvantages of the different head positions from >30 degrees left to <30 degrees right.Öğe Seeing Is Believing: Ultrasound-Guided Internal Jugular Vein Cannulation(LIPPINCOTT WILLIAMS & WILKINS, 2012) Kara, Inci; Apiliogullari, Seza; Duman, Ates; Celik, Jale Bengi; Ozbek, Seda[Abstract not Available]Öğe Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study(SPRINGER, 2013) Ozbek, Orhan; Acar, Kadir; Koc, Osman; Saritas, Kadir; Toy, Hatice; Solak, Yalcin; Ozbek, SedaRenal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.Öğe Spinal intramedullary metastasis as the first manifestation of lung cancer(ELSEVIER SCIENCE INC, 2015) Nayman, Alaaddin; Ozbek, Seda; Temizoz, Osman; Kanat, Fikret; Kivrak, Ali S.[Abstract not Available]Öğe Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients(TAYLOR & FRANCIS LTD, 2015) Nayman, Alaaddin; Onal, Ibrahim Ozkan; Apiliogullari, Seza; Ozbek, Seda; Saltali, Ali Ozgul; Celik, Jale Bengi; Temizoz, OsmanBackground and aim: Trendelenburg positioning (TP) is a common approach used during internal jugular vein (IJV) cannulation. No evidence indicates that TP significantly increases the cross-sectional area (CSA) of the IJV or decreases the overlap between the carotid artery (CA) and the IJV in dialysis patients. The primary aim of this study was to investigate the effects of the TP on the CSA of the right IJV and on its relationship to the CA. Methods: Thirty-seven consecutive hemodialysis patients older than 18 years of age were enrolled. We measured the CSA of the right IJV and overlap rate (at end-expiration at the level of the cricoid cartilage) between the CA and the IJV in two positions: State 0, table flat (no tilt), with the patient in the supine position; State T, in which the operating table was tilted to 15 degrees of TP. Results: Data were collected for all of the 37 patients enrolled in the study. The change in CSA and overlap between the CA and the IJV from the supine to the TP was not significantly different. The CSA was paradoxically decreased in 11 of 37 patients when changed from State 0 to State T. Conclusions: TP does not significantly increase the CSA of the right IJV or decrease the overlap between the CA and the IJV in dialysis patients. In fact, in some patients, it reduces the CSA. Therefore, the use of the TP for IJV cannulation in dialysis patients can no longer be supported.
