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Öğe The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort(Springer, 2024) Guclu, Derya; Ogul, Hayri; Unlu, Elif Nisa; Tuncer, Kutsi; Kose, Mehmet; Kantarci, Mecit; Eren, SuatObjectiveTo describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography.Materials and methodsThis was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness & GE;1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial.ResultsAn AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1-this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone-this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures.ConclusionA 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types.Öğe The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort (Jul, 10.1007/s00256-023-04409-1, 2023)(Springer, 2024) Guclu, Derya; Ogul, Hayri; Unlu, Elif Nisa; Tuncer, Kutsi; Kose, Mehmet; Kantarci, Mecit; Eren, Suat[No abstract available]Öğe Assessment of the Effect of Psoriasis and Methotrexate Treatment on Liver Stiffness by ARFI Imaging(Duzce Univ, Fac Medicine, 2023) Guclu, Derya; Karagun, Ebru; Unlu, Elif Nisa; Oktay, Mehtap; Pasin, OzgeObjective: To investigate whether psoriasis and methotrexate used in its treatment cause liver fibrosis and eventually to evaluate the safety of methotrexate in treatment.Methods: 44 cases were included in the study. Methotrexate-using (group 1, n=14) and methotrexate-not-using (group 2, n=13) psoriasis patients were compared retrospectively with a healthy control group (group 3, n=17) according to mean shear wave rates obtainedResults: Mean shear wave velocities were calculated as 2.57 & PLUSMN; 1.13 m/sec in the patients using methotrexate, 2.31 & PLUSMN; 1.16 m/sec in the patients who did not use methotrexate, and 1.56 & PLUSMN; 0.62 m/sec in the healthy control group. While the average shear wave velocity of the 3rd group was found to be significantly lower than that of the 1st and 2nd groups (p=0.032; p=0.012), no significant difference was observed between the 1st and 2nd groups (p=0.755).Conclusions: Shear wave imaging with ARFI quantification findings revealed no evidence that methotrexate therapy is associated with liver fibrosis in psoriasis patients and we think that the increase in liver tissue stiffness in patients using methotrexate for psoriasis is secondary to the inflammatory process caused by psoriasis itself rather than methotrexate.Öğe Assessment of the involvement of the inferior glenohumeral capsuloligamentous complex in frozen shoulder using shear wave elastography: a study with MRI correlation(Oxford Univ Press, 2025) Soylu, Hakan Huseyin; Unlu, Elif Nisa; Guclu, Derya; Ogul, Hayri; Sungur, Mehmet Ali; Temel, Mustafa HuseyinObjectives This study aimed to evaluate the efficacy of shear wave elastography (SWE) as a diagnostic tool for frozen shoulder (FS). Methods Thirty patients with FS and 34 healthy volunteers were included in the study. Patients with clinical findings consistent with FS and whose MRI results were indicative of FS were included. SWE was performed on these patients, measuring stiffness in the anterior band of the inferior glenohumeral capsuloligamentous complex (IGHCC) using the Virtual Touch Quantification elastography method. Stiffness values were expressed as shear wave velocity (SWV) in meters per second, and statistical analyses were performed to compare stiffness values between the FS and control groups. Results Significant differences in SWV values were observed between the FS and the control groups (P < .001). Additionally, a significant interaction between group and gender was observed (P = .007) based on a 2-way analysis of variance. Conclusion SWE revealed significant stiffening of the IGHCC in FS patients compared to controls, demonstrating its practicality and reliability as an imaging method alongside MRI for assessing IGHCC involvement in FS patients. Advances in knowledge SWE may serve as an alternative imaging method for diagnosing and monitoring FS.Öğe Comparison of conventional MR arthrography and 3D volumetric MR arthrography in detection of cartilage defects accompanying glenoid labrum pathologies(Springer, 2024) Gokce, Ayse; Guclu, Derya; Unlu, Elif Nisa; Kazoglu, Ibrahim; Arican, Mehmet; Ogul, HayriObjectivesIn this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies.Materials and methodsA total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated.ResultsCartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17-19%, 100-100%, and 49-51%, respectively, while those values were 67-65%, 92-97%, and 84-77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively.ConclusionT1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement.Öğe COVID-19 Olası/Kesin Tanılı Hastalarda Serbest Radikal Ve Antioksidan Enzim Düzeylerinin Değerlendirilmesi(2023) Davran, Fatih; Hacıoğlu, Ceyhan; Alpay, Merve; Yıldız Gülhan, Pınar; Öztürk, C. Elif; Ince, Nevin; Unlu, Elif NisaAmaç: Koronavirüs hastalığı 2019 (COVID-19), küresel halk sağlığını tehdit eden ve bir pandemiye yol açan karmaşık bir hastalık olmasına rağmen, hastalığın patogenezinde yer alan pro-oksidan/oksidan dengesizliğinin katkıları yeterince araştırılmamıştır. Bu nedenle, bu çalışmanın amacı, COVID-19 hastalarında sigara kullanımının oksidatif stres ve antioksidan savunma sistemi biyobelirteçleri üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntemler: Çalışmaya katılan kişiler 4 gruba ayrıldı: (Kontrol grubu) COVID-19 tanısı olmayan ve sigara kullanmayan 45 sağlıklı birey, (Grup 2) COVID-19 tanısı olmayan ve sigara kullanan 45 birey, (Grup 3) COVID-19 tanılı ve sigara kullanmayan 45 hasta, (Grup 4) COVID-19 tanılı ve sigara kullanan 45 hasta. Katılımcıların serumlarındaki D-dimer, nitrik oksit (NO), glutatyon redüktaz (GR), süperoksit dismutaz (SOD), katalaz (CAT), malondialdehid (MDA), total antioksidan seviyeleri (TAS) ve total oksidan seviyeleri (TOS) seviyelerini ticari kitler kullanarak ELİSA yöntemine göre analiz edildi. Bulgular: COVID-19 tanısı alan kişilerdeki D-dimer seviyelerinde anlamlı bir artış söz konusudur (pÖğe Düzce Üniversitesi Araştırma Hastanesi’nde Enfeksiyon Hastalıkları Servisinde Takip Edilen COVID-19 Hastalarının Yatış Süresine Etki Eden Faktörler(2024) Çakır, Yasemin; İnce, Nevin; Yekenkurul, Dilek; Yıldırım, Mustafa; Sungur, Mehmet Ali; Öztürk, Cihadiye Elif; Unlu, Elif NisaAmaç: Aralık 2019’da ortaya çıkan ve tüm dünyada pandemiye sebep olan yeni coronavirüs 19 hastalığı (COVID-19), iki yıldan uzun süredir tüm dünyada milyonlarca insanı enfekte etmiştir. Bu çalışmada, COVID-19 tanısı ile hastanede yatan hastaların yatış süresine etki eden faktörlerin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Mart-Haziran 2020 tarihleri arasında enfeksiyon hastalıkları servisinde yatan COVID-19 tanılı hastalar dahil edildi. Hastaların demografik özellikleri, vital bulguları, hemogram, üre, kreatin, C-reaktif protein (CRP), alanin aminotransferaz (ALT), aspartat transaminaz (AST), laktat dehidrojenaz (LDH), protrombin zamanı (PT), uluslararası normalleştirilmiş oran (INR), procalsitonin (pct), d-dimer, ferritin, troponin, nötrofil/lenfosit oranı (NLR) trombosit-lenfosit oranı (PLR), monosit-lenfosit oranı (MLR) ve ortalama trombosit hacmi (MPV)-lenfosit oranı (MPVLR), COVID-19 PCR, akciğer görüntüleme bulguları, tedavi ve hastane yatış süreleri retrospektif olarak incelendi. Bulgular: Çalışmamızda hastaların yaş ortalaması 56,51±15,48, kadın erkek oranı 1/1, ortalama yatış süresi 7,58±3,35 gündü. DM, HT ve malignitesi olan hastalarda, favipravir, enoksaparin ve vitamin C desteği alan hastalarda daha uzun hastane yatışı olduğu, uzun süre hastane yatışı olan hastalarda ateş, pct, AST, LDH değerlerinin kısa yatış süresi olan hastalara göre daha yüksek olduğu saptandı. Lenfosit sayısı ve yüzdesi, NLR, monosit sayısı ve MPV/lenfosit oranı yedi günden uzun süre yatan hastalarda anlamlı derecede düşük bulundu. Sonuç: Hastaneye başvuru şikayetlerinin yatış süresini öngörmede etkisiz olduğu saptandı.Öğe Duzce University Faculty of Medicine Radiology Department in the COVID-19 Pandemic Process(Duzce Univ, 2020) Guclu, Derya; Unlu, Elif NisaRadiology plays an important role in the COVID-19 pandemic outbreak. Besides its role in the diagnosis and follow-up of COVID-19, it undertakes important tasks both in the protection of healthcare workers and in avoiding a potential cause of spread. The aim of the present study is to share our experience and approach during the pandemic and to contribute to the management of other probable pandemic processes.Öğe Fokal Asimetrik Meme Dansitelerinin Değerlendirilmesinde Tomosentezin Tanıya Katkısı(2023) Güçlü, Derya; Naldemir, İbrahim Feyyaz; Unlu, Elif Nisa; Onbas, OmerAmaç: Bu çalışma ile mamografik incelemelerde fokal asimetrik dansite saptanan ve ek tetkik gerektiren olgularda tomosentezin tanıya katkısını araştırmak amaçlanmıştır. Gereç ve Yöntemler: Hastanemiz Radyoloji Anabilim Dalı Meme Görüntüleme Ünitesine Şubat 2020-Haziran 2022 tarihleri arasında tarama ya da tanısal amaçlı dijital mamografi tetkiki yapılan ve fokal asimetrik meme dansitesi saptanan 56 olguya, ek olarak tomosentez inceleme yapıldı ve bulgular BI-RADS kullanılarak sınıflandırıldı. Hasta yaşı, meme paterni, fokal asimetik dansite bulunan meme ve kadranı kaydedildi. Sonrasında tamamlayıcı ve altın standart tetkik olarak bilateral meme ultrasonografi incelemesi yapılarak bulgular kaydedildi. Bulgular: Dijital mamografi görüntüleme sonucunda fokal asimetrik dansite nedeniyle BI-RADS 0 olarak değerlendirilen 56 kadın olgunun ortalama yaşları 51,5 ± 8,1’dir. %12,5’i (n=7) A tipi, %42,9’u (n=24) B tipi, %41,1’i (n=23) C tipi, %3,6’sı (n=2) D tipi meme paternine sahiptir. Fokal asimetrik dansitelerin % 44,6’sı (n=25) sağ, %55,4’ü (n=31) sol memede saptanmıştır. Dijital tomosentez incelemelerinin değerlendirilmesinde, olguların % 41,1’i (n=23) BI-RADS 1, % 16,1’i (n=9) BI-RADS 2, % 21,4’ü (n=12) BI-RADS 3, 21,4’ü (n=12) BI-RADS 4 olarak sınıflanmıştır. Ultrasonografik incelemede hastaların %42,9’u (n=24) asimetrik fibroglandüler doku, %17,9’u (n=10) olası benign lezyon, % 19,6’sı (n=11) ise malign lezyon olarak değerlendirilmiştir. Histopatolojik inceleme önerilen 12 hastanın ikisi stromal fibrozis, diğer 10’u ise biri lobüler olmak üzere invaziv meme karsinomu olarak değerlendirilmiştir. Sonuç: Bu çalışma mamografik incelemeler ile morfolojisi değerlendirilemeyen ve ek tetkik gerektiren fokal asimetrik dansitelerde tomosentezin tanısal önemini vurgulamaktadır. Tomosentez, son dekatta kullanımı giderek artan ve parankime süperpoze lezyonlarda yaşanabilecek tanı güçlüklerini çözebilecek görece yeni bir tekniktir.Öğe Glenohumeral Joint Volume Measurement in Patients with Shoulder Instability: A 3D Volumetric Magnetic Resonance Arthrographic Study(Mdpi, 2024) Gueclue, Derya; Unlu, Elif Nisa; Arican, Mehmet; Acar, Oguzhan; Uludag, Veysel; Ogul, HayriBackground and Objectives: This study aimed to compare capsular volume in patients with shoulder instability to that in control subjects without instability using magnetic resonance (MR) arthrography. The objective was to develop a reliable screening method with which to assess shoulder volume. Materials and Methods: In 21 patients with atraumatic shoulder instability and 21 controls, thin-slice 3D volumetric MR arthrography sequences were obtained. MR arthrography images were uploaded to 3D reconstruction, and 3D images were generated. From the 3D reconstructed images, volumetric measurements of rotator interval (RI), anterior and posterior capsular (AC, PC) recesses, biceps tendon sheath (BS), axillary recess (AR), and total glenohumeral joint (TGJ) were performed. Individuals with any extra-articular contrast leakage were also recorded. Results: A retrospective study analyzed a patient group of 21 individuals with shoulder instability (mean age 29.52 +/- 12.83 years) and a control group of 21 individuals without instability (mean age 35.71 +/- 12.77 years). No statistically significant differences were identified between the groups with regard to age, gender, or side distribution. The mean total joint volume was significantly higher in the instability group (29.85 +/- 6.40 cm3) compared to the control group (23.15 +/- 3.48 cm3, p = 0.0001). Additionally, the mean volumes of the RI, AC, PC, BS, and AR were all significantly greater in the patient group compared to the control group. Conclusions: 3D volumetric MR arthrographic measurements of the shoulder joint capacity can provide valuable insights for clinical follow-up and guide surgical treatment decisions in cases of atraumatic shoulder instability.Öğe Relationship between SLAP Lesions and Shoulder Joint Capsule Thickness: An MR Arthrographic Study(Mdpi, 2024) Guclu, Derya; Uludag, Veysel; Arican, Mehmet; Unlu, Elif Nisa; Ogul, HayriBackground and Objectives: This study aimed to evaluate the relationship between SLAP lesions and the shoulder joint capsule thickness via MR arthrography. Understanding the relationship between SLAP lesions and the joint capsule thickness is important because an increased capsule thickness may indicate chronic inflammation and contribute to persistent pain and dysfunction. These findings have significant clinical implications for the diagnosis, management, and treatment strategies of shoulder joint pathologies. Materials and Methods: We retrospectively analyzed the MR arthrography results of 78 patients who underwent shoulder imaging at D & uuml;zce University Medical Faculty between October 2021 and November 2024. The study included patients diagnosed with SLAP lesions and compared them with a control group without such pathology. Data on joint capsule thickness at the level of the axillary recess, SLAP lesion type, cuff pathology, and demographic information were collected and analyzed. Results: The study included 32 patients with SLAP lesions and 46 control subjects. The mean age of the patients was 44.75 +/- 14.18 years, whereas the control group had a mean age of 38.76 +/- 13 years. The patient group presented a significantly greater mean anterior capsule thickness (3.13 +/- 1.28 mm vs. 1.72 +/- 0.7 mm, p = 0.0001), posterior capsule thickness (3.35 +/- 1.32 mm vs. 1.95 +/- 1.06 mm, p = 0.0001), and maximum capsule thickness (3.6 +/- 1.32 mm vs. 2.06 +/- 1.01 mm, p = 0.0001) in the axillary recess. SLAP type 2 lesions were the most common type (43.76%) in the patient group. Conclusions: This study revealed a significant association between SLAP lesions and an increased shoulder joint capsule thickness. These findings suggest that MR arthrography is an effective tool for assessing the joint capsule changes associated with labral tears, contributing to the better diagnosis and management of shoulder joint pathologies in clinical practice.Öğe Shear wave elastography and T2*mapping in the detection of early-stage trochlear cartilage damage(Sage Publications Ltd, 2023) Kaplan, Meral; Guclu, Derya; Unlu, Elif Nisa; Ogul, Hayri; Onbas, OmerBackground The presence of degenerative changes in joint cartilage is one of the major features in osteoarthritis. Purpose To investigate the contribution of shear wave elastography and T2* mapping to the early diagnosis of femoral trochlear cartilage damage. Material and Methods A total of 30 individuals whose trochlear cartilage structure was evaluated as normal in conventional magnetic resonance imaging (MRI) sequences (control group) were prospectively compared with 30 patients who had early-stage cartilage damage findings on conventional MRI (study group), by performing B-mode ultrasonography, shear wave elastography, and T2* mapping. Cartilage thickness, shear wave, and T2* mapping measurements were recorded. Results After evaluating B-mode ultrasound and conventional MRI sequences, cartilage thickness was found to be significantly higher in the study group on both B-mode ultrasound and MRI. Shear wave velocity values of the study group (medial condyle [MC] 4.65 & PLUSMN; 1.11 m/sn, intercondylar [IC] 4.74 & PLUSMN; 1.20 m/sn, and lateral condyle [LC] 5.42 & PLUSMN; 1.48 m/sn) were observed to be significantly lower than the control group (MC 5.60 & PLUSMN; 0.77 m/sn, IC 5.85 & PLUSMN; 0.96 m/sn, and LC 5.63 & PLUSMN; 1.05 m/sn) (P < 0.05). T2* mapping values were significantly higher in the study group (MC 32.38 & PLUSMN; 4.04 ms, IC 35.78 & PLUSMN; 4.85 ms, and LC 34.04 & PLUSMN; 3.40 ms) than that of the control group (MC 28.07 & PLUSMN; 3.29 ms, IC 30.63 & PLUSMN; 3.45 ms, and LC 29.02 & PLUSMN; 3.24 ms). Conclusion Shear wave elastography and T2* mapping are reliable methods for evaluating early-stage trochlear cartilage damage.Öğe Shear Wave Ultrasound Elastography and Diffusion-Weighted Magnetic Resonance Imaging Findings of Pleural Based Masses with Histopathologic Correlation(Duzce Univ, Fac Medicine, 2021) Unlu, Elif Nisa; Altinsoy, Hasan Baki; Balaby, Ege Gulec; Sungur, Mehmet Ali; Boran, Mertay; Onal, BinnurObjective: The study aims to evaluate the usefulness of non-invasive diagnostic methods, shear wave elastography (SWE), and diffusion-weighted magnetic resonance imaging (DWI) to differentiate benign and malignant lesions in the thoracic pleural based masses by comparing them with histopathological findings. Methods: Sixty-three patients having a pleural-based peripheral mass on computed tomography (CT), admitted to the interventional radiology department for transthoracic biopsy, were included in the study. All patients underwent DWI, and ADC values of the groups were measured. Transthoracic biopsy was performed with the guidance of US from the area where the highest shear wave velocity (SWV) value was calculated. ADC and SWV values of histopathologically proven benign and malignant lesions were statistically compared. Results: Fifty-six patients were male, and seven were female. The mean age was 64.68 +/- 10.13 years (41-85 years). Fourty-four patients were malignant, and 19 were benign. The maximum SWV was found to be 4.13 +/- 0.59 m/s in malignant cases and 3.55 +/- 0.71 m/s in benign cases, and the difference was significant (p = 0.001). Mean ADC value was measured as 1.04 +/- 0.30 x 10-3 mm2/s in malignant cases and 1.32 +/- 0.33 x 10-3 mm2/s in benign cases on DWI and the difference was significant (p = 0.002). In malignant cases, the minimum ADC was 0.73 +/- 0.29 x 10-3 mm2/s, and 0.99 +/- 0.44 x 10-3 mm2/s in benign cases, the difference was significant (p = 0.024). ROC analysis revealed a cut-off value of >= 4.08 m/s for SWVmax, <= 1.01x10-3 mm2/s for mean ADC, and <0.8x10-3 mm2/s for minimum ADC showed a significant performance in distinguishing malignant and benign lesions. Conclusions: Transthoracic US elastography and DWI are useful in differentiating malignant and benign lesions in appropriate cases. Both SWE and DWI are useful in routine use because they are non-invasive and do not contain radiation. In particular, SWE is suitable for biopsy guidance and may prevent the possibility of insufficient material.
