Amaç: Çalışmamızın amacı merkezimizde koroner Bilgisayarlı tomografi (BT) anjiografi çekilen hastalarda koroner arterlerin varyasyon ve anomalilerinin prevalansını ve özelliklerini değerlendirmektir. Yöntemler: Radyoloji kliniğimize 64 ve 256 kesitli BT koroner anjiografi uygulanmış ardışık 1200 hastada retrospektif olarak koroner arter anatomi varyantları incelendi. Tüm incelemeler kardiyak rekonstrüksiyon yazılımı ile BT iş istasyonlarında gerçekleştirildi. Bulgular: Çalışmamızda; %88,6‘sında sağ dominansı, %9,6‘inde sol dominansı ve %1.8‘ünde kodominansı izlendi. Çalışmamızda konus arteri; %61 olguda proksimal Sağ koroner arter(RCA)den orijin almaktayken, %21 olguda ostial RCA'dan, %15,5 olguda aortadan orijin almaktaydı. Sinoatriyal nod(SA)arteri%79 RCA köken alır iken, %12,4'ünde sol sirkumfleks arter(LCX)‘ten köken almaktaydı. SA nod arteri %4,1 olguda hem RCA hemde LCx'ten orijin almaktaydı. Sol ana koroner arter(LMCA)'de ramus intermedius dalı %33,6 olguda izlendi.Myokardiyal bridge %12,1 olguda izlenmiş olup olguların çoğusol ön inen arter (LAD)'de izlendi. Koroner ektazi-anevrizma %1,75 olguda izlendi. Yüksek çıkış anomalisi %1,3 vakada gözlenmiş olup olguların çoğunluğunu LMCA oluşturmaktaydı. Sonuç:Toplumumuzda koroner varyasyon ve anomaliler geniş yelpazede izlenmektedir. Bu varyasyon ve anomalilerin bazılarının sıklığı literatür ile uyumlu iken bazıları ise farklılık göstermektedir.

Amaç: İnme, vasküler nedenler dışında belirgin bir sebep olmaksızın beyin kan akımının bozulmasıyla fokal serebral fonksiyon kaybı belirtilerinin hızla ortaya çıkması ve 24 saatten uzun sürmesi olarak tanımlanır. İnme, morbidite ve mortalitenin önde gelen nedenlerinden biridir ve hastalar sıklıkla ilk olarak acil servislere başvurmaktadır. İnme, iskemik (%80-85) ve hemorajik (%15-20) olmak üzere iki ana tipe ayrılır. İskemik inmede erken tanı ve uygun tedavi ile iskemik beyin hasarı önlenebilir. Bu amaçla son yıllarda skorlama yöntemleri üzerine yoğun çalışmalar yapılmakta olup FAST-ED (Sahada İnme Triajı Skoru) skorlaması da bunlardan biridir. Yaptığımız çalışmamızda, inme hastalarında FAST-ED skoru, laboratuvar değerleri, başvuru şekli ve zamanı, verilen tedaviler ve demografik özellikler gibi çeşitli faktörlerin mortalite ve prognoz üzerindeki etkileri incelendi. Ayrıca hastaların uygun inme merkezine yönlendirilmeleri için kolay uygulanabilen FAST-ED skoru ile LVOS (büyük damar tıkanıklı inme) olasılıklarını tespit etmek ve NLR gibi kolay erişilebilir parametrelerin inme prognozu ve mortalite açısından önemini ortaya koymak amaçlandı. Yöntemler: 20 ağustos 2018 ve 31 ağustos 2019 tarihleri arasında hastanemiz acil servisine inme tanısı ile yatırılan 327 hasta dosyası incelendi. Homojen grup oluşturmak için katı dışlama kriterleri sonrası İskemik inmeli 163 hasta FAST-ED skoru (Field Assessment Stroke Triage for Emergency Destination) ile düşük (0-1 puan), orta (2-3 puan) ve yüksek (≥4 puan) risk olarak üç gruba ayrılarak sırasıyla grup 1-2-3 olarak adlandırıldı. Bu gruplar başvuru şekli, süresi, mortalite oranları, trombolitik tedavi ve laboratuvar parametreleri açısından değerlendirildi. İstatistiksel analizlerde Ki-Kare, Student-T, Kruskal Wallis ve Mann-Whitney U testleri kullanıldı; p

Objective:The aim of this study was to evaluate the anatomy of dural venous sinus variations through three-dimensional phase-contrast (3D-PC) magnetic resonance venography (MRV). Awareness of the normal anatomical variations of venous sinuses and apparent MRV flow gaps prevent misdiagnosis of dural venous sinus diseases.Materials and Methods:The dural venous sinuses were assessed using nonenhanced 3D PC-MRV. Of these 968 patients, 154 were excluded due to venous thrombosis and mass invasion. A total of 814 patients (186 male and 628 female) were included in the study.Results:The most common variation of superior sagittal sinus (SSS) was atresia of anterior one-third SSS 19 (2.3%). Other variations were hypoplasia of the anterior half of SSS 2 (0.2%), atresia of posterior one-third of SSS (7, 0.9%), and combined variation of SSS (13, 1.6%). The left transverse sinus was hypoplastic in 224 (27.5%) and aplastic/atretic in 259 (31.8%) cases. The right transverse sinus was hypoplastic in 76 (9.3%) and aplastic/atretic in 57 (7.0%) patients. The combined variation of bilateral transverse sinuses had 42 (5.2%) cases. The left sigmoid sinus was hypoplastic in 22.2% (181) of cases. The right sigmoid sinus was hypoplastic in 60 (7.4%). Two patients had hypoplastic bilateral sigmoid sinuses (0.2%). The right occipital sinus was identified in 20 (2.5%) patients. Left occipital sinus was noted in 2 (0.2%) patients. Duplication or triplication of the occipital sinus is noted in 5 (0.6%) study populations. Straight sinus continued in 13 (1.6%) cases with the right transverse sinus and in 29 (3.6%) patients with left transverse sinus.Conclusion:These anatomical variants can be a potential pitfall in the MRV diagnosis of dural sinus variations, especially when there are no supportive imaging features such as brain infarcts or appropriate clinical background. 3D PC-MRV is a great option for patients with gadolinium allergy/renal insufficiency/pregnant patients. We hope this article can add information and assist in preoperative venous analysis for neurosurgeons and neuroradiologists.

Brain tumors can appear differently in children and adults. The most common CNS tumors in two different age groups should be recognized. Pediatric brain tumors will be specifically addressed in the pediatric radiology section, and in this chapter, the most common pediatric brain tumors will be highlighted with examples to reinforce the topic of adult brain tumors discussed in the previous article.

The aim of this study was to investigate the value of point shear-wave elastography (pSWE) in the measurement of iron overload in the liver and other visceral organs in patients with beta thalassemia major (BTM). The study included 103 patients diagnosed with BTM who were referred to our clinic for cardiac and liver T2* measurement and a control group of 120 age- and gender-matched healthy volunteers. Cardiac and hepatic T2* measurements were performed in the patient group. Hepatic, pancreatic, splenic, and renal pSWE values were measured in both groups. The pSWE values were compared between the two groups. In the patient group, correlations between pSWE values, cardiac-hepatic T2* values and hepatic size, patient age, and serum ferritin levels were analyzed. Hepatic, pancreatic, splenic, and renal pSWE values were significantly higher in the patient group compared to the control group (p ≤ 0.001, < 0.001, 0.014, 0.026, respectively). In the patient group, hepatic pSWE values established a significant correlation with cardiac T2* values, liver size-T2*, pancreatic pSWE values, serum ferritin levels, and age (p = 0.006, < 0.001, 0.001, 0.042, 0.001, 0.032, respectively). In the ROC analysis, the area under the ROC curve was 0.807 for hepatic pSWE in the discrimination of thalassemia patients and healthy controls, and the cut-off value was 1.42, which gave a sensitivity and specificity of 75.7

Spinal cord and paraspinal mass lesions can be identified radiologically, allowing for the planning of treatment processes.Magnetic Resonance Imaging (MRI) is the most important non-invasive radiological method for identifying spinal lesions . Apart from its lack of ionizing radiation, MRI is used for diagnosing lesions affecting the spinal cord due to its high soft tissue resolution . Moreover, preoperative imaging of the brain and spine is mandatory to exclude cerebrospinal fluid displacing masses. Lesions within the spinal cord typically demonstrate contrast enhancement. Detection of malignant cysts within the lesion is crucial for surgery. Peripheral enhancement necessitates resection. A comprehensive spinal MRI should include contrast-enhanced brain MRI to exclude metastatic lesions in cases of lesion detection. Spinal lesions can be metastatic lesions of intracranial neoplasms.

INTRODUCTION:The purpose of this study was to examine N-acetyl aspartate (NAA)/creatine (Cr) and glutamate, glutamine, and gamma-aminobutyric acid complex (Glx)/Cr levels in patients with obsessive compulsive disorder (OCD) and healthy controls' orbitofrontal cortex (OFC) and caudate nucleus (CN) by proton magnetic resonance spectroscopy (1H-MRS) method and to investigate their relationship with oxidative stress markers glutathione peroxidase (GPx) and superoxide dismutase (SOD). METHODS:This study included patients with OCD (n = 25) and healthy controls (n = 25) ranging in age from 18 to 65. We used the ELISA method to evaluate serum SOD and GPx levels. Levels of NAA/Cr and Glx/Cr in the orbitofrontal cortex and caudate nucleus were measured using the 1H-MRS method. RESULTS:Our study did not detect statistically significant differences in the orbitofrontal cortex Glx/Cr and NAA/Cr levels between the OCD patients and the control group. OCD patients exhibited a decrease in NAA/Cr levels, consistent with impaired neuronal integration, and an increase in Glx/Cr levels, consistent with hyperactivation, in the caudate nucleus compared to the control group. We observed a negative correlation between NAA/Cr levels in the caudate nucleus and the levels of SOD and GPx. CONCLUSIONS:Our study is the first to assess CN and OFC together in OCD patients using 3 T MR, investigating the relationship between neurometabolite concentrations and oxidative stress parameters. The negative correlation we observed between NAA/Cr levels and SOD and GPx in the caudate nucleus suggests that increased oxidative stress in this brain region in OCD patients may contribute to impaired neuronal integration and functionality.

The anterior ethmoidal artery (AEA) is an important risk area in endoscopic sinus surgery. This study aimed to evaluate the course of AEA according to the Keros classification and the presence of supraorbital ethmoid cell (SOEC) and to prevent possible complications by emphasizing the importance of preoperative paranasal computed tomography (CT) imaging. This approach will increase the effectiveness of endoscopic sinus surgery and improve patient safety. The paranasal CT scan images of patients aged > 18 years between October 2020 and November 2021 from our center were retrospectively analyzed. The images were primarily evaluated in the coronal plane, and the sagittal and axial planes were utilized to evaluate variations in AEA regarding the skull base. Furthermore, the relation of AEA course with Keros classification and SOEC was evaluated. The study included 1000 patients aged 18–80 years (right and left, a total of 2000 samples). Grade 3 AEA was the most common regarding the skull base. Keros Type 2 was the most common classification. Overall, 48.7

BACKGROUND:Epidural steroid injections are common procedures used to treat lumbosacral radicular pain due to lumbar disc herniation (LDH). It is crucial for the clinician to anticipate which patients can benefit from interventional treatment options.OBJECTIVE:This study aimed to examine the effect of radiological and clinical parameters on lumbar transforaminal epidural steroid injections (TFESI)/local anesthetic injection outcomes in patients with LDH.METHODS:This study included 286 patients with LDH (146 males and 140 females). All patients received a fluoroscopically guided TFESI (triamcinolone acetonide 40 mg, lidocaine 2%, and 2.5 ml of physiological saline). Patients were evaluated according to radicular pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale at baseline and 3 months after the injections. Demographic, clinical and magnetic resonance imaging (MRI) findings were recorded to assess the predictive factors for TFESI outcomes. Pfirrmann Grades 1 and 2 were classified as low-grade nerve root compression and Grade 3 was classified as highgrade nerve root compression.RESULTS:Compared to baseline measurements there were significant improvements in radicular pain, ODI score, Laseque angle, and Schober test scores 3 months after injection. Improvements of at least 50% in radicular pain relief and the ODI functionality index were (n= 214) 82%, (n= 182) 70% respectively at 3 months. Correlation analyses revealed that a shorter duration of symptoms, lowgrade nerve root compression and foraminal/extraforaminal location on MRI findings were associated with a favorable response.CONCLUSIONS:Lowgrade nerve root compression was a predictor of a favorable response to TFESI.

This study aimed to evaluate the diagnosis and determine major and minor criteria of celiac disease (CD) with the malabsorption patterns (MABP) in the small intestine and colon on computed tomography (CT) and additional CT findings. This retrospective study was conducted with 116 patients diagnosed with CD, 14 CD patients recovering with treatment, and 35 control patients with non-CD. All patients had CT examinations and histopathological diagnoses. The sensitivity, specificity, PPV, NPV, and accuracy values of each CT finding defined in the literature were statistically evaluated. According to the patient and control groups, the numerical values of the findings and the sensitivity and specificity values were measured according to this cut-off value. The distribution of CT findings according to pathological Marsh data was evaluated in CD patients. Sensitivity and specificity were found to be higher in small bowel MABP findings, mesenteric hypervascularity, and increased SMV/aorta diameter. There was a numerically significant difference in MDCT findings between the control and pathological Marsh groups. In the ROC analysis performed in terms of the total numerical values of each MDCT finding observed between the groups, it was found that there were more than 7 MDCT findings, 100% sensitivity, and 92% specificity. The presence of four major and three minor criteria or three major and four minor criteria were considered significant. Being aware of CT findings below the iceberg that may suggest CD in abdominal CT examinations performed in patients with atypical clinical and malabsorption findings or other nonspecific findings may prevent diagnostic delay and unnecessary procedures.

Aim: This article aims to study the clinical outcomes in patients with chronic subdural hematoma (CSDH) who underwent burr hole drainage or craniotomy. Patients and Methods: The length of hospitalization, Glasgow outcome scales (GOS) of patients undergoing burr-hole drainage or craniotomy, were evaluated and compared statistically. In this study, we also evaluated the relationship by receiver operating characteristic (ROC) analysis. Results: The sex and age distribution and specific clinical parameters of the patients were investigated. In this study, we provide the evidence of the GOS and length of hospitalization findings of the patients and the superiority of burr hole drainage over craniotomy. Conclusions: Chronic subdural hematoma responds better to burr hole drainage with shorter hospitalization and improved Glasgow score.

PURPOSE:This study aimed to investigate the prevalence of persistent trigeminal arteries (PTAs) using computed tomography (CT) angiography, emphasize its major characteristics, and compare the findings with those reported in the relevant literature.METHODS:Patients who underwent cerebral CT angiography in our radiology clinic for any preliminary diagnosis between December 2013 and December 2020 were included in this retrospective study. The patients were reviewed in terms of their age, sex, and the presence of PTAs. The localization of the PTA, vascular connection, PTA type (according to Saltzman and Salas classification), and vascular pathology at the level of anastomoses were examined in the patients with PTAs.RESULTS:A total of 1150 patients, (632 [55%] males and 518 [45%] females) were included in this study. A total of seven (0.6%) patients had PTAs. PTAs were located on the right and left sides in three (43%) and four (57%) patients, respectively. A total of three (43%), two (28%), and two (28%) cases were classified as types I, II, and III PTA based on the Saltzman classification, respectively. Moreover, four (57%) and three (43%) cases were lateral and medial types based on the Salas classification, respectively.CONCLUSION:In conclusion, understanding the diagnosis and classification of PTAs is crucial for the diagnosis of possible vascular pathologies by neuroradiologists and physicians performing neurovascular interventional procedures or operations. If these vascular pathologies remain undetected, they may cause fatal bleeding or embolism during surgeries and endovascular procedures.

Aim: Thyroid-associated orbitopathy (TAO) is the most common cause of proptosis in adults and the clinical picture is mostly associated with thyroid dysfunction. MRI is frequently used because of its advantages, such as high soft tissue resolution, multiple plane evaluation, and no risk of ionizing radiation exposure to the lens. The research aim was to present cases of thyroid orbitopathy with MRI findings and to compare the findings with existing literature. Material and Method: Patients who visited our radiology clinic with a preliminary diagnosis of TAO between April 2015 and February 2021 and underwent orbital MRIs were included in the study. We evaluated parameters such as age, sex, presence of proptosis, orbital muscle involvement, increase in orbital fatty tissue, and lacrimal gland involvement. Results:A total of 35 patients were included in our study. The mean age was 40.6 (18-60) years, 19 (54%) patients were female, and 16 (46%) were male. All patients were diagnosed with Graves’ disease, whereas no patient was diagnosed with Hashimoto’s thyroiditis. The most common findings were proptosis in 33 (94%) patients, inferior rectus involvement in 27 (77%) patients, and medial rectus muscle involvement in 25 (71%) patients. No significant correlation was found between the presence of uni/bilateral involvement and TSH values (p = 0.008). Conclusion: In conclusion, since the presence of orbital involvement is crucial for treating thyroid diseases, all orbital structures involved should be reported by imaging. Orbital MRI is an effective imaging modality in the detection and differential diagnosis of TAO.

This study investigated the incidence of thyroid Zuckerkandl Tubercle (ZT) using a computed tomography (CT) scan of the neck with contrast to identify the typologies in ZT-positive CT scans, investigate the presence of nodules located in that area, and compare the results with the relevant literature. We selected and retrospectively examined the CT scan images of patients who presented to our clinic with CT scans of the neck with contrast that clearly showed thyroid tissue and boundaries. Patients were evaluated based on age, gender, and presence of thyroid ZT. Patients with thyroid ZT were further investigated for localization and type of tubercles as well as for presence of nodules at the tubercle level. A total of 1000 patients (mean age: 48.4 ± 19.1) were included in the study. Out of the total 222 (22.2%) patients who had thyroid ZT, 134 (60.4%) patients had unilateral thyroid ZT on the right side and 29 (13.1%) patients had unilateral thyroid ZT on the left side; 59 (26.6%) patients had bilateral thyroid ZT. In addition, nodules at the ZT level were observed in 13 (1.3%) of the patients. A review of all cases with ZTs indicated that 63% were Type 1, 31% were Type 2, and 5% were Type 3. During the thyroid operations, ZT is essential for locating the recurrent laryngeal nerve. Reporting the presence of ZTs based on CT scans is crucial because it can prevent unnecessary interventional procedures, misdiagnoses, and likely complications in patients with planned thyroid operations.

Abstract Creatine deficiency syndromes are congenital metabolic diseases characterized by decreased cerebral creatine levels as a result of disorders in creatine synthesis and transport. Therefore, magnetic resonance spectroscopy is a valuable tool for diagnosis. This disease can be explained by congenital disorders occurring in three forms at different stages of the creatine metabolic pathway. Two of disorders arise autosomal recessively in creatine biosynthesis, arginine-glycine amidinotransferase, and guanidinoacetate methyltransferase enzyme deficiency. The third disorder occurs as a result of an SLC6A8 variant in the form of creatine carrier protein deficiency. In this article, a patient with SLC6A8 carrier deficiency is presented.

BACKGROUND:Diverticula are commonly observed in the duodenum. Duodenal Diverticulum (DD) usually does not give symptoms throughout life and is diagnosed by coincidence. However, it may present with different symptoms in patients.OBJECTIVE:This study aims to evaluate the prevalence of DD and Juxtapapillary Duodenal Diverticulum (JDD) and its association with other possible pathologies and to determine its clinical impact by using Computed Tomography (CT).METHODS:This retrospective observational study, which was taken consecutively between the years of 2013-2020, was evaluated in the Radiology Department. The total number of cases was 4850 (male-2440; female-2410). CT images were evaluated by two experienced radiologists at the workstation. DD and JDD prevalence and clinical findings in the hospital registry system were examined.RESULTS:The age of the patients included in the study ranged from 17 to 92 years (mean age 46.94±16.42). In patients with DD (female-130; male-101), mean age was 62.24 ± 12.69 (21-92). The prevalence of DD was 4.76% (n=231). The prevalence of JDD was 4.02% (n=195) and increased with age (p<0.01). The average diameter of the JDD was measured as 23.29±8.22 (9.5-55.3) mm. A significant positive correlation was found between age and DD diameter (p=0.039). DDs were found most commonly 84.42% (n=195) in the second segment of the duodenum as JDD. In patients with JDD, the mean diameter of choledochus and wirsung canal were 6.7 ± 2.4 (3-15.3) mm and 0.31 ± 0.1 (0.1-6.5) mm respectively. The choledochal diameter was correlated with the JDD size (p = 0.004). Cholelithiasis (n=56), choledocholithiasis (n=20), cholecystitis (n=52), diverticulitis (n=15), duodenitis (n=37), pancreatitis (n=5) and hiatal hernia (n=60) with JDD were observed. Periampullary carcinoma was detected in one patient.CONCLUSION:Our study shows that cholelithiasis, choledocholithiasis, cholecystitis, diverticulitis, duodenitis, pancreatitis may be associated with JDD. Therefore, in contrast-enhanced abdominal CT scans taken for various reasons, investigation of the presence and characteristics of JDD and detection of pathologies that may be associated with JDD are important for patients to benefit from early diagnosis and treatment opportunities and to take precautions against possible complications.

BACKGROUND Cystic fibrosis (CF) is an autosomal recessively inherited disease. Clinical findings vary by age of the patient, the organ systems involved, and the severity of the CFTR gene mutation. Pancreatic and liver involvement is prominent and exocrine pancreatic insufficiency is observed in the majority of patients. Point shear wave elastography (pSWE) is a non-invasive method that can quantitatively determine tissue elasticity and stiffness. In this study, the morphological evaluation of the pancreas was performed using the pSWE technique in pediatric patients diagnosed with CF. The effectiveness of this method for early detection of pancreatic insufficiency was investigated. METHODS Fifty-five patients with CF (24 girls, 31 boys) and 60 healthy children (29 girls, 31 boys) without any chronic diseases and who were suitable for the pSWE examination were included in the study. RESULTS The mean value of pSWE was 1.12±0.16 in the healthy group and 0.97±0.16 in the patients with cystic fibrosis. There was a statistically significant difference between the two groups (p <0.001). Significant negative correlations were found with between pSWE and age (r:-0.319; p=0.018), height (r:-0.293; p=0.03), serum glucose (r:-0.346; p=0.01), HbA1C (r:-0.592; p=0.02), and duration of the disease (r:-0.806; p<0.001). CONCLUSION Investigating pancreatic elasticity and detecting pancreatic insufficiency using pSWE (a simple, inexpensive, and non-invasive method) in the early period before overt laboratory and clinical symptoms of EPI can positively contribute to long-term results in young patients with CF.