Bişar Akbaş

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.

Background/Objectives: Same-session hybrid treatment joins embolization to immediate microsurgical resection under one anesthetic, closing the interval of partial devascularization that follows staged embolization. Comparative data are scarce. We set out to compare angiographic, functional and safety outcomes after hybrid and after endovascular-only treatment and to judge how far any difference reflects case selection and calendar period rather than the strategies themselves. Methods: We reviewed 43 consecutive patients treated for cerebral arteriovenous malformation at one center between May 2012 and December 2024. Nineteen received same-session hybrid treatment and 24 embolization without same-session surgery. The primary endpoint was complete obliteration on six-month angiography. Differences are reported with 95% confidence intervals, and odds ratios were estimated using Firth penalized regression, since both principal comparisons showed complete separation. Results: Hybrid patients were younger (median 31.0 versus 42.5 years; p = 0.040), with similar sex distribution and Spetzler–Martin grade. Complete obliteration was reached in all 19 hybrid patients (100%) and in 14 of 24 endovascular-only patients (58.3%), representing a difference of 41.7 percentage points (95% CI 17.6–61.2). All four deaths occurred in the hybrid group (21.1% versus 0%; p = 0.031). Complications (15.8% versus 12.5%) and favorable outcome (mRS 0–2, 68.4% versus 75.0%) did not differ. The strategies also belonged to different periods. Eight of 19 hybrid but 21 of 24 endovascular patients were treated before 2019 (p = 0.003), as were three of the four deaths. Conclusions: The hybrid treatment obliterated every malformation but accounted for every death, with no difference in functional outcome. Because the groups served different clinical purposes in different eras, these observations are hypothesis-generating rather than grounds for changing practice.

Elastographic data regarding thyroid involvement in systemic sclerosis (SSc) are limited. This study aimed to evaluate thyroid parenchymal stiffness in patients with SSc using two-dimensional shear wave elastography (2D-SWE) and to investigate its relationship with clinical parameters. This single-center, cross-sectional case-control study included 36 SSc patients and 36 age- and gender-matched healthy controls. All participants underwent thyroid ultrasonography and 2D-SWE. Thyroid volume was calculated using the ellipsoid formula, and elasticity values were recorded in kilopascals (kPa). Clinical characteristics, laboratory parameters, and disease severity indices were recorded, and correlation analyses were performed. Thyroid volume and isthmus thickness were similar between groups (all p > 0.05; d = 0.10-0.35). Right, left, and total thyroid elasticity values were significantly higher in SSc patients than in controls before and after smoking adjustment (all unadjusted p ≤ 0.001; all adjusted p ≤ 0.007; d = 0.83, 0.79, and 0.90, respectively). Right lobe elasticity correlated weakly with erythrocyte sedimentation rate (r = 0.355; p = 0.034), while left and total thyroid elasticity correlated moderately with ejection fraction (r = 0.423; p = 0.010 and r = 0.390; p = 0.019, respectively). No significant associations were found with disease duration, modified Rodnan skin score, EUSTAR Activity Index, Medsger Disease Severity Score, autoantibody status, or major organ involvement. In SSc, thyroid parenchymal stiffness increases without volume change. This suggests that the fibrotic process may be reflected in the thyroid tissue at a subclinical level. Thyroid elastography may be a potential method for evaluating organ-specific fibrotic changes in SSc; further large-scale and prospective studies are needed to clarify its clinical significance.

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.

Background/Aims: This study aimed to evaluate preoperative models based on gadoxetic acid (Gd-EOB-DTPA [gadolinium ethoxyben zyl diethylenetriamine pentaacetic acid])–enhanced magnetic resonance imaging (MRI) radiomics for predicting the histopathological grade of hepatocellular carcinoma (HCC). Materials and Methods: This retrospective study included 68 treatment-naïve patients with histopathologically confirmed HCC from September 2015 to November 2021. Tumors were categorized into well-differentiated and non-well-differentiated groups. Radiomics features were extracted from preoperative hepatobiliary phase MRI images. Logistic regression (LR) with least absolute shrinkage and selection operator selection was used to identify key radiomics features and clinical parameters. Three models—radiomics, clinical, and combined clinical-radiomics (CCR)—were developed to predict HCC differentiation. Results: The radiomics and clinical models achieved area under the curve (AUC) values of 0.803 and 0.749, respectively, while the CCR model showed superior performance (AUC 0.827). In the clinical model, the albumin-bilirubin score was an independent risk factor (P < .05). The radiomics score was significantly lower in well-differentiated tumors (P < .001). Radiomics features were independent predic tors in the CCR model (P = .005). Conclusion: Radiomics features from hepatobiliary phase MRI and clinical parameters can effectively predict the differentiation grade of HCC, aiding in preoperative decision-making. However, the study is limited by its small sample size and the absence of external vali dation; therefore, further multicenter studies are necessary. Cite this article as: Akbas B, Balli T, Aikimbaev K, et al. Prediction of histopathological grade of hepatocellular carcinoma by gadoxetic acid–enhanced magnetic resonance imaging radiomics features. Turk J Gastroenterol. Published online November 21, 2025. doi:10.5152/tjg.2025.25431.

Purpose: This study aimed to investigate the characteristics of abdominal crush injuries using multidetector computed tomography (MDCT) in survivors of earthquakes centered in Kahramanmaraş. Materials and Methods: Retrospective evaluation was conducted on 255 patients who sustained injuries due to an earthquake centered in Kahramanmaraş and were treated at our hospital. Patients clinically suspected of having abdominal crush trauma underwent MDCT examinations. The presence of abdominal wall injuries, solid organ injuries, free fluid in the abdomen, pneumoperitoneum, and subcutaneous emphysema findings were examined. Results: The median time between injury and MDCT examination was 3 days, ranging from 4 hours to 8 days. Among pediatric and adult age groups, males constituted 42.6% (52/122) and 47.4% (63/133), while females were 57.4% (70/122) and 52.6% (70/133), respectively. The mortality rates for pediatric and adult age groups were 0.4% (1/122) and 4.3% (11/133), respectively. Among patients with fatal outcomes, rates of acute kidney injury, subcutaneous emphysema, spleen injuries, and renal/perirenal injuries were 8.3% (1/12), liver and abdominal wall injuries were 16.7% (2/12), and free fluid in the abdomen was observed at a rate of 33.3% (4/12). Conclusion: Abdominal wall injuries were the most frequently observed manifestations of crush injuries, with renal/perirenal injuries being the most common among solid organs, and liver injuries being commonly seen among intraperitoneal organs. These findings underscore important characteristics of abdominal crush trauma related to earthquakes.