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Öğe Advanced MRI findings in patients with breast hamartomas(Turkish Soc Radiology, 2011) Erdem, Gulnur; Karakas, Hakki Muammer; Isik, Burak; Firat, Ahmet KemalPURPOSE Although it has been stated that breast hamartomas are rare tumors, radiologists frequently encounter them in their daily practices. Fat, glandular and fibrous tissues all produce a mass of disorganized but mature specialized cells. Because hamartomas do not have specific diagnostic histological features, the clinical and radiological findings are important in their diagnosis. The aim of this study is to present the advanced magnetic resonance imaging (MRI) findings of breast hamartomas. MATERIALS AND METHODS Eight patients with breast hamartomas were examined using MRI techniques in addition to ultrasonographic and/or mammographic findings. RESULTS Each of the lesions examined showed a gradual enhancement pattern in its time-signal intensity curve on dynamic contrast-enhanced MRI. On MR spectroscopy, water and lipid peaks were detected that resembled normal breast tissue. The diffusion features of the lesions were variable due to the different ratios of the tissue elements constituting them on diffusion-weighted imaging (DWI). CONCLUSION Advanced MRI findings may clarify diagnoses by providing additional information following sonography, especially in lactating or pregnant women, in whom mammographic examination is not preferred.Öğe The Assessment of Hepatosteatosis in Living-Donor Liver Transplant: Comparison of Liver Attenuation Index and Histopathologic Results(Baskent Univ, 2017) Kahraman, Aysegul Sagir; Karakas, Hakki Muammer; Kirimlioglu, Hale; Kahraman, Bayram; Yilmaz, Sezai; Kirimlioglu, VedatObjectives: The purpose of the study was to determine the diagnostic value of computed tomography densitometry in the quantification of hepatosteatosis. Materials and Methods: Fifty-one potential liver donors, ranging in age from 19 to 52 years (mean age: 32.4 years +/- 10.2), participated in the study. The mean hepatic attenuation and mean splenic attenuation were determined using regions of interest measurements. The difference between the mean hepatic attenuation and mean splenic attenuation (or liver attenuation index), with liver attenuation index = mean hepatic attenuation - mean splenic attenuation were calcu lated. Computed tomography densitometric para meters were correlated with histopathologic results. Results: From the histopathologic analysis, the degree of macrovesicular hepatosteatosis was 0% to 8% (mean: 1.1% +/- 2%). Seven donors (13.7%) had a degree of macrovesicular steatosis of > 5%, and 12 donors (23.5%) had >= 2%. Of the 29 normal donors with histopathologic verification, computed tomography densitometry predicted <= 5% of the hepa to steatosis in 27 donors, and >= 2% hepato-steatosis in 2 subjects. The liver attenuation index was sig nificantly correlated to the histopathologic results. The mathematical relation between liver attenuation index and the degree of histopathologic hepatosteatosis was calculated using the least-squares methods, which provided quadratic polynomials. Conclusions: Computed tomography densitometry is a rapid, robust, noninvasive technique for the assessment of hepatosteatosis. When used in conjunction with clinically stable reference measurements of spleen, the density measurements of liver correctly predicted the presence of fatty infiltration with significant sensitivity (77%) and specificity (75%). This technique, which was refined during the course of our liver transplant program, minimizes the need for highly invasive percutaneous liver biopsies.Öğe Bilateral Anterior Inferior Iliac Spine Avulsion in an Adolescent Soccer Player: A Typical Imitator of Malignant Bone Lesions(Lippincott Williams & Wilkins, 2009) Karakas, Hakki Muammer; Alicioglu, Banu; Erdem, GulnurAvulsion fractures are usually diagnosed easily in acutely presented cases. The diagnosis becomes definite if clinical and radiological follow up reflect the fracture's healing phase. A 13-year-old soccer player with bilateral anterior inferior iliac spine (AIIS) avulsion, who had been examined in other institutions with a pre-diagnosis of malignancy, is reported. Clinically, such cases display the importance of medical management of athletic injuries by specially trained physicians. From the perspective of preventive medicine, the high incidence of AIIS injuries-during soccer games, and the bilateral nature of the damage mandate a review of the training programs and shooting techniques for adolescent players.Öğe Bilateral Giant Benign Cystic Mesothelioma (Peritoneal Inclusion Cysts): Ultrasonography and Magnetic Resonance Imaging Findings(Galenos Yayincilik, 2007) Erdem, Gulnur; Celik, Onder; Hascalik, Seyma; Karakas, Hakki Muammer; Firat, Ahmet KemalPeritoneal inclusion cysts are most common in women of reproductive period and involve the abdomen, pelvis, and retroperitoneum. Generally these cases with a history of previous abdominal surgery present with chronic abdominal and pelvic pain. Peritoneal inclusion cysts are lined with mesothelial cells; this condition has also been referred to as benign cystic mesothelioma. In this study, we present the ultrasonographic and magnetic resonanse imaging (MRI) findings of giant benign cystic mesothelioma in 30-year-old infertil woman and the approaches of the treatment mentioned in literature. On ultrasonography and MRI, peritoneal inclusion cysts are seen as abdominopelvic multiloculated cystic masses. In that case, peritoneal inclusion cysts should be added into the differential diagnosis list in the cases with a history of previous abdominal surgery.Öğe BILATERAL SEMINAL VESICLE AND UNILATERAL RENAL AGENESIS IN CASE WITH PRIMARY INFERTILISM(Aves, 2007) Erdem, Glnur; Karakas, Hakki Muammer; Ugras, Murat; Alkan, Alpay; Altinok, Tayfun; Doganay, SelimIntroduction: Agenesia of the seminal vesicle is an uncommon cause of the male infertility. While unilateral agenesia of seminal vesicle is observed in 0.6-1% of male population, bilateral agenesia is extremely rare. These malformations may be associated with unilateral or bilateral agenesia of the vas deferens or unilateral renal agenesia. 70-80% of the cases with bilateral agenesia of the seminal vesicle have gene mutations related to cystic fibrosis. In his article we presented the ultrasonographic and magnetic resonance imaging findings of bilateral agenesia of the seminal vesicle and unilateral renal agenesia in primary infertile case who has not cystic fibrosis. Materials and Methods: Pelvic magnetic resonance imaging (MRI) and abdominal ultrasonography was utilized in 29 years old male patient with primary infertility. Results: Bilateral seminal vesicle agenesis was found in MRI. In spermiogram, neither live nor dead spermium was detected. Abdominal ultrasonography was yielded as unilateral renal agenesis and contralateral compensatris hypertrophy consecutively on left and right sides. Conclusion: Pelvic and transrectal ultrasonography gives valuable data on investigation of the etiology of primary infertility. Pelvic MRI is important to distinguish the hypoplasia and the agenesis of the seminal vesicle.Öğe Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited(Springer France, 2008) Karakas, Hakki Muammer; Celik, Tayfun; Alicioglu, BanuBackground and objectives Living donor liver transplantations (LDLT) donor candidates are being assessed with MRCP (magnetic resonance cholangiopancreatography) to identify their suitability for standard surgical techniques. Variations of the bile duct anatomy play an important role in donor selection and in the selection of the resection technique. If bile duct anatomy is misrecognized, complications may occur. Anatomic variations are classified according to the origin of the right posterior hepatic duct (RPHD). According to the so called Huang classification, type A1 is the most, and type A5 is the least frequent variation. These frequencies were initially validated on Chinese population. Later studies revealed significant variability in frequency for the so called trifurcation, the variation in which a common junction of RHPD, right anterior hepatic duct (RAHD) and left hepatic duct (LHD) (A2) exists. In this study we aimed to determine the bile duct anatomy variations for the Anatolian Caucasians. Methods One hundred and thirty-four healthy subjects were investigated under 1.5 T MRI, with breath-hold (expiration) heavily T2-weighted turbo spin echo (TSE) static fluid imaging (TR/TE = 8,000/800). The sequence has permitted three to five oblique coronal thick sections (40 mm) around a common axis. Sequences were repeated until anatomically interpretable images were obtained. Diagnostic images could not be obtained in 22 subjects. Radiologists who were fully experienced in LDLT assessment investigated these images, and classified them for the surgical variations of the bile duct anatomy. One hundred and twelve subjects (58 men, 54 women) who were classified were between 14 and 81 years of age (mean: 39.3; SD 14.1). According to Huang classification, 61 of them (55%) were classified as type A1 (normal right and left hepatic duct junction), 16 (14%) as type A2 (common junction of RAHD, RHPD and LHD), 24 (21%) as type A3 (aberrant drainage of RPHD to left main duct), and 11 (10%) as type A4 (aberrant drainage of RPHD to main hepatic duct). When subjects, in whom the distance (d) between RPHD insertion and the right and left hepatic duct junction is less than 1 cm, are classified as type A2, the type A1 prevalence decreases to 28%. For the entire population that distance was between 3 and 25 mm (mean: 9.8, SD: 4.8). Accordingly, the frequency of type A1 anatomy was 8-29% lower than the respective frequency in Chinese population. Conclusion From the surgical perspective, close proximity (d < 1 cm) of RPHD to right and left hepatic duct junction is considered as type A2 variation. According to that concept, type A1, usually accepted as the dominant anatomic variation, is encountered only in 28% of the Anatolian Caucasians. We have proposed a modified surgical classification in which Huang type 2 was subdivided into types K2a (close proximity) and K2b (trifurcating). The predominance of K2 types in the population of the study may necessitate the use of bench ductoplasty in many liver grafts.Öğe Diffusion-Weighted Images Differentiate Benign From Malignant Thyroid Nodules(Wiley, 2010) Erdem, Gulnur; Erdem, Tamer; Karakas, Hakki Muammer; Mutlu, Deniz Yakar; Firat, Ahmet Kemal; Sahin, Ibrahim; Alkan, AlpayPurpose: To reveal the possible role of diffusion-weighted images (DWI) in the differential diagnosis of benign and malignant thyroid nodules by comparing the results of fine-needle aspiration cytology (FNAC). Materials and Methods: In an 18-month period (December 2005 to May 2007), 27 cases with benign thyroid nodules with a total of 52 benign nodules, nine cases with thyroid gland malignancy and 24 healthy control cases were included in the study. Cases that were indicated to undergo to FNAC examination and sent by a clinician for biopsy to the radiology unit were included in the study to assess the cytopathologic confirmation of the clime, ultrasonographic, and magnetic resonance imaging (MRI) findings. Results: The mean apparent diffusion coefficient (ADC) values of thyroid nodules were 2745.3 +/- 601.1 x 10(-6) mm(2)/s (1605-3899 x 10(-6)mm(2)/s) in the benign group and 695.2 +/- 312.5 x 10(-6)mm(2)/s (165-1330 x 10(-6)mm(2)/s) in the malignant group. Normal thyroid tissues had mean ADC values of 1344.1 +/- 276.4 x 10(-6) mm(2)/s (1015-1764 x 10(-6)mm(2)/s). The ADC values of three subgroups were significantly different (P = 0.0001). A reduced ADC was observed in most. types of malignant tumors due to the consequent decrease of the extracellular extravascular space. Conclusion: Our preliminary results showed that ADC values of nodules may provide useful data about the nature of a thyroid nodule.Öğe Diffusion-weighted imaging evaluation of subtle cerebral micro structural changes in intrauterine fetal hydrocephalus(Elsevier Science Inc, 2007) Erdem, Gulnur; Celik, Onder; Hascalik, Seyma; Karakas, Hakki Muammer; Alkan, Alpay; Firat, Ahmet KemalObjective: Hydrocephalus is an important etiological factor in neurological decline. With the advent of fetal ultrasound, fetal hydrocephalus is now more frequently detected than in the past. Ultrasonography (USG) provides information on general morphology, but microstructural changes that may play a prognostic role are beyond the resolution of that technique. These changes may theoretically be revealed by diffusion-weighted magnetic resonance imaging (DW-MRI). In this study, our preliminary findings of DW-MRI on the hydrocephalic fetuses are presented. Materials and Methods: Twelve fetuses with fetal USG diagnosis of hydrocephalus were investigated using a 1.5-T MR scanner. In addition to conventional techniques, DWI was performed. It was obtained using a single-shot echo-planar imaging sequence (TR/TE: 4393/81 ms; slice thickness: 5 mm; interslice gap: 1 mm; FOV: 230 mm; matrix size: 128x256; b values: 0 and 1000 s/mm(2)). Apparent diffusion coefficient (ADC) values were measured in the white matter of the periventricular frontal and occipital lobes, basal ganglia, thalamus, centrum semiovale and cerebrospinal fluid in the lateral ventricle. These values were compared with the normal prenatal ADC values from a radiological study published in the literature. bilateral supratentorial ventricular dilatation that was compatible with hydrocephalus. On conventional T1- and T2-weighted imaging, cerebral parenchyma had normal signal pattern and ADC values were significantly lower than those reported for fetuses with normal brain. These values were lower in hydrocephalic fetuses with statistical significance (P<.05-.01). Conclusion: DWI is a sensitive technique to investigate cerebral microstructure. The reduction in cerebral blood flow and alterations in cerebral energy metabolism in cases with hydrocephalus have been shown before. Changes in cerebral blood flow and energy metabolism, as a consequence of cerebral compression, may occur in hydrocephalus. Elevated ventricular pressure may cause cerebral ischemia. The anaerobic glycolysis seen in the hydrocephalic brain tissue by increasing the lactate concentration and intracellular fluid flux may be the reason for the reduced ADC values in hydrocephalic fetuses. However, long-term prospective trials on the correlation of ADC values and neurological outcome are necessary to exploit the full benefit of that novel technique. (c) 2007 Elsevier Inc. All rights reserved.Öğe Diffusion-weighted imaging features of brain in obesity(Elsevier Science Inc, 2008) Alkan, Alpay; Sahin, Ibrahim; Keskin, Lezan; Cikim, Ayse Sertkaya; Karakas, Hakki Muammer; Sigirci, Ahmet; Erdem, GulnurPurpose: Obesity is characterized by an altered distribution of body fluid. However, distribution of fluid (extracellular/intracellular) in brain tissues has not been studied in obese subjects yet. The purpose of this study was to detect possible brain diffusion changes especially in satiety and hunger related centers in obese subjects by diffusion weighted imaging (DWI). Methods: Conventional MRI and DWI of the brain was obtained from 81 obese patients (obese=68, morbid obese= 13) and 29 age-matched, nonobese. The apparent diffusion coefficient (ADC) values were calculated in hypothalamus; amygdala; hippocampal gyrus-1 thalamus; insula; cingulate gyrus; orbitofrontal, dorsomedial and dorsolateral frontal, middle temporal and occipital cortex; cerebellum; midbrain and corpus striatum. Results: The ADC values of hypothalamus, hippocampal gyrus, amygdala, insula, cerebellum and midbrain were significantly increased in patients (n:81) when compared to nonobese subjects. The ADC values of thalamus, hippocampal gyrus, amygdala, orbitofrontal, occipital, dorsolateral and middle temporal cortex, insula and midbrain were significantly increased in morbid obese when compared to nonobese subjects. The ADC values of orbitofrontal and occipital cortex were significantly higher in morbid obese than the values in the obese. The body mass index positively correlated with ADC values of amygdala, insula, orbitofrontal and middle temporal cortex. Conclusion: We observed increased ADC values of distinct locations related to satiety and hunger that suggest altered fluid distribution and/or vasogenic edema in obese subjects. Awareness of this abnormalities in brain tissue composition/function in obesity may contribute to better understanding of the underlying mechanisms. (0 2008 Elsevier Inc. All rights reserved.Öğe The Effects of Hypothyroidism Due to Iodine Deficiency in Neonatal Brain: The Changes in Brain Metabolites Detected by Magnetic Resonance Spectroscopy(Elsevier Science Bv, 2009) Akinci, Aysehan; Karakas, Hakki MuammerIodine is an essential trace element for the synthesis of thyroid hormones, which have been shown to be absolutely necessary for the development of the fetal brain during intrauterine life, starting from the second half of gestation. Most studies show that iodine deficiency and maternal-fetal hypothyroxinemia have negative effects on fetal neural maturation, dendritic arborization and synaptic formation. They delay the myelinization process and gliogenesis, which start in the second half of gestation and continue in postnatal life. Altered levels of iodine are correlated with defective brain development and neuronal maturation. Various degrees of irreversible neurocognitive defects that are caused by severe iodine deficiency, and subsequent maternal and fetal hypothyroxinemia are well-known. Recent studies further showed that, even in cases without clinical hypothyroidism, maternal hypothyroxinemia due to mild-to-moderate iodine deficiency would lead to fetal brain damage that could be reversed with early thyroxine therapy. Magnetic resonance spectroscopy (MRS) is a sensitive technique that detects alterations in brain metabolite levels in various neurodevelopmental disorders. Of these metabolites, N-acetyl aspartate (NAA) is exclusively present in neurons and their axons, and is therefore used to predict neuronal function and myelin maturation. Cerebral NAA level has been shown to decrease in almost all neuronal diseases, and is therefore extensively used in the evaluation of various demyelinizating and degenerative brain disorders. Choline (Cho) is the next most important cerebral metabolite, which reflects the rate of membrane turnover. Of many cerebral metabolites, only creatine (Cr) appears to be constant under various metabolic conditions; therefore, it is used as a reference value in semiquantitative assessments (e.g., a decreased NAA/Cr ratio is interpreted as a decline in NAA level). In untreated hypothyroidism, NAA/Cr ratio decreases, whereas Cho/Cr ratio increases. These ratios normalize with appropriate thyroxine therapy. Recently, intrauterine hypothyroxinemia due to iodine deficiency was also shown to cause a significant decrease in NAA/Cr ratio in neonates with hypothyroidism. Early thyroxine therapy caused normalization of NAA levels in these neonates.Öğe Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?(Springer, 2008) Firat, Yezdan; Sireci, Sule; Yakinci, Cengiz; Akarcay, Mustafa; Karakas, Hakki Muammer; Firat, Ahmet Kemal; Kizilay, AhmetWe investigated the incidence and co-existence of hearing impairment and renal abnormalities in healthy children with preauricular tags and pits. Study population consists of 13,740 primary school children from routine health check. Thirty-five children with preauricular tags and pits were noted. Control group consisted of 91 patients without pits and tags, who underwent renal ultrasound and were scheduled to pediatric outpatient clinic. Urinanalysis, renal ultrasound, otoacoustic emission were performed in both the groups. The prevalence of renal abnormality (1/36; 2.7%) and hearing impairment (1/36; 2.7%) in patients with preauricular tags and pits was similar to that of control group (3/91; 3.2% and 4/91; 4.3%) (P = 0.87, P = 0.64, respectively). According to our results, it is not necessary to investigate hearing or urinary abnormality in patients with preauricular tag or pit, unless there is an association of a syndrome or family history of hearing or renal impairment.Öğe Magnetic resonance spectroscopy features of normal-appearing white matter in patients with acute brucellosis(Elsevier Ireland Ltd, 2008) Kayabas, Uner; Alkan, Alpay; Firat, Ahmet Kemal; Karakas, Hakki Muammer; Bayindir, Yasar; Yetkin, FundaWe aimed to evaluate whether the subtle metabolic cerebral changes are present in normal-appearing white matter on conventional MRI, in patients with acute brucellosis, by using MR spectroscopy (MRS). Sixteen patients with acute brucellosis and 13 healthy control subjects were investigated with conventional MRI and single-voxel MRS. Voxels were placed in normal-appearing parietal white matter (NAPWM). N-Acetyl aspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were calculated. There was no significant difference between the study subjects and the control group in NAA/Cr ratios obtained from NAPWM. However, the Cho/Cr ratios were significantly higher in patients with acute brucellosis compared to controls (p=0.01). MRS revealed metabolic changes in normal-appearing white matter of patients with brucellosis. Brucellosis may cause subtle cerebral alterations, which may only be discernible with MRS. Increased Cho/Cr ratio possibly represents an initial phase of inflammation and/or demyelination process of brucellosis. (C) 2007 Elsevier Ireland Ltd. All rights reserved.Öğe Microstructural Changes in Uterine Leiomyomas and Myometrium: A Diffusion-Weighted Magnetic Resonance Imaging Study(Karger, 2009) Erdem, Gulnur; Celik, Onder; Karakas, Hakki Muammer; Hascalik, Seyma; Firat, Ahmet KemalAlthough morphological and histopathological changes in uterine leiomyomas have been investigated in detail, the microstructural disruptions could not be studied in the living organism. Diffusion-weighted magnetic resonance imaging (DWI) is a novel tool to assess microstructural changes in vivo. The aim of this study was to investigate and characterize the diffusional property of leiomyomatous tissues with DWI. Sixteen females with a total of 21 leiomyomas were imaged with a 1.5-tesla clinical MR scanner. DWI images of leiomyomas, adjacent myometrial and myometrial tissues of healthy controls were obtained and quantified using apparent diffusion coefficient (ADC) maps. Mean ADC values of these groups were 1,201, 1,684, 1,661 mm(2)/s x 10(-6), respectively. ADC values in leiomyomas were significantly lower than those observed in the myometrium (p < 0.001). Cut-off values produced 91% sensitivity and 100% specificity. As ADC values implied the presence of cytotoxic edema in leiomyomas, the technique was found to be promising in observing temporal variations in leiomyomas and to monitor even the most subtle effects of therapeutic interventions. Copyright (C) 2009 S. Karger AG, BaselÖğe Novel noninvasive detection method for endometriosis: research and development of scintigraphic survey on endometrial implants in rats(Elsevier Science Inc, 2008) Hascalik, Seyma; Celik, Onder; Kekilli, Ersoy; Elter, Koray; Karakas, Hakki Muammer; Aydin, Nasuhi EnginIn this experimental study on endometriosis, the majority of the implants were successfully detected with technetium-(Tc-99m) labeled red blood cell scintigraphy.Öğe The role of MRS in the differentiation of benign and malignant soft tissue and bone tumors(Elsevier Ireland Ltd, 2011) Doganay, Selim; Altinok, Tayfun; Alkan, Alpay; Kahraman, Bayram; Karakas, Hakki MuammerObjective: The aim of our study was to investigate the value of choline in the discrimination of benign and malignant soft tissue and bone tumors. Materials and methods: The study group consisted of thirty subjects with bone or soft tissue tumors larger than 1.5 cm in diameter. The experiments were performed in a 1.5 T MR scanner. Coils were selected according to specific locations. A single-voxel MRS was performed for three different TE (time to echo) (31, 136, 272 ms). The volume of interest was positioned on the brightest enhancement. The presence of a cholin peak on at least 2 of these spectrums was considered as the marker of malignancy. The sensitivity, specificity and accuracy of the MRS in the detection and diagnosis of malignant lesions were calculated. The reproducibility of MRS and histopathological results were tested with kappa statistics. Results: Histopathologically, 18 (60%) of the lesions were classed as malignant whereas 12 (40%) were classed as benign. With MRS, 15 (50%) of these lesions were classed as malignant and 15 (50%) as benign. Two patients who were found spectroscopically to have malignant tumors were shown histopathologically to have benign types. Five patients with an MRS showing a benign type were classed with malignant types in histopathological examinations. MRS had a sensitivity rate of 72.2%, specificity of 83.3%, and an accuracy rate of 76.6% in detecting malignant bone and soft tissue tumors. The interrater reliability of both techniques had a kappa value of 0.533. Conclusions: MRS may help in the differentiation of benign and malignant soft tissue and bone tumors. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe SUBAREOLAR BREAST ABSCESS: ADVANCED MAGNETIC RESONANCE IMAGING FINDINGS(Aves, 2008) Erdem, Gulnur; Isik, Burak; Karakas, Hakki Muammer; Firat, Ahmet KemalBreast abscesses are generally seen in women in lactation period and located in the retroareolar and periareolar areas. Occasionally, subareolar abscesses may occur in young and middle aged women in non-lactation. Advanced imaging techniques may be needed to discriminate inflammatory breast carcinomas from subareolar abscesses with high risk of recurrence. We detected multipl breast abscesses in 26 year-old woman in non-lactation period and presented the findings of dynamic magnetic resonance imaging, diffusion-weighted imaging and magnetic resonance spectroscopy in addition to the findings of ultrasonography and conventional magnetic resonance imaging. Although the diagnosis of breast lesions depends basically on clinical findings, mammography and sonography findings, the usefulness of advanced magnetic resonance imaging techniques has been reported increasingly in differential diagnosis. This imaging techniques provide additional information to mammography and ultrasonography by bringing about non-invasive approaches.Öğe The subpubic angle in sex determination: Anthropometric measurements and analyses on Anatolian Caucasians using multidetector computed tomography datasets(Elsevier Sci Ltd, 2013) Karakas, Hakki Muammer; Harma, Ahmet; Alicioglu, BanuIntroduction and aim: The investigation of new anatomical criteria and revalidation of existing ones in sex determination for different populations are among main research foci of forensic anthropometry. In that context, the pelvis is the most extensively studied bone. A number of qualitative classifications, dimensional measurements and indices have been proposed for investigative anthropometry and forensic studies. Independent use of these parameters generally provided an accuracy rate of 70-75%. In this study, the accuracy rate of the subpubic angle in sex determination was investigated in living Anatolian Caucasians. Material and method: The subpubic angle was identified and measured on three-dimensional computed tomographic images of pelves. Data were obtained using 64-detector computed tomography (MDCT) with an isotrophic resolution of 500 mm. The sample included 66 males (41.6 +/- 14.9 years of age) and 43 females (41.1 +/- 14.2 years of age). Measurements were taken on a dedicated three-dimensional image analysis workstation. The subpubic angle was electronically measured. The technique and methodology was validated on a standard skeletal model. Intraobserver agreement was analyzed with intraclass correlation coefficient, and intraobserver variability was evaluated with technical error of measurement (inter-and intra-observer TEM), relative technical error of measurement (rTEM) and coefficient of reliability (R) measures. The subpubic angle for the study group and for both sexes was reported as minimum-maximum (mean +/- SD). Independent-Samples T Test for equality of means was used to determine the difference between the two sexes regarding the subpubic angle. The correlation between the subpubic angle and the age of subjects were using Pearson Correlation Coefficients in males and in females. Logistic regression model was used to classify subjects according to their sex. Receiver operating characteristic curve analysis was performed to determine a cut-off value for further studies and to test the performance of the binary classification test. Results: Intraclass correlation for the subpubic angle (0.990), TEM (1082), rTEM (1.492), and R (0.990) represented almost complete reliability and accuracy of the measurement method. The subpubic angle was between 48 degrees and 81 degrees (65.9 degrees +/- 7.2 degrees) in males and was between 64 degrees and 100 degrees (82.6 degrees +/- 7.7 degrees) in females. Statistically significant difference was found between males and females regarding the subpubic angle (p < 0.0001). The subpubic angle was not significantly correlated with age in males (p = 0.953), or in females (r = 0.975). The accuracy of the subpubic angle in sex determination was 90.8%. With a cut-off value of 74 degrees, sensitivity of subpubic angle to detect female phenotype was 88% and its specificity was 95%. Conclusion: The subpubic angle is an accurate parameter in sex determination with high sensitivity and specificity. (C) 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.Öğe Total body height estimation using sacrum height in Anatolian Caucasians: multidetector computed tomography-based virtual anthropometry(Springer, 2011) Karakas, Hakki Muammer; Celbis, Osman; Harma, Ahmet; Alicioglu, BanuEstimation of total body height is a major step when a subject has to be identified from his/her skeletal structures. In the presence of decomposed skeletons and missing bones, estimation is usually based on regression equation for intact long bones. If these bones are fragmented or missing, alternative structures must be used. In this study, the value of sacrum height (SH) in total body height (TBH) estimation was investigated in a contemporary population of adult Anatolian Caucasians. Sixty-six men (41.6 +/- 14.9 years) and 43 women (41.1 +/- 14.2 years) were scanned with 64-row multidetector computed tomography (MDCT) to obtain high-resolution anthropometric data. SH of midsagittal sections was electronically measured. The technique and methodology were validated on a standard skeletal model. Sacrum height was 111.2 +/- 12.6 mm (77-138 mm) in men and 104.7 +/- 8.2 (89-125 mm) in women. The difference between the two sexes regarding SH was significant (p < 0.0001). SH did not significantly correlate with age in men, whereas the correlation was significant in women (p < 0.03). The correlation between SH and the stature was significant in men (r = 0.427, p < 0.0001) and was insignificant in women. For men the regression equation was [Stature = (0.306 x SH) + 137.9] (r = 0.54, SEE = 56.9, p < 0.0001). Sacrum height is not susceptible to sex, or to age in men. In the presence of incomplete male skeletons, SH helps to determine the stature. This study is also one of the initial applications of MDCT in virtual anthropometric research.Öğe Ultrasonographic Screening of Newborns for Congenital Anomalies of the Kidney and the Urinary Tracts(Urol & Nephrol Res Ctr-Unrc, 2010) Tabel, Yilmaz; Haskologlu, Zeliha Sule; Karakas, Hakki Muammer; Yakinci, CengizPurpose: To search for the efficiency of scanning the newborns with routine urinary system ultrasonography. Materials and Methods: Urinary ultrasonography has been carried out on 721 infants born in or brought to our hospital. During the study, name, sex, week of birth, presence of antenatal diagnosis or urinary tract infections, and pathologies in examinations of the babies were recorded. Ultrasonography analysis was done with a scanner by a radiologist. Patients identified to have patholog y, were watched closely in pediatric nephrology clinic, and advanced visualizations and treatments were carried out. Results: Seventy-six infants (10.5%) had congenital anomalies of the kidney and the urinary tracts that prompted medical and/or surgical intervention. Of whom, 32 were diagnosed with antenatal ultrasonography and 44 during their initial postnatal ultrasonography screening. The most frequent identified pathology was hydronephrosis, in particular physiologic hydronephrosis (35.8%). The most frequent congenital urinary anomaly which caused hydronephrosis was ureteropelvic obstruction. Conclusion: It is suggested to apply the urinary ultrasonography scanning to all the infants that are born or brought to the university hospital. If possible, it is to be considered to include urinary ultrasonography scanning in newborn scanning programs.Öğe THE VALUE OF MAGNETIC RESONANCE IMAGING IN BILATERAL SYNCHRONOUS BREAST CANCER(Kare Publ, 2005) Tuncbilek, Nermin; Okten, Ozerk Omur; Karakas, Hakki Muammer; Tokatli, FusunThe prevalence of synchronous bilateral breast cancer is approximately 1-3%. It has a greater risk for distant metastasis than unilateral breast cancer. The early determination of the bilaterality and multifocality of the breast cancer could change the therapeutic options, and subsequently reduce the mortality and morbidity rates. Current screening methods for the breast cancer are mammography and clinical examination. In this paper, we evaluated the additional diagnostic value of dynamic contrast-enhancement magnetic resonance mammography to conventional techniques.
