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Diffusion weighted imaging in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes

100%
Kış N., Erok B.
European Journal of Clinical and Experimental Medicine
|
2021
|
issue 3
215-220
EN
Introduction. Renal cell carcinoma (RCC) is the most common malignant renal tumor in adults accounting for 80-90% of primary malignant adult renal neoplasms. RCC represents a very heterogenous groups of tumors with a number of distinct histological varieties, of which the major 3 subtypes are clear cell RCC (70-80%), papillary RCC (13-20%), and chromophobe RCC (5%). Imaging features are varied from solid and relatively homogenous appearance to markedly heterogenous appearance with cystic changes, hemorrhage and necrosis. The use of diffusion weighted imaging (DWI) for RCC subtyping and also for differentiation of high grade and low grade tumors has been showed to be useful in many studies in the literature. Aim. In this study, we aimed to determine the comparative contribution of DWI in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes at standard high b-value (1000 s/mm2) versus low b-value (500 s/mm2). In addition, we also aimed to assess the diagnostic performance of DWI for differentiating high grade clear cell RCC from low grade clear cell RCC based on Fuhrman grades in our patients. Material and methods. 62 cases with a prediagnosis of RCC according to MRI findings including DWI sequence with histological verification and subtyping of renal cortical tumor following a total or partial nephrectomy were included in the study. Results. Among 62 cases, 46 were male and 16 were female, with mean age of 59.5±15.7. Pathological diagnoses of 62 cases were as follows, clear cell RCC, (44) papillary cell RCC (14) and chromophobe cell RCC (4). They were divided into two groups as clear cell RCC group (44 cases) and non-clear cell RCC group (18 cases). There was no statistically significant difference between the mean ADC values of clear cell and non-clear cell groups at b-value of 1000 s/mm2 (p>0.05). However, the mean ADC level for clear cell RCC group at b-value of 500 s/mm2 were significantly higher than for non-clear cell RCC group (p<0.05). When a value of 0.99x10-3 mm2/s was set as cut-off for ADC at b-factor of 500 s/mm2, differentiation was achieved with a high sensitivity (91%) and specificity (56%). Regarding the diagnostic performance of DWI for differentiating high from low Fuhrman grades clear cell RCCs, there was no statistically significant difference between the ADC values of Grade I-II clear cell RCC cases and Grade III-IV clear cell RCC cases at b-factor of 1000 s/mm2 (p>0.05). However, ADC values for grade III-IV group was statistically significantly lower than ADC values for Grade I-II group at b-factor of 500 s/mm2 level. Conclusion. ADC measurements at moderate b-value of 500 s/mm2 were more sensitive in subtyping and grading of RCC cases. This technique can be used in clinical practice as a fast and additional sequence in abdominal MRI.
2
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Non-ketotic hyperglycemia and diabetic striatopathy – a rare presentation with hemichorea-hemiballismus

81%
Erok B., Keklikoğlu T. O., Kış N., Önder H.
European Journal of Clinical and Experimental Medicine
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2022
|
issue 1
122-125
EN
Introduction and aim. Non-ketotic hyperglycemia (NKHG), also known as hyperosmolar hyperglycemic state (HHS) is a serious metabolic complication of diabetes mellitus (DM).The mortality rate can be up to 20% and this is much more higher than that of diabetic ketoacidosis (DKA). It is usually precipitated by an event such as pulmonary/urinary infection, myocardial infarction (MI) or stroke. In this state of metabolic derangements, central nervous system (CNS) manifestations including altered mental status with or without focal neurological deficits are prominent clinical presentations. On the other hand, HHS may also be complicated with various other CNS events. Herein, a quite rare presentation of HHS with hemichorea ‒ hemiballismus in a 71 year old female patient with type 2 DM is presented. Description of the case. A 71-year-old female patient type 2 DM presented to our emergency department with progressive involuntary movements on the right upper and lower extremities accompanied by semiconsciousness during the last 24 hours. On neurological examination, cranial nerves and cerebellar signs were found to be normal, as the deep tendon reflexes. However, involuntary non-rhythmic writhing movements at rest were present on her right sided extremities. The fingerstick evaluation showed marked hyperglycemia (HG). The laboratory findings were characterized with high blood glucose level without obvious acidosis compatible with HHS. In urine analysis, glucosuria without significant ketonuria was detected. On head CT, subtle hyperdensity was noted in the left neostriatal regions without any mass effect or perilesional edema, compatible with left sided diabetic striatopathy (DS). Conclusion. Diabetic striatopathy is a quite rare presentation of HHS with hemichorea – hemiballismus. The characteristic computed tomograhy (CT) findings of associated striatopathy should be differentiated from vascular lesions that may also present with unilateral findings in the course of HHS and should not be overlooked in diabetic patients to recognise the ongoing HHS before the coma precedes.
3
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A benign entity – cerebral multinodular and vacuolating neuronal tumor

81%
Kış N., Erok B., Kılıç H., Önder H.
European Journal of Clinical and Experimental Medicine
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2022
|
issue 1
126-128
EN
Introduction and aim. Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a rare benign, mixed glial/ neuronal lesion which has been included in the recent (2016) World Health Organization (WHO) Classification of the central nervous system tumors.Most of the reported cases are remarkable with adult onset seizure in the literature.They can also be found incidentally in nonepilepsy patients with or without headache We aimed to present this unique entity with its typical magnetic resonance imaging (MRI) features. Description of the case. A 21-year old man presented with complaint of headache that increased in frequency within the last few months.No relevant seizure or any other signs of note.He was diagnosed with MVNT by imaging andstarted to be followed-up.The repeat MRI 6 months later showed no interval changes. Conclusion. Clinicians should be aware of that it is a do not touch lesion in asymptomatic patients with no need for biopsy or surgery and follow up imaging is sufficient when presented with the typical MRI manifestations. Surgical resection may be required for seizure control and was reported in few cases with no tumoral regrowth in the literature.
4
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Contribution of diffusion weighted MRI to the differential diagnosis of renal masses

71%
Kış N., Gülden Düzkalır H., Oğuzhan Ağaçlı M., Erok B., Gamze Kılıçoğlu Z.
European Journal of Clinical and Experimental Medicine
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2022
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issue 1
44-48
EN
Introduction and aim. We aimed to assess the usefulness of diffusion weighted imaging (DWI) and apparent diffusion coefficients (ADCs) for characterizing renal masses. Material and methods. In this retrospective study we measured the ADC values of renal masses at b=0, b=500 and b=1000. Measurements were made by placing a circular region of interest with a diameter of 1 cm. ADC values from normal renal parenchyma were taken to define the ADC and to compare with the ADC values of the lesions. Results. A total of 72 lesions of 54 patients were included.40 of the masses were benign and 32 were malignant. The ADC values of benign lesions at both b values were significantly higher than malignant lesions. We found the lowest values in angiomyolipomas (AMLs) and oncocytomas and the highest values in Bosniac type I cysts. Similarities was found between the ADC values of some AMLs and the RCCs. In terms of statistical results, the inclusion of AMLs in the analysis did not significantly affect the difference between malignant and benign lesions. Conclusion. In our study, the ADC values of benign renal masses were higher than those of normal renal parenchyme, which is higher than those of malignant renal masses.The lowest ADC values were observed in AMLs and oncocytomas.
5
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Contribution of semiquantitative analysis with dynamic contrast enhanced magnetic resonance imaging to the differential diagnosis of focal liver lesions

71%
Düzkalır H. G., Kış N., Urgun D. A., Ağaçlı M. O., Kılıçoğlu Z. G.
European Journal of Clinical and Experimental Medicine
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2023
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issue 2
344-356
EN
Introduction and aim. We aimed to evaluate the usefulness of dynamic contrast-enhanced (DCE) MRI semiquantitative analysis values in focal liver lesions (FLL) to provide additional qualities that can be used in daily practice in the differential diagnosis of lesions. Material and methods. This retrospective study included 91 patients with liver masses on DCE-MRI. The sensitivity and specificity of time intensity curves (TIC) and semiquantitative analysis values were evaluated to differentiate benign and malignant lesions. Results. The study included 91 patients (376 lesions), aged between 28-81 years. Of the lesions, 303 were malignant and 73 were benign. In TIC semiquantitative analysis, it was found that “Tpeak” and “wash-out” rate values showed differences, especially in the differentiation of HCC, metastasis, and hemangioma. Area under curve, maximum relative enhancement, and “wash-in” and “wash-out” values of metastases and hemangiomas were different. Brevity of enhancement values of HSK, hemangiomas, and metastases were found to be different. The risk of malignancy was found to be high when the “wash-out” ratio was above 0.08 (sensitivity: 64.3%, specificity: 70.4%). Conclusion. We think that the 0.08 threshold value we found for the washout ratio with DCE-MRI semiquantitative analysis data will be useful in daily practice in the differentiation of malignant and benign FLL.
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