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Öğe Atlanto-odontoid osteoarthritis in rheumatoid arthritis: dynamic CT findings(Springer, 2004) Baysal, O; Baysal, T; Sigirci, A; Ersoy, Y; Altay, ZWe analyzed the CT appearances of degenerative change in the atlanto-odontoid joint (AOJ) in patients with rheumatoid arthritis (RA) and evaluated the effect of these changes on atlanto-axial joint (AAJ) rotation by dynamic CT. This revealed that 9 patients (24%) treated with methotrexate had degenerative features in the AOJ. The ratio of AAJ rotation to the total rotation of the cervical spine was significantly higher in normal subjects (54+/-3%) than in patients (38+/-12%). The degree of AAJ rotation was significantly lower in the patient group with degenerative features in the AOJ (20.9+/-8.4degrees) than in patients without degenerative features (28.5+/-7.4degrees). RA patients with a history of longstanding disease and treatment with antirheumatic drugs may develop AO OA. Although secondary OA was described as healing phenomena in the joints of RA patients, it can limit rotation in the AAJ and cause suboccipital neck pain. A regular check-up of the AAJ and AOJ by means of dynamic CT in all RA patients is proposed to avoid possible antirheumatic drug complications.Öğe Bardet-Biedl syndrome associated with vaginal atresia(Turkish J Pediatrics, 2003) Uguralp, S; Demircan, M; Çetin, S; Sigirci, AThis is a case report of Bardet-Biedl syndrome associated with vaginal atresia diagnosed in a 15-year-old girl. She had mild mental retardation; obesity; nistagmus, retinitis pigmentosa and optic atrophy in both eyes; accessory digit on the left hand; polydactyly in lower extremities; a mobile, painful, nonfixed mass of 6 cm in diameter in the pelvic region; a palpable cystic mass in front of the rectal wall; and no vaginal opening. Secondary sex characteristics were determined. The vaginal atresia was distinguished from vaginal agenesis by the presence of proximal vagina in radiological examination.Öğe Brain MR spectroscopy in children with a history of rheumatic fever with a special emphasis on neuropsychiatric complications(Elsevier Sci Ireland Ltd, 2004) Alkan, A; Kutlu, R; Kocak, G; Sigirci, A; Emul, M; Dogan, S; Aslan, MPurpose: To investigate whether there are metabolite changes in basal ganglia of children with complete healing of rheumatic fever (RF), history of Syndenham chorea (SC) and obsessive compulsive-tic disorder (OCTD) developed after RF when compared with healthy controls and each other. Material and methods: A total of 49 children with history of RF and 31 healthy controls were included into the study. All patients and control group underwent a detailed neuropsychiatric evaluation. Children with the history of RF were classified into-three groups as; group 1: with history of RF without neuropsychiatric complications (NCRF), group 2: only with history of SC (HSC), group 3: with HSC and OCTD (OCTD). After MR imaging, single voxel MR spectroscopy was performed in all subjects. Voxels (15 x 15 x 15 mm) were placed in basal ganglia. N-acetyl aspartate (NAA)/creatin (Cr), and choline (Cho)/Cr ratios were calculated. Results: OCTD were detected in 13 children with HSC. NAA/Cr ratio was found to be decreased in these children when compared with NCRF (n:29), HSC without OCTD (n:7) and control groups (n:3 1). No significant difference was found in metabolite ratios of children with HSC without OCTD when compared with NCRF and control groups. There were no significant differences in Cho/Cr ratio between patient and control groups. Conclusion: Although MR imaging findings was normal, MR spectroscopy findings (decreased NAA/Cr ratio) in our study support the neuronal loss in basal ganglia of children with OCTD and could indicate the development of permanent damage. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe The cisternal segment of the abducens nerve in man: three-dimensional MR imaging(Elsevier Sci Ireland Ltd, 2004) Alkan, A; Sigirci, A; Ozveren, AF; Kutlu, R; Altinok, T; Onal, C; Sarac, KPurpose: The goal of this study was to identify the abducens nerve in its cisternal segment by using three-dimensional turbo spin echo T2-weighted image (3DT2-TSE). The abducens nerve may arise from the medullopontine sulcus by one singular or two separated rootlets. Material and methods: We studied 285 patients (150 males, 135 females, age range: 9-72 years, mean age: 33.3 +/- 14.4) referred to MR imaging of the inner ear, internal auditory canal and brainstem. All 3D T2-TSE studies were performed with a 1.5 T MR system. Imaging parameters used for 3DT2-TSE sequence were TR:4000, TE:150, and 0.70 mm slice thickness. A field of view of 160 mm and 256 x 256 matrix were used. The double rootlets of the abducens nerve and contralateral abducens nerves and their relationships with anatomical structures were searched in the subarachnoid space. Results: We identified 540 of 570 abducens nerves (94.7%) in its complete cisternal course with certainty. Seventy-two cases (25.2%) in the present study had double rootlets of the abducens nerve. In 59 of these cases (34 on the right side and 25 on the left) presented with unilateral double rootlets of the abducens. Thirteen cases presented with bilateral double rootlets of the abducens (4.5%). Conclusion: An abducens nerve arising by two separate rootlets is not a rare variation. The detection of this anatomical variation by preoperative MR imaging is important to avoid partial damage of the nerve during surgical procedures. The 3DT2-TSE as a noninvasive technique makes it possible to obtain extremely high-quality images of microstructures as cranial nerves and surrounding vessels in the cerebellopontine cistern. Therefore, preoperative MR imaging should be performed to detect anatomical variations of abducens nerve and to reduce the chance of operative injuries. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Delayed myelination in a rhizomelic chondrodysplasia punctata case: MR spectroscopy findings(Elsevier Science Inc, 2003) Alkan, A; Kutlu, R; Yakinci, C; Sigirci, A; Aslan, M; Sarac, KRhizomelic chondrodysplasia punctata is a member of genetic peroxisomal disorders. Delayed myelination, which is probably related to the inadequacy of plasmalogens biosynthesis, is an important feature of this disorder. Direct assessment of neuropathologic aspects of RCDP syndrome such as neuronal degeneration and delayed myelination is possible with MR spectroscopy. In this report, MR spectroscopy findings (decreased Cho/Cr and increased Ins-Gly/Cr ratios and increased levels of mobile lipids) of a rhizomelic chondrodysplasia punctata case supporting delayed myelination are presented. This is the second report of MR spectroscopy examination of the specific brain metabolic changes associated with rhizomelic chondrodysplasia punctata. (C) 2003 Elsevier Science Inc. All rights reserved.Öğe Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis(Wiley, 2001) Sigirci, A; Baysal, T; Kutlu, R; Aladag, M; Sarac, K; Harputluglu, HPurpose. The purpose of this study was to evaluate the Doppler sonographic blood-flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission-phase) ulcerative colitis (UC). Methods. The IMAs and SMAs of 25 patients with active-phase UC (group 1), 19 patients with remission-phase UC (group 2), and 22 healthy, asymptomatic subjects (control group) were evaluated by duplex Doppler sonography. The 25 patients in group 1 were categorized into 2 subgroups on the basis of the extent of disease as determined by double-contrast barium enema x-ray study and colonoscopy. The first subgroup (group 1a) consisted of 11 patients with active involvement of the left colon from the rectum to the splenic flexure. The second subgroup (group 1b) consisted of 14 patients with active involvement of the entire colon. The peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (Vmean), resistance index (RI), and pulsatility index (PI) were determined from the Doppler spectral analysis. The inner diameter and cross-sectional area of the IMA and SMA were measured, and the blood-flow volume was calculated. The results were compared between the patient groups and control subjects. Results. In the IMA, the mean blood-flow volume, mean PSV, mean EDV, and Vmean were significantly higher, the mean PI was significantly lower, and the mean diameter and the mean cross-sectional area were significantly larger in group 1 than in group 2 or in the control group (p < 0.001). The mean PSV and the Vmean of the IMA were significantly higher in group la than in group Ib (p < 0.05). The mean blood-flow parameters in the SMA were not significantly different between groups 1 and 2 or between either group 1 or group 2 and the control subjects. The mean EDV in the SMA was significantly higher and the mean PI and the mean RI were significantly lower in group 1b than in group 1a (p < 0.01). Conclusions. Duplex Doppler sonography of the IMA and SMA can be used to evaluate inflammatory disease of the large bowel, to assess disease extent, and to document response to therapy. (C) 2001 John Wiley & Sons, Inc.Öğe Doppler waveforms and blood flow parameters of the superior and inferior mesenteric arteries in patients having Behcet disease with and without gastrointestinal symptoms -: Preliminary data(Amer Inst Ultrasound Medicine, 2003) Sigirci, A; Senol, M; Aydin, E; Kutlu, R; Alkan, A; Altinok, MT; Yologlu, SObjective. To evaluate hemodynamic changes in mesenteric arteries in patients with Behcet disease with and without gastrointestinal symptoms. Methods. Doppler sonography of mesenteric arteries was performed in 25 symptomatic and 15 asymptomatic patients having Behcet disease and in 25 healthy control subjects. The peak systolic, minimal, and mean velocities, resistive and pulsatility indexes, inner diameter, cross-sectional area, and blood flow volume of mesenteric arteries were evaluated. The results were compared between patient groups and controls. Results. The mesenteric artery flow was significantly greater in patients in the symptomatic group than in those in the asymptomatic group or in controls. In the superior mesenteric artery, mean velocity and mean blood flow volume (0.35+/-0.18 m/s and 711+/-404 mL/min, respectively; P<.0001) in the symptomatic group were significantly higher than in the asymptomatic group (0.16±0.07 m/s and 305±168 mL/min, respectively) or in controls (0.15±0.07 m/s and 290±123 mL/min, respectively). The mean peak systolic velocity (1.23±0.47 m/s; P<.005) in the symptomatic group was significantly higher than in controls (0.93+/-0.23 m/s). In the inferior mesenteric artery, mean velocity and mean blood flow volume (0.25+/-0.10 m/s and 139+/-79 mL/min) in the symptomatic group were significantly higher than in the asymptomatic group (0.16+/-0.07 m/s; P<.006; and 78±26 mL/min; P<.007) or in controls (0.17+/-0.07 m/s; P<.0031; 83±48 mL/min; P<.004). Conclusions. In this study, symptomatic patients with gastrointestinal Behcet disease were associated with a significant increase in mesenteric artery flow that could be evaluated easily on spectral patterns of arteries during Doppler sonography. The Doppler sonographic findings also revealed that intestinal involvement in patients with Behcet disease without gastrointestinal symptoms is not significantly different from that of healthy controls.Öğe Early MRI findings in stab wound of the cervical spine(Springer-Verlag, 2002) Alkan, A; Baysal, T; Saraç, K; Sigirci, A; Kutlu, RMR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings.Öğe Early- and late-state subacute sclerosing panencephalitis: Chemical shift imaging and single-voxel MR spectroscopy(Amer Soc Neuroradiology, 2003) Alkan, A; Sarac, K; Kutlu, R; Yakinci, C; Sigirci, A; Aslan, M; Baysal, TBACKGROUND AND PURPOSE: Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. Our aim was to determine the metabolic abnormalities of brain in early- and late-stage SSPE by using MR spectroscopy and to assess areas of involvement in the early stages when MR imaging findings were normal. METHODS: Children with stage II (n = 3) or III (n = 3) SSPE and 10 healthy, age-matched children underwent MR imaging, multivoxel MR spectroscopy, and short-echo single-voxel MR spectroscopy (SVS). Areas of involvement in the brain were determined with chemical shift imaging. For SVS, 2 x 2 x 2-cm voxels were placed in the frontal subcortical white matter (FSWM) and parieto-occipital white matter (POWM). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (Ins)/Cr, and NAA/Cho ratios were calculated. RESULTS: Comparisons of NAA/Cr, Cho/Cr, Ins/Cr and NAA/Cho ratios between patients and control subjects showed significant differences in FSWM and POWM (P <.0l). In patients with SSPE, NAA/Cr ratios in POWM were significantly less than those in FSWM (P <.0l). NAA/Cr ratios in patients with stage II SSPE and those in the control group were not significantly different; this may reflect the absence of neuronal loss. Decreased NAA/Cr, increased Cho/Cr and Ins/Cr ratios, and increased lactate and lipid peaks were found in patients with stage III SSPE. CONCLUSION: MR spectroscopy showed findings suggestive of inflammation in stage II and findings of demyelination, gliosis, cellular necrosis, and anaerobic metabolism in stage III. MR spectroscopy could be a promising technique for early diagnosis and treatment planning in cases of SSPE.Öğe The effects of the chorda tympani damage on submandibular glands: biometric changes(Elsevier Sci Ltd, 2003) Miman, MC; Sigirci, A; Ozturan, O; Karatas, E; Erdem, TObjective: It was aimed to analyze the biometric changes in ipsilateral submandibular glands of patients with unilateral chorda tympani (ChT) section during otological operations, compared with change in size of the contralateral glands and with those of healthy subjects. Method: 29 patients with unilateral complete ChT section and 29 healthy subjects with identical ages, genders, and weights to the patient group were examined ultrasonographically. The patients having a mean duration to follow-up examination of 32 months (2-84 months) were subdivided into two groups by their time to follow-up as short-term patient group (2-12 months. 14 patients) and long-term patient group (13-84 months. 15 patients). The ultrasonographic dimensions and volumes of submandibular glands were compared statistically between the groups. Results: In the patient group. the glands on the contralateral, non-operated side were found to be greater than the ipsilateral. denervated glands in terms of both paramandibular depth dimension (P <0.05) and volume (P <0.01). The differences could be determined only in long-term patient group. When comparing the submandibular glands of the patient group with those of the control group, it was found that paramandibular depth dimension and volume of the submandibular g-lands on the contralateral, non-operated side were statistically greater (P <0.01). There was no difference between submandibular glands on the operated side of the patient group and those of the control group (P >0.05). Conclusion: The late (13-84 months) biometric results of ChT damage on submandibular gland were significant for increase in the size of the contralateral, non-denervated submandibular gland. An atrophying effect was not ascertained in the submandibular glands denervated parasympathetically due to the section of the ChT. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe En-plaque tuberculomas of tentorium in a pregnant woman(Springer-Verlag, 2003) Alkan, A; Parlak, M; Baysal, T; Sigirci, A; Kutlu, R; Altinok, TEn-plaque tuberculoma is a rare manifestation of CNS tuberculosis and presents as a solitary, focal, caseous plaque-like lesion. It is difficult to differentiate en-plaque like meningeal tuberculoma from true primary or secondary meningeal neoplasia. Good response to antituberculosis treatment in a patient with tuberculosis history and typical MR findings confirm the diagnosis. We present the follow-up MR imaging findings of a case in which an enplaque tuberculoma on tentorium was diagnosed during pregnancy in a patient with a history of tuberculosis. To the best of our knowledge, enplaque tuberculomas of tentorium during pregnancy have not been reported before.Öğe Endothelial function and slow coronary flow(Elsevier Science Inc, 2003) Sezgin, A; Sigirci, A; Barutcu, I; Topal, E; Sezgin, N; Ozdemir, R; Gullu, H[Abstract Not Available]Öğe Giant axonal neuropathy: MRS findings(Sage Publications Inc, 2003) Alkan, A; Kutlu, R; Sigirci, A; Baysal, T; Altinok, T; Yakinci, CGiant axonal neuropathy (GAN) is a rare genetic disease of childhood involving the central and peripheral nervous systems. Axonal loss with several giant axons filled with neurofilaments is the main histopathological feature of peripheral nerve biopsies in this disease. Routine neuroimaging studies reveal diffuse hyperintensities in cerebral and cerebellar white matter. In this case report, the authors present the brain magnetic resonance spectroscopic features (normal N-acetylaspartate/creatine and increased choline/creatine and myoinositol/creatine ratios), which might indicate the absence of neuroaxonal loss and the presence of significant demyelination and glial proliferation in white matter, of an 11-year-old boy diagnosed with GAN.Öğe Glutaric aciduria type I diagnosed after poliovirus immunization: Magnetic resonance findings(Elsevier Science Inc, 2002) Alkan, A; Baysal, T; Yakinci, C; Sigirci, A; Kutlu, RGlutaric aciduria type I is an uncommon inborn error of metabolism. It is a serious disease, often with a fatal outcome. Magnetic resonance imaging findings and the clinical course of monozygotic twin females with glutaric aciduria type I who were admitted with acute encephalopathic crisis symptoms 3 days after immunization for poliovirus are presented in this report. Magnetic resonance imaging findings revealed hyper-intensity in the putamen, head of the left caudate nucleus, and globus pallidus, periventricular white matter (on T-2-weighted images), arachnoid cysts in bilateral temporal regions, and enlargement of the sylvian fissures. Glutaric aciduria type I should be included in the differential diagnosis of patients with acute encephalopathic crisis occurring shortly after poliovirus immunization. Typical magnetic resonance findings guide urinary organic acid analysis in these patients. (C) 2002 by Elsevier Science Inc. All rights reserved.Öğe Hallermann-Streiff syndrome associated with complete agenesis of the corpus callosum(Sage Publications Inc, 2005) Sigirci, A; Alkan, A; Biçak, U; Yakinci, CHallermann-Streiff syndrome is a rare clinical entity with unknown etiology characterized by a birdlike face, microphthalmia, a beaked nose, hypotrichosis, and proportional small stature. We present a 4-year-old boy in whom magnetic resonance imaging showed complete agenesis of the corpus callosum, which has not been presented in the literature.Öğe Infantile Sandhoff's disease: Multivoxel magnetic resonance spectroscopy findings(B C Decker Inc, 2003) Alkan, A; Kutlu, R; Yakinci, C; Sigirci, A; Aslan, M; Sarac, KSandhoff's disease is a rare, genetic lysosomal storage disease leading to delayed myelination or demyelination. Although neuroimaging findings in this disease have been reported previously, magnetic resonance spectroscopy findings have not been reported. In this report, we present magnetic resonance imaging and magnetic resonance spectroscopy features of two cases with Sandhoff's disease. Magnetic resonance spectroscopy revealed findings indicating widespread demyelination in both cases and neuroaxonal loss and anaerobic metabolism in the second case. Magnetic resonance spectroscopy could provide useful information in the explanation of the clinical picture of cases with Sandhoff's disease.Öğe Intratesticular arteriovenous malformation - Color Doppler sonographic findings(Amer Inst Ultrasound Medicine, 2003) Kutlu, R; Alkan, A; Soylu, A; Sigirci, A; Dusak, AArteriovenous malformations (AVMs) of male genitalia are rare. In the literature there are reports of AVMs involving the scrotum,(1,2) penis,(3) spermatic cord,(4) testis, and epididymis(5) and interventional. treatment of scrotal AVMs.(6) In our literature search, we found no report about intratesticular AVMs. In this report we present the sonographic features of a small intratesticular AVM, which was incidentally found in a patient during scrotal examination for infertility evaluation. This rare entity should be considered in the differential diagnosis of intratesticular masses.Öğe Lower prevalence of non-tumoral perfusion defects in left hepatic lobe during CT arterial portography with splenic artery injection(Elsevier Sci Ireland Ltd, 2004) Kutlu, R; Akbulut, A; Sigirci, A; Alkan, A; Karaman, I; Baysal, T; Sarac, KObjective: To determine whether there is a difference in the prevalence of non-tumoral perfusion defects (NTPD) in left hepatic lobe during CT arterial portography (CTAP) through splenic (SA) and superior mesenteric artery (SMA) injection. Methods and patients: For the preoperative evaluation, 59 patients (20 females, 39 males) who either have colorectal carcinoma metastasis (n: 42) or hepatocellular carcinoma (n: 17) underwent CTAP examination. Patients were divided, into two groups (SA and SMA) according to the injection artery. The presence and type of NTPD in the left hepatic lobe were determined and compared. Results: There were significant differences in peripherally located wedge shaped, perihilar-periligamentous and pericholecystic NTPD, but no significant difference was found in lobar/segmental defects between the groups. Conclusions: Our study demonstrated lower prevalence of NTPD in the left hepatic lobe in CTAP's performed through SA injection and we think that this could be explained by the streamlining of portal blood flow. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Multivoxel magnetic resonance spectroscopy in a rhizomelic chondrodysplasia punctata case(Sage Publications Inc, 2005) Sigirci, A; Alkan, A; Kutlu, R; Gülcan, HA case of a 5-day-old newborn with rhizomelic chondrodysplasia punctata was investigated with multivoxel magnetic resonance spectroscopy, including chemical shift imaging maps, which disclosed a decrease in the choline peak and the choline signal intensity, respectively, in the right cerebral hemisphere. This is the second report of multivoxel magnetic resonance spectroscopy examination of the brain associated with rhizomelic chondrodysplasia punctata in the literature. Multivoxel magnetic resonance spectroscopy with chemical shift imaging maps has the advantage of obtaining more information in a short period of time, which shortens the duration of anesthesia and its associated risks and complications. We suggest that future efforts be directed to evaluating such patients with multivoxel magnetic resonance spectroscopy instead of single-voxel magnetic resonance spectroscopy.Öğe Neurofibromatosis type 1: Diffusion weighted imaging findings of brain(Elsevier Ireland Ltd, 2005) Alkan, A; Sigirci, A; Kutlu, R; Ozcan, H; Erdem, G; Aslan, M; Ates, OPurpose: The purposes of this study were to evaluate the differences in apparent diffusion coefficient (ADC) values between infra and supratentorial unidentified bright objects (UBOs), between UBOs and normal appearing side (NAS, contralateral regions of the UBOs and/or normal appearing region without UBOs) in the neurofibromatosis type 1 patients (NF1) and control group and also to investigate correlation between age and ADC values. Methods: A total of 30 patients and 26 healthy controls were included. The MRI examination consisted of routine imaging and diffusion weighted imaging (DWI). Seven distinct locations (frontal, parieto-occipital and cerebellar white matter, globus pallidum, thalamus, hippocampus, and midbrain) were selected for the analysis. The ADC values were calculated directly from these automatically generated ADC maps with ROI. Results: The ADC values of UBOs were significantly increased in cerebellar white matter, hippocampus, globus pallidum, midbrain, and thalamus when compared with NAS and control group. There were statistically significant differences between NAS and control group in the ADC values obtained from hippocampus and thalamus. There were statistically significant differences between supra and infratentorial UBOs in ADC values. There was a negative correlation between age and the ADC values obtained from normal appearing midbrain, hippocampus, thalamus, and globus pallidum. Conclusion: ADC values both in UBOs and in the normal appearing locations as hippocampus and thalamus were detected to be higher in the patients with NF1. The detection of lesions might be independent of MRI appearance in NF1, i.e. although the brain is affected, MRI appearance may be normal. Therefore, DWI and ADC values should also be utilized in the delineation of brain involvement of NF1 patients. (C) 2005 Elsevier Ireland Ltd. All rights reserved.
