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OBJECTIVES: To review a single center outcome of patients with Langerhans Cell Histiocytosis diagnosed at a tertiary referral hospital from Turkey.Methods: The files between 1989 and 2015 of 80 patients with LCH were retrospectively analyzed. RESULTS: During the 25 years, 80 patients were diagnosed with LCH. The median age at diagnosis was 53 months (2-180 months) and the median follow-up time of patients was 10 years and 9 months (24 months-25 years). Bone was the most frequently affected organ (n:60, 75%). Initially, 43 patients (54%) had single system (SS) disease, 20 patients (25%) had multisystem (MS) disease without risk organ involvement (MS-RO-), and 17 patients (21%) had a multisystem disease with risk-organ involvement (MS-RO+). The overall survival (OS) rate was 91%, and event-free survival (EFS) rate was 67% at 10 years. 10-year OS rate was lower for patients with MS-RO+ (65%) when compared to those with, MS-RO-, and SS (100%, 97%, p value=<0.001). The overall survival rate was also lower in patients with lack of response to systemic chemotherapy on 12th week (p=<0.001), younger age (<2 years) at presentation (p=<0.02), skin involvement (<0.001) and lack of bone lesions at presentation (<0.001). DISCUSSION: In the group with MS-RO+, OS is significantly low compared to other groups. Further efforts are warranted to improve survival in MS-RO+ patients.
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AIM: The aim of this prospective study was to evaluate the overall findings of conventional enteroclysis (CE) with complementary magnetic resonance enteroclysis (MRE) in small bowel disease. METHODS: The study included 32 patients referred from various clinical departments, with known or suspected small bowel disease and abnormalities on CE. Immediately after CE, true fast imaging with steady-state precession (true FISP), and unenhanced and gadolinium-enhanced T1-weighted fast low-angle shot (FLASH) sequences with fat saturation were obtained. Mucosal, mural and luminal changes of the small bowel were evaluated by each technique. In addition, bowel wall thickening, bowel wall enhancement and perienteric changes were assessed by MRE. The radiological findings obtained were evaluated together as a combination, and the role of MRE in the determination of the activity and complications of the small bowel disease was assessed. Radiological findings were correlated with clinical evaluation and follow-up in all cases, including endoscopy in 14 cases and surgery in 5 cases. RESULTS: MRE provided important supplementary mural and extramural information, including degree of pathological wall thickness, mural enhancement pattern associated with disease activity, perivisceral collection, abscess formation, mesenteric fibrofatty proliferation, lymphadenopathy and increase in perienteric vascularity. Short strictures were not revealed on MRE; however, for patients with a history of abdominal malignancy, MRE helped characterize the level of any obstruction and the extent of the disease. CONCLUSION: We recommend MRE for patients who have findings of advanced inflammatory bowel disease or neoplasm on CE examination. The combination of these two techniques can provide important information on the degree and extent of the disorder.
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Medios de Contraste , Enfermedades Intestinales/diagnóstico , Intestino Delgado/patología , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
AIMS: To report the magnetic resonance imaging (MRI) findings of osteomalacic insufficiency fractures of the pelvis. MATERIALS AND METHODS: In all, 12 persons presenting with chronic pelvic pain and with a definitive diagnosis of osteomalacia (OM) were enrolled in this study. Radiological work-up included direct radiographs (n = 12), computed tomography (n = 5), scintigraphy (n = 12) and MRI (n = 12). The location of the insufficiency fractures and corresponding MRI appearances were evaluated. Depending on the presence or absence of signal intensity around the fractures, the lesions were grouped into active and chronic forms. RESULTS: A total of 34 insufficiency fractures were depicted on imaging studies. MRI demonstrated 33 of the lesions. All the insufficiency fractures were seen as a hypointense lines or fissures on T1- and T2-weighted and STIR MR images. There was a high frequency of insufficiency fractures at the sacrum and iliac bone (16/34, 47%). Overall, 11 chronic-type (no abnormal signal intensity around the fissure) and 22 active-type (abnormal signal intensity around the fissure) insufficiency fractures were detected by MRI. Follow-up MR examinations of 2 subjects showed that abnormal signal intensity had disappeared after appropriate treatment. CONCLUSION: The results of this study showed that the iliac and sacral bones are frequently involved in patients with OM. MRI can determine the clinical activity of the disease, and can monitor the response to treatment of the active type of insufficiency fractures.
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Fracturas Óseas/diagnóstico , Osteomalacia/complicaciones , Huesos Pélvicos/lesiones , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Fracturas Óseas/diagnóstico por imagen , Humanos , Ilion/lesiones , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Dolor Pélvico/etiología , Radiografía , Sacro/lesionesRESUMEN
BACKGROUND: The aim of this study was threefold; to define the enteroclysis (EC) findings of intestinal involvement in Behcet disease (BD), to compare these findings with those seen in Crohn disease (CD), and to determine the relation between the duration of BD and severity of the EC findings. METHODS: From 1997 to 2000, 17 BD and 50 CD cases were examined by EC examination. EC was performed with a 13-F balloon catheter via transnasal entubation. Mucosal and mural changes were evaluated. Statistical analysis was performed with the Mann-Whitney U test to determine the relation between duration of BD and severity of the EC findings. P = 0.05 was considered statistically significant. RESULTS: In 12 (70.58%) of 17 BD cases, EC demonstrated intestinal pathologic findings such as ulcerations, fold thickening, granular pattern, pseudopolyp formation, and bowel wall thickening. No statistical correlation between the severity of EC findings and the duration of BD was found. CONCLUSION: EC should be the radiologic method to evaluate the intestinal pathology in symptomatic BD patients. The main EC finding in BD was ulceration mostly in the aphthous form. The EC findings in BD, even in longstanding cases, are usually mild when compared with those seen in CD.
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Síndrome de Behçet/diagnóstico por imagen , Enfermedad de Crohn/diagnóstico por imagen , Enfermedades Intestinales/diagnóstico por imagen , Adulto , Cateterismo , Medios de Contraste , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Íleon/diagnóstico por imagen , Masculino , Radiografía , Factores de TiempoRESUMEN
The physics of ultrasound and mechanisms of artifacts are well-known. In this report, an unusual manifestation of mirror-image artifact (MIA) that is completely different from the real image of the structure, demonstrated during a routine abdominal ultrasonographic examination, is described. There have hitherto been no reports on the ultrasonographic appearance of such a MIA.
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Artefactos , Hígado/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
We report magnetic resonance imaging findings of diskovertebral lesions in a case of ankylosing spondylitis mimicking metastatic and/or infectious disease. Multiple hypointense areas were seen on T1-weighted images corresponding to hyperintense areas on T2-weighted images in dorsal, lumbar, and sacral vertebral bodies and the manubriosternal joint, with accompanying soft tissue masses. Diagnosis was achieved through biopsy, regression of the paravertebral soft tissue masses, later detection of bilateral sacroiliitis on computed tomography, and presence of histocompatibility antigen HLA-B27.
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Imagen por Resonancia Magnética , Espondilitis Anquilosante/patología , Adulto , Femenino , Antígeno HLA-B27/aislamiento & purificación , Humanos , Radiografía , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/diagnóstico por imagenRESUMEN
Radiation-induced changes in the sacroiliac joints mimicking metastases on MR images were evaluated. Twelve patients who received radiotherapy to the pelvic region due to pelvic malignancy were included in the study. All patients had undergone external beam radiation therapy to the pelvic region, and 2 patients received supplementary internal radiation. The changes in the sacroiliac joints were evaluated. Computed-tomography-guided core bone biopsy from the bone marrow was taken from their corresponding MR sections in 5 of the patients. T1 hypointense and T2 hyperintense areas with ill-defined margins in the bone marrow adjacent to the sacroiliac joints were observed in all patients. On bone scintigraphy all the lesions demonstrated increased activity. Other radiological modalities excluded fracture, soft tissue mass, and osseous destruction. Bone biopsies demonstrated peritrabecular fibrosis and inflammatory cell infiltration. Patients receiving radiotherapy to the pelvis may demonstrate T1 hypointense/T2 hyperintense, ill-defined postradiotherapeutic benign changes in the sacroiliac joints. In the absence of any other signs of disease progression and when the imaging pattern is typical, close radiological follow-up should be sufficient to rule out metastases.
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Neoplasias de la Médula Ósea/secundario , Médula Ósea/efectos de la radiación , Neoplasias Óseas/secundario , Imagen por Resonancia Magnética , Neoplasias Pélvicas/radioterapia , Traumatismos por Radiación/diagnóstico , Articulación Sacroiliaca/efectos de la radiación , Adulto , Anciano , Médula Ósea/patología , Neoplasias de la Médula Ósea/diagnóstico , Neoplasias Óseas/diagnóstico , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Articulación Sacroiliaca/patologíaRESUMEN
Mesenteric cysts are rare intra-abdominal tumors. The absence of characteristic clinical findings makes diagnosis cumbersome. In this report, the significance of the preoperative radiological workup was discussed in an adult patient with a mesenteric cyst. The complete resection of the cyst is treatment of choice.
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Quiste Mesentérico/diagnóstico por imagen , Anciano , Humanos , Masculino , Quiste Mesentérico/patología , Quiste Mesentérico/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Caudal regression is a rare congenital spinal anomaly characterized by partial or total agenesis of the sacral and/or lumbar spine. Sacral and/or lumbosacral agenesis has been well described. However, especially as far as MRI studies are concerned, thoracolumbosacral agenesis has rarely been reported.
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Región Lumbosacra/anomalías , Imagen por Resonancia Magnética , Anomalías Múltiples/diagnóstico , Femenino , Humanos , Lactante , Síndrome , Vértebras Torácicas/anomalíasRESUMEN
The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty-four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by chi2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.
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Brazo/irrigación sanguínea , Brazo/diagnóstico por imagen , Derivación Arteriovenosa Quirúrgica , Fallo Renal Crónico/terapia , Cuidados Preoperatorios , Ultrasonografía Doppler en Color , Adulto , Anciano , Catéteres de Permanencia , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial/diagnóstico por imagenRESUMEN
OBJECTIVE: The aim of this study is to determine new criteria in the diagnosis of subclinical varicocele in infertile patients. METHODS: A total of 208 testes in 104 patients who were infertile and had no varicocele on physical examination were studied by color Doppler ultrasonography (CDUS) with classical and new criteria. Population proportion difference test was used to compare two methods. RESULTS: One hundred and fourteen testes were accepted as varicocele negative in the same testes units in both methods. Ninety-four testes were varicocele positive with new criteria while 88 of these 94 testes were diagnosed also varicocele positive with the classical criteria. The value of Z* with population proportion difference test was 0.59 which is less than 1.96, which means the proportion of varicocele detection in two methods did not differ. CONCLUSION: Because a gold standard that defines the presence of a subclinical varicocele has not yet been established, new criteria may be needed. However, our new criteria did not add new information to the diagnosis of subclinical varicocele in infertile patients.
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Ultrasonografía Doppler en Color , Varicocele/diagnóstico por imagen , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Diagnóstico Diferencial , Humanos , Infertilidad Masculina/diagnóstico por imagen , Infertilidad Masculina/etiología , Infertilidad Masculina/fisiopatología , Masculino , Estudios Prospectivos , Varicocele/complicaciones , Varicocele/fisiopatologíaRESUMEN
A 74-year-old man reported headaches and blurring of vision for 1 month. MRI showed a nonenhancing infundibular cyst. Neurologic findings, blood and cerebrospinal fluid examinations, and chest and abdominal CT were all normal. MRI 4 months later showed no change. The patient was without any medication other than simple analgesics. One year later, the stalk had returned to its normal size and configuration on MRI.
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Núcleo Arqueado del Hipotálamo/patología , Quistes/patología , Enfermedades Hipotalámicas/patología , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Remisión EspontáneaRESUMEN
A 68-year-old woman who had previously undergone small intestinal resection because of leiomyosarcoma was referred to our clinic with epigastric pain. A double-contrast barium study and the subsequent abdominopelvic CT and abdominal MRI examinations demonstrated multiple extraluminal growing tumors arising from the walls of stomach, small bowel, and colon. A CT-guided aspiration biopsy revealed malignant mesenchymal tumor. The presence of disseminated intra-abdominal masses without concomitant ascites and invasion of tissue planes on CT in a patient operated on prior because of a leiomyosarcoma led to the diagnosis of gastrointestinal leiomyosarcomatosis. In this report we discuss the radiological approach to this rare entity.