Seray Gizem Gür Özcan

The Importance of Body Fat Composition Evaluated by Computed Tomography and Its Prognostic Significance in Patients with Testicular Cancer - Istanbul Medical Journal

Background: This study aimed to evaluate the diagnostic performance of the Kaiser score (KS) on the modified abbreviated breast magnetic resonance imaging (AB-MRI) protocol for characterizing breast lesions by comparing it with full-protocol MRI (FP-MRI), using the histological data as the reference standard. Methods: Breast MRIs detecting histologically verified contrast-enhancing breast lesions were evaluated retrospectively. A modified AB-MRI protocol was created from the standard FP-MRI, which comprised axial fat-suppressed T2-weighted imaging (T2WI), pre-contrast T1-weighted imaging (T1WI), and first, second, and fourth post-contrast phases. Two radiologists reviewed both protocols, recording the KS for each detected lesion. Sensitivity, specificity, and positive and negative predictive values, as well as accuracy, were calculated for each protocol. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic performance of the modified AB-MRI compared to the FP-MRI. Results: In total, 154 patients with 158 histopathologically proven lesions (107 malignant, 51 benign) were included. For the diagnostic performance of the KS for modified AB-MRI and FP-MRI, the sensitivity was 96.3% vs. 98.1%, the specificity was 78.4% vs. 74.5%, PPV was 90.4% vs. 89%, NPV was 90.9% vs. 95%, and the diagnostic accuracy was 90.5% vs. 90.5%. The area under the curve (AUC) obtained from the ROC curve analysis was 0.873 and 0.863 for modified AB-MRI and FP-MRI for reader 1, respectively, and 0.859 and 0.878 for modified AB-MRI and FP-MRI for reader 2, respectively, (p < 0.001). Conclusions: Our modified AB-MRI protocol revealed comparable results in terms of the diagnostic value of the KS in characterizing breast lesions compared to FP-MRI and reduced both scanning and interpretation time.

Objective:: This study aims to investigate the association of preoperative body composition parameters, measured by computed tomography in patients undergoing surgery for renal cell carcinoma, with its stage and to survey the relationship with postoperative hospitalization duration and survival. Methods:: Demographic data, pathology results, cancer stages, and hospitalization duration of 104 patients undergoing surgery at the urology clinic due to renal cell carcinoma between 2019 and 2023 were analyzed retrospectively. On computed tomography scans acquired during diagnosis, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue, and skeletal muscle area were measured. The ratios of body composition parameters were computed. Results:: When the correlation between survival time and body composition in deceased patients was analysed, a moderate but significant correlation was observed between skeletal muscle area value and total adipose tissue / skeletal muscle area ratio (r=0.630, p=0.001; r=0.598, p=0.002). A significant and strong correlation was observed between total adipose tissue value and survival (r=0.704, p<0.001). Subcutaneous adipose tissue / skeletal muscle area was found to be an independent risk factor associated with mortality, and a ratio of 0.98 or less increased the mortality risk approximately 16-fold. Conclusion:: The relationship between body composition parameters measured by computed tomography, which can be easily evaluated pre-treatment, and mortality, postoperative recovery and length of hospital stay can be evaluated, giving clinicians an idea about the potential difficulties that patients may encounter during the treatment process. For this purpose, the subcutaneous adipose tissue / skeletal muscle area ratio is the most helpful parameter that can be used.

Objectives: The aim of this study is to investigate the hiatus defect diameter by measuring on multi-detector computed tomography images in hiatal hernia patients. Methods: The multi-detector computed tomography images of 50 patients and 50 individuals in control group included in this study were investigated. The hiatus surface area (cm²), hiatus antero-posterior and transverse diameters (cm), and the thickness of both diaphragmatic crura (mm) were measured by reformatting contrast-enhanced thoraco-abdomino-pelvic computed tomography images using the region of interest method. Results: In this study, a significant difference was obtained among groups according to hiatus surface area, hiatus antero-posterior, and transverse diameter measurements, and both left and right diaphragmatic crural thickness measurements (P<0.001). In the patient group, the cut-off values were determined by using ROC analysis, and the values above these cut-off values enabled a hernia diagnosis with high sensitivity and specificity. Conclusions: Measuring the hiatus surface area on multi-detector computed tomography images could serve as a supplementary criterion for diagnosing of hiatal hernia.

Aim: The aim of this study is to measure the diameter of the cystic artery using computed tomography in patients undergoing emergency surgery for the diagnosis of acute cholecystitis, as well as to understand the role of cystic artery diameter in the diagnosis of acute cholecystitis, and to investigate its association with clinical data, laboratory data, and computed tomography findings. Methods: A total of 187 patients admitted to the general surgery clinic between 2019 and 2023, comprising 123 individuals as the patient group and 64 individuals as the control group, were reviewed in terms of their radiological images, demographic data, and laboratory parameters. The patients' surgical records, laboratory parameters, and computed tomography scans taken during the diagnosis were investigated. Results: The diameter of the cystic artery was measured, and a cut-off value of cystic artery diameter >1.9 mm was found to be sensitive and specific for the diagnosis of acute cholecystitis (AUC: 0.852, 94% sensitivity, 75% specificity, p 1.9 mm was found to be highly specific for the diagnosis of acute cholecystitis. This study suggests that the measurement of cystic artery diameter can be used as an additional criterion in the evaluation of computed tomography for the diagnosis of acute cholecystitis.

Aim: The aim of this study is to measure the diameter of the cystic artery using computed tomography in patients undergoing emergency surgery for the diagnosis of acute cholecystitis, as well as to understand the role of cystic artery diameter in the diagnosis of acute cholecystitis, and to investigate its association with clinical data, laboratory data, and computed tomography findings. Methods: A total of 187 patients admitted to the general surgery clinic between 2019 and 2023, comprising 123 individuals as the patient group and 64 individuals as the control group, were reviewed in terms of their radiological images, demographic data, and laboratory parameters. The patients' surgical records, laboratory parameters, and computed tomography scans taken during the diagnosis were investigated. Results: The diameter of the cystic artery was measured, and a cut-off value of cystic artery diameter >1.9 mm was found to be sensitive and specific for the diagnosis of acute cholecystitis (AUC: 0.852, 94% sensitivity, 75% specificity, p 1.9 mm was found to be highly specific for the diagnosis of acute cholecystitis. This study suggests that the measurement of cystic artery diameter can be used as an additional criterion in the evaluation of computed tomography for the diagnosis of acute cholecystitis.

The aim of this study was to evaluate the reliability and quality of information provided by artificial intelligence chatbots regarding the diagnosis, preventive methods, and treatment of contrast-associated acute kidney injury, while also discussing their benefits and drawbacks. The most frequently asked questions regarding contrast-associated acute kidney injury on Google Trends between January 2022 and January 2024 were posed to four artificial intelligence chatbots: ChatGPT, Gemini, Copilot, and Perplexity. The responses were evaluated based on the DISCERN score, the Patient Education Materials Assessment Tool for Printable Materials score, the Web Resource Rating scale, the Coleman-Liau index, and a Likert scale. As per the DISCERN score, the quality of information provided by Perplexity received a rating of "good", while the quality of information acquired by ChatGPT, Gemini, and Copilot was scored as "average." Based on the Coleman-Liau index, the readability of the responses was greater than 11 for all artificial intelligence chatbots, suggesting a high level of complexity requiring a university-level education. Similarly, the understandability and applicability scores on the Patient Education Materials Assessment Tool for Printable Materials and the Web Resource Rating scale were low for all artificial intelligence programs. In consideration of the Likert score, all artificial intelligence chatbots received favorable ratings. While patients increasingly utilize artificial intelligence chatbots to acquire information about contrast-associated acute kidney injury, the readability and understandability of the information provided may be low.

Mesenteric vein thrombosis (MVT) is a rare cause of acute abdomen and accounts for only 5-15% of all acute mesenteric ischaemia cases. MVTs are classified as either primary MVT, in which the underlying cause can not be determined, or secondary MVT, in which the etiology can be determined. Symptoms usually begin with nonspecific abdominal pain. Progressively increasing abdominal pain is often accompanied by nausea, vomiting and bloody diarrhea. In severe cases, sepsis and septic shock are seen. As the cases usually present with nonspecific symptoms, diagnosis and treatment may be delayed. Despite advanced diagnostic techniques, high mortality rates are seen. We aimed to present a case with a complaint of abdominal pain who underwent interventional thrombectomy and thrombolysis with the diagnosis of superior MVT.

Aim: In this prospective study, our goal is to evaluate the effect of iodine-based contrast agent on renal Apparent Diffusion Coefficient (ADC) before and after the contrast agent in patients with normal and abnormal Glomerulary Filtration Rate (GFR) values using computed tomography (CT) imaging.Methods: The patients who applied for CT examination at an age older than 40 years and met the inclusion criteria of patient and control groups were included. DWI was evaluated by two radiologist in the same session. The range of interest (ROI) was adjusted to be less than 1.5 cm².The Spearman correlation test was used for statistical analysis.Results: A total of 48 subjects (23 and 25 subjects for patient and control groups, respectively) with two DWI scans were included. ADC values were compared for both kidneys before and after the administration of the contrast agent and a significant decrease in post-ADC values was observed in the control group (right kidney pre-ADC: 2,11±0,17 x10ˉ³, post-ADC 2,07±0,15 x10ˉ³ mm²/s, p=0,016; left kidney pre-ADC: 2,11±0,17 x10ˉ³ mm²/s, post-ADC 2,04±0,14 x10ˉ³ mm²/s, p=0,011). However, there was no significant difference between the patient groups according to the administration of contrast agent (right kidney pre-ADC: 1,97±0,22 x10ˉ³ mm²/s, post-ADC: 1,97±0,24 x10ˉ³ mm²/s, p=0,95; left kidney pre-ADC: 1,96±0,23 x10ˉ³ mm²/s, post-ADC: 1,98±0,22 x10ˉ³ mm²/s, p=0,64). Moreover, pre-ADC values in the patient group were relatively low. Pre-ADC values in both groups for the right kidney were 1,97±0,22 x10ˉ³ mm²/s and 2,11±0,17 x10ˉ³ mm²/s, respectively (p=0,016). Pre ADC values in both groups for the left kidney were 1,96±0,23 x10ˉ³ mm²/s and 2,11±0,17 x10ˉ³ mm²/s, respectively (p=0,018). No significant differences in the post-ADC values were observed between the two groups.Conclusion: No decrease in ADC values was observed after the administration of iodine-based contrast agent in patients with a GFR less than 60, whereas there was a relatively high decrease in patients with normal GFR.