Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Evaluation of Interobserver and Intraobserver Differences of Graf Method in Developmental Hip Dysplasia(2023) Dogruel, Halil; Baymurat, Alim Can; Tuncay, Ismail Cengiz; Atalar, HakanPurpose: The aim of this study was to evaluate possible differences in hip ultrasonography (US) results between physicians working in different medical centers. Method: In this study, a total of 117 horizontal US images representing all sonographic types of developmental dysplasia of the hip (DDH) were utilized. Four experienced researchers independently measured the 117 US images at different times. The results obtained by each researcher were documented separately, including alpha and beta angles, Graf types. All of the collected data were analyzed statistically to assess for interobserver and intraobserver variability. Results: The study found that the average change between the alpha angles ranged from a minimum of 1 to a maximum of 4. The mean change between the beta angles was wider, ranging from a minimum of 1.8 to a maximum of 8.2. To evaluate the differences between the Graf hip typologies, paired groups were formed and Cohen's Kappa method was used. For the first group k= 0.661, for the second group k= 0.671, for the third group K= 0.647, for the fourth group k= 0, 718, k= 0.717 for the fifth group and k= 0.637 for the sixth group. Interobserver Kappa evaluation results (k=0.647) showed moderate and significant agreement. Conclusion: The results revealed a moderate to substantial level of agreement between the researchers. Based on these findings, it was concluded that the use of US for screening and follow-up of the Graf hip typing method should be performed by experienced professionals.Item Use of Generalizability Theory Evaluating Comparative Reliability of the Scapholunate Interval Measurement With X-ray, CT, and US(2023) Kuru, Cigdem Ayhan; Sezer, Rahime; Cetin, Can; Haberal, Bahtiyar; Yakut, Yavuz; Kuru, Ilhami; 0000-0003-3173-1757; 0000-0003-4613-1607; 0000-0002-1668-6997; 36604227; W-9080-2019Rationale and Objectives: There is no universally accepted standard technique for measuring the scapholunate interval and no specific sources of measurement error have been identified. We aimed to establish a set of normal radiological criteria for the scapholunate interval that could be used in comparative studies of wrist pathology to determine interobserver reliability and to identify potential errors that might influence measurements.Materials and Methods: A total of 60 healthy volunteers participated in the study. Scapholunate interval was measured by three independent observers using X-ray, CT, and US in four positions, including neutral, fist, radial and ulnar deviation. Inter-observer reliability was tested using intraclass correlation coefficient. Generalizability theory was applied to evaluate specific sources of measurement error related to participant, observer, imaging modality and measurement position.Results: In neutral position, the scapholunate interval measured by X-ray, CT, and US was 3.1 mm, 3.5 mm and 3.5 mm respectively. The interval remained constant during fist and radial deviation but decreased during ulnar deviation. Correlation coefficients ranged from 0.874 to 0.907 for X-ray, 0.773-0.881 for CT and 0.964-0.979 for US. In the generalizability study, the participant x modality x position interaction accounted for the largest proportion of total variance (29%).Conclusion: X-ray, CT, and US are reliable modalities for measuring the scapholunate interval, with US having the highest reliability. Participant and position factors may independently contribute to measurement error. Therefore, standardized measurement positions are recommended to obtain reliable measurement results.Item Dynamic Sonography and CT Findings of Unilateral Submandibular Gland Agenesis Associated with Herniated Hypertrophic Sublingual Gland(2014) Yerli, Hasan; https://orcid.org/0000-0003-2463-1758; 23893549; AAK-9572-2021Congenital agenesis of the submandibular gland is uncommon. We report dynamic sonography and CT findings of the unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland tissue through the mylohyoid gap. The dynamic sonography examination applied at rest and during the modified Valsalva maneuver demonstrated hypertrophied sublingual gland prolapsing to the anterior part through the mylohyoid gap. This may be the first reported case describing dynamic sonography findings of this entity. CT confirmed the agenesis of the left submandibular gland and compensatory hypertrophy of the ipsilateral sublingual gland. (c) 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:176-179, 2014Item Ultrasonography Study on The Segmental Aplasia of The Great Saphenous Vein(2014) Oguzkurt, Levent; 23761865Purpose To assess the frequency and anatomic distribution of the segmental aplasia of the great saphenous vein (GSV) using ultrasonography in patients who presented with a clinical etiologic anatomic and pathophysiologic (CEAP) score 1 and above. Materials and Methods A prospective study on 670 limbs of 335 consecutive patients evaluated for segmental aplasia of the GSV with ultrasonography. The difference of segmental aplasia of the GSV between patients with and without GSV insufficiency was searched. Results Segmental aplasia of the GSV was found in 223 of 670 limbs (33%). Segmental aplasia of the GSV was seen in 65 of 189 limbs (34.4%) with GSV insufficiency and 45 of 146 limbs (30.8%) with normal GSV on the right side (P=0.52), and 65 of 194 limbs (33.5%) with GSV insufficiency and 44 of 141 limbs (31.2%) with normal GSV on the left side (P=0.72). Conclusion Segmental aplasia of the GSV was seen in one-third of patients who had a CEAP score 1 and above. The frequency of the segmental aplasia was almost the same in the right and the left limbs and was similar in patients with or without GSV insufficiency.Item Value of Sonographic Anterior-Posterior Renal Pelvis Measurements Before and After Voiding for Predicting Vesicoureteral Reflux in Children(2015) Demir, Senay; Tokmak, Naime; Cengiz, Nurcan; Noyan, Aytul; 0000-0002-4209-9075; 25545034; GPX-7059-2022; AAD-5713-2021; AAK-9310-2021PurposeVoiding cystourethrography (VCUG) is the gold standard for diagnosing vesicoureteral reflux (VUR), but it is important to minimize the use of VCUG because of the urinary catheterization and radiation exposure required. Ultrasound (US) observations suggest that pelvicalyceal dilatation varies according to the degree of bladder fullness in children with urinary tract infection. The aim of this study was to assess whether anterior-posterior (AP) measurements of the renal pelvis on US before and after voiding can be used as a screening tool while predicting the presence of VUR in children. MethodsThe subjects were toilet-trained children older than 4 years who required VCUG. Two groups were established based on the VCUG results: a VUR group of 40 kidney units (each unit defined as calyces and ureter) that exhibited different severities of reflux, and a control group of 68 kidney units unaffected by VUR. Prior to VCUG, US AP measurements of the renal pelvis of each kidney unit were recorded when the urinary bladder was full and again after bladder emptying. The change in AP measurement from before to after voiding was compared between the two groups. ResultsThe mean change in AP measurements from before to after voiding in the VUR group was significantly greater than that in the control group (p=0.003). ConclusionsComparing US AP measurements of the renal pelvis before and after voiding is useful for identifying children who are suspected to have VUR and thus require immediate VCUG. (c) 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:490-494 2015Item A Potential Therapeutic Pitfall in The Treatment of Venous Reflux Due to Variant Planar Anatomy of Varicose Segments(2018) Deniz, Sinan; Tureli, Derya; Akpinar, Burcu; Oguzkurt, Levent; 28728467Purpose To elaborate on a planar anatomic variant of great saphenous vein as a potential therapeutic pitfall in the treatment of venous reflux. Materials and methods Lower extremity veins in 568 limbs with great saphenous vein insufficiency were sonographically mapped. A rather overlooked variation, the saphenous bow, was studied with emphasis on anatomic clarification and its involvement in venous insufficiency. Results This variation, observed in 5.1% (n=29) of limbs, comprised two segments; one uninterrupted great saphenous vein proper coursing throughout saphenous compartment and one extra-compartmental segment originating distally from and proximally fusing with it. Venous arch remains within compartment only briefly during take-off and re-entry. Extra-compartmental venous arch had reflux either alone (10.3%) or together with intra-compartmental segment (75.9%). Conclusion This variation, part of saphenous segmental aplasia/hypoplasia complex, is associated with venous insufficiency. Meticulous mapping of great saphenous vein territory and identification of such variants during planning stage is indispensable for optimal clinical outcomes of treatment.Item Is it Possible to Differentiate Types of Breast Implants by Imaging in the Era of Implant-associated Lymphoma?(2022) Celik, Levent; Gunes, Gozde; 35410617Objectives: Breast Implant-Associated Anaplastic Large-cell Lymphoma (BIA-ALCL) has been recognised in recent years, and there is extensive ongoing research. Although the exact mechanism and cause are still unclear, we now know that the disease is more associated with textured implants. To the best of our knowledge, no previous studies investigating the radiological differential of various implants have been conducted. In this essay, we aimed to demonstrate dicriminating in vitro and in vivo imaging features of variuos types of breast implant devices using mammography, ultrasound, and Magnetic Resonance Imaging (MRI). Methods: Five different implant devices from various manufacturers with various surface textures, including smooth, micro-textured, regular macro-textured, lightweight macro-textured, and polyurethane-coated were used. In vitro mammography was performed with a digital mammogram (Amulet Innovality, Fuji, Japan), and in vitro and in vivo sonography were performed with Esaote MyLab9 using a 7.5 MHz linear probe. In vitro MRI was performed with a 1.5T magnet (Symphony TIM upgrade and Aera, Siemens Healthcare, Erlangen, Germany) with a 7-channel breast coil (Sense coil, Innova, Germany). MRI studies included fat sat T2 Weighted Sequences (T2WS), non-fat sat T2WS, and silicone only sequences. Results: Each imaging technique had different contributions to dealing with this challenge. Mammography and MRI were limited to identifying the capsule's double bands. We could only differentiate the lightweight macro-textured implant on the mammogram as the borosilicate microspheres were represented by tiny, round lucencies within the gel. Ultrasound imaging with the proper technique was very helpful in identifying the surface. The inner capsule (implant shell) was identified as parallel double echogenic bands on the in vitro sonogram. Bands of the smooth implant were better delineated compared to the textured implants. The double echogenic bands of the polyurethane-coated implant were not even identified individually. The reverberation artifact caused by the smooth implant was the main discriminating in vivo sonographic feature of smooth implants. The hyperintense polyurethane-coated capsule was identified on fat-saturated T2WS and non-fat-saturated T2WS via in vitro MRI. The tiny hypointense microspheres of the lightweight implant were also identified on the silicone-only sequence of the in vitro MRI. Conclusion: In this study, we have shown that breast implant material and type may differ with the help of in vitro and in vivo imaging characteristics on different radiological modalities. These different imaging features could be used for recognising and labelling the implant type, especially macro-textured implants that are reported to be more associated with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) compared to other types. We believe evaluating these imaging characteristics during daily practice will help radiologists become aware of the implant type and possible complications or diseases associated with that type.Item Analysis of Risk Factors for Ultrasonographic Graf Type IIa (-) Hips in Developmental Dysplasia: A Hospital-Based Case-Control Study with Follow-Up Outcomes(2021) Haberal, Bahtiyar; Sahin, Orcun; Tuncay, Ismail Cengiz; 0000-0002-1668-6997; 0000-0002-6035-6258; W-9080-2019; AAF-4032-2021Objective: To examine the association of Graf type IIa(-) hips with maternal and infant risk factors in newborns and to evaluate the follow-up outcomes. Materials and Methods: Two different risk analyses were performed. In the first analysis, Graf type I hips were grouped as "controls," and Graf type II were grouped as "cases." In the second analysis, all the Graf type I and Type IIa(+) hips were grouped as "controls," and all Graf type IIa (-) hips were considered as "cases." Maternal age, presence of consanguinity, pregnancy, and smoking were considered as maternal risk factors. Sex, birth weight, gestational age, associated congenital anomalies, and family history were considered as infant risk factors. Further, we determined the risk factors for Graf type IIa and type IIa (-) hips. Results: The study population included 73 cases (11.4%) and 569 controls (88.6%), including 322 (50.2%) male and 320 (49.8%) female infants. Graf type IIa hips revealed significant differences for gestational age (>42 wk), birthweight (>3500 g), and maternal age (<= 20 y). At follow-up, all Graf type IIa(+) hips became Graf type I mature hips. In contrast, three Graf type IIa(-) hips (3/12, 25%) required additional treatment. Conclusion: Significant risk factors for Graf type IIa(-) hips were female sex, gestational age of >42 wk, and birthweight of >3500 g. Almost one-quarter of Graf type IIa (-) hips may require additional treatment. Thus, significant risk factors for Graf type IIa(-)should be remembered in clinical practice.Item Diagnostic value of shear wave velocity in polycystic ovarian syndrome(2021) Gursu, Turkan; Cevik, Halime; Desteli, Guldeniz Aksan; Yilmaz, Birnur; Bildacı, Tevfik Berk; Eraslan, Alper; 34970437Aim: In polycystic ovarian syndrome, the ovaries become stiffer due to chronic anovulation. We aimed to compare tissue elasticity in terms of shear wave velocities measured using acoustic radiation force impulse imaging technique between the ovaries of polycystic ovarian syndrome women and non-polycystic ovarian syndrome women. Material and methods: The study was designed as a retrospective data analysis of women who underwent transvaginal ultrasound and acoustic radiation force impulse imaging in a university hospital between July 2014 and March 2015, for various reasons. There were 32 polycystic ovarian syndrome patients and 32 patients without a diagnosis of polycystic ovarian syndrome. Age, body mass index, fasting glucose levels, cycle day 3 follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, prolactin, antimullerian hormone levels, and menstrual patterns with clinical hyperandrogenism were evaluated. On the menstrual cycle days 2-4, by performing a transvaginal ultrasound scan, the ovarian volumes and antral follicle counts in both ovaries were recorded for each woman. The ultrasound system was converted into the elastography mode, and acoustic radiation force impulse imaging was performed. Shear wave velocity (m/sec) was measured at least 5 times for each ovary, and the mean value was calculated for each polycystic ovarian syndrome and non-polycystic ovarian syndrome woman. Results: Age, body mass index, fasting glucose levels, cycle day 3 follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, and prolactin levels were similar between the groups (p 0,05). Antimullerian hormone levels, antral follicle counts, and mean ovarian volumes were statistically different between the groups (p <0,05). Mean shear wave velocity values for both ovaries were 2.12 +/- 0.82 (0.78-4.9) m/sec in the polycystic ovarian syndrome group, and 1.18 +/- 0.41 (0.77-2.0) m/sec in the non-polycystic ovarian syndrome group, which was statistically significantly different (p = 0.016). Conclusion: In our study, we found significantly higher shear wave velocity levels in polycystic ovarian syndrome women than non-polycystic ovarian syndrome women, which indicates an impact of the condition on shear wave velocity. The increased acoustic frequencies cause a decreased response in time to transition, and motion becomes out of phase; in other words, scattered waves are faster in stiffer ovaries. Our results are thus compatible with the pathophysiology of the disease. Shear wave velocity is a beneficial tool for evaluating ovarian elasticity in polycystic ovarian syndrome patients in whom the levels are found to be significantly higher than non-polycystic ovarian syndrome women. In light of these findings, shear wave velocity is expected to be slower than polycystic ovarian syndrome levels in ovulatory women.Item Comparison of Epicardial Fat, Carotid and Femoral Intima-Media Thicknesses Between Hypertensive, Pre-Hypertensive and Control Groups(2020) Gunesli, Aylin; Yilmaz, Mustafa; 0000-0002-2557-9579; S-6973-2016Objective: The aim of this study was to evaluate whether pre-hypertension is a risk factor for cardiovascular events. For this reason epicardial fat thickness (EFT), carotid intima-media thickness (CIMT) and femoral intima-media thickness (FIMT), known as markers for subclinical atherosclerosis and cardiovascular risks were measured and compared among the pre-hypertensive, hypertensive and control groups. Material and methods: This cross-sectional study included 57 healthy controls (group 1), 58 pre-hypertensive patients (group 2) and 56 hypertensive patients (group 3). Pre-hypertension is defined as systolic blood pressure (SBP) 120-140 mm Hg and diastolic blood pressure (DBP) 80-90 mm Hg. Hypertension is defined as SBP>140 mm Hg and/or DBP>90 mm Hg. EFT, CIMT and FIMT were measured and compared among these groups. Results: There was a statistically significant difference among the groups in terms of EFT and CIMT (p<0.001, for both comparison). In addition there was a statistically significant difference between groups 2 and 1, and between groups 3 and 2 in terms of EFT and CIMT (p<0.001, for all comparisons). When we compared the all groups in terms of FIMT, we found a statistically significant difference (p<0.001). There was a statistically significant difference between groups 3 and 2 (p=0.001). However, there was not a statistically significant difference between groups 2 and 1 (p=0.773). Conclusion: These results may indirectly suggest that subclinical atherosclerosis and cardiovascular risks may be increased in pre-hypertensive patients. However, atherosclerosis in the carotid arteries may be affected by lower blood pressure than the femoral arteries.