Purpose: To evaluate the contribution of MRI to ultrasound (US) in the diagnosis of fetal anomalies. Materials and Methods:After informed consent and institutional review board approval, concomitant US and MR imaging were performed for 184 fetuses with suspected anomalies in university hospital. Postnatal final diagnoses were obtained for 183 anomalies in 151 fetuses either by radiological examination, surgery, autopsy, or inspection. The prenatal US and MR diagnoses were compared with respect to postnatal diagnoses. Sign test was used to determine the statistical significance.Results: Both ultrasound and MR imaging correctly diagnosed 93 (50%) cases and failed in 12 (7%) cases. Ultrasound was superior in 7 (4%) cases. MR imaging was superior in 71 (39%) cases (P < 0.001). MR contributed to the prenatal diagnosis by the confirmation of the suspected US diagnosis in 13%, by demonstration of additional findings in 31% and by changing the diagnosis in 56% of the cases. The contribution rates were 55% for the central nervous system (CNS) (P < 0.001), 44% for thorax (P ¼ 0.016), 38% for gastrointestinal system (GIS) (P ¼ 0.031) and 29% for genitourinary system (GUS) (P ¼ 0.003) anomalies. In facial, cardiac and extremity-skeletal system anomalies, there was not a significant contribution of MR imaging over US.Conclusion: MR imaging can be used as an adjunct to US in the prenatal diagnosis of fetal anomalies of not only the CNS but also the non-CNS origin especially those involving the GIS, GUS and thorax. ULTRASOUND (US) IS the standard and primary modality used for the imaging of the fetus. It is widely available, easy to apply, cost-effective, safe for the fetus and allows real-time imaging. However, it has some limitations. Especially in case of oligohydramnios, large maternal body habitus and inappropriate fetal position, its effectiveness reduces. Also in the evaluation of some body parts and complex pathologies, the results of US might be unclear (1,2). In such cases, MR imaging is being increasingly used as a complementary imaging modality.Magnetic resonance imaging has the potential to improve diagnostic accuracy of the prenatal imaging and facilitate the pregnancy management (3-5). It offers a high spatial, temporal, and contrast resolution, which makes the detailed study of fetal pathologies possible. To date, it has not been shown that MR imaging has any adverse effects on the fetal growth or development (2,6).Multiple studies have up to now been published to compare the effectiveness of the prenatal US and MR imaging. These studies showed that MR imaging provides additional information to US in 36% to 57% of the cases (3,4,7,8). Although this effect has been well-established for CNS anomalies, it has not been well-documented for non-CNS anomalies. Additionally, there were some important limitations of these previous studies. In most of these studies, the comparison of the imaging methods had been made without postnatal correlation and MR results had been accepted as the gold-standard. Secondarily, in most...

Introduction. Spontaneous rectus sheath hematoma (SRSH) is characterized by bleeding within the rectus abdominis muscle sheath, one of the rare causes of acute abdominal pain. Early diagnosis is imperative in SRSH to prevent complications and the treatment is usually conservative. We intended to present in this study our experience with SRSH patients with respect to diagnostic evaluation and management of their disease. Materials and Methods. In this retrospective study, 14 patients who had received treatment for SRSH in our clinic between January 2012 and December 2017 were assessed in terms of demographic and clinical characteristics, comorbidities, laboratory parameters, diagnostic approach methods, treatment practices, length of hospital stay, and patient outcomes. Results. The patients consisted of 10 (71.4%) females and 4 males (28.6%). The age of the patients ranged between 47 and 93 with a mean age of 66.5 ± 12.1. Anticoagulant treatments were being administered to 5 (35.7%) patients, antiplatelet treatments to 4 (28.5%) patients, and both anticoagulant and antiplatelet treatments to 4 (28.5%) patients. The most common triggering factor was severe cough and the most common initial symptom acute abdominal pain (71.4%). In physical examinations, the entire patients had generalized abdominal tenderness, 10 (71.4%) voluntary guarding and 7 (50%) a right lower quadrant mass. The diagnosis was confirmed by abdominal ultrasonography and computed tomography. Based on the computed tomography findings, the disease was classified as Type 2 found in 9 (64.3%) patients, Type 1 in 3 (21.4%) patients, and Type 3 in 2 (14.2%) patients. All the patients were treated conservatively. They were hospitalized for 1 to 23 days. There was no mortality. All the patients were followed up between 3 months and 2 years and no recurrence was recorded. Conclusion. Considering the presence of SRSH particularly in older female patients who use anticoagulant drugs and have newly developed an abdominal pain and a palpable mass after coughing spells is the key to make an early and correct diagnosis and to prevent possible morbidity and mortality with an appropriate treatment method.

The main purpose of this study was to investigate the relation between carotid intima-media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT (r = .42, P < .001), age (r = .23, P < .001), hypertension (r = .27, P = 0.001), diabetes (r = 0.11, P = 0.02), smoking (r = .24, P = .01), dyslipidemia (r = .2, P = 0.03), and β-blocker use (r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect complex coronary artery lesions.

Objective: The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atherosclerosis in hypertensive patients. Methods: In this study on diagnostic accuracy, 374 consecutive hypertensive patients with at least one cardiovascular risk factor were enrolled. AKW was measured on chest X-ray. Cardio-ankle vascular index (CAVI) was measured by VaSera-1000 CAVI instrument. The diagnostic value of AKW was assessed using ROC analysis. Results: There was a significant correlation between aortic knob width and CAVI (r=0.45, p<0.001), age (0.39, p<0.001), systolic (r=0.17, p<0.001), diastolic (r=0.23, p<0.001) and mean (r=0.2, p<0.001) blood pressures. In linear regression analysis CAVI (β=0.3, 95% CI 0.33-0.98, p<0.001), age (β=0.3, 95% CI 0.09 -0.21, p<0.001) and diastolic blood pressure β=0.2, 95% CI 0.08-1.9, p<0.001) were independently associated with AKW. It was significantly higher in patients with subclinical atherosclerosis (CAVI ≥9) than borderline (8 ≤CAVI <9) (41.4±5.5 versus 36.7±5.3 mm, p<0.001) and healthy (CAVI <8) subjects (41.4±5.5 versus 35.5±4.3 mm, p<0.001). Analysis using the ROC curve has demonstrated that aortic knob of 41 mm constitutes the cut-off value for the presence of subclinical atherosclerosis with 71% sensitivity and 77% specificity (AUC-0.67, 95% CI 0.51-0.82). Conclusion: Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis. (Anadolu Kardiyol Derg 2012; 12: 102-6) Key words: CAVI, subclinical atherosclerosis, aortic knob, diagnostic accuracy, sensitivity, specificity 102 ÖZET Amaç: Bu çalışmanın amacı göğüs grafisinde aort topuz genişliğinin (ATG) hipertansif hastalarda subklinik aterosklerozun bir göstergesi olup olmadığını araştırmaktır. Yöntemler: Hipertansif ve en az bir tane kardiyovasküler risk faktörü olan 374 hasta bu tanısal değeri çalışmaya alındı. Kardiyo-ayak bileği vasküler indeksi (CAVI) VaSera VS-1000 cihazı ile değerlendirildi. Aort topuz genişliği göğüs grafisinde ölçüldü. ATG'nin tanısal değeri ROC analizi ile değerlendirildi. Bulgular: Aort topuz genişliği ile CAVI arasında istatistiksel olarak anlamlı bir ilişki vardı (r=0.45, p<0.001). Ayrıca, yaş (0.39, p<0.001), sistolik kan basın-cı (r=0,17, p<0.001), diyastolik (r=0.23, p<0.001) ve ortalama kan basıncı (r=0.2, p<0.001) ile CAVI arasında anlamlı bir ilişki bulundu. Lineer regresyon analizinde CAVI (β=0.3, p<0.001), yaş (β=0.3, p<0.001) ve diyastolik kan basıncı (β=0.2, %95 GA 0.08-1.9, p<0.001) ile ATG arasında bağımsız bir ilişki vardı. ATG subklinik aterosklerozu olanlarda (CAVI ≥9) sınırda anormal (8 ≤ CAVI <9) (41.4±5.5 karşı 36.7±5.3 mm, p<0.001) ve normal olanlara (CAVI <8) (41.4±5.5 karşı 35.5±4.3 mm, p<0.001) göre anlamlı olarak yüksekti. ROC analizinde aortik topuzun 41 mm olması subklinik atherosklerozu %71 duyarlılık ve %77 özgüllük ile tespit edebiliyordu (EAA 0.67, %95 GA 0.51-0.82). Sonuç: Göğüs grafisinde aortik topuzun değerlendirilmesi hipertan...

The diagonal earlobe crease (ELC) has been regarded as a simple marker of atherosclerosis. There is no knowledge concerning the relation of ELC to the presence, extent, and severity of peripheral arterial disease (PAD). Patients (n = 253) without known atherosclerotic vascular disease and symptoms were enrolled consecutively. Ankle brachial index (ABI) was measured. Patients with ELC had lower ABI compared to those with no ELC (1.02 ± 0.12 vs 1.11 ± 0.08, P < .001). Multivariate analysis demonstrated ELC (95% confidence interval [CI]: 3.3-21.9; P: .001) and age (95% CI: 0.87-0.99; P = .02) as independent determinants of abnormal ABI. There was incremental increased frequency of ELC from normal ABI to significant PAD. We have shown for the first time a significant and independent association between presence of ELC and increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease.