Browsing by Author "Aslan, Hulya"

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Association Between the Elasticity of Hip Muscles and the Hip Migration Index in Cerebral Palsy
(2019) Analan, Pinar Doruk; Aslan, Hulya; https://orcid.org/0000-0002-3528-3712; https://orcid.org/0000-0002-7138-246X; 30779197; AAA-8043-2021; AAK-9104-2021
Objectives-Cerebral palsy (CP) increases the risk of hip displacement during childhood. Abnormal hip muscle forces have been proposed as the predisposing factors. In CP, the amount of hip displacement is commonly evaluated by the Reimers hip migration index (MI) on an anteroposterior pelvic radiograph. To the best of our knowledge, the association between the elasticity of hip muscles measured by shear wave elastography and the MI has not been studied yet. Herein, we aimed to analyze the correlation between the elasticity of hip muscles and the MI. Methods-Bilateral hips of 25 children with spastic CP were included prospectively in this study. Anteroposterior pelvic radiographs were used to measure the MI. Shear wave elastography was performed to evaluate the elasticity of muscles. The correlation between the MI and the elasticity of hip flexor and adductor muscle groups was assessed. Also, the association between the elasticity of agonist/antagonist muscles was analyzed. Results-The MI showed fair to good correlations with hip flexors and adductors for both readers (0.71 >= r >= 0.52). The mean MIs of the patients +/- SDs were 22.64% +/- 7.79% for reader 1 and 21.55% +/- 8.83% for reader 2. The elasticity of agonist/antagonist muscle groups showed little/no to a weak correlation for both readers (0.32 >= r >= -0.07). Conclusions-Although, hip flexor and adductor muscle elasticity showed a correlation with MI, it seems very hard to say that increased elasticity of hip flexor and adductor muscles causes hip dislocation.
Breast Involvement by Hematologic Malignancies: Ultrasound and Elastography Findings with Clinical Outcomes
(2017) Aslan, Hulya; Pourbagher, Aysin; 0000-0002-7138-246X; 29296470; AAK-9104-2021
Objective: Hematological malignancies very rarely involve the breast. The aim of this study is to retrospectively evaluate B-mode ultrasound (US) and elastography (ES) findings of breast involvement by hematologic malignancies with clinical outcomes. Materials and Methods: All core-needle biopsy results that were performed at our tertiary breast center from January 2013 to September 2016 were searched. Our search revealed 9 patients with breast involvement either by leukemia or lymphoma. All patients were examined using B-mode US and ES. US and ES findings were analyzed with the consensus of two radiologists, and clinical outcomes were noted. Results: The mean age of the study population was 41.6 years (range, 20-83 years). Two patients showed diffuse hypoechoic parenchymal infiltration. The elasticity assessments of these lesions were soft and intermediate. The remaining 7 patients had mass lesions. The elasticity assessment of these masses according to Breast Imaging Reporting and Data System US was as follows: Soft (n = 1), intermediate (n = 4), high (n = 2). Conclusions: It is important to consider that hematologic malignancies may appear as soft or intermediate lesions on ES. Patients' history and clinical background should help us to consider breast involvement. In addition, the clinical outcomes may not be related with elasticity assessments.
Chondro-osseous Type Metaplastic Carcinoma of Breast
(2015) Pourbagher, Aysin; Aslan, Hulya; Bolat, Filiz Aka
A Comparison of The Effects of Lidocaine and Saline Injection on Pain, Disability, and Shear-Wave Elastography Findings in Patients with Myofascial Trigger Points
(2019) Analan, Pinar Doruk; Aslan, Hulya; Umay, Sermin Tok; 0000-0002-7161-016X; AAW-6708-2020
BACKGROUND/AIMS To compare the effects of lidocaine injection (LI) and saline injection (SI) on the myofascial trigger points (MTrPs) in the trapezius muscle on pain, disability, and shear-wave elastography (SWE) in patients with myofascial pain syndrome (MPS). The secondary aim was to evaluate the correlations between SWE and pain with disability scores. MATERIAL and METHODS This prospective study included 45 patients with MTrPs due to MPS. The patients were evaluated using the visual analog scale (VAS), Neck Disability Index (NDI), and SWE immediately before and 15 days after the injections. The patients were randomly assigned to an LI (n=20, 30 MTrPs) or an SI (n=25, 32 MTrPs) group. The LI group was treated with lidocaine, and the SI group was treated with SI. RESULTS Visual analog scale and NDI scores improved significantly in both groups after injection (p <= 0.05). In addition, 16 MTrPs in the LI group and 3 MTrPs in the SI group were completely resolved. Maximum shear-wave velocity (V(s)max) and mean shear-wave velocity significantly decreased in the SI group after injection (p=0.025). The size of MTrPs decreased in the LI group (p=0.02). Pre-injection V(s)max and resting VAS were weakly correlated (r=0.309). No significant correlation was found on other SWE measurements with VAS and NDI scores (r<0.3). CONCLUSION Lidocaine injection and SI effectively improved the disability and pain in patients with MPS. LI is more effective than SI in reducing the size of the trigger points and resolving MTrPs. SWE findings may not completely reflect the severity of pain and correlate with disability.
Effects of chronic flexed wrist posture on the elasticity and cross-sectional area of the median nerve at the carpal tunnel among chronic stroke patients
(2018) Aslan, Hulya; Analan, Pinar Doruk; 0000-0002-3528-3712; 29400371; AAA-8043-2021
Aim: To investigate the effects of chronic flexed wrist posture following spasticity on the elasticity and cross-sectional area (CSA) of the median nerve at the carpal tunnel among chronic stroke patients. Material and method: This prospective study included 24 consecutive patients (mean age, 56.5 +/- 11.56 years) with unilateral wrist spasticity following a stroke in a chronic phase. The CSA of the median nerve was measured by ultrasound (US). The elasticity was measured by Virtual Touch tissue imaging quantification (VTIQ; Siemens, Erlangen, Germany). SWV and CSA of the median nerves of the affected and unaffected sides for each patient were compared. The correlations between duration of time since the stroke, SWV and CSA of the median nerve were assessed. The interobserver agreement was assessed. Results: The CSA of the median nerve at the affected side was significantly lower than that of the unaffected side (p = 0.03). The SWV of the median nerve at the affected side was significantly higher than that on the unaffected side (p < 0.001). The interobserver agreement was excellent for both CSA and SWV measurements. There was a negatively fair correlation between CSA at the affected side and duration of time since stroke (r = -0.58, p < 0.05). The SWV of the median nerve at the affected side was not correlated with the duration of time since stroke (r <= 0.3, p >= 0.05). Conclusions: These results suggest that chronic flexed wrist posture may cause atrophy of the median nerve due to chronic compression after stroke and increase in the stiffness of the median nerve.
Granulocytic sarcoma of finger: a case report
(2016) Purbager, Aysin; Ozen, Merve; Aslan, Hulya; Tok, Sermin; Kocer, Emrah
Granulocytic sarcoma is an extramedullary tumor of immature myeloid cells. Such tumors may be located in any part of the body. We report a case of isolated granulocytic sarcoma of finger; which, to our knowledge, is the first report of that localization. A thirty-year-old woman with acute myeloid leukemia (AML) presented with progressive swelling and onychoptosis at her right fourth finger. The distal phalanx was excised and the tumor turned out to consisted of atypical myeloid cells, infiltrating bone trabeculae. Despite its rarity, considering myeloid sarcoma of the finger as a possible diagnosis may prevent inappropriate treatment in leukemia patients.
Idiopathic Granulomatous Mastitis: Magnetic Resonance Imaging Findings with Diffusion
(2016) Aslan, Hulya; Pourbagher, Aysin; Colakoglu, Tamer; https://orcid.org/0000-0002-7138-246X; 26508792; AAK-9104-2021
Background: Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease with unknown etiology which can mimic breast carcinoma, both clinically and radiologically. Magnetic resonance imaging (MRI) findings of IGM have been previously described; however there is no study evaluating diffusion-weighted MRI findings of IGM. Purpose: To analyze conventional, dynamic contrast-enhanced, and diffusion-weighted MRI signal characteristics of IGM by comparing it with the contralateral normal breast parenchyma. Material and Methods: A total of 39 patients were included in the study. On dynamic contrast-enhanced MRI, the distribution and enhancement patterns of the lesions were evaluated. We also detected the frequencies of involving quadrants, retroareolar involvement, accompanying abscess, and skin edema. T2-weighted (T2W) and STIR signal intensities and both mean and minimum apparent diffusion coefficient (ADC) values were compared with the contralateral normal parenchyma. Results: IGM showed significantly lower mean and minimum ADC values when compared with the normal parenchyma. Signal intensities on T2W and STIR sequences of the lesion were significantly higher than the normal parenchyma. On dynamic contrast-enhanced MRI, 7.7% of the patients had mass-like contrast enhancement, 92.3% of the patients had non-mass-like contrast enhancement. Abscess was positive in 33.3% of the patients. Conclusion: As a result, IGM showed commonly non-mass-like lesions with restricted diffusion. Although it is a benign pathology, it may show clustered ring-like enhancement like malignant lesions.
Is There A Correlation Between the Severity of Idiopathic Granulomatous Mastitis and Pre-Treatment Shear-Wave Elastography Findings? Original Research
(2018) Aslan, Hulya; Arer, Ilker Murat; Pourbagher, Aysin; Ozen, Merve; 0000-0002-7138-246X; 30665211; AAK-9104-2021; HCH-8774-2022
AIM: The aim of this study was to analyze the correlation between the severity of idiopathic Garulomatous Mastitis (IGM) and the pre-treatment Shear-Wave Elastography (SWE) findings. MATERIAL AND METHODS: A total of 39 patients diagnosed with granulomatous mastitis were included in the study between the dates of December 2014 and February 2017. The patients were divided into two groups. Group 1 was treated using a conservative protocol and steroids. Group 2 was treated surgically. Pre-treatment SWE findings of both groups were compared. RESULTS: The mean ages of the patients in group 1 and 2 were 38.44 +/- 9.6 and 3605 +/- 7.44 years, respectively. There were not any significant differences between the groups with regard to frequency of BI-BADS categories and Virtual touch tissue imaging (VTI) patterns. The mean Shear-Wave Spead (SWS) were 1.98 +/- 1.02 m/sec and 2.82 +/- 1.66 m/sec in group 1 and 2 respectively. The difference was not significant (p >= 0.05). The BI-RADS categories and VTI patterns did not show significant difference when the recurrent and non-recurrent patients were compared. CONCLUSION: There may not be a correlation with the pre-treatment SWE findings and severity of the IGM.
Magnetic resonance imaging findings of extraskeletal mesenchymal chondrosarcoma of wrist: a case report
(2016) Pourbagher, Aysin; Aslan, Hulya; Bal, Nebil
Extraskeletal mesenchymal chondrosarcomas (EMC) are high grade malignant tumors that rarely involves wrist. Published reports about them are mostly based on conventional radiography, tomography and conventional magnetic resonance imaging (MRI) findings. We did not recognize any report of dynamic-contrast enhanced MRI so far. Herein, we present dynamic contrast enhanced and Diffusion Weighted MRI findings of a case with extraskeletal mesenchymal chondrosarcoma of the wrist. In conclusion, EMC might show peripheral enhancement at early arterial phase and restricted diffusion on MRI. The knowledge of the imaging spectrum of the EMC might help us suggesting the diagnosis.
Metaplastic Carcinoma of the Breast: Analysis of 38 Cases from a Single Institute
(2020) Hasbay, Bermal; Aka Bolat, Filiz; Aytac, Huseyin Ozgur; Aslan, Hulya; Purbager, Aysin; 0000-0002-7138-246X; 0000-0002-3583-9282; 31769499; AAK-9104-2021; AAJ-7913-2021
Objective: To evaluate the pathological and radiological features, hormone profiles, surgery and treatment methods of metaplastic breast carcinoma cases diagnosed at our center in the light of current literature. Material and Method: A total of 38 metaplastic breast cancer cases diagnosed between 2006-2018 at our center were included in the study. The patients were evaluated in terms of age, tumor size, localization, histological grade, hormone profiles (ER, PR, Her2-neu), American Joint Committee on Cancer (AJCC) Tumor, Lymph node status, Metastases (TNM) stage, progression, survival, radiological features, types of surgery and therapy modalities (chemotherapy and / or radiotherapy). Results: The age of the patients ranged between 32 and 95 years. Pathological evaluation of cases showed that 14 were pure epithelial (IC-NST + squamous cell carcinoma) and 24 were metaplastic carcinomas with mesenchymal differentiation. Ductal carcinoma in situ (DCIS) was accompanying an invasive component in twenty cases. Seventeen patients had lymph node metastasis. Twelve patients developed distant metastasis. Thirty patients were triple negative for hormone receptors. The mean follow-up period of the patients was 34 months. The estimated life expectancy was 116 months. All of the patients received chemotherapy and 28 patients received adjuvant radiotherapy. There was no correlation between tumor size and lymph node or distant metastasis in our series. Our findings are consistent with the literature. Conclusion: Metaplastic breast carcinoma is a rare entity among breast carcinomas. Metaplastic carcinomas of the breast draw attention with the differences in their clinical course and the radiological and pathological heterogeneity.
Not Otherwise Specified-Type Sarcoma of Breast with CD10 Expression: Case Report
(2019) Hasbay, Bermal; Bolat, Filiz Aka; Aslan, Hulya; Aytac, Huseyin Ozgur; 31620687
Primary breast sarcomas are very rare and account less than 1% of invasive breast carcinomas. Primary sarcomas of breast are leiomyosarcoma, angiosarcoma, liposarcoma, fibrosarcoma, rhabdomyosarcoma, malignant peripheral nerve sheath tumor and pleomorphic sarcoma. Recently, a new CD10 positive group of sarcoma was identified. These tumors cannot be classified as a soft tissue sarcoma and show diffuse strong positive staining pattern with CD10 (NSCD10). Herein we report clinical and morphological characteristics of two cases diagnosed with not otherwise specified-type sarcoma with CD10 expression by histologically and immunohistochemical findings with the literature. NSCD10 shows similarity with leiomyosarcoma and sarcomatoid-type metaplastic carcinoma histomorphologically among specific sarcomas of breast. CD10 expression should be taken into consideration in the presence of not diagnosed and not specified tumors and CD10 should be added to the immunohistochemical panel.
Postoperative Spondylodiscitis and Epidural Abscess Becoming Visible on Magnetic Resonance Imaging before Positive Laboratory Tests
(2015) Pourbagher, Aysin; Tok, Sermin; Aslan, Hulya
Post operative disc space infection is relatively uncommon. The incidence of postoperative disc space infection is 0.21 %-3.6 % in association with all vertebral surgical procedures. Surgery causes a variety of neuroendocrine and metabolic responses which generally results in immunosupression. Clinical results of immunosupression include delayed wound healing and septic complications. In this article, we report magnetic resonance imaging findings of a case with spondylodiscitis and spinal epidural abscess in which the imaging findings were apparent before the infection and inflammation related laboratory findings laboratory findings become positive. She has a history of surgery due to lumbar herniated disc a month. She was complaining of back and left leg pain. We performed contrast-enhanced MR imaging. MR imaging showed post operative changes at level L5 and S1. There was contrast enhancement at the level of the surgical gap in the posterior paravertebral muscles. MR imaging may help to differentiate postoperative spondylodiscitis and epidural abscess from early postoperative changes even before the laboratory tests appearing positive. In our case, surgery induced immunosupression may cause the infection and inflammation related laboratory findings being within normal limits at the beginning.
Quantitative elastography in differentiating benign and malignant breast lesions
(2016) Purbager, Aysin; Pekoz, Burcak Cakir; Aslan, Hulya; Agildere, Ahmet Muhtesem; 0000-0003-4223-7017; 0000-0002-7138-246X; AAB-5802-2020; AAK-9104-2021
Purpose: The purpose of this study was to evaluate the effectiveness of quantitative elastography in differentiating benign and malignant breast lesions that were detected by B-mode ultrasonography, to compare shear wave velocities of benign and malignant lesions, and to determine cut-off values differentiating malignant lesions from benign ones Material and Methods: In this prospective study we enrolled 254 breast lesions of 240 patients detected by B-mode ultrasonography, and underwent biopsy in our department. Shear wave elastography was performed to all lesions before biopsies. The patients who had radiotherapy or chemotherapy previously were not included. Elastography examinations were performed by one of the two radiologists specialising in breast radiology. The mean and median shear wave velocities, and standard deviation values were measured in meters/second. Both mean and median shear wave velocities were compared with histopathology results. Sensitivity, specificity, and the area under the curve were obtained by using a receiver operating characteristic curve analysis Results: The mean age of the patients, lesion size, mean and median shear wave velocities were significantly different between benign and malignant groups. The mean shear wave velocity of benign and malignant lesions were 3.59 +/- 1.2m/s and 5.59 +/- 1.9m/s, respectively. The cut-off value for the mean shear wave velocity was 4.08 m/s (71.6% sensitivity and 69.6% specificity) to differentiate malignant lesions from benign ones Conclusion: Quantitative elastography is an effective and complementary method making a significant contribution in differentiating benign and malignant lesions. In this respect, we believe that clinical usage of shear wave elastography should be generalized
The Role of Shear-Wave Elastography in the Differentiation of Benign and Malign Non-Mass Lesions of the Breast
(2018) Aslan, Hulya; Pourbagher, Aysin; Ozen, Merve; 0000-0002-7138-246X; 30569901; AAK-9104-2021; HCH-8774-2022
AIM: The aim of this study is to retrospectively assess the additional diagnostic value of shear wave elastography (SWE) added to ultrasound (US) versus US alone in differentiating malignant and benign non-mass lesions (NMLs) of the breast by readers with different experience levels and to assess interreader agreement. MATERIAL AND METHODS: This retrospective study enrolled 53 NMLs (31 benign, 22 malignant). Two radiologists (readers 1 and 2 had 15 years and 1 year of experience in breast imaging, respectively) independently reviewed each study and determined the BI-RADS category using US alone and again after adding SWE to US. Diagnostic performances of US alone and US combined with SWE were compared for both readers. Areas under receiver operating characteristic curves (AUCs) were estimated. The levels of interobserver agreement were determined by the calculated kappa coefficient. RESULTS: With the addition of SWE to US, AUCs for differentiation of benign and malignant lesions increased sign/ icantly for the less experienced reader (0.56 vs. 0.79; p=0.028), but not for the more experienced reader (0.60 vs. 0.75; p=0.170). While evaluating US alone, the interobserver agreement was moderate, and the interobserver variability among the readers was statistically significant (k=0.493, p<0.001). After adding SWE, the agreement increased to 0.773, and the interobserver variability among the readers became non-significant (k=0.773, p=0.688) CONCLUSIONS: SWE increased the diagnostic performance of relatively less experienced reader significantly. SWE improved interobserver agreement of two readers with different levels of experience and reduced the interobserver variability in differentiating benign and malignant NMLs of the breast.
Ultrasound Elastography and Magnetic Resonance Imaging Findings of Breast Angiosarcoma Mimicking a Benign Lesion by Elastography: A Case Report
(2017) Aslan, Hulya; Pourbagher, Aysin; Ezer, Ali; Bolat, Fİliz Aka; Yabanoglu, Hakan; 0000-0002-7138-246X; 0000-0002-1161-3369; 0000-0002-3834-9924; 0000-0003-0268-8999; AAK-9104-2021; AAJ-7865-2021; AAJ-8558-2021; AAK-2011-2021
Introduction: Primary and secondary angiosarcomas of the breast are rare neoplasms. Radiologically, magnetic resonance imaging, mammography, and ultrasound (US) findings of angiosarcomas have been reported previously. However, ultrasound (US) elastography findings of angiosarcoma have not been reported yet. Currently, US elastography should be used commonly to decide biopsy or short-term follow-up of breast lesions. Case Presentation: A 39-year-old female from Adana, Turkey, was admitted to Dr.Turgut Noyan Adana Teaching and Medical Research Center at the breast center of Baskent University, with a palpable right breast mass, which had been enlarging for one year in 2015. Our breast center is a tertiary referral center. B-mode US and US elastography findings suggested that the lesion was benign; however, magnetic resonance imaging showed a mass enhancing intensely at early phases with rapid wash out. The final diagnosis of the mastectomy specimen confirmed low-grade angiosarcoma. If the recommendation would have been based on the elastography findings, it would have been catastrophic because angiosarcomas tend to rapidly increase in size. Conclusions: B-mode US and elastography findings of breast angiosarcoma may mimic benign lesions.