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    Can T1W and T2W Dixon Sequences Replace the Standard MRI Protocol in Diagnosing Sacroiliitis?
    (Ubiquity Press Ltd, 2024) Karatoprak, Nur Betul; Ozdemir, Zeynep Maras; Karatoprak, Sinan; Kahraman, Aysegul Sagir; Karaca, Leyla; Yolbas, Servet
    Objectives: This study aims to assess the performances of T1-weighted (T1W) and T2-weighted (T2W) Dixon sequences as replacements for the standard magnetic resonance imaging (MRI) protocol for diagnosing active and chronic sacroiliitis. Materials/Methods: This single-centre, prospective study included 107 patients who underwent 3 Tesla MRIs. The patients with inflammatory low-back pain (aged 18-50 years) were included. The exclusion criteria included pregnancy, pelvic infection/malignancy history, pelvic metal implants or foreign body artefacts. The imaging protocol comprised standard T1W and T2W fat-saturated (T2W-FS) sequences and T1W-T2W Dixon sequences. Active sacroiliitis signs were assessed by comparing T2W-FS images with T2W Dixon water-only (WO) images. Chronic sacroiliitis signs were evaluated by comparing the standard T1W sequence with T1W-T2W Dixon fat-only (FO), in-phase (IP) and out-of-phase (OP) images. The quantitative analysis involved calculating signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) for bone marrow edema (BME) and periarticular fat deposition (PFD). Descriptive statistics, correlation, diagnostic performance tests and interobserver reliability tests were performed in the qualitative analysis. Results: There were no statistically significant differences in BME detection between the T2W-FS and T2W Dixon-WO images. T2W Dixon exhibited significantly greater SNRs-CNRs than did the standard protocol for BME and periarticular fat deposition assessments. T1W-T2W Dixon imaging demonstrated sufficiently high diagnostic performance for detecting erosions, periarticular fat deposition and ankylosis compared with the standard protocol. Conclusions: The T2W Dixon sequence has the potential to replace the standard protocol, which would reduce acquisition time. However, we do not recommend the use of the T1W Dixon sequence in routine practice, since standard T1W images provide similar or superior results to T1W Dixon images.
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    Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients?
    (British Inst Radiology, 2020) Erbay, Mehmet Fatih; Kamisli, Ozden; Karatoprak, Nur Betul
    Objective : T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS. Methods: We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI-ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated. Results: No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score. Conclusions: TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains. Advances in knowledge: TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.
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    Investigation of the prognostic value of psoas muscle area measurement in pediatric patients before liver transplantation: A single-center retrospective study
    (Wiley, 2021) Dag, Nurullah; Karatoprak, Sinan; Ozturk, Mehmet; Karatoprak, Nur Betul; Sigirci, Ahmet; Yilmaz, Sezai
    Background: In this study, our aim is to investigate the prognostic value of psoas muscle area (PMA) evaluation before liver transplantation (LT) in pediatric patients. Methods: Two hundred seventy-six patients under 18 years of age who underwent LT between January 2012 and December 2019 were included in the study. The patients' demographic, laboratory, clinical, and imaging data were scanned retrospectively. PMA was measured at the L4/5 level using computed tomography images. To determine reproducibility, a different radiologist evaluated 30 randomly selected patients. Results: In patients with end-stage liver disease (ESLD), PMA was significantly lower than in patients with acute liver failure (P < .001). In patients with ESLD, a weakly significant correlation was found between PMA and 1-year survival after LT (r: .251, P = .030), hospitalization period (r: -.275, P = .039), and pediatric ESLD score (r: -.338, P < .001). Interobserver correlation was excellent (ICC: .941, 95% CI: .925, .971). Conclusion: In children with ESLD, PMA evaluated before LT can be used as a negative prognostic factor.
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    Nervus ischiadicus variations and clinical importance: A cadaver and MRI study
    (Bayrakol Medical Publisher, 2025) Tas, Ferhat; Ozbag, Davut; Ogeturk, Murat; Ozdemir, Zeynep Maras; Karatoprak, Nur Betul; Cevirgen, Furkan; Arpaci, Furkan
    Aim: In this study, the variations, bifurcation levels, morphometric and topographic features of the ischiadicus nerve (NI), which has an important role in its protection, were investigated. Material and Methods: In eighteen cadaver limb dissections, variations related to NI and musculus piriformis (MP) and NI bifurcation levels, morphometric and topographic features of NI were investigated. At the foramen infrapiriforme (FI) exit, the distance between NI and trochanter major (TM), spina iliaca anterior superior (SIAS), crista iliaca (CI), spina iliaca posterior superior (SIPS), hiatus sacralis (HS) and tuber ischiadicum (TI) was measured. NI variations were investigated in 115 hip MRIs of 59 patients in the radiology archives. Results: No variation was encountered in NIs other than Type A, which is the most common and considered normal. In all lower extremities, it was observed that the NI bifurcated in the distal 1/3 of the thigh (Group E). FI-TM: 71 +/- 9.62 mm, FI-SIAS: 129.56 +/- 8.98 mm, FI-CI: 134.6 +/- 6.33 mm, FI-SIPS: 80.77 +/- 10.40 mm, FI-HS: 78.16 +/- 10.54 mm and FI-TI: 55.11 +/- 5.56 mm was found. 115 Magnetic resonance radiographs (MRI) showed Type B variation in 5 hips (4.34%) and Type A variation in the others (95.65%). Discussion: We think that our cadaver and MRI study can serve as a guide during clinical practice and will be useful in reducing NI injuries.
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    Percutaneous radiological biliary interventions after failed endoscopic treatment in living liver donors: experience of a high-volume transplantation center
    (Wiley, 2021) Karatoprak, Sinan; Kutlu, Ramazan; Karatoprak, Nur Betul; Dag, Nurullah; Yilmaz, Sezai
    This study aimed to evaluate the role of percutaneous radiological treatments for biliary complications (BCs) in donors after living donor liver transplantation (LDLT). We retrospectively evaluated BCs in donors involved in 1839 LDLTs between May 2009 and January 2019 at our centre. BCs were classified according to the modified Clavien-Dindo classification (MCDC). Patients treated with percutaneous transhepatic biliary intervention (PTBI) were identified. Complications requiring endoscopic, interventional or surgical treatment (MCDC grades III-IV) involved 123 (6.6%) donors. Complications comprised leakage, n = 73 (60%); stricture, n = 36 (29%); and both leakage and stricture, n = 14 (11%). Percutaneous drainage of biloma formations under ultrasound guidance was performed in 57 donors, endoscopic treatment in 83 and PTBI in 14. Of 83 patients who received endoscopic treatment, 13 were referred for PTBI due to failure or uncannulation. Eight of 14 patients were successfully treated with PTBI. Six patients were treated with a rendezvous procedure combining percutaneous and surgical treatments. In 13 patients, no BCs were developed after catheter or stent removal. In donors with BCs, the treatment should progress from the least invasive method to surgery. In some patients, percutaneous radiological treatments eliminate the need for surgery or can guide surgical treatment.