Hakan Mutlu
Gulhane Military Medical Academy, Radiology, Faculty Member
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Objective: Vertebroplasty is a method that stabilizes the fracture and relieves pain by injecting cement into the vertebral body that has lost its height for some reason. Cement injection can also be done through kyphoplasty and... more
Objective: Vertebroplasty is a method that stabilizes the fracture and relieves pain by injecting cement into the vertebral body that has lost its height for some reason. Cement injection can also be done through kyphoplasty and cannulated screw. During the injection, protrusion of the cementum from the corpus is a complication that must be avoided in this procedure. Cement extending out of the corpus may cause pulmonary cement embolism (PCE) via the azygos vein. Case: A 76-year-old female patient was admitted to our clinic with the complaint of low back pain that had been going on for one year. The patient, who did not have motor or sensory deficits in the examination, described neurogenic claudication at 200 meters as well as sensitivity in the lumbar region. An osteoporotic collapse fracture in the L1 vertebra was detected in the patient's imaging. Transpedicular fixation, decompression, and cement-augmented pedicle screw were applied to the patient. After the operation, ven...
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The usual complications of submucous resection of the nasal septum (SMR) are septal hematoma, infection, hemorrhage, septal perforation, and nasal deformity. We present a case of nasal septal cyst which may be a rare complication of SMR.... more
The usual complications of submucous resection of the nasal septum (SMR) are septal hematoma, infection, hemorrhage, septal perforation, and nasal deformity. We present a case of nasal septal cyst which may be a rare complication of SMR. Entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa is thought to be the cause. The patient underwent deroofment of the left cystic wall by lateral rhinotomy. There was no recurrence after one year.
Research Interests: Surgery, Medicine, Complication, Humans, Pubmed, and 8 moreMale, Cyst, Adult, Perforation, Deformity, Nasal septum, Medical and Health Sciences, and Cysts
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The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging... more
The purpose of the study was to differentiate between benign and malignant thyroid nodules using nodule-spinal cord signal intensity and nodule apparent diffusion coefficient (ADC) ratios on diffusion-weighted magnetic resonance imaging (DW-MRI). Forty-four patients (27 females, 17 males; mean age, 49 years) with nodules who underwent DW-MRI were included in this study. The images were acquired with 0, 50, 400 and 1000 s/mm(2)b values. ADC maps were calculated afterwards. Fine needle aspiration biopsies (FNAB) were performed at the same day with DW-MRI acquisition. The diagnosis in patients where malignity was detected after FNAB was confirmed by histopathologic analysis of the operation material. The signal intensities of the spinal cord and the nodule were measured additionally, over b-1000 diffusion-weighted images. Nodule/cord signal intensity (SI) ratios were obtained and the digital values were calculated by dividing to ADC values estimated for each nodule. Statistical analysis was performed. The (nodule SI-cord SI)/nodule ADC ratio is calculated in the DW images, and a statistically significant relationship was found between this ratio and the histopathology of the nodules (P<.001). The ratio was determined as 0.27 in benign and 0.86 in malignant lesions. The result of receiver operating characteristic (ROC) analysis was statistically significant, and the area under curve (100%) was considerably high. The threshold value was calculated as 0.56 according to the ROC analysis. According to this threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates for (nodule SI/cord SI)/ADC ratios in differentiating benign from malignant thyroid nodules are calculated as 100%, 97%, 83%, 100%, and 98%, respectively. We have found that (nodule/cord SI)/nodule ADC ratio has the highest values for sensitivity and specificity among the tests defined for characterization of nodules.
Research Interests: Algorithms, Radiology, Magnetic Resonance Imaging, Nuclear medicine, Medicine, and 15 moreDiffusion MRI, Humans, Female, Male, Apparent Diffusion Coefficient, Clinical Sciences, Aged, Middle Aged, Clinical Imaging, Image Enhancement, Adult, Reproducibility of Results, Receiver Operating Characteristic, Effective Diffusion Coefficient, and Diffusion magnetic resonance imaging
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Objective:The aim of this study was to determine the correlation between tuberculous meningitis and tuberculous otomastoiditis.Materials and methods:Meningeal involvement sites were investigated by magnetic resonance imaging in 32... more
Objective:The aim of this study was to determine the correlation between tuberculous meningitis and tuberculous otomastoiditis.Materials and methods:Meningeal involvement sites were investigated by magnetic resonance imaging in 32 patients (21 males, 11 females) who had previously been diagnosed with tuberculous meningitis. Clinical and laboratory findings and responses to anti-tuberculous treatment were evaluated, and the presence of concomitant tuberculous otomastoiditis was also investigated.Results:The meningeal involvement site was unilateral (in the sylvian fissure and the perimesencephalic cistern) in 28 patients (87.5 per cent), and bilateral and widespread in four patients (12.5 per cent). Tuberculous otomastoiditis was found in 11 of the patients with tuberculous meningitis (34.3 per cent). Otomastoiditis was on the same side as the meningeal involvement in nine of these 11 patients. Bilateral otomastoiditis with meningeal involvement was observed in two patients.Conclusions:Tuberculous meningitis is frequently accompanied by otomastoiditis, although the exact causal relationship between the two conditions is unclear. Since meningitis is a serious clinical condition, concomitant otomastoiditis generally remains unrecognised. Tuberculosis should be considered in the differential diagnosis of patients with otitis or otomastoiditis who do not respond to antibiotic therapy.
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... İzole sol ventriküler noncompaction: Manyetik rezonans görüntüleme bulguları - Orijinal Görüntü Mecit Kantarcı , Cihan Duran , Onur Sıldıroğlu , Levent Ulusoy , Hakan Mutlu , Bülent Karaman. ... Kardiyak patolojiler için MR... more
... İzole sol ventriküler noncompaction: Manyetik rezonans görüntüleme bulguları - Orijinal Görüntü Mecit Kantarcı , Cihan Duran , Onur Sıldıroğlu , Levent Ulusoy , Hakan Mutlu , Bülent Karaman. ... Kardiyak patolojiler için MR tekniğindeki son gelişmeler umut vermeye başlamıştır. ...
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We report the magnetic resonance (MR) angiographic findings of an asymptomatic case with abnormal branching of aortic arch and Kommerell's diverticulum, which to our knowledge has not been described previously.
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We read the interesting article of Kul et al, "Diagnostic efficacy of the diffusion-weighted imaging in the characterization of different types of breast lesions," which was published in the November 2014 issue of the journal.... more
We read the interesting article of Kul et al, "Diagnostic efficacy of the diffusion-weighted imaging in the characterization of different types of breast lesions," which was published in the November 2014 issue of the journal. The study included fairly important information which was very useful to us. However, we would like to make a few contributions. The Discussion section of the study compares apparent diffusion coefficient (ADC) values obtained for benign and malignant lesions with similar articles published in the literature. In that section, it is specified that ADC values of lesions and corresponding thresholds are the lowest values established in the literature and the possible reasons for the low values. In our opinion, one of the reasons for those low values of ADC obtained in that study is that gradients used for diffusion-weighted imaging were obtained with values of b5 50, 400, and 1000 sec/mm, not the use of b5 0 sec/mm. If ADC maps were generated based on b5 0 sec/mm values in the study, the resulting ADC values would be higher. SUVmax (maximum standard uptake values) are used for tumor assessment in positron emission tomography / computed tomography (PET/CT) imaging, a physiological imaging technique. This value indicates and quantifies the tumor cell region that has the most FDG (fluorodeoxyglucose) uptake. In another physiological imaging DWI, the area with the most limited diffusion clearly shows the tumor. The most appropriate parameter to show and quantify the related areas is the minimum ADC (ADCmin). 2 We believe that minimum ADC values may give more accurate results compared to mean ADC values.
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Primary angiosarcoma of the spleen is a rare neoplasm with a very poor prognosis. We present computed tomography and magnetic resonance imaging of a 49-year-old man with primary splenic angiosarcoma and liver metastasis. The literature on... more
Primary angiosarcoma of the spleen is a rare neoplasm with a very poor prognosis. We present computed tomography and magnetic resonance imaging of a 49-year-old man with primary splenic angiosarcoma and liver metastasis. The literature on primary splenic angiosarcoma is reviewed and imaging variability of this rare tumor is discussed.
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Research Interests: Cancer, Medicine, Hepatology, Biopsy, Abdominal Imaging, and 15 moreDiffusion MRI, Humans, Female, Male, Hepatocellular Carcinoma, cerebral Venous sinus thrombosis, Differential Diagnosis, Histogram, Clinical Sciences, Biomarker, Effective Diffusion Coefficient, Imaging biomarker, Malignancy, Diffusion magnetic resonance imaging, and Liver neoplasms
Midgut volvulus is a rare complication of intestinal malrotation in adults. We present a case of intestinal malrotation with surgically proven midgut volvulus. Multidetector computed tomography with postprocessing of imaging data using... more
Midgut volvulus is a rare complication of intestinal malrotation in adults. We present a case of intestinal malrotation with surgically proven midgut volvulus. Multidetector computed tomography with postprocessing of imaging data using three-dimensional reconstruction techniques provided better demonstration of the abdomen than other imaging modalities. To our knowledge, this is the first presentation of midgut volvulus on multidetector computed tomography in adults. The literature on midgut volvulus is also reviewed and imaging findings of this disease are discussed.
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Spina bifida may occur during the first weeks after conception; folic acid deficiency is strongly related to this anomaly. We argue that the low prevalence rate of spina bifida may indicate a relatively good nutrition state of a... more
Spina bifida may occur during the first weeks after conception; folic acid deficiency is strongly related to this anomaly. We argue that the low prevalence rate of spina bifida may indicate a relatively good nutrition state of a population, given that folic acid is found in many food products commonly eaten. The aim of this study is to examine the relationship between folic acid intake and spina bifida occulta prevalence in the Belentepe Byzantine population in Anatolian peninsula, and to compare the prevalence rates with various other ancient Anatolian populations by focusing on sacral spina bifida occulta in the Byzantine population. A total of 62 available human sacra were included in the study and compared with other sacra from relevant research using chi-squared test. Four male individuals had sacral spina bifida occulta with a prevalence rate of 6.45%, which is found to be lower in comparison to other ancient populations from western to eastern Anatolia. The present-day ecology of Belentepe indicates that foods rich with folic acid are common in and around the region. While some studies indicate the contrary, a comparison regarding the sacral spina bifida occulta prevalence with other populations in Anatolia shows a correlation between folic acid intake and proximity to a Mediterranean climate.
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Fluid-attenuated inversion recovery (FLAIR) imaging with contrast enhancement is highly sensitive for detecting subarachnoid space disease. We hypothesized that contrast-enhanced FLAIR imaging with magnetization transfer would offer... more
Fluid-attenuated inversion recovery (FLAIR) imaging with contrast enhancement is highly sensitive for detecting subarachnoid space disease. We hypothesized that contrast-enhanced FLAIR imaging with magnetization transfer would offer superior sensitivity to contrast-enhanced T1-weighted MR imaging with magnetization transfer in detecting TB meningitis. Forty-four patients referred for suspected TB meningitis underwent MR imaging studies. The patients had either proven TB meningitis or negative TB meningitis. The MR imaging examinations included both contrast-enhanced FLAIR and T1-weighted MR images with magnetization transfers that were independently reviewed by two neuroradiologists. Each of the sequences was reviewed individually and separately and was assigned a score of positive or negative for TB meningitis. Of the 21 studies of patients with proven TB meningitis, nine were positive based on contrast-enhanced FLAIR images with magnetization transfer, and 13 were positive based o...
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Amac: Tarama ya da kitle on tanisi ile mammografi cekilen ve arteriyal kalsifikasyon saptanan olgularin karotis intima-media kalinliklarini ve koroner kalsiyum skorlarini olcerek kardiyovaskuler hastalik riskini arastirmaktir. Gerec ve... more
Amac: Tarama ya da kitle on tanisi ile mammografi cekilen ve arteriyal kalsifikasyon saptanan olgularin karotis intima-media kalinliklarini ve koroner kalsiyum skorlarini olcerek kardiyovaskuler hastalik riskini arastirmaktir. Gerec ve Yontemler: Haziran 2009 ve Nisan 2012 tarihleri arasinda, GATA Haydarpasa Egitim Hastanesi Radyoloji Klinigi’nde rutin tarama ya da tani amaciyla mammografi cekilen ve arteriyal kalsifikasyon saptanan 69 kadin olgu calismaya dahil edildi. Olgular kardiyovaskuler hastaliklar acisindan ozgecmisi ve aile oykusu sorgulandi. Biyokimyasal olarak lipid ve seker profilleri kaydedildi. Ultrasonografi ile bilateral olarak karotis intima-media kalinliklari olculdu ve koroner kalsiyum yukunu degerlendirmek icin multidedektor BT ile cekim yapildi. Bulgular: Calismada koroner arter hastaliginin bir gostergesi olan koroner kalsiyum yuku ile kardiyovaskuler risk faktorleri olan hipertansiyon, hiperlipidemi, sigara kullanimi, postmenopozal sure arasinda anlamli iliski...
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In daily practice, endovenous laser treatment is an alternetive treatment choise in lower extremity venous insufficiency and varices. Even it has generally in higher proportion than surgery in many cases. Advantages related to ablation... more
In daily practice, endovenous laser treatment is an alternetive treatment choise in lower extremity venous insufficiency and varices. Even it has generally in higher proportion than surgery in many cases. Advantages related to ablation are; fewer complication and recurrence ratio, smaller procedure duration, no need for general anesthesia, and significant patient comfort. The aim of this study is to investigate the efficiency of the endovenous laser ablation treatment that has recently become popular alternative to surgery, in short and long term period.In our department, between May 2009 and March 2012, 8 women (53.3 %) and 7 men(46.6 %) who had lower extremity varicose veins were treated by endovenous laser ablation. The patients were recalled for color Doppler examination at 3 rd, 6 th and 12 th month following the ablation day. We observed recanalization in a patient(8.3 %). We achieved total ablation in other cases (93.3 %). In conclusion, laser ablation treatment in lower extremity
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ABSTRACT
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This study investigated the diagnostic value of proton magnetic resonance spectroscopy (MRS) findings in temporal lobe epilepsy (TLE). 24 patients whose neurologic examinations revealed TLE were examined by EEG, magnetic resonance imaging... more
This study investigated the diagnostic value of proton magnetic resonance spectroscopy (MRS) findings in temporal lobe epilepsy (TLE). 24 patients whose neurologic examinations revealed TLE were examined by EEG, magnetic resonance imaging (MRI) and MRS and ten healthy volunteers by MRI and MRS. In the patient group, EEG abnormalities were seen in 15 cases, MRI abnormalities in 12 and MRS abnormalities in 17. In 14 patients, MRS lateralized the seizure focus. MRS is an effective modality for demonstrating temporal lobe abnormalities and contributes to lateralization of the epileptic focus.
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We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides... more
We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients’ instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.
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A woman, aged 65 years, was investigated because of the recent onset of abdominal pain. A computed tomography (CT) scan of the abdomen revealed a mass, approximately 6 × 8 cm in size, in the left mid-abdomen (Fig. 1). Although the center... more
A woman, aged 65 years, was investigated because of the recent onset of abdominal pain. A computed tomography (CT) scan of the abdomen revealed a mass, approximately 6 × 8 cm in size, in the left mid-abdomen (Fig. 1). Although the center of the mass was somewhat heterogeneous, the margins were well-defined and there was no apparent stranding or inflammation of the surrounding fat tissue. The proximal small bowel was moderately dilated. At laparotomy, she had a large mass in the upper jejunum that was removed by segmental resection. Histological evaluation revealed a diffuse large B-cell lymphoma. Six months after surgery she developed obstructive jaundice. Magnetic resonance cholangiopancreatography revealed dilatation of the bile duct apparently caused by obstruction in the region of the ampulla. A repeat CT scan showed marked thickening of the wall of the second part of the duodenum (long arrow) and a dilated bile duct (short arrows). Duodenal endoscopy was abnormal and biopsies confirmed the presence of large B-cell lymphoma. She was treated by chemotherapy. Diffuse large B-cell lymphomas account for 50–66% of extranodal lymphomas in the gastrointestinal tract. The most common sites are the stomach and the ileocecal region. Although most of these neoplasms are primary, a minority may progress from less aggressive lymphomas such as MALT lymphomas or follicular lymphomas. Therapeutic options include surgery, chemotherapy and radiotherapy. Surgery is indicated in those who present with bowel obstruction and is sometimes necessary in order to obtain tissue for diagnosis. Patients with localized (stage 1 or 2) large B-cell lymphoma can be treated initially with either surgery or radiotherapy. Those with more advanced disease are best treated by chemotherapy. The prognosis varies widely and is dependent on tumor stage, lactate dehydrogenase concentrations, performance status and age.
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Neurofibromatosis is an autosomal dominant disorder with a frequency of approximately 1 : 3000 in most populations. The most common form is neurofibromatosis 1; a disorder that is also called von Recklinghausen’s disease or generalized... more
Neurofibromatosis is an autosomal dominant disorder with a frequency of approximately 1 : 3000 in most populations. The most common form is neurofibromatosis 1; a disorder that is also called von Recklinghausen’s disease or generalized neurofibromatosis. This is characterized by café-au-lait spots, neurofibromas, schwannomas and Lisch nodules. The latter are pigmented hamartomas of the iris, probably derived from melanocytes. Patients with neurofibromatosis 2 have café-au-lait spots and bilateral acoustic nerve tumors. Involvement of the gastrointestinal tract has been reported in 10–25% of patients with neurofibromatosis 1. This can take the form of solitary or multiple neurofibromas, florid enlargement of nerve plexuses (plexiform neurofibromas) or carcinoid tumors of the duodenum. With immunohistochemistry, neurofibromas typically express the S100 protein, although this can also occur in a variety of other tumors including malignant melanomas. The genetic basis of neurofibromatosis 1 is reduced or absent expression of a gene called NF1 that encodes a major regulator (neurofibromin) of the Ras oncogene. The patient whose images are illustrated below was a 24-year-old man who was admitted to hospital because of intermittent abdominal pain and increasing abdominal distension. He was known to have neurofibromatosis 1. A computed tomography (CT) scan revealed multiple, well-defined, low-attenuation lesions throughout the abdomen (Fig. 1). A magnetic resonance imaging (MRI) scan using T2-weighted images showed multiple high-intensity lesions in the region of the thoracic, abdominal and pelvic nerve root locations (Fig. 2). The MRI appearance was typical of multiple neurofibromas. As the patient was thought to have intestinal obstruction, laparotomy was performed with resection of most of the abdominal masses. Histological examination of the tissue was consistent with neurofibromatosis. Widespread abdominal neurofibromatosis of the type illustrated in the figures appears to be rare. A more common problem is a limited number of gastrointestinal tumors that occasionally result in complications such as gastrointestinal bleeding and small bowel obstruction.
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... Mecit Kantarci, MD,* Bulent Karaman, MD,* C. Cinar Basekim, MD,* Mehmet Incedayi, MD,* Hakan Mutlu, MD,* Onur Sildiroglu, MD,* Sukru Yildirim ... REFERENCES 1. Saglam L, Akgun M, Aktas E. The usefulness of induced-sputum and... more
... Mecit Kantarci, MD,* Bulent Karaman, MD,* C. Cinar Basekim, MD,* Mehmet Incedayi, MD,* Hakan Mutlu, MD,* Onur Sildiroglu, MD,* Sukru Yildirim ... REFERENCES 1. Saglam L, Akgun M, Aktas E. The usefulness of induced-sputum and fiberoptic bronchoscopy in diagnosis of ...
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Due to the increasing popularity in recreational diving long-term health consequences of this sport have aroused interest in the diving community. Although not as important as dysbaric osteonecrosis, ischemic brain lesions, or... more
Due to the increasing popularity in recreational diving long-term health consequences of this sport have aroused interest in the diving community. Although not as important as dysbaric osteonecrosis, ischemic brain lesions, or neurophysiological symptoms, paranasal sinus mucosal hypertrophy (PSMH) has also been discussed as being more prevalent among divers. In this study, we used magnetic resonance imaging (MRI) to compare asymptomatic divers with control subjects for PSMH. We enrolled 79 male divers (34.0 +/- 5.7 yr) and 79 nondiving age- and sex-matched controls (33.8 +/- 6.1 yr). We used a questionnaire to elicit diving history. Divers with a history of sinus barotrauma, subjects with a history of chronic sinusitis or nasal allergies, and those with retention cysts, nasal polyps, or mastoiditis were excluded. T1-, T2-weighted axial and coronal images of the paranasal sinuses were taken with a 1.5-T MRI device. The threshold for PSMH was defined as mucosal thickness above 3 mm. MRI revealed PSMH in 33 (41.8%) divers and 18 (22.8%) controls. There were no significant differences between the groups with respect to age, smoking history, or alcohol consumption. PSMH identified in divers did not show an association with age or diving history. The higher rate of PSMH identified in divers suggests that diving may cause changes in the paranasal sinus mucosa.
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Research Interests: Magnetic Resonance Imaging, MRI, Medicine, Diving, Humans, and 15 moreMale, Incidence, Medical Physiology, Middle Aged, Questionnaires, Adult, Asymptomatic, Occupational Diseases, Cross Sectional Studies, Military Personnel, Case Control Studies, Hyperintense Lesion, Cerebral White Matter, Military Diver, and Brain injuries
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... (15:54) Hastalar bu oyun sayesinde daha az acı hissediyor. ... Yanlış Tanı Konulan Konsolide Akciğer Rıfat Eralp ULUSOY, MD a , Murat VELİOĞLU, MD b , Ata KIRILMAZ, MD a , Hakan MUTLU, MD a , Fethi KILIÇASLAN, MD a , Namık ÖZMEN, MD a... more
... (15:54) Hastalar bu oyun sayesinde daha az acı hissediyor. ... Yanlış Tanı Konulan Konsolide Akciğer Rıfat Eralp ULUSOY, MD a , Murat VELİOĞLU, MD b , Ata KIRILMAZ, MD a , Hakan MUTLU, MD a , Fethi KILIÇASLAN, MD a , Namık ÖZMEN, MD a , Mehmet UZUN, MD a ...
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To present the magnetic resonance imaging (MRI) appearances of spinal split-cord malformation (SCM) and to investigate the various types of congenital spinal disorders associated with SCM. MR examinations of 23 patients with SCM were... more
To present the magnetic resonance imaging (MRI) appearances of spinal split-cord malformation (SCM) and to investigate the various types of congenital spinal disorders associated with SCM. MR examinations of 23 patients with SCM were carried out in our hospital between June 2002 and May 2007 and retrospectively analysed. Nineteen (82.6%) patients were diagnosed as type I SCM, while four (17.4%) were diagnosed as type II SCM. The most commonly involved site of SCM was the dorsolumbar area (47.8%) while cervical involvement was the least common (4.3%). No accompanying congenital spinal disorders were detected in four patients (17.4%). In 19 patients (82.6%), congenital spinal disorders accompanying SCM were detected, the most common of which was a low-lying cord, found in 14 patients (60.9%). Other anomalies included hydromyelia in seven patients (30.4%), lipoma in six (26%), meningomyelocele in four (17.4%), thick filum in three (13%) and dermoid cyst in three (13%). In preoperative planning for SCM, its characteristics and those of the accompanying anomalies should be determined. MRI is a valuable tool for making such determinations.