Browsing by Author "Turko, Ensar"

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Clinical Impacts of Juxtapapillary Duodenal Diverticulum Detected on Computed Tomography
(Bentham Science Publ Ltd, 2022) Dundar, Ilyas; Goya, Cemil; Hattapoglu, Salih; Ozkacmaz, Sercan; Ozgokce, Mesut; Turkoglu, Saim; Turko, Ensar
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 Diverticilium (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.
Comparison of Medical Treatment Efficiency With Shear Wave Elastography Values of Thrombus in Patients With Lower Extremity Deep Vein Thrombosis
(Lippincott Williams & Wilkins, 2023) Ince, Suat; Ozgokce, Mesut; Ozkacmaz, Sercan; Dundar, Ilyas; Turko, Ensar; Ayyildiz, Veysel A.; Goya, Cemil
In lower-extremity deep vein thrombosis (DVT), thrombus age is essential for successful treatment. The aim of our study was to compare the shear wave elastography (SWE) values measured before treatment and achieved lumen patency after treatment in lower-extremity DVT patients with total occlusion. Patients diagnosed with DVT in the acute-subacute stage (<4 week) with total thrombosis in lower extremity were included in this prospective study. Shear wave elastography measurements were performed where the thrombus was most prominent and homogeneous. To evaluate patient response to treatment, lumen patency (partial [>25%] or total recanalization) was examined using color Doppler imaging in the first and third months posttreatment. Shear wave elastography values with and without patency were compared using an independent t test. Among 75 patients in this study, at the first-month color Doppler imaging examination, the SWE values were 1.77 +/- 0.49 (1.09-3.03) m/s in patients who achieved lumen patency (n = 42) and 2.21 +/- 0.54 (1.24-3.36) m/s in those who did not show lumen patency (n = 33). The difference between the groups' mean elastography value was statistically significant (P < 0.001). At the third-month examination, the SWE values were 1.76 +/- 0.46 (1.09-3.03) m/s in patients with lumen patency (n = 55) and 2.52 +/- 0.48 (1.74-3.36) in patients without lumen patency (n = 20). The difference between the 2 groups' mean elastography value was statistically significant (P < 0.001). We concluded that it is more difficult to achieve lumen patency in veins occluded by thrombus with higher elasto values, and endovascular interventional procedures should be considered during the initial treatment of high SWE value thrombosis.
Does Contrast-Enhanced Computed Tomography Raise Awareness in the Diagnosis of the Invisible Side of Celiac Disease in Adults
(Springer, 2022) Goya, Cemil; Dundar, Ilyas; Ozgokce, Mesut; Turko, Ensar; Ozkacmaz, Sercan; Durmaz, Fatma; Hattapoglu, Salih
Purpose 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. Methods 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. Results 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. Conclusions 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. [GRAPHICS] .
Evaluation of Celiac Disease With Uniphasic and Multiphasic Dynamic Mdct Imaging
(Springer, 2021) Goya, Cemil; Dundar, Ilyas; Ozgokce, Mesut; Turkoglu, Saim; Turko, Ensar; Ozkacmaz, Sercan; Almali, Necat
Purpose An analysis of dynamic contrast MRI has been shown to provide valuable information about disease activity in Crohn's disease and Celiac disease (CD). However, there are no reports of dynamic multi-detector computer tomography use in patients with CD. The aim of this study is to determine and compare the perfusion dynamics of the patients treated with control subjects and the perfusion dynamics in patients with untreated CD, using dynamic contrast in MDCT and compare studying contrast dynamics in Marsh types as well. Methods In this retrospective study, uniphasic and multiphasic MDCT, untreated, treated, incompatible CD patients and healthy control group duodenum wall thickness and HU values were compared in terms of patient groups and modified Marsh types. Result In dynamic CT, the highest contrast curve was observed in the untreated group and Marsh type 1. While the contrast curve of the untreated and non-compliant patients increased rapidly and showed wash out, the type 4 contrast curve was observed, whereas the treated and control group slowly increased type 5 contrast curve. In the contrast-enhanced CT in the venous phase, in the ROC analysis between Marsh 1-2 and Marsh 3a-c, the sensitivity was 97% and the specificity was 87% when the cut off was taken as 4.45 mm for wall thickness (p: 0.005). Conclusion Contrast-enhanced single-phase and dynamic MDCT imaging in CD patients may be useful in evaluating the inflammatory and pathological process in the small intestine. [GRAPHICS] .
Radiological Evaluation of Response To Treatment in Hepatobiliary Fascioliasis
(Elsevier Espana Slu, 2022) Goya, Cemil; Ozkacmaz, Sercan; Ozgokce, Mesut; Turko, Ensar; Dundar, Ilyas; Durmaz, Fatma
Purpose: In this study, we aimed to evaluate the computed tomography (CT) findings of Fasciola hepatica infestations on initial and follow-up imagings after treatment, and also to describe the role of CT during diagnosis. Methods: In this retrospective study, patients with a diagnosis of fascioliasis by clinical and laboratory examination who underwent initial and follow-up contrast-enhanced abdominal CT scans after treatment (a single oral dose of 10 mg/kg Triclabendazole) were included. The CT scans were evaluated regarding liver and spleen sizes, portal and splenic vein diameters, involved hepatic segment numbers and involvement patterns, the presence of focal perihepatic hyperdensity, gallbladder wall thickening, dilatation of the intrahepatic biliary tract, periportalright subdiaphragmatic lymphadenopathy, hepatic subcapsular and intra-abdominal bleeding, and perihepatic/intraabdominal free fluid. Initial (pre-treatment) and post-treatment CT scans (average 25 months after the treatment) were compared with for these features. Results: A total of 36 patients with a mean age of 39.28 +/- 14.64 [15-83] years, were included in this study. After treatment, marked improvement in liver parenchymal involvement, biliary and hepatic subcapsular hematoma were detected and focal perihepatic hyperdensity, free intraperitoneal fluid disappeared. Conclusion: Contrast-enhanced abdominal CT can be used in the diagnosis and posttreatment follow-up of fascioliasis. Awareness of intrahepatic/extrahepatic lesions and all the complications of fascioliasis can greatly aid the diagnosis and also evaluation of the response to treatment. (C) 2021 Elsevier Espana, S.L.U. All rights reserved.
Radiological Tips on Pulmonary Sarcoidosis Imaging: the Invisible Side of Iceberg's
(Bayrakol Medical Publisher, 2023) Turko, Ensar; Ozgokce, Mesut; Durmaz, Fatma; Ozel, Enes; Asker, Selvi; Goya, Cemil; Ozkacmaz, Sercan
Aim: In our study, we aimed to investigate computed tomography (CT) findings in lung sarcoidosis in the light of different studies in the literature. Material and Methods: Between January 2018 and September 2021, all thorax computed tomography reports were retrospectively scanned in our clinic. The imaging characteristics of 60 patients were examined, whose sarcoidosis findings were defined and diagnosed as sarcoidosis. Results: In the staging of sarcoidosis, 15 (25%) patients were stage I, 42 (70%) patients were stage II, 2 (3.3%) patients were stage III, and 1 (1.7%) patient were stage IV. All our patients with lymph nodes (57 (Stage I and II)) were observed symmetrically. Calcification was present in 5 (8.7%) patients with lymph nodes, and 52 (91.3%) did not have calcification or necrosis. In 6 patients, lymph nodes other than the mediastinum were detected in the axilla and abdomen. When the lymph nodes seen in the axilla and abdomen other than the mediastinum were examined, it was found that the lymph nodes in the mediastinum were larger. In addition, it was determined that the fatty hilus of these lymph nodes, which were detected outside of the mediastinum, could not be distinguished. No accompanying cavitary lesion was observed in any of the lung parenchymal findings. In addition, in 16 (26.6%) patients with parenchymal results, scattered nodules smaller than 1 cm were observed without any other parenchymal conclusion. An increase in peribronchovascular cuffing and peribronchovascular nodular appearances were observed in 20 (33.3%) patients.Discussion: Sarcoidosis is a disease that should always be considered in the differential diagnosis of atypical parenchymal findings in the lung or mediastinal lymph nodes.
The Role of Computed Tomography Hounsfield Unit Values in the Differentiation of Benign and Malignant Cavitary Lung Lesions Computed Tomography Hu Values in the Differentiation of Cavitary Lung Lesions
(Bayrakol Medical Publisher, 2021) Dundar, Ilyas; Ozgokce, Mesut; Durmaz, Fatma; Ayyildiz, Veysel Atilla; Yildiz, Hanifi; Turko, Ensar; Goya, Cemil
Aim: This study aims to investigate the rote of Hounsfield unit (HU) values measured by contrast-enhanced computed tomography (CT) in the differentiation of benign and malignant cavitary lesions (CLs), which are frequently encountered in the lung parenchyma. Material and Methods: In this retrospective descriptive study approved by the relevant ethics committee, thoracic CT records taken for various reasons between 2019 and 2021 were scanned from the hospital database. According to the demographic characteristics and histopathological results, the patients were divided into benign and malignant groups. The HU values of 24 patients with CLs were measured by CT and the averages were calculated. HU values were compared by independent t-test. Results: Of the 24 patients, 20 were mate (83.3%) and 4 were female (16.7%), and the mean age was 59.98 +/- 16.65 (22-78) years. There were a total of 34 cavitary lung lesions in these 24 patients, including 18 benign (52.94%) and 16 malignant (47.06%) lesions. The mean age of 13 patients (54.17%) with benign etiology was 51.62 +/- 18.79 (22-78) and the mean size of all benign lesions was 30.05 +/- 9.51 (16-53) mm. The mean age of the 11 patients (45.83%) with malignant etiology was 68.55 +/- 6.56 (57-78) and the mean size of all malignant lesions was 39.25 +/- 23.45 (13-95) mm. The mean HU values of the 18 benign and 16 malignant CLs were 32.11 +/- 12.25 (15-60) and 63.88 +/- 24.5 (15-109), respectively, representing a statistically significant difference (p=0.001). In receiver operating characteristic curve analysis, the area under the curve was 86.8%, and when the cut-off was determined as 41.5, the sensitivity was 87.5% and the specificity was 88.9%. Discussion: We think that HU density values measured from the CL wall by contrast-enhanced CT may be useful in the differentiation of frequently detected benign and malignant CLs, which have similar radiological imaging findings.
Spleen Stiffness Measurement by Using Shear-Wave Elastography as a Predictor of Progression To Secondary Myelofibrosis
(Lippincott Williams & Wilkins, 2021) Ekinci, Omer; Ozgokce, Mesut; Turko, Ensar; Merter, Mustafa
Objective Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative diseases that can transform to secondary myelofibrosis (SMF). In this study, we evaluated spleen stiffness using shear-wave elastography (SWE) as a predictor of progression to SMF. Methods Participants were grouped as healthy volunteers (HVs), PV/ET patients, and SMF patients. Participants' spleen sizes, spleen stiffness values, bone marrow fibrosis degrees, and the other parameters were evaluated. Spleen stiffness values and spleen sizes were compared between groups. Results Of the 121 participants included in this study, 52 patients were HVs, 52 patients were PV and/or ET patients, and 17 patients were SMF patients. In terms of age and sex, there was no difference between groups. Splenic parenchymal stiffness median values by using SWE were found to be 0.82 m/s in HVs, 1.41 m/s in PV/ET patients, and 2.32 m/s in SMF patients (P < 0.001). In terms of median length of the spleen, the difference between groups was significant (P < 0.001). In addition, we found a significant positive correlation between spleen stiffness and bone marrow fibrosis degree (P < 0.001, r = 0.757). However, in multivariate analysis, there was no strong independent risk factor for spleen stiffness. Conclusion In this study, we showed that measurement of spleen stiffness using SWE can distinguish SMF from PV/ET patients and HVs. Therefore, we believe that SWE may be used as a noninvasive and easily accessible method to check the fibrotic progression of bone marrow in PV and ET patients to monitor the transformation to SMF, and enables to detect fibrosis in early phase.