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    A critical overview of the imaging arm of the ASAS criteria for diagnosing axial spondyloarthritis: what the radiologist should know
    (Turkish Soc Radiology, 2012) Aydingoz, Ustun; Yildiz, Adalet Elcin; Ozdemir, Zeynep Maras; Yildirim, Seray Akcalar; Erkus, Figen; Ergen, Fatma Bilge
    The Assessment in SpondyloArthritis international Society (ASAS) defined new criteria in 2009 for the classification of axial spondyloaithritis (SpA) in patients with >= 3 months of back pain who were aged <45 years at the onset of back pain. This represents a culmination of a number of efforts in the last 30 years starting with the 1984 modified New York criteria for ankylosing spondylitis, followed by the 1990 Amor criteria and the 1991 European Spondyloarthropathy Study Group criteria for SpA. The importance of new ASAS criteria for radiologists is that magnetic resonance imaging (MRI) takes center stage and is one of the major criteria for the diagnosis of axial SpA when active (or acute) inflammation is present on MRI that is highly suggestive of sacroiliitis associated with SpA. According to the new criteria, sacroiliitis on imaging plus >= 1 SpA features (such as inflammatory back pain, arthritis, heel enthesitis, uveitis, dactylitis, psoriasis, Crohn's disease/colitis, good response to non-steroidal anti-inflammatory drugs, family history for SpA, HLA-B27 positivity, or elevated C-reactive protein) is sufficient to make the diagnosis of axial SpA. A number of rules and pitfalls, however, are present in the diagnosis of active sacroiliitis on MRI. These points are highlighted in this review, and a potential shortcoming of the imaging arm of the ASAS criteria is addressed.
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    Demystifying ABER (ABduction and External Rotation) sequence in shoulder MR arthrography
    (Aves, 2014) Aydingoz, Ustun; Ozdemir, Zeynep Maras; Ergen, Fatma Bilge
    ABduction and External Rotation (ABER) sequence in magnetic resonance (MR) arthrography of the shoulder is particularly important to better depict abnormal conditions of some glenohumeral joint structures and surrounding tissues by making imaging possible under a stress position relevant to pathologic conditions. Among the structures and tissues better depicted in this position are articular surface of the supraspinatus tendon, anteroinferior portion of the glenoid labrum, and anterior band of the inferior glenohumeral band. Despite these benefits of the ABER sequence, it is either not being used extensively as part of shoulder MR arthrograms or, when utilized, not properly assessed, mostly due to some practical difficulties in setting up the sequence and unfamiliarity with the alignment of structures displayed on MR images. In this technical note, we aimed to explain the ABER sequence planning in a step-by-step manner with emphasis on scout series set-up, and also present an outline of anatomic landmarks seen on ABER images.
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    Ischiofemoral Space on MRI in an Asymptomatic Population: Normative Width Measurements and Soft Tissue Signal Variations
    (Springer, 2015) Ozdemir, Zeynep Maras; Aydingoz, Ustun; Gormeli, Cemile Ayse; Kahraman, Aysegul Sagir
    To make normative width measurements of the ischiofemoral (IF) space in an asymptomatic population and to record soft tissue MRI signal variations within the IF space in order to determine whether such variations are associated with IF space dimensions. Normative width measurements of the IF space were prospectively made in 418 hips on 1.5 T MR images of 209 asymptomatic volunteers. Quantitative and qualitative assessments of the IF soft tissues including the quadratus femoris (QF) muscle were also made. The mean IF space width was 2.56 +/- 0.75 cm (right, 2.60 +/- 0.75 cm; left, 2.53 +/- 0.75 cm). Soft tissue MRI signal abnormalities were present within the IF space in 19 (9.1 %) of 209 volunteers. Soft tissue abnormalities within the IF space included oedema (3/209, 1.4 %) of the QF and/or surrounding soft tissue, and only fatty infiltration (16/209, 7.7 %) of the QF. Bilateral IF spaces are asymmetrical in asymptomatic persons. There is a parts per thousand yen10 % of width difference between right and left IF spaces in approximately half of asymptomatic individuals. Fatty infiltration and oedema can be present at the IF space in a small portion of the asymptomatic population, who also have narrower IF spaces than those without soft tissue MRI signal abnormalities. aEuro cent Bilateral IF spaces are commonly asymmetrical in asymptomatic individuals. aEuro cent MRI signal abnormalities can be observed within IF space in asymptomatic people. aEuro cent Abnormal quantitative/qualitative MRI findings are not necessarily related to IF impingement.
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    MRI of lower extremity impingement and friction syndromes in children
    (Aves, buyukdere cad 105-9, mecıdıyekoy, sıslı, ıstanbul 34394, turkey, 2016) Aydingoz, Ustun; Ozdemir, Zeynep Maras; Gunes, Altan; Ergen, Fatma Bilge
    Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon-lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data.
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    A Novel Physical Examination Test for Ischiofemoral Impingement: Validation With Magnetic Resonance Imaging Correlation
    (Lippincott Williams & Wilkins, 2021) Ozdemir, Zeynep Maras; Yildirim, Tulay; Karaca, Leyla; Kahraman, Aysegul Sagir; Aydingoz, Ustun
    Objective The purpose of this study was to propose and validate a novel physical examination test for ischiofemoral impingement with magnetic resonance imaging (MRI) correlation. Methods We prospectively studied 24 women with buttock (deep gluteal) pain and 27 asymptomatic women. Each group underwent a 2-stage physical examination test that featured hip adduction-external rotation-extension and knee flexion. Visual analog scale pain scores were noted just before and during test stages on both sides. The MRI findings of the ischiofemoral impingement were evaluated quantitatively and qualitatively. Results Mean ages were 56.0 and 55.2 years (P = 0.797), and mean body mass indexes were 29.1 and 28.8 kg/m(2) (P = 0.817) in symptomatic and asymptomatic groups, respectively. Ischiofemoral spaces were significantly narrower (P < 0.001), ischial angles were wider (P < 0.001, right; P = 0.002, left), and soft tissue edema at the ischiofemoral space was more common (P < 0.001) in the symptomatic group, which also had higher pretest visual analog scale scores (P < 0.001) that increased significantly during both upright standing (P = 0.003, right; P < 0.001, left) and recumbent (P < 0.001 for both sides) stages of the physical examination test. Conclusions A novel physical examination test significantly increases symptoms of ischiofemoral impingement with positive MRI correlation.
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    RE: QUADRICEPS FAT PAD IMPINGEMENT AND SYNOVIAL HYPERTROPHY WITH MILD TO MODERATE LIPOMA ARBORESCENS
    (Lippincott Williams & Wilkins, 2016) Ozdemir, Zeynep Maras; Aydingoz, Ustun
    [Abstract Not Available]
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    Ultrasonography-Guided Injection for Quadriceps Fat Pad Edema: Preliminary Report of a Six-Month Clinical and Radiological Follow-Up
    (Ubiquity Press Ltd, 2016) Ozdemir, Zeynep Maras; Aydingoz, Ustun; Korkmaz, Mehmet Fatih; Tunay, Volga Bayrakci; Ergen, Fatma Bilge; Atay, Ozgur; Baysal, Ozlem
    Purpose: To investigate efficacy and safety of ultrasonography-guided local corticosteroid and anesthetic injection followed by physical therapy for the management of quadriceps fat pad (QFP) edema. Materials and Methods: We prospectively evaluated 1671 knee MRI examinations in 1542 patients for QFP edema with mass effect, which was present in 109 (6.5%) knees. Participants were assigned into injection and therapy groups (both received the same physical therapy program). Injection group was first treated with ultrasonography-guided QFP injection of 1 mL corticosteroid and 1 mL local anesthetic agent. Patients were evaluated at baseline and 1-, 2-, 6-month follow-up for pain using static and dynamic visual analogue scale (VAS), suprapatellar tenderness, and QFP edema on MRI. Results: Final sample size consisted of 19 knees (injection group, 10; therapy group, 9) in 17 patients. An overall improvement was detected in both groups between baseline and final assessments. The injection group fared better than the therapy group in static VAS scores (3.33 +/- 1.70 versus 0.56 +/- 1.33), while there was no such difference for dynamic VAS. Incidence of suprapatellar tenderness decreased in both groups, statistically significantly in the injection group (from 100% to 0%). Pain reduction was greater in the injection group at the first month (88.9%-90% good response versus 50%-66.7% good response, static-dynamic VAS scoring, respectively), whereas there was no such superiority at the sixth month. No severe adverse events were identified. Conclusion: Ultrasonography-guided local injection followed by physical therapy is safe in the management of QFP edema; however, it is not superior to stand-alone physical therapy program in the long term.