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    Diagnostic value of “t sign” on MRCP-MIP imaging in the evaluation of pancreas divisum
    (2019) Haberal, Kemal Murat; Ozer, Digdem; Hekimoglu, Omer Koray
    Aim: To determine the “t sign” diagnostic criteria on MRCP-MIP imaging in patients with pancreas divisum (PD).Material and Methods: Between May 2013 and August 2019 a total of 1289 patients who underwent both ERCP and MRCP, were enrolled to the study. To select the patients with PD diagnosis on both MRCP and ERCP were planned. Patients were compared with control group. MRCP assessment included presence and type of PD, relationship of common bile duct on axial and coronal MIP-MRCP images. Test characteristics were introduced for demonstrating diagnostic value of “t sign” on MRCP in patients with PD in the study group compared with those in the control group. Analysis was performed using the Breeze/STAT statistical calculation with computation of the 95% confidence intervals (CIs). Results: Twenty-eight patients with diagnosis of PD according to the MRCP reports were selected for the study. Of the 28 cases, five patients without PD biliary morphology excluded from the study group due to ERCP results and one patient with the diagnosis of ”probable PD” by the ERCP report was also excluded. Twenty-two patients had typical PD (95.45 %) and incomplete PD was demonstrated in one case (4.55%) . Sensitivity, specificity, positive predictive value, negative predictive value and accuracy value of MRCP-MIP imaging for demonstrating PD with using “t sign” criteria were 100%, 99%, 100%, 99% and 99% respectively. (95% CI).. Conclusion: We concluded that, dorsal main pancreatic duct (MPD) and common bile duct cross relation was identified in all complete PD patients as a “t sign” diagnostic criteria on coronal MIP-MRCP images.
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    Use of susceptibility weighted imaging to assess hemorrhage in brain metastases
    (2018) Kural Rahatli, Feride; Yildirim Donmez, Fuldem; Haberal, Kemal Murat; Agildere, Ahmet Muhtesem
    Aim: Detection of intratumoral hemorrhage in metastatic lesions leads to determination of treatment options.We evaluated the diagnostic value of precontrast SWI for the detection of blood products in brain metastases by comparing SWI to conventional sequences. Material and Methods: Brain magnetic resonance imaging (MRI) sequences were acquired between April 2014 and November 2015 from 21 patients with brain metastases, and were retrospectively evaluated for the presence of hemorrhagic elements. All examinations were performed on a 1.5 Tesla Siemens scanner. Our routine protocol included axial T1-weighted (T1W), T2-weighted (T2W), and FLAIR sequences, coronal and sagittal T2W sequences, post gadolinium axial and sagittal T1W sequences, and a coronal FSE T1W sequence, in addition to the precontrast SWI sequence. Results: Seventy-one intraparenchymal metastatic lesions (range: 0.5–3.5 cm) were detected. No hemorrhages were detected in 25 lesions (35.2%), while in 12 lesions (16.9%) hemorrhage was detected by SWI and T1 and/or T2 weighted images. In 34 lesions (47.88%) hemorrhage was detected only on the SWI sequence, and it was not seen on the conventional sequences. Conclusion: SWI provided better information for the evaluation of intratumoral hemorrhage than T1W and T2W sequencesof the inner structure of metastases. T1W and T2W images did not provide sufficient detection of hemorrhagic elements; SWI is therefore needed to detect intratumoral hemorrhage, and the sequence should be added to the protocol to allow better characterization.