Hasan Bilen Onan

Background: Acute toxic hepatitis after work-related exposure to petroleum products is rare. Its imaging features are not well known. Methods: Seven men aged 18–35 years cleaned the same petroleum storage tank for two days. Symptoms began about 5 days later. Ultrasound and CT were done at admission. Non-contrast 3 T MRI with in-phase and opposed-phase imaging was done about 10 days after exposure. The splenic signal intensity ratio (SIR, in-phase/opposed-phase) was compared with that of 15 age- and sex-matched healthy controls. Results: At admission, median ALT was 481 U/L, median AST 227 U/L, and median total bilirubin 6.1 mg/dL. The injury was hepatocellular by R ratio in the six patients with raised ALT. Periportal edema was seen in 6 of 7 patients. No patient had biliary obstruction or vascular thrombosis. Notably, all seven patients demonstrated paradoxical splenic signal loss on in-phase compared with opposed-phase MRI, with a median splenic signal intensity ratio (SIR) of 0.77 (IQR, 0.74–0.81; range, 0.70–0.87). Splenic SIR was lower in patients than in healthy controls (median 0.77 vs. 1.05; p < 0.001). All patients recovered with supportive care. Conclusions: In this single exposure cluster, the spleen lost signal on in-phase images. This pattern is usually linked to iron or other T2* effects. The finding is preliminary. It needs confirmation with iron measurement, hemolysis tests, and follow-up MRI.

Microwave ablation (MWA) is a widely used treatment for liver metasta-ses, particularly for lesions smaller than 3 cm. Although generally safe, rare complications such as segmental or lobar portal vein thrombosis (PVT) can occur. We present a unique case of tumor-like focal fat deposition in the left hepatic lobe following left PVT, a rare complication of MWA, in a 59-year-old female with pancreatic adenocarcinoma liver metastasis. Post-ablation imaging revealed geographic-shaped areas of focal hepatic steatosis confined to the left lobe, accompanied by left PVT. Dual-echo MRI, a routine but highly effective imaging sequence for liver fat characterization, was instrumental in distinguishing benign fat deposition from tumor recurrence. This case highlights the importance of recognizing focal hepatic steatosis as a rare but significant complication of MWA and PVT, with implications for clinical management and follow-up strategies.

Purpose: This study assessed the influence of external carotid artery (ECA) versus combined ECA and internal carotid artery (ICA) supply on surgical outcomes of Juvenile nasopharyngeal angiofibroma (JNA). Materials and Methods: This retrospective observational study included patients with juvenile nasopharyngeal angiofibroma who underwent preoperative transarterial embolization followed by endoscopic resection between 2007 and 2025. Patients were stratified by vascular supply (ECA-only vs. ECA+ICA) and Andrews–Fisch stage. Demographic data, intraoperative blood loss, and residual tumor status were retrospectively analyzed. Results: The mean age was 17.7 years (range 9–62). Age and ECA branching patterns did not differ significantly between groups. All stage I–II tumors were supplied exclusively by the ECA, whereas stage III–IV tumors showed both ECA-only and ECA+ICA supply. Mean intraoperative blood loss did not differ significantly between vascular groups but was markedly higher in stage III–IV disease than in compared with stage I–II. Residual tumor occurred only in patients with ECA+ICA supply. Conclusion: ICA contribution is strongly associated with advanced-stage JNA and increased risk of residual tumor, although it does not significantly elevate intraoperative blood loss. These findings highlight tumor stage as the main predictor of bleeding and completeness of resection.

Purpose: Dimercaptosuccinic acid (DMSA) renal cortical scintigraphy is the reference standard for the non-invasive diagnosis of renal scar tissue; however, it involves exposure to low doses of radiation. Shear wave elastography (SWE) has recently emerged as a radiation-free, easily applicable technique to measure renal stiffness in renal scar tissue examination. This study aimed to compare the results of DMSA and SWE tests and evaluate whether SWE could serve as an alternative to DMSA in patients. Materials and Methods: This study included 72 patients who underwent elastography of both kidneys prospectively between January 2017 and May 2024 in patients who underwent DMSA examination for various indications. SWE values and stiffness average, standard deviation (SD), median, interquartile range (IQR), and IQR/median values were recorded. Regions of interest were measured in nine areas, three from each of the upper, middle, and lower poles, and mean values were calculated. Results: The mean age of the patients was 21.8±12.9 years. Among the patients, 47 (33.1%) had ectopic kidneys, and 48 (33.8%) had horseshoe kidneys. The mean SWE value was 7.06±1.1 kPa, the stiffness average was 8.63±5.2 kPa, the stiffness SD was 5.77±3.5 kPA, the stiffness median was 4.15±2.3 kPa, the stiffness IQR was 1.20±1.0 kPa, and the stiffness IQR/median was 16.9±15.1%. A statistically significant correlation was observed between the SWE value and DMSA results (p=0.002). Conclusion: The SWE value is successful in evaluating renal parenchyma and shows significant correlation with DMSA results.

Purpose: To investigate the influence of sarcopenia on the outcomes of endovascular treatment in patients with pelvic venous insufficiency (PVI). Material and Methods: A retrospective analysis was conducted on 62 female patients who underwent endovascular treatment for PVI between January 2012 and July 2020. The patients were evaluated using the Visual Analog Scale (VAS) for chronic pelvic pain, both before treatment and three months post-treatment. A successful treatment outcome was defined as a reduction in pelvic pain by 50% or more. Sarcopenia was diagnosed based on the skeletal muscle mass index (SMI) of the patients. Results: Sarcopenia was present in 20 (32.3%) patients. There was no significant difference in preprocedural VAS scores between sarcopenic and non-sarcopenic patients (36.2 ± 16.9 vs. 34.9 ± 16.1, p = 0.781). However, non-sarcopenic patients achieved a significantly greater reduction in VAS scores post-treatment (67.6 ± 22.4% vs. 53.1 ± 24.4%, p = 0.025). A moderate negative correlation was observed between sarcopenia and successful treatment outcomes (r = -0.365, p = 0.004). Conclusion: Sarcopenia negatively impacts the effectiveness of endovascular treatment in patients with PVI. Graphical

Flow-diverting stents in the management of extracranial carotid artery aneurysms - Diagnostic and Interventional Radiology

Purpose The purpose of this study is to investigate the morphometric properties of the internal carotid artery (ICA) by measuring the diameters and angles of its segments and exploring variations related to sex and the presence of aneurysms. Methods Digital subtraction angiography (DSA) images were utilized from 130 aneurysm patients and 75 non-aneurysm individuals to create 3D ICA models using 3D Slicer software. Segment diameters were measured via Autodesk Meshmixer 3.5.474 and angles were evaluated using ImageJ software. Results In total, DSA images of 130 aneurysm patients and 75 individuals with normally reported carotid systems were evaluated. It was found that the intracranial aneurysms (IAs) were predominantly formed on the anterior cerebral artery (ACA) in males (%43), whereas in females IAs were frequently localized in the C6 segment (31.7%) and middle cerebral artery (MCA) (30.2%). In the control group, the evaluation of gender differences in segment diameters and angles revealed that males had significantly larger C4 and C5 segment diameters (4.62 vs. 4.32 mm and 4.41 vs. 4.09 mm, respectively) and a greater C6 angle (146.9° vs. 139.7°) compared to females. Comparisons between patients with an aneurysm at the anterior cerebral artery (ACA) and the control group revealed that the ACA group had wider diameters in the C1 (4.88 vs. 4.53 mm), C3 (4.65 vs. 4.4 mm), C5 (4.51 vs. 4.25 mm), and ACA (2.36 vs. 2.06 mm) segments. Additionally, the ACA group had wider angles in the ACA (104.1° vs. 94.1°) and C6 segments (147.7° vs. 143.3°), whereas the control group exhibited wider angles in the middle cerebral artery (MCA) segment (141.5° vs. 135.5°) compared to the ACA aneurysm group. Patients with anterior cerebral artery (ACA) aneurysms exhibited larger diameters in C1, C3, C5, C6, and ACA segments compared to the control group. Additionally, while the control group had larger MCA angle, patients with ACA aneurysms had larger angles in C6 segment and ACA. Conclusion Our results demonstrated that formation of aneurysms is affected by anatomical configuration of the ICA as well as sex characteristics, particularly regarding the ACA and MCA bifurcation angles, which showed associations with aneurysms in the respective branches.