{"id":10618,"date":"2020-12-29T19:05:50","date_gmt":"2020-12-30T00:05:50","guid":{"rendered":"https:\/\/cornflowerblue-rail-980953.hostingersite.com\/?p=10618"},"modified":"2020-12-29T19:10:22","modified_gmt":"2020-12-30T00:10:22","slug":"whats-new-in-msk-imaging-turkish-december-2020","status":"publish","type":"post","link":"https:\/\/staging-hub.acoredu.com\/tr\/whats-new-in-msk-imaging-turkish-december-2020\/","title":{"rendered":"What&#8217;s new in MSK Imaging (Turkish) &#8211; December 2020"},"content":{"rendered":"<h5><span style=\"color: #3366ff;\"><strong>Vertebral K\u0131r\u0131lganl\u0131k K\u0131r\u0131klar\u0131nda MDCT ile Kemik \u0130li\u011finde \u00d6dem ve K\u0131r\u0131k Ya\u015f\u0131 Tahmini<\/strong><\/span><\/h5>\n<p><strong>Giri\u015f<\/strong>: Her ne kadar daha \u00f6nceki \u00e7al\u0131\u015fmalar kemik ili\u011fi \u00f6deminin varl\u0131\u011f\u0131ndan ziyade benign ve malign VKK ayr\u0131m\u0131na odaklanm\u0131\u015f olsa da, kemik y\u0131k\u0131m\u0131 olmadan kortikal ya da trabek\u00fcler g\u00f6r\u00fclen k\u0131r\u0131klar, dif\u00fcz vertebral skleroz ve paravertebral yumu\u015fak doku de\u011fi\u015fiklikler, Vertebral Kompresyon K\u0131r\u0131klar\u0131n\u0131n (VKK) bilinen BT bulgular\u0131ndand\u0131r. Vertebral g\u00f6vdenin \u00f6n k\u0131sm\u0131nda g\u00f6r\u00fclen bir step defekti, yumu\u015fak doku kanamalar\u0131 ve \u00e7izgisel beyaz bir bant g\u00f6r\u00fcn\u00fcm\u00fc, akut (2 aydan k\u0131sa s\u00fcreli) kompresyon k\u0131r\u0131klar\u0131n\u0131n radyografik bulgular\u0131ndand\u0131r ancak BT\u2019de de g\u00f6r\u00fclebilirler.<\/p>\n<p><strong>Soru<\/strong>: BT bulgular\u0131, vertebral k\u0131r\u0131lganl\u0131k k\u0131r\u0131klar\u0131nda g\u00f6r\u00fclen ve MR\u2019de do\u011frulanacak kemik ili\u011fi \u00f6demi ve k\u0131r\u0131k ya\u015f\u0131n\u0131 \u00f6ng\u00f6rebilir mi?<\/p>\n<p><strong>T\u00fcr<\/strong>: Retrospektif \u00c7al\u0131\u015fma<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: Spinal BT ve MR g\u00f6r\u00fcnt\u00fcleri mevcut, 103 hastada saptanm\u0131\u015f toplamda 186 adet torakolumbal kompresyon k\u0131r\u0131\u011f\u0131 retrospektif olarak \u00e7al\u0131\u015fmaya dahil edilmi\u015ftir (14 erkek, 89 kad\u0131n; ortalama ya\u015f, 76)<\/p>\n<p><strong>Dahiliyet Kriterleri<\/strong>: Benign k\u0131r\u0131lgan kompresyon k\u0131r\u0131klar\u0131n\u0131 bulmak i\u00e7in, malign durum tan\u0131s\u0131 almam\u0131\u015f torakolumbal kompresyon k\u0131r\u0131\u011f\u0131 tan\u0131l\u0131 vakalar aras\u0131ndan, son 7 g\u00fcn i\u00e7erisinde spinal BT ve MR \u00e7ektirmi\u015f olanlar \u00e7al\u0131\u015fmaya al\u0131nm\u0131\u015ft\u0131r.<\/p>\n<p><strong>D\u0131\u015flama Kriterleri<\/strong>: \u015eiddetli darbeden travma vakalar\u0131 (motorlu ara\u00e7 kazalar\u0131 ve y\u00fckseklikten d\u00fc\u015fmeler), enfeksiyon ge\u00e7iren hastalar, metal e\u015fya yerle\u015ftirilmi\u015f olmas\u0131ndan dolay\u0131 kemik ili\u011fi sinyallerini bozan vakalar, d\u00fc\u015f\u00fck kaliteli g\u00f6r\u00fcnt\u00fcler ve k\u0131r\u0131\u011f\u0131n patolojik seyirli olup benign t\u00fcm\u00f6r (hemanjiom) i\u00e7ermesi gibi durumlarda hastalar \u00e7al\u0131\u015fman\u0131n d\u0131\u015f\u0131nda b\u0131rak\u0131lm\u0131\u015ft\u0131r.<\/p>\n<p><strong>Y\u00f6ntem<\/strong>: Vakalar\u0131 grupland\u0131rmak amac\u0131yla kemik ili\u011fi \u00f6demi varl\u0131\u011f\u0131 MR arac\u0131l\u0131\u011f\u0131yla incelenmi\u015f ve olanlar ekstansif (vertebral g\u00f6vdenin %50\u2019sinden fazlas\u0131n\u0131 kapsam\u0131\u015f olacak \u015fekilde) ve vertebral g\u00f6vdenin %50\u2019sinden az\u0131n\u0131 kapsam\u0131\u015f \u015fekilde alt gruplara ayr\u0131lm\u0131\u015ft\u0131r. BT\u2019de 5 kilit \u00f6zellik izlenmi\u015ftir: kemi\u011fin kortikal b\u00f6lgesinde, kemik ucunda ya da trabek\u00fcler alanda bir k\u0131r\u0131k \u00e7izgisi ve kondensasyon band\u0131 varl\u0131\u011f\u0131 ve trabek\u00fcler aten\u00fcasyon ve para \u2013 vertebral yumu\u015fak doku de\u011fi\u015fiklikleri<\/p>\n<p><strong>Sonu\u00e7lar<\/strong>: Kemik ili\u011fi \u00f6demi g\u00f6r\u00fclen vakalarda, say\u0131lan 5 BT bulgular\u0131n\u0131n hepsi g\u00f6zlenmi\u015ftir. Artm\u0131\u015f trabek\u00fcler aten\u00fcasyon, kortikal ya da kemik ucunda k\u0131r\u0131k \u00e7izgisi varl\u0131\u011f\u0131 ve para \u2013 vertebral yumu\u015fak doku kal\u0131nl\u0131\u011f\u0131, kemik ili\u011fi \u00f6demi g\u00f6r\u00fclen k\u0131r\u0131k vakalar\u0131 i\u00e7in harika tan\u0131 endikasyonlar\u0131 olarak \u00f6ne \u00e7\u0131km\u0131\u015f, ekstansif \u00f6dem g\u00f6r\u00fclen vakalarda para \u2013 vertebral yumu\u015fak doku geni\u015fli\u011fi \u00f6zellikle artm\u0131\u015f ancak trabek\u00fcler aten\u00fcasyon, vertebral g\u00f6vdenin %50\u2019sinden az\u0131n\u0131 kaplayan kemik ili\u011fi \u00f6demi grubundakilere k\u0131yasla az bulunmu\u015ftur. Lineer kar\u0131\u015f\u0131k model analizlerinde, yaln\u0131zca artm\u0131\u015f trabek\u00fcler aten\u00fcasyon k\u0131r\u0131kta daha ilerlemi\u015f bir ya\u015f\u0131n g\u00f6stergesi olarak saptanm\u0131\u015f, kemik ili\u011fi \u00f6demi varl\u0131\u011f\u0131nda, vakalarda \u00f6nemli bir ya\u015f fark\u0131na rastlanmam\u0131\u015ft\u0131r.<\/p>\n<p><strong>\u00d6zet<\/strong>: Vertebral k\u0131r\u0131lganl\u0131k k\u0131r\u0131klar\u0131nda BT bulgular\u0131, kemik ili\u011fi \u00f6deminin varl\u0131\u011f\u0131 ve \u015fiddetiyle \u00f6rt\u00fc\u015fen sonu\u00e7lar sunmakta ve k\u0131r\u0131k ya\u015f\u0131n\u0131n tek \u00f6nemli g\u00f6stergesinin trabek\u00fcler aten\u00fcasyon art\u0131\u015f\u0131 oldu\u011fu g\u00f6r\u00fclmektedir.<\/p>\n<p><strong>Yorumlar<\/strong>: Yay\u0131n\u0131n i\u00e7in te\u015fekk\u00fcr ederiz. Subakut ve kronik k\u0131r\u0131klar\u0131n tan\u0131s\u0131nda skleroz ve kemik yo\u011funlu\u011funun kullan\u0131ld\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fc ancak bu \u00e7al\u0131\u015fma, k\u0131r\u0131k ya\u015f\u0131n\u0131n anla\u015f\u0131lmas\u0131 \u00fczerine bilgimizi bir sonraki ad\u0131ma ta\u015f\u0131m\u0131\u015f.<\/p>\n<p><strong>Stajyer i\u00e7in spot bilgi<\/strong>:<\/p>\n<ul>\n<li>Vertebral k\u0131r\u0131klarda ya\u015f tahmini zordur.<\/li>\n<li>Kemik ili\u011fi \u00f6demi, skleroz ve kemik yo\u011funlu\u011fu gibi bulgular\u0131 kullanarak ya\u015f tahmini s\u00fcreci kolayla\u015ft\u0131r\u0131labilir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Artroskopik Rotator Man\u015fet Tedavisinden Sonra Tendon \u0130yile\u015fmesinin UTE \u2013 T2 Y\u00f6ntemiyle Kantitatif Manyetik Rezonans G\u00f6r\u00fcnt\u00fclemesi<\/strong><\/span><\/h5>\n<p><strong>Giri\u015f<\/strong>: Ultrashort Echo Time \u2013 T2 (UTE \u2013 T2), k\u0131sa ve \u00e7ok k\u0131sa echo zaman aral\u0131klar\u0131nda farkl\u0131 yank\u0131 zamanlar\u0131n\u0131 kullanarak detayl\u0131 yap\u0131land\u0131rma ve tendon gibi k\u0131sa yap\u0131lar\u0131n g\u00f6r\u00fcnt\u00fclenmesini sa\u011flayan bir g\u00f6r\u00fcnt\u00fcleme sekans\u0131. UTE \u2013 T2 tekni\u011fi, tendonlarda biyokimyasal de\u011fi\u015fikliklerin ke\u015ffi i\u00e7in kullan\u0131l\u0131yor. Rotator man\u015fet kaslar\u0131n\u0131n iyile\u015fmesinin proliferatif ve remodeling fazlar\u0131nda, iyile\u015fme alan\u0131nda \u00f6nce d\u00fczensiz bir kolajen yara dokusu olu\u015fur. Sonra, kolajen lifleri birikmeye, y\u00f6n de\u011fi\u015ftirmeye ve yeniden d\u00fczenlenmeye ba\u015flar. UTE \u2013 T2 de\u011ferlerinin, kolajen matrisindeki bu biyokimyasal de\u011fi\u015fikliklere hassas oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n<p><strong>Ama\u00e7<\/strong>: UTE \u2013 T2 verilerindeki dikey de\u011fi\u015fikliklere, klinik seyre ve Artroskopik Rotator Man\u015fet Tedavisi (ARMT) g\u00f6rm\u00fc\u015f hastalar\u0131n iyile\u015fme derecelerine dayanarak hastalar\u0131n iyile\u015fme s\u00fcrecini de\u011ferlendirmek.<\/p>\n<p><strong>T\u00fcr<\/strong>: Kohort \u00e7al\u0131\u015fmas\u0131<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: 2015 ve 2017 y\u0131llar\u0131 yaras\u0131nda, spor hekimli\u011fi merkezinde, supraspinatus tendon y\u0131rt\u0131lmas\u0131ndan dolay\u0131 tedavi g\u00f6ren ve unilateral ARMT i\u00e7in randevu alm\u0131\u015f hastalardan (n = 25) olu\u015fan bir dizi. T\u00fcm lezyonlar artroskopi arac\u0131l\u0131\u011f\u0131yla do\u011frulanm\u0131\u015f ve bir grup (n = 15) ya\u015f aral\u0131\u011f\u0131 uyumlu g\u00f6n\u00fcll\u00fc, sa\u011fl\u0131kl\u0131 kontrol grubu olarak \u00e7al\u0131\u015fmaya dahil edilmi\u015ftir.<\/p>\n<p><strong>Dahiliyet Kriterleri<\/strong>:<\/p>\n<p>ARMT grubu;<\/p>\n<ol>\n<li>DeOrio ve Cofield kriterlerine g\u00f6re k\u00fc\u00e7\u00fck ve b\u00fcy\u00fck supraspinatus tendon y\u0131rt\u0131\u011f\u0131 ( 1 cm\u2019den b\u00fcy\u00fck ama 5 cm\u2019den k\u00fc\u00e7\u00fck) olmas\u0131,<\/li>\n<li>30 kg\/m<sup>2<\/sup>\u2019den k\u00fc\u00e7\u00fck v\u00fccut kitle indeksi,<\/li>\n<li>Ameliyat \u00f6ncesi semptomlar\u0131n\u0131n 12 aydan daha k\u0131sa bir s\u00fcre boyunca g\u00f6zlenmi\u015f olmas\u0131.<\/li>\n<\/ol>\n<p><strong>D\u0131\u015flama Kriterleri<\/strong>:<\/p>\n<ol>\n<li>Rotator man\u015fet kaslar\u0131nda, Goutallier s\u0131n\u0131fland\u0131rmas\u0131na g\u00f6re 3 veya 4. Derece ya\u011f dejenerasyonu bulunmas\u0131,<\/li>\n<li>Orta ve ciddi derecelerde glenohumeral artrit,<\/li>\n<li>Kas \u2013 sinir hastal\u0131klar\u0131, romatoid artrit, travma ya da di\u011fer sistemik hastal\u0131klar\u0131n (diyabet, hipertansiyon vb.) varl\u0131\u011f\u0131,<\/li>\n<li>Klostrofobi gibi MR kontraindikasyonlar\u0131.<\/li>\n<\/ol>\n<p><strong>Y\u00f6ntem<\/strong>: Hastalar ARMT sonras\u0131 3, 6, 12 ve 24. aylarda kantitatif MR ve klinik de\u011ferlendirmeden ge\u00e7tiler. Ya\u015f e\u015fle\u015fmesi sa\u011flanan kontrol grubunda, kay\u0131t sonras\u0131 3. ve 12. aylarda genel de\u011ferlendirme yap\u0131ld\u0131. Klinik de\u011ferlendirmede Constant, American Shoulder and Elbow Surgeons ve Fudan University Shoulder skorlama sistemleri kullan\u0131ld\u0131. UTE \u2013 T2 y\u00f6ntemiyle yap\u0131lan MR g\u00f6r\u00fcnt\u00fclemelerinde, iyile\u015fme alanlar\u0131nda elde edilen T2 de\u011ferleri baz al\u0131nd\u0131 ve iyile\u015fme derecesinin de\u011ferlendirilmesinde Sugaya s\u0131n\u0131fland\u0131rmas\u0131 kullan\u0131ld\u0131. UTE \u2013 T2 de\u011fi\u015fikliklerinin, klinik verilerin ve Sugaya s\u0131n\u0131fland\u0131rma bulgular\u0131n\u0131n dikey analizeri yap\u0131ld\u0131.<\/p>\n<p><strong>Sonu\u00e7lar<\/strong>:<\/p>\n<ol>\n<li>Yeniden y\u0131rt\u0131lman\u0131n g\u00f6r\u00fclme oran\u0131 %8\u2019di (2\/25, hepsi Sugaya tip IV). T\u00fcm hastalarda (yeniden y\u0131rt\u0131lman\u0131n g\u00f6r\u00fcld\u00fc\u011f\u00fc hastalar dahil) klinik skorlamaya g\u00f6re, 12 ay i\u00e7erisinde, 24. aya kadar s\u00fcren tatmin edici sonu\u00e7lar elde edildi.<\/li>\n<li>3 ve 6. aylar aras\u0131nda, iyile\u015fme alan\u0131ndaki ortalama UTE \u2013 T2 verilerinde art\u0131\u015f g\u00f6r\u00fcld\u00fc (p = 0.03) ve 12 ay i\u00e7erisinde veriler, sa\u011fl\u0131kl\u0131 control grubunkilere benzer bir de\u011fere azalarak sabitlendi (p = 0.1).<\/li>\n<li>12 ve 14. aylar aras\u0131nda, UTE \u2013 T2 verilerinde \u00f6nemli bir de\u011fi\u015fikli\u011fe rastlanmad\u0131 (p = 0.6).<\/li>\n<li>Sugaya s\u0131n\u0131fland\u0131rmas\u0131na g\u00f6re iyile\u015fme alan\u0131ndaki UTE \u2013 T2 verileri, iyile\u015fme a\u015famas\u0131 kapsam\u0131nda olduk\u00e7a de\u011fi\u015fkendi (p &lt; 0.05). Ayr\u0131ca 6. Ve 12. aylarda UTE \u2013 T2 verileri ve klinik skorlar aras\u0131nda dikkate de\u011fer bir korelasyon saptand\u0131.<\/li>\n<\/ol>\n<p><strong>\u00d6zet<\/strong>: Bu \u00e7al\u0131\u015fmada kantitatif UTE \u2013 T2 verileri ve klinik seyir aras\u0131nda, iyile\u015fme s\u00fcrecine dayal\u0131 bir ili\u015fki sergilendi. Bu ili\u015fki, tendon iyile\u015fme s\u00fcrecinde non \u2013 invasif bir teknik olarak UTE \u2013 T2 verilerinin kullan\u0131m\u0131n\u0131n potansiyelini kan\u0131tlarken, 12 ayl\u0131k takip s\u00fcrecinde iyile\u015fmi\u015f tendonun sa\u011fl\u0131kl\u0131 kontrol grubundakilere benzer bulgular verecek bir seviyeye ula\u015ft\u0131\u011f\u0131n\u0131 da g\u00f6stermi\u015f oldu.<\/p>\n<p><strong>Yorum<\/strong>: Bu inovatif \u00e7al\u0131\u015fma i\u00e7in te\u015fekk\u00fcr ederiz. \u015eu a\u015famada pratik kullan\u0131m g\u00f6stergeleri mevcut olmayabilir ancak tendon iyile\u015fme s\u00fcrecine dair anlay\u0131\u015f\u0131m\u0131za kesinlikle katk\u0131da bulunmu\u015f oldu.<\/p>\n<p><strong>Stajyer i\u00e7in spot bilgi<\/strong>:<\/p>\n<ul>\n<li>Rotator man\u015fet tendon yaralanmalar\u0131nda fonksiyonun yeniden ba\u015flamas\u0131n\u0131n mevcut g\u00f6stergesi, klinik seyre ba\u011fl\u0131d\u0131r.<\/li>\n<li>De\u011ferlendirmenin nesnel g\u00f6stergelere g\u00f6re yap\u0131lmas\u0131 \u00f6nemlidir.<\/li>\n<li>UTE, iyile\u015fmenin derecelendirilmesinde alternative bir yolak \u00e7izmektedir ancak teknik ve yorumland\u0131rmalar hen\u00fcz erken a\u015famalar\u0131ndad\u0131r.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Sagittal T2 \u2013 DIXON Turbo Spin \u2013 Echo Sekans\u0131yla Dejeneratif Omurga G\u00f6r\u00fcnt\u00fclemesi<\/strong><\/span><\/h5>\n<p><strong>Giri\u015f<\/strong>: Sagittal T2 \u2013 DIXON Turbo Spin \u2013 Echo (TSE) sekans\u0131 g\u00f6r\u00fcnt\u00fclemenin tan\u0131sal performans\u0131n\u0131 \u00f6l\u00e7mek ve MR\u2019da dejeneratif omurga g\u00f6r\u00fcnt\u00fclemelerinde, yaln\u0131z ya\u011f odakl\u0131 g\u00f6r\u00fcnt\u00fclerin, kapsaml\u0131 sagittal T1 sekanslar\u0131n\u0131n yerine ge\u00e7ip ge\u00e7emeyece\u011fini saptamak.<\/p>\n<p><strong>Soru<\/strong>: T1 sekanslar\u0131 ayr\u0131ca \u00e7ekilmeksizin T2 DIXON sekanslar\u0131 omurgada yayg\u0131n dejeneratif de\u011fi\u015fiklikleri saptayabilir mi?<\/p>\n<p><strong>T\u00fcr<\/strong>: Retrospektif kar\u015f\u0131t ba\u011flamsal g\u00f6zlem \u00e7al\u0131\u015fmas\u0131<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: Sagittal T2 DIXON sekans\u0131 (tamamlanma s\u00fcresi: 3 dakika 25 saniye) ve T1 sekans\u0131ndan (tamamlanma s\u00fcresi: 3 dakika 3 saniye) lumbar omurga MR g\u00f6r\u00fcnt\u00fclemeleri tamamlanm\u0131\u015f ve lumbar s\u0131rt a\u011fr\u0131s\u0131 (LSA) belirtisi g\u00f6steren 35 hasta (56.5 \u00b1 19.8 ya\u015flar\u0131nda, %62.9\u2019u erkek).<\/p>\n<p><strong>Dahiliyet Kriterleri<\/strong>: Yaln\u0131zca hem sagittal T2 DIXON hem de kontrasts\u0131z T1 sekanslar\u0131nda, t\u00fcm lumbar omurgan\u0131n MR g\u00f6r\u00fcnt\u00fcleri mevcut olan hastalar \u00e7al\u0131\u015fmaya dahil edilmi\u015ftir.<\/p>\n<p><strong>D\u0131\u015flama Kriterleri<\/strong>:<\/p>\n<ol>\n<li>Hastan\u0131n 18 ya\u015f\u0131n\u0131n alt\u0131nda olmas\u0131,<\/li>\n<li>G\u00f6r\u00fcnt\u00fclenme verilerinde hareket kaynakl\u0131 bozulmalar,<\/li>\n<li>G\u00f6r\u00fcnt\u00fclenme alan\u0131nda implant varl\u0131\u011f\u0131,<\/li>\n<li>Lumbar omurgaya m\u00fcdahale i\u00e7eren ameliyat ge\u00e7mi\u015fi,<\/li>\n<li>Lumbar skolyoz<\/li>\n<li>Lumbar omurga seviyesinde yap\u0131sal de\u011fi\u015fiklikler g\u00f6steren konjenital hastal\u0131k ge\u00e7mi\u015fi (spina bifida, gergin omurilik vb.),<\/li>\n<li>Hematopoietik hastal\u0131k tan\u0131s\u0131,<\/li>\n<li>Vertebral k\u0131r\u0131k, malign kemik lezyonu ya da spondilodiskit lezyon varl\u0131\u011f\u0131.<\/li>\n<\/ol>\n<p><strong>Y\u00f6ntem<\/strong>: Tan\u0131sal g\u00fcven (1 \u2013 d\u00fc\u015f\u00fck, 2 \u2013 orta ve 3 \u2013 y\u00fcksek) ve vertebral kemik ili\u011finde sinyal de\u011fi\u015fiklikleri kapsam\u0131nda g\u00f6r\u00fclen dejeneratif de\u011fi\u015fiklikler iki okuyucu taraf\u0131ndan (R1 ve R2) iki g\u00f6r\u00fcnt\u00fc katman\u0131 halinde (katman 1: yaln\u0131z ya\u011f, yaln\u0131z su ve faz i\u00e7i DIXON sekanslar\u0131; katman 2: yaln\u0131z su ve faz i\u00e7i DIXON sekans\u0131 g\u00f6r\u00fcnt\u00fcleriyle T1 MR g\u00f6r\u00fcnt\u00fcleri) de\u011ferlendirilmi\u015ftir. Okuyucular ve katmanlar aras\u0131nda sonu\u00e7lar k\u0131yaslanm\u0131\u015ft\u0131r.<\/p>\n<p><strong>Sonu\u00e7<\/strong>: katman 1 ve 2\u2019nin iki okuyucu baz\u0131nda k\u0131yaslanmas\u0131 esnas\u0131nda, g\u00f6r\u00fcld\u00fckleri segment a\u00e7\u0131s\u0131ndan saptanan patoloji ya da dejeneratif de\u011fi\u015fiklikler taraf\u0131ndan etkilenmi\u015f segment say\u0131s\u0131nda bir farka rastlanmam\u0131\u015ft\u0131r. Her iki katman\u0131n da okuyucular taraf\u0131ndan de\u011ferlendirilmesinde, okuyucular aras\u0131nda \u00f6nemli bir fark g\u00f6zlenmeyecek \u015fekilde tan\u0131sal g\u00fcven y\u00fcksek bulunmu\u015ftur.<\/p>\n<p><strong>\u00d6zet<\/strong>: Lumbar s\u0131rt a\u011fr\u0131s\u0131 g\u00f6r\u00fclen hastalarda, T2 DIXON sekans\u0131 ya da ayr\u0131ms\u0131z T1 sekans\u0131nda MR g\u00f6r\u00fcnt\u00fclemesi, y\u00fcksek tan\u0131sal g\u00fcvenle yayg\u0131n dejeneratif de\u011fi\u015fikliklerin saptanmas\u0131nda yeterli olabilir. Kapsaml\u0131 bir T1 sekans\u0131na ba\u015fvurmamak toplam g\u00f6r\u00fcnt\u00fc tamamlanma s\u00fcresini dikkate de\u011fer \u00f6l\u00e7\u00fcde k\u0131saltabilir.<\/p>\n<p><strong>Yorum<\/strong>: \u00c7al\u0131\u015fman i\u00e7in te\u015fekk\u00fcrler. T2 Dixon g\u00f6r\u00fcnt\u00fclenmesi bizim muayenelerimizde de uzun zamand\u0131r rutin olarak kullan\u0131lmaktayd\u0131. Hem g\u00f6r\u00fcnt\u00fc s\u00fcresini k\u0131salt\u0131yor hem de \u00fc\u00e7 d\u00fczlemli T2 Dixon g\u00f6r\u00fcnt\u00fcleri, ilik de\u011ferlendirmesi ve patoloji bulgular\u0131n\u0131 ayn\u0131 taramada sundu\u011fundan, di\u011fer t\u00fcm g\u00f6r\u00fcnt\u00fc sekanslar\u0131n\u0131n yerini de iyi tutuyor.<\/p>\n<p><strong>Stajyer i\u00e7in spot bilgi<\/strong>:<\/p>\n<ul>\n<li>Kas kemik sistemi MR\u2019lar\u0131nda ilik de\u011ferlendirmesi \u00f6nemlidir.<\/li>\n<li>MR\u2019da s\u00fcre \u00e7ok \u00f6nemlidir.<\/li>\n<li>\u00c7ok odakl\u0131 Dixon g\u00f6r\u00fcnt\u00fcleri, T1 g\u00f6r\u00fcnt\u00fclerinin atlanmas\u0131na bir \u00e7\u00f6z\u00fcm olana\u011f\u0131 sunabilir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Akromial Morfolojik \u00d6zelliklerin ve Akromioklavikular Artrozisin K\u0131smi Supraspinatus Tendon Y\u0131rt\u0131klar\u0131 Tedavisinde Platelet Zengini Plazma Kullan\u0131m\u0131 \u00dczerinde Etkileri<\/strong><\/span><\/h5>\n<p><strong>Giri\u015f<\/strong>: Otolog platelet zengini plazman\u0131n (PZP) tendon anormalliklerinin tedavisinde kullan\u0131m\u0131 zamanla yayg\u0131n hale gelmi\u015ftir. Bu esnada ultrason rehberli\u011finde tendon y\u0131rt\u0131\u011f\u0131n\u0131n yerini do\u011fru belirlemek, i\u011fnenin ucunu do\u011fru yerle\u015ftirmek ve PZP\u2019nin y\u0131rt\u0131\u011f\u0131 gerekti\u011fi \u015fekilde doldurdu\u011fundan emin olmak \u00f6nemlidir. \u015eu ana kadar supraspinatus y\u0131rt\u0131klar\u0131n\u0131n (k\u0131smi ve tam) ya da subakromial \u2013 subdeltoid alanlarda y\u0131rt\u0131kla alakal\u0131 olu\u015fan bursitin b\u00fcy\u00fckl\u00fc\u011f\u00fc \u00fczerinde, ultrason rehberli\u011finde ger\u00e7ekle\u015ftirilen PZP naklinin \u00f6nemini ara\u015ft\u0131ran bir \u00e7al\u0131\u015fma ger\u00e7ekle\u015ftirilmemi\u015ftir.<\/p>\n<p><strong>Soru<\/strong>: Orta uzunlukta bir d\u00f6nemde ultrason rehberli\u011finde platelet zengini plazma uygulamalar\u0131n\u0131n supraspinatus tendonu k\u0131smi y\u0131rt\u0131klar\u0131 \u00fczerinde etkileri nelerdir? \u0130deal olmayan sonu\u00e7lar\u0131n ortaya \u00e7\u0131kmas\u0131nda g\u00f6r\u00fclen prognostik belirte\u00e7ler nelerdir?<\/p>\n<p><strong>T\u00fcr<\/strong>: Prospektif \u00e7al\u0131\u015fma<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: Toplamda 128 hasta \u00e7al\u0131\u015fmaya dahil edilmi\u015ftir (66 erkek, 62 kad\u0131n; ortalama ya\u015f, 48.3; ya\u015f aral\u0131\u011f\u0131 20 \u2013 59)<\/p>\n<p><strong>Dahiliyet Kriterleri<\/strong>: 20 \u2013 60 ya\u015f aral\u0131\u011f\u0131nda, k\u0131smi supraspinatus y\u0131rt\u0131klar\u0131 MR\u2019la tan\u0131 alm\u0131\u015f ve 3 aydan uzun s\u00fcredir omuz a\u011fr\u0131s\u0131ndan \u015fikayet\u00e7i hastalar \u00e7al\u0131\u015fmaya dahil edilmi\u015ftir.<\/p>\n<p><strong>D\u0131\u015flama Kriterleri<\/strong>:<\/p>\n<ol>\n<li>Travma, ameliyat ya da omuz bozukluklar\u0131 ge\u00e7mi\u015fi,<\/li>\n<li>Opyat ya da non \u2013 steroidal anti \u2013 inflammatuar ajan (NSAID) kullan\u0131m\u0131,<\/li>\n<li>Omuza yap\u0131lan ge\u00e7mi\u015f infiltratif uygulamalar,<\/li>\n<li>1 y\u0131ldan uzun s\u00fcredir MR g\u00f6r\u00fcnt\u00fc yoklu\u011fu,<\/li>\n<li>Supraspinatus y\u0131rt\u0131\u011f\u0131n\u0131n tam olmas\u0131, kas \u2013 tendon kesi\u015fiminde yer almas\u0131 ya da k\u0131smi olsa da 1.5 cm\u2019den b\u00fcy\u00fck olmas\u0131,<\/li>\n<li>B\u00f6lgede ilgili ba\u015fka tendon ya da kemik incinmesinin bulunmas\u0131,<\/li>\n<li>Belirgin glenohumeral artrozis varl\u0131\u011f\u0131 (klinik a\u00e7\u0131dan \u00f6nemli eklem alan\u0131 daralmas\u0131, k\u0131k\u0131rdak alt\u0131 bulgular ya da 2 mm\u2019den b\u00fcy\u00fck boyutlarda osteofit varl\u0131\u011f\u0131),<\/li>\n<li>Inflamatuar ya da kristal artropati varl\u0131\u011f\u0131.<\/li>\n<\/ol>\n<p><strong>Y\u00f6ntem<\/strong>: 4 senelik bir s\u00fcre\u00e7 i\u00e7erisinde, 1.5 cm\u2019den k\u00fc\u00e7\u00fck boyutlarda supraspinatus y\u0131rt\u0131klar\u0131 olup 3 aydan uzun s\u00fcren bir omuz a\u011fr\u0131s\u0131 i\u00e7in, ultrason rehberli\u011finde PZP uygulamas\u0131 ge\u00e7irmi\u015f (1 mL) hastalar \u00e7al\u0131\u015fmaya al\u0131nm\u0131\u015ft\u0131r. Akromionu ve akromioklavikular artrozu incelemek i\u00e7in MR kullan\u0131lm\u0131\u015f, primer (ba\u011flant\u0131l\u0131 bursit ve y\u0131rt\u0131\u011f\u0131n boyutlar\u0131) ve seconder (hareketlilik ve a\u011fr\u0131) bulgular 3. ayda toplanm\u0131\u015ft\u0131r.<\/p>\n<p><strong>Sonu\u00e7<\/strong>: 3. ay toplanan sonu\u00e7larda, hastalar\u0131n %71.1\u2019inde y\u0131rt\u0131\u011f\u0131n ideal bir iyile\u015fme s\u00fcrecinden ge\u00e7ti\u011fi ve hastalar\u0131n %66.7\u2019sinde bursit bulgusunun \u00e7\u00f6z\u00fcmlendi\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Y\u0131rt\u0131k boyutlar\u0131ndaki de\u011fi\u015fiklikler, hareketlilik ve a\u011fr\u0131 bulgular\u0131 b\u00fcy\u00fck \u00f6l\u00e7\u00fclerde de\u011fi\u015fmi\u015f, klinik a\u00e7\u0131dan y\u0131rt\u0131k ve bursit iyile\u015fmesinde, ideal olmayan geli\u015fmelerin en b\u00fcy\u00fck g\u00f6stergeleri tip 3 akromion ve akromioklavikular artrozun g\u00f6r\u00fcld\u00fc\u011f\u00fc tip 1 ya da tip 2 akromion olmu\u015ftur.<\/p>\n<p><strong>\u00d6zet<\/strong>: \u0130zole, 1.5 cm\u2019den k\u00fc\u00e7\u00fck, k\u0131smi supraspinatus tendon y\u0131rt\u0131klar\u0131nda tip 3 akromion ya da ciddi akromioklavikular artrozis varl\u0131\u011f\u0131, ideal olmayan bir klinik geli\u015fimin g\u00f6stergelerinden olup b\u00f6yle durumlarda akromioplasti d\u00fc\u015f\u00fcn\u00fclmelidir; ama tip 1, 2 ya da 4 akromion vakalar\u0131nda, akromioklavikular artrozis olsa da olmasa da PZP terapisi birincil tedavi se\u00e7enekleri aras\u0131nda de\u011ferlendirilmelidir.<\/p>\n<p><strong>Yorum<\/strong>: \u00c7al\u0131\u015fmalar\u0131n i\u00e7in te\u015fekk\u00fcrler. Bizim de deneyimlerimize g\u00f6re tip 3 akromion olduk\u00e7a nadir bir bulgudur ve genelde akromioklavikular eklem civar\u0131nda ortaya \u00e7\u0131k\u0131p osteofit olu\u015fumuyla beraber kendini g\u00f6sterir. PZP tedavi \u00e7al\u0131\u015fmalar\u0131n\u0131n en b\u00fcy\u00fck eksikliklerinden biri basit steroid tedavisi ya da fizyoterapi gibi di\u011fer tedavi se\u00e7enekleriyle k\u0131yaslamas\u0131n\u0131n olmamas\u0131 olmu\u015ftur ve rotator man\u015fet tedavilerinde etkileri (daha \u00e7ok fibroz dolgu olarak), en iyi ihtimalle zay\u0131f bir \u015fekilde kan\u0131tlanm\u0131\u015f denebilir.<\/p>\n<p><strong>Stajyer i\u00e7in spot bilgi<\/strong>:<\/p>\n<ul>\n<li>K\u0131smi kal\u0131nl\u0131kta rotator man\u015fet y\u0131rt\u0131klar\u0131 tedavisinde PZP, bir se\u00e7enektir.<\/li>\n<li>Bu tedavi y\u00f6nteminin sonu\u00e7lar\u0131yla alakal\u0131 hi\u00e7bir sa\u011fl\u0131kl\u0131 kan\u0131t yoktur.<\/li>\n<li>Rotator man\u015fet y\u0131rt\u0131klar\u0131nda, ultrason rehberli\u011finde yap\u0131lan enjeksiyonlarda, akromion \u015feklinden kaynaklanan mekanik zorluklar ortaya \u00e7\u0131kabilir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Dirsekte Ulnar N\u00f6ropati Tan\u0131s\u0131 i\u00e7in Ideal Ultrason Temelli \u00d6l\u00e7\u00fc Se\u00e7imi: 1961 Olgulu Meta \u2013 Analiz<\/strong><\/span><\/h5>\n<p><strong>Giri\u015f<\/strong>: Dirsekte Ulnar N\u00f6ropati (DUN), periferal s\u0131k\u0131\u015fma n\u00f6ropatileri aras\u0131nda en yayg\u0131n olanlardand\u0131r. Genel olarak, ultrasonun DUN tan\u0131s\u0131nda yeterli oldu\u011fu d\u00fc\u015f\u00fcn\u00fclse de, yap\u0131lan \u00f6nceki \u00e7al\u0131\u015fmalar kullan\u0131lan ultrason \u00f6l\u00e7\u00fcm teknikleri ve referans aral\u0131klar\u0131 a\u00e7\u0131s\u0131ndan olduk\u00e7a heterojen bulunmu\u015ftur; kullan\u0131lan \u00e7e\u015fitli parametreler (\u00e7ap, enine kesit alanlar, ulnar sinir oranlar\u0131), \u00f6l\u00e7\u00fcm alanlar\u0131 (orta koldan bile\u011fe kadar) ve \u00f6l\u00e7\u00fcm esnas\u0131nda dirsek fleksiyon dereceleri \u00e7al\u0131\u015fmadan \u00e7al\u0131\u015fmaya olduk\u00e7a de\u011fi\u015fkendir.<\/p>\n<p><strong>Soru<\/strong>: Dirsekte ulnar n\u00f6ropatinin tan\u0131s\u0131 i\u00e7in en uygun ultrason \u00f6l\u00e7\u00fcm tekni\u011fi ve referans de\u011ferleri nelerdir?<\/p>\n<p><strong>T\u00fcr<\/strong>: Meta &#8211; Analiz<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: 19 ara\u015ft\u0131rma (1961 muayene) de\u011ferlendirilmi\u015ftir.<\/p>\n<p><strong>Dahiliyet Kriterleri<\/strong>: Nisan 2019 \u00f6ncesi dirsekte ulnar n\u00f6ropatisi olan hastalar\u0131n tan\u0131sal do\u011frulu\u011funu de\u011ferlendiren \u00e7al\u0131\u015fmalar dikkate al\u0131nm\u0131\u015ft\u0131r.<\/p>\n<p><strong>Y\u00f6ntem<\/strong>: Medial epikondilde, sinirin proksimal ve distal seviyelerde \u00e7ap, enine kesit y\u00fczey alan\u0131 (EKYA), maksimal \u00e7ap, maksimal EKYA ve sinir oranlar\u0131 gibi \u00e7e\u015fitli ultrason \u00f6l\u00e7\u00fcmlerinin sensitivitesini, spesifisitesini ve tan\u0131sal g\u00f6receli olas\u0131l\u0131klar oran\u0131n\u0131 (GOO) k\u0131yaslamak amac\u0131yla rastgele etkiler modellemesi uygulanm\u0131\u015ft\u0131r. Sensitivite ve meta \u2013 regresyon analizlerinin yap\u0131lma amac\u0131 da klinik ve g\u00f6r\u00fcnt\u00fclemeye dayal\u0131 de\u011fi\u015fkenlerin ultrason GOO de\u011ferleri \u00fczerindeki etkisini de\u011ferlendirmektir.<\/p>\n<p><strong>Sonu\u00e7<\/strong>: Medial epikondil seviyesinde ulnar sinirin 10 \u2013 10.5 mm<sup>2<\/sup> referans de\u011feri kapsam\u0131nda EKYA \u00f6l\u00e7\u00fcm\u00fc, di\u011fer tekniklerden daha y\u00fcksek bir sensitivite sunmu\u015ftur. Her ne kadar sinir oranlar\u0131 di\u011fer \u00f6l\u00e7\u00fcmlerden daha y\u00fcksek bir spesifisite g\u00f6sterse de, oranlar\u0131n ve referans aral\u0131klar\u0131n tan\u0131m\u0131 \u00e7al\u0131\u015fmadan \u00e7al\u0131\u015fmaya de\u011fi\u015fkendir. ROC analizleri, Medial epikondil seviyesinde EKYA \u00f6l\u00e7\u00fcmlerinin yap\u0131lmas\u0131nda daha y\u00fcksek bir tan\u0131sal performansla \u00f6ne \u00e7\u0131km\u0131\u015f, ortalama EKYA \u00f6l\u00e7\u00fcmleri ultrasonda GOO\u2019nun \u00f6nemli bir g\u00f6stergesi olarak de\u011ferlendirilmi\u015ftir. EKYA\u2019da g\u00f6r\u00fclen her 1 mm<sup>2<\/sup>\u2019lik art\u0131\u015f GOO\u2019da %36\u2019l\u0131k bir y\u00fckselmeyle kar\u015f\u0131lanm\u0131\u015f ve ultrasonun tan\u0131sal performans\u0131 dirsek fleksiyonunun her derecesinde ayn\u0131 bulunmu\u015ftur.<\/p>\n<p><strong>\u00d6zet<\/strong>: Ulnar n\u00f6ropatinin tan\u0131s\u0131nda, ulnar sinirin medial epikondil seviyesinde (proksimal ya da distal seviyelerde de\u011fil), EKYA \u00f6l\u00e7\u00fcm\u00fc (\u00e7ap de\u011fil) ve 10 \u2013 10.5 mm<sup>2<\/sup>\u2019lik bir referans de\u011ferinin kullan\u0131m\u0131 \u00f6nerilmektedir. Ultrason \u00f6l\u00e7\u00fcmleri dirsek fleksiyonunun her derecesinde yap\u0131labilir. Maksimal sinir \u00e7ap\u0131, maksimal EKYA ya da sinir oranlar\u0131 DUN tan\u0131s\u0131nda uygun teknikler olarak de\u011ferlendirilemez.<\/p>\n<p><strong>Yorum<\/strong>: Yay\u0131n\u0131n i\u00e7in tebrikler. Ulnar n\u00f6ropatinin referans standartlar\u0131 s\u00f6z konusu oldu\u011funda, yalanc\u0131 negatif elektrofizyoloji \u00f6l\u00e7\u00fcmleri ve bariz semptomlar\u0131n yoklu\u011funda subklinik n\u00f6ropati, \u00f6nemli engeller olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. Yine de bu \u00e7al\u0131\u015fma ultrasonun DUN tan\u0131s\u0131nda kullan\u0131m\u0131n\u0131 sa\u011flamla\u015ft\u0131rmakta gayet yard\u0131mc\u0131 oluyor. Yazar\u0131n deneyimine g\u00f6re, ultrasonun baz\u0131 di\u011fer \u00f6nemli kullan\u0131mlar\u0131 da, MR\u2019la takibi daha zor olan, ulnar sinir ve triseps s\u0131k\u0131\u015fma sendromlar\u0131n\u0131n dinamik de\u011ferlendirmelerinde \u00f6ne \u00e7\u0131k\u0131yor.<\/p>\n<p><strong>Stajyer i\u00e7in spot bilgi<\/strong>:<\/p>\n<ul>\n<li>Ulnar sinirin enine kesit y\u00fczey alan\u0131 ulnar n\u00f6ropatinin \u00f6nemli bir g\u00f6stergesidir.<\/li>\n<li>Ulnar siniri medial epikondil seviyesinde \u00f6l\u00e7mek gerekir.<\/li>\n<li>Enine kesit y\u00fczey alan\u0131 i\u00e7in 10 \u2013 10.5 mm<sup>2<\/sup>\u2019lik bir referans de\u011feri, ulnar n\u00f6ropati kapsam\u0131nda iyi bir g\u00f6stergedir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Superolateral Hoffa Ya\u011f Yast\u0131\u011f\u0131 \u00d6demi ve Patellofemoral Maltracking: Sistematik \u0130nceleme ve Meta-Analiz<\/strong><\/span><\/h5>\n<p>Jun Ho Kim and Seul Ki Lee Kim JH, Lee SK.<\/p>\n<p>American Journal of Roentgenology. 2020 Jun 6:1-3.<\/p>\n<p><strong>Ge\u00e7mi\u015f<\/strong>: Superolateral Hoffa ya\u011f yast\u0131\u011f\u0131 (SHYY) \u00f6demi, gen\u00e7 yeti\u015fkinlerde \u00f6n diz a\u011fr\u0131s\u0131 ve patellan\u0131n alt u\u00e7 hassasiyeti ile karakterize altta yatan bir sendromun bulgusudur. Patellar tendon ve lateral femoral kondil aras\u0131ndaki s\u00fcrt\u00fcnmeye ba\u011fl\u0131 olarak olu\u015fan ve inflamatuar reaksiyonla SFYY\u2019deki \u00f6demat\u00f6z de\u011fi\u015fikli\u011fe neden olur. Patellar tendon ve lateral femoral kondil aras\u0131ndaki SHYY\u2019nin T2 a\u011f\u0131rl\u0131kl\u0131 veya proton yo\u011funlu\u011fu a\u011f\u0131rl\u0131kl\u0131 ya\u011fa doymu\u015f g\u00f6r\u00fcnt\u00fclerinde fokal artm\u0131\u015f sinyal yo\u011funlu\u011funu g\u00f6zlemleyerek MR bu klinik tan\u0131y\u0131 do\u011frulamak i\u00e7in m\u00fckemmel bir yetenek g\u00f6stermi\u015ftir.<\/p>\n<p><strong>Sorular<\/strong>: SHYY \u00f6deminin patellar maltracking ve yer de\u011fi\u015ftirme ile ili\u015fkili oldu\u011fu iyi biliniyor. Soru, . iki grubunda maltracking ile ilgili parametrelere sahip oldu\u011fu g\u00f6z \u00f6n\u00fcnde bulunduruldu\u011funda, SHYY \u00f6demli hastalar\u0131n \u00f6demi olmayan hastalara k\u0131yasla daha semptomatik olup olmad\u0131\u011f\u0131d\u0131r. Patellofemoral maltracking\u2019in hangi g\u00f6r\u00fcnt\u00fc parametreleri superolateral Hoffa ya\u011f yast\u0131\u011f\u0131 (SHYY) \u00f6demi ile ili\u015fkilidir?<\/p>\n<p><strong>T\u00fcr<\/strong>: Sistematik inceleme ve meta-analiz<\/p>\n<p><strong>Dahiliyet Kriteri<\/strong>: \u00c7al\u0131\u015fmalar, SHYY \u00f6demli ve \u00f6demsiz hastalar\u0131n kar\u015f\u0131la\u015ft\u0131rmas\u0131ndaki kriterlere ve MR\u2019daki patellofemoral maltraking parametrelere uyuyorsa dahil edildiler.<\/p>\n<p><strong>Metod<\/strong>: SHYY \u00f6demi ve patellofemoral maltracking aras\u0131ndaki ili\u015fkiyi de\u011ferlendiren \u00e7al\u0131\u015fmalar\u0131 tan\u0131mlayabilmek i\u00e7in MEDLINE, Embase ve Cochrane K\u00fct\u00fcphanesi veritabanlar\u0131nda sistematik bir ara\u015ft\u0131rma yap\u0131ld\u0131. Patellofemoral maltracking de\u011ferlendirmesinde kullan\u0131lan parametreler her bir \u00e7al\u0131\u015fma i\u00e7in incelendi. \u0130ki g\u00f6zlemci \u00e7al\u0131\u015fma se\u00e7imi, metodolojik kalite de\u011ferlendirmesi ve bilgi elemesi yapt\u0131.<\/p>\n<p><strong>Sonu\u00e7lar<\/strong>: Mevcut \u00e7al\u0131\u015fmadaya dahil olmak i\u00e7in dokuz \u00e7al\u0131\u015fma uygun bulundu. Dahil olan \u00e7al\u0131\u015fmalardan, patellofemoral maltracking\u2019i de\u011ferlendiren dokuz parametre analiz edildi: lateral patellofemoral a\u00e7\u0131, patellar e\u011fim, patellar laterilizasyon, troklear derinlik, oluk a\u00e7\u0131s\u0131, lateral troklear e\u011fim a\u00e7\u0131s\u0131, tibial tuberozite ve troklear oluk aras\u0131 uzakl\u0131k ve Insall-Salvati oran\u0131. SHYY \u00f6demi olan hastalar\u0131n \u00f6demi olmayan hastalara g\u00f6re daha b\u00fcy\u00fck troklear e\u011fimi, daha b\u00fcy\u00fck patellar laterilizasyonu, daha b\u00fcy\u00fck tibial tuberozite ve troklear oluk(TTTO) aras\u0131 uzakl\u0131\u011f\u0131 ve daha b\u00fcy\u00fck Insall-Salvati oran\u0131 vard\u0131.<\/p>\n<p><strong>\u00d6zet<\/strong>: Daha lateral yerle\u015fmi\u015f patella, daha b\u00fcy\u00fck TTTO, patella lata gibi patellafemoral maltracking g\u00f6r\u00fcnt\u00fc parametreleri SHYY \u00f6demi ile ili\u015fkilidir.<\/p>\n<p><strong>Yorum<\/strong>: SHYY \u00f6demi pato-anotomik bir bulgudur ve superolateral patellofemoral s\u0131k\u0131\u015fman\u0131n oldu\u011fu yerde g\u00f6zlenir. Fakat, a\u011fr\u0131yla ili\u015fkisinin ya da hareket alan\u0131nda k\u0131s\u0131tlanman\u0131n de\u011ferlendirilmesi zor. SHYY \u00f6deminin patellofemoral yerde\u011fi\u015ftirme ile ili\u015fkisini \u00f6zetleyen g\u00fczel bir \u00e7al\u0131\u015fma i\u00e7in tebrikler.<\/p>\n<p><strong>Eve g\u00f6t\u00fcr\u00fclecek mesaj<\/strong>:<\/p>\n<p>\u00d6n diz a\u011fr\u0131s\u0131 s\u0131kt\u0131r ama mevcut zorlu bir senaryodur. Ana sebeplerden biri patellar maltrackingdir.<\/p>\n<p>Superolateral ya\u011f yast\u0131\u011f\u0131 \u00f6demi maltracking\u2019in ikincil g\u00f6stergesidir.<\/p>\n<ul>\n<li>Odaklanacak b\u00f6lgeler:<\/li>\n<li>Lateral yerle\u015fmi\u015f patella<\/li>\n<li>Daha b\u00fcy\u00fck TTTO aral\u0131\u011f\u0131<\/li>\n<li>Patella alta<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Patella \u0130nstabilitesinin Kauntitatif De\u011fi\u015fken De\u011ferlendirmesi: MR Esasl\u0131 Bir \u00c7al\u0131\u015fma<\/strong><\/span><\/h5>\n<p>Michael V. Friedman, Travis J. Hillen, Sunil Misra, Charles F. Hildebolt1 and David A. Rubin Friedman MV, Hillen TJ, Misra S, Hildebolt CF, Rubin DA.<\/p>\n<p>American Journal of Roentgenology. 2020 Sep 9:1-8.<\/p>\n<p><strong>Ge\u00e7mi\u015f<\/strong>: Troklear displazi, tibial tuberozitenin lateralizasyonu ve y\u00fcksek pozisyonlu patella, hastalar i\u00e7in patella instabilitesine zemin haz\u0131rlayan en \u00f6nemli fakt\u00f6rler olarak tan\u0131mland\u0131lar. Bu de\u011fi\u015fken fakt\u00f6rlerin do\u011fru de\u011ferlendirilmesi ve karakterize edilmesi hasta y\u00f6netiminde yard\u0131mc\u0131 olur, i\u00e7lerinden troklear displasi en \u00f6nemli anatomik fakt\u00f6rlerden biri olarak kabul edilir.<\/p>\n<p><strong>Sorular<\/strong>: Patellar instabilite i\u00e7in \u00fc\u00e7 MR parametresi -TT-PCL, TT-TG ve troklear displazi tekrarlanabilirlik ile g\u00fcvenilir bir \u015fekilde \u00f6l\u00e7\u00fclebilir mi? Patella instabilitesine anatomik yatk\u0131nl\u0131\u011f\u0131 bireysel mi \u00f6l\u00e7\u00fcyorlar yoksa ba\u015fka parametrelerle birlikte mi?<\/p>\n<p><strong>T\u00fcr<\/strong>: Retrospektif \u00e7al\u0131\u015fma.<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: \u00c7al\u0131\u015fma pop\u00fclasyonu tek bir klinikte 2013\u2019ten 2015\u2019e kadar patella dislokasyo vaka tan\u0131s\u0131n\u0131 hem klinik hem MR\u2019dan alm\u0131\u015f 43 kad\u0131n ve 57 erkekten (ortalama ya\u015f 21.7, aral\u0131k 13-50 ya\u015f aras\u0131) olu\u015fuyor.<\/p>\n<p><strong>Dahiliyet Kriteri<\/strong>: Patella dislokasyon vaka tan\u0131s\u0131n\u0131 hem klinik hem MR\u2019dan alm\u0131\u015f olan hastalar. Klinik muayene pozitif apprehesion testi sonucunu, a\u015f\u0131r\u0131 patella kadran translasyonu, eklem ef\u00fczyonu ve pozitif cruciate ve menisk\u00fcs bulgular\u0131n yoklu\u011funu a\u00e7\u0131\u011fa \u00e7\u0131kard\u0131.<\/p>\n<p><strong>Dahil edilmeme kriteri<\/strong>: Patella instabilite vaka \u00f6yk\u00fcs\u00fc, ge\u00e7mi\u015f diz ameliyat\u0131 ya da istenilen \u00f6l\u00e7\u00fcmleri etkileyebilecek patella diskolasyonu s\u0131ras\u0131nda olu\u015fan cruciate ya da kollateral ligaman hasar\u0131.<\/p>\n<p><strong>Metod<\/strong>: Patella dislokasyon hasar\u0131 tan\u0131s\u0131 alan 100 hasta ve 100 ya\u015f-cinsiyet e\u015fle\u015ftirilmi\u015f kontrol hastas\u0131 MR ile muayene edildi. Tibial t\u00fcberk\u00fcl ve posterior cruciate ligaman (TT-PCL) aras\u0131 uzakl\u0131k, tibial t\u00fcberk\u00fcl ve troklear oluk (TT-TO) aras\u0131 uzakl\u0131k ve TG derinli\u011fi (troklear displazi) ba\u011f\u0131ms\u0131z olarak kas iskelet ihtisas e\u011fitimi alm\u0131\u015f \u00fc\u00e7 radyolog taraf\u0131ndan hesapland\u0131. S\u0131n\u0131f i\u00e7i korelasyon katsay\u0131s\u0131, intraobserver ve intereobserver g\u00fcvenilirli\u011fi i\u00e7in de\u011ferlendirildi. \u0130ki grup i\u00e7in de parametreler birbirilerine ba\u011f\u0131mla\u015f\u0131kl\u0131k i\u00e7in test edildi ve prevalans ve patellar instabiliteyle ili\u015fkileri i\u00e7in kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131.<\/p>\n<p><strong>Sonu\u00e7lar<\/strong>: T\u00fcm \u00fc\u00e7 parametre de neredeyse m\u00fckemmel intraobserver ve intereobserver g\u00fcvenilirlik g\u00f6sterdi ve patellar instabilite grubunda \u00f6nemli derecede daha s\u0131k olarak bulundu. Troklear displazi, patellar instabiliteyle en \u00e7ok ili\u015fkili \u00e7\u0131kt\u0131, hem \u00f6zg\u00fcn parametre hem de anormal TT-TO ile ikili kombinasyonda. Normal TT-TO ve TT-PCL i\u00e7in uygun s\u0131n\u0131r e\u015fi\u011fi s\u0131ras\u0131yla 15.00 mm ya da daha az\u0131, 21.30 mm ya da daha az\u0131d\u0131r. Troklear displazinin troklear derinlik ile de\u011ferlendirmesinde uygun normal s\u0131n\u0131r e\u015fi\u011fi 4.95 mm ya da daha fazlas\u0131d\u0131r.<\/p>\n<p><strong>\u00d6zet<\/strong>: TT-PCL, TT-TO ve troklear displazi \u00f6l\u00e7\u00fcmleri g\u00fcvenilir bir \u015fekilde MR ile neredeyse m\u00fckemmel intraobserver ve intereobserver g\u00fcvenilirli\u011fi ile de\u011ferlendirilebilir. TT-TO (\u2264 15.00 mm) ve TT-PCL (\u2264 21.30) i\u00e7in normal s\u0131n\u0131r e\u015fikleri MR\u2019da d\u00fc\u015f\u00fcr\u00fclebilir. \u00c7al\u0131\u015fmatroklear displaziyi troklear derinlikle de\u011ferlendirirken 5 mm ya da fazlas\u0131n\u0131 normal s\u0131n\u0131r e\u015fi\u011fi olarak kabul etti. Sonunda, TT lateralizasyonunun ve troklear displazinin prevalans\u0131 \u00f6nemli olarak patella instabilite pop\u00fclasyonunda daha y\u00fcksektir ve patella instabilite geli\u015fimindeki en \u00f6nemli fakt\u00f6r troklear displazidir.<\/p>\n<p><strong>Yorum<\/strong>: \u0130yi i\u015f! Tebriler. G\u00f6zlem ve retrospektif \u00e7al\u0131\u015fmalar maalesef nedenselli\u011fi g\u00f6sermek i\u00e7in kullan\u0131lamazlar. Ba\u011flant\u0131 daha iyi bir terim olur. Umuyorum ki, cerrahlar patellofemoral yer de\u011fi\u015fimi\/maltracking esnas\u0131nda trokleplasti yaparken daha dikkatli olurlar, ki bu Kuzey Amerika\u2019sa daha az s\u0131kl\u0131kla yap\u0131lan bir presed\u00fcrd\u00fcr.<\/p>\n<p><strong>Eve g\u00f6t\u00fcr\u00fclecek mesaj<\/strong>:<\/p>\n<ul>\n<li>Patella instabiliteli hastalar klinik muayenede patellalar\u0131n\u0131 hareket ettirince endi\u015feli olurlar.<\/li>\n<li>Patella instabilitesi i\u00e7in primer neden troklear displazidir.<\/li>\n<li>Displazi g\u00f6stergesi olarak troklear derinli\u011fe bak.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Ya\u015fl\u0131 Hastalarda Radyografik Olarak Gizli Kal\u00e7a K\u0131r\u0131\u011f\u0131 i\u00e7in Geli\u015fmi\u015f G\u00f6r\u00fcnt\u00fclemenin Kullan\u0131m\u0131: Sistematik Bir \u0130nceleme ve Meta-Analiz<\/strong><\/span><\/h5>\n<p>Haj-Mirzaian A, Eng J, Khorasani R, Raja AS, Levin AS, Smith SE, Johnson PT, Demehri S.<\/p>\n<p>Radiology. 2020 Jul 7:192167.<\/p>\n<p><strong>Ge\u00e7mi\u015f<\/strong>: Radyografilerde kal\u00e7a k\u0131r\u0131\u011f\u0131n\u0131n genel oran\u0131 tan\u0131mlanmad\u0131 ama klinik bulgulara g\u00f6re bu t\u00fcr k\u0131r\u0131klara sahip oldu\u011fundan \u015f\u00fcphelenilen ya\u015fl\u0131 hastalarda cerrahi gereksinim (cerrahi kal\u00e7a k\u0131r\u0131\u011f\u0131) belirsiz kalmaktad\u0131r. Cerrahi kal\u00e7a k\u0131r\u0131klar\u0131 acil cerrahi m\u00fcdahele gerektiren k\u0131r\u0131klar olarak tan\u0131mland\u0131 ve femur ba\u015f\u0131, femur boynu, intertrokanterik ve subtrokanterik k\u0131r\u0131klar\u0131 kapsamaktad\u0131r. Ayr\u0131ca, bu hastalarda geli\u015fmi\u015f g\u00f6r\u00fcnt\u00fclemenin \u00f6nemli kapsaml\u0131 bir \u015fekilde de\u011ferlendirilmedi.<\/p>\n<p><strong>Sorular<\/strong>: Ya\u015fl\u0131 hastalarda radyografik olarak gizli kal\u00e7a k\u0131r\u0131\u011f\u0131n\u0131n frekans\u0131 nedir? Daha riskte olan bir alt pop\u00fclasyon var m\u0131? BT ve kemik taramas\u0131 gizli k\u0131r\u0131klar\u0131 saptamakta MR kadar etkili mi?<\/p>\n<p><strong>T\u00fcr<\/strong>: Meta-analiz<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: 35 \u00e7al\u0131\u015fma tan\u0131mland\u0131 (2992 hasta; ortalama ya\u015f 76.8, \u00b1 6.0 [standart sapma]; %66 kad\u0131n).<\/p>\n<p><strong>Dahiliyet kriteri<\/strong>: \u00c7al\u0131\u015fmalar e\u011fer hastalar klinik olarak kal\u00e7a k\u0131r\u0131\u011f\u0131ndan \u015f\u00fcphelenildiyse dahil edildi ama cerrahi kal\u00e7a \u00e7\u0131k\u0131\u011f\u0131 i\u00e7in radyografik bir kan\u0131t yoktu ( Belirli bir k\u0131r\u0131k yoklu\u011fu ya da sadece izole b\u00fcy\u00fck trokanter k\u0131r\u0131\u011f\u0131 dahil).<\/p>\n<p><strong>Dahil edilmeme kriteri<\/strong>: Klinik olarak kal\u00e7a k\u0131r\u0131\u011f\u0131ndan \u015f\u00fcphelenilmeyen hastalar\u0131 de\u011ferlendiren \u00e7al\u0131\u015fmalar, \u0130ngilizce olmayan yay\u0131nlar, vaka raporu, vaka serisi, incelemesi, d\u00fc\u015f\u00fcnce\/editoryal, hayvan \u00e7al\u0131\u015fmas\u0131<\/p>\n<p><strong>Metod<\/strong>: Ba\u015flang\u0131\u00e7tan Eyl\u00fcl 27, 2018\u2019e kadar yay\u0131nlanm\u0131\u015f \u0130ngiliz dilindeki g\u00f6zlemsel \u00e7al\u0131\u015fmalar\u0131 bulmak i\u00e7in bir literat\u00fcr taramas\u0131 yap\u0131ld\u0131. MR\u2019\u0131n referans standart\u0131 olarak kullan\u0131ld\u0131\u011f\u0131 her \u00e7al\u0131\u015fma i\u00e7in cerrahi kal\u00e7a k\u0131r\u0131\u011f\u0131 oran\u0131 raporland\u0131. Gizli k\u0131r\u0131\u011f\u0131n karma oran\u0131, BT\u2019nin ve kemik taramas\u0131n\u0131n tan\u0131sal performan\u0131 ve kan\u0131t g\u00fcc\u00fc de\u011ferlendirildi.<\/p>\n<p>Sonu\u00e7lar:<\/p>\n<ol>\n<li>Klinik olarak kal\u00e7a k\u0131r\u0131\u011f\u0131ndan \u015f\u00fcphelenilen 56-82 ya\u015f hastalar radyografik olarak gizli kal\u00e7a k\u0131r\u0131\u011f\u0131n\u0131n frekans\u0131 y\u00fcksektir (%39-%92 aral\u0131\u011f\u0131nda).<\/li>\n<li>Gizli kal\u00e7a k\u0131r\u0131\u011f\u0131na y\u00fcksek olas\u0131l\u0131kla sahip olan hastalar; izole b\u00fcy\u00fck trokanter k\u0131r\u0131\u011f\u0131n\u0131n radyografik kan\u0131t\u0131na sahip olanlar(g\u00f6receli risk, 2.4), en yaz 80 ya\u015f\u0131nda olanlar (g\u00f6receli risk 1.3) ve tart\u0131\u015fmal\u0131 radyografik raporlara sahip (g\u00f6receli risk 1.5) olanlard\u0131r.<\/li>\n<li>Bt ve kemik taramas\u0131n\u0131n gizli kal\u00e7a k\u0131r\u0131\u011f\u0131 i\u00e7in hassasiyeti MR\u2019a g\u00f6re daha d\u00fc\u015f\u00fckt\u00fcr. (Hassasiyet s\u0131ras\u0131yla %79 ve %87)<\/li>\n<\/ol>\n<p><strong>\u00d6zet<\/strong>: Akut kal\u00e7a a\u011fr\u0131s\u0131 olan ya\u015fl\u0131 hastalar\u0131n ve negatif ya da tart\u0131\u015fmal\u0131 ilk radyografik bulgusu olan ya\u015fl\u0131 hastalar\u0131n gizli kal\u00e7a k\u0131r\u0131\u011f\u0131na sahip olmalar\u0131 y\u00fcksek ihtimaldir. Bu y\u00fczden, geli\u015fmi\u015f g\u00f6r\u00fcnt\u00fclemenin (tercihen MR) uygulanmas\u0131 t\u00fcm hastalarda klinik olarak uygun olabilir.<\/p>\n<p><strong>Yorum<\/strong>: Yay\u0131n\u0131n\u0131z i\u00e7in tebrikler! Analiz kal\u00e7a k\u0131r\u0131\u011f\u0131nda MR\u2019\u0131n gereksinimi kan\u0131tl\u0131yor, iyi bilinen bir olgu..\u00a0 Fakat, acilde MR\u2019a g\u00f6re yap\u0131lmas\u0131 \u00e7ok daha kolay olan daha yeni teknolojiler de\u011ferlendirilmeli de\u011ferlendirilmeli: ince kesit BT, kemik ili\u011fi \u00f6demi harital\u0131 DECT vs.<\/p>\n<p><strong>Eve g\u00f6t\u00fcr\u00fclecek mesaj<\/strong>:<\/p>\n<ul>\n<li>Radyografilerde gizli kal\u00e7a k\u0131r\u0131\u011f\u0131n\u0131 ka\u00e7\u0131r\u0131lmas\u0131 y\u0131k\u0131c\u0131 sonu\u00e7lar\u0131 olan s\u0131k bir problemdir.<\/li>\n<li>Ya\u015fl\u0131larda uygun klinik hikayeyle geli\u015fmi\u015f g\u00f6r\u00fcnt\u00fcleme -MR- uygulamaktan \u00e7ekinme \u00e7\u00fcnk\u00fc net olarak seyiri de\u011fi\u015ftirir.<\/li>\n<li>Limitli MR-Koronal STIR ve Koronal T1 pelvik kesitler de\u011ferlendirme i\u00e7in yeterlidir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>Radyografik Olarak Gizli Kal\u00e7a K\u0131r\u0131klar\u0131n\u0131n Te\u015fhisinde Limitli MR Protokollerinin Tan\u0131sal Do\u011frulu\u011fu: Sistematik bir \u0130nceleme ve Meta-Analiz<\/strong><\/span><\/h5>\n<p>Wilson MP, Nobbee D, Murad MH, Dhillon S, McInnes MD, Katlariwala P, Low G.<\/p>\n<p>American Journal of Roentgenology. 2020:1-9.<\/p>\n<p><strong>Ge\u00e7mi\u015f<\/strong>: Bu sistematik inceleme ve mata-analizin as\u0131l amac\u0131 radyografik olarak gizli proksimal femur k\u0131r\u0131klar\u0131n\u0131n te\u015fhisinde limitli MR protokollerinin tan\u0131sal do\u011frulu\u011funu referans standard\u0131 olarak klinik sonucu olan veya olmayan multiparametrik MR protokol\u00fc ile kar\u015f\u0131la\u015ft\u0131rmakt\u0131r. Ana ikincil hedefler, tek d\u00fczlemli T1 a\u011f\u0131rl\u0131kl\u0131, STIR, T1 a\u011f\u0131rl\u0131kl\u0131 ve STIR ve T2 a\u011f\u0131rl\u0131kl\u0131 protokollerin radyografik olarak gizli proksimal femur k\u0131r\u0131\u011f\u0131 te\u015fhisi i\u00e7in tan\u0131sal do\u011frulu\u011funu de\u011ferlendirmeyi i\u00e7erir.<\/p>\n<p><strong>Sorular<\/strong>: Radyografik olarak gizli proksimal femur k\u0131r\u0131klar\u0131n\u0131n te\u015fhisi i\u00e7in limitli MR protokollerinin tan\u0131sal do\u011frulu\u011fu nedir?<\/p>\n<p><strong>T\u00fcr<\/strong>: Sistematik inceleme ve meta-analiz<\/p>\n<p><strong>Dahiliyet kriteri<\/strong>: Min\u00f6r travma sonras\u0131 akut kal\u00e7a a\u011fr\u0131s\u0131 olan hastalarda radyografik olarak gizli proksimal femur k\u0131r\u0131\u011f\u0131n\u0131n te\u015fhisi i\u00e7in limitli MR protokol\u00fcn\u00fcn tan\u0131sal do\u011frulu\u011funu referans standard\u0131 olarak klinik sonucu olan veya olmayan multiparametrik MR protokol\u00fcne g\u00f6re kar\u015f\u0131la\u015ft\u0131rmas\u0131n\u0131 i\u00e7eren t\u00fcm orijinal makaleler t\u00fcm metin incelemesi ile de\u011ferlendirildi.<\/p>\n<p><strong>Dahil edilmeme kriteri<\/strong>: Analizden \u00e7\u0131kar\u0131lan \u00e7al\u0131\u015fmalar sadece e\u011fer de\u011ferlendirilen pediatrik hastalar 18 ya\u015f\u0131ndan k\u00fc\u00e7\u00fckse, 10 hastadan az\u0131n\u0131 i\u00e7eriyorsa, travma sonras\u0131 akut kal\u00e7a a\u011fr\u0131s\u0131 olan hastalar d\u0131\u015f\u0131nda bir hasta pop\u00fclasyonu kullan\u0131ld\u0131ysa, radyografik olarak gizli olmayan k\u0131r\u0131klar\u0131 i\u00e7eriyorsa, indek testi olmayan limitli bir MR protokol\u00fcyse, multiparametrik MR referans standart\u0131 de\u011filse ya da yazar ya da yazarlarla e-posta yaz\u0131\u015fmalar\u0131 yap\u0131ld\u0131ktan sonra 2&#215;2 olas\u0131l\u0131k tablosunu yeniden olu\u015fturmak i\u00e7in yeterli bilgi yoksa yap\u0131ld\u0131. Ayr\u0131ca, derleme makaleler, klavuzlar, fikir birli\u011fi beyanlar\u0131, mektuplar ve ba\u015f yaz\u0131lar gibi orijinal olmayan makaleler de dahil edilmedi.<\/p>\n<p><strong>Metod<\/strong>: Radyografik olarak gizli proksimal femur k\u0131r\u0131\u011f\u0131n\u0131n te\u015fhisi i\u00e7in limitli MR protokol\u00fcn\u00fcn tan\u0131sal do\u011frulu\u011funu referans standard\u0131 olarak klinik sonucu olan veya olmayan multiparametrik MR protokol\u00fcne g\u00f6re kar\u015f\u0131la\u015ft\u0131rmas\u0131n\u0131 de\u011ferlendiren 10 ya da daha fazla hastal\u0131 orijinal makaleler analize dahil edildi. Hasta, klinik, MR ve performans parametreleri iki g\u00f6zlemci taraf\u0131ndan ba\u011f\u0131ms\u0131z olarak belirlendi. \u0130ki de\u011fi\u015fkenli miks etkili regresyon modeli kullan\u0131larak meta-analiz ger\u00e7ekle\u015ftirildi.<\/p>\n<p><strong>Sonu\u00e7lar<\/strong>: Meta-analize be\u015f \u00e7al\u0131\u015fma dahil edildi.<\/p>\n<ol>\n<li>Radyografik olarak gizli kal\u00e7a k\u0131r\u0131klar\u0131 te\u015fhisinde limitli MR protokolleri i\u00e7in karma ve a\u011f\u0131rl\u0131kl\u0131 \u00f6zet sensetivite ve spesifisite ve \u00f6zet ROC e\u011fimi alt\u0131nda kalan b\u00f6lge s\u0131ras\u0131yla %99, %99 ve %1\u2019di.<\/li>\n<li>Sadece tek d\u00fczlemli T1- a\u011f\u0131rl\u0131kl\u0131 dizim, sadece STIR dizimi, T1 a\u011f\u0131rl\u0131kl\u0131 ve STIR dizimleri ve sadece T2 a\u011f\u0131rl\u0131kl\u0131 dizim i\u00e7in k\u00fcmele\u015fmi\u015f sensetivite ve spesifisite de\u011ferleri s\u0131ras\u0131yla %97 ve %100, %99 ve %99, %100 ve %99, %86 ve %97\u2019dir.<\/li>\n<li>Sadece 3-T taray\u0131c\u0131s\u0131 ile senseitivite %100 elde edilmi\u015ftir ve sadece sertifikal\u0131 radyologlar taraf\u0131ndan yorumlan\u0131nca %99 elde edilmi\u015ftir.<\/li>\n<\/ol>\n<p><strong>\u00d6zet<\/strong>: \u015e\u00fcphelenilen ama radyografik olarak gizli kal\u00e7a k\u0131r\u0131klar\u0131 olan hastalarda standart bak\u0131m olarak limitli MR protokolleri kullan\u0131labilir. Koronal T1-a\u011f\u0131rl\u0131kl\u0131 ve STIR dizilimlerinden olu\u015fan bir protokol %100 sensetiviteye sahiptir.<\/p>\n<p><strong>Yorum<\/strong>: \u00c7al\u0131\u015fman\u0131z i\u00e7in te\u015fekk\u00fcrler. \u00d6zellikle akut kal\u00e7a a\u011f\u0131r\u0131s\u0131 olan ya\u015fl\u0131 hastalar\u0131da ya da a\u011f\u0131rl\u0131ks\u0131z MR\u00a0 ve X-Ray normal, limitli MR ise ED\u2019den daha s\u0131k kullan\u0131lmal\u0131d\u0131r. Analiz yine iyi bilinen bir bilgi olan MR\u2019\u0131n kal\u00e7a k\u0131r\u0131klar\u0131ndaki yarar\u0131n\u0131 kan\u0131tl\u0131yor. Fakat, acilde MR\u2019a g\u00f6re yap\u0131lmas\u0131 \u00e7ok daha kolay olan daha yeni teknolojiler de\u011ferlendirilmeli de\u011ferlendirilmeli: ince kesit BT, kemik ili\u011fi \u00f6demi harital\u0131 DECT vs.<\/p>\n<p><strong>Eve g\u00f6t\u00fcr\u00fclecek mesaj<\/strong>:<\/p>\n<ul>\n<li>Gizli kal\u00e7a k\u0131r\u0131\u011f\u0131n\u0131n te\u015fhisinde MR m\u00fckemmeldir.<\/li>\n<li>5 dakikadan az olan k\u0131sa dizilimli MR, gizli k\u0131r\u0131klar\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131n\u0131 te\u015fhis edebilir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h5><span style=\"color: #3366ff;\"><strong>\u015e\u00fcphelenilen Radyografik Olarak Negatif Bilek K\u0131r\u0131klar\u0131 i\u00e7in \u00c7ift Enerjili BT: Prospektif Tan\u0131 Testi Do\u011fruluk \u00c7al\u0131\u015fmas\u0131<\/strong><\/span><\/h5>\n<p>M\u00fcller FC, Gosvig KK, B\u00f8rgesen H, Gade JS, Brejneb\u00f8l M, Rodell A, N\u00e8mery M, Boesen M.<\/p>\n<p>Radiology. 2020 Jul 14:192701.<\/p>\n<p><strong>Ge\u00e7mi\u015f<\/strong>: Bilek travmas\u0131 olan hastalarda ve radyografide negatif bulgu bulundu\u011funda radyografik olarak gizli k\u0131r\u0131klar i\u00e7in genellikle ilave MR muayenesi istenir. Baz\u0131 ortamlarda \u00e7ift enerjili BT MR\u2019dan daha kolayca bulunabilir. Bu \u00e7al\u0131\u015fman\u0131n amac\u0131, bilek travmal\u0131 ve klinik olarak bilek k\u0131r\u0131\u011f\u0131ndan \u015f\u00fcphelenilen ancak radyografilerde negatif bulgu bulunan hastalarda kemik ili\u011fi \u00f6demi ve k\u0131r\u0131k saptamakta yard\u0131m etmesi i\u00e7in \u00e7ift enerjili BT\u2019nin tan\u0131 testi do\u011frulu\u011funu de\u011ferlendirmektir.<\/p>\n<p><strong>Sorular<\/strong>: Bilek k\u0131r\u0131\u011f\u0131ndan klinik olarak \u015f\u00fcphelenilen ve radyografide negatif bulgu bulunan hastalarda kemik ili\u011fi \u00f6demi ve k\u0131r\u0131k saptanmas\u0131nda \u00e7ift enerjili BT ne kadar etkilidir?<\/p>\n<p><strong>T\u00fcr<\/strong>: Prospektif \u00e7al\u0131\u015fma<\/p>\n<p><strong>Kat\u0131l\u0131mc\u0131lar<\/strong>: Yeti\u015fkinler Ocak 2018 ve Kas\u0131m 2018 aras\u0131nda prospektif olarak kaydedildi. 46 hastan\u0131n 50 bile\u011findeki yedi y\u00fcz elli kemik b\u00f6ylece analize dahil edilmi\u015f oldu.<\/p>\n<p><strong>Dahiliyet kriteri<\/strong>: MR\u2019a y\u00f6nlendirilen bilek travmal\u0131 yeti\u015fkinler (\u226518 ya\u015f) e\u011fer ili\u015fkili travma ge\u00e7mi\u015fleri varsa ve radyografilerinde negatif ya da neticesiz bulgu varsa ama klinik olarak \u015f\u00fcphelilerse uygun g\u00f6r\u00fcld\u00fcler. G\u00f6zle g\u00f6r\u00fclen k\u0131r\u0131klar\u0131 olup MR\u2019a y\u00f6nlendirilen radyografide bulunmayan ek k\u0131r\u0131klardan \u015f\u00fcphelenilen hastalar da uygun bulundu.<\/p>\n<p><strong>Dahil edilmeme kriteri<\/strong>: MR kontraendikasyonlar\u0131, gebelik, ge\u00e7mi\u015f cerrahi, lgili bilekte metal implant ya da kolu ba\u015ftan yukar\u0131 kald\u0131ramama<\/p>\n<p><strong>Metod<\/strong>: Bilekler \u00e7ift enerjili BT ve MR ile muayene edildi ve g\u00f6r\u00fcnt\u00fcler klinik bilgi verilmemi\u015f 4 okuyucu taraf\u0131ndan okundu. Kemik ili\u011fi \u00f6demi ve k\u0131r\u0131\u011f\u0131 kemik ba\u015f\u0131na oranland\u0131. Kemik ili\u011fi \u00f6demi i\u00e7in referans standard\u0131 MR ve \u00e7ift enerjili BT\u2019nin kombine okunu\u015fuydu. Be\u015finci radyolog \u00e7eli\u015fki ihtimaline kar\u015f\u0131 sonu\u00e7lara hakemlik yapt\u0131. Tan\u0131 testi do\u011frulu\u011fu, okuyucular i\u00e7in ayn\u0131 binom testleri kullan\u0131larak her okuyucu i\u00e7in hesapland\u0131.<\/p>\n<p><strong>Sonu\u00e7lar<\/strong>:<\/p>\n<ol>\n<li>Radyografik olarak gizli bilek k\u0131r\u0131klar\u0131 te\u015fhisinde yard\u0131m i\u00e7in MR da \u00e7ift enerjili BT de y\u00fcksek sensetivite (%80 ve %91) ve spesifisite (%93 ve %87) sahipti.<\/li>\n<li>Radyografik olarak negatif bilek k\u0131r\u0131\u011f\u0131 bulgulu travmatik kemik ili\u011fi \u00f6demi olan hastalardaki bile\u011fi tasvir etmede \u00e7ift enerjili BT\u2019nin sensetivitesi %94\u2019t\u00fc.<\/li>\n<\/ol>\n<p><strong>\u00d6zet<\/strong>: Bile\u011fin kemik ili\u011fi \u00f6demini te\u015fhis etmede \u00e7ift enerjili BT y\u00fcksek sensetiviteye ve orta spesifisiteye sahipti. \u015e\u00fcphelenilen bilek k\u0131r\u0131\u011f\u0131 olan ve radyografik olarak negatif bulgu bulunan hastalardaki bilek k\u0131r\u0131\u011f\u0131n\u0131 tasvir etme de \u00e7ift enerjili BT y\u00fcksek sensetivite ve spesifisiteye sahipti.<\/p>\n<p><strong>Yorum<\/strong>: Yay\u0131n\u0131n\u0131z i\u00e7in te\u015fekk\u00fcrler. Ekstremite k\u0131r\u0131klar\u0131 i\u00e7in geni\u015f \u00e7al\u0131\u015fmalar DECT literat\u00fcr\u00fcnde eksik. DECT ve MR kar\u015f\u0131la\u015fmas\u0131 da ayn\u0131 zaman da m\u00fckemmel. Tecr\u00fcbemize g\u00f6re, hasta al\u00e7\u0131land\u0131\u011f\u0131nda kemik ili\u011fi \u00f6demi belli bir sebepten \u00f6t\u00fcr\u00fc g\u00f6r\u00fclm\u00fcyor. Bu da DECT\u2019in sensetivitesini d\u00fc\u015f\u00fcr\u00fcyor.<\/p>\n<p><strong>Eve g\u00f6t\u00fcr\u00fclecek mesaj<\/strong>:<\/p>\n<ul>\n<li>Kemik \u00f6demi te\u015fhisinde \u00e7ift enerjili BT yard\u0131mc\u0131 olabilir.<\/li>\n<li>Acilde DECT\u2019in ula\u015f\u0131labilirli\u011fi art\u0131yor ve gizli bilek hasarlar\u0131nda ve uygun tedavi ba\u015flamada h\u0131zl\u0131 bir \u00e7\u00f6z\u00fcm oluyor.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Translation by<\/strong>: Umut Y\u00fccel, Melis S\u0131ryol and Mine Sorkun<\/p>\n","protected":false},"excerpt":{"rendered":"Vertebral K\u0131r\u0131lganl\u0131k K\u0131r\u0131klar\u0131nda MDCT ile Kemik \u0130li\u011finde \u00d6dem ve K\u0131r\u0131k Ya\u015f\u0131 Tahmini Giri\u015f: Her ne [&hellip;]","protected":false},"author":3,"featured_media":7174,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[209],"tags":[],"class_list":["post-10618","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-tr"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.1 - 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