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Öğe Assessment of common extensor tendon vascularization using superb microvascular imaging: a potential tool in the evaluation of extracorporeal shock wave therapy and therapeutic ultrasound effectiveness in lateral epicondylitis(Sage Publications Ltd, 2023) Ustabasioglu, Fatma; Gunay, Burak; Samanci, Cesur; Ustabasioglu, Fethi EmreBackground Lateral epicondylitis, also known as tennis elbow, is the most common elbow pain in the adult age group. Purpose To evaluate common extensor tendon (CET) vascularity with superb microvascular imaging (SMI) before and after extracorporeal shock wave therapy (ESWT) and ultrasound (US) treatment in patients with lateral epycondylitis and to compare the effects of two different treatments on tendon vascularity. Material and Methods Patients with lateral epycondylitis were divided into two groups; 30 patients were treated with ESWT (group 1) and 30 patients were treated with therapeutic US (group 2). We performed a high-frequency (14-MHz) linear array transducer to evaluate tendon anatomy and vascularity before and after treatment in both groups. Results The decrease in Patient-Rated Tennis Elbow Evaluation (PRTEE) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). Likewise, the decrease in visual analog scale (VAS) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). A significant difference was found between the CET SMI values of group 1 and group 2 after treatment, according to the chi-square test (P < 0.001). In the post-treatment VAS and PRTEE comparison of both groups, the score reduction in group 1 was higher than in group 2, and this decrease was statistically significant (P < 0.001). Conclusion We can evaluate CET vascularization with the SMI method as a new potential diagnostic tool in comparing the effectiveness of different treatments in cases of lateral epicondylitis.Öğe EVALUATION OF ACCURACY OF SHEAR WAVE ELASTOGRAPHY AND SUPERB MICROVASCULAR IMAGING METHODS IN DIAGNOSIS OF PIRIFORMIS SYNDROME: A PRELIMINARY STUDY(Elsevier Science Inc, 2022) Gulsaran, Ugur; Ustabasioglu, Fatma; Gunay, Burak; Ustabasioglu, Fethi EmrePiriformis syndrome is a neuromuscular disease resulting from sciatic nerve compression caused by an abnormal condition in the piriformis muscle. Superb microvascular imaging (SMI) is a new ultrasound imag-ing technique that visualizes low-velocity and small-diameter blood vessel flow. In our prospectively designed study, we aimed to evaluate the accuracy of diagnosis of piriformis syndrome with innovative methods such as shear wave elastography (SWE) and SMI. Thirty-two patients diagnosed with unilateral piriformis syndrome were accepted to the statistical stage. The side without symptoms was considered the unaffected side Bilateral piriformis muscles were examined by ultrasonography. Muscle thickness was determined on gray scale, stiffness on SWE and vascularity characteristics on power Doppler and SMI by two independent radiologists. Piriformis muscle stiffness on the non-pathological (unaffected) side was measured by SWE as 18.27 +/- 7.301 kPa, and the mean stiffness on the pathological side was 29.70 +/- 10.095 kPa. Pathological side muscle stiffness was signifi-cantly higher (p < 0.05). Using innovative methods such as SWE and SMI in addition to conventional ultrasonog-raphy as much as possible in our daily practice and research helps us in making the correct diagnosis in piriformis syndrome. (E-mail addresses: ugurgulsaran@yandex.com.tr fatmaustabasioglu@gmail.com drburakgunay@gmail.com ustabasioglu@hotmail.com) (c) 2022 World Federation for Ultrasound in Medicine & Biology. All rights reserved.Öğe Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model(Springer France, 2023) Turkyilmaz, Zeliha; Kula, Osman; Celik, Ahmet Onur; Demirel, Tugrul; Gunay, BurakPurposeKnowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches.MethodsThe computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined.ResultsNormal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo.ConclusionPreoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.Öğe Evaluation of placenta in patients with gestational diabetes using shear wave elastography and superb microvascular imaging(Sage Publications Ltd, 2024) Celik, Ahmet Onur; Gunay, Burak; Coker, Gonca Busra; Ustabasioglu, Fethi Emre; Ates, Sinan; Tuncbilek, NerminBackground: Gestational diabetes mellitus (GDM) is a common disease, and the placenta shows various functional and morphological changes in these patients. Superb microvascular imaging (SMI) and shear wave elastography (SWE) are innovative ultrasound (US) methods that provide detailed information about tissue vascularization and elasticity.Purpose: To evaluate placental changes in patients with GDM with SMI and SWE methods.Material and methods: For this case-control study, 20 healthy and 20 women with GDM were included. Women at >21 weeks of pregnancy were evaluated with SMI and SWE by two independent radiologists. Mean SMI values and mean SWE values from three different region of interest-based measurements were compared between the two groups.Results: We identified that the mean SMI and SWE value of the GDM group was found to be significantly higher than that of the control group (P = 0.002, P = 0.001 respectively). Using a receiver operating characteristic curve, the cutoff value of the SMI ratio, which maximizes the prediction of the presence of GDM, was 0.1234279750 (95% confidence interval [CI] = 0.625-0.920), the SWE cut-off value was 15.5 kPa (95% CI = 0.794-0.989).Conclusion: We have demonstrated that evaluation with SMI and SWE might allow quantitative assessment of the morphological changes of placentas in women with GDM. We believe that the use of innovative methods such as SMI and SWE in addition to conventional US examinations in daily practice and studies will provide significant clinical benefits to patient management.Öğe Local Recurrence of Metatarsal Aneurysmal Bone Cyst after Percutaneous Sclerotherapy(Galenos Publ House, 2022) Gunay, Burak; Ustabasioglu, Fethi Emre; Ciftdemir, Mert; Uslu, Burak; Usta, Ufuk[Abstract Not Available]Öğe Neutrophil to Lymphocyte Ratio and Serum Biomarkers : A Potential Tool for Prediction of Clinically Relevant Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage(Korean Neurosurgical Soc, 2023) Kula, Osman; Gunay, Burak; Kayabas, Merve Yaren; Akturk, Yener; Kula, Ezgi; Tutunculer, Banu; Sut, NecdetObjective : Subarachnoid hemorrhage (SAH) is a condition characterized by bleeding in the subarachnoid space, often resulting from the rupture of a cerebral aneurysm. Delayed cerebral ischemia caused by vasospasm is a significant cause of mortality and morbidity in SAH patients, and inflammatory markers such as systemic inflammatory response index (SIRI), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and derived NLR (dNLR) have shown potential in predicting clinical vasospasm and outcomes in SAH patients. This article aims to investigate the relationship between inflammatory markers and cerebral vasospasm after aneurysmatic SAH (aSAH) and evaluate the predictive value of various indices, including SIRI, SII, NLR, and dNLR, in predicting clinical vasospasm. Methods : A retrospective analysis was performed on a cohort of 96 patients who met the inclusion criteria out of a total of 139 patients admitted Trakya University Hospital with a confirmed diagnosis of aSAH between January 2013 and December 2021. Diagnostic procedures, neurological examinations, and laboratory tests were performed to assess the patients' condition. The Student's t-test compared age variables, while the chi-square test compared categorical variables between the non-vasospasm (NVS) and vasospasm (VS) groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic accuracy of laboratory parameters, calculating the area under the ROC curve, cut-off values, sensitivity, and specificity. A significance level of p<0.05 was considered statistically significant. Results : The study included 96 patients divided into two groups : NVS and VS. Various laboratory parameters, such as NLR, SII, and dNLR, were measured daily for 15 days, and statistically significant differences were found in NLR on 7 days, with specific cut-off values identified for each day. SII showed a significant difference on day 9, while dNLR had significant differences on days 2, 4, and 9. Graphs depicting the values of these markers for each day are provided. Conclusion : Neuroinflammatory biomarkers, when used alongside radiology and scoring scales, can aid in predicting prognosis, determining severity and treatment decisions for aSAH, and further studies with larger patient groups are needed to gain more insights.Öğe PET/CT for Early Detection of COVID-19 Pneumonia: Diffuse Fluorodeoxyglucose Uptake in the Lungs without any Additional Changes in a Patient with Breast Cancer(Galenos Yayincilik, 2021) Ozdemir, Busra; Gunay, Burak; Karabulut, Derya; Altun, Gulay DurmusCoronavirus disease-2019 (COVID-19), which causes infections in the upper and lower respiratory tract, became a pandemic shortly after it was first diagnosed in Wuhan city, China. Many people are affected with high mortality rates and severe respiratory distress syndrome. During this pandemic, all physicians paid attention to the findings of COVID-19. Suggestive findings in (18)fluorine-fluorodeoxyglucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) were characterized as increased F-18-FDG uptake in bilateral peripheral consolidative areas and ground glass opacities. We aimed to show diffuse FDG uptake in PET images with indefinable lesions in CT as a suspicious finding for early COVID-19.Öğe The relationship between computed tomographic obstruction index and pulmonary vein cross-sectional area in acute pulmonary embolism(Springer-Verlag Italia Srl, 2020) Ustabasioglu, Fethi Emre; Solak, Serdar; Kula, Osman; Gunay, Burak; Serez, Bilkay; Tuncbilek, NerminPurpose To investigate whether the increased obstruction of the pulmonary arteries was associated with reduced pulmonary vein areas in acute pulmonary embolism (APE). Method We retrospectively analyzed a consecutive series of computed tomography pulmonary angiography studies of 107 patients with APE and 101 controls without APE between November 2010 and January 2019. The control and patient groups were compared with each other for differences between the mean cross-sectional areas of pulmonary veins. Further analysis was conducted by dividing the patient group into high-risk patients (>= 20%) and low-risk patients (< 20%) according to the pulmonary arterial obstruction index. The mean cross-sectional area of the pulmonary veins in these two groups was compared. Results The mean cross-sectional areas of the 4 pulmonary veins at the ostium level (CSAPV) were significantly lower for the patient group (mean: 102.6 mm(2)) compared with the control group (111.8 mm(2)) (p < 0.001). CSAPV cutoff value for determining the diagnosis of APE that maximized the accuracy was 109.12 mm(2) (AUC = 0.721; 95% CI 0.649-0.794); its sensitivity and specificity were 78.2% and 69.2%, respectively. CSAPV cutoff value for differentiating high-risk APE that maximized the accuracy was 102.6 mm(2) (AUC = 0.634; 95% CI 0.525-0.743); its sensitivity and specificity were 61.9% and 53.8%, respectively. Conclusions There is a negative correlation between the CSAPV and thrombotic material burden in the pulmonary arteries of patients with APE. Hence, the CSAPV can be used as a diagnostic tool in the evaluation of the presence and severity of pulmonary embolism.Öğe Renal leiomyoma: An uncommon differential diagnosis of renal masses in pediatric age(Elsevier Science Inc, 2021) Karabulut, Derya; Alkan, Aykut; Ozgur, Cihan; Gunay, Burak; Burgazdere, Gulsah; Puyan, Fulya OzLeiomyoma is a mesenchymal tumor which arise from any structure or organ containing smooth muscle, but is frequently seen in the female genital tract. Renal leiomyoma is extremely rare benign lesion with low incidence (1:1000), has been reported mostly in adults and very few cases have been described in the pediatric age-group. It is often asymptomatic and can be diagnosed when reaches large sizes. Hereby, we present a case of renal leiomyoma in a smaller size, in the pediatric age group.Öğe The Role of Superb Microvascular Imaging and Shear Wave Elastography in the Prediction of Hemorrhage Complications After Renal Parenchyma Biopsy(Lippincott Williams & Wilkins, 2023) Gunay, Burak; Uslu, Burak; Celik, Ahmet Onur; Korkmaz, Selcuk; Ustabasioglu, Fethi Emre; Solak, Serdar; Kula, OsmanObjectives: The aim of study was to evaluate the diagnostic utility of the renal parenchyma elasticity with the shear wave elastography (SWE) and microvascularization with the superb microvascular imaging (SMI) technique before kidney biopsy and to predict the complication of hemorrhage before kidney biopsy.Methods: A total of 75 patients were included in the prospective study. Before the biopsy, vascularity features of the kidney parenchyma in the area to be biopsied were assessed by SMI and parenchymal stiffness by SWE and were examined by 2 independent radiologists.Results: A statistically significant difference was found in the SMI and SWE values between the groups with and without hematoma and hematuria when compared with the Student t test and Mann-Whitney U test (P < 0.05). The SWE hardness cutoff value, which maximizes the prediction of the development of hematuria, was found to be 18.40 kPa, and the sensitivity and specificity values were 84.4% and 62.8%, respectively. In SMI vascularity index values, the cutoff value was found to be 0.247410800 kPa, and sensitivity and specificity values were 81.3% and 83.7%, respectively. The cutoff value of the SMI vascularity index values that maximized the prediction of hematoma development was 0.297009650, and the sensitivity and specificity values were 87% and 87%, respectively.Conclusions: We believe that evaluating and standardizing the microvascularization and elasticity of the kidney parenchyma before a percutaneous kidney biopsy will be potentially useful as a guiding method in the prediction of postbiopsy hemorrhage development.Öğe Ultrasound evaluation of stiffness and vascularity of renal parenchymal damage secondary to hydronephrosis in pediatric patients using shear wave elastography and superb microvascular imaging(Wiley, 2024) Gunay, Burak; Solak, Serdar; Ustabasioglu, Fethi Emre; Kula, Osman; Karabulut, Derya; Tuncbilek, NerminAims: The purpose of this study is to assess the diagnostic value of SWE (shear wave elastography) and renal parenchymal elasticity and microvascularization with the SMI (super microvascular imaging) technique in diagnosing and predicting the progression of renal parenchymal damage in pediatric patients with hydronephrosis. Patients and Methods: A total of 45 patients were included in the prospective study. To evaluate parenchymal changes, SWE and SMI-Vacularity Index (VI) measurements were performed in various sections of the affected and normal kidneys. The affected and control renal pelvises' anteroposterior (AP) diameters were also measured. Results: The average SWE values were measured as 16.62 kPa for the affected kidneys, whereas the control kidneys showed an average SWE value of 12.70 kPa, indicating a statistically significant difference (p < .01). Furthermore, in the affected kidneys, the average SMI-VI value was measured as 5.92, whereas the control kidneys exhibited a higher average SMI-VI value of 6.64, showing a statistically significant difference (p < .01). A reverse correlation was found between renal pelvis AP diameter and SMI-VI values, while a positive correlation existed between renal pelvis AP diameter and SWE values. Conclusions: We believe that SWE and SMI may be useful for diagnosing and predicting the progression of renal parenchymal damage in pediatric hydronephrotic patients.