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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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    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.